Letter From the Editor

Bruce D. Cheson, MD

The important thing isn’t the soundness or otherwise of the argument, but for it to make you think.

–Albert Camus “The Plague”

The other morning I picked up the Washington Post, and on the front page was an article stating that certain organizations were making the H1N1 (Swine) flu vaccine mandatory for hospital employees. I thought little of it until I read further and found that one of these was Medstar Inc, the corporation that owns my hospital, and that anyone who comes even remotely in contact with patients is required to be vaccinated—not only for H1N1 but the seasonal vaccine as well, or be subject to immediate termination! The roles include 25,000 employees as well as 5,000 affiliated doctors, volunteers, and anyone who enters a facility, including delivery people. There is precedent: New York State employees—522,000 of them—are required to be vaccinated, as are the 12,000 employees of the Hospital Corporation of America.

Now, I am not against vaccines. Indeed, in the 1950s I was one of the original Polio Pioneers and have my pin to prove it! It was a randomized, placebo-controlled study, and I received the actual substance. I will admit that, decades later, when that vaccine was found to be contaminated with SV40 and associated with an increased incidence of lymphoma (spell irony), I was taken aback. Fortunately, that scare was unsubstantiated. But what of the current scare? That was polio, this is the flu! I have never had a flu vaccine and have never had the flu, thus, I am concerned when such a practice becomes mandatory.

My objection is not on religious grounds as I do not suspect anything porcine will be injected into my system, but it is of the unknown. We know little about this vaccine and potential long-term complications. It was fortunately and unfortunately, produced rapidly in response to the growing concern of the pandemic. However, are the risks and consequences actually greater than with the garden variety, ever-mutating flu? There are exemptions: egg allergy, religious grounds. Demoralization is not even on the list. It troubles me that Tony Fauci, who I admire, was on television the other evening stating that, had the H1N1 vaccine been ready earlier, they would have just mixed it in with the standard flu vaccine. Is government taking over medicine? Is this the sign of things to come?

I did not see hospital visitors on that list of the “must be vaccinated”. One obviously cannot mandate that everyone undergo vaccination. Thus, another consequence of this mass hysteria is that visitors to patients in hospital are being curtailed or even eliminated altogether at several outside centers. This whole scene caused me to delve into the book shelves in my basement, retrieve and reread Camus’ “The Plague” where he described a village where dead rats began appearing, and human deaths followed shortly. They walled off the town so that no one could leave or enter, loved ones were separated and even communication to the outside was prohibited. Eventually, the plague subsided, the townspeople were jubilant; yet the bacillus was only in hiding, and it was only a matter of time before those rats were roused up again “to die in a happy city”. Existential ? Yes. Allegorical? Yes. But it just goes to show you that you can only protect some of the people some of the time.

Actually today was the first day the mandatory seasonal flu vaccine clinic. The queue was so long that several of my colleagues gave up.

If ever I am forced to give in (before they run out of the vaccines, which appears imminent), I expect to be standing in the queue waiting for my turn whilst reading one of my pile of recently purchased books, several of which are Victorian mystery novels. Those olde English folke sure could write. I started off with Dickens’ Mystery of Edwin Drood…a bit dense, but a good tale, albeit his unfinished work. However, the author of the introduction alluded to a contemporary of Dickens: Wilkie Collins. His most famous book, Moonstone, was considered the first of the mystery novels and one of the all time greatest. Yet, the author himself preferred The Woman in White, a 783 page tome that I polished off in less than a week as I was unable to put it down until the last mystery was revealed. Highly recommended, a jolly good read.

Also highly recommended are the articles in this month’s issue of CAHO, which features recent advances in Waldenstrom’s macroglobulinemia therapy by Drs. Natalia
Neparidze and Madhav Dhodapkar. The journal also highlights news from the ECCO/ESMO meeting and an anti-angiogenic therapy update from Dr. Robert Figlin.

So, when questioned next about when I am going to get the swine flu vaccine—I shall respond: When pigs fly!!

Until next month…

Bruce D. Cheson, MD