Vaccination a CME Issue

Volume 90 No. 10 October 2007 Vaccination A CME Issue UNDER THE JOINT VOLUME 90 NO. 10 October 2007 EDITORIAL SPONSORSHIP OF: Medicine Health The Warren Alpert Medical School of Brown University HODE SLAND Eli Y. Adashi, MD, Dean of Medicine R I & Biological Science PUBLICATION OF THE RHODE ISLAND MEDICAL SOCIETY Rhode Island Department of Health David R. Gifford, MD, MPH, Director COMMENTARIES Quality Partners of Rhode Island Richard W. Besdine, MD, Chief 298 Feudalism or Futilism: Another Modest Proposal Medical Officer Joseph H. Friedman, MD Rhode Island Medical Society 299 A Sovereign Called Malaria: Humanity’s Lethal Companion Barry W. Wall, MD, President Stanley M. Aronson, MD EDITORIAL STAFF Joseph H. Friedman, MD CONTRIBUTIONS Editor-in-Chief Joan M. Retsinas, PhD SPECIAL CME ISSUE: Vaccination Managing Editor Guest Editors: Anne S. De Groot, MD, and Leonard Moise, PhD Stanley M. Aronson, MD, MPH Editor Emeritus 300 Vaccine Renaissance – From Basic Research to Implementation Anne S. De Groot, MD, and Leonard Moise, PhD EDITORIAL BOARD Stanley M. Aronson, MD, MPH 301 Progress Towards a Genome-derived, Epitope-driven Vaccine for Jay S. Buechner, PhD Latent TB Infection John J. Cronan, MD Leonard Moise, PhD, Julie McMurry, MPH, Daniel S. Rivera, James P. Crowley, MD E. Jane Carter, MD, Jinhee Lee, DVM, PhD, Hardy Kornfeld, MD, Edward R. Feller, MD William D. Martin, and Anne S. De Groot, MD John P. Fulton, PhD Peter A. Hollmann, MD 304 The New HPV Vaccine and the Prevention of Cervical Cancer Sharon L. Marable, MD, MPH Michael Steller, MD Anthony E. Mega, MD Marguerite A. Neill, MD 308 Vaccines and Autism: An Update Frank J. Schaberg, Jr., MD Gita V. Harappanabally, MD, Christine L. Trask, PhD, and Lawrence W. Vernaglia, JD, MPH Newell E. Warde, PhD David E. Mandelbaum, MD, PhD OFFICERS 311 Tularemia Vaccines – An Overview Nick Tsiongas, MD, MPH Julie A. McMurry, MPH, Leonard Moise, PhD, Stephen H. Gregory, PhD, President and Anne S. De Groot, MD Diane R. Siedlecki, MD President-Elect 318 HIV Vaccine Update: Recent Developments and Current Trials Vera A. DePalo, MD Michelle Lally, MD, MSci, Kaitlin Lemei, and Kenneth Mayer, MD Vice President Margaret A. Sun, MD 321 Rotavirus Vaccines – Success After Failure Secretary Penelope H. Dennehy, MD Mark S. Ridlen, MD Treasurer 325 CME Background and Questions Barry Wall, MD Immediate Past President COLUMNS DISTRICT & COUNTY PRESIDENTS 327 HEALTH INSURANCE UPDATE – Small Employer Health Insurance Availability Geoffrey R. Hamilton, MD Act – HEALTHpact Rhode Island Bristol County Medical Society Herbert J. Brennan, DO Patricia E. Huschle, MS Kent County Medical Society 328 HEALTH BY NUMBERS – Perinatal Depression in Rhode Island Rafael E. Padilla, MD Pawtucket Medical Association Samara I. Viner-Brown, MS, Hyun (Hanna) K. Kim, PhD, and Rachel Cain Patrick J. Sweeney, MD, MPH, PhD 330 GERIATRICS FOR THE PRACTICING PHYSICIAN – Geriatric Osteoporosis Providence Medical Association Nitin S. Damle, MD Tom J. Wachtel, MD, FACP, CMD Washington County Medical Society Jacques L. Bonnet-Eymard, MD 334 PHYSICIAN’S LEXICON – Forty Days In Limbo Woonsocket District Medical Society Stanley M. Aronson, MD Cover: Emerging Infectious Diseases,” by 334 Vital Statistics Eric Avery, MD, Clinical Associate Profes- 336 October Heritage sor of Psychiatry and Behavioral Sciences and Associate Member of The Institute for the Medicine and Health/Rhode Island (USPS 464-820), a monthly publication, is owned and published by the Rhode Island Medical Society, 235 Medical Humanities at The University of Texas Promenade St., Suite 500, Providence, RI 02908, Phone: (401) 331-3207. Single copies $5.00, individual subscriptions $50.00 per year, and $100 Medical Branch, Galveston, Texas. For thirty per year for institutional subscriptions. Published articles represent opinions of the authors and do not necessarily reflect the official policy of the Rhode Island years Dr. Avery has made prints. His social Medical Society, unless clearly specified. Advertisements do not imply sponsorship or endorsement by the Rhode Island Medical Society. Periodicals postage paid at Providence, Rhode Island. ISSN 1086-5462. POSTMASTER: Send address changes to Medicine and Health/Rhode Island, 235 Promenade St., content prints explore human rights abuses, Suite 500, Providence, RI 02908. Classified Information: RI Medical Journal Marketing Department, P.O. Box 91055, Johnston, RI 02919, and social responses to disease (HIV and phone: (401) 383-4711, fax: (401) 383-4477, e-mail: [email protected]. Production/Layout Design: John Teehan, e-mail: [email protected]. Emerging Infectious Diseases), death, sexu- 297 ality and the body. e-mail: [email protected] VOLUME 90 NO. 10 OCTOBER 2007 Commentaries Feudalism or Futilism: Another Modest Proposal After all, the health care crisis has been I recently engaged in a debate with a sharks and predator fish, and we wouldn’t with us since before I started medical bio-ethicist from the Cato Institute, a want to upset the ecological balance by school, and it seems hopeless. I thought “think” tank based on the principle that too much. So there have to be some holes. that the “futile” solution was mass extinc- the government that governs least gov- In Bill O’Reilly’s categorization of tion. It certainly seemed like an unpopu- erns best. I corresponded with her after conservatives as being “traditionalists” it lar approach, but it would free up a lot the Providence Journal published an ar- makes eminent sense to consider times of money if all the sick and uninsured ticle she wrote. gone by in which health care was not in simply died. Declining an embrace of anarchy, crisis, and people didn’t depend on There are a number of economic the institute members believe that people “handouts” and government dole. When approaches to comparing the two feudal/ don’t want, hence shouldn’t be forced, bills couldn’t be paid, there was always futile approaches. In each one, the out- to pay taxes, except for services that ev- indentured servitude, back in the good come is improved efficiency, which is, eryone desires, like “roads, military and old feudal days. And it seems that it is an after all, what our government is about. police.” The possibility that we may not idea whose time has come, again. I haven’t yet asked my bio-ethicist col- “all” agree on military funding, or which Only a couple of years ago, in prepa- league at the Cato which solution would roads should be built, is possibly too ration for the disaster of rapidly escalat- be closer to their philosophical founda- mundane a consideration in their ethe- ing mortgage bills facing the working tions. I am pretty sure that they’d elect real, philosophical realm. (My father-in- poor and lower middle class, Congress the first. Feudalism, when practiced the law was a distinguished philosopher and made it virtually impossible for poor way it “should” be, free from external my son may follow in his footsteps, but people to declare bankruptcy. Only cor- restraint, is another form of allowing free- it’s hard not to be a bit cynical here.) porations and wealthy people can escape dom and nature to take its course, un- This got me to thinking about adopt- their obligations. And now that the hous- contaminated by any humanitarian tink- ing these principles to health care. With ing crisis has somehow managed to de- ering that always throws a monkey the exception of our current federal ad- velop, forcing these people to lose their wrench into the mix. After all, if some- ministration, everyone believes there is a houses and still not escape their debt, the one invested in a slave, wouldn’t that per- health care crisis in this country. Of need for indentured servitude is clear. son try as hard as possible to keep that course, it has been going on for quite Imagine someone needing an opera- slave in tiptop shape? It makes a lot of while, and those of us with reasonable tion that will cost $20,000, and the pa- sense. And it solves a lot of problems with- incomes and medical insurance seem to tient has already maxed out his credit out the invasiveness and inherent bully- be surviving it quite well, but we in card, has no insurance and will become ing of forcing people to pay taxes. health-care know that more than a few disabled without the operation. If some- It’s time to stop trying futile ap- people are suffering out there. And our one, even the doctor, perhaps, picks up proaches to health care. More money president, in a “what me worry?” ap- the tab, they might be able to have the won’t stanch the crisis. Only wise, cost- proach that reflects the philosophical person become a slave for some fixed pe- saving, effective approaches will do that. mood of the ruling elite, publicly re- riod of time. The “owner” would be re- It’s time to stop being futile and start marked that anyone in the United States sponsible for housing, feeding and cloth- thinking feudal. who needed care merely had to go to the ing the person, paying for the medical And I haven’t even seen “Sicko” yet! local emergency room. care, but in return would have a slave Luckily, in the US we presumably who would be protected by government – JOSEPH H. FRIEDMAN, MD have a “safety net.” We all agree that there laws limiting work to perhaps 16 hours should be one. Even the Cato Institute (I per day. Various limitations could be de- Disclosure of Financial Interests think). The only question is how fine to veloped, by the local state authorities, Joseph Friedman, MD, Consultant: make the holes. We could make it very explicating the minimum housing, cloth- Acarta Pharmacy, Ovation, Transoral; fine so that no one falls through, or we ing and food allowances.

Load more