Psyche, Science, and Society

Psychologist accused of war crimes opposes torture investigations

As a conflict has arisen as to whether the nation should seek accountability for torture and other human rights abuses during the so-called “War on Terror,” the public and media have largely ignored  the spectacle of those, like Richard Cheney and John Yoo, who are likely targets of human rights abuse investigations. Potential investigations are denounced as political attacks that will gravely damage the country’s security. The media have largely ignored the self-serving nature of these denunciations.

The latest human rights abuse target to join the anti-accountability chorus is former Guantanamo intelligence psychologist Col. Larry James (retired), about whom questions have been raised regarding unethical or even illegal participation in war crimes. In a press release from Wright State University, where he is now Dean of the School of Professional Psychology, James –– has come out against Attorney General Holder’s limited criminal investigation of CIA torture :

“To reopen cases that were adjudicated as legal may be harmful to the mission and morale of the intelligence community,” said Col. (Ret.) Larry James, now the Dean of the School of Professional Psychology at Wright State University. “That said, I agree with President Obama’s statement several months ago to ‘turn the page’ and move on with regard to the interrogation of detainees of the Global War on Terrorism.”

James said the outcome of appointing the special prosecutor could have negative repercussions on the intelligence-gathering function.

“Being an interrogator is a stressful, challenging and dangerous job,” he said. “If there is new evidence that suggests crimes have been committed, then it would make sense to move forward with an investigation. However, since at the time of the interrogations they were deemed legal and acceptable by that sitting administration, I do not believe the investigation is warranted or necessary. I advise the president to be supportive of our current mission and be very careful as he moves forward in this sensitive area.”

James has previously made clear his belief that intelligence professionals should close their eyes to possible abuses outside of their immediate sphere of action. Thus, when asked by an Associated Press reporter to comment on reports of a secret Camp 7 at Guantanamo, James replied:

“I learned a long, long time ago, if I’m going to be successful in the intel community, I’m meticulously _ in a very, very dedicated way _ going to stay in my lane…. So if I don’t have a specific need to know about something, I don’t want to know about it. I don’t ask about it.”

Like so many others arguing against torture investigations, James may have reason to desire a shut down of torture inquiries. Last month, the Canadian Centre for International Justice and the Center for Constitutional Rights appealed to the Canadian government for a criminal investigation of James for potential involvement in war crimes:

“Allegations of abuse during Dr. James’ January to May 2003 deployment include beatings, religious and sexual humiliation, rape threats and painful body positions. Canadian citizen Omar Khadr is one of the prisoners who has alleged brutal treatment in the spring of 2003 when he was only 16 years old.

“Based on this information, the CCIJ and CCR called on the Canadian government to investigate whether action should be taken against Dr. James or other attendees of the APA Convention who may have been involved in abuse of detainees.”

The two human rights organizations outlined the evidence justifying a criminal investigation in a background document they presented to the Canadian government. At that time, James was in Toronto for the annual meeting of the American Psychological Association [APA], where he became President of the APA Division of Military Psychology Among the serious concerns regarding James’s behavior warranting investigation are that he consulted to interrogators at Guantanamo while isolation was part of the standard operating procedure to make new detainees dependent on their interrogators.

James, however, has repeatedly claimed credit for ending all abuses at Guantanamo, and later, at Abu Ghraib. Thus, his sanitized memoir detailing these claims is entitled Fixing Hell. Similarly, James told a task force convened by the American Psychological Association in 2005 that he and other psychologists ended abuses at detention facilities:

“I am very proud of the fact, it was psychologists who fixed the problems and not caused it. This is a factual statement! the fact of the matter is that since Jan 2003, where ever we have had psychologists no abuses have been reported.”  [Emphasis in original.]

James has an idiosyncratic definition of “abuse.” He claims at times never to have witnessed abuses at Guantanamo, where he was deployed as a member of the Chief Psychologist of the Joint Intelligence Group and BSCT #1 [Behavioral Science Consultation Team] in 2003 and 2007:

“When I walk through the camps, I can’t tell you that I have stumbled across a lot of things that are wrong. During my time here, I am proud to say that I have not seen a guard or interrogator abuse anyone in any shape or form,” said James. “These young men and women go out of their way well beyond the call of duty to make sure that detainees are treated safely and humanely at all times.”

James’s account, of course, differs from that of every independent source that has examined Guantanamo and found persistent abuses continuing up to the present. [Even in his own account of his deployment at Guantanamo in his  self-justifying "memoir," James reports witnessing several instances of abuse - abuses which, however, he apparently failed to report to his commanders.]

In his memoir James claims to have had special responsibility for juveniles detained at Guantanamo. Yet, during his deployment there, young Mohammed Jawad [evidently between 12 and 16 when incarcerated there] was subjected to the mandatory four weeks isolation upon his arrival in February 2003. Later that year Jawad was subjected to further isolation and other abuse on the recommendation of a BSCT psychologist; James declined to condemn this abuse to a Newsweek reporter, implying that there were extenuating circumstances. Later, in May 2004, Jawad was also subjected to extended sleep deprivation in the so-called “frequent flyer program” in which, in the words of his military JAG attorney:

“Mohammad Jawad’s arms and legs were … shackled in preparation for the first of 112 moves up and down the hall of L Block, every 3 hours for the next 14 days.”

Also while James was deployed at Guantanamo, adolescent Omar Khadr reported being used as a human mop “because he had urinated on himself during a bout of shackled isolation.” The claim was investigated by the military, which has refused to release any information regarding the investigation. Records released by the Canadian government show that Khadr, like Jawad, was subjected to the “frequent flyer” sleep deprivation program in 2004. Despite his professed concern for the decent treatment of juvenile detainees, other than his Newsweek comment, James nowhere describes his relationship to the Jawad or Khadr cases or comments on the documented abuse these young boys suffered at Guantanamo during and after his deployment.

Does James believe that no investigation of his actions at Guantanamo is warranted as his actions there “were deemed legal and acceptable by that sitting administration”? In other words, was he just following orders?

Due to the secrecy surrounding Guantanamo, we do not know James’s actual conduct  at Guantanamo. With his call to stop investigations of detainee abuses, James seems to desire that we never know. If he is innocent of participation in abuses, only an investigation will clear his name. If, however, he did participate in abuses, no defense that “at the time of the interrogations they were deemed legal and acceptable by that sitting administration” should be allowed to obscure the truth, and no claims of damage to the morale of the intelligence community should be allowed to impede an investigation and appropriate criminal and/or professional penalties.

Only the full truth can allow the abused detainees, the nation, and the profession of psychology, to “turn the page and move on.” In the absence of the truth we will be forever looking over our shoulders, wondering just who did what and what did happen during this sorry chapter in our nation’s recent history.

1 comment September 7th, 2009

Inequality, bad for almost everything

A new book — The Spirit Level: Why More Equal Societies Almost Always Do Better, by Richard Wilkinson and Kate Pickett — out in Britain and Canada but not available in the US till December, presents extensive evidence that inequality is a major contributor to poor health and virtually all other social outcomes. Importantly, the differences they find in outcomes between more and less equal societies are often huge, suggesting that inequality is a major contributor. A major causal factor seems to be differential social status, with those at higher status doing better on most measures.

While I have not read the book yet [I have it on pre-order], it sounds very important. It has received numerous glowing review, including in the Guardian, the Globe and Mail, and the Irish Times.  A summary of their argument can be read in a 2006 paper [pdf]  in the journal Social Science and Medicine. Summaries of their evidence can also be found on the British Equality Trust web site.

September 7th, 2009

Navarro: Obama’s Mistakes in Health Care Reform

As we watch Obama’s health care reform plans destruct, veteran leftist health policy expert Vincent Navarro, long-time editor of the International Journal of Health Services, dissects the disaster:

Obama’s Mistakes in Health Care Reform

By Vincent Navarro

Let me start by saying that I have never been a fan of Barack Obama. Early on, I warned many on the left that his slogan, “Yes, we can,” could not be read as a commitment to the major change this country needs (see “Yes, We Can. Can We? The Next Failure of Health Reform”). Still, I actively supported him against John McCain and was very pleased when he became president – for many reasons, encompassing a broad range of feelings. One reason was that Obama is African-American, and the country needed to have a black president. Another was that his election seemed to signal the end of the Bush era. But, the most important reason was that I saw him as a decent man, surrounded by some good people who could promote change from the center and open up some possibilities for progress, giving the left a chance to influence the administration’s policies. Well, after just over seven months of the Obama White House, I have no reason to doubt that he is a decent man, but I am dismayed by the bad judgment he has shown in the choice of some of his staff and advisors. I really doubt that he is going to be able to make the changes we need. As I said, I never had great expectations about him and his policies, but even the lowest of my expectations have not been met.

Some among the many skeptics on the left might add, “What did you expect?” Well, at least I expected Obama to show the same degree of astuteness that he and his team had shown during the campaign. He seemed to be a brilliant strategist, and his election proves this. But my greatest disappointment is the strategies he is now following in his proposals for health care reform – they could not be worse. I am really concerned that the fiasco of this reform may make Obama a one-term president.

Error number One

One of the two major objectives for health care reform, as emphasized by Obama, is the need to reduce medical care costs. The notion that “the economy cannot afford a medical care system so costly, with the annual increases of medical care running wild” has been repeated over and over – only the tone varies, depending on the audience. An element of this argument is Obama’s emphasis on eliminating the federal deficit. He stresses that most of the government deficit is due to the outrageous growth in costs in federal health programs. Thus, a crucial part of the message he is transmitting is the health care reform objective of reducing costs.

This message, as it reaches the average citizen, seems like a threat to achieve cost reductions by cutting existing benefits. This perception is particularly accentuated among elderly people – which is not unreasonable, given that the president indicates that the funds needed to provide health benefits coverage to the 48 million currently uncovered will come partially from existing programs, such as Medicare, with savings supposedly achieved by increasing efficiency. To the average citizen (who has developed an enormous skepticism about the political process), this call for savings by increasing efficiency sounds like a code for cutting benefits. Not surprisingly, then, one sector of the population most skeptical about health care reform is seniors – the beneficiaries of Medicare. The comment that “government should keep its hands off my Medicare,” as heard at some of the town hall meetings, is not as paradoxical or ridiculous as the liberal media paint it. It makes a lot of sense. An increasing number of elderly people feel that the uninsured are going to be insured at the expense of seniors’ benefits.

Error Number Two

The second major objective of health care reform as presented by Obama is to provide health benefits coverage for the uncovered: the 48 million people who don’t have any form of health benefits coverage. This is an important and urgently needed intervention. The U.S. cannot claim to be a civilized nation and a defender of human rights around the world unless this major human and moral problem at home is resolved once and for all. But, however important, this is not the largest problem we have in the health care sector. The most widespread problem is not being uninsured but underinsured: the majority of people in the U.S. – 168 million, to be precise – are underinsured. And many (32 per cent) are not even aware of this until they need their health insurance coverage. This undercoverage is an enormous human, social, and economic problem. Among people who are terminally ill, 42 per cent worry about how they or their family will pay for medical care. And most of these people are insured – but their insurance does not cover all of their conditions and necessary interventions. Co-payments, deductibles, and other extra expenses – besides the insurance premiums – can amount to 10 per cent or even higher proportion of disposable income.

During the presidential campaign, both Obama and Hillary Clinton, in discussing the need for health care reform, made frequent reference to heart-breaking stories – cases in which families and individuals suffer under our current system of medical care. But none of the proposals that the Obama administration is ready to support would address most of these cases. It will be an embarrassing and uncomfortable moment during the 2012 presidential campaign if someone asks candidate Obama about what has happened to some of the people whose stories he told in the 2008 campaign.

Error Number Three

Obama plans to cover the uninsured by increasing taxes on the rich (a very popular measure, as shown in all polls) and by transferring funds saved through increased efficiencies in existing programs, including Medicare (an unpopular measure, for the reasons I’ve mentioned). We see here the same problems we’ve seen with other programs targeted to specific, small sectors of the population, such as the poor. Programs that are not universal (i.e., do not benefit everyone) are intrinsically unpopular. This is why antipoverty programs are unpopular. People feel that they are paying, through taxation, for programs that do not benefit them. Compassion is not, and never has been, a successful motivation for public policy. Solidarity is. You support others with the understanding that they will support you when you need it most. The long history of social policy, in the U.S. and elsewhere, shows that universality is a better way to get popular support for a program than means-testing for programs targeted to specific vulnerable groups. The limited popularity of the welfare state in the U.S. is precisely due to the fact that most programs are not universal but means-tested. The history of social policy shows that the best way to resolve poverty is not by developing antipoverty programs, but by developing universal programs to which all people are entitled – for example, job and incomes programs. In the same way, the problem of noncoverage by health insurance will not be resolved without resolving the problem of undercoverage, because both result from the same failing: the absence of government power to ensure universal rights. There is no health care system in the world (including the fashionable Swiss model) that provides universal health benefits coverage without the government intervening, using its muscle to control prices and practices. The various proposals being put forward by the Obama administration are simply tinkering with, not resolving, the problem. You can call this government role “single-payer” or whatever, but our experience in the U.S. has already shown (what other countries have known and practiced for decades) that without government intervention, all the measures now being proposed by this administration will be handsome bailouts for the medical-insurance-pharmaceutical complex.

Error Number Four

I can understand that Obama does not want to advocate single-payer. But he has made a huge tactical mistake in excluding it as an option for study and consideration. He needs single-payer to be among the options under discussion. And he needs single-payer to make his own proposal “respectable.” (Keep in mind how Martin Luther King became the civil rights figure promoted by the establishment because, in the background, there was a Malcolm X threatening the establishment.) This was a major mistake made by Bill Clinton in 1993. When Clinton gave up on single-payer, his own proposal became the “left” proposal (unbelievable as that may seem) and was dead on arrival in Congress. The historical function of the left in this country has been to make the center “respectable.” If there is no left alternative, the Obama proposals will become the “left” proposal, and this will severely limit whatever reform he will finally be able to get.

But there’s another reason that Obama has erred in excluding single-payer. He has antagonized the left of his own party that supports single-payer, without which he cannot be reelected in 2012. He cannot win only with the left, of course, but he certainly cannot win without the mobilization of the left. His victory in 2008 is evidence of this. And today, the left is angry at him. It is a surprise to me, but Obama is going to pay the same price Clinton paid in 1994. Clinton antagonized the left by putting deficit reduction (under pressure from Wall Street) at the top of his policies and supporting NAFTA against the wishes of the AFL-CIO and the majority of Democrats. The Gingrich Republican Revolution of 1994 was due to a demobilization of the left. The Republicans got the same (I repeat the same) number of votes in the 1994 congressional election that they got in 1990 (the previous non-presidential election year). Large sectors of the grassroots of the Democratic Party that voted Democratic in 1990 stayed home in 1994. Something similar could happen in 2010 and in 2012. We could see a strong mobilization of the right and a very demoralized left. We are already seeing this. Why aren’t those on the left out in force at the town hall meetings on health care reform? Because the option they want – single-payer – has already been excluded from the debate by a president they fought to get elected.

This is my concern. The alternative to Obama is Sarah Palin or someone like her. Palin has a lot of support among the people who mobilized to support John McCain. And the ridicule heaped on her by the liberal media (which is despised by large sectors of the working class of this country) helps her, or her like, enormously. I am afraid we may have, in the near future, friendly fascism. And I do not use the term lightly. I grew up under fascism, in Franco’s Spain, and if nothing else, I recognize fascism when I see it. And we are seeing a growing fascism with a working-class base in the U.S. This is why we cannot afford to see Obama fail. But his staff and advisors are doing a remarkable job to achieve this. Ideologues such as chief-of-staff Rahm Emanuel (who, when a congressman, was the most highly funded by Wall Street) and his brother, Ezekiel Emanuel (who did indeed write that old people should have a lower priority for health care spending) are leading the country along a wrong path.

I don’t doubt that President Obama, a decent man, wants to provide universal health care to all citizens of this country. But his judgment in developing his strategy to reach that goal is profoundly flawed, and, as mentioned above, it may cost him the presidency – an outcome that would be extremely negative for the country. He should have called for a major mobilization against the medical-industrial complex, to ensure that everyone has the same benefits that their representatives in Congress have, broadening and improving Medicare for all. The emphasis of his strategy should have been on improving health benefits coverage for everyone, including those who are currently uncovered. And to achieve this goal – which the majority of the population supports – he should have stressed the need for government to ensure that this extension of benefits to everyone will occur.

That he has not chosen this strategy touches on the essence of U.S. democracy. The enormous power of the insurance and pharmaceutical industries corrupts the nature of our democracy and shapes the frontiers of what is possible in the U.S. Given this reality, it seems to me that the role of the left is to initiate a program of social political agitation and rebellion (I applaud the health professionals who disrupted the meetings of the Senate Finance Committee), following the tactics of the Civil Rights and anti-Vietnam War movements of the 1960s and 1970s. It is wrong to expect and hope that the Obama administration will change. Without pressure and agitation, not much will be done.

********

Vicente Navarro, M.D., Ph.D., professor of Health Policy at The Johns Hopkins University and editor-in-chief of the International Journal of Health Services. The opinions expressed here are those of the author and do not necessarily reflect the views of the institutions with which he is affiliated. Dr Navarro can be reached at vnavarro@jhsph.edu

September 7th, 2009

US troops invade Afghan hospital

In the early years of the Iraq war there were repeated reports of US troops violating medical facilities by invading hospitals and firing upon ambulances. A new report from the AP suggests that similar tactics may be being utilized in Afghanistan. According to the AP, a Swedish NGO, the Swedish Committee for Afghanistan, accuses US troops of invading and searching a hospital, looking for “insurgents.”

A Swedish charity accused American troops Monday of storming through a hospital in central Afghanistan, breaking down doors and tying up staff in a search for militants. The U.S. military said it was investigating….

On Monday, the Swedish Committee for Afghanistan said the U.S. Army’s 10th Mountain Division forced their way into the charity’s hospital without permission to look for insurgents in Wardak province, southwest of Kabul.

“This is a clear violation of internationally recognized rules and principles,” said Anders Fange, the charity’s country director. He said it also went against an agreement between NATO forces and charities working in the area.

The U.S. troops came to the hospital looking for Taliban insurgents late at night last Wednesday. Fange said they kicked in doors, tied up four hospital guards and two people visiting hospitalized relatives, and forced patients out of beds during their search.

As is common in counterinsurgency situations, the troops’ actions were likely to enrage the population US forces claim to be trying to win over:

They also barged into women’s wards, he said, adding that strange men entering rooms where women are in beds is a serious insult to the local Pashtun culture and word of it could turn the community against international troops.

The US military confirmed that US troops searched the hospital and announced they are conducting an “investigation” of the other claims.

In addition to violating international law, these actions gy US troops pose a great danger to medical personnel:

“If the international military forces are not respecting the sanctity of health facilities, then there is no reason for the Taliban to do it either,” he said. “Then these clinics and hospitals would become military targets.”

Additionally, if the US feels free to violate the sanctity of medical facilities, we can assume that other combatants around the world will be emboldened to act similarly, placing civilians in conflict situations at greater risk.

September 7th, 2009

revere: Swine flu adjuvant essential for global equity

In response to the spreading swine ful pandemic, some on the left (and right, I imagine) are spreading the usual vaccines are a dangerous conspiracy ideas. One factor pointed to is that may vaccines contain ingredients, that have not received optimal testing. Revere at Effect Measure demolishes this argument. He also explains why it is essential for global equity that Americans receive a vaccine with an adjuvant to increase immunity, as occurs in Europe. The spreading of anti-adjuvant rumors are endangering the lives of many in the developing world. Is that what leftists ought to be doing?

Swine flu vaccines, adjuvants, equity, safety

By revere

When it comes to US swine flu vaccine policy, I’m not calling the shots, but if I were I’d do it differently than the current plan, which calls for a vaccine containing only viral antigen and no immunity boosting adjuvant. I opt for a vaccine with an adjuvant, probably the one that has been used for years in Europe, MF59. If I were to make a decision like that, I could well be making a mistake, because no one really can know at this point what is going to happen or not happen. We can only go on the best data we have coupled with some principles of what’s right. On that basis and using my own fallible judgment I’d move as fast as I could to develop, distribute and deliver a swine flu vaccine that contained an immununity-boosting adjuvant.

Europe’s adjuvanted flu vaccines don’t appear to be any less safe than non-adjuvanted ones and are far more effective and efficient in the use of the scarce active ingredient, the viral antigen. It is availability of viral antigen that is limiting vaccine production. Unadjuvanted vaccines require much more viral antigen than those with adjuvants. We have written about adjuvants many time here (e.g., here), and recently Vincent Racaniello over at Virology Blog had a great post on the likely requirement for an adjuvant in any swine flu vaccine that could be given with only one dose. Obviously anything that will make more protection available to more people is a good thing, but like everything in public health, there is a balance to be struck and no sure way in knowing how to strike it.

One balance is between the potential added risk of a vaccine with an adjuvant versus one without it. The risks are on both sides. Any vaccine carries a risk but a call to slow down approval until the safety of the vaccine and/or adjuvant is assured misunderstands the problem and carries the risk of killing people who might have gotten the vaccine earlier or in a more effective form. Let’s briefly discuss the safety issue (we’ve done it before, so this isn’t new). The problem with any vaccine, adjuvanted or not, is that it will be given to hundreds of millions of people. Any clinical trial would involve at most a few thousand. If some very rare adverse event occurred in one in every 100,000 people from the vaccine, then there would be 500 such events if 50 million people were vaccinated (roughly the number vaccinated in 1976 against swine flu). No clinical trial could pick up an event that rare. It would be invisible.

The difference is that in 1976 the virus never infected anyone outside of the soldiers at Fort Dix (see our post here). But the current virus has gone pandemic. If it infects (conservatively) 30% of the population of the US and the vaccine is 70% effective, we would prevent 10.5 million people from being infected (that’s the 1/6 we reach with vaccine — 50 million out of 300 million — 15 million [30%] of whom will be infected, of which 70%, or 10.5 million will be protected). If this is like seasonal flu, where the estimated CFR is 0.1%, we have 500 rare adverse events (some, but not all of which might be fatal) versus an estimated 10,500 flu fatalities and many more severely ill in the ICU. If the CFR is anywhere higher than 0.1%, the imbalance gets much worse. If we vaccinate many more than 50 million things tip in favor of the vaccine even more. But of course we don’t know the attack rate, the vaccine efficacy, the CFR or the rate of rare adverse events (1 in 100,000 is actually pretty high). But almost any way I figure it, vaccination comes out ahead and there is no way to estimate the rate of a rare adverse event prior to using the vaccine. That’s true for every drug or over the counter consumer product. It’s why we need good post market surveillance. But saying we’re going to wait to find out isn’t an option. It’s not feasible and it means no vaccine if we require it.

Another balancing problem. The regulatory approval process for an adjuvanted vaccine will take somewhat longer. The delay will mean that people who might have gotten vaccinated with an unadjuvanted earlier approved vaccine will be saved. This may or may not be true (Canadian authorities deny it). But the more important question has to do with global supply. If the rich countries like the US won’t use adjuvanted vaccine, they will use up twice as much or more of the scarce viral antigen, meaning that much less for the rest of the world, including the world’s poorest countries. Helen Branswell has a typically thorough article on the debate:

Individuals and organizations concerned about global equity are urging countries with vaccine contracts to stretch supplies by using boosting compounds called adjuvants so developing countries can also get some serum.[snip]

The WHO had asked countries with first access to pandemic shots to employ vaccine sparing approaches, such as the use of adjuvants, so that there will be more to go around. Without frugal use in wealthy countries, the vast majority of nations will have limited access, at best, to vaccine against the novel H1N1 virus.

[snip]

U.S. authorities have made it clear they will only use adjuvanted vaccine if their supplies won’t meet American needs. They will not use the boosting compounds to stretch supplies for the developing world.

That position has also drawn fire, including by the head of the Gates Foundation’s global health program.

In a commentary published in the New England Journal of Medicine, Dr. Tachi Yamada said it would be inexcusable for people in poorer countries to die because richer countries use up most of the limited vaccine supplies. And he specifically pointed to the reluctance to use adjuvanted vaccines, currently licensed in parts of Europe but not in North America.

“Under a global health crisis where millions could die we have to really think hard whether we play by the rules we establish for normal times, or we think much more aggressively and take greater risks,” he said in an interview last month. (Helen Branswell, Canadian Press)

There are a lot of other balance issues here, including one raised by WHO’s vaccine chief Dr. Marie-Paule Kieny. If the swine flu virus drifts genetically, those getting an adjuvanted vaccine may be at an advantage.

The bottom lines for me as a public health professional and as an advisor to friends and family is this. For reasons of global equity and plausible public health advantage, the US should move expeditiously to an adjuvanted vaccine, probably with something like the MF59 adjuvant that has been used for a dozen years in Europe without apparent mishap. I will myself get both seasonal flu vaccine, and when my turn in the queue comes, the swine flu vaccine (containing an adjuvant, I hope, which would be especially helpful to people my age). I will urge every member of my family from my youngest grandchildren to my aged mother-in-law to do the same, and to add pneumococcal vaccine to the mix if they haven’t already done so. I will urge this on anyone and everyone who asks or is within hearing to do the same. But . . .

I am not in favor of forcing people to be vaccinated. If too many people decline this could result in a public health tragedy, the loss of life or productivity that could have been saved. If enough people are vaccinated to produce sufficient herd immunity to dampen an epidemic, those who aren’t vaccinated will have been free-riders, but that’s the way it is sometimes. Some will decline out of fear, some will decline out of selfishness, some will decline out of ignorance, too many will be denied by lack of access. And some will, like me, make a decision based on their own informed and considered judgment and come up with a different answer.

Good luck to all of us.

September 7th, 2009