There’s a reason it’s called Public Health

Physicians and other healthcare workers who refuse influenza immunization at 535-bed Children’s Hospital of Philadelphia can’t work in patient care.

“If you don’t want to get the vaccine, you have two weeks of unpaid leave to think about it, and if you still don’t want to get it, you’re fired,” said Paul Offit, MD, CHOP’s Chief of Infectious Diseases and Director of the Vaccine Education Center.

There’s no provision to let workers wear a mask instead, like many healthcare facilities allow, because he said, “masks aren’t particularly effective…”

As healthcare organizations rush to comply with new federal immunization reporting requirements for their workers, many infection control experts are questioning the mask option, saying it’s an inefficient, ineffective, and dehumanizing alternative to immunization, one that gives workers an excuse not to get their annual flu vaccines.

Mask mandates are “a silly half-way measure that really doesn’t serve any useful purpose other than to identify a person as a healthcare worker who is choosing not to get vaccinated — selfishly,” Offit said. “You might as well wear a scarlet letter for all the good it does…”

The national average for vaccine refusal by hospital workers is 18%, and some hospitals report they have reduced the refusal rate to 10%, but other hospitals’ have lagged…

Bonnie Castillo, National Nurses United said…”If we in the healthcare and science communities are spreading bogus science on one hand, how do we expect to be credible on any other topic of infectious disease, or worker and patient protection? You have to be consistent.”

For Offit, a focus on getting all healthcare workers immunized is really the only solution to keeping patients safe from infection. One must remember that patients’ lives are at stake, he said…

Several years ago, a child with cancer “came into this hospital for care, but caught the influenza virus in this hospital and died from it,” he said. “She no doubt caught it from us.”

If you want a job in a science-based facility, it’s perfectly reasonable to require that you perform your work up to the standards of the science involved. If you can’t agree to that, then it’s your responsibility to find employment where your beliefs fit.

The same responsibility should apply to the facility. As Dr. Offit makes clear. You ain’t about to treat burns by spitting on them and rubbing in soot…because your patient’s shaman said that’s the appropriate traditional treatment.

Yes, I’ve been in a hospital where that question had to be answered.

Railroads ignore the need for updated safety rules after derailments


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A pair of train derailments in 2012 that killed two people in Maryland and triggered a fiery explosion in Ohio exposed a little-known and unsettling truth about railroads in the U.S. and Canada: No rules govern when rail becomes too worn down to be used for hauling hazardous chemicals, thousands of tons of freight or myriad other products on almost 170,000 miles of track.

U.S. transportation officials moved to establish universal standards for when such steel gets replaced, but resistance from major freight railroads killed that bid, according to Associated Press interviews with U.S. and Canadian transportation officials, industry representatives and safety investigators.

Now, following yet another major accident linked to worn-out rails — 27 tanker cars carrying crude oil that derailed and exploded in West Virginia earlier this year — regulators are reviving the prospect of new rules for worn rails and vowing they won’t allow the industry to sideline their efforts…

In the meantime, federal regulators haven’t taken the positive steps that they need to, said Ronald Goldman, an attorney for the families of the two 19-year-old women who died in a 2012 derailment outside Baltimore.

“It’s a lack of will, not a lack of ability, in my opinion,” he added…

Um, lack of integrity?

All sides agree it’s difficult to pinpoint how many accidents are tied to worn rail. Since 2000, U.S. officials blamed rail wear as the direct cause of 111 derailments causing $11 million in damage.

That’s less than 1 percent of all accidents, yet it masks a broader safety dilemma: Years of massive loads rolling over a rail will exacerbate defects in the steel, such as cracks or fractures. Investigators ultimately list the defect as the cause of a derailment, but it might never have been a problem if the rail had not been worn down.

Two accident causes in particular have the strongest correlation with worn-out rails: “detail fractures” that result from fatigued metal, and “vertical splits” in the head of the rail, where it makes contact with a train’s wheels, according to the FRA.

Those problems caused a combined 1,200 derailments with $300 million in damages, three deaths and 29 people injured in the U.S. between 2000 and the present…

The AP requested details on rail wear standards from each of the seven major freight railroads — BNSF Railway, Union Pacific, Canadian Pacific, CSX, Canadian National, Norfolk Southern and Kansas City Southern. They either refused the request or referred questions to the railroad association, which also declined to release the standards.

Railroad have been above the law even longer than oil companies. It’s no wonder they believe their self-regulation is the only way to run a railroad. No doubt.

Yale researcher follows the money that runs the climate denial network


ALEC/Bush flunky Michael Leavitt in 2004AP Photo/Elaine Thompson

This week, Justin Farrell, a professor at the Yale School of Forestry and Environmental Studies, released a comprehensive report in Nature Climate Change detailing just who these people opposing climate action are, where their funding comes from, and how the groups they work through are interrelated. Eric Roston reports for Bloomberg:

A loose network of 4,556 individuals with overlapping ties to 164 organizations do the most to dispute climate change in the U.S., according to a paper published today in Nature Climate Change. ExxonMobil and the family foundations controlled by Charles and David Koch emerge as the most significant sources of funding for these skeptics. As a two-week United Nations climate summit begins today in Paris, it’s striking to notice that a similarly vast infrastructure of denial isn’t found in any other nation.

The role of ExxonMobil and the Kochs in influencing climate denial hadn’t been empirically studied before now, according to Justin Farrell, an assistant professor of sociology at the Yale School of Forestry & Environmental Studies and the author of the new paper. He said the flow of money from group to group and person to person is often opaque to researchers.

ExxonMobil has maintained for years that it does not fund denial of climate change. A spokesman pointed out that the company’s $100 million founding commitment to Stanford University’s Global Climate & Energy Project was made in 2002, right in the middle of the period covered by the Nature Climate Change study. Representatives for any of the Koch family foundations could not be reached for comment.

Farrell said he focused on ExxonMobil and the Koch foundations because “they are reliable indicators of a much larger effort of corporate lobbying in the climate change counter-movement.” He examined Internal Revenue Service data showing which groups in the network of climate contrarians accepted funding from ExxonMobil or Koch foundations between 1993 and 2013. Recipients from those two sources tend to occupy central nodes in what he calls a “contrarian network.” Groups funded by ExxonMobil or the Kochs “have greater influence over flows of resources, communication, and the production of contrarian information,” Farrell wrote.

You can read more about this study – and more – at Bloomberg.