Sunday, October 25, 2009

Selected Thoughts on The Atlantic November 2009

Selected thoughts on the November 2009 issue of The Atlantic:

Seeing Too Much (by Jamais Cascio)
Cascio discusses "augmented reality" technologies and worries that such technologies will lead to increased cultural tribalism: only interacting with people with similar political beliefs or only going to restaurants or places highly rated by your "group". I'm not sure that technology is really playing a role in driving this. Much has been written elsewhere about The Big Sort in American life.

Shots In The Dark (by Shannon Brownlee and Jeanne Lenzer)
Brownlee and Lenzer take a contrarian position on a contentious topic. The release of Superfreakonomics has provoked a lot of discussion about contrarianism recently (see, eg, here, here, and here for three takes on the issue). Instead of climate change or drunk-driving, Brownlee and Lenzer take on the efficacy of the influenza vaccine. They begin their article with the breathless prose that is emblematic of calculated contrarian analysis:
But what if everything we think we know about fighting influenza is wrong? What if flu vaccines do not protect people from dying—particularly the elderly, who account for 90 percent of deaths from seasonal flu? And what if the expensive antiviral drugs that the government has stockpiled over the past few years also have little, if any, power to reduce the number of people who die or are hospitalized? The U.S. government—with the support of leaders in the public-health and medical communities—has put its faith in the power of vaccines and antiviral drugs to limit the spread and lethality of swine flu. Other plans to contain the pandemic seem anemic by comparison. Yet some top flu researchers are deeply skeptical of both flu vaccines and antivirals. Like the engineers who warned for years about the levees of New Orleans, these experts caution that our defenses may be flawed, and quite possibly useless against a truly lethal flu. And that unless we are willing to ask fundamental questions about the science behind flu vaccines and antiviral drugs, we could find ourselves, in a bad epidemic, as helpless as the citizens of New Orleans during Hurricane Katrina.
There are some good points raised in the article, but I'm not sure they are as revolutionary as made out. For example, vaccines work by inducing an immune response in the recipient so that if, in the future, the individual is exposed to the real pathogen their body is set up to fight it off. This, of course, means that for the vaccine to work the individual being vaccinated must have a robust enough immune system for this response to be initiated. To confirm this, in some cases (such as among health workers), an analysis is done after vaccine administration to determine the person's antibody titer and confirm that a sufficient immune response was initatied. This means, of course, that those individual most at risk for the flu--people with weakened immune systems--are also those individuals for whom the vaccine is least likely to be completly effective. This is why those who work or live with individuals at risk are themselves encouraged to get the seasonal flu shot in an effort to limit risk of passing the infection on.

An strong critique of the article has been offered over at the Effect Measure blog. In the comments, there is long response from Brownlee and Lenzer. This is worth checking out, I think it illustrates one of the main problems: the conflation of shallow evidence of vaccine efficacy in the elderly with the usefulness of a general vaccination program in the face of a global pandemic. This stance is unfortunate.

Additionally, I am slightly disappointed that Brownlee and Lenzer did not put their article in the context of the growing opt-out rate for childhood vaccines--a problem which is starting to lead to out-breaks for such old fashioned ailments as Measles. I fear that the anti-Vaccine movement will be fortified by this article.

There is a detailed discussion of additional flu vaccine issues at Science-Based Medicine. It is worth reading.

Brave Thinkers
The cover feature this month is a brief profile of 27 people who may be responsible for ideas which will 'upend the established order.' I find such list-based articles rather unsatisfying. The article does not really tell you enough about any of the ideas promulgated by these people to form an opinion. Plus, the colored backgrounds used in the magazine for this piece made the text hard to read in the low-light environments I often end up trying to read in (a bit nit-picky, yes I admit).

The Devil's in the Details (by Benjamin Schwarz)
I have been watching Mad Men recently, so Schwarz's piece on the show to be very timely. Schwarz's includes a thoughtful discussion of the trend toward more literary, 'megamovie' television series. The review points out the glaring errors in the otherwise nearly-fetish level realism of the show, and I feel correctly points out Betty Draper as the most problematic of the characters.

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