The Most-Responded-to Articles of 2009:
“The Case Against Breast-Feeding”
Hanna Rosin, April
“How American Health Care Killed
David Goldhill, September
“The End of White America”
Hua Hsu, January/February
“Dear President Bush”
Andrew Sullivan, October
“Let’s Call the Whole Thing Off”
Sandra Tsing Loh, July/August
The Most-Read Articles of 2009
An annotated list
“Shots in the Dark,” by Shannon Brownlee and Jeanne Lenzer (November Atlantic), is a danger to public health and a disservice to readers. I’m confident that Dr. Tom Jefferson was selectively quoted. His own published article concludes that in young adults the efficacy of vaccine against flu is 80 percent when the strains in the vaccine are well matched with the circulating virus. The H1N1 vaccine is well matched with the epidemic virus, and it is precisely children and young adults in whom the virus is causing disease and death.
Everyone in public health knows that, owing to senescence of the immune system, influenza and other vaccines are less effective in the old than in the young. However, another published analysis by Dr. Jefferson states that in homes for the elderly, flu vaccine reduces pneumonia by 46 percent and death by 42 percent, whereas in the elderly living in the general community it prevents 26 percent of hospital admissions for pneumonia and reduces mortality from all causes by 47 percent.
Your readers should ignore the inaccurate advice in the article and take advantage of vaccination.
Stanley A. Plotkin, M.D.
Emeritus Professor of Pediatrics
University of Pennsylvania
Have these vaccines been tested for efficacy using a randomized, placebo-controlled methodology, or haven’t they? The authors and several of the medical experts they interviewed seem to imply that the vaccines have not undergone rigorous efficacy tests of any kind, yet a cursory look at the relevant medical literature reveals a number of peer-reviewed papers that certainly appear to be evaluations of vaccine efficacy using a randomized, placebo-controlled design. So, can we lay folk have an answer, once and for all?
La Crosse, Wis.
Shannon Brownlee and Jeanne Lenzer reply:
We checked with Tom Jefferson to see if he felt we quoted him “selectively,” and he told us: “The Atlantic piece is an accurate reporting of both my work and my current thinking.” Although the studies he reviewed did show some benefit in terms of reducing the incidence of flu in healthy adults, Jefferson also concluded that there is “insufficient evidence to assess [vaccines’] impact on complications.” The elderly and the infirm suffer the serious consequences of flu, but vaccines don’t tend to protect them (since they often can’t mount an antibody response to the vaccine). This leads Jefferson and several other top experts we interviewed to conclude that further, high-quality studies are in order.
We agree with Stanley Plotkin that in nursing homes, vaccines do appear to offer a sort of “cocoon of protection” when the staff as well as the residents are vaccinated. However, Plotkin appears not to recognize that the claim that vaccines reduce all-cause mortality by 47 percent simply isn’t plausible (in part because flu and its complications cause only 10 percent of winter deaths among the elderly).
In response to Josh Miner’s question, the answer is yes—and no. Such studies generally examine antibody response or flu symptoms, rather than the serious question most people care about: Does flu vaccine prevent pneumonia or death for those most at risk of those outcomes? Healthy young adults and children are at low risk of hospitalization or death from flu. Committing them to ongoing risk, however low, in order to protect another sector (the elderly) is something that deserves both serious scientific scrutiny and public discussion.
Hanna Rosin’s “Did Christianity Cause the Crash?” (December Atlantic) contained some well-researched, objectively presented facts that startlingly link what is known as the “prosperity gospel” to the wave of foreclosures in the economic downturn. I don’t take issue with the content of the article itself, but as a Christian I am strongly offended by the implications of the title. The doctrine that God wants all of his followers to be rich is false doctrine, pure and simple. Such teachings are in direct contradiction with scripture, as are the preachers who teach such principles.
There are passages in the Bible that speak directly about wealth, but they do so in an entirely different context. Jesus spoke of people using wealth to further the kingdom of God by giving it to those in need. The account of the rich ruler (Luke 18:18–30) puts this teaching into practice when Jesus asks the rich man to sell all his belongings and give the money to the poor. The man was sad because of his misplaced love for his wealth. I imagine if anyone asked preachers such as Joel Osteen or Fernando Garay to do as Jesus asked the rich ruler, their reaction would be one of similar despair. Jesus taught, in Luke 6:20–26, “Blessed are the poor,” not “Blessed are those who flaunt their Mercedes Benz to their congregation.” This is not to say that Jesus despised wealth, but rather despised how men often hoard their wealth instead of providing for those in need (Luke 21:1–4).
I read Philip Caputo’s “The Fall of Mexico” (December Atlantic) with concern. The government of Mexico recognizes the seriousness of the challenges posed by organized crime. For too long, drug syndicates were given a free hand to corrupt law-enforcement agencies, terrorize honest judges, and kill or buy the silence of journalists and of others who tried to stop the traffickers from supplying drugs to the U.S. market.