Letters to the editor

The Flu-Shot Debate

“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
Doylestown, PA.

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?

Josh Miner
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.

Christianity and the Crash

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).

Ryan Barefoot
Kissimmee, Fla.

Mexico’s War on Drugs

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.

However, by confining his analysis to only one of Mexico’s 32 states and failing to interview law-enforcement officials or others directly engaged in President Felipe Calderón’s unprecedented effort to defang the trafficking organizations, Mr. Caputo is guilty of exactly the sins he accuses other journalists of committing: using “simple story lines” based on rumor, incomplete information, and interviews that serve only to confirm his dark vision, to raise the alarmist specter of a military coup or of Mexico becoming a failed state. Mexico simply does not fit the pattern of a failed state, and it is time serious and thoughtful magazines like The Atlantic debunked simplistic media myths or spaghetti-western-like narratives of the challenges Mexico faces today.

Arturo Sarukhan
Ambassador of Mexico to the United States

Philip Caputo replies:

I did not go to Mexico with any preconceived ideas, as Ambassador Sarukhan asserts. The realities I saw there darkened my vision. Approximately 16,000 Mexican citizens have been murdered in the past three years. That’s no “spaghetti western” screenplay; that’s a fact. Complaints about human-rights violations committed by law-enforcement and military authorities (kidnappings, assassinations, etc.) have increased sixfold in the same period.

As to Sarukhan’s complaint that I confined my analysis to only one state, I’ll make two points. First, the current epicenter of the violence is the state of Chihuahua. In 2009 alone, more than 2,300 people were murdered in Juárez, its largest city. As of late November, the homicide rate in Juárez was 153 murders per 100,000 people, making it the bloodiest city in the world. This despite the presence of thousands of army troops and federal police, some of whom, as I reported, have committed crimes themselves. Second, the butchery is by no means confined to Chihuahua, but occurs nationwide. Had my analysis expanded to other regions, the picture would have been even darker than the one I presented.

Bland Thinking

Number of women listed by The Atlantic among the 27 brave thinkers in its November feature on that topic: four. Number of nonwhite males: four. Number of nonwhite women: zero. Number of Atlantic editors listed by this reader as able to make a brave, unbiased selection of new thinkers: zero.

Brigette De Lay
Dakar, Senegal

Post-crash Sustainability

As a sustainability advocate, I was inspired by Wayne Curtis’s article (“Houses of the Future,” November Atlantic) describing the various home-building techniques New Orleans is applying. The energy-efficient, small-footprint houses are simple in design yet boast advances in power management and owner involvement. In cities like Cleveland, this is not the case. The nation’s financial crisis has hit hardest here, sweeping thousands of houses into foreclosure and inevitable abandonment. The houses still standing are, by and large, stripped of any plumbing or electrical system and often harbor drug addicts or homeless individuals. Most of these houses will be crushed and thrown in a landfill.

There is another option: with the help of visionary community leaders and progressive nonprofit organizations, some houses will be carefully “deconstructed” and recycled. I can’t help but think that some new, model neighborhoods springing up in storm-torn New Orleans could benefit from the sustainable building materials Cleveland’s older houses can provide. Framing lumber cut 120 years ago is much stronger than new wood and feels more robust, while reclaimed flooring has a rich history and patina unmatched by new hardwoods. This vintage building material defines the idea of carbon neutrality, and Cleveland’s once proud houses can continue being houses—not just another layer in a landfill.

Adam C. Smith
Cleveland Heights, Ohio

Correcting the Record

The bizarre caricature of Arthur Koestler that Christopher Hitchens has substituted for a review of my biography (“The Zealot,” December Atlantic) is Hitchens’s responsibility, not mine, but his blithe indifference to facts should not go unchallenged.

It’s not true—and I did not write—that Koestler had “fond memories” of the 1919 Communist putsch in Hungary, nor that he felt “nostalgia for Béla Kun.” Koestler’s fond memories and nostalgia were reserved for Count Mihali Károlyi, who headed the first Hungarian Democratic Republic in 1918 after the collapse of the Hapsburg monarchy at the end of World War I. Béla Kun overthrew Károlyi’s government in his putsch of 1919, and Kun’s anti-Semitic forces chased Koestler and his family out of the country. It would be even odder than Hitchens thinks if Koestler were to feel nostalgia for such a man.

It’s also not true that Koestler was “a dedicated agent of the Comintern” in Spain. He was a comparatively junior member of the German Communist Party in Exile, a reporter for the News Chronicle, and a secret propagandist for Willi Münzenberg (who was an agent of the Comintern). The executions Koestler overheard while in a Spanish jail were carried out in Seville, not Málaga.

Hitchens describes Koestler during the 1948 war for Israeli independence as “initially taking the side of the Menachem Begin ultranationalists but eventually becoming sickened by the violence of the Zionist right and finally worrying whether there should be a Jewish state at all,” which is a perverse misreading of what actually happened. When Koestler arrived in Palestine, he had good connections with both David Ben Gurion’s left-wing Labor Party and Menachem Begin’s right-wing Irgun. Finding the two at dangerous loggerheads over how to fight the war, Koestler pleaded with Ben Gurion and Begin to forget their differences and form a coalition, and also tried (and failed) to persuade the more extreme Stern gang to drop its terrorist methods. He never doubted the necessity of a Jewish state, nor denied its right to exist, but simply made it clear that he didn’t want to live in such a state himself.

Michael Scammell
New York, N.Y.

Christopher Hitchens replies:

Michael Scammell seems to have forgotten the distinction between Károlyi and Kun. As his own book puts it, “In March 1919 a Communist dictatorship took over from Károlyi, with Béla Kun as its de facto head,” and on the ensuing May Day, “following Soviet practice, the whole of Budapest was turned into a gigantic fairground … Arthur accompanied his cousin Margit Aldor to some factory meetings and started reading the Red Gazette … Fond memories [emphasis mine] of that turbulent spring were to persist well into Arthur’s adulthood, exercising a strong influence on his later decision to join the Communist Party.” How could that be clearer? As Scammell goes on to say: “Béla Kun was a Jew. More than half his ‘People’s Commissars’ were Jews.” It was precisely the anti-Semitic backlash against Kun, and Communism and liberalism, that drove the Koestler family to flee Budapest for Vienna.

I did not say that Koestler was a senior agent of the Comintern. I said he was a dedicated agent of it. His boss, Münzenburg, was a wholly owned subsidiary of the Comintern, as Scammell concedes. In 1975, when Time wrote that Koestler had once “taken orders from Moscow,” he declined the suggestion that he defend himself and wrote: “When I was a correspondent in the Spanish Civil War I did indeed follow the instructions of the Communist propaganda apparatus.”

Koestler was in several of Franco’s jails but, as Scammell writes: “Nationalists’ reprisals were carried out not only on the beaches and streets of Málaga but also in the prisons. From his solitary cell, Koestler heard the nightly roll call of condemned men and listened to the melancholy shuffle of dragging feet as up to fifty prisoners were hustled down the corridors to meet their end.”

Scammell also writes, about Koestler’s admittedly fluctuating attitude toward the Zionist right, that his novel Thieves in the Night contains a “conditional defense of terrorism” comparable to “Soviet (and Stalinist) arguments” and that “when it came to Jewish affairs, he tended to lose his moral bearings, perhaps blinded by a sentimental loyalty to Jabotinsky and the Revisionist fervor of his youth.” Later, in Promise and Fulfillment, Koestler was to agree with Chaim Weizmann’s comment that “the Jews’ very existence was the fundamental cause of anti-Semitism” and to argue, “The only way to end it was for Jewry outside Israel to cease to exist.” (!) After battling this and other contradictions, as Scammell records, “Koestler seemed to think he might at last get free of his Zionism.”

Can it be that I have read Scammell’s book with more attention than he gave to compiling it?


The Most-Responded-to Articles of 2009:

“The Case Against Breast-Feeding”
Hanna Rosin, April

“How American Health Care Killed My Father”
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

Also See:
The Most-Read Articles of 2009: An annotated list

Corrections and Clarifications: Sandra Tsing Loh’s “On Being a Bad Mother” (December Atlantic) mistitled Ayelet Waldman’s book. The book is called Love and Other Impossible Pursuits. “Shots in the Dark,” by Shannon Brownlee and Jeanne Lenzer (November Atlantic), misidentified the London School of Hygiene and Tropical Medicine. The Huffington Post employs eight reporters, more than indicated in the “Brave Thinkers” profile of Arthur Sulzberger Jr. (November Atlantic).