Posted: November 6, 2009
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Article SummaryThe CDC website has detailed advice for parents with a child home sick with swine flu. But it’s not necessarily very practical or user-friendly advice. Deborah Franklin’s November 6, 2009 story on NPR’s “Morning Edition” features some of the ways the CDC’s recommendations might be a tad unrealistic. She used me to say the obvious: that there’s nothing wrong with telling parents how to achieve maximum infection control at home, but it would help to offer a Plan B for parents who can’t or won’t do it all. The link includes both the audio clip and a print version of the story from NPR’s website. This is an email I sent the reporter before the interview with some thoughts on public health professionals’ reluctance to help people prioritize among their recommended precautions.

Prioritizing among Precautions:
The Best Is the Enemy of the Good

Email from Peter M. Sandman to Deborah Franklin

The audio of Deborah Franklin’s November 6, 2009 story on NPR’s “Morning Edition” is also online, as is a print version of the story.

It is very common for official health advice to be impractical, as if officials had never thought through what it might be like to try to carry out the advice.  Other good examples:

  • “Cough into your sleeve” – try to do that while standing on the bus, one hand holding the strap and the other holding your pocketbook or briefcase.
  • “Wash your hands” – futile in most of the developing world, where clean running water is the exception rather than the rule and soap is a luxury.

The parents you’re talking to are obviously right that much of the homecare advice on the CDC website is impractical.  It’s the best case.

I have no objection to health officials telling people what’s best.  I fervently object to their reluctance to tell people what’s second best – which corners to cut and which to try extra-hard not to cut when they can’t do it all.  I used to think this purism – “the best is the enemy of the good” – was motivated by a fear of lawsuits.  Now I think it runs deeper than that: Too many public health professionals seem more committed to making sure their advice is “right” than to making sure it’s actionable. 

Perhaps the most vivid example of this aversion to workarounds is routine pediatric vaccinations.  Large numbers of parents are nervous about the ever-increasing number of vaccines recommended for children.  They’re willing to vaccinate their kids, but they worry about the possible health effects of too many vaccines, especially all at once.  Yet the CDC provides only one recommended vaccination schedule: THE recommended vaccination schedule.  It has nothing for a parent who seeks a prioritization of the recommended vaccines: “If I’m only willing to do half as many, which ones should I skip?”  Because public health officials refuse to offer a pared-down vaccination schedule as a Plan B, parents worried about vaccination must resort to privately developed recommendations instead.

Similarly, consider the situation of children for whom the CDC recommends both the seasonal flu vaccine and the pandemic flu vaccine.  The CDC also advises that the LAIV (FluMist) formulations shouldn’t be given within 28 days of each other, because their possible effect on each other hasn’t been studied.  But the CDC website has no advice on what parents should be doing right now: Get the kid the seasonal vaccine that’s available, and wait a month for the pandemic vaccine, or skip the seasonal vaccine for now (since there’s virtually no seasonal flu so far) and wait to get the pandemic vaccine ASAP? 

In other words, the impractical homecare advice is pretty typical….

Copyright © 2009 by Peter M. Sandman

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