The Chronicle of Higher Education: Colloquy

This discussion is closed. This is a transcript.

Who knows best how to keep students healthy?

Author: Colloquy Moderator
Date: 02-12-04 16:11

College students face health risks every day, but not every concern receives equal priority and resources. Campus health professionals have traditionally played a major role in determining which illnesses should be the main focus of on-campus efforts at prevention and education. With the recent passage of laws requiring colleges to inform students about meningitis-vaccine options, however, many of the health professionals say legislators and parents have made the decisions for them. Many college health officials say the disease is relatively rare and they have more-pressing concerns to deal with. They also claim that legislators and parents have been swayed by emotion instead of medical knowledge. Is it fair to let those groups decide how college health professionals should address health concerns? Or should the decisions be the responsibility of the people who actually treat the students every day? Read more ...

more of the nanny state

Author: Bill O'Malley, Prof. Ethics
Date: 02-16-04 11:35

Here is another example of those on the far left in this country saying

1. the general public is too stupid to make decisions

2. the general public only uses emotion to make decisions

3. only we "professionals" know what is best for you.

College students are adults. They don't need their parents to make decisions for them. And they certainly don't need "professionals" holding their hand.

I'll bet a years salary that these "professionals" have a political agenda. Those on the far left only feign altruism. They are only interested in power and control---and this is another perfect example.

Leave it alone liberals. Its fine the way it is without your meddling...

Re: Who knows best how to keep students healthy?

Author: Anonymous, Lg. Res. I Univ.
Date: 02-16-04 14:51

The title here feeds in to a traditional, paternalistic view of medical care. That view would answer that the physcian knows best - just do what He tells you and don't argue. If your doctor thinks the risk is low enough or the work load too high, he just won't tell you about it. Ignorance is bliss, right?

As a parent, I don't want restrictions in information, I want to be informed so that I can make my own choice. Both parents and children should be informed about this - just as we inform everyone about wearing seatbelts.

If the major problem is work overload for documentation, then look at alternative ways to get the message across...direct letters to first year students, K-12 education, community advertising, family practice physicians. With the surge in electronics, it would be easy to send the message electronically - in websites and email, or the ubiquitous newsletters (usually devoted to sports and opportunities to buy logo paraphenalia).

Besides, I didn't hear about it oncampus or even in The Chronicle...I saw it on NOVA.

Re: more of the nanny state

Author: dlr-Washington State
Date: 02-17-04 12:02

I received a "to the parents of" letter last summer from some kind of menengitis non-profit org. Presumably it was funded by the drug company making the vaccine. It was a reminder for me of the existense of the disease and of the vaccine and prompted me to do further reaseach. I fail to see why there needs to be any new laws or why the college should be burdened in any way since there is ample information available to parents and students.

Re: more of the nanny state

Author: Psychologist
Date: 02-17-04 15:49

To Bill O'Malley: Huh? "Far left?" What are you talking about?

I'll quickly address the question that actually was asked. Parents and lawmakers should allow campus health professionals to make decisions about what services to provide and how to provide them. These decisions should involve the various stakeholders, e.g., students, administrators, local public health officials, among others. Different institutions will come to different conclusions based on the unique aspects of the institution and the availability of off campus resources. Political and commercial interests should have no part in the discussion.

Re: more of the nanny state

Author: Chung Nguyen, UC Berkeley alum
Date: 02-17-04 16:02

The government should not force schools to enact measures, especially when there would be no financial support from state budgets. From the article, I had an especially strong feeling that drug companies are really pushing this vaccine. The interviewed expert at Berkeley stated clearly that statistically speaking, this vaccine was not very effective. Medical experts and school administrators should determine steps to take for their own institutions, not the government, parents, special interest groups (no matter how good their intention), and especially not drug companies whose only concern is the mighty dollar.

Re: Who knows best how to keep students healthy?

Author: John Garner
Date: 02-18-04 10:32

Gee,

It seems to me that there is some over-reaction going on.

First, every public school corporation that I know of requires immunizations and records regarding immunizations from students enrolling in their schools. How is this different philosophically?

Second, bacterial meningitis is rare. I am not sure regarding the safety of the vaccine. In some diseases, and this may NOT be one, the vaccines provide more of a risk than the disease itself to the population that would be found in a post-secondary institution from a statistical standpoint.

The risk of side effects that would come from mass innoculations sometimes outweigh the benefit of disease prevention. At other times, this is not the case.

This is a decision that should be assessed by an unbiased source such as the Center for Disease Control (CDC) or perhaps a State Board of Health who would be more likely to give an unbiased opinion on this matter.

After we know more regarding the statistics regarding bacterial meningitis from an unopinionated source, then perhaps we might be able to offer an intelligent response in this discussion that addresses the issue instead of offering a knee-jerk reaction that is rooted in politics or a emotional appeal from victims or families of victims of the disease.

Re: Who knows best how to keep students healthy?

Author: Retired: Eckerd College
Date: 02-20-04 12:28

In the fall of 1953, when I came down with spinal meningitis, on the DePauw Univ. campus, I had never heard of the disease. I was very healthy and playing on the football team. The only case in the state of Indiana that fall, no one knows how I contracted the bacteria. I almost died, were it not for the incredible skill and quick actions of doctors at the Univ. of Indiana Medical Center. I was in isolation for many weeks.

It changed my life since I had to drop all of my lab courses (was going to be pre-med) and led me to the humanities (since I could read in the hospital). I became a professor of philosophy.

It is not just the cost to the person who contracts the disease, but given its contageous nature, my entire fraternity and associates had to be treated for many weeks.

It is important that we provide information about the nature of this disease to all college students and their parents. It attacks the spine and nervous sytem very quickly and it is imperative that the symptoms we understood and recognizaed. (My college doctor thought I had the flu until my legs were paralized.)

Yes, we should educate and make the vaccine available for those who elect to portect themselves. To do less is to put ones head in the sand.

Merle F. Allshouse

Re: Who knows best how to keep students healthy?

Author: Merle Allshouse, Ret. Eckerd
Date: 02-20-04 12:53

It is clear that many of those responding to this issue have not had spinal meningitis. As a Freshman at DePauw Univ., in the fall of 1953, I came down with the disease, the only known case in the state of Indiana at the time. I had never heard of meningitis, and as a healthy lad on the football team, it was the least of my concerns.

Thanks to many weeks of superb medical care and isolation at the Indiana Univ. Medical Center, I survived. There was a cost, not only to me personally, but also to my fraternity and friends, all of whom had to be treated on the campus. Fortunately no one else contracted the disease.

It is imperative that students and parents be well educated about the symptoms of this disease. It moves very fast. The DePauw campus doctor thought I had the flu until I lost all feeling in my legs.

It is unethical to not provide good information through the campus health center about this and other killer diseases. Not every one will act on good information. But given the highly contageous nature of meningitis, the decision ito innoculate or not is more than just an individual one. It involves the entire campus community.

Re: more of the nanny state

Author: Merle Allshouse, Ret. Eckerd C
Date: 02-20-04 16:27

P.S. to my spinal meningitis story.

It certainly became a campus issue at DePauw Univ. when several hundred students had to be treated with sulfadiazine and my entire dorm and several classrooms had to be thoroughly disinfected.

When this disease strikes it has a social consequence and thus needs to be treated as a public health issue. There is a public good here, for which political labels are not relevant.

Re: Who knows best how to keep students healthy?

Author: DE Teodoru
Date: 02-20-04 20:18

Colleges in some areas are in proximity to the university medical college. As a rule, teaching institutions provide far more competent health care that community hospitals, than even their own satelite hospitals. But most colleges, like summer camps, have rather easy-going medical care. The physicians therein are not top drawer and are certainly not payed top-dollar. I couldn't finish if I were to go into cases where the Hetardo Rutgers Health Care system misread X-Rays, just to site on example. Of course, Rutgers is connected with the New Jersey College of Medicine. But the issue is triage. If an incompetend-- or nearly so-- or a swamped heath care provider fails to see a brewing sign of health care danger or misjudges a chronic condition, the student is not likely to go further, given the youthful assumption of indestructability. Sending them to the University Hospital's ER-- a wait amongst hundreds of criminal trauma cases-- leads to many lost hours. All in all, that leads to the student going untreated.

Basically, the campus MD serves as an eidemiologic control officer, looking for gross patterns, and is not as dogged an investigator as the family physician, who is rarely contacted by the campus doc. It is no surprise, therefore, that one sees very sick kids coming home on break with little nipping in the bud by the campus health care system of whatever ails him/her.

Re: Who knows best how to keep students healthy?

Author: David Lawrance
Date: 02-22-04 09:22

Providing information about a vaccine is not the problem. Getting it for people who want it is not the problem. But, it is a problem when legislators bypass their entire communicable diseaseandp to add an unfunded mandate upon arents and students and universities to accomplish the task, It is a problem when more and more states, require an immunization that bypasses funding for other mandated vaccines because then its cost is not income means-tested. Let's add on to that that there is a no-fault administrative method for patients to recover damages caused by other required vaccines, but they will have to sue to recover damages from this one. (It does seem to be an extremely safe vaccine.)

We can and do argue about the effectiveness of our laws concerning public health. But, at least there is an attempt to focus most of the money where it will do the most good. Meningococcal vaccine has a terrible cost-benefit ratio. The cost of vaccine to save a life is in the millions of dollars. That may not be too insurance to spend to save a life, but there are many other public health measures that have exceptionally better bang for the buck. This is the reason why the ACIP did not recommend that college students get the shot, but that they should consider it. That is a unique recommendation for a vaccine.

I'll give Aventis-Pasteur a lot of credit. They find advocates for a cause against which they have a vaccine that doesn't sell well. They pump a few million dollars into "educational" promotion. They pay to fund a lobbyist in each state to push a model act that requires this additional immunization. They write a grant to the ACHA to promote an educational program for colleges. Laws get passed. Hundreds of thousands of shots are delivered. It was an extremely good investment for them, because there were no public health advocates who would do the work for them.

I'll skip over the parts about not actually being to deliver enough vaccine at times. And about vaccine recalls. Recalls happen. And, they must have been taken by surprise at how quickly their marketing plan actually worked (it takes months for batches of vaccine to be prepared and released.) This must serve as an object lesson to those with trying to milk the last few drops out of a marginal product. Menommune is mostly used in the U.S. because other meningococcal vaccines are availabe in Europe. Menomune will likey soon be replaced by an updated vaccine in the U.S. that actually works well. When the conjugate vaccine comes out, we can immunize everyone all over again.

Legislators got their chance to vote to save a life. The campaign was a natural. I wish they would spend a little more time on the less glamorous job of enacting insurance laws so that uninsurance and underinsurance disappeared. That would save thousands of lives and cost the state less than what it currently pays. That mandate, might have to be funded. Not so easy.

Re: Who knows best how to keep students healthy?

Author: F.Milley Meningitis Angels
Date: 02-22-04 23:10

This is Frankie Milley of Meningitis Angels, Yes! another anti meningitis group. We unlike the others mentioned are not funded by pharmaceuticals companies to date. We are funded by parents and individuals who believe this disease is here and it is deadly. Many of us already destroyed by it.

Trying to save the lives of others. We also service the victims and family with support groups and when funding available provide victims with educational and physical help aids and one day funding available we hope to give educational scholarships for college and technical training and in home relief for care givers. We net work for other helps and services. We educate legislators including many of those who have passed the laws you mentioned in your article.

To Dr. Dietrich and those who want to gripe about paper work. Until you watch your perfectly healthy son, who just 24 hours before was planning his pro-golf career, picking his college courses and beginning his adult life lay on a table with blood coming from every orifice of his body and dying. Until you tend a child or young adults side 24 hours a day , 7 days a week who is so debilitated from the disease they no longer have legs or arms, see, hear, walk because of paralysis, no longer can control their body functions or now so brain damaged they will not be able to attend school, when just 24 hours before they were honor students, artist and/or athletes. Until you set at your child or young adults bed side and sign papers for them to be chopped away piece by piece or watch their body rot until they only resemble the person they once were, or until your family is falling apart under the pressure from the effects of this horrible disease. I suggest you rethink your statements. Many survivors suffer life long surgeries and disease from the effects of meningitis. Time and time again parents listen to such as yourself and live to regret it.

Oh, by the way your stats are from 1998, please! How ironic my precious son is one of these 1998 stats. I along with others believe the number of cases reported are much higher, but because, of uneducated emergency room and pediatric doctors and staff on this disease. Many patients are misdiagnosed.

It is the ignorant thinking, lack of education on this disease and vaccination , that will continue to see infants, children and young adults be seriously debilitated and/or die and from this disease. The United States has seen outbreaks/epidemics in military barics in the past. We vaccinate our military now.

Thousands of cases of meningococcal meningitis are reported in Africa daily. Epidemics have happened around the world. "Epidemics are a plane ride away." As a parent who lost an only child to meningococcal meningitis. How anyone could be against education and a person's right to vaccinate themselves or their child against a deadly disease is totally devastating to me. A cost of $50 to $85 per student is a small price to pay for life and limb. How much do you spend on a night out? Do you have children? Have you ever buried a child? Are you willing to gamble your child's life?

Mr. Pike is right, many of the tragedies that befall college students are brought on by bad choices. Often from things educated against from the time of day care through high school. Meningitis is not a choice, it is not a stranger. It is here and it is deadly. Maybe, Menomune is not the best, but it is all we have. If only, Ryan had a 90% chance. He would 100% be here.

How many tears must we cry and how many will die before you listen?

Frankie Milley, Meningitis Angels Heaven and Earth Bound, Inc.
Founder/Managing Director and Mom to HBA, Ryan Milley
Our Web Address is
http://www.meningitis-angels.org
Meet Ryan
http://www.meningitis-angels.org/ryanhb.htm

Re: Who knows best how to keep students healthy?

Author: me
Date: 02-23-04 13:41

I don't think anyone on this board is "pro-meningitis," Mr. Milley, nor does anyone want to take away a person's right to vaccinate. But why should meningitis, in particular, demand this level of mandatory governmental support in terms of required vaccinations?

There are fewer than 500 deaths/year in the US from meningitis, but there are more than ten times as many from hepatitiis, thirty times as many from tuberculosis, and nearly eighty times as many from salmonella. Even the Center for Disease Control considers the "moderately elevated" risk among college freshman not to justify the program -- their estimates state that "vaccination of all freshmen would result in the administration of 1.4--2.3 million doses of vaccine each year, preventing 37-69 cases [...] and two to four deaths per year."

As much as I sympathize with you, I'd rather see $100 million spent on the prevention of TB and syphillis.