Thursday, April 2, 2009

Little Ones and Lockjaw

Some concerned family members have asked me to provide evidentiary support for our decision to avoid vaccinations, so far, for our children. Understanding this valid concern, I'm more than willing to provide some. There are many vaccinations that can be discussed, but I'll just focus on tetanus right now because it was mentioned specifically.

I have zero medical training. I'm not responsible for your medical decisions. If you make any judgements based on this post, your lockjaw isn't my fault.

This is hardly a scientific study, but rather my own analysis of other studies. I'm going to show a blatant disregard for things such as significant digits and formal terminology. Where assumptions need to be made, I will tend to grant the benefit of the doubt to support of vaccination. I'm open to corrections, so if you have any please leave a comment or write an e-mail. Finally, I'm going to avoid wasting time defining everything. There is plenty of information available on what tetanus is and what the DPT vaccination is.

Generally, when considering whether to receive medical treatment, an analysis of the benefits and the risks is prudent. If the treatment provides a great benefit while having little risk, it should probably be taken. However, if the benefit does not outweigh the risk associated with the treatment, it should probably not be taken. If the risk and benefit are considered to be equal, the treatment most likely isn't worth the trip to the doctor.

I'm going to roughly evaluate the benefits and risks associated with the DPT vaccine where the benefits apply to tetanus. The DPT vaccine is one of the most well documented. It's difficult to find anything reliable on DTaP. The only thing I read about that had any semblance of a scientific study regarding Pediarix (DTaP/IPV/Hep B, the five-in-one currently used in the U.S.) contained a sampling of only 400, 8 of which had questionable serious adverse events. The sample size is way too small for the probabilities we're considering here, so it's hardly worth mentioning.

If someone wants to argue that the drugs have improved, put forth some serious studies that are readily available to interested parents. In this information age, there's absolutely no excuse for doing otherwise. The onus is not on me to prove how safe a treatment is. If they can't make a decent study readily available to me, they have no business sticking it in my kids.

Before looking at the probabilities of getting tetanus, I would like to establish one fact: the vaccination is not the only thing that prevents tetanus. Sanitation and wound hygeine are also factors. All three of these factors have become more significant over time - the number of vaccinations has increased, sanitation has improved, and wound hygeine has improved.

A Population-Based Serologic Survey of Immunity to Tetanus in the United States by the New England Journal of Medicine found that 69.7% of people at least six years old surveyed from 1988 to 1991 were immune to tetanus. For the sake of simple argument, let's assume that 69.7% of the U.S. population was immune in 1990.

Now, refer to Figure 1 near the bottom of the Tetanus Surveillance report by the Centers for Disease Control. It shows the decline of tetanus cases and tetanus deaths from 1947 to 1997. Tetanus cases began to be recorded in a consistent manner at 1947 when the vaccine was beginning to be used in a widespread manner.

According to the graph, 0.4 of every 100,000 people in the U.S got tetanus in 1947. In 1990, it was 0.025. 0.025 is 6.25% of 0.4. This suggests that the chance of getting tetanus in 1990 was 6.25% of what it was in 1947.

Now, let's assume that 100% of the population was not immune in 1947. This isn't true (though the percentage immune was probably very small), but it doesn't matter for this argument. With that assumption, the percentage of vulnerable people in 1990 was 30.3% of what it was in 1947.

Compared to 1947, the number of non-immune people in 1990 was 30.3% while the number of tetanus cases was 6.25%. In other words, the percentage of tetanus cases decreased faster than tetanus immunity. Yes, these are very rough estimates, but I think they still make one thing clear. Immunity could not have been the only factor in the reduced cases of tetanus.

Now, let's consider the benefits of the tetanus vaccination:

Even though immunity isn't the only factor, let's be conservative and assume that an unvaccinated person today will have the same probability of getting tetanus that people did in 1947 when the vaccination was rare. (I'd go back to a time before the vaccination even existed, but the numbers are less reliable. I want to compare apples to apples as much as possible.) The probability of getting tetanus for that year was .000,4%. Add the fact that the life expectancy of a United States female today is 81 years. This means that, for our argument, the probability of an unvaccinated person getting tetanus today is 1 out of 3,086.

What about death? Let's use the data in the graph again. Consider that, in 1997, about 0.000,016% of the population got tetanus while 0.000,002% died from it. This means that, with 1997 medical care, 1 out of 8 tetanus patients died. If the chance of getting tetanus is 1 in 3,086, then the chance of dying to it with 1997 care is 1 in 24,688. Rough, yes, but good enough for now.

It is not the case that being vaccinated means you will not get tetanus, but let's just assume that it does anyway. This means that the benefit of getting vaccinated is the prevention of a 1 in 3,086 chance of getting tetanus, or the prevention of a 1 in 24,688 chance of death due to tetanus.

On to the risks:

One source of data for the DPT vaccination is a UCLA study published in 1981. According to the National Vaccine Information Center:

"The UCLA/FDA study showed that 1 in 875 DPT shots results in a convulsion or collapse/shock reaction. Two babies in the study died following DPT reaction symptoms, but their deaths were classified as sudden infant death syndrome (SIDS or crib death)."

There were 15,752 DPT immunizations in that study, so if you associate the deaths with the vaccination that's a 1 in 7,876 probability. The cause of those deaths is questionable, so we'll leave them out.

1 in 875 vaccinations result in a serious adverse reaction, but a person's chances of a bad reaction increase if they have more than one shot. According to the typical DPT vaccination schedule, it was administered five times to young children. (It is recommeded that an adult receive a tetanus booster shot every ten years, but this is different from DPT or its variants.) This gives us a 1 in 175 chance of convulsion or collapse/shock in a lifetime.

In 1994, the NVIC reported on a year-long investigation of the Vaccine Adverse Reaction Reporting System (all data available for download at http://vaers.hhs.gov). It found that "A total of 54,072 reports of adverse events following vaccination were listed in a 39-month period from July 1990 to November 1993 with 12,504 reports being associated with DPT vaccine, including 471 deaths." (http://www.whale.to/vaccine/nvic4.html) Keep in mind that these are only the results of the national reporting system. The article goes on to explain, "At the end of February 1994, NVIC/DPT also conducted a survey of 159 doctors' offices in seven states, including Arkansas, California, Georgia, Illinois, Maryland, New York, and Texas. When asked the question, "In case of an adverse event after vaccination, does the doctor report it and, if yes, to whom?" only 28 out of 159, or 18 percent said they make a report to the FDA, CDC or state health department. In New York, only one out of 40 doctors' offices confirmed that they report a death or injury following vaccination."

Ick. Let's be generous and assume that the VAERS database contained 20% of the total number of incidents. That means there were really 62,520 adverse events from DPT, 2,355 of which were deaths. So, how many DPT vaccinations were given during this time period?

I can't seem to find any information that even comes close to estimating the number of actual DPT vaccinations in the U.S. during this period, but I think we can still come up with a very generous estimate. According to the typical DPT vaccination schedule, it was administered five times to young children. I'm going to assume that the CDC's DTaP schedule resembles the old DPT schedule. I'm going to assume that every child born during the time periods that qualify them as being due for a shot during the study's time period lived long enough to get all five shots, and that every single one of them did in fact get all five shots. We can estimate this number of children using the annual birth numbers listed at http://www.johnstonsarchive.net/policy/abortion/ab-unitedstates.html. This estimate is 65,499,055.

Something close to 65,499,055 children were born during five 39-month periods that make them due for DPT shots during the time period analyzed for the NVIC study. I'll assume that 65,499,055 shots actually were given even though it realistically would have been fewer. With 62,520 adverse events and 2,355 deaths, this suggests a 1 in 1,048 chance of adverse event per shot and a 1 in 27,813 chance of death per shot. Multiply those by five shots per person, and you get a 1 in 210 chance of adverse event in a lifetime and a 1 in 5,563 chance of death in a lifetime.

Here's a quick review of my estimates:

If you are unvaccinated:

1:3,086 to get tetanus in lifetime
1:24,688 to die from tetanus in lifetime
1:2 chance your dad's fingers will bleed from too much typing

If you are vaccinated:

1:875 to have convulsion or collapse/shock per shot
1:1,048 to have adverse event per shot
1:27,813 to die per shot
1:175 to have convulsion or collapse/shock in lifetime
1:210 to have adverse event in lifetime
1:5,563 to die in lifetime

So far, it's looking like DPT isn't worth the effort to pull up my child's sleeve. Even if we assume the VAERS database contains every single incident, it still looks bad for DPT. Also, consider that this does not even take into account the tetanus booster everyone is supposed to get every ten years. I don't even need to bother with it.

Based on all of these extremely conservative estimates, if my concern is Tetanus, it would be irresponsible of me to have my children vaccinated.

Wednesday, February 18, 2009

A Stick of Mint

One of the neat things about Linux is that you can install an entire operating system on a little USB stick. This allows you to run your personal operating system from just about any computer at any location. As you can imagine, there are many reasons for doing this. I'll explain mine below.

I have access to a laptop with an encrypted hard drive with Windows installed on it. I won't get in to the reasons why, but I should not be installing any programs on it. Use your imagination. If I can't install programs on Windows, I could normally resize the Windows partition and install Linux on the cleared space. However, I can't just resize the partition because the hard drive is encrypted. The one good thing is that the bios is not password protected, so I am free to change the boot order. This allows me to boot the laptop from things other than hard drives, such as CDs or USB drives.

I put an 8GB thumb drive on my Christmas list, and my brother-in-law was kind enough to get me one. Let the experimentation begin!

You can do this with as little as 1GB, but that only leaves you with about 200 MB of extra data storage. 4GB should give you plenty of wiggle room for installing updates, configuration changes, and adding several extra programs. With 8GB, I have plenty of extra room for things like music and videos.

I tried this twice, and I'll explain why later. The first method is simpler but limits your storage space to about 4GB. The second method unlocks all the available space on your USB drive.

Ubuntu has a program called usb-creator, and I used it for both methods. It is installed by default on Ubuntu 8.10, but it also works on Ubuntu 8.04 if you download it. To use it, look for the option to create a USB startup disk under the Administration menu. You might be doing this from a Live CD, which is just fine. I heard that you can even run usb-creator from Windows, so you are free to do this from your Linux or Windows desktop if you wish.

In order to boot from a live CD or a USB drive, you may need to change the boot order in your bios. This method can vary depending on your motherboard, so I won't get into that here.

The First Method:

For my first go, I formatted my entire USB drive with a FAT32 partition before using usb-creator. To do this, you can use the program, GParted, which can be found in the administration menu as "Format Hard Disk." You will need at least one FAT32 partition because the USB drive will be running Linux similar to the way your Live CD does. Don't worry, the program will enable a way to save your files and changes as I mentioned earlier.

When you run usb-creator, the program will ask you to select a .iso file to use for the installation. This can be the same .iso file you used to create your live CD. I used a second thumb drive to hold this .iso file while the program running off the live CD installed to my new thumb drive. I suppose you could copy the .iso file to the home folder of the live CD, which means it would be stored in RAM and erased when you rebooted. That's fine because you only need it once, and it allows you to get away with using only one thumb drive for the entire process.

I used a .iso file for the Ubuntu 8.10 64-bit Desktop version the first time. This worked right "out of the box" with only one small issue that I will discuss later.

One of the other options the program gives you is the ability to enable persistency. This allows your changes to the operating system to be saved, making it much nicer than just running from the Live CD. This option presents you with a slider, allowing you to designate an amount of "persistent space" on your thumb drive. This space can be as small as 128MB or as large as 4GB. Here's what's really happening behind the scenes:

The usb-creator program will copy the Live CD files from the .iso image to your thumb drive just like it does for CDs, and mark the FAT32 partition as bootable. This takes up about 700MB of the parition's space. Then, the program will create what is called a persistency file. This file is named "casper-rw" and is stored on the root of your FAT32 partition right along with the Live CD files. This persistency file is used by your Linux installation to store all the changes you make to the operating system. All your configuration changes, software updates, and added data files such as music or office documents are magically stored inside this persistency file. Think of it as a big, complex .zip file. The FAT32 file system cannot handle files that are larger than 4GB, no matter what operating system you are using. You cannot create a persistency file larger than 4GB, and as a result, you cannot store more than 4GB of extra data in it. There is a way around this, and I used it for my second method which I will discuss later.

Anyway, once you tell the program how large you want the persistency file to be, it's ready for you to click, "Make Startup Disk." Writing to flash isn't exactly speedy, so this may take a few minutes. Once it's finished, shut down operating system, remove the CD when it tells you to, and boot up again with the USB stick in the computer of your choice.

When I did this the first time, I had an almost fully functional Ubuntu operating system. It takes a while to boot up because flash drives are slower than hard drives. However, once the operating system is up and running, most things seem to run quite smoothly. The one thing that did not work right away was the wireless card. All I had to do was connect the laptop to my wired network, go to Hardware Management in the Administration menu, and select the wireless driver I wanted to enable. It downloaded the driver and turned it on after I rebooted. This is a Dell Latitude D630.

I noticed that whenever I would boot off the thumb drive, it would come up with a menu similar to the one you see on the Live CD. If you just select the default or let it timeout to the default for you, it will continue to boot to your persistent Ubuntu installation. I also noticed that Ubuntu did not require any login credentials by default, just like the Live CD. You can enable this if you want, and I did the first time, but I won't get into that right now.

One of the most fun things about having Linux on the laptop was that I was able to install Adobe Flash and watch TV shows on Hulu.com via my 32" LCD TV. I didn't have to worry about hauling a larger, noisier desktop machine over by the TV and running network cables to the family room. There were two drawbacks to this, however. First, the only sound output on the laptop is meant for microphones. In order to hear the shows we had to turn the volume all the way up on the TV and computer. I am sure a desktop or other laptop with standard sound output would not have this problem. Second, the laptop doesn't like displaying at full resolution on my TV, so the picture is smaller than it could be if the show is in widescreen. I also think that a desktop would fix this issue, because the operating system won't have to worry about the laptop's built-in display. I may still figure out how to get this to work.

Anyway, I did have one small problem when I tried installing updates from Synaptic Package Manager. I selected "Mark All Upgrades" and let it do its thing, as usual. However, when it was done, it gave me an error about a broken symbolic link. This error would pop up every time I did an update in the future. After a bit of research, I found out that it was because of an issue downloading Linux kernel updates onto Live CD types of installations. Remember, the usb-creator method of making a bootable thumb drive treats your installation much like a Live CD. The update that caused the bug wasn't really necessary, and the bug itself seemed to be harmless. I also discovered a way to fix it, but I won't go into that here.

Remember that my persistency file was only about 4GB in size. The core Linux installation was about 700MB. This left me with around 3.5GB of wasted space. I used GParted to turn that extra space into a separate FAT32 partition so I could store other files on it and access them while Linux was running. However, in the end I decided I really wanted to have all of my storage space on a single partition so I could install as many programs as I wanted in the future. This brings me to...

The Second Method:

I also had recently done some research on another popular Linux distribution called Linux Mint. According to DistroWatch.com, it is the third most popular Linux distro after Ubuntu and openSUSE. Linux Mint is based off of Ubuntu similar to the way Ubuntu is based off of Debian. However, they seem to focus on a much more user friendly experience (though I would definitely not complain about Ubuntu being unfriendly) and a better "out of the box" experience. The primary version of the operating system comes with media codecs and other free proprietary software (such as Adobe Flash) preinstalled. It also comes with some applications called Mint Tools, which have been added to make life a little easier. The graphical interface is also attractive, and more familiar to people who are used to Windows.

Since changing how persistent data was stored on my thumb drive would require me to basically start over from the beginning anyway, I decided to use Linux Mint 6 64-bit for my .iso this time. But why did I need to start over?

I found out that instead of using the casper-rw persistence file, it is also possible to simply create a separate partition with the label "casper-rw" and it will store all of the persistent data. You just need to delete the casper-rw file so Linux knows to use the partition instead.

The recommended file system for this partition is ext2. Why not ext3? Well, ext3 does a lot of extra writing to the drive for things like indexing, which isn't necessary and will actually wear out your flash drive faster. (Flash drives are supposed to have a more limited lifespan than hard drives, so keep this in mind if you ever use them for important data.) Also, it is my understanding that some of the features of ext3 aren't even enabled when running like a Live CD, so much of the benefit of ext3 is wasted anyway. So, I used GParted to make a 900MB FAT32 partition for the Live CD portion of the operating system combined with a temporary minimal casper-rw file, and used the rest of the space for ext2.

After the partitions were set up, I went to usb-creator and had it make my Linux Mint bootable drive with a minimum persistence file of 128MB. After that was finished, I deleted the casper-rw file from the FAT32 partition. In order to make use of that extra space, I went back to GParted and resized the FAT partition to 700MB and added the extra to my ext2 partition. Then, I had to label the ext2 partition as "casper-rw" by using the following command in the terminal:

e2label /dev/ casper-rw

The exact location of the ext2 partition should be listed in GParted, so be sure to use that in the command.

I rebooted, took out the CD, booted from the thumb drive, and had Linux Mint running. There was just one problem: no persistence. Of course, it was the first thing I tested. I did some research and learned a little about the Live CD menu that pops up before you actually boot into Linux. On the Live CD, and on the thumb drive, there is a file that tells the menu what options to display and how to behave. This file is /syslinux/syslinux.cfg. This file needs to tell Linux to boot into persistent mode, not just normal Live mode. I am assuming that for whatever reason, usb-creator was able to properly modify this file for Ubuntu but not for Mint, so I had to do it myself. Here's how:

Above the line that says "label live" you need to insert the lines:

label custom
menu label Start Linux Mint in ^persistent mode
kernel /casper/vmlinuz
append file=/cdrom/preseed/mint.seed boot=casper persistent initrd=/casper/initrd.gz quiet splash --

You'll notice that the only difference between the custom section and the live section is the word "persistent." After you insert those lines, you need to go to the top line and change it to say:

default custom

I guess this tells the menu to use the information in the "custom" label as the default option. For the heck of it, I also changed the "timeout 100" line to say:

timeout 50

After doing this, two things happened. First, I noticed that I no longer got the boot menu at all! The thumb drive just went straight into Linux Mint. I'm not sure why this happened, but I might have messed up the syntax in the config file. After all, this was all new to me. I actually thought this was a good thing, however, because I really don't need that menu anyway. The other thing that happened: persistent mode was now working. I guess I killed two birds with one stone.

After I installed the wireless driver exactly as before, everything worked perfectly. I didn't have to install Adobe Flash because it was already installed, and Hulu worked the same as before. I also heard that DVDs play just fine right out of the box.

Instead of using Synaptic Package Manager for my updates, I used mintUpdate, which was located in the lower right corner of the tray. One of the neat things about mintUpdate is that it ranks each update on a scale of 1 to 5. If something is very important and/or very safe to install, it gets a 1. If something is unnecessary and/or unstable, it gets a 5. I've heard that these ranks can change based on user feedback, so even if a package gets through initial testing but causes problems later, it can be moved down the list. By default, mintUpdate only displays and installs updates with a rank of 1 to 3. I changed it to display all five ranks, but only install 1 to 3. Guess what package showed up in the list of unsafe updates? The kernel update that gave me that error under Ubuntu. One of Linux Mint's tools just prevented me from getting an unnecessary error that Ubuntu would have given me (and did). I am a happy camper.

Linux Mint looks like the best option for Windows users that want to get away from Windows. I'm already talking it up to my friends. It's free, easy to use, and has a nice graphical interface that feels a bit more like what we're used to under Windows. (As with most Linux distros, you customize the GUI to look very different if you wish.) It comes with a complete office suite and e-mail client among other useful software, and it's completely free. Check it out at http://www.linuxmint.com/.

Friday, November 14, 2008

Brain Drain

In the technology industry, we understand that outsourcing is a growing problem for the American worker. However, we don't always understand why this problem is growing. If someone tells you, "It's just because they work for cheap over there," he could probably use a lesson in taxation. A family member e-mailed me the following:


Bar Stool Economics

Suppose that every day, ten men go out for beer and the bill for all ten comes to $100. If they paid their bill the way we pay our taxes, it would go something like this:

The first four men (the poorest) would pay nothing.
The fifth would pay $1.
The sixth would pay $3.
The seventh would pay $7.
The eighth would pay $12.
The ninth would pay $18.
The tenth man (the richest) would pay $59.

So, that's what they decided to do. The ten men drank in the bar everyday and seemed quite happy with the arrangement, until one day, the owner threw them a curve. 'Since you are all such good customers, he said, 'I'm going to reduce the cost of your daily beer by $20. Drinks for the ten now cost just $80.

The group still wanted to pay their bill the way we pay our taxes so the first four men were unaffected. They would still drink for free. But what about the other six men - the paying customers? How could they divide the $20 windfall so that everyone would get his 'fair share'? They realized that $20 divided by six is $3.33. But if they subtracted that from everybody's share, then the fifth man and the sixth man would each end up being paid to drink his beer. So, the bar owner suggested that it would be fair to reduce each man's bill by roughly the same amount, and he proceeded to work out the amounts each should pay.

And so:

The fifth man, like the first four, now paid nothing (100% savings).
The sixth now paid $2 instead of $3 (33%savings).
The seventh now pay $5 instead of $7 (28%savings).
The eighth now paid $9 instead of $12 (25% savings).
The ninth now paid $14 instead of $18 (22% savings).
The tenth now paid $49 instead of $59 (16% savings).

Each of the six was better off than before. And the first four continued to drink for free. But once outside the restaurant, the men began to compare their savings.

'I only got a dollar out of the $20,'declared the sixth man. He pointed to the tenth man,' but he got $10!'

'Yeah, that's right,' exclaimed the fifth man. 'I only saved a dollar, too. It's unfair that he got ten times more than I!'

'That's true!!' shouted the seventh man. 'Why should he get $10 back when I got only two? The wealthy get all the breaks!'

'Wait a minute,' yelled the first four men in unison. 'We didn't get anything at all. The system exploits the poor!'

The nine men surrounded the tenth and beat him up.

The next night the tenth man didn't show up for drinks, so the nine sat down and had beers without him. But when it came time to pay the bill, they discovered something important. They didn't have enough money between all of them for even half of the bill!

And that, boys and girls, journalists and college professors, is how our tax system works. The people who pay the highest taxes get the most benefit from a tax reduction. Tax them too much, attack them for being wealthy, and they just may not show up anymore. In fact, they might start drinking overseas where the atmosphere is somewhat friendlier.

David R. Kamerschen, Ph.D. Professor of Economics, University of Georgia

For those who understand, no explanation is needed.
For those who do not understand, no explanation is possible.


This is one of the reasons why socialism sounds nice and fair, but is actually impractical. Other countries such as France are starting to realize that different forms of wealth tax are actually losing the country tax dollars. Also, before you criticize a politician because he provided a tax cut you don't agree with, look up the actual results of that tax cut and how it affected overall tax revenue. You may be in for a shocker.

Here's something to ponder: how do you think the FairTax would affect the customers at the bar?