Evidence, schmevidence! Occupational medicine edition

The LA Times reports today that another porn star has become infected with HIV. This brings the total of infections to three in the past year. Although porn workers are required to be HIV tested every 14 days, condoms are not mandated. The lack of mandate is unfortunate given that we have great evidence for the effectiveness of condoms in reducing HIV transmission.

Now let’s switch gears and talk about healthcare workers. Increasingly, hospitals are mandating influenza vaccination. A new paper in the latest issue of the American Journal of Preventive Medicine by investigators at Johns Hopkins describes a systematic review of the literature on mandatory influenza vaccination for healthcare workers. One key finding was that mandating influenza vaccination increased compliance (imagine that!). But (and it’s a very big but) there was either no demonstrated statistically significant reduction in sick leave after mandating vaccination or no evaluation was performed in the studies reviewed. Moreover, none of the studies evaluated the impact on patients. At the end of the day, we still have no evidence that vaccinating healthcare workers reduces influenza in hospitalized patients. That doesn’t mean vaccination is not a good idea. I would argue that bare below the elbows is a good idea, but I’m quick to acknowledge that we don’t have data that it reduces infections, and therefore I don't support a mandate.

So here we have two industries struggling with evidence: one won’t mandate a proven prophylactic strategy, and the other seems quite comfortable mandating a prophylactic strategy that isn't proven. The root cause in both cases appears to be the same—an attempt to please the customer. It’s a whole lot easier for hospitals to mandate flu vaccine and publicly pat themselves on the back and tout how they are serious about patient safety than to develop and enforce policies and practices that keep healthcare workers home when they are sick.

Photo: Francine Orr, Los Angeles Times


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