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{\it John Vatalaro -- Does the Vaccine Matter?}
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You have done a good job of explaining the issues
raised by the Brownlee-Lenzer article and how
they relate to things we have discussed in our
class.  There are a few points where you could
say more (see comments below).  Your writing is
also quite good, although I think the production
of the paper was a bit rushed and the proof-reading
suffered as a result.   I have marked some of the 
improvements there on the paper.  Overall, though,
this is good work.
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{\it Specific Comments}
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\item{1.}  Technical point:  The quotation reports
a statement by Lisa Jackson, but you took it
from the Brownlee-Lenzer article.  In a case like
this, the standard way to make the citation would be to 
identify who said the quotation in the text (that is,
put Lisa Jackson's name there).  Then the citation 
would indicate where in the article the quotation 
was taken from and the parenthetical note (or
the foot- or end-note) would identify the authors
of the article.
\item{2.}  I'm not an expert on the immunology here,
but I think the concerns about mutation of the H1N1
virus are not directly related to the question of 
how many people build up immunity.  I think there is
some basic underlying mutation rate in the reproduction
cycle of the virus that produces new genetic strains
of the virus independently of whether people have immunity.  
A more important concern would be that the virus might 
mutate to acquire {\it resistance} to anti-viral medications like
Tamiflu, etc. 
\item{3.}  As you say after this point, the situation
is even more complicated than this because seasonal
flu is always caused not just by one virus strain,
but by several.  (Also, in cases like this where
there is a common word like ``strain'' that is 
being used in a technical sense, it is {\it not} a 
good idea to try to find synonyms to vary the 
word choice.  ``Strand'' really means something
different.  It's OK to use ``strain'' every time
even if it sounds like you are repeating yourself.) 
\item{4.}  ``Adds onto'' does not really sound right 
here.  Maybe:  ``Influenza also interacts with 
sicknesses such as AIDS, asthma, and cancer to 
cause additional deaths.''
\item{5.}  This is one place where what you say
is not actually correct.  It's not that Brownlee
and Lenzer are ``arguing'' that the cohort studies
have these fantastic results.  They are reporting
the claims made by those studies to call them
into question.  I know you know this, but what
you wrote does not make this clear.
\item{6.}  As the article reports, there is pretty 
good evidence that the seasonal flu vaccine 
produces a good immune response in young, healthy people.
So in fact, this seems to me to be one of the 
strongest arguments {\it for} giving the vaccines.
If you can prevent the spread of the virus to 
the people who are most at risk, then that is 
a good thing.  
\item{7.}  You say medical professionals are 
``not too fond'' of placebo-controlled trials
for flu vaccines ``for ethical reasons.''  That is accurate.
But you seem to be overlooking the main reason for the strength 
of their objections.  The first ethical principle of 
medicine (from the Hippocratic oath) is ``do no harm.''  If, as
a doctor, you give someone a placebo in a trial of 
a vaccine that turns out to be effective,
aren't you doing harm if they get
sick and possibly die from the illness?
This seems to be a real ethical dilemma to me!
\item{8.}  This is the wrong word -- you 
mean ``efficacy'' or ''effectiveness''  (that 
is: whether vaccines work at all, not how well they 
work).
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{\it Brandon Nunn -- ``Does the Vaccine Matter''}
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You have done a very good job of explaining the issues
raised by the Brownlee-Lenzer article and how
they relate to things we have discussed in our
class.  There are a few points where I think there
are additional issues that you have not accounted for,
or are dismissing too quickly (see comments below).  But
over all, this is strong work.
Your writing is also generally very good, although
there are a few questionable word choices.
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{\it Specific Comments}
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\item{1.}  The ``healthy user'' effect could also 
apply when {\it healthy} elderly people are vaccinated,
but sicker (say home-bound or bed-ridden) elderly 
people are not able to get to vaccination centers.  
That is, it's not just the age of the vaccine recipients
(or non-recipients) that matters.  It's really their general 
condition.
\item{2.}  ``Connoisseur'' is not the right word here.
I think you mean ``expert.''  One can be a ``connoisseur''
of opera, fine wines, or gourmet food, but not of vaccines(!)
Beware of thesaurus suggestions for synonyms.  There
are very few cases where two words are exact equivalents.
Words generally have shades of meaning that make all
the difference.  
\item{3.}  You say medical professionals 
have ethical concerns about placebo-controlled trials
for flu vaccines.   That is accurate, although I 
don't think that the main reason is concern for
their reputations.
You seem to be overlooking the main reason for the strength 
of their objections.  The first ethical principle of 
medicine (from the Hippocratic oath) is ``do no harm.''  If,
as a doctor, you give someone a placebo in a trial of 
a vaccine that turns out to be effective,
aren't you doing harm if they get
sick and possibly die from the illness?
To justify that action, you have to argue that the greater
good for society of doing the vaccine trial
outweighs the concerns of individual patients.
But that is not the way doctors are trained to think and
I am not sure I would want their focus on the individual
to change(!) This seems to be a real ethical dilemma with no
easy answers to me.
\item{4.}  This is a very good point.  The ``flip side''
is that stories about
courageous pioneers in science ``bucking the received wisdom''
and staking out controversial new positions have a certain {\it appeal
for some people}.  Some of us like to ``root for'' the 
underdogs in this kind of situation.   I think that
angle of the story is probably one reason why this article
appeared in a general-audience periodical like the {\it Atlantic}.
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{\it Kyle Walraven -- No title}
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You have done a good job of explaining the issues
raised by the Brownlee-Lenzer article and how
they relate to things we have discussed in our
class.  There are a few points where you could
say more (see comments below).  Your writing is
also good (but see the suggestions for changes
written into the paper).  
Overall, this is very good work.
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{\it Specific Comments}
\bigskip
\item{1.}  You say medical professionals 
have ethical concerns about placebo-controlled trials
for flu vaccines.   That is accurate, but
you almost seem to be minimizing 
the main reason for the {\it strength} 
of their objections.  The first ethical principle of 
medicine (from the Hippocratic oath) is ``do no harm.''  If,
as a doctor, you give someone a placebo in a trial of 
a vaccine that turns out to be effective,
aren't you {\it doing harm} if they get
sick and possibly die from the illness?
To justify that action, you have to argue that the greater
good for society of doing the vaccine trial
outweighs the concerns of individual patients.
But that is not the way doctors are trained to think and
I am not sure I would want their focus on the individual
to change(!) This seems to be a real ethical dilemma with no
easy answers to me.
\item{2.}  This is a good point.  There is
undoubtedly a certain {\it appeal} connected to stories about
courageous pioneers in science ``bucking the received wisdom''
and staking out controversial new positions.  I think that
angle of the story is probably one reason why this article
appeared in a general-audience periodical like the {\it Atlantic}.
\item{3.}  The discussion of what a non-expert
can do in the circumstances is good, although
I think you are being somewhat too pessimistic.
If you believe the model of science that Grinnell
proposes, the credibility process will tend to 
produce more and more reliable results over time.
So the situation is not always going to be what
it is now where even the ``experts'' disagree.
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{\it Mary Arnold -- ``Does the Vaccine Matter?''}
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You have done a very good job of explaining the issues
raised by the Brownlee-Lenzer article and how
they relate to things we have discussed in our
class.  There are a few points where you could
say more (see comments below).  Your writing is
also very good (I only have a few suggestions for changes
written into the paper).  Overall, this is very good work.
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\noindent
{\it Specific Comments}
\bigskip
\item{1.}  If you go back and look again at the Brownlee-Lenzer
article, you will see that Jefferson was trained at the 
London School of Tropical Hygiene.  The article says he
is ``currently a physician based in Rome and the head
of the Vaccines Field at the Cochrane Collaboration.''
\item{2.}  As you point out later, this is not the whole story,
though.  One of the reasons to immunize even the young and
healthy is so that they do not spread the virus to 
older and sicker individuals whose immune systems are
less able to protect them.
\item{3.}  This is the point I was making in 2. above,
and it just might be one of the strongest arguments 
{\it in favor of} the flu vaccinations.  Studies have
shown pretty conclusively that the vaccines do produce
strong immune responses (production of antibodies) in
younger, healthier people.  If they are not as susceptible
to infection, they may also not be spreading the virus
around to people who are more susceptible to the 
virus and secondary infections.
\item{4.}  This is an interesting secondary aspect of this
article.  There is
undoubtedly a certain {\it appeal} connected to stories about
courageous pioneers in science ``bucking the received wisdom''
and staking out controversial new positions.  I think that
angle of the story is probably one reason why this article
appeared in a general-audience periodical like the {\it Atlantic}.
\item{5.}  A final general comment.  You say medical professionals 
have ethical concerns about placebo-controlled trials
for flu vaccines.   That is accurate, it would be 
good to say some more about the main reason for 
the {\it strength} of their objections.  The first 
ethical principle of medicine (from the Hippocratic 
oath) is ``do no harm.''  If, as a doctor, you give someone 
a placebo in a trial of a vaccine that turns out to be 
effective, aren't you {\it doing harm} if they get
sick and possibly die from the illness?
To justify that action, you have to argue that the greater
good for society of doing the vaccine trial
outweighs the concerns of individual patients.
But that is not the way doctors are trained to think and
I am not sure I would want their focus on the individual
to change(!) This seems to be a real ethical dilemma with no
easy answers to me.
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{\it Andrew Coury -- ``The H1N1 Vaccine: a False Sense of Security''}
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You have done a good job of explaining the issues
raised by the Brownlee-Lenzer article and how
they relate to things we have discussed in our
class.  There are a few points where you could
say more or where what you say seems to be a bit
questionable (see comments below).  Your writing is
also good (but see the suggestions for changes
written into the paper).  
Overall, this is good work.
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{\it Specific Comments}
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\item{1.}  The end of the previous paragraph and the start of the 
next one at this point appear to be contradicting one another.
I think the first statement reflects initial estimates of the
possible severity of an H1N1 outbreak.  If those estimates
came true, then the 90,000 deaths {\it would not} be 
``a relatively small number.''  It would be significantly 
larger than ($2.5$ times, in fact) the usual 36,000 deaths per 
year attributed to seasonal flu.  It is true that other 
causes of death produce greater mortality.  But this 
would still be a rather large number of deaths compared
to the expected levels.  
\item{2.}  You are referring to what is often called
the ``healthy user effect.''
\item{3.}  In fact the kind of randomized, placebo-controlled
trials that Jefferson is proposing have never ``gotten off the 
ground.''  So saying he ``introduce[d]'' one is not correct.
\item{4.}   You say medical professionals 
have resisted placebo-controlled trials
for flu vaccines.   That is accurate, it would be 
good to say some more about the main reason for 
the {\it strength} of their objections.  The first 
ethical principle of medicine (from the Hippocratic 
oath) is ``do no harm.''  If, as a doctor, you give someone 
a placebo in a trial of a vaccine that turns out to be 
effective, aren't you {\it doing harm} if they get
sick and possibly die from the illness?
To justify that action, you have to argue that the greater
good for society of doing the vaccine trial
outweighs the concerns of individual patients.
But that is not the way doctors are trained to think and
I am not sure I would want their focus on the individual
to change(!) This seems to be a real ethical dilemma with no
easy answers to me.
\item{5.}  ``Chaos would erupt'' seems somewhat overstated
to me.  Of course, I cannot really predict what the reaction would 
be in that situation, but I think this kind of breakdown
in society would only happen if the death rate from the 
H1N1 flu was extremely high, {\it and} the vaccines
were shown to be ineffective, {\it and maybe} there
was some flagrantly improper behavior on the part of the vaccine
producers and the government that came to light.  Whether
or not the vaccines work the way most doctors think
they do, I don't know any credible evidence that 
the push to produce the vaccines and the antivirals
has been improper (that is, ethically shady).  Raising 
questions is not the same as proving misdeeds!
\item{6.}  You're getting close to the point I was
making in item 4 above.  But if you look at it from
the point of view of a practicing physician, the issues
become, if anything, even more confusing(!)
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{\it Paige Carr -- What Should We Do?  Questioning the Flu Vaccine}
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Your discussion of the appeal that ``maverick'' researchers
like Lisa Jackson and Tom Jefferson have for readers is 
especially good (see comments 3 and 4 below).  
The rest of the paper is also a good
summary of some of the issues raised by the Brownlee-Lenzer
article and how they related to things we have discussed
in this course.  The writing seems a bit technically 
rough this time, though (see the comments and corrections
on the paper itself).  There are a few instances where
you used the wrong word.  There are also some awkward
or ungrammatical sentences.  I think this might have
been rushed because of the end of the semester.  But
be sure you put in some more time on proof-reading 
in the future.  
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{\it Specific Comments}
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\item{1.}  This sounds very cynical.  Are you saying that
one cannot believe {\it anything} one hears in the news?
While there are certainly efforts to falsify the 
record and spread incorrect information, is everything
suspect?
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\item{2.}  The views of the Lisa Jackson, Tom Jefferson,
and other scientists reported in this article are very
much minority views at present.  So it is important
to qualify this by saying ``{\it some} flu researchers.''
\medskip
\item{3.}  I think you have ``nailed'' the ``good story''
aspect of this article.  There is
undoubtedly a certain {\it appeal} connected to stories about
courageous pioneers in science ``bucking the received wisdom''
and staking out controversial new positions.  I think that
angle of the story is probably one reason why this article
appeared in a general-audience periodical like the {\it Atlantic}.
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\item{4.}  See the previous comment.  Portraying these scientists
as such underdogs in the ``credibility process'' makes them
sympathetic figures for readers.  
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\item{5.}  You say medical professionals 
have ethical concerns about placebo-controlled trials
for flu vaccines.   That is accurate, it would be 
good to say some more about the main reason for 
the {\it strength} of their objections.  The first 
ethical principle of medicine (from the Hippocratic 
oath) is ``do no harm.''  If, as a doctor, you give someone 
a placebo in a trial of a vaccine that turns out to be 
effective, aren't you {\it doing harm} if they get
sick and possibly die from the illness?
To justify that action, you have to argue that the greater
good for society of doing the vaccine trial
outweighs the concerns of individual patients.
But that is not the way doctors are trained to think and
I am not sure I would want their focus on the individual
to change(!) This seems to be a real ethical dilemma with no
easy answers to me.
\medskip
\item{6.}  Let me play ``devil's advocate'' for a moment
and bring up the following question.  Suppose you 
decide after consulting your conscience that you will not
get the flu vaccine.  But suppose you are a flu
``carrier'' who does not get sick but spreads
the virus around to others who have weaker immune
systems and get sick from the virus.  Is that something
that can be justified?  Doesn't society have an interest
in protecting its more vulnerable members from 
this situation?  In fact, to me one of the strongest
arguments {\it for vaccination}, even with the all 
the questions, is that it may do something to prevent
the transmission of the virus by boosting the immune
responses of the young, healthy members of the population.
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{\it Jonathan Ye -- Is Over-Preparing for the Flu Possible?}
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This is a mostly good discussion of some of the issues
about influenza vaccines raised by the Brownlee-Lenzer
article.  Your way of looking at the situation is 
probably a prudent one, especially if a really virulent
strain of influenza emerges in the future (or H1N1 mutates
into something much worse than it now appears to be).  I think one omission, though, is that you  
only tangentially address what is probably the main thrust of what
they are saying -- namely, that double-blind, randomized, 
placebo-controlled trials of flu vaccines are needed
to determine whether they really work as advertised.  
See item 2 below for the main reason why this has not
happened and some of the ethical questions involved.    
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{\it Specific Comments}
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\item{1.}  This makes it sounds as though the media were 
making up alarming figures about swine flu deaths.  I think
they have tended to sensationalize in some cases.  But also
recall that the early projections of how serious the swine
flu pandemic would be (from the CDC and other scientists)
{\it were} much worse-sounding than the way things have
actually turned out (so far, at least!)  Some of the 
original projections had something like 90,000 deaths
in the US.  It does not look anything like that serious
now, of course, so it is easy to fault some of the early
reporting.  But at the time, I am sure that the media
just thought they were doing their part to educate
people to a threat to public health.
\item{2.}   You say correctly that double-blind randomized
trials with use of placebos would probably yield the 
most conclusive evidence about whether flu vaccines
are effective.  But as Brownlee and Lenzer indicate
no such trials have ever been carried out, and they
are not likely to be carried out.  You don't mention
a key point about why this is the case: physicians have 
major ethical concerns about placebo-controlled trials
for flu vaccines.  The first 
ethical principle of medicine (from the Hippocratic 
oath) is ``do no harm.''  If, as a doctor, you give someone 
a placebo in a trial of a vaccine that turns out to be 
effective, aren't you {\it doing harm} if they get
sick and possibly die from the illness?
To justify that action, you have to argue that the greater
good for society of doing the vaccine trial
outweighs the concerns of individual patients.
But that is not the way doctors are trained to think and
I am not sure I would want their focus on the individual
to change(!) This seems to be a real ethical dilemma with no
easy answers to me. 
\item{3.}  I am not sure that I ``buy'' your reasoning for
why you think the estimate that as many as 50\% of health-care professionals
are reluctant to be vaccinated for flu is incorrect.  It
might not be anywhere near that high, but I think your
objections are mostly wide of the mark.  
It is certainly true that not all health-care professionals
have direct contact with patients.  But the possibility
of passing or spreading the virus due to contacts with
patients is not the only reason why such professionals
might consider getting the vaccine.  If they believed
in the effectiveness of the vaccine, wouldn't getting
the vaccine be a good idea simply to protect their
own health?  Also, the issue is not whether these professionals
believe in vaccines in general.  I'm sure almost all of them
do because of the success of vaccines in eradicating 
other diseases like smallpox, polio, etc.  The issue
is really whether the seasonal and H1N1 {\it flu vaccines}
do what their supporters think they do.  And there, 
I think that many health-care professionals think
the jury is still out (even if they are not as negative
about the vaccines as some of the people mentioned in
the article are).   Finally, although it has not received
much media coverage, I know that there have been some
cases where health-care professionals {\it have} resisted 
mandates that they get the vaccines.  (This has probably
remained ``under the radar'' because the availability
of H1N1 vaccine has been so limited so far, and the
available doses have been reserved for individuals
considered to be at high personal risk -- pregnant mothers,
younger children, etc.)
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{\it Stephanie Craig -- Immunization: Is It Really All It Is Cracked Up To Be?}
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At the end, you come down pretty squarely in favor of 
randomized, double-blind, placebo-controlled clinical
trials for influenza vaccine.  I'm wondering how 
you would answer the questions raised in point 2 below,
though.  Do you believe that the benefit to society 
as a whole of knowing better evidence of the efficacy (or not)
of flu vaccine outweighs the potential harm that 
might be caused to participants in the trials?
Would getting some real form of ``informed consent''
from the participants possibly address this objection?

In any case, your paper is well-written and makes some
good connections with topics we discussed this semester.
Good work.
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{\it Specific Comments}
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\item{1.}  You are right to point out that this view is
based on the underlying assumption that the vaccine
does reduce the chance of death or other serious 
complications from the flu.   But it would be 
good to say some more about the main reason for 
the {\it strength} of doctors' objections to doing
this kind of trial.  The first 
ethical principle of medicine (from the Hippocratic 
oath) is ``do no harm.''  If, as a doctor, you give someone 
a placebo in a trial of a vaccine that turns out to be 
effective, aren't you {\it doing harm} if they get
sick and possibly die from the illness?
To justify that action, you have to argue that the greater
good for society of doing the vaccine trial
outweighs the concerns of individual patients.
But that is not the way doctors are trained to think and
I am not sure I would want their focus on the individual
to change(!) This seems to be a real ethical dilemma with no
easy answers to me.
\item{2.}  ``Widespread panic would ensue'' seems somewhat overstated
to me.  Of course, I cannot really predict what the reaction would 
be in that situation, but I think this kind of breakdown
in society would only happen if the death rate from the 
H1N1 flu was extremely high, {\it and} the vaccines
were shown to be ineffective, {\it and maybe} there
was some flagrantly improper behavior on the part of the vaccine
producers and the government that came to light.  Whether
or not the vaccines work the way most doctors think
they do, I don't know any credible evidence that 
the push to produce the vaccines and the antivirals
has been improper (that is, ethically shady).  Raising
questions is not the same as proving misdeeds!
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{\it Josh Hauser -- Swine Flu}
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Your paper is OK as a summary of some of the issues
raised in the Brownlee-Lenzer article.  But it never goes
into anything in much depth and there are some important
points that are glossed over or misstated (see comments 
below).  It seems to me that you could have put some 
more time and effort into this.
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{\it Specific Comments}
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\item{1.}  This is an overstatement if you take the whole
world into account.  If you are talking about the US, and
the rest of the industrialized world, then this is closer
to being true.  Be more careful about the broad, general statements like this.
\item{2.}  The first flu vaccines were developed in the 1940's and 
widespread use of influenza vaccine is actually
a relatively recent development (the last 50 years or so).  When
I was a child, for instance, use of such vaccines was not promoted
to anything like the degree that is true now.
Also, the first sentence of the second paragraph just repeats
something you said in the previous paragraph.
\item{3.}  You say correctly that double-blind randomized
trials with use of placebos would probably yield the 
most conclusive evidence about whether flu vaccines
are effective.  But as Brownlee and Lenzer indicate
no such trials have ever been carried out, and they
are not likely to be carried out any time soon.  You don't mention
a key point about {\it why} this is the case:  physicians have 
major ethical concerns about placebo-controlled trials
for flu vaccines.  The first 
ethical principle of medicine (from the Hippocratic 
oath) is ``do no harm.''  If, as a doctor, you give someone 
a placebo in a trial of a vaccine that turns out to be 
effective, aren't you {\it doing harm} if they get
sick and possibly die from the illness?
To justify that action, you have to argue that the greater
good for society of doing the vaccine trial
outweighs the concerns of individual patients.
But that is not the way doctors are trained to think and
I am not sure I would want their focus on the individual
to change(!) This seems to be a real ethical dilemma with no
easy answers to me. 
\item{4.}  I am not an expert here, but I don't think immunologists
would say that
that viruses can become ``resistant to {\it vaccines}.''  The
vaccine just produces an immune response in the vaccinated
person (production of antibodies).  That result provides some
protection if the person later encounters a similar
virus.  A virus could later mutate to become less susceptible
to the person's augmented immune system, but that is not resistance
to the vaccine itself.  On the other hand, the development
{\it resistance to antiviral drugs} by viruses is a serious concern.
\item{5.}  Careful -- it is not Tamiflu itself that
is the confounding factor.  The confounding factor
is that the people who can afford Tamiflu have higher
standards of living, better living conditions, better
hygiene, better health care, etc.  So the confounding factor is actually
the higher income level.  (It is associated both with
access to Tamiflu and to the outcome of treatment for
flu.)  
\item{6.}   There is another side of the ``good story''
aspect of this article.  There is
undoubtedly a certain personal {\it appeal} in stories about
courageous pioneers in science ``bucking the received wisdom''
and staking out controversial new positions.  I think that
angle of the story is probably one reason why this article
appeared in a general-audience periodical like the {\it Atlantic}.
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{\it Patrick Jarvis -- Does the Vaccine Matter?}
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Patrick, your paper about the Brownlee-Lenzer article is well written.
Your discussion of the reason why no randomized, double-blind, 
placebo-controlled studies of flu vaccines have been done (page 2 
of your paper) is also very good.  
However, based on things here, and 
on the first paper, I think we really need to work on your {\it close reading}
skills.  You seem to jump to unwarranted conclusions at times 
(perhaps because of your own personal opinions).  Some of the things you are
saying here are serious misrepresentations of what Brownlee and 
Lenzer are really getting at (see comments 2 and 4 below especially).  Either
because of how you read their article, or because of a lack of 
care in writing, you are off the mark in several places.
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{\it Specific Comments}
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\item{1.}  Strictly speaking, of course, {\it the virus} did not 
shut down Mexico City or colleges.  The closures were {\it precautionary
measures} by public health officials to prevent even wider
spread of the virus.  This is an important point because
it shows that many of the inconvenient effects of this 
pandemic have actually been the results of choices made
by humans.  On the other hand, I don't want you to think 
I am arguing that those closures and other measures were
unnecessary.  If the H1N1 strain this year had turned out
to be as bad as the 1918 - 1919 ``Spanish flu,'' the situation
would have been {\it very different}.  The problem is that there
is no way to tell ahead of time whether a new flu strain
is mostly a nuisance
(like this year) or a major public health disaster (like 1918 - 1919).
\item{2.}  I think this is a {\it crucial misreading} of their main point.
(You are not alone in thinking this, but I am sure they would disagree
pretty strenuously with what you are saying!)  If you read more carefully, you
will see that Brownlee and Lenzer never say they do not think people 
should get the vaccine.
They say that it has never been {\it satisfactorily demonstrated
that the flu vaccine works} the way its supporters claim.  And, they 
have other questions about the way government health officials
have ``pushed'' the vaccine and anti-viral drugs even though
there is no real proof that they work.   Especially
if there was another major public health disaster like the 1918 - 1919
``Spanish flu,'' their point is that we have to be better prepared (perhaps
by producing {\it better vaccines} or by developing other measures).
\item{3.}  See point 1 above.  The problem is that there is
simply no way to tell ahead of time how severe a public health challenge a new influenza
strain will be.  In fact, there may not even {\it be} any way to tell (even in 
principle), because there is an essential component of {\it randomness} involved in
the genetic mutations that produce new strains of flu virus.   
\item{4.}  Careful again -- the mocking is {\it most definitely not} directed against
the vaccine itself.  It is directed against the claim made in the ``cohort studies''
that immunization could reduce deaths by 50\% to 90\%.  This is another important
place where I don't think your reading of what the article was
saying was careful enough.
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{\it Nick Foster -- (No title)}
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Your discussion of the ethical issues that are cited by doctors
as the reasons for why no randomized, double-blind, placebo-controlled
trials of flu vaccines have been undertaken is very good.   You 
have also summarized most of the other points in the Brownlee-Lenzer
article very well and raised some interesting questions.  
Your writing is generally very good, although there are a few
unclear places and minor slips.  (See the corrections and suggestions
on the printout.)
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{\it Specific Comments}
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\item{1.}  Using ``find'' and ``discover'' sounds strange here because
it sounds as though the vaccines exist somewhere out there and we
just have to locate them.  It would be better to use ``develop''
or ``produce'' because what is actually being done is taking general 
methods for producing vaccines and adapting them to the particular
strains of flu virus that are the targets at this time.
\item{2.}  There seems to be a typo or something missing here.  I 
cannot tell what this is supposed to be saying.
\item{3.}  ``Knowing for sure'' is probably too strong here.
There is always {\it some} question about whether a scientific
result is completely credible.  Those studies would make the 
evidence for the effectiveness of flu vaccine much stronger,
but not certain.
\item{4.}  There is also an interesting secondary aspect of this
article.  There is undoubtedly a certain {\it appeal} connected to stories about
courageous pioneers in science ``bucking the received wisdom''
and staking out controversial new positions.  If they turn out to
be correct in the long run, they are often the individuals 
looked on as heroes in the subsequent history of the subject.  I think that
angle of the story is probably one reason why this article
appeared in a general-audience periodical like the {\it Atlantic}.
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{\it Dan Schmader -- Does the Vaccine Matter?}
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This is a reasonably good summary of the ideas from 
the Brownlee-Lenzer article.  You might have brought
out connections with things we discussed in class somewhat
more explicitly in some places.  The writing is also
general good on a ``local level.''  But the paper as
a whole is somewhat repetitive.  I think making a 
tight outline before
starting to write might have helped here.  

A minor technical point:  it's a {\it number} of people, not an 
{\it amount} of people.  People come in individual
units.  You use ``amount'' for things like flour
or liquids where it is difficult or impossible 
to isolate individual units of ``stuff.''
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{\it Specific Comments}
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\item{1.}  This is what is commonly called the ``healthy user bias.''
It is a classic example of a possible confounder in studies of the 
effectiveness of a medical treatment.
\item{2.}  This is again an analyis of possible confounders in
the ``cohort studies'' commonly used to justify the effectiveness
of the flu vaccines.  It would be good to make the connection
with the topics we discussed in class that are very closely
related.  
\item{3.}  It is true that there is a certain amount of
reluctance to accept new ideas on the part of doctors.
But there is another side of the ``good story''
aspect of this article too.  There is
undoubtedly a certain personal {\it appeal} in stories about
courageous pioneers in science ``bucking the received wisdom''
and staking out controversial new positions.  I think that
angle of the story is probably one reason why this article
appeared in a general-audience periodical like the {\it Atlantic}. the ``good story''
aspect of this article.  
\item{4.}  Grinnell's book is definitely {\it not a novel}. 
A novel is a work of fiction in a long format.  That does not
apply to ``Everyday Practice of Science.''  
\item{5.}  You say medical professionals 
have ethical concerns about placebo-controlled trials
for flu vaccines because of the possibility of someone
dying in the trial.   If you dig into this a little
deeper, though, things get even more 
difficult to decide.  The first 
ethical principle of medicine (from the Hippocratic 
oath) is ``do no harm.''  If, as a doctor, you give someone 
a placebo in a trial of a vaccine that turns out to be 
effective, aren't you {\it doing harm} if they get
sick and possibly die from the illness?
To justify that action, you have to argue that the greater
good for society of doing the vaccine trial
outweighs the concerns of individual patients.
But that is not the way doctors are trained to think and
I am not sure I would want their focus on the individual
to change(!) This seems to be a real ethical dilemma with no
easy answers to me.
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{\it Greg Monfette -- The Pandemic-Preventing Vaccine's Legitimacy}
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This is a reasonably good summary of the points raised in 
the Brownlee-Lenzer article.  You have done a good job, too,
of connecting their points to things we discussed in class.
(However, I think the organization of the paper somewhat
undercuts the connections -- see point 5 below.)  The writing 
is very good, with a few relatively minor exceptions (see the 
corrections and suggestions marked in the printout).
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{\it Specific Comments}
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\item{1.}  The {\it Atlantic Monthly} is actually a very old print
magazine (first published about 150 years ago).  It has only recently
``gone online.''
\item{2.}  ``Unraveled'' is a strange word choice here.  I think 
you mean {\it devastated} or {\it swept through}, or something
like that.  Also, it is important to realize that the 1918-1919
``Spanish flu'' epidemic was a {\it world-wide} phenomenon, not
limited to the US.
\item{3.}  I think you are referring her to the ``cohort studies''
of the seasonal flu vaccines that are commonly used to justify
the vaccines' effectiveness.  The claim is actually that 
the vaccines reduce {\it mortality} (deaths) by 50\%.  
Critics like Tom Jefferson are mostly critical of this kind
of claim which is pretty clearly too strong.  
\item{4.}   Saying that ``many of the top researchers question
the validity of this'' is not accurate.  People like
Lisa Jackson, Tom Jefferson, etc. mentioned in this article
are actually pretty rare and definitely outside the mainstream
of the medical community's opinions about the usefulness of
the flu vaccines.
\item{5.}  In terms of the organization of the paper, I think it
would have been better to combine the discussion you have
on page 4 with this point.  Here you are just saying there
are confounding factors, but there you are explaining what
they are and how they relate to what we discussed.  It would
be more unified not to break things up the way you did. 
\item{6.}  You say medical professionals 
have ethical concerns about placebo-controlled trials
for flu vaccines because of the possibility of someone
dying in the trial.   If you dig into this a little
deeper, though, things get even more 
difficult to decide.  The first 
ethical principle of medicine (from the Hippocratic 
oath) is ``do no harm.''  If, as a doctor, you give someone 
a placebo in a trial of a vaccine that turns out to be 
effective, aren't you {\it doing harm} if they get
sick and possibly die from the illness?
To justify that action, you have to argue that the greater
good for society of doing the vaccine trial
outweighs the concerns of individual patients.
But that is not the way doctors are trained to think and
I am not sure I would want their focus on the individual's
health
to change(!) This seems to be a real ethical dilemma with no
easy answers to me.
\item{7.}  ``Worldwide fear and chaos'' seems somewhat overstated
to me.  Of course, I cannot really predict what the reaction would 
be in that situation, but I think this kind of breakdown
in society would only happen if the death rate from the 
H1N1 flu was extremely high, {\it and} the vaccines
were shown to be ineffective, {\it and maybe} there
was some flagrantly improper behavior on the part of the vaccine
producers and the government that came to light.  Whether
or not the vaccines work the way most doctors think
they do, I don't know any credible evidence that 
the push to produce the vaccines and the antivirals
has been improper (that is, ethically shady).  (Raising
questions is not the same as proving misdeeds!)
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{\it Carl Losito -- Does the Vaccine Matter?}
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The technical aspects of your writing show some 
improvement here.  However, I am afraid that what 
you are saying, while clearer, is often confused, incorrect, or
incomplete.  See the comments below for some major
examples of this.   
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{\it Specific Questions}
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\item{1.}  This first paragraph is somewhat incoherent because
it mixes the discussion of seasonal flu and H1N1 flu to such 
an extent.  It also overdramatizes the seriousness of H1N1 flu
according to the data that has come out over the past several
months.  If the current patterns hold, the death rate from 
H1N1 flu will actually be {\it much lower} than originally predicted,
and even lower than a typical seasonal flu.  
\item{2.}  There may be some people who oppose all vaccines
for the reasons you state here.  However, that is certainly
not the issue raised by Brownlee and Lenzer in this article.
Their concern is that we are relying too much on flu vaccines
that have never been convincingly proved to work as well as
they are supposed to.  If a really serious flu epidemic 
comes (like the 1918 - 1919 ``Spanish flu''), they 
want to warn people that we might be putting too much 
confidence in these unproven vaccines. 
\item{3.}  At least so far, this is not really accurate.
H1N1 infections have not been especially severe or more serious
than the usual seasonal flu strains.
\item{4.}  This was one of the very early predictions that
was made before the outbreak really started in the US.  Unless
the virus mutates in a way to make it much more virulent, I
doubt that anyone thinks that many deaths will actually 
result in the US.  
\item{5.}  There is a somewhat subtle point here that I 
think you are not appreciating.  The {\it seasonal} flu
typically kills more older people than younger ones (partly
because there are many older, sicker individuals who succumb
to secondary infections, etc.)  Most of the efforts to 
immunize against seasonal flu have targeted this age group.
But the situation is reversed for the H1N1 flu.  Most of 
the more severe cases and deaths (for whatever reason) have 
occurred in younger patients, and young children, pregnant
women, etc. are the highest priority recipients of the H1N1
vaccine as it comes on line.  So what you are saying here 
is really only applicable to the H1N1 flu vaccination effort.  
The article is dealing with both H1N1 and seasonal flu, though,
so it matters which vaccination effort you are talking about.
\item{6.}  Careful -- antibiotics are drugs that target
{\it bacteria}.  Influenza is a viral disease and treatments
for it involve a combination of vaccination and anti-viral
drugs, which are different.
\item{7.}  You really need to qualify this statement.  
This point of view is actually held by only a small minority
of experts (many of whom are quoted in this article).  Most
immunologists believe that the ``cohort studies'' questioned
by people like Lisa Jackson, Tom Jefferson, and Sumit 
Majumdar {\it have demonstrated} the effectiveness of seasonal 
flu vaccines.    
\item{8.}  Careful -- confounding factors can lead to 
misleading results in a study.  They cannot affect
a vaccine's value -- it either works to the desired degree 
or it does not.  
\item{9.}  The concluding sentences of this paragraph are 
very confused.  The adverse reactions you mention are
ones that have been reported with Tamiflu.  But
Tamiflu is not a vaccine.  It is an anti-viral
drug that is supposed to help an infected person 
combat the virus when it is already present in his or her 
body.  Then, the moral
and ethical arguments are usually made {\it against}
the idea of doing double-blind, randomized, placebo-controlled
studies of vaccines or drugs like Tamiflu.   The kind of 
clinical trials you are describing have, in fact, {\it never}
been done.  
You just throw out the phrase ``moral and ethical reasons''
without explaining what the issues are.  This is an important
point that deserves a lot more discussion.  The first 
ethical principle of medicine (from the Hippocratic 
oath) is ``do no harm.''  If, as a doctor, you give someone 
a placebo in a trial of a vaccine that turns out to be 
effective, aren't you {\it doing harm} if they get
sick and possibly die from the illness?
To justify that action, you have to argue that the greater
good for society of doing the vaccine trial
outweighs the concerns of individual patients.
But that is not the way doctors are trained to think and
I am not sure I would want their focus on the individual's
health to change(!) This seems to be a real ethical dilemma with no
easy answers to me.
\item{10.}  The issue is not whether technology will become
available.  It is whether the trials can be done in
a way that does not raise the ethical issues raised
in the previous point. 
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{\it Amanda Cabrera -- (No Title)}
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You were the only one in the class who chose this topic!  I am glad you did, 
though, because your paper does a very good job of describing
Strogatz's blog post about looking at the world through
mathematical eyes, and the specific pattern given by 
Zipf's Law.  Your writing is generally very good too!
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{\it Specific Comments}
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\item{1.}  Don't overuse the word ``unique.''  This should be 
applied only to cases where there really is only one of the 
things you are talking about.  I think what you mean here is
closer to ``uncommon'' or ``unusual.''
\item{2.}  It is good that you mentioned this.  And of course,
many of the critical comments about Strogatz's blog post were
pointing out exactly this aspect of the pattern (that the largest
cities can be different).  There is
also a subtler point here, though.  Namely, Zipf's Law is,
like most scientific patterns, subject to measurement errors
and ``noise'' in the data.  This means that the 
${\rm Population} = c ({\rm rank})^k$
power law is never going to match the measurements of populations
for actual cities {\it exactly}.  The pattern only becomes apparent
if you do the kind of statistical data analysis we did in the 
lab (and you look at enough of the cities to see whether
the largest ones are outliers to the main pattern).   Of course, that
kind of detailed analysis would be difficult to describe in 
a general-audience periodical's blog where authors cannot assume
that readers have the mathematical background to appreciate
the procedures carried out in the data analysis.  In a way, 
Strogatz was forced to leave out most of the stuff that would 
have addressed the objections the readers came up with. (It is 
{\it really hard} to write correctly and meaningfully about 
math or science for a general audience!)  But I agree that he
might have ``headed off'' some of the criticism by 
saying somewhere that Zipf's Law is really an {\it approximate
relation}, not an equation that holds exactly 
in all possible cases, and the pattern holds better for
cities farther down in the rank hierarchy.  
He was leaving himself open
to silly responses by not making that aspect of the
topic clearer.   
\item{3.}  You could view this as a quantitative measure
of ``economies of scale'' (as discussed in economics)!
\item{4.}  I think your objection here can be attributed 
the fact that you are looking
at living organisms on an inappropriate distance and size scale (thinking
of the whole rather than the parts, in effect).  
Think about what a living body looks like on the level of 
individual cells, blood vessels, etc.  At that scale, doesn't
a living body start to resemble a city with smaller streets (capillaries),
major highways (big arteries and veins), ``traffic'' (blood flow), 
utilities (organs), etc.(!)
\item{5.}  Maybe, but see point 2 above.  Telling the whole
story requires readers to have some knowledge and tolerance
for mathematics that is not always present!
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{\it Shelby Proft -- (No Title)}
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Your writing is much improved this time (see the comments on the 
printout for some suggestions and corrections).  You are entitled
to your own opinion on this issue, and there are certainly a lot
of people who would agree with the stand you are taking here.
However, I don't think the Brownlee-Lenzer article is really
making the same point.  It's quite a bit more subtle (see comments
1 and 5 below especially!)
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{\it Specific Comments}
\bigskip
\item{1.}  I have to disagree pretty strongly with this statement.
(And Brownlee and Lenzer, the authors of the article, would 
disagree too!)  There have been a lot of the ``cohort studies'' discussed
in the article done that appear to {\it support} the claim that seasonal
flu vaccine reduces mortality from flu.  The skeptics mentioned in
the article (Lisa Jackson, Tom Jefferson, etc.) have publicized 
some contrary results, but their work is actually still very controversial
in the medical community.  Moreover, Brownlee and Lenzer's main point,
as I see it, is {\it not} that the flu vaccines are useless.  Instead, 
they want
to raise these issues because the methodological problems
with the cohort studies that are the main evidence for the flu
vaccine supporters mean that (in their view)
{\it we don't really know whether flu vaccines work ``as advertised.''}
They {\it may} work just fine, but we don't know because the correct
tests have not been done to decide!
This is especially serious because most public health people
would agree that it is only a matter of time before a really 
serious flu epidemic (like the 1918 - 1919 ``Spanish flu,'' not
like H1N1 this year, apparently, at least so far) occurs again.
Hence the concern they point out about a ``false sense of security.''    
\item{2.}  Since you have not mentioned Lisa Jackson before or
explained which side of the issue she has argued, it would be
good to put in a sentence introducing all of that before this
quotation.
\item{3.}  As the article reports, there is pretty 
good evidence that the seasonal flu vaccine 
produces a good immune response in young, healthy people.
So in fact, this seems to me to be one of the 
strongest arguments {\it for} giving the vaccines.
If you can prevent the spread of the virus to 
the people who are most at risk by lowering the
incidence of the disease in younger, healthier people
who might spread it around, then that is 
a good thing.  
\item{4.}  Careful -- these side effects are actually reported
with use of {\it Tamiflu}, not the seasonal flu
vaccine.  The effects (and effectiveness) of vaccines
and of anti-virals are two different issues!
\item{5.}  The most perplexing aspect of this whole 
story is probably why medical professionals are 
opposed to placebo-controlled trials
for flu vaccines ``for ethical reasons.''  You do not
say enough about this, but it is a key point in
this whole discussion.  The first ethical principle of 
medicine (from the Hippocratic oath) is ``do no harm.''  If, as
a doctor, you give someone a placebo in a trial of 
a vaccine that turns out to be effective,
haven't you done harm if they get
sick and possibly die from the illness?
To justify that action, you have to argue that the greater
good for society of doing the vaccine trial
outweighs the concerns of individual patients.
But that is not the way doctors are trained to think and
I am not sure I would want their focus on the individual
to change(!)
This seems to be a real ethical dilemma to me!
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{\it Jack Karlovec -- Does the Vaccine Matter?}
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This is reasonably good as a summary of the start of the
Brownlee-Lenzer article.  But you spend too much time at
the start describing the MedImmune factory procedures, which
are of really limited relevance.  The rest is somewhat superficial
and you have only touched on some of the key points.  Plus,
I think you have misunderstood what might be the key point
of the article.  See comments 2 and 4 below.  Your writing
is generally better than on the first paper.  But it is not considered
good writing style to break out points in a ``bullet list''
(like the one on your page 3) in this kind of writing.  
Use complete sentences and paragraphs.  The ``bullet lists''
are fine for oral presentations or more informal memos, etc.
But don't use them here.
\bigskip
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{\it Specific Comments}
\bigskip
\item{1.}  These figures are actually the averages for years in
which only the ``usual,'' seasonal flu viruses are presesent.
The original estimates were that H1N1 could kill as many as
90,000 people in the US this year.  Fortunately, it now
seems unlikely that the total will be that high.  But there
is really no way to predict how serious a new flu strain will be
until after its effects are observed.
\item{2.}  You seem to be making a {\it crucial misreading} of the main point
of the Brownlee-Lenzer article.
(You are not alone in thinking this, but I am sure they would disagree
pretty strenuously with what you are saying!) 
If you read more carefully, you will see that Brownlee and Lenzer 
never say they do not think people should get the vaccine.
They say that it has never been {\it satisfactorily demonstrated
that the flu vaccine works} the way its supporters claim it does.  
And, they have other questions about the way government health officials
have ``pushed'' the vaccine and anti-viral drugs even though
there is no real proof that they work.   Especially
if there was another major public health disaster like the 1918 - 1919
``Spanish flu,'' their point is that we have to be better prepared (perhaps
by producing {\it better vaccines} or by developing other measures).
The ``bullet points'' on your page 3 are really some of the arguments
proposed by scientists like Lisa Jackson, Tom Jefferson, and some 
others for why the vaccines might not be working.  But the
key point in the article is the rather technical point 
that the best tests of effectiveness of the vaccines (randomized, double-blind,
placebo-controlled) have never actually been carried out.  
\item{3.}   This is a good point.  There is also
undoubtedly a certain {\it appeal} connected to stories about
courageous pioneers in science ``bucking the received wisdom''
and staking out controversial new positions.  I think that
angle of the story is probably one reason why this article
appeared in a general-audience periodical like the {\it Atlantic}.
\item{4.}  What you are saying here is only partly true.  
Maybe the most perplexing aspect of this whole 
story is why medical professionals are 
opposed to placebo-controlled trials
for flu vaccines ``for ethical reasons.''  You do not
say enough about this, but it is a key point in
this whole discussion.  The first ethical principle of 
medicine (from the Hippocratic oath) is ``do no harm.''  If, as
a doctor, you give someone a placebo in a trial of 
a vaccine that turns out to be effective,
haven't you done harm if they get
sick and possibly die from the illness?
To justify that action, you have to argue that the greater
good for society of doing the vaccine trial
outweighs the concerns of individual patients.
But that is not the way doctors are trained to think and
I am not sure I would want their focus on the individual
to change(!)
This seems to be a real ethical dilemma to me!
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