A physician takes his flu vaccine under protest

To hospital administration,

I am writing this letter to inform you that when I take my mandated influenza vaccine I will be doing so under protest and with the understanding that failure to do so could result in loss of my ability to earn income for myself and my family.  Unfortunately, I do not qualify for any of the exemptions allowed by our facility.  Since I am not religious, I have no religious objections, I am not allergic, and I have never had Guillane-Barre as a result of a flu vaccine.  My objection to the vaccine is based on rational evidence and moral indignation.

From the standpoint of rational evidence, I was amused that Dr. Eric Kasowski (of the CDC’s influenza division) in his position paper “Healthcare Workers Must Be Vaccinated Against Influenza” cited no research papers.  This is very unusual given that this is a document directed at health care professionals.  No papers were cited to support this statement because there are no such papers.  The gold standard for evidence-based decision making in health care comes from The Cochrane Collaboration.  This group of experts makes recommendations on all aspects of medicine and science based on a pooling of the best research studies and with a strict avoidance of all commercial or coercive interests.

In their paper titled “Vaccines to prevent influenza in healthy adults” the Cochrane group concluded, “In average conditions 100 people need to be vaccinated to avoid one set of influenza symptoms. Vaccine use did not affect the number of people hospitalized or working days lost but caused one case of Guillane-Barre syndrome for every one million vaccinations.  Fifteen of the 36 trials were funded by vaccine companies and four had no funding declaration.  Our results may be an optimistic estimate because company-sponsored influenza vaccine trials tend to produce results favorable to their products and some of the evidence comes from trials carried out in ideal viral circulation and matching conditions and because the harms evidence base is limited.”  This is hardly compelling evidence.

The Cochrane paper, “Influenza vaccination for healthcare workers who work with the elderly,” found “that vaccinating healthcare workers who look after the elderly in long-term care facilities did not show any effect on the specific outcomes of interest, namely laboratory-proven influenza, pneumonia or deaths from pneumonia.”  Thus, even in the most high-risk health care population and scenario, there is NO evidence that influenza vaccination protects patients.  In fact, vaccination may actually increase risk because the health care provider, feeling that they are protected by the vaccine, may be less likely to carry out the behaviors that do protect patients.

In their paper “Physical interventions to interrupt or reduce the spread of respiratory viruses,” the Cochrane group reviewed 67 studies and found that simple measures such as hand washing, and simple masks were effective in reducing viral (including influenza) transmission.  Further , they “found no evidence that the more expensive, irritating and uncomfortable N95 respirators were superior to simple surgical masks.”   Thus there is NO evidence that not taking a vaccine poses any risks to patients and thus the requirements to wear an arm band (similar to a Star of David or Scarlet Letter) is exposed for what it really is … a way of shaming non-compliers.

In fact, evidence would suggest that it is the vaccinated that are less likely to carry out the behaviors that do work, and it is perhaps they who should wear the arm band.  Furthermore, individuals who are coerced to take a treatment are more likely to experience adverse reactions due to the nocebo effect, which is like a placebo effect but with negative effects.  Such nocebo reactions would likely result in more days lost than days lost due to influenza contracted because of a lack of vaccination.

I would now like to address my moral objections to this requirement.  Let me preface my statement by saying that if the organization had simply been honest and stated that they were requesting employees be vaccinated because less than 90% compliance would be met by a financial penalty from our government payers at a time when the hospital was already under financial stress, I would have been first in line to get my vaccine.  Every day I make personal sacrifices in order to support the financial interests of the hospital in which I work.  I continue to work in an ER that is severely understaffed relative to its workload.  Every shift I arrange for serial ER visits and rechecks of non-paying patients with pyelonephritis, PID, cellulitis, MRSA abscesses, pneumonia, etc rather than having them admitted where they would cost the hospital even greater lost revenues.  This is done at great personal expense (and medico-legal risk) to myself and my group.  I say this to demonstrate that I would do almost anything to help the hospital’s bottom line, and I believe that is true of almost anyone in the organization.  But rather than banking on this goodwill from the employees and staff, the institution chose to frame this as a patient care issue.  Worst of all, it portrayed the providers of healthcare as some sort of danger to the patients that the hospital cares for, as if we were potential vectors of disease should we not comply with this mandate; essentially painting as a threat those that provide care under a real threat of contagion, violence, stress, litigation, government fines and circadian disruption.  This was all done with overwhelming evidence to the contrary.

But even if it were true that healthcare workers were transmitting flu to patients and that vaccination could prevent this from happening, forcing a professional to do even that which is beneficial is profoundly immoral.  Values can only exist when there is freedom of choice.  As philosopher Harry Binswanger recently observed; “You cannot achieve anyone’s good by force, because values are objective.  Values only exist if they are judged by the acting party as beneficial to him.  No one can be forced to make a rational judgement.  The only effect of the force is the destruction of the alleged beneficiary (and everyone else).”

This was probably expressed best by the philosopher Ayn Rand who stated: “A value which one is forced to accept at the price of surrendering one’s mind, is not a value to anyone; the forcibly mindless can neither judge nor choose nor value.  An attempt to achieve the good by force is like an attempt to provide a man with a picture gallery at the price of cutting out his eyes.”  So even if there were a benefit to be had from flu vaccination, it would be wrong to force us to have it.  It is even worse when it is done with evidence to the contrary.

I will therefore submit for flu vaccination on or before November 1, 2012; but please be aware that I am doing so under compulsion and the threat of losing my means of earning a living.


Doug McGuff, MD,

Doug McGuff is an emergency physician.

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  • civisisus

    “Every shift I arrange for serial ER visits and rechecks of non-paying patients with pyelonephritis, PID, cellulitis, MRSA abscesses, pneumonia”

    Serial ER visits? as if there are not less expensive venues in which patients may get care? Oh, that’s right, you’re caring exclusively for society’s leeches who pay nothing for care they receive.

    We know you’re trying hard, Dr. McGuff – we’ve read your ‘woe is me’ post (perhaps the largest & fastest growing internet genre among physicians). By the way, that Binswanger reference is the loony Randian cherry on your bullshit sundae. Mmmm, mmm!

    Now try a little harder.

    • dougmcguffmd


      There actually are not less expensive venues for these patients to get care. That is why they are in the ER to begin with. And they are not leeches (as you suggest is my belief). Many are the best kind of people who are hard working and too proud to take the easy route, throw in the towel and go on the public dole. Even if that is not the case, they are sick and need care. The was no “woe is me” intended. I was attempting to demonstrate that I am more than willing to do things to help the institution survive during these tough financial times. If they had just framed the issue for what it actually was…another flaming hoop lit by CMS for hospitals to jump through in order to avoid a financial penalty for less than 90% compliance…I would have been the first in line to receive my vaccine. Instead it was framed as a patient safety issue and done so in a way that the providers of care were painted as potential disease vectors.

      Make no mistake. This is not an issue about vaccines or patient safety. This is about control…pure and simple.

      By the way, your use of profanity is the venomous cherry on your petulant sundae.

  • http://twitter.com/harnessg Glen

    So, you didn’t have to have an MMR before you were hired?

    • dougmcguffmd


      First, the MMR has something that the Flu vaccine does not: proven efficacy. As such, it is a vaccine that I would voluntarily submit to. If my hospital does require it, I am certain that would be spelled out in my independent group’s contract with the facility (I am not a hospital employee) before I actually began work. This flu vaccine requirement was sprung on us without any such prior agreement. I pay my own insurance (with $5,000 deductible) and get no sick days or paid time off from the institution, but must submit to having something injected into my body of very questionable efficacy that could at least make my arm red and sore and at worst give me Guillanne-Barre Syndrome.

      Not addressing you specifically Glen, but there seems to be a wide-spread sentiment that doctors should just submit to authority rather than rely on their own judgements that fall within the realm of their training and experience. Is that really the kind of person you want to depend upon when your life is at stake?

      • Jen


        DrMcGuff is correct, unlike many other vaccines the flu vaccine is a ‘best researched guess’ of what strain may hit this season by the CDC. Since there is no proof of efficacy, compelling hospital employees to take the shot adds stress to the employer/employee relationship and strips the employee of autonomy to refuse a medical treatment; ironically which all of our patients are allowed. The thought process to implement or encourage the shot is well meaning but the application by most employers nationally is terrible. I wish my facility would put this much effort towards other proven measures. Great read btw, thanks.

        • Ana

          Immunization requirements for work do not strip *patient autonomy*. You are still allowed to refuse the flu shot. But if you make that choice, there will be limitations imposed at the workplace.

          Many jobs have immunization, drug-testing, or other medical requirements. Is it right? That’s debatable. But it’s certainly not a violation of patient autonomy. Nobody is assaulting you with the flu shot, here.

  • Nathan Johnson

    The other consideration is herd immunity. That might be difficult to pick up in a clinical trial.

  • Bradley Evans

    Thanks. Great article.

  • simon

    This guy is stupid

  • Penelope

    Wonderfully stated Doug and thank you for sharing so articulately. These are my exact sentiments towards this vaccine which my institution also mandated. We can look back in history at many ‘vaccines/medicines’ which were intended to do one thing and caused another.
    The shocking aspect of all of this is that more people aren’t outraged at this-even if it does ‘prove’ to be true. And finally, SO WHAT if I get the flu? I’ll stay home and take care of myself!

  • http://twitter.com/theYogaDr Kathleen Summers MD

    Great contribution. Thanks so much for sharing!

  • Courtney84

    I had life threatening anaphylaxis after my first and last flu-shot, a flu shot I received to comply with my hospital’s mandatory vaccination policy. Thankfully it only cost me a $50 ER co-pay and a vacation day, not my life.

    I’m not anti-vaccination by any means, but I have no faith that adverse reactions are being reported appropriately. I asked the employee health unit that provided the vaccine, the ER that treated me, and the PCP I followed up with after the ER visit about reporting. All three said that reporting was not their responsibility and deferred to one of the others. I finally asked if I should report it myself and they said that wouldn’t be appropriate. I’m sure anaphylaxis in an individual with no egg allergy is rare – but it would be nice if we had a number to assign to how rare it was.

  • http://profiles.google.com/mhirzel Mary L. Hirzel

    “…they were requesting employees be vaccinated because less than 90%
    compliance would be met by a financial penalty from our government
    payers at a time when the hospital was already under financial stress.”

    Is this what is actually behind this push? Can you document this? thanks

    • http://www.facebook.com/susanlrichey Susan Richey

      I asked the head of Infectious Disease at my hospital point blank if they were receiving financial incentives for promoting this mandatory flu vaccination policy. He declined to answer me. But I do believe there is some pressure to comply with this –and to hospitals, pressure comes in the form of money. I have no doubt we will find the source for this statement. And if it is true…then all our hospitals are guilty of corruption.
      (Even those well meaning but completely uninformed physicians responding to this article to try to shame Dr Doug)

  • MrsTNT608

    Thank you for sharing! I feel the exact same way. I am a Christian but my beliefs do not prevent me from accepting the flu shot. It has been mandated by my employer too and it makes me even more furious because I work in an office environment. We are an affiliate of a hospital health system. We don’t see patients at all, yet we are mandated along with the hospital employees. I feel like I’ve been bullied and it’s hard for me to be engaged at work. I’m seriously doubting my decision to work for this employer. If they can mandate what we put in our bodies now, what’s next? Mandatory birth control??? Anyway, again, thanks for sharing.

  • traumadoc

    i also had a life threatening experience. i was a dr. without borders for many years. had many vaccines injected into my body. i was ok until i was ordered to having a flu. i refused and i was told i would be let go(not that we get payed so much). because i did not want to miss an important mission, i took it. well, i almost died on my trip!!! sure could’ve used the bully law to back me up,LOL!!! so, if peanut butter and milk and fish are good for you—-give it to everyone despite the reaction!!!!!

  • http://twitter.com/asthehosptuRNs Lisa

    Thank you, thank you, THANK YOU for echoing my sentiments on the flu vaccine. I have never had one in all my 44 years, and as a nurse, I won’t be coerced into one anytime soon.

  • http://www.facebook.com/profile.php?id=1138076670 Lori Selby Devine

    Thank you for writing this. Thank you for taking a stand! I was gulliby excited when I saw the resuts of the Cochrane study–thinking it might change things to have some good evidence based medicine to debunk the nonsense that they are perpetrating on us. But I guess that was just wishful thinking becasue our facility tightened it’s restrictions this year instead of loosening them. I refused the shot last year and wore the mask and I intend to do that again this year, but after 17 years of faithful employment I am seeking out a new career. I refuse to let someone bully me into taking anything.

  • http://www.caduceusblog.com/ Deep Ramachandran

    Doug, this is a cogent, intelligent, well researched argument against the flu vaccine. Now please shut up and take your medicine. . . good boy! I kid;)
    On a more serious note. . .
    As you undoubtedly see from all the supportive comments, your article will give ammunition to the minions of anti-vaccine/vaccine-phobia types who will unabashedly use your article as a form of medical advice, now validated by a major media outlet. This article will surely make the rounds and you will be universally hailed by vaccine conspiracy theorists as the physician who had the guts to say that vaccines don’t do anything for anybody, but nobody listened to him.

    When people who are convinced that the flu vaccine doesn’t do anything but make you sick and doesn’t actually protect you, you will be quoted as the reason why. When mothers tell their babies’ pediatricians why they don’t want their child vaccinated, because “some doctor said we don’t need it” you will be the “some doctor”. When anti-vaccine conspiracy theorists are looking for a keynote speaker for their next convention, they’ll google you.

  • annnie

    Thank you Dr.Mcgruff for elegantly stating how so many of your fellow healthcare workers feel upon this subject!

  • http://www.facebook.com/susanlrichey Susan Richey

    Nice evaluation, Dr Doug…however, I would urge you to stand by your ethics. In this, as you would in any part of life. How you do anything is how you do everything. Your employer IS acting like a dictator in this sense and should not be rewarded with your compliance. You family will be fine with a change of employer, but when your ethics begin to erode..no one is fine with your lapse in integirty. I made those same arguments to the head of my hospital in 2005…although I am not a physician, I am intelligent and well read, and maybe a little bit wise. In any event, the nazi hospital I worked for is Virginia Mason in Seattle, I was exempt from the shot because of a neurological illness that happened after 3 vaccines – I urge you to watch your symptoms carefully each time you take a vaccination. Did you get a little bit weaker? Did you have more signs of inflammation? Did your overall health decline? Even marginally. Pay attention to these details – it takes the brain a few months to start to unravel until the signs become clear. Inflammation is the brain just continues unless halted by treatment. This happened to me at that same institution 15 years previously..but they wanted me to wear the mask. And oddly, I drew the same connection to the “star of David” and even fashioned a yellow star and attached it to my badge. My manager thought I was really crazy at that point, but you absolutely nailed it. They have no scientific evidence that it will work..the vaccine or the mask..and yet they are forcing all employees to ‘drink the koolaid’. It is shameful. And I admire and applaud you for doing some research on this. And I hope you have made the right choice for you…

  • http://www.facebook.com/profile.php?id=100000334411343 James Robert Hoff Jr.

    hey deep. my son took his vaccinations when he was a baby 2 days later he ran an extremele high fever and it cost him his hearing. so dont tell me how great vaccinations are. no one should be forced to put anything in there body if they dont feel comfortable with it. i took the dam flu shot so i could visit my grandson who is fighting nueroblastoma cancer. a couple days later i was sick as hell and missed 2 days work. so plese dont tell me how great your vaccines are.

    • Eli Ramz

      Was your child forced to get his vaccines? No you made that decision as a parent. You’re the one rhett chose to do that. I believe there are risks on both sides; you however are the one that must decide which set of risks you are willing to take for your child.

  • Christian Darwin

    You might want to know: Under current American law, you can still be protected under the “religious beliefs” law, because it includes personal intellectual or spiritual convictions.
    This is also allowed under the gist that employers aren’t allowed to ask your religion.

  • http://www.facebook.com/clifford.comstock Clifford Comstock

    Were all just a bunch of Lab Rats!

  • http://twitter.com/erbr1985 Robert Erb

    I will be losing my job because I will not take a flu vaccine by Dec 15th!! IU Health offers exemptions but they go to a board of the Docs and you will not get a exemption. I do not see how I can be such a good employee and get thrown . Forced vaccine is not the way to go and is agianst everything I thought America stood for! What will they force next?!

  • LF

    did you ever consider the health of your patients? you might not need the flu shot, but by not getting one you put all of the immunocompromised and “vaccine-nonresponders” at risk of developing a serious infection! i am 30 and perfectly healthy, but get my flu shot religiously every year just because of the above considerations, not to protect myself.

  • http://cynicalpharmacist.blogspot.com The Cynical Pharmacist

    I agree, transparency and disclosure are very important. But, you lost me by mentioning Ayn Rand.

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