Thursday, November 26, 2009

I cheated

But not at poker. (Perish the thought!)

On Tuesday I got a free vaccination for H1N1 ("swine") flu from the Southern Nevada Health District. I don't meet their criteria, but I got it anyway. How? Easy. I lied.

They are not yet offering the vaccine to the general public. You have to be in one of the "priority" groups. Or, more precisely, you have to tell them that you're in one of the "priority" groups. For some of the groups, they have no way of knowing whether you're telling the truth.

I didn't think I could convince them that I was pregnant, or that I was under 24 years of age. But how are they going to know whether I live with or care for a child that is under six months of age, or whether I have one of the qualifying pre-existing health conditions (such as asthma)? They won't.

Of course, I could have waited until they finish with the priority group immunization and start offering the vaccine to everybody, as they promise they eventually will. But there's no indication of when that might be. It takes a couple of weeks after vaccination before it takes effect, and I wanted to be protected as soon as possible. There are a few reasons for that. First is my ongoing, daily exposure to people at the poker tables. Second is that the holidays will presumably increase such exposure. Third is that I'll be flying to Washington, D.C., again in late December, and thus be subject to prolonged confinement in close proximity to others. Fourth is that in early January I plan to visit my elderly parents, and would hate to unknowingly be in the early contagious phase of influenza right then and thereby unwittingly expose them.

In my not-so-humble opinion, the published guidelines are inadequate. It's true that I am demographically and medically not one of the people at high risk for developing the severe, life-threatening complications of this or any other form of influenza. But presumably it is a worthwhile public health goal to reduce the total number of cases as well as reducing the number of severe cases. After all, since not all high-risk people are going to get the shot (or the nasal spray form of the vaccine), the next most effective way of protecting them is to immunize as many people as possible that might come in contact with them--herd immunity, they call it.

I'm in a position of coming in contact with a large number of random strangers from all over the country, and doing so in a way that has a pretty decent likelihood of contracting and then spreading the virus, if I'm susceptible. Poker cards and chips are filthy things. I'm convinced that they serve as efficient vectors for respiratory viruses. (The technical term is fomites, which, incidentally, is pronounced FOE-muh-teez, despite most health professionals of my acquaintance being ignorant of Latin and pronouncing it the way it looks: FOE-mites, with a long I.)

Worse, poker players are filthy things, too. They are just appallingly casual about picking their noses, picking their teeth, eating finger food at the table, licking their fingers, sneezing and coughing into their hands, and other disgusting, disease-spreading activities. The great majority of men in a casino do not do even a token hand-washing after attending to their business in the restrooms. The people I see and play with on a daily basis are not even clued-in enough to be embarrassed by any of these unhygienic behaviors.

People situated as I am can either serve as Typhoid Marys for contagious illnesses, or more like graphite control rods in a nuclear reactor, depending on whether we are immune. If you vaccinate all the local poker players in Vegas and Atlantic City, for example, you would interrupt a bunch of transmissions of flu to them and, subsequently, from them to others. (I'm not claiming that they are the only group one could identify with that characteristic, but they form one such group.)

Of course, I recognize that from the perspective of a public health agency trying to formulate policies, it's pretty hard to write guidelines that are precise enough to be useful for that sort of situation. It's difficult to make a meaningful prescription out of "Get the shot if you tend to have a lot of interactions with a lot of people from a lot of different places in which you exchange a lot of hand-held objects and in which a lot of those involved tend to do a lot of gross, uncareful things with their bodily secretions."

So I don't really blame the health department for not writing their guidelines broadly enough to include the likes of me, even though I think that they would in an ideal world. For me it is sufficient to have the educated guess that most public health officials, if they knew of my situation, would agree that I'm a pretty good target for immunization, in order to reduce the total national influenza burden, even if not explicitly listed in the "priority groups."

When, therefore, they make "cheating" so obviously easy to do, I not only don't feel a smidgen of guilt about it, I think I'm doing the world some good.


Jeff Simpson said...

I disagree with your decision to lie in order to get vaccinated. First, it is dishonest. Second, your belief that you know better than public health authorities is self-serving and could deprive a child or some other at-risk person of their ability to be vaccinated.

You should have waited your turn and, when you were eligible, acted immediately to be vaccinated. That is how members of civilized society should behave. Lying and breaking the rules to put yourself ahead of others violates the social compact.

Your action was hardly unique. During a time when the vaccine is in short supply, the cumulative effect of all of the lying vaccination recipients might result in more sickness and death than would have happened had people waited their turn.

I wouldn't be proud of what you did.

buttnugget said...

For someone who "feels no guilt" you sure are doing a hard job to justify what you did. I guess when it comes to self preservation ethics and morals can be damned. Just push your way to the front of the line. Would you as well push an infant out of the last lifeboat on the Titanic? If you think that I'm being dramatic, think again. There's a reason you are not on the immunization schedule and others are. YOU are not likely to die of H1N1 infection (nor your aging parents). A child or pregnant woman are. You taking that vaccine means one less for those who truly are at risk. Please don't kid yourself with your justifications. What you did was wrong. No ifs, ands or buts about it. Sorry to be so hard, but as a physician I find this kind of me first behavior reprehensible.

Anonymous said...

Usually I enjoy your blogs but I have to be honest, this one was not a good one. It shows how selfish and self-serving your attitude can be. You even wrote several justifications but the bottom line, you cared only about yourself and no one else. There are others out there that are more deserving and you took that opportunity away from an individual that needs it more than you. Sure, there will be more vaccines available later but right now, there is not enough to go around. You could had waited. Sorry, but this attitude you demonstrated is just another example of how many in our society choose to be selfish over doing what is right.

Ray said...

"Sorry to be so hard, but as a physician I find this kind of me first behavior reprehensible."

Well said Dr. Buttnuggett.

Pretty awesome if you really are a doctor.

Oh yeah, I agree with Dr. BN. Priority isnt (and shouldnt be) given to people most likely to contract. It is given to those most likely to be in grave danger if the contract the virus.

Yes you can more likely give it to someone else if you are more exposed, but I would assume that there aren't too many pregnant women and toddlers haunting the poker halls you frequent.

timpramas said...

My wife and six-year old daughter had the H1N1 virus earlier this month. They suffered through it, but are fine, as are most people who are unlucky enough to catch the virus. For some though, catching the virus is life-threatening. Previously, my wife and daughter had the chance to lie to doctors and get the vaccine but we recognized (even my six-year old)that the vaccine in short supply needed to go to those more vulnerable in our society. After all the posts where you condemn poker pros for cheating, poker players for collusion, and even a post where you call Obama corrupt, how can you brag about being a liar? Especially on a topic where there is more than money at stake. Shame on you.

genomeboy said...

I have to also express a bit of unease with your decision. My wife got vaccinated by her hospital (she's an internist), and our kids got vaccinated, but I did not get the vaccine (despite my wife being able to procure a dose somewhat illicitly).

Maybe I'm the dupe, especially if I do contract H1N1, but I was a bit uneasy taking the vaccine away from a child or healthcare worker or other person reasonably higher in priority than I.

I was especially surprised given your religious devotion to the rules of poker. Your posts sometimes make it seem you are taking the moral high ground on the felt, often to a fault.

Thus, surprising that that attitude of fairness you often display did not carry over in this case.

Plus, I thought you once took an oath...

Couga said...

It would be less disturbing to me to read how you cheated a poker.

Im Just Saying said...

I am in more than one of the high risk qualifiers. I have never gotten the flu shot and frankly have little to no intention of getting the H1N1 vaccination. In an effort to continue to support your blog and twitter that I've enjoyed for so long, I'm donating my place in line after-the-fact, thereby alleving you of any guilt and denying your detractors of their sanctimony. --I'm Just Saying

DrChako said...

I won't jump on you as the others did. They did quite an effective job and there's nothing I can add to that discussion.

I'm also a physician and I see daily just how bad this H1N1 can be. There are some young and really sick people in my hospital. They were healthy and then they were in the ICU.

I'm approaching this from the public health perspective. You are certainly not alone in the cheater category. If it's that easy to lie, you are certainly not the only one doing so. Unfortunately, there was a conflict between finding a fair way to administer the vaccine and getting it out there in time. I'm certain the CDC expected a certain amount of cheaters, but there was nothing they could do about it but expect that the majority would "do the right thing."

In your case, it's highly doubtful that your specific vaccine would have been the one to save a life. In the bigger picture, it's all about how many people with a similar philosophy are out there.


PS. I also wonder if, as a poker player, you calculated the pot odds in all this. Rounders are a typically selfish bunch. I bet if you could do a survey of poker players that they would have a higher percentage of cheaters than the average population.

PPS. I also wonder just how many of your readers that didn't comment feel the same way as you (meaning they'd cheat). I guess they probably wouldn't tell anyone about it, which means your other problem here was showing your hand after you cheated.

Anthony said...

I'm disappointed. Ive been a regular blog reader for over the past year and sometimes I think you can be abit overzealous in adhering to the strict letter of the rules of poker. However, thats your "m.o.", so I've come to expect that and accept it. But with this single post you've undermined your entire moral high ground you've taken in regards to your poker ettiquete and views. Now I share many of the same views regarding poker, I detest cheating, but am a little more relaxed on the rules, taking a more "spirit of the game" approach if you will. If someone obviously accidently string bets or some such, let them make there bet, etc. etc. But your rationale in this post can just as easily be distorted to rationalize cheating in poker. Maybe the cheater needs the money to feed his family more than the person(s) being cheated. While nobody expects you to be morally superior to the rest of the general public, this particular post does show a certain degree of hypocrisy that leaves a bad taste in my mouth.

Michael said...

Not to pile on, but I have to agree with most of the sentiment here. There's an awful lot of justification for something that you don't feel guilty with. I understand your around a large lot, but so is every tourist to Vegas or cashier during the holiday season. In reference to the plane ride, there are plenty that fly weekly. I get the self serving side of this, I was concerned prior to my Vegas trip two weeks ago of being around so many people and the plane ride, and like many have elderly parents too, but ultimately decided that if it was going to happen so be it, I'd deal with it then.

Anonymous said...


I've read your blog pretty regularly for the past year, and I can't quite believe what you wrote in this post. I keep hoping for an "April Fools" moment from you, but I know it's not coming.

I don't think "I'm Just Saying" is serious -- he can't atone for you.

I think you need to rethink what you did. And when you come to the conclusion that I think is inevitable, you'll have to figure out a way to make good.

Anonymous said...

I'm sure the point is taken by now, but maybe next time...shhhhh!

Here in Arizona there is no longer any priority groups as there is plenty but when they first started the lines were full of "cheaters".

I think your point about the airplane and eldery parents is well taken. I can't imagine how bad I'd feel if I gave my parents something that could kill them.

Sauza said...

I think that this situation is kind of like misreading your hand, and then playing it badly from there. If you've learned anything from it then it is forgivable.

I note that there has not been one supportive or agreeable comment, but 13 that chastise you for it. I do commend you for posting them, rather than taking the easy way out by choosing not to. For that, you have my respect.


Rakewell said...

Actually there was one supportive comment.

And, FWIW, I stand by my decision. I have thought about writing a longer explanation, but it would involve complex and even-further-off-topic subjects such as medical ethics, the bluntness of general medical guidelines as guides to very specific situations, the role of the individual against the state, competition for and allocation of scarce resources, factual investigation of just how available the vaccine is around here at the moment, etc. It just seems like more trouble than it's worth, so I'll let my initial stab at it stand (or fall) by itself. But I still believe that I made a reasonable and honorable decision, in spite of having carefully considered the comments to the contrary.

Grange95 said...

I think your rationale is bit off. You live in Vegas and rarely travel. Assuming you use reasonable care not travel when sick, not to play when sick, and to practice good hygiene around others (and I think you are highly likely to do all of these), you are a low probability vector for passing the flu on to others. So, in terms of advancing public health as a whole, your being vaccinated is worth a lot less than a vaccination for the tourist or conventioneer sitting next to you who is flying back home with a new bug to pass around West Podunkville.

Out of your four proffered reasons for getting vaccinated, the first three are really just variations on "I don't want to get the flu." Guess what--most of the rest of us would rather miss that experience, too. Only the fourth reason (visiting your elderly parents) has any real merit as to why someone who is otherwise reasonably healthy and not in a high-risk group should be able to cut in line and get vaccinated. However, holiday travel to see family is something you share with millions of other people, most of whom will wait their turn to be vaccinated. If you want to protect your parents, the answer is not to cut in line for a vaccination, but to pick up the phone and persuade your parents to get vaccinated.

To be blunt, your situation isn't really "special" enough to justify special privileges.

Simon said...

Why would you even want the shot?

There are some who call me... Tim said...

Congratulations - you just put yourself in the same category as the scumbags on Wall Street who got H1N1 vaccinations before children, health professionals, etc. who are more needful of the shot.

Sad.... so sad... especially the "justifications" you list. "Oh my - I will be flying with the unclean, and sitting next to the unclean, and who knows what else!"

Very sad, and very disappointing.

Im Just Saying said...

Actually I was being quite serious. I reject the notion that Grump is in the minority in obtaining the vaccination. Every year there is a shortage of flu vaccine, every year people jump the line, and every year life goes on and the 6 o'clock news moves on to some other vague threat.

Further, Grump's constant interactions with tourists make him an ideal incubator. He is as high risk as a constant traveler. The plane is limited to a few hundred people, how many people could he infect in a casino?

genomeboy said...

"But I still believe that I made a reasonable and honorable decision"

I understand how you can somehow think, given your previous libertarian musings, that you made a reasonable decision.

However, I am completely at a loss to understand in what alternate universe your decision could be considered honorable.

1. in accordance with or characterized by principles of honor; upright: They were all honorable men.
2. of high rank, dignity, or distinction; noble, illustrious, or distinguished.
3. worthy of honor and high respect; estimable; creditable.
4. bringing honor or credit; consistent with honor.
5. (initial capital letter)
a. (used as a title of respect for certain ranking government officials.)
b. British. (used as a title of courtesy for children of peers ranking below a marquis.) Abbreviation: Hon.

Anonymous said...

Apparently I read this post soon after it went up. F-Train mentioned it, so I went back to take a look-see.

Frankly, I'm amazed. I didn't comment the first time 'round because the post didn't seem that remarkable. Grump's reasoning seemed sound to me (and if it was wrong, that doesn't necessarily impugn his motivations).

Did I use impugn right there?

Anyway, its exceedingly unlikely someone will die because Grump got a flu shot. In fact, you could probably argue that unless the location he got the shot at actually RUNS OUT of flu shots and has to turn down someone at risk (or the line became long enough someone left that day), he has done nothing to the system except (perhaps) push back the day when the vaccine is available to the general public.

So really even if you want to look at from the perspective of Grump taking the vaccine away from someone else - he probably only keeping it away from another healthy adult for a day. And that's a stretch.

Seriuosly, to listen to the rest of y'all, you'd think he was running around the Bellagio with a plague-filled syringe looking for a pregnant lady to stab in the uterus.

Cardgrrl said...

Okay, I wasn't gonna chime in here, but I can't resist now.

I'm not a big fan of the Every-Man-Decide-For-Himself-School of Public Health Policy. So I would have preferred that Rakewell not jump the queue. His reasoning may or may not have been sound, but more than that I think it sets a bad societal example for people whose judgment I think very likely WILL NOT be sound.


In the grand scheme of things I am much more concerned about and disapproving of professional, regular players who come to the poker table when they are "getting the flu," "feeling crummy," "just barely recovering from the flu," "only sneezing 6 times an hour," or whatever. If you have a contagious disease, STAY HOME. You are putting vulnerable people at risk and slowing your own recovery.

So, to all you out there inspired to heap opprobrium upon the Grump, please ask yourself: Have I ever sat at the poker table when I wasn't healthy?

If so, kindly dismount your high horse.

That is all.

Anonymous said...

A year later. This still pisses me off. I wonder, would you do it again?