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I have thought of getting the influenza vaccine to my 14 year old son. But after doing some reasearch I found out that there have been cases of Guillain-Barré syndrome. Would it be a good idea to get the vaccine?

Thank you for the A2A:To really answer this question in a meaningful manner you need to understand the basics of medicine. To begin with, life is a series of risks, and medicine is all about how we manage those risks. The other important thing to know is that we humans are very poor at judging actual risks associated with an action we take. A lot of people are more afraid of an airplane trip than going the same distance by car, even though all of the statistics show that you are far more likely to die in a car crash than in a plane crash if you travel the same distance. We perceive risks as higher if we view something as unpleasant and we may under estimate the risk if we think it makes our lives easier or if we find it pleasant.Now, being young and healthy means that you’re less likely to come to any serious harm from the seasonal flu. However, there are a few rare instances every year when otherwise healthy adolescents end up in an ICU, die from the flu or develop Guillain-Barre. An adolescent is of course far more likely to die from a car accident than from any of those things happening, just to put things into perspective.The problem with flu is of course that although the course of this disease is usually fairly benign in young healthy people, by this I mean it’s unpleasant yes and you’ll be really sick for a week or so, but you’re not likely to die from it. However, you can still infect younger siblings or your elderly grandparents. In their cases the flu has a much greater potential for causing severe disease. Each year we estimate that some 12,000 to 56,000 people die from the flu in the US if you look at the statistics from the past 15 years. Most of these will have a prior medical history, but it does include cases of otherwise healthy people such as pregnant women that are at an increased risk. These statistics also includes grandparents that die several years before their time because they may not have the margins needed to fight of the disease or get secondary complications such as a bacterial pneumonia or a heart attack.If we just look at Guillain-Barre, you’re statistically about ten times more likely to develop Guillain-Barre after having the flu, than if you get the vaccine. But then again, if you are really afraid of developing Guillain-Barre you should really refrain from eating chicken as most cases of Guillain-Barre are associated with salmonella or campylobacter gastroenteritis caused by under cooked chicken or poor food hygiene when preparing fowl. You should also not grow old as the risk of developing Guillain-Barre is more common the older you become.As we are always talking about risks this means that when a certain medication is recommended it is done so on the basis that using it is less dangerous than not using it. In this case you are more likely to be harmed by the flu than the vaccine against it. The benefits are lower compared to the risks if you are 14 years of age and otherwise healthy than if you are 70 years of age with heart disease, this is true. But the vaccine is still safer than the disease, otherwise the vaccine would not be approved for use by the FDA or EMEA.A lot of people tend to write that you should research vaccines before getting them. This is all well and good, but they then provide you with links to sites where information isn’t exactly unbiased and full of misunderstandings (unintentional or intentional). Some things like vaccines and medical procedures tend to be scary and so we view those risks as higher than they really are. We also view natural things as better, and of course a home cooked meal with produce form your local farmer, is probably much healthier than processed frozen food you by in your local market. But this does not always mean that natural is better as diseases like the flu can actually became quite dangerous for previously healthy individuals if you are the unlucky one to get a more severe form than the average person.If someone told you that it is 10 times more likely that you would be killed in a car accident if you take your blue car than your red car when you go grocery shopping, most people would take the red car right? Especially if someone explained to you that your red car is much more visible in traffic and so it’s less likely that someone misses to see you enter the intersection. A dark blue car is much more likely to blend into the background especially if it is dark outside.But if someone says, it’s 10 times more likely that you get Guillain-Barre from the flu than the vaccine, then it’s much harder for us to grasp the facts. It’s less likely that those that develop Guillain-Barre from flu will write about it on the internet, those opposed to vaccines are very vocal, write about it on the internet, but if your elderly grandparents die it’s not exactly unexpected, the numbers of cases and fatalities each seasonal flu aren’t easily available for you to check yourself, the list of ingredients looks scary, and so on. The arguments behind the vaccines aren’t always straight forward and so it becomes much harder to get a balanced information to make your decisions from.I work in medicine, I’ve read the statistics, I have access to the scientific literature in a way that most people don’t outside academia and I have training in this field that allows me to weigh the pros and cons of vaccines. So it’s easier for me to judge these risks than it is for you. As a result I recommend my parents to get the flu vaccine and the pneumococcal vaccine because I want them to live long and healthy lives. I had the flu vaccine two weeks ago. But of course, I work in a hospital and so I’m more likely to be exposed to the seasonal flu and I don’t want to spread this to my patients or to my family members.

What do I need to check on my car if I'm going on a cross-country trip?

Giving your car an audit before a cross-country trip is a great idea to help mitigate the risk of breakdowns and car accidents. It is recommended to do the following:Schedule a check up if you have time.Not a bad idea to have a professional take a look at your car. But if you don’t have time, Drive Safely has this great guide to prepping for a road trip.Check your fluid levelsEngine oil, transmission fluid, brake fluid, windshield wiper fluid, and power steering fluid are all crucial!Check your batteryCheck the wear and air level on your tiresEnsure your brake pads are in good shapeBring any necessary items for the terrain you may encounterSnow chains, for example.Make sure your cargo load is appropriate for your car; you don’t want to add too much weight.Unless you’re moving, this really shouldn’t be too much of a factor, but good to keep in mind.Locate your license, registration, insurance forms, and roadside assistance informationHopefully you won’t need to use these, but always good to be prepared in case of an accident or emergency.Drive safe!

How do you recognise someone who is 'nouveau riche'?

Ryublevka, the most elite Moscow luxury suburbFor over three years, I had worked as a private English tutor to the children of wealthy Russians. I prepared the kids for their assessments to the International schools and helped with homework if they already attended local international schools.I couldn’t get a job with ultra-wealthy Russian families - oligarchs, billionaires and such; however, all the families that I worked for easily fell into the infamous top 1% wealth-wise.All the rich people in Russia are nouveau riche. No old money exists in Russia. Private accumulation of wealth began in the early 1990s. In fact, all except two families that I worked for, made their fortunes in the “crazy 90s.” The other two became rich in the 2000s.With rare exceptions , they all were dirt poor in the Soviet Union. By modern standards, USSR was a poverty-stricken country. Their families just managed to get by, couldn’t afford healthy food, nice clothes, didn’t have any equity except for some banged-up car that had to be repaired every week (even apartments were owned by the state). It’s a classic rags-to-riches story on a large scale.I had a student, whose mom’s dad was a member of the Politburo, the creme de la creme of the Soviet elite. Her name was Natalya, and according to Natalya’s description, her family had an upper-middle-class life: a relatively big apartment, trips to Czech Republic and Bulgaria, Eastern European consumer goods, one nice Volga car with a chauffeur and a countryside cottage (dacha).So even for Natalya coming from the Soviet nomenklatura, there had been quite a spectacular leap to a three-story state-of-the-art mansion, shop-till-you-drop lifestyle, trips to five-star hotels in different parts of the the world and her son admittance to one of the top public schools in England.Another thing to note, it was a uniform group of folks who lived close together along Rublevo-Uspenskov “Highway” who developed a commonly shared list of must-have things: to describe one family is to describe them all. It was truly a distinct country within the country.Nearly half of the landowners in Moscow’s luxury suburb of Rublyovka, a string of luxurious villages south-west of Moscow along Rublevo-Uspenskov “Highway,” where all my clients resided, are linked to Russia’s ruling elite.The ruling elite and ultra-rich live east of the “highway” close to the Moscow river or on its banks. To the west, there are merely rich Russians. The two groups almost never cross paths, so there you have another division along the wealth lines.Rublevo-Uspenskoe “Highway” is a two-lane road with two-way traffic with no barrier between them. When there is a car accident one can be stuck for hours, because it would completely block the road.President Putin and Prime Minister Medvedev live in Ryublevka, too. To allow the motorcade to pass on its way to the Kremlin, traffic cops would shut off both lanes of the road for half an hour or so, and the inbound traffic would bottle up to cost you another hour or two.I often asked myself, why would anyone with so much money want to live there if you can’t get in and out without losing hours in traffic?It was a status symbol, of course. If you bought yourself a house in Ryublevka it meant you made it. In Russian lingo, it was an equivalent to a cosmonaut flying into outer space or an athlete winning a gold medal in the Olympic games.The rich had a community there with shared interests and similar level of wealth, therefore the silly narrow road was a nuisance one had to live with.Why wouldn’t they build another road then? Maybe because the rich felt or knew that they were temporarily staying there, until the next revolution wipes the slab clean.I once looked out through the window of a Ryublevka mansion and envisioned all the fancy houses in view from my third floor perch engulfed in flames. They were burning and the peasants and proletarians on the ground level cheered and shrieked, punching the air with pitchforks. Surely, my fantasies are shared by others.It never ceased to shock me to leave behind decrepit, butt-ugly apartment blocks of Moscow, and within minutes (provided there was no traffic) find myself surrounded by lean in roofs protruding above fifteen-foot fence. The owners of the mansions who traveled to the city must have thought about it a thousand times - this can’t last forever. This is Russia. Violent redistribution of wealth happens. Sooner or later.That’s why there was no clear future path for their children in Russia, so from the very birth they were destined to leave Russia behind in case of trouble.They had British nannies. Many mothers gave birth in Florida for their children to have American citizenship. It was strange to see American citizens who literally had never stepped foot on the US soil.Many of them spoke English as the first language, especially if they attended a local International school (that followed British curriculum).After International school, they would be sent to public schools in the UK. Some families would move overseas with their children. One of my clients moved to London, another one to Hong Kong. After the public school, there would be a university, preferably in the UK, with the US as the second option.The UK was their first choice, because they didn’t have to pay as much taxes as in the US. They were paranoid about the IRS and had horrid stories from their friends who ran in trouble with their taxes. Apparently, Brits didn’t care about the taxes, as long as rich Russians bought elite property and spent their money there.The student-teacher dynamics that parents expected from me was quite idiosyncratic. The crucial thing was to establish rapport with the student. The parents explained to me that the main goal was not that their child made progress in his/her studies, but that he/she was happy and had a positive relationship with the teacher.I had to be a teacher, a friend, an older brother, and sometimes a father, too. The job implied balancing a formal behavior of a teacher with informal behavior of a friend, which I found an interesting, although bizarre challenge.Many kids felt outright lonely or/and isolated. Most of them spent more time with their nannies than with their parents. All of them, bar none, were good kids. Obviously, spoilt silly, but it was expected. They were also really smart.Their parents tried to compensate for their poor childhood and surrounded them with a roomful of toys. At any house, there was enough merchandise to open a toy store.They wore only designer clothes and had private doctors visits. They had at least two nannies each (nannies worked on a rotating basis - one week on, one week off) and coaches. At one place, I would run into a swimming coach leaving the house and on the way out cross paths with a music teacher.There were dog groomers, nail specialists, janitors, drivers, cooks, lady cleaners, physicians, Chinese teachers, French teachers, Russian teachers, Maths teachers, gardeners.One family was about to move to Hong Kong and one of their nannies, Marina, developed a crush on me. I was married, but didn't wear a wedding band. So Marina finally plucked up courage and suggested to me that we totally should hook up: we’d spend two weeks in Hong Kong, she’d be the kids’ nanny and I’d be their English tutor at their family house there, followed by two weeks at her house in Tver. A couple of lovebirds with overlapping shifts, dividing their time between two countries. And if we wanted to take some time off from each other, we could just change shifts so they didn’t overlap. What a sweet deal.Now, what I did find extremely challenging, is that the students would sabotage the studies, possibly because they sensed their parents didn’t care about it all that much in the first place. And I wasn’t allowed to be too strict, because I had to stay their friend no matter what.If no progress was made for a long time, a heroic act was demanded of both of us with double shifts and crazy deadlines and physical and psychological pressure. It was a very Russians thing. Let it slide for sometime, then overcompensate -then it’s war, take no prisoners -we are Russians and everything is possible! Fingers crossed.Then, suddenly it was June 1st with three months of summer break ahead, and the family had to stay at their villa in Italy or Spain. More heroic acts would be required of me, but not until September 1st.There were two notable exceptions: parents who had studied in the US or the UK and spent a long time there. They were progress-oriented in this kind of super-rational way, which basically meant non-stop heroism: no days off, study till either one of us drops from exhaustion.Natalya, whose dad was a Politburo member, had the same principle - her heroic act lasted 24/7. She constantly kept tabs on her son, Nikita. Nikita was an overachiever in figure skating and all of his school subjects. If Nikita got a B, she would hire the best teacher in this subject in Moscow and have him come every day until her son got only straight As.When Nikita began to study in the International School, she talked me into teaching him geography, because he was getting too many B’s. We had regular lessons until Nikita became the best student in geography (while I had already forgotten most of what we’d studied together).Natalya then sent him to one of the top public schools in England and they kept mailing Nikita’s fantastic class reports. When one time Natalya didn't like Nikita’s latest report, she moved to England to organize his studies.The constantly present dichotomy between no-work and too-much-work greatly fascinated me. They just couldn't find the middle ground, nice balance between work and play, it was either work-work or play-play.They had to work a lot to get rich (or commit a lot of violence in the 1990s), but once they did they could finally take it easy. This is what they told me. We don’t have to work hard anymore. We’re rich. We live in Ryublevka.It was all very feudal, of course. Each of them had a proof in the form of a family tree that their ancestors were aristocrats before the Soviet Union. They even hung the family tree picture in the golden frame on the wall. Fathers and mothers and their children were aristocrats. Every single one of them. They wished to impress with a genealogical bloodline similar to German Barons with at least two century old noble heritage.In the free market capitalism one has to work till his last day, because competitors can take you out of business any day. Apparently, not so in Russia. Once you made your money, you can just have fun and stay rich.They traveled to Paris and Dubai, staying only in the most expensive hotels and eating in the most expensive restaurants. They had parties. Men had their man entertainment. Women had theirs. Sometimes they’d take off in the middle of the week, together, and disappear for a week or two, leaving kids to their nannies and the house to the housekeeper.They had their country house cottages in Forte De Marmi, Italy or Marbella, Spain. The Ryublevka rich bought houses in the same area so they could continue spending time together overseas. Russians like to gather in big groups, drink alcohol and have rowdy fun.This was a movable feast all right. They didn't seem to have a single care in the world. They lived like there was no tomorrow. Like it all could end any moment, and they had to spend their money right away, quick, because it would all disappear without a trace if they sit on it, or invest it into anything that wasn’t connected to their personal well-being, like stocks or other people businesses.’They cared for themselves, but at the end of the day, they didn't even care about each other. They were dancing on the edge of civilization, ecstatically and almost beautifully, and when the music stopped they would be somewhere else, under some other guise, maybe poor again, maybe rich. Life was a mystery, and if they got a nice hand of cards might as well make the most of it.Because there would be the day, when the apartment building residents take canisters with gasoline and their pitchforks to make a short trip down the two-lane road and burn Ryublevka down to the ground.Life lasts but a blink of an eye. They worked hard, and now they can live their lives to the fullest. This is the Russian way.

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