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Point/Counterpoint Editorials |

Rebuttal From Mr Shepherd et alRebuttal From Mr Shepherd et al FREE TO VIEW

Steven L. Shepherd, MPH; Eric J. Goodrich, MD; Julie Desch, MD; Paul M. Quinton, PhD
Author and Funding Information

From the School of Medicine (Dr Goodrich) and Department of Pediatrics (Dr Quinton), University of California, San Diego. Mr Shepherd and Dr Desch do not have any professional affiliations.

Correspondence to: Steven L. Shepherd, MPH; e-mail: steveshepherd@cox.net


Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Quinton’s laboratory research is supported by grant funds from Cystic Fibrosis based non-profit organizations. Mr Shepherd and Drs Goodrich and Desch have reported that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;145(4):684-685. doi:10.1378/chest.13-2407
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This debate concerns a policy of the Cystic Fibrosis Foundation (CF Foundation) and the science that supports it—or does not—and we thank Dr Jain and colleagues1 for their willingness to address this issue. First, some clarification. Dr Jain and colleagues1 speak of “recommendations.” Dr Jain and his colleagues all served on the committee that recommended updates (Infection Prevention and Control Committee, CF Foundation, written communication, May 19, 2013) to the CF Foundation’s guidelines.2 But with respect to the recommendation that led to the ban, it was the CF Foundation that made it into policy. Dr Jain and colleagues are responsible for their recommendations; the CF Foundation is responsible for its policy.

The authors also state that the CF Foundation invited public comment1 on their recommendations. In January 2013, the committee forwarded 98 recommendations to the CF Foundation.3 In May 2013, these recommendations were distributed to cystic fibrosis (CF) center personnel and others for public comment.3 But the CF Foundation announced its ban on March 14, 2013,4 2 months before public comment began. The ban was put in place without public comment, and the CF Foundation has refused opportunities to discuss it ever since.

Finally, the authors speak of new knowledge1 that now warrants the ban. Presumably they are referring to findings in the 16 papers compiled by the CF Foundation to support the ban.5 As we discussed in our Counterpoint Editorial,6 none of these papers shows person-to-person transmission in settings of the sort covered by the ban. The remainder of the Point Editorial relies on old knowledge about transmission in CF camps, in clinics and hospitals, and among adults using no protective behavior and in repeated, sustained, close-quarter contact—none of which describes the contemporary public and professional settings to which the CF Foundation’s ban applies.

In their argument, Jain et al1 posit three questions, answer yes to all (as do we), and conclude the CF Foundation’s policy is, therefore, warranted. We conclude otherwise. Stopping with these three questions falls woefully short of an analysis sufficient to support the CF Foundation’s policy. Virtually every action in life carries some degree of risk for something. Yet we generally proceed—else we would never drive a car—by extending the risk analysis to include an assessment of likelihood, of steps that can be taken to reduce the risk, and the benefits to be gained by accepting the risk. Leaving out these steps may have produced a course of action Jain et al1 (and the CF Foundation) consider the most prudent, but it also yields the most simplistic, constricted, and damaging of the many options one might otherwise envision.

Salt Lake City’s Salt Palace Convention Center, site of the 2013 North American CF Conference, encompasses 675,000 square feet. Because of an unquantified risk, the CF Foundation refused to allow us or any two adults with CF in that building at the same time. Lacking even a ballpark estimate, some new knowledge the CF Foundation might usefully pursue is to actually quantify that risk. We suspect it would be tiny. If not, the CF Foundation would have evidence to warrant its ban. Until then, the ban is causing more harm than good and should be revoked.

References

Jain M, Saiman LM, Sabadosa K, LiPuma JJ. Point: does the risk of cross infection warrant exclusion of adults with cystic fibrosis from Cystic Fibrosis Foundation events? Yes. Chest. 2014;145(4):678-680.
 
Saiman L, Siegel J; Cystic Fibrosis Foundation Consensus Conference on Infection Control Participants. Infection control recommendations for patients with cystic fibrosis: microbiology, important pathogens, and infection control practices to prevent patient-to-patient transmission. Infect Control Hosp Epidemiol. 2003;24(suppl 3):S6-S52. [CrossRef]
 
Campbell PW, Saiman L, Marshall BC, Hazle L. Infection prevention and control policy. Cystic Fibrosis Foundation website. http://www.cff.org/UploadedFiles/LivingWithCF/Webcasts/ArchivedWebcasts/Germs/IPC-Webcast-03-27-13-Final.pdf. March 27, 2013. Accessed August 21, 2013.
 
CF Foundation updates infection prevention and control policy for all Foundation events and meetings. Cystic Fibrosis Foundation website. http://www.cff.org/aboutCFFoundation/NewsEvents/3-14-Infection-Prevention-Control-Policy-Update.cfm. March 14, 2013. Accessed August 27, 2013.
 
References for CF Foundation’s updated infection prevention and control policy. Cystic Fibrosis Foundation website. http://www.cff.org/UploadedFiles/aboutCFFoundation/InfectionPreventionControlPolicy/References-for-CFF-IPC-policy.pdf. April 2013. Accessed August 27, 2013.
 
Shepherd SL, Goodrich EJ, Desch J, Quinton PM. Counterpoint: does the risk of cross infection warrant exclusion of adults with cystic fibrosis from Cystic Fibrosis Foundation events? No. Chest. 2014;145(4):680-683.
 

Figures

Tables

References

Jain M, Saiman LM, Sabadosa K, LiPuma JJ. Point: does the risk of cross infection warrant exclusion of adults with cystic fibrosis from Cystic Fibrosis Foundation events? Yes. Chest. 2014;145(4):678-680.
 
Saiman L, Siegel J; Cystic Fibrosis Foundation Consensus Conference on Infection Control Participants. Infection control recommendations for patients with cystic fibrosis: microbiology, important pathogens, and infection control practices to prevent patient-to-patient transmission. Infect Control Hosp Epidemiol. 2003;24(suppl 3):S6-S52. [CrossRef]
 
Campbell PW, Saiman L, Marshall BC, Hazle L. Infection prevention and control policy. Cystic Fibrosis Foundation website. http://www.cff.org/UploadedFiles/LivingWithCF/Webcasts/ArchivedWebcasts/Germs/IPC-Webcast-03-27-13-Final.pdf. March 27, 2013. Accessed August 21, 2013.
 
CF Foundation updates infection prevention and control policy for all Foundation events and meetings. Cystic Fibrosis Foundation website. http://www.cff.org/aboutCFFoundation/NewsEvents/3-14-Infection-Prevention-Control-Policy-Update.cfm. March 14, 2013. Accessed August 27, 2013.
 
References for CF Foundation’s updated infection prevention and control policy. Cystic Fibrosis Foundation website. http://www.cff.org/UploadedFiles/aboutCFFoundation/InfectionPreventionControlPolicy/References-for-CFF-IPC-policy.pdf. April 2013. Accessed August 27, 2013.
 
Shepherd SL, Goodrich EJ, Desch J, Quinton PM. Counterpoint: does the risk of cross infection warrant exclusion of adults with cystic fibrosis from Cystic Fibrosis Foundation events? No. Chest. 2014;145(4):680-683.
 
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