text:
Victims, vectors and villains: are those who opt out of vaccination morally responsible for the deaths of others?
http://orcid.org/0000-0001-5940-602XEuzebiusz Jamrozik1,
http://orcid.org/0000-0003-2995-2067Toby Handfield2,
Michael J Selgelid1
1Centre for Human Bioethics, SOPHIS, Monash University, Clayton, Victoria, Australia
2Department of Philosophy, SOPHIS, Monash University, Clayton, Victoria, Australia
Correspondence to Dr Euzebiusz Jamrozik, Centre for Human Bioethics, Monash University, Clayton, VIC, 3800, Australia; zeb.jamrozik{at}monash.edu
Mass vaccination has been a successful public health strategy for many contagious diseases. The immunity of the vaccinated also protects others who cannot be safely or effectively vaccinated—including infants and the immunosuppressed. When vaccination rates fall, diseases like measles can rapidly resurge in a population. Those who cannot be vaccinated for medical reasons are at the highest risk of severe disease and death. They thus may bear the burden of others' freedom to opt out of vaccination. It is often asked whether it is legitimate for states to adopt and enforce mandatory universal vaccination. Yet this neglects a related question: are those who opt out, where it is permitted, morally responsible when others are harmed or die as a result of their decision? In this article, we argue that individuals who opt out of vaccination are morally responsible for resultant harms to others. Using measles as our main example, we demonstrate the ways in which opting out of vaccination can result in a significant risk of harm and death to others, especially infants and the immunosuppressed. We argue that imposing these risks without good justification is blameworthy and examine ways of reaching a coherent understanding of individual moral responsibility for harms in the context of the collective action required for disease transmission. Finally, we consider several objections to this view, provide counterarguments and suggest morally permissible alternatives to mandatory universal vaccination including controlled infection, self-imposed social isolation and financial penalties for refusal to vaccinate.
Public Health Ethics
http://dx.doi.org/10.1136/medethics-2015-103327
Vaccine-preventable infectious diseases
Many vaccine-preventable infections are transmitted between human beings and can cause serious harm or death. Measles, for example, is one of the most infectious known human viruses. It is transmitted via the airborne route, and outbreaks can result from minimal social contact between contagious and susceptible individuals.1 ,2 In most people, measles causes mild disease, but in some cases there are serious sequelae including lung inflammation (pneumonitis), brain inflammation (encephalitis), permanent disability and death. US historical data suggest a death rate of about 1 in every 350–1200 cases.1 ,3 Risks of both complications and death are highest in infants, young children, the malnourished and the immunosuppressed.3 Prior to widespread measles vaccination, there were, on average, >500 000 cases of measles and 400 deaths per year in the USA.1 Measles previously also accounted for a significant proportion of deaths among young people undergoing chemotherapy for leukaemiai.4 Currently, measles continues to cause >100 000 deaths per year worldwide—mostly in children under 5 years of age in sub-Saharan Africa and India, in communities where vaccination rates remain suboptimal.5
Modern inoculations for many common diseases are extremely safe and effectively prevent illness in the vast majority of those vaccinated. Vaccines have played a major role in the eradication of smallpox and near eradication of polio. High rates of vaccination against such diseases also protect those who cannot be safely vaccinated, such as infants and the immunosuppressed, through promotion of herd protection (or 'herd immunity').6
The measles vaccine is especially safe and effective, with significant side effects from vaccination being exceedingly rare. A careful long-term follow-up study of measles, mumps, and rubella (MMR) vaccination found zero deaths due to the vaccine and a less than one in a million chance of encephalitis.7
There are several groups that cannot be safely or effectively vaccinated with some vaccines (eg, infants, the immunodeficient and the immunosuppressed).8 ,9 The only way these vulnerable individuals can be effectively protected against common infections, apart from extremely onerous social isolation (eg, 'boy in a bubble' scenarios), is through herd protection (achieved by high vaccination rates).ii Herd protection models for measles suggest that well over 90% of a population need to be vaccinated in order to reliably prevent sustained transmission.10–12 Recent outbreaks have shown that measles can spread quickly and cause significant harm when vaccination rates fall.2 ,3 The presence of such vulnerable individuals raises questions as to whether these people should bear the burdens of the decisions of others not to vaccinate and to what degree the latter should be considered morally responsible for resultant harms to the former.
In this article, we propose that those who opt out of vaccination are morally responsible (and in particular, blameworthy) for the harms suffered by others as a result of infectious outbreaks. In other words, non-vaccinators are morally blameworthy for the morbidity and mortality caused by infectious diseases that can be prevented by vaccination. Exactly how blame should in practice be apportioned among different individuals is a question that is beyond the scope of this article to resolve: but we show that there is at least one plausible and morally defensible way that blame could be ascribed to non-vaccinators. If our argument is sound, it joins other significant grounds that support public health intervention in this area.13–16
We focus on the example of measles because it is highly contagious in social situations where people merely share the same air. Similar considerations apply to many other common infections transmitted in similar ways, but we leave aside diseases with other modes of transmission, noting that these differences and their moral aspects have received some attention elsewhere.16 ,17
One way to support our thesis would be to analyse the concept of moral responsibility so as to identify sufficient conditions, and then to show that these conditions apply to non-vaccinators and the harms they cause. While we think this route is defensible, it is difficult to frame in a way that is not question-begging. Any account of sufficient conditions (for moral responsibility) that supports our conclusion is likely to be more contentious than the conclusion itself.
Instead, we adopt the following, two-pronged strategy. First, we simply conjecture that non-vaccinators are responsible for harms and present some relatively uncontentious necessary conditions of moral responsibility. We consider some possible objections to our responsibility thesis, organised around these conditions, and show that they all fail. Thus, we show that there is no knockdown objection to our claim. Second, we argue that there are a number of cases where we do in fact consider individuals blameworthy for harms that bear important similarities to the harms caused by non-vaccinators. The legitimacy of considering individuals responsible in these other cases suggests that it is analogously legitimate to consider non-vaccinators responsible.
Moral responsibility, blame and risk
Those who are morally responsible for an outcome are proper subjects of praise or blame for that outcome. So, for our purposes, to say that someone is morally responsible for an outcome O is equivalent to saying that they are worthy of (ie, deserve) praise or blame for O. The project of analysing the necessary and sufficient conditions for moral responsibility, however, remains contentious. We do not hope to offer a complete account here. Instead, we propose three necessary conditions for moral responsibility. The conditions will be specified only roughly, but with enough precision to ensure that they can be uncontroversially applied to the vast majority of cases of harm caused by refusal to vaccinate.
An agent A is morally responsible for outcome O only if
(Cause) Agent A performs an action Φ that is a relevant part of a causal explanation of O.
(Salience) Outcome O is morally salient—it is a good or bad outcome.
(Foreseeability) Outcome O is a predictable or foreseeable outcome of action Φ.
Evidently, refusal to vaccinate frequently satisfies the salience condition: the harms caused by infectious diseases are highly significant. Further, we see no difficulty meeting the foreseeability condition. No doubt, when inoculation was a novel invention and mechanisms of transmission were less widely understood, refusal of a vaccination would not have always satisfied the foreseeability condition. But now, at least in those countries where vaccination is widely available, it is practically common knowledge that non-vaccination can have dangerous consequences for oneself and for others. The most serious source of potential resistance is the causal condition. Although it is undeniable that some individuals' refusal to vaccinate is part of the causal explanation of some infections, it might be disputed whether the 'relevant' sort of causal connection required for moral responsibility is present. For the moment, we put this objection to the side: it will be addressed in a section below.
These conditions provide a natural way to identify possible sources of objection to our conjecture that non-vaccinators are responsible for harms that result from their resultant lack of immunity. In the following sections, we consider and address the following purported objections:
Non-vaccinators lack the relevant sort of agency to be considered responsible for harms that result from a failure to vaccinate. The harms do not arise from anything that non-vaccinators do.
Harms due to a failure to vaccinate are due to collective behaviours of many individuals, and consequently the causal condition for responsibility is not satisfied.
Non-vaccinators may be morally responsible for the decision whether or not to vaccinate, but there is no duty to vaccinate. Vaccination is supererogatory, and so failure to vaccinate is not blameworthy.
Objection: non-vaccination and agency
To legitimately consider someone morally responsible for an outcome, it is necessary that the person had a relevant form of agency, and that this agency was involved in the appropriate way in the outcome for which they are attributed responsibility. It is for this sort of reason that it does not make much sense to consider someone responsible for the fact that 2 is a prime number; nor for the actions of their ancestors of 20 generations earlier. These states of affairs do not stand in the appropriate causal relationship to the agency of an allegedly responsible person. No one can causally influence what happened 20 generations earlier, nor can one influence a mathematical fact.
In non-vaccination cases, it might be objected that the harms that result from non-vaccination are not harms that the non-vaccinator has caused to occur; they are, rather, harms that the non-vaccinator has merely failed to prevent. Or a somewhat different claim might be made: that the agent has not intended the harm. For one or both of these reasons, it might be argued, the agency of the non-vaccinator is not sufficiently involved in the harm for us to hold the agent responsible.
Considered generally, this type of objection relies on two claims. First: a conceptual claim is required, distinguishing two types of harm, such that stereotypical wrongful harms fall in one category, while harms suffered as a causal consequence of non-vaccination fall in the other. As already suggested, all manner of distinctions might be used in this way: we can distinguish between harms that are a result of doing versus allowing; or harms that we commit rather than those that we omit to prevent; or harms that we intend versus those that we do not intend.18 Call this first part of the response the conceptual claim.
Second, it must be argued that the distinction identified in the conceptual claim separates states of affairs for which we may be held responsible and those for which we cannot. "We can be held responsible for the harms that we inflict on others, but not for those that we merely fail to prevent", or something to this effect. Call this the moral significance claim.
This response is implausible because there are numerous examples—unrelated to vaccination—which illustrate the credibility of considering individuals responsible for harms that they both (i) did not intend and (ii) did not cause directly by their actions, but merely failed to prevent. Consider:
Intoxicated driver. A driver is driving while intoxicated at a safe and reasonable speed. Due to her intoxication, however, she blacks out briefly. During the blackout, she runs a red light, and her vehicle collides with a pedestrian, killing him.
In such cases, the relevant agent does not intend the harm: the harm comes about as a result of failures to act. Indeed, at the crucial time of the red light signal, the driver is not capable of acting in the required way because she is unconscious. Perhaps in some cultures, and in some historical periods, this driver would not be considered responsible for her careless behaviour; but in many cultures and jurisdictions she would be, and it is not credible to suppose that some conceptual error is occurring in such cases. If it is coherent to consider individuals responsible in cases like this, then there is no principled basis for objection that non-vaccinators cannot be considered responsible because they lack appropriate agency for the harms that they transmit to others. That said, it remains very plausible that intentionally caused harms warrant more blame than unintentionally caused harms. We might think that the person who accidentally forgets to get vaccinated deserves less blame than the person who actively decides against vaccination. In addition, in some countries vaccination is difficult to obtain, and where it is not universally and freely available (or heavily subsidised), some people may have difficulty paying the financial costs. Cases like these would seem to be much less culpable, especially where vaccines are not available, and blame may be attributable to local or international public health agencies. But this is no objection to our thesis that non-vaccinators (with easy access to vaccines) can legitimately be considered responsible.
Objection: collective action and individual responsibility
Typically, one person being unvaccinated is extremely unlikely to cause harm to others because the probability of having direct contact with both a contagious person (to become infected) and a vulnerable person (infecting them) is low, at least in populations where vaccine uptake levels are high. Actual transmissions to vulnerable individuals will typically involve a chain of transmission involving dozens of unvaccinated individuals.
Is the collective nature of the harm-causing process compatible with considering individuals responsible? We might have concerns about overdetermination (where multiple chains of transmission within an outbreak are sufficient to cause a given harm) or because of more general concerns that our ordinary assumptions about individual responsibility are not appropriate to collective causation.
To address the concern about overdetermination first: this will depend to a large extent on disease epidemiology. Take two extreme cases:iii (i) endemic malaria: each sick person's clinical case of malaria is likely to be overdetermined since they will be infected with parasites transmitted to them by many other people, and each episode of transmission is itself potentially sufficient to cause clinical malaria; and (ii) measles in a country with a high vaccination rate: here each sick person's clinical case of measles is much more likely to have been transmitted to them by just one other person, and each sick person is unlikely to have had sufficient contact with more than one infectious case.iv
In cases like the former (endemic malaria), our ordinary ascriptions of responsibility might seem inappropriate. Blaming someone for a bad outcome usually implies that, had the blamed party behaved otherwise, the bad outcome would not have occurred. This is precisely what fails to hold in overdetermination cases.
Legal doctrine has evolved ingenious strategies to address this sort of concern so that parties who participate in multiple, simultaneous wrongs (eg, Jones burns down the factory from the outside, Smith blows it up from the inside; had one of them not acted, the factory would have been destroyed anyway) cannot benefit from the overdetermination of the damage they collectively do. In dealing with overdetermination of risks, the measures become even more conceptually sophisticated.19 ,20 We suggest something similar should happen here: we should adjust our understanding of causation so as to ensure that overdetermined harms are still caused in the relevant sense. Blind adherence to a counterfactual test of causal responsibility will give an absurd answer to questions of blameworthiness. That suggests we should reject the counterfactual test rather than denying that anyone should be blamed for overdetermined harms.v
Overdetermination aside, the question of how to apportion individual responsibility in cases where one group (those who opt out of vaccination) collectively causes harms to another group (those who are vulnerable to vaccine-preventable disease) remains. Even for cases like measles in high-income countries, one individual alone opting out of vaccination is rarely sufficient to cause infection in another. Such transmission will most commonly involve a causal chain leading back to many other susceptible people, some of whom have chosen to remain susceptible by opting out of vaccination.vi
Suppose a chain of transmitters (T1 → T2 → ··· → T100) infect an immunosuppressed victim V. Suppose all T1–T100 opted out of vaccination, knowing that this might cause harm to others. Suppose further that they all engaged in similar risk-creating behaviours: they had similar exposure to immunosuppressed individuals and took similar precautions with washing hands and the like. Had T100 obtained a vaccination, V would not have become unwell.vii But it is also the case that had T99 obtained a vaccination, V would not have become unwell. And so on, for every member of the chain. So who is responsible?
At this point, it is helpful to stress the distinction between moral responsibility for conduct versus moral responsibility for consequences of our conduct. It is possible to think that someone is blameworthy for their conduct without holding them blameworthy for all the bad consequences of their conduct. The distinction is philosophically important because the outcomes of our actions are never entirely under our control, whereas our conduct is—at least to a much greater degree. If we consider individuals responsible to different degrees because their conduct, though similar, led to different outcomes, then we introduce an element of luck into our system of moral judgement. This 'moral luck' is a pervasive feature of normal moral practices involving praise and blame, but it is controversial among theorists whether it can be justified.21
So, in the present case, with respect to their conduct, ex hypothesi, each of the 100 individuals is equally blameworthy. They all imposed similar risks and had similar foreknowledge and control over those risks. Their moral responsibility for harm to others will be affected by moral luck because not everyone who behaves in a similarly blameworthy way will cause the same harms. While all non-vaccinators are guilty of equally blameworthy conduct (ie, they have all behaved equally badly), only those who are actually involved in chains of transmission to vulnerable individuals end up being morally responsible/blameworthy for harm because causation is a necessary condition for blameworthiness; and the causal difference between these groups is a matter of sheer luck. With regard to moral responsibility for harm, therefore, moral luck is inescapable.
We claim that those non-vaccinators involved in a chain causing harm are blameworthy for avoidable harms arising from non-vaccination and, in practice, this means that they could legitimately be blamed for these harms.viii We do not claim that there is a uniquely appropriate way, in theory or practice, to assign blame for the eventual harms, at least in part because of the element of moral luck that influences the outcomes of risky behaviours. With regard to theory, there may be multiple plausible views about the degree of blame that the 100 individuals in question deserve for harm to V. With regard to practice, indeterminacy could be resolved by adopting particular conventions or laws. There are numerous examples of stable moral practices in which we hold people blameworthy for the outcomes of their collective risky behaviour and we see no reason to think that an appropriate custom could not be devised for non-vaccination.
To illustrate, consider three ways (not exhaustive) in which we might ascribe blame to those involved in chains of transmission:
Nobody among T1–T100 is blamed for the harm to V.
Only T100 is blamed for the harm to V (proximate cause).
All individuals, T1 to T100, are blamed to an equal degree for the harm to V.
With regard to the first option: is it plausible to think that no one is blameworthy for the harm? A crucial requirement for any credible account of individual and collective responsibility is that individuals are not left with perverse incentives to (collectively) impose large risks on others for little or no benefit to themselves. Allowing non-vaccinators to escape all responsibility for subsequent deaths fails this basic test.22
The second of these policies (blaming the proximate cause T100) might be appealing in practice because of its convenience: it requires only one individual be found to receive the warranted blame. Theoretically, however, it is implausible to consider the proximate cause more blameworthy (for harm) than any other member of the chain. Of 100 individuals who imposed similar risks and had similar causal involvement in the death, it was sheer luck that made T100 the ultimate transmitter of the harm to a vulnerable person.23 There would thus be a very strong element of moral luck, making it, on some views, unfair to blame only T100, given that T1–T99 were all similarly blameworthy. Nevertheless, a moral community could have practical or policy reasons (eg, deterrence) to blame only the proximate transmitter—even if this blame were out of proportion to her causal role in the harm.ix
The third policy would regard each individual in the chain (who had reasonable opportunity to act otherwise) as blameworthy for the harms that arise. By considering each morally responsible, we acknowledge that each is implicated in causing avoidable harm.x
That said, there remain many unresolved questions about how to apportion blame in collective action cases. In our contrived example, the causal roles of T1–T100 are all similar. But in cases where the contributions are heterogeneous (eg, some better foresee harms than others, some take more/better infection control measures than others, etc), we may need to discriminate different degrees of blame deserved by the various agents. For instance, one fundamental issue is whether it is possible to meaningfully quantify the degree of causal contribution that an agent (or chance) makes to an outcome. Intuitively, we can at least make a partial ranking of contributions in multiagent cases: some contribute more than others, though some contributions may be incomparable. While we may take some guidance from this partial ranking information, it will leave some issues indeterminate. For instance, if A makes a greater contribution than B, this may constrain us to ascribe a greater quantum of deserved blame to A. But suppose that a third agent C is involved, and neither A's contribution nor B's contribution is comparable to the contribution of C. (To illustrate with an example: Transmitter A may have made a greater contribution than transmitter B, because although both refused vaccinations, transmitter A made more reckless visits to hospitals and other environments in which immunosuppressed individuals reside. Transmitter C took the most stringent hygiene precautions of all, but C was also the blogger who spread 'antivaccination' ideas to A and B, such that they would have been much more likely to get a vaccination had C not written the blog. We might think that C's contribution is so different from A's and B's that it cannot obviously be rated as greater, less than or equivalent in magnitude to either of them.) How much blame does C deserve relative to these others? Any particular answer will involve some arbitrariness.
At least one further question remains: does the blame deserved by one agent change, depending on whether other agents (or chancy processes) are involved in causing the harm? Suppose that an agent's causal contribution to an outcome (including the degree to which he foresaw and intended the outcome) is the same in two scenarios S1 and S2, but that in S1 the outcome is facilitated (or hindered) by another agent, whereas in S2 he achieves the outcome alone. Does the agent deserve the same or a different degree of blame for the outcomes in these alternative scenarios? One possibility is to treat the total quantum of blame deserved for a given harm as constant, regardless of the number of agents, and to distribute it among the agents who causally contribute (eg, if three play similar roles in collectively causing a death, they may each deserve a reduced share of the blame that would ordinarily be ascribed to one individual for that death). This is what typically happens with liability to pay compensation. The amount of compensation required is constant, and mechanisms like joint and several liability allow that constant sum to be distributed in a variety of ways over the liable parties. On this approach, the presence of an additional agent will lead to a reduction in degree of blame deserved. Another possibility is that the blame deserved by the agent is identical in the two cases: despite the fact that our agent had an accomplice in his blameworthy deed, the degree of blame he deserves for the harm remains the same.xi
Regardless of how we resolve these issues, it should be stressed again that any such proposal that makes causation a necessary condition of blame for harm will be affected by moral luck (just as in the case of blaming the proximate cause T100). Given this, we may wish to consider whether it is preferable (in practice) to adopt other policies—such as vaccine mandates—which would arguably involve a fairer distribution of risk and avoid the case where an unlucky subset of risk imposers would be blamed for their chance involvement in harms.
While it may not be possible to prescribe one uniquely preferred approach to apportioning moral responsibility to individuals in cases of collective responsibility, we believe that at least one of the above methods of attributing blame is defensible, and that is all we require for the defence of our thesis. While the incompleteness of our account may leave some degree of arbitrariness in the choice of rules to ascribe responsibility in theory and practice, this is no worse than the degree of arbitrariness in extant norms and laws: we punish attempted murderers less harshly than successful ones; we blame reckless drivers who cause injury much more harshly than those who luckily avoid injuring anyone; and we are of course resigned to blaming much less harshly those who simply evade detection.
Objection: vaccination is supererogatory
The final objection we consider concedes that non-vaccinators are responsible for imposing risks on others, but denies that they are blameworthy. The idea is that while it might be praiseworthy to obtain a vaccination, it is strictly supererogatory to do so. Refusal to vaccinate is permissible either because vaccination comes at a significant cost to oneself or because the magnitude of risk imposed is not considered morally significant. This latter argument might proceed either by asserting that the absolute risk is small or by asserting that the overall risks and benefits of some social practice are equitably shared across the population.
Partiality to self
It is unreasonable to expect individuals to do everything they can to minimise risks to others. In particular, it is hard to accept that individuals have to bear significant risks of injury to themselves in order to achieve modest risk reductions for numerous others. Even if the net effect of the action is to reduce levels of expected harm to others, we might hold that—in some cases—there is a reasonable degree of partiality to oneself, such that it is merely supererogatory to undergo the risk in question. Serving as an experimental subject in a new drug trial might be an example where the risks are distributed in this fashion.
Having stated this objection, it is evidently implausible in the case of vaccination. First and foremost, non-vaccinators usually make themselves worse off by refusing a vaccine. So it is simply not the case that they would have to undergo a significant cost in order to reduce risk to others. But suppose we defer to a sincere non-vaccinator's claim that they believe it to be an undue hardship to receive a vaccine. How then do the burdens of vaccination compare to the potential risks to others? Taking measles as an example again, the risk of death due to vaccination is zero and the risk of serious vaccine reaction requiring hospitalisation is around 0.003% per dose,7 whereas the risk of death due to measles in an immunocompetent person is up to 1 in 350–1200 per infection and the risk of significant disease requiring hospitalisation is approximately 20%.3 Thus, in terms of hospitalisation, it is around 6000 times more dangerous to have measles than to have a dose of measles vaccine (and in terms of risk of death, the comparison is even more stark). Since the virus is so infectious, the risk of transmitting it while infected is high, and so the risk of harming or killing others is not negligible. For the risk of harming others to be so low as to be commensurate with the risk of vaccination, the lifetime odds of being part of a chain that reaches a non-immune person would have to be significantly lower than 6000 to 1 against (which could, admittedly, be the case if vaccination rates are sufficiently high and stable).
Second, even if it could be shown that the requisite probabilities are met in one place and at one point in time such cases will be exceedingly rare and difficult to identify. The risks change as a greater or lesser number of others opt out of vaccination, and as more people travel and cases are imported from other populations (which frequently occurs for many vaccine-preventable diseases).
Finally, non-vaccinators will tend to benefit from the herd immunity that is achieved by others undertaking vaccination, giving rise to a free-riding concern.26 Partiality to oneself is a much less plausible reason for failing to do good if one is already benefiting substantially from the equivalent sacrifices of others.
Small risks
Once herd protection is established at some level, the individual risk contributed by one non-vaccinator is admittedly small. It could be argued that it is therefore inappropriate to regard these risks as blameworthy. But this is, to use a term from Derek Parfit, a mistake in moral mathematics.27 Even small contributions are morally significant, especially (i) when small risks are run many times, as when the unvaccinated have social contact with many others, and (ii) where, taken together, they cause great harm. Herd protection is not binary—that is, it is not 'present' or 'absent', depending on whether some threshold rate of vaccination has been achieved. Herd protection is a probabilistic phenomenon reflecting a higher or lower level of the 'background' risk of sustained transmission of infection. Unless or until an infectious disease has been eradicated worldwide, there is thus no level at which the risk of harming others by remaining unvaccinated is zero. Further, if the number of non-vaccinators is small, then although the total risk of harm to others will be small, each individual will be responsible for a sizeable proportion of that total risk.
Distribution of risks
In some cases, societies allow small risks to be imposed on others because these risks are part of a social system of mutual risk taking that, overall, produces significant benefits; driving personal automobiles may be one example. Yet, for such a system of shared risk to be justifiable, the risks and benefits must be shared equitably.28 Systems that allow non-medical exemptions for vaccination blatantly fail this requirement. Infants are vulnerable in multiple ways and many immunosuppressed people are already badly off in terms of health. The burden of risk will fall inequitably on these groups. Both the probability of infection and the probability of severe disease and death (upon infection) are higher for the vulnerable. By contrast, a system of mandatory vaccination (except for those excluded for medical reasons) involves sharing the small risk of vaccination equitably across the population, for significant health benefits, shared by all.
Alternative duty assignments
It might be wondered what concrete assignments of rights and obligations would be morally acceptable ways to address the risk of infectious diseases. In the absence of mandatory vaccination, should non-vaccinators be required to take other steps to reduce the risks they impose on others? Or should systems of liability hold all non-vaccinators to account for their risk imposition, whether or not specific harms arise?20
An argument that the present assignment of obligations is inadequate can be made from considerations of economic efficiency. The risks imposed by non-vaccinators constitute a cost that is not consented to. In the jargon of economics, this is an externality: a cost that falls on people not participating in the relevant activity. And where there are externalities, there will often be inefficiency: people will choose a balance of activities that does not optimise welfare.29 In this case, the cost to the immunosuppressed of being exposed to a risk of infection is greater than the value to the unvaccinated of remaining unvaccinated. To identify how to remove the inefficiency, we can imagine various thought experiments, regarding what would happen if it were possible to negotiate a mutual agreement without excessive transaction costs, assuming a determinate division of rights.
On one salient alternative, imagine that the unvaccinated have a right to remain unvaccinated, but that the immunosuppressed can band together to purchase the compliance of the unvaccinated with a universal vaccination scheme. Given the very significant gains that the immunosuppressed stand to achieve, it is plausible that they would be willing to pay more than enough to obtain the compliance of at least a very large proportion of the unvaccinated community. The result would be to improve the position of the immunosuppressed, who are now better protected from immunity, and to improve the position of the unvaccinated, who have been adequately compensated for frustrating their preference for non-vaccination. This is a Pareto superior outcome, and the inefficiency has been removed. A scheme like this, on the other hand, could create perverse incentives for people to cultivate or imitate a preference not to be vaccinated.
Another salient possibility is to allocate the immunosuppressed an enforceable right not to be exposed to (avoidable) infection risks. In this case, the immunosuppressed could demand that those who chose not to be vaccinated (i) remain absent from public life, (ii) provide monetary compensation for the risks they impose on the immunosuppressed, (iii) undertake controlled infectionxii or (iv) become vaccinated. It is very plausible that (iv) is the most preferred option for the non-vaccinators, given the very high costs of the other options. So, again, the inefficiency will have been removed: the immunosuppressed will enjoy the benefits of universal vaccination, and a scheme like this would not obviously create perverse incentives.
Both of these scenarios give very clear support to the intuitive claim that it is unreasonable for some to impose the risks of non-vaccination upon the immunosuppressed. It is unreasonable because it is possible to bring about other arrangements that make some better off, and nobody worse off.
Both of the above scenarios are admittedly unrealistic because it would be intolerably costly to engage in all the relevant transactions involving everyone with whom we might need to interact over the course of our lives. But a more realistic, centralised proposal is that those who refuse vaccination might merely be given the choice between (i) providing monetary compensation for the risks they impose on the immunosuppressed or (ii) becoming vaccinated. Monetary compensation could be achieved in practice via imposition of a new (non)vaccination tax. Those who are vaccinated could receive a rebate for the tax in question, so only those who remain unvaccinated end up paying. The revenue raised could be paid out in individual compensation settlements for infection-related harms or could simply be paid directly to vulnerable individuals as compensation for exposure to risk itself.
A typical person transmitting infection may seem innocent because they do not choose to contract or transmit the infection, just as the driver of a car rarely chooses the moment when his brakes fail. Yet we are all at risk of being both the victims and vectors of infectious disease, and by taking reasonable steps, where possible, to ensure that we are immune from being a victim, we also prevent ourselves from being a vector.23 Vaccination is a prime example of an action that, in this way, prevents harm to oneself as well as harm to others. We have argued that those who opt out of vaccination and transmit preventable disease to others can be considered morally responsible for the harms and deaths that result. Our current practices of attributing blame may not regard the avoidable transmission of vaccine-preventable disease as villainous behaviour, but the arguments of this article demonstrate that this attitude might warrant change.
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. Herd protection as a public good: vaccination and our obligations to others. In: Dawson A, Verweij M, eds. Ethics, prevention and public health. Oxford University Press, Oxford, UK 2009:160–78.
. Vaccination ethics. Public Health Ethics 2011:143–53. http://dx.doi.org/10.1017/CBO9780511862670.009
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. Ethical principles for collective immunisation programmes. Vaccine 2004;22:3122–6. doi:10.1016/j.vaccine.2004.01.062
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OpenUrlCrossRefWeb of Science
Contributors All authors contributed to the research and the writing of this article, and approved the final manuscript.
Funding Green Templeton College, Ethox Centre and Green Templeton College, Oxford University (Andrew Markus Visiting Scholarship), Monash University (Australian Postgraduate Award).
↵i Measles still poses significant risks in this context despite prior vaccination of patients with cancer.
↵ii That is, a sufficiently high proportion of those with whom they come into contact must be vaccinated or immune from past infection: to minimise risk, this proportion must approach 100%.
↵iii Noting that a wide range of cases exist between these extremes.
↵iv Although for both malaria and measles there is some evidence of a relationship between pathogen 'dose' and severity of disease.
↵v Even where overdetermination applies, other authors have provided a coherent account of moral reasons not to contribute to collective harms where those harms are likely to be overdetermined (eg, climate change). Barry C & Overland G. Individual Responsibility for Carbon Emissions. In: eremy Moss (ed), Climate Change and Justice, Cambridge University Press, Cambridge, UK, 2015:165–183. Similar reasoning may apply to infection, and this may be a fruitful path for future enquiry.
↵vi It is not merely that these events are earlier in time to the ultimate transmission event of interest (eg, to a vulnerable person) but that it is the combined actions (ie, refusals to vaccinate) of the collective involved in the chain that are together sufficient to cause harm.
↵vii We here assume, for illustrative purposes, that V's infection is not overdetermined—that is, V would not have been infected by another chain of transmitters if the chain of infection from T1 to T100 to V had not occurred.
↵viii Here, and below, we distinguish being blameworthy (or being morally responsible) in theory from being blamed (or being held morally responsible) in practice. While the moral practice of blame might often map onto theoretical accounts of blameworthiness, this need not always be the case. For practical reasons, for example, we may sometimes choose not to actually blame those who are blameworthy (for harm). While the majority of this article focuses on the question of who is morally blameworthy for what (in theory), in what follows we also consider suggestions regarding who should be blamed for what (in practice).
↵ix And following David Lewis, it could be argued that this practice does treat all wrongdoers equally: they are all subjected to equivalent risks of being blamed.2,4
↵x It also anticipates a potential objection in that we need not trace the causal chain back ad infinitum since only some members of the chain had reasonable opportunity to act otherwise: for example, when an outbreak in a high-income country begins with an imported case from a low-income country or a community with poor access to vaccination.
↵xi Cf. Robert Nozick: "Responsibility is not a bucket in which less remains when some is apportioned out; there is not a fixed amount of punishment or responsibility which one uses up so that none is left over for the other."2,5
↵xii Controlled infection would aim to make the person immune and thus pose no risk of transmitting the disease. This would involve intentional infection with medical oversight in an isolated environment where transmission is prevented. Medical oversight decreases risks to the infected individual, but it is worth noting that for many vaccine-preventable diseases there is no curative treatment for most complications, should they arise, which would limit the application of this approach (and demonstrates another advantage of vaccination).
Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Case for persuasion in parental informed consent to promote rational vaccine choices
Jennifer O'Neill, Journal of Medical Ethics, 2020
Protective efficacy of standard Edmonston - Zagreb measles vaccination in infants aged 4.5 months: interim analysis of a randomised clinical trial
Cesário L Martins et al., BMJ, 2008
Two centuries of immunisation in the UK (part II)
Sarah Lang et al., Archives of Disease in Childhood, 2019
Non-specific effects of standard measles vaccine at 4.5 and 9 months of age on childhood mortality: randomised controlled trial
Peter Aaby et al., BMJ, 2010
Should measles vaccination be compulsory
Eleanor Draeger et al., BMJ, 2019
The optimal age of measles immunisation in low - income countries: a secondary analysis of the assumptions underlying the current policy
Peter Aaby et al., BMJ Open, 2012
Testing the hypothesis that diphtheria – tetanus – pertussis vaccine has negative non-specific and sex - differential effects on child survival in high - mortality countries
Should childhood vaccination be mandatory? Yes
Paul A Offit, BMJ: British Medical Journal, 2012
Vaccine mandates in the US are doing more harm than good
Allan S Cunningham, BMJ: British Medical Journal, 2015
Factors associated with incomplete immunisation in children aged 12–23 months at subnational level, Nigeria: a cross-sectional study
Paul Eze et al., BMJ Open, 2021


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Frothed milk is the silky, creamy foam that accentuates the texture of your beverage, while steamed milk adds a bit of natural sweetness to take the bitter edge off your espresso-based drinks.
Making espresso drinks like lattes and cappuccinos just isn't the same without a milk frother or steamer. Without it, your drinks are going to fall flat, and you can forget making latte art.
In this guide, we'll help you pick the best milk frother and steamer so that you can take your coffee game to the next level.
Best Electric Milk Frother – The Secura Automatic Electric Milk Frother and Warmer covers all the bases for frothing and heating milk for most coffee and espresso drinks.
Best Handheld Milk Frother - Aerolatte Original Frother isn't automatic, but gives you more manual control over your froth and heat.
We have chosen 11 milk frother and steamer options in our milk frother reviews for you to check out before you buy.
But before we get to our reviews, you should consider the differences between three main types of milk frothers and steamers for creating and cappuccinos, lattes, and other espresso-based drinks.
What is a milk frother and what does it do? Here are the 3 types available for home use.
A steam wand style frother works by injecting hot air directly into the milk. You'll see these on the best espresso machines.
They're like an upside-down straw that pushes out hot air. They can take a bit of practice to use: you need good tip placement and temperature control to properly produce foam.
They introduce heat as you use them, meaning that temperature control can be a bit limited. These work very quickly, taking as little as thirty seconds to produce enough froth for one drink.
A hand-held wand frother works by agitating the milk with a whisk and introducing bubbles through this agitation. These come in both electric and hand-powered varieties.
These usually don't heat the milk. This means that you get to control the temperature of the process on your own, but it adds an additional step if you don't want cold foam.
Because I know you might be tempted to, check out our guide Can you microwave milk?
While using these devices is pretty easy, you can't do other things because they need your full attention. They tend to take a couple of minutes to produce a small amount of milk foam.
Pitcher-style frothers feature an agitation device in the bottom as well as heating elements. Most modern frothers in this style can froth and heat separately, giving you complete control over temperature.
They're also completely automatic, meaning that you're free to do other things while your milk froths. They take between one and seven minutes to work, depending on the amount of milk you're agitating or heating.
Typically have a fairly limited capacity which means that you can froth enough milk for a single large cappuccino, but not much more than that.
Okay, so what do we recommend? The following products are our top picks for the best milk frothers and warmers on the market.
The Secura Automatic Milk Frother makes both hot and cold frothy milk. The stainless steel pitcher comes with a detachable base to avoid scorching any wooden table tops in your home.
The markings inside the Secura Frother are quite specific, and there is a minimum fill line so you can avoid burning your milk.
Be prepared for this tool to get quite hot within the nonstick pitcher. Should you notice any scorching, be aware that there is a free cleaning brush included that will help you clear away any burnt milk protein.
Will work with 120v electric plugs as found in the United States.
Can prep both hot and cold frothed milk. Press the start button once for hot and twice for cold.
Has an auto shut off feature.
Holds 125ml of milk for frothing or 250ml for warming.
Be aware that even with the detachable base, this tool should not be submerged. Be prepared to let the pitcher soak if needed.
If you've only got one coffee drinker in the house, this tool is ideal. For more, be aware that this tool will froth milk in about 45 seconds. The second person in line will not have to wait long!
The Breville BMF600XL Milk Cafe Milk Frother offers coffee and hot beverage fans plenty of options. The pot comes with two disks, one for frothing and one for steaming, but both keep the milk moving and prevent scorching. These discs store a magnet on the base of the tool.
For larger households, this pitcher is a great choice as it will make up to 3 cups of frothed milk. The heater allows for a temperature variance from 120 to 160 degrees Fahrenheit / 49 to 71 degrees Celsius, so no risk of burning chocolate or other additives.
a stainless steel interior and exterior, so it is dishwasher safe.
An auto shutoff to avoid bubbly, milky messes.
A handle with plenty of clearance to help you keep away from the hot pitcher.
It's important to treat the pitcher gently.
The frothing discs are held in place inside the pitcher via magnetic force, but if the pitcher gets dinged up the magnets may not seat effectively. Over time, they may be knocked loose during the spinning phase.
Easy to clean and use, the Capresso frothPRO 202 Automatic Milk Frother may be a great starting place for making great milk foam in your kitchen.
Capresso's unit is one of the easiest automatic frothers to clean featuring removable disks and a dishwasher-safe carafe which is a wonderful contrast to some of the other units in this review.
It has two disks and three heat settings to give you complete control over the finished product. It completes a cycle in about two minutes which is not the fastest, but you're free to do other things while you wait.
With an 8 oz frothing capacity, this machine can process nearly twice as much milk peruse as some of the other carafe frothers we recommend. It's still not a colossal amount of milk, but you might be able to make two medium cappuccinos with a single use.
While Capresso only offers a one-year limited warranty, we're not as worried about this model breaking as we are some others and it's fairly inexpensive.
The Chef's Star MF-2 frother offers multiple settings to create either the perfect addition to a hot beverage or stand-alone hot milk. Also, this tool features a separate frothing whisk at the bottom of the pitcher, so you can simply whisk cold milk as an addition to your coffee.
Your Chef's Star frother can heat up to 8 full ounces of milk at one time in under two minutes. If you plan to froth milk, you should only add about 4 ounces to allow for expansion.
This product is best for making a single cup of delicious coffee with plenty of froth, but if you've got many lattes or cappuccinos to make, this tool will take some time!
Automatic carafe-style frothers have two major downsides: You have limited control over temperature, and they tend to be fairly small.
The Aerolatte frother solves both of those issues. Since it's a wand, you can stick it into your own container of milk of any size.
This frother places you in charge of heat control. While this is a bit more work, it also lets you heat your milk to the exact temperature you want, when you want to.
To clean, Aerolatte recommends that you basically froth soapy water and then give it a rinse. This is a total breeze compared to cleaning any of the carafe units we reviewed. You don't need to fiddle with parts or wipe anything down.
Like other carafe frothers, the Epica milk frother produces a bit more foam per use than you'd need for a large cappuccino and needs to be cleaned between uses.
You're not supposed to immerse this unit in water, but cleaning still proves fairly easy, although we prefer the Capresso and Nespresso when it comes to cleaning.
The froth that comes out of this unit is thick with small bubbles. There are two heat settings, enabling the production of hot and cold froth.
You can vary your foam by temperature manipulation: heat milk before frothing for big bubbles, and run once on cool froth then once on warm froth for rich microfoam.
Consider the fat content of your milk as well. Low-fat milk will generate thick, dry foam, while higher fat content will produce a creamier mouthfeel but less dense foam.
Epica has included two frothing attachments to give you additional control.
This unit is almost totally silent. You're not going to disturb anyone or wake anyone up when you use it, unlike a steam wand.
The PowerLix frother is just that: a multipurpose frother that produces plenty of bubbles in cold milk. However, it doesn't heat the milk.
If you like your frothed milk to be hot, you'll need to warm the milk before you start frothing.
However, if all you're needing is bubbles, this is a great tool with plenty of options. The frother includes patterns that will create custom stamps on the coffee, including hearts, snowflakes, and flowers.
The PowerLix comes with its own stand. The whisk is easy to clean stainless with plenty of power, just put in the AA batteries and fire it up.
The Bodum milk frother looks a great deal like a French press and functions in much the same way. However, the frothing filter is much finer than the one you'll find on a French press plunger.
See our French press reviews for a better comparison.
Pour cold, low-fat milk into the frother. Place the cap on the pitcher and rotate the spout to avoid spills. Work the plunger up and down until milk starts to fluff up.
Once it's frothed, if you would like warm milk, simply remove the plunger top and place the glass pitcher inside your microwave.
It's not fancy, but this frother will work consistently, can't overflow without your notice and is most unlikely to burn. Plus, it's an arm workout! The carafe will take up to 8 ounces of milk for frothing so that you can offer several people a great cup of coffee at the same time.
The Bialetti Manual Milk Frother is also ready to help you burn some calories before you drink your coffee! This frother is quite large and has space for three cups of frothed milk.
The Bialetti milk frother will also work as a French press. You will need to take care to clean the filters well, but the fine frothing filter will likely make for a very smooth cup of French press coffee so that the cleanup will be worth it!
Even though this particular model is discontinued, the Nespresso Aeroccino Plus is highly recommended and may still be available online. While it's not perfect, it does what's needed for latte and espresso drinks.
If you need the latest model, check out the Nespresso Aeroccino4 Milk Frother instead.
Hot froth in 70 seconds!
You will need to clean out this unit in between consecutive uses to prevent build up which could cause spillage during subsequent use.
The capacity of this machine is adequate but a little disappointing. While it's really fast, you get enough foam peruse for a single cappuccino.
If you're planning on making multiple drinks at once, consider a hand frother, steam wand, or a unit with a bit more interior volume.
The froth created by this machine is excellent, and you can literally cut it with a knife. It's also one of the fastest with an operating time of just over a minute.
For those who have little patience to wait, this might be one of the better options.
The Verismo milk frother makes it easy to create hot or cold froth for your favorite coffee and espresso drinks. This tool features both a whisk attachment and a blending tool that will create plenty of smooth, velvety milk for lattes.
The power base, ideal for easy storage, especially if your kitchen is small.
A detachable cup, complete with non-stick interior and easy to clean up.
A lid with a plastic insert to keep that frothy milk under control!
You can create both hot and cold froth for the beverage of your choice. This is a very sharp-looking tool and would look great beside your Verismo brewing tool. If you love a daily Starbucks but want to enjoy the convenience of rich coffee at home, check out this tool.
Even if you aren't into espresso-based drinks, frothing milk can add a drastic change to your morning cup of coffee.
We think the Secura Automatic frother is a great choice for those who want easy preparation with plenty of options, while the Aerolatte may be ideal for those just getting started with creating their own beverages and don't want all the bells and whistles.
We love coffee and are always on the lookout for new tips and ideas. Help out a fellow coffee addict by sharing your thoughts and milk frother experiences in the comments below.
We're eager to hear about your favorite milk steamers and frothers and best tips on how to use them.
I have a cheap battery operated hand held stick one (less than $20). A store brand (London Drugs). I've had it for years and still is great.


As a homeowner in Bensalem, Pennsylvania, the best way to make sure the HVAC system in your home remain in good working condition is by understanding how it operates. Even if you can't maintain or fix the HVAC system on your own, you will be able to recognize when it needs maintenance or repair. If you're willing to learn how your HVAC system works, this brief guide goes over the major parts of your air conditioner.
The compressor, which is typically a part of the air conditioner's outside unit, is responsible for changing the pressure of the working gas. While working fluid will enter the compressor in the form of low-pressure gas, the working fluid leaves the compressor in the form of hot, high-pressure gas. The compressor does this by forcing the working fluid's molecules to become closer together. The compressor then transfers the high-pressure working fluid to the condenser. Routine checks for the compressor should establish that there are no broken capacitors or broken valves.
The working fluid enters the condenser as a warm, high-pressure gas. All air conditioners feature metal fins, which work to remove heat quickly from the high-pressure gas. Therefore, once the gas leaves the air conditioner's condenser, it will be much cooler in temperature. The biggest change that occurs to the working fluid in the condenser is that it converts from gas to liquid. The working fluid is funneled into the evaporator through a small hole. During routine inspection, check for leakage and damage to the metal fins.
In the evaporator, the pressure of the working liquid starts to drop. This causes the working liquid to evaporate back into a gas. To become a gas once more, the working liquid needs to use the heat from the air around it. As you check around the evaporator, ensure the cleanliness of the evaporator unit and the fan.
The workings of an air conditioner are not as complex as you may think. Based on this information, if you think your air conditioner is in need of repairs or maintenance, call us at Custom Aire at (215) 638-1800.


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WhatsApp India: Five lynched after online child kidnap rumors
By Swati Gupta and Bard Wilkinson, CNN
Updated 0837 GMT (1637 HKT) July 3, 2018
Incidents involving fake rumors spread via WhatsApp have increased across India in the last month.
New Delhi (CNN) A mob in India lynched five people after rumors spread by WhatsApp messages prompted suspicion that they were child abductors, the latest in a spate of violent crimes linked to the messaging service.
The victims were killed in Dhule district of the western state of Maharashtra on Sunday morning after locals accused them of being part of a gang of "child lifters," police said.
It was the fourth time in recent weeks that WhatsApp messages have inspired deadly attacks in India.
The men, poor agricultural workers from a nearby district, were attacked by a group of about 40 people after they arrived by bus. They were surrounded by a crowd of almost 3,000 people.
WhatsApp messages warning residents of possible kidnappers had been circulating in Dhule for 10 to 15 days.
"Someone starts the rumor and it goes on from there," M. Ramkumar, Superintendent of Police, Dhule, told CNN.
"They (the victims) were traveling to different places to ask for alms," he added.
A police team reached the area after the lynching took place. Two policemen sustained injuries when the mob turned on the officers, said Ramkumar.
Police confirmed a total of 23 people have been arrested in connection with the incident and police are searching for the remainder of the 40 accused. Those arrested have been charged for murder and rioting.
The police have suspended internet and mobile facilities in Dhule district in an attempt to halt the spread of the false messages.
Nationwide spread
Earlier last week, three people were killed in the northeastern state of Tripura after social media, including WhatsApp, rumors of child abduction.
One of the men who was killed Thursday had been hired by the Tripura administration to make announcements through a loudspeaker and warn residents against fake rumors.
The death of a child during a family dispute earlier in the week had fueled fears of kidnap across the region.
Two men killed over false child kidnapping claims on WhatsApp, Facebook
"All over social media, people were sharing (fake images and videos) that child lifters looking for human organs such as kidneys and livers were out in the area to kidnap children," said Smriti Ranjan Das, a senior police official to CNN.
On June 8, two men traveling in a SUV were lynched by a mob in the northeastern state of Assam after rumors that a child was being held in the car spread through the local village on social media sites Facebook and WhatsApp. The car was stopped by locals and the men were pulled out and beaten to death.


These wiry, well-branched stems support thousands of cheerful blooms!
Synonym: T. dipterocarpum. One of the gems of the sunny to lightly shaded garden, this is one of the hardiest Meadow Rues, and certainly among the most beautiful, its lavender petals surrounding a large cluster of bright yellow stamens for a lovely two-tone look that blends into a giant cloud of purple from a distance. Long-blooming and easy to care for, it is a must-have for the rear of the border, the center of the bed, and anywhere you desire a stunning accent planting.
T. rochebrunianum blooms freely from midsummer 'til early fall, its small flowers appearing all over wiry, well-branched dark brown stems. Below it, the foliage makes a bright foundation, its blue-green tones and lush growth contrasting with the airiness of the flowering stems. This perennial reaches 4 to 6 feet tall and 2 to 3 feet wide in the garden, and remains attractive even out of bloom thanks to its healthy foliage and plumply rounded shape.
Native to Japan, this perennial thrives in any moist, well-drained soil, combining well with other summer-blooming perennials from Coreopsis to Echinacea. It makes a fine succession planting to Lupinus, bridging the awkward garden season between summer and fall. Zones 4-7.


Angel Fire Resort features eighty runs, ranging from gentle groomed cruisers to challenging hike-only steeps. With three terrain parks, four gladed tree skiing areas, tubing hill and a full ski and snowboard school, there is something for everyone. We continue to offer New Mexico's only night skiing and our nearby Nordic Center at the Country Club offers cross-country skiing, snowshoeing and sledding.
The entire winter is packed with fun events and activities from fireworks and torchlight parades on Christmas Eve and New Year's Eve to the beach party vibe in March.
Friday - Saturday 9 a.m. to 8 p.m.


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Urbana campus ranked ninth by U.S.News
Aug 19, 2004 9:00 am by Inside Illinois | 217-333-1085HonorsCampus Life
The Urbana campus was ranked ninth among public national universities in the U.S.News & World Report rankings released Aug. 20.
The UI's undergraduate engineering program was ranked fourth among all schools offering doctoral degrees, and the business college was ranked 11th among all schools offering undergraduate business programs. (As is its custom, the magazine provided rankings only for these two disciplines.)
Within the UI engineering college, a number of specialties were highly ranked, including agricultural engineering (2), aeronautical (7), biomedical (25), chemical (7), civil (1), computer (4), electrical (4), environmental (4), industrial (12), materials (1), mechanical (6), nuclear (8).
In the business college, the undergraduate accounting program was ranked second in the nation. Other top-ranked business program specialties: finance (16), insurance (6), international business (25), management (15), marketing (12), quantitative analysis (10), real estate (5).
The magazine's rankings methodology and the complete rankings are on the USNews.com Web site and will be published in the magazine's "America's Best Colleges" issue as well as the weekly edition of the magazine, both of which go on sale Aug. 23.


Some years back, a few of us made the pitch for a "Mythical Midrange Mac Minitower," to use the term coined by Macworld Senior Editor Dan Frakes. I preferred to call it a "headless iMac," since I envisioned something with the guts of the iMac, but without the display. I was thinking of a 21st century equivalent of the fabled Mac IIcx/IIci. These were powerful (for their time) relatively lightweight Macs with a room for expansion cards and other goodies.
Well, Apple has their own concept of what a mid-priced Macintosh should be, at least so far as Steve Jobs is concerned. Don't forget that, under his tutelage, a Mac is primarily an all-in-one computer with minimal expansion possibilities. That tradition was first restored with the original iMac, and let's not forget the various portable Macs over the years. Today's MacBook, MacBook Pro, and MacBook Air families sell far more units that any of the traditional desktop models.
Where the original iMac was a relatively inexpensive entry-level computer, today's iMac, when it comes to performance benchmarks, plays a very close second to the humongous Mac Pro; that is, unless your app diet consists of software that has been specially tuned to sing when extra processor cores are available. For most of you, the difference won't be perceptible, though you will perceive the serious lack of internal expansion.
Yes, Apple does sell some iMacs with a second drive, solid state, in its build-to-order section. This is not something offered by Apple aftermarket, although MacSales, a Mac accessory and memory supplier, will take your 2010 iMac and do the upgrade for you in their own facility, if you care to live without your computer for a few days. And, of course, spend lots of extra money for the convenience of that extra drive.
Now since Apple is offering an iMac with two drives, would it take very much engineering to provide easy rear access to a second drive slot? That way you could buy your own internal expansion drive, mechanical or solid state, whenever you want, and simply pop it in. Understand I realize that retrofitting the current model is a chore, but surely Apple's brilliant designers can devise a user-friendly alternative.
Now remember that most people who buy a Mac Pro do it because of the ability to add up to four internal drives, plus expansion cards. But let's not go there, because a second expansion card isn't really practical in an iMac, unless Apple somehow achieves much greater feats of miniaturization. The solution is Thunderbolt, with essentially gives you a two-way external PCI Express port for up to six devices. You can add a second display, hard drives, and whatever accessory makers design in the months to come.
Suddenly, the iMac becomes a worthy replacement for the Mac Pro for many power users and content creators. Yes, I realize that, as consumer-grade processors become faster and gain extra cores, the workstation parts, such as the Intel Xeon, will also gain in CPU horsepower. Depending on Intel's design goals, there probably won't be a convergence, where a single product line serves both consumers and professional users.
Regardless, it's clear to me that the iMac, though a descendant of the original compact Mac, can serve a variety of customers with different needs, at a pretty affordable price. Yes, I grant there are loads of PC boxes that sell for hundreds less. But when it comes to all-in-ones, the iMac is extremely competitive.
As I said before, I realize there are many Mac users, although the number continues to diminish, for whom an iMac is a poor substitute for a digital audio or video workstation. Although the form factor is wrong, Apple also expects Mac Pros to also serve as high-end replacements for the now-departed Xserve. The low-end is occupied by a special Mac mini, and that actually may be enough server in certain environments. Indeed, a Mac mini with Thunderbolt port (and I expect one to arrive in the near future) will mean that you can hook up high-performance RAID drives. Maybe it won't offer the redundancy of a real server, meaning the second power supply. But the mini is cheap enough that, if it fails, the techs at the data center can quickly unplug the external drives and move them to another box.
As far as the iMac Pro is concerned, actually you don't have to call it a "Pro," or offer any special model designation. Since Apple already gives you a two-drive option, the only real change involves making the expansion process easy for customers. Again, it probably won't cost a lot for Apple's engineering team to devise a solution.
Unfortunately, Apple continues to make far too many products that are hostile to internal changes, except in a very limited way. I realize it'll probably never happen on an iPhone or an iPad, though I suppose an SD card and/or Thunderbolt port might be practical some day for the latter.
As with the "Mythical Midrange Mac Minitower," this is probably all a pipe dream. Apple no doubt has other priorities.
This article was posted on Friday, March 25th, 2011 at 12:00 AM and is filed under News and tagged with: Apple, Dan Frakes, iMac, IMac G3, Iphone, Mac Mini, Mac Pro, Macbook, MacBook Air, Macbook Pro, Macintosh, Macintosh IIcx, Macworld, RAID, Steve Jobs, Thunderbolt port, Xserve.
i imagine a small door like that in overalls to use the potty. snap- it opens, pull the drive out of its sata/2 connectors, plop a new drive in, reinstall or migrate. simple. not too hard. used to be a Lead Macgenius- so I know it wouldnt be too much trouble- theres lots of room in most imacs for a few clips/hinges.
What is the fixation on internal expansion? What if Thunderbolt was ten times faster and wireless? Would you still want a computer with empty bays in it to hold things? Most people would rather have a smaller computer. Besides, I'd rather have my expansion stuff outside, so I could swap out any attached component or the main computer itself.
Would it be less of an issue if everything stacked like Legos? What if someone sold an expansion chassis?
I've often wanted Apple to put their spin on a modular and easily upgraded system. Unfortunately the closest they have ever come to that is the awesome internals of the Mac Pro.
I'd like something even more idiot proof that could be configured from parts supplied by Apple where motherboards and other previously internal components could be hot swapped and automatically accepted by the system.
Perhaps the Thunderbolt bus could drive something like this forward?
Apple has been stepping on the Mac Pro's oxygen tube for a while — not killing it outright, but letting it slowly slip away.
The message is clear from Cupertino — the future for them is all about products that users don't customize themselves.
Thunderbolt may provide some external options, but the innards, from software to hardware, are all going on lockdown.
Complete lockdown of the guts is a Steve Jobs trademark. He wants to sell appliances, not customizable electronics. Thunderbolt will go a long way toward eliminating the need for additional internal expansion capabilities. Once the iMac ships standard with an SSD boot drive, large HD for data and Thunderbolt it will suffice for most customers.
– the iMac GPU is rarely anything but merely adequate and will never offer good performance for those working on multiple displays with 3D or high res 2D. Apple's obsession with thin cases and low power draw means that a high performance GPU is completely out of the question.
– I have never been satisfied with the quality of external drive enclosures.
I'll spare you the horror stories from me, the retail customers I served for 4 years and the company I now work for. I've witnessed over 100 enclosure failures, a couple dozen causing data loss.
As Apple aren't a company that are big on 'options' I guess the ability to hang whatever antiglare display/s I choose off of whatever videocards I can get my hands on is an obvious benefit over an iMac to me.
If Apple could not crank out an iMac with a few extra access doors in nothing flat, then they should hire some new engineers. The problem is, instead, that Apple really does not care to do so. Apple is many things, but they are not a company which cares to listen to customers or wants the customer to be able to change, upgrade, or expand the capability of their equipment. Indeed, I believe Apple would just as soon permanently seal the unit at the factory to prevent it being opened by anyone, which is both sad and unfortunate as it drives people who need that capability to other providers of solutions. In doing so Apple, Apple marginalizes itself in ways no competitor could hope to do and makes the decline of the Mac platform a self-fulfilling prophesy.


Giridhar, one of those present called quite excited after the programme saying how happy he was that he got an opportunity to watch this movie. I recently saw the movie for the second time in full and yet again felt amazed.
Gripping. The Krishna Arjuna war or Arjuna's penance is an imporatant work in TN. Thevaaram, Bharavi's sanskrit work Kiratarjuniam in sanskrit which was composed when he was the court poet of Mahendra Pallava, The mamallapuram Arjuna's penance and the miniature of chila period & pallava period.


Vincent is a painstaking researcher and he has gathered an unrivalled collection of printed items relating to life in North Kerry in the century between 1870 and 1970. He now shares this collection with us in this beautifully produced book… a collector's item.
Posters, tickets and playbills etc. were usually displayed for a while and then discarded. But Listowel is lucky to have a collector who saw the value of these documents as an important piece of social history. In this book, Vincent shares with us his huge collection of printed memorabilia along with his knowledge of the stories behind the posters.


Besides Rocky Mountain Calvary Chapel, there are seven other Calvary Chapel's in Alberta. If you are looking for other Calvary Chapel churches around Alberta during your travels, visit one of these churches.
We are thankful for the faithfulness of the LORD Jesus Christ in adding to His Church as He so desires. We are grateful for the call on hearts of men to shepherd the flock of God across our nation. We are a fellowship of churches.
The Calgary Dream Centre is a faith-based recovery organization working to help individuals escape the cycle of homelessness and addiction through a holistic process of transformation.
The Messenger mission is from Matthew 28:19 "Go therefore and make disciples of all the nations". Their goal is to organize events that purposefully share the hope and life changing message of Jesus Christ.
The Mustard Seed is a Christian not-for-profit organization that is committed to following the example of Christ in caring for the poor and bringing dignity to the marginalized.
non-profit agency offering assistance for anyone facing an unplanned pregnancy or experiencing post abortion stress.
Vigilant Minds is a cult recovery ministry that provides confidentiality, assurance, fellowship, information, and direction. They exist to assist with spiritual healing through the love and grace found in Jesus Christ.
worldwide by fostering an understanding of God's Word through Bible translation, while nurturing literacy, education and stronger communities.


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Hampshire /
Petersfield /
Comedy All Stars The Little Summer Show Theatre & Performing Arts
aldy74
The biggest comedy club in the land returns with its little show In Petersfield!
James Alderson brings the second little Comedy All Stars show to The Studio at The Petersfield School with another great line up to please everyone!
Opening the show is Ria Lina recent star of The World Stands Up! Armed with her Ukulele and songs to make you cry with laughter, Ria is bringing her hilarious set to Petersfield for the first time after storming the Horndean Big Show Back last year! New songs and new jokes too!
Next up is South Coast Comedian of the Year Mike Cox, a rising star for sure. Mike is starting to play some of the biggest clubs in the land, and you'll see why in this show!
Headlining is current TV favourite Stephen Bailey - who has just hosted his own TV special on Comedy Central! Not only has Stephen been host of Celebs on the Farm in the UK, but also Celebs on The Ranch in the states, and a regular host on Big Brother's Bit On The Side. You'll also recognise him from Comedy Central's Roast Battles, Live At The Comedy Store, as a regular resident co-host on Zoe Ball on Saturday/Sunday, made his acting debut in Coronation Street in 2018, and his first stand-up special will be aired on Comedy Central in 2019!
Don't miss this great night of Summer comedy in air conditioned surroundings, with a cheap bar, free parking and all held together by an award winning host!
TICKETS: http://www.wegottickets.com/event/457751
Date(s)27 Jul 2019
WebsiteVisit website
VenueThe Studio @ The Petersfield School
AddressCranford Road, Petersfield, Hampshire,
GU32 3LU
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The Good Intent
ROOMS FROM£60
836mAWAY
Offering a restaurant and a la carte restaurant, The Good Intent is located in Petersfield. This 16th-century coaching inn offers free Wi-Fi and free private parking on site..
Postcode: GU31 4AF
Distance from The Studio @ The Petersfield School:
CHECK AVAILABILITYHotel details, map & prices
The Half Moon
2.22kmAWAY
Featuring free WiFi, The Half Moon offers pet-friendly accommodation in Petersfield. Guests can enjoy the on-site bar. Free private parking is available on site.
Postcode: GU31 4BE
Mays Cottage Bed and
Mays Cottage Bed and Breakfast offers accommodation in Petersfield. Free WiFi is offered throughout the property and free private parking is available on site. Each room is fitted with a flat-screen TV.
Postcode: GU31 5AB
The Cricketers Inn
The Cricketers Inn is a country pub with en suite rooms, free on-site parking and a restaurant & bar. Other features include regular music nights, home-made pizzas made in a wood-fired oven and cream teas..
Postcode: GU32 2DW
Mallards
ROOMS FROM£86.17
Featuring free WiFi throughout the property, Mallards is a holiday home, set in Steep. The property is 37 km from Southampton and free private parking is available. There is a seating area and a kitchen.
Postcode: GU32 2BL
Poet's Barn
ROOMS FROM£209.83
Poets Barn offers pet-friendly accommodation in Steep, 36 km from Southampton and 28 km from Portsmouth. The unit is 47 km from Reading. Free private parking is available on site.
Postcode: GU32 1AA
View all hotels near The Studio @ The Petersfield School
Disclaimer: This event is not organised by BritEvents, and we cannot be held responsible for the accuracy of the information provided, errors, or omissions. Always check the information provided before you book tickets.
Time(s) 8:00 PM - 10:30 PM
Cost 10
Venue The Studio @ The Petersfield School
Cranford Road
Category Theatre & Performing Arts
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Kids, youth, householders or ascetics, everyone's a fan of Shiva. So just what makes Shiva so cool? Here's 5 reasons.
Sadhguru: It is not just gods who worship Shiva. Demons, goblins and all kinds of creatures worship him. Ghosts, ghouls, goblins, devils, demons – all those beings rejected by everyone – Shiva accepted them.
When his marriage happened, the tradition goes about describing that everybody who was anybody, everybody who was somebody, everybody who was nobody – they all attended. All the gods and divine beings, all the asuras, demons, demented beings, devils and ghosts – everyone came. Usually, these people don't get along with each other. But in Shiva's wedding, everyone was there. Because he was "Pashupathi", the Lord of animal nature, all the animals came. And of course, the snakes wouldn't miss it, so they all came. The birds and insects didn't want to miss it, so they were guests too. Every living creature came to this wedding.
What the story is trying to say is, when we talk of this being, we are not talking of a genteel, civilized man but of a primal figure, in a state of absolute oneness with life. He is pure consciousness, completely without pretention, never repetitive, always spontaneous, forever inventive, ceaselessly creative. He is simply life itself.
Sadhguru: Generally, Shiva is the symbolism of ultimate masculinity, but you will see in the Ardhanarishvara form of Shiva, one half of him is a fully developed woman. Let me tell you the story of what happened. Shiva was in an ecstatic condition and because of that, Parvati was drawn to him. After Parvati did many things to woo him and sought all kinds of help, they got married. Once they were married, naturally, Shiva wanted to share whatever was his experience. Parvati said, "This state that you are in within yourself, I want to experience it too. What should I do? Tell me. I am willing to do any kind of austerity." Shiva smiled and said, "There is no need for you to do any great austerity. You just come and sit on my lap." Parvati came and with absolutely no resistance towards him, sat on his left lap. Since she was so willing, since she had placed herself totally in his hands, he just pulled her in and she became half of him.
You need to understand, if he has to accommodate her in his own body, he has to shed half of himself. So he shed half of himself and included her. This is the story of Ardhanarishvara. This is basically trying to manifest that the masculine and the feminine are equally divided within yourself. And when he included her, he became ecstatic. What is being said is that if the inner masculine and feminine meet, you are in a perpetual state of ecstasy. If you try to do it on the outside, it never lasts, and all the troubles that come with that are an ongoing drama!
#3 He "destroys" the dance floor!
Sadhguru: Natesha or Nataraja – Shiva as the Lord of Dance – is one of the most significant forms of Shiva. When I visited CERN in Switzerland – where all the atom-smashing takes place – I saw that there is a Nataraja statue in front of the entrance, because they identified that there is nothing in human culture which is closer to what they are doing right now. It represents the exuberance of creation, the dance of creation which self-created itself from the eternal stillness.
Sadhguru: Shiva is constantly represented as a drunkard and an ascetic at the same time. He is a yogi – if he sits in meditation he won't move. At the same time, he is always drunk and inebriated. This doesn't mean he was going to the local bar! The science of yoga gives this possibility that you can remain calm and still be in an extreme sense of pleasure all the time. Yogis are not against pleasure. They are just unwilling to settle for little pleasures. They are greedy. They know if you drink a glass of wine, it just gets you a little buzzy and then tomorrow morning you get a headache and everything. You can enjoy intoxication only if you can be totally drunk but hundred percent stable and alert. And nature has given you this possibility.
So all you have to do is produce a little bit of Anandamide because there is a whole marijuana garden inside! If you cultivate it properly and keep it on, you can be stoned all the time.
Sadhguru: When you say "Shiva," it is not about religion. Today, the world is divided in terms of which religion you belong to. Because of this, if you utter something, it looks like you belong to some religion. This is not religion, this is the science of inner evolution. This is about transcendence and liberation: it does not matter what your genetics are, who your father was, or what limitations you are born with or acquired, you can transcend all of that if you are willing to strive.
Nature has set some laws for human beings – they have to be within that. Breaking the laws of physical nature is spiritual process. In this sense, we are outlaws, and Shiva is the ultimate outlaw. So you cannot worship Shiva, but you may join the Gang.