On the Efficacy of Flu Vaccine 430
The Atlantic is running a major article questioning the received wisdom about flu vaccines and antivirals, for both seasonal flu and H1-N1. "When Lisa Jackson, a physician and senior investigator with the Group Health Research Center, in Seattle, began wondering aloud to colleagues if maybe something was amiss with the estimate of 50 percent mortality reduction for people who get flu vaccine, the response she got sounded more like doctrine than science. 'People told me, "No good can come of [asking] this,"' she says... Nonetheless, in 2004, Jackson and three colleagues set out to determine whether the mortality difference between the vaccinated and the unvaccinated might be caused by a phenomenon known as the 'healthy user effect.' Jackson's findings showed that outside of flu season, the baseline risk of death among people who did not get vaccinated was approximately 60 percent higher than among those who did, lending support to the hypothesis that on average, healthy people chose to get the vaccine, while the 'frail elderly' didn't or couldn't. In fact, the healthy-user effect explained the entire benefit that other researchers were attributing to flu vaccine, suggesting that the vaccine itself might not reduce mortality at all." Read below for more excerpts from the article.
The annals of medicine are littered with treatments and tests that became medical doctrine on the slimmest of evidence, and were then declared sacrosanct and beyond scientific investigation. ...
This is the curious state of debate about the government's two main weapons in the fight against pandemic flu. At first, government officials declare that both vaccines and drugs are effective. When faced with contrary evidence, the adherents acknowledge that the science is not as crisp as they might wish. Then, in response to calls for placebo-controlled trials, which would provide clear results one way or the other, the proponents say such studies would deprive patients of vaccines and drugs that have already been deemed effective. ...
In the absence of better evidence, vaccines and antivirals must be viewed as only partial and uncertain defenses against the flu. And they may be mere talismans. By being afraid to do the proper studies now, we may be condemning ourselves to using treatments based on illusion and faith rather than sound science.
All I have is an anecdote (Score:3, Interesting)
Re:All I have is an anecdote (Score:5, Insightful)
If its four or five days from two illnesses then its not Flu. Thats a cold.
Re:The one crucial point (Score:5, Informative)
The WHO and CDC are driving the H1N1 vaccines, not the vaccine companies. No matter how good the lobbyists for the vaccine companies are, they aren't good enough to get the government to step in and bear the liability without some government agency agreeing that there is actually something there to address.
(The issue with H1N1 is not its lethality once it has infected a person, but how good a job it does of infecting those who are exposed)
Re:The one crucial point (Score:5, Insightful)
No matter how good the lobbyists for the vaccine companies are, they aren't good enough to get the government to step in and bear the liability without some government agency agreeing that there is actually something there to address.
Huh?
The US Government backstops liability for all vaccines, except where it grants outright immunity from lawsuits.
1986: http://en.wikipedia.org/wiki/National_Childhood_Vaccine_Injury_Act [wikipedia.org]
The liability is otherwise so big that no private insurer will touch it.
(Same thing goes for nuclear power.)
Both the USA's dept of Health and Human Services (HHS) and the European Union's Parliment have granted pharmaceutical companies immunity from lawsuits relating to H1N1 vaccines. The USA's HHS Secretary went one step further and granted immunity for all future swine flu vaccines.
I'm not sure how Europe normally handles vaccine liability, but I'm sure a /.er can fill us in.
You're right though that the WHO and CDC are driving the H1N1 vaccines.
They're so desperate to get out ahead of the flu that they're accepting calculated risks.
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A recent Time article about the virus and vaccination said that the 2 billion for this round of H1N1 vaccines may very well have saved the vaccination companies. The big drug companies don't usually want to make vaccines, not sexy enough or profitable enough. The few small players in it do a steady business but don't get big chunks of money for R+D. This vaccination for everyone changes this a bit. It also may encourage the big pharm companies to get back into the game, I heard a recent radio news bit about
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A few billion dollars spent on vaccines is going to save hundreds of thousands or millions of lives. That's a fucking fantastic cost-benefit ratio for public health dollars.
Re:The one crucial point (Score:5, Insightful)
You seem to be confusing the current seasonal flu with the pandemic of 1918.
They are by no stretch of the imagination comparable.
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H1N1 is a particular strain of influenza A that has made its way around the world and vaccination against this strain is being done separate from the seasonal flu shot. Concern over this strain is related to its virulence and early reports of death amongst young, immunocompetent individuals - people normally not adversely affected by influenza.
The common cold and the flu are not the same thing - there is a believed to be a high mortality from influenza ( http://aje.oxfordjournals.org/cgi/content/full/163/2 [oxfordjournals.org]
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But, that's not the scenario that we're in. We're looking at billions for the vaccines, and tens or hundreds saved. Not thousands. not millions. With the incomplete testing done, and many assumptions being made (hey, it's similar to something else, it oughta act the same).
According to the CDC, the vaccine can cause Guillain-Barré Syndrome in 1 of 100,000 treated, or roughly 3,000 people in the United States (by the 2008 US Census population estimate).
T
Re:The one crucial point (Score:5, Insightful)
No, it shouldn't. Pandemic refers to the number of people infected and how quickly it spreads, not how deadly it is. People should fucking learn what this term means, rather than assuming it means "AMAZING DEADLY SUPER VIRUS". We should NOT redefine it to mean "SUPER DEADLY SUPER VIRUS".
Swine flue IS a pandemic. It's not super amazingly deadly, but it IS a pandemic. The paranoia is not the fault of the government. This paranoia is the fault of the dipshit idiot populous that elects idiots into the government and then ceases to think for themselves.
Re:The one crucial point (Score:5, Insightful)
Actually, if anyone bothered to look into it, rather than listening to the media outlets, 'the swine flu' is less than half as likely to kill you as the average seasonal flu. By 'average seasonal flu' I mean take the past 50 years worth of deaths related to seasonal flus and you'll find about 0.12% of the infected people die. By contrast, 0.05% of those infected with 'the swine flu' have died.
It is a pandemic, but the flu has been a pandemic forever, as is the common cold. The media just doesn't have anything else to get our attention so this is what they exaggerate into being scary.
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The problem is that H5N1 is rattling around out there, and it can cross-breed with H1N1 strains. So far H5N1 doesn't spread well in humans, but it *is* quite deadly. If someone gets two strains of flu at the same time, they're likely to hybridize. So it's important to keep flu infections to a minimum. Given time, H5N1 will become less deadly as it evolves to live with people, but it needs to have it's numbers kept down until it does. And that means don't give it the genes that H1N1 uses for spreading.
Re:The one crucial point (Score:5, Informative)
Pandemic: An epidemic (a sudden outbreak) that becomes very widespread and affects a whole region, a continent, or the world.
Influenza A Virus Subtype H1N1(commonly called the swine flu) erupted suddenly, became widespread, eventually being found on all continents(save Antarctica).
Therefore, yes, H1N1 is, by definition, a pandemic.
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No, H1N1 is not a pandemic. H1N1 is a CLASS of influenza viruses, and its not a new class. 'The swine flu' is a member of the H1N1 class. The class is the most common, by a land slide.
You've had a H1N1 infection before unless you're a few months old.
'The swine flu' is by definition a pandemic.
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Also, almost no one has any natural immunity or resistance to H1N1, and it would take quite a chunk out of the economy if ~1/4 of the workforce were to have to take two to three weeks off sometime this winter...
Re:The one crucial point (Score:4, Insightful)
Anytime there's a controversy over vaccines or prescription drugs, there is only one thing that needs to be widely understood by everyone: pharmaceutical companies cannot make money from healthy people.
Of course they can.
Between 1900-02, the life expectancy at birth was 49.24. In 1997, the life expectancy at birth was 76.5. Statistic [bc.edu]
Keeping your customers healthy now pays big dividends later.
Healthy people age into old age. Well, duh.
They have families. They have pets. They work longer and have more discretionary income.
That makes it worthwhile to invest in a broad spectrum of products that would have had little meaning to the industrial laborer of 1920 who was unlikely to see his fiftieth birthday.
Re:The one crucial point (Score:4, Insightful)
"Pharma doesn't make a dime from healthy people."
Well, that's a myth. Pharma makes big dollars *even* from healthy people. All you need to consider is that "cosmetics" is another name for "pharma".
"They want you in poor health, but not quite ready to die."
That's not exactly true. An overall ill society is not a society that will pay for expensive treatments. Pharma needs a healthy mixture (pun intended) of long-term ill people and healthy people to pay for the treatment; that's why you see a lot of investment on first world-low impact illnesses (when treated) like obesity, hypertension or diabetes or, the best of all, cosmetics (where the "illness" is only in the mind of the buyer) but so little on, say, malaria.
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Basically, what I am saying is that you cannot trust the Bible(a religious, not scientific, book) to tell you the average age of people.
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I assume that if a person has high fever with a sudden onset and extreme fatigue [wikipedia.org] then they won't be back at work in a couple of days.
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Re:All I have is an anecdote (Score:4, Informative)
There was something that went around in 1979 of that sort -- you could watch it hopping from person to person as exposure occurred. Two or three days incubation, sick as hell for 24 hours (everything emptied out both ends), then it went away as suddenly as it came, with no aftersymptoms.
However, most short-term stomach/intestinal upsets are not flu. Per some hospital studies, about 90% of presented cases are actually food poisoning.
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If you missed 2-3 days work then it wasn't the flu anyway. So it must have been coincidental.
Personally, I've never ever had a flu vaccine. But I don't think I've ever had the flu either, certainly not in the last 15 years. Sure, flue-like-symptoms but only for a few days at a time.
Well one time went for longer, but that turned out to be sinusitis, and my god did those headaches hurt.
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What else changed when you started getting the flu shot? If you now have a mind to protect your health by getting the shot, then you're probably also doing more things like washing your hands, eating better, etc
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I have an anecdote for you, the four years I received a flu shot I didn't get the flu until the next March or April. And it happened all four times! So I consider them useless for me, just postpones influenza until the weather is much nicer. I'd rather have my flu when the snow is piled high and its below freezing thanks
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You can call this the death of common sense due to overspecialization, or whatever you like, but it isn't difficult to apply a little logic to foresee the result. Given that information, it should be obvious that the vaccine will not stop the flu and will not protect you from getting the flu. It will only determine which strain you get.
The latter applies if and only if you are actually exposed to one of the strains that the vaccine does not cover, which has fairly low probability, as the strains that the vaccine covers are the ones that are determined to be the most common that year. Then as "those strains decline and other strains become dominant", the vaccine shifts to cover the new most common ones the next year.
Re:All I have is an anecdote (Score:4, Informative)
Logic doesn't help you if you don't understand the biology of influenza. It's not like there are several strains of influenza just waiting around, hiding in trash cans for the poor sap that gets immunized against it. During a given season, Influenza comes in waves of a particular strain, and in some cases, a couple of strains. It is a bit of a dance to figure out which strains are going to hit a given area six months in a year to advance. You can google for the particulars but epidemiologists have had a reasonable measure of success getting it right.
Even with that knowledge, we've known that influenza vaccines aren't all that good. What you have is a treatment with few downsides (and there are complications from the vaccines, they just aren't all that common) and a few upsides basically a modest benefit. This sort of treatment, while depressingly common from an epidemiology standpoint, makes "soundbite medicine" rather difficult and makes it hard to argue for any given protocol.
Something that seems to be missing from this whole affair is the built in experiment that this creates. If you can deliver the vaccine to a very broad spectrum of a population and let the individual decide if they want the vaccine, then you'll have large numbers of both cases - vaccinated and unvaccinated. IF you had a mechanism to track this (and that's where we fail here), then in six months and one year, you query those people, see if they're still alive. After all, we don't care if you died from influenza or the marthambles - if the vaccine keeps you out of the grave, then it's a win. That would answer the bottom line question of whether or not the vaccine actually helped you. You need big numbers to prevent a number of pre selection biases, but it's sort of doable.
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> then in six months and one year, you query those people, see if they're still alive. After all, we don't care
> if you died from influenza or the marthambles - if the vaccine keeps you out of the grave, then it's a win.
Er... death isn't the only consequence worthy of avoidance. That's the same logic health insurance companies (and government agencies in countries with socialized medicine) use in non-pandemic years when trying to argue that Tamiflu and Relenza aren't cost effective, on the grounds tha
this article has many problems and is bad science (Score:5, Informative)
Re:this article has many problems and is bad scien (Score:4, Insightful)
"H1N1 flu is demonstrably lethal to children, healthy young adults, and people under 65 with common preexisting health conditions like asthma or HIV."
What you seem to forget is that seasonal flu -*any* year's seasonal flu, is demonstrably lethal to children, healthy young adults, and people under 65 with common preexisting health conditions like asthma or HIV.
Certainly all this issue seems to be poisoned by sensationalist press beyond repair, one way or another but, to-date, all objective measures seems to point that while H1N1 *could* have been a tragic deathly pandemia it will be no significantly worse than any other seasonal flu (and even its very highly contagious rates owes a significant percentage to the fact that it is actively seeked and diagnosed), but Pandora's box is already opened and it's in no one interest (press, pharma, government) to try to close it now.
"I'm sick and tired of seeing popular magazines make selective and incorrect use of data and invalid logic to draw incorrect conclusions that mislead the public"
That's the way the go with everything, so no surprise there.
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You're oversimplifying. Generally speaking, the flu strains that are going around in any given year are related. Yes, there are different strains, but they usually have very similar surface proteins. So it's true that the vaccine you get in any given year is not guaranteed to exactly match the strains you are exposed to. Nobody even pretends that it will. Mass vaccination is all about statistics - reducing the number of people who get infected so that the spread of the disease is limited, and peop
Scientists don't get to say "we don't know" (Score:2, Interesting)
Not that the medical establishment even gets trained to do this. The last thing a sick person wants to hear is "we haven't got a clue what's happening".
Anecdotes are all we have in everything except the exact sciences. All other sciences is based on anecdotes and stories, or their similar, but more systematic brother : data. Only things confirmed by controlled and direct experiments is real, trustworthy data, only such things lend themselves to real predictions. And most sciences, like medical science, clim
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I mainly agree with you. Just a few quick points.
1. Funding issues will, for evolutionary reasons (i.e. whether a scientific career 'lives' or 'dies') have a profound effect on prevailing attitudes in the mainstream of various areas of the sciences (i.e. if your research group generally turns out pro-drug papers in journals, you are more likely to get pharmaceutical sponsorship than if you don't.)
2. The 'no scientific evidence' argument appears many times in an attempt to discredit an unpopular idea. The
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I had the same result from simply drinking water (Score:4, Interesting)
During a typical winter I would be sick at least twice on average, usually missing about four or five days of work in total. Since I've started having seasonal flu shots I have not had any winter illness and missed no time from work.
Since we're going into anecdotes I can say I used to get a bit more sick than that, about three times a winter with usually one incredibly bad illness lasting about a week.
I stopped drinking soda, and drink water instead, and now I might get one mild cold a winter but sometimes not. I get about the same level of exercise and eat about the same (i.e. whatever the hell I want) with perhaps a touch more vegetables.
That's also all without ever having a flu vaccine shot. You have to wonder if just a few simple lifestyle changes across the U.S. would not totally eclipse any benefit from flu shots. And since I am not getting sick as often, I'm also not getting other people sick as often - the exact same benefit some claim for the vaccine approach. Only my overall health in all other matters is better too, unlike a flu vaccine which prevents only one thing, and temporarily at that (I have nothing against things like polio vaccines which make a ton of sense because they last forever).
It's not you, it's who you'd infect (Score:5, Insightful)
The flu shot is not about preventing you from dying. It's to avoid you from getting sick and infecting other people who may have weaker immune systems and have higher risk of dying if they get sick.
question for you: (Score:3, Interesting)
>The flu shot is not about preventing you from dying. It's to avoid you from
>getting sick and infecting other people who may have weaker immune
>systems and have higher risk of dying if they get sick.
It's been a long time since biology classes in high school.
Even if I'm immunized, can't I be a carrier?
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I don't think you can be a carrier of a virus the way you can a bacteria (i.e. Typhoid Mary)
Sure you can. A "carrier" in that sense is just someone who has the disease but doesn't appear to have symptoms. But that's subjective -- i.e. how many sneezes or coughs equal one flu?
It's estimated that as much as 90 percent of all sexually-active adults have contracted HPV, the virus that causes genital (and other) warts, and a big part of the reason why HPV is so successful is because so many carriers are asymptomatic.
Lies! (Score:2)
1918 (Score:2)
In a widely spread pandemy we all could get a chance of exposion, and there is where vaccines will make a difference.
Even with modern antiviral and antibacterial drugs, vaccines, and prevention knowledge, the return of a pandemic virus equivalent in pathogenicity to the virus of 1918 would likely kill >100 million people worldwide. A pandemic virus with the (alleged) pathogenic potential of some recent H5N1 outbreaks could cause substantially more deaths.
[T]he 1918 virus is the likely ancestor of all 4 o
Editorializing (Score:4, Insightful)
Re:Editorializing (Score:4, Insightful)
All you have to do is look up Vaccine on Wikipedia to see some people don't like vaccines for whatever reason ("it's god's will that we die" or whatever). Not worth giving those freaks any more attention, really, unless these claims are different in some way.
Freaks are against science, yourself included (Score:4, Insightful)
All you have to do is look up Vaccine on Wikipedia to see some people don't like vaccines for whatever reason
It's stupid to inject yourself with something that does nothing. Especially when the thing that may not do anything for you, also has a non-zero chance of side effects that are much less pleasant than the original thing you were trying to prevent. That's a pretty good reason.
This article points out that we don't really know if the flu vaccine (any flu vaccine) does anything.
Since there is no good evidence either way, "better to be safe than sorry" can apply either way too. Which makes your heavy-handed dismissal of those questioning the flu vaccine every bit as faith based as the "freaks" you look down on with such contempt.
Meet the enemy, for he is you.
Re:Editorializing (Score:5, Insightful)
The problem with this article is that Ms. Jackson isn't even asking the right *question*. Of *course* healthy people don't get a significant personal benefit from being vaccinated. Nobody ever said they did. If all you care about is yourself, and you are healthy as an ox, then by all means don't get vaccinated. Not getting vaccinated is a great way to get your inheritance early. Just get H1N1, then visit your elderly uncle to cheer him up. You'll transmit the virus to him, he'll die, and you'll be rich. But if you want your elderly uncle to live, or, worse luck, he's already written you out of the will, then you might as well get vaccinated.
IOW, the point of the vaccine is to prevent the pandemic, not to protect you. So the *right* question to ask is, does the H1N1 vaccine confer any immunity to the recipient? This is a question that can readily be answered by an epidemiology study, and that can also be ethically studied in a double-blind study - just vaccinate half of a healthy population, don't vaccinate the other half, and see how many get H1N1 and how many don't. The problem is that if the vaccine works, you don't know until it's too late. So it's good for checking your work, but no good for making the decision as to whether to do mass vaccinations - mass vaccinations are pointless after the pandemic has run its course.
I suspect that epidemiology studies are just as good for evaluating the efficacy of the vaccine *after* the pandemic has passed anyway, so that's probably why they don't do double blind studies. But I'm not a virologist, so that's just a WAG.
What I really wish people would do would be to stop coming up with conspiracy theories about vaccines - these are really harmful. Information is what we need, not panicked hyperbole.
As soon as you mentioned "Group Health"... (Score:5, Informative)
... I became biased against any conclusion. Up here in the Pacific Northwest, the common nickname of this HMO is "Group Death". They're not exactly known for high quality care or cutting edge research - they're mainly known for denying treatments as "experimental" for years after those treatments have become the norm in most medical circles.
I remember an acquaintance (husband of a co-worker) who kept getting denied treatment for (IIRC) a persistent and very painful hydrocele. The Group Health doc told him nothing could be done - surgical correction of this was "experimental and dangerous". Finally out of desperation they consulted with an outside doc, who told them this was a very simple routine procedure! They paid out-of-pocket for the surgery, and the problem was quickly rectified.
I know nothing about the particular doctor who did this flu vaccine study - but, given her employer, I have very little confidence that she is particularly knowledgeable. I'm sure Group Health would love to save the 15 or 20 bucks per patient they're currently having to spend on this vaccine.
Re:As soon as you mentioned "Group Health"... (Score:4, Insightful)
But bear in mind that if she's wrong the company's costs, on balance, will be much higher when their insured start showing up in the hospital not having gotten the vaccine. The vaccine, if it works, should be a cost saving measure for them.
It seems to me that they'd want to get this right.
(This is all subject, of course, to speculation on my part regarding the cost of the vaccine, versus the cost and likelihood of hospitalization in its absence. Though I'd point out that, if the vaccine isn't cost effective for the insurer, they could elect not to cover it regardless of its effectiveness.)
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... we should fear goverment run health car...
Would they just run you over with that car when you hit a certain age? A bit like Death race 2000?
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I was a group health member for many years. I would speak well of it,. But mainly I wanted to speak to the perjogative "group death". It happens group health started up about 1948. The local AMA hated it. They did things like kick the group health docs out of the chapter. And so on. This phrase "group death" was their invention. So consider the source.
Oh group health is a coop, One thing you might approve of is that they do not pay inflated salaries to their executives.
HMOs are a recent invention.
Or.... (Score:5, Insightful)
Also a second situation which would lead to the similar results. That people who got the shot...*gasp* likely got the shot the previous year and *shock* have some built up immunity due to the previous years shot.
This physician... not a biologist. Sounds like shes not very good at what shes supposed to be doing. The information she presented proves nothing. She randmly concludes just 1 or many possible scenarios based on her predisposition. Poor poor science.
There are randomized controlled trials (Score:4, Informative)
Randomized, controlled trials have shown the effectiveness of flu vaccines, contrary to the claims of the article. (Example: Wilde et al., "Effectiveness of Influenza Vaccine in Health Care Professionals." [ama-assn.org])
In addition, research into mortality reduction already takes into account comorbid conditions and age. (Example: Nordin et al., "Influenza Vaccine Effectiveness in Preventing Hospitalizations and Deaths in Persons 65 Years or Older in Minnesota, New York, and Oregon: Data from 3 Health Plans." [uchicago.edu])
The article is at best poorly researched and at worst intentional FUD.
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Mod parent up! This is better data than a magazine article
Re:There are randomized controlled trials (Score:5, Informative)
The article seems to be primarily advocating double-blind, controlled clinical trials among the elderly, since that is the group where death is the primary concern rather than just getting sick.
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There are many obstacles to overcome (Score:4, Informative)
Due to a long history of unethical behavior in the medical field, there are stringent requirements that require one to show a need for research and to demonstrate safety concerns before one can begin an investigation.
This often means that simple experiments that could show benefit and harm of an intervention will not be done because of a large body of circumstantial evidence.
There has to be a fairly even view of outcomes on both sides of a trial before it will be approved - or other studies showing possible efficacy of the side that is under question will need to be done first.
When these situations arise, one can often perform the experiment in a subset of the population in which vaccine efficacy is questioned and benefits are unknown.
The population of HIV infected individuals is one such population and there are double-blind placebo controlled trials done in this group.
The annals of internal medicine (an American College of Phyicians publication) http://www.annals.org/cgi/content/full/131/6/430 [annals.org] published an investigation showing the efficacy of the influenza vaccine in a population that was least likely to benefit from it. While mortality data is not available here, its results stand on their own as a testament to the clinical efficacy of the vaccine.
article is BS (Score:5, Insightful)
36,000 die of complications from the flu annually in the US. That's very nearly as many as die from car accidents.
There is a very simple way to test the effectiveness of a vaccine and that is to carry out a double blind study utilising placebos alongside the active vaccine. Any effect that is solely due to the "healthy user effect" would be virtually eliminated.
further problems: the article has no references, no real hard data from relevant studies and several studies contradict the article's assertions.
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And that study is exactly what they proposed doing, but it was declared to be unethical and hence can't be done.
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nonsense. These kind of studies are done all the time, there is absolutely nothing unethical about them! Now it would be a different story if you were to force people into studies but that is a separate issue entirely.
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Have you got a reference to a double blind study done on high risk people comparing placebo and a flu vaccine?
http://www.ncbi.nlm.nih.gov/pubmed/10498559 [nih.gov] and http://www.ncbi.nlm.nih.gov/pubmed/7966893 [nih.gov] are the best I can find, which do seem to contradict the claims in the article.
Note, I have nothing against vaccines. My kid got a flu vaccine this year and is up to date on all his other ones. I'm not an anti-vaccine nut who think that all our health issues are caused by vaccines :)
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It just seems to me that the only reason for the article to have mentioned it would be to imply how "worthless" these vaccines supposedly are. As if 36,000 people aren't worth the trouble just because the flu virus isn't the top killer. I mean, you could use the exact same argument for car accidents and it wouldn't detract from the need for car accident safety testing any more than the article's assertion does for flu vaccination and testing.
Comment removed (Score:5, Insightful)
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some kind of stunt by Group Health or other elements of the private health industry to wriggle out of paying for flu shots.
Presumably if vaccines were either effective or ineffective the insurance companies would want to know which is which, right? Or is there some sort of calculus that says that vaccines could be effective for a given individual, but not cost effective for a larger group? I, a lay, would assume that "effective" and "cost effective" are the same, but I may be missing something.
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It's not it being profit-focused that's the problem. I too mixed this up at first.
But then I heard about how it's handled in China: There doctors only get money for healty clients in the group they are assinged to.
Let's say they are assigned to 5000 people. And for every sick one, they get X Yuán less, so that if badness of the percentage of sick people is parallel to the badness of the money they will get. Then they will be very motivated to keep people healthy, and to earn money, because it will be t
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Group Healthy is a coop. I find it hard to consider them profit-focused.
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Basically, it was done with me taking it seriously after reading this. Excuse the generalization. But this is so much following the manufactroversy pattern so much... Let it be a guy claiming tha
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INDIVIDUALS making FREE-AS-IN-SPEECH decisions on THEIR OWN health care..
Raise your hand if your employer picked your insurance for you.
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What the hell does "whimpish dispositions" mean?
I can tell you that there were a lot of things in my childhood that didn't kill me and made me weaker. Is that because I'm a wimp? I'm sorry. Sometimes the kid with asthma needs medicine to live. Am I a pussy for owning an inhaler?
Get bent.
Clinical trials (Score:2)
The flu shot is tested annually through peer-reviewed clinical trials. The shot is compared to its protective factor year over year. I believe the data shows it works.
Define "flu" (Score:2)
Part of the research I've read recently claims we have no solid definition of the mortality rate of the "flu". The problem is unless you take a culture and analyze it in a lab, you can't tell if the disease is really influenza or one of a hundred or so others that cause similar symptoms. But people who report to their doctor about symptoms aren't always lab tested to see exactly what they have. It'll get noted as "the flu", when it may not be influenza at all, skewing all the statistics.
The article I was [theatlantic.com]
The Scientific Method (Score:5, Insightful)
We killed smallpox outright, but every vaccine since then has been prevented from achieving its final goal through the effort of anti-vax forces of one kind or another. That's the reason I have to be against this sort of article - even the chance that it might be correct isn't worth the near-certainty that it will be another blow for vaccination in general. If they had any sort of actual firm proof, it would be different, but this sort of conjecture *is* dangerous - and not to the person doing the conjecturing.
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Uhm, the flu vaccines are good for life, the problem is the flu mutates every year which is why you need a new one every year.
Every vaccine for a virus works the same way, there are no magic bullets (yet), sounds like you think there is some sort of conspiracy going on here...
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You probably shouldn't worry about dependency with the vaccine. Unlike a chemical medication which augments or replaces your natural response to influenza, the vaccine "tricks" your body into thinking you have the flu and spurs your immune system to learn how to destroy the infection. It's actually providing a small exercise for your immune system.
I get the vaccine each year primarily because I can't be out of work for a week. Because I happen to be an employer, rather than employed, I can expect to lose ab
Vaccine still good, even if study is accurate. (Score:2)
Even if the flu vaccine does nothing to reduce mortality directly, it would still be a societal benefit if it, on average, delays infection by a few days as it would spread out the infections over time giving the medical infrastructure a better chance of not being overwhelmed during a pandemic.
Additionally, retrospective studies (as opposed to randomized trials), really suck at identifying the magnitude of conflating factors (but can be good in indicating that there ARE conflating factors).
Illness vs mortality (Score:2)
I read that article before. The fatal weakness of its reasoning is that it only focuses on fatalities. The reality is that even if you got ill with the flu, you almost never died (under 0.1% fatality rate). Even the super-fatal pandemic flu of 1918 was about 5% fatal among those sickened. I doubt if it is feasible to get a statistically significant count of fatalities in a controlled study sample.
But even if you do not die, flu is pretty costly. It is costly in the time you spend miserable, sick and out of
Flu Me Once (Score:2)
What i learned: doctors shouldn't over prescribe Tamiflu because resistance might develop - even though it doesn't work.
Flu spreads could be reduced if the government wasn't always scaring "flu-sufferers" into going to the emergency room (and giving the bug to others) even though only almost none of them (93%) actually have the flu.
I learned other things too. That basically the writer is looser with factual logic than those he accuses of same.
Mostly anti-vaccine agit-prop, and not not very good either.
- js
Placebo study has already been done, in a way (Score:3, Informative)
In 1968 and 1997, the vaccine produced was the wrong one, it didn't match the prevalent strains for the following winter. People who got vaccinated were effectively receiving a placebo for the strain that they were most likely to come in contact with. There was not a corresponding spike in the number of deaths. It could be argued that those strains were less deadly than usual, but it would be an amazing coincidence if it just happened to correspond to the two years no one got an effective vaccine.
If the flu vaccine reduces the number of deaths by 50% as is claimed, there should have been a 33% rise in deaths when no one was immunized. There wasn't.
More of the people most at risk are getting vaccinated, 15% of people over 65 vaccinated in 1989, 65% today. That should have caused a significant reduction in mortality. But the number of deaths is rising. Again, an amazing correspondence is claimed, that the strains are more deadly every year.
These are the two reasons that further study is needed, regardless of how strong your faith in vaccination is.
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I took a placebo and I didn't catch Flu.
Re:Good article (Score:5, Funny)
Re:Good article (Score:5, Funny)
Re:Good article (Score:5, Interesting)
You joke, but there's mounting evidence that the placebo effect is indeed getting stronger [wired.com].
(Of course, conducting a double-blind test to confirm this would create numerous paradoxes)
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I took a placebo and I didn't catch Flu.
Actually it sounds like you caught a nasty case of placebocitis, a nasty flu-like infection that has no perceivable symptoms including a lack of high fever, no stomach ache or GI irritation, soreless throat, non-inflamed tonsils, and pounding migraine headaches not being reported.
W
Re:Good article (Score:5, Funny)
I don't whether to laugh or cry.
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Sounds like you're having a devil of a time figuring it out.
Re:Good article (Score:5, Interesting)
"Let's pray that science wins out over irrationality."
That's what the article's point is! It's not saying "vaccines don't work" it's saying "they say vaccines reduce the death rate by 50% and the numbers don't bear that out. What's the real number?"
And that's a fair question. We know the virus isn't 100% effective, it damn near killed this girl: http://www.google.com/search?pg=q&fmt=.&q=dystonia+flu+vaccine [google.com]
Neither though is anybody saying the vaccine is zero percent effective or universally toxic, what happened above is a rare edge case (but as an aside it would be nice to be able to predict when this was going to happen, this is a fairly *catastrophic* edge case).
But the examples brought up in the article do suggest there is sustantive argument that the claimes reductin of 50% reduction in martaliry rate is indeed in question, that's all.
Nobody's actually measuring people who have anti-bodies of a specific type, the data gathered is fairly meaningless by lumping a lot of things (rhinovirus, coronovirus etc) as "flu", also the cohort factor and related effects do have a demonsterable non-zero effect on the mortality rate.
So, it's not a question of is the vaccine useful or nor, more like a plea for more accurate analysis and gathering of the data in question.
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And since they apparently haven't done the studies needed to show that your understanding is wrong. Or the article is wrong, of course.
FluMist (Score:5, Informative)
The live attenuated flu vaccine, FluMist is substantially more effective than the inactivated injected vaccine (something that's blindingly obvious to those of us who've studied basic immunology). It provides a potent T-cell response, and a large pool of memory cells. Furthermore, it has been shown to be effective against viruses that have undergone some genetic drift.
For anyone who is old enough, has no respiratory problems, and who isn't immunosuppressed, the live nasal spray vaccine is a much more sensible choice.
For additional data refer here: http://www.cdc.gov/flu/professionals/acip/efficacycomparison.htm [cdc.gov]
Re:FluMist (Score:5, Insightful)
T
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You say, "Furthermore, it has been shown to be effective against viruses that have undergone some genetic drift." But there's nothing about that in the CDC site.
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I read quite a lot beyond that site. I did not, however, have time to link everything I've ever read about that vaccine in my post (having worked for one of the virologists consulting for the project) at the time the vaccine was going through trials and getting FDA approval.
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You say, "Furthermore, it has been shown to be effective against viruses that have undergone some genetic drift." But there's nothing about that in the CDC site.
It's in there, in this part: "...An open-label, nonrandomized, community-based influenza vaccine trial conducted during an influenza season when circulating H3N2 strains were poorly matched with strains contained in the vaccine also indicated that LAIV, but not TIV, was effective against antigenically drifted H3N2 strains during that influenza season..."
LAIV = Live Attenuated Influenza Vaccine
TIV = Tri-valent Influenza Vaccine
Re:FluMist (Score:5, Informative)
The live attenuated flu vaccine, FluMist is substantially more effective than the inactivated injected vaccine (something that's blindingly obvious to those of us who've studied basic immunology). It provides a potent T-cell response, and a large pool of memory cells. Furthermore, it has been shown to be effective against viruses that have undergone some genetic drift.
I happen to have worked in the influenza vaccine business before. For children and younger recipients, what you've said has been clinically demonstrated to be true -- live attenuated influenza vaccine (LAIV, you may also see it referred to as CAIV in some literature) gives a more intense response, and better protection against mismatched strains.
However, things get a little iffy when it gets to the adult population, where there doesn't seem to be any superiority for LAIV in that group (your link shows that).
While it's not exactly known why, last I heard the theory was that, in contrast to the naive response in children, adults already have pre-existing responses to various wild influenza strains, that (although not matched to the target strains) cross-react with the LAIV and neutralize it too quickly, before it has a chance to replicate a little and provoke a stronger response (that matches the targeted strains).
I haven't seen this last part in print anywhere (although I also haven't been looking), it was just an idea that was being passed around by some researchers who were working at MedImmune (company that makes FluMist).
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My unit tests don't generally kill people though.
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T
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You don't only get vaccinated for yourself. You also get vaccinated so that you don't transmit the virus to those with compromised immune systems.
If the vaccine doesn't reduce mortality, as this study suggests, then that indicates that the vaccine doesn't do anything. If it doesn't do anything, how it taking the vaccine helpful to other people?
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If the vaccine doesn't reduce mortality, as this study suggests, then that indicates that the vaccine doesn't do anything.
Really? If it doesn't prevent death, its worthless? That's essentially the opposite of what this (admittedly bad) article argues - that the vaccine doesn't save those who get it because they wouldn't have died anyways. What it saves them from is the illness (which is way bad enough to justify the vaccine, even without risk of death), and the risk of spreading the illness to others, like the sickly and elderly who do not get the vaccine. It looks like the study we really need is one correlating the inci
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I'd be pissed if the doctor didn't tell me there was a very slim chance that it might be a more serious form. The Doc did the right thing, as it emphasized that the patient should come back if things get worse, indicating that it might be a bacterial caused menegitis.
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But there is still no excuse for not properly verifying the efficacy of the seasonal flu vaccine. As pointed out earlier, most of the data used to support the flu vaccine is of poor quality. In particular, flu deaths are never verified as actually being the flu and not one of several other flu-like illnesses, plus the trend that healthy people get the vaccine more than vulnerable people.
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A real pandemic looks like something out of a bad sci-fi film about the end of the world.
3 unusual deaths in San Diego does not.