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Medicine

On the Efficacy of Flu Vaccine 430

Posted by kdawson
from the because-we-just-know-it-works-that's-why dept.
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.
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On the Efficacy of Flu Vaccine

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  • by rcolbert (1631881) on Saturday October 17, 2009 @04:46PM (#29779757)
    It really seems the data can be massaged to draw any conclusion that is desired. In my case, up until three years ago I had never had a flu shot. 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. While hardly scientific, it seems to me that the downside/upside in my personal case weighs heavily towards receiving the vaccine. There are clearly other viruses in human history where vaccination has had a profound and measurable effect which is beyond debate.
  • by OeLeWaPpErKe (412765) on Saturday October 17, 2009 @05:24PM (#29780005) Homepage

    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, climate science, social science, and any part of the humanities just doesn't allow experiments. We can't infect people with designed viruses to see what they do, we can't inject masses of gasses into a planetary athmosphere and see what happens and we can't run experiments on humans, never mind the issue that repeating any experiment on a thinking creature can obviously only result in a manipulated result.

    But the problem is more general. People abhor the answer : "we don't know this" or " we couldn't change this". Science has long since become a sort of religious status, where it's claims are total. Details like that the scientific method just doesn't work like this are not mentioned. You can see the headlines : "does the earth warm ? Scientists doubt it" (that would be what the scientific method dictates : that you doubt it, and the more you believe it's warming the more thoroughly you should go looking for any indication that you're wrong. Some scientists actually still do this, but it's an ever shrinking group, especially in the politicized sciences)

    But the issue of not knowing is problematic. Take the economic crisis for example : the basis of the problem is that nobody expected the cascade effect that failing mortgages would have. The problem is : the scientific reasoning for concluding that it couldn't happen was, statistically, very sound : it never happened before. In 50, and for some banks 200 years of data, the statistical algorithms never encountered that situation, so they concluded it to be impossible. You can wine all about it, but that's an entirely correct conclusion.

    Whatever your position about climate change, it is a science that will encounter the same problem : It has very limited data at the moment, real, quality (calibrated and double-checked), first hand data is limited to less than 200 years, and the list of huge energy reserves that are not considered is very likely to be a long list. The list of how they respond to different climatic events is likewise limited : we don't even know how half of them reacted in the past. Even if we did know that, there is the possibility that we are in a new situation, and things could react very differently to a very different situation. If such were true all statistical inferences would be 100% correct, and yet they would not match reality at all. You cannot test for this (despite how much people like to think that if "variance is explained 100%" that it can't happen, even though the variance in the financial data was 100% explained, it failed to predict the cascade failure). Yes humans put (a bit, compared to the ocean) of co2 in the athmosphere, they also put a few million other gases in the athmosphere. What will happen ? The pedantic, information theoretically correct answer is : "we haven't seen this before, we don't know. If we saw this one gas rise in concentration due to natural causes, a million years ago we would have seen a tempearture rise". Of course nobody likes that answer.

    Evolution theory dictates that training everyone's immune system before infection will result in one of 2 things :
    a) either viruses die
    b) they learn to bypass it entirely, making vaccines entirely ineffective
    So far, every success by science in finding some way to fight disease has ended in option b. It just never was vaccination, the human immune system, our last line of defence, that was manipulated by science. And it's a defensible position that a number of incidents came close to b), like the spanish flue of 1930 for example.

  • Re:Good article (Score:5, Interesting)

    by moosesocks (264553) on Saturday October 17, 2009 @05:27PM (#29780031) Homepage

    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)

  • Re:Good article (Score:5, Interesting)

    by rs79 (71822) <hostmaster@open-rsc.org> on Saturday October 17, 2009 @05:42PM (#29780135) Homepage

    "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.

  • question for you: (Score:3, Interesting)

    by maillemaker (924053) on Saturday October 17, 2009 @05:57PM (#29780245)

    >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?

  • life expectancy (Score:0, Interesting)

    by HomelessInLaJolla (1026842) <lajollahomeless@hotmail.com> on Saturday October 17, 2009 @06:53PM (#29780597) Homepage Journal

    There is a certain amount of data manipulation and exploitation of ignorance which goes into people's perception of life expectancy. Conventional wisdom is that modern medicine has extended the span of our lives significantly and that there should be no question that the billions and trillions of dollars funnelled to the medical industry through the stock market and the government tax and dole system is justified.

    Is it really?

    There is a book composed of writings about two thousand and five hundred years old [usccb.org] which states,"Seventy is the sum of our years, or eighty, if we are strong; Most of them are sorrow and toil; they pass quickly, we are all but gone. [usccb.org]"

    Two thousand and five hundred years ago the sorrowful and melancholic writers of that scripture could acknowledge that the general span of years was seventy or eighty. Would the author have written seventy or eighty if it were really thirty or fifty, or ninety or one hundred?

    In light of that fact (that those words were indeed written that long ago and there is no reason to believe the author was mis-stating the span of years)... say again how the expenditure of modern medicine has really and truly done anything for that taxpaying and consumer investment base.

    What you believe about the medical industry is hype and advertising.

    I wonder, then, what happened between five hundred years B.C. and 1900 AD which caused the life expectancy to cave in by half...

  • by MichaelSmith (789609) on Saturday October 17, 2009 @07:13PM (#29780725) Homepage Journal

    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.

  • by mschuyler (197441) on Saturday October 17, 2009 @07:23PM (#29780763) Homepage Journal

    And I would need convincing that this isn't some kind of stunt by Group Health or other elements of the private health industry to wriggle out of paying for flu shots. Gotta love profit-focused private "health" care, and its useful idiot defenders on the Right.

    Hmm. Guess I better toss that notice from Group Health encouraging me to come in and get a shot then. I forgot they were part of the vast right wing conspiracy. Gotta love government-controlled and "cost containment" "health" care, and its useful idiot defenders on the Left.

  • by astar (203020) <max.stalnaker@gmail.com> on Saturday October 17, 2009 @07:32PM (#29780811) Homepage

    Group Healthy is a coop. I find it hard to consider them profit-focused.

  • Antivaxxer replies (Score:1, Interesting)

    by badzilla (50355) <ultrak3wlNO@SPAMgmail.com> on Saturday October 17, 2009 @08:07PM (#29780967)

    My GP nags me to have an anti-flu vaccination every October. For quite a few years I did accept and I would say the treatment actually was effective in the sense of I did have lower incidence of cold/flu than previously when I didn't get the innoculation.

    However, over the past few years I refused to take it. Reasons: worry about dependency (am I heading towards being unable to live without annual shots) and uneasiness about what the hell is actually in this stuff. No matter how nicely you ask they will not tell you what -exactly- they are proposing to stick into your body. If you want me to stop being an anti-vaxxer then maybe that's possible but "just trust us we are medical professionals" is not going to do it for me.

  • Imagine (Score:1, Interesting)

    by Anonymous Coward on Saturday October 17, 2009 @09:45PM (#29781389)

    Imagine there's no Heaven. It's easy if you try, no hell below us- above us only sky. Imagine all the people living for today.

    Imagine there's no countries. It isn't hard to do.
    Nothing to kill or die for and no religion too. Imagine all the people living life in peace.

    You may say that I'm a dreamer. But I'm not the only one. I hope someday you'll join us
    And the world will be as one.

  • Re:question for you: (Score:3, Interesting)

    by PCM2 (4486) on Saturday October 17, 2009 @09:59PM (#29781439) Homepage

    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.

  • by SuperKendall (25149) on Saturday October 17, 2009 @11:23PM (#29781721)

    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).

The opposite of a correct statement is a false statement. But the opposite of a profound truth may well be another profound truth. -- Niels Bohr

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