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.
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.
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.
Re:All I have is an anecdote (Score:3, Insightful)
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
Editorializing (Score:4, Insightful)
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.
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.
Comment removed (Score:5, Insightful)
Re:All I have is an anecdote (Score:1, Insightful)
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.
If you reliably get influenza every year (and can reliably postpone it with a vaccine too) then you might want to ask the doctor if he can prescribe anything for hypochondria. I hear there's promising results from carbon monoxide.
Re:Just like when a programmer is sure his code wo (Score:2, 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.
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.
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.)
Re:The one crucial point (Score:3, Insightful)
Re:The one crucial point (Score:1, Insightful)
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)
I am the AC to whom you replied.
The problem is that this hysteria shouldn't occur anyway. If it does occur, it might be justifiable if we were talking about some deadly or crippling disease that poses a real danger. This H1N1 is nothing but a nuisance by comparison. There is no justification for the tremendous governmental and medical resources that are being devoted to it. Words like "global pandemic" should be reserved for something more dangerous than the sniffles and anyone who's ever heard of the "boy who cried wolf" understands that.
The lobbyists don't really have to be very good when you think about it. There is nothing government loves more than a panic that it can resolve, as if to say "see, aren't you glad you gave us those expanded powers, we can use them now to save you from this threat!" I cannot ignore that, especially not when new laws are being proposed to forcibly quarantine anyone who refuses vaccination against this or other threats. Whether it's to save the children, fight terrorism, or protect from a "pandemic", there is nothing the government loves more than a crisis that justifies the expansion of power, power that will not be given back once the crisis is over. So, they don't need much convincing to jump on this one.
So the government benefits because it stands to get more of what it wants: power and an excuse for the exercise of it. The pharmaceutical companies benefit because they stand to get more of what they want: money, and in this case with little or no liability. The media benefits because sensationalism sells. If you assume three entirely selfish entities who always act in their own interests, which is not exactly a leap of faith here, why wouldn't BOTH the companies AND the government jump all over this and view it as a golden opportunity?
The only people who don't benefit from this are the general public. But it's not like they had much of a voice in this process anyway.
Re:FluMist (Score:5, Insightful)
T
Re:MDs should be experts in stastics (Score:3, Insightful)
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.
Re:There are randomized controlled trials (Score:1, Insightful)
This "I have news for you" fellow seems like a legit guy, I think I can trust him. Wait, no, it's some dime-a-dozen anonymous fucktard on the Internet who thinks the big evil vaccines are out to get him. The source in the summary is a fear-mongering piece of shit from a popular magazine. The *multiple* sources provided by the OP are peer-reviewed scientific journals. I think that's a pretty damn good basis to prefer them.
Yes, they do have to "guess", but it's not just "throw darts at the influenza strain dartboard" guessing like you try to pass it off as. They are well-researched "guesses" that take into account much information. No, it's not perfect, but it's better than nothing. Yes, they're constantly mutating, so what? Yes, there is plenty of evidence [wikipedia.org], of which the OP provided some. Just because you ignored it doesn't mean it's not there; it just means you are freely engaging in selection bias. Lastly, thiomersal has been removed from plenty of vaccines and still has no evidence for it being harmful [wikipedia.org] anyway.
Your sig is amusingly fitting here.
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.
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:Scientists don't get to say "we don't know" (Score:3, Insightful)
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 problem is that you have to show that the idea that you are against would reasonably imply the existence of the scientific evidence that hasn't been observed. (This bit of the logic is regularly lacking when 'scientists' dismiss ideas on the account of 'no scientific evidence'.)
3. Statistics. There is a very good book: http://www.amazon.com/Common-Errors-Statistics-Avoid-Them/dp/0471460680 [amazon.com] and the first two sentences of the first chapter spell it out: no matter how precise the 'maths' is, it is an error to rely solely on statistics. From a pure maths perspective, bear in mind that a random number chosen from the reals in the interval [0,1], with equal probability for each number, has 0% chance of being a real number that will ever be explicitly picked out in any scientific document, past present or future. (This is a trivial application of measure theory.)
4. The 'evolution theory' bit on the end heavily oversimplifies things. (If you assume that (a) does not happen, it does not follow, even from evolution theory, that (b) will necessarily happen: there are other possibilities).
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.
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:As soon as you mentioned "Group Health"... (Score:3, Insightful)
... 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?
Re:All I have is an anecdote (Score:3, Insightful)
> 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 that it only reduces the "acute phase" by a day or so. What they conveniently omit is the fact that they might "only" reduce the phase when you're laying in bed in the fetal position hating life by a day or so, but they ALSO reduce both the duration and severity of the "misery" phase afterwards... the point when you're well enough to go back to work, but still feel and look like shit, with a runny nose that just won't quit, sore throat, and the rest. Both drugs can dramatically improve the overall experience, and make it a lot less awful than it would be if you did nothing to stop it.
As far as efficacy goes, I've religiously caught the flu at least once every year when I didn't get vaccinated. I've only gotten sick once when I was vaccinated, and I'm not sure whether THAT was a mild flu, or just a really bad cold.
There IS one problem with the "pick 3 strains" strategy -- it works a lot better in places like Iowa, Arizona, and South Carolina than it does in places like Miami, Orlando, and New York City, where there are literally millions of visitors every year from every single continent, and whose local flu strains weren't part of the vaccine mix.
Re:Beware of antivaxxers (Score:3, Insightful)
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 that vaccines are not effective, or someone proving 'alternative' medicine, or someone proving creationism. It always begins by this heroic , legendary whistleblower "scientist" that gets the inspiration to think in a non-mainstream way and the response they get to their BS is obviously lack of respect from science's side, yet they use it to prove that science is being "doctrinal" about it...
Re:The one crucial point (Score:3, Insightful)
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).
The CDC also shows a relationship between egg allergies and possibly fatal side effects from the vaccination. They simply state that if you have an egg allergy, do NOT take the vaccine. That's approx 2.5% of the population under 5 years old. That's ok, the population under 5yo is only 21,000,000 (again, 2008 US Census est), which would bring the possible death toll to 525,000.
So, we're up to 528,000 possibly dead from the vaccine.
The CDC also indicates [cdc.gov] "Life-threatening allergic reactions to vaccines are very rare. If they do occur, it is usually within a few minutes to a few hours after the shot is given." No numbers are included here, and I wasn't able to find any.
"Very rare" is a wonderful number. They use the same term for the Yellow Fever vaccine, which is estimated to be fatal in 1 in 400,000.
The US has started using a combined number in reporting H1N1 cases, so their national number of 928 doesn't give a good indication of how many were really H1N1 related. Still, 928 untreated and dead, versus hundreds of thousands who could die from the vaccine (a small percentage of the total population, but still more than necessary) makes for an unjustified number.
I'm not gathering these numbers from any fear mongering source. I've researched these numbers from trustworthy sources (hmm, like the CDC themselves). The answer of "shut up and trust the government" is never a good answer. Question everything, and you won't be made a fool of. Well, in this case, you may not end up dead from the cure.
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.
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.
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.
Re:Beware of antivaxxers (Score:1, Insightful)
and its useful idiot defenders on the Right.
I really liked your post until you gave away your ignorance. To think that the Left isn't motivated by the exact same things (lobbyists/bribes/brainwashing) as the Right is blatantly, and dangerously, ignorant. A good citizen is a skeptic citizen.
Re:Beware of starry-eyed, pie-in-the-sky liberals (Score:3, Insightful)
INDIVIDUALS making FREE-AS-IN-SPEECH decisions on THEIR OWN health care..
Raise your hand if your employer picked your insurance for you.
Re:All I have is an anecdote (Score:2, Insightful)
Re:this article has many problems and is bad scien (Score:2, Insightful)
"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." I didn't forget that at all. I simply pointed out that even if it's true that seasonal or H1N1 flu vaccination doesn't reduce the mortality rate of people over 65 (which I'm not saying is the case), that's still not a valid reason to conclude that seasonal/H1N1 flu vaccination doesn't reduce the mortality rate or have other benefits for other groups--which is the invalid deductive leap the article makes. (The article doesn't rely SOLELY on this single study; they do try to selectively pull in some other evidence from other studies. But primarily, this article is driven by the study of mortality rates among people over 65.)
It's also worth pointing out that mortality rate is only one of many metrics that can be used to evaluate the efficacy of vaccination. For example, productivity gains from preventing or minimizing the duration/severity of seasonal/H1N1 flu infection are another benefit. Flu can lead to complications like pneumonia, which even if not fatal can lead to additional complications like liver, kidney, or heart damage, etc.
Re:All I have is an anecdote (Score:3, Insightful)
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:Beware of antivaxxers (Score:3, Insightful)
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.
Re:The one crucial point (Score:3, Insightful)
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 that happening. [redorbit.com]
In a way I can see encouraging companies that can help combat a pandemic to stay in business. But really this H1N1 strikes me as a 2 billion bailout for the vaccine makers.
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.
Re:The one crucial point (Score:3, Insightful)
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.
Re:Antivaxxer replies (Score:3, Insightful)
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 about $8000 in income if I get the flu. Small business has it's down side. I also happen to have a pragmatic minimalist view of medication. I have about 8 different head/chest/cold medications in my cabinet. Each does one specific thing - I don't buy "combination" medications like Nyquil or Contac Cold & Flu. On the rare occasion I don't feel well, I take what I need to ensure that I get a good night's sleep and avoid sinusitis (to which I'm sensitive) - no more, no less.
As an engineer, I look at the problem logically and find the most efficient solution I'm aware of. The vaccine has a very low incidence of problems. The payback is cutting my chance in half (or better) of losing $8000 for a $10 copay with my insurance. I figure the possible complications from actually getting the flu are just as bad - and more likely to occur - as complications from the influenza vaccine, so the worst case is it's a wash. Plus, it reduces the chance that my wife and daughter will get it, though they get vaccinated as well - no sense in them feeling like crap for a week. It's not perfect, but it's better than the alternative.
As soon as we get H1N1 in my area, I'm getting it. My local school system is offering it free of charge to students (note: not requiring it). Smart, if you ask me, as the schools and school age children are the number 1 vector for local spread of the virus (business travelers are the number 1 vector for spread between localities, imho).