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Flu Watch: UPDATED with Facts and Everything!

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UPDATE: This post is simply a suggestion to educate yourself before getting a flu shot. I am NOT opposed to vaccines in general, but am questioning the wisdom of the flu shot for reasons explained below.

Flu shots are nowhere near 100% effective; in fact, even proponents admit that 69% is about the best effectiveness rate they can get in adults, and that’s in a very good year. The sources in the original post were called into question, though, and I agree -- they were not great. So here are new sources, including the CDC, a couple of flu experts, and a major medical journal.

First, here is what the CDC’s own website states in response to the question, “How well does the seasonal flu vaccine work?”:

How well the flu vaccine works (or its ability to prevent influenza illness) can range widely from season to season and also can vary depending on who is being vaccinated. At least two factors play an important role in determining the likelihood that influenza vaccine will protect a person from influenza illness: 1) characteristics of the person being vaccinated (such as their age and health), and 2) the similarity or "match" between the influenza viruses in the vaccine and those spreading in the community. During years when the viruses in the vaccine and circulating viruses are not well matched, it’s possible that no benefit from vaccination may be observed. During years when the viruses in the vaccine and circulating viruses are very well matched, it’s possible to measure substantial benefits from vaccination in terms of preventing influenza illness. However, even during years when the vaccine match is very good, the benefits of vaccination will vary across the population, depending on characteristics of the person being vaccinated and even, potentially, which vaccine was used.

[bolding throughout added]

For a better look at flu vaccine effectiveness, here’s a link to an interview an NPR reporter did with two vaccine experts, Michael Osterholm, director of the Center for Infectious Disease Research and Policy, and a professor of environmental health sciences, at the University of Minnesota's School of Public Health, and William Schaffner, president of the National Foundation for Infectious Diseases, as well as a professor and chair of the Department of Preventive Medicine at Vanderbilt University Medical Center in Nashville.

The interview looked at details of a study showing that flu vaccines are not much use for individuals over age 65. The study was co-authored by Osterholm and published in the Lancet Infectious Diseases, a highly regarded British medical journal, so whatever its flaws, it is a serious piece of research.

When questioned about the effectiveness of the traditional flu shot, Osterholm notes:

“…we found that the vaccine was protective, so in two-thirds of the studies.
And when it was protective, it was protective at about a 59-percent rate across all the different studies.”

In children, the shot was less effective, according to Osterholm:

“In the first year, they found the vaccine worked 66 percent of the time. And in the second year, they found it worked minus-7 percent of the time or not a measurable effect."

What about the newer nasal “puff” vaccine? For adults, Osterholm says:

“… we could not identify any studies that either from an observational disease - or observational study standpoint or from an actual vaccine randomized control trial standpoint, showed that the vaccine was effective.”

Using the nasal puff vaccines in children had better results:

“…the live attenuated vaccine in children under eight years of age actually worked quite well. It was consistent protection. The pool, the average protection level was 83 percent.”

But here’s what the study found in regard to seniors, one of the groups often urged to get flu shots because older people tend to be less healthy than younger people. Again, here is Osterholm:

Even in this year's [2011] data for the Centers for Disease Control and Prevention, which was reported several days ago for the 2009-2010 influenza season, they were unable, in their observational studies, to demonstrate a significantly protective effect in those 65 years of age and older.

At this point in the program, a caller asks why we need an annual flu shot, when other vaccinations last for years. Osterholm replies:

… the fact that we have to get vaccinated every year shows you that somehow the immune system's not picking this up. And when you put that into perspective with what happened with the pandemic, we had a number of 70- and 80-year-olds during the pandemic who surely had some innate protection against that virus based on just looking at the population risk of getting infected, and it turned out that these were people who were exposed 60 years before or more to that same circulating type of virus, and 60 years later, their bodies still recognized the fact that they had seem a similar virus 60 years ago.

It had induced antibody or a number of other parts of their immune system so that they were protected. That's what we need to move towards. The idea that we have to vaccinate every year already says that we're not doing a very good job of taking that immune system we have and turning it on in the right way to protect ourselves.

Immunity in people who are in their 70s and 80s is most likely due to having had the flu, not from flu shots, since those were not being widely given to the general public 60 years ago. In other words, the immunity they obtained from having the flu lasted for decades, something that doesn't happen with today’s flu shot.

Finally, the CDC’s estimate of 33,000 to 36,000 annual deaths attributed to the flu has been revised downward – by the CDC. The actual figure is about 22,000 deaths each year, and that includes those attributed to flu and pneumonia. That’s a fatality rate of .007 – not even close to 1%. Of course zero would be better, but scaring people into getting a shot of questionable effectiveness without informing them of the issues involved is not playing fair.

And yes, I know this is way too long for a Quick Hit and I promise I won't do it again.

[here is the original post]
Swine flu mutations are underway, with the virus gaining the ability to move from animals to people.

Is this the massive pandemic epidemiologists say is coming? No one knows yet. But before you rush out to get a flu shot, it would be wise to educate yourself so you can make an informed decision on protection issues and potentially serious side effects.


Submitted by hipparchia on

there's never a zero risk from anything. there's always the chance that a medicine, or a treatment, or a disease, or a food, or a supplement, or (fill in the blank) will harm you or kill you.

from CDC Statement on Discontinued Use of Pandemrix Influenza Vaccine in Europe

The Centers for Disease Control and Prevention (CDC) has become aware of recommendations made by the Finland National Institute for Health and Welfare (THL) to discontinue vaccination with Pandemrix, an adjuvanted H1N1 influenza vaccine, while an investigation is conducted looking into the observed rise in cases of narcolepsy among children and adolescents, mainly in Sweden and Finland.


Pandemrix is not licensed for use in the United States. No adjuvanted influenza vaccines are licensed in the United States.

so, while there may be potentially serious side effects from swine flu vaccinations, or from any other vaccinations, the swine flu vaccine causing the problem in finland, sweden, and possibly other parts of europe, is NOT IN USE IN THE UNITED STATES.

just what is an adjuvant and why would anybody want to use one anyway? answer: it's an ingredient that by itself does not give you immunity but when added to a vaccine it increases your immune reaction, which means that if a vaccine is in short supply, then less of it can be used to vaccinate more people.

the cdc has a short faq on adjuvants in vaccines.

on protection issues-

1. yes, it's true, the immunity you get from a flu shot starts to decline after a few months but probably it remains strong enough to last the whole flu season.

2. there are people who contracted the spanish flu in 1918 and survived it and are still alive today and who appear to still have active immunity against the disease 90 years later. this suggests the possibility that getting the actual flu/swine flu/bird flu/whatever disease and surviving it might give you more immunity than just getting a vaccination, but this obviously doesn't work if the disease ends up killing you first.

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Submitted by twig on

and there is considerable doubt among health care professionals as to whether or not flu vaccines actually protect people against the flu.

An independent analysis by the internationally renowned Cochrane Collaboration of worldwide influenza vaccine studies, published in the British Medical Journal on Oct. 28, concluded there is little scientific proof that inactivated influenza vaccine is safe and effective for children and adults. Citing the Cochrane Collaboration finding as well as methodological flaws in a child influenza vaccine study published Oct. 25 in the Journal of the American Medical Association (JAMA), the National Vaccine Information Center is calling on the Centers for Disease Control (CDC) to stop recommending annual flu shots for all infants and children until methodologically sound studies are conducted. (my bolding)

"There is a big gap between policies promoting annual influenza vaccinations for most children and adults and supporting scientific evidence," said epidemiologist Tom Jefferson, Cochrane Vaccines Field, Rome, Italy, who coordinated the comprehensive analysis for the prestigious Cochrane Collaboration. "Given the significant resources involved in annual mass influenza campaigns, there is urgent need for re-evaluation of these strategies."


"The CDC has pushed mass use of influenza vaccine in all children without scientific evidence the policy is either necessary or safe," said NVIC President Barbara Loe Fisher. "Where is the good science to back up the policy? If the recently published CDC-funded influenza vaccine study in JAMA is the kind of flawed science public health officials are using to convince the public the vaccine is safe, it is no wonder that many parents don't trust what public health officials say about vaccination. The CDC should stop recommending annual influenza vaccination of all young children when there is insufficient scientific justification for it."

I don't mean to be combative/defensive about this. It's a monumentally complex subject with all sorts of political aspects and I am way unqualified to address most of them. But nearly all the nurses and doctors I know avoid flu shots. I stopped getting them after my son, who was 8 or 9 at the time, had one and came down with the flu 12 hours later. The pediatrician apologized and said, 'Yes, sometimes that happens, we don't really know why.'

None of us ever had a flu shot again, and we rarely get the flu. Maybe we are just lucky. But still I think it's important for people to educate themselves about their own health and grill their doctors about their recommendations, instead of just blindly going along.

Submitted by hipparchia on

I stopped getting them after my son, who was 8 or 9 at the time, had one and came down with the flu 12 hours later.

it takes about 3 weeks for the body to manufacture immune antibodies after a vaccination, so odds are your son caught the flu from somebody else who had it and was going around spreading their germs all over the place. very common in school-age kids, since we generally crowd hundreds of them together all day in school buildings.

But nearly all the nurses and doctors I know avoid flu shots.

they're not alone - only about 60% of healthcare workers get flu shots apparently.

What Does the Research Say?

- Health care workers who get vaccinated help to reduce the following:
--- transmission of influenza
--- staff illness and absenteeism
--- influenza-related illness and death, especially among people at increased risk for severe influenza illness

- Higher vaccination levels among staff have been associated with a lower risk of nosocomial (hospital-acquired) influenza cases.

- Influenza outbreaks in hospitals and long-term care facilities have been attributed to low influenza vaccination coverage among health care workers in those facilities.

- Higher influenza vaccination levels among health care workers can reduce influenza-related illness, and even deaths, in settings like nursing homes.


Are Health Care Workers Who Decline Flu Shots Irresponsible?

If an office worker gets sick, he or she might spread germs to co-workers who sit nearby. But if doctors or nurses get the flu, they can pass it to the dozens of patients they come into contact with each day—many of whom have other conditions that render them more susceptible to infection. The flu still kills thousands of people each year in the U.S., most frequently those with underlying conditions, who also have more frequent contact with medical personnel than the healthy.

whether or not flu vaccines actually protect people against the flu.

this article is about mmr vaccines [measles/mumps/rubella] but it discusses the concept of herd immunity:

Herd immunity occurs when a few unvaccinated children are protected by the fact that almost everyone around is vaccinated and therefore cannot infect them. It's important for those for whom vaccines have not worked, those who have immune problems, or those who cannot be vaccinated due to specific health risks. But it requires very high rates of vaccination, typically 80-90 percent.

so if the people most likely to get, and die from, flu are the ones who are already sick or are elderly [immune systems not as good as they once were] or are very young [immune systems not yet fully developed] and the vaccination requirement for protecting the sick, and elderly, and very young by way of herd immunity is 80-90% and the people who are tasked with taking care of the sick, the elderly, the very young only have a 60% participation rate in the herd immunity model, then is it that "vaccinations don't work" or is it that "ur doin it rong"?

The pediatrician apologized and said, 'Yes, sometimes that happens, we don't really know why.'

did your son get the flu, or a flu-like illness after his vaccination? i ALWAYS get a "flu-like illness" after vaccinations, with tetanus vaccinations being one of the worst [high fever, all-over aches, etc for two days], but i'm pretty sure that getting actual tetanus would be worse.

but it's true, there are a number of reasons why someone could get a flu shot and still get either the flu or an illness resembling the flu, and we wouldn't know for sure what the cause was in every case.

But still I think it's important for people to educate themselves about their own health and grill their doctors about their recommendations, instead of just blindly going along.

i definitely agree with you on that! :)

Submitted by hipparchia on

i followed your link and read the article [ok, i only skimmed it] and did not find any links to the cited cochrane study or studies.

there IS a link at the bottom of the article to the national vaccine information center. it's a nonprofit group that appears to mostly be anti-vaccination. their idea of establishing a vaccine adverse event reporting system is a good one, but even that is fraught with methodological difficulties.

Submitted by hipparchia on

they have several studies on flu vaccines. also: Spotlight on the Cochrane Acute Respiratory Infections Review Group.

cochrane appears to be all about rigorousness in medical testing, which i'm all in favor of in general, but are you going to volunteer your mom and pop or grandma and grandpa to go to the nursing home where nobody gets a flu vaccination so that they be the control group in a rigorous randomized controlled trial? flu vaccines are safe, they're cheap, they're probably effective, and we could be spending the $$$$$$$$ [these trials aren't cheap] on testing cancer drugs, say, which really DO have awful side effects [fairly often] and not much efficacy [sometimes] and cost huge amounts of money [always].

if you read through all the flu-related cochrane summaries, what you mostly see is the criticism that nobody is doing rigorous randomized controlled trials on flu shots, and therefore we can't say that it's been proven once and for all beyond a shadow of a doubt that flu shots "work." i didn't read every single one of the summaries in depth, but none of them said outright that flu shots are dangerous or that they definitely do not work, only that the evidence for or against them is of lesser quality.

complexity, yeah. but offering a couple of links to a couple of scare-mongering sites without offering at least a couple of links to sites with opposing or corroborating information is not educating people.

introducing some simplicity... if i were going to the doctor for cancer treatment, i'd want the best evidence-based medicine available, but for a $25 flu shot that might not but probably will protect me from flu, i don't care about that level of proof. ymmv, and that's ok too [as long as you're not a healthcare worker taking of my loved ones when they're in the hospital].

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Submitted by twig on

which you cite here: "offering a couple of links to a couple of scare-mongering sites without offering at least a couple of links to sites with opposing or corroborating information is not educating people."

Seriously? I don't know about where you are, but here in Southern California, we are bombarded by "get your flu shot" messages -- tv, pharmacies, doctor's offices, etc., are all pushing this. And I do mean pushing. Nowhere among these messages do I see any suggestion of "... if it's right for you."

Meanwhile, here's a good example of pro-flu shot reporting, which doesn't tell you some very important information -- i.e., getting a shot now is not going to protect you against the new swine flu variation -- until the last sentence! Assuming you read that far. Pyramid-style reporting in journalism usually puts the least informative details at the end of the story, in case there are space issues and the last few sentences have to be lopped off. I would not call the fact that the shots don't work against this particular type of flu irrelevant, would you?

So I think the other side has plenty of exposure. Not to mention, here we are -- on the internet. If someone says something you think is questionable, it takes all of five seconds to search for opposing points of view. Most people are very hesitant to question a doctor, but we have access to incredible amounts of information on our own.

Submitted by hipparchia on

yep, that's a universal. if you'd rather, we could just send swat teams armed with flu-vaccine dart guns door-to-door every fall, shooting everyone in sight. :)

the problem with making the decision about getting vaccinated a purely personal issue is that the spread of easily transmissible infectious diseases through a population is NOT a purely personal issue.

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Submitted by twig on

to arrive ;-), here's a very small excerpt from a report on the 2010 swine flu season.

The WHO reported international swine flu deaths totaling 25,174 as of late spring 2010. (22) According to the CDC, the US—which has approx. 5% of the world’s population—had 10,837 swine flu deaths, or 43% of the world’s swine flu deaths. Britain, with about 1% of the world’s population, reported 2% of the world’s swine flu deaths. Poland, with 0.6% of the world’s population, reported swine flu deaths equal to 0.06% of the world’s total. In other words, the U.S. had over 8 times its proportional share of swine flu deaths, the U.K. 2 times its share, and Poland 1/10 of its proportional share. Disturbingly, this closely correlates with reported swine flu vaccination rates: The US reportedly administered vaccines to about 30% of its population,(23) the U.K. about 8% (24), while Poland refused swine flu vaccines altogether. (25)

(my bolding throughout)

So Poland had far better outcomes in terms of mortality without flu shots than the U.S. and Great Britain had with them.

As for the public health aspect, here is an excerpt from a statement by Dr. Wolfgang Wodarg, medical expert specializing in epidemiology and former Chair of the sub-committee on Health of the Parliamentary Assembly. He is referring here to authorities with WHO declaring a worldwide pandemic in 2009. You probably recall that we were told that since swine and bird flus had combined with human flu virus, the results would be lethal. The World Health Organization (WHO) even raised the worldwide pandemic phase to 6, the highest level available, which turned out to be a very costly false alarm.

The WHO by its decision to announce the pandemic therefore had a key role to play. By its announcement, it also decided on expenditures to be made from national budgets worldwide, which, according to analysts, amount to 18 billion USD. This is a lot of money which could have been used for many other health issues. Every day there are 26 000 children worldwide who die of avoidable diseases and undernourishment! This is something we need to consider when we look at the allocation of health expenditures.

So maybe it depends on your definition of public health. Are you referring only to people you or I may come in contact with or people in other parts of the world who could be helped by the money these agencies squander to "save" us?

Finally, check out this report from the CDC in 2009. Here is one tiny excerpt:

"These data suggest that receipt of recent (2005 to 2009) seasonal influenza vaccines is unlikely to elicit a protective antibody response to the novel influenza A (H1N1) virus."

Further in the report there is an editorial note mentioning that adults -- especially those aged 60 and above -- already have some degree of preexisting immunity to H1N1, possibly from earlier exposure or previous vaccinations. Seems redundant to continue having flu shots, doesn't it? How often do you get tetanus vax -- every ten years or so, iirc. So why are flu shots needed every year? Because there are new strains of flu virus? Okay, but this year's shot won't contain whatever new bugs come along because no one knows what they are.

So by now I must sound like a libertarian crackpot, but that's not really the case. I just don't happen to think the flu shots are all that effective or that necessary. People still get the flu, even with the shots, since no one can predict which strain(s) of flu virus will be circulating each year, not to mention the effectiveness issue. Are those people a public health hazard (aside from them going out in public when they're symptomatic)?

So I choose not to get that particular shot, and you prefer to get it. We agree to disagree, you might say. I don't think either way is superior. I'm just doing what I think is best for me, based on available information, and vice versa. What's wrong with that?

Submitted by hipparchia on

since no one can predict which strain(s) of flu virus will be circulating each year

that's a lot like saying no one can predict where the next hurricane is going to hit, ie kinda true on the face of it, but not really entirely. we do actually have tools for predicting what flu viruses are more likely to be circulating through various populations in the near future:

they're imperfect because we don't yet know everything there is to know about predicting flu outbreaks, but we're working on improving that. some examples:

also, we can say with some certainty that the hurricanes in the atlantic ocean are not going to strike the california coast. :)

wolfgang wodard...

first off, he may have a good point about big pharma and a few corrupt govt officials profiting from the swine flu scare, because we already know that big pharma and some corrupt govt officials have done this kind of thing before, but it would take more digging than i have time for right now to find out just how much of that there is and was going on.

that said, wolfgang was apparently going around in dec 2009 through jan or feb of 2010 touting his discovery that unvaccinated poland had by far the fewest swine flu deaths:

but... by about feb or march of 2010 though, swine flu cases were dropping off in vaccinated europe but beginning to rise in poland:

that would have been about the end of the 2009-2010 flu season. and by oct 2010 [the beginning of the 2010-2011 flu season] cases of swine flu had increased dramatically in poland:

some miscellaneous links i have left over on poland and swine flu:

"These data suggest that receipt of recent (2005 to 2009) seasonal influenza vaccines is unlikely to elicit a protective antibody response to the novel influenza A (H1N1) virus."

from that same article:

Results among adults suggest that some degree of preexisting immunity to the novel H1N1 strains exists, especially among adults aged >60 years. One possible explanation is that some adults in this age group have had previous exposure, either through infection or vaccination, to an influenza A (H1N1) virus that is genetically and antigenically more closely related to the novel influenza A (H1N1) virus than are contemporary seasonal H1N1 strains.

so it's possible that seasonal flu vaccinations from earlier years [before 2005] were conferring some immunity for the new swine flu.

speaking of crackpots, your first link is to a site where the "professional panel" includes a licensed marriage and family therapist, a psychologist, a dentist, an investment advisor, a kindergarten-elementary school teacher... uhhh... dunno about you, but i'm beginning to wonder how many of these people, even the doctors and nurses and other medical professionals, are truly experts in vaccines? the makeup of that panel reminds me of some of the shenanigans that the climate deniers use to try to convince people that they're "experts".

Submitted by JuliaWilliams on

As a healthcare worker I feel it is not only irresponsible, but unethical to not get flu vaccines, in addition to getting boosters of others, such as MMR and DtAP, etc. (most nursing programs require titers of the common infectious diseases, and boosters if needed before you can have contact with patients, and rightly so). To expose patients who are immuno-compromised, cannot have vaccines for whatever reason, (such as allergies), or newborns and infants who have not completed their series, is the height of malpractice, IMO. The anti-vax woo is getting stronger and more insidious, their campaigns have learned to couch their information with misleading studies and so-called "experts" who are difficult to unmask. They have a websites (such as "natural news") that sell herbal remedies and anti-vax articles, and there are a lot of them. One good site that snarkily takes them down is this one, but we need all the help we can get.

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Submitted by twig on

but actually I've said several times in this thread that I am NOT anti-vaccine. Everyone in this house has been vaccinated, including dogs and cats. We chose not to get the annual flu vaccine. That's our choice.

When we are sick, we stay home. Limiting social contact is one of the best methods of preventing spread of the flu. Yes, I know we could be contagious before the symptoms appear. But scaremongering the "public health threat" that people like me may pose is just silly. In the reply to Hipparchia's comment above, there's this link to an interview with flu experts who admit the vaccines are effective 59 to 69 percent of the time. So whether I have a shot or not, I can still get the flu and pass it on to others.

There's also the argument about the flu shot giving people a false sense of security. If they don't feel well, but had a shot, they may think 'Well, it can't be the flu, because I had a shot, so I'll just go out to a movie/dinner/whatever.' But they're not a threat to the public?

Finally, here's a link to a nurses' discussion group which is about 50-50 divided on the issue. This remark is from that discussion:

As far as my getting the shot protecting others, I was unaware the shot produced a magical force field around me so that I can't pick up the virus on my clothing from the lady behind me in line at 7-11 who is coughing her head off. Or maybe it produces a repellant that keeps the virus from jumping off a patient's visitors into my hair or all over my scrub top. Do those who drop their kids at day care not go inside to see them safely in? Never hug your kids before heading out for a night shift? You know if you do you are basically hugging every other kid in their class.

If you read the entire thread, please notice that I have not mentioned autism, mercury, thimerosal, Alzheimer's, or any of the other issues sometimes linked to vaccines. That's because -- to repeat myself -- I am not opposed to vaccines in general, only those that do not work. I'm not sure why that is turning out to be such a big problem.

Submitted by JuliaWilliams on

Factual, and well-sourced, with credible sources. I, myself find it difficult to slog through the muck and get to the truth, so I found that post invaluable. I'm not sure where you get the idea that any "McCarthyism" was being slung your way, but the fact remains that getting the vaccine is better than not, especially for healthcare workers, and whether or not people get a false sense of security, they still are better protected, (and thus protect their patients better). And your quote from a nurses blog just serves to illustrate why reading the opinions of uninformed people can skew the conversation. The point of vaccination is not to reduce the exposure, but to reduce the chance you may get the illness. Yes, you may come in contact with sick people, everywhere, but certain common-sense precautions have been shown to be highly effective in reducing transmission, eg, scrupulous handwashing, covering your face when coughing or sneezing and yes, vaccinations:
"Regardless of the isolation precautions used to prevent in-
fluenza acquired in health care settings, the primary preventive
measure for influenza remains vaccination. Improved rates of
vaccination of all persons at increased risk of influenza-related
complications, their household contacts, and health care personnel, would substantially limit the introduction of influenza
into health care facilities and impede person-to-person transmission when influenza is introduced."

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Submitted by twig on

where do you draw the line between informed/uninformed?

The McCarthyism is in this part of your response:

The anti-vax woo is getting stronger and more insidious, their campaigns have learned to couch their information with misleading studies and so-called "experts" who are difficult to unmask. They have a websites (such as "natural news") that sell herbal remedies and anti-vax articles, and there are a lot of them. One good site that snarkily takes them down is this one, but we need all the help we can get.

This is exactly how the medical establishment marginalizes anyone who doesn't agree with them, people like Kilmer McCully, John Epley, or Michael Holick, to name only a few. They're ostracized and made out to be charlatans. And then what happens? Their unconventional ideas turn out to be worthwhile and are implemented by traditional docs.

btw, the blog you linked to in your earlier comment, the one that was so good at sorting out quacks, the doctor recommends tamoxifen to prevent breast cancer, conveniently overlooking the fact that tamoxifen is linked to higher incidence of uterine cancer and other negatives. That's a great solution if you want to keep your patients coming back for more. Which is apparently exactly what the medical establishment wants, since they work so hard to suppress alternative treatments.

Submitted by JuliaWilliams on

and if you're doing that, then you're either confused or uninformed. And that website was cited for his ability to have a bit of fun with teh anti-vaxers, and he does it well, I didn't rec him for treatment advice. And sometimes a charlatan is a charlatan, we have to go with research and best practice, that's all we've got.

Submitted by lambert on

Can you give an example?

The discourse being infested with trolls and shills may be another reason resolution is hard. What's the commenting and account policy like? Curated, as here?

twig's picture
Submitted by twig on

a nurse raises, instead of criticizing the source?

And really, how do we ever know if people we are quoting are really those people or not? The copy on a lot of doctors' websites and blogs isn't written by those doctors, I can assure you. It's written by people like me, who have been covering health issues for years. And the doctor I work for, who has a huge, active practice, does not endorse flu shots or get them herself, for all the reasons I've mentioned here, plus she's opposed to the preservatives and other ingredients. Yes, she's a real MD, and she has a Masters in Public Health, so she's not ignorant of the consequences.

Submitted by JuliaWilliams on

The original question or post was full of anti-vax dog-whistles "mercury" ,"aluminum", alzheimer-causing, reproductive effects , etc, with NO cites to studies (and which were shot down later in the thread) Now I'm not sure as to the curating but the posts that made me most suspicious were those of anecdotal evidence, or statements like this:

Nov 23, '10 by citylights89
I have to bump this up.

Just a quick input about vaccines: Not too long ago, Bill Gates said that the world population could be controlled with the use of vaccines, health care, and reproductive services. That's pretty scary and its not the first time that I have heard something to this effect, with the exception of the health care part. All this is done to release CO2 levels. Methinks the New World Order is on its way...

Submitted by hipparchia on

hi, julia! thank you for weighing in on this discussion. i was hoping someone with real health care chops would give the rest of us (who only read, write and opine about this stuff) some real direction.

and do feel free to steal ANYTHING i write!

Submitted by lambert on

I had more in mind that people would try to fake medical credentials, like RN's who weren't really RN's, and sock puppets and so forth.

It's hard to filter to the winger crazies. What makes it hard up here is that many of them are very sound on gardening and food -- which are deeply political issues. And then suddenly matters wander off into how the zoning board is a stalking horse for Agenda 21 (not really, but you see what I mean).

Submitted by JuliaWilliams on

medical professionals generally online, and on threads like that the only tells would be gross errors in medical terminology, or descriptions of practices, etc. Sadly, apparently there are some in the medical community, and even physicians, that are woefully misinformed, or adhere to a belief system that allows them to muddy the debate with anecdotes and skewed interpretations of studies (such as the physician who started the latest modern anti-vax craze). It's certainly healthy to be sceptical but the point at which scepticism becomes ideology is generally pretty clear-that is, the best research and solid evidence is ignored in favor of pandering to an already biased audience (kind of like the climate change deniers). Getting vaccine opinions and advice from either RNs or physicians who have a poor, or nonexistent grasp, of epidemiology and public health, or an ideological agenda, can, and does, lead to the issues we have today. (Such as the blanket immunity of vaccine manufacturers, who were going out of business, and thus causing vaccine shortages, which was due to an onslaught of lawsuits directly related to anti-vax movements)

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Submitted by twig on

has to do with flu, but aside from that, you say: oct 2010 [the beginning of the 2010-2011 flu season] cases of swine flu had increased dramatically in poland:

Okay, first of all, Oct 2010 is a different flu season. And here are the results: 12 deaths from swine flu in a country of 38 million. That's a fraction of a fraction -- not anywhere near what you might expect in a country that refused vaccines.

Second, here's a discussion of medical experts who should meet with your approval. Some excerpts:

If we talk about the vaccine doing its very best, when it's closely matched to the circulating strain, the H1N1 pandemic vaccine was as close a match as we've had for almost 40 years, meaning that the strain did not change in any measurable way that should or could impact vaccine effectiveness.

And all we're pointing out is even with that, we still only got 59 to 69 percent [effectiveness]. Do I think that's a lot better than zero? Absolutely. And when I tell people to get vaccinated for that benefit, absolutely. But it begs the question about what do we really know about this vaccine. How well is it really, really protecting?


For example, the fact that we have to get vaccinated every year shows you that somehow the immune system's not picking this up.

I read that as ineffective. You may see it differently. I chose not to get an ineffective vaccine.

And there's also the issue of liability, which is part of why Poland rejected the vaccine in the first place. If this is such a safe product, why were manufacturers absolved of any legal liability? That's not at all reassuring.

Submitted by JuliaWilliams on

See this. And while 90-100% effectiveness would be ideal, the idea that it is not effective just flies in the face of fact. It is 60-70% effective, and not getting it makes you 0% covered. I refuse to not do everything I can to protect my patients, (and family), but YMMV.

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Submitted by twig on

making sure no corporations are harmed, citizens be damned. Kind of business as usual, don't you think, letting the big operators off the hook? If the vaccine is so freaking safe, why don't they stand behind it?

I'm leaving for a few days, and won't be able to reply but in response to your last sentence, clearly this is a choice you've made. I, too, want to have a say in the matter, and I choose not to get a shot of questionable effectiveness. Since only 40 - 62% of other healthcare workers consider the shot worthwhile, clearly I'm not alone.

Submitted by JuliaWilliams on

did not consider the shot worthwhile, only that they weren't getting the flu shot. You cannot infer motivation from that. There may be many reasons, and I can envision a few of them-such as lack of convenient hours, for example for the midnight shift workers, lack of time for overworked residents, etc. Once facilities change their flu vaccine delivery to a more convenient system, eg, on-site, more days, more convenient hours, I imagine the percentage would go up-oh wait it does.
(And here's one system that achieved an 86% rate)

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Submitted by twig on

you say I cannot infer motivation, but then you do exactly that! And please -- excuses like "inconvenient" or "no time" are the best you can do? If a person really thinks something is important, he or she finds the time for it, especially since it takes all of maybe 60 seconds to a flu shot and even supermarket pharmacies sell them. I assume these people go to supermarkets or maybe walk past a drugstore now and then.

The increased vax rate study you cite actually found that intimidation (euphemistically described as "...emphasized accountability to the highest levels of the organization") was the most effective tactic for getting people to comply. Alrighty, a nice fit for our current near-police state!

As for the 86% compliance in the second link, what does that prove? There's nothing in the story suggesting that deaths or incidences of flu were lower with the higher vax rates. Just because some facility managed to do it doesn't mean it's worth doing, especially since they can't even cite benefits.

Submitted by hipparchia on

herd immunity is sorta complicated 1 2 3 4 5 6 7 but basically the vaccination rate needs to be higher than the threshold for herd immunity for that particular disease. and that threshold can be higher than 90% for some diseases.

i don't know what the magic threshold is for flu, but if you need, for example, 92% vaccination rate and you only get 86%, then you may not see appreciable benefits, which could explain why "they can't even cite benefits."

even with 100% vaccination rates of health care workers and a theoretical disease where you only need, say, 50% vaccination for herd immunity, the patients still come in contact with other people besides the health care workers. and if a large portion of those other people are not vaccinated, then the overall vaccination rate of the population may still be below the rate needed for herd immunity for that disease.

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Submitted by twig on

could cure whatever ailed you. Obviously, we could trade links on this all day, without accomplishing much.

I'm trying to think of a topic that all doctors agree on (other than obvious things, like the heart pumps blood), but there isn't much. There's still a raging debate among doctors over whether vitamins are beneficial or a waste of money.

We both know that there are dozens of controversies about what works in medicine and what doesn't. A lot of it depends on the individual patient -- health history, genetics, environmental issues, diet, activity level, medications, and so on.

So back to my original point, which is simply that each of us needs to play a role in our health and not mindlessly follow some blanket directive that may or may not apply to you.

Otherwise, you're putting yourself at risk for unintended consequences.

Submitted by cg.eye on

Not when babies in Colorado are suffering from a whooping cough increase. There are other factors at play, but I believe it increased because families decided to ignore the benefits of herd immunity, or at least roll the dice that it would benefit them, other kids be damned.

You cannot believe in a culture in which each citizen depends on each other, and does his or her part, without believing in the principle of vaccination -- and this chipping away of that principle due to concerns about non-US-approved vaccines is no better than defunding public health initiatives such as contact tracing, even that was also controversial during the height of the AIDS crisis. Any one person can choose to not get vaccinated, but I'm conservative on this point -- YMMV.

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Submitted by twig on

because I don't see anything questioning vaccines for whopping cough or any other health issue -- except influenza.

As for the "non US-approved vaccines," I didn't know correntewire's readership was American only. Maybe it is helpful to people in other countries to have this information.

And before you unequivocally accept the benefits of flu vaccinations, you might want to read this, a survey of flu vaccine studies. The authors conclude vaccines have some benefit, so they are clearly not anti-vaccine. But are you willing to believe there is no bias in the studies after reading the last paragraph? I'm not.

Influenza vaccines have a modest effect in reducing influenza symptoms and working days lost. There is no evidence that they affect complications, such as pneumonia, or transmission. WARNING: This review includes 15 out of 36 trials funded by industry (four had no funding declaration). An earlier systematic review of 274 influenza vaccine studies published up to 2007 found industry funded studies were published in more prestigious journals and cited more than other studies independently from methodological quality and size. Studies funded from public sources were significantly less likely to report conclusions favorable to the vaccines. The review showed that reliable evidence on influenza vaccines is thin but there is evidence of widespread manipulation of conclusions and spurious notoriety of the studies. The content and conclusions of this review should be interpreted in light of this finding.

Submitted by lambert on

This is almost turning into a truther situation, and the sign of some deep disability in the discourse -- where it just takes too damn much time to sort out the issues. So, people like me seek proxies... But where are the proxies to be found? And resolution?

* * *

1. It's clear that the medical profession and medical journals, sadly, are often corrupt and deeply implicated with Big Pharma and health care for profit generally. It's only natural that people, especially those impacted by the "health" "care" system would seek a "second opinion" by doing their own research and developing their own sources, exactly as anti-resource extraction groups have done.

2. On the other hand, when we talk about vaccines, it's very clear that we are in the territory of public goods, where one unvaccinnated child can infect an entire school, even if that child went unvaccinnated under the rubric of "personal choice" or whatever the ideology is. "Public health" is public, right? But much of the political discourse today denies the notion of public good in the first place, and in consequence, vaccination. However, if we move the conversation over to a different arena, I'm not all happy that we've medicalized non-compliant behaviors and are now drugging young childen, boys, mostly, under the rubric of ADD. But if we accept the medicalized frame, than vaccination and ADD drugs are both measures for the public good. But if we do not.... What is the criterion for saying where the public good applies?

3. We have the subsidiary issue that not all medicines, including vaccines, work. I myself remember the swine flu panic back in the days of the Ford administration, where, IIRC, not only was the vaccine not effective, there was no epidemic. And I don't take flu shots (a) because they cost me $25, (b) I don't think they're all that effective, and (c) I'm not out in public spaces like schools or churches or corporate cubes a lot.

4. Also too pandemics. At this point, would I trust the government enough to comply with mass vaccination? I'm not sure. Incentives don't seem to operate in a life-saving manner for people like me in any other arena, so why would things be different in a pandemic?

And I don't have time to read this whole thread and form my own views.

Submitted by JuliaWilliams on

If I get infected, and before i even know I'm sick, I can spread the illness to many many others, some of whom are so compromised they might die. In addition, I have family members that have the same issues. I have to go with every possible thing I can do to prevent transmission. (Efficacy of 60-70% is a heck of a lot better than zero.) And, vaccinations are free for all employees at my facility, as at other hospitals. (BTW, our county public heath facility provides free flu shots every year)

Submitted by hipparchia on

i've been fortunate in recent years and can get a flu shot for about $10 at work, but i'll skip meals if i have to to come up with the $25-$50 i've paid in other years.

some other ideas for free or low-cost flu shots. for you in particular, since you don't have medicare or insurance and aren't likely to buy enough stuff at a drug store to make coupons worthwhile, i'd suggest checking with your state or county health dept and/or calling the vna nearest you.

1976 swine flu nothingburger? this article suggests the possibility that 30+ years later some people (approx 17%) who got the 1976 swine flu shot had active immunity to the 2009 swine flu virus. only 4% of people who didn't get the 1976 swine flu shot showed the same amount of immunity. it wasn't a rigorously done trial, but the results are suggestive.

re the next pandemic, the 1976 swine flu appeared to be closely related to the 1918 killer flu, hence that panic to turn out a vaccine in a hurry and get everyone vaccinated. if you got that vaccine back then, take heart, it's possible still have enough antibody-manufacturing capability left to help you fight off the next pandemic.

re immunity, either from shots or from getting the disease and recovering from it - it's not exactly an on-off switch. when a virus or other disease-causing organism invades, your body fights back via several mechanisms, including manufacturing specific antibodies to the invading organism. if your body has never seen that particular organism before, it takes a while to make enough of the specialized antibodies, but if you've already been exposed to that virus (or microbe etc), either by vaccination or by having the actual disease, then your body ramps up the antibody manufacture much faster.

so, more antibodies manufactured faster = either shorter-and-milder bout of disease or no noticeable infection at all.

having to lie around the house for a few days feeling miserable beats being completely flattened for 3 weeks and a trip to the hospital. been there, done that (one of those flu shot shortages, not by choice) and if getting a flu shot every year means that once every few years i feel like crap for 3 or 4 or 5 days, then yes, i consider that my flu shots have "worked." ymmv, and probably most people would consider getting a very mild bout of flu to be proof that their flu shot did not "work."

However, if we move the conversation over to a different arena, I'm not all happy that we've medicalized non-compliant behaviors and are now drugging young childen, boys, mostly, under the rubric of ADD. But if we accept the medicalized frame, than vaccination and ADD drugs are both measures for the public good.

sloppy thinking on your part. the harm from "over-utilization" of flu shots is miniscule, to the point that it's almost impossible to over-utilize flu shots. the harm from over-utilization of add drugs is much, much greater. medicating kids into compliance with an increasingly rigid and demanding society is not only an abdication of responsibility for taking care of our kids, it's also a symptom of a more general abdication of responsibility for taking care of our society as a whole.

What is the criterion for saying where the public good applies?

that's certainly an important discussion, hugely important, and it's probably a discussion and not a single criterion, but let's start with the postulate that there are small harms and great evils and that just because both might be "medicalized" they're not necessarily equivalent.

And I don't have time to read this whole thread and form my own views.

me either. this is why i'm a fan of big government - hire a bunch of people, make sorting through piles of this kind of information their one and only job, pay them a comfortable salary with decent benefits, and keep an eagle eye on them for signs of incompetence and corruption.

Submitted by lambert on

is not only about flu shots, but about vaccination and about forced medical treatment in general, and when it's justified; that is, the entire thread.

Sloppy writing on my part, possibly (though I'm not sure how the conversation can be identified with flu shots only).

I've only got time to answer the one point, though doubtless there's other important material in it, if I read it carefully.

Submitted by hipparchia on

i take back what i said about your thinking.

as for the conversation, the conversation here has been about flu shots: whether or not they work, what constitutes evidence that they do or do not work, who/what is or is not a credible source of information/evidence, risk perception, whether in the face of imperfect evidence you should get flu shots or avoid them, and what constitutes scare-mongering.

these are all points that are integral parts of the other conversations you mention - vaccination in general, forced medical treatment, substituting medical treatments for fixing societal problems, etc - but those conversations are other conversations, even if they sometimes closely parallel this one.

Submitted by jawbone on

been having winters with a cold/something which would take about 5-6 weeks to clear up, then I would get another one. Rinse, lather, and repeat.

It was exhausting and I was miserable.

The next year I got a flu shot from the local visiting nurses' association. Almost immediately I got an autumn cold/something, miserable. But it cleared up faster, iirc. However, I was skeptical of its efficacy.

However, as I continued to get the flu shots, I've had fewer and fewer winter cold-like episodes/somethings. I've read that the immunitiy from previous years does continue into future years.

In the mid-90's I also began allergy shots, for my almost non-stop sinus headaches. That was amazing: The dr. had said it would take 6-8 weeks for the shots be be effective, but, within a month I realized I'd barely used my stock of OTC sinus headache remedies I had them everywhere: desk area at home, kitchen, bathroom, bedroom, office, purse, car -- to try to get the meds workig before the headache got really bad. I did have to add more anti-allergens to the shots I got.

(When I was in the burn center for a month I didn't get the shots, and when I was ready to start again, I couldn't afford the private insurance for a couple months and had to wait for Medicare to start. Then I learned my allergist wouldn't accept Medicare payments. But with the supplemental insurance, IF I paid up front for the tests and serum, he would treat me and I would be reimbursed. I couldn't afford the up front part.... Very diappointing.

I now have a cold/something, and have been told to stay away from my friend with the stroke as she is considered to be very frail right now. The nurse used another word, and I can't recall what it is. So, that's why I'm online. Without the allergy shots, I'm fearful I'll end up with sinusitus again. Ack.

Submitted by hipparchia on

And yes, I know this is way too long for a Quick Hit and I promise I won't do it again.

sometimes you just can't tell ahead of time when a post [quick hit or otherwise] is going to spark a big discussion!

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Submitted by twig on

I actually thought your piece from a couple days ago, about the changes coming to Medicare and Medicaid, was far more interesting and discussion worthy. This is about one shot -- changing Medicare and Medicaid is about the rest of our lives. Big difference!

Submitted by hipparchia on

flu shots are not the only public policy issue where we have to make decisions and have only imperfect and/or incomplete information.