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The Gap Between Stats and Understanding In Flu Cases
KentuckyFC writes "Bird flu gets all the headlines but ordinary flu kills several orders of magnitude more people each year and represents a significant threat to our society. The frightening thing about ordinary flu is how little we understand about how it spreads. According to a report at the physics arXiv blog, researchers trying to model this process say they still don't know some basic probabilities associated with infection (pdf, abstract). For instance, given that the disease has manifested itself clinically in an individual, what are the chances of that person dying? And if a virus can be caught from a number of different host species (as it might eventually be with bird flu) what is the probability of transmission?"
That is a the popular perception. But it does not reflect reality: death risk from ordinary flu is actually statistically negligible. See for example this page http://thinktwice.com/cdc_2001.pdf taken from the CDC National Vital Statistics Report.
Yes, those are official statistics. Time to think twice. Yes, part of it is the good money made on all those flu shots. But that is only a small part of it. To learn more about the real reason, watch this talk by radiologist David Ayoub: http://video.google.com/videoplay?docid=6890106663412840646. Hard to believe? Verify the sources, they check out. Welcome to the real world.
Given the fact in the Netherlands and Belgium we have http://www.degrotegriepmeting.nl/ -- an effort by some medical institutions and related institutions to monitor the migratory patterns of the flu. This is the fourth year they're monitoring. The same kind of project happens in Portugal: http://www.gripenet.pt/ Moreover there's http://www.eiss.org/ -- the European Influenza Surveillance Scheme. So if you want to talk about current statistical data, it's right there and active.
Nothing like that even enters into their paper, so pardon me for finding it a bit one-sided approach.
Jeroen Ruigrok/Asmodai
The problem with the flu is the same as the common cold; the virus mutates too quickly for scientists to create a vaccine. Molecular biologists are making great advancements in understanding the genetics of pathology - advancements are occurring at such a phenomenal rate that even studies from a few years ago are considered out of date.
The media is unfortunately oblivious to the reality of virology; announcing that the bird flu or SARS or some other pandemic will decimate the population in the near future gets great ratings. Unfortunately, it is not the scientists who are releasing these stories. It is reporters, editors, publishers, with no real understanding of medicine, genetics, pathology, or virology.
- Demosthenes
cynicsreport.com
I have an idea. How about letting the human species's immune system continue to adapt for the flu rather than short-circuiting continued adaptation the way we are in countless other areas by creating drugs that then eventually become ineffective as the diseases evolve while human immune systems devolve and put all that research time and money toward some of the infinite number of more pressing problems that need to be addressed now? We're the one species that's going to go down as not only having messed up the planet and ecosystems for all the other species, but also the one that actually largely put the most effort they possibly could into actually making themselves maladapted to the very planet they forced the most adaption of species for.
Vaccination stimulates the human species' [no need for "s" after the apostrophe] immune system by exposing it to a safe version of the pathogen. In this way the immune system continues to "adapt for the flu", exactly as you had hoped, and in no way short-circuits the continued adaptation. As the influenza virus mutates, so does the vaccination, and each year the scientists try to figure out which strain of flu to protect against. (One year they guessed wrong, and the flu vaccine ended up next to useless as it protected against a strain of flu that only appeared in a small minority of people.)
Even for other vaccinations such as TdaP (tetanus, diphtheria, acellular pertussis) which is given only every ten years, vaccinations don't interfere with adaptation. The special case you may be thinking of is with smallpox, which was completely eradicated to the point that there is no further need for vaccination. That is not interference with adaptation, since:
- any reintroduction of smallpox is by artificial means, so in any case adaptation has nothing to do with it
- it's not worthwhile continuing to administer smallpox vaccine to let the immune system "adapt" to a potential smallpox outbreak, since the smallpox vaccine itself has a number of significant side effects. I myself was offered the smallpox vaccine shortly after the Sept11 incidents, and there was a non-negligible chance of serious illness including hospitalization and, by extension, death. (I did accept, but the threat level then decreased and it was no longer considered necessary.)
- if smallpox were to return due to natural circumstances rather than some human reintroducing the locked-up version, it would evolve from an existing virus in the wild, and vaccinations would play no part in whether the human immune system adapted
- Letting the human immune system adapt doesn't work all that well. SARS is an example of a virus for which we don't have a vaccine, and it had a mortality rate approaching 10%. That sucks. No antibiotics or other antimicrobial drugs, either, so you can't blame it on that.
I don't know if you're actually referring to the use of antibiotics, where pathogens do evolve against a fixed, unchanging drug molecule, but there are certainly advantages to having antibiotics, too, just as there are appropriate circumstances for sterilizing medical instruments or wearing disposable gloves. Nowadays we can treat skin cancer by a simple office procedure, for which the risk is negligible. Can you imagine if we didn't use sterile instruments, or if the doctor didn't wear sterile gloves, or we couldn't treat a surgical wound infection with antibiotics?Be careful not to confuse excessive anti-exposure measures with vaccination, which takes leverages rather than suppresses the immune system.
404555974007725459910684486621289147856453481154 in hex is "You sank my Battleship?"
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Are you scared yet?
You don't need statistics to show that vaccines work. it is scientifically provable.
You give someone a vaccine, they get the antibodies for the virus they didn't have before. You can see them in your blood. How do you think this stuff works?
This isn't saying anything as to whether or not the flu shot should be a required vaccine or not, IMO NO vaccine should be required by law, but up to the parent. And I have never gotten a flu shot in my life and I likely never will until I am 70 and at risk, because other wise it is just fear-mongering nonsense (the flu is not going to kill me, a healthy 28 year old. At worst I will get a 2 week paid vacation).
As for the video and the claims of vaccine causing autism in some? May or may not be true. IMO it is not the issue. Think of how many times a child cuts themselves on metal each year. The likelihood of them getting a SERIOUS case of tennis from these injuries far exceeds the likelihood of them acquiring autism.
There is a degree of risk in almost every treatment in modern science. You go into routine surgery to get your appendix removed, you might die from the anesthetic. But the risk of dying is MUCH HIGHER without treatment. No different than many vaccines - the risk of death from the disease is much higher than any risk of autism. Nearly ever kid in the US gets a huge vaccine regiment, hardly any have autism. To me, that makes the probability pretty small. Much smaller than the odds of dying from any of these eliminated diseases used to be.
I don't have any conceptual problems with the theory behind vaccines, but there is some serious question as to whether or not flu vaccines have decreased the flu death rate in the population at large.
Sounds like the perfect job for an AI system to figure out. A Bayesian net or a hidden Markov model should be right up to this. Less complaining, more coding!
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I like how the next article on the blog is about increasing your Google page rank and tips for within-site cross linking. The link from slashdot should help.
Let's take a look at the last century. As I see it, roughly half of the people who died of flu, did so in the 1918 pandemic. In other words, one single variant of the flu killed as much as a century's worth of regular flu. It makes no sense to ignore a flu variant which to all appearances is more lethal than the 1918 flu (all we know is that more than half of the people who we figure out had it die which is much worse in general than the 1918 flu was), even if it is barely contagious. Obviously, there might be a big drop in lethality, if it adapts to humans. But if there isn't, and as in the 1918 flu epidemic, it infects about 20% of humanity (as I dimly recall), then that means 10% of humanity dies (as opposed to about 2% for the 1918 flu).
Give it a rest. Vaccines don't cause autism. Mercury in vaccines especially doesn't cause autism, because there isn't any mercury in most vaccines, and there hasn't been any for years. This was effectively ended by going to single-dose vaccines to prevent the need to stabilize or sterilize the multi-dose vials. It increased cost, but it eliminated a small (but nonzero) dose of a heavy metal. There's still no evidence of significant harm during the mercury era, but that era ended years ago.
Britain did a lovely experiment with mass hysteria and autism, dropping their MMR immunization rate substantially in response to this kind of fear-mongering. The result: measles made a comeback, and diagnoses of autism continued to increase. We still don't understand whether (or why) autism is on the rise, but vaccinations were effectively ruled out a long time ago.
As far as the massive money made on the flu shot, give that a rest too. Vaccines are hard to convince drug companies to make, because the liability exposure is large and the profit on the drug is quite small. In the USA, if it weren't for federal intervention (surveillance and liability coverage), we wouldn't have domestic manufacture of any of them. Remember that flu shot shortage a few years ago? It happened because a British manufacturer of the vaccine, Chiron, had a facility declared ineligible (for quality reasons) to ship product. In the USA, there isn't enough domestic manufacturing capacity to make up that kind of a hit.
As far as how benign influenza is, try that line out on the half dozen families in my state who had a previously healthy school-age child die suddenly from the flu a couple of years ago. We had a bad strain come through that year, and we saw a lot of cases of partial or complete airway obstruction from the necrotizing tracheobronchitis that seems to be caused by certain kinds of flu A. Or just talk to the hundreds of people who were hospitalized last year, or the tens of thousands who lost a week from work and felt like they got hit by a car. Or talk to me - I'm a hospital pediatrician practicing in a site where I see all of this and more, and where I've seen directly the difference that the flu shot makes. And yes, I get mine, and I have done so every year for a LONG time.
If you're a healthy adult and you don't mind a moderate statistical risk that you're going to feel like crap for a week at some point in the next six months, by all means run and hide from the shot. But don't let the vaccines-cause-civilization-decay folks panic you out of something that has kept a lot of my patients healthy.
Yeah, I had a bad case of Navratilova last year. Almost as bad as that case of Hingis my friend had.
Wait, tennis?
Recent tests of symptomatic treatment of influenza have shown that this doesn't work, i.e. the lethality of the virus is based on its primary action. Given that governments will probably be too afraid or powerless to stop all air travel and movement from affected areas when it starts, this could realistically happen again.
The worst of it is that it will probably start in China , where a major population reduction would probably suit the Communist Party down to the ground. The survivors would be too busy reconstructing society to think about revolution, and the pressure on resources would suddenly drop dramatically. Provided they could protect themselves, the leaders of China would have little reason to try and stop a world wide influenza pandemic.
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OK, so bird flu gets more press than normal human strains.
I think the question is not is bird flu more dangerous than normal flu, but what will happen if bird flu infects people and then mutates.
Normal human strains of flu have been around for a long time, sometime mutates into something really bad. We have had a lot of experience of this, and there are a lot of infection models.
We know nothing of what will happen if bird flu gets into humans and mutates because it hasn't yet happened (although there is conjecture that this is what happend with the flu outbreak during the great war).
It's just like saying that those NASA people are wasting money tracking asteroids, as mankind hasn't suffered a big asteroid strike, and it's all hype. I would rather have some people looking into these things and generating hype, instead of directing their resources into something else (like preventing car accidents) even though it would give a better lives saved to dollar ratio.
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You're forgetting the concept of herd immunity and the fact that older adults just don't have that good of a response to flu vaccines. Restricting flu vaccines to 70+ people would result in lots of younger people having the flu that wouldn't kill them, but they would infect lots of older people who don't have a good response to the vaccine -- killing them.
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We had a nurse at work give Flu shots but only six of 150 employees got one, the same number as last year. Last year nearly everyone in the entire building, except for those who had the shot, got the Flu.
When I asked people why, their excuses were: they saw something on the Internet about how vaccines makes you sick, it will give you the Flu, they want their body to fight it naturally, there's mercury in it. I was amazed at the level of paranoia.
One woman had a valid excuse she lost her hearing after receiving a flu shot but it was temporary and I have no idea why she said it was because of the shot but I have no way of knowing for sure.
I said, well, they're nuts and for example would you rather get Polio or a vaccine to prevent it rather than the full force of the virus? And it's arrogant too not to get a Flu shot since just because it may not affect you much you may pass it on to an elderly person, a baby or a person with sever health problems.
Smallpox? Polio? Have you totally taken leave of your senses? If you want to express doubts about the efficacy and safety of some vaccines, be my guest. You may well be right about many of them. But keep some sense of proportion, quit telling others (incorrectly) that they don't know what they are talking about, and get a grip on reality.
You can't see ANYTHING from a car, You've got to get out of the goddamned contraption and walk...Edward Abbey
In America, only old people have smallpox vaccination scars, and only old people knew people who had polio. Actually most people with a real cold believe they have the flu.
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It's the vaccine that may be the cause of the arthritis, it may be the adjuvants.
One doesn't develop systematically antibodies against everything that gots injected under the skin. How otherwise would you explain that no reaction happen (most of the time) following tatoos ? That people who develop antibodies against bioengineered drugs only develop them over time (and not right at the first exposure) ?
For the white cells to react, the intruder must be flagged as something worthy of a reaction, otherwise the intruding substance just gets cleaned up silently by macrophages.
For actual microbes (viruses and bacteria) that is mainly due to the destruction they cause. This damage triggers and inflamation which stimulates the immune response.
But a lot of vaccine are often only bioengineered inert proteins. They don't atract the lymphocyte's attention and may end up silently cleaned up. On of the technique consist to ad a special substance that will increase the probability of an immune response, that will boost the tendency of the body to react and produce antibodies.
The problem is that some adjuvant bring a small risk that the bodies over reacts and is stimulated to produce antibodies against other things too, like against it self and thus the dogs in the experiment you mention develop arthritis.
But that depends on the quantity of vaccines they got exposed too, and the composition of the vaccine regarding the response-boosting adjuvants.
Regularly old adjutants (either preservatives or boosters) get phased out and replaced by newer safer methodology.
But the process of vaccination (producing antibodies against foreign substance) isn't dangerous per se. And anyway is happening all the time continuously, whether or not someone gets shots by his doctor or not. If your not sick for long periods of time, that's not because you managed to somehow avoid all bacteria, it's just that your immune system is at work and manage to correctly handle continuously all pathogens present in your everyday environment.
Autoimmune diseases are also at increased risk after a disease, because the immune system got stimulated (and also because of the mimickery some bacteria use to try to hide - Antibodies that work against them may end up working against the body)
Lastly, autoimmune disease depends mainly on the genetic make-up of an individual. There are people at greater risk of autoimmune response and people at lower risk (also for various reason I won't detail here, being female doesn't help). And as I said before, if your at risk (have several family members with diseases like arthritis, lupus, psoriasis, etc.) running away from vaccine won't help, you could develop some as a consequence of a disease.
About Allergy : They are not caused by a depressed immune system. They are a (bad) reaction of the immune system and for that you need a working one. Once again it depends on the individual genetic markup.
But as you point out environmental exposition may play a role in the balance.
The cells involved in allergy (eosinophils) seem to normaly be usefull against parasites. In third world countries, those cells get someting to work on and thus remain busy. In our clean occidental settings, they stay useless. In some people, those cells just stay calm and don't do much. But in people with the wrong genes, the cells may try to work too much and do things they aren't supposed to : this bring you allergy (and the problem with allergy is, unlike a parasites which usually is 1 animal in 1 precies location, the allergenic substance can get in your blood and disseminate and trigger response in the whole body thus provoking anaphylaxis).
Note that, as mentioned before, some way to stimulate the immune response is needed in allergy too. Often this is linked to a family of proteins like lysozyme in the saliva of animals whose fur causes allergy (those proteins are used to kill bacteria but might be very slightly reactive in humans and thus trigger a response).
Probably (as pointed
"Sufficiently advanced satire is indistinguishable from reality." - [Tips: 1DrYakQDKCQ6y52z6QbnkxHXAocMZJE61o ]
Strunk names a few exceptions to this rule, but none of them apply here.
I don't mean to be a grammar nazi, but the parent did bring up the subject.
$META_SIG_JOKE
Bird Flu is not some kind of crazy new flu. It is regular flu. It happens to be a strain that is particularly virulent but not so great at spreading from human to human. It is the same virus that causes regular flu but has a chromosomal arrangement that is just not so great for birds or people. That is what makes influenza so versatile and adaptable. It has a rearrangeable chromosome.
That's what I love about Slashdot --you learn something new every day!
:)
Thanks for the tip. A few more corrections like this, and I'll have enough experience points to advance to the next level of Grammar Nazi!
404555974007725459910684486621289147856453481154 in hex is "You sank my Battleship?"
[GPG key in journal]
You don't need statistics to show that vaccines work. it is scientifically provable.
Oh really? How exactly do you prove something "scientifically" without analyzing data? And how do we analyze data? Oh damn... there's that nasty "statistics" again...
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