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On the Efficacy of Flu Vaccine
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.
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.
It really seems the data can be massaged to draw any conclusion that is desired. In my case, up until three years ago I had never had a flu shot. During a typical winter I would be sick at least twice on average, usually missing about four or five days of work in total. Since I've started having seasonal flu shots I have not had any winter illness and missed no time from work. While hardly scientific, it seems to me that the downside/upside in my personal case weighs heavily towards receiving the vaccine. There are clearly other viruses in human history where vaccination has had a profound and measurable effect which is beyond debate.
My understanding is that vaccines are around 70% effective.
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.
Let's pray that science wins out over irrationality.
At least we know that not taking the vaccine does not have side effects (contamination (Baxter), coadjuvants (some vaccines), etc.) or does it?
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.
Ok, maybe just statistics, that sometimes are worse if not interpreted correctly. That 'healthy people', the one that takes seriously enough prevention to, between other measures, get the vaccine, are less exposed to disease risks in general, and even when they get the flu (seasonal or not) they usually take measures to make it less deadly. The point is, between equaly exposed people vaccine lower the risks? In a widely spread pandemy we all could get a chance of exposion, and there is where vaccines will make a difference.
In this case it seems lots of people believe that vaccines are good, that anything that reduces use of them is bad, and since testing them could cause reduction in use, testing is bad. Never mind that they might not be as good as imagined; this is beyond question, and it's simply a matter of getting others to accept the same belief, no matter what means is used. It really makes me sick to read question-and-answer documents that constantly avoid direct answers to questions of whether a given person gets a benefit from an injection.
While this does raise some questions about the efficacy of the vaccine. It doesn't prove conlusively it does nothing. Not that you would know that from the editorializing the author does.
H1N1 in San Diego is a KILLER... three atypical deaths recently...
The vaccine isn't even available due to a Federal faux paux that failed to ship to hospitals.
San Diego is your test bed for determining whether it works unless the Feds ship soon.
... I became biased against any conclusion. Up here in the Pacific Northwest, the common nickname of this HMO is "Group Death". They're not exactly known for high quality care or cutting edge research - they're mainly known for denying treatments as "experimental" for years after those treatments have become the norm in most medical circles.
I remember an acquaintance (husband of a co-worker) who kept getting denied treatment for (IIRC) a persistent and very painful hydrocele. The Group Health doc told him nothing could be done - surgical correction of this was "experimental and dangerous". Finally out of desperation they consulted with an outside doc, who told them this was a very simple routine procedure! They paid out-of-pocket for the surgery, and the problem was quickly rectified.
I know nothing about the particular doctor who did this flu vaccine study - but, given her employer, I have very little confidence that she is particularly knowledgeable. I'm sure Group Health would love to save the 15 or 20 bucks per patient they're currently having to spend on this vaccine.
#DeleteChrome
You don't only get vaccinated for yourself. You also get vaccinated so that you don't transmit the virus to those with compromised immune systems.
I am really so tired of all of the anti-vaccination propaganda being put out, and those same people will probably warp studies like this one to fit their absurd ideas about how vaccines are almost as bad as chemtrails.
The live attenuated flu vaccine, FluMist is substantially more effective than the inactivated injected vaccine (something that's blindingly obvious to those of us who've studied basic immunology). It provides a potent T-cell response, and a large pool of memory cells. Furthermore, it has been shown to be effective against viruses that have undergone some genetic drift.
For anyone who is old enough, has no respiratory problems, and who isn't immunosuppressed, the live nasal spray vaccine is a much more sensible choice.
For additional data refer here: http://www.cdc.gov/flu/professionals/acip/efficacycomparison.htm
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.
Randomized, controlled trials have shown the effectiveness of flu vaccines, contrary to the claims of the article. (Example: Wilde et al., "Effectiveness of Influenza Vaccine in Health Care Professionals.")
In addition, research into mortality reduction already takes into account comorbid conditions and age. (Example: Nordin et al., "Influenza Vaccine Effectiveness in Preventing Hospitalizations and Deaths in Persons 65 Years or Older in Minnesota, New York, and Oregon: Data from 3 Health Plans.")
The article is at best poorly researched and at worst intentional FUD.
Due to a long history of unethical behavior in the medical field, there are stringent requirements that require one to show a need for research and to demonstrate safety concerns before one can begin an investigation.
This often means that simple experiments that could show benefit and harm of an intervention will not be done because of a large body of circumstantial evidence.
There has to be a fairly even view of outcomes on both sides of a trial before it will be approved - or other studies showing possible efficacy of the side that is under question will need to be done first.
When these situations arise, one can often perform the experiment in a subset of the population in which vaccine efficacy is questioned and benefits are unknown.
The population of HIV infected individuals is one such population and there are double-blind placebo controlled trials done in this group.
The annals of internal medicine (an American College of Phyicians publication) http://www.annals.org/cgi/content/full/131/6/430 published an investigation showing the efficacy of the influenza vaccine in a population that was least likely to benefit from it. While mortality data is not available here, its results stand on their own as a testament to the clinical efficacy of the vaccine.
When all else fails, try.
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.
That fact tends to get lost in the fear-mongering. It's probably the main reason why we're making such a big deal out of the swine flu when the regular flu still kills thousands more people per year than the swine flu. The explanation for that is pretty simple: popular panic about a virus sells vaccines for that virus. The more I see the media and others telling us how afraid we should be of the swine flu, the more convinced I am that they are using this angle because there is no rational reason for most people to buy this vaccine. This is like the security theater that Schneier warns us about, except this time it isn't about airports, it's about medicine.
My unit tests don't generally kill people though.
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.
Sigs are too short to say anything truly profound so read the above post instead.
I think it's commendable that folks still challenge received wisdom, and are actually attempting to answer difficult questions, as opposed to merely sweeping them under the carpet.
However at the same time, we need to be super, super careful that we don't encourage the fringe extremist nutters in the antivax movement, who are sure to seize upon doubts of the efficacy of the swine flu vaccine as PROOF that all vaccination is bad, and that we should protect our kids by going to flu and chickenpox parties because it's "natural".
And I would need convincing that this isn't some kind of stunt by Group Health or other elements of the private health industry to wriggle out of paying for flu shots. Gotta love profit-focused private "health" care, and its useful idiot defenders on the Right.
The flu shot is tested annually through peer-reviewed clinical trials. The shot is compared to its protective factor year over year. I believe the data shows it works.
Part of the research I've read recently claims we have no solid definition of the mortality rate of the "flu". The problem is unless you take a culture and analyze it in a lab, you can't tell if the disease is really influenza or one of a hundred or so others that cause similar symptoms. But people who report to their doctor about symptoms aren't always lab tested to see exactly what they have. It'll get noted as "the flu", when it may not be influenza at all, skewing all the statistics.
The article I was reading in Atlantic Monthly makes the claim that people who die from flu-like symptoms aren't always lab tested, either. Thus, the mortality rates for "the flu" may have little to do with influenza.
While we as a society have had great success with vaccination campaigns against diseases like the measles, mumps, rubella, polio and small pox, the same can't convincingly be said about influenza.
Learning HOW to think is more important than learning WHAT to think.
It's not easy to account for the lives lost due to waste of limited resources on medicine that doesn't help. If flu vaccines don't help most people, then let's find out so we can spend time doing things that do help.
I'm all for testing the conventional wisdom, and when combined with my tendency to avoid medicine where it isn't necessary it appears that I should support this kind of article. But when it comes to vaccines there's a problem - antivaxxers. Regardless of the chance that one particular vaccine might not really be worth taking, it's frankly irresponsible to put out this kind of article without firm proof. Show me where the clinical trials for the vaccines went wrong and how everyone else who looked at the efficacy of the flu vaccine missed it. Otherwise... and I really hate to say this... shut up. There are people out there who will use this as ammunition in their irrational campaign against vaccines in general, and those people will get other people killed. Not just people who choose not to get themselves vaccinated for the flu, but their children, and the children of other people who for are unable to get the vaccine due to an allergy, or for whom the vaccine had no effect. Those people would normally be protected by group immunization that kept them from ever being in contact with the virus in question, but when there's a real movement in our country to avoid vaccines... well we start to slip below the threshold in some places.
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.
Does a line appended to your comment give your post meaning in and of itself, or only in relation to those without?
Although with the taxes we're going to have to pay to get out from under the drunken sailor spending sprees of Bush and Obama, we're all going to feel like we've died twice.
Not that the medical establishment even gets trained to do this. The last thing a sick person wants to hear is "we haven't got a clue what's happening".
Anecdotes are all we have in everything except the exact sciences. All other sciences is based on anecdotes and stories, or their similar, but more systematic brother : data. Only things confirmed by controlled and direct experiments is real, trustworthy data, only such things lend themselves to real predictions. And most sciences, like medical science, climate science, social science, and any part of the humanities just doesn't allow experiments. We can't infect people with designed viruses to see what they do, we can't inject masses of gasses into a planetary athmosphere and see what happens and we can't run experiments on humans, never mind the issue that repeating any experiment on a thinking creature can obviously only result in a manipulated result.
But the problem is more general. People abhor the answer : "we don't know this" or " we couldn't change this". Science has long since become a sort of religious status, where it's claims are total. Details like that the scientific method just doesn't work like this are not mentioned. You can see the headlines : "does the earth warm ? Scientists doubt it" (that would be what the scientific method dictates : that you doubt it, and the more you believe it's warming the more thoroughly you should go looking for any indication that you're wrong. Some scientists actually still do this, but it's an ever shrinking group, especially in the politicized sciences)
But the issue of not knowing is problematic. Take the economic crisis for example : the basis of the problem is that nobody expected the cascade effect that failing mortgages would have. The problem is : the scientific reasoning for concluding that it couldn't happen was, statistically, very sound : it never happened before. In 50, and for some banks 200 years of data, the statistical algorithms never encountered that situation, so they concluded it to be impossible. You can wine all about it, but that's an entirely correct conclusion.
Whatever your position about climate change, it is a science that will encounter the same problem : It has very limited data at the moment, real, quality (calibrated and double-checked), first hand data is limited to less than 200 years, and the list of huge energy reserves that are not considered is very likely to be a long list. The list of how they respond to different climatic events is likewise limited : we don't even know how half of them reacted in the past. Even if we did know that, there is the possibility that we are in a new situation, and things could react very differently to a very different situation. If such were true all statistical inferences would be 100% correct, and yet they would not match reality at all. You cannot test for this (despite how much people like to think that if "variance is explained 100%" that it can't happen, even though the variance in the financial data was 100% explained, it failed to predict the cascade failure). Yes humans put (a bit, compared to the ocean) of co2 in the athmosphere, they also put a few million other gases in the athmosphere. What will happen ? The pedantic, information theoretically correct answer is : "we haven't seen this before, we don't know. If we saw this one gas rise in concentration due to natural causes, a million years ago we would have seen a tempearture rise". Of course nobody likes that answer.
Evolution theory dictates that training everyone's immune system before infection will result in one of 2 things :
a) either viruses die
b) they learn to bypass it entirely, making vaccines entirely ineffective
So far, every success by science in finding some way to fight disease has ended in option b. It just never was vaccination, the human immune system, our last line of defence, that was manipulated by science. And it's a defensible position that a number of incidents came close to b), like the spanish flue of 1930 for example.
Even if the flu vaccine does nothing to reduce mortality directly, it would still be a societal benefit if it, on average, delays infection by a few days as it would spread out the infections over time giving the medical infrastructure a better chance of not being overwhelmed during a pandemic.
Additionally, retrospective studies (as opposed to randomized trials), really suck at identifying the magnitude of conflating factors (but can be good in indicating that there ARE conflating factors).
Realities just a bunch of bits.
The problem with a clinical trial for H1N1 vaccines is that they take too long to set up and analyze. By the time the data collection closed, we'd be into the summer of 2010, and then what good would have come of it? To accumulate enough data, it would have to be a multicenter trial (i.e. conducted in many different cities). Given the public policy enforcing vaccination, it would be extremely difficult (impossible) to get approval from a hospital research ethics board to even run the trial.
Unfortunately medicine is not a 'hard' science, in spite of our best efforts the systems are too complex and difficult to completely control (unlike physics or chemistry). Not to mention the fact that most doctors trained in the life sciences and do not understand the mathematics well enough to analyze a clinical trial, so unless they have sought out additional training in epidemiology/statistics, their grasp of numbers is always suspect.
That being said, if most doctors are numerically challenged, journalists tend to be both numerically and scientifically illiterate, which I suppose is even worse.
Failing to reduce the mortality rate doesn't mean it didn't work. That data point alone is meaningless. If it reduced the infection rate by 100 times, but the mortality rate was slightly higher, then it was still a HUGE help!
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.
T
Laws are horrible moral guides, moral guides make even worse laws.
I can't really explain it, but I usually only die when I get a flu shot.
I'm not acting until I here what world-renowned scientist Jenny McCarthy has to say.
Reading the article, it seems as if the flu vaccine is reasonably effective in reducing morbidity (incidence of infection) among the majority of the population, who are healthy and have noncompromised immune systems. But, the evidence is unclear as to whether it reduced mortality (death) among people who are old or otherwise have weakened immune systems. Even if the vaccine does nothing at all for the elderly per se, it doesn't mean immunization of the healthy is a bad idea, for two reasons. First, as mentioned in the article, herd immunity effects can reduce the incidence of flu in the elderly, thus indirectly reducing mortality. Second, influenza sucks and reduces productivity by knocking people out of work for 3 days. In an economic sense, it is totally worth doing, even if it doesn't reduce deaths at all. The conclusion of the article should be "flu vaccinations are worthwhile, if not exactly for the reason you thought they were."
LOL.
When you regurgitate silly right-wing talking points SCREAM AND YELL and STAMP YOUR FEET LIKE THIS, set up straw men and knock them down, it makes you look like the paragon of sensible, common sense, level headed conservatism.
Really!
By the way, all health authorities, public and private, have to ration. I've got no idea where people got the idea that one should pay for an average health plan (whether private or single payer), and then expect to have millions spent on cutting edge, experimental, and extremely expensive medicine when they get sick.
Believing that paying for a bargain-basement health plan in the US and believing that you'll get Herceptin when you get breast cancer, is extremely naive.
Oh, and by the way: even in the SOCIALIST COMMUNIST NAZI government run health systems, if you don't like the basic plan, you're free to go private. Of course, they'll ration too. I've never heard of a country with a single-payer or government run health system not let people go private and pay for gold-plated health cover.
Of course, if were weren't listening to fat, drug-addled idiots on AM radio or FOX News, and actually spent time in the real world, you'd already know this, wouldn't you?
You get nothing for nothing in this world, dumbarse.
>The flu shot is not about preventing you from dying. It's to avoid you from
>getting sick and infecting other people who may have weaker immune
>systems and have higher risk of dying if they get sick.
It's been a long time since biology classes in high school.
Even if I'm immunized, can't I be a carrier?
A work that expires before its copyright never enters the public domain and thus enjoys eternal copyright protection.
I read that article before. The fatal weakness of its reasoning is that it only focuses on fatalities. The reality is that even if you got ill with the flu, you almost never died (under 0.1% fatality rate). Even the super-fatal pandemic flu of 1918 was about 5% fatal among those sickened. I doubt if it is feasible to get a statistically significant count of fatalities in a controlled study sample.
But even if you do not die, flu is pretty costly. It is costly in the time you spend miserable, sick and out of action. It is costly to the colleagues, friends and family that you in turn sicken. It is costly to society as a whole. Vaccines either prevent that sickening altogether or reduce its severity. That makes vaccination campaigns valuable to society as a whole -- even to the unvaccinated -- because any flu case prevented or shortened will eliminate yet another infection source. Since flu spreads, well, virally, stopping even one source is significant. That's why govt agencies tend to be on board, because they are worried about the health of the overall society.
Flu vaccines do save lives, just not necessarily the lives of the people who get them. By not getting the vaccine you expose other, more vulnerable people to higher risk.
Not getting vaccinated is highly irresponsible, and anyone who doesn't should be quarantined.
In a widely spread pandemy we all could get a chance of exposion, and there is where vaccines will make a difference.
Even with modern antiviral and antibacterial drugs, vaccines, and prevention knowledge, the return of a pandemic virus equivalent in pathogenicity to the virus of 1918 would likely kill >100 million people worldwide. A pandemic virus with the (alleged) pathogenic potential of some recent H5N1 outbreaks could cause substantially more deaths.
[T]he 1918 virus is the likely ancestor of all 4 of the human and swine H1N1 and H3N2 lineages, as well as the "extinct" H2N2 lineage.
[A]ge-specific death rates in the 1918 pandemic exhibited a distinct pattern that has not been documented before or since: a "W-shaped" curve, similar to the familiar U-shaped curve but with the addition of a third (middle) distinct peak of deaths in young adults 20-40 years of age. Influenza and pneumonia death rates for those 15-34 years of age in 1918-1919, for example, were >20 times higher than in previous years. Overall, nearly half of the influenza-related deaths in the 1918 pandemic were in young adults 20-40 years of age, a phenomenon unique to that pandemic year.
1918 Influenza: the Mother of All Pandemics
[2006]
He's not 100 percent certain, yet he tells the patent that anyway!?! How f-ed up is that?
So you think doctors should withhold information that is critical to the patient's understanding that if the disease gets worse the patient should come back and seek immediate treatment without delay? That would be fucked up. Perhaps you wouldn't mind sharing with the rest of us your sure fire 100% accurate fool-proof method of diagnosing bacterial meningitis.
MDs are insured and only have to spend a few days in court if some one calls them out on it then if they are proven wrong the Hospital insurance takes the fall and all our costs go up while the MDs pay stays the same. What we really need to do is hold each physician criminally responsible for what they say and do in a clinical setting.
Medicine is not an exact science and if you propose to make doctor's criminally liable when they are "proven wrong" you will put an end to the entire medical industry. That would be fucked up.
Don't get me wrong, there are bad doctors out there who are incompetent and they should be removed from the system. But faulting a doctor because they are unable to prove their diagnosis beyond ANY doubt which would expose them to reprisal if the test provided a false result would pretty much send medicine back a couple of hundred years.
The last thing the medical industry needs is more lawyers unless you want to continue to drive up the costs beyond the reach of everyone.
Dean's Rule #45. The truth hurts for a moment. A lie hurts for a long time.
What i learned: doctors shouldn't over prescribe Tamiflu because resistance might develop - even though it doesn't work.
Flu spreads could be reduced if the government wasn't always scaring "flu-sufferers" into going to the emergency room (and giving the bug to others) even though only almost none of them (93%) actually have the flu.
I learned other things too. That basically the writer is looser with factual logic than those he accuses of same.
Mostly anti-vaccine agit-prop, and not not very good either.
- js
First, as others have stated this research is questionable based on many published, properly blinded studies.
Second, the point of the flu vaccine is not only to decrease mortality due to the flu. It also, surprise, keeps you from getting the flu. So, you don't spend a week or two in bed missing work, vacation, your kid's birthday or whatever. And, it keeps you from spreading the flu. It's a public health issue more than anything else. If you're vaccinated and come in contact with the flu, it dies and you don't spread it. This spares other people from coming in contact with it including people who aren't vaccinated and might die from it.
Thanks, kdawson, for popularizing this woo-woo riddled crap. This place is start to look the nerd version of the Huffington Post.
Note that the story only suggests that the vaccine doesn't help the elderly and weak. They even admit this themselves in a q&a:
"One of the most compelling arguments for flu vaccination is to provide herd immunity. In other words, by keeping young healthy people from getting sick it is believed that we can slow the spread of the disease to others. That could help to protect those who can’t benefit from a vaccine due to a weak immune system. Studies in nursing homes suggest that there is benefit to the elderly when caretakers are immunized along with residents."
from http://www.theatlantic.com/doc/200910u/h1h1-qa
I think they're being dishonest when they conflate two claims:
* the vaccine may not help the elderly and weak
with
* the vaccine has no value (a much stronger claim and one that they don't make a good case for).
Herd immunity is pretty much the whole point of mass immunization. Ignoring that make them guilty of exactly what they accuse the other side of. Not pretty....
There is a certain amount of data manipulation and exploitation of ignorance which goes into people's perception of life expectancy. Conventional wisdom is that modern medicine has extended the span of our lives significantly and that there should be no question that the billions and trillions of dollars funnelled to the medical industry through the stock market and the government tax and dole system is justified.
Is it really?
There is a book composed of writings about two thousand and five hundred years old which states,"Seventy is the sum of our years, or eighty, if we are strong; Most of them are sorrow and toil; they pass quickly, we are all but gone."
Two thousand and five hundred years ago the sorrowful and melancholic writers of that scripture could acknowledge that the general span of years was seventy or eighty. Would the author have written seventy or eighty if it were really thirty or fifty, or ninety or one hundred?
In light of that fact (that those words were indeed written that long ago and there is no reason to believe the author was mis-stating the span of years)... say again how the expenditure of modern medicine has really and truly done anything for that taxpaying and consumer investment base.
What you believe about the medical industry is hype and advertising.
I wonder, then, what happened between five hundred years B.C. and 1900 AD which caused the life expectancy to cave in by half...
the NPG electrode was replaced with carbon blac
No, MDs shouldn't be experts in statistics. They should be experts in observing and diagnosing symptoms, and not waste their time learning the minutiae of fields they will never use. A front line MD need a basic understanding of what it the conclusions of statistical studies mean. The researchers, who may or may not have MDs, should be the experts in statistics, and/or collaborate with actual statisticians.
>> Oh, and by the way: even in the SOCIALIST COMMUNIST NAZI government run health systems, if you don't like the basic plan, you're free to go private.
Except Canada. Which, by the way, speaking as a Canadian, I'm okay with.
http://en.wikipedia.org/wiki/Bayesian_inference#False_positives_in_a_medical_test
The doctors are. Evidently, you're not.
You must be a better coder than I. QQ /s
Read the Atlantic article. The researchers' data set was specific to seasonal flu in people 65 and older!!! Yet did the article highlight this or confine the discussion to efficacy against seasonal flu among people 65 and older? No--it mentioned it once and then made general statements about the potential efficacy of vaccination for ALL PEOPLE for both seasonal flu and H1N1! Even if vaccination against seasonal flu doesn't reduce the death rate of people over 65 at all, H1N1 flu is demonstrably lethal to children, healthy young adults, and people under 65 with common preexisting health conditions like asthma or HIV. By getting vaccinated against H1N1, you not only reduce YOUR risk of death, but also the risk that you'll contract and pass on H1N1 to someone else who will then die of it. Get vaccinated!!! Also, look at how the article selectively hypes the credentials of the vaccine skeptics. They say Jefferson "knows the flu-vaccine literature better than anyone else on the planet." Really? There are 7 billion people on the planet; that's a bold statement. They say the Cochrane Collaboration is "a highly respected international network." That may be true, yet they fail to apply corresponding adjectives to Dr. Anthony Fauci, who was highly respected and the director of the NIAID the last time I checked. Selective, arbitrary hyping of the credentials of skeptical researchers on one side of the debate only is a classic pop science writing technique to sell magazines and create controversy. Where have I seen this before? Cecilia Farber's horrendous Harper's magazine article promoting HIV denialism (and nearly all other HIV denialist writing, incidentally). Selective credential hyping makes me doubt the authors' impartiality and trustworthiness on the whole topic. The article also states that young, healthy people "aren’t the people who die from seasonal flu." That's a wild overgeneralization. Young, healthy people have a lower risk of dying from seasonal flu but no guarantee it won't kill them. Many will read that statement and forget that (a) it excludes pregnant women, who are young and otherwise healthy but not defined as "young, healthy people" because they are immune suppressed during their pregnancy and highly vulnerable to death from the flu, and (b) the statement is about seasonal flu, not H1N1 which is already killing healthy young people today! The researchers are reasonable in calling for more studies on this question and pointing out the problem in rolling out treatments not tested in controlled trials, but Fauci is right in pointing out that giving people a placebo in a traditional prospective, double-blinded trial could be unethical. There is a potential perfect solution to this problem alluded to already by ColdWetDog. Since we have a shortage of the H1N1 vaccine at this time anyway, set up a study that looks at the death rate of people depending on what date they are vaccinated, before and after vaccination. The people waiting for vaccination (due to the shortage) become the controls for themselves (after vaccination) as well as for the people who get vaccinated earlier. Since we're UNABLE to vaccinate everyone right away due to insufficient availability of the vaccine, there's no ethical problem. This is called a "waiting list control." This would require a large study size and more statistical care than a traditional treatment/placebo protocol, but would be an ethical way to get the data we want for H1N1. I'd fully support doing such a study. Popular magazines should either stop covering science or should get scientists to review their articles written by lay journalists for scientific and statistical accuracy before they publish. The editors at magazines like The Atlantic and Harper's clearly do not have the scientific or statistical literacy to do the job themselves. 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 and cause people to doubt that HIV is the cause of AIDS, fear and doubt vaccines when they should welcome them, etc. Creating FUD and misconceptions is harmful to public health, leads to the deaths of innocent people who can't decipher misinformation, and drives up health care costs for us all.
They probably using a "Mortality" number that is based on the people that are already sick. "Mortality of those With Influenza" => Number of people that are ALREADY sick, that DIE from the disease "Incidence" => Number of people that ACQUIRE the disease. If you vaccinate people you reduce the number that are infected, but those that get infected anyway still have the same risk of dying. This DOES NOT mean the vaccine is ineffective, you are still reducing the number of infections in the general population and hence removing them from the risk of dying from that disease. So the "Mortality rate" is not affected but the "Incidence Rate" IS affected by around 50-60% (IIRC) which is significant. There's also something called "herd immunity" which basically means that if a lot of people around you are immune and you are not immune your chances of acquiring the disease are lower since your peers cannot transmit it to you. So if you make enough people immune to a certain disease the rate of infection drops a lot more than you would expect, the reverse is also true... if people stop using vaccines ( say for Measels ) the risk of large outbreaks increases significantly.
In 1968 and 1997, the vaccine produced was the wrong one, it didn't match the prevalent strains for the following winter. People who got vaccinated were effectively receiving a placebo for the strain that they were most likely to come in contact with. There was not a corresponding spike in the number of deaths. It could be argued that those strains were less deadly than usual, but it would be an amazing coincidence if it just happened to correspond to the two years no one got an effective vaccine.
If the flu vaccine reduces the number of deaths by 50% as is claimed, there should have been a 33% rise in deaths when no one was immunized. There wasn't.
More of the people most at risk are getting vaccinated, 15% of people over 65 vaccinated in 1989, 65% today. That should have caused a significant reduction in mortality. But the number of deaths is rising. Again, an amazing correspondence is claimed, that the strains are more deadly every year.
These are the two reasons that further study is needed, regardless of how strong your faith in vaccination is.
This sentence no verb.
My GP nags me to have an anti-flu vaccination every October. For quite a few years I did accept and I would say the treatment actually was effective in the sense of I did have lower incidence of cold/flu than previously when I didn't get the innoculation.
However, over the past few years I refused to take it. Reasons: worry about dependency (am I heading towards being unable to live without annual shots) and uneasiness about what the hell is actually in this stuff. No matter how nicely you ask they will not tell you what -exactly- they are proposing to stick into your body. If you want me to stop being an anti-vaxxer then maybe that's possible but "just trust us we are medical professionals" is not going to do it for me.
"Don't belong. Never join. Think for yourself. Peace." V.Stone, Microsoft Corporation
"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.
What? They don't even work that way. The shot is different every year and could even vary by location. The shot would have to be the same from year to year for any kind of build up if it's even possible.
One of the other reasons that it may be a total waste to get the seasonal flu shot is that they are only guessing at what "the flu" will be like each year.
Here is a CDC update on this flu season's (09-10) shot.
http://www.cdc.gov/flu/flu_vaccine_updates.htm It covers only three of dozens of strains/variations. The swine flu is a mix of two different strains making a whole new one problem but, version of the flu may be around for years and years before it even effects enough patients to become noticed.
Here is a article on how the flu strains are named or defined.
http://flu.emedtv.com/flu/types-of-flu.html
I think it would be far more effective to educate the people about how to effectively manage or prevent flu right now, than telling people about vaccines, spending millions on them and not even knowing if they are effective. The UK's NHS is running a "wash your hands" campaign, which is a start. General hygiene seems to be misunderstood by many people. Touching a handrail in public and then picking your nose doesn't ring a bell? Seen it too often. One thing that I've seen a lot in most Asian countries is people just wearing face-masks. It would greatly reduce the risk of the flu spreading, if a person being sick is wearing a face-mask. But it seems that in the western world (Europe, North America) wearing a face-mask does not agree with fashion. And who would want to out themselves by wearing a face-mask anyways. But staying home can't be too hard?! Why are there still millions of people leaving their house while sick? Policies at work, at educational institutions, government institutions, etc. should regulate this and not leave it up to the one being sick. Now I also have to add that I'm recovering from a flu (be it H1N1 or not, I don't know). I stayed at home the whole time, and worked from home. It was a nasty bugger that one. If a vaccine would have prevented it, I think I would have gladly received any vaccine.
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.
Substitute arrows with vaccines, archers with doctors, Irishmen with patients and scouts with lawyers and researchers.
Mit der Dummheit kämpfen Götter selbst vergebens
INDIVIDUALS making FREE-AS-IN-SPEECH decisions on THEIR OWN health care..
Raise your hand if your employer picked your insurance for you.
"MDs shouldn't be experts in statistics."
And then you end up with MD treating as maeningitis any one that goes with a headache or, even worse, discrediting your symptoms as maeningitis as they "always" mean you got a cold. Statistics *is* a tool for proper diagnostics.
Dude, I've never seen a pregnant woman even sneeze. Barf yes, but not due to infection. OTOH, women I know get good care and take their vitamins while pregnant. Infants are also said to have very good immunity due to extra stuff they got from their mom before birth.
On another note, there is nothing unethical about doing voluntary double-blind trials. I'm not getting a vaccine, but I might participate in a trial where I may or may not get one.
Imagine there's no Heaven. It's easy if you try, no hell below us- above us only sky. Imagine all the people living for today.
Imagine there's no countries. It isn't hard to do.
Nothing to kill or die for and no religion too. Imagine all the people living life in peace.
You may say that I'm a dreamer. But I'm not the only one. I hope someday you'll join us
And the world will be as one.
gr8_phk: Considering your personal experience with the individuals you happen to have known is not a scientifically valid way of determining the severity of the threat that seasonal flu or H1N1 pose to different demographic groups. Only scientific studies of large groups and retrospective studies of particular groups (e.g. reviewing the demographics of those who die of flu/H1N1 vs. demographics of the population as a whole) can accurately determine risk levels. See http://www.flu.gov/individualfamily/parents/pregnant5tips.html, which notes "Pregnant women, even ones who are healthy, can have medical complications from the seasonal and H1N1 (Swine) flu."
You are correct that infants do get a partial immune boost from antibodies they receive from the mother. However, you are not correct in concluding that infants therefore have "very good immunity" to seasonal flu, H1N1, or pathogens in general. In fact, infants younger than 6 are both more generally vulnerable to disease (because they have not yet been exposed to germs and developed the diverse immunity of an adult) and also particularly vulnerable to seasonal flu and H1N1. That is why cdc.gov notes that "people who live with or care for children younger than 6 months of age" are one of the priority groups for H1N1 vaccination: not to protect them, but to reduce the risk of transmission to their infants under 6 months who are especially vulnerable. See http://www.cdc.gov/media/pressrel/2009/r090729b.htm
It's true that you could volunteer to participate in a study, and I'm glad you're willing to help advance science in that way. However, consent from the subjects is not (alone) sufficient to guarantee that conducting a study is ethical. Scientific ethics guidelines require that the study be deemed inherently ethical by a Human Subjects Research review board. Regardless of what level of risk the subjects are willing to accept, it's only ethical to conduct a study that exposes them to a level of risk that is commensurate with the scientific benefit to be achieved, and not in excess of some absolute limits as well. For example, even if there were human subjects willing with full informed consent to allow their syphilis to go untreated, it would not be ethical to conduct a study that studied the long-term effects of untreated syphilis by deliberately denying available treatment to participants with syphilis (a la the infamous Tuskegee study, which of course compounded the injustice further by using prison inmates as subjects, not getting their informed consent to boot, and selectively using subjects from a particular ethnic group rather than others, among other issues).
As I said: "they should be experts in observing and diagnosing symptoms" and "a front line MD need a basic understanding of what it the conclusions of statistical studies mean."
Knowing what positive predictive values are (or, if you want to get really fancy, multiplying likelihood ratios) doesn't qualify as being an expert in statistics. To use an example in the context of this story, there's no reason why a regular MD should know how to do epidemiological studies properly. They also should DO epidemiological studies, at least not without the proper support, of course.
"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.
I think the fact that it is somehow culturally acceptable to be out and about when you're sick probably causes an order of magnitude more infections of the flu than any vaccine could hope to prevent. Someone showing up to class or work with sniffles and a cough (that aren't caused by seasonal allergies) is equivalent to them saying "I'm probably going to make half of you miserable for the better part of the next week, but I really don't give a crap!"
My favorite is when someone declares, "It's OK, I'm not contagious." Because the person who's showing up to remedial math class with boogers the size of golf balls is surely an expert on such things.
In addition to quarantining myself from the general population as much as possible surrounding an illness, I also have taken on good practices to prevent catching things, and to prevent spreading anything I may be carrying... washing my hands thoroughly with soap, especially before eating; coughing and sneezing into my sleeve rather than into my hands; touching food with my right hand and touching anything a lot of other people touch (paper towel dispensers, door handles, faucets, railings, etc.) with my left (it's difficult to be 100% on that one, but at the very least it can provide a non-contaminated path from the restroom to the lunch room).
-- I prefer the term "karma escort."
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.
"There is more worth loving than we have strength to love." - Brian Jay Stanley
Comment removed based on user account deletion
Interesting. Do you the think the closure of almost 20% of our hospitals this past decade and the lay-offs this year of 50,000 public health workers has anything to do with the mortality rate?
Point me to exactly where people are being turned away from the existing hospitals in droves. Also please point me to a study that shows total number of people served since larger hospitals have opened to take over what many of the closed hospitals were doing and you seem to be pointing to only one side of a statistic.
Were the lay-offs mostly front line staff or middle management? Again you do not specify and your argument has that rabid frothing sort of "Faither" ring to it where you simply pick numbers out of a hat that say what you believe.
"There is more worth loving than we have strength to love." - Brian Jay Stanley
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".
Too late because the media already has done that redefinition for you. Just like the term "Cracker".
You can hardly blame the populace for having concern when every authoritative broadcasts sources goes on and on about how deadly it is. Even then a large number of people seem to have "self vaccinated" against the FUD and are taking a more reasoned approach. That includes questioning if they really need an H1N1 shot or not based on risks of contraction instead of "OMG I AM GOING TO DIE WITHOUT IT".
"There is more worth loving than we have strength to love." - Brian Jay Stanley
You have to polish your "anecdote" a little dude, nobody is sick twice and then only for 5 days, acute flu symptoms last for 4-5 days each time. The other thing is, whether vaccine work or not is has never been proven and is NOT beyond debate, how dare you btw?!
During a typical winter I would be sick at least twice on average, usually missing about four or five days of work in total. Since I've started having seasonal flu shots I have not had any winter illness and missed no time from work.
Since we're going into anecdotes I can say I used to get a bit more sick than that, about three times a winter with usually one incredibly bad illness lasting about a week.
I stopped drinking soda, and drink water instead, and now I might get one mild cold a winter but sometimes not. I get about the same level of exercise and eat about the same (i.e. whatever the hell I want) with perhaps a touch more vegetables.
That's also all without ever having a flu vaccine shot. You have to wonder if just a few simple lifestyle changes across the U.S. would not totally eclipse any benefit from flu shots. And since I am not getting sick as often, I'm also not getting other people sick as often - the exact same benefit some claim for the vaccine approach. Only my overall health in all other matters is better too, unlike a flu vaccine which prevents only one thing, and temporarily at that (I have nothing against things like polio vaccines which make a ton of sense because they last forever).
"There is more worth loving than we have strength to love." - Brian Jay Stanley
Interesting article with an interesting discussion thread attached (not that I read it all — it goes on forever). It got me wondering: why not remove the placebo effect entirely?
In other words, the point of having a group that receives a placebo in addition to a group that receives the actual drug being studied is to account for the effect of being studied (overly simplified explanation, of course). But wouldn't it be better to use the placebo effect to remove itself? This can be accomplished by telling both groups that they're in the placebo group.
If both groups think they're getting a placebo, then the placebo effect will be eliminated from both groups, and all that will be left to be measured is the actual physiological effect of the drug itself.
Another idea is to include a third group which receives the drug, but is not led to believe that it's a placebo. Then the study will actually measure the physiological effect of the drug alone, as well as the psychological effect of taking the drug.
The flu shot is not about preventing you from dying.
If it is not then how do you justify giving it? Any medical procedure, including vaccination, carries the risk of serious complications and potentially death. If there is no benefit to the person taking the vaccine and a tiny (1-2 in a million), but non-zero, chance of serious complications and death then it would be unethical to give the vaccine to someone. Those with weaker immune systems can be protected by taking precautions to isolate them: this risks nobody's life.
Of course this is only true if there is zero benefit from the flu vaccine. Given a brief search on the web the mortality rate looks to be around 1 in 10,000 per year so even a 1% decrease in mortality would justify the vaccine on purely medical grounds.
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?
If the vaccine does not protect the recipient then it would be unethical to give it because of the tiny, but non-zero, risk of serious complications and even death from the vaccination itself. Assuming a one in a million rate of problems then in country the size of Canada you would effectively be harming or killing 30 people a year to reduce (not stop) the spread of the flu. To put it another way would you advocate harming (e.g. remove one kidney) or killing 30 people every year if using their organs, tissues etc. could save the lives of 3,000?
When I go to the doctor I want to make sure that he or she is thinking about what is best for me, not what might be best for everyone else. If they are not doing so then how can you trust their medical advice?
Most US people are Vitamin D deficient. See the Vitamin D Council web site for how to test and supplement:
http://www.vitamindcouncil.org/
http://www.vitamindcouncil.org/newsletter/vitamin-d-and-h1n1-swine-flu.shtml
A 21st century issue: the irony of technologies of abundance in the hands of those still thinking in terms of scarcity.
It's totally irresponsible to post this odd-ball article on a website frequented by medical know-nothings who would like nothing better than to believe the flu vaccine is virtually 100% ineffective when that's not at all the case.
Sorry, but you're suggesting there's no cross-immunity whatsoever between flu strains from year to year (or even decade to decade). You're patently wrong.
Just for one example, I'm sure you've heard about how the elderly who were around for the last swine flu epidemic are partially resistant to this new swine flu.
There are also numerous other comments and links on this very thread discussing partial immunity between flu strains.
H1N1 is not a strain, its a class and its the most common to human infections. H1N1 does not refer to 'the swine flu', even if 'the swine flu' is part of the H1N1 class.
Another neat fact, the CDC seems to think just about every case of 'the flu' this summer was 'the swine flu', all million plus cases.
Please get a clue and stop spreading the FUD, I'm sick of hearing people talking about how scary this is.
You are 8 times more likely to die in a car accident than from the swine flu, and TWICE as likely to die from the vaccine than the flu itself. Stop listening to CNN/NBC/CBS/ABC/FOX as if they provide facts. News outlets provide sensationalism, not facts. They want ratings for ad dollars, not the truth.
Persistent Volume manager for Kubernetes - https://github.com/dwimsey/openshift-pvmanager
It's sad that someone modded your post down and the ridiculous GP post up =\
I'm no fan of the government running things, but the scare tactics, cries of "socialism", "death squads" etc. are so laughable they just hurt any attempt to propose an alternative where there is private competition for health care without government intervention.
I wish the "good" conservatives and republicans would speak up, and shout down the haters and hypocrites. We need good small-government ideas coming from the right, not mindless hate-filled partisan drivel.
Correct: you CANNOT be a carrier if you are immune.
Note that the immunization, where we (try to) render you immune, may not be successful (I think it's a 1% failure rate for the flu vaccine or something), so in that sense you might still be a carrier even if you've been immunized, if the immunization failed. But if you are immune, you will not be a carrier.
A fellow poster replied saying something like, you can't be a carrier and not get sick. This is not right; you certainly can be a carrier, and not feel sick. The virus is still in your body and you are still infectious. Now, if this falls within your definition of "sick", then it's true that "you can't be a carrier and not get sick" because, as a carrier, you'd be by (this) definition sick. But you certainly can be a carrier and not have any symptoms. But then you're not immune, and the point is that some 98-99% of people who get vaccinated for flu successfully become immune to the influenza virus (at least, those strains in the vaccine). Takes about 2 weeks to take full effect.
Anyway, this herd immunity effect is certainly beneficial, although I wouldn't say that it's the only reason we ask young healthy "I never get the flu" type people to get the flu shot; there's also the fact that flu can lay you low pretty significantly. You may not die from it, but you might have to take a week off work or something. Wouldn't you rather be playing WOW or reading Slashdot or something?
404555974007725459910684486621289147856453481154 in hex is "You sank my Battleship?"
[GPG key in journal]
in the meantime, glutamine and theanine
If you think vaccines work get one.
They work or they don't.
You believe what you want to believe.
It does not make your vaccine shot less effective if I don't get one - does it??
It easier to cover YOUR feet with leather than to cover the whole world.
Wear your shoes - leave others in peace.
Influenza A Virus Subtype H1N1(commonly called the swine flu) erupted suddenly, became widespread, eventually being found on all continents(save Antarctica). Therefore, yes, H1N1 is, by definition, a pandemic.
So is gingivitis then. Where is the multi-million dollar crusade against gingivitis? Oh my mouth is screaming at the injustice! Why hasn't the gingivitis pandemic been declared!?
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...
But people want to be and enjoy being misled. In fact, we love it and pay for it willingly. What, are you new on this planet or something?
The "return" key is that one above the right shift....
Where is this free beer everyone on Slashdot keeps talking about?
Ah, actually what was pointed out was that *those who tout flu vaccines as a panacea* are doing exactly what parent just claimed.
Dear god. I'm three beers in and even I realized at a glance that the parent post is denial / reactionary idiocy: "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." Immunity to WHAT? The reason you have to get shots every year is because the freak'n flu virus evolves so rapidly!
Back to the actual study that Dr Jackson et al did.
"Jackson’s papers “are beautiful,” says Lone Simonsen, who is a professor of global health at George Washington University, in Washington, D.C., and an internationally recognized expert in influenza and vaccine epidemiology. “They are classic studies in epidemiology, they are so carefully done.”
Sounds like the lady knows her stuff! "Classic studies in epidemiology" sounds good. Too bad she found out the WRONG answer and had trouble getting her paper published.
It wouldn't be so bad if there was no risk to getting the flu shot because then it just becomes a waste of money that could be better spent elsewhere in the health system. The reality is much scarier. All vaccines cause ischemia according to Dr. Moulden (www.brainguardmd.com). It is the alumina stabilizers along with other adjuvants that are
INDIVIDUALS making FREE-AS-IN-SPEECH decisions on THEIR OWN health care
For one, "free as in speech decisions" is a terrible phrase. Decisions don't have much to do with speech at all, health care has nothing to do with the first amendment, and nobody is going to confuse a decision with "free as in beer".
For another, very few people are able to make unrestricted decisions about their own health care. The insurance market is laughably non-free. You are simply subjected to corporate rationing instead of government rationing, which is no better.
I'd love to get all my compensation in cash, so I could make my own choices. But health insurance is given as an untaxed benefit - an equivalent amount of cash would result in me getting less insurance because I'd be taxed. So we need to get rid of income tax, so we can be compensated in cash, so I can buy my own insurance. More freedom all-around!
Constitutionally Correct
I believe most of the "corporate rationing" you allude to is actually due to existing government regulation. The insurance market, as it stands, is not very free. But it's hardly the fault of "evil corporations".
Constitutionally Correct
...not just the healthy and wealthy. The flu vaccine works in the Province of Ontario, Canada. The cost to the provincial health care system is clearly offset by a large, positive economic benefit, as measured by fewer sick-days and higher productivity. It was a no-brainer to continue the public flu inoculation program.
A good result like this is not observable by American epidemiologists, through the fog of the private health-care patchwork. Go public health-care!
A vaccine does absolutely nothing to protect you from becoming infected by a virus. It just minimized the effects that that virus will have when and if you do get it. Your probability of getting the virus does not change at all.
Actually, it might go up slightly since you are in public and perhaps at a doctor's office to get the vaccine. Lots of chances to get the flu there.
or else!
I don't claim to be an expert, but I do understand that there is a large difference between being "certain" and "almost certain" when it comes to a medical diagnosis.
So which is it? Are you pissed he didn't tell you there was a slim chance because he was "certain" you didn't have it? or did he do the right thing just because he countered his statement saying to come back if you feel worse?
If i were a poor immigrant, and I just coughed up a large sum of money for a Dr visit and and tells me he's "certain" I don't have the bad kind of meningitis, do you really think I'm going to come back when I feel a bit worse?
....strange that my assessment of the situation is modded a troll while your self contradicting statement gets modded "insightful"
"To use an example in the context of this story, there's no reason why a regular MD should know how to do epidemiological studies properly."
Opening them to consider biased and unproper statistic studies published by the chem comps as legit.
OK, that's a nice nitpicking clarification. Yes, if we're going to be painfully precise, a vaccine prepares your body so that it will be able to rapidly respond to later infection from a virus. Vaccination primes the host's immune system so that it can respond to infection "by (1) neutralizing the target agent before it can enter cells, and (2) by recognizing and destroying infected cells before that agent can multiply to vast numbers." (Wikipedia, "Vaccine") When the host produces an effective immune response to the vaccination, when later exposed to the virus, the host will on average either have no perceptible signs and symptoms of infection or will have signs and symptoms that are reduced compared to what they would have been without vaccination.
All that being said, it's critical to realize that "reduced signs and symptoms of infection" includes absolutely critical things like:
1) reduced likelihood of death or disability from the primary viral infection and its side effects (which in the case of flu can include organ failure!)
2) reduced likelihood of death or disability from secondary infections that are side effects of the primary infection (such as bacterial pneumonia as a follow-on consequence of primary viral flu infection)
3) reduced risk of the body entering a state where it is capable of infecting others
4) reduced risk of death or disability in others who are exposed to the host since the host never becomes capable of infecting them in the first place
So although "minimizing the effects of the virus" may sound on the face of it like a minor thing, it can actually be tremendously important or even lifesaving!
I experienced the benefits of partial immunity a couple of seasons ago. I get vaccinated against seasonal flu every year. A friend of mine is skeptical of vaccines and didn't get vaccinated against flu; neither did his girlfriend, as far as I know. They came on a ski trip and stayed in a small ski cabin with me and friends while the girlfriend was coughing and hacking in the midst of full-blown flu infection. That year, the flu vaccine only provided partial protection against some, but not all of the strains that ultimately predominated that year. I knew I was going to contract flu given the confined cabin, state of her infection, and infectiousness of the flu. Sure enough, I came down with the flu, BUT it was mild and only lasted about three days vs. the much longer course it can frequently run otherwise, which was likely a result of the partial effective immunity I received via vaccination.
I wish my friends would get vaccinated for my benefit as well as their own!
A front line MD should NEVER make final treatment or diagnosis decisions based directly on primary studies.
Standard of care, when it is based on actual evidence instead of tradition, is determined by consensus based on meta-studies that look at several primary studies. That means that the conclusions are consistent and have been filtered through layers of actual experts in many fields, not just statistics, before they turn into clinical recommendations.
So no, not being an expert in statistics does not leave an MD treating patients open to considering biased and improper studies. Again, to use this story as an example, if your MD recommends you don't get a flu shot because of a primary study he read about, go see someone else. Unless, of course, he's running an ethics board approved study you want to participate in, and is getting your informed consent.
What's the contradiction? The Doctor didn't say he was certain.
Well in the case of Meningitis, you can't be 100% certain without expensive lab work and procedures that can introduce their own risk of infection. It is the Doctor's responsibility to give the patient his best advice based on accepted medical practices, the patient history and his experience. In this case he had a strong opinion that it was vial in nature and would improve, but warned that if symptoms got worse it might be bacterial.
As a poor immigrant (or HMO member) would you rather the Doctor spent your money for additional testing to eliminate the remote chance or trust his advice to wait and see?
I think you got flagged as a troll since the first of your comment sounds like a rant against doctors in general.
Malpractice suits don't even help. MDs are insured and only have to spend a few days in court if some one calls them out on it then if they are proven wrong the Hospital insurance takes the fall and all our costs go up while the MDs pay stays the same. What we really need to do is hold each physician criminally responsible for what they say and do in a clinical setting
Actually, the profit margins for many Doctors and specialists are getting smaller over time due to the increased insurance premiums. Google shows this as an example. http://www.nysun.com/new-york/rising-insurance-rates-put-city-doctors-out/57934/. Other articles claim the Insurance premiums have risen %130 in the last 10 years, and Doctors salaries not kept pace with inflation as a result.
I won't t argue about the competence of Doctors in general, but I do feel they are under a lot of pressure to diagnose correctly while keeping costs down. I recognize that it's a tough job, and it's statistically guaranteed that some small percentage of patients will get misdiagnosed or receive an incorrect treatment. Surgical errors will still happen, particularly since the shear number of surgeries performed in the US is rising and the media is eager to publicize any errors.
Of course, half of the Doctors out there are below average performers. (yes that was a joke)
whoah, I gotta stop replying to Slashdot articles when I am cracked out tired! I read "can't" as "can"! At least that explains the mod.
*hangs head and slurks away*
"A front line MD should NEVER make final treatment or diagnosis decisions based directly on primary studies."
Not based directly but taking them into account. They in fact, do it.
"if your MD recommends you don't get a flu shot because of a primary study he read about, go see someone else."
So now, you expect *the patient* to know more about the issue than the MD... Not that they are going to tell me what they base their decision exactly on (but, of course, if "who's the doctor here?" is not enough, why spend my time going to the doctor, I could diagnose and treat myself! faster and by your account, quite the same).
"Unless, of course, he's running an ethics board approved study"
The members of the ethical board are going to be MDs and lawyers, so your point is? (are going to be the lawyers the statistics experts?)
"So now, you expect *the patient* to know more about the issue than the MD..."
I was being facetious. No, you shouldn't have to know more than your doctor. MDs should know better than to make treatment decisions based on small, preliminary studies. Note, no statistical knowledge needed, just a basic knowledge of how your field works.
"The members of the ethical board are going to be MDs and lawyers, so your point is?"
You don't actually know much about research ethics boards, do you? An academic ethics board reviewing medical research generally consists mostly of working scientists from various disciplines, some academic MDs, also from various disciplines and some others, such as graduate student reps (one of my roommates in grad school was on the university's animal research ethics board). I've never seen one that has a lawyer as a permanent member, but I wouldn't be surprised if some do, particularly in the US. They all have access to legal advice, of course. Generally the board will either have one or more members with extensive research statistics experience but will also have access to statistical specialists if they need.
Anyway, the point was that if an MD is making treatment decisions based on the bleeding edge of research then he is not treating according to the standard of care but is essentially doing a research trial and needs to get ethics approval.
You don't actually know much about research ethics boards, do you? They are generally composed mostly of working scientists in a variety of fields, including some research MDs. Most of the members will indeed be experts in applied statistics of various kinds, and will have access to actual statisticians if needed. I've never met an ethics board with a lawyer as an actual sitting member, although I suppose it could happen, but they do have access to legal advice, of course.
Anyway, the point was that if your doctor is making treatment decisions based on primary studies and not the standard of care then he is essentially doing an experiment and needs to get both ethics approval and informed consent from his patients.
http://content.nejm.org/cgi/content/full/361/13/1260
Methods: We carried out a randomized, double-blind, placebo-controlled trial of licensed inactivated and live attenuated influenza vaccines in healthy adults during the 2007–2008 influenza season and estimated the absolute and relative efficacies of the two vaccines.
Results: Absolute efficacy against both types of influenza, as measured by isolating the virus in culture, identifying it on real-time polymerase-chain-reaction assay, or both, was 68% (95% confidence interval [CI], 46 to 81)
68% is about standard for seasonal flu vaccine efficacy -- because researches have to guess at the likely circulating forms of flu virus in the coming year when developing vaccine the year before the viruses appear and do not usually guess all of the forms correctly. However, it is reasonable to assume that the H1N1 vaccine will be more effective because we knew the form of flu that was likely to circulate this winter when it appeared last spring and developed a vaccine against it.
The flu vaccine promotes the growth of antibodies against the types of flu in the vaccine and decreases the chance of getting those flu strains in the vaccines.
Reports seem to indicate that the reason H1N1 is dangerous is that people who are young adults are most likely to get really sick, because their immune systems react too strongly to the flu. Not unlike histamine reactions, it's a case of too much of a good thing.
The premise of using death rate as a metric is where I find the flaw, a vaccine is intended to prevent the disease, and that should be measurable by checking the verified infection rates in vaccinated and non-vaccinated populations with similar health, income, and exposure factors. The cost of having a worker or caregiver home sick would justify the cost of prevention in most cases. Add the cost saving of reduced spread rates for the infection and you don't need to argue mortality rates to justify a vaccination policy.