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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.
... 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
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
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.
The WHO and CDC are driving the H1N1 vaccines, not the vaccine companies. No matter how good the lobbyists for the vaccine companies are, they aren't good enough to get the government to step in and bear the liability without some government agency agreeing that there is actually something there to address.
(The issue with H1N1 is not its lethality once it has infected a person, but how good a job it does of infecting those who are exposed)
Nerd rage is the funniest rage.
Logic doesn't help you if you don't understand the biology of influenza. It's not like there are several strains of influenza just waiting around, hiding in trash cans for the poor sap that gets immunized against it. During a given season, Influenza comes in waves of a particular strain, and in some cases, a couple of strains. It is a bit of a dance to figure out which strains are going to hit a given area six months in a year to advance. You can google for the particulars but epidemiologists have had a reasonable measure of success getting it right.
Even with that knowledge, we've known that influenza vaccines aren't all that good. What you have is a treatment with few downsides (and there are complications from the vaccines, they just aren't all that common) and a few upsides basically a modest benefit. This sort of treatment, while depressingly common from an epidemiology standpoint, makes "soundbite medicine" rather difficult and makes it hard to argue for any given protocol.
Something that seems to be missing from this whole affair is the built in experiment that this creates. If you can deliver the vaccine to a very broad spectrum of a population and let the individual decide if they want the vaccine, then you'll have large numbers of both cases - vaccinated and unvaccinated. IF you had a mechanism to track this (and that's where we fail here), then in six months and one year, you query those people, see if they're still alive. After all, we don't care if you died from influenza or the marthambles - if the vaccine keeps you out of the grave, then it's a win. That would answer the bottom line question of whether or not the vaccine actually helped you. You need big numbers to prevent a number of pre selection biases, but it's sort of doable.
Faster! Faster! Faster would be better!
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.
According to Webster's New World Medical Dictionary:
Pandemic: An epidemic (a sudden outbreak) that becomes very widespread and affects a whole region, a continent, or the world.
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.
I don't like Linux. This doesn't make me a troll.
There was something that went around in 1979 of that sort -- you could watch it hopping from person to person as exposure occurred. Two or three days incubation, sick as hell for 24 hours (everything emptied out both ends), then it went away as suddenly as it came, with no aftersymptoms.
However, most short-term stomach/intestinal upsets are not flu. Per some hospital studies, about 90% of presented cases are actually food poisoning.
~REZ~ #43301. Who'd fake being me anyway?