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.

Comments

Re:All I have is an anecdote

[MichaelSmith]

If its four or five days from two illnesses then its not Flu. Thats a cold.

It's not you, it's who you'd infect

[Anonymous Coward]

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.

Editorializing

[Gudeldar]

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.

Re:Editorializing

[Threni]

All you have to do is look up Vaccine on Wikipedia to see some people don't like vaccines for whatever reason ("it's god's will that we die" or whatever). Not worth giving those freaks any more attention, really, unless these claims are different in some way.

Re:Editorializing

[mellon]

The problem with this article is that Ms. Jackson isn't even asking the right *question*. Of *course* healthy people don't get a significant personal benefit from being vaccinated. Nobody ever said they did. If all you care about is yourself, and you are healthy as an ox, then by all means don't get vaccinated. Not getting vaccinated is a great way to get your inheritance early. Just get H1N1, then visit your elderly uncle to cheer him up. You'll transmit the virus to him, he'll die, and you'll be rich. But if you want your elderly uncle to live, or, worse luck, he's already written you out of the will, then you might as well get vaccinated.

IOW, the point of the vaccine is to prevent the pandemic, not to protect you. So the *right* question to ask is, does the H1N1 vaccine confer any immunity to the recipient? This is a question that can readily be answered by an epidemiology study, and that can also be ethically studied in a double-blind study - just vaccinate half of a healthy population, don't vaccinate the other half, and see how many get H1N1 and how many don't. The problem is that if the vaccine works, you don't know until it's too late. So it's good for checking your work, but no good for making the decision as to whether to do mass vaccinations - mass vaccinations are pointless after the pandemic has run its course.

I suspect that epidemiology studies are just as good for evaluating the efficacy of the vaccine *after* the pandemic has passed anyway, so that's probably why they don't do double blind studies. But I'm not a virologist, so that's just a WAG.

What I really wish people would do would be to stop coming up with conspiracy theories about vaccines - these are really harmful. Information is what we need, not panicked hyperbole.

Or....

[plague911]

There are so many conclusions which can drawn from those statistics its silly. Here is another example. Healthy people dont die as often period. If you are sickly you are more likely to still get a disease even if you were given the immunization short. Followed by the fact that sickly people die more often when they do get sick.

Also a second situation which would lead to the similar results. That people who got the shot...*gasp* likely got the shot the previous year and *shock* have some built up immunity due to the previous years shot.

This physician... not a biologist. Sounds like shes not very good at what shes supposed to be doing. The information she presented proves nothing. She randmly concludes just 1 or many possible scenarios based on her predisposition. Poor poor science.

article is BS

[wizardforce]

Influenza causes only a small minority of all deaths in the U.S., even among senior citizens,

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.

Beware of antivaxxers

[benjfowler]

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 Scientific Method

[PieSquared]

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.

Re:FluMist

[tehdaemon]

TFA implies that "anyone who is old enough, has no respiratory problems, and who isn't immunosuppressed,", will have a strong immune response to the flu whether or not the get the vaccine. Those who do not fall into this category don't have a strong enough immune system to react to the vaccine anyway and receive no benefit. The studies to confirm or deny this have not been done.

T

Re:The one crucial point

[jedidiah]

You seem to be confusing the current seasonal flu with the pandemic of 1918.

They are by no stretch of the imagination comparable.

Re:The one crucial point

[Mr. Freeman]

"Words like "global pandemic" should be reserved for something more dangerous than the sniffles"

No, it shouldn't. Pandemic refers to the number of people infected and how quickly it spreads, not how deadly it is. People should fucking learn what this term means, rather than assuming it means "AMAZING DEADLY SUPER VIRUS". We should NOT redefine it to mean "SUPER DEADLY SUPER VIRUS".

Swine flue IS a pandemic. It's not super amazingly deadly, but it IS a pandemic. The paranoia is not the fault of the government. This paranoia is the fault of the dipshit idiot populous that elects idiots into the government and then ceases to think for themselves.

Re:The one crucial point

[TubeSteak]

No matter how good the lobbyists for the vaccine companies are, they aren't good enough to get the government to step in and bear the liability without some government agency agreeing that there is actually something there to address.

Huh?
The US Government backstops liability for all vaccines, except where it grants outright immunity from lawsuits.
1986: http://en.wikipedia.org/wiki/National_Childhood_Vaccine_Injury_Act
The liability is otherwise so big that no private insurer will touch it.
(Same thing goes for nuclear power.)

Both the USA's dept of Health and Human Services (HHS) and the European Union's Parliment have granted pharmaceutical companies immunity from lawsuits relating to H1N1 vaccines. The USA's HHS Secretary went one step further and granted immunity for all future swine flu vaccines.

I'm not sure how Europe normally handles vaccine liability, but I'm sure a /.er can fill us in.

You're right though that the WHO and CDC are driving the H1N1 vaccines.
They're so desperate to get out ahead of the flu that they're accepting calculated risks.

Re:The one crucial point

[BitZtream]

It's not super amazingly deadly,

Actually, if anyone bothered to look into it, rather than listening to the media outlets, 'the swine flu' is less than half as likely to kill you as the average seasonal flu. By 'average seasonal flu' I mean take the past 50 years worth of deaths related to seasonal flus and you'll find about 0.12% of the infected people die. By contrast, 0.05% of those infected with 'the swine flu' have died.

It is a pandemic, but the flu has been a pandemic forever, as is the common cold. The media just doesn't have anything else to get our attention so this is what they exaggerate into being scary.