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

All I have is an anecdote

[rcolbert]

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.

Re:Good article

[moosesocks]

You joke, but there's mounting evidence that the placebo effect is indeed getting stronger.

(Of course, conducting a double-blind test to confirm this would create numerous paradoxes)

Re:Good article

[rs79]

"Let's pray that science wins out over irrationality."

That's what the article's point is! It's not saying "vaccines don't work" it's saying "they say vaccines reduce the death rate by 50% and the numbers don't bear that out. What's the real number?"

And that's a fair question. We know the virus isn't 100% effective, it damn near killed this girl: http://www.google.com/search?pg=q&fmt=.&q=dystonia+flu+vaccine

Neither though is anybody saying the vaccine is zero percent effective or universally toxic, what happened above is a rare edge case (but as an aside it would be nice to be able to predict when this was going to happen, this is a fairly *catastrophic* edge case).

But the examples brought up in the article do suggest there is sustantive argument that the claimes reductin of 50% reduction in martaliry rate is indeed in question, that's all.

Nobody's actually measuring people who have anti-bodies of a specific type, the data gathered is fairly meaningless by lumping a lot of things (rhinovirus, coronovirus etc) as "flu", also the cohort factor and related effects do have a demonsterable non-zero effect on the mortality rate.

So, it's not a question of is the vaccine useful or nor, more like a plea for more accurate analysis and gathering of the data in question.

I had the same result from simply drinking water

[SuperKendall]

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).