Categories
Antivaccine nonsense Medicine Science

More examples of how influenza still kills

The flu season continues apace around my part of the country. I wrote about it about a week and a half ago, in particular how people don’t get their flu shots because they don’t think they need them, because they don’t think the flu is a serious disease. Two more stories illustrate this disconnect. For instance, here’s a story about three people in their 20s who died of the flu in Michigan. The key heart-wrenching passage is this:

Ashley McCormick was 23 years old when she died December 27.

“We were like, ‘This is the flu. How can this happen? It’s just the flu.’ I mean, everybody gets the flu and this doesn’t happen,” says Ashley’s mother, Patricia McCormick.

Ashley’s parents say she first started coming down with the flu symptoms December 21st. A trip to urgent care didn’t help and by the night of Christmas, Ashley’s symptoms were worse than ever.

Her father rushed her to the hospital but doctors couldn’t save her. She graduated from Rochester High School and wanted to be a teacher for special needs children. Her parents say she had no underlying health conditions and she did not get a flu shot.


Tragically mistaken myths like this are why people like Ashley McCormick don’t get flu shots. Everybody might get the flu at one time or another, but tragic cases like Ashley’s do happen often enough that it makes sense to get vaccinated. The same thing apparently drove Chris Wright, a mail carrier who was described as very healthy, to make the same ill-fated decision:

Chris Wright, a 41-year-old father of five, was very healthy according to family members. He died Sunday at Oakwood Southshore Medical Center in Trenton, Mich., but had also been treated at Mercy Memorial Hospital in Monroe.

“He always said, ‘I never get sick. I’m healthy as a horse,’ ” said his wife Susan. That is why he didn’t think it was necessary to get a flu shot, she added.

I don’t care how healthy you are. The flu can kill.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

278 replies on “More examples of how influenza still kills”

Isn’t it the case that with some types of flu young and healthy people die because they are healthy and have a strong immune system?

The Spanish Flu was one like that.

@Pris: yes. I’ve seen the phrase “cytokine storm” mentioned in context with this. As I understand it, the immune system overreacts and the overreaction kills the patient.

And horses can also die very quickly.

I can see why a healthy young person might forego a flu vaccination if there is a shortage of the vaccine so as to allow those most at risk to get it. I can also see why if they are on very limited income and have to pay for the shot (I get it through work so don’t have to worry about that).

It has also only been fairly recently that flu shots for all ages (except young infants) has been recommended.

Recent research into the 1918 influenza pandemic and other more recent influenza pandemics, attribute the high mortality in younger people to cytokine storms…an overreaction of the body’s immune system to an infection:

http://en.wikipedia.org/wiki/Cytokine_storm

Children ages six months and older should receive seasonal influenza vaccine and any child between the ages of 6 months-8 years of age will require two doses of influenza vaccine, given one month apart…if they are receiving seasonal influenza vaccine for the first time:

http://www.cdc.gov/flu/protect/children.htm

Near where I live, there has been a increased amount of individuals who have been hospitalized with the flu, as well as more individuals in the area where I volunteer at. Talking to the families, a familiar theme emerges, usually that they didn’t think the flu was that bad and that they didn’t get vaccinated for it.

We also heard that 2 patients at a nearby hospital had died of the flu. According to the news reports, both had not been vaccinated for the flu.

I only expect it to get worse, with January and February usually being the worst months for the flu.

So, get the shot, if you haven’t done so.

Most large chemists in Ireland provide a walk in vaccination service for 25 euros. There shouldn’t be much excuse for not getting the jab.

I often wonder why most countries don’t provide a universal jab to anyone who wants it. It must pay for itself purely in terms of productivity – people not off sick or to provide care for sick kids, but also in reduced seasonal pressure on the GP and hospital system.

Another problem with H1N1 and why it kills young, healthy people is it has a receptor for lung tissue. Once it gets to the lungs the immune system follows it there and causes pulmonary consolidation.

Just dropping in for another quick second drug-dealers.

Really — seriously — I have to ask this question: I am practically a middle aged man who has never had a flu shot. Yet guys, how is it possible that I don’t get the flu. Perhaps I have a strong immune system but I do get colds occasionally, but never the flu. Again drug-dealers, given the odds, surely by now I should have come down with even one episode of the flu.

Now of course you guys are well aware of my stance on vaccines, but I am really curious at what crocks you guys will spew to account for my case.

Greg, I once got struck by a car while on foot, and I’m still alive and able to walk. Does that mean defensive driving is unnecessary?

Also, calling us “drug dealers” is libel in the highest order.

Greg: Every year, folks that had confirmed flu were disproportionately not vaxed. Forgive me for not thinking your anecdote eclipses that.

@greg sounds like you’re volunteering for vivisection given you apparently possess the cure to flu in your body. More seriously I bet you have had the flu in the past whether you care to admit it or not.

Greg the dim,
I suppose you might recognize the differences in mathematics and human beings. Math gives the same answer for the same conditions. Every time. Humans don’t work that way. There are too many variables to create the same conditions so the answer varies. Even when the conditions appear the same.

A sufficiently motivated 8th grade algebra student could have figured that out. Yet you fail. I do not wish the flu on anyone but you try the patience of more stalwart folk than I. Try and work out some of the variables that might have resulted in your good fortune fool.

Flu may have killed a child in my area. In addition 45 dead from flu (two children) in the province so far. In the article, they seem to go out of their way to emphasize they don’t know if the flu killed the child, and that most people who get the flu don’t die. Must be hard to find the fine line between being realistic and too alarmist.

http://www.nugget.ca/2014/01/17/hospital-reports-childs-death

Congratulations Greg, on your pure luck, and on bringing it up on an article in which two young people died demanding an explanation for your blind luck.

I do wonder, how many young people would get the shot if it was easier to get. I have a lot of friends who just can’t be bothered, it’s more laziness than delusions of invincibility. Anecdote alert: two friends who never got it because it involved a doctors appointment/waiting in line in a pharmacy/an extra step at a time when they didn’t want to think about it have consistently got the shot when their jobs started offering it (non-healthcare employers).

I actually got into a discussion with my PCP about the manner in which his office offers flu shots during December, I was in for another reason, and the nurse flew off a quick, “you want a flu shot?” when she was doing vitals. Like, “you could get it, but it’s not really important we’re just required to offer.” Of course I already had it, but when I told him the passive, flippant way it was offered, he was shocked. If it’s an extra step, an extra buck (even if only $25) and it isn’t encouraged, many people just won’t do it. He said he would discuss with his staff…I go back Friday, let’s see if the manner has changed. 🙂

So, my point: is it actively feeling invincible, or just laziness?

Greg, I got to 40 without ever having the flu – bad colds, yes, but never the flu – then H1N1 knocked me horizontal in 2009. And my whole family. Followed by secondary infections – bronchitis, ear infections, eye infections. I took pride in how healthy my kids were, how we rarely got sick, and we all suffered for a month and a half when the flu finally got us. Don’t be so cocky.

Sullivan – the first symptom I had, I remember clearly – I was out cleaning up the horse paddock when I started to feel like I had to breathe in extra hard to catch my breath – a real heavy feeling. It was quite distinct, and the headache, and fever set in within a couple of hours.

@Greg
All of the cycling “authorities” recommend wearing a helmet – and yet I rode a bicycle as my primary means of transportation for 8 years and never hit my head. Obviously there’s only one explanation – it’s all a conspiracy concocted by helmet manufacturers. What kind of crock will you spew out to account for my case, Greg? And don’t try to tell me that I was just lucky, or that even a small chance of getting a serious head injury greatly outweighs the minor inconvenience of wearing a helmet, because I’ll just call you names and pretend to be too stupid to understand basic logic.

Influenza was a factor in my most serious illness, although I don’t believe I actually had it.

When I was four years old, I developed meningitis. I went from fine to deathly ill incredibly fast, and my parents rushed me to the ER, where a family got upset that we were taken ahead of their son with a broken leg; but the hospital knows not to mess around with a 107 fever. Especially in the middle of an influenza outbreak.

The hospital was *packed*. Although I probably did not have influenza, the staff were seriously overloaded — to the point where the lab misplaced the specimen from my spinal tap. So they did a second tap. They misplaced that too, so we’ll never know what organism was responsible. I was put into isolation in case it was HiB and given antibiotics, but the course of the illness over the next couple of weeks suggested viral and they let me come out of isolation. Supplies were running low, though, and they had to improvise with the splint for my arm with the IV.

I believe that if there hadn’t been that influenza outbreak, I would know what organism had caused my meningitis, and I believe my care would’ve been better as well with a less overtaxed hospital. But you do not get to choose these things, and the staff did an excellent job despite the challenges.

Less people getting influenza would definitely be a good thing. My family got to see first-hand how severely taxed the system can get during an influenza outbreak; wouldn’t it be good to be able to avoid that?

in particular how people don’t get their flu shots because they don’t think they need them, because they don’t think the flu is a serious disease.

Sorry, I had to stop here.

This nonsense about how if it doesn’t kill you, it’s not a big deal nor worth vaccinating against drives me crazy.

I get vaccinated against the flu not because I think it is going to kill me, but because I CAN. The flu sucks. It may not kill you, but it makes you feel pretty lousy for a few days, at best, and more likely knocks you out of commission. Who the fuck wouldn’t want to avoid that if you can?

And if you have kids, it is even better to avoid it, because taking care of kids when you are dragging yourself around because of the flu is a major PITA.

Shit, give me a cold vaccine if you can, because even a common cold makes life suck. And vaccines are such trivial sacrifices to make to help avoiding this other crap.

Having had the flu a few times when I was younger, the experience was bad enough to remind me that I need to get my flu shot on a yearly basis….regular colds are bad enough, but the flu is something else entirely…why take the chance, given that the Influenza vaccine is among the safest on the market, with the fewest recorded side effects?

Aren’t you doing the same thing that you’re always accusing the anti-vaxers of doing–using “heart-wrenching” (your words) anecdotal news stories to support your position?

Do we know the circumstances surrounding these anecdotes, such as the use or possible misuse of prescription or over-the-counter medications?

Most people’s knee-jerk reaction to a 103F temperature is to gulp down a few Tylenols or ibuprofen or Nyquil or whatever other OTC combo drug the TV tells you is the best way to get yourself back to normal quicker so you don’t miss any work or school, for goodness sakes, because we’re taught that fever is bad and if you don’t suppress it your brain will fry (yes, I’ve actually heard that phrase used!) even though evidence suggests that suppressing fevers can be detrimental to the immune response, and you know, increase your chances of dying.

http://jrs.sagepub.com/content/103/10/403.long

So…other than not being vaccinated, are there any other questions that we should be asking in response to these tragic deaths? Besides vaccination, is there anything else we could be doing that might reduce the risk of mortality and morbidity from influenza? Shouldn’t we be applying the same skepticism to the spurious claims of big pharma drugmakers as we do to the claims of homeopaths?

Just askin’.

Jen, who’s been vaccinated for flu (and TDaP, too-gonna be a granny soon!) 😀

On a related note, I’m looking forward to a skeptic’s take on the Brandlistuen study. Any takers?

http://ije.oxfordjournals.org/content/early/2013/10/24/ije.dyt183.abstract

Hey Sarah,

I will continue to wear a helmet when I am ice-skating even though I realize that there is only a remote chance that I will fall and seriously hurt myself. After all, helmets have proven themselves to be safe and effective. As for the flu shots, I am not so sure that they don’t carry serious adverse events, and they may not be at all effective.

Sarah, I will continue to pass on the flu shots, but feel free to take my extra doses. And Sarah, if you don’t keel over from taking them and do make it to a ripe age then congrats. And if fate have it that we both find ourselves in the same nursing home at such ripe ages, I will give you props again. Even if you are a complete basket case from vaccine induced degenerative illness, and are not aware of what I am saying.

The Register-Guard (Eugene, OR) has the funeral for the local 5-yr old flu victim – Ronan Burgess – on the front page as the leading human interest story with a large photo of the bereaved parents embracing a friend.
The R-G continues to urge citizens to get flu shots (too much ignorant resistance here) and some of the local pharmacies are running out.
Our family is vaccinated.

@ AnObservingParty

So, my point: is it actively feeling invincible, or just laziness?

I plead the latter, compounded by a fear of needles.
Plus, available physicians are somewhat of a rarity in my region (unless you happen to be a Swiss banker). It’s not an excuse, but it doesn’t help.

@ Fabricate Diem, Punc

Yet guys, how is it possible that I don’t get the flu

Not everybody got the flu. That’s not the same as no-one getting it.
The lowest value I have seen in a scientific article is 3 % of people who got the flu in the control group, against 1.6 % in the vaccinated group (infections confirmed by serotypage).
Orac talked about this article, but my quick search didn’t find it.
Now, Let’s use these very conservative values. Why worry about 3 people over one hundred, and what’s all of this fuss about saving 1.4 guy from the flu?

Well, 3% of my country’s population is 1.8 million people. In the US, that would be over 10 millions.
That’s a lot of people getting off job, with a good number of them crowding doctors’ offices or hospitals.
And this is just from the main strain of flu for the year. Minor flu-like illnesses of the season will add up their own victims.
Suddenly, having the government interested in halving these numbers seems like a good economical and humane investment.
I may be lucky enough not to get a nasty bit of flu, but I certainly have to be luckier not to know someone who suffered from the flu.

tl;dr: if you are lucky enough, you won’t get contaminated during flu season, or even if you are, you will only get mild symptoms.
If you are unlucky, you, or someone dear to you, may be in for some pain.
So, tell me, do you feel lucky?
You should.

Greg, did it ever occur to you that by insulting us instead of providing evidence, you’re only making yourself look suspicious?

Greg doesn’t care what we think of him. Like all trolls, he’s in it for the lulz.

Like a wart, if you ignore him, he goes away eventually.

@Jen in TX: Hey, welcome back! Congrats on the upcoming grandma-hood, and I’m so glad you were considerate enough to get the flu shot and TDaP!

Yes, we have all been taught fever is bad. OTOH, the last time I had the flu, I had gone to work fine at 7 pm and was in the ER with fever, severe body aches and a 104 fever before midnight (NY Eve….happy NY to me!). Because I am a nurse, and the curious type – and since the kids were out of the house and away from exposure – I decided the next day to find out HOW feverish I could get. I chickened out at 106.7 and took NSAIDS – I was so very miserable from the pain the fever, and everything. Even with my own kids, I generally treated fever by behavior than temperature (if they had a fever and were playing normally, fine. If they were miserable and crying, then they got NSAIDS). I do the same for me. Bedrest, fluids, and only medicate if necessary.

I get the flu shot every year now. I don’t want to go through that again. EVER. 7 days off work and 3 additional weeks of having no strength and no energy with 2 children under 7 is no fun.

I’m so glad Greg is Superman and has never had the flu. I hope, for his sake, he never does. And I don’t intend to meet you in the nursing home, Greg. I plan on traveling the world like my parents do and my grandparents did. Flu shots, all available vaccines and all. Not a single case yet of degenerative brain disease.

As for the flu shots, I am not so sure that they don’t carry serious adverse events, and they may not be at all effective.

Greg, what exactly is the basis for your concern that the rsisk of serious adverse events due to being vaccinated against the flu is greater than the risks associated with not being vaccinated? Be specific.

What exactly is the basis for your belief that the fle vaccine may not be at all effective–i.e., that this years flu vaccination campaign will not prevent a single case of influenza from occurring? Again, be specific.

Greg,

I am practically a middle aged man who has never had a flu shot. Yet guys, how is it possible that I don’t get the flu.

What do you mean by, “I don’t get the flu”? If you are unvaccinated you have between a 1 in 10 and a 1 in 20 chance of getting influenza in any given year. If you are approaching middle age I would expect you to have had influenza once or twice in your lifetime. If you had it as a child and the same strain comes around, you may be lucky enough to have natural immunity.

Getting the vaccine drastically reduces your chances to more like 1 in 100 or even 1 in 200 in a good year. The chances of a serious adverse reaction to the vaccine are in the order of one in a million. Even your mathematical skills should be up to figuring out it is a good idea to get the vaccine.

You may be happy playing the odds, but you will regret it if you do go down with influenza, especially if you pass it on it to your children or to an elderly relative.

By the way, don’t you work with children with autism? Aren’t you are required to have up-to-date vaccinations, including influenza, for a job like that?

Greg: How is it that you just just know that you have a “strong immune system”? Laboratory analysis of immunuglobin levels? You have applied an erroneous coorelation. The mere absence of disease is an extremely crude and totally anecdotal measure.

I just wanted to thank Orac and the commenters here. I’ve never had the flu vaccine, and as far as I can remember, I’ve never had the flu. So, I thought, what’s the point of getting the vaccine? Then I learned (somewhere, can’t remember where) that some people can get asymptomatic cases of the flu. You don’t have symptoms, but you’re potentially spreading that flu to people who WILL have symptoms. Not only do I not want to catch the flu, I don’t want any of the people I interact with to catch it.

The CVS near my house gives the flu jab on a walk-in basis. Not sure how much it costs, but they accept insurance, and I’ll be going this week to get my first flu jab.

Keating, there is no “pro and con”, only true and false. We don’t cover “both sides” of the issue because only one side exists.

Here’s the difference between using published, confirmed cases of influenza-associated deaths and using “heart-wrenching” anecdotes of how bad vaccines might be: These are confirmed and published cases.

In each anecdotal story about vaccine A causing diseases B, C, D, and E, there is always some doubt. There is a lack of a confirmation by legitimate scientists. There is some sort of innuendo, name-calling, or something that makes us realize that the story being told is a tale best used to scare children into eating their veggies.

We all remember Desiree Jennings. AoA, Generation Rescue, and any other anti-vaccine organization out there embraced her as a symbol of how horrible the flu vaccine is. Then what happened? I find her VAERS report in which it is clearly reported that hers is a psychogenic condition and everyone disavows her. Where is she now if she is such a great example of the horrors of the flu vaccine? They got rid of her faster than the British medical board got rid of Wakefield.

In essence, if you put up your vaccine injuries up against the actual deaths and severe cases of vaccine-preventable diseases, you’ll find yourself laughed at, embarrassed, and cowering behind ad hominem and appeal to popularity. This is the case with Greg. He’s never been able to bring forth a proper argument or proper evidence of what he says, just name-calling and innuendo. That is the whole of his arguments, and that’s why no one takes him seriously.

Ooops, that particular “Doshi problem.” Not article. If I remember correctly, Reuben goes into a lot of Doshi’s BS

Hmmm Roche paid a $3 Billion settlement. For lying on purpose to sell more drugs, and hide critical trials that show the drugs are not so good, even dangerous such as Paxil. And your response is a personal attack on the messenger whose only request is transparency. So typical.

@Gray Falcon It is unclear whether you are on the side of transparency or not. Do you think, by the way, that Roche was unfairly treated by having to pay $3 Billion dollars for lying? The truth in that case was evident. Roche was lucky not to have criminal liabilities as well.

Notice, for those medications that work well and have few side effects, there is almost no controversy. The controversy always seems to come when Big Pharma knows it is selling a dog, a dangerous or ineffective drug, and tries to cover it up, and attack the persons who brought the problem to light.

Thank God for trial lawyers who show up on the doorstep of Big Pharma and crush them.

” Here, from the radical, fruitcakes of the New York Times is the crux of the problem…http://www.nytimes.com/2013/06/30/business/breaking-the-seal-on-drug-research.html?pagewanted=1&_r=0″

Is there something in that article about flu vaccine? I don’t see it.

Or are you reiterating the worn-out meme about how some research has been questioned and/or found fraudulent, therefore all medicine is untrustworthy?

It is interesting that Doshi’s critics ([1], [9]) seem to evade the crucial issue of the extent the flu vaccines are succeeding in preventing clinical flu. The results of two recent meta-analyses are by no means encouraging ([6], [7]). In [6], which deals with 65+ individuals (one of the high priority groups for mass vaccination according to the CDC), it is stated that “the usefulness of vaccines on the community [as opposed to long-term care facilities] is modest”; in [7] the effectiveness of vaccines in children younger than 2 (inactivated vaccines) or older than 2 (both inactivated and live attenuated vaccines) was found to be “low”. One of the main reasons given to explain these disappointing results is that “vaccines are specifically targeted at influenza viruses and are not designed to prevent other causes of influenza-like illness”[7].

In an interview the senior author of [6] and [7], Dr. Tom Jefferson, put the issue in a refreshingly explicit way: “The vaccine doesn’t work very well at all. […] Vaccines are being used as an ideological weapon. What you see every year as the flu is caused by 200 or 300 different agents with a vaccine against two of them. That is simply nonsense.”[8]

BMJ is not a refereed journal

The BMJ iPad app brings you the best of print and online, including live links to the latest news, blogs, video, and podcasts. Get the BMJ iPad app.

Review
Press
Are US flu death figures more PR than science?
BMJ 2005; 331 doi: http://dx.doi.org/10.1136/bmj.331.7529.1412 (Published 8 December 2005)
Cite this as: BMJ 2005;331:1412

Article
Related content
Read responses (11)
Article metrics

PDF
Section PDF
Easy Read
Respond to this article

Recent rapid responses

Rapid responses are electronic letters to the editor. They enable our users to debate issues raised in articles published on bmj.com. Although a selection of rapid responses will be included as edited readers’ letters in the weekly print issue of the BMJ, their first appearance online means that they are published articles. If you need the url (web address) of an individual response, perhaps for citation purposes, simply click on the response headline and copy the url from the browser window.

Displaying 1-10 out of 11 published
Sort by:
Order:
NextLast
Flu Vaccine Research: More Detailed Statistics Needed
5 May 2006

In his article, Peter Doshi contests the official government statistics for flu deaths, claiming the figures are too high. In his letter in response to this article, Prof. Marco Mamone-Capria writes that the situation is more complicated, regarding alleged flu deaths, than public health authorites would have the public believe. And he raises questions about how useful flu vaccines might be.

Some clarifications might be attained by means of more precise and detailed statistics. For example, during each year in which there is a promotional campaign for flu vaccines, there are four groups of persons: 1) Those who got their flu vaccine, and then got the flu. 2) Those who did not get a flu vaccine, and did not get the flu. 3) Those who did not get a flu vaccine, and got the flu. 4) Those who got their flu vaccine and did not get the flu.

Statistics for each of these groups would provide important information for scholars, and the public, in helping to arrive at informed opinions and decisions. Along a similar line, it would seem likely and logical that many, if not most, of the alleged flu deaths are among persons in the over 65 age group. In fact, this group is a specific target during flu vaccine promotional campaigns. How many of the alleged flu deaths in this age group include persons who got their flu vaccine in the wake of the public health officials’ warnings and suggestions, and how many among persons who did not heed the warnings and did not get a flu vaccine? Such statistics might provide important information relating to the relative urgency to get flu vaccines, and relating to how useful and effective flu vaccines really are.

Competing interests: None declared

Competing interests: None declared

Gordon F. Moran, Independent scholar

Via delle Terme, 3, Firenze, Italy 50123

Click to like:
6
Vote up!
How useful are flu vaccines?
25 January 2006

Thompson et al. [1] highlight the correlation between “pneumonia and influenza” estimated death rates and the percentage of samples positive for influenza A(H3N2) viruses by week in United States from 1990 to 1998 (cf. Fig. 1, [1]). This correlation is not in itself inconsistent with the hypothesis that other factors might substantially or even predominantly contribute to the mortality seasonal burden. Apart from the respiratory illnesses caused by the increase of environmental pollutants during the winter season [2], it is worth remembering that “Cold weather alone causes striking short term increases in mortality, mainly from thrombotic and respiratory disease”, even without an influenza epidemic [3].

This is in agreement with the generally recognized circumstance that “isolation of human influenza viruses in the blood has been reported only rarely”[1] and that the immediate cause of death in almost all cases is not the viral infection itself but an indirect “complication”, like secondary bacterial pneumonia.

That there is a serious problem here for the conventional estimates of the “pneumonia and flu” death rates is widely accepted. For instance, one member of the Simonsen et al. team, Jonathan Dushoff, published a few months ago a useful note emphasizing: “Approaching a consensus on the health and mortality burden of influenza, and on the cause of winter excess mortality in general, is an important scientific and public policy goal. For this to happen, further progress is needed in several areas”, and concluding: “The contribution of influenza to morbidity and mortality – and, more broadly, cataloging the causes of daily and season excess deaths and hospitalizations – remain as unresolved questions with important scientific and public-health implications.” ([4])

More should be done in the way of epidemiological research to assess the relative weight of all plausible factors and to ascertain how frequently the flu viruses are actually involved in the fatal outcomes. Most importantly, it must be pointed out that the so-called “complications” are also linked to influenza-like illness (ILI), which is “clinically indistinguishable from influenza” [6]. ILI, defined as a symptomatic syndrome, is in fact caused by hundreds of different agents, including RSV (respiratory syncytial virus), picornaviruses, parainfluenza, hMPV (human metapneumovirus), coronaviruses etc.(see e.g. [5]).

Now, an important public health issue arises at this point, since vaccine is protective only against two of the agents causing symptomatic, clinical flu. It follows that even if clinical flu were the underlying cause of seasonal differences in “pneumonia and influenza” death rates, this would not in itself provide a solid ground for the mass flu vaccination campaigns.

It is interesting that Doshi’s critics ([1], [9]) seem to evade the crucial issue of the extent the flu vaccines are succeeding in preventing clinical flu. The results of two recent meta-analyses are by no means encouraging ([6], [7]). In [6], which deals with 65+ individuals (one of the high priority groups for mass vaccination according to the CDC), it is stated that “the usefulness of vaccines on the community [as opposed to long-term care facilities] is modest”; in [7] the effectiveness of vaccines in children younger than 2 (inactivated vaccines) or older than 2 (both inactivated and live attenuated vaccines) was found to be “low”. One of the main reasons given to explain these disappointing results is that “vaccines are specifically targeted at influenza viruses and are not designed to prevent other causes of influenza-like illness”[7].

In an interview the senior author of [6] and [7], Dr. Tom Jefferson, put the issue in a refreshingly explicit way: “The vaccine doesn’t work very well at all. […] Vaccines are being used as an ideological weapon. What you see every year as the flu is caused by 200 or 300 different agents with a vaccine against two of them. That is simply nonsense.”[8]

So it appears that the picture, not only at a theoretical level but even as regards “public health efforts”[9], is much more complicated than that provided by the NIH and CDC representatives.

References

[1] Thompson WW, Shay D, Weintraub E, Brammer L, Meltzer M, Cox N, Bresee J. “Are estimates of influenza-associated deaths in the US really just PR?”. BMJ [rapid response] (18 Jan 2006) (retrieved 23 Jan 2006).

[2] Crowe D. “The Peril of Correlation”. BMJ [rapid response] (14 Jan 2006) (retrieved 23 Jan 2006).

[3] Donaldson G. C., W R Keatinge W. R., “Excess winter mortality: influenza or cold stress? Observational study”, BMJ, Vol. 324, pp.89-90 (12 Jan 2002)

[4] Dushoff J. “Assessing influenza-related mortality: comment on Zucs et al.”, Emerging Themes in Epidemiology, 2005, 2:7, doi:10.1186/1742-7622-2-7

[5] Kelly H., Birch C. “The causes and diagnosis of influenza-like illness”, Australian Family Physician Vol. 33, No. 5, May 2004, pp. 305-9

[6] Jefferson T., Rivetti D., Rivetti A., Rudin M., Di Pietrantonj C., Demicheli V., “Efficacy and effectiveness of influenza vaccines in elderly people: a systematic review”, Lancet, Vol. 366, pp. 1165-74 (1 Oct 2005).

@Keating – and what does that have to do with Vaccines?

Decades of research shows them to be effective, safe, and not the kind of thing that is even “controversial” anymore – unless you are an anti-vax head.

I have also never had the flu shot however have had the flu in the past. Honestly I don’t know weather to get it or not. I respect both sides of the arguement and haven’t been able to find a convincing enough reason to get the vaccine, however I am open to consdering it. Here are my questions;

1. If you have had the flu before, does it not naturally stengthen your immune system?
2. Are more people actually dying from the flu, or because of so much tv and internet news it is just getting reported more?
3. My friend works in health care where over 80% of staff are vaccinated, and yet our citizens are still experiencing high rates of the flu, our hospitals are full, and people are still dying. Does getting the vaccination really make that much difference? At least where I live, the stats don’t seem to support it.

Any feedback would be much appreciated. Thanks!!

It is interesting how Greg et al accuse the proponents of the flu vaccine as being drug pushers. Let’s turn the tables for once and more accurately portray the truth.

It is those who reject the vaccine who are going to put the most money in the hands of hospitals, doctors, and drug companies. People who get the flu often get very sick. They are often put in the hospital. They are often put in the ICU. They sometimes die. This is all VERY expensive. The flu vaccine saves lives and saves money.

If the anti-vaccine people had their way, costs would soar. My proof?

http://www.plosone.org/article/info:doi/10.1371/journal.pone.0066312

http://www.cdc.gov/flu/news/nivw-flu-vaccine-benefits.htm

Radical fruitcakes, no. Trustworthy, also no. Not since they printed the Bush administration’s lies about Iraq and alleged “weapons of mass destruction” without bothering to fact-check, and dismissed evidence provided by critics of the war. So not only is that article irrelevant, this isn’t even argument from authority, it’s Argument from Unreliable Authority. You might as well ask me to believe in Santa Clause because Bernie Madoff told you he’s real. Sure, the Times might print the truth, but I’m skeptical of them on anything more potentially controversial than “new species of ant found in the Broadway median.”

@Canadian Social Worker,

1. Having influenza does not strengthen your immune system. It most cases it does leave you with some level of immunity to that strain of influenza and perhaps a few related strains, which is a far more limited effect than the phrase “strengthen your immune system” would imply.

2. It’s my understanding that the death rate from flu varies from year to year and strain to strain.

3. I don’t understand your statement. What does the immunization rate of hospital staff have to do with the people from the general public hospitalized for influenza?

@MoB – I would hope that the hospital staff would have a higher rate of vaccination than the general population, if they are being inundated with Flu patients (which, of course lends credence to wanting to get the vaccine – if so many flu victims are going to the hospital).

Death rates do vary significantly – as does the strain of flu….why anyone would want to take their chances, I’ll have no idea.

Katherine: due to the Affordable Care Act, your flu vaccine will cost $0.

I had the real flu in college. What a miserable experience. A full week in bed and another two weeks of feeling pretty crappy and exhausted. Unfortunately, we often use the word “flu” to describe any bad cold, so for many people “the flu” is 2-3 days of sore throat, Kleenex, and sinus pressure and little reason to vaccinate. If, like my mother, you got to spend two weeks in the ICU, you’ll be a lot better about getting that little vaccine.

Exactly, Lawrence.

For the past few months, the alt med woo-esphere has been saturated with anti-flu-vaccine articles/videos/ faux studies as it is every year about this time- which is precisely WHEN people contract flu.( PRN, Natural News, AoA, TMR).

Now why would they do this?
They keep telling us how they only have public welfare in mind and wish to protect people from corporate malfeasance and greedy SB doctors. I tend to doubt their veracity.

What I suspect is directly the opposite:
they want to increase their own power and prestige amongst their audience as well as filling their coffers- they are competitors of SBM although they would have you believe that they ‘enlightening’ you because of the goodness of their hearts and their concern for all mankind.

In their universe, the flu doesn’t really harm anyone- no one dies of it- whilst the vaccine does great harm. The flu can be entirely avoided, they say, by eating a proper diet and taking supplements to “strengthen the immune system”. They also JUST happen to sell diet books, videos, pure food products,water filtres, juicers and supplements- in other words, what you need to avoid the flu, according to them.

People who accept SBM data about the flu or the vaccine would therefore NOT want to follow their regimes. This is why they would do or say anything to besmirch SB information.
And they DO say anything to manipulate their followers into doubting research. It’s a great hoax and the victims are anyone who buys either their information or their products.
You’ve been HAD.

If you would believe them, you cannot trust governmental health agencies, doctors, universities, researchers, medical associations/journals or
the mainstream media.

So I ask again:
would you doubt everything experts tell you and instead believe some guy on the internet who wants your money?

And -btw- these simple, humble health advocates live in palaces ( see Quackwatch/ recent additions for an article about Mercola- featuring photos of his estate; or go to paradisegardensnaplesfl.com for a real estate agent’s- a Ms Flax- site about Null’s 6miilion USD abode).

Thanks Meph,

I can see how question 3 is confusing. Let me reword it. The city and province I live in has a really high vaccination rate, and yet we are getting tons of news reports that there are a lot of cases of the flu, and many have been hospitalized with it. I guess what I am asking is that if vaccination rates are at the 80% level, and there are people still getting hospitalized and dying, is the vaccine making a difference?

Also, if the death rates vary from year to year how can people use that as a measure of the flu vaccine being effective?

Thanks!

@Krebiozen, you wrote to Greg,

Getting the vaccine drastically reduces your chances to more like 1 in 100 or even 1 in 200 in a good year. The chances of a serious adverse reaction to the vaccine are in the order of one in a million. Even your mathematical skills should be up to figuring out it is a good idea to get the vaccine.

I think you give his mathematical skills *way* too much credit.

You may be happy playing the odds, but you will regret it if you do go down with influenza, especially if you pass it on it to your children or to an elderly relative.

He’d be unhappy if he went down with influenza since that’s an utterly miserable experience, but he’d have some excuse about how the evil doctors caused it. I doubt he’d have the slightest regret if every one of his children (if he has any) and every elderly relative died of flu which they provably caught from him.

*Reading Willcox copy pasta*

Gah. Déja vu. This article I alluded in 25 was part of the Jefferson/Cochrane panel controversy. Still cannot find the article itself
But I found this old post about Jefferson’s declarations on influenza.
Short version: he is overaching a bit.

About flu vaccine efficacy, Mark Crislip did a good job 5 years ago.
He is notably quoting a number of studies where the presence of the influenza virus’ DNA was checked among the studied patients, as part of comparing infected vs non-infected people, to avoid some of the biases alluded by Jefferson & co quotations.

Back at checking local physicians for an appointment for the flu shot. Spent enough time procrastinating about it.

@Canadian Social Worker:

1. If you have had the flu before, does it not naturally stengthen your immune system?

It may actually leave you worse off the next time, thanks to original antigenic sin.

(For those following along, OAS appears to be off the hook in VAERD.)

@CS – you need to define “high vaccination rate” because even an 80% rate leaves a lot of people unvaccinated & the flu is highly contagious – plus the vaccine isn’t 100% effective, so even a portion of the vaccinated will contract the disease (hopefully with few symptoms & a shorter duration).

You can only improve your chances if you vaccinate – better safe than sorry.

Peter Doshi is not a member of Johns Hopkins medical school’s faculty (he has been a guest lecturer, but otherwise has not taught students). He has never practiced medicin, nor done clinical research. He doesn’t have a background in science research but instead a background in the history of science.

And finally, he’s and HIV / AIDS denialist.

Greg,

Lots of soldiers came home from world war 2 without a scratch. Does that mean they are immune to bullets?

And an apology for the “drug dealer” comment is in order.

C

Hmmm

I’m tempted to say “you lose” here and leave it at that, but I’m waiting for the coffee to brew.

Roche paid a $3 Billion settlement.

You mean GlaxoSmithKline. It was actually two separate settlements.

For lying on purpose to sell more drugs, and hide critical trials that show the drugs are not so good, even dangerous such as Paxil.

Again, you’re kind of making a hash of this. Three-quarters of the first billion related to promoting Paxil and Wellbutrin for off-label uses (depression in under-18 patients in the first case, weight loss and other conditions in the latter). With Paxil, they also misreported a trial such that they claimed efficacy in this age group when it wasn’t really there. This doesn’t really have anything to do with Paxil’s ultimate “black box” warning regarding pediatric use.

The remainder had to do with failing to include postmarketing safety data regarding Avandia.

The big chunk, $2 billion, was about two things: (1) misreporting best prices to Medicaid for reimbursements and (2) promoting (including physician kickbacks) Advair, Lamictal, Zofran, Imitrex, Lotronex, Flovent, and Valtrex for unapproved uses and thus causing false claims to be submitted to federal programs.

Financially defrauding the feds is a really, really bad idea. It also is the bulk of what you’re pointing at yet unrelated to your putative point.

You folks must think we are just stupid.

Given that you barely understand what you’re talking about and much of it doesn’t have anything to do with influenza, you’re making it awfully tempting. Who’s “we”?

Hmmm Roche paid a $3 Billion settlement.

Yes, to which the obvious reply must be “Did you have a point?”

Surely you’re not arguing that because one company settled a charge of deceptive buisness practices influenza vaccines have been proven to be unsafe or ineffective?

Notice, for those medications that work well and have few side effects, there is almost no controversy.

Given that vaccines demonstrably work very, very well, with few side effects (the most common of which are both minor and transient –soreness at the site of injection, mild fever, etc.– and those that could be considered serious all but vanishingly rare)–I’m glad we can agree that no controversy exists.

Hi JGC (or anyone else),

As I am working through all this JGC’s point reminded me about another question I wanted to ask.

What about the theory that getting the flu shot every year will eventually wear down your immune system because the body loses it’s ability to develop it’s own capacity to fight things off?

@CS, you need to factor into the calculation the fact that flu vaccine is only around 60% effective.
So if you have a population which is 80% vaxed, then only 48% of your population is protected. That still leaves a lot of room for unvaxed or vaxed but unprotected people to come down with the flu.
But remember, 52% of the population would have been protected by vaccine, halving attack rates and mortality from flu.

Okay thanks Dingo 🙂

I guess what concerns me is all of this death talk people use to encourage others to get vaccinated. I guess I am just debating with myself if that is a fair argument. If the flu shot is only 60% effective, how many people are we actually saving? Still hard to prove…at least I think??

I’d originally had an appointment with my GP to get the flu shot back in October, but there was a conflict with another, more critical appointment, so it got postponed indefinitely. It was actually Orac’s previous flu-related post that finally got me motivated. I went to the nearby pharmacy, filled in a quick questionnaire, and got my injection (multi-dose but, sadly, no thimerosol). If I can avoid the bug for another few days, I should be relatively safe. Unless I get one of those neuro-degenerative diseases so-o-o-o-o many of the vaccinated succumb to…
And, thanks to the evil socialist regime of Canuckistan, I didn’t have to (directly) pay for it. Unlike all those over-the-counter flu medications. Hmm, anybody ever check out if they’ve got any connections with the anti-flu-vaccination crowd? “Big chicken soup”?

@CSW – we know that a significant number of people die of flu-related complications (depending on the year – between 6000 & about 30,000 in the US alone) – so getting your flu shot is a good idea, just as a preventative measure.

People wear seatbelts every single day, yet very few people get in car accidents (proportionally)…but getting your flu shot, like wearing a seatbelt, decreases your chance of serious injury (or infection) – increasing the overall chances you’ll never die either in a car accident or by the flu.

Since the flu vaccine is incredibly safe and effective (though the effectiveness leaves something to be desired, but the effectiveness is never “zero”) you have nothing to lose by getting one.

When I got my flu shot in October, I jokingly asked for extra thimerosol. The nurse simply looked puzzled. Perhaps we don’t have a lot of mercury militia types around here.

@Canadian Social Worker

Please remember that in your first post you said that 80% of healthcare staff had been vaccinated against seasonal flu, not 80% of your province’s population. If you think the figures some people have subsequently calculated don’t have an acceptable cost benefit for the province as a whole, please bear in mind that these figures really only relate to healthcare staff, who, if they should become sick, are an obvious risk to others given the nature of their job.

This level of vaccination is paying off very well. If anything, the concern is that the coverage amongst healthcare staff should be higher.

What about the theory that getting the flu shot every year will eventually wear down your immune system because the body loses it’s ability to develop it’s own capacity to fight things off?

See the comment about “original antigenic sin” at #55. Vaccines have the luxury of not generating full-blown responses that can prove to be a liability down the road.

^ (I forget where the calculation of the immune system’s theoretical memory capacity is, but there’s no issue of its “wearing down.”)

What about the theory that getting the flu shot every year will eventually wear down your immune system because the body loses it’s ability to develop it’s own capacity to fight things off?

Keep in mind that your body is exposed to literally millions of antigens daily environmentally, through diet, etc.. If this hasn’t been seen to cause the body’s ability to develop protective antibodies to “wear down” why would you expect being exposed to a few dozens of antigens as the result of immunization to do so?

Rather than’wear down the ability of the body to developprotective antibodiesimmunization capitalizes on that ability by exposing the immune system to specific antigens efectively ‘teaching’ it to recognize wild type viruses when exposed.

Thanks JGC and Narad. What are your favourite sources of information on the topic?

As for why people do not get their flu shots – laziness may be one factor but it’s not crucial. I work at school, under our former head teacher we would get flu shots at our school nurse’s office and we would only have to pay an equivalent of $10 for the vaccine itself. There were maybe about five teachers (out of 60) who would go for it, me and the head teacher included. Even though it was cheap and convenient. The rest thought that flu is not that bad, that they are strong and healthy, that the shot is not really effective or that it wears down the immune system.
Now we have a new head teacher and getting the shot is much more complicated for me, I have to get a doctor’s appointment and pay three times as much – but I still do it, had my shot back in October, and so did my husband.

Got the flu shot Thursday. Learning I could be asymptomatic and contagious was the winning argument. I have a friend with stage IV cancer, and will not risk exposing him unknowingly. Biggest reaction was a sore shoulder interfering with sleep.

Comments are closed.

%d bloggers like this: