Flu Shots

[alfaniner]

Many times what people attibute to "stomach flu" is actually a case of food poisoning.

[Capsid]

That would be because it's a waste of resources for seasonal flu.
I thought it was because there are insufficient doses manufactured for everyone to get the vaccine annually.

[kellyb]

I thought it was because there are insufficient doses manufactured for everyone to get the vaccine annually.

It's sort of a self-fulfilling prophesy, circular type thing, I think.
The manufacturers don't make more because there's not more demand.
If the NHS were to aggressively pursue a universal vaccination policy, the supply would fall into place.

Here in the US we've been having an excess for the past couple of years. Our government has awarded multiple million (or billion? I forget...) dollar contracts to manufacturers to make more, but the demand hasn't quite caught up with the new supply yet.

[Capsid]

It's sort of a self-fulfilling prophesy, circular type thing, I think.
The manufacturers don't make more because there's not more demand.
If the NHS were to aggressively pursue a universal vaccination policy, the supply would fall into place.

Here in the US we've been having an excess for the past couple of years. Our government has awarded multiple million (or billion? I forget...) dollar contracts to manufacturers to make more, but the demand hasn't quite caught up with the new supply yet.
Are there even enough chickens in battery farms to lay sufficient eggs to grow the virus on? Bird flu wiping out the chicken population would be a set back too.

[Ivor the Engineer]

Are there even enough chickens in battery farms to lay sufficient eggs to grow the virus on? Bird flu wiping out the chicken population would be a set back too.

I thought that when I heard the manufacturing capacity has been increased to 500 million doses/year on the radio the other week. That's one heck of an omelette!

[kellyb]

Are there even enough chickens in battery farms to lay sufficient eggs to grow the virus on? Bird flu wiping out the chicken population would be a set back too.

It wouldn't take long to come up with more chickens, I don't think. I don't know where the manufacturers get their eggs from, though.
Here in the US, those big contracts are going in part to the creation of immortalized cell lines for growing the viruses, too. A couple of companies are using that dog kidney line, I know. They're thinking they can get a higher antigenic yield out of them, in addition to not having to worry about adventitious agents. MedImmune (the flumist folks) have some really fancy new stuff they're working on that involves manufacturing viruses without the use of any animal products (synthetic nutrient stuff to replace FBS.)

[kellyb]

Here:
http://www.drugresearcher.com/news/ng.asp?id=67556
ETA:
And here's something on where MedImmune's going:
http://www.who.int/vaccine_research/diseases/influenza/Kemble_LAIV_cell_dev_US.pdf

[MinorityView]

Many times what people attibute to "stomach flu" is actually a case of food poisoning.

Gotta wonder what sort of "informed consent" we have going on, when someone can get a flu shot and not even know what the shot actually prevents! A bit of a communication problem, perhaps:eye-poppi?

[Eos of the Eons]

Gotta wonder what sort of "informed consent" we have going on, when someone can get a flu shot and not even know what the shot actually prevents! A bit of a communication problem, perhaps:eye-poppi?


That's a stretch. Not knowing the exact difference between stomach flu and respiratory flu is completely different from knowing what the flu shots actually prevent.

For example, when I got the flu shot the nurse told the 3 strains it protects against this year, and what protection it offers. Then I consented to the shot.

When I saw the doctor there was no consent needed, as nothing was prescribed for the stomach problem (probably mild stomach flu as there was no diarrhea involved, just fever and vomitting). The doc acknowledged the likely cause to be viral (not which virus per se), and only recommended higher intake of fluids and not ingesting milk products. You don't need any type of consent for that advice.

Doc called it stomach flu, and that really didn't mean much to me until skeptigirl pointed out the exact difference. There's still no confirmation on what virus my son did or did not get. Could be the respiratory version for all we know.

[MinorityView]

I was actually thinking of the earlier poster, who was hoping that the flu shot would prevent the vomiting and runs she had last year.

Glad that you knew what the shot was supposed to prevent.

[Professor Yaffle]

Its amazing how much the language we use can influence the assumptions we make. We don't have the term "stomach flu" here - we usually call it a tummy bug or just "sickness and diarrhea". So nobody thinks it has anything to do with the flu, or assumes that a flu shot would prevent it.

[Ivor the Engineer]

Its amazing how much the language we use can influence the assumptions we make. We don't have the term "stomach flu" here - we usually call it a tummy bug or just "sickness and diarrhea". So nobody thinks it has anything to do with the flu, or assumes that a flu shot would prevent it.

When I first heard the term 'stomach flu' used in American films I thought it was a different condition to what we in the UK call a tummy bug. Stomach flu sounds far more severe.

Amazing how you often go off the last thing you ate before you vomit, even if it had nothing to do with causing the illness.

[Physiotherapist]

Sometimes it is referred to as 'Gastric flu' in the UK, rather than a tummy bug.

I remember going to Boston several years ago now. They are famous for Clam Chowder there and at lunchtime of the day I was due to fly back to the UK, I stopped and had some for lunch. I then got on a night flight back to the UK and was served Salmon.

I landed at about 7.15 am UK time. I was very tired, so when I got home, went to bed and slept and woke up later feeling very unwell with violent stomach pains and diarrhoea that put me out of action for a week.

Now, I am not exactly sure whether I was poisoned by British Airways salmon, but I have most definitely not eatan Clam Chowder since that time.

[Michelle]

Well, I remember that during my last flu I puked a few times. It's not because I had nausea - it's because that I was coughing so much it ended up bringing my lunch up a couple times.

[Capsid]

Sometimes it is referred to as 'Gastric flu' in the UK, rather than a tummy bug.

I remember going to Boston several years ago now. They are famous for Clam Chowder there and at lunchtime of the day I was due to fly back to the UK, I stopped and had some for lunch. I then got on a night flight back to the UK and was served Salmon.

I landed at about 7.15 am UK time. I was very tired, so when I got home, went to bed and slept and woke up later feeling very unwell with violent stomach pains and diarrhoea that put me out of action for a week.

Now, I am not exactly sure whether I was poisoned by British Airways salmon, but I have most definitely not eatan Clam Chowder since that time.I thought you said you had a strong immune system?

[Dymanic]

Well, I remember that during my last flu I puked a few times. It's not because I had nausea - it's because that I was coughing so much it ended up bringing my lunch up a couple times.I almost feel like puking just thinking about it.

[Physiotherapist]

I thought you said you had a strong immune system?


I do. This happened at least 10 years ago now.

[Capsid]

I do. This happened at least 10 years ago now.I don't follow your logic. Was your immune system different 10 years ago?

Your immune sytem is dictated by your genes, so for it to change would mean your genes have changed. What does happen is that as you get exposed to more pathogens your immune system gets educated, so that in your example the food poisoning you experienced would be less severe if you were exposed to the same pathogenic organism at a later date. So you may be confusing a strong immune system (which has no meaning) with what comes naturally with age (or vaccination).

[Big Les]

I had some sort of gastric bug for the first time ever this year, and it didn't occur to me to think of it as any kind of flu. I did feel like I might die though, which was interesting. Not as interesting as the dark blue vomit I was unhappily offloading into a bucket at 4am. NHS Direct asked if I'd swallowed any household cleaning products...

[Rolfe]

I had to give a basic lecture on elementary immunology and vaccinations today. I found myself from time to time addressing Physiotherapist's fallacies, and explaining to the students that this was a common misconception, and why it wasn't like that.

I don't know whether this was a good thing or not!

My best bit, though, was when I explained to them about subunit vaccines, and the number of antigens in a vaccine course compared to the number of antigens on the surface of one streptococcus bacterium, and why it was that anyone claiming that a child's immune system could be overloaded simply did not understand the first thing about the subject.

Rolfe.

[MinorityView]

Hi Rolfe,
When doing historical research, I came across the theory that one reason so many people died of the Black Death when it came roaring into Europe in the 1300s is because there had been flooding and famine about 20 years earlier. As a result of the bad weather, failed crops and generally miserable conditions, lots of people were "sickly" and died easily.

Obviously, it was a disease to which most people had no resistance, but still, some people didn't die, some people got sick but survived, so there had to be variation in the ability of the immune system to cope. And yes, I know some people weren't exposed and that was why they didn't die.

Just curious. How does outright malnutrition during some period of early life affect the functioning of the immune system for the rest of a person's life? Has this been studied? There are, unfortunately, large numbers of candidates available throughout the world for such a study.

[Dymanic]

When doing historical research, I came across the theory that one reason so many people died of the Black Death when it came roaring into Europe in the 1300s is because there had been flooding and famine about 20 years earlier. As a result of the bad weather, failed crops and generally miserable conditions, lots of people were "sickly" and died easily.Has your historical research uncovered further confirmation for this hypothesis by establishing whether malnourishment may have played a role in other events such as the plague of Justinian in 541 AD (which, at its height, killed 10,000 a day in Constantinople), or the Antonine Plague of 165 - 180 AD (which may have killed as many as 5,000 a day in Rome)? Does it seem reasonable to postulate that poor nutrition was a primary causal agent in every single one of the epidemic events which have so often been noted to follow first encounters between Europeans and indigenous populations in the Americas or the Pacific?

[Rolfe]

I'm not aware of any clearly-demonstrated link in animals between malnutrition in early life and later susceptibility to infection, but I can ask around. It's exactly the sort of thing I'd expect a bunch of academic agricultural experts to know. I do recall when I was a student, an elderly vet telling me that during the war there were a couple of years which were very tight indeed and most of the youngstock bred then were malnourished, however they recovered well in the end.

Rolfe.

[Eos of the Eons]

What does malnutrition or nutrition have to do with flu shots?? Do we need another thread?

[Dymanic]

What does malnutrition or nutrition have to do with flu shots?? An argument often heard from opponents of vaccination is that such factors as nutrition, hygene, and overall health best explain individual variation in susceptibility to illness. Declines in diseases evidence the impact of modern methods of hygene, etc; despite the degree to which those declines correlate with increased vaccine coverage. And of course neither our ancestors nor any of the people in undeveloped places where diseases still thrive ever heard about the importance of a diet including lots of fresh fruits and vegetables, or the value of fresh air and sunshine and physical activity.

[Eos of the Eons]

Ah, I see where this is going then. It's tough luck for the young and old (most susceptible to death or irreparable damage), we're not going to vaccinate anymore. If you survive your babyhood and toddlerhood with all the usual diseases, then you can live with the consequences until you die of secondary diseases after contracting the flu in your elder years. Sounds like fun. Age is a factor, not just nutrition. Age is more of a factor than nutrition. That is why vaccines exist, to protect those that need it most.

Thing is, even in the old days before vaccines there were people who found some diseases were tamer one year. They would try to get it that year, because they knew it wouldn't kill them, and they were protected the next time it came around. It's not hard to figure out you only get it once. This happened with smallpox. Then Jenner figured out cowpox was even milder.

We tackled smallpox before getting onto tough ones - like the flu that changes every year too much for us to gain long-term protection by getting it "naturally".

In the 1700s 1/3 of children died of smallpox before they were three. Others were blinded & pockmarked. Now we have no clue how bad it was. In 1801 people were lining up to get vaccinia scratched into their skin.

Other diseases with known fatality rates are also kept in check with modern vaccines. It's far too easy to take vaccines for granted.

An ounce of prevention is worth a pound of cure. I don't know where I learned that, but I so get what it means. People who would rather try to stamp out a fire once it starts will get burned.

http://www.sudantribune.com/spip.php?article24466

It is no coincidence that vaccinated children survive, but the unvaccinated die.

[robinson]

How does outright malnutrition during some period of early life affect the functioning of the immune system for the rest of a person's life? Has this been studied? There are, unfortunately, large numbers of candidates available throughout the world for such a study.

Yes, and indeed we do know that malnutrition and undernourishment lead to decreased immune response.

http://books.google.com/books?id=IAwrj_eyiEEC&pg=PA162&lpg=PA162&dq=malnutrition+in+early+life+and+later+susceptibi lity+to+infection&source=web&ots=EogukZA1TE&sig=3KgAlo9XTi4CmkmYwH6hnJ_qSIY

Malnutrition during pregnancy can effect much later events as well, including immune system problems etc

[Eos of the Eons]

What does that have to do with flu shots? The people that the flu kills the most are not malnourished, they are just very young or getting older.

[Skeptic Ginger]

Gotta wonder what sort of "informed consent" we have going on, when someone can get a flu shot and not even know what the shot actually prevents! A bit of a communication problem, perhaps:eye-poppi?Why would you assume (wrongly) because people are misinformed about flu in general that the people providing the vaccinations aren't giving the accurate information at the time of the shots?

In this country a VIS (Vaccine information statement) is required to be given, by law whenever vaccines are given.

Current influenza VIS, inactivated vaccine (http://www.immunize.org/vis/2flu.pdf)

Current influenza VIS, live intranasal vaccine (http://www.immunize.org/vis/liveflu.pdf)

[Skeptic Ginger]

Well, I remember that during my last flu I puked a few times. It's not because I had nausea - it's because that I was coughing so much it ended up bringing my lunch up a couple times.That's a classic symptom of pertussis (whooping cough), not influenza.

Specificity is 45%-84% according to this article (http://findarticles.com/p/articles/mi_m0689/is_1_54/ai_n8705005) meaning posttussive vomiting is diagnostic for pertussis 45%-84% of the time.

[Skeptic Ginger]

Why some of you think influenza is no big deal when it kills thousands and thousands of people every year is beyond me.

Why do you suppose the WHO has an entire department dedicated to influenza?

WHO Global Influenza Programme (http://www.who.int/csr/disease/influenza/mission/en/#mission)

And why do so many countries invest so much of their public health resources toward this infection?

National Influenza Centers (http://www.who.int/csr/disease/influenza/centres/en/index.html)



WHO Influenza Overview (http://www.who.int/mediacentre/factsheets/fs211/en/) Influenza rapidly spreads around the world in seasonal epidemics and imposes a considerable economic burden in the form of hospital and other health care costs and lost productivity.

In annual influenza epidemics 5-15% of the population are affected with upper respiratory tract infections. Hospitalization and deaths mainly occur in high-risk groups (elderly, chronically ill). Although difficult to assess, these annual epidemics are thought to result in between three and five million cases of severe illness and between 250 000 and 500 000 deaths every year around the world. Most deaths currently associated with influenza in industrialized countries occur among the elderly over 65 years of age.Who cares about a bunch of old geezers anyway?


Much less is known about the impact of influenza in the developing world. However, influenza outbreaks in the tropics where viral transmission normally continues year-round tend to have high attack and case-fatality rates. For example, during an influenza outbreak in Madagascar in 2002, more than 27 000 cases were reported within three months and 800 deaths occurred despite rapid intervention. An investigation of this outbreak, coordinated by the World Health Organization (WHO), found that there were severe health consequences in poorly nourished populations with limited access to adequate health care (see "Outbreak of influenza, Madagascar, July-August 2002," Weekly Epidemiological Record). It is not possible to extrapolate the exact annual burden of influenza in the tropics from data from such occasional and severe outbreaks.And all these people are malnourished, living in squalor, and their loss has little impact on the rest of the world.



Vaccination is the principal measure for preventing influenza and reducing the impact of epidemics. Various types of influenza vaccines have been available and used for more than 60 years. They are safe and effective in preventing both mild and severe outcomes of influenza (see WHO position paper, “Influenza vaccines”, Weekly Epidemiological Record).

It is recommended that elderly persons, and persons of any age who are considered at “high risk” for influenza-related complications due to underlying health conditions, should be vaccinated. Among the elderly, vaccination is thought to reduce influenza-related morbidity by 60% and influenza-related mortality by 70-80%. Among healthy adults the vaccine is very effective (70-90%) in terms of reducing influenza morbidity, and vaccination has been shown to have substantial health-related and economic benefits in this age group.I suppose that last little bit is a big lie generated by vaccine manufacturers and sucked up by the corrupt government public health organizations which in turn dupe the majority of health care providers. Of course such fine young educated persons as yourselves have taken the time to conduct your own scientific research and you are too wise to be duped like those of us with university degrees and years of experience. We providers have naturally lost all objectivity in our fields despite how much we have also taken the time to absorb all the information we can.



WHO position on influenza vaccines (http://www.who.int/wer/2005/wer8033.pdf) Although influenza vaccination is increasing throughout the world, especially in many middle-income countries of Latin America and central and eastern Europe, no country fully implements its vaccine recommendations. Even in wealthy industrialized countries, significant proportions of the groups at risk of complications from influenza are not vaccinated.

WHO strongly emphasizes the importance of raising the public consciousness of influenza and its complications as well as of the beneficial effects of influenza vaccination. There is a growing awareness of the considerable influenza morbidity among schoolchildren and the often severe clinical course of influenza in the youngest age groups. Children are also playing a crucial role in the transmission of the infection. Furthermore, significant herd immunity effects have been observed in non-immunized segments of the population following immunization of children in Japan, the Russian Federation and the United States. Therefore, further exploration of the safety and cost–effectiveness of introducing influenza vaccination into national immunization programmes is clearly warranted.This position statement according to the antivax position expressed by members in this thread indicates pure corruption and not an ounce of expertise. No researchers and public health professionals dedicated to their work remain at the WHO. In fact, no researchers and public health professionals even exist anymore. They are all ignorant dupes, so say Ivor, robinson and kellyb, those great intellects of the JREF forum.

[Skeptic Ginger]

The antivaxers have latched on to this, "better nutrition and sanitation eliminated infection fatalities, not vaccines", lie and continue to promote it despite the fact it has been thoroughly debunked. It only takes a cursory view of the disease elimination curves when individual vaccines were introduced to see the correlation is with vaccine introduction, not nutrition and sanitation. I suppose if you weren't alive in the 50s it's easy to imagine we were all drinking gutter water and suffering from malnutrition.

[Professor Yaffle]

That's a classic symptom of pertussis (whooping cough), not influenza.

Specificity is 45%-84% according to this article (http://findarticles.com/p/articles/mi_m0689/is_1_54/ai_n8705005) meaning posttussive vomiting is diagnostic for pertussis 45%-84% of the time.

(Going completely off topic for a moment) I vomit from coughing pretty much every time I have a really bad cold that goes to my chest. But I think that is a combination of asthma and a very strong gag reflex. Strangely, the vomiting actually relieves the coughing for a short while. I was undiagnosed for quite a lng time as a child, and in order to get any relief with the cough medicines the doctors kept telling me to take, I had to take the vilest expectorant known to man, whih would make me sick so that I would feel better for a short time.

[Professor Yaffle]

Just a question about specificity (its a long time since I learned any of this). In the example you gave above, would rates of pertussis affect the specificity of the symptom? For example, if pertussis is rife, there would be a high specificity because so many people would have it, there would be proportionally fewer false negatives. If pertussis is all but wiped out, nearly all cases of psosttussive vomitting would be due to something else - ie false positives, so specificity would be low. Have I got that right? If so, what background level of pertussis is the figure you gave based on? Is it based on a community with high vaccination rates (I could only get the astract so I couldn't read it all).

I'm not actually going anywhere, or trying to make a point with this, I am just interested.

[fls]

Just a question about specificity (its a long time since I learned any of this). In the example you gave above, would rates of pertussis affect the specificity of the symptom?

No, but you're on the right track. Rates don't affect sensitivity and specificity or likelihood ratios. The specificity tells you, of all the people who don't have pertussis, how many don't have pertussive vomitting.

But rates do affect positive predictive value and negative predictive value. And that is what you are asking in your paragraph below. "What portion of people with pertussive vomitting have pertussis?" And rates are used with likelihood ratios to determine the probability of pertussis, given that you have pertussive vomitting.

For example, if pertussis is rife, there would be a high specificity because so many people would have it, there would be proportionally fewer false negatives. If pertussis is all but wiped out, nearly all cases of psosttussive vomitting would be due to something else - ie false positives, so specificity would be low. Have I got that right? If so, what background level of pertussis is the figure you gave based on? Is it based on a community with high vaccination rates (I could only get the astract so I couldn't read it all).

I'm not actually going anywhere, or trying to make a point with this, I am just interested.

The LR in the chart is 2.2, so it would double your odds of having pertussis. For example, if the background rate is 0.1%, your odds of having pertussis are 0.002 to 1. If the background rate is 10%, your odds of having pertussis are 0.2 to 1.

Linda

[Professor Yaffle]

Thanks Linda, That's what I thought specificity meant (I read a good article on the subject by Ben Goldacre a while back about sensitivity, specificity, positive predictive value etc), but I became a little confused by Skeptigirl's mention of it and thought I had remembered wrongly. Must have misunderstood what she was saying.

Edit - here's the article I mentioned: http://www.badscience.net/2006/12/crystal-balls-and-positive-predictive-values/

[Ivor the Engineer]

<snip>

WHO position on influenza vaccines (http://www.who.int/wer/2005/wer8033.pdf)

This position statement according to the antivax position expressed by members in this thread indicates pure corruption and not an ounce of expertise. No researchers and public health professionals dedicated to their work remain at the WHO. In fact, no researchers and public health professionals even exist anymore. They are all ignorant dupes, so say Ivor, robinson and kellyb, those great intellects of the JREF forum.

It's so much easier to discredit your opponents when you misrepresent their position.

It appears to be reasonable to spend money on vaccinating at-risk groups, such as those below 5, those above 65 years old and HCW's.

It is only reasonable to recommend spending money vaccinating everyone if you want to ensure there is enough manufacturing capacity to produce a vaccine for large numbers of people in a short period of time, as would be required for a flu pandemic.

BTW, thank you for the complement;).

[Dymanic]

It appears to be reasonable to spend money on vaccinating at-risk groups, such as those below 5, those above 65 years old and HCW's.

It is only reasonable to recommend spending money vaccinating everyone if you want to ensure there is enough manufacturing capacity to produce a vaccine for large numbers of people in a short period of time, as would be required for a flu pandemic.Even if the only payoff you were looking for in vaccinating large numbers of people was avoiding deaths and hospitalizations in at-risk groups, you might still consider trying to increase coverage to the point where you could protect more of them through herd immunity. If what you were looking at was the money, you might take a different approach, looking at the estimated number of productive hours saved per dose. And if you considered neither of those, you might still want to give some thought to the special circumstance the pandemic prospect represents. There is something admittedly distasteful about the idea of encouraging the ramping up of manufacturing capacities as a hedge against the pandemic threat by promoting seasonal vaccines, but I don't see much willingness to prop up the effort with public money. What other alternatives do you see?

[Ivor the Engineer]

Even if the only payoff you were looking for in vaccinating large numbers of people was avoiding deaths and hospitalizations in at-risk groups, you might still consider trying to increase coverage to the point where you could protect more of them through herd immunity.

Yes, that is why HCW's and carers are given the flu jab in the UK. I've already said if I was often around people who are classed as an at-risk group I'd get a flu shot and encourage them to get one too.

If what you were looking at was the money, you might take a different approach, looking at the estimated number of productive hours saved per dose.

Yet most companies don't offer to pay for their employees to have the flu jab.

And if you considered neither of those, you might still want to give some thought to the special circumstance the pandemic prospect represents. There is something admittedly distasteful about the idea of encouraging the ramping up of manufacturing capacities as a hedge against the pandemic threat by promoting seasonal vaccines, but I don't see much willingness to prop up the effort with public money. What other alternatives do you see?

I know it's a radical concept, but what about telling people the truth?

[Dymanic]

I know it's a radical concept, but what about telling people the truth?The Truth -- as recognized by the vast majority of virologists, epidemiologists, physicians, and public health care officials -- is that the most effective means of preventing serious illness as well as lost productive time due to influenza is through vaccination. Increasing coverage has a bonus, that being greater incentive for vaccine manufactures to increase production capacities, and that truth has been told as well -- but it would be a pretty rare individual who would take that into consideration when deciding whether or not to seek vaccination, so placing a lot of emphasis on it wouldn't make much sense. Physicians continue to recommend the flu vax for individual patients because they recognize it as in the best interests of the individual patient, and public health care officials continue to promote the practice because they recognize it as being in the best interests of large numbers of people taken together. Pharmaceutical companies (some of them) continue to produce flu vaccine because they find it to be in their own interests to do so, and The Truth is that they aren't going to do it for any other reason. If governments and the people they represent do not consider the pandemic threat serious enough to justify sinking money into response measures, it's hardly realistic to expect companies to lose money picking up the slack.

[Skeptic Ginger]

Thanks Linda, That's what I thought specificity meant (I read a good article on the subject by Ben Goldacre a while back about sensitivity, specificity, positive predictive value etc), but I became a little confused by Skeptigirl's mention of it and thought I had remembered wrongly. Must have misunderstood what she was saying.

Edit - here's the article I mentioned: http://www.badscience.net/2006/12/crystal-balls-and-positive-predictive-values/

Well I understand the same thing as Linda as far as predictive value so it appears my over simplified and mostly hasty version of specificity was the problem.

Here's the simple way I remember the interpretation:

Specificity - the 'p' is my mnemonic for positive - refers to the percentage of people you would erroneously include who tested positive but didn't have the condition.

Sensitivity - the 'n' is my mnemonic for negative - refers to how many people you would miss because of falsely negative tests.

[Ivor the Engineer]

The Truth -- as recognized by the vast majority of virologists, epidemiologists, physicians, and public health care officials -- is that the most effective means of preventing serious illness as well as lost productive time due to influenza is through vaccination.

It's just that the flu vaccine does not appear to be very effective at preventing serious illness, or reducing lost productive time.

Increasing coverage has a bonus, that being greater incentive for vaccine manufactures to increase production capacities, and that truth has been told as well -- but it would be a pretty rare individual who would take that into consideration when deciding whether or not to seek vaccination, so placing a lot of emphasis on it wouldn't make much sense.

It would be the only reason I would consider getting a flu jab this year.

Physicians continue to recommend the flu vax for individual patients because they recognize it as in the best interests of the individual patient, and public health care officials continue to promote the practice because they recognize it as being in the best interests of large numbers of people taken together.

Well they have to be seen to be doing something don't they? I'm sure most like to think they are making a significant difference, even if the evidence indicates otherwise.

Pharmaceutical companies (some of them) continue to produce flu vaccine because they find it to be in their own interests to do so, and The Truth is that they aren't going to do it for any other reason. If governments and the people they represent do not consider the pandemic threat serious enough to justify sinking money into response measures, it's hardly realistic to expect companies to lose money picking up the slack.

Most governments with a rational policy appear to offer the flu jab to those most at risk from serious complications (and their immediate contacts), for what good it will do them.

This (http://www.cdc.gov/flu/professionals/acip/persons.htm) page from the CDC is funny:

The page says this...

Annual vaccination against influenza is recommended for:

all persons, including school-aged children, who want to reduce the risk of becoming ill with influenza or of transmitting influenza to others;
all children aged 6–59 months (i.e., 6 months–4 years);
all persons aged 50 years and older;
children and adolescents (aged 6 months–18 years) receiving long-term aspirin therapy who therefore might be at risk for experiencing Reye syndrome after influenza virus infection;
women who will be pregnant during the influenza season;
adults and children who have chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, hematological or metabolic disorders (including diabetes mellitus);
adults and children who have immunosuppression (including immunosuppression caused by medications or by human immunodeficiency virus;
adults and children who have any condition (e.g., cognitive dysfunction, spinal cord injuries, seizure disorders, or other neuromuscular disorders) that can compromise respiratory function or the handling of respiratory secretions or that can increase the risk for aspiration;
residents of nursing homes and other chronic-care facilities;
health-care personnel;
healthy household contacts (including children) and caregivers of children aged <5 years and adults aged 50 years and older, with particular emphasis on vaccinating contacts of children aged <6 months; and
healthy household contacts (including children) and caregivers of persons with medical conditions that put them at higher risk for severe complications from influenza.

...but means:

Annual vaccination against influenza is recommended for:

all persons, except those who would be harmed by getting it.

So why bother with all the bollocks pretending to target particular groups?

[Skeptic Ginger]

Your claims the flu vaccine lacks effectiveness is based on research which has been discredited by more specific and careful studies.

[Dymanic]

It's just that the flu vaccine does not appear to be very effective at preventing serious illness, or reducing lost productive time.In other words, your rhetorical question: "what about telling people the truth?" really means: "what about telling people the truth as I see it, rather than as they see it?"

It would be the only reason I would consider getting a flu jab this year.That would surely place you in a very small percentage of individuals as far as that decision is concerned.

Well they have to be seen to be doing something don't they? I'm sure most like to think they are making a significant difference, even if the evidence indicates otherwise.Which is it? Validation seekers, or simple minds / noble hearts? Are you sure you don't want to just go with "evil conspirators"?

Most governments with a rational policy appear to offer the flu jab to those most at risk from serious complications (and their immediate contacts), for what good it will do them.It's nice to see that you acknowledge that this is a rational policy, even if you do immediately turn around and contradict yourself by implying that it does no good.

[Acleron]

I know it's a radical concept, but what about telling people the truth?

But you complained that the truth was scare tactics.

[Ivor the Engineer]

In other words, your rhetorical question: "what about telling people the truth?" really means: "what about telling people the truth as I see it, rather than as they see it?"

The truth would include a balanced appraisal of the evidence, as was provided to my mother by her GP.

That would surely place you in a very small percentage of individuals as far as that decision is concerned.

Possibly.

Which is it? Validation seekers, or simple minds / noble hearts? Are you sure you don't want to just go with "evil conspirators"?

Can I mix and match? I'm going for validation seekers with noble hearts for the most part, with a few evil conspirators sprinkled on the top.

It's nice to see that you acknowledge that this is a rational policy, even if you do immediately turn around and contradict yourself by implying that it does no good.

The flu vaccination provides a variable level of protection against seasonal flu in these groups, ranging from poor to good. It's just that it doesn't stop many of them being admitted to hospital or dying.

[T.A.M.]

I am a little late to the party, but as a practicing Family Physician, I would very much like to see this evidence that allegedly proves the flu vaccine:


...does not appear to be very effective at preventing serious illness, or reducing lost productive time.

As Ivor has contended.

From the pov of my own practice, I actively promote the annual influenza vaccine to the following groups:

1. Children 6 months to 2 years
2. All Adults age 65 and over
3. All Health Care Workers
4. All individuals age 2 and older who have chronic illnesses

The rest, we discuss the shot, and if they wish to have one, then I give them one.

TAM:)

[T.A.M.]

That's a classic symptom of pertussis (whooping cough), not influenza.

Specificity is 45%-84% according to this article (http://findarticles.com/p/articles/mi_m0689/is_1_54/ai_n8705005) meaning posttussive vomiting is diagnostic for pertussis 45%-84% of the time.

Looking at the variation (very wide) in the sensitivity and specificity in that article's chart for signs/symptoms associated with pertussis, it tells me that no one symptom is diagnostic.

1. Posttussive nausea and vomiting - common with any cough. The repetitive nature of Whooping Cough is the cause, not the origin of the illness.
2. "Barking" cough - seen in croup, tracheitis, and sometimes just in a good old URTI.
3. cough lasting longer than 2-3 weeks: varies from person to person, infection to infection. I have seen people with a good old "cold" have the couhg for 4-6 weeks after the initial infection. Allergies and Asthma also provide a sustained cough.

TAM:)

[kellyb]

I am a little late to the party, but as a practicing Family Physician, I would very much like to see this evidence that allegedly proves the flu vaccine:



As Ivor has contended.

From the pov of my own practice, I actively promote the annual influenza vaccine to the following groups:

1. Children 6 months to 2 years
2. All Adults age 65 and over
3. All Health Care Workers
4. All individuals age 2 and older who have chronic illnesses

The rest, we discuss the shot, and if they wish to have one, then I give them one.

TAM:)

Regarding kids under 2:

http://www.bmj.com/cgi/content/full/333/7574/912


In children under 2 years inactivated vaccines had the same field efficacy as placebo,8 and in healthy people under 65 vaccination did not affect hospital stay, time off work, or death from influenza and its complications.


And in adults under age 65:
http://www.cochrane.org/reviews/en/ab001269.html

There is not enough evidence to decide whether routine vaccination to prevent influenza in healthy adults is effective


Main results
Forty-eight reports were included: 38 (57 sub-studies) were clinical trials providing data about effectiveness, efficacy and harms of influenza vaccines and involved 66,248 people; 8 were comparative non-randomised studies and tested the association of the vaccines with serious harms; 2 were reports of harms which could not be introduced in the data analysis.
Inactivated parenteral vaccines were 30% effective (95% CI 17% to 41%) against influenza-like illness, and 80% (95% CI 56% to 91%) efficacious against influenza when the vaccine matched the circulating strain and circulation was high, but decreased to 50% (95% CI 27% to 65%) when it did not. Excluding the studies of the 1968 to 1969 pandemic, effectiveness was 15% (95% CI 9% to 22%) and efficacy was 73% (95% CI 53% to 84%).

[robinson]

Studies of the effects on influenza-like illness and its complications most closely replicate real life conditions because no one knows what agent (if any) causes this disease. Influenza-like illness is an acute respiratory disease caused by many different viruses (including influenza A and B), which presents with symptoms and signs that cannot be distinguished from those of influenza. Influenza-like illness does not have documented laboratory isolation of the causative agent and is the syndrome that most commonly presents to doctors ("the flu").
http://www.bmj.com/cgi/content/full/333/7574/912

What in the hell?

[kellyb]

http://www.bmj.com/cgi/content/full/333/7574/912

What in the hell?

Yeah...there are a bunch of viruses that "act" just like "the flu". They've done studies on people admitted to the hospital with "influenza like illness" and it's generally only 10-20% of them that end up having actual influenza. The rest are RSV, adenoviruses, rhinoviruses, human metapneumovirus, etc.

ETA:
Here's one that found it was 28% of people with "the flu" that had actual influenza in the year with the most influenza activity over 5 years:

http://www.health.gov.au/internet/wcms/Publishing.nsf/Content/cda-pubs-cdi-2004-cdi2802-htm-cdi2802d.htm

In the winter of 2003 Western Australia experienced its largest epidemic of influenza for at least five years, with activity peaking in August and September. The season was short resulting in very high numbers of cases during the peak weeks. Activity in country areas followed the peak of Metropolitan activity. Influenza A virus was detected in 28.3 per cent of the sentinel samples, and influenza B in less than one per cent. Both routine and sentinel detections and the overall estimates of influenza-like illnesses (ILI) seen by general practitioners at sentinel practices peaked in August and September 2003. The combination of influenza detections and an increase in ILI seemed to be the most accurate predictor of the beginning of winter influenza activity. There was a shift in age distribution for influenza A compared with 2003. Both the sentinel surveillance and routine samples demonstrated an increase of influenza in children and young adults. The majority of influenza A isolates were identified as A/Fujian/411/2002-like, a variant of the A/Moscow strain included in the vaccine. Despite this mismatch there did not seem to have been any noticeable increase in the risk of influenza infection in the vaccinated populations from the sentinel practices, nor was there a relative increase in disease among the highly vaccinated elderly population. A number of other respiratory viruses were identified as causes of influenza-like illness in the sentinel samples. Rhinoviruses and human metapneumovirus were the most common, the latter occurring mainly in adults. Commun Dis Intell 2004;28:169-174.

And as far as viruses that are the most likely to land a kid in the hospital:

http://www.medscape.com/viewarticle/468724_4

RSV A and B. We estimate that ~116 500 children are hospitalized each year in the United States because of RSV infection. This number grows to ~144 000/year if we include children seen at CHW as outpatients (mostly emergency room visits). Approximately 50% of the identified (by MPCR) common respiratory viruses in hospitalized previously healthy children were RSV A and B.

PIV-1, -2 and -3. Combined, this family of viruses causes the second largest number of pediatric hospitalizations (~65 000) for community-acquired respiratory viruses


Influenza A and B. We estimate that ~40 000 children are hospitalized each year in the United States with influenza A or B infection.

As important as it is to understand how these common respiratory viruses present in hospitalized children, it is equally important to understand that there were no clinical symptoms that could be used to diagnose which virus infected which patient in our study.

[Skeptic Ginger]

...


The flu vaccination provides a variable level of protection against seasonal flu in these groups, ranging from poor to good. It's just that it doesn't stop many of them being admitted to hospital or dying.Do you ever cite any sources for your claimed facts?

Effectiveness of influenza vaccine in the community-dwelling elderly. (http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17914038&ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVDocSum)CONCLUSIONS: During 10 seasons, influenza vaccination was associated with significant reductions in the risk of hospitalization for pneumonia or influenza and in the risk of death among community-dwelling elderly persons. Vaccine delivery to this high-priority group should be improved. Copyright 2007 Massachusetts Medical Society.

A cohort study of the effectiveness of influenza vaccine in older people, performed using the United Kingdom general practice research database. (http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=15195237&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVAbstractPlus)CONCLUSIONS: Influenza vaccination reduces the number of hospitalizations and deaths due to respiratory disease, after correction for confounding in individuals >64 years of age who had a high risk or a low risk for influenza. For elderly people, untargeted influenza vaccination is of confirmed benefit against serious outcomes.

One study found there was bias in the studies in that healthier seniors were more likely to get flu shots but a number of other studies found much less bias and concluded there was indeed lower morbidity and mortality in flu shot recipients.

[Skeptic Ginger]

Looking at the variation (very wide) in the sensitivity and specificity in that article's chart for signs/symptoms associated with pertussis, it tells me that no one symptom is diagnostic.

1. Posttussive nausea and vomiting - common with any cough. The repetitive nature of Whooping Cough is the cause, not the origin of the illness.
2. "Barking" cough - seen in croup, tracheitis, and sometimes just in a good old URTI.
3. cough lasting longer than 2-3 weeks: varies from person to person, infection to infection. I have seen people with a good old "cold" have the couhg for 4-6 weeks after the initial infection. Allergies and Asthma also provide a sustained cough.

TAM:)Many things cause persistent cough. But just out of curiosity, in adults, how frequent have you seen posttussive vomiting? I see more healthy people than sick ones and deal with the infection control and exposure follow up of pertussis, so my experience is distorted in this case. I have seen literature citing posttussive vomiting (again in adults only) as highly specific. I wonder if the specificity cited didn't include children which in my experience often have vomiting with URIs and sometimes it presents as posttussive.

Michelle is the first adult I have heard complain of this symptom during different URI events.

BTW, there is a probable and possible case definition for pertussis that I use in dx, contact tracing and work furloughs and it does of course require more than one symptom. We try to get confirmed cultures and/or serologies in all active cases.

[Skeptic Ginger]

Yeah...there are a bunch of viruses that "act" just like "the flu". They've done studies on people admitted to the hospital with "influenza like illness" and it's generally only 10-20% of them that end up having actual influenza. The rest are RSV, adenoviruses, rhinoviruses, human metapneumovirus, etc....You are confusing the fact an infectious organism is not always identified (because it doesn't always need to be to treat people) with the idea the provider is somehow diagnosing people as having influenza when they have other infections. ILI and influenza are not interchangeable diagnoses. We do know the difference. :rolleyes:

[Ivor the Engineer]

The full abstracts for Skeptigirl's evidence for the effectiveness of the seasonal flu vaccine:

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=15195237&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVAbstractPlus

BACKGROUND: The effectiveness of influenza vaccination against hospitalization and death can only ethically be assessed in observational studies. A concern is that individuals who are vaccinated are healthier than individuals who are not vaccinated, potentially biasing estimates of effectiveness upward. METHODS: We conducted a historical cohort study of individuals >64 years of age, for whom there were data available in the General Practice Research Database for 1989 to 1999 in England and Wales. Rates of admissions for acute respiratory diseases and rates of death due to respiratory disease were compared over 692,819 person-years in vaccine recipients and 1,534,280 person-years in vaccine nonrecipients. RESULTS: The pooled effectiveness of vaccine against hospitalizations for acute respiratory disease was 21% (95% confidence interval [CI], 17%-26%). The rate reduction attributable to vaccination was 4.15 hospitalizations/100,000 person-weeks in the influenza season. Among vaccine recipients, no important reduction in the number of admissions to the hospital was seen outside influenza seasons. The pooled effectiveness of vaccine against deaths due to respiratory disease was 12% (95% CI, 8%-16%). A greater proportionate reduction was seen among people without medical disorders, but absolute rate reduction was higher in individuals with medical disorders, compared with individuals without such disorders (6.14 deaths due to respiratory disease/100,000 person-weeks vs. 3.12 deaths due to respiratory disease/100,000 person-weeks). Clear protection against death due to all causes was not seen. CONCLUSIONS: Influenza vaccination reduces the number of hospitalizations and deaths due to respiratory disease, after correction for confounding in individuals >64 years of age who had a high risk or a low risk for influenza. For elderly people, untargeted influenza vaccination is of confirmed benefit against serious outcomes.

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17914038&ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVDocSum

BACKGROUND: Reliable estimates of the effectiveness of influenza vaccine among persons 65 years of age and older are important for informed vaccination policies and programs. Short-term studies may provide misleading pictures of long-term benefits, and residual confounding may have biased past results. This study examined the effectiveness of influenza vaccine in seniors over the long term while addressing potential bias and residual confounding in the results. METHODS: Data were pooled from 18 cohorts of community-dwelling elderly members of one U.S. health maintenance organization (HMO) for 1990-1991 through 1999-2000 and of two other HMOs for 1996-1997 through 1999-2000. Logistic regression was used to estimate the effectiveness of the vaccine for the prevention of hospitalization for pneumonia or influenza and death after adjustment for important covariates. Additional analyses explored for evidence of bias and the potential effect of residual confounding. RESULTS: There were 713,872 person-seasons of observation. Most high-risk medical conditions that were measured were more prevalent among vaccinated than among unvaccinated persons. Vaccination was associated with a 27% reduction in the risk of hospitalization for pneumonia or influenza (adjusted odds ratio, 0.73; 95% confidence interval [CI], 0.68 to 0.77) and a 48% reduction in the risk of death (adjusted odds ratio, 0.52; 95% CI, 0.50 to 0.55). Estimates were generally stable across age and risk subgroups. In the sensitivity analyses, we modeled the effect of a hypothetical unmeasured confounder that would have caused overestimation of vaccine effectiveness in the main analysis; vaccination was still associated with statistically significant--though lower--reductions in the risks of both hospitalization and death. CONCLUSIONS: During 10 seasons, influenza vaccination was associated with significant reductions in the risk of hospitalization for pneumonia or influenza and in the risk of death among community-dwelling elderly persons. Vaccine delivery to this high-priority group should be improved. Copyright 2007 Massachusetts Medical Society.

So both studies confirm exactly what I said in my previous post, which was that the flu shot varies in effectiveness from poor to good and doesn't stop many people being admitted to hospital or dying. This (http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=16368725&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVAbstractPlus) study gives some idea of what is going on in the second study, which appears to show a significant reduction in risk of death:

BACKGROUND: Numerous observational studies have reported that seniors who receive influenza vaccine are at substantially lower risk of death and hospitalization during the influenza season than unvaccinated seniors. These estimates could be influenced by differences in underlying health status between the vaccinated and unvaccinated groups. Since a protective effect of vaccination should be specific to influenza season, evaluation of non-influenza periods could indicate the possible contribution of bias to the estimates observed during influenza season. METHODS: We evaluated a cohort of 72,527 persons 65 years of age and older followed during an 8 year period and assessed the risk of death from any cause, or hospitalization for pneumonia or influenza, in relation to influenza vaccination, in periods before, during, and after influenza seasons. Secondary models adjusted for covariates defined primarily by diagnosis codes assigned to medical encounters. RESULTS: The relative risk of death for vaccinated persons compared with unvaccinated persons was 0.39 [95% confidence interval (95% CI), 0.33-0.47] before influenza season, 0.56 (0.52-0.61) during influenza season, and 0.74 (0.67-0.80) after influenza season. The relative risk of pneumonia hospitalization was 0.72 (0.59-0.89) before, 0.82 (0.75-0.89) during, and 0.95 (0.85-1.07) after influenza season. Adjustment for diagnosis code variables resulted in estimates that were further from the null, in all time periods. CONCLUSIONS: The reductions in risk before influenza season indicate preferential receipt of vaccine by relatively healthy seniors. Adjustment for diagnosis code variables did not control for this bias. In this study, the magnitude of the bias demonstrated by the associations before the influenza season was sufficient to account entirely for the associations observed during influenza season.

[Professor Yaffle]

Many things cause persistent cough. But just out of curiosity, in adults, how frequent have you seen posttussive vomiting? I see more healthy people than sick ones and deal with the infection control and exposure follow up of pertussis, so my experience is distorted in this case. I have seen literature citing posttussive vomiting (again in adults only) as highly specific. I wonder if the specificity cited didn't include children which in my experience often have vomiting with URIs and sometimes it presents as posttussive.

Michelle is the first adult I have heard complain of this symptom during different URI events.

BTW, there is a probable and possible case definition for pertussis that I use in dx, contact tracing and work furloughs and it does of course require more than one symptom. We try to get confirmed cultures and/or serologies in all active cases.

As I said I often vomit from coughing ifI have a really bad cold that goes to my chest, or if I am having an asthma attack due to animal allergy. I do have a very strong gag reflex though and just brushing my teeth has made me sick occasionally. Even holding a pencil between my teeth for too long makes me gag.

[Rolfe]

I've had an annoying tickly cough for, I dunno, about five years. Seems to be going away gradually. When it was more severe than it is at present I had post-tussive vomiting fairly frequently. Even now, I still have it very occasionally. I don't have a diagnosis on it, it might be an allergy I suppose, but it sure as hell isn't whooping cough (I had that when I was eight, and I know the difference!).

Rolfe.

[Hardenbergh]

I've only had one flu shot (against my better judgment) in my entire life. I rarely get the flu but the one time I had a flu shot, I had a mild case of the flu very shortly after getting the vaccine.

My mother had one flu shot many years ago and in her own words, "I was sicker than a dog." She never allowed her doctor to talk her into getting another one. She's almost 76 years old and she's standing her ground.

[Dymanic]

I've only had one flu shot (against my better judgment) in my entire life. I rarely get the flu but the one time I had a flu shot, I had a mild case of the flu very shortly after getting the vaccine.

My mother had one flu shot many years ago and in her own words, "I was sicker than a dog." She never allowed her doctor to talk her into getting another one. She's almost 76 years old and she's standing her ground.Do you feel that you have a good understanding of why it is that anecdotal evidence tends to be regarded by scientists as being of such questionable value?

[Rolfe]

My mother had very severe flu about 10 years ago, which progressed to bronchitis. She was very ill indeed. Ever since then she had made a point of getting a flu vaccination every year, and has never had flu since then. She has never felt the slightest bit unwell after any of the vaccinations, and pooh-poohs the idea that the vaccination might cause illness.

I had the vaccination a few weeks ago (as described in real time earlier in this thread I think), and observed no ill effects.

Are my anecdotes as good as your anecdotes?

Rolfe.

[Hardenbergh]

Do you feel that you have a good understanding of why it is that anecdotal evidence tends to be regarded by scientists as being of such questionable value?

It is my sincere belief that frequent handwashing equals or surpasses the benefits of a flu shot. I very rarely get a cold or the flu. Of course, some people have a stronger immune system than others.

[Dymanic]

It is my sincere belief that frequent handwashing equals or surpasses the benefits of a flu shot.Being a cautious and attentive driver almost certainly reduces one's chances of being injured in an automobile accident too, but this does not negate the benefits of seatbelts and airbags.

Did you understand my question?

[Hardenbergh]

Being a cautious and attentive driver almost certainly reduces one's chances of being injured in an automobile accident too, but this does not negate the benefits of seatbelts and airbags.

Did you understand my question?

I guess handwashing would be of very little benefit, if we were facing an epidemic or full-blown pandemic of Swine flu. I live in a dream world.

[Dymanic]

I guess handwashing would be of very little benefit, if we were facing an epidemic or full-blown pandemic of Swine flu. We face a flu epidemic every winter. During a pandemic, more people are affected, but some would be expected to avoid infection. Given the constraints on developing, manufacturing, and distributing a pandemic vaccine, precautions such as handwashing would be among the only defenses available to most people.

I live in a dream world.It does appear that, like so many people, your decision-making process defaults to simple intuition, and you seem to be a little fuzzy on some of the basic facts as well -- but you don't have to surrender so easily; perhaps some hope remains that you can learn a more logical and evidence-based approach.

[Skeptic Ginger]

I've only had one flu shot (against my better judgment) in my entire life. I rarely get the flu but the one time I had a flu shot, I had a mild case of the flu very shortly after getting the vaccine.

My mother had one flu shot many years ago and in her own words, "I was sicker than a dog." She never allowed her doctor to talk her into getting another one. She's almost 76 years old and she's standing her ground.Typical example of superstitious medicine. I'll stick with evidence based. The evidence is it works.

[Skeptic Ginger]

It is my sincere belief that frequent handwashing equals or surpasses the benefits of a flu shot. I very rarely get a cold or the flu. Of course, some people have a stronger immune system than others.And the reason you couldn't use both measures is?

[Skeptic Ginger]

I guess handwashing would be of very little benefit, if we were facing an epidemic or full-blown pandemic of Swine flu. I live in a dream world.That is again, not an evidence based conclusion. Handwashing and vaccine would both be important.

[Skeptic Ginger]

Apparently you are having trouble interpreting these results. So let's take a closer look. I have expanded your emphasis, you missed some key facts.
The full abstracts for Skeptigirl's evidence for the effectiveness of the seasonal flu vaccine:

http://www.ncbi.nlm.nih.gov/sites/en...RVAbstractPlus


BACKGROUND: The effectiveness of influenza vaccination against hospitalization and death can only ethically be assessed in observational studies. A concern is that individuals who are vaccinated are healthier than individuals who are not vaccinated, potentially biasing estimates of effectiveness upward. METHODS: We conducted a historical cohort study of individuals >64 years of age, for whom there were data available in the General Practice Research Database for 1989 to 1999 in England and Wales. Rates of admissions for acute respiratory diseases and rates of death due to respiratory disease were compared over 692,819 person-years in vaccine recipients and 1,534,280 person-years in vaccine nonrecipients. RESULTS: The pooled effectiveness of vaccine against hospitalizations for acute respiratory disease was 21% (95% confidence interval [CI], 17%-26%). The rate reduction attributable to vaccination was 4.15 hospitalizations/100,000 person-weeks in the influenza season. Among vaccine recipients, no important reduction in the number of admissions to the hospital was seen outside influenza seasons. The pooled effectiveness of vaccine against deaths due to respiratory disease was 12% (95% CI, 8%-16%). A greater proportionate reduction was seen among people without medical disorders, but absolute rate reduction was higher in individuals with medical disorders, compared with individuals without such disorders (6.14 deaths due to respiratory disease/100,000 person-weeks vs. 3.12 deaths due to respiratory disease/100,000 person-weeks). Clear protection against death due to all causes was not seen. CONCLUSIONS: Influenza vaccination reduces the number of hospitalizations and deaths due to respiratory disease, after correction for confounding in individuals >64 years of age who had a high risk or a low risk for influenza. For elderly people, untargeted influenza vaccination is of confirmed benefit against serious outcomes.Vaccine recipients had equal outcomes when there was no flu around. That contradicts the single study which found no difference between vaccine recipients in or out of flu season. The contradicted study suggested the reason for less morbidity and mortality in the vaccine group was that healthier people chose to be vaccinated. This is a bit counter-intuitive since providers encourage less healthy people to get vaccinated and there is evidence people do follow their provider's advice. This study contradicts that finding and suggests the vaccine benefit shows up during flu season as you would expect.

This study also shows both healthy and less healthy people see a reduction in hospitalization and death when vaccinated.

You also seem to think the number here, 12% represents the effectiveness against the flu. Not so, it is the reduction in deaths in all respiratory infections. The reason for using this calculation is because it is not practical nor necessary to culture the organism in every pneumonia death. One assumes if deaths are lower among vaccine recipients when flu is prevalent, and the same when flu is not prevalent that the vaccine is preventing flu deaths.

You also claim this is a minor benefit. With 35,000 annual deaths from influenza, 12% more would be dying without the use of the vaccine. Annual flu vaccine would be preventing about 4,500 deaths if my rapid math estimate is correct. So again, your claim the cost of the vaccine is not worth benefit is simply warped.



http://www.ncbi.nlm.nih.gov/sites/en...ubmed_RVDocSum


BACKGROUND: Reliable estimates of the effectiveness of influenza vaccine among persons 65 years of age and older are important for informed vaccination policies and programs. Short-term studies may provide misleading pictures of long-term benefits, and residual confounding may have biased past results. This study examined the effectiveness of influenza vaccine in seniors over the long term while addressing potential bias and residual confounding in the results. METHODS: Data were pooled from 18 cohorts of community-dwelling elderly members of one U.S. health maintenance organization (HMO) for 1990-1991 through 1999-2000 and of two other HMOs for 1996-1997 through 1999-2000. Logistic regression was used to estimate the effectiveness of the vaccine for the prevention of hospitalization for pneumonia or influenza and death after adjustment for important covariates. Additional analyses explored for evidence of bias and the potential effect of residual confounding. RESULTS: There were 713,872 person-seasons of observation. Most high-risk medical conditions that were measured were more prevalent among vaccinated than among unvaccinated persons. Vaccination was associated with a 27% reduction in the risk of hospitalization for pneumonia or influenza (adjusted odds ratio, 0.73; 95% confidence interval [CI], 0.68 to 0.77) and a 48% reduction in the risk of death (adjusted odds ratio, 0.52; 95% CI, 0.50 to 0.55). Estimates were generally stable across age and risk subgroups. In the sensitivity analyses, we modeled the effect of a hypothetical unmeasured confounder that would have caused overestimation of vaccine effectiveness in the main analysis; vaccination was still associated with statistically significant--though lower--reductions in the risks of both hospitalization and death. CONCLUSIONS: During 10 seasons, influenza vaccination was associated with significant reductions in the risk of hospitalization for pneumonia or influenza and in the risk of death among community-dwelling elderly persons. Vaccine delivery to this high-priority group should be improved. Copyright 2007 Massachusetts Medical Society.So both studies confirm exactly what I said in my previous post, which was that the flu shot varies in effectiveness from poor to good and doesn't stop many people being admitted to hospital or dying. Where do you get this "poor effectiveness" here? Again, you don't even know what you are looking at. There are many causes of pneumonia. The influenza vaccine is not going to protect people against all pneumonia. That's ignorant. Studies report decreases in total pneumonia cases like I said, because we calculate rates based on sampling, not based on culturing each infective organism in each patient.

This study gives some idea of what is going on in the second study, which appears to show a significant reduction in risk of death:

Quote:
BACKGROUND: Numerous observational studies have reported that seniors who receive influenza vaccine are at substantially lower risk of death and hospitalization during the influenza season than unvaccinated seniors. These estimates could be influenced by differences in underlying health status between the vaccinated and unvaccinated groups. Since a protective effect of vaccination should be specific to influenza season, evaluation of non-influenza periods could indicate the possible contribution of bias to the estimates observed during influenza season. METHODS: We evaluated a cohort of 72,527 persons 65 years of age and older followed during an 8 year period and assessed the risk of death from any cause, or hospitalization for pneumonia or influenza, in relation to influenza vaccination, in periods before, during, and after influenza seasons. Secondary models adjusted for covariates defined primarily by diagnosis codes assigned to medical encounters. RESULTS: The relative risk of death for vaccinated persons compared with unvaccinated persons was 0.39 [95% confidence interval (95% CI), 0.33-0.47] before influenza season, 0.56 (0.52-0.61) during influenza season, and 0.74 (0.67-0.80) after influenza season. The relative risk of pneumonia hospitalization was 0.72 (0.59-0.89) before, 0.82 (0.75-0.89) during, and 0.95 (0.85-1.07) after influenza season. Adjustment for diagnosis code variables resulted in estimates that were further from the null, in all time periods. CONCLUSIONS: The reductions in risk before influenza season indicate preferential receipt of vaccine by relatively healthy seniors. Adjustment for diagnosis code variables did not control for this bias. In this study, the magnitude of the bias demonstrated by the associations before the influenza season was sufficient to account entirely for the associations observed during influenza season.
Right, Ivor, take one study, despite the fact the other two have different outcomes and proclaim it is the correct outcome. I posted this study for a reason. I did so because I was consciously not trying to cherry pick the data. You, however, don't seem to have the same objective view. Why am I not surprised?

[Deetee]

It is my sincere belief that frequent handwashing equals or surpasses the benefits of a flu shot. I very rarely get a cold or the flu. Of course, some people have a stronger immune system than others.
What is the basis for this belief? Do you realise that flu is primarily spread by droplets which are inhaled? If someone coughs in your face, do you rush to the bathroom to wash your hands?

I am not saying influenza virus cannot be transmitted via contaminated hands/fomites in a situation where the environment has become contaminated (as can also happen with rhinovirus - the common cold), but hand washing is highly unlikely to prevent direct infection from a contact.

[Dymanic]

Do you realise that flu is primarily spread by droplets which are inhaled?It's always hard to tell how good a match the current year's vaccine is until well into the season, and while some of us find that an interesting and important question, most people would probably find it preferable to opt out of that investigative process by simply avoiding exposure.

That might be easier to accomplish if more were known about the mechanical details of influenza spread. Unfortunately, the relative importance of airborne/droplet versus contact/fomite transmission is still an open question at this point (as are questions regarding the relative importance of airborne versus droplet and contact versus fomite).

The best bet is to get the vax, avoid crowded elevators and such during the peak of the season, and wash your hands a lot.

[Skeptic Ginger]

It's always hard to tell how good a match the current year's vaccine is until well into the season, and while some of us find that an interesting and important question, most people would probably find it preferable to opt out of that investigative process by simply avoiding exposure.

That might be easier to accomplish if more were known about the mechanical details of influenza spread. Unfortunately, the relative importance of airborne/droplet versus contact/fomite transmission is still an open question at this point (as are questions regarding the relative importance of airborne versus droplet and contact versus fomite).

The best bet is to get the vax, avoid crowded elevators and such during the peak of the season, and wash your hands a lot.There's strong evidence most influenza is droplet spread and some evidence for true airborne spread. That indicates there is some influence from the genetic make up of individual strains. The available studies have been considered in preparation for the next pandemic since it affects the choice of respiratory protection for health care workers. We also know the ability of the virus to survive on surfaces in the winter contributes to the seasonal nature of annual flu epidemics. I have personally read a fair amount of the research.

I agree with you. There is no reason to omit any simple measures. All three you mention are important.

I don't agree that one is part of an experiment with each year's flu vaccine. We have 30+ years of experience with the process. The vaccine composition is based on sampling the virus. The virus' genetic changes gradually accumulate. They usually 'drift' and don't 'shift' as often. That means even when the vaccine is not an exact match, one usually gets some immunity from the vaccine anyway. You get milder cases rather than prevented cases, but you still benefit from the vaccine.

[Ove]

Over here the doctors stresses that people "with normal health" has no need for flu vaccinations. Some compagnies tries to bully their employees into taking the shot but the unions have fought a sucessfull battle against this praxis.

But off course, nobody is making any money on theese vaccinations over here. There is a small fee which only covers the actual cost but the shot is free for anyone over 65 and anyone else if the doctor advises it.

And yes, it only covers SOME types of flu...

[Ivor the Engineer]

Over here the doctors stresses that people "with normal health" has no need for flu vaccinations. Some compagnies tries to bully their employees into taking the shot but the unions have fought a sucessfull battle against this praxis.

But off course, nobody is making any money on theese vaccinations over here. There is a small fee which only covers the actual cost but the shot is free for anyone over 65 and anyone else if the doctor advises it.

And yes, it only covers SOME types of flu...

Sounds like another case for... The Vaccination Squad!

[Skeptic Ginger]

Over here the doctors stresses that people "with normal health" has no need for flu vaccinations. Some compagnies tries to bully their employees into taking the shot but the unions have fought a sucessfull battle against this praxis.

But off course, nobody is making any money on theese vaccinations over here. There is a small fee which only covers the actual cost but the shot is free for anyone over 65 and anyone else if the doctor advises it.

And yes, it only covers SOME types of flu...There is a history behind not vaccinating healthy people. Vaccine supply has put restraints on how many doses one has to use each year. Then came some additional research showing that vaccinating people around those who are most vulnerable also prevents influenza deaths. Vaccine production is therefore being encouraged by the public health system in the US at least and the vaccine promotion is being expanded.

And, as a healthy person with a healthy child who is well aware of the fact influenza risk is not zero in all healthy people all the time, I have made sure both my son and I have a flu shot every year. Infectious disease prevention is my specialty, I have an MSN as a nurse practitioner, 30 years of experience and 17 years in private practice in this field. I am not duped and I am not poorly informed. I'm certainly not exaggerating the risks to others or promoting vaccine for profit when I make the decision to vaccinate my son and myself every year.

I read a voracious amount of the research in vaccines and infectious disease. I know full well why I vaccinate my son and myself. The risk of influenza, however small, is still higher than the risk of influenza vaccine and the outcome of the gamble Ivor thinks nothing of taking can, in the worst case, be death. It's a simple risk reduction measure. It is relatively inexpensive. The idea of not preventing a preventable death with such a simple measure is a superstitious decision. The evidence based decision is to get an annual influenza vaccination.

[Ivor the Engineer]

<snip>

I read a voracious amount of the research in vaccines and infectious disease. I know full well why I vaccinate my son and myself. The risk of influenza, however small, is still higher than the risk of influenza vaccine and the outcome of the gamble Ivor thinks nothing of taking can, in the worst case, be death. It's a simple risk reduction measure. It is relatively inexpensive. The idea of not preventing a preventable death with such a simple measure is a superstitious decision. The evidence based decision is to get an annual influenza vaccination.

Using your definition, the guy who puts £26 on the 100-to-1 shot at the races is being extremely rational.

How is taking a gamble which is so heavily stacked in your favour irrational? Am I also being irrational when I choose to drive to work, rather than walk? We all know walking has health benefits and I'm much less likely to die if I walk instead of using a car.

What you don't seem to get is that there are some risks which are below the level of significance for most people to be bothered to do anything about reducing them. There are all sorts of things you could spend your time and money on reducing the risk of them happening to you. Getting a flu vaccination is nowhere near the top of that list.

[Dymanic]

There's strong evidence most influenza is droplet spreadPretty much a no-brainer, really.

and some evidence for true airborne spread.Which is another way of saying that the evidence for true airborne spread is conflicting. The question is one which has very significant implications for infection control, especially during a pandemic, and with all the research that's been done on influenza, you'd think we might have definitive answers to such a basic question. But we don't.

That indicates there is some influence from the genetic make up of individual strains.Of individual human strains?

We also know the ability of the virus to survive on surfaces in the winter contributes to the seasonal nature of annual flu epidemics.What we don't know is how much. Insights gained by exposing guinea pigs to flu at different temperatures and humidities are useful. Extrapolating them broadly to the epidemiology of influenza in humans is treacherous.



What you don't seem to get is that there are some risks which are below the level of significance for most people to be bothered to do anything about reducing them.Like quitting smoking, or maintaining reasonable limits on their intake of alcohol, sugar, fat, and salt, or refraining from talking on the cell while driving...

There are all sorts of things you could spend your time and money on reducing the risk of them happening to you. Getting a flu vaccination is nowhere near the top of that list.I guess that depends a lot on what else is on your list.

[Skeptic Ginger]

Using your definition, the guy who puts £26 on the 100-to-1 shot at the races is being extremely rational.

How is taking a gamble which is so heavily stacked in your favour irrational? Am I also being irrational when I choose to drive to work, rather than walk? We all know walking has health benefits and I'm much less likely to die if I walk instead of using a car.

What you don't seem to get is that there are some risks which are below the level of significance for most people to be bothered to do anything about reducing them. There are all sorts of things you could spend your time and money on reducing the risk of them happening to you. Getting a flu vaccination is nowhere near the top of that list.You are once again resorting to stupid comments, Ivor. Time to stop the exchange. When you have something new and reasonable to add I'll take the time to reply.

[Skeptic Ginger]

Pretty much a no-brainer, really.

Which is another way of saying that the evidence for true airborne spread is conflicting. The question is one which has very significant implications for infection control, especially during a pandemic, and with all the research that's been done on influenza, you'd think we might have definitive answers to such a basic question. But we don't.

Of individual human strains?

What we don't know is how much. Insights gained by exposing guinea pigs to flu at different temperatures and humidities are useful. Extrapolating them broadly to the epidemiology of influenza in humans is treacherous.



Like quitting smoking, or maintaining reasonable limits on their intake of alcohol, sugar, fat, and salt, or refraining from talking on the cell while driving...

I guess that depends a lot on what else is on your list.You might want to read a little more about the genetic variables of pathogens within species. And maybe actually look at the research on influenza transmission. There are more than a few studies using actual human to human transmission under real conditions.

[Dymanic]

You might want to read a little more about the genetic variables of pathogens within species. And maybe actually look at the research on influenza transmission. There are more than a few studies using actual human to human transmission under real conditions.
This post is entirely content-free.

My position is that the mechanical details of influenza transmission are not thoroughly understood. I didn't pull that idea out of thin air. I've spent more time reading about this than is probably healthy. You seem eager to avail yourself of every opportunity to provide reminders of how qualified you are to address these issues, yet your conclusions frequently bear the flavor of dated literature, and your position clearly differs from that of some whose credentials are even more impressive than your own. Your dispute is really with them, not me. Don't shoot the messenger.

[Skeptic Ginger]

This post is entirely content-free.

My position is that the mechanical details of influenza transmission are not thoroughly understood. I didn't pull that idea out of thin air. I've spent more time reading about this than is probably healthy. You seem eager to avail yourself of every opportunity to provide reminders of how qualified you are to address these issues, yet your conclusions frequently bear the flavor of dated literature, and your position clearly differs from that of some whose credentials are even more impressive than your own. Your dispute is really with them, not me. Don't shoot the messenger.Content free? Mechanical details not thoroughly understood?

Perhaps we are arguing semantics about what "thoroughly" means but I understand the details quite well from the research I read and in addition, I don't draw the same conclusions you did about the reason for the variable results in the studies I have read.

Give me a few minutes and I'll find some of the sources I recommend you look at. If you have some of your own, post away.

[Dymanic]

Content free?Other than one of your familiar attempts to establish yourself as the resident expert by casting aspersions upon anyone with the temerity to disagree with you, yes.

Give me a few minutes and I'll find some of the sources I recommend you look at. If you have some of your own, post away.Be funny if we were reading the same papers and drawing different conclusions, wouldn't it?

Here's one

http://www.cdc.gov/ncidod/EID/vol12no11/06-0426.htm

"Several authors have stated that large-droplet transmission is the predominant mode by which influenza virus infection is acquired (1–3). As a consequence of this opinion, protection against infectious aerosols is often ignored for influenza, including in the context of influenza pandemic preparedness. For example, the Canadian Pandemic Influenza Plan and the US Department of Health and Human Services Pandemic Influenza Plan (4,5) recommend surgical masks, not N95 respirators, as part of personal protective equipment (PPE) for routine patient care. This position contradicts the knowledge on influenza virus transmission accumulated in the past several decades. Indeed, the relevant chapters of many reference books, written by recognized authorities, refer to aerosols as an important mode of transmission for influenza (6–9)."

You may have made up your mind on this, but lots of others haven't.

[Skeptic Ginger]

How is this not content, Dym?Skep:and some evidence for true airborne spread.

Dym: Which is another way of saying that the evidence for true airborne spread is conflicting.That statement is specifically what I take issue with in your post. The evidence is not conflicting if in some strains where the virulence is high, airborne transmission is observed and in some strains where only droplet transmission is observed the virulence is genetically influenced and is lower.

I have read the same position papers of numerous national organizations on their recommendations for respiratory protection for pandemic flu as well as many of the references the conclusions were based on. But I have also been following the genetic research on the currently spreading HPAI H5N1 in great detail.

The H1N1 influenza of 1918 had the characteristic of being extremely virulent. The epidemiology suggested it was indeed being passed via aerosols. The pattern of spread of HPAI H5N1 is affected by the amount of viral shedding and the cells which are susceptible. In chickens, the virus is present in every body fluid. It actively reproduces in the gut, blood, neuro, and respiratory cells of the chicken. In humans it has so far shown an affinity for the lower respiratory cells and in a couple cases, the nervous tissues of humans.

The genetic comparisons of the H1N1 from 1918 and the HPAI H5N1 from today reveals a suspect genetic difference which could account for the difference between a pandemic and just a lethal but poorly transmitted human influenza. That difference is a genetic substitution of only a couple nucleic acids which appear to allow the virus entry into cells higher in the human respiratory tract.

It is currently hypothesized that one reason for the lack of transmission of H5N1 is the fact only lower respiratory tract cells are entered by the virus as it currently exists. Thus a larger infective dose is required and less airway shedding is occurring when infection does occur. It is clear, however, that the 1918 virus was significantly more transmissible than typical influenza in addition to being more highly pathogenic.

So tell me how it is you want to lump all strains together and draw the conclusion that it isn't clear what role aerosols play in transmission and the data is conflicting? What we don't know is what role aerosols will play when the specific pandemic emerges.

And as far as your personalizing the matter in your comments, just stick with the supportable facts and lay off the insults because you don't like my questioning your statement. If you don't like the way I come across then put me on ignore. Your whining that my disagreement with you is, "one of [my] familiar attempts to establish [my]self as the resident expert by casting aspersions upon anyone with the temerity to disagree with [me]" suggests you didn't understand what I was disagreeing with and that's why you mistook my comments as "casting aspersions". No, I said what I did because your comments suggested a lack of familiarity with the H5N1 and 1918 virus genetic research papers. And I have yet to change that conclusion.

Since you say you are well read on the current epidemiology, try these to understand where I am coming from and what my objection to your conclusion the research left one with "conflicting results":

A single mutation in the PB1-F2 of H5N1 (HK/97) and 1918 influenza A viruses contributes to increased virulence. (http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&uid=17922571&cmd=showdetailview&indexed=google)

Haemagglutinin mutations responsible for the binding of H5N1 influenza A viruses to human-type receptors (http://www.nature.com/nature/journal/v444/n7117/full/nature05264.html)

Avian flu: Influenza virus receptors in the human airway (http://www.nature.com/nature/journal/v440/n7083/pdf/440435a.pdf)

This new, large-scale sequencing effort promises to provide a more comprehensive picture of the evolution of influenza viruses and of their pattern of transmission through human and animal populations.... (http://www.nature.com/nature/journal/v437/n7062/full/nature04239.html)

(scroll down) Copy of original letter found in Detroit in 1959 (http://web.uct.ac.za/depts/mmi/jmoodie/influen2.html)Camp Devens, Mass.
Surgical Ward No 16
29 September 1918
(Base Hospital)

...Camp Devens is near Boston, and has about 50,000 men, or did have before this epidemic broke loose. It also has the Base Hospital for the Div. of the N. East. This epidemic started about four weeks ago, and has developed so rapidly that the camp is demoralized and all ordinary work is held up till it has passed...I recently finished the book, The Great Influenza: The story of the deadliest pandemic in history (http://www.amazon.com/Great-Influenza-deadliest-pandemic-history/dp/0143036491/ref=pd_sim_b_img_1) which describes the pandemic in meticulous detail. The speed of the 1918 virus, especially in the beginning of the second wave (the largest wave) can not be accounted for if only droplet spread is considered.

Genetics are the key. But in addition to the lethality of the virus, the ease with which it infects a new victim as well as genetic factors which affect the volume and location of viral shedding contribute to the pathogenesis of influenza.

And I might add that the SARS virus research found quite a difference in the survivability of corona viruses on surfaces. I can't imagine the influenza virus does not also have genetic factors influencing its survivability on surfaces. The idea "we don't know" depends on if you question the results of high quality research or recognize different results can be accounted for once you recognize you are not comparing the same strains in each study.

[Dymanic]

The evidence is not conflicting if in some strains where the virulence is high, airborne transmission is observed and in some strains where only droplet transmission is observed the virulence is genetically influenced and is lower.
I'll concede that. By some definition of conflicting. But the broad question: how does influenza spread? is generally taken to refer to seasonal influenza, and approaches to answering it tend to assume that the answers may be applied generally to all seasonal strains.

But I have also been following the genetic research on the currently spreading HPAI H5N1 in great detail.
In that case, you have probably noticed, as I have, that the leading experts in this area tend to be rather cautious in reaching conclusions. The people who express high degrees of confidence in what they know about this matter invariably turn out to be those who really don't know that much about it. But the discussion about flu shots is really a separate one, and in the context of this discussion, what is primarily relevant as pandemic flu is concerned is that the prospect has brought increased focus on infection control measures, which in turn highlights the fact that we don't really know how flu spreads.

The Reveres have posted on this many times; maybe you'd find it more palatable coming from them:

"In this week's Science magazine Stephen Morse calls attention to what we have been saying here for a long time. We don't really know how influenza spreds from person to person."
http://scienceblogs.com/effectmeasure/2006/11/how_does_flu_spread.php#more

"Unfortunately and as we have pointed out here too many times to count or even link to, we know very little about how flu virus is actually passed around in the community. Except here at Effect Measure, you wouldn't necessarily know this from reading most of what's printed about flu. Maybe you didn't even believe it when we said it. Well now this surprising piece of ignorance is the subject of more conversation in the flu community:"
http://scienceblogs.com/effectmeasure/2007/07/figuring_out_how_flu_gets_arou.php#more

So tell me how it is you want to lump all strains together and draw the conclusion that it isn't clear what role aerosols play in transmission and the data is conflicting? What we don't know is what role aerosols will play when the specific pandemic emerges.
Try it this way:
Q: So tell me how it is you want to lump all strains together and draw the conclusion that it isn't clear what role aerosols play in transmission and the data is conflicting?
A: What we don't know is what role aerosols will play when the specific pandemic emerges.

And as far as your personalizing the matter in your comments, just stick with the supportable facts and lay off the insults because you don't like my questioning your statement.That's great advice, skeptigirl, I'll try to remember that.

[Sinope]

Flu shots in the news here today.

w ww.telegraph.co.uk/news/main.jhtml?xml=/news/2007/11/24/nflu124.xml

The creator of the flu jab has agreed with warnings that a major outbreak of the illness is likely and admits that his drug will do little to stop it.

Dr Graeme Laver, who helped to create the vaccine more than 40 years ago, said that although the jab could afford some protection to the 15 million Britons who receive it each year, it should not be relied on.


The Australian scientist, who receives royalties for Relenza but not for Tamiflu, said he had never been impressed with the power of his own vaccine.

"It is better than nothing and I wouldn't want to advise people not to take it," he said. "But you can't rely on it doing any good."

[Physiotherapist]

Here is the link:-


www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/11/24/nflu124.xml

You have to post a certain number of times before the links will work.

[robinson]

http://www.channel4.com/news/articles/society/health/warning+from+flu+jab+inventor/1090747

How about that link?

His comments are set to fuel the debate about the efficacy of the flu jab, which has already come in for criticism.

Last month a study by the Health Protection Agency (HPA) found the vaccine had no "protective effect" on lowering numbers of elderly people admitted to hospital with respiratory infections

[Eos of the Eons]

These news stories are typically DUMB. Tamiflu is not a vaccine, it's just an antiretroviral drug. The flu vaccine was never ever NEVER made to help ward of any type of pandemic that may be caused by things like H5N1. It's only made to fight of the yearly strain that comes through.

Where do you guys find the time to dig up such stupidity? Don't you have better things to read? For these news station to cherry pick bad studies like that after we've already explored them in this thread is just sad. They obviously are just regular journalists with no background in determing what is good data vs bad.

[Ivor the Engineer]

These news stories are typically DUMB. Tamiflu is not a vaccine, it's just an antiretroviral drug. The flu vaccine was never ever NEVER made to help ward of any type of pandemic that may be caused by things like H5N1. It's only made to fight of the yearly strain that comes through.

Where do you guys find the time to dig up such stupidity? Don't you have better things to read? For these news station to cherry pick bad studies like that after we've already explored them in this thread is just sad. They obviously are just regular journalists with no background in determing what is good data vs bad.

Which "bad studies" would they be? Could you explain why these studies are "bad"? E.g., were there methodological flaws in them? Too small sample size? Non-representative samples used? The authors managed to hood-wink their peers who reviewed them?

Or is the only criterion for a study to be classed as “bad” simply that it challenges an opinion that you already hold?

[robinson]

The inventor of the flu jab has warned it would do little to prevent a flu epidemic in Britain this winter, adding to fears about the vaccine's ineffectiveness.

Dr Graeme Laver, who helped create the jab more than 40 years ago, believes it should not be relied upon to protect from a potentially severe flu epidemic.

The Australian scientist also claims that people's lives could be saved if drugs such as Tamiflu and Relenza were used instead, once the disease has already struck.

These are both currently prescription-only in the UK but Dr Laver argues they should be sold over the counter so that they were more readily available to flu sufferers.

http://www.channel4.com/news/articles/society/health/warning+from+flu+jab+inventor/1090747

The scientist who invented the Flu vaccine says Tamiflu and Relenza would save lives.

Oseltamivir is an antiviral drug that is used in the treatment and prophylaxis of both Influenzavirus A and Influenzavirus B. Like zanamivir, oseltamivir is a neuraminidase inhibitor. It acts as a transition-state analogue inhibitor of influenza neuraminidase, preventing progeny virions from emerging from infected cells.

Oseltamivir was the first orally active neuraminidase inhibitor commercially developed. It is a prodrug, which is hydrolysed hepatically to the active metabolite, the free carboxylate of oseltamivir (GS4071). It was developed by Gilead Sciences and is currently marketed by Hoffmann-La Roche (Roche) under the trade name Tamiflu. In Japan, it is marketed by Chugai Pharmaceutical Co., which is more than 50% owned by Roche. Oseltamivir is generally available by prescription only.

Roche estimates that 50 million people have been treated with oseltamivir. The majority of these have been in Japan, where an estimated 35 million have been treated.
http://en.wikipedia.org/wiki/Tamiflu

[Skeptic Ginger]

In that case, you have probably noticed, as I have, that the leading experts in this area tend to be rather cautious in reaching conclusions. The people who express high degrees of confidence in what they know about this matter invariably turn out to be those who really don't know that much about it. But the discussion about flu shots is really a separate one, and in the context of this discussion, what is primarily relevant as pandemic flu is concerned is that the prospect has brought increased focus on infection control measures, which in turn highlights the fact that we don't really know how flu spreads.

The Reveres have posted on this many times; maybe you'd find it more palatable coming from them:

"In this week's Science magazine Stephen Morse calls attention to what we have been saying here for a long time. We don't really know how influenza spreds from person to person."
http://scienceblogs.com/effectmeasure/2006/11/how_does_flu_spread.php#moreNot only is this not new to me, I have said as much myself many times. But you need to look at the context of the comments. Just who it is they mean when they say "we" don't know.

The article ends saying:There are still many questions about the spread of ordinary influenza and even more about H5N1. Tellier believes the existing evidence is more than adequate to demand the use of N95 respirators in health care institutions, not just during "aerosolizing procedures" as currently recommended by CDC but anywhere where there is coughing and sneezing from infected patients. We find it curious that he says nothing about using ultraviolet light germicidal irradiation (UVGI) units in healh care facilities since his evidence seemed to suggest it was useful and there is no comparable evidence for N95 masks. The role of hand hygiene and various kinds of personal distancing still remains unknown. Morse's plea for more investment in research in this area seems more than responable.

The debates will continue, even as a great deal of poorly founded advice is being handed out witout much questioning. Much of it, like advocating cough and hand hygiene, are at worst harmless and at best will have some effectiveness and not just for influenza. But none of it is obvious and some of it -- the contention that surgical masks are sufficient because transmission is by large droplet -- is potentially harmful.

The depths of our ignorance in this age of sophisticated molecular biology is truly impressive.I would take this one step further. N95 masks filter out particulates >1 micron. Influenza virons are < 1 micron. The only way an N95 is going to work against influenza aerosols is by some kind of wick action. And no one has tested N95s against influenza.

In the US, respiratory protection must be NIOSH approved for the specific hazard if an employee is going to be exposed to that hazard. N95s are approved for tuberculosis, a bacterium 2 microns in size on average. In addition, TB is not highly contagious. It takes a large inoculum to infect a person.

So in the context of this article, the author is correct in saying the people making the decisions about respiratory protection are not basing those decisions on adequate science. I have voiced this opinion directly to the CDC. I am not the only one to do so and there are people there looking at the problem. Unfortunately, the current political climate is one which is suppressing information which involves employer expenses for employee safety. The failure of OSHA to enact the TB protection rule which was in the final rule stage just before Bush came into office is an example. They simply unfunded the finalizing process of the rule making.

I have also been dismayed that my colleagues assume that because N95s are approved for TB they must work for any airborne infection. My colleagues have yet to notice health care workers have been told to wear surgical masks (not designed for, not tested, and not effective against) to protect themselves from extremely hazardous airborne infections for close to a century. So it is no surprise it isn't dawning on most of them that they are making the same untested assumptions using N95s as the panacea for preventing airborne transmission of influenza and other airborne infectious diseases.

The culture of health care led to the deaths of ~800 health care workers in the SARS outbreaks. Take care of the patient the best you can, your safety is not something to stop work over and no, we just didn't prepare for this sort of thing ahead of time. You can bet had that been an industrial setting, work would have stopped soon after the first worker's death. By the same token, the OSHAct was passed in 1974 yet not really applied in the health care industry until 1989. To think nothing has changed as we plan for the next flu pandemic is appalling.

So in that context, we don't really have enough information about the spread of influenza. I beg to differ that it is the researchers with the knowledge deficit. Rather, it is the policy makers and the health care providers. And respiratory protection measures need to be tested. We most definitely have not done that research.

The researchers which have expressed the need for caution are the geneticists. Some are latching on to each new discovery as if it is a eureka moment only to find out later it wasn't quite that simple.


"Unfortunately and as we have pointed out here too many times to count or even link to, we know very little about how flu virus is actually passed around in the community. Except here at Effect Measure, you wouldn't necessarily know this from reading most of what's printed about flu. Maybe you didn't even believe it when we said it. Well now this surprising piece of ignorance is the subject of more conversation in the flu community:"
http://scienceblogs.com/effectmeasure/2007/07/figuring_out_how_flu_gets_arou.php#moreThese comments again refer to a particular "we". In this case it is the lay public. Infection control 101 says you don't just look at the presence of organisms, you have to know if it matters. If you've read my spiel about the Listerine fraud, you've heard the same thing there. So what it kills germs? What matters is does it prevent disease? And the answer is a resounding, "No".

Try it this way:
Q: So tell me how it is you want to lump all strains together and draw the conclusion that it isn't clear what role aerosols play in transmission and the data is conflicting?
A: What we don't know is what role aerosols will play when the specific pandemic emerges.Which doesn't mean we don't really know how influenza is transmitted. Rather, it means the people making policy decisions are not paying careful enough attention to the role aerosols might play when the pandemic strain emerges.




That's great advice, skeptigirl, I'll try to remember that.Well comparing notes here,

Your comments, "one of your familiar attempts to establish yourself as the resident expert by casting aspersions upon anyone with the temerity to disagree with you"

and

"You seem eager to avail yourself of every opportunity to provide reminders of how qualified you are to address these issues, yet your conclusions frequently bear the flavor of dated literature, and your position clearly differs from that of some whose credentials are even more impressive than your own. Your dispute is really with them, not me. Don't shoot the messenger."

vs

My comments, "Perhaps we are arguing semantics about what "thoroughly" means but I understand the details quite well from the research I read and in addition, I don't draw the same conclusions you did about the reason for the variable results in the studies I have read.

Give me a few minutes and I'll find some of the sources I recommend you look at. If you have some of your own, post away."

and

"You might want to read a little more about the genetic variables of pathogens within species. And maybe actually look at the research on influenza transmission. There are more than a few studies using actual human to human transmission under real conditions"

You could have taken offense to my comment, (apparently that's what you did), or you could have asked what it was I might have read that you hadn't. I can see where it sounded condescending, but had you not said the study results were conflicting, I wouldn't have thought you weren't aware of the discoveries from the genetic research on the 1918 and the HPAI H5N1 viruses and in particular on how that was affecting human to human transmission. In addition, simply clarifying the context of "who" didn't know addressed our different conclusions. No reason for any offense.

[Skeptic Ginger]

http://www.channel4.com/news/articles/society/health/warning+from+flu+jab+inventor/1090747

The scientist who invented the Flu vaccine says Tamiflu and Relenza would save lives. Here's a little more about the good doctor.

Dr Graeme Laver (http://www.abc.net.au/stateline/act/content/2006/s1596607.htm)

He's retired, worked on influenza for 35 years and has been voicing his dislike about the way AU has been planning for the flu pandemic. He complains that the AU authorities are not stockpiling enough antivirals. It appears from this article the reference to the vaccine not working is only in regards to response to a pandemic. And we know that. The problem isn't the vaccine's ineffectivness, it's the impracticality of producing and distributing it in time to affect the pandemic.

Here are the quotes from the news article that support my conclusion:with warnings that a major outbreak of the illness is likely...

"You could have a really severe epidemic. Thousands will be ill and many will die. The safe and effective anti-flu drugs could, if used correctly, avoid much of this distress."...

He said drugs that fight flu once it has struck, such as Tamiflu and Relenza, should be readily available over the counter instead of by prescription as they are at present....That's exactly what he is saying in the other article I linked to.

The news article is also misleading when after this discussion with the Dr they add, Dr Laver said: "If the seasonal flu is as bad as it was in Australia, you are in for a pretty bad time...

The number of flu victims in Australia tripled this year compared to last year, with those normally not affected by the disease catching it.

In just five weeks in New South Wales, 800 people died from pneumonia, which often develops from flu.Sure, but that's still the typical cycle and it was the same rate this year as in 2003. (scroll down to figure 3) (http://www.health.nsw.gov.au/infect/pdf/flureport.pdf)


The news article implies the Dr is talking about vaccine use in seasonal flu but he is mostly talking about using the vaccine in a pandemic. His point is the anti-flu drugs could treat active cases and save lives. But Dr L seems to be oblivious to the fact if you dump Tamiflu on the market, drug resistance will emerge and the drug will not be effective curtailing a pandemic.

[Skeptic Ginger]

These news stories are typically DUMB. Tamiflu is not a vaccine, it's just an antiretroviral drug. The flu vaccine was never ever NEVER made to help ward of any type of pandemic that may be caused by things like H5N1. It's only made to fight of the yearly strain that comes through.

Where do you guys find the time to dig up such stupidity? Don't you have better things to read? For these news station to cherry pick bad studies like that after we've already explored them in this thread is just sad. They obviously are just regular journalists with no background in determing what is good data vs bad.Well, Sinope was right to post it. I don't think she had to dig it up. But it's too bad that She, Ivor and robinson are so convinced vaccines are bad they read what they want to in a news report rather than actually look objectively at the research.

[Skeptic Ginger]

Here's more from the Dr.

Make antivirals available to everyone before the next flu season
Dr Graeme Laver - former professor of biochemistry & molecular biology at the Australian National University (http://www.aussmc.org/ScienceBlog14Mar07.php)

Make Tamiflu S3 and stop flu deaths: biologist (http://www.pharmacynews.com.au/articles/Make-Tamiflu-S3-and-stop-flu-deaths-biologist_z135946.htm)

Flu deaths 'could be prevented' - People are dying unnecessarily from flu as too many restrictions are placed on key drugs, a leading expert says. (http://news.bbc.co.uk/1/hi/health/6261478.stm)Seasonal flu is estimated to kill several thousand people each year in the UK.

Dr Laver said: "People are dying from seasonal flu, but we seem to have a blind spot about it as there are drugs that would make them better in a couple of days.

"The current set of flu vaccines are not that effective, so having Tamiflu available over-the-counter would be of huge benefit.

"The problem is that at the moment there are lots of restrictions and you need to get a prescription and that can take a couple of days during which the flu will have taken hold."

'Overblown'

Dr Laver said if it was to work pharmacists would have to be in charge of testing patients for flu which can be done by a quick saliva test so that it was not given to people with a common cold.

And he added fears over resistance to the drug developing from increased use had been "overblown".

"What is the point of stockpiling Tamiflu and perhaps never using it when it could help people now." One has to know the context of his statement the vaccine isn't "that effective". He could be into the antiviral approach and speaks to that bias. He could just be noting the deaths are still occurring and not looking at vaccine use.

But regardless, he doesn't support those remarks with any facts or research. And he clearly is on a promo campaign to make the antivirals easier to get.

[robinson]

Use of oseltamivir during an outbreak of influenza A in a long-term care facility in Taiwan.
Chang YM, Li WC, Huang CT, Huang CG, Tsao KC, Cheng YH, Chiang SL, Yang SY, Chen CH, Huang YC.

Center for Disease Control, Department of Health, Taiwan, ROC; Taipei Medical University, Taipei, Taiwan, ROC.

We studied the effectiveness of oseltamivir during an outbreak of influenza A among previously vaccinated patients and staff in a long-term care facility. Seven of 14 staff members and 14 of 41 residents developed either influenza-like illness (ILI) or other respiratory symptoms during a 14-day period from late January to 8 February 2004. On 9 February, therapeutic oseltamivir (75mg twice daily for five days) was administered to one staff member and seven residents who had developed ILI within the previous 48h (treatment group). Prophylactic oseltamivir (75mg once daily for seven days) was administered to 12 staff members and 30 residents who were asymptomatic or whose respiratory symptoms did not meet the diagnosis of ILI (prophylaxis group). The remaining four residents and one staff member had had ILI for more than two days (with subsiding symptoms) and did not receive oseltamivir ('no-oseltamivir' group). None of the 42 subjects in the prophylaxis group developed ILI. Presence of influenza A virus was demonstrated in 24 subjects: seven out of eight in the treatment group, 12 of 42 in the prophylaxis group and all five in the no-oseltamivir group. For confirmation of diagnosis, real-time reverse transcription-polymerase chain reaction was more sensitive than antigen detection and virus isolation. In-time therapeutic and prophylactic oseltamivir successfully interrupted an outbreak of influenza A in a long-term care facility.
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17945389&ordinalpos=6&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVDocSum

What a conundrum. First people who were vaccinated got the Flu, then an antiviral drug prevented people from becoming very ill, maybe death as well. Some don't want the drug used because it might lead to the Flu becoming resistant to the drug. There seems to be a multitude of issues.

More and more reports are linking severe and sometimes fatal neuropsychiatric disorders to oseltamivir, especially in children and adolescents. These disorders include suicidal behaviour, hallucinations, seizures, delirium and extrapyramidal disorders.

(1) Oseltamivir is an antiviral drug used for influenza. It has only been tested in children to a limited extent. (2) A few deaths have been reported in children receiving oseltamivir, in some cases due to neurological causes. All of these deaths occurred in Japan. The European Medicines Agency has described 2 deaths, both attributed to suicide, in adolescents aged 14 and 17 who were taking oseltamivir. Both patients had developed behavioural disorders before their death. (3) According to the US Food and Drug Administration, neuropsychiatric disorders were reported in 32 children (mainly in Japan), and include delirium, behavioural disorders, hallucinations, convulsions and confusion. (4) Disturbing neurological toxicity has been observed in young rats exposed to oseltamivir, leading the American and European agencies to warn against the use of oseltamivir in infants less than one year old. (5) Severe cutaneous adverse effects, including cases of Lyell syndrome, were reported in children taking oseltamivir. (6) In practice, oseltamivir is only modestly effective in the prevention of influenza and treatment of suspected influenza. There is no evidence of an effect on complications of the flu in adults or children at higher risk. The possibility of serious adverse effects should be weighed against the limited benefit of oseltamivir.

Damn.

[robinson]

Why are Flu vaccines such a topic of conversation?

Flu Shot Not Necessary for Most People

DENVER — Public health officials say Americans should roll up their sleeves for a dose of reality: For most of us, getting a flu shot is not a life-or-death matter.

The flu vaccine (search) will not necessarily prevent you from experiencing the flu's miserable symptoms, like fever, hacking cough, runny nose and "hit-by-a-truck" body aches.

Studies show the shot generally works well, but its effectiveness can range from 52 to 90 percent depending on the strain of virus and a person's age.

If you are elderly or chronically ill, the vaccine can help jump-start your body's weakened defenses and perhaps prevent the worst from happening.

But the millions of people who are younger and healthier do not really need it — especially during a vaccine shortage, public health officials say.

"Right now the entire country runs on fear and we don't need to live like that," said Catharine A. Kopac, a Georgetown University gerontology researcher. "We somehow think we should be disease-free all the time. If you're leading a healthy life and you get sick with the flu, you're probably going to get through it."
...

In the United States, the flu's average annual death toll is 36,000. Rarely do the victims die from the virus itself. Rather, it weakens their immune systems so that a bacterial infection — often pneumonia — delivers the fatal blow.

...

Still, infectious-disease experts say flu should no longer be a catastrophic illness among otherwise healthy people, at least not in the way it was in 1918 when it killed 40 million people worldwide.
...

And unlike 1918, now there are at least four anti-viral medications that can relieve the flu's worst effects if taken within 48 hours of the onset of symptoms.
http://www.foxnews.com/story/0,2933,136611,00.html

I know, I know, I can't believe I am using a FOX News story as a source. It was just the first on the Google list. It does give some idea of the kind of things people read or hear from the News.

I know of one Flu vaccine riot that occurred two years ago when there was a shortage, or a perceived shortage. Old people went crazy, because they thought they wouldn't get a shot. It was horrible.

I consider vaccines the second most important advance in Medicine, (the first being clean water), and don't doubt vaccines have saved more lives and prevented more suffering than anything.

The concept of stimulating the immune system to prevent a life threatening illness is sound and scientific. I don't think any sane, educated person doubts this. Questioning the economics and science of vaccines, as well as wanting to know all the information about them, especially the cost, risk and the efficiency, is the sort of thing a skeptic would do.

One thing about medicine, modern science, is that every time it turns out there was some horrible unforeseen side effect, and it is covered up, or worse, denied by the authorities, it undermines trust. Evasion and dishonesty destroy our faith in medicine. The ever present economic issues also cause troubles. People remember bad events far more than they do all the good science has done.

Insulting people, or worse, acting like they are dumb because they ask questions, because they are seeking the truth, really puts scientist or medical authorities in a bad light.

To be effective in educating people, about anything, you have to behave in a stable, rational, and most importantly, honest manner. Anything else and you put yourself in a position to be ignored, distrusted, or considered a pawn of the evil Multinational Military-Industrial complex.

Ignoring the facts, or acting like a jackass because you don't like the way people behave, or what they believe, doesn't change any of this. There are risks and pitfalls in everything, vaccines and medicine are no different. Covering up the unpleasant facts, or the errors that have been made, doesn't advance the goals of science. Putting profit first doesn't either. Pretending that these human failings don't exist is just dumb.

An honest discussion about something does far more to educate people than name calling, or venting your frustration in public. Try to behave like an educated self disciplined person, even when dealing with those you find ignorant.

Just some thoughts on Flu vaccines and the conversation. Don't take it too seriously.

I've been vaccinated many times, and depending on where I am going, I still get boosters for some things. I'm not sure if they all work, but I don't like to gamble with my health. I'm far more concerned about the safety of a vaccine than I am getting the disease the vaccine is designed to prevent. Because I am 100% sure I am getting the shot, while getting the disease is far less likely.

This is human nature.

[Skeptic Ginger]

Use of oseltamivir during an outbreak of influenza A in a long-term care facility in Taiwan.
.... http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17945389&ordinalpos=6&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVDocSum

What a conundrum. First people who were vaccinated got the Flu, then an antiviral drug prevented people from becoming very ill, maybe death as well. Some don't want the drug used because it might lead to the Flu becoming resistant to the drug. There seems to be a multitude of issues. Let me help you out here robinson, since you are drawing conclusions this data does not support.

Out of a total of 35 persons who were vaccinated, 19 eventually had influenza virus cultured. That is not unexpected in the elderly which is why we want to vaccinate the staff.

At first it looks like 50% of the staff got flu. Actually the abstract says 5 of those 7 were given "prophylaxis". Prophylactic oseltamivir ... was administered to 12 staff members and 30 residents who were asymptomatic or whose respiratory symptoms did not meet the diagnosis of ILIOnly 2 of the 14 staff members actually had influenza. We don't know anything about whether or not they were expected to get a good or poor response to the vaccine.

Only one staff member was "treated" and one was already recovering. The staff member who was recovering and the 4 patients who were also recovering and not treated had vaccinations and cultured positive for flu and got better on their own without treatment. Nothing suggests they had severe illness or that the vaccine did not modify their illness. The remaining four residents and one staff member had had ILI for more than two days (with subsiding symptoms)

19 of the 35 had treatment and positive flu cultures and no symptoms. Nothing here tells us how many of those people were expected to get a good or poor responses from the vaccine. A poor response is still expected to modify illness. Nothing here tells us what benefit occurred between vaccine and no vaccine. All we know is they had no symptoms. We also have 15 with no symptoms and no virus detected. We also don't know the attack rate without vaccine. Having virus cultured in a person with no symptoms does not indicate vaccine failure. It indicates success in preventing illness but perhaps failure in preventing spread. That is not a zero benefit outcome.

This study was looking at the benefit of adding Tamiflu, not the failure of the vaccine. You cannot draw the conclusions you would like to here that the vaccine was of no benefit. Well, you can but that would be ignorant because that isn't what this study found.

[Skeptic Ginger]

...http://www.foxnews.com/story/0,2933,136611,00.html

I know, I know, I can't believe I am using a FOX News story as a source. .....

Insulting people, or worse, acting like they are dumb because they ask questions, because they are seeking the truth, really puts scientist or medical authorities in a bad light.

To be effective in educating people, about anything, you have to behave in a stable, rational, and most importantly, honest manner. Anything else and you put yourself in a position to be ignored, distrusted, or considered a pawn of the evil Multinational Military-Industrial complex.

Ignoring the facts, or acting like a jackass because you don't like the way people behave, or what they believe, doesn't change any of this. There are risks and pitfalls in everything, vaccines and medicine are no different. Covering up the unpleasant facts, or the errors that have been made, doesn't advance the goals of science. Putting profit first doesn't either. Pretending that these human failings don't exist is just dumb.

An honest discussion about something does far more to educate people than name calling, or venting your frustration in public. Try to behave like an educated self disciplined person, even when dealing with those you find ignorant.

Just some thoughts on Flu vaccines and the conversation. Don't take it too seriously.

I've been vaccinated many times, and depending on where I am going, I still get boosters for some things. I'm not sure if they all work, but I don't like to gamble with my health. I'm far more concerned about the safety of a vaccine than I am getting the disease the vaccine is designed to prevent. Because I am 100% sure I am getting the shot, while getting the disease is far less likely.

This is human nature.Robinson, if you were the least bit interested in learning new things, you wouldn't find yourself being insulted. But if you are going to proclaim interpretations of research and news reports that are simply false, I am going to say so. Get an education, learn what it is you are reading, or stop whining about being criticized.

No where in that news article is the public health saying not to get flu shots. They are saying in times of vaccine shortage the vaccine needs to be prioritized. This article is from 2004 when there was a critical vaccine shortage.Nevertheless, the sudden vaccine shortage this fall is igniting a "scarcity mentality" similar to runs on banks during stock market crashes and convenience stores when hurricanes brew offshore.



This is a misinterpretation by the reporter: The flu vaccine (search) will not necessarily prevent you from experiencing the flu's miserable symptoms, like fever, hacking cough, runny nose and "hit-by-a-truck" body aches. The flu vaccine won't prevent all colds. The reporter doesn't get it and adds to the public's ignorance because of it.



One thing about medicine, modern science, is that every time it turns out there was some horrible unforeseen side effect, and it is covered up, or worse, denied by the authorities, it undermines trust. Evasion and dishonesty destroy our faith in medicine. The ever present economic issues also cause troubles. People remember bad events far more than they do all the good science has done. So you don't like personal attacks then you turn around and attack every health care professional on this board. Maybe it didn't occur to you that this false accusation is a personal affront to me and many other people here.

[Ivor the Engineer]

Well, Sinope was right to post it. I don't think she had to dig it up. But it's too bad that She, Ivor and robinson are so convinced vaccines are bad they read what they want to in a news report rather than actually look objectively at the research.

I DO NOT THINK VACCINES [IN GENERAL] ARE BAD!

STOP TELLING LIES!

[Sinope]

I DO NOT THINK VACCINES [IN GENERAL] ARE BAD!

STOP TELLING LIES!

Yeah, neither do I! In fact, I just got myself a Hep B vaccination on Friday.:) I don't agree with the "immunisation schedule" in this country but that does not equate to thinking vaccines are "bad".

[Dymanic]

These comments again refer to a particular "we". In this case it is the lay public.No, they don't. Here, try another sample:

"We've talked here fairly often that the way and how far influenza virus spreads isn't understood or known precisely. That seems to be a big surprise, not only to the public but to many in the public health community who should know better."
http://scienceblogs.com/effectmeasure/2007/09/knowing_what_we_dont_know.php#more

What the reveres are saying here is that it isn't just the lay public that doesn't get it that nobody knows exactly how influenza spreads; lots of people in the public health community don't get it either. I think you're doing a fine job of illustrating the point.

So in the context of this article, the author is correct in saying the people making the decisions about respiratory protection are not basing those decisions on adequate science.That author is saying that the science doesn't yet exist.

I beg to differ that it is the researchers with the knowledge deficit. Rather, it is the policy makers and the health care providers. And respiratory protection measures need to be tested. We most definitely have not done that research.Sounds like what you're saying here is that researchers have no deficit of knowledge, even when it comes to things they haven't yet researched.

Which doesn't mean we don't really know how influenza is transmitted. Rather, it means the people making policy decisions are not paying careful enough attention to the role aerosols might play when the pandemic strain emerges.I'm not at all optimistic about the prospects for containing or even slowing the spread of a pandemic strain of flu. In a discussion we had not long ago, we explored at some length (to a point approaching meltdown, actually) the contrast between this lack of optimism on my part and confidence on your part in the adequacy of public health measures to contain early outbreaks. I remembered some of the details of that discussion, but sort of forgot why I decided not to continue it.

My personal pandemic response plan may be summarized by the single word: "hunkering", and I wouldn't relish the prospect of being on the front lines in that battle. I don't want to add to the list of incorrect assumptions I may have made in that thread, but I'll risk guessing that you are among those likely to be on those front lines should a pandemic occur anytime soon. That alone deserves some respect, as does your willingness to prepare yourself by delving deeply into the science. There are ample opportunities for various interpretations of the available evidence. Some of them are mutually exclusive. I expect to continue to find aspects of your interpretations that I regard as mistaken, but I'll try harder to find more tactful ways to express these concerns. Taking a good hard look at some of these issues can be upsetting for just about anyone (an observation which may go a long way toward explaining why so many people seem to prefer to ignore them), and I'm also willing to guess that you're capable of finding enough about this to get upset about without any help from me. (Yes, this is my awkward way of apologizing for getting snarky).

The science of influenza is advancing so rapidly that even full-time virologists (let alone policy makers) are hard pressed to keep up (so if you're more concerned now about the possibility of airborne transmission than you were six months ago, I'll take that as an indication that you've been reading since the last time we discussed this). On the opposite end of the spectrum are the other ninety-nine plus percent of the people whose decisions will impact the spread of a pandemic flu just as they impact the spread of seasonal flu, and (as we're seeing in this very thread) most of them are going to base those decisions on whatever they are able to glean from the popular news media. Where some of the details are concerned the jury is still out. We're not going to get the public interested in those deliberations. They don't give a damn about alpha 2,6 galactose linkages, or how many microns in size an influenza virion is, and they aren't ever going to. While we're waiting for a final verdict, what the public needs to know is that even seasonal flu can touch their lives in ways that they may tend to underestimate (and which surely justify at least the simplest level of precaution such as flu shots and handwashing) and that a pandemic flu has the potential to rock their world, and if they're counting on somebody else to save their butts when it happens, they're likely to end up as disappointed as some former residents of New Orleans who once took the same gamble.

[Ivor the Engineer]

Reality check, anyone?

http://www.swissre.co.nz/resources/264e3100455c7acfb280ba80a45d76a0-Publ07_FR_Influenza_Pandemics_en.pdf

ETA: http://www.swissre.com/resources/bbab850046606bf6b89cfd276a9800c6-SHAN-753GRL_Pandemic%20influenza.pdf

[Deetee]

Using your definition, the guy who puts £26 on the 100-to-1 shot at the races is being extremely rational.

How is taking a gamble which is so heavily stacked in your favour irrational? Am I also being irrational when I choose to drive to work, rather than walk? We all know walking has health benefits and I'm much less likely to die if I walk instead of using a car.

What you don't seem to get is that there are some risks which are below the level of significance for most people to be bothered to do anything about reducing them. There are all sorts of things you could spend your time and money on reducing the risk of them happening to you. Getting a flu vaccination is nowhere near the top of that list.

The risk/rationality analogy is not that someone is rational if he will bet £26 hoping the 100 to one shot comes in, but that he is rational betting £26 as insurance against the possibility that the 100 to one shot does come in (an outcome he does not wish to happen), -just in case.

The question then becomes one of choice regarding the percieved risks - Is it really 100 to one? Can I afford to risk having no insurance/protection? What if it is 1000 to one, or 10 to one - will my choice be the same?
What if the risks are slight even if the horse comes in - do I risk death if it does, or just a minor inconvenience?

If the risk of death is high, then I may choose to insure myself against what may be extremely long odds - that is rational. E.g., The risk of catching HIV from a single sexual exposure with someone whose HIV status is unknown is probably something like one hundred thousand to one in the UK. But catching HIV could kill you, so rational(?) people use protective methods.
If on the other hand the illness one risks catching is trivial, then one may choose to entertain quite short odds, say 10 to one, and choose to not have protection.

We continually face a large variety of risks in life. We can choose to run the risk of some things, like driving as opposed to walking. Some risks are necessary to run, just for us to enjoy a decent life on this earth. Vaccinations are mostly actions that protect against risks - for some diseases it's a no-brainer, for others like flu or chickenpox the benefits may be less clear. There is sufficient evidence to point to the benefits of flu vaccine in the elderly, so that is something I would have/recommend. That's my opinion. Having the vaccine costs very little in terms of risks and in the UK it is free.

Sure, other things might work out as more cost-effective interventions in a health care setting. Perhaps the answer is to charge for vaccines, so their costs are covered in some way?

Regarding risks, people also chose to run risks if they feel they can control whether they will experience the adverse event. So people drive, thinking "I'm a skillful driver, if something happens I am in control and can react/avoid the accident". In an aeroplane, there is no control factor, so some are irrationally afraid to fly, but happily drive like maniacs on the road.

This philosophy is often pure kidology, but its a factor in what we chose to do each day. Catching diseases can be viewed in this way too - we might say "But I can chose my sexual partners with care - the chance she has an STD will be very small". But with droplet or airborne infections such as flu, measles or chicken pox it is harder to predict exposure.

[Skeptic Ginger]

No, they don't. Here, try another sample:

"We've talked here fairly often that the way and how far influenza virus spreads isn't understood or known precisely. That seems to be a big surprise, not only to the public but to many in the public health community who should know better."
http://scienceblogs.com/effectmeasure/2007/09/knowing_what_we_dont_know.php#more

What the reveres are saying here is that it isn't just the lay public that doesn't get it that nobody knows exactly how influenza spreads; lots of people in the public health community don't get it either. I think you're doing a fine job of illustrating the point.We are looking at a half full/empty glass here. There is no sense trying to argue which it is. My comment about the lay public was in reference to the blog which is discussing a different "we" than me. In addition, I think I made it clear that many health care professionals do not understand disease transmission. Did you simply ignore what I posted?

But from my perspective as an infectious disease specialist, and from the influenza researcher's perspective, half full half empty depends on the context of the discussion. Just what is it you don't know about influenza transmission?

That author is saying that the science doesn't yet exist.Again, just what specific unknown are you referring to? What kind of detail are you referring to? There's no data on N95s. I practically screamed about that in my post in case you missed it. If you are referring to whether it is 60/40 aerosol/droplet or 5/95, again DEPENDS on the specific strain. So unless you want the answer regarding a single strain, no amount of research is going to answer the question about all strains. But whether it is droplet and aerosols specifically, there is evidence of both.

Do we know if the aerosols can drift 50 yards or 100 yards? Probably not.

Sounds like what you're saying here is that researchers have no deficit of knowledge, even when it comes to things they haven't yet researched. It sounds to me like you aren't reading what I posted, have a preconceived idea what I've said and fit what I said into that preconceived idea. I suggest you re-read my posts.

I'm not at all optimistic about the prospects for containing or even slowing the spread of a pandemic strain of flu. In a discussion we had not long ago, we explored at some length (to a point approaching meltdown, actually) the contrast between this lack of optimism on my part and confidence on your part in the adequacy of public health measures to contain early outbreaks. I remembered some of the details of that discussion, but sort of forgot why I decided not to continue it.Here we are getting closer to the actual underlying difference in our opinions.

So tell me, what is it you think the public health is going to mess up on? I'll give you my scenario.

The initial outbreak will be in a third world country. It will go unnoticed at first because the country lacks public health infrastructure. Once recognized, it will be too late to completely contain it. (Any outbreaks in countries with infrastructure occurring earlier will be contained.)

It will begin to spread but in the first wave of the pandemic, the virus will have not yet mutated to the fully adapted human strain. It will be less contagious than in the second wave. In this phase, persons entering this country from areas experiencing acute cases will be isolated and contacts including health care workers will all be given Tamiflu.

This is the time when the public health interventions will be the most effective. Heck, Indonesia is successfully implementing these measures now.

Again, in the countries without public health infrastructure, WHO will step in to assist. Tamiflu will slow the spread but not by enough to stop it. The virus strain will continue to drift and the most infectious version will replace the less infectious versions. Vaccine production will begin about this time. Some time after these events a second wave will begin.

The public health agencies in developed countries will continue to slow the spread by using Tamiflu and Relenza as Tamiflu resistance increases. The vaccine supply will begin and the prioritized persons will get their first doses. Whether from here it turns out the virus overwhelms the system or the system keeps the worst of it under control is unknown. It will depend on the speed of the pandemic spread and the production and effectiveness of vaccine and the anti-virals.

I base this scenario on what is currently being done when human cases occur today, on the public health infrastructure one can observe today, on the outcome of current interventions, on current surveillance, on the genetic discoveries about how H5N1 influenza is spreading and the comparisons between H5N1 and the 1918 strain, and on the history of the 1918 pandemic which began with a smaller, shorter wave of cases, subsided and re-emerged as a much more widespread pandemic.


My personal pandemic response plan may be summarized by the single word: "hunkering", and I wouldn't relish the prospect of being on the front lines in that battle. I don't want to add to the list of incorrect assumptions I may have made in that thread, but I'll risk guessing that you are among those likely to be on those front lines should a pandemic occur anytime soon.No, I'll be in the back giving advice, vaccines and prophylactic prescriptions. I am a health care worker advocate. I don't believe we should be martyrs. Had I been a hospital nurse told to take care of a SARS patient without being given PPE that was tested and known to be effective in protecting the worker, I would have walked off the job. And I wouldn't have been the least bit hesitant nor would I have felt guilty about doing so. I hold a deep grudge against the health care establishment for their failure to protect health care workers against airborne and bloodborne infections. The same hazards would have never been tolerated in the industrial fields.

... I expect to continue to find aspects of your interpretations that I regard as mistaken,Just be sure you are interpreting my 'aspects' correctly. I don't think you are.


The science of influenza is advancing so rapidly that even full-time virologists (let alone policy makers) are hard pressed to keep up (so if you're more concerned now about the possibility of airborne transmission than you were six months ago, I'll take that as an indication that you've been reading since the last time we discussed this).I've always assumed airborne transmission. Where do you see I posted otherwise?

[Skeptic Ginger]

I DO NOT THINK VACCINES [IN GENERAL] ARE BAD!

STOP TELLING LIES!Oh, excuse me, "some vaccines". :rolleyes:

[Skeptic Ginger]

Yeah, neither do I! In fact, I just got myself a Hep B vaccination on Friday.:) I don't agree with the "immunisation schedule" in this country but that does not equate to thinking vaccines are "bad".Right, just the ones you are misinformed about.
To be honest, Ivor, I don't think the NHS/HPA are much better than the CDC (well maybe a little bit, but not much;))

When I first started researching vaccines, I was struck by how "wrong" the NHS information was. (I mean they didn't quite claim measles caused death in 1 in 333 but some of the information was nearly that far off!) Now, I sorta agree with Beth(CDC), I can't trust what they say.

(I feel I should point out here I am not anti-vaccination at all, I just think parents should have clear and accurate information on which to make decisions for their children, which is not happening at the moment)

There is no way I would give my child ALL the vaccines on the UK schedule right now. If I was in the US, I think only really uneducated (about vaccines) people would give their children ALL the recommended vaccines. It is really crazy there. There are so many vaccines.

I posted on Robinsons thread about aluminium. I think that is a real worry, especially in the US if a baby gets all the "mandated" vaccines. The MRL in the US is also a lot higher than the WHO's MRL. (WHO revised in 2006 to 0.14mg/kg Oral therefore injected safety 0.00014mg/kg)

If lives would be saved...

All the "meningitis" vaccines seem to be very effective at preventing whatever particular serotype they are for. I am not seeing a big decrease in overall cases of meningitis though.

We started vaccinating for Men C in 2001 in the UK. Now we have practically no cases of Men C but the total number of cases of meningococcal meningitis are more in 2005 than in 1990 for example.

w ww.hpa.org.uk/infections/topics_az/meningo/data_meni_t03.htm (you will have to C+P )

I think they would be better off putting the money into investigating why these bacteria cause problems for a small number of people instead of vaccinating all children.

Well if only that were true. Unfortunately it's not. I am not sure how Prevenar (prevnar) got onto the UK schedule for example, after the JCVI looked at the US results. (they initally rejected it 4 months before it was passed) "Willy Nilly" would be a good description I think:)

What "facts" do you mean?

[Dymanic]

Just what is it you don't know about influenza transmission?I don't know whether most cases of influenza are spread by large or small droplets. For one thing.

I've always assumed airborne transmission. Where do you see I posted otherwise?

You might be surprised to find out most cases of influenza are spread by droplets, rather than truly airborne. To which I responded:

I'd be surprised to find that all the back-and-forth over the issue of large versus small droplet transmission has been resolved.

[Skeptic Ginger]

I don't know whether most cases of influenza are spread by large or small droplets. For one thing.



To which I responded:In context:
Originally Posted by Dymanic
That's good, because when you start talking about contacts of contacts, you could be looking at a pretty large number of people. Due to the way influenza is transmitted, just the number of contacts could be nothing to sneeze at (so to speak).

You might be surprised to find out most cases of influenza are spread by droplets, rather than truly airborne. That means short airborne distances and surface contact. Hand washing alone could probably prevent more than half of influenza cases.
Most of the research does show large droplet spread and very little aerosol.

Some of the research found aerosol.

Conclusion, some strains can be more infectious, not all strains are. It isn't a "back and forth" issue. That's what I tried to tell you in the beginning of this exchange.

[Ove]

There is a history behind not vaccinating healthy people. Vaccine supply has put restraints on how many doses one has to use each year. Then came some additional research showing that vaccinating people around those who are most vulnerable also prevents influenza deaths. Vaccine production is therefore being encouraged by the public health system in the US at least and the vaccine promotion is being expanded.

And, as a healthy person with a healthy child who is well aware of the fact influenza risk is not zero in all healthy people all the time, I have made sure both my son and I have a flu shot every year. Infectious disease prevention is my specialty, I have an MSN as a nurse practitioner, 30 years of experience and 17 years in private practice in this field. I am not duped and I am not poorly informed. I'm certainly not exaggerating the risks to others or promoting vaccine for profit when I make the decision to vaccinate my son and myself every year.

I read a voracious amount of the research in vaccines and infectious disease. I know full well why I vaccinate my son and myself. The risk of influenza, however small, is still higher than the risk of influenza vaccine and the outcome of the gamble Ivor thinks nothing of taking can, in the worst case, be death. It's a simple risk reduction measure. It is relatively inexpensive. The idea of not preventing a preventable death with such a simple measure is a superstitious decision. The evidence based decision is to get an annual influenza vaccination.


I an definitely not a member of the "All vaccinations are bad" army but i am opposed to forcing people into taking a vaccination against a disease that pose no lethal threat to them and that is unfortunately what some employers are doing. Flu is a annoying disease, yes but is is not lethal to the average person. You, as a professional, must know that the risk you are talking about reducing for you and your son doesn't exist. The "risk" is a week in bed more or less nothing else, unless off course you are suffering from some disease that has weakned you.

The other thing is that we over here HAS been in the situation where those really needing the shot couldn't get it because "healthy" people had used up all the vaccine.

I am by no means against vaccinations, my kids have had them all, MFR - Meningitis ... you name it and i have too but as a normal healthy person i will not take a flu shot just because my boss is afraid that i might stay home for a week.

[Skeptic Ginger]

I an definitely not a member of the "All vaccinations are bad" army but i am opposed to forcing people into taking a vaccination against a disease that pose no lethal threat to them and that is unfortunately what some employers are doing. Flu is a annoying disease, yes but is is not lethal to the average person. You, as a professional, must know that the risk you are talking about reducing for you and your son doesn't exist. The "risk" is a week in bed more or less nothing else, unless off course you are suffering from some disease that has weakned you.
....I addressed the shortage issue, see my previous posts. Regarding the week in bed thing, believe what you want. The actual data is the influenza virus causes serious disease including pneumonia and death. If you think that isn't the case then post some actual science not your misinformed opinion.

Regarding the "being forced to get a flu shot", do you work in a hospital or other health care setting? That is the only adult vaccine requirement I can think of which fits your description. In the case of hospitals and other health care inpatient settings, the evidence is the staff bring the flu virus into the hospital and patients become infected. Some of them then die from the infections they acquired from the health care provider. Just as hospitals strive to decrease the spread of nosocomial infections to the patients by having health care workers practice good infection control technique, employers have every right to require employees get flu shots to protect the patients. Employees have to by law get TB skin tests to work in the hospitals here. The employees superstitious beliefs about flu vaccinations is not a sufficient reason to put patients at risk. Go work somewhere else if you think it infringes on your rights. What about the rights of the patients not to be put at risk because of someone's superstitious fears?

And like it or not, the recommendations come from a panel of experts who do a thorough evaluation of the research. The fact some not-even-medically-educated maybe not-even-college-graduates believe they personally are more qualified and have done a more thorough job of reviewing the literature does not place the opinions of the experts in question.

[Ivor the Engineer]

Here's what another expert thinks about the evidence for flu vaccination:

http://www.bmj.com/cgi/content/full/333/7574/912

Summary points
Public policy worldwide recommends the use of inactivated influenza vaccines to prevent seasonal outbreaks

Because viral circulation and antigenic match vary each year and non-randomised studies predominate, systematic reviews of large datasets from several decades provide the best information on vaccine performance

Evidence from systematic reviews shows that inactivated vaccines have little or no effect on the effects measured

Most studies are of poor methodological quality and the impact of confounders is high

Little comparative evidence exists on the safety of these vaccines

Reasons for the current gap between policy and evidence are unclear, but given the huge resources involved, a re-evaluation should be urgently undertaken

The optimistic and confident tone of some predictions of viral circulation and of the impact of inactivated vaccines, which are at odds with the evidence, is striking. The reasons are probably complex and may involve "a messy blend of truth conflicts and conflicts of interest making it difficult to separate factual disputes from value disputes"22 or a manifestation of optimism bias (an unwarranted belief in the efficacy of interventions).23

ETA: http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17443504&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVDocSum

Vaccines for preventing influenza in healthy adults.

BACKGROUND: Different types of influenza vaccines are currently produced world-wide. Healthy adults are at present targeted only in North America. Despite the publication of a large number of clinical trials, there is still substantial uncertainty about the clinical effectiveness of influenza vaccines and this has a negative impact on their acceptance and uptake. OBJECTIVES: To identify, retrieve and assess all studies evaluating the effects (efficacy, effectiveness and harms) of vaccines against influenza in healthy adults. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 4, 2005) which contains the Cochrane Acute Respiratory Infections Group trials register; MEDLINE (January 1966 to January 2006); and EMBASE (1990 to January 2006). We wrote to vaccine manufacturers and first or corresponding authors of studies in the review. SELECTION CRITERIA: Any randomised or quasi-randomised studies comparing influenza vaccines in humans with placebo, no intervention. Live, attenuated, or killed vaccines or fractions of them administered by any route, irrespective of antigenic configuration were assessed. Only studies assessing protection from exposure to naturally occurring influenza in healthy individuals aged 16 to 65 years were considered. Comparative non-randomised studies were included if they assessed evidence of the possible association between influenza vaccines and serious harms. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial quality and extracted data. MAIN RESULTS: Forty-eight reports were included: 38 (57 sub-studies) were clinical trials providing data about effectiveness, efficacy and harms of influenza vaccines and involved 66,248 people; 8 were comparative non-randomised studies and tested the association of the vaccines with serious harms; 2 were reports of harms which could not be introduced in the data analysis.Inactivated parenteral vaccines were 30% effective (95% CI 17% to 41%) against influenza-like illness, and 80% (95% CI 56% to 91%) efficacious against influenza when the vaccine matched the circulating strain and circulation was high, but decreased to 50% (95% CI 27% to 65%) when it did not. Excluding the studies of the 1968 to 1969 pandemic, effectiveness was 15% (95% CI 9% to 22%) and efficacy was 73% (95% CI 53% to 84%). Vaccination had a modest effect on time off work, but there was insufficient evidence to draw conclusions on hospital admissions or complication rates. Inactivated vaccines caused local tenderness and soreness and erythema. Spray vaccines had more modest performance. Monovalent whole-virion vaccines matching circulating viruses had high efficacy (VE 93%, 95% CI 69% to 98%) and effectiveness (VE 66%, 95% CI 51% to 77%) against the 1968 to 1969 pandemic. AUTHORS' CONCLUSIONS: Influenza vaccines are effective in reducing cases of influenza, especially when the content predicts accurately circulating types and circulation is high. However, they are less effective in reducing cases of influenza-like illness and have a modest impact on working days lost. There is insufficient evidence to assess their impact on complications. Whole-virion monovalent vaccines may perform best in a pandemic.

[Dabljuh]

Vaccines in general are just as bunk as Homeopathy; The originating theories behind vaccination and homeopathy are related to each other. Vaccination just turned out to make more money (you give "medicine" to the healthy) when for homeopathy as a faux remedy better medications became available. There's way too little high-quality research in that direction, and too much research designed by pharma Marketing teams. More doctors however buy into the vaccination theory (which has some realistic concepts behind it) than homeopathy, but they both don't work other than to give quacks an income. Except that there's a significantly greater risk involved with vaccines than is with homeopathy.

The pharmaceutical industry is making an assload of money with vaccines. "Shortages" only serve to inflate prices, combined with the annual scaremongering. There's no such thing as a free lunch, vaccines are usually patented and trademarked, if you *appear* to get a free shot, it's government or employer paying for it. Which means, in both cases, in the end you pay, but even if you refuse the shot, you pay. Unfair? Talk to your employer/representative.

All the "zomg the one year I didn't take a flu shot I got the flu" stories are statistically improbable. I consider a mix of the following scenarios: Someone is paying to plant opinion here (Call it the Pharma PR brigade) or the other problem. Someone who has had a flu shot by definition can't get the flu, so the same symptoms are classified and diagnosed as something else. When you go to the doctor with flu symptoms and tell him "Dude I didn't get my flu shot this year" then you have the flu. When you have flu symptoms and had the flu shots, you get diagnosed with something else. Differential diagnosis, baby!

[Deetee]

Vaccines in general are just as bunk as Homeopathy; The originating theories behind vaccination and homeopathy are related to each other. Vaccination just turned out to make more money (you give "medicine" to the healthy) when for homeopathy as a faux remedy better medications became available. There's way too little high-quality research in that direction, and too much research designed by pharma Marketing teams. More doctors however buy into the vaccination theory (which has some realistic concepts behind it) than homeopathy, but they both don't work other than to give quacks an income. Except that there's a significantly greater risk involved with vaccines than is with homeopathy.
Well, we know from your previous form that you do not base any of your opinions on facts or evidence, so I am entirely unsurprised that you are talking gibberish.

The pharmaceutical industry is making an assload of money with vaccines. "Shortages" only serve to inflate prices, combined with the annual scaremongering. There's no such thing as a free lunch, vaccines are usually patented and trademarked, if you *appear* to get a free shot, it's government or employer paying for it. Which means, in both cases, in the end you pay, but even if you refuse the shot, you pay. Unfair? Talk to your employer/representative.
Pharmaceutical companies make money from their products. Homeopathic producers make money too. The margins on the former are minimal, on the latter quite huge.
I understand some manufacturers have given up trying to compete in the vaccine market, because profits are not great, and R&D costs are high (homeopaths never have this problem).
Certainly I accept that Pharma companies will try to maximise profits, sometimes using tactics that verge on the amoral/illegal, or rarely even using illegal means.

All the "zomg the one year I didn't take a flu shot I got the flu" stories are statistically improbable. I consider a mix of the following scenarios: Someone is paying to plant opinion here (Call it the Pharma PR brigade) or the other problem. Someone who has had a flu shot by definition can't get the flu, so the same symptoms are classified and diagnosed as something else. When you go to the doctor with flu symptoms and tell him "Dude I didn't get my flu shot this year" then you have the flu. When you have flu symptoms and had the flu shots, you get diagnosed with something else. Differential diagnosis, baby!
Strangely, your "flame" about flu diagnosis is probably the only thing you have said which is true. This scenario can often happen.

BTW - Which poster/s do you think are being "paid to plant opinion here" by Pharma?

[Dabljuh]

I'm not pointing fingers.* Just the sheer number of posts of the virtually same story is suspicious.

Do you think no one here is paid to plant opinion as a viral marketing scheme? Companies pay 6 digits and more for their web site that no one looks at. Would you think that they didn't pay anyone to plant things at sites that people do look at?

And I'm not even thinking of a gullible doctor who simply repeats whatever marketing crap he was conned with at his seminars. But that's part of viral marketing too. It's fake mouth to mouth propaganda.

I'm just thinking of Wikipedia. What's the percentage of paid, intellectually dishonest marketing folks in the top 1000 editors there?

As someone who has been there both as an observer and participants, I'd say you get close to 30-50% near the top 50 and still a two digit figure in the top 500. Some people are just addicted. But its an addiction to both learning and communication (both are basic drives, instincts to speak) too many are way dishonest. Of course to be good at this, one cannot too stubbornly give away his paid-for stance. It's simple enough to dismiss any counterarguments and go on to discredit the other source.

Or what you also did. You give me right with the false diagnosis problem, saying it was the only thing that was true in my post. Right. The only thing. Incompetent doctors are the problem, not the Pharma industry. <points finger>*

Poor poor pharma companies and their low low return of investments. We should have the government give subsidies to them. Maybe we can force everyone to use their products. Lets make it something that at least sounds sensible. Like forcing every kid to be vaccinated before it can enter a public school?

*Well I guess I am pointing fingers now after all

[ZirconBlue]

Do you think no one here is paid to plant opinion as a viral marketing scheme?

Perhaps, but, luckily, must of us have had the vaccine.

[Deetee]

The type of forum in which I would expect some Pharma "mole" to be planting information/disinformation would be one of the numerous outlets for medical advice/help/opinion. The JREF is quite a unique board, and the science/medicine threads are not where posters come to seek advice. Indeed, each time someone has raised an issue about medical problems they usually get told to go see a doctor and not rely on information from the net.

I have never encountered anyone remotely promoting any particular pharmceutical company's agenda here.


Or what you also did. You give me right with the false diagnosis problem, saying it was the only thing that was true in my post. Right. The only thing. Incompetent doctors are the problem, not the Pharma industry. <points finger>*


So I get it, because I siad that misdiagnosis and mislabelling of flu-like illnesses occurs, this puts me into the camp of a Pharma mole trying to lay the blame on incompetent doctors not the Pharma industry?

FYI, I actually am a doctor, and have never been in the employ of a Pharma company, and I have just been pointing out bad Pharma tactics in the NHS homeopathy thread, if you care to look.

So come on, which of us are the Pharma moles?

[fls]

Someone is paying to plant opinion here (Call it the Pharma PR brigade)

I made six figures last year, just from my postings on the JREF. Skeptigirl makes more posts on this subject because she's a nurse and gets paid less than physicians (for an equivalent amount of work). I'll probably move on to some other forums next year. My oldest child is in high school and I need to be able to pay for university soon.

I also receive support from a few other conglomerates. Nobody in their right mind would willingly support universal health care unless their pockets were lined.

Linda

[Ivor the Engineer]

The risk/rationality analogy is not that someone is rational if he will bet £26 hoping the 100 to one shot comes in, but that he is rational betting £26 as insurance against the possibility that the 100 to one shot does come in (an outcome he does not wish to happen), -just in case.

The question then becomes one of choice regarding the percieved risks - Is it really 100 to one? Can I afford to risk having no insurance/protection? What if it is 1000 to one, or 10 to one - will my choice be the same?
What if the risks are slight even if the horse comes in - do I risk death if it does, or just a minor inconvenience?

If the risk of death is high, then I may choose to insure myself against what may be extremely long odds - that is rational. E.g., The risk of catching HIV from a single sexual exposure with someone whose HIV status is unknown is probably something like one hundred thousand to one in the UK. But catching HIV could kill you, so rational(?) people use protective methods.
If on the other hand the illness one risks catching is trivial, then one may choose to entertain quite short odds, say 10 to one, and choose to not have protection.

We continually face a large variety of risks in life. We can choose to run the risk of some things, like driving as opposed to walking. Some risks are necessary to run, just for us to enjoy a decent life on this earth. Vaccinations are mostly actions that protect against risks - for some diseases it's a no-brainer, for others like flu or chickenpox the benefits may be less clear. There is sufficient evidence to point to the benefits of flu vaccine in the elderly, so that is something I would have/recommend. That's my opinion. Having the vaccine costs very little in terms of risks and in the UK it is free.

Sure, other things might work out as more cost-effective interventions in a health care setting. Perhaps the answer is to charge for vaccines, so their costs are covered in some way?

Regarding risks, people also chose to run risks if they feel they can control whether they will experience the adverse event. So people drive, thinking "I'm a skillful driver, if something happens I am in control and can react/avoid the accident". In an aeroplane, there is no control factor, so some are irrationally afraid to fly, but happily drive like maniacs on the road.

This philosophy is often pure kidology, but its a factor in what we chose to do each day. Catching diseases can be viewed in this way too - we might say "But I can chose my sexual partners with care - the chance she has an STD will be very small". But with droplet or airborne infections such as flu, measles or chicken pox it is harder to predict exposure.

Excellent post, Deetee.

With regards to charging for vaccinations, I definitely think for vaccination of under-14's against chickenpox it would be worth while considering.

[Professor Yaffle]

I made six figures last year, just from my postings on the JREF. Skeptigirl makes more posts on this subject because she's a nurse and gets paid less than physicians (for an equivalent amount of work). I'll probably move on to some other forums next year. My oldest child is in high school and I need to be able to pay for university soon.

I also receive support from a few other conglomerates. Nobody in their right mind would willingly support universal health care unless their pockets were lined.

Linda

Skeptigirl hardly makes any money from this. She just posts because a doctor ordered her to.

[Ivor the Engineer]

I made six figures last year, just from my postings on the JREF. Skeptigirl makes more posts on this subject because she's a nurse and gets paid less than physicians (for an equivalent amount of work). I'll probably move on to some other forums next year. My oldest child is in high school and I need to be able to pay for university soon.

I also receive support from a few other conglomerates. Nobody in their right mind would willingly support universal health care unless their pockets were lined.

Linda

Damn right.

http://www.time.com/time/magazine/article/0,9171,716812,00.html

Monday, Oct. 29, 1923

Fourteen thousand " panel" doctors serving 15,000,000 people under the British national health insurance scheme voted to strike Jan. 1 if a cut in their stipend proposed by the Government is ordered. Under the National Insurance Act adopted when David Lloyd George was Chancellor of the Exchequer in 1911, five parties are concerned—insured workingmen, employers, insurance societies, doctors, the Government.

When employed, workmen contribute five pence a week to the National Health Fund, women four pence. Employers duplicate these amounts. The workmen must join an "approved society"—fraternal or commercial insurance organizations. The physicians who take insurance practice are assigned a panel of patients to whom they undertake to give all necessary medical service. They have been receiving 9s. 6d. a year for each patient, of which the approved societies pay seven shillings three pence, the Government making up the remainder. The Government is now in financial straits and proposes that the panel doctors' fee be 8s. 6d. per patient, the societies to pay all of this. The societies urge a still further reduction to the pre-War figure of 7 shillings.

The panel doctors flatly refuse any cut. They declared they will resign in a body and have appointed a Strike Committee of 200 practitioners. They are backed up in their fight against "medical slavery" by the British Medical Association and its organ the British Medical Journal. Health insurance was initiated in Germany some 25 years ago and has been widely introduced in Europe. But it has generally been opposed by the medical profession, and with particular violence in the U. S.

You physicians can be a testy lot, can't you?

:D

[fls]

I made six figures last year, just from my postings on the JREF. Skeptigirl makes more posts on this subject because she's a nurse and gets paid less than physicians (for an equivalent amount of work).

Skeptigirl hardly makes any money from this. She just posts because a doctor ordered her to.

<giggle>

You win.

Linda

[Dabljuh]

The type of forum in which I would expect some Pharma "mole" to be planting information/disinformation would be one of the numerous outlets for medical advice/help/opinion. The JREF is quite a unique board, and the science/medicine threads are not where posters come to seek advice. Indeed, each time someone has raised an issue about medical problems they usually get told to go see a doctor and not rely on information from the net.Right. This forum would not be targeted. Since viral marketing only works in places where you'd expect to be marketed, right.
I have never encountered anyone remotely promoting any particular pharmceutical company's agenda here.Erectile problems? Buy Viagra! This post has been brought to you by Pfizer!

(Oh and get a flu shot while you're on the way. There's so many different flu shots to choose from...)
FYI, I actually am a doctor, and have never been in the employ of a Pharma company, and I have just been pointing out bad Pharma tactics in the NHS homeopathy thread, if you care to look.Right, since a marketing outlet specialized on pharmaceuticals would never hire a doctor. Most doctors do... doctory stuff. They wouldn't post in forums, Ever. Especially not to advocate things.

[Dymanic]

Most of the research does show large droplet spread and very little aerosol.

Some of the research found aerosol.

Conclusion, some strains can be more infectious, not all strains are.That looks to me like a hasty conclusion, particularly considering the sparcity of the data.

It isn't a "back and forth" issue. That's what I tried to tell you in the beginning of this exchange.And what I've tried to tell you all along is that the issue regarding the mechanical details of influenza transmission is viewed as very much a back-and-forth one by a great many well-qualified others. That you could look at the reveres' comments and return with the impression that their statements confirm your position that strong conclusions are justified by the existing science suggests to me that further efforts on my part are more likely to upset you than disuade you, so I'm going to give it a rest. After this last word, of course:

So far, everything you have offered by way of support for the above conclusion has to do with pandemic influenza. That is where a lot of the research action has been recently, and the intensity of this focus has provided new hints toward the solving of some old puzzles, but some of the results are rather subject to overinterpretation, which is what I see you doing. I don't see it as being at all clear how the results of studying pandemic influenza extrapolate to seasonal influenza.

It may very well be that the prevalence of airborne versus droplet transmission does vary markedly from one seasonal strain to another. It may also be that this variation in transmissibility has more to do with genetic variation in the viral genome than with, say, patterns of pre-existing immunity in host populations. I think it would be VERY difficult to conclusively demonstrate either of one of these propositions, and I don't see you as having come anywhere near having done so, not the least reason being the size of the gap between the sequencing of a genome and the application of knowledge thusly aquired toward making predictions at a level of complexity above that of a "live" virus; that is, at the level of the dynamic interaction between a viral swarm and a population of hosts.

But, hypothetically, let's suppose you had.

Does this influence the way we respond to someone like Hardenbergh, whose -- "sincere belief that frequent handwashing equals or surpasses the benefits of a flu shot" -- triggered this cascade of dialogue? Can we easily agree with Deetee, who suggested: "hand washing is highly unlikely to prevent direct infection from a contact"? Isn't that now the sort of thing that's going to vary unpredictably from one year to the next with the degree to which the currently circulating strains are airborne? Given the ever-present realities of finding a balance between what would be ideal and what resources are available, does our new found insight make the task of standardizing infection control measures easier, or harder?


Discussions on seasonal influenza do have a tendency to gravitate toward pandemic influenza, and (obviously) I find it hard to resist that pull myself, but I do think the quality of the discussions can suffer from all the constant toggling between the two. Maybe it would help to return briefly to the questions in the opening post in this thread, started over a year ago:

Are flu shots just another money making gimmick?Pharmaceutical companies have enormous resources, but they're expensive resources. Decisions must constantly be made as to what are the best (i.e., the most profitable) use of these resources. Because strains of influenza virus are constantly mutating, each year's output of product becomes worthless at the end of the season, at which time millions of unused doses are typically destroyed. Uptake of flu vaccines tends to be somewhat sporadic and therefore difficult to predict, with many people opting out of the flu vax, a surprising number of them basing this decision on one of the most persistent of all urban myths: the notion that you can get the flu from the vax. The end result is that production of influenza vaccine is among the least profitable uses to which a pharmaceutical company can dedicate its resources, and all but a handful of companies choose not to bother with it at all. So if it's a gimmick, it's not a particularly clever one.

Do they protect only against previous years strains and are not effective against yet unknown strains?That depends on just how 'unknown' the unknown strains are. Exposure to viral antigen (whether it's from vaccination or infection) stimulates a humoral immune response which results in production of antibodies specific to those antigens. Just how much those antibodies will cross-react with other antigens depends on how similar they are to the ones previously encountered.

Is real influenza pretty rareIt is usually estimated that somewhere between 5 and 20 percent of the population gets the flu during a typical season. Is that "rare"?

and when most people say the got the flu the didn't have it and it was not something that would have been stopped by the shot.I think it's wise to take a cautious approach in general to what most people say, but if what they said was they had the flu, and what they actually had was something else (which is something which surely happens a LOT), then that's hardly an indictment against a vaccine designed to prevent Influenza.

[Skeptic Ginger]

Here's what another expert thinks about the evidence for flu vaccination:

http://www.bmj.com/cgi/content/full/333/7574/912
ETA: http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17443504&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVDocSum

Ivor, we've been over that stuff in this thread already. How many times are you going to repost the same stuff?

The Cochrane review is not the magical definitive result in all cases and it's been discussed. Go back through the thread. In addition, research supporting the flu vaccinations has been posted here.

[Skeptic Ginger]

I made six figures last year, just from my postings on the JREF. Skeptigirl makes more posts on this subject because she's a nurse and gets paid less than physicians (for an equivalent amount of work). I'll probably move on to some other forums next year. My oldest child is in high school and I need to be able to pay for university soon.

I also receive support from a few other conglomerates. Nobody in their right mind would willingly support universal health care unless their pockets were lined.

LindaI've thought about changing my profession to 'secret shopper'. I hear they have more fun than information planters.

[Skeptic Ginger]

That looks to me like a hasty conclusion, particularly considering the sparcity of the data.Sparcity of data? Try 100 years of epidemiology. On average every year between 10-30% of the population in North America contract influenza. Just what is it you think you are going to change with this research we have yet to undertake?

I already said I agree with you 100% that health care worker protection is seriously ignored on the research front.

I'll get to the rest of your post later. I need a cookie.

[Ivor the Engineer]

Ivor, we've been over that stuff in this thread already. How many times are you going to repost the same stuff?

The Cochrane review is not the magical definitive result in all cases and it's been discussed. Go back through the thread. In addition, research supporting the flu vaccinations has been posted here.

I think the point is that the research is generally of poor quality, but few seem to mind because it supports their existing beliefs about the effectiveness of the flu shot.

Here's what Tom Jefferson had to say to the critics of his article in the BMJ:

http://www.bmj.com/cgi/eletters/333/7574/912

Author’s response (Tom Jefferson, Coordinator, Cochrane Vaccines Field)

The responses by Mandl, Fedson and Nichol, Nicoll et al and Griffith all have one common theme: the authors’ obstinate refusal to look in a dispassionate fashion at the totality of comparative evidence of the effects of inactivated vaccines for seasonal influenza. My analyses was based on 206 studies (several million observations’ worth of data) included in systematic reviews spanning some 40 years. No one so far has challenged my key conclusion that the optimistic WHO statement that vaccination of the elderly reduces the risk of serious complications or of death by 70%-85% is not based on evidence.

The interesting hypotheses by Mandl and Griffith do not fit some of the evidence in the elderly population. They cannot explain how in years of good matching between vaccine antigenic content and circulating viruses the vaccines fail to prevent deaths from all respiratory diseases in elderly community dwellers (1.32, 95% CI 1.25 to 1.39, 426668 observations) while at the same time preventing 42% (25% to 55%, 404759 observations) of deaths from all causes1, presumably including deaths from falls, accidental poisoning, accidents, hypothermia and so on.

Fedson and Nichol deride my choice of example of poor methodological quality of a large number of available cohort studies: failure to report vaccine content, its match to circulating viruses and the level of circulation. The authors of the studies either did not know such details or like Fedson and Nichol thought them irrelevant and would leave a reader -Sherlock Holmes to work them from “official records”. Vaccine matching and level of circulating influenza viruses are the most important predictor of vaccine efficacy and effectiveness. The closer the match and the higher the viral circulation, the better the performance of the vaccine2. Without such knowledge it would be very difficult to give an honest and reliable assessment of the effects of the vaccine. That is one of the reasons why these studies are of poor quality.

I note with worry their statement that decisions should be made on three of the most notoriously biased sources of information: non- randomised studies, expert opinion and economic evaluations3 4. It is precisely because the vast majority of comparative evidence on the elderly comes from non-randomised studies that we are left with the question: are the effects we witness due to the vaccines or are they due to confounding? The tone of the response by Fedon and Nichol (lack of vaccines’ effect in small children is “undoubtedly due to small numbers” and my concern over “lack of vaccine safety data” a statement from which they conveniently omitted the key word “comparative”) would suggest that my review appeared to be questioning a dogma. Heretics like me get short shrift.

I repeat my statement that especially in the elderly there are at present an insufficient numbers of field trials (5, of which only one has been carried out in the last decade) to allow reasonable certainty of the effects of inactivated vaccines. The nature of the evidence from non- randomised designs when analysed critically and exhaustively is weak and contradictory. I repeat my observation that the totality of safety evidence from comparative (i.e. studies in which a proportion of participants were contemporaneously exposed or not to the vaccines) sources is tiny in small children (35 observations) and small in the elderly (2963 observations).

Nicoll and co-authors claim that there is little new in my review. Certainly the evidence I quote has been in the public domain for some time. So why has an independent policy evaluation not taken place before? Such an evaluation is welcome but I fear it may take the guise of a descriptive (e.g. ecological) or non-randomised design (i.e. retrospective cohort). If that were the case, we may have to find out whether inactivated influenza vaccines do protect vulnerable people in potentially the most disagreeable and inhuman way: the hard way.

Tom Jefferson
Coordinator
Cochrane Vaccines Field

1. Rivetti D, Demicheli V, Di Pietrantonj C, Jefferson TO, Thomas R. Vaccines for preventing influenza in the elderly. The Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD004876. DOI: 10.1002/14651858.CD004876.

2. Demicheli V, Rivetti D, Deeks JJ, Jefferson TO. Vaccines for preventing influenza in healthy adults. The Cochrane Database of Systematic Reviews 2004, Issue 3. Art. No.: CD001269.pub2. DOI: 10.1002/14651858.CD001269.pub2.

3. Kunz R, Oxman AD. The unpredictability paradox: review of empirical comparisons of randomised and non-randomised clinical trials. BMJ 1998; 317; 1185-1190

4. Jefferson T, Demicheli V, Vale L. Quality of systematic reviews of economic evaluations in health care JAMA2002; 287 (21): 2809-2812.

Competing interests: TJ owned shares in Glaxo SmithKline and received consultancy fees from Sanofi- Synthelabo (2002) and Roche (1997-1999).

It seems to me, skeptigirl, that you are totally and utterly convinced the flu vaccine is worth the effort, and no amount of evidence would convince you otherwise.

What is quite funny is the way you and a few other "sceptics" here brush off the expert, (peer-reviewed) reviews of the evidence I post links to, often with a single sentence, using my lack of expertise in the area as a flaw of the study, as though the studies are crap simply because I found them!

For example, you are quick to say:

"The Cochrane review is not the magical definitive result in all cases..."

when it refutes your claims for the effectiveness of the flu vaccine, but I'm sure if it had the "correct" conclusion it would be one of the strongest pieces of evidence available.

[robinson]

Of course. This is called "evidence based medicine".

[Eos of the Eons]

What the FRAC is viral marketing???

Who wants to buy my newly warped chicken pox that no vaccine can protect you from? I mutated it myself with Kryptonite.. and am working on the vaccine right now. Everyone will want my vaccine after my shiny new virus kills some 10 thousand people. Mwah haaaaaa haaaa haaaaaaa!!!

[robinson]

Viral marketing used to be called word of mouth advertising. The idea is that if people believe the product is good, they will pass along the marketing message voluntarily, causing it to spread, like a virus.

I'm hoping you already know this, and are just being funny. :D

[Eos of the Eons]

Sure, but how is Dab using the term? I don't get most of his ramblings, especially what he is going on about viral marketing.

[robinson]

Ah, I missed that. It seems to be in reference to how ardent some are here at supporting flu shots no matter what evidence is presented. Don't you wish somebody would pay you for all the time you wast... um... spend here educating people and stuff?

[Skeptic Ginger]

There actually was a marketing scheme he is referring to, Eos. It was for some youth consumer market. I'll see if I can Google it.

[Skeptic Ginger]

Here's a newer version.

a new era for advertisers, in which commercials are replaced by messages planted in online conversations between friends. (http://www.ft.com/cms/s/0/01341240-8cbd-11dc-b887-0000779fd2ac,dwp_uuid=e8477cc4-c820-11db-b0dc-000b5df10621.html)

I'll keep looking for the pioneer event and the product they were selling.

[robinson]

Gibson wrote about this in Pattern Recognition. (http://en.wikipedia.org/wiki/Pattern_Recognition_%28novel%29)

Lonely Girl from YT is an example of viral marketing.

[Skeptic Ginger]

Here's another one, still not the original though.

Sony pays PR firm to lie about wanting a PSP for Christmas (http://www.videogamesblogger.com/2006/12/12/sony-pays-pr-firm-to-lie-about-wanting-a-psp-for-christmas-terrible-rapsong-video-included.htm)

[Eos of the Eons]

So, why is dab mentioning it, and in what context, for in this thread? He's the only one advertising, and for Viagra of all things. What is his point exactly?

[Skeptic Ginger]

So, why is dab mentioning it, and in what context, for in this thread? He's the only one advertising, and for Viagra of all things. What is his point exactly?I missed the Viagra reference. Dab implied I was a drug company chat plant:

I'm not pointing fingers.* Just the sheer number of posts of the virtually same story is suspicious.

Do you think no one here is paid to plant opinion as a viral marketing scheme? Companies pay 6 digits and more for their web site that no one looks at. Would you think that they didn't pay anyone to plant things at sites that people do look at?

And I'm not even thinking of a gullible doctor who simply repeats whatever marketing crap he was conned with at his seminars. But that's part of viral marketing too. It's fake mouth to mouth propaganda.

I'm just thinking of Wikipedia. What's the percentage of paid, intellectually dishonest marketing folks in the top 1000 editors there?

As someone who has been there both as an observer and participants, I'd say you get close to 30-50% near the top 50 and still a two digit figure in the top 500. Some people are just addicted. But its an addiction to both learning and communication (both are basic drives, instincts to speak) too many are way dishonest. Of course to be good at this, one cannot too stubbornly give away his paid-for stance. It's simple enough to dismiss any counterarguments and go on to discredit the other source.

Or what you also did. You give me right with the false diagnosis problem, saying it was the only thing that was true in my post. Right. The only thing. Incompetent doctors are the problem, not the Pharma industry. <points finger>*

Poor poor pharma companies and their low low return of investments. We should have the government give subsidies to them. Maybe we can force everyone to use their products. Lets make it something that at least sounds sensible. Like forcing every kid to be vaccinated before it can enter a public school?

*Well I guess I am pointing fingers now after allThen Linda just caved and let all the cats out of the bags.
:bigcat :bigcat :bigcat :bigcat



I forgot to comment on the, "gullible doctor who simply repeats whatever marketing crap he was conned with at his seminars". There must also be a conspiracy to keep people like you out of med school, eh Dabljuh? I bet it's frustrating to know with your superior intellect you could out do the best of them, but there's that darn screening process the pharmaceutical companies control. They only want dupes. Except the neurosurgeons. They do let in would be doctors who might make good neurosurgeons even if they aren't dupes. Maybe you could be a neurosurgeon, Dabljuh.

[Ove]

I addressed the shortage issue, see my previous posts. Regarding the week in bed thing, believe what you want. The actual data is the influenza virus causes serious disease including pneumonia and death. If you think that isn't the case then post some actual science not your misinformed opinion.

Regarding the "being forced to get a flu shot", do you work in a hospital or other health care setting? That is the only adult vaccine requirement I can think of which fits your description. In the case of hospitals and other health care inpatient settings, the evidence is the staff bring the flu virus into the hospital and patients become infected. Some of them then die from the infections they acquired from the health care provider. Just as hospitals strive to decrease the spread of nosocomial infections to the patients by having health care workers practice good infection control technique, employers have every right to require employees get flu shots to protect the patients. Employees have to by law get TB skin tests to work in the hospitals here. The employees superstitious beliefs about flu vaccinations is not a sufficient reason to put patients at risk. Go work somewhere else if you think it infringes on your rights. What about the rights of the patients not to be put at risk because of someone's superstitious fears?

And like it or not, the recommendations come from a panel of experts who do a thorough evaluation of the research. The fact some not-even-medically-educated maybe not-even-college-graduates believe they personally are more qualified and have done a more thorough job of reviewing the literature does not place the opinions of the experts in question.

Sorry i dont think you understand. I live in DENMARK. Things are quite different over here and mostly to the better ;) IF you had bothered to look up my data in stead of releasing a bucket of venom you 'might have found an explanation to the differencies. Some compagnies over here HAVE made attempts to bully their employees into taking the shot and frankly i fail to see how you should know anything about that and NO I AM NOT TALKING ABOUT HOSPITAL STAFF or other care related jobs but industrial work.

Do i make myself clear?

And before you put your head too much at rest at that pillow called "a panel of experts" let me remind you that american "panel of experts" during the last century has made a number of ga-ga recommendations. Example: Lobotomy in much too many cases, Male circumsion to prevent penile cancer, Thalidomid against pains during pregnancy, DDT Powdering over entire cities to wipe out bugs, ..... The list is endless

But to your information. The Danish "Serum institute" which is a goverment fundet medical board advises to vaccinate.

1.People over 65 and residents at nursing homes and similar
2.People with lung diseases and heart/cardial diseases.
3.People with aquiered or obtained defects in their immune system
4.People working in health care, educational institutions and day care.

Period......

[Professor Yaffle]

And before you put your head too much at rest at that pillow called "a panel of experts" let me remind you that american "panel of experts" during the last century has made a number of ga-ga recommendations. Example: Lobotomy in much too many cases, Male circumsion to prevent penile cancer, Thalidomid against pains during pregnancy, DDT Powdering over entire cities to wipe out bugs, ..... The list is endless


Uh oh... He's mentioned the C word...

;)

[robinson]

Be sure and focus on that, and ignore everything else.

[Dabljuh]

Wow, Skeptigirl, here I was, thinking that the entire system of academia (Which I have visited for a few years) was entirely built up on

Breach of Rule 9 removed.

And then you come here and destroy my opinion on academia with one single argument. Neurosurgeons. Bravo. Why didn't I think of that.

[Chris Haynes]

...And before you put your head too much at rest at that pillow called "a panel of experts" let me remind you that american "panel of experts" during the last century has made a number of ga-ga recommendations. Example: ..., Thalidomid against pains during pregnancy, ...
.......

Ove, enlighten me... All this time I was under the impression that the USA was one country that did not allow thalidomide to be approved for sale (though it is now approved for certain things, like leprosy (http://www.fda.gov/cder/news/thalinfo/default.htm)). Did someone actually disregard Dr. Frances Kelsey's (http://www.fda.gov/fdac/features/2001/201_kelsey.html)concerns?

[fls]

Ove,

I just wanted to give you a quick heads-up, so you have a chance to edit your post before Skeptigirl sees it. You won't help your case if you say a bunch of stuff that is wrong. For example, thalidomide was never approved in the US, let alone for pregnancy pains, expert panels recommend against the use of circumcision for the purpose of preventing penile cancer, etc.

Hope this helps.

Linda

[fls]

Dabljuh,

If that's what you spent all your time doing during your brief stint in academia, it would explain quite a lot. ;)

Linda

[Ivor the Engineer]

Uh oh... He's mentioned the C word...

;)

I wondered why the flashing light and claxton had gone off.

Just to clarify Linda's misunderstanding (or is it misdirection - she might be being paid to plant false info.;)) of Ove's claim, US doctors did promote circumcision for many years on shaky or no evidence. Only since the 1970's have professional bodies there started to say it's not worth while (medically).

As an interesting little aside, I've recently purchased Gray's Anatomy for Students. Looking at the section on male genitalia, there is no mention or photos of the prepuce at all! Even in my other (American) anatomy book, the only mention of the male prepuce is along the lines of "this is the bit which is removed during circumcision." Medical students in the US must think foreskin on a male child is a deformity which needs to be removed, kind of like a 6th finger.

[Dabljuh]

Ivor, but we must unquestioningly accept all opinions from people who are obviously better educated on the subject than we are. After all that is the true path of a skeptic!

[Dabljuh]

Dabljuh,

If that's what you spent all your time doing during your brief stint in academia, it would explain quite a lot. ;)

LindaLook, the problem is intrinsic to any system where new members are selected by and through the old members.

I'm almost certain there's a specific name for that sociological phenomenon. Does anyone know the name for that, so it can be googled?

[fls]

Look, the problem is intrinsic to any system where new members are selected by and through the old members.

...must...resist...

...circumcision...joke...bad...

...very bad...

[Ivor the Engineer]

Look, the problem is intrinsic to any system where new members are selected by and through the old members.

I'm almost certain there's a specific name for that sociological phenomenon. Does anyone know the name for that, so it can be googled?

In-Group bias.

[Dabljuh]

How about "Groupthink"

[Dabljuh]

How about "Groupthink"

"Groupthink" and "Academia" produce some highly interesting results on google.

[Ivor the Engineer]

I think groupthink is a pretty good description of what goes on here.

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

Symptoms of groupthink

In order to make groupthink testable, Irving Janis devised eight symptoms that are indicative of groupthink (1977).

1. Illusions of invulnerability creating excessive optimism and encouraging risk taking.

2. Rationalising warnings that might challenge the group's assumptions.

3. Unquestioned belief in the morality of the group, causing members to ignore the consequences of their actions.

4. Stereotyping those who are opposed to the group as weak, evil or stupid.

5. Direct pressure to conform placed on any member who questions the group, couched in terms of "disloyalty".

6. Self censorship of ideas that deviate from the apparent group consensus.

7. Illusions of unanimity among group members, silence is viewed as agreement.

8. Mindguards — self-appointed members who shield the group from dissenting information.

Go take a look at the "6 Reasons to Question Vaccinations" thread and see how many of the above tactics you can spot being used against me (and a few others), to a greater or lesser extent.

Can you spot who in the medical threads takes on the role of Mindguard(s)?

[Dabljuh]

This is a must read about "Groupthink in Academia"

http://www.ornery.org/essays/warwatch/2006-10-08-1.html

Originally, it was just a handful of scientists working on the cutting edge of a strange approach to the Grand Unified Theory -- the attempt to discover how gravity relates to the other three Forces of physics (electromagnetic, strong nuclear, and weak nuclear).

These guys were legitimate scientific heroes -- that is, they pursued their ideas despite the fact that they were getting little or no funding. Because of the way science works in the American university, the lack of prospects for grant money meant that they couldn't even get tenure. They sacrificed in order to follow up on a very, very promising line of inquiry.

Then, all of a sudden -- Smolin isolates the six-month period in which it happened -- a few leading professors suddenly declared that String Theory, instead of being a weird backwater, was Where It's At.

Overnight, those untenured recluses were the most important guys in the field.

Well, fads come and go in every discipline. But this time something strange and different happened. String Theory very quickly became, not the hottest field, but the Only Game In Town.

Smolin charts it very carefully. Within a very short time, the only young graduate students who were getting prestigious job offers were the ones working on String Theory. It was harder and harder to get any papers published in the peer reviewed journals unless you were working on String Theory.

Luckily we know medicine is so much more reliable as a testable science than physics.

[Dabljuh]

This article also has a list of groupthink symptoms, they're slightly different. Lets see if they can apply to vaccinations. (Note that these are just symptoms of groupthink, not proof of anything)

1. Overestimates its invulnerability or high moral stance,Well... knowing some "internet forum doctors" I feel this is true.

2. Collectively rationalizes the decisions it makes,"It'd be unethical to test vaccinations against a placebo since we already know they're effective"

3. Demonizes or stereotypes outgroups and their leaders,Everyone who opposes vaccination is a quack and a homeopath and a "spiritual healing" emo idiot.

4. Has a culture of uniformity where individuals censor themselves and others so that the facade of group unanimity is maintained, andAny doctor who disagrees about vaccinations is attacked on a personal level

5. Contains members who take it upon themselves to protect the group leader by keeping information, theirs or other group members', from the leader. Those quasi-doctors here, maybe?

Er well. I haven't done much research into groupthink in academia. Will have to do so in the future. Interesting subject.

[fls]

Luckily we know medicine is so much more reliable as a testable science than physics.

The result of smashing people together at high speeds would be pretty consistent, anyway.

Linda

[fls]

Er well. I haven't done much research into groupthink in academia. Will have to do so in the future. Interesting subject.

Doubleplusgood.

Linda

[Eos of the Eons]

I don't where dab gets his ridiculous quotes from. Not from anyone here. The strawmen are waving in the wind. Not even a good try to build anything that resembles what anyone states here.

There are no mindguards here. You guys are simply resorting to examples of paranoid speak. "mindguard" is paranoid speak for "I don't like that you rip my garbage to shreds".

What you don't seem to get, and it's always frustrating, is that there is no objection to "dissenting information". There is debunking of BAD misinformation or clarification of information that has been misrepresented.

The fact that you have to resort to paranoid speak rather than present your "dissenting information" in a professional and informative manner is telling.

Dab figures magic water is a better idea than vaccines. Magic water won't prevent the tetanus microbe from putting you in the hospital for a month or killing you should you come in contact with it. But, whatever, I guess this is just more "mind guard" posting from me.

[Dabljuh]

There are no mindguards here. You guys are simply resorting to examples of paranoid speak. "mindguard" is paranoid speak for "I don't like that you rip my garbage to shreds".You do realize that if I was paranoid, you would reinforce that perception of you by telling me that I was just paranoid and you're not a brainwashed "mind guard" ? Well that's the problem with paranoia...

But actually I think the "mindguards" wouldn't be located here, I'd think they'd be meant to keep the minds "pure" internally (inside the academic system). Meaning few individuals (mind guards) would viciously call out and attack people who voice thoughts that dissent from groupthink, e.g., publish a vaccination-critical paper.

What you don't seem to get, and it's always frustrating, is that there is no objection to "dissenting information". There is debunking of BAD misinformation or clarification of information that has been misrepresented. Lets for a second pretend that was the case. Facts. Stuff like that. You have all the facts behind you and I'm just using dirty tactics.

Dab figures magic water is a better idea than vaccines. Magic water won't prevent the tetanus microbe from putting you in the hospital for a month or killing you should you come in contact with it. But, whatever, I guess this is just more "mind guard" posting from me.What the frack is magic water? Weren't you just calling me out for using straw mans 10 lines up?

[Eos of the Eons]

Aww, dab gets his buttons pushed so easily.

What is magic water, awww, you don't like when I call homeopathy magic water?

Hmm, analyzing a badly done paper is a necessary criticism. If you don't like those criticisms, then why don't you defend the paper rather than resorting to paranoid accusations of mindguarding?

Go ahead. Defend away. Would love to see your facts.

[robinson]

...The strawmen are waving in the wind. ... Magic water won't prevent the tetanus microbe from putting you in the hospital for a month or killing you should you come in contact with it. ...

Talk about strawmen. Get a grip. Tetanus isn't some superbug like Hospital Staph. Exposure happens all the time. It rarely makes anybody sick. You obviously don't know much about Tetanus, or how to make a point for that matter.

In regards to Flu shots, Tetanus is a good example of a vaccine that works, if we had a Flu shot that worked as well as a Tetanus shot we wouldn't fear the Flu. Or be having this conversation.

[kellyb]

Back to the flu...
There was a thread here a while back about how the maternal immune response to influenza might cause schitzophrenia in a fetus.
There was an article about that this week:

http://www.washingtonpost.com/wp-dyn/content/article/2007/11/23/AR2007112301327.html

But if research into the links between early maternal infections and schizophrenia might one day provide researchers with clues about how to attack the disease before symptoms become apparent, it also raises difficult public health conundrums.
That's because the newest studies suggest the culprit may not be infections such as the flu per se, but pregnant mothers' immune reactions to such infections. Current guidelines recommend that pregnant women get a flu shot -- and the point of the flu vaccine is to set off an immune reaction. If the risk for schizophrenia is increased as a result of maternal antibodies, might protecting mom and baby from the flu raise the risk the child could get schizophrenia years down the road?

I like the psychology here:


"Obviously, the safe thing to do is to go with the experts, and the experts are the CDC," said Paul Patterson, a professor of biology at the California Institute of Technology and one of the leading researchers into the link between maternal infections and schizophrenia. "However, if it was my wife, I would not [want] her vaccinated."

Hmm...

[Eos of the Eons]

Exposure to tetanus rarely makes anyone sick? Evidence? The exposure we want to protect people from is the direct contact with the bloodstream. You need protection when that happens. Obviously you don't know anything about when tetanus becomes a menace. If you don't care about this risk, then don't get the shot. Take your chances that you will never need the protection, I don't care.

Flu strains are ever changing. Tetanus is completely different. If you figure you can come up with a better vaccine for the kind of bugs that the flu strains are, then give it a shot.

Get a clue about the different kinds of microbes there are, and then get back to us.

http://www.gsbs.utmb.edu/microbook/intoviro.htm


Virus-flu
Bacteria-tetanus
Toxin-what makes tetanus dangerous

[Eos of the Eons]

Out of context again kelly, typical tactic.

He said he would recommend it for his PREGNANT wife. He also wouldn't want her to get the flu either, for the SAME reason. I guess he's going to lock her up in a sterile bubble for nine months.


Epidemiologists have found that children of women who were pregnant during widespread flu epidemics seemed to have higher risk for schizophrenia. But critics have said there's insufficient evidence to assert a causative relationship because such studies did not confirm that the pregnant women had the flu.

Still, your expert, as quoted above, is still afraid.

[kellyb]

Out of context again kelly, typical tactic.

He said he would recommend it for his PREGNANT wife.

Indeed, that is the topic of the article.
I thought I was being clear by prefacing the link and quote with:

There was a thread here a while back about how the maternal immune response to influenza might cause schizophrenia in a fetus.
There was an article about that this week:

Maybe I should have bolded it when I wrote it to keep the confusion down, though.

[Eos of the Eons]

Hmm, yes, your post hasn't changed at all. I like how you left your psychology comment though.

[Dymanic]

There was a thread here a while back about how the maternal immune response to influenza might cause schitzophrenia in a fetus.And, in that thread, you noted:
It's interesting that it's not even the actual flu virus that does it. It's the mother's immune response. (probably inflammatory cytokines).
But it might be IgG, too...

So, if we call it 50/50 that it's cytokines versus IgG, and if the chances of catching flu are, say, one in ten, then with the vax you have a 100% chance at a 50% chance of aquiring the risk factor (treating seroconversion as a given), and without the vax, you have a one in ten chance at a 100% chance.

Is that about the way you'd figure it?

[kellyb]

Hmm, yes, your post hasn't changed at all. I like how you left your psychology comment though.

What do you mean?

[Dabljuh]

Symptom of Groupthink:
3. Demonizes or stereotypes outgroups and their leaders,

Aww, dab gets his buttons pushed so easily.

What is magic water, awww, you don't like when I call homeopathy magic water?
I'm not a homeopath. I think it's quackery, just like vaccination. I'd readily say that if done properly, homeopathy at least isn't dangerous. Unlike vaccination. But that's the limit of my defense of homeopathy.

Go ahead. Defend away. Would love to see your facts.Facts? This is the internet. All that can be provided is argument. Arguments can be rejected, or refuted. And have been provided already.

[Dabljuh]

Epidemiologists have found that children of women who were pregnant during widespread flu epidemics seemed to have higher risk for schizophrenia. But critics have said there's insufficient evidence to assert a causative relationship because such studies did not confirm that the pregnant women had the flu.

I.e. hypochondriacs would more likely bear schitzophrenic children?

[kellyb]

And, in that thread, you noted:



So, if we call it 50/50 that it's cytokines versus IgG, and if the chances of catching flu are, say, one in ten, then with the vax you have a 100% chance at a 50% chance of aquiring the risk factor (treating seroconversion as a given), and without the vax, you have a one in ten chance at a 100% chance.

Is that about the way you'd figure it?

Yep. That looks about right. It might vary some with your chances of catching the flu.

[kellyb]

I.e. hypochondriacs would more likely bear schitzophrenic children?

I don't think that's exactly what they meant. :)

[Eos of the Eons]

Symptom of Groupthink:



I'm not a homeopath. I think it's quackery, just like vaccination. I'd readily say that if done properly, homeopathy at least isn't dangerous. Unlike vaccination. But that's the limit of my defense of homeopathy.

Facts? This is the internet. All that can be provided is argument. Arguments can be rejected, or refuted. And have been provided already.

Still waiting for you defence of the study.

What is your evidence that homeopathy is less dangerous than vaccination?

Homeopathy kills when people delay real treatments. Homeopathy kills when it is used instead of vaccination.

People don't die when they are vaccinated. People die if they use homeopathy instead of getting a tetanus shot.

Doing nothing is far worse than prevention with vaccines.

I like your reasoning if you use it on yourself though. Go ahead, use homeopathy instead of getting a tetanus shot.

[Dabljuh]

Still waiting for you defence of the study.Of what study? I didn't post one, did I? And why would I have to defend it? Forgot your pills today?

What is your evidence that homeopathy is less dangerous than vaccination?Homoepathy = Water, maybe sugar. Vaccinations = Oh crud. Lab remnants, chemicals, alcohol, mercury, proteins. Evidence? I don't need evidence for something that is so trivially obvious to me. If you need evidence to believe that. Well. I'd say you misunderstand the concept of skepticism.

Homeopathy kills when people delay real treatments. Homeopathy kills when it is used instead of vaccination. Hypocratic oath is "Do no harm", not "Do something! Anything! Now!!" Getting _any_ treatment is dangerous and risky in any case. There could be misdiagnosis, misapplication, labels got switched. It's risky. The argument that "any" medication is better than "no" medication is the biggest fraud big pharma ever made people believe. Congratulations: You're a dupe. Duped by the pharma industry.

People don't die when they are vaccinated. People die if they use homeopathy instead of getting a tetanus shot.Right... homeopathy causes tetanus... see above.

Doing nothing is far worse than prevention with vaccines.Duped, deluxe, with stars.

I like your reasoning if you use it on yourself though. Go ahead, use homeopathy instead of getting a tetanus shot.How about I just do nothing. Since tetanus' bacteria are everywhere, I guess I'm doomed.

[Ove]

Ove, enlighten me... All this time I was under the impression that the USA was one country that did not allow thalidomide to be approved for sale (though it is now approved for certain things, like leprosy (http://www.fda.gov/cder/news/thalinfo/default.htm)). Did someone actually disregard Dr. Frances Kelsey's (http://www.fda.gov/fdac/features/2001/201_kelsey.html)concerns?

Sorry, didn't know that. I was under the impression that it was world wide but fortunately for you some american doctors was wiser. :)

[Ove]

Ove,

I just wanted to give you a quick heads-up, so you have a chance to edit your post before Skeptigirl sees it. You won't help your case if you say a bunch of stuff that is wrong. For example, thalidomide was never approved in the US, let alone for pregnancy pains, expert panels recommend against the use of circumcision for the purpose of preventing penile cancer, etc.

Hope this helps.

Linda

Yes i was wrong with Thalidomide (fortunately for you) on circumsision you are wrong. But i merely used those examples to show that "experts" also have been very vrong. I could also have mentioned the doctors that believed that if a child was born as a hermaphrodite you could just chop off the penis and raise the child as a girl. The doctor that practiced this procedure still hasn't admitted he was wrong despite one of the cases led to suicide and several led to severe psycic problems.

I was also trying to point out that the "experts" she was referring to obviously had different opinions to the experts i am referring to. I know "my" experts are 100% free of commercial interests the same cannot be said about american "experts" they have a long history of saying what the pharmaceutical industry like to hear.

I am not talking bribe, off course not, but if your research is funded by the pharmaceutical industry you just dont say that their products are not needed do you?

[Ivor the Engineer]

<snip>

The doctor that practiced this procedure still hasn't admitted he was wrong despite one of the cases led to suicide and several led to severe psycic problems.

<snip>

Doctors to admit they are human and make mistakes like the rest of us?

http://www.cbc.ca/health/story/2007/07/31/disclosure-doctors.html

Where does this leave physicians who may fear malpractice or loss of face among peers?

Levinson says she's studied the issue and concedes that malpractice is a barrier. "I think most physicians — and this was in our study — that have actually disclosed to a patient, said it actually enhanced the relationship."

And patients, too, often have positive reactions, she says. "When doctors do disclose they often find patients the opposite of angry — and forgiving." Research also shows that patients do want to know the bad news, rather than taking an "ignorance is bliss" approach.

[Dabljuh]

I find this very research objectionable. Here we have doctors who considered the possibility that lying to your patient may actually be good for them, and did a study to test that hypothesis.

Of course most doctors know better than even such a mere study. I mean, what's next, a study questioning the efficacy and safety of vaccines?

[fls]

Yes i was wrong with Thalidomide (fortunately for you) on circumsision you are wrong. But i merely used those examples to show that "experts" also have been very vrong. I could also have mentioned the doctors that believed that if a child was born as a hermaphrodite you could just chop off the penis and raise the child as a girl. The doctor that practiced this procedure still hasn't admitted he was wrong despite one of the cases led to suicide and several led to severe psycic problems.

You are talking about something different. Sure there is variation in opinion among physicians (it's been said that if you have 10 physicians in a room you'll hear 15 different opinions). So you will always be able to find ideas, some that were even widely promoted, that were wrong. But what we are talking about here is when there is consensus among people with knowledge and experience. And I should make it clear that there is a difference between recognizing that circumcision reduces penile cancer (which expert panels agree on) and recommending that the procedure actually be performed for that reason.

I was also trying to point out that the "experts" she was referring to obviously had different opinions to the experts i am referring to. I know "my" experts are 100% free of commercial interests the same cannot be said about american "experts" they have a long history of saying what the pharmaceutical industry like to hear.

Some experts have professional associations with pharmaceutical companies. Many do not. The same goes for Danish physicians, unless you have some other explanation for the publication of pharmaceutical company sponsored clinical trials in medical journals by Danish physicians.

I have experience working with people on advisory committees in both the US and Canada. My impression is that the biggest reason for any differences in the recommendations is that the people the recommendations are for are different. Americans have different priorities and are operating within a different health care system than you see in Canada or in EU member states. It doesn't make sense to take it out of context when the context is going to lead to differences.

I am not talking bribe, off course not, but if your research is funded by the pharmaceutical industry you just dont say that their products are not needed do you?

It depends upon what the research shows. And the vast majority of physicians are not in that situation, anyway. That a few may be biased doesn't account for the rest. Especially since physicians don't like to agree on anything.

Linda

[Deetee]

Talk about strawmen. Get a grip. Tetanus isn't some superbug like Hospital Staph. Exposure happens all the time. It rarely makes anybody sick. You obviously don't know much about Tetanus, or how to make a point for that matter.

Eos is obviously talking about those who are unprotected by the tetanus vaccine.

In the UK, we recently had an epidemic of tetanus in drug users. I had two patients in my hospital who needed prolonged care in ITU (and one had been fully vaccinated as a child).

Lets just take one type of tetanus, neonatal tetanus. In the third world this is reported to affect half a million infants each year. Here you can see some data (http://www.who.int/immunization_monitoring/diseases/neonatal_tetanus/en/index.html). A quarter of a million died from this over 2 years 2000-3

What was it you said again? "Exposure happens all the time. It rarely makes anybody sick. You obviously don't know much about Tetanus"
:boggled:

[Deetee]

Evidence? I don't need evidence for something that is so trivially obvious to me. If you need evidence to believe that. Well. I'd say you misunderstand the concept of skepticism.
It's quite obvious what you are. Troll, nothing more, probably less. You display total bewilderment/ignorance at the concept of critical thinking, rational appraisal of evidence and the scientific method.

Hypocratic oath is "Do no harm", not "Do something! Anything! Now!!" Getting _any_ treatment is dangerous and risky in any case. There could be misdiagnosis, misapplication, labels got switched. It's risky. The argument that "any" medication is better than "no" medication is the biggest fraud big pharma ever made people believe. Congratulations: You're a dupe. Duped by the pharma industry.

Right... homeopathy causes tetanus... see above.

Duped, deluxe, with stars.

How about I just do nothing. Since tetanus' bacteria are everywhere, I guess I'm doomed.

Yup - getting any treatment is dangerous. If I wasn't a nice person, I'd say that the sooner you get a significant illness the sooner you'll come to your senses. However, I suspect that even if that happened, cognitive dissonance would prevail.

[Ivor the Engineer]

<snip>

I have experience working with people on advisory committees in both the US and Canada. My impression is that the biggest reason for any differences in the recommendations is that the people the recommendations are for are different. Americans have different priorities and are operating within a different health care system than you see in Canada or in EU member states. It doesn't make sense to take it out of context when the context is going to lead to differences.

I think that is probably right. I get the impression getting sick in the US, even if treatment leads to a full recovery, can be a very expensive business. In the UK we tend to be less uptight about illness, probably because we know the cost of treatment is not going to bankrupt us.

It depends upon what the research shows. And the vast majority of physicians are not in that situation, anyway. That a few may be biased doesn't account for the rest. Especially since physicians don't like to agree on anything.

Linda

Are there any professional groups of people who do like to agree on anything?

[Ivor the Engineer]

Dabljuh is a member of the not-worried-enough well.

[Chris Haynes]

Sorry, didn't know that. I was under the impression that it was world wide but fortunately for you some american doctors was wiser. :)

More accurately she was a Canadian who was working for the FDA. She did become a naturalized American citizen (just like my hubby's parents, dragging him along with them).

[LibraryLady]

I got the flu and the pneumonia shot on Wednesday. After the Winter From Hell last year, I'm doing all I can to avoid illness. By this time last year I was already sick and stayed sick until the end of January.

[robinson]

Based on this conversation, as well as the vaccine thread, I am going to get a couple of boosters now, rather than wait.

[Dabljuh]

I'm gonna do nothing. And continue smoking and drinking like a badass.

I do drink orange juice though.

Lets see who gets the sickest this winter!

[robinson]

I was talking about Tetanus and Staph boosters. I got surgery coming up, and both of those can kill you, when it gets put deep inside your body. Lots of stuff that is harmless on the outside, can kill you when it is inserted into your flesh. I lost my best friend to Hospital Staph after he had simple surgery.

A neighbor still has MRSA ten years later, in his artificial hip. He has to take antibiotics or it breaks out. Thank medicine for at least having a vaccine now to prevent super bugs from killing us.

[Skeptic Ginger]

Talk about strawmen. Get a grip. Tetanus isn't some superbug like Hospital Staph. Exposure happens all the time. It rarely makes anybody sick. You obviously don't know much about Tetanus, or how to make a point for that matter.

In regards to Flu shots, Tetanus is a good example of a vaccine that works, if we had a Flu shot that worked as well as a Tetanus shot we wouldn't fear the Flu. Or be having this conversation.Personally, I don't fear the flu because I do get the vaccine. If I still contract the infection it is most likely going to be mild.

[Skeptic Ginger]

I was talking about Tetanus and Staph boosters. I got surgery coming up, and both of those can kill you, when it gets put deep inside your body. Lots of stuff that is harmless on the outside, can kill you when it is inserted into your flesh. I lost my best friend to Hospital Staph after he had simple surgery.

A neighbor still has MRSI ten years later, in his artificial hip. He has to take antibiotics or it breaks out. Thank medicine for at least having a vaccine now to prevent super bugs from killing us.That's MRSA, not MRSI, BTW. And if your neighbor has had ten years on prophylactic antibiotics after a hip replacement, I hope he's considered getting a second opinion.

[Skeptic Ginger]

I'm gonna do nothing. And continue smoking and drinking like a badass.

I do drink orange juice though.

Lets see who gets the sickest this winter!Is that OJ reference because you believe vitamin C is going to protect you from infection?

[Skeptic Ginger]

... I'd readily say that if done properly, homeopathy at least isn't dangerous. Unlike vaccination. But that's the limit of my defense of homeopathy.....Baby death: call for homeopath rules (http://www.smh.com.au/articles/2007/11/19/1195321684868.html)

And there are several more examples in this thread, Child dies after being given homeopathic "medicine". (http://forums.randi.org/showthread.php?t=15225)

[robinson]

I changed it skeptigirl, thanks. Next time I see him, I will ask about that. I don't think it is just the Vit C in OJ, there is something about oranges and lemons that seems to prevent infections. Just taking Vit C doesn't seem to work as well.

[Dabljuh]

Robinson, you might be interested in what "the doctor within" says. Link (http://www.thedoctorwithin.com/index_fr.php?page=articles/whole_food_vitamins.php)

Basically, "Vitamin C" as it is found in oranges and most other plants, also animals, and as it is needed by the body, is a very fragile complex from different molecules. Ascorbic acid is merely one part of this complex. However it also happens to be the part that is produced industrially the easiest.

So basically, ascorbic acid alone doesn't help, it can even harm the body. Ascorbic acid doesn't help to cure or prevent scurvy. Only the entire vitamin C complex can do that. So the "vitamin C pills" and all that are worthless.

The thing with O-Juice is that often it's made from concentrat and sterilized/pasteurized. So what you have in the end is a product that contains no real vitamin C, but is enriched with ascorbic acid after the fact.

[Dabljuh]

Baby death: call for homeopath rules (http://www.smh.com.au/articles/2007/11/19/1195321684868.html)

And there are several more examples in this thread, Child dies after being given homeopathic "medicine". (http://forums.randi.org/showthread.php?t=15225)In the first entry, it's claimed that it is the lack of real medication that killed the baby, not whether it received homeopathic remedy or not. The second is a link to nothingness with wild claims. Epilepsi kills babies?

[Eos of the Eons]

I was talking about Tetanus and Staph boosters. I got surgery coming up, and both of those can kill you, when it gets put deep inside your body. Lots of stuff that is harmless on the outside, can kill you when it is inserted into your flesh. I lost my best friend to Hospital Staph after he had simple surgery.

A neighbor still has MRSA ten years later, in his artificial hip. He has to take antibiotics or it breaks out. Thank medicine for at least having a vaccine now to prevent super bugs from killing us.

Vitamin C protects you from getting scurvy. That's it. That's all. Unless you go to woo sites that say different.

Otherise, it is times like this that demonstrate you are capable of learning. Good job.

[Physiotherapist]

Vitamin C protects you from getting scurvy. That's it. That's all.



Eos,

This is not true. Vitamin C is needed in the body for other things other than the prevention of scurvy. I don't mean woo either, just scientific fact!!

[Eos of the Eons]

Eos,

This is not true. Vitamin C is needed in the body for other things other than the prevention of scurvy. I don't mean woo either, just scientific fact!!
do please then specify which deficiencies it prevents, I mean like anemia... things like that. I know you need vit c to absorb iron. That's only one kind of anemia though. It won't help with sickle cell. I posted scurvy, and should have posted other deficiency diseases that you will get from not ingesting vitamin c.

What I'm saying, though, is that it won't prevent the common cold or other non-deficiendy diseases. Unless you know of supposed non-deficiency diseases that it could prevent... then please provide the evidence, blah de blah, as usual. Thank you for this chance to clarify.

[Skeptic Ginger]

I changed it skeptigirl, thanks. Next time I see him, I will ask about that. I don't think it is just the Vit C in OJ, there is something about oranges and lemons that seems to prevent infections. Just taking Vit C doesn't seem to work as well.I'd love to see the research supporting that if you know of any.

[Skeptic Ginger]

... Epilepsi kills babies?Actually, yes. If not halted, such seizures can be fatal (http://www.fda.gov/fdac/features/1999/199_epil.html).

[Skeptic Ginger]

Re vitamin C's role in the body:

Vitamin C
The presence of ascorbate is required for a range of essential metabolic reactions in all animals and in plants and is made internally by almost all organisms, humans being one notable exception....The pharmacophore of vitamin C is the ascorbate ion. In living organisms, ascorbate is an antioxidant, as it protects the body against oxidative stress,[4] and is a cofactor in several vital enzymatic reactions.[5]


And the effects on respiratory infections:

Review Vitamin C as an Antioxidant: Evaluation of Its Role in Disease Prevention
Sebastian J. Padayatty, MRCP, PhD, Arie Katz, MD, Yaohui Wang, MD, Peter Eck, PhD, Oran Kwon, PhD, Je-Hyuk Lee, PhD, Shenglin Chen, PhD, Christopher Corpe, PhD, Anand Dutta, BS, Sudhir K Dutta, MD, FACN, and Mark Levine, MD, FACN (http://www.jacn.org/cgi/reprint/22/1/18.pdf)Other than preventing scurvy, vitamin C has no proven benefits. In humans, vitamin C treatment has not resulted in changes in biomarkers of oxidation or in clinical outcome.

This statement from Medline Plus on Vitamin C, (http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-vitaminc.html)Common cold prevention (extreme environments)

Scientific studies generally suggest that vitamin C does not prevent the onset of cold symptoms. However, in a subset of studies in people living in extreme circumstances, including soldiers in sub-arctic exercises, skiers, and marathon runners, significant reductions in the risk of developing colds by approximately 50% have been reported. This area merits additional study, and may be of particular interest to elite athletes or military personnel. is consistent with this dissertation/meta-analysis (warning, very large PDF file) on the subject:

Do vitamins C and E affect respiratory infections; Harri Hemilä; Department of Public Health; University of Helsinki
Finland? (http://ethesis.helsinki.fi/julkaisut/laa/kansa/vk/hemila/dovitami.pdf)The new trials did not find reduction of common cold incidence in the ordinary Western population with vitamin C supplementation. Nevertheless, in this thesis it is shown that there may be sub-populations, such as people undergoing heavy acute physical stress and young males with low dietary vitamin C intakes, in which regular vitamin C supplementation may reduce the incidence of the common cold.



But while that author is extremely critical of the negative findings, at least some of the studies cited were fairly small. For example in Vitamin C Supplementation and Respiratory Infections: a Systematic Review (http://findarticles.com/p/articles/mi_qa3912/is_200411/ai_n9469932) you find:In this review, the vitamin C trials with military personnel and with other subjects living under conditions comparable to those of military recruits are analyzed to find out whether vitamin C supplementation affects respiratory infections. For this systematic review, we identified seven trials with military personnel, three trials with students in crowded lodgings, and two trials with marathon runners. Eight of these trials were double blind and placebo controlled and seven were randomized. Five small trials found a statistically significant 45 to 91% reduction in common cold incidence in the vitamin C group. These trials were short and the participants were under heavy exertion during the trial. Furthermore, three other trials found a statistically significant 80 to 100% reduction in the incidence of pneumonia in the vitamin C group. The large number of positive findings seems to warrant further consideration of the role of vitamin C in respiratory infections, particularly in military recruits.

The same author of the dissertation also co-wrote the following review:

Vitamin C and acute respiratory infections (http://www.ingentaconnect.com/content/iuatld/ijtld/1999/00000003/00000009/art00004)So far over 60 studies have examined the effects of vitamin C on the common cold. No effect on common cold incidence was observed in the six largest studies, indicating that vitamin C has no preventive effects in normally nourished subjects in the Western countries. There are, however, smaller studies reporting benefit. In three trials of subjects under heavy acute physical stress, common cold incidence decreased by on average 50%, and in four trials of British males common cold incidence decreased by on average 30% in the vitamin C groups. The dietary vitamin C intake in the UK is low, and consequently the benefit may be due to the correction of marginal deficiency, rather than high vitamin doses. Regular vitamin C supplementation (ge1 g/day) has quite consistently reduced the duration of colds, but the size of the benefit has varied greatly. In the four largest studies the duration of colds was reduced only by 5%. In two of these studies, however, absence from school and work was reduced by 14–21% per episode, which may have practical importance. Three controlled studies recorded a reduction of at least 80% in the incidence of pneumonia in the vitamin C group, and one randomised trial reported substantial treatment benefit from vitamin C in elderly UK patients hospitalized with pneumonia or bronchitis. It seems that the preventive effects of supplementation are mainly limited to subjects with low dietary vitamin C intake, but therapeutic effects may occur in wider population groups. Further carefully designed trials are needed to explore the effects of vitamin C.

In my reading it seems a bit tricky to filter out the bias going into the reviews. If you 'believe' then smaller studies become more significant. If you doubt then inconsistent findings become less significant. Until some mechanism is suggested why the results should be so different in a group such as marathon runners or the military under stress in the Arctic, I tend to discard such findings as inconclusive. For the general population, large studies have shown vitamin C has essentially no effect on numbers of colds or duration of colds. Unless you have young children, adults don't necessarily catch that many colds over a short duration of time. So the fact a small study over a short time span found effects really seems more prone to error than a large study over a longer time span.

A reduction of 5% duration seems pretty minimal. 20% less time loss from school or work might be more significant. You have to know how good the blinding of the study was. If your cold lasted as long with and without but you went back to work anyway, either it was milder or you just believed you were better sooner. That one is hard to know without looking at how well the study was blinded.

As for the elderly benefiting, there are other studies with similar populations showing no benefit. And look at the actual cited study of the benefit in the elderly:

Vitamin C in respiratory infections - adapted from the International Journal of Vitamin and Nutrition Research, 64,3:212-219, 1994 (http://findarticles.com/p/articles/mi_m0887/is_n1_v14/ai_16623077)Extensive controlled trials have demonstrated that vitamin C supplementation can decrease the severity and duration of the common cold, although it does not appear to prevent colds from occurring...

...Fifty-seven elderly patients who were hospitalized for acute bronchitis or pneumonia were randomly assigned to receive either 200 mg/day of vitamin C or an inactive placebo. The patients' progress was assessed using a clinical scoring system based on the major symptoms of respiratory infection.

The clinical scoring system showed that patients who received vitamin C fared significantly better than those who received placebo. This was particularly true for those patients who were most severely ill at the start of the study. Among the severely ill patients, many had blood vitamin C levels low enough to suggest that they were at least marginally deficient in this vitamin when they were admitted to the hospital. Six patients died during the study: five in the placebo group and one in the group that received vitamin C. The difference in death rates between the vitamin C and placebo groups was not statistically significant.So they got better according to some scores, but again, we don't know how well the study was blinded. The patients may have been deficient so their supplements were indicated anyway. It doesn't mean extra C helped. And if the difference in death rate was not statistically significant, you have to wonder what the objective measures were which were "significantly better".

It also seems that in comparing these trials, little is paid to the fact some show decreased rates of infection while others show decreased duration. Such findings are not consistent yet in the meta-analysis they are scored equally as if the results correlate.

But I have not looked at all of the studies involved in these reviews, so I maintain an open but skeptical mind on the benefits of vitamin C for infection.



I do however, take a smaller vitamin C supplement along with vitamin E (studies indicate together matters) for the potential cardiac benefits. It's one of those decisions based on the fact that it is inexpensive, I am not substituting these for a better alternative, the risk of harm is low (though at least one study showed a worse outcome with only one of these two than no supplement), and the potential benefit worthwhile. The results of the combination also suggest the results of either vitamin alone might not show a benefit because the combination is required for some as yet unknown reason.

[robinson]

Vitamin C would be an entire topic unto itself.

[robinson]

Exposure to tetanus rarely makes anyone sick? Evidence? The exposure we want to protect people from is the direct contact with the bloodstream.

No, it is deep puncture wounds, or other injuries where you have damaged flesh with little oxygen that allows the Tetanus to poison us. Necrosis of umbilical cords cut with unsanitary instruments is the main reason for infant Tetanus and the resulting deaths.

Tetanus is pretty much everywhere. But it can't grow in the presence of oxygen. Hence it is not a problem in the bloodstream, but in tissue that is injured and not oxygenated.

[Skeptic Ginger]

Vitamin C would be an entire topic unto itself.I'll take that as a, 'you have no sources'.

[Skeptic Ginger]

No, it is deep puncture wounds, or other injuries where you have damaged flesh with little oxygen that allows the Tetanus to poison us. Necrosis of umbilical cords cut with unsanitary instruments is the main reason for infant Tetanus and the resulting deaths.

Tetanus is pretty much everywhere. But it can't grow in the presence of oxygen. Hence it is not a problem in the bloodstream, but in tissue that is injured and not oxygenated.Robinson, by leaving part of the quote out you are essentially misquoting Eos.

And if you want to get technical, it is the toxin in the bloodstream that is the actual problem and what the vaccine addresses.

The tetanus bacillus grows in the anaerobic environment. It produces a neurotoxin. If it only stayed in the local area you would not get systemic tetany you'd only get local tetany.

The vaccine is actually against the toxin, not the bacteria. Your body's immune system takes care of the infection.

The tetanus vaccine (http://www.vaccineinformation.org/tetanus/qandavax.asp) is an inactivated toxin (poison) called a toxoid. It is made by growing the bacteria in a liquid medium and purifying and inactivating the toxin.

[Dabljuh]

The vaccine is actually against the toxin, not the bacteria. Your body's immune system takes care of the infection.

Quote:
The tetanus vaccine is an inactivated toxin (poison) called a toxoid. It is made by growing the bacteria in a liquid medium and purifying and inactivating the toxinTBH that sounds like a load of crap. Vaccinations against poisoning? Are people who get Botox treatments somehow immune to Botox in time? No.

Skeptigirl, did you find a study that compared freshly pressed OJ to Ascorbic Acid to a Placebo?

[Deetee]

TBH that sounds like a load of crap. Vaccinations against poisoning? Are people who get Botox treatments somehow immune to Botox in time? No.
With regard to tetanus, it is not crap, it is how the vaccine works.
I don't expect you to have known this, because you have consistently displayed woeful ignorance about each and every vaccine discussed on these boards and have persistently ignored offers to try and give you a simple undersatnding of the principles involved. However I still live in the forlorn hope that one day, before reflexly spouting complete nonsense, you might take the trouble to check up something before you shoot your mouth off on whichever topic it is that you have chosen as your method of revealing the yawning depths of your ignorance.

Skeptigirl, did you find a study that compared freshly pressed OJ to Ascorbic Acid to a Placebo?
It was Robinson who said he thought fresh OJ was better than Vitamin C. What do you think Skeptigirl is - your personal, one-woman Googlebot?
You have a computer - use it.

[Ivor the Engineer]

TBH that sounds like a load of crap. Vaccinations against poisoning? Are people who get Botox treatments somehow immune to Botox in time? No.

<snip>

Actually, yes.

http://dystonia.mighty-site.com/pages/immunity/128.php

Immunity

Because botulinum toxin is a biological product, it is possible for the body to create antibodies and develop immunity to the effects of the toxin. Measures are in place to guard against immunity:

The “recipes” for botulinum toxins have been refined to reduce the chances of the body forming antibodies

Physicians use the smallest dose needed to get a positive result

Injections are typically not repeated more often than every 3-4 months

Physicians generally use one serotype at a time rather than alternate or mix type A and type B

An important distinction must be made between individuals who have become immune to the toxin and individuals who have not had an optimal treatment: Someone who has become immune to botulinum toxin does not react at all to the product. This is very different from someone who gets some results from the injections but not the results they were hoping for or expecting. If a person is getting any results at all then there is hope that the way the botulinum toxin is administered can be manipulated to get a good result.

If you are receiving botulinum toxin injections and getting some result but not the result you expected or unacceptable side effects, ask your physician about the specific symptoms that concern you. Treatment with botulinum toxin may require a trial period to establish the appropriate dose, injection sites, and targeted symptoms but it is a very adaptable treatment that can create a dramatic benefit. A physician may test a patient for immunity by injecting a tiny amount of botulinum toxin into the brow muscle and observing the effect.

In some cases, a patient who has previously been successfully treated with botulinum toxin begins to experience a loss in benefit. Several factors could be responsible for this change. The nature and pattern of muscle contractions may change over time, thus necessitating an adjustment in the site of injection and dosage. If deep muscles become involved, it may be difficult to access those muscles. If you notice a change in how your symptoms respond to botulinum toxin, discuss these changes with your doctor.

http://www.tjclarkinc.com/bacterial_diseases/tetanus_and_botulism.htm

Immunity

On the average there are about 25 cases of botulism annually in the U.S. Prior to the advent of critical care, the case fatality rate exceeded 60%, but currently it is about 20%. The first (or only) patient in an outbreak has a 25% chance of death, whereas subsequent cases which are diagnosed and treated more quickly, carry only a 4% risk.

The toxins that cause botulism are each specifically neutralized by its antitoxin. Botulinum toxins can be toxoided and make good antigens for inducing protective antibody. As with tetanus, immunity to botulism does not develop, even with severe disease, because the amount of toxin necessary to induce an immune response is toxic. Repeated occurrence of botulism has been reported.

Once the botulinum toxin has bound to nerve endings, its activity is unaffected by antitoxin. Any circulating ("unfixed") toxin can be neutralized by intravenous injection of antitoxin. Individuals known to have ingested food with botulism should be treated immediately with antiserum.

A multivalent toxoid evokes good protective antibiody response but its use is unjustified due to the infrequency of the disease. An experimental vaccine exists for laboratory workers.

[Professor Yaffle]

TBH that sounds like a load of crap. Vaccinations against poisoning? Are people who get Botox treatments somehow immune to Botox in time? No.


Like the diphtheria vaccine, the tetanus vaccine is a toxoid (http://www.drspock.com/article/0,1510,4866,00.html). Toxoid vaccines are made by treating the toxins (or poisons) produced by the germ that causes the disease (in this case /Clostridium tetani) with heat or chemicals, such as formalin. While this process destroys the toxin's ability to cause illness, the toxin is still able to stimulate the immune system to produce protective antibodies. Exposing someone to this inactive form of tetanus toxin allows her body's defense system to be prepared if she ever encounters the actual disease.


http://www.drspock.com/article/0,1510,10398,00.html

Someone else may be able to provide a better source for this. It was just the first one I found.

[Dabljuh]

Congratulations: You convinced me. This is actually pretty interesting to me. It seems like these toxins are actually tested and all (on actual guinea pigs, not just the figure of speech) by injecting the immunized guinea pigs with the toxin, and they do become immune.

This means you have here at least one vaccination that works. Hence, I no longer believe that all vaccinations are BS. I'll have to learn to differentiate between vaccinations that are BS and those that aren't.

[Professor Yaffle]

And how will you differentiate between them? The ones that you have been given the actual information on work, and the ones you remain in ignorance about don't work?

[Deetee]

Congratulations: You convinced me.
Great Scott, Prof Yaffle!
You deserve a beany bag, or similar award. Perhaps even the Randi $million...?
I have never before seen Dabs convinced by a source that wasn't "the doctor within (http://www.thedoctorwithin.com/index_fr.php?page=content.php)".
How'd ya do it?

[Professor Yaffle]

Great Scott, Prof Yaffle!
You deserve a beany bag, or similar award. Perhaps even the Randi $million...?
I have never before seen Dabs convinced by a source that wasn't "the doctor within (http://www.thedoctorwithin.com/index_fr.php?page=content.php)".
How'd ya do it?

I must be having a good day.

[Deetee]

New info just in on the risks of cardiovascular disease in patients with flu (http://www.inthenews.co.uk/news/health/flu-raises-heart-attack-risk-$1176209.htm). Its also in most papers today, I gather.
This is not "new", as it has been reported previously (http://www.eurekalert.org/pub_releases/2007-04/oup-nrs041607.php), as some have alluded to in the thread above.
However, it provides more food for thought concerning possible benefits of flu vaccination.

One problem - I can't seem to find the article. It is reputed to be in the current online edition of the European Heart Journal (http://eurheartj.oxfordjournals.org/content/vol28/issue23/index.dtl). Perhaps I am going blind.

[Skeptic Ginger]

Interesting, something saying the same thing was on Yahoo news a few months back. I'll try to find the specifics from that news report.

Reuters Nov 16, 2006 (http://www.msnbc.msn.com/id/15755608/)The study, which was conducted in Poland and presented at the American Heart Association meeting in Chicago, involved 658 patients with coronary artery disease. Of those, 325 received an active flu vaccine and 333 received a placebo.

After 296 days, patients who did not receive the vaccine were nearly twice as likely to have a heart attack, undergo an unplanned angioplasty to open blocked arteries or die from heart-related causes.

How could the flu vaccine prevent heart attacks? (http://health.howstuffworks.com/flu-heart.htm)For years, studies have drawn a link between influenza and heart disease. As early as 2003, a study published in the "New England Journal of Medicine" involving people with heart problems -- either prior heart attacks, angioplasty or stent placement (to open arteries) -- found that those who got the flu shot were 20 percent less likely to end up in the hospital with a heart-related problem and 50 percent less likely to die in the year following vaccination... at least four studies since 2003, the most recent one conducted in Poland in 2006, show that heart patients who receive the flu vaccine are hospitalized less and have lower fatality rates in the year following vaccination than heart patients who do not receive the vaccine. The data shows anywhere from a 25 to 50 percent decrease in mortality and hospitalization rates from heart-related events for vaccinated patients. One study found that heart-attack deaths rise in flu season and fall in the off-season like clockwork.Maybe those reports of increased deaths around the Xmas holidays are not from stress. It's be interesting to compare December death stats from the north and south hemispheres.

I thought my news clipping was from this year but it could have been last year. I'll find the file note I have and see.

[Skeptic Ginger]

Here it is.

Recent respiratory infection and risk of cardiovascular disease: case-control study through a general practice database (http://eurheartj.oxfordjournals.org/cgi/content/full/ehm516v1)

[Ivor the Engineer]

Before you all get excited about the flu vaccine's amazing ability to prevent heart attacks, let's have a look at that study done in Poland:

http://circ.ahajournals.org/cgi/content/meeting_abstract/114/18_MeetingAbstracts/II_906-c

Influenza Vaccination in Prevention from Coronary Events in Coronary Artery Disease. FLUCAD Study.

Background: Influenza vaccination is recommended in patients (p) with cardiovascular disease, however there is few data proving its protective effect on clinical course of coronary artery disease (CAD). We present, to the best of our knowledge, first, randomized, double blind, placebo controlled study in this field. The aim of the study was to evaluate the effect of influenza vaccination on the incidence of coronary events in p with CAD confirmed by coronarography.

Methods: Single center, randomized, prospective, double blind, placebo controlled study. The randomization was 1:1 (placebo : active vaccine). Cox proportional hazards model analysis was performed. Study group: Between October 2004 and February 2005, we included and vaccinated 658 CAD p; 477 men, mean age 59.9+/–10.3 years. There were 287 p enrolled before discharge from the hospital after percutaneous coronary intervention (PCI), and 371 p without recent PCI.

Results: 325 p received the active vaccine, and 333 p received placebo. There were no significant differences between the study groups. No patient was lost to follow-up. Mean follow-up was 296.8+/–35.7 days. Primary end-point: cardiovascular death occurred in 2 p (0.61%) in the vaccine vs in 2 p (0.60%) in the placebo group (NS). First composite end-point: cardiovascular death, or myocardial infarction, or non-planned coronary revascularization (PCI or coronary bypass surgery) tended to occur less frequently in the vaccine group in comparison to the placebo group: 9 p (2.8%) vs 17 p (5.1%), respectively, (HR 0.54; 95% CI, 0.24 to 1.21; p= 0.13). Second composite end-point: cardiovascular death, or myocardial infarction, or non-planned revascularization or hospitalization for ischemia occurred significantly less frequently in the vaccine group: 16 p (4.9%) vs 30 p (9.0%) in the placebo group, (HR 0.54; 95% CI, 0.29 to 0.991; p=0.047). On multivariate analysis : primary PCI (HR 2.93; 95% CI 1.51 – 5.65, p=0.0014), influenza vaccination (HR 0.38; 95% CI 0.19 – 0.78, p=0.009), and female sex (HR 2.15; 95% CI 1.11 – 4.15, p=0.023), emerged as independent predictors of the occurrence of composite point 2.

Conclusion: Influenza vaccination may reduce frequency of coronary events in patients with coronary artery disease.

The difference between the two groups was barely significant at the 5% level (0.047) for the second end-point. Just as many people died in both groups.

[Deetee]

The difference between the two groups was barely significant at the 5% level (0.047) for the second end-point. Just as many people died in both groups.
This may just be barely significant because the study groups are very small for a study looking at cardiovascular outcomes, which in themselves are infrequent events. (For example, it took over 8000 patients to demonstrate the risk from Vioxx). Multivariate analysis showed flu vaccination was an independent predictor (p=0.009).

So however you look at it, there is a difference in cardiovascular events. Taken in conjunction with the underlying pathogenesis mechanism, which is both plausible and real, I think we can conclude that vaccination is likely to have a protective benefit.

Or, to put it another way, using your Polish data, you need to vaccinate only 23 patients to prevent one cardiovascular event (death, myocardial infarction, operative intervention (angioplasty or coronary bypass surgery) or hospitalisation).
Care to calculate the cost/benefit ratio for those, or work out the QALYs?

[Deetee]

http://news.bbc.co.uk/1/hi/health/7155563.stm

Pneumovax is (reportedly) preventing kiddie deaths in the UK.

Hard info awaited.....

[Eos of the Eons]

Oh pish, it has saved only approximately 300 kids from the illness so far, that's nothing *rolls eyes*/sarcasm.

[Deetee]

Yup - a mere trifle.....
(a drop in the ocean compared to the tens of thousands of kids being killed or worse from the vaccine's toxic mercury, aluminium and other heavy metal content!)
;)

[jimtron]

I've never had a flu shot that I recall, but in Chicago there have been quite a few cases (http://www.chicagobusiness.com/article/20130108/NEWS03/130109811/chicago-hospitals-flooded-with-flu-patients), so I'm thinking about getting one. Anyone have opinions about getting the shot at Walgreens? http://www.walgreens.com/topic/health-shops/flu-shots.jsp

[DavidS]

I've never had a flu shot that I recall, but in Chicago there have been quite a few cases (http://www.chicagobusiness.com/article/20130108/NEWS03/130109811/chicago-hospitals-flooded-with-flu-patients), so I'm thinking about getting one. Anyone have opinions about getting the shot at Walgreens? http://www.walgreens.com/topic/health-shops/flu-shots.jsp
First: IANAD

Methinks that any influenza vaccine you get in the U.S., whether at Walgreens or Walter Reed, will be of similar quality, one of a few variations from some very few sources and handled with adequate care.

I got mine at Kroger this year, Walgreens last year, and the office cafeteria the year before.

By "any influenza vaccine" I mean "the flu shot" that millions of ordinary folks get. I wouldn't be at all surprised to learn of some more specialized vaccine preparations more specifically targeted or reserved to folks with some special conditions. If you think you might be one of those folk (or if you want an opinion more likely to matter), ask a doctor.

[Silly Green Monkey]

DT vaccine protects against the toxin, not the pathogen? NEAT! I didn't know that!

[jimtron]

First: IANAD

Methinks that any influenza vaccine you get in the U.S., whether at Walgreens or Walter Reed, will be of similar quality, one of a few variations from some very few sources and handled with adequate care.

I got mine at Kroger this year, Walgreens last year, and the office cafeteria the year before.

By "any influenza vaccine" I mean "the flu shot" that millions of ordinary folks get. I wouldn't be at all surprised to learn of some more specialized vaccine preparations more specifically targeted or reserved to folks with some special conditions. If you think you might be one of those folk (or if you want an opinion more likely to matter), ask a doctor.

Thanks for the response. Just found this article:
http://www.slate.com/articles/double_x/doublex/2012/10/vaccines_at_the_pharmacy_states_should_let_drugsto res_give_shots.html

[Capsid]

I wouldn't be at all surprised to learn of some more specialized vaccine preparations more specifically targeted or reserved to folks with some special conditions.The flu vaccines available differ in their formulations; some are whole inactivated virus, some subunit proteins, some live attenuated virus. But they are all designed to induce an antibody response to the HA (haemagglutinin) protein which is associated with protection. They aren't targeted to specialised groups but maybe administered differently. For immunocompromised individuals the vaccine may be given as two half dose shots separated by ~1 month.

[dafydd]

Congratulations: You convinced me. This is actually pretty interesting to me. It seems like these toxins are actually tested and all (on actual guinea pigs, not just the figure of speech) by injecting the immunized guinea pigs with the toxin, and they do become immune.

This means you have here at least one vaccination that works. Hence, I no longer believe that all vaccinations are BS. I'll have to learn to differentiate between vaccinations that are BS and those that aren't.

Would you like to know which vaccinations worked for me?

[Dymanic]

Would you like to know which vaccinations worked for me?Don't hold your breath. Last Activity: 20th July 2008 05:01 PM

[Skeptic Ginger]

The flu vaccines available differ in their formulations; some are whole inactivated virus, some subunit proteins, some live attenuated virus. But they are all designed to induce an antibody response to the HA (haemagglutinin) protein which is associated with protection. They aren't targeted to specialised groups but maybe administered differently. For immunocompromised individuals the vaccine may be given as two half dose shots separated by ~1 month.I've not see whole cell flu vaccine in a couple decades in the US. Do they still use it elsewhere?

I'm also unsure of your other recommendations here, they don't make sense.

For people over 65 there is now a high dose vaccine, not a split low dose. If a person is immunocompromised they need more, not less. And you'd never give an immunocompromised person the live vaccine as long as the killed vaccine is available.

[Skeptic Ginger]

I've never had a flu shot that I recall, but in Chicago there have been quite a few cases (http://www.chicagobusiness.com/article/20130108/NEWS03/130109811/chicago-hospitals-flooded-with-flu-patients), so I'm thinking about getting one. Anyone have opinions about getting the shot at Walgreens? http://www.walgreens.com/topic/health-shops/flu-shots.jsp
There's no question, unless you have some rare contraindication, get the vaccine and Walgren's is as good as anyplace. Usually the pharmacists are the one giving you the vaccine in the drug and grocery stores.

[Skeptic Ginger]

Don't hold your breath. Last Activity: 20th July 2008 05:01 PM

The repeating peril of resurrected threads: ghosts.;)

[Cainkane1]

Are flu shots just another money making gimmick? Do they protect only against previous years strains and are not effective against yet unknown strains? Is real influenza pretty rare and when most people say the got the flu the didn't have it and it was not something that would have been stopped by the shot.
All I know is this. In Jan 1998. I got the worst case of flu I had ever had in my life. I had had the vaccine about six weeks before I got sick andif it helped even a little I don't know about it.

[Skeptic Ginger]

All I know is this. In Jan 1998. I got the worst case of flu I had ever had in my life. I had had the vaccine about six weeks before I got sick andif it helped even a little I don't know about it.Could have meant the difference between surviving or not.

But most vaccines have a failure rate and flu vaccine is no exception. It's not a reason not to get the vaccine.

BTW, that was an old post you replied to. More resurrected thread ghosts. :)

[Cainkane1]

Could have meant the difference between surviving or not.

But most vaccines have a failure rate and flu vaccine is no exception. It's not a reason not to get the vaccine.

BTW, that was an old post you replied to. More resurrected thread ghosts. :)
The post was on the board. You may be right. If I had not had the vaccine I might have died. I've had it this year and so far no flu. I wash my hands a lot especially when I've been in a public place.

[macdoc]

Got my flu shot today as it's hitting Canada early and I'm leaving for Aus in two weeks so I should be just about topped up on anti-bodies for the plane trip. Last trip home got hammered by something - kid behind me in customs was hacking and coughing and no place to hide from the particulates plus tired from a 30 hour journey. Didn't take long to come down with whatever nasty he was spreading.

Officials here in Canada say this year's vaccine is well targetted for the particular strain.

Boston has declared a public health state of emergency it's getting hit so hard.
http://www.guardian.co.uk/world/2013/jan/10/flu-boston-massachusetts-health-emergency

[Capsid]

I've not see whole cell flu vaccine in a couple decades in the US. Do they still use it elsewhere? There are places in Europe where it is/was used:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2738456/

I'm also unsure of your other recommendations here, they don't make sense.

For people over 65 there is now a high dose vaccine, not a split low dose. If a person is immunocompromised they need more, not less. And you'd never give an immunocompromised person the live vaccine as long as the killed vaccine is available.I think we are in agreement and I wasn't making recommendations. I am immunocompromised and was given the pandemic flu as two doses (maybe it wasn't a half dose each time but I thought it was) it wasn't live either.

[Skeptic Ginger]

There are places in Europe where it is/was used:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2738456/

I think we are in agreement and I wasn't making recommendations. I am immunocompromised and was given the pandemic flu as two doses (maybe it wasn't a half dose each time but I thought it was) it wasn't live either.

Capsid, I'm surprised you don't know what you got. You know so much about viruses.

You got 2 different full dose flu formulations if this was in 2009. The 2009-2010 seasonal vaccine containing 3 strains was already in production when the new variant 2009H1N1 emerged. Instead of delaying production of the seasonal vaccine the decision was made to simply use a separate vaccine for the new strain.

If it was after 2009 and you didn't get vaccine containing protection for the 2009H1N1, for kids under age 9 it was recommended they get 2 doses of seasonal vaccine a month apart so that in essence they received 2 doses of the 2009H1N1. It's possible someone recommended that for an immunocompromised patient but I don't believe it is a standard recommendation. It wouldn't be wrong for a prescriber to make such an independent decision as long as there was a reasonable rationale for it. It's called off-label prescribing.

[Capsid]

Capsid, I'm surprised you don't know what you got. You know so much about viruses.

You got 2 different full dose flu formulations if this was in 2009. The 2009-2010 seasonal vaccine containing 3 strains was already in production when the new variant 2009H1N1 emerged. Instead of delaying production of the seasonal vaccine the decision was made to simply use a separate vaccine for the new strain.

If it was after 2009 and you didn't get vaccine containing protection for the 2009H1N1, for kids under age 9 it was recommended they get 2 doses of seasonal vaccine a month apart so that in essence they received 2 doses of the 2009H1N1. It's possible someone recommended that for an immunocompromised patient but I don't believe it is a standard recommendation. It wouldn't be wrong for a prescriber to make such an independent decision as long as there was a reasonable rationale for it. It's called off-label prescribing.Yes, I should have paid more attention but I was one of many that day being immunised. Our local GP's surgery run 3 flu clinics where everyone who is recommended for the vaccine (elderly, asthmatics, immunocompromised etc) is vaccinated; I think they do several hundred in a morning since I was number 400 plus so it was a bit of a rush. I am fairly confident it was the GSK vaccine. Remember I'm in the UK, so the procedure may be different.

[Skeptic Ginger]

...Remember I'm in the UK, so the procedure may be different.The principles of vaccinating an immunocompromised person are going to be the same, even if the procedures aren't. I can't think of any reason to give an immunocompromised person a smaller dose.

Anyway, no matter.

[BenBurch]

I can't wait until this universal flu vaccine they have been talking up appears. Maybe this decade.