Flu Shots

[eeyore1954]

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.

[Katana]

Well, according to the Cochrane Database, which is an independent organization that compiles currently-available data and is considered the gold standard for evidence-based medicine, there isn't a lot of evidence to support routine flu vaccines.

Preventing flu among healthy adults:
Influenza vaccines are effective in reducing serologically confirmed cases of influenza. However, they are not as effective in reducing cases of clinical influenza and number of working days lost. Universal immunisation of healthy adults is not supported by the results of this review.

Preventing flu among elderly:
In long-term care facilities, where vaccination is most effective against complications, the aims of the vaccination campaign are fulfilled, at least in part. However, according to reliable evidence the usefulness of vaccines in the community is modest. The apparent high effectiveness of the vaccines in preventing death from all causes may reflect a baseline imbalance in health status and other systematic differences in the two groups of participants.

Preventing flu among patients with cystic fibrosis:
There is currently no evidence from randomised studies that influenza vaccine given to people with CF is of benefit to them. There remains a need for a well-constructed clinical study, that assesses the effectiveness of influenza vaccination on important clinical outcome measures.

Preventing flu among children:
Influenza vaccines are efficacious in children older than two years but little evidence is available for children under two. There was a marked difference between vaccine efficacy and effectiveness. That no safety comparisons could be carried out emphasizes the need for standardisation of methods and presentation of vaccine safety data in future studies. It was surprising to find only one study of inactivated vaccine in children under two years, given recent recommendations to vaccinate healthy children from six months old in the USA and Canada. If immunisation in children is to be recommended as public-health policy, large-scale studies assessing important outcomes and directly comparing vaccine types are urgently required.

Linky (http://www.mrw.interscience.wiley.com/cochrane/cochrane_search_fs.html?mode=startsearch&products=all&unitstatus=none&opt1=OR&Query2=&zones2=article-title&opt2=AND&Query3=&zones3=author&opt3=AND&Query4=&zones4=abstract&opt4=AND&Query5=&zones5=tables&FromYear=&ToYear=&Query1=influenza+vaccine&zones1=%28article-title%2Cabstract%2Ckeywords%29)

[Taffer]

Are flu shots just another money making gimmick?

Nope. Many people here can get them for free.

Do they protect only against previous years strains and are not effective against yet unknown strains?

They are developed based on previous strains, yes. Whether they are effective against current years really depends on how much the virus has changed. Viruses, especially Infuenza Viruses, mutate and evolve very quickly. However, that being said, mutations do not always impact immune factors. 'Flu' mutants which have different surface proteins will be less effectively (or not at all, depending on the change) targetted by any vaccination.

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.

Oh god yes. It's a peeve of mine, actually.

As Katana has pointed, it is not the most supported vaccination out there. However, that being said, for the you, elderly and especially the immunocompromised, it's not entirely silly to have them. Especially since they are free/cheap (at least here, dunno about elsewhere), don't harm, and could actually work (obviously depending on the strain). One major problem is you're not particularly likely to know if it has 'worked', since you wouldn't get sick!

(Yes, gross oversimplification I know.)

[Demigorgon]

Basicly, if you haven't had that particular strain before, yes it's worth it. Otherwise you've probably immunized yourself already if you've already had it. It just mutates to damn fast. Damn you evolution!

[Capsid]

Influenza does not mutate it reassorts.

[Bowser]

Influenza reassorts AND mutates AND recombines.

If you want to follow the progress of actual flu infections, the CDC has a good website. You can follow the wave across the country. Last year it started on the left coast and headed east. The posted CDC data tends to be a week or so behind.

http://www.cdc.gov/flu/weekly/fluactivity.htm

[Taffer]

Influenza reassorts AND mutates AND recombines.


Bowser has it. ;)

[Capsid]

I stand corrected.

[Luke T.]

I was given the flu shot every year for 20 years in the Navy. When I retired, I didn't go out and get the flu shot. That December, I got the flu. And I was a piece of raw meat to that bug. It was so bad, I ended up in the hospital. The admitting nurse in the ER said, "A lot of people come in here thinking they have the flu, but they don't have the flu. You have the flu. :)

Was not pleasant.

One shot I do believe in. The flu shot. I also believe in the pneumonia shot, probably more than the flu shot. I didn't even know there was such a thing until I got out of the Navy. Every year, I would get a cold and it would spread to my lungs and I would be hacking for weeks. Bent over double hacking. And on one occasion, coughing up blood.

I went to the Navy doc and he said I have asthma. He gives me an inhaler. As if every doctor in my life before then somewho missed that I had asthma. But hey, he's a doc, do what he says. So I use the inhaler and coughed like I have never coughed in my life. Then I noticed a whole bunch of my shipmates were carrying inhalers.

Freaking quack!

A corpsman who was on the ball got me some antibiotics and that was that.

Once I retired, I got this pneumonia shot my wife told me about, and its been six years since I have had that hacking.

[LibraryLady]

Bowser has it. ;)

I hope you feel better soon, Bowser.

I get the flu shot--it's free, I get it where I work, and I'm exposed to lots of coughing, sneezing people all day. It's worth it for me.

[skullerello]

I've never had a "flu-shot"; I lived in a tiny, geographically isolated area. I worked in a convenience store, and still never got sick. I wasn't exposed to a large number of the (U.S.) population, but, from over a cross-section of the entire state of Wisconsin; and, still, I never got sick.
But my friend Donna (who'd had a liver-transplant) always insisted that I should still get a "flu-shot" .
I'd known other folks who had gotten their flu-shots and, yet, still managed to get sick.
I deemed them all "weak-willed losers".
I continued to drink heavilly, and began instead, to chart my BM's.

[This Guy]

I was given the flu shot every year for 20 years in the Navy. When I retired, I didn't go out and get the flu shot. That December, I got the flu. [SNIP]

Nice to see there are other swabbies on here ;)

I got off active duty from the Navy in 1986, after about 12 years. Might have had a flu shot the first few years out, because I was working at a medical facility (honestly don't remember getting the shot, but it's likely they offered them free to us). But haven't had one for over 10 years now, and unless it passed unnoticed, I haven't had the flu once.

I used to hate getting the shot. It always wasted me. I'd have to go back home, and just crash for the rest of the day. By the next morning I'd be ok, but that night after the shot I was useless.

I keep thinking that as I get older, I should start taking them again. But figure I'll wait till I get a good case of the flu before I do.

[Mongrel]

Do they work - Evidence points that way.
Would I have it if offered - damn right.

I never had Flu until 2000\2001. New Years Eve so I was imbibing freely after I'd finished work and got light headed quicker than I would have expected. About 9PM I started to get a scratchy throat, I thoughtobviously that I was just getting a little dehydrated so alternated beers with juice for the rest of the night.

Next morning I surfaced into conciousness with the worst sore throat I'd ever had, muscle pains that felt like I'd been the victim of a brutal mugging, a feeling that my skin had been lightly sandpapered all over, a wracking cough and a fever high enough that my Pharmacist girlfriend was going to carry me to A&E.

Those symptoms lasted for about 5 days (the fever went down quickly with NSAIDs) and after that I was as weak as a kitten for another 6 or 7. I learnt two things from this;
Being off work for a couple of days means you haven't had Flu, it's just a cold.
If you're ever offered a Flu shot - take it

[Hydrogen Cyanide]

This evening during her violin lesson my daughter started to feel very tired and cruddy. Her eyes would start tearing for no apparent reason. In the car she insisted on having the heat on full blast.

When we got home she asked for more blankets because she could not get warm. I took her temperature and it was over 100 degrees F. And now her muscles hurt, lots.

So she now has the flu.

A couple of weeks ago she got her Tdap vaccine. I explained to her that this was new because pertussis was coming back, and it was very very bad and can cause death in very young children. I did tend to rant about my opinion on anti-vaxers.

Then later in the week her oldest brother got the influenza vaccine because he has a very severe heart disorder. The doctor even told me he worries more about the flu than pertussis with him (my oldest could not get the Tdap because he is 18 years old).

So now my daughter asked me twice this evening if she has the flu her brother was vaccinated for... and is it the one that causes death.

Oh, crud... I feel like a bad scaremongering parent right now.

I did tell her that the deaths are with older people and those with health problems (like her brother), not young healthy kids like herself.

I hope I'm right.... and I hope I don't get what she has.

[Fidelio]

At my age of 54 it matters not whether 'tis woo woo or not. (Anecdote follows)

Prior to getting flu shots I was in bed for around a week a year...what the bug was I have no way of knowing... (it ain't like the guys in the navy uniforms from the CDC come knocking on the door)

I haven't had that since. Therefore as I am too old to spend a week with one foot in the grave and the other on a banana peel, I choose the shots.
[/anecdote]

[rjh01]

I used to be sick for a couple of weeks every winter with the flu. Now work offers it to us for free. I take it and not been sick since. With one exception. I had not taken the flu shot that year.

[skeptigirl]

Influenza is not rare. CDC current flu activity as well as activity the past few years. (http://www.cdc.gov/flu/weekly/fluactivity.htm) The WHO, Europe, and a few other countries have similar report web sites.

The flu is a serious respiratory infection not a stomach infection as many believe. There are ~200 known respiratory pathogens and the flu represents only a small percentage. But it kills many more people than most the others. If you have a sudden onset of a high fever, headache, muscle aches, and by the next day have a sore throat and cough during flu outbreaks it is more likely the flu than not. If you have a scratchy throat and runny nose that turns into a cough and has a mild fever it is unlikely to be the flu.

A considerably large portion of public health money is spent by all modern countries monitoring and evaluating flu risk annually. This includes monitoring human and animal influenza disease. The virus' genetic drift (and shift when recombinant strains emerge) is continually determined by sampling the virus from animals and humans as outbreaks circle the globe following the endless winter.

Vaccine composition is determined by the WHO twice a year based on what is actually circulating. Vaccine strain viral cultures maintained by the WHO are then distributed to vaccine manufacturers from which they produce vaccine. There is a southern hemisphere and a northern hemisphere version with production set for the fall in each hemisphere. It contains 3 strains because adding more gets you the law of diminishing return. You get very little additional coverage for circulating strains by adding more than 3. The vaccine will change 1,2 or 3 of the strains it contains from year to year.

The virus' lethality and complication rate are seriously underestimated by most people.

The vaccine is very safe compared to the risk from the disease.

It doesn't make you ill as many believe. There are placebo controlled studies showing that.

The vaccine is not the biggest money maker for drug companies which is one reason not enough is produced every year.

The current HPAI-H5N1 (bird flu) reminder that a deadly pandemic of influenza is cyclic and we have no means yet to stop it when it happens has renewed interest in potential profit therefore research has resumed in earnest among a few vaccine manufacturers.

A recent study (http://www.sciencedaily.com/releases/2006/10/061026185115.htm) published which analyzed the viral changes of regular flu over a few years indicated it remains the same as far as your immune system recognizing it for long stretches then a new version will emerge and rapidly become the dominant strain. This happened recently with H5N1 (http://www.promedmail.org/pls/askus/f?p=2400:1001:3124651568547661419::NO::F2400_P1001 _BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,35025) as well though the new version remains deadly and is not spreading among humans very efficiently just like the first version. Original article (http://www.pnas.org/cgi/content/abstract/0608157103v1?etoc) (BTW, there are several H5N1 strains that are not very dangerous and are worldwide. The deadly version emerged from the mild strains in 1997.)

Your vaccine will last anywhere from several months to a few years depending on your immune system but since you don't get a 'series' it doesn't last as long as say a tetanus vaccine. However it's a moot point since the virus will drift enough to appear as a new organism to your immune system every year or two anyway.

Oh, BTW, as an infectious disease practitioner, I get a flu shot and give one to my son every year.

[Dymanic]

Once I retired, I got this pneumonia shot my wife told me about, and its been six years since I have had that hacking.
If you were under 65 when you got the first pneumovax, you should get a booster after five years.

[jimtron]

(bump)

Any significant downsides to getting a flu shot?

[skeptigirl]

None that are evidence based.

[ChaoticLimbs]

I take medical advice from my doctor, not anonymous internet-people.
He went to school for that.

[skeptigirl]

I take medical advice from my doctor, not anonymous internet-people.
He went to school for that.So what is your point? That the medical providers in this forum somehow can't make a simple statement about the risks vs benefit of flu vaccinations?

I'd be careful if I were you about putting so much faith in your personal physician. I teach my patients that they should consider health care more of a buyer beware situation. The more you know about your medical care, the better you can determine together with your provider what the best course of care should be.

[Complexity]

I plan on getting a flu shot soon.

[JEROME DA GNOME]

Are vaccines stifling the progress of evolution?

[skeptigirl]

No, Jerome, unless you want evolution divorced from all technology. Are cars making us poorly adapted creatures? What about horses? Shoes? Houses? ........

[JEROME DA GNOME]

No, Jerome, unless you want evolution divorced from all technology. Are cars making us poorly adapted creatures? What about horses? Shoes? Houses? ........

Does not a flu vaccine; for the most part, just prevent the sickly from dying?

[skeptigirl]

No. It prevents healthy people from dying as well, it keeps young children out of the hospital, and some of those elderly people you speak of have plenty more to contribute to the world if they stick around longer.

And, you asked about evolution. Since the elderly are past reproduction, evolution is not going to be affected anyway.

[UnrepentantSinner]

(bump)

Any significant downsides to getting a flu shot?

I don't plan on getting one any time soon so it's my unbiased opinion that there are no down sides to getting a flu shot and, if you want to get one, you should.

[JEROME DA GNOME]

No. It prevents healthy people from dying as well, it keeps young children out of the hospital, and some of those elderly people you speak of have plenty more to contribute to the world if they stick around longer.

But mostly the sickly succumb. I found this: Flu-Related Deaths Up Sharply (http://www.cbsnews.com/stories/2003/01/07/health/main535605.shtml)

To the original point: Despite the advent of a vaccine four decades ago, flu-related deaths in the United States have risen dramatically since the 1970s...

Flu deaths have increased since the advent of the vaccine?
Maybe the distributors also believe that the vaccine mucks with evolution?



And, you asked about evolution. Since the elderly are past reproduction, evolution is not going to be affected anyway.

No, we have drugs that allow for the elderly to procreate. This goes to the same question. Should we use drugs to allow the elderly to have children? Is this stifling evolution?

[rjh01]

But mostly the sickly succumb. I found this: Flu-Related Deaths Up Sharply (http://www.cbsnews.com/stories/2003/01/07/health/main535605.shtml)

To the original point:

Flu deaths have increased since the advent of the vaccine?
Maybe the distributors also believe that the vaccine mucks with evolution?



I do not understand your point. The article you quoted explains it all.
The rising death toll is attributed largely to the nation's growing number of elderly people, who are especially vulnerable to the flu.

Only about 65 percent of older people get vaccinated, and the annual shots do not protect aging immune systems as well as they do younger ones.
In other words the death toll would have been even higher if the vaccine did not exist.

[Roboramma]

Are vaccines stifling the progress of evolution? Would that be a bad thing?

But to answer your question - no. All it does is change the selective pressures, just like any other change to the environment.

A flu vacine means the those who put their resources in to things other than preventing themselves from getting the flu, and fighting it when they've got it, are more likely to survive. Say there were a mutation that caused it's bearers to be more likely to be able to run fast, but also to have a slightly greater susceptibility to the flu. The vacine would remove a selective pressure against this mutation, and it might begin to spread through the population. Is that stifling evolution?

Such an idea isn't all that far fetched. Sickle-cell anemia and it's relationship to maleria is a good example of exactly what I'm talking about.

[sophia8]

No, we have drugs that allow for the elderly to procreate. This goes to the same question. Should we use drugs to allow the elderly to have children? Is this stifling evolution?
Wrong. In the case of women, no amount of "drugs" will let them pass on their genes once they are past the menopause; post-menopausal mothers have no eggs of their own and have to use donor eggs, which are invariably from healthy young women. Men can produce sperm and pass on their genes at any age; the only drug they are likely to need is Vl@gr@.

[Roboramma]

No, we have drugs that allow for the elderly to procreate. This goes to the same question. Should we use drugs to allow the elderly to have children? Is this stifling evolution? If we are making it easier for the elderly to procreate what sort of evolutionary outcomes would you expect to occur?
The only ones I would expect would be positive:
By making it possible for the elderly to procreate we change the selective landscape, and health in old age would be selected for. If people can reproduce longer, dying at sixty, rather than seventy, is suddenly selected against.
So, if anything, I would expect the outcome (long term obviously) of this to be evolution toward longer lifespans.

Again, how is that bad, exactly?

[Complexity]

What 'progress' of evolution?

[fls]

Women past menopause can still influence evolution if you take into consideration the Grandmother Hypothesis. The additional care provided by a grandmother could increase the chance of survival of her grandchildren and therefore the genes that they share.

Linda

[Michael Redman]

A money making scheme? It's primarily the government pushing flu shots. There's no money in it for them. Very little, if any, money in it for doctors and nurses who dispense it, and they're the other folks telling people to get them. If there was money in it for the manufacturers, there would be advertisement. I've never seen a commercial advertisement pushing flu shots.

[Michelle]

A money making scheme? It's primarily the government pushing flu shots. There's no money in it for them. Very little, if any, money in it for doctors and nurses who dispense it, and they're the other folks telling people to get them. If there was money in it for the manufacturers, there would be advertisement. I've never seen a commercial advertisement pushing flu shots.

Then it is obviously a scheme by the government to control your brain and make you blind to the great conspiracies they are leading while making you hate communists. :P

I'm getting mine monday... I don't like shots :boxedin: But I hate flus even more!

[kellyb]

It's being pushed because the same manufacturing facilities used to make the seasonal vaccines can be quickly converted to make birdflu vaccines in the event of a pandemic.
So a while back the WHO decided that the best way to save the world from birdflu would be to increase seasonal vaccine uptake by 75% in the developed world.
If people don't buy the seasonal flushots every year, then the manufacturers will withdraw from the market, close the plants, etc. and then we'll be up the proverbial creek without a paddle when we really need a gazillion doses of, say, an H5N1 vaccine.

Hence the CDC's ever-expanding recommendations which appear (and are, I'd argue..hi, skeptigirl. :)) rather bizarre on the surface, and strange things like this:
http://www.local6.com/spotlight/14350182/detail.html

Strip Club Offers Free Flu Shots

CASSELBERRY, Fla. -- An adult nightclub in Casselberry is offering free flu shots to Central Floridians.

Rachel's Gentlemen's Club launched a free flu shot service at the business located on Semoran Boulevard in Casselberry.

[JEROME DA GNOME]

I do not understand your point. The article you quoted explains it all.

In other words the death toll would have been even higher if the vaccine did not exist.

The article stated; according to the CDC, that flu deaths have increased fourfold since the introduction of the vaccine.

Fourfold is 4 times as many.

[JEROME DA GNOME]

A money making scheme? It's primarily the government pushing flu shots. There's no money in it for them. Very little, if any, money in it for doctors and nurses who dispense it, and they're the other folks telling people to get them. If there was money in it for the manufacturers, there would be advertisement. I've never seen a commercial advertisement pushing flu shots.

The governmnet advertises for the manufactures.

[Dymanic]

It's being pushed because the same manufacturing facilities used to make the seasonal vaccines can be quickly converted to make birdflu vaccines in the event of a pandemic.
The argument I've most often encountered is exactly the reverse: that the pandemic influenza threat is overstated (or even completely fabricated) in order to stimulate sales of seasonal flu vaccines -- an argument which (where it is permitted to do so) may be dismissed as conspiracy theory.

Your logic makes at least enough sense to deserve a closer look. What you are basically saying is that the consensus among a large community of infectious disease experts is that the best hope of marshalling an effective response to an influenza pandemic is a widespread program of vaccination. This consensus rests on the assumption that it is possible to formulate a vaccine capable of providing effective protection against an influenza virus (any influenza virus). Whether you believe that or not is irrelevant; you are (indirectly) arguing that they believe it. If you follow me so far, I wonder if you'd agree that if they believe that a vaccine can be effective against a pandemic influenza, it is very likely that they may also believe that a vaccine can be effective against seasonal influenza, and that while it may be true that stimulating sales of seasonal vaccines might be viewed as the most direct approach to the problem of limited vaccine production capacity (given the constraints of a system in which health care is profit-based), it logically follows that the same experts would also be very likely to view the practice as the most effective way of controlling seasonal influenza? As kind of a bonus?

[JEROME DA GNOME]

The argument I've most often encountered is exactly the reverse: that the pandemic influenza threat is overstated (or even completely fabricated) in order to stimulate sales of seasonal flu vaccines -- an argument which (where it is permitted to do so) may be dismissed as conspiracy theory.

Your logic makes at least enough sense to deserve a closer look. What you are basically saying is that the consensus among a large community of infectious disease experts is that the best hope of marshalling an effective response to an influenza pandemic is a widespread program of vaccination. This consensus rests on the assumption that it is possible to formulate a vaccine capable of providing effective protection against an influenza virus (any influenza virus). Whether you believe that or not is irrelevant; you are (indirectly) arguing that they believe it. If you follow me so far, I wonder if you'd agree that if they believe that a vaccine can be effective against a pandemic influenza, it is very likely that they may also believe that a vaccine can be effective against seasonal influenza, and that while it may be true that stimulating sales of seasonal vaccines might be viewed as the most direct approach to the problem of limited vaccine production capacity (given the constraints of a system in which health care is profit-based), it logically follows that the same experts would also be very likely to view the practice as the most effective way of controlling seasonal influenza? As kind of a bonus?

I am beginning to think this should be moved to the CT section.

Are people/groups this calculating?

[kellyb]

I wonder if you'd agree that if they believe that a vaccine can be effective against a pandemic influenza, it is very likely that they may also believe that a vaccine can be effective against seasonal influenza, and that while it may be true that stimulating sales of seasonal vaccines might be viewed as the most direct approach to the problem of limited vaccine production capacity (given the constraints of a system in which health care is profit-based), it logically follows that the same experts would also be very likely to view the practice as the most effective way of controlling seasonal influenza? As kind of a bonus?

Well, flushots aren't particularly harmful, and they appear to have some small effectiveness, so it could easily be viewed as a win/win situation.
There's also a lot of research going into ways to make the vaccines more effective, which I think you'd agree is a good idea if the ultimate goal is to save lives, particularly in the event of a pandemic.

[Frost]

But mostly the sickly succumb. I found this:

To the original point:

Flu deaths have increased since the advent of the vaccine?
Maybe the distributors also believe that the vaccine mucks with evolution?





No, we have drugs that allow for the elderly to procreate. This goes to the same question. Should we use drugs to allow the elderly to have children? Is this stifling evolution?


Wouldn't sick days due to the flu be something worth preventing too?

[JEROME DA GNOME]

Well, flushots aren't particularly harmful, and they appear to have some small effectiveness, so it could easily be viewed as a win/win situation.
There's also a lot of research going into ways to make the vaccines more effective, which I think you'd agree is a good idea if the ultimate goal is to save lives, particularly in the event of a pandemic.

According to the CDC; since the introduction of the flu shot, flu deaths have increased by 4 times.

:jaw-dropp

4 times as many people have died each year since the flu shot began to be implemented.

I suggest a moratorium to see if the flu shot contributes to flu deaths.

[JEROME DA GNOME]

Wouldn't sick days due to the flu be something worth preventing too?

Sure, if it is proven to do that. The evidence thus far suggests that the flu shot may have contributed to a 4 times greater death rate due to the flu.

[kellyb]

Wouldn't sick days due to the flu be something worth preventing too?

From "Preventing Flu in Healthy Adults", that Katana mentioned earlier;

http://64.233.179.104/scholar?hl=en&lr=&q=cache:V2gTLPDN5TQJ:www.nuh.com.sg/x_apebm/CourseMaterials/5_Overview_Meta_UP/2_Article1.pdf+

Effect of vaccination on other outcomes
Six trials evaluated time off work, estimating that vaccination saved on average around 0.12 working days. This result was not statistically significant.



http://www.bmj.com/cgi/content/full/333/7574/912
The second problem is either the absence of evidence or the absence of convincing evidence on most of the effects at the centre of campaign objectives (table 2). 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

[Dymanic]

The evidence thus far suggests that the flu shot may have contributed to a 4 times greater death rate due to the flu.Statistics isn't really your strong suit, is it?

[kellyb]

Your logic makes at least enough sense to deserve a closer look.

Take a look. :)
(dug up links)
It's not my logic; it's just a fact.

http://www.pharmaceutical-business-review.com/article_feature.asp?guid=C4410902-FB92-4ADE-89F0-26BADA77D453

Ultimately, an improved vaccination coverage for the common seasonal influenza is a fundamental part of a strategy to enhance global preparedness for the anticipated avian influenza pandemic.

As part of its pandemic preparedness plan, designed to contain the threat posed by the avian H5N1 strain, the WHO clearly states that adequate manufacturing capacities for pandemic vaccines can best be achieved by increasing vaccination coverage during seasonal epidemics.

http://www.who.int/mediacentre/events/2005/03_WHO_Klaus_Stohr.pdf


Influenza pandemic vaccines: challenges
and opportunities

Influenza Pandemic Vaccines
Production capacity


Increase vaccination coverage of seasonal influenza
vaccine in developed countries to 75%

Now this part is my logic, but I wonder... how do you convince a whole, whole, whole bunch more people to start getting flushots?
What would be an effective way of getting 75% coverage in developed countries?

And I think that's what's up with this:



http://www.ama-assn.org/ama1/pub/upload/mm/36/2004_flu_nowak.pdf



“Recipe” that Fosters Higher Interest and
and Demand for Influenza Vaccine

1.Influenza’s arrival coincides with immunization “season” (i.e., when people can take action)

2.Dominant strain and/or initial cases of disease are:
–Associated with severe illness and/or outcomes
–Occur among people for whom influenza is not generally perceived to cause serious complications (e.g., children, healthy adults, healthy seniors)
–In cities and communities with significant media outlets (e.g., daily newspapers, major TV stations)

3.Medical experts and public health authorities publicly (e.g., via media) state concern and alarm (and predict dire outcomes)–and urge influenza vaccination.


4.The combination of ‘2’ and ‘3’ result in:
A.Significant media interest and attention
B.Framing of the flu season in terms that motivate behavior (e.g., as “very severe,” “more severe than last or past years,” “deadly”)

5.Continued reports (e.g., from health officials and media) that influenza is causing severe illness and/or affecting lots of people–helping foster the perception that many people are susceptible to a bad case of influenza.

6.Visible/tangible examples of the seriousness of the illness (e.g., pictures of children, families of those affected coming forward) and people getting vaccinated (the first to motivate, the latter to reinforce)


7.References to, and discussions, of pandemic influenza–along with continued reference to the importance of vaccination.
(emphasis mine)

That kinda threw me for a loop for a while and had me wondering exactly who the CDC worked for...but the idea that they're doing that to comply with the WHO objective of increasing vaccine uptake for the purpose of saving the world from birdflu makes sense to me.

[Ivor the Engineer]

Take a look. :)
(dug up links)
It's not my logic; it's just a fact.

http://www.pharmaceutical-business-review.com/article_feature.asp?guid=C4410902-FB92-4ADE-89F0-26BADA77D453

.



http://www.who.int/mediacentre/events/2005/03_WHO_Klaus_Stohr.pdf






Now this part is my logic, but I wonder... how do you convince a whole, whole, whole bunch more people to start getting flushots?
What would be an effective way of getting 75% coverage in developed countries?

And I think that's what's up with this:



http://www.ama-assn.org/ama1/pub/upload/mm/36/2004_flu_nowak.pdf



















(emphasis mine)

That kinda threw me for a loop for a while and had me wondering exactly who the CDC worked for...but the idea that they're doing that to comply with the WHO objective of increasing vaccine uptake for the purpose of saving the world from birdflu makes sense to me.

Hmmm. That sounds ethically dubious. A government agency frightening people to boost sales so the manufacturers don't close their plants down. I suppose the question is: Do the ends justify the means?

[Dymanic]

It's not my logic; it's just a fact.It's your interpretation of (one set of) facts. To be a bit pedantic.

The first of your links was to an article in a business journal. Not sure why you'd consider that relevant to evaluating whatever motivations WHO and CDC might have for promoting flu vaccines.

As for the second, if the quote: "the WHO clearly states that adequate manufacturing capacities for pandemic vaccines can best be achieved by increasing vaccination coverage during seasonal epidemics." appears anywhere, I'm danged if I can find it; I'm not sure if the formatting problems with that PDF are local to my system or what, but it's looking pretty mangled here. I'm able to resolve that it predicts the outcomes of increase vaccination coverage of seasonal influenza
vaccine in developed countries to 75% as:

Significant decrease in death and disease from seasonal influenza
Cost-effective reduction in health implications (cost-saving in some countries)
Increase in global vaccine production capacity by 60%

Which is pretty much what I said above.

As for the third, I think the reason the business about the "recipe" throws you for a loop is that you assume that it is intended to be prescriptive rather than descriptive; you are reading motivation into it. Speaking of a "recipe for disaster" doesn't necessarily imply a desire or an intent to try to cook one up. A clue is this statement: "A large component of consumer demand for flu vaccination is contingent upon things we can’t control"

The CDC doesn't have control over the virus, it doesn't have control over the media, it doesn't have control over individual physicians and care providers, and it doesn't have control over what every public health care person may say in front of a microphone. The article addresses the challenges of effective risk communication in the face of such uncontrollable factors, and basically concludes that people are going to believe what they're going to believe, and behave how they're going to behave, and there really isn't all that much you can do about it.

[robinson]

Considering the amount of time and effort required to gain approval for a medicine or drug, how can each years new flu vaccines possibly meet the safety and efficiency test before being used?

How can anyone even know if they are safe? And that the vaccine actually works? Where is the science to back up the claims made?

[robinson]

Take a look. :)
(dug up links)
It's not my logic; it's just a fact.

Wow. Wow. I'm not sure what to think. Can that be true?

[kellyb]

As for the second, if the quote: "the WHO clearly states that adequate manufacturing capacities for pandemic vaccines can best be achieved by increasing vaccination coverage during seasonal epidemics." appears anywhere, I'm danged if I can find it;

That's weird...
It's not a PDF.
Can you get to it through a google search?
http://www.google.com/search?hl=en&rls=GGLF%2CGGLF%3A2006-13%2CGGLF%3Aen&q=%22As+part+of+its+pandemic+preparedness+plan%2C+ designed+to+contain+the+threat+posed+by+the+avian+ H5N1+strain%2C+the+WHO+clearly+%22&btnG=Search


As for the third, I think the reason the business about the "recipe" throws you for a loop is that you assume that it is intended to be prescriptive rather than descriptive; you are reading motivation into it. Speaking of a "recipe for disaster" doesn't necessarily imply a desire or an intent to try to cook one up.

You can't be serious!
Nowak is the CDC's "Communicatons" director. He's a marketing guy. Before he went to work for the CDC he worked in advertising.

Look what they say next:

Influenza Immunization
Communication Challenges (2)

•Some component of success (i.e., higher demand for influenza vaccine) stems from media stories and information that create motivating (i.e., high) levels of concern and anxiety about influenza.
•Inducing worry, raised anxiety, and concern in people brings forth a number of issues and presents many dilemmas for health care professionals.

And can leave you searching for the
“Holy Grail” of Health Communication
(Lanardand Sandman, 2004)

The belief that you can inform and warn people, and get them to take appropriate actions or precautions with respect to a health threat or risk without actually making them anxious or concerned. (Remember the quiz?)
This is not possible. Rather. . .
“This is like breaking up with your boyfriend without hurting his feelings. It can’t be done.”

Not prescriptive my butt!

The article addresses the challenges of effective risk communication in the face of such uncontrollable factors, and basically concludes that people are going to believe what they're going to believe, and behave how they're going to behave, and there really isn't all that much you can do about it.

Yeah...you're left with sending media packets out and hoping that just scaring the snot out of people is effective.

[ExMinister]

So, would the medical practitioners here posting consider it worthwhile to spend $26 per flu shot to have an otherwise healthy family of four vaccinated, with small children, ages 4 and 5? It's definitely not free in our community. I'm considering it because we all had the flu back in 2003, my 8-month-old's turned into croup and pneumonia, he had to be hospitalized and almost didn't make it. This was serologically tested (type B, if I recall) influenza and we were all sicker than I can ever remember having been. But if the shots aren't all that effective, I hate to spend $26 per shot.

[Dymanic]

It's not a PDF.
Whatever. I'm willing to stipulate that the WHO is interested in increasing manufacturing capacities for flu vaccines as a preparedness measure against pandemic flu, and that this increases their interest in promoting seasonal vaccines. I just don't see this as their only motivation for doing so; they also believe in vaccination as an effective measure against seasonal influenza.

You can't be serious!I am completely serious. I know that you are quite attached to this document, and to a certain interpretation of it. Demand for flu vaccines can vary widely from one season to another. Understanding this fluctuation is a problem for a person with experience in marketing; hence, this evaluation:

"Vaccination demand, particularly among people who don’t routinely receive an annual influenza vaccination, is related to heightened concern, anxiety, and worry."

In other words (ignoring two categories: people who routinely get the vax, and people who never get the vax), demand is not based on critical thinking, scientific literacy, reasoned judgement, careful consideration of evidence, or anything like that; it's based on emotion. This is an observation, being made by someone with experience in making observations about what motivates demand for a product.

Look closely at these statements:

"Medical experts and public health authorities publicly (e.g., via media) state concern and alarm (and predict dire outcomes)–and urge influenza vaccination"

"Some component of success (i.e., higher demand for influenza vaccine) stems from media stories and information that create motivating (i.e., high) levels of concern and anxiety about influenza."

"The combination of ‘2’ and ‘3’ result in:
A.Significant media interest and attention"

These are descriptions of aspects of a process over which the WHO and the CDC have no control. The article's central theme reduces to: "You can't use science to persuade idiots; the threats they will take seriously will be those which the media selects for entertainment value".

[ExMinister]

Disregard above question, have found a place offering the shots for free. :) Even if they're just a little bit effective, they're probably worth getting if free. Having the flu was a wretched experience that I would definitely like to avoid repeating.

[kellyb]

"Medical experts and public health authorities publicly (e.g., via media) state concern and alarm (and predict dire outcomes)–and urge influenza vaccination"

These are descriptions of aspects of a process over which the WHO and the CDC have no control.

So after the CDC decides they need their spokespeople in the media stating concern and alarm, and predicting dire outcomes...and they end up in the news doing just that, it's a process they have no control over?
You don't think the CDC ever contacts the media with good stories that need to be told in the interest of health communication?

[JEROME DA GNOME]

So, would the medical practitioners here posting consider it worthwhile to spend $26 per flu shot to have an otherwise healthy family of four vaccinated, with small children, ages 4 and 5? It's definitely not free in our community. I'm considering it because we all had the flu back in 2003, my 8-month-old's turned into croup and pneumonia, he had to be hospitalized and almost didn't make it. This was serologically tested (type B, if I recall) influenza and we were all sicker than I can ever remember having been. But if the shots aren't all that effective, I hate to spend $26 per shot.

According to the CDC, flu deaths have increased by 4 times since the introduction of the flu shot.

There should be a moratorium until science determines if the flu shot is a factor in the increased flu deaths.

[JEROME DA GNOME]

Disregard above question, have found a place offering the shots for free. :) Even if they're just a little bit effective, they're probably worth getting if free. Having the flu was a wretched experience that I would definitely like to avoid repeating.

I doubt the shots are "free". Who is really paying for the shots?

[JEROME DA GNOME]

So after the CDC decides they need their spokespeople in the media stating concern and alarm, and predicting dire outcomes...and they end up in the news doing just that, it's a process they have no control over?
You don't think the CDC ever contacts the media with good stories that need to be told in the interest of health communication?

Drug companies do not lobby the governmnet!

You are outrageous!

:boggled:

[Dymanic]

You don't think the CDC ever contacts the media with good stories that need to be told in the interest of health communication?The CDC "serves as the national focus for developing and applying disease prevention and control, environmental health, and health promotion and health education activities designed to improve the health of the people of the United States."

With that mission statement in mind, what would you consider the ideal approach to communicating a threat, when a consensus among experts indicates that a threat exists?

[JEROME DA GNOME]

The CDC "serves as the national focus for developing and applying disease prevention and control, environmental health, and health promotion and health education activities designed to improve the health of the people of the United States."

With that mission statement in mind, what would you consider the ideal approach to communicating a threat, when a consensus among experts indicates that a threat exists?

Assuming that the CDC being a governmental organization is immune from the vast amounts of cash funneled into the governmnet by the manufacturers of the vaccine the implication of your question would be correct.

[kellyb]

With that mission statement in mind, what would you consider the ideal approach to communicating a threat, when a consensus among experts indicates that a threat exists?

Are you talking about birdflu here or seasonal flu?
I don't really see where you're going with this. Health marketing uses a variety of strategies.
Here are just a few:

(from their script suggestions page)
http://www.cdc.gov/healthmarketing/entertainment_education/tips/influenza.htm
Case Examples
1. A 70-year-old grandmother flies across the country to visit her family. After landing, she has a scratchy throat, coughs a little, and is tired and maybe even a little feverish, but she chalks it up to the long flight. At her daughter's house, she lies down. The daughter checks on her a bit later, and finds her burning with fever, with an intense headache and body aches. She is coughing and congested. The daughter calls a doctor who says the symptoms sound like influenza infection. Has the mother had a flu shot? No. The mother and daughter immediately go to the hospital emergency room where the diagnosis is acute bronchitis infection and pneumonia. The mother is hospitalized, antibiotics are administered, but her condition declines. She dies three days later.



http://www.cdc.gov/healthmarketing/basics.htm
A Health Marketing Example
The CDC develops a new rapid HIV testing kit that provides results in half the time of current tests. To efficiently market the new product, the testing kits are announced by the national media and medical journals. The CDC sends free samples of the new testing kits to each of the state health departments, who deliver them to local health departments, clinics and hospitals. Here is how the CDC used the marketing mix:
Product: new HIV testing kit; released by a credible research agency
Price: free for trial use
Place: widely and evenly distributed throughout states using state and local health departments
Promotion: national media publicizes to public; journals inform medical community



http://www.cdc.gov/healthmarketing/entertainment_education/index.htm

The media is a resource.
They also make little posters and stuff.


http://www.cdc.gov/flu/professionals/flugallery/2007-08/edumat_dad-baby.htm
http://www.cdc.gov/flu/professionals/flugallery/2007-08/edumat_mom-baby.htm
http://www.cdc.gov/flu/professionals/flugallery/2007-08/images/p_grandfather65_aa_180x240.gif
http://www.cdc.gov/flu/professionals/flugallery/2007-08/images/p_nurse_personal_5people_180x240.gif

[Ivor the Engineer]

Why don't they try honest(-ish) marketing?

Like saying:

"Guys, if we don't use enough flu vaccine the companies that make it for us are going to ramp down production and close their manufacturing plants. When pandemic flu arrives, a lot more people than usual will be at risk of serious or fatal illness and require a flu jab. Unless we have the capacity to treat them now, many more people will die in the future."

[kellyb]

I guess they think what they're doing now is more effective?
Plus, they do seem to really think that getting every man, woman and child (and infant now) to get a flu vaccine every year will save lots of lives from seasonal flu.
So since the "Do this or DIE" "message" is effective, why mess with perfection?
I also get the impression that there's a kind of almost religious-type "belief" in flu vaccines. People are slow to let go of old ideas about stuff. It's human nature.
Or something. I dunno.
Weird situation, for sure.

[Dymanic]

Are you talking about birdflu here or seasonal flu?
Let's say seasonal flu.

I don't really see where you're going with this.
You asked: "You don't think the CDC ever contacts the media with good stories that need to be told in the interest of health communication?" I'm asking whether you think it is proper for the CDC to do such a thing, or what sort of alternative you might propose.

Plus, they do seem to really think that getting every man, woman and child (and infant now) to get a flu vaccine every year will save lots of lives from seasonal flu.I think that's an important point. The conspiracy theorist might argue that they (which includes most physicians as well as public health officials) really don't think flu vaccines are effective, but promote the practice because they are all in Big Pharma's pockets. I'm glad that we agree on this.

I also get the impression that there's a kind of almost religious-type "belief" in flu vaccines.That sounds a lot like a familiar creationist argument. I think it's useful to make a distinction between subjective opinions and reasoned judgements. A frighteningly large number of people in Idiot America are unable to make this distinction. Since you aren't one of them, it's surprising to see you try to dismiss a consensus among public health care professionals as some mere quirk of human nature.

[Beth]

I guess they think what they're doing now is more effective?
Plus, they do seem to really think that getting every man, woman and child (and infant now) to get a flu vaccine every year will save lots of lives from seasonal flu.
So since the "Do this or DIE" "message" is effective, why mess with perfection?
I also get the impression that there's a kind of almost religious-type "belief" in flu vaccines. People are slow to let go of old ideas about stuff. It's human nature.
Or something. I dunno.
Weird situation, for sure.

The problem I see with this sort of marketing approach is that it degrades the credibility of the CDC. It's essentially crying wolf falsely and everyone knows the moral of that story. I have little respect for the CDC these days and almost all of their loss of crediblity in my eyes comes as a result of their public advisory messages and policy recommendations in regard to vaccinations.

[Segnosaur]

The article stated; according to the CDC, that flu deaths have increased fourfold since the introduction of the vaccine.

Fourfold is 4 times as many.

But the article already explained the problems:

- The total number of deaths may be higher, but then there are also more people alive, and they are living longer (and flu tends to affect older people more). For example, lets say you had a town of 100 people in the 70s. Lets say 10% of the people there MIGHT die from the flu, and a vaccine is brought in that will save half the deaths. As a result, 5 people die, 5 are saved. Twenty years later, the population of the town has doubled. 10% of the people might still die from the flu (total of 20 people)... Vaccines are still 50% effective. As a result, 10 people will die, 10 will be saved. The vaccine has saved people (in fact, more people than before), but because there are simply more people around more people die.

- the article you referred to also pointed out that many people in high risk groups simply aren't taking the vaccine. Can't blame the vaccine if you're not taking the shot.

[Segnosaur]

(bump)

Any significant downsides to getting a flu shot?
Don't think there's anything that significant. There is the cost (even if you get the shot for 'free', the government still charges you for it through your taxes). And, since most flu vaccines use eggs for incubation, people with an allergy to eggs might have a bad reaction to it.

[robinson]

Does anyone have any actual information about how Flu shots are made each year? Where do they get the "new" flu from to make the vaccines? How do they test them to make sure they are safe? That they actually work?

Solid scientific information about the manufacturing process. the safety and efficiency testing, would go a long way towards encouraging skeptical people to get the vaccines. It seems the problem is a lot of people are skeptical of the value of getting a shot.

If somebody is skeptical of a claim, evidence is one of the best ways to convince people to change their minds. Spurious claims and sketchy evidence, or worse, wild claims and fear mongering, don't do anything except further more skepticism about the validity of a claim.

How hard would it be to simply publish the scientific facts, along with the evidence for these facts, rather than keep claiming something is true?

So, does anyone actually have any facts about Flu vaccines? In regards to the main issues that are questioned by skeptics?

[fls]

I think I have less trouble trusting the ACIP because rather than picturing them as nameless corporate drones, some of them are people I worked with (my residency research was on vaccine policy) and whose opinions are highly respected for a reason. Plus I've served on various public health/advisory committees and so have first-hand experience with the kind of discussions that take place.

ETA: I've never seen anything remotely as 'calculating' as Kelly has proposed. The kind of people that are drawn to serve on these committees tend to be from the opposite end of the spectrum (usually at least a few raised as idealist hippie types (myself included ;)).

However, if the CDC is untrustworthy, what about policy from other countries (http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/07vol33/acs-07/index_e.html)?

Linda

[kellyb]

Hmm...I just jumped over to the WHO site, and it looks like it's a different branch of the CDC (not the ACIP) doing the brainstorming here...

http://www.who.int/csr/resources/publications/influenza/WHO_CDS_CSR_GIP_2004_3.pdf


Vaccines for pandemic influenza
Informal meeting of WHO, influenza vaccine manufacturers,
national licensing agencies, and government representatives
on influenza pandemic vaccines
SUMMARY REPORT
11–12 November 2004
Geneva, Switzerland

The American representative is:

Members of the WHO Global Influenza Surveillance Network:
Dr Nancy Cox
Director, WHO Collaborating Centre for Surveillance, Epidemiology and Control of
Influenza; Chief, Influenza Branch, Viral Disease Division
Centers for Disease Control and Prevention
Atlanta, Georgia USA

So she's way up in the WHO and the CDC.

And some of the highlights of the meeting:

Increased vaccination coverage during seasonal epidemics should be
recognized as the best long-term strategy for ensuring an adequate
manufacturing base for pandemic vaccines; national policies should seek to
improve vaccination coverage of groups at high risk of complications during
seasonal epidemics

Roles and responsibilities. Concerning roles and responsibilities, governments
were urged to provide a better environment for the development of influenza
vaccines in general, most notably by increasing the uptake of seasonal vaccines,
when this conforms with national health priorities. It was up to countries with
resources and manufacturing capacity to prepare the stage for responding to what
would unquestionably be a global threat.

Health officials and industry executives were in full agreement that increased use
of vaccines for seasonal epidemics represents the best long-term strategy for
increasing manufacturing capacity for pandemic vaccines.


These efforts went hand-in-hand with campaigns to improve uptake of seasonal
vaccine; several countries (Canada, Switzerland, the UK, and the USA) reported
impressive progress in this regard.

Yeah...I bet they did.

At this point industry stepped up and got to make their requests:

Partnerships needed in specific areas. Industry identified five main areas in
which public-private partnerships were needed to move the process forward: (1)
development of the seed vaccine and registration of a mock-up product, (2)
expansion of production capacities, (3) assurance of adequate supplies and
equitable distribution, (4) acceleration of time to market, and (5) assurance of
liability protection.


(2) Expanded capacity. Vaccine formulation – antigen content, adjuvants,
immunogenicity, and dose schedule – would ultimately influence the number of
doses available. Furthermore, increased uptake of seasonal vaccines would
profoundly expand global manufacturing capacity. This could be achieved
through government policies aimed at meeting WHO recommendations and
targets for seasonal vaccine coverage in high risk groups in countries where
influenza vaccination is part of national priorities for combating infectious
diseases.

(3) Supplies and distribution. Industry was keenly aware of the problem of
inadequate supply and inequitable distribution. Again, increased uptake of
seasonal vaccines was the best long-term strategy for increasing overall capacity.


Here's another one



http://www.who.int/csr/resources/publications/influenza/WHO_CDS_CSR_GIP_05_8-EN.pdf

2. Increase the supply of influenza vaccines
– Find ways to bridge the gap between current vaccine production capacity and
the expected demand during a pandemic
Ways must be found to ensure that countries without domestic manufacturing
capacity will have access to affordable vaccines in adequate quantities. Several
approaches are being pursued, including antigen sparing strategies, technology
transfer, and cell-culture and recombinant vaccine development. Increasing the
demand for seasonal vaccines expands overall manufacturing capacity. The
comparative effectiveness and implementation costs for the various approaches
have not been reviewed. An action plan, with specific recommendations for
countries with and without vaccine production capacity, is urgently required.

Increasing demand for influenza vaccines????

How in the world do you do that, I wonder....

Enhance utilization of seasonal influenza vaccines in high risk groups, in line
with WHO targets (50% coverage in 2006 and 75% in 2010)
Achievement of this goal requires global leadership in assessing and
communicating progress in influenza coverage in countries having national policies
for influenza vaccination and, elsewhere, in vulnerable groups. Other activities
include the development of recommendations to augment vaccine coverage in
target groups, support for the implementation of national vaccination programmes,
and the acquisition of better epidemiological and economic data on the burden of
seasonal influenza in developing countries.

So...
They were shooting for 50% by 2006 (last year)...and 75% by 2010...so we've got a ways to go with this whole thing, still, I think...

[fls]

I guess what I don't understand is why it is unreasonable to improve vaccination coverage in high risk groups - so much so that suggesting it's a good idea for more elderly people be vaccinated than unvaccinated becomes evidence of conspiracy?

Linda

[kellyb]

Most of the US is targeted for flu vaccination now.


What do you thnk about the "7 step recipe"?
Do you agree with Dymanic; it's simply a description of something the CDC has no control over?

[Beth]

You know Kelly, your posts do show evidence of a conscious plan to increase vaccination coverage. But I'm not entirely sure it's a 'bad thing'. Basically, the risk of an new pandemic flu is strain in real enough. They've happened in the past, it's pretty much a sure thing that it will occur again, it's a matter of when, not if. It makes sense to figure out how to make sure the manufacting and distribution facilities are in place to respond quickly and effectively to such an event and doing it the way they are makes sense economically, not just for vaccine manufacturers, but also for the general public.

While I don't like the scare tactics, as long as the vaccines remain optional I don't have a problem with the strategy of increasing demand for seasonal vaccines, particularly when they are targeting those who are most at risk.

[fls]

Most of the US is targeted for flu vaccination now.

But the 'targeting' and goals are really just directed at the high risk groups - trying to improve coverage to greater than 50% in the elderly, for example, where it will provide the most benefit.

What do you thnk about the "7 step recipe"?
Do you agree with Dymanic; it's simply a description of something the CDC has no control over?

It was clearly descriptive. Some parts would make no sense if read as prescriptive.

Linda

[kellyb]

While I don't like the scare tactics, as long as the vaccines remain optional I don't have a problem with the strategy of increasing demand for seasonal vaccines, particularly when they are targeting those who are most at risk.

It's kind of a weird situation, though, in that those who are most at risk are also the same people the vaccine doesn't even work in. (the very young and the very old).
And really, it's everyone who's being targeted now.

Remember this part of the recipe?

2.Dominant strain and/or initial cases of disease are:
–Associated with severe illness and/or outcomes
–Occur among people for whom influenza is not generally perceived to cause serious complications (e.g., children, healthy adults, healthy seniors)

And then there's the CDC's version of the vaccine's effectiveness that they use to push it, which doesn't line up with reality.
And that's not cool, either.
And then there's the overblown figures on annual influenza deaths (36,000?)
http://www.bmj.com/cgi/content/full/331/7529/1412
And THAT's not cool, either.
So the whole shebang leaves a bad taste in my mouth.

Not that I have any better ideas myself on what to do about pandemic influenza, because you're right...eventually some new, bad flu virus will emerge, even though I personaly doubt it'll be H5N1. But eventually one will, and it'll be "a lot worse" than seasonal flu.
But still....

[kellyb]

But the 'targeting' and goals are really just directed at the high risk groups -

Almost everyone is part of the high risk group, though. Infants, children, parents, grandparents, etc, etc.

It was clearly descriptive. Some parts would make no sense if read as prescriptive.

Linda

Ok. Let's break this down to it's most basic form.

Does the CDC contact the media and provide them with information to raise awareness about health related issues and motivate health behavior?

[JEROME DA GNOME]

But the article already explained the problems:

- The total number of deaths may be higher, but then there are also more people alive, and they are living longer (and flu tends to affect older people more). For example, lets say you had a town of 100 people in the 70s. Lets say 10% of the people there MIGHT die from the flu, and a vaccine is brought in that will save half the deaths. As a result, 5 people die, 5 are saved. Twenty years later, the population of the town has doubled. 10% of the people might still die from the flu (total of 20 people)... Vaccines are still 50% effective. As a result, 10 people will die, 10 will be saved. The vaccine has saved people (in fact, more people than before), but because there are simply more people around more people die.

- the article you referred to also pointed out that many people in high risk groups simply aren't taking the vaccine. Can't blame the vaccine if you're not taking the shot.

Those are all speculative reasons. This is why I propose a moratorium to determine if the flu shot does or does not contribute to flu death.

[Beth]

It's kind of a weird situation, though, in that those who are most at risk are also the same people the vaccine doesn't even work in. (the very young and the very old).
And really, it's everyone who's being targeted now.

Remember this part of the recipe?

And then there's the CDC's version of the vaccine's effectiveness that they use to push it, which doesn't line up with reality.
And that's not cool, either.
And then there's the overblown figures on annual influenza deaths (36,000?)
http://www.bmj.com/cgi/content/full/331/7529/1412
And THAT's not cool, either.
So the whole shebang leaves a bad taste in my mouth. Yeah, I agree. Not cool. As I said, the CDC does not have a lot of credibility with me. I kinda resent it. I'd like to be able to rely on their recommendations and not have to research stuff to the extent that I do.

Not that I have any better ideas myself on what to do about pandemic influenza, because you're right...eventually some new, bad flu virus will emerge, even though I personaly doubt it'll be H5N1. But eventually one will, and it'll be "a lot worse" than seasonal flu.
But still....

Oh, I agree with you regarding the kind of tactics you've posted about. Public trust is hard to regain and the loss of it has bad long-term consequences.

[fls]

It's kind of a weird situation, though, in that those who are most at risk are also the same people the vaccine doesn't even work in. (the very young and the very old).

Vaccine efficacy and effectiveness has been demonstrated in the old and the young in systematic reviews. The data on those less than 2 is arguably too sparse for separate analysis. Since complications are more severe in that age group, most places recommend that that group not be neglected while waiting for additional information. Effectiveness does decrease with extreme age, but it seems reasonable to continue helping the few for which it is effective.

And really, it's everyone who's being targeted now.

The emphasis continues to be on the high-risk groups.

And then there's the CDC's version of the vaccine's effectiveness that they use to push it, which doesn't line up with reality.
And that's not cool, either.
And then there's the overblown figures on annual influenza deaths (36,000?)
http://www.bmj.com/cgi/content/full/331/7529/1412
And THAT's not cool, either.
So the whole shebang leaves a bad taste in my mouth.

That is merely one person's opinion, and it seems to be someone who is unfamiliar with how to derive a reasonable figure. You would prefer that the CDC use a number it knows to be a gross underestimate instead of figuring out a way to get a more representative number?

Linda

[fls]

Almost everyone is part of the high risk group, though. Infants, children, parents, grandparents, etc, etc.

Huh? None of those are inclusive categories for high risk groups.

Ok. Let's break this down to it's most basic form.

Does the CDC contact the media and provide them with information to raise awareness about health related issues and motivate health behavior?

You are implying that they are making stuff up while everyone else stands idly by, in order to do so.

Linda

[robinson]

That isn't an answer.

[kellyb]

Huh? None of those are inclusive categories for high risk groups.
Are those groups not being targeted for increased vaccine uptake?

You are implying that they are making stuff up while everyone else stands idly by, in order to do so.

Linda
Is that a cryptic "Yes"?
(I'm thinking it is.)

[robinson]

Vaccine efficacy and effectiveness has been demonstrated in the old and the young in systematic reviews.

Link?

[kellyb]

Vaccine efficacy and effectiveness has been demonstrated in the old and the young in systematic reviews.
In the elderly, the same systematic reviews said a lot of it had to be due to selection bias, right?
Have you seen the new Simonsen study from a month or two ago?

The data on those less than 2 is arguably too sparse for separate analysis. Since complications are more severe in that age group, most places recommend that that group not be neglected while waiting for additional information.
Vaccinate all the babies now, figure out if it's safe and effective later.
Got it.

[Dymanic]

Have you seen the new Simonsen study from a month or two ago?I have. But for balance, let's include the one by Nichol et al (http://content.nejm.org/cgi/content/full/357/14/1373), which came out at about the same time, and indicated a 27% reduction in hospitalizations and a 48% reduction in mortality among vaccinated elderly.

[skeptigirl]

Do they work - Evidence points that way.
Would I have it if offered - damn right.

I never had Flu until 2000\2001. New Years Eve so I was imbibing freely after I'd finished work and got light headed quicker than I would have expected. About 9PM I started to get a scratchy throat, I thoughtobviously that I was just getting a little dehydrated so alternated beers with juice for the rest of the night.

Next morning I surfaced into conciousness with the worst sore throat I'd ever had, muscle pains that felt like I'd been the victim of a brutal mugging, a feeling that my skin had been lightly sandpapered all over, a wracking cough and a fever high enough that my Pharmacist girlfriend was going to carry me to A&E.

Those symptoms lasted for about 5 days (the fever went down quickly with NSAIDs) and after that I was as weak as a kitten for another 6 or 7. I learnt two things from this;
Being off work for a couple of days means you haven't had Flu, it's just a cold.
If you're ever offered a Flu shot - take itCould have been influenza but without a lab test one can't be sure. But your point is correct in that many cases of influenza are quite severe.

Characteristics of influenza: known flu cases around sudden onset high fever headache muscle aches bronchial cough

The influenza virus infects cilia cells in your trachea, whereas many other upper respiratory viruses infect the cells lining the pharynx. Influenza virus can also infect cells lining the lower airways and the alveoli (lung) in some cases. Despite the image of influenza being a minor illness, it is one of the deadliest infections on the planet.

The vaccine is practically painless, quick, cheap and by far the benefit outweighs any extremely rare risk from the vaccine. The main risk is a serious allergic reaction and in 17 years giving a couple thousand flu shots a year I have never seen a single allergic reaction. I have even vaccinated two people with a severe egg allergy using a special protocol and neither reacted.

One person in 17 years had temporary brachial nerve inflammation for several months. It has not recurred and he continues to get flu shots every year. I have not had a single other significant reaction reported to me from my patients.

In adults, placebo controlled double blind prospective studies have failed to find anything other than a mild sore arm as a reaction to a flu shot yet the myth the shots make you ill persist. In children very mild fever and malaise can occur but it is not common.

[skeptigirl]

....They are developed based on previous strains, yes. Whether they are effective against current years really depends on how much the virus has changed. Viruses, especially Infuenza Viruses, mutate and evolve very quickly. However, that being said, mutations do not always impact immune factors. 'Flu' mutants which have different surface proteins will be less effectively (or not at all, depending on the change) targetted by any vaccination...The strains included in each years' vaccine are determined by the WHO every 6 months. Samples of circulating virus are continually collected from 'sentinel' sites during influenza seasons in countries all over the world. The genetic changes are continually monitored. Based on the sampling, the WHO makes recommendations and provides the vaccine strains for manufacturers. In the Northern hemisphere in summer the strains are determined and in the Southern hemisphere in their summer the southern strains are determined. Then everyone produces the same vaccine for that year in that hemisphere. Only when significant genetic changes in circulating virus occur after the vaccine production has begun is there a mismatch. And even in those years the vaccine still offers reasonable protection.

The research on the effectiveness has already been well covered here. Sadly a couple members of our forum have latched on to some initial studies which found little difference in death rates in the elderly since introduction of large scale flu vaccine programs. A fair amount of research after those particular studies consistently found clinical benefits in influenza vaccine programs. I was interested in those initial studies and appreciate that they were brought up in the discussions we have had here. If the science wasn't supporting flu vaccinations it would be time to reconsider them.

However, it is time to move on. Look at the research in its entirety and not the cherry picked studies favoring either side. I have reviewed as much of the research as anyone here and I am confident the vaccine benefit is tremendous and the risk minuscule. I have also seen the studies on the outcomes from influenza itself. This is, like I said, one of the deadliest and probably the most underestimated infections on the planet.

Risk perception is a funny thing. If millions of people get infected but the fatality rate is 1-2%, we don't perceive the threat. It's easy to think those people who died were not like us. If a few hundred get infected and 90% die, that disease is incredibly feared. Yet the math might easily show your risk of dying is greater from the first infection because the odds of getting it are so much higher. That is what happens with influenza. But the years when a greater number of young, otherwise healthy people die from influenza are only recognized in hindsight. And once that happens, it's too late for the vaccine to prevent the deaths.

[kellyb]

I have. But for balance, let's include the one by Nichol et al (http://content.nejm.org/cgi/content/full/357/14/1373), which came out at about the same time, and indicated a 27% reduction in hospitalizations and a 48% reduction in mortality among vaccinated elderly.


So...it was another 50% reduction in all cause mortality?


http://www.cidrap.umn.edu/cidrap/content/influenza/general/news/oct0907elderly.html

Simonsen and colleagues also write that since 1968, flu has accounted for an average of about 5% of all winter deaths in older people. Yet the results of cohort studies have prompted claims that flu vaccination reduces the risk of winter death from any cause by about 50% for community-dwelling people older than 65. "That influenza vaccination can prevent ten times as many deaths as the disease itself causes is not plausible," say Simonsen et al.

So, would you agree that there appears to be something very, very wrong with studies like the Nichol one?

[Dymanic]

So, would you agree that there appears to be something very, very wrong with studies like the Nichol one?
I'll concede the possibility -- if you'll concede the possibility that there may be something very wrong with Simonsen's numbers. Are you aware that his method of estimating excess mortality due to influenza is not universally accepted?

[kellyb]

I'll concede the possibility -- if you'll concede the possibility that there may be something very wrong with Simonsen's numbers. Are you aware that his method of estimating excess mortality due to influenza is not universally accepted?

Yes.

But the point that the flu doesn't cause anywhere near 50% of winter mortalities in the elderly, so any study that finds that flu vaccination reduces mortality by 50% has to be suffering from some kind of bias so severe it's basically worthless...that point is solid.

[Frost]

Correct me if I'm wrong, but aren't flu shots made from a killed virus? How in the world would a killed virus cause disease/death?

[Puppycow]

I'd be careful if I were you about putting so much faith in your personal physician.

I've run into doctors that said things I found hard to believe. One prescribed me antibiotics and told me I could stop taking taking them as soon as I felt better, my immune system would finish off the rest. I went to get my prescription filled and the pharmacist said I need to take them all without fail. That one doctor was the only one I ever heard that from. All others have said you have to take them all without fail.

[skeptigirl]

According to the CDC; since the introduction of the flu shot, flu deaths have increased by 4 times.

:jaw-dropp

4 times as many people have died each year since the flu shot began to be implemented.

I suggest a moratorium to see if the flu shot contributes to flu deaths.Jerome, unless you cite a source so we can see if we agree with your interpretation of the facts, no one in this forum is likely to believe what you post.

[skeptigirl]

Take a look. :) (dug up links)
It's not my logic; it's just a fact......
That kinda threw me for a loop for a while and had me wondering exactly who the CDC worked for...but the idea that they're doing that to comply with the WHO objective of increasing vaccine uptake for the purpose of saving the world from birdflu makes sense to me.If you think the threat of pandemic flu has anything to do with the current market for flu vaccine, you'd be wrong. I get an occasional question if the vaccine would cover bird flu mostly from people who already know the answer is no. Also, out of sight, out of mind. Bird flu is simply not on the flu vaccine patient's mind right now.

[skeptigirl]

Hmmm. That sounds ethically dubious. A government agency frightening people to boost sales so the manufacturers don't close their plants down. I suppose the question is: Do the ends justify the means?What nonsense. You guys are finding links that are irrelevant to the real world. I am in the real world. I am vaccinating the same people I vaccinate every year. Nothing has changed except there is a lot of vaccine this year.

[Ivor the Engineer]

What nonsense. You guys are finding links that are irrelevant to the real world. I am in the real world. I am vaccinating the same people I vaccinate every year. Nothing has changed except there is a lot of vaccine this year.

No, it is not nonsense at all. It is basic supply and demand. Companies with shareholders are not going to waste money scaling up production facilities and making bucket loads of flu vaccine unless they have a market for it. So how is the demand for flu vaccination being grown?

It would seem by promoting it as more effective than it actually is and making flu sound like it's set to become the next plague. Nice to see those in public health communications have learned something from alternative medicine.

I still don't see why they could not appeal to peoples' rational mind, and explain why having a large manufacturing base for flu vaccine will be essential if many deaths are to be avoided from a future pandemic.

It is rather ironic that you, of all people, should be supportive of a marketing campaign which aims to motivate people by appealing to their irrational mind.

[fls]

Are those groups not being targeted for increased vaccine uptake?

Not by any reasonable use of the word 'targeted'.

Is that a cryptic "Yes"?
(I'm thinking it is.)

I'm sorry. I thought that was a "does a bear poop in the woods" type question.

Yes. The mission of the CDC is to promote health which includes providing the media with information to raise awareness about health related issues and motivate health behavior.

Linda

[Acleron]

The benefits of flu vaccination appear unclear.

The most recent Skeptics Guide to the Universe podcast features an interview with Dr Mark Crislip, an infectious diseases specialist. He debunked many myths about the flu vaccine and concluded it was safe and effective.

However the Lancet Infectious Diseases (http://www.docguide.com/news/content.nsf/news/852571020057CCF685257362004B9807)has a recently published paper calling into doubt the benefits of vaccination for the over 65's. This group is the main focus of many vaccination programs, certainly in the UK.

Sorry the link is not directly to the Lancet

[fls]

In the elderly, the same systematic reviews said a lot of it had to be due to selection bias, right?
Have you seen the new Simonsen study from a month or two ago?

No. They concluded the vaccines were effective and added there may be some effect from selection bias (i.e. healthy vacinee bias). Studies that have specifically looked at this selection issue (such as the Nichols study) find that adjustments in group characteristics do account for this bias, and that the measured affect is fairly robust.

Yes. The Simonsen study shows that comparing apples and oranges on the basis of colour shows greater differences than comparing them on the basis of 'fruit'. It shows that the portion of deaths related to influenza in a study population should not be assumed to be comparable to the portion of deaths related to influenza in the general population. While it may be reasonable to expect to find that about 5 percent of deaths in an average time period are due to influenza in a sample drawn from a general population, it is not reasonable to assume that 5 percent of deaths during a virulent influenza outbreak drawn from a sample of the frail elderly will be found to be due to influenza. And that the number of excess deaths is sensitive to the method used to measure excess deaths.

Vaccinate all the babies now, figure out if it's safe and effective later.
Got it.

That's the point of expert review. There aren't simple answers to questions such as how much confidence we need before acting - the answer depends on the details. We already have information about safety and effectiveness in babies, and knowledgeable and experienced people have weighed these issues and provided an opinion, which includes the recommendation that better information should continue to be obtained.

Linda

[fls]

Link?

The links are in the reference I provided here (http://forums.randi.org/showthread.php?postid=3090340#post3090340).

Linda

[fls]

So, would you agree that there appears to be something very, very wrong with studies like the Nichol one?

No. It simply shows that studies like the Nichol one are necessary. And that randomized clinical trials would provide useful information. Careful attention must be paid to the validity of generalization.

There are several types of selection bias that are relevant. The first is that of the healthy-vacinee - people who get vaccines are different in important ways from those who don't in ways that will influence outcomes. Another type of selection bias is that of the population from which the sample is selected. And this is of more relevance to external validity and generalizing the study conclusions to a larger population.

Linda

[Ivor the Engineer]

For those who can't be bothered to search:

Ref. 17 in Linda's link:

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=16437500&ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVDocSum

BACKGROUND: In children and adults the consequences of influenza are mainly absences from school and work, however the risk of complications is greatest in children and people over 65 years old. OBJECTIVES: To appraise all comparative studies evaluating the effects of influenza vaccines in healthy children; assess vaccine efficacy (prevention of confirmed influenza) and effectiveness (prevention of influenza-like illness) and document adverse events associated with receiving influenza vaccines. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2005); OLD MEDLINE (1966 to 1969); MEDLINE (1969 to December 2004); EMBASE (1974 to December 2004); Biological Abstracts (1969 to December 2004); and Science Citation Index (1974 to December 2004). We wrote to vaccine manufacturers and a number of corresponding authors of studies in the review. SELECTION CRITERIA: Any randomised controlled trials (RCTs), cohort and case-control studies of any influenza vaccine in healthy children under 16 years old. DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial quality and extracted data. MAIN RESULTS: Fifty-one studies involving 263,987 children were included. Seventeen papers were translated from Russian. Fourteen RCTs and 11 cohort studies were included in the analysis of vaccine efficacy and effectiveness. From RCTs, live vaccines showed an efficacy of 79% (95% confidence interval (CI) 48% to 92%) and an effectiveness of 33% (95% CI 28% to 38%) in children older than two years compared with placebo or no intervention. Inactivated vaccines had a lower efficacy of 59% (95% CI 41% to 71%) than live vaccines but similar effectiveness: 36% (95% CI 24% to 46%). In children under two, the efficacy of inactivated vaccine was similar to placebo. Thirty-four reports containing safety outcomes were included, 22 including live vaccines, 8 inactivated vaccines and 4 both types. The most commonly presented short-term outcomes were temperature and local reactions. The variability in design of studies and presentation of data was such that meta-analysis of safety outcome data was not feasible. AUTHORS' CONCLUSIONS: Influenza vaccines are efficacious in children older than two years but little evidence is available for children under two. There was a marked difference between vaccine efficacy and effectiveness. That no safety comparisons could be carried out emphasizes the need for standardisation of methods and presentation of vaccine safety data in future studies. It was surprising to find only one study of inactivated vaccine in children under two years, given recent recommendations to vaccinate healthy children from six months old in the USA and Canada. If immunisation in children is to be recommended as public-health policy, large-scale studies assessing important outcomes and directly comparing vaccine types are urgently required.

Ref. 18:

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17259870&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVDocSum

BACKGROUND: Two systematic reviews evaluating influenza vaccine efficacy in healthy children have recently been published. Although quantitative summary estimates were similar, authors' conclusions were quite contrasting. We carried out another meta-analysis reevaluating study inclusion criteria and using metaregression techniques in addition to sensitivity and subgroups analyses to evaluate potential sources of heterogeneity of efficacy estimates, including methodologic quality of studies. METHODS: Only randomized clinical studies assessing the efficacy of influenza vaccine in healthy children/adolescents (age < or =18 years) for preventing naturally occurring influenza and/or acute otitis media cases were included. Summary estimates of effect were obtained using a random effects model. The methodologic quality of each study was assessed using 3 systems: Chalmers scale, Jadad scale and Schulz components (randomization, allocation concealment and double-blinding). RESULTS: The overall vaccination efficacy was 36% (95% confidence interval: 31-40%) against clinically diagnosed illnesses (evaluated by 19 randomized clinical studies for a total of 247,517 children); 67% (51-78%) against laboratory-confirmed cases (18 trials, n = 8574); and 51% (21-70%) against acute otitis media (11 trials, n = 11,349). Significant sources of between-study heterogeneity were participants' age and study quality both directly correlated with the efficacy. When the analysis was performed excluding USSR studies, the overall efficacy of the vaccine in preventing clinical cases substantially increased (from 36% to 61%). CONCLUSIONS: These findings may indicate that the vaccine efficacy might be greater than the overall estimates. Although no safety and cost considerations are addressed in this analysis, the present findings support vaccination as a possible option for the prevention of influenza in healthy children and adolescents.

Ref. 19:

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=15780733&ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVDocSum

We conducted a meta-analysis of 13 randomised clinical trials evaluating the efficacy of influenza vaccine in healthy children. Against culture-confirmed influenza the overall efficacy was 74% (95% confidence interval, CI, 57%-84%), 65% for inactivated and 80% for live-attenuated vaccine. Corresponding figures were 59% (95% CI 43%-71%), 63% and 54% for serologically-confirmed influenza, and 33% (95% CI 29%-36%), 33% and 34% for clinical illness. Influenza vaccine is effective in preventing laboratory-confirmed and clinical influenza in healthy children, with no clear difference between inactivated and live-attenuated vaccine. Data on infants and younger children were too scanty to allow separate assessment.


Ref. 67:

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17167134&ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVDocSum

BACKGROUND: The efficacy of influenza vaccines may decline during years when the circulating viruses have antigenically drifted from those included in the vaccine. METHODS: We carried out a randomized, double-blind, placebo-controlled trial of inactivated and live attenuated influenza vaccines in healthy adults during the 2004-2005 influenza season and estimated both absolute and relative efficacies. RESULTS: A total of 1247 persons were vaccinated between October and December 2004. Influenza activity in Michigan began in January 2005 with the circulation of an antigenically drifted type A (H3N2) virus, the A/California/07/2004-like strain, and of type B viruses from two lineages. The absolute efficacy of the inactivated vaccine against both types of virus was 77% (95% confidence interval [CI], 37 to 92) as measured by isolating the virus in cell culture, 75% (95% CI, 42 to 90) as measured by either isolating the virus in cell culture or identifying it through real-time polymerase chain reaction, and 67% (95% CI, 16 to 87) as measured by either isolating the virus or observing a rise in the serum antibody titer. The absolute efficacies of the live attenuated vaccine were 57% (95% CI, -3 to 82), 48% (95% CI, -7 to 74), and 30% (95% CI, -57 to 67), respectively. The difference in efficacy between the two vaccines appeared to be related mainly to reduced protection of the live attenuated vaccine against type B viruses. CONCLUSIONS: In the 2004-2005 season, in which most circulating viruses were dissimilar to those included in the vaccine, the inactivated vaccine was efficacious in preventing laboratory-confirmed symptomatic illnesses from influenza in healthy adults. The live attenuated vaccine also prevented influenza illnesses but was less efficacious. (ClinicalTrials.gov number, NCT00133523.) 2006 Massachusetts Medical Society

Ref. 68:

During the 2003-2004 influenza season, we conducted a case-control study of influenza vaccine effectiveness (VE) among Colorado residents aged 50-64 years. Cases (n=330) were identified from laboratory-confirmed influenza reports to the Colorado Department of Public Health and Environment (CDPHE). Controls (n=1055) were recruited by random-digit dial telephone survey. VE was 60% (43-72%) and 48% (21-66%) among those without and with high-risk medical conditions, respectively. VE was 90% (68-97%) and 36% (0-63%) against influenza-related hospitalization for persons without and with high-risk conditions, respectively.

ETA: Ref. 52:

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

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.

[Professor Yaffle]

How close are we to developing a universal flu vaccine? Is it a strong possibility, or just some slightly promising research that has been Daily Mailed:

http://www.dailymail.co.uk/pages/live/articles/health/healthmain.html?in_article_id=425227&in_page_id=1774

[fls]

The benefits of flu vaccination appear unclear.

The most recent Skeptics Guide to the Universe podcast features an interview with Dr Mark Crislip, an infectious diseases specialist. He debunked many myths about the flu vaccine and concluded it was safe and effective.

However the Lancet Infectious Diseases (http://www.docguide.com/news/content.nsf/news/852571020057CCF685257362004B9807)has a recently published paper calling into doubt the benefits of vaccination for the over 65's. This group is the main focus of many vaccination programs, certainly in the UK.

Sorry the link is not directly to the Lancet

It's not really calling into doubt the benefits, but rather the extent of the benefit if that makes sense. The link that Kelly provided earlier does a better job of summarizing the paper, I think.

http://www.cidrap.umn.edu/cidrap/content/influenza/general/news/oct0907elderly.html

There is a fairly consistent reduction in mortality of 40 to 50 percent in various studies. The question becomes in what way are those excess deaths related to influenza?

Are they simply related to characteristics of people who are vaccinated vs. those who aren't - the healthy-vacinee selection? That is, have we simply found a way to divide people into groups at higher and lower risk of death for other reasons? Studies taking that into consideration (such as the Nichol study) don't find evidence of this effect, and if it were present wouldn't account for much.

Do they simply reflect the combination of an effective vaccine and the expected number of influenza-related deaths in the general population? I think Simonsen is directing his complaint at the assumption, and I think it is a valid complaint. The expected number of influenza-related deaths in the relevant population is much lower (he mentions 5 percent). This suggests that what happens during the study is much different from what happens in the general population. Some of these differences are obvious - studies showing this difference focus only on the highest risk period where influenza-related deaths are a higher proportion of all deaths. And the study populations are also at a higher risk of their death being related to influenza. So these studies will over-estimate the magnitude of the impact if applied directly to a general population. If you want a better estimate, you need studies that more directly answer that question. The question is whether trying to obtain the answer to that question with RCT's is ethical given that the answer wouldn't change the current recommendations nor the direction of current research towards more immunogenic vaccines and use of anti-viral drugs.

Linda

[JEROME DA GNOME]

Jerome, unless you cite a source so we can see if we agree with your interpretation of the facts, no one in this forum is likely to believe what you post.

I did earlier in the thread. I was reiterating the point.

[kellyb]

Is this correct or incorrect?

http://archinte.ama-assn.org/cgi/content/full/165/3/265#IOI40800T1



UNADJUSTED NUMBERS OF SEASONAL EXCESS DEATHS, 1968 TO 2001
Excess all-cause mortality was only a small portion of the approximately 500 000 deaths that occur annually among the elderly during winter months, never exceeding 10%

Also..I remember this from a few years ago, when Chiron had the contamination issues and we had a huge national shortage of flu vaccines. It was supposed to be the deadliest circulating flu virus in recent years...

Our results have obvious implications for influenza vaccination policy. For the 2004-2005 season, we face a severe influenza vaccine shortage that will likely result in lower coverage among the elderly, and the effect of this shortfall on mortality is a matter of great interest.37 The present findings, and those of at least 1 other study,35 indicate that the shortage will have little impact, perhaps owing to disparities in vaccination rates33-34 and possibly vaccine failure due to immune senescence.38 Other cohort studies suggest that the shortage will have a tremendous impact on mortality among the elderly.13-19,36 Either way, this vast disconnect between conclusions from different studies must be sorted out.

Who ended up being right there?

And just for fun:

http://www.thelancet.com/journals/lancet/article/PIIS0140673605678841/fulltext


We believe that the vaccine effectiveness estimates derived from cohort studies reporting on mortality, for example, are—literally—unbelievably large. Jefferson and colleagues compile cohort study results for prevention of death from all causes, and find a vaccine effectiveness of 47% in community-dwelling elderly people. But because the periods during which the underlying cohort studies record mortality typically include the entire winter season, this estimate implies that influenza is involved in about half of all winter deaths among elderly people, which in turn would mean that influenza is the leading contributing factor to winter mortality in this age-group. This figure is in stark contrast to the finding from our excess-mortality study, which showed that influenza is associated with an average of about 5% of all winter deaths in this age-group.

[kellyb]

In the elderly, the same systematic reviews said a lot of it had to be due to selection bias, right?

No. They concluded the vaccines were effective and added there may be some effect from selection bias (i.e. healthy vacinee bias).


You answered "no" and then went on to explain how the answer is "yes".

Here's what they said:


http://www.thelancet.com/journals/lancet/article/PIIS0140673605673394/fulltext


We think the residual heterogeneity could be the result of the unpredictable nature of the spread of influenza and influenza-like illness and the bias caused by the non-randomised nature of our evidence base. The findings of the cohort studies that we included are likely to have been affected to a varying degree by selection bias;

A further example of the potential effect of such bias is the apparently counterintuitive effectiveness of the vaccines in elderly individuals living in the community. In this population, the vaccines are apparently ineffective in the prevention of influenza, influenza-like illness, pneumonia, hospital admissions, or deaths from any respiratory disease, but are effective in the prevention of hospital admission for influenza and pneumonia and in the prevention of deaths from all causes. That such differences are the result of a baseline imbalance in health status and other systematic differences in the two groups of participants cannot be discounted. Evidence from randomised controlled trials, in which bias is reduced to a minimum, is scant and badly reported. Unfortunately, because of the global recommendations on influenza vaccination, placebo-controlled trials, which could clarify the effects of influenza vaccines in individuals, are no longer possible on ethical grounds.

[dudalb]

The Anti Vaccination woo amazes me because so many people buy into it who should really,really,know better.
Some are diving by paranoia against that all purpose villian "big Pharma",others,on the opposite end of the spectrum,by standard issue "Government is Evil" theories.

[fls]

You answered "no" and then went on to explain how the answer is "yes".

I went on to explain that while they mentioned that the presence of a particular type of selection bias wasn't ruled-out, other studies, like the Nichol study, did not find evidence that it had much of an effect.

Here's what they said:

http://www.thelancet.com/journals/lancet/article/PIIS0140673605673394/fulltext

My intention with post #107 was to explain the differences between some types of selection bias and how they were relevant. That explanation would apply here as well.

Linda

[fls]

Is this correct or incorrect?

http://archinte.ama-assn.org/cgi/content/full/165/3/265#IOI40800T1

The question is, what kind of biases could be influencing the results and whether they pose a threat to internal or external validity. They appear to be more of a threat to external validity which means that while you can draw conclusions about the effectiveness of the vaccine, there is a disconnect when attempting to estimate the magnitude of the impact in the general population. In particular, I think this quote from the article is relevant - "we conclude, therefore, that there are not enough influenza-related deaths to support the conclusion that vaccination can reduce total winter mortality among the US elderly population by as much as half."

Linda

[kellyb]

The question is, what kind of biases could be influencing the results and whether they pose a threat to internal or external validity.

I'd say the question is "Does this implausible/impossible finding suggest that there is some bias here?"
Once that's established (or not) you can move onto figuring out what it might or might not be.
They appear to be more of a threat to external validity which means that while you can draw conclusions about the effectiveness of the vaccine, there is a disconnect when attempting to estimate the magnitude of the impact in the general population.
I'm not following you at all. (I guess).
If there's obviously a bias present in the study, it impacts the findings of the study in the group that was just studied...not just extrapolation to the general population.

In particular, I think this quote from the article is relevant - "we conclude, therefore, that there are not enough influenza-related deaths to support the conclusion that vaccination can reduce total winter mortality among the US elderly population by as much as half."
They also say that a study that finds such a thing must have some serious biases present, which casts doubt on the other findings of the study. That seems to be the opinion of the NIH/NIAID people and the Cochrane Collaboration.

[fls]

I'd say the question is "Does this implausible/impossible finding suggest that there is some bias here?"
Once that's established (or not) you can move onto figuring out what it might or might not be.

Okay.

I'm not following you at all. (I guess).
If there's obviously a bias present in the study, it impacts the findings of the study in the group that was just studied...not just extrapolation to the general population.

Not really. There are many different kinds of bias and they affect different kinds of validity differently.

They also say that a study that finds such a thing must have some serious biases present, which casts doubt on the other findings of the study. That seems to be the opinion of the NIH/NIAID people and the Cochrane Collaboration.

Not really. Biases, such as the ones they are considering, have independent effects. For example, if a choose a bunch of basketball players when attempting to find the average height of US males, that my sample is unrepresentative does not mean that their measured height is inaccurate.

Linda

[skeptigirl]

No, it is not nonsense at all. It is basic supply and demand. Companies with shareholders are not going to waste money scaling up production facilities and making bucket loads of flu vaccine unless they have a market for it. So how is the demand for flu vaccination being grown?

It would seem by promoting it as more effective than it actually is and making flu sound like it's set to become the next plague. Nice to see those in public health communications have learned something from alternative medicine.

I still don't see why they could not appeal to peoples' rational mind, and explain why having a large manufacturing base for flu vaccine will be essential if many deaths are to be avoided from a future pandemic.

It is rather ironic that you, of all people, should be supportive of a marketing campaign which aims to motivate people by appealing to their irrational mind.Public health agencies are promoting flu vaccinations and when there wasn't enough vaccine the last couple years, public health also instituted some policies to encourage reluctant manufacturers to produce more vaccine. This year more producers are in the market.

You need to stop putting everything into a single category: drug company profit. Everything medical does not revolve around that concept. Believe it or not, a whole bunch of people in medicine are professionals who gain satisfaction from doing a good job. Some of them are public health officials and practitioners. Public health practitioners recognize the benefit of getting more flu vaccine doses to the public. They recognize the benefit and the barriers. Public health has a mission which includes promoting things like flu vaccination because it benefits public health. I don't know a single provider who has stock in a drug company or makes decisions about their job based on promoting the pharmaceutical industry's profit margin.

Drug companies are not charged with the mission of promoting public health. Of course they don't want to produce vaccine there is no market for. Because flu vaccine is only good for the specific season, production has to be matched to the market. But sometimes the demand changes during the flu season. A couple years ago an increase in pediatric deaths from flu occurred sparking a demand for flu vaccine. But supplies were already used up.

Year before last half the supply was contaminated and had to be tossed. There were only 2 flu vaccine manufacturers producing vaccine for the US market. That was bad.

In order to address these problems, the public health has to guarantee a market for vaccine. We can't expect the manufacturers to over produce but if we need a back up supply then overproduction is called for. So public health has been trying to address these problems.

You seem to think any marketing of something which evidence shows benefits the public health is just a marketing scheme for someone's profit. That is naive.

[robinson]

Do flu vaccines still contain Thimerosal?

[skeptigirl]

The Anti Vaccination woo amazes me because so many people buy into it who should really,really,know better.
Some are diving by paranoia against that all purpose villian "big Pharma",others,on the opposite end of the spectrum,by standard issue "Government is Evil" theories.Add to that the, "Natural things are better and vaccines are artificial", and, "The diseases are gone because we have better sanitation, not because of vaccines" myths.

[skeptigirl]

Do flu vaccines still contain Thimerosal?Flu vaccines in multi-dose vials contain thimerosal. Flu vaccines in single dose vials or syringes don't.

But thimerosal is just another boogey man. There has never been any actual observed data linking thimerosal to vaccine side effects despite much research looking for it.

[Procida]

Considering the amount of time and effort required to gain approval for a medicine or drug, how can each years new flu vaccines possibly meet the safety and efficiency test before being used?

How can anyone even know if they are safe? And that the vaccine actually works? Where is the science to back up the claims made?

They can't back it up, because of the logistics. The situation which applied in 2003 applies today:

URL broken to allow 'take':

fda.gov /ohrms/dockets/ac /03/transcripts/3922t1.doc

DR. DECKER: Yes, Dr. Royal, let me help answer your question. You caught Sam offguard because he's just focused on manufacturing.

The simple answer is nobody can do anything to address that. Everyone has to take it on faith that the strains selected, if grown properly and inoculated, will produce the relevant antibodies and they will not only work against that strain, but they will, hopefully, work against whatever circulates.

All that has to be taken on faith, because by the time you produce it, there's no time left to do any testing. Were there any time to do testing, there would be no time left to manufacture anything.

So from the manufacturer's point of view, their obligation is to produce whatever this Committee tells them to produce. Whether or not it works has to be based on the faith that the data collected by CDC and FDA and presented to this Committee will be relevant and accurate.

.....And then just further to the clinical side of things, we don't really ever know how immunogenic any particular strain is going to be before a vaccine is manufactured, and there really isn't time to do the kind of clinical trials you would anticipate for any other kind of vaccine. Influenza virus vaccine is different from every other one in that it is changed almost every year and it's a new experience with each one.

[Procida]

It's totally logical for Lone Simonsen to take this approach. Her main aim, since 2000, hasn't really been to challenge the lack of science. In fact, that's a red herring, and i wonder why she even bothers, unless its to maintain some sort of veneer of "accountability".

Simonsen's main aim is, and always has been, to use the old japanese approach, vaccinate everyone who might transmit, to vaccinate the older people with stronger vaccines, and more doses and to aggressively treat with antivirals.

Much of that was laid out in a document, not for public circulation, but which I have a copy of.

It's called "Prevention and Control of Influenza in the United States: preparing for the next pandemic." January 1996, (WP3.0\flu plan\Draft #6) held at the Parklawn Building, 5600 Fishers Lane, Maryland, on February 29, 1996.

While the document was not for public circulation salient points were published in JAMA, January 17, 1996, vol 275, No. 3 Page 179-180

On page four it states quite clearly that the principal objective is to vaccinate the entire USA population. Amongst a huge raft of other things.

discussion of the Simonsen study is a dead duck issue, since it's not going to make a jot of difference to The Plan (which is what the 1996 document was called), which will go ahead, period.

Why argue the dust, when the mantlepiece will never shift?

Fact is the vaccine will stay, everyone who wants it can have it and more, and discussion about it is a waste of breath.

[Procida]

Those are all speculative reasons. This is why I propose a moratorium to determine if the flu shot does or does not contribute to flu death.Never going to happen, because it doesn't matter. The rationale is that old people will die anyway, and most old people who die after receiving a flu shot have die of whatever is written on the death certification, but it won't be the vaccine that killed them.

What matters is the bigger picture. It's important that everyone is vaccinated, regardless of whether it works, so that capacity to manufacture is there for when the pandemic comes.

Flu vaccine manufacturers couldn't care less if the vaccine works or not, any more than the cold medicine manufacturers care whether that they don't work, and are dangerous in under twos....

How do you think they got away with the decades of sales for cold medicines for kiddies? Of course the manufacturers will fight FDA to continue sales. You bet that decision will be watered down. Cold medicines are one of their best income earners.

And so will flu vaccine be, when everyone takes the vaccine every year.

Think about it. What more could you want from a company, then guaranteed income poking 260+ million americans every year?

That's where to stick your investment dollar. In flu vaccine manufacturing companies, and those making AIDS vaccines. You can't go wrong.

[skeptigirl]

They can't back it up, because of the logistics. The situation which applied in 2003 applies today:

Here's the html link (http://72.14.253.104/search?q=cache:OM2A3uhpR-EJ:www.fda.gov/OHRMS/DOCKETS/ac/03/transcripts/3922t1.doc+fda.gov+/ohrms/dockets/ac+/03/transcripts/3922t1.doc&hl=en&ct=clnk&cd=1&gl=us&client=firefox-a) from Google search since the other is a Word Doc.

Welcome to the forum. :D

There is a certain amount of evidence gained from 30+ years of manufacturing and using influenza vaccine. If the process has worked for that long, why should it not work the next time? And this year's vaccine (http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5606a1.htm) has two of last years strains and one new strain from 2006. That is pretty common, so there is often data on one or more of the vaccine strains in the trivalent vaccines.

[skeptigirl]

Never going to happen, because it doesn't matter. The rationale is that old people will die anyway, and most old people who die after receiving a flu shot have die of whatever is written on the death certification, but it won't be the vaccine that killed them.

What matters is the bigger picture. It's important that everyone is vaccinated, regardless of whether it works, so that capacity to manufacture is there for when the pandemic comes.

Flu vaccine manufacturers couldn't care less if the vaccine works or not, any more than the cold medicine manufacturers care whether that they don't work, and are dangerous in under twos....

How do you think they got away with the decades of sales for cold medicines for kiddies? Of course the manufacturers will fight FDA to continue sales. You bet that decision will be watered down. Cold medicines are one of their best income earners.

And so will flu vaccine be, when everyone takes the vaccine every year.

Think about it. What more could you want from a company, then guaranteed income poking 260+ million americans every year?

That's where to stick your investment dollar. In flu vaccine manufacturing companies, and those making AIDS vaccines. You can't go wrong.

You seem to have a number of unsubstantiated claims in this post. You are over generalizing.

I agree a lot of manufacturers happily and knowingly profit from bogus products. HeadOn, Airborne, Listerine just to name a few are knowingly marketed fakes. Some drug producers do care about quality since that is a marketing issue.

But you and a million other people convinced of the Big-Pharma-all-for-profit conspiracy forget the fact there is a prescriber involved in prescription drugs. And we are not stupid, we aren't duped, and only a few of us are in on the profit sharing.

Your flu vaccine conspiracy is totally unsupported imagination on your part. it would be great if we had the capacity to make flu vaccine for everyone when the next big one hits. Right now we are at about 5%. It ain't gonna be pretty when it happens.

[Ivor the Engineer]

Public health agencies are promoting flu vaccinations and when there wasn't enough vaccine the last couple years, public health also instituted some policies to encourage reluctant manufacturers to produce more vaccine. This year more producers are in the market.

You need to stop putting everything into a single category: drug company profit. Everything medical does not revolve around that concept. Believe it or not, a whole bunch of people in medicine are professionals who gain satisfaction from doing a good job. Some of them are public health officials and practitioners. Public health practitioners recognize the benefit of getting more flu vaccine doses to the public. They recognize the benefit and the barriers. Public health has a mission which includes promoting things like flu vaccination because it benefits public health. I don't know a single provider who has stock in a drug company or makes decisions about their job based on promoting the pharmaceutical industry's profit margin.

Drug companies are not charged with the mission of promoting public health. Of course they don't want to produce vaccine there is no market for. Because flu vaccine is only good for the specific season, production has to be matched to the market. But sometimes the demand changes during the flu season. A couple years ago an increase in pediatric deaths from flu occurred sparking a demand for flu vaccine. But supplies were already used up.

Year before last half the supply was contaminated and had to be tossed. There were only 2 flu vaccine manufacturers producing vaccine for the US market. That was bad.

In order to address these problems, the public health has to guarantee a market for vaccine. We can't expect the manufacturers to over produce but if we need a back up supply then overproduction is called for. So public health has been trying to address these problems.

You seem to think any marketing of something which evidence shows benefits the public health is just a marketing scheme for someone's profit. That is naive.

I'm not sure how you came to that conclusion from my posts. Looking at the efficacy of flu vaccine it certainly seems worthwhile (IMO) making sure there is sufficient manufacturing capacity when flu turns much more deadly again for young healthy people. What I object to is using fear to motivate people. It seems a bit strange for someone like yourself who would like people to be more rational, being ok with a marketing campaign that uses irrational fear to motivate them.

Perhaps my naivety is that I believe people could be motivated to get a seasonal flu vaccination without spinning the message. But if I am being naive, shouldn't the JREF and other promoters of critical thought just give up now?

[JEROME DA GNOME]

But you and a million other people convinced of the Big-Pharma-all-for-profit conspiracy forget the fact there is a prescriber involved in prescription drugs. And we are not stupid, we aren't duped, and only a few of us are in on the profit sharing.



Were not prescribers duped as to effects of the drug thalidomide?

[Procida]

Welcome to the forum. :Dwhy thankyou.

There is a certain amount of evidence gained from 30+ years of manufacturing and using influenza vaccine. If the process has worked for that long, why should it not work the next time?did you not read Lone Simonsen's first article? Which stated that for the last 30 years, the vaccine basically hasn't worked in the elderly?



And this year's vaccine[/url] has two of last years strains and one new strain from 2006. That is pretty common, so there is often data on one or more of the vaccine strains in the trivalent vaccines.Exactly what are you trying to tell me?

How to suck eggs?

As it happens I know more about the process than you ever will.

It's highly likely that the coming vaccine for the coming flu season will not match at all, because the viruses are mutating faster than was thought.

[Procida]

You seem to have a number of unsubstantiated claims in this post. You are over generalizing.And you don't?

I agree a lot of manufacturers happily and knowingly profit from bogus products. HeadOn, Airborne, Listerine just to name a few are knowingly marketed fakes. Some drug producers do care about quality since that is a marketing issue.And your point, with regard to the flu vaccine... is... what?

But you and a million other people convinced of the Big-Pharma-all-for-profit conspiracy forget the fact there is a prescriber involved in prescription drugs. [b][i]And we are not stupid, we aren't duped, and only a few of us are in on the profit sharing. [b]/i]You are the one saying "you are not stupid" etc.

To me, the word conspiracy is ridiculous. I'm happy to make my money where the takers are. So long as people are prepared to buy cold medicines that don't work, and flu vaccines they don't need, but do want, then I'm happy.

If you think something will do you good, then go for it, because at least you will have a 30% placebo effect as a head start. And if it doesn't do you any good, and actually harms you, that's not going to harm me, because CDC and FDA and VAERS do such a good job of making sure that anything alleged to be from a vaccine is attributed to something else.

As far as I am concerned, where my money is, is nothing to do with a conspiracy. it's a win/win situation.

Everyone thinks they are intelligent, and smart, and if they want to give their babies cold medicines and vaccines because it reinforces their belief that they are intelligent and smart, then they are welcome to it.

But when you put your money into financial investment, ethics has no place in judgement. Besides, what is not ethical for one person is highly ethical for another. I know heaps of people who despise Walmart, but have their money there, because that's where the masses spend their dollars.

it's not a conspiracy. It's called "Welcome to the real world."

Your flu vaccine conspiracy is totally unsupported imagination on your part. it would be great if we had the capacity to make flu vaccine for everyone when the next big one hits. Right now we are at about 5%. It ain't gonna be pretty when it happens.

there is no conspiracy. The flu vaccine is crap, and has been since 1954. Up until 1976, the person in charge of it, continually told the DBS it was crap, and that all came out in a usa senate hearing.

It's there in print if you chose to chase it down.

Long Simonsen basically took the data from the time that doctor resigned to now, and said that the vaccine is still crap.

BUT.... rather than feed the anti-vaccine sails, she has taken a prudent course. She's telling the FDA and CDC that they have done the "right" thing with the wrong data.

And that to justify what they've done all along, and make people think its really a matter of medical semantics, they need to give the vaccine to everyone else (which helps me immensely), and make new, more potent vaccines for the elderly to compensate for immunological senescence. Those vaccines will be more expensive, and even better value.

All she's doing is re-wallpapering the old building, creating a crown for herself, and given the CDC and FDA gratefully received wiggle room. As well as giving encouragement to the anti-viral development, so make sure you have shares in them as well.

Whatever, when it comes to any drugs or vaccines.

So long as the shares stay high, that's all that matters, because those investing them them will make their money off those who chose to have the vaccine... whether it works or not... or chose to give their kiddos cold medicines, whether they work or not.

What you don't get, skeptigirl, is that I'm not a conspiracist. I don't care.

I'm quite happy for people to shoot themselves up with whatever they want, so long as they do what they do, with their eyes wide open, not under the illusion that its the be-all and end all if they don't.

It's the best marketting strategy out to make people run around like headless chooks believing that the world will end with the next pandemic if there is not enough vaccine.

and its great for investors too. That's why its done. It's called marketting massage. It's nothing to do with a conspiracy. Every time you watch your telelvision, and watch an advertisement, you are using your free will to tacitly opt in to marketting massage, to the benefit of investors.

Again, its the real world, and the same applies with vaccines.

[Procida]

Were not prescribers duped as to effects of the drug thalidomide?

No they were not duped.

Most prescribers were aware that there were serious doubts. they chose to say nothing about it, just as the CDC and FDA knew from 1976, that the flu vaccine was rubbish.

This is what amazes me about Lone Simonsen's article. She says on page 661:

We find it peculiar that the claims that influenza vaccination can prevent half - or more - of all winter deaths in elderly people have not been more vigorously debated. That influenza vaccination can prevent ten times as many deaths as the disease itself causes, is not plausible

Either she is stupid, or she is naive. FDA and CDC know full well that the data is rubbish. But why debate it for goodness sake!!! The vaccine will be used regardless. And Lone Simonsen, is just one more cog in the wheel to all the CDC and FDA to vaccinate everyone, because she says:

Influenza vaccines have convincingly been shown to be effective in preventing influenza infection in healthy adults

Now, you can believe that, or not, as you chose. After all, we've been told that the influenza vaccine has convincingly been shown to be effective in elderly since the late 1950's and its only now, that Lone Simonsen has started to talk about what we've all known for decades; that the flu vaccine is a dog. (which is an insult to a dog).

But with her approval, and with her comments a few years ago endorsing the vaccination of babies, and children, she's worth them cultivating, by saying nothing. Okay, she makes them look a bit daft, but essentially she's saying "never mind, you did the right thing with the right motives, but lets do more..." so they will buy that quite happily.

The illusion is created that if we are "honest" about one thing (that the vaccine in the elderly is a dog) then people will assume that we are honest about it being useful in babies, children, and healthy young adults. It's called "playing the field while at the same time neutralising the opposition".

Anyone with a marketting degree can tell you that. Ask Novaks. he's the expert. That's why they employ him.

Back to Thalidomide.

In USA Thalidomide didn't get approved because the lady in charge knew all about the issues and refused to register it. All the thalidomide children in the USA were the result of parents who chose to go offshore and buy something, and use it outside of registration. That was their choice, and by chucking that die, they paid the price. It wasn't her fault their kids were damaged. She did the right thing.

I've only one piece of advice with regard to the flu vaccine, and that's to buy shares in it.

[Procida]

deleted

[Procida]

deleted. sheesh....

[Procida]

I'm not sure how you came to that conclusion from my posts. Looking at the efficacy of flu vaccine it certainly seems worthwhile (IMO) making sure there is sufficient manufacturing capacity when flu turns much more deadly again for young healthy people.

Why do you object to that? Just about every advertising campaign is based on a human emotion.

When the house or life-insurance salesperson comes to your house and does the spiel which is crafted to create fear and unsettle you, so that he can convince you to buy his product, and you will feel good because now you don't have to worry about being afraid, how is that any different?

If you study the way vaccine campaigns have been run since 1950, every single one has been based on creating fear, creating a market, people complying, so they no longer feel fear.

Fear, is the very foundation of all advertising. "Fear" that you won't be accepted by your peers because you have B.O.,; have the wrong shoes, and the wrong car; that you won't be "loved" because you don't dress right; don't eat enough junk food; or drink the right alcohol.... The whole of society is based on keeping up with the rest so that you fit into the tribe.

Eveyrthing most people do, and say -- the way they present themselves to society at large is underpinned by the word "fear".

I honestly can't see why that bothers you. it's reality. If you buy into it, then that's silly, but most people do. That's why marketters use the strategy.

And if you don't believe me, just go and turn on your TV and look at the real motive behind every advertisement. While the first word that comes to your mind might be acceptance, the underlying emotion tapped is "fear of not being accepted".

Vaccine strategies are simple. Fear of pain, fear of illness, fear of death. Fear of pain, illness and death is the most basic human emotion, and the simplest string to pull of them all. The others only rank slightly higher in the pyramid.

But using fear as a marketting campaign is the most rational financial move, because it works.

So what does that say? Does it say that people are stupid? Probably. That's why the majority of society was once (and plainly still are, but in a different context) flat earthers.

What I object to is using fear to motivate people. It seems a bit strange for someone like yourself who would like people to be more rational, being ok with a marketing campaign that uses irrational fear to motivate them.

Perhaps my naivety is that I believe people could be motivated to get a seasonal flu vaccination without spinning the message. But if I am being naive, shouldn't the JREF and other promoters of critical thought just give up now?


If you used rational thought, then you'd have to deal with the fact that flu pandemics have always been around, and that there are many people alive today, who have never had a flu vaccine and who have never had the flu at all. And there were many people who nursed family and or patients, and went through the 1918 flu pandemic and never got sick.

Or if you want to take tetanus as another example, you would have to deal with the fact that before there was even a vaccine on the market, even in a society which had no clean water, no sewage, people who didn't like baths, and who lived in, on and around horses all the time, tetanus rates were about 7 per million per year.

The problem with logic, is that someone will have to ask why it is that the other 999,993 per million never got tetanus.

When someone asks that question, people start to realise that nasty though tetanus was in the worst of circumstances, and still is today, if you do get it, that surprisingly the majority of us never got it. (another deviation of rational logic is that no-one talks about all the studies which show natural immunity to tetanus, or for that matter, natural immunity to rabies amongst trappers.) That might "confuse" the issue. The issue is getting people to take the shot.

You do what it takes, to make people say yes.

Even with tetanus, the quickest and easiest way they will get you to have a booster, even if you don't need one, is to persuade you that if you don't, you will get the most awful tetanic spasms, pain, and die. And you wouldn't want that would you? So you say yes.

Since when does rational thought, or rational decision making come into vaccines, or anything else when it comes to a marketting campaign?

Anyone who was rational, might decide that the chances of them getting tetanus was so remote they could skip the vaccine.

Or someone else apply rationale, might say that even though the chances are super remote ,they would have it anyway.

Both decisions are logical, and done by free-choice without the use of coercion.

The problem is that most people don't know that their chances of getting tetanust without a shot are super remote. And most people also don't know that you won't be getting tetanus alone in that booster shot. You'll also be getting diphtheria, whooping cough and haemophilus.

Never mind that your rational chances of getting diphtheria and haemophilus are minisculely less than your chances of being killed by lightening.

[Professor Yaffle]

Just one question. If the flu vaccine is so obviously ineffective for the elderly, why do the NHS spend money on providing it (free) to over 65s (and a few other risk groups) in the UK? Its not like we just jump on the bandwagon and provide everything that is recommended in the US. We don't include the chickenpox vaccine for example (although they are re-examining that at the moment.

Same with things like tetanus. Nobody needs to use fear to get us to have a tetanus shot. The doctor tells us that given what has happened we should have one just as a precaution (if it is a while since we had one) and pretty much everyone goes along with that. No mention of spasms and doctors implying that it is likely that we will get teanus. That's the thing about precautions, you don't just have to take into account how likely something is, you also have to take into account what the consequences of the (remote) possibility. For example, I could go out in my car one day without wearing a seatbelt, because the chances that I will actually be involved in an accident on that day are pretty low. But the consequences of not wearing a seatbelt if that low possibility did happen are very serious, so I wear my seatbelt. It is the same with vaccines, but instead of the risk increasing over days (number of days I drive my car) it is increased over the population.

[kellyb]

If the flu vaccine is so obviously ineffective for the elderly, why do the NHS spend money on providing it (free) to over 65s (and a few other risk groups) in the UK?
1) it might work a little bit, sometimes
2) the ineffectiveness was just figured out a couple of years ago
3) as with many things, the research is conflicting

[skeptigirl]

Were not prescribers duped as to effects of the drug thalidomide?No, not at all. There is a known risk in prescribing any drug that side effects not apparent in drug trials might show up when the drug is released and more widespread use occurs. The overall benefits of bringing new drugs to market by far outweigh the risks that some of those drugs are going to harm people.

[JEROME DA GNOME]

No, not at all. There is a known risk in prescribing any drug that side effects not apparent in drug trials might show up when the drug is released and more widespread use occurs. The overall benefits of bringing new drugs to market by far outweigh the risks that some of those drugs are going to harm people.

Really, so the benefit always outweighs the harm?

[skeptigirl]

why thankyou.

did you not read Lone Simonsen's first article? Which stated that for the last 30 years, the vaccine basically hasn't worked in the elderly?


Exactly what are you trying to tell me?

How to suck eggs?

As it happens I know more about the process than you ever will.

It's highly likely that the coming vaccine for the coming flu season will not match at all, because the viruses are mutating faster than was thought.At this point, neither of us knows what the other knows so insulting my intelligence and knowledge base will not earn you any more credibility in this forum.

I have read the studies which found little decrease in the death rate among seniors after the widespread introduction of influenza vaccine. I have also read substantial research which contradicts that finding. Linda has posted links to a wide variety of studies. Why do you only rely on a single one?

The reference in my post to past strains was in reply to the claims influenza vaccine is released untested each year.

[skeptigirl]

Really, so the benefit always outweighs the harm?Are you referring to a single drug, or to the process of developing and introducing new drugs into the market place?

For a single drug, the evidence is often incomplete until it reaches widespread use. Since one cannot foretell those side effects prescribers are conservative using newly developed drugs. We tend to use them when existing drugs are ineffective.

The alternative would be to never introduce new drugs. So, yes the benefit of developing and introducing new drugs as a whole by far outweighs the risks. We have lengthened the life expectancy and improved the quality of life for countless more people than those who have been harmed.

What would you suggest? Never introducing new drugs? Studying them in hundreds of thousands of volunteers before releasing them to the market? Delaying introduction of drugs with the potential to cure fatal diseases because the research is incomplete?

As for ThalidomideThalidomide was chiefly sold and prescribed during the late 1950s and early 1960s to pregnant women, as an antiemetic to combat morning sickness and as an aid to help them sleep. Before its release inadequate tests were performed to assess the drug's safety, with catastrophic results for the children of women who had taken thalidomide during their pregnancies. You are referring to something which occurred almost 50 years ago. Are you aware that the field of evidence based medicine really only began in earnest ~100 years ago? So you are using an example from the time when evidence based medicine was a mere 50-60 years old. Prescribers were not "duped" at that time. They had substantially less evidence to go on. Are you suggesting we should halt the progress we've made in a mere 100 years because for all the benefit there has been some harm?

[JEROME DA GNOME]

Are you referring to a single drug, or to the process of developing and introducing new drugs into the market place?



I am referring to what you wrote.

The overall benefits of bringing new drugs to market by far outweigh the risks that some of those drugs are going to harm people.

I highlighted it when I quoted you. I left the rest of the quote to allow for context of your thoughts.

[skeptigirl]

I am referring to what you wrote....I wrote about both. Which of the two things I wrote about were you referring to?

Ducking my answer I see. No comments I take it, on what would you suggest be done to correct this injustice you perceive?

[skeptigirl]

...I highlighted it when I quoted you. I left the rest of the quote to allow for context of your thoughts.And not knowing which of my two comments you were referring to, I addressed both. I see you are at a loss of words to reply.

[JEROME DA GNOME]

And not knowing which of my two comments you were referring to, I addressed both. I see you are at a loss of words to reply.

Are you playing a game?

I quoted you twice now and highlighted what you said!

Are you unable to justify what you wrote?

[skeptigirl]

Could you please respond to post #138, Jerome?

[Sinope]

Just one question. If the flu vaccine is so obviously ineffective for the elderly, why do the NHS spend money on providing it (free) to over 65s (and a few other risk groups) in the UK? Its not like we just jump on the bandwagon and provide everything that is recommended in the US. We don't include the chickenpox vaccine for example (although they are re-examining that at the moment.



You could probably ask that question about other vaccines too. Look at Prevenar, the most recent addition. Now reccomended to all children despite evidence from the US that there was no real decrease in IPD. Actually since the vaccine has been introduced, pneumococcal meningitis in children under one has increased in the US. Some of the new serotypes are antibiotic resistant - the vaccine could actually do more harm than good. Yet it is now routinely given to most children. Why? "

When Pediacel was introduced in 2004 (after some "iffy" trials), it was recommended to the government by a committee that had at it's head Prof. Langman, who also happens to receive funds from MSD (the vaccine manufacturers) for research at his dept at Birmingham university. Conflict of interests?

Many other members of the JVIC have conflicts of interests with vaccine manufacturers. It really isn't much different here to the US.

I am pretty sure, from the evidence that they will not introduce the CP vaccine here. It is pretty ineffective long term and the increase in shingles is not desirable.

[skeptigirl]

You could probably ask that question about other vaccines too. Look at Prevenar, the most recent addition. Now reccomended to all children despite evidence from the US that there was no real decrease in IPD. Actually since the vaccine has been introduced, pneumococcal meningitis in children under one has increased in the US. Some of the new serotypes are antibiotic resistant - the vaccine could actually do more harm than good. Yet it is now routinely given to most children. Why? "

When Pediacel was introduced in 2004 (after some "iffy" trials), it was recommended to the government by a committee that had at it's head Prof. Langman, who also happens to receive funds from MSD (the vaccine manufacturers) for research at his dept at Birmingham university. Conflict of interests?

Many other members of the JVIC have conflicts of interests with vaccine manufacturers. It really isn't much different here to the US.

I am pretty sure, from the evidence that they will not introduce the CP vaccine here. It is pretty ineffective long term and the increase in shingles is not desirable.

What do you base that conclusion on? And welcome to the board. :D

The recommendations for use of the vaccine here as well as the recommendation of who should get it and the supporting data for the recommendation can be found here in the ACIP report. (http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5604a1.htm)

[JEROME DA GNOME]

Could you please respond to post #138, Jerome?

Sure, but post #138 is not following the quote it references.

[JEROME DA GNOME]

Are you referring to a single drug, or to the process of developing and introducing new drugs into the market place?

I was asking you if all benefits outweigh all detriments. This was based on your statement which I quoted.

For a single drug, the evidence is often incomplete until it reaches widespread use. Since one cannot foretell those side effects prescribers are conservative using newly developed drugs. We tend to use them when existing drugs are ineffective.

Agreed.

The alternative would be to never introduce new drugs. So, yes the benefit of developing and introducing new drugs as a whole by far outweighs the risks. We have lengthened the life expectancy and improved the quality of life for countless more people than those who have been harmed.

Agreed.

What would you suggest? Never introducing new drugs? Studying them in hundreds of thousands of volunteers before releasing them to the market? Delaying introduction of drugs with the potential to cure fatal diseases because the research is incomplete?

I would suggest allowing the market to play-out. Currently we have a system in which very well-funded drug companies have a great deal insulation from penalty because the governmnet has approved of potentially dangerous drugs.

As for Thalidomide You are referring to something which occurred almost 50 years ago. Are you aware that the field of evidence based medicine really only began in earnest ~100 years ago? So you are using an example from the time when evidence based medicine was a mere 50-60 years old. Prescribers were not "duped" at that time. They had substantially less evidence to go on. Are you suggesting we should halt the progress we've made in a mere 100 years because for all the benefit there has been some harm?

I am not in any way suggesting that past learning be disregarded.

[Eos of the Eons]

I would hope vaccine manufacturers are paying someone to research vaccines before administering them to the entire population. Nobody is going to do it for free.

Prevnar’s effectiveness is not in question, says Davis: It prevents infections by Streptococcus pneumoniae bacteria that cause tens of thousands of potentially deadly bacterial meningitis and bloodstream infections each year, and untold millions of painful ear infections.
http://www.med.umich.edu/opm/newspage/2003/vaccinestudy.htm
http://www.prnewswire.com/cgi-bin/stories.pl?ACCT=104&STORY=/www/story/03-16-2000/0001167064&EDATE=

Better than antibiotics...

[kellyb]

I would hope vaccine manufacturers are paying someone to research vaccines before administering them to the entire population. Nobody is going to do it for free.


http://www.med.umich.edu/opm/newspage/2003/vaccinestudy.htm
http://www.prnewswire.com/cgi-bin/stories.pl?ACCT=104&STORY=/www/story/03-16-2000/0001167064&EDATE=

Better than antibiotics...

When it comes to the serotypes in the vaccine, yeah. It's one of the most effective vaccines ever made.
The problem is non-vaccine serotypes filling in the ecological niche left as a result of vaccination (especially mass vaccination) and doing all the things the old serotypes did.
Here in the US we're about to add 6 more serotypes to the vaccine to "fix" it, but there are about 100 pneumococcal serotypes, so more will probably just fill in the hole again. It'll never end.
We're also (here in the US) about to add a 4 valent meningococcal vaccine to the pediatric schedule. So it'll be....interesting...to see what happens next, and what emerges. Something will for sure, and the hope is that the new emergers will be milder than the vaccine types. But who knows?
We'll see, I guess.

[Eos of the Eons]

Of course it will never end. You get rid of the more damaging ones, and new ones will emerge. Don't get rid of the more damaging ones and new ones will emerge anyways. Might as well try to stay on top of the current damaging ones and keep up the research and new discoveries and try to keep the damage to a minimum.
Microbes will always be changing. That is what they do. There are far far far far far many more of them than us, and they will always be changing to exploit what others don't. That is the nature of evolution.

So, let's keep up as much as we can and eliminate the current and expected worst of the microbes. Our bodies can deal with the less damaging ones well enough. We do every day.

[kellyb]

So, let's keep up as much as we can and eliminate the current and expected worst of the microbes. Our bodies can deal with the less damaging ones well enough. We do every day.

But the ones that emerge do the exact same things as the old ones did. The net benefit, if it's there at all, is very, very small.
Pneumococcal meningitis (the ultimate bad outcome with pneumococcal bacteria) in kids under one has gone up, not down, since Prevnar use became widespread, and it's the non-vaccine serotypes that emerge doing it.
Just adding more and more and more serotypes to the vaccines for forever and ever and ever seems like a strange way of going about things to me.

Like, what's going to happen to the meningococcal B serotype once Menactra is used universally?
It's already been one of the "worst" serotypes. Won't removing serotypes A,C, and Y just make B go bonkers?

[Eos of the Eons]

Since when has it gone up? Since they actually began to diagnose them? Not every doc takes a swab, not every doc ever takes a swab. Once something comes on the radar in an area, then they attempt to get more confirmed diagnoses.

And, like I said, microbes are going to change anyways. Let's keep up the research and stay on top of the most harmful ones. Sure doesn't hurt.

TB is still on the radar, but the outbreaks were much much worse 30 years ago. Outbreaks are quarantined and actions are taken much more quickly now. Far less people get it. The vaccine is barely used, but available.

Flu shots are redone each year to keep up with new strains.

The alternative is to just let people die. If that's what you're suggesting, then NO THANKS.

[kellyb]

Since when has it gone up? Since they actually began to diagnose them? Not every doc takes a swab, not every doc ever takes a swab. Once something comes on the radar in an area, then they attempt to get more confirmed diagnoses.

.

The CDC has been doing surveillance for a while...
Click through the s.pneumo stats from 2001-2002 to present, and watch deaths in kids under one and 2, and meningitis...

http://www.cdc.gov/ncidod/dbmd/abcs/survreports.htm

Prevnar was approved for use in 2000, but they had manufacturing issues through most of 2001, and in 2002, uptake was still at 40%.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5231a2.htm

In the past few years, the vaccine serotypes have been eliminated more or less, but the non-vaccine serotypes stepped in immediately. The difference is small, but pneumococcal deaths in kids under 2 and meningitis seems to be ever so slightly going up according to the ABC data.

Let's keep up the research and stay on top of the most harmful ones. Sure doesn't hurt.

But it looks like the most harmful ones are whichever ones have "room" to be most harmful, and when you go removing big chunks of the human bacterial flora, you don't really know what's going to happen next. 6 more pneumococcal serotypes plus 4 meningococcal serotypes is a fairly significant change. How does anyone know what emerges next won't be a lot worse?

[skeptigirl]

Originally Posted by skeptigirl
Are you referring to a single drug, or to the process of developing and introducing new drugs into the market place?

I was asking you if all benefits outweigh all detriments. This was based on your statement which I quoted.Again you refuse to answer a simple request for a clarification so I may respond to your answer. I am done trying. If you ever care to answer that simple request for that simple clarification I will answer. Try re-reading the posts. I will not provide further spoon feeding to you on the matter.

Originally Posted by skeptigirl
What would you suggest? Never introducing new drugs? Studying them in hundreds of thousands of volunteers before releasing them to the market? Delaying introduction of drugs with the potential to cure fatal diseases because the research is incomplete?

I would suggest allowing the market to play-out. Currently we have a system in which very well-funded drug companies have a great deal insulation from penalty because the governmnet has approved of potentially dangerous drugs.This is absurd. Drug companies have been held accountable for outcomes not revealed at the time of marketing on numerous occasions. What country are you in?

Originally Posted by skeptigirl
As for Thalidomide you are referring to something which occurred almost 50 years ago. Are you aware that the field of evidence based medicine really only began in earnest ~100 years ago? So you are using an example from the time when evidence based medicine was a mere 50-60 years old. Prescribers were not "duped" at that time. They had substantially less evidence to go on. Are you suggesting we should halt the progress we've made in a mere 100 years because for all the benefit there has been some harm?

I am not in any way suggesting that past learning be disregarded.So here you are admitting and agreeing to prescribers not being duped and that the system has great benefits along with recognized risks. What is your beef then? With the exception you think falsely that drug companies are over-protected by government from liability, you have no issues.

There are many things in the pharmaceutical industry which need constant monitoring and continual improvement. But the system, overall, has been beneficial in no uncertain terms.

[skeptigirl]

The emergence of resistance is greater/faster with treatment than with prevention. With treatment you have an actively multiplying organism and the potential for resistance to emerge is related to the numbers of replications within the environment adaptation is at issue in.

With vaccine the resistance is dependent upon a susceptible host or niche as the opportunity for a resistant strain to emerge. So there are less organisms competing, but there are not more organisms actively multiplying in the niche or host. Ergo the odds are much lower that a resistant strain will find that niche or host.

In either case the alternative is to not stop the infection, clearly a poor option. So vaccines and prevention remain preferable to treatment or no intervention.

[JEROME DA GNOME]

Again you refuse to answer a simple request for a clarification so I may respond to your answer. I am done trying. If you ever care to answer that simple request for that simple clarification I will answer. Try re-reading the posts. I will not provide further spoon feeding to you on the matter.

Let me explain how a conversation works.

When I ask you a question the fact that you ignore the question and question me about something which I did not assert does not give you the right to claim I am refusing to answer.

In fact; I did answer your question, despite you not answering mine. You have still not answered the original question I asked which began this conversation between you and I.

Please read the thread before posting. This will allow for reasoned knowledgeable conversation.

[skeptigirl]

I will not spoon feed you, Jerome. Go back and reread the exchange.

[JEROME DA GNOME]

I will not spoon feed you, Jerome. Go back and reread the exchange.

I am interested and enjoy your thoughts; I am saddened that we are having a hard time having a conversation.

I hope that you can forgive my incompetence and allow for future conversation.

[skeptigirl]

Of course.

And, BTW, I'm not upset you can't clarify your question. I am just refusing to play what I see as a game.

[robinson]

Here, let me clear all this for you.

Were not prescribers duped as to effects of the drug thalidomide?

No, not at all. There is a known risk in prescribing any drug that side effects not apparent in drug trials might show up when the drug is released and more widespread use occurs. The overall benefits of bringing new drugs to market by far outweigh the risks that some of those drugs are going to harm people.

Really, so the benefit always outweighs the harm?

Are you referring to a single drug, or to the process of developing and introducing new drugs into the market place?

For a single drug, the evidence is often incomplete until it reaches widespread use. Since one cannot foretell those side effects prescribers are conservative using newly developed drugs. We tend to use them when existing drugs are ineffective.

The alternative would be to never introduce new drugs. So, yes the benefit of developing and introducing new drugs as a whole by far outweighs the risks. ... Are you suggesting we should halt the progress we've made in a mere 100 years because for all the benefit there has been some harm?

I am referring to what you wrote.

I highlighted it when I quoted you. I left the rest of the quote to allow for context of your thoughts.

I wrote about both. Which of the two things I wrote about were you referring to?

Ducking my answer I see. No comments I take it, on what would you suggest be done to correct this injustice you perceive?

And not knowing which of my two comments you were referring to, I addressed both. I see you are at a loss of words to reply.

Are you playing a game?

I quoted you twice now and highlighted what you said!

Are you unable to justify what you wrote?

Could you please respond to post #138, Jerome?

Sure, but post #138 is not following the quote it references.

See? Now it all makes sense. :D

[robinson]

It seems obvious that if you are one of the few people who dies from a drug or vaccine, the benefits to you don't balance with the good done. Same for serious lifetime damage, disability, etc etc

If you look at the larger picture, drugs are good. Vaccines are good. Sure a few people are going to die, have deformed babies or suffer somehow. But most people won't, so it doesn't matter.

[Jeff Corkern]

Are vaccines stifling the progress of evolution?


Evolution is adapation of species to survive current conditions, whatever they are. That's it.

There is no such thing as "progress" of evolution. Evolution is entirely a random thing. It has no goal, it isn't going ANYWHERE. Define precisely what you mean by that, please?

Helping the elderly to live, or the so-called "weak" to live, does NOT violate evolution. Evolution is NOT a law we have to worry about violating. It is simply a process.

[skeptigirl]

Here, let me clear all this for you.
[snip]
See? Now it all makes sense. :DI'd hate for Jerome to get even more confused by this.

Here is really all you needed:
Originally Posted by JEROME DA GNOME
Really, so the benefit always outweighs the harm?

Originally Posted by skeptigirl
Are you referring to a single drug, or to the process of developing and introducing new drugs into the market place?

For a single drug, the evidence is often incomplete until it reaches widespread use. Since one cannot foretell those side effects prescribers are conservative using newly developed drugs. We tend to use them when existing drugs are ineffective.

The alternative would be to never introduce new drugs. So, yes the benefit of developing and introducing new drugs as a whole by far outweighs the risks. ... Are you suggesting we should halt the progress we've made in a mere 100 years because for all the benefit there has been some harm?

[Eos of the Eons]

The antivaxxers do figure kids should be killed by measles or secondary infections after getting the flu rather than get "icky" vaccines that may cause a sore arm or some allergic reaction. They figure dying of the disease is better than getting inactivated, dead, or other bits of microbes in the arm, since vaccination is "unnatural" compared breathing microbe & microbe bits in the usual way. They do suggest that flirting with disaster by getting polio "naturally" is better than the reduced risks offered by vaccination.

They will spout on forever and ever about conspiracy theories between doctors and 'big pharma'. They will suggest we're creating new niches for even deadlier microbes by building up our immune systems with vaccination.

What they ignore are all the deaths and injuries that microbes cause. They can do this because vaccines have allowed them to be blind to actual effects of diseases. It's like telling someone with scurvy they are stupid for not eating oranges since oranges are at the grocery store... thing is not everyone has access to grocery stores or oranges. Not everyone has access to vaccines either. Ask parents of dead kids what they figure the "risks" posed by vaccines are. I'm sure they'd rather have a kid with a sore arm rather than a dead kid.
In 2002, among diseases for which vaccines are universally recommended, WHO estimates that fewer than 1,000 children under 5 years died from polio;
4,000 children died from diphtheria;
15,000 children died from yellow fever; 198,000 children died from tetanus;
294,000 children died from pertussis;
386,000 children died from Hemophilus influenzae type b (Hib);
and 540,000 children died from measles.[4]
Among adults, 600,000 deaths were attributed to hepatitis B virus infections, the majority of which were acquired in childhood.

http://www.medscape.com/viewarticle/532395

To put vaccines in perspective, I quote this article:

The human immune system is remarkable in its capacity to respond to millions of different antigens. Children are exposed to many thousands of bacteria, fungi and viruses beginning at the moment of birth. In the first few months of life the human immune system responds to many foreign antigens from these organisms. Each bacterium contains hundreds of different antigens including carbohydrates, fatty substances, proteins, RNA and DNA. Children develop antibodies to 17 different proteins in one common bacterium (Moraxella catarrhalis) and a strep throat infection results in immune responses to 25-50 different antigens.1 Some new highly effective vaccines are made using only one or two bacterial antigens. For example, Haemophilus influenzae type b vaccines, or Hib as they are commonly called, contain only a single bacterial antigen attached to a protein. Children immunized with these vaccines are protected against meningitis and sepsis caused by the Haemophilus influenzae type b organism. Therefore, the immune systems of children who receive this vaccine are exposed to far fewer antigens than children naturally infected with the bacterium. Since all children would be exposed to the bacterium if they were not immunized, the use of the Hib vaccine actually reduces the burden on the immune system.

We do know that encephalitis is one of the factors that pre-disposes children to autism. All three of the diseases prevented by the MMR vaccine, measles, mumps and rubella, can cause encephalitis. We would not want to leave children unprotected against these diseases for even a short period of time. The routine use of MMR has resulted in the prevention of many thousands of cases of congenital rubella syndrome, a recognized cause of autism.
http://www.vaccinesafety.edu/Testimony-O99.htm

[Rolfe]

Well, I'm going to get a flu jag tomorrow, for the first time ever, so I'll keep you posted.

Last year we were all told at work to get the vaccination because of the avian flu work we do here, but the call came late and for one reason or another I never actually got it. This year, my mother asked me to enquire of our new medical practice whether the district nurse could make a house call to give her hers. When I called, I mentioned the possibility that I might also have to have one because of the avian flu connection. The receptionist informed me that in fact, because my mother lives with me I'm classed as her "carer", and as such should be vaccinated against flu anyway. I didn't know that. I should probably have been done last year on the same grounds, but I didn't move back home until late October, after Mum had had her vaccination on that occasion.

So I'll just do it, anyway it means that if there is a later instruction at work that those dealing with avian surveillance shoulf be done, I've pre-empted it. So I'm going to show up at the vaccination clinic tomorrow lunchtime, with mother in tow.

Any ill effects, you will be told!

Rolfe.

[skeptigirl]

Well, I'm going to get a flu jag tomorrow, for the first time ever, so I'll keep you posted.

Last year we were all told at work to get the vaccination because of the avian flu work we do here, but the call came late and for one reason or another I never actually got it. This year, my mother asked me to enquire of our new medical practice whether the district nurse could make a house call to give her hers. When I called, I mentioned the possibility that I might also have to have one because of the avian flu connection. The receptionist informed me that in fact, because my mother lives with me I'm classed as her "carer", and as such should be vaccinated against flu anyway. I didn't know that. I should probably have been done last year on the same grounds, but I didn't move back home until late October, after Mum had had her vaccination on that occasion.

So I'll just do it, anyway it means that if there is a later instruction at work that those dealing with avian surveillance shoulf be done, I've pre-empted it. So I'm going to show up at the vaccination clinic tomorrow lunchtime, with mother in tow.

Any ill effects, you will be told!

Rolfe.The annual vaccine offers no protection against H5N1, the strain typically referred to as "avian flu".

However, persons living with or caring for persons in the "at special risk" categories should most definitely get a flu vaccination to prevent giving the infection to the vulnerable person. Infants < 6 years cannot get the vaccine and do not all have protective levels of maternal antibody. Persons in poor health and advanced age may not respond as well to the vaccination. Both groups rely on healthy people getting vaccinated to prevent the spread of flu to them.

And, while it isn't as common, healthy children and adults die from influenza every year. Flu is one of the most underestimated threats of all the vaccine preventable diseases.

Public Health Alert - INFLUENZA DEATHS IN CHILDREN IN WESTERN AUSTRALIA - July 2007 (http://www.health.sa.gov.au/pehs/Alerts-&-Recalls/070709-PHA-flu-deaths-wa.pdf)

No one seems concerned until after the fact, and past hazards are quickly forgotten.

Experts urge calm after influenza deaths - Aug 14, 2007 (http://www.abc.net.au/news/stories/2007/08/14/2004956.htm)Parents are being warned to watch out for flu-like symptoms in their children as a virulent strain of the virus appears to have claimed the life of a sixth child.

The latest victim is a two-year-old boy from the city of Bathurst, west of Sydney, who died of a flu-related illness.

In Queensland, fears of an epidemic have prompted the State Government to release a stockpile of the antiviral drug Tamiflu to aged care homes and pharmacies.

But disease experts say parents should not panic.Woman's death likely to be flu: SA Health - Aug 17, 2007 (http://www.abc.net.au/news/stories/2007/08/17/2007397.htm)The South Australian Health Department says it is likely a 48-year-old Adelaide woman died of the influenza A virus.

The woman was sent home from work sick on Monday and by Tuesday she was dead.

She tested positive to the A-strain of the flu virus.

Chris Baggoley from the Health Department says they have had more than 100 reports of the flu this month; four times that of August last year.

[Rolfe]

The annual vaccine offers no protection against H5N1, the strain typically referred to as "avian flu".


Yes, I think the rationale was the concern about a pandemic flu strain possibly being produced in a human being who was infected by both ordinary epidemic flu and avian flu simultaneously. While it's far more likely this would happen in the far east than in Scotland, I imagine the PtB though it best that anyone potentially exposed to avian flu should have the extra protection against epidemic flu just in case.

Rolfe.

[Capsid]

The M2 protein in influenza A strains is conserved and with whole vaccines there may be some immunisation against this protein which could help protect from pandemic flu.

[Rolfe]

Well, I had the flu vaccine about two-and-a-half hours ago and I feel perfectly normal.

The nurse said, where do you work?, then shot me with pneumococcus vaccine as well. I sense some crossed wires here - I don't know any veterinary or zoonotic association with pneumococcus - but as my policy is to take any vaccine they'll give me unless there are positive contraindications, I just let her do it.

Only side-effect, right arm (pneumococcus) bled all over my NWO Kitty t-shirt.

Rolfe.

[Rolfe]

Five hours post-vaccine, no effects at all (apart from slight tenderness felt in upper arm when shoudering open a door).

Rolfe.

[annexw]

Got my flu shot yesterday at around this time. According to the paperwork, it was .5ml of influac M20.

That, of course, means nothing to me but it might to someone else. The nice nurse who vaxed me even told me that this season they are expecting only 60-70% chance that the vaccine will be of the 'right' strain. I will take those odds over getting the flu.

Also got a little flyer telling me about the flu and that this vaccine is a dead vaccine so you can not get the flu from it. That was helpful as I did not know that.

Feeling no ill effects at all, no bruise, no bleeding nada.

[Rolfe]

About nine hours post-vax now, situation normal.

Rolfe.

[Ivor the Engineer]

About nine hours post-vax now, situation normal.

Rolfe.

Can't you just make something up to make it a bit more exciting?

[Acleron]

A co-worker had the flu jab eight days ago and has been off work since. She and her family are convinced she has caught the flu despite being told she was given a killed vaccine and that being an asthmatic she is prone to respiratory problems. They have obviously been misled by people making up stories and will continue to propagate the false meme to others and reduce the uptake of the vaccine.

[Rolfe]

I didn't sleep well last night and woke up with a headache.

In fact this isn't at all unusual for me, I get headaches a lot, and the not sleeping well had more to do with posting late on the forum than anything else. As a result I feel a bit lousy this morning. However, I can't see any reason at all to link this with the vaccine. My upper arms (especially the right) are a little tender, but nowhere near enough to keep me awake (in fact I think I really only noticed because I was lying awake anyway), and this is essentially trivial.

However, if I wanted to make a connection, then of course I'd make it. I had the vaccine yesterday, and I feel lousy today. Post hoc, but almost certainly not propter hoc.

When I got home yesterday evening I discovered that my mother (who also had the vaccine at the same time) had cut her finger rather nastily while slicing meat. Spent some time cleaning the cut with antiseptic and applying a dressing.

Might as well blame that on the vaccine!

Rolfe.

[Ivor the Engineer]

Is that the best you can do! Damn it woman, I want excitement!

I haven't had a flu jab and I didn't sleep well last night either. I also feel lousy today.

At least your mother had the decency to spill some blood to make this drama a bit more interesting.

[Rolfe]

Oh, I spilled some blood as well. All over my nice new NWO Kitty t-shirt.

But the nice nurse gave me a sticking plaster for it.

Rolfe.

[Ivor the Engineer]

Better. Are you sure it wasn't arterial spray?

[Physiotherapist]

Well, I have not had a flu vaccination since I was at school, at least 25 years ago now and I have absolutely no intention of getting one anytime soon either. The last time I had flu that I recall was also about 25 to 30 years ago. The most I have ever had since have been a few colds and sore throats, but nothing more and these have not lasted long and have been few and far between too.

[Rolfe]

Well fancy that. And my old Uncle Herb lived to 106 although he smoked 40 a day.

Rolfe.

[Dymanic]

The last time I had flu that I recall was also about 25 to 30 years ago.The fact that YOU haven't caught the flu certainly doesn't suggest that flu isn't out there. If it's really been that long since your immune system has encountered an influenza virus, one implication of that is that the antigens borne by presently circulating strains are going to be very different from any to which you possess immune memory. Maybe you've just been lucky or maybe there's some other reason you've been spared, but whatever it is, one probable result is that your chances of a severe encounter are increasing with each passsing year.

[Eos of the Eons]

Had the flu shot this morning. Just maybe a wee bit sore in the area I was shot. There are 3 strains covered in the shot this year.

I have a sensitivity to eggs, and even though I usually take an antihistamine as a precaution- I didn't bother this time. (wouldn't recommend this to anyone with a severe egg allergy though)

I'm sorry to say I didn't get any a darn reaction at all, not one hive, not any itching at the site even. I was hoping to liven up this thread a bit, but no such luck.

No blood, not even any ooze.
*throws out unneeded cotton swab with tape*

I work around pregnant moms and kids, as well as the elderly with chronic conditions. Now I've done all I can this year to prevent spreading nasty flu bugs around the centre. It was an easy thing to do, and free because of my job. The rest of the time I will follow the handwashing protocols to do that much more.

Will report back tomorrow if there's any headache.

[Physiotherapist]

I think I just have an extremely good immune system and this coupled with a good quality diet and plenty of exercise seems to render me immune to most things, when others around me are falling like flies.

I do remember the last time I had flu at school and it was pretty nasty, however, rather than being one of the first to get it, I was in fact one of the last people to get it.

[Eos of the Eons]

The rising death toll is attributed largely to the nation's growing number of elderly people, who are especially vulnerable to the flu.

Health and Human Services Secretary Tommy Thompson said the news "that influenza may be taking an even larger toll than we have realized" underscores the importance of flu shots, especially for older people.
http://www.cbsnews.com/stories/2003/01/07/health/main535605.shtml

I got the shot because I will be around a lot of ederly folks, not just my own grandparents. It will help get some herd immunity up to protect folks who don't get the shot. Will your grandparents get the shot this year? What about elderly parents? Would you get the shot to help shield them?

The flu shot is not covered for people at certain ages because they are not as at much risk of dying. We already know that.

[Ivor the Engineer]

http://www.cbsnews.com/stories/2003/01/07/health/main535605.shtml

I got the shot because I will be around a lot of ederly folks, not just my own grandparents. It will help get some herd immunity up to protect folks who don't get the shot. Will your grandparents get the shot this year? What about elderly parents? Would you get the shot to help shield them?

The flu shot is not covered for people at certain ages because they are not as at much risk of dying. We already know that.

My mother's excellent GP has told her that she is not in an at-risk group, but because she is over 65, she can have a flu jab if she wants one.

If I was working with vulnerable people, I would get a flu shot (for what it's worth).

[Rolfe]

I think I just have an extremely good immune system and this coupled with a good quality diet and plenty of exercise seems to render me immune to most things, when others around me are falling like flies.

I do remember the last time I had flu at school and it was pretty nasty, however, rather than being one of the first to get it, I was in fact one of the last people to get it.


You may have a naturally good immune system, however, do you have any evidence that "a good quality diet" makes any difference? While I accept that malnutrition and deficiencies may increase susceptibility to infection, beyond this I know of no influence of diet quality.

In addition, why should exercise confer resistance to infectious disease? In fact, exercise may reduce the immune response by increasing concentrations of steroid hormones, which can be immunosuppressive. What is it that can improve the immune response, that I don't know about?

Rolfe.

PS. Still a bit tender on the right arm which got the pneumococcus jag, otherwise nothing. Still got the darn headache, i.e. situation normal.

Last night my mother asked me if I'd had any reaction to the flu jag. I said no, apart from slight tenderness in the arm. She said it was the same for her. She then launched into a rant about all the old biddies she's spoken to who swore that the vaccine gave you the flu and they felt bad after it and so on. She declared that she thought this was total nonsense. I remarked that I could say I'd slept badly and felt unwell the next day, but I thought that was unrelated to the vaccination. Of course, if I was predisposed to blame the vaccine, then undoubtedly I would. I think some people even imagine themselves into symptoms by anticipating them when the are vaccinated.

[Physiotherapist]

Yes, I agree that too much exercise can be immunosuppressive. However, moderate exercise can help boost the immune system.

I remember as a student in London, I would cycle to lectures, which was a good round trip. I was always more worried at times about London traffic and ensuring that I didn't get knocked off the bike by some maniac, not looking where they were going than I ever was about getting flu - which I never did and have not done since.

[Capsid]

Yes, I agree that too much exercise can be immunosuppressive. However, moderate exercise can help boost the immune system.

I remember as a student in London, I would cycle to lectures, which was a good round trip. I was always more worried at times about London traffic and ensuring that I didn't get knocked off the bike by some maniac, not looking where they were going than I ever was about getting flu - which I never did and have not done since.
What do you mean by "boost the immune system"?

[Professor Yaffle]

I do relatively little exercise and could eat much better than I usually do. I hardly ever get colds etc and I can't remember having the flu (though I may have had it as a child).

Don't you just love those anecdotes...?

[Physiotherapist]

I eat a balanced diet with plenty of fruit and vegetables, chicken, fish, little red meat and plenty of nuts and seeds. I find that if I eat like this, I always seem to have a lot more energy than if I eat processed food.

Exercise also helps me to feel more energised too. It keeps my muscles toned and my joints are also more flexible because of this.

People who eat a lot of processed food and have a very poor diet can be vitamin and mineral deficient.

These deficiencies can lead to people being more susceptible to disease, such as colds, flu's etc.

[Physiotherapist]

I do relatively little exercise and could eat much better than I usually do. I hardly ever get colds etc and I can't remember having the flu (though I may have had it as a child).



I take it you have had a flu vaccination then? Or is this just one of your little anecdotes?!!

[Rolfe]

I eat a balanced diet with plenty of fruit and vegetables, chicken, fish, little red meat and plenty of nuts and seeds. I find that if I eat like this, I always seem to have a lot more energy than if I eat processed food.

Exercise also helps me to feel more energised too. It keeps my muscles toned and my joints are also more flexible because of this.

People who eat a lot of processed food and have a very poor diet can be vitamin and mineral deficient.

These deficiencies can lead to people being more susceptible to disease, such as colds, flu's etc.


That's mostly complete woo-woo waffle.

Yes, actual genuine deficiencies can predispose to disease, but these are relatively rare. The rest of it is just unsubstantiated anecdote.

How can exercise "boost the immune system"? What do you mean by "boost the immune system"? I want specifics here.

Rolfe.

[Ivor the Engineer]

There's this (http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=10091272&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVAbstractPlus) on exercise and the immune system:

Comparison of immune function in athletes and nonathletes reveals that the adaptive immune system is largely unaffected by athletic endeavour. The innate immune system appears to respond differentially to the chronic stress of intensive exercise, with natural killer cell activity tending to be enhanced while neutrophil function is suppressed. However, even when significant changes in the level and functional activity of immune parameters have been observed in athletes, investigators have had little success in linking these to a higher incidence of infection and illness. Many components of the immune system exhibit change after prolonged heavy exertion. During this 'open window' of altered immunity (which may last between 3 and 72 hours, depending on the parameter measured), viruses and bacteria may gain a foothold, increasing the risk of subclinical and clinical infection. However, no serious attempt has been made by investigators to demonstrate that athletes showing the most extreme post-exercise immunosuppression are those that contract an infection during the ensuing 1 to 2 weeks. This link must be established before the 'open window' theory can be wholly accepted. The influence of nutritional supplements, primarily zinc, vitamin C, glutamin and carbohydrate, on the acute immune response to prolonged exercise has been measured in endurance athletes. Vitamin C and glutamine have received much attention, but the data thus far are inconclusive. The most impressive results have been reported in the carbohydrate supplementation studies. Carbohydrate beverage ingestion has been associated with higher plasma glucose levels, an attenuated cortisol and growth hormone response, fewer perturbations in blood immune cell counts, lower granulocyte and monocyte phagocytosis and oxidative burst activity, and a diminished pro- and anti-inflammatory cytokine response. It remains to be shown whether carbohydrate supplementation diminishes the frequency of infections in the recovery period after strenuous exercise. Studies on the influence of moderate exercise training on host protection and immune function have shown that near-daily brisk walking compared with inactivity reduced the number of sickness days by half over a 12- to 15-week period without change in resting immune function. Positive effects on immunosurveillance and host protection that come with moderate exercise training are probably related to a summation effect from acute positive changes that occur during each exercise bout. No convincing data exist that moderate exercise training is linked with improved T helper cell counts in patients with HIV, or enhanced immunity in elderly participants.

[Physiotherapist]

That's mostly complete woo-woo waffle.



Far from it Rolfe!!!

Why do you think the obesity epidemic is growing? There are people out there who do eat lots of processed food, fish and chips and MacDonalds on a daily basis, week in week out and year in year out. They don't seem to know any better and this coupled with a lack of exercise signals obesity and vitamin and mineral deficiencies with everything in the body working less efficiently.

Did you ever watch Supersize Me? This American guy lived on MacDonalds food for a whole month. He had a cardiologist and a DO who were looking after him during this time and he underwent a full medical exam and had bloods taken beforehand and everything was in normal range. After a month, his weight had increased by 2 stones, his cholesterol, which was normal before had increased to about 6 and most worrying was his liver enzymes, which had increased to dangerous levels, as if he had been consuming too much alcohol. The medics informed him that if he had continued this diet he would have had liver damage. By the end of the month, he felt unwell, had poor skin and had no energy whatsoever. Once he went back to his normal diet and started to exercise again, he felt better and did eventually loose the excess weight that he had put on.

This is an extreme example, but there are people like this around and couch potatoes who eat a very poor diet all the time that is highly processed, with a lot of saturated fat and sugar can be at risk of obesity, diabetes, stroke, heart attack and vitamin and mineral deficiencies because they can not get what they need from the quality of the food they are eating.

I do believe the saying that "you are what you eat".

I am lucky in my work as a Physical Therapist and Sports Massage Therapist, that I do a lot of work with athletes who are in very good physical shape. They like to keep that way too.

So no Rolfe, it is no a lot of "woo-woo nonsense" as you put it. It is a sad fact and a reality of life.

[Professor Yaffle]

I take it you have had a flu vaccination then? Or is this just one of your little anecdotes?!!

I am entitled to get the flu vaccine, as I have asthma. But I don't usually get around to having it. I think I have had it once, maybe twice.

So, yeah, it was just an anecdote to demonstrate why your anecdote doesn't necessarily mean anything.

[Acleron]

Far from it Rolfe!!!

Why do you think the obesity epidemic is growing?

Lack of vaccination to adenovirus?

[Dymanic]

What do you mean by "boost the immune system"? I want specifics here.
Me too. Maybe we could look at what is mean by the terms: "immunocompromised" and "immunosuppressed", and then work backwards from there. Or we could look at autoimmune disorders in the hope of finding some point at which further "boosting" of an immune system might not be an obviously good thing.

One way to increase immunity to a specific pathogen is to provoke a humoral response, but that requires actual exposure to the foreign antigens, either through vaccination or infection. Short of that, I'm not sure what could be done to "boost" the system's ability to form antibodies -- but there are subtle aspects to the interplay between humoral and cell-mediated immune response, and this surely includes some aspects which are not yet understood, so maybe there's some room for "boostability" there.

[JJM]

Far from it Rolfe!!!

Why do you think the obesity epidemic is growing? There are people out there who do eat lots of processed food, fish and chips and MacDonalds on a daily basis, week in week out and year in year out. They don't seem to know any better and this coupled with a lack of exercise signals obesity and vitamin and mineral deficiencies with everything in the body working less efficiently.

Did you ever watch Supersize Me? {snip}

This is an extreme example, but there are people like this around and couch potatoes who eat a very poor diet all the time that is highly processed, with a lot of saturated fat and sugar can be at risk of obesity, diabetes, stroke, heart attack and vitamin and mineral deficiencies because they can not get what they need from the quality of the food they are eating.

I do believe the saying that "you are what you eat". {snip}

So no Rolfe, it is no a lot of "woo-woo nonsense" as you put it. It is a sad fact and a reality of life.Do you have anything to offer other than anecdote? Do you understand why anecdote is unacceptable?

You believe the saying you quote; but belief is all you can have when you have no data.

What are these vitamin and mineral deficiencies? Are they recorded in medical literature (let's stick to developed countries)?

[JJM]

I eat a balanced diet with plenty of fruit and vegetables, chicken, fish, little red meat and plenty of nuts and seeds. I find that if I eat like this, I always seem to have a lot more energy than if I eat processed food."Seem" is the operative word, here, in this anecdote.

{snip} People who eat a lot of processed food and have a very poor diet can be vitamin and mineral deficient.

These deficiencies can lead to people being more susceptible to disease, such as colds, flu's etc.Where has this been published in the medical literature?

[Physiotherapist]

I was talking about developed countries! Oh, I forgot, it isn't where you come from - the States!!!

It is not anecdote and can all be proved by simple blood tests.

Blood tests are fact.

[JJM]

{snip} It is not anecdote and can all be proved by simple blood tests.

Blood tests are fact.Great, cite the medical studies that support your claims.

Remember, you have made many, disparate claims. They include notions about immune function, vitamin/mineral deficiencies, and susceptibility to disease (which can be different from immune function). You might like to select one notion at a time.

[Eos of the Eons]

Aww man, this sinus infection I've been fighting off for a few days is still hanging around. So, I do have a headache and some queasiness, but am sure it is more to do with the yellow boogers I've been blowing for 4 days now. I have the afternoon off tomorrow, so if the sinuses are still getting progressively worse then I'll have to drag myself into a walk-in.

My nose hurts. My arm is fine though.

[Physiotherapist]

I still don't see the point in getting a flu jab if I have never had flu. I really don't see any reason to start now, especially as they don't give you full protection against all strains out there. What is the point. To my mind it is a waste of money and time.

[JJM]

I still don't see the point in getting a flu jab if I have never had flu. {snip}So. I guess you have no valid information behind your dubious claims. Have you not realized that unsupported speculation does not impress? Why do you post here? Is it gratifying even though you cannot answer your critics?

Addressing your immediate post- the point of vaccination is not to prevent the flu you never had, it is to prevent the flu you might get. Duh. It can also prevent you from giving the flu to someone who might be vulnerable. In the "States," that would include the patients of physical therapists.

[ZirconBlue]

Far from it Rolfe!!!

Why do you think the obesity epidemic is growing? There are people out there who do eat lots of processed food, fish and chips and MacDonalds on a daily basis, week in week out and year in year out. They don't seem to know any better and this coupled with a lack of exercise signals obesity and vitamin and mineral deficiencies with everything in the body working less efficiently.

Did you ever watch Supersize Me? This American guy lived on MacDonalds food for a whole month. He had a cardiologist and a DO who were looking after him during this time and he underwent a full medical exam and had bloods taken beforehand and everything was in normal range. After a month, his weight had increased by 2 stones, his cholesterol, which was normal before had increased to about 6 and most worrying was his liver enzymes, which had increased to dangerous levels, as if he had been consuming too much alcohol. The medics informed him that if he had continued this diet he would have had liver damage. By the end of the month, he felt unwell, had poor skin and had no energy whatsoever. Once he went back to his normal diet and started to exercise again, he felt better and did eventually loose the excess weight that he had put on.

This is an extreme example, but there are people like this around and couch potatoes who eat a very poor diet all the time that is highly processed, with a lot of saturated fat and sugar can be at risk of obesity, diabetes, stroke, heart attack and vitamin and mineral deficiencies because they can not get what they need from the quality of the food they are eating.

I do believe the saying that "you are what you eat".

I am lucky in my work as a Physical Therapist and Sports Massage Therapist, that I do a lot of work with athletes who are in very good physical shape. They like to keep that way too.

So no Rolfe, it is no a lot of "woo-woo nonsense" as you put it. It is a sad fact and a reality of life.

What does any of this have to due with the immune system? Is obesity a communicable disease?

[Rolfe]

Far from it Rolfe!!!

Why do you think the obesity epidemic is growing? There are people out there who do eat lots of processed food, fish and chips and MacDonalds on a daily basis, week in week out and year in year out. They don't seem to know any better and this coupled with a lack of exercise signals obesity and vitamin and mineral deficiencies with everything in the body working less efficiently.

Did you ever watch Supersize Me? This American guy lived on MacDonalds food for a whole month. He had a cardiologist and a DO who were looking after him during this time and he underwent a full medical exam and had bloods taken beforehand and everything was in normal range. After a month, his weight had increased by 2 stones, his cholesterol, which was normal before had increased to about 6 and most worrying was his liver enzymes, which had increased to dangerous levels, as if he had been consuming too much alcohol. The medics informed him that if he had continued this diet he would have had liver damage. By the end of the month, he felt unwell, had poor skin and had no energy whatsoever. Once he went back to his normal diet and started to exercise again, he felt better and did eventually loose the excess weight that he had put on.

This is an extreme example, but there are people like this around and couch potatoes who eat a very poor diet all the time that is highly processed, with a lot of saturated fat and sugar can be at risk of obesity, diabetes, stroke, heart attack and vitamin and mineral deficiencies because they can not get what they need from the quality of the food they are eating.

I do believe the saying that "you are what you eat".

I am lucky in my work as a Physical Therapist and Sports Massage Therapist, that I do a lot of work with athletes who are in very good physical shape. They like to keep that way too.

So no Rolfe, it is no a lot of "woo-woo nonsense" as you put it. It is a sad fact and a reality of life.


Total lack of facts here I'm afraid.

The reasons for the obesity epidemic are many, but I would agree that lack of exercise is right up there at the top. We're actually eating less than our ancestors, just burning off far less. However, that's not what you were claiming. You were claiming that the exercise you took was enough to give you effective protection from flu, without needing a vaccine. And that your "healthy" diet, with all those fruits and vegetables and nuts and seeds, also added to this protection.

Still waiting for the evidence.

Of course I've seen Supersize Me. Twice. Fascinating. Much of what Morgan Spurlock suffered was attributable to his very sudden change of diet, and there was evidence that his body was beginning to cope with it by the second month. He also featured one guy who had eaten innumerable Big Macs (without the chips) for many years and was fine. However, such an extreme situation is not comparable to your original claim.

Ivor the Engineer's citation is interesting, but hardly conclusive.

Now, Physiotherapist. Are you saying that because you are not a couch potato existing on junk food then you won't get flu? Are you saying that your special diet of squirrel things protects you, as compared to any other ordinary Joe who eats regular non-junk food? Are you saying that the exercise you take protects you?

Shifting the argument to extremes of poor nutrition is not an answer.

Rolfe.

[Dymanic]

I still don't see the point in getting a flu jab if I have never had flu. I really don't see any reason to start now, especially as they don't give you full protection against all strains out there. What is the point. To my mind it is a waste of money and time.I don't know how things are where you live, but I paid zip for mine, and it took all of five minutes. If you don't see the point, take a closer look at what JJM just said. Immune function and susceptibility are not necessarily the same thing.

[Rolfe]

I still don't see the point in getting a flu jab if I have never had flu. I really don't see any reason to start now, especially as they don't give you full protection against all strains out there. What is the point. To my mind it is a waste of money and time.


The enormity of the lack of understanding of the principles of the flu vaccination implicit in that post is jaw-dropping.

And, like Dynamic, I paid zip for mine, I was allowed time off work to go get it, and I've had zero adverse effects. (The arm the nurse shot with the pneumococcus vaccine is still tender, that's all. Otherwise nothing at all.)

I suspect the tales of adverse reactions to this vaccine are to a large extent examples of nocebo that Robinson was going on about in another thread. Expect a bad reaction from a vaccine and you'll either worry yourself into it, imagine yourself into it, or attribute something completely coincidental to it.

Rolfe.

[Physiotherapist]

The better your diet is at providing everything that you need from it and with regular exercise, the more efficiently your body will function and this includes the immune system.

The evidence speaks for itself in that I have not had flu since childhood - as stated before some 25 to 30 years ago.

Nuts, seeds and grains are a good way of getting lots of essential nutrients.

[Capsid]

The better your diet is at providing everything that you need from it and with regular exercise, the more efficiently your body will function and this includes the immune system.

The evidence speaks for itself in that I have not had flu since childhood - as stated before some 25 to 30 years ago.

Nuts, seeds and grains are a good way of getting lots of essential nutrients.
That's not boosting the immune system though; it's helping it to work optimally. You can't magically make your immune system better.

[Rolfe]

And one person not having flu since childhood is hardly evidence of anything at all. Remember my Uncle Herb?

Rolfe.

[UnrepentantSinner]

And one person not having flu since childhood is hardly evidence of anything at all.

I disagree completely!

It's either evidence of them:
A. Having been raised in a hermetically sealed bubble or box since childhood
or (and more likely)
B. Not being able to discern between flu symptoms and cold symptoms and claiming that times they have had the flu were actually the cold.

Of course C, D, E and F include being full of **** and a couple of other options, but they'd be more conclusive than evidentiary.

I will grudingly agree with one point Physio tried to make assuming he's under 40 - getting the vaccine is an overprecaution unless we have a killer strain. Since I'm only 39 I've chosen to forgo the vaccine and will do so for the next year or couple. He's free to continue doing so into his 40s, but I hope someone close to him will avoid mentioning the irony in his obituary.

[Dymanic]

Not being able to discern between flu symptoms and cold symptoms and claiming that times they have had the flu were actually the cold.That's a mistake a lot of people make, but it's usually the other way around.

getting the vaccine is an overprecaution unless we have a killer strainIf we have a "killer strain", all bets are off. When a virus emerges which has antigens very much different from those of any previously encountered strain, immune memory specific to those strains doesn't help much (whether it was aquired through infection or vaccination), so more people get sick, and more of them get sicker. In other words, while it is possible for a pandemic strain to possess some unique properties making it particularly virulent, this isn't necessarily a requirement; theoretically, a significant antigenic shift alone would be enough to cause a pandemic.

The last killer strain (the H1N1 virus which caused the "Spanish Flu" pandemic of 1918) was especially tough on the very young and the very old, pregnant women, and those with pre-existing health problems -- just as is the case with ordinary seasonal flu. But it also affected previously healthy young adults in disproportionate numbers, leading many theorists to propose that a major factor was the so-called "cytokine storm", wherein a particularly robust cell-mediated immune response becomes disregulated and a positive feedback loop insues, causing an out-of-control proliferation of a class of proteins which (in addition to promoting inflammation) serve as chemical messengers (one of the messages being: "send more chemical messengers").

So, in the face of a pandemic, optimal immune fitness (whatever that is) may in fact be a distinct disadvantage. The system just doesn't seem to be designed to handle that; it seems (to me) that it assumes that a effective humoral response will develop before the cell-mediated response does too much damage. If that doesn't happen within a certain time, the cell-mediated response never gets the signal to stand down, and it becomes a toss-up as to whether it will be that response that kills the host (through inflammation, cell death, and accumulation of detritus in the lungs), or the activities of the virus itself (as it infects more and more cells, co-opting more and more of their resources for its replication rather than their own vital functions).

[Acleron]

theoretically, a significant antigenic shift alone would be enough to cause a pandemic.

But this very much less likely. The infection by flu virus at present occurs in those people who do not recognise the antigens, the virulence must be the deciding factor.

[Physiotherapist]

I disagree completely!

It's either evidence of them:
A. Having been raised in a hermetically sealed bubble or box since childhood
or (and more likely)
B. Not being able to discern between flu symptoms and cold symptoms and claiming that times they have had the flu were actually the cold.

Of course C, D, E and F include being full of **** and a couple of other options, but they'd be more conclusive than evidentiary.

I will grudingly agree with one point Physio tried to make assuming he's under 40 - getting the vaccine is an overprecaution unless we have a killer strain. Since I'm only 39 I've chosen to forgo the vaccine and will do so for the next year or couple. He's free to continue doing so into his 40s, but I hope someone close to him will avoid mentioning the irony in his obituary.


No, I was not raised in a 'bubble' and lived a normal life. I went to school and had all the childhood illnesses.

Of course I can distinguish the difference between flu and a cold and it was flu that I had.

I have had quite a few colds over the years, that have not really stopped me doing anything, but not flu. I do know the difference.

Yes, I am still under 40, but what has being in your 40's got to with having flu vaccinations or anything for that matter?

[Capsid]

I don't think you can be absolutely certain that you had the flu unless you had a test to confirm this at the time. There are many, many viruses that would give you flu like symptoms. If you were laid up in bed for about a week then that could have been flu.

[MosheJW]

I remember reading once that repeated use of antibiotics makes your immune system "lazy" and less capable of dealing with pathogens on it's own (and then when you get something, it hits you much harder...)
I really don't know much about how the immune system works, but I would think that the same problem would happen with vaccines (also against viruses).
Is this true?

[Acleron]

I remember reading once that repeated use of antibiotics makes your immune system "lazy" and less capable of dealing with pathogens on it's own (and then when you get something, it hits you much harder...)
I really don't know much about how the immune system works, but I would think that the same problem would happen with vaccines (also against viruses).
Is this true?

No.

[skeptigirl]

A co-worker had the flu jab eight days ago and has been off work since. She and her family are convinced she has caught the flu despite being told she was given a killed vaccine and that being an asthmatic she is prone to respiratory problems. They have obviously been misled by people making up stories and will continue to propagate the false meme to others and reduce the uptake of the vaccine.It's called catching a virus in the line waiting for the flu shot. ;)

[skeptigirl]

I think I just have an extremely good immune system and this coupled with a good quality diet and plenty of exercise seems to render me immune to most things, when others around me are falling like flies.
...Oh yes, that's the, "we are at the top of the food chain" myth. ;)

[skeptigirl]

...- getting the vaccine is an overprecaution unless we have a killer strain. Since I'm only 39 I've chosen to forgo the vaccine and will do so for the next year or couple. ...I had a discussion about this risk perception issue today. The person was choosing not to get a flu shot because he didn't perceive himself at risk of flu. His particular rationale was he didn't feel he knew enough about the safety of the vaccine.

I was trying to point out he was comparing the vaccine risk vs 'nothing' because he wasn't considering the flu risk in his thought process.

So what was my point? Simple. You have this belief about the risk of flu that you have very likely never really looked in to. What have you done to evaluate if you are at risk from influenza? Have you read studies? Looked at the epidemiology in 39 yr olds? Anything?

Not likely. Yet that was supposedly OK and reliable, while in this guy's case he felt he needed to actually look at the research on the vaccine, couldn't trust any health care provider (not just me) to give their opinion on the vaccine, and he didn't think the disease risk warranted looking into the vaccine.

So how is it you know what your risk is of getting influenza in any given year and how is it you know you cannot suffer from any serious complications from flu? Have you ever actually looked at the data?

[skeptigirl]

I don't think you can be absolutely certain that you had the flu unless you had a test to confirm this at the time. There are many, many viruses that would give you flu like symptoms. If you were laid up in bed for about a week then that could have been flu.
You can make a reasonable assumption if:

Influenza is in the area
You have fever >101F (37C)
Sudden onset
Muscle aches and headache
No appetite
And severe coughing
Bronchitis is also more typical since the virus often infects the cilia in the trachea

[skeptigirl]

I remember reading once that repeated use of antibiotics makes your immune system "lazy" and less capable of dealing with pathogens on it's own (and then when you get something, it hits you much harder...)
I really don't know much about how the immune system works, but I would think that the same problem would happen with vaccines (also against viruses).
Is this true?This is a common misunderstanding of antibiotic resistance.

The actual resistance develops in the microbes, not in the host.

[Dymanic]

The infection by flu virus at present occurs in those people who do not recognise the antigensIndeed. Young children, for example; who, having less extensive immunological histories, would be expected to exhibit poorer antigen recognition, and would therefore be expected to get sick more easily, get sicker, and stay sick longer -- which is exactly what the data indicate. Clinical attack rates and case fatality rates are both much higher in young children than in other age groups, and they typically shed virus for a longer period of time. Same strains of virus, poorer antigen recognition, more severe illness.

the virulence must be the deciding factor.It's not that simple.

[skeptigirl]

Indeed. Young children, for example; who, having less extensive immunological histories, would be expected to exhibit poorer antigen recognition, and would therefore be expected to get sick more easily, get sicker, and stay sick longer -- which is exactly what the data indicate. Clinical attack rates and case fatality rates are both much higher in young children than in other age groups, and they typically shed virus for a longer period of time. Same strains of virus, poorer antigen recognition, more severe illness.

[Re virulence is the difference] It's not that simple.It's not just virulence, neither is it simple immunological history.

Virulence, exposure dose, route of entry (eg inhaled vs skin contact), and a number of host factors such as but not limited to previous antigen exposure can make a difference in disease severity.

Age alone matters for many infectious organisms. For example in the H5N1 bird flu and in SARS, a cytokine storm is suspected as the reason young healthy patients suffered respiratory failure while some elderly patients did not. Measles, mumps and chicken pox all affect the very young and adults more severely on average than they affect children from about 2 yrs to their early teens**. I'm not aware if this has been explained yet, perhaps someone else knows the pathophysiology making the difference. Hepatitis A is often asymptomatic in kids under age 12 or so. And for that matter, hepatitis B and C are harmless in some patients and at least in the case of hepatitis C, those infected at younger ages are more likely to clear the virus and remain unaffected by it.

** And just to head off the repeated arguments we should let some kids get those infections naturally, the rate of secondary, sometimes fatal skin infection in kids with chicken pox is greater than in adults (probably owing to the fact kids scratch with dirty hands), one cannot assure kids will get mumps in childhood if left up to nature, leaving them vulnerable to severe disease as adults, and with all three, infection before age 2 is riskier and even if complications occur at a lower rate, deaths and severe disease still occur at all ages.

[Ivor the Engineer]

** And just to head off the repeated arguments we should let some kids get those infections naturally, the rate of secondary, sometimes fatal skin infection in kids with chicken pox is greater than in adults (probably owing to the fact kids scratch with dirty hands), one cannot assure kids will get mumps in childhood if left up to nature, leaving them vulnerable to severe disease as adults, and with all three, infection before age 2 is riskier and even if complications occur at a lower rate, deaths and severe disease still occur at all ages.

Nice work skeptigirl, technically correct and all the right wishy-washy terms:

"sometimes-fatal skin infection"

"severe disease as adults"

"before age 2 is riskier"

"deaths and severe disease still occur at all ages"

Is there a recommended minimum number of times to use the word "death" (or its synonyms) when talking to parents about vaccination?

Do similar tactics usually work to persuade healthy 5-49 year-olds to pay to have flu shots they don't need?

[skeptigirl]

Nice work skeptigirl, technically correct and all the right wishy-washy terms:

"sometimes-fatal skin infection"

"severe disease as adults"

"before age 2 is riskier"

"deaths and severe disease still occur at all ages"

Is there a recommended minimum number of times to use the word "death" (or its synonyms) when talking to parents about vaccination?

Do similar tactics usually work to persuade healthy 5-49 year-olds to pay to have flu shots they don't need?Care to paraphrase my statements with your alternative language substitutions so we can judge which is more accurate?

[Dymanic]

Is there a recommended minimum number of times to use the word "death" (or its synonyms) when talking to parents about vaccination?Or seatbelts?

[Ivor the Engineer]

Or seatbelts?

I would have thought in the case of seatbelts, physics and demonstrations using eggs and dummies would have been quite sufficient.

[Dymanic]

I would have thought in the case of seatbelts, physics and demonstrations using eggs and dummies would have been quite sufficient.Would you have thought that the "tactics" used to persuade people of the importance of wearing seatbelts did not include mentioning the numbers of fatalities that might have been prevented?

[Ivor the Engineer]

Would you have thought that the "tactics" used to persuade people of the importance of wearing seatbelts did not include mentioning the numbers of fatalities that might have been prevented?

Almost certainly not. Big numbers when it comes to fatalities are good at scaring people, especially when they are not put into proportion or context.

[alfaniner]

I still don't see the point in getting a flu jab if I have never had flu. I really don't see any reason to start now, especially as they don't give you full protection against all strains out there. What is the point. To my mind it is a waste of money and time.

Spending two days moaning on the couch might convince you otherwise...

...I have had quite a few colds over the years, that have not really stopped me doing anything, but not flu. I do know the difference...

So, that super-duper immune system is doing its job, huh? If you can get one, you can get the other.

[annexw]

The better your diet is at providing everything that you need from it and with regular exercise, the more efficiently your body will function and this includes the immune system.

The evidence speaks for itself in that I have not had flu since childhood - as stated before some 25 to 30 years ago.

I have never had the flu myself that I am aware of.

Unlike yourself, I have a crappy diet (full of processed sugary foods), only recently began exercising in any real way. I'm anaemic as well, but I rarely get anything more then a cough in the winter. Every once in a while I will get stuffy nose.

By your standard, I should have been dropping sick a lot more then I ever did and now that I have started working-out, I shall be invincible!

Honestly, its because of attitudes like that to the flu shot that after I got mine I had to come into work with a killer headache. If I had called in sick, half the office would blame it on the flu vax.

To recap: I've never had the flu and iI got my flu vax to help keep that so.

[Michelle]

I have a very active life. I do a lot of exercise and a good diet and yet I've had flu 2 times in the past three years. BAD ones. You know, the type where you puke your stomach out? Yea. Not fun.

So this year I had my flu shot. And as you can see, I'm just fine! I had a sore arm for 2 hours or so and that's it. Maybe a little weird feeling a few hours afterwards too but by the morning I was perfectly new.

Flu shots are the way to go!

[Capsid]

Actually, I think one of the major factors is the probability of exposure. If you work in a closed environment with lots of other colleagues then the chance of you catching a new infection which your immune system has not seen before is greatly increased. This is also why schools are such efficient breeding grounds for viruses/bacteria. Lots of uneducated immune systems waiting to be deluged with thousands of new antigens; exposure is inevitable.

[Eos of the Eons]

My son has a fever and is throwing up today :( I didn't have the money to get the kids any flu shots this year.

Nobody else is sick yet. I'll find out how well this flu shot works soon though, I'm sure. I need to be in good shape for a new job, argh. Silly germy kids, lol.

I was feeling well enough for a work-out yesterday myself (finally beating this sinus infection).

[Michelle]

Actually, I think one of the major factors is the probability of exposure. If you work in a closed environment with lots of other colleagues then the chance of you catching a new infection which your immune system has not seen before is greatly increased. This is also why schools are such efficient breeding grounds for viruses/bacteria. Lots of uneducated immune systems waiting to be deluged with thousands of new antigens; exposure is inevitable.

Oh absolutely. I mean, when I went to college I would desinfect my keyboard before using a computer. That way, everyone in the class had the flu but I did not

Computer lab keyboards are like the #1 flu source.

[Eos of the Eons]

Handwashing is becoming the biggest deal ever too, for obvious reasons. My region holds hand washing workshops :D

http://www.canadian-health-network.ca/servlet/ContentServer?cid=1138724359598&pagename=CHN-RCS/CHNResource/CHNResourcePageTemplate&c=CHNResource

And some people accuse medical folks of JUST pushing pills. Sheesh. Prevention is the key, then no pills will ever be needed. Not only that, but my doctor never prescribes pills when viruses are involved.

[JJM]

Almost certainly not. Big numbers when it comes to fatalities are good at scaring people, especially when they are not put into proportion or context.Is this like telling people it is more hazardous driving their kids around than getting them vaccinated?

[Physiotherapist]

So, that super-duper immune system is doing its job, huh? If you can get one, you can get the other.


Yes, it sure is - it needs the odd little thing to give it a workout!!

Still no flu and definitely no flu shot anytime soon!!

[JJM]

I still don't see the point in getting a flu jab if I have never had flu. {snip}Did you walk to work or bring your lunch? [non sequitur]

[Rolfe]

I have to say that in this neck of the woods they don't offer the flu vaccine to young heathy types unless there is some other reason. Like working in a hospital or caring for an elderly person. However, that was still a non sequitur. Like, I don't bother to fasten my seat belt because I've never been in an accident.

Rolfe.

[MinorityView]

I have a very active life. I do a lot of exercise and a good diet and yet I've had flu 2 times in the past three years. BAD ones. You know, the type where you puke your stomach out? Yea. Not fun.

So this year I had my flu shot. And as you can see, I'm just fine! I had a sore arm for 2 hours or so and that's it. Maybe a little weird feeling a few hours afterwards too but by the morning I was perfectly new.

Flu shots are the way to go!

The kind where you puke your stomach out? The flu shots are for respiratory flu. Stomach flu is something altogether different, and I hate to tell you this, but there are currently no shots for adults.

So sorry!:D

[Eos of the Eons]

Bah humbug. The doc did say my kid was getting the stomach flu. Now I've been exposed. Argh. I can only hope I've gotten it before and won't get sick at my new job.

*worries*

[skeptigirl]

My son has a fever and is throwing up today :( I didn't have the money to get the kids any flu shots this year.

Nobody else is sick yet. I'll find out how well this flu shot works soon though, I'm sure. I need to be in good shape for a new job, argh. Silly germy kids, lol.

I was feeling well enough for a work-out yesterday myself (finally beating this sinus infection).While anorexia is a typical flu symptom and kids throw up regardless of the kind of infections they have, there is a common misconception that "stomach flu" is influenza. Influenza is a serious respiratory infection, not a GI infection.

Influenza
High fever
Sudden onset
Head and muscle aches
Severe respiratory symptoms

The reason it tends to be worse than a 'cold' is the virus more frequently invades the upper and middle airway (as opposed to just the upper airway typical of the common cold), in particular the cilia cells.

[skeptigirl]

Gave a flu shot today to one of the fire fighters who had never gotten one before. He apparently got the flu last year after not getting a flu shot. It changed his mind. :D

BTW, these are guys I've been vaccinating every year for the last 15 years though he hadn't been with the department that long.

[skeptigirl]

Bah humbug. The doc did say my kid was getting the stomach flu. Now I've been exposed. Argh. I can only hope I've gotten it before and won't get sick at my new job.

*worries*Tell your doctor the infectious disease nurse practitioner on your skeptic community forum said he was contributing to the common influenza misconceptions using the term "stomach flu". The most common actual diagnosis, and a better means of educating patients would be to call it a "probable norovirus". Miserable but short lived.

[Eos of the Eons]

That is a gripe I have with the doctors in my area walk-ins. They get in a hurry for the after lunch rush, and skip over any real chance to educate anyone. At least he didn't prescribe anything other than lots of fluids, no milk products, and rest. My son's fever broke this evening, and he ate supper fine. I've learned more from you, as his symptoms match what you've posted on it. It is really a sad state of affairs. At least I know my regular doctor is better with these things.

[skeptigirl]

:D Thanks for the compliment.

[Ivor the Engineer]

I have to say that in this neck of the woods they don't offer the flu vaccine to young heathy types unless there is some other reason. Like working in a hospital or caring for an elderly person. However, that was still a non sequitur. Like, I don't bother to fasten my seat belt because I've never been in an accident.

Rolfe.

That would be because it's a waste of resources for seasonal flu.

I think the problem some Americans have understanding this is because US expenditure on health care just goes up and up each year, whereas the NHS has a budget to try to stick to. The NHS provides health care much cheaper than the free-market system in US.

http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=283969

It must really piss off capitalist types that a state-run system can beat a free-market one for cost-effectiveness:D