Reassessing Flu Shots

[Mirzam]

(Sorry about the silly typo in the heading - I have no idea how to edit the title)

http://well.blogs.nytimes.com/2012/11/05/reassessing-flu-shots-as-the-season-draws-near/

Quote:

“We have overpromoted and overhyped this vaccine,” said Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy, as well as its Center of Excellence for Influenza Research and Surveillance. “It does not protect as promoted. It’s all a sales job: it’s all public relations.” (my emphasis)

Quote:

“I’m an insider,” Dr. Osterholm said. “Until we started this project, I was one of the people out there heavily promoting influenza vaccine use. It was only with this study that I looked and said, ‘What are we doing?’ ”

[Mirzam]

New York Times - Flu Vaccine Does Not Work - Yet More Research Says (Republished from Infomail 7/Nov/12 from NY USA charity Alliance for Human Research Protection)

Quote:

Last month we reported that respected international scientists–such as Dr. Tom Jefferson who have examined the evidence about the efficacy of the influenza vaccine–concluded that annual flu shots “are likely an utter waste of time and money.“  See, http://www.ahrp.org/cms/content/view/879/9/

[kathymuggle]

Thanks, Mizram.  Your links do not surprise me.

I wonder if anyone still thinks flu vaccines are something almost everyone should get? 

[Mosaic]

I fixed the typo in the thread title... hope that's ok!

And wow... this stood out to me:

When the vaccine matches the circulating viruses, 33 adults need to be vaccinated to avoid one set of influenza symptoms; when there is only a partial match, 100 people must be vaccinated for the same effect. It was also concluded that the vaccines appear to have no effect on hospital admissions, transmission or rates of complications.

[WildKingdom]

When the vaccine matches the circulating viruses, 33 adults need to be vaccinated to avoid one set of influenza symptoms; when there is only a partial match, 100 people must be vaccinated for the same effect. It was also concluded that the vaccines appear to have no effect on hospital admissions, transmission or rates of complications.

At NNT (number needed to treat) of 33 is pretty good for a prophylactic medication.

More info here regarding statistical analysis.  http://www.medicine.ox.ac.uk/bandolier/booth/glossary/outputs.html

[Turquesa]

Originally Posted by WildKingdom 


At NNT (number needed to treat) of 33 is pretty good for a prophylactic medication.

More info here regarding statistical analysis.  http://www.medicine.ox.ac.uk/bandolier/booth/glossary/outputs.html

To avoid one set of symptoms. Not to avoid sick days, transmission, hospitalization, death...not even to avoid another set of symptoms.

Jefferson's research found that the vax only reduces the targeted clinical influenza by about 6%...hardly a figure to justify bullying hospital employees into compliance.

[Mosaic]

Oh, thanks WildKingdom... that definitely clarifies it for me. From the NNT description, this was something even I could understand!

It is also worth mentioning that prophylactic interventions that produce small effects in large numbers of patients will have high NNTs, perhaps 20-100.

[Rrrrrachel]

That's a great link wildkingdom. I'm a stats nerd and I love a good description of relative risk.

Turquesa, I interpret "one set of symptoms" here to mean one person getting noticeably sick. No sick means no sick days, etc. not as you don't get a runny nose but you do get a cough, which it seems like might be how you're interpreting it?

[Turquesa]

A set of symptoms is a person?

On another note, did anyone notice that a CDC official posted in the comments section? Intriguingly, she did not address a shred of Jefferson's research. Jefferson himself accuses flu shot apologists of cherry-picking data, and he dedicates his life's work to selecting solidly designed independent data. So I'm left to wonder the quality of the uncited data that she's presenting.

Here's an interesting interview with Jefferson: http://www.time.com/time/health/article/0,8599,1967306,00.html

[Taximom5]

Originally Posted by WildKingdom 


At NNT (number needed to treat) of 33 is pretty good for a prophylactic medication.

[/URL]

Because the pharmaceutical industry paid someone to say so?

"Hey, we want to give 33 of you a medication that 32 of you won't need. Oh, and there are side effects, some of which may be severe. That's pretty good for a prophylactic medication."

Oh, sure. No problem.

"If you tell a lie big enough and keep repeating it, people will eventually come to believe it."

[Rrrrrachel]

Turquesa, yeah I think that's the idea.

Taxi, the nature of any prophylactic is that you're going to give it to some people who don't actually need it. That's not scandalous.

[kathymuggle]

Originally Posted by Rrrrrachel 


Taxi, the nature of any prophylactic is that you're going to give it to some people who don't actually need it. That's not scandalous.

Whether or not is scandalous depends on the nature of the disease and the nature of the vaccine.  Context.  

You want to vaccinate 33 people to prevent one case of tetanus? Go for it .  Tetanus is pretty severe (in reality, iirc,  you have to vaccinate 200 000 plus people to prevent a case of tetanus).

The flu is not that severe in healthy individuals - having to vax 33 people to prevent one case may be overkill, particularly given the fact that the flu shot is not without side effects.  The LAIV (flumist) seems quite reactive:

http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/flu.pdf

"Among healthy adults, a significantly increased rate of cough, runny nose, nasal congestion, sore throat, and chills was reported among vaccine recipients. These symptoms were reported in 10%–40% of vaccine recipients, a rate 3%–10% higher than reported for placebo recipients"

Just because a NNT of 33 is good for prophylactic medication in general, does not mean it is good enough with regards to flu shots.

I guess everyone will have to decide for themselves whether they want to risk the flu or the side effects.  As long as everyone has the proper numbers on flu severity and vaccine effectiveness and safety, cool.  

-------------------------

OT:  As an FYI for any lurking vaxxers out there, the CDC also said LAIV carried a significantly increased risk of asthma and reactive airway disease in children up to 59 months.   Page 166 - in the sidebar.  Sorry, it will not cut and paste.  If people are going to vaccinate their children for the flu, they might want to investigate the safety of the two types of flu shots (as I am sure most people here would )

Edited by kathymuggle - 11/10/12 at 2:55pm

[Mirzam]

Originally Posted by Rrrrrachel 


Taxi, the nature of any prophylactic is that you're going to give it to some people who don't actually need it. That's not scandalous.

What is scandalous is those that don't want said prophylactic are not allowed to refuse it, even though it is more than likely useless, if they want to keep their job.

[Rrrrrachel]

Kathy, obviously it is a judgement call where the trade off is between severity of the disease vs side effects of the vaccination.

Mirzam, there are all kinds of requirements to all kinds of jobs. In many fields there is a long list of things you have to do or have to get or keep a job. I don't see how this is any different, but I guess it's a matter of perspective.

[kathymuggle]

nm - argumentative

[mar123]

I have never had the flu shot, nor have I ever had the flu. Neither my husband nor my kids have ever had the flu shot, nor have they had the flu. Since I am a teacher and exposed to pretty much everything that goes around, it really is surprising to some people. I tend to think some of us have natural immunity to certain things. I am not a 100% non-vaxer, mainly because I live in a very international place, with lots of tourists, etc. I do space out any vaccines my kids get and research the individual shots. There are others besides the flu that we have turned down: chicken pox, HPV, ear infection, etc.

A teacher I work has a son who is about 18 months. He just had a bunch of shots and the flu shot at the same time. I mentioned that giving all of that together increases the likelyhood of severe reactions. She said the doc told her that too, but she did it anyway. Her son has been sick ever since, which was 5 weeks ago (he is taken care of at home by his grandmother and had previously had few illnesses). But if you mention the vaccines in any way, she becomes livid and refuses to admit his illnesses might be related in any way to having so many shots at one time. It breaks my heart to see him looking so frail. He isn't eating and has lost weight. It's so sad.