[p2p-research] How effective is the flu shot? [Greg Laden's Blog]

[Paul D. Fernhout]

Ryan-

Greg Laden suggests essentially that anyone who believes vitamins help 
prevent flu is a "moron":
   "How effective is the flu shot? "
http://scienceblogs.com/gregladen/2009/10/how_effective_is_the_flu_shot.php
"In conclusion, no, it is not 1%. It is closer to 70 to 90% just like the 
CDC says, on average, for people not otherwise at risk who are under 65. If 
you don't get vaccinated because you think vaccines are dangerous or you 
think you can avoid the flu by taking vitamins then you are a moron. If you 
do't get vaccinated because you think the flu vaccine is only 1% effective 
then you are ... an entirely different kind of moron. Either way, get a shot 
and don't be a moron. The person you give the flu to because you didn't get 
the shot may be one of those that dies. Wouldn't that be smart. Not."

Guess he has not read this:
"Vitamin D deficiency linked to more colds and flu"
http://www.scientificamerican.com/blog/60-second-science/post.cfm?id=vitamin-d-deficiency-linked-to-more-2009-02-23
"Is sunshine more than just a home remedy for a cold? New research suggests 
it may be: In a study that will be published tomorrow, people with low 
levels of vitamin D — also known as the "sunshine vitamin" — were more 
likely to catch cold and flu than folks with adequate amounts. The effect of 
the vitamin was strongest in people with asthma and other lung diseases who 
are predisposed to respiratory infections."

Links to:
   http://archinte.ama-assn.org/cgi/content/full/169/4/384

General google search:
   http://www.google.com/search?hl=en&q=vitamin+d+flu

More on the general issue of benefits of the flu shot:
   http://www.ehow.com/about_5232321_dr-mercola-flu-shot-information.html
"""
A study in the New England Journal of Medicine reported that the influenza 
vaccine was not associated with a reduced rate of pneumonia in older people. 
More elderly people are taking the vaccine, but there has not been reduced 
rates of death from influenza. A study in the Cochrane Database of 
Systematic Reviews in 2006 revealed that the flu vaccine was no more 
effective in young children than a placebo. ... According to a study in the 
Archives of Pediatric and Adolescent Medicine, flu shots had no correlation 
between hospitalization and doctor visits through two flu seasons.
The U.S. Centers for Disease Control and Prevention recommends that children 
from six months to 18 years of age receive a yearly flu shot. It has long 
been recommended that older people get an annual flu shot.
"""

And further:
"""
According to Dr. Mercola. there is evidence that flu shots could cause 
Alzheimer's disease in adults and possibly autism in children.#  According 
to Dr. Mercola, vitamin D is the best immunization against influenza, and it 
is plentiful in sunshine. He suggests vitamin D supplements for people who 
live in areas with a sun deficiency during the flu season. Dr. Mercola 
suggests eating nutritiously and avoiding sugar. He also suggests increasing 
the omega-3 fats in your diet, which include fatty fish, flax seed and 
walnut oil. He also recommends eating garlic. Dr. Mercola promotes having an 
exercise program. He also suggests washing your hands regularly, and 
addressing any emotional stress going on in your life. Olive leaf extract is 
recommended with its many antiviral properties. Getting extra sleep will 
give you strength in the fight against influenza. It is always a good idea 
to stay away from people who are sneezing, coughing and show flu symptoms.
"""

So, by not getting enough vitamin D, this science blogger is putting others 
around him at risk of dying. But worse, he then tells others not to explore 
these issues themselves. So, this "science blogger" ignores the results of 
scientific research, as well a common sense that nutrition is linked to 
health, and then calls people names for thinking other than he does. And 
then proceeds to put both himself and everyone who listens to him at risk 
for contracting and spreading flu. And, he apparently then feels very 
self-righteous about all that, like he is doing a big public service. His 
advice about the flu shot may (or may not) be accurate; but his advice about 
vitamins is certainly off-base.

So, I guess this is how science works? :-) Ironically, that is the way 
science often does work, at least behind the scenes. :-)

 From a farside cartoon:
http://2.bp.blogspot.com/_zPsyjCql8DY/Se52aa3Yd4I/AAAAAAAAABI/LSEZeOrSFVI/s320/FarsideScientists1.jpg
"Your research paper is too similar to the research  goals of my friend 
reviewer #2, reviewer #2 doesn't like your haircut. Manuscript Decision: 
reject."

Or in more technical terms:
   http://www.its.caltech.edu/~dg/crunch_art.html
"""
Other kinds of dishonesty will also become more common. For example, peer 
review, one of the crucial pillars of the whole edifice, is in critical 
danger. Peer review is used by scientific journals to decide what papers to 
publish, and by granting agencies such as the National Science Foundation to 
decide what research to support. Journals in most cases, and agencies in 
some cases operate by sending manuscripts or research proposals to referees 
who are recognized experts on the scientific issues in question, and whose 
identity will not be revealed to the authors of the papers or proposals. 
Obviously, good decisions on what research should be supported and what 
results should be published are crucial to the proper functioning of science.
   Peer review is usually quite a good way to identify valid science. Of 
course, a referee will occasionally fail to appreciate a truly visionary or 
revolutionary idea, but by and large, peer review works pretty well so long 
as scientific validity is the only issue at stake. However, it is not at all 
suited to arbitrate an intense competition for research funds or for 
editorial space in prestigious journals. There are many reasons for this, 
not the least being the fact that the referees have an obvious conflict of 
interest, since they are themselves competitors for the same resources. This 
point seems to be another one of those relativistic anomalies, obvious to 
any outside observer, but invisible to those of us who are falling into the 
black hole. It would take impossibly high ethical standards for referees to 
avoid taking advantage of their privileged anonymity to advance their own 
interests, but as time goes on, more and more referees have their ethical 
standards eroded as a consequence of having themselves been victimized by 
unfair reviews when they were authors. Peer review is thus one among many 
examples of practices that were well suited to the time of exponential 
expansion, but will become increasingly dysfunctional in the difficult 
future we face.
   We must find a radically different social structure to organize research 
and education in science after The Big Crunch. That is not meant to be an 
exhortation. It is meant simply to be a statement of a fact known to be true 
with mathematical certainty, if science is to survive at all. The new 
structure will come about by evolution rather than design, because, for one 
thing, neither I nor anyone else has the faintest idea of what it will turn 
out to be, and for another, even if we did know where we are going to end 
up, we scientists have never been very good at guiding our own destiny. Only 
this much is sure: the era of exponential expansion will be replaced by an 
era of constraint. Because it will be unplanned, the transition is likely to 
be messy and painful for the participants. In fact, as we have seen, it 
already is. Ignoring the pain for the moment, however, I would like to look 
ahead and speculate on some conditions that must be met if science is to 
have a future as well as a past.
   It seems to me that there are two essential and clearly linked conditions 
to consider. One is that there must be a broad political consensus that pure 
research in basic science is a common good that must be supported from the 
public purse. The second is that the mining and sorting operation I've 
described must be discarded and replaced by genuine education in science, 
not just for the scientific elite, but for all the citizens who must form 
that broad political consensus.
""""

On his general theme or cost/benefit, it's a slippery subject, but by 
general logic, if only 5% to 20% of people get the flu in one year, a flu 
shot can't be much more effective than that even if it is 100% effective. See:
   http://www.cdc.gov/flu/about/qa/disease.htm
"In the United States, on average 5% to 20% of the population gets the flu"

And, as he suggests, citing:
http://scienceblogs.com/effectmeasure/2009/07/transmission_pathogenicity_vir_1.php
flu shots are sometimes only about 50% effective (sometimes they help not at 
all, sometimes they may help a lot, although some suggest there is a window 
where a flu shot makes you more vulnerable to the flu immediately 
afterward). So, if 5% gets the flu, and there are hardly any severe 
symptoms, and the flu shot is not very effective, then yes, the benefit to 
you of getting a flu shot could be in the 1% range of likely benefit in some 
years. H1N1 this year may be that case (even as, there may be some people in 
that 1% who might benefit from it greatly). Even if 20% of people get the 
flu, and the flu shot is 100% effective, and the flu is severe, then that is 
only 20% effectiveness in that sense for getting a shot. So, is it worth the 
risk of any shot? Well, it depends on how safe you think the shots are, and 
what your risk is of getting a severe flu. Note that many people can 
minimize their time exposed to crowded flu-prone situations, and many people 
can also do things suggested to improve their immune systems, so for someone 
in that situation, a flu shot might not make as much sense as for others. 
Surprisingly, those you most expect to get flu shots, medical workers, have 
less than a 40% rate of getting them:
   "Even health care workers reject flu shots"
  http://www.msnbc.msn.com/id/27214082/ns/health-cold_and_flu/

But, however safe flu shots might be, multiply the risks of getting a flu 
shot by 80 times for each year of your life. Maybe health care workers think 
about stuff like that? Of course, maybe the future of medicine lies in 
teleoperated robots to prevent the spread of diseases? :-)
   http://en.wikipedia.org/wiki/Telemedicine
   http://www.google.com/search?hl=en&source=hp&q=medical+robots

Let's say you get the multi-dose version with mercury (still using it 
apparently):
  http://wiki.answers.com/Q/What_are_the_ingredients_in_the_swine_flu_vaccine
One version: "The single-dose formulation is preservative-free; thimerosal, 
a mercury derivative, is not used in the manufacturing process for this 
formulation. The multi-dose formulation contains thimerosal, added as a 
preservative; each 0.5 mL dose contains 24.5 mcg of mercury. "

Now, a microgram is one millionth of a gram. So, this is 24 millionths of a 
gram. Multiply this over a lifetime exposure for flu shots as recommended by 
about 100 times. So, that is about 2.4 thousandths of a gram of mercury 
lifetime exposure, from flu shots or 0.0024 gram of mercury injected into 
your body. Or 2.4 milligrams.

Is that total amount dangerous? Well, it may depend how much body burden 
your body has already of heavy metals, as well as how good your body is at 
sequestering them or excreting them. People working on the autism-mercury 
link (or maybe also now the alzheimer-mercury/aluminum link) hypothesize 
some people are better at excreting heavy metals than other. Clearly, 
mercury is not good for you (among the other things in vaccinations not good 
for you). See:
http://www.idph.state.il.us/envhealth/factsheets/mercuryhlthprof.htm
http://www.epa.gov/mercury/exposure.htm
"Outbreaks of methylmercury poisoning have made it clear that adults, 
children, and developing fetuses are at risk from dietary exposure to 
methylmercury. During these poisoning outbreaks some mothers with no 
symptoms of nervous system damage gave birth to infants with severe 
disabilities and it became clear that the developing nervous system of the 
fetus may be more vulnerable to methylmercury than is the adult nervous system."

But, the question is, is that much mercury OK? That's what part of the 
controversy is about. As well as the general issue of, why is it still 
there? Are there no safer alternatives? How much money is saved by having 
multi-dose containers? People don't even want preservatives in their food 
nowadays if they can avoid them.

Also note that ingested mercury may only be absorbed slightly (less than 
0.01%),
   http://en.wikipedia.org/wiki/Mercury_poisoning
"Animal data indicate that less than 0.01% of ingested mercury is absorbed 
through the intact gastrointestinal tract; though it may not be true for 
individuals suffering from ileus."

Injected mercury may sit in the body for a long time and be completely 
absorbed.

So, the mercury in a shot may have 10000 times the effect the same amount of 
inorganic mercury ingested might have. By that standard, a lifetime of flu 
shots may be equivalent to ingesting about 24 grams of mercury. That might 
be a lethal dose if you got it all at once. From:
   http://www.epa.gov/ttn/atw/hlthef/mercury.html
"The acute lethal dose for most inorganic mercury compounds for an adult is 
1 to 4 grams (g) or 14 to 57 milligrams per kilogram body weight (mg/kg) for 
a 70-kg person. "

Of course, you don't get it all at once. It's been said "the dose makes the 
poison", though on the other hand, what is good for one creature may be 
poison for another. But even these tiny amounts, injected directly in ways 
that bypass the bodies normal ways of dealing with heavy metals or other 
things, may add up.

I'd suspect that many people are not even aware mercury is still used in 
shots at this point. It surprised me to see it there still.

So, I don't really know how safe that flu shot is, or how effective it is, 
especially if you plan to get it every year like recommended. But, I do know 
that it seems supplementing with Vitamin D and using other wellness 
strategies really do work to prevent some flu as well as minimize the 
symptoms, with very low risk.

By the way, it's also anecdotal that having Lyme disease, due to its 
autoimmune aspects, greatly reduces the number of colds and flus you get, 
although I don't recommend that approach to preventing the flu. :-) 
Sometimes the cure is worse than the disease. :-) But it could be an 
interesting area of research, if the medical community was not mostly 
denying Lyme disease as a chronic problem. This book has a somewhat herbal 
approach to treating chronic Lyme disease:
http://www.amazon.com/Lyme-Disease-Solution-Kenneth-Singleton/dp/1934812005
"Lyme disease has become the fastest-growing infectious disease transmitted 
by ticks (or other vectors) in the United States, but still remains a 
condition that is frequently misunderstood, overlooked, and misdiagnosed. 
Written by a leading practitioner of Lyme-aware medicine, this comprehensive 
guide will reveal to you the facts about this very serious disease - 
symptoms of which can mimic cardiac, neurological, and rheumatoid conditions 
- and will tell you what you need to know about the diagnosis, treatment, 
and prevention of Lyme disease. Kenneth B. Singleton, M.D., M.P.H., is a 
board-certified physician specializing in internal medicine. One of the most 
trusted voices in the medical field of Lyme disease today, Dr. Singleton 
earned his master's degree of public health from Johns Hopkins University 
and received training in acupuncture from UCLA. He completed his training in 
internal medicine at Wright State University in Dayton, Ohio, and has been 
practicing medicine since 1981. His medical practice is located in Towson, 
Maryland."

Alas, rather than spend billions of dollars researching and treating a real 
epidemic like Lyme disease, one that even infected the previous president of 
the USA and may have been responsible for trillions of dollars of bad 
decisions like Iraq, the US medical establishment instead sees fit to focus 
billions on H1N1 while denying that Lyme disease is a serious problem.

Oh, and the vaccine for Lyme disease? Apparently, anecdotally, it often gave 
you Lyme disease.
http://sci.tech-archive.net/Archive/sci.med.diseases.lyme/2005-03/0986.html
But the manufacturer said it was withdrawn due to "poor sales".
http://www.lymepa.org/html/vaccine_pulled_off_the_market.html
"""
Benjamin Luft, a panel member from the Department of Medicine
University Hospital and Medical Center Health Sciences Center at the
State University of New York at Stony Brook, described the "twilight
zone" of the "disconnect" between the patient testimony and the
sponsor's denial of significant adverse events. ...
  For those investigating LYMErix outside the FDA-pharma circle, the
questions just mount. Is the vaccine sparking a devastating autoimmune
reaction that places a third of its recipients at risk for something
much worse, much less treatable, than Lyme disease? Is it igniting
asymptomatic Lyme disease (an entity researchers now say may be as
pervasive as the symptomatic kind), revealing infection with the Bb
spirochete to be persistent or far more common than generally thought?
Do the bizarre Western blot patterns reflect a raging, expansive immune
response to the OspA molecule, as Paul Fawcett believes, suggesting
that Lyme disease pathology is still misunderstood? Or are the bands
merely artifacts, testament to gross misinterpretation of lab results
by the field's leading lights going back years? Are the answers even
knowable in the face of what could be the ultimate nightmare scenario -
vaccine trials performed according to a disease definition that is
incomplete, arbitrary, or wrong? Perhaps most pertinent, why are we
asking these questions now, after the product's release?
   The problem may stem from the race to market LYMErix.  ...
A result of that competition, says one scientist close to the action,
was pressure to complete clinical trials so the vaccine could move
through the approval process. "And in retrospect," he says, "the
approval itself was rushed, mainly because it was not known how often
booster immunizations would be needed and what the consequences of
getting or not getting the booster would be."
"""

Lots more in that last link about complete disagreements about how safe and 
effective LYMErix was. But, never an admission of problems.

Now, the last Swine flu mass immunization rushed out in the 1970s created 
autoimmune disorders. LYMErix apparently did so too, around the 1990s. But, 
everyone says it won't happen this time with this new H1N1 vaccine that has 
been rushed out. I hope they are right.

Still, maybe this whole set of issues should call into question vaccination 
as a good approach to deal with new and emerging health threats, compared to 
building up general health or doing research into new areas, including a lot 
more basic research into the human immune system and the management of the 
ecology and evolution of microbes?

But, this issues goes way back:
   http://ije.oxfordjournals.org/cgi/content/full/32/6/918
"""
The 100-page 1911 Preface to The Doctor’s Dilemma is part of the lifelong 
battle he waged against the medical profession. His writings on the subject 
range from an 1887 book review attacking vivisection through the 1931 
collection of articles comprising Doctors’ Delusions to the 1944 summary 
comments in Everybody’s Political What’s What? As Shaw declared doctors fair 
game, he portrayed more than 20 physicians in his dramatic works, although 
they are more likely to be fools than the knaves found in Molière. 
Throughout, the controlling theme is victimization as Shaw’s suspicions set 
the doctor against the patient.
   While the nature of his attack was peculiar, the underlying reasons were 
rooted in biography. In 1881 despite being vaccinated, Shaw caught smallpox. 
He claimed to be unblemished but his chin and jaw were pockmarked, marks 
concealed by growing the famous beard. Psychologically marked as well by his 
encounter with the dread disease, he proceeded to attack doctors and the 
vaccination that failed to protect him. For him, vaccination was Edward 
Jenner’s stunt, a stunt that managed to kill one baby a week. In addition to 
Jenner, Shaw specifically attacked Louis Pasteur and Joseph Lister. The 
three men had one thing in common: their fame rested on controlling 
micro-organisms. Shaw denounced the trio as murderers posing as saviours of 
mankind.
   Despite his animus, Shaw counted physicians among his friends, including 
controversial bacteriologist Sir Almroth Wright, the model for Sir Colenso 
Ridgeon in The Doctor’s Dilemma. Ridgeon’s dilemma, the morality of saving 
one life over another, was one that Shaw had discussed with Wright. 
Additionally, Shaw listened to Wright’s latest theories on vaccine therapy, 
including Wright’s belief that microbes are vehicles of disease but not the 
cause, a belief which earned him the label Almroth Wrong from his colleagues.
"""

Shaw may have been wrong about many things (like the value of 
disinfectants). But, the notion that microbes are the vehicles of disease, 
but no the cause, may be an important insight still not fully explored by 
modern science. After all, if germs caused disease by themselves, why do 
doctors not all die of infectious diseases in a few years of practice? There 
must be some reason the doctors do not get those diseases. And that 
something may be good nutrition or a positive attitude or humor or some 
other aspects of wealth that all relate to having a healthy immune system 
able to handle infectious diseases well, at least if you avoid a lot of 
direct exposure to the worst of them or practice good hygiene.

Anyway, the behavior of 60% of medical workers wanting to avoid the vaccine 
seems very telling, that maybe they understand Sir Almroth Wright's points 
more and more. Clearly, there is a conflict here in more than just "the CDC 
vs. an uninformed public" when most health care worker are apparently 
rejecting the vaccine.

On Sir Almroth Wright:
   http://en.wikipedia.org/wiki/Almroth_Wright
"""
Wright warned early on that antibiotics would create resistant bacteria, 
something that has proven an increasing danger. He made his thoughts on 
preventive medicine influential, stressing preventive measures. Wright's 
ideas have been re-asserted recently — 50 years after his death — by modern 
researchers in articles in such periodicals as Scientific American.
   He also proposed that logic be introduced as a part of medical training, 
but his idea was never adopted. Wright also pointed out that Pasteur and 
Fleming, although both excellent researchers, had not actually managed to 
find cures for the diseases which they had sought cures, but instead had 
stumbled upon cures for totally unrelated diseases.
"""

Interesting -- so, doctors don't have to know much about logic?

And of course, remember what happened to the doctor who suggested hand 
washing would save lives:
   http://en.wikipedia.org/wiki/Ignaz_Semmelweis
"""
Semmelweis was outraged by the indifference of the medical profession and 
began writing open and increasingly angry letters to prominent European 
obstetricians, at times denouncing them as irresponsible murderers. His 
contemporaries, including his wife, believed he was losing his mind, and in 
1865 he was committed to an asylum. In an ironic twist of fate, he died 
there of septicaemia only 14 days later, possibly after being severely 
beaten by guards. Semmelweis' practice only earned widespread acceptance 
years after his death, when Louis Pasteur developed the germ theory of 
disease which offered a theoretical explanation for Semmelweis' findings. He 
is considered a pioneer of antiseptic procedures.
"""

Guess, at the time, Greg Laden might have called Wright and Semmelweis 
"morons"? Same as it seems he would probably call Mercola a "moron" for 
suggesting vitamins and so on can help prevent the flu?

Nutrition (including fasting) and other cheap aspects of a healthy life and 
strong immune system like good sleep seem truly to be the undiscovered 
country of our modern profit-driven medicine system, however much individual 
practitioners know the importance of these things. Well, OK, there are other 
alternative practices too. :-)

This might no bother me so much if people like Gred Laden (or Ryan) did not 
seem so ready to lock up people or blame others as being killers for 
disagreeing with aspects of the medical status quo's current riorities and 
practices, especially given clear evidence when things have gone wrong in 
the past. Again, nothing personal is meant here. One can see this sort of 
thing all over the blogosphere. And in all different ways on various sides.

I'm sure Greg Laden means well, and he makes some good points and brings up 
an important issue. But somehow, there is a point where perceived scientific 
"certainty" crosses over into action (like, trying to blame the unvaccinated 
for causing people's deaths, even if there may be some truth to that, as 
part of a bigger system, if one might also, say, include some blame for 
apparent conflict-of-interests leading people to mistrust vaccine 
recommendations in the first place).

Ryan is right to bring up the issue of "legitimacy". Perhaps another way to 
phrase that is "confidence". What causes, say, Greg Laden to be so confident 
about vaccinations that he can say those who think nutrition is important in 
fighting disease are "morons"? I know he doesn't say that exactly, but he 
sure implies it. What is it about linking oneself to the major current 
well-funded scientific authorities that causes that?

Do the major current scientific authorities getting the big bucks in 
research grants these days even still have a claim to very much more 
legitimacy than others, in the same way that Fox News or the New York Times 
might (or might not) a claim to legitimacy on political reporting over 
bloggers because they have a big audience and lots of working capital? 
Maybe, as Kevin Carson suggested here (as well as Ryan did elsewhere):
http://listcultures.org/pipermail/p2presearch_listcultures.org/2009-October/004997.html
"""
"Fact-checking" for the blogosphere works
about the same as for Wikipedia:  it's not a function of the
individual blogger, but of the relationship between bloggers.  And I
suspect the blogosphere collectively stacks up pretty well against
"professional" journalists when it comes to fact-checking.  Any error
of fact or reasoning in a major blog is subject to being ruthlessly
exposed by other bloggers.
"""

So, has the blogosphere essentially taken over a key aspect of science 
reporting as well as changing the dynamics of moving from science studies to 
public policy?

Anyway, this issue of "legitimacy", also linked to "certainty", and then 
further linked to "advocacy", is, as Ryan suggests, very interesting. And 
this vaccine debate is, in miniature, as Michel suggests, a place to explore 
that perhaps. No doubt it will be the subject of many PhD theses in years to 
come. :-)

--Paul Fernhout
http://www.pdfernhout.net/

Ryan wrote:
>  Sent to you by Ryan via Google Reader: How effective is the flu shot?
> [Greg Laden's Blog] via ScienceBlogs : Combined Feed by Greg Laden
> none at example.com on 10/8/09
> 
> There are several answers to this question. One was overheard the other
> day among a bunch of well educated people oriented towards science who
> were taking a break from their job.
> 
> Person 1: "So, how effective is the seasonal flu shot?"
> 
> Person 2: "I heard about 1%. If you get the flu shot, you'll have a 1%
> difference in if you get the flu."
> 
> Person 3: "That's crazy. I don't know where you are getting your data
> from. It can't be 1%, but I admit I don't know what the actual answer
> is, but it can't be that."
> 
> Persons 4 through 6: "Well, if YOU don't know, and HE says 1%, I'm
> going with the 1%. Too much trouble to get a flu shot anyway."
> 
> Person 3: "Wait, wait! That's crazy! That makes no sense!" as persons
> 1, 2, 4, 5 and 6 are filing out of the break room to go back to
> work. "You can't leave thinking that 1% is correct! It can't be
> correct!!!"
> 
> Person 5: [Over her shoulder on the way out the door.] "Hey, why don't
> you go ask your husband. He's a Scienceblogger, right?"
> Read the rest of this post... | Read the comments on this post...
> Things you can do from here:
> - Subscribe to ScienceBlogs : Combined Feed using Google Reader
> - Get started using Google Reader to easily keep up with all your
> favorite sites