Long-time readers of this newsletter are aware of my skepticism regarding the flu vaccine. At the same time, headlines shouting about the looming flutastrophe can’t fail to grab my attention.
The other day I walked past one of the televisions at my gym, and a graphic about hospitals turning away flu victims caught my eye. How horrible! Oh, wait. The routine emergency room advice in flu season is to “stay away”, because 1) most likely there is nothing an emergency room doc can do for you, 2) the flu is almost certainly not a medical emergency but 3) you WILL pass the illness along to other people waiting in the hospital. Some of them are barely clinging to life and so, please, just leave before your unpleasant illness leads to someone else’s death.
It is strange that my viewpoint seems so out of sync. After all, the scientific evidence is that influenza vaccine does not do the job. In the past 10 years the flu vaccination rate in the US has doubled, but the death rate is unchanged. All evidence points to the fact that those who are most likely to die from the flu, the elderly and infants, are the least likely to be helped by flu vaccination. There is limited evidence that the vaccine is of significant benefit in any way.
Furthermore, there have been a series of controversies and governmental hearings in Europe and the US about medical organizations acting as advertising agents of companies producing influenza-related vaccines and drugs, abdicating their ethical responsibilities.
ONE possible explanation for vaccine ineffectiveness arises from the nature of the ever-mutating flu virus. Each year a panel of experts determine which specific forms of flu virus are likely to be the cause of the coming year’s epidemic. Then manufacturers produce that year’s vaccine against those strains. They have not been able to be particularly accurate, probably then compromising the vaccine.
This year the CDC claims that the vaccine is spot on. That makes me unusually receptive to the possibility that this year’s vaccine might be effective. HOWEVER, such predictions have been wrong many times in the past. Furthermore, the CDC is not the independent body it should be. The Influenza Division at the CDC receives funding from the companies that make flu vaccines and antiflu drugs. Just as with the antiflu drugs, the CDC Influenza Division has ignored the determinations of truly independent experts, like the Cochrane Collaboration, when those determinations have been unfavorable to influenza vaccine. I have difficulty blindly trusting their pronouncements at this point.
Another example comes from the Center for Infectious Disease Policy and Research at the University of Minnesota, http://www.cidrap.umn.edu/cidrap/files/80/ccivi%20report.pdf
In the preface to the 150 page report, the leader of the group (former head of the Minnesota Department of Public health) Michael Osterholm included a pertinent quote -
“The greatest obstacle to discovering the shape of the earth, the continents, and the oceans was not ignorance but the illusion of knowledge.”
–Daniel Boorstin
The CIDPR report noted that the ineffectiveness of the present vaccine should lead us to look for a better vaccine or some better approach. In an interview with the New York Times, Osterholm commented, “I’m an insider. 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?’ ”
That is an excellent question and reassurance that my own judgment is sound. Go ahead and get the vaccine if you wish. This year the vaccine might actually work, but that would be something new. Just make certain that you take a healthy dose of skepticism along with the vaccine.
Well said Dr. Carlston. I think you have some great points. I am at times very mixed about our mass medical recommendations that we give. The idea of herd immunity is a reasonable one; however it does come with costs, side effects, and unforeseen side effects. I, myself, did get the flu vaccine this year before the CDC even said that it was a good match. I did it because it became more of a hassle to walk around the hospitals if one hadn’t gotten the flu vaccine as a doctor or nurse. Because we’d have to wear masks and there’s a sticker that identifies us on our name tag of our vaccine status. I did it not for health reasons, but for the mere reason of going with the flow so that I didn’t have to put on a mask and change masks and be labeled with a scarlet sticker. My wife is a bit tougher than me on this stance. She is a surgeon as well, but she has chosen to avoid the flu vaccine which has been her practice for years. But we’ve been criticized by many of our own colleagues for skipping on the flu vaccine. From my own personal experience of getting the flu vaccine, there doesn’t seem to be a positive correlation for me for avoiding the flu on years of getting the vaccine. But I do have hopes for our medical science and I think I will contine considering getting the flu vaccine almost every year. But I must also say that it is starting to sound a little ridiculous to push the flu vaccine so severely when the proof isn’t quite in place.
- Calvin Lee, MD