Faith Healing Does Not Prevent Death From H1N1 Influenza
A few weeks ago, an anguished blog on TPM recapitulated a news story from the Midwest. According to the news reports, two parents who believed in the power of faith healing watched their 11-year old daughter die from uncontrolled diabetes while they prayed for her recovery without seeking medical help.
The responses of commenters were extraordinary in their outrage at this act of parental negligence, in some cases expressing a fury that was almost palpable. One comment called the parental decision "premeditated murder" and demanded the severest penalty legally possible.
A recent Washington Post/ABC news poll reported that only 52 percent of parents polled said they would have their child vaccinated against the H1N1 influenza virus when the vaccine became available. Scaled to the larger population, that unwillingness translates into tens of millions of children at increased risk for serious illness and death. The H1N1 virus is unusual in that its threat to the elderly is less than that of seasonal flu, but its lethality in children is much higher. Already in the U.S., at least 96 and probably more children have died from H1N1 flu, and the epidemic is still growing -
On the other hand, the vaccine appears to be efficacious, based on antibody responses and parallels with similar flu vaccines - H1N1 Vaccination - as well as safe - Vaccine Safety - CDC and Vaccine Safety - WHO . It therefore appears that many more children may be condemned to death if current resistance to vaccination persists.
I hope it's clear that I use the term "condemned to death" metaphorically. I don't denounce the parents, who undoubtedly care deeply about their children's health. Rather, I would make the following point. Among these millions of reluctant parents, I expect there have been thousands or more who encountered the news story about the faith healing couple, and who reacted with the same outrage I described above. And yet, negligent deaths among children from faith healing in the U.S. are likely to be fewer - probably far fewer - than deaths from infectious diseases that would have been averted by vaccination. If they are not, faith healing is a far worse threat to this nation's health than most of us realize.
What is ironic, of course, is that if one asks either the faith healing believers or the vaccine rejectionists about their decisions, each expresses equal faith in the rational nature of their decisions, with the corresponding view that those who criticize are biased and closed-minded. Indeed, the choices are often justified on the basis of testimonial evidence - the paralytic who walked again after a faith healer touched him, or the child who died the day after vaccination - even though we also know that when the claims are subjected to rigorous scrutiny, none of the evidence supports the claims of efficacy for faith healing or excessive risk for vaccination.
The issue of vaccination in general is too broad to address here, except to say that the viral nature of Internet rumors combined with a natural suspicion of government and of authority figures tend to reinforce the understandable skepticism of individuals urged to take action for their own good. The H1N1 threat is severe enough, however, and the dangers to children great enough, to emphasize that in this case, the innocent will be destined to suffer, and on rare occasion to die, if well-intentioned but misguided suspicion of vaccination is not countered.
In that sense, the guilty parties may ultimately be less the well meaning but misinformed parent, and more those of us with some knowledge of public health who don't do our job. That means providing accurate information, but it also means treating the lay public with respect rather than an accusatory attitude, so that they respond favorably to our attempts at education. When I used the term "condemned to death" earlier, I emphasized that I did not mean it literally. But even as I reread what I wrote, I find it too willing to pin blame on others, particularly if we antagonize those whom we wish to convince. When it comes to condemning children to death, we must be careful that we're not the ones doing the condemning.
According to the AP story
It appears that the 2009 H1N1 may run its course before the vaccine is available in quantities large enough to do much good.
October 23, 2009 5:56 PM | Reply | Permalink
It's true, as you say, that vaccine development has been delayed, and so it's a legitimate worry that we may be losing opportunities to prevent illness. However, according to CDC Director Thomas Frieden, speaking this evening on NPR, it is unlikely that a large fraction within the group "1 in 5 U.S. children" had swine flu. Rather, that is true only in communities where swine flu was prevalent - not nationwide. The epidemic still appears to be growing, so there is still time to prevent many cases, if adequate vaccine supplies are available, as hoped, within the next 4 weeks. The longer the delay, the less the value of the vaccine.
October 23, 2009 7:13 PM | Reply | Permalink
Yes, I noticed this evening that the CDC was backing away from the earlier story.
Wonder why they don't do a proper study by randomly sampling people and determining what proportion have antibodies to H1N1? You would probably only need to sample 1000 people or so to get a pretty good idea of geographic and age distribution of H1N1 prevalence.
October 23, 2009 11:27 PM | Reply | Permalink
When I was a kid I got the flu every year. If one kid got the chicken pox, other brothers slept with that kid.
Same with measles and whatever else was floating around.
I remember the 'asian' flu was going to kill us all. Folklore. I always wondered if Chinese kids got the Kansas flu.
I wonder what modern day science would have done with the plagues we lived through back then?
There was that terrible flue that killed so many here and in Northern Europe in the early 20th century. I found out that my grandmother was not an only child but that she had an older brother who died in that epidemic. Her parents left a little rocking chair in the corner facing the corner of the room.
Every couple years we are all warned that a new virus has been isolated and we are all going to die. I wonder also if drug companies are not the subsidizers of the scientific tests.
Faith healing keeps people who are going to live alive.
THATS ALL I GOT
October 23, 2009 7:38 PM | Reply | Permalink
The H1N1 flu season is expected to last into the winter, thus the duration of the season is longer, H1N1 vaccine will still be of value.
We laugh at the climate change deniers, but question the science of vaccines. Experts like Jenny McCarthy, Jim Carey and Bill Mahrer have provided support for parents who are reluctant to have their children vaccinated.
The glorious result of refusing vaccinations has been going from virtually eradicating Pertussis to a skyrocketing of deaths from the disease. Children are dying because Americans are scientifically illiterate.
http://www.mlive.com/opinion/kalamazoo/index.ssf/2009/05/editorial_pertussis_deaths_are.html
Available data suggests that children and pregnant women are at high risk of complications or death from H1N1. So do we go with what public health officials suggest, or our guts?
On his last show, Mahrer quoted a NYT article on controversy surrounding vaccines that supported his anti-vaccine POV. in actuality, the article was about people who refused vaccination and the frustrations of health care officials. It was a view of the opponents of vaccines but did not come out in support of their position. Bill Mahrer mis-characterized the article.
http://www.nytimes.com/2009/10/16/health/16vaccine.html?_r=1&pagewanted=print
October 23, 2009 9:03 PM | Reply | Permalink
Why blame parents? It's the government that can't deliver enough vaccine.
October 24, 2009 11:26 AM | Reply | Permalink
Thank you for this post, Fred.
It's remarkable how many people misunderstand the role and importance of vaccination in public health. Some of these people make money by promoting their views, on the air and in print. Cases in point:
• rmrd0000 mentions Bill Maher's angry anti-vaccination rant on one of his recent shows, where Maher even denied the efficacy of the Salk vaccine!
• The recent issue of The Atlantic includes an article by Shannon Brownlee and Jeanne Lenzer suggesting that the H1N1 vaccine is useless.
Influenza is a remarkably adaptive organism, so developing a vaccine for it is an annual challenge. Some years we do well, other years not so well. Combine that with a bit of all-American skepticism about the motives and competency of government and you've got a fertile medium for the growth of conspiracy theory bugs.
Someday we will develop better ways to fight the flu, but this is the best we have now. Once the vaccine becomes available, everyone gets to make a choice about whether to take it. I hope most will chose to take it and to inoculate their children.
October 24, 2009 11:54 AM | Reply | Permalink
I'm familiar with the Atlantic article, Red. It does not address the H1N1 vaccine, but rather flu vaccination in general. The article presents a one-sided view, not supported by data, implying that flu vaccination does not reduce deaths in elderly patients, and makes a number of false statements in the process. However, there is good evidence for a modest mortality rate reduction in the elderly, despite the fact that their immune responses to the vaccine are not as strong as those of younger individuals. Some of the best data come from the UK, based on hundreds of thousands of individuals, as well as trials in The Netherlands. The only true uncertainty is whether the vaccine is protective in the very old - e.g., those age 85 or older.
The efficacy of vaccination in non-elderly individuals is not in doubt, and its efficacy in children is conclusively esstablished. Because H1N1 flu is less dangerous to the elderly and more dangerous to children than seasonal flu, vaccination against this illness is critically important.
Finally, to return the the very old individuals who might not benefit from personal vaccination, they still benefit from the vaccination of other, younger individuals, because when flu becomes less prevalent, even those with poor immunity are less at risk, simply because they are less likely to be exposed. This concept - the principle that vaccination reduces illness by protecting individuals but also by reducing the likelihood of disease thread - is known as "herd immunity" and is an essential component of the rationale for vaccination.
October 24, 2009 12:13 PM | Reply | Permalink
Herd immunity is also a pretty good rationale for not getting vaccinated if you perceive there is a risk in doing so, especially if the majority are in fact getting the immunization. And therein lies much of the problem.
October 24, 2009 12:24 PM | Reply | Permalink
Yes, that's the old Tragedy of the Commons.
However, in this case it would not be in one's self interest to avoid vaccination, because herd immunity is only one part of the equation - individual protection by the vaccine is the other important part.
(The only exception would be individuals in whom the vaccine is known to be contraindicated, but these are a small minority)
October 24, 2009 12:39 PM | Reply | Permalink
Fred, the Atlantic article begins by describing the government's efforts to limit the spread and severity of H1N1 by fighting it the same way we fight seasonal flu – using vaccines and antiviral drugs. Then it questions whether that approach is worthwhile and goes on to say more research is needed.
The article is riddled with references to swine flu and H1N1. I cite it as an example of destructive pop journalism looking for an easy headline and a quick controversy.
Should we have better tools to use against all forms of influenza? Of course.
Would more research be helpful? Show me the money.
Right now we have vaccination and antiviral drugs. They work pretty well, much better than sitting around hoping you don't get exposed.
Let's fight for more funding and better research all year long. But right now let's use the tools that are available to us.
I've received my seasonal flu shot and probably won't qualify for the swine flu vaccination due to age. But I'm lobbying hard for my children and grandchildren to get in line.
October 24, 2009 1:18 PM | Reply | Permalink
You're right that the Atlantic article was written in response to interest in H1N1 flu, but my point was that it didn't address the efficacy of the H1N1 vaccine, but rather focused its attention on the efficacy of previous flu vaccines in the elderly.
You are also right that the article included "references" in a colloquial sense of referring to individuals and published reports, but it didn't provide the actual references to those reports in the scientific literature. I had to take the trouble to look up the relevant material and read the journal articles, which is why I felt confident in refuting the claims in The Atlantic.
We agree on the need for more research, and I doubt anyone disagrees, but I thought the article did a disservice to the extent that it reinforced false beliefs fostered by vaccination opponents. Your characterization, "pop journalism" is accurate.
October 24, 2009 2:28 PM | Reply | Permalink
I am a health professional and I am frustrated with the lack of H1N1 vaccine, especially for my own children.
The Spanish Flu pandemic of 1918 was a global disaster and something like it will probably happen again. The Spanish Flu went on for approximately 18 months and had three distinct waves. The first wave was mild, but the second and third were much worse. The Spanish Flu was also caused by an H1N1 subtype influenza virus.
The current Swine Flu may be following a similar pattern, it is too soon to tell. However, for patient's hospitalized with Swine Flu there has been about a 15% mortality rate in recent weeks. If a patient requires intensive care, then the rate is greater than 30%. Troubling signs.
October 24, 2009 12:06 PM | Reply | Permalink
Yes, well in in 1918 they were busy fighting unnecessary wars abroad as they are now. Just heard CDC got $2B to develop a better method of producing vaccines. Iraq was getting more than twice that much in a week. We live and die by our priorities.
October 24, 2009 12:11 PM | Reply | Permalink
Hi Steve - The delay in getting enough H1N1 vaccine to satisfy the need is frustrating. The main obstacle appears to be biology - the vaccine is produced from virus grown in embryonated eggs, but the H1N1 virus has been growing more slowly than anticipated. The CDC estimates that the additional doses needed will be available within the next few weeks. While the delay is unfortunate, the additional supplies should still provide an opportunity for most children to be vaccinated before contracting the illness, and is a reason to emphasize the importance of informing parents about the risks they impose on their children if they don't avail themselves of the vaccine.
The 1918 pandemic killed possibly as many as 40 million people worldwide, but that figure is unlikely to be repeated with the current H1N1 virus. The large majority of the deaths in the earlier pandemic were not due to the virus itself, but to bacterial superinfection occurring in individuals whose respiratory system had been damaged by the virus. That was before the antibiotic era, and we are now capable of treating those bacterial infections successfully in most cases. The virus itself can be lethal in a minority of individuals, and that is probably responsible for most of the deaths in the current pandemic. We still have more than enough cause to worry, but a repeat of 1918 is probably something we have little reason to anticipate.
October 24, 2009 12:30 PM | Reply | Permalink
The 1918 flu may have killed up to 100 million people it is hard to estimate the number of deaths. It is likely that 30% of the population was infected, approximately 500 million people. There is also much debate about the cause of the deaths, the flu virus itself was responsible for many of them. While we have antibiotics and other treatment modalities, it is possible to overwhelm the hospitals by sheer numbers of sick. There is always a limit to the number of patients that can be treated.
We are seeing the exact same problem with the current swine flu: bacterial super-infection causing pneumonia. However, pneumonia is not just a simple "take your antibiotics and you are fine" disease. We are still seeing a current 30% mortality rate among ICU patient's with swine flu. While the vast majority of swine flu patients will not end up in the hospital, much less ICU, so most people will be fine. Remember, the Spanish Flu also seemed mild at first. We don't know how long it will take for it to burn out.
We are very likely to see a repeat of a deadly global pandemic in the future. It will be worse than 1918 because the earth is more densely populated. Most people on earth don't have access to modern medical care.
I am also familiar with how vaccines are produced. The manufacturers knew months ago how fast the H1N1 virus grew, but they still assured us they would have 120 million doses by the middle of October, but have only produced 13 million.
October 24, 2009 1:04 PM | Reply | Permalink
Steve - You make a good point about increased population density, and I agree we are likely to see a deadly pandemic in the future, of unpredictable magnitude. However, given our current armamentarium of vaccination, antibiotics, and neuraminidase inhibitors such as Tamiflu, the current H1N1 pandemic is not likely to be a repeat of 1918 in terms of population incidence or case fatality rates.
Could you provide a source for your claim about the vaccine manufacturers? According to Anthony Fauci, the virus growth rates have been slower than anticipated.
October 24, 2009 1:28 PM | Reply | Permalink
It wouldn't matter so much that the virus is growing slower if we had more capacity to grow it. The infrastructure needs to be in place to be ready to handle the threat. It drives me nuts to think of the trillions we waste on providing the infrastructure for nukes and God knows what else we hope to never need but we spend the money anyway.
Remarkably little has changed since 1918. We may have antibiotics but we have fewer hospital beds. If you are sick enough to be dying of super pneumonia with an immune system down for the count you probably are going to need more than a pill.
October 24, 2009 2:40 PM | Reply | Permalink
FYI- None of this matters since all public flu shot clinics are closed due to lack of supply!
October 24, 2009 1:52 PM | Reply | Permalink
That's not correct,, Hmmm -
http://www.cnn.com/2009/HEALTH/10/24/h1n1.obama/
Of interest in today's news is that President Obama has declared swine flu a national emergency, as an administrative measure designed to exempt hospitals, clinics, and other providers from requirements that could impede their efforts to care for large numbers of individuals. It's also interesting that the news of an increasing flu burden seems to have changed some of the prevailing attitudes. A few weeks ago, the news was dominated by reports of individuals insisting that no-one could ever force them to get a flu shot. Now, we hear about people demanding, "where's my flu shot?", and I wouldn't be surprised if that includes a few of the previous resisters.
October 24, 2009 2:07 PM | Reply | Permalink
Fred-you actually DO NOT know everything! When I do a search right now for a place to get a seasonal flu shot (let alone a swine flu shot)in my area, I get this announcement:
At this time, all clinics offered to the public have been cancelled for the 09/10 influenza season due to lack of vaccine supply. You may be able to find a seasonal flu vaccine by visiting the American Lung Association locator at www.flucliniclocator.org, or by contacting your primary care physician.
Again, all of the public clinics in my area are closed due to lack of supply. Obama can say whatever he wants to say, that does not change the facts on the ground.
October 24, 2009 3:10 PM | Reply | Permalink
That's a scream, Hmmmm. First, you announce that all flu clinics are closed, and then when I provide a link showing they're not, you say, "Well, in my area, they're closed." That's OK, except I don't think you should have made your dogmatic first set of comments.
October 24, 2009 3:48 PM | Reply | Permalink
Your link says no such thing! It just says that Obama declared an emergency.
Second, the bold statement in my post is a direct copy from the web site that lists area locations for flu shots.
As for dismissing it by saying that is just my area--well I don't really give a rip about YOUR area either! Lots of shots in NY or Ohio don't help me or my friends and family at all.
October 24, 2009 4:26 PM | Reply | Permalink
The link showed a picture of hundreds of people lined up outside a clinic yesterday in Los Angeles waiting to get their H1N1 flu shots. I probably should have mentioned that the information was in the photo, not the main text.
October 24, 2009 4:58 PM | Reply | Permalink
The Federal Government announced back in July we would have 120 million doses by October 15. Here is a link to doses shipped:
CDC H1N1 Flu
October 24, 2009 2:07 PM | Reply | Permalink
That doesn't answer my question, Steve. I wondered whether you had a source for your claim that manufacturers promised to meet demand months ago despite knowing at the time that the virus was growing too slowly for them to do that. That may be true, but it is contradicted by recent statements that the slower than anticipated growth of the virus is responsible for the longer than anticipated time to satisfy the demand.
October 24, 2009 2:11 PM | Reply | Permalink
I read reports back in April that the virus was slow growing, yet we were reassured we would have 120 million units by October. My fault for trusting the government. My source is my memory, I don't have any desire to find any other source. I would recommend you check out www.cdc.gov.
October 24, 2009 2:44 PM | Reply | Permalink
I don't want to pursue it either, Steve. If we are being misled now, it wouldn't be the first time. I hope you're able to get your kids vaccinated soon.
October 24, 2009 4:13 PM | Reply | Permalink
Fred. In this blog, you tar those who oppose H1N1 vaccination as equalling believers in faith healing. And yet what evidence do you offer that H1N1 vaccine, specifically, works? I followed your links, and they use phrases like "are expected to be as safe and effective as previous..." etc. In short, there are no double-blind trials of the vaccine that I can find on your links. (Please do provide if they are available.)
In addition, there are constant rows - in many countries - of health care workers not wanting to take the vaccine. Are they all faith healers, willing to kill, as well?
What strikes me most here Fred, is your style of argument. I disagreed with how you tackled criticism early on, when you threw the "extremist" label on people you disagree with, and - when challenged - fell back on what I considered to be the smirking response that "the more 'you extremists' shout, the better for Obama."
And here, we see you NOT offering up the kind of evidence you would need to provide to make your case, followed by labelling your opponents faith healers, and then going so far as to talk about the number of child deaths they would be causing. In short Fred, if you make charges like this, you really do need to produce some heavyweight evidence. Condemning children to death? Really?
Step carefully Fred. Because if you can't produce the goods here - which you haven't to date - and with charges like this hanging in the air, I'd say you need to shut the fuck up for a while, and maybe rethink your blogging style.
October 24, 2009 3:14 PM | Reply | Permalink
I already provided links above, Quinn, to the CDC main site and subsidiary sites that answer your questions, including reference to controlled trials showing the efficacy of the H1N1 vaccine. If you look again, you should find the information. Needless to say, it's too early to judge H1N1 vaccine efficacy on the basis of epidemiologic data, but the immunologic data are convincing, and the parallels with other flu vaccines leave little doubt that this vaccine will be protective. Its safety is also documented by data from thousands of recipients.
My main point in this post is that vaccine rejectionists are risking the lives of their children by refusing to have them vaccinated. Health care workers who refuse vaccination are jeopardizing the lives and health of patients, and are failing in their professional obligations. The literature on the efficacy of flu vaccination is enormous, and the fact that the vaccine is protective is well established. A very recent New England Journal of Medicine article described a controlled trial that further confirmed this conclusion in younger subjects, and multiple studies in the literature demonstrate efficacy in the elderly, with some uncertainties about the very elderly.
My concerns about the rejectionists is that the issue is not philosophical or an ideological abstraction, but one of life or death. The vaccine deniers are reminiscent of the global warming deniers in their misrepressentation of evidence and refusal to accept the reality of a large body of data. In each case, the consequences are substantial.
Finally, if after diligent searching, you still can't find data supporting the statements I've made, I'll try to help you out, but you should make an effort first.
October 24, 2009 4:03 PM | Reply | Permalink
Fred. Stop being an ass. YOU put up the post. YOU are the one who claims to have evidence, and who is accusing the others of being "faith healers." YOU are the one who only provided links to top-level, generic CDC info. If you're going to make claims such as you've made, then please provide the evidence. You have, thus far, provided NO evidence of the efficacy of the H1N1 vaccine.
I am not stating my opinion on its efficacy, or vaccination in general. I may well agree with you. But what you have done is made a charge, using emotionally-laden language, with NO evidence to back it up. And when links or evidence of some sort was requested, you basically came back and said, "They're there. I saw them. Now go find it yourself." I'm sorry, but I went back, and found no references to thorough trials which tested the efficacy of this vaccine. I don't want generic info that vaccines are good, or parallels, I'm asking whether this vaccine has been shown to reduce the chances that people will get the flu. Simple.
Right now, since you are so concerned about the specifics, the practicality of this, and not some high level ideological debate, one would think you would have this specific information on hand. If you do not, then either you are not as far from the faith healers as you might wish, or you have vastly overstated your claims and overreached with your attack.
When it comes to charges about dead children, one is best-advised to avoid such charges altogether, or - if made- to be 100% sure of the evidence. I would suggest you are not.
October 24, 2009 4:58 PM | Reply | Permalink
I assumed that since the CDC site included links to specific topics, including the H1N1 vaccine, that you would have clicked on those links to find the trial data on H1N1 efficacy. I don't invent conclusions out of thin air, but only after I've seen the evidence. In this case, I spent time confirming the information on H1N1. If you follow the links, and still can't find it, let me know and I'll try to point you in the right direction.
I think you should be a bit ashamed for your use of the term "charges about dead children". I hope that anyone reading my post will notice the care I took to avoid making "charges". On the other hand, the danger that children will die if not vaccinated is very real, and that's something I both care about and know something about, which is why I hoped this post might make a difference for the good.
October 24, 2009 5:09 PM | Reply | Permalink
Fred, Quinn has told you twice that he followed your links TWICE and couldn't find information about efficacy and safety. You have now told him TWICE that if he worked hard enough at it and still couldn't find it you would help him out. I think he has been a good enough boy and you should help him out.
I also think that you would convince more people of your side of things if you didn't come off sounding like you believe you are the smartest person in the room and that it is almost painful for you to explain in language that the hoi palloi can comprehend.
October 24, 2009 5:23 PM | Reply | Permalink
C'Ville: oh well. Good try.
October 24, 2009 5:41 PM | Reply | Permalink
CVille - I appreciate the many good points you make elsewhere, but you're way off base here. If you read my post, you'll find it moderate and non-accusatory, with particular pains not to condemn the parents I referred to who are reluctant to have their children vaccinated, but to suggest they should be treated with respect. Quinn then came barging in saying I hadn't offered evidence about the relevant vaccine, and then concluded his first comment with "shut the fuck up". His second comment accused me of making "charges about dead children" - both false and inflammatory because of "charges" were what I avoided making.
As for the evidence, I am always willing to back up my assertions, but less willing to save others the trouble of following up links I give if they approach me in an adversarial mode - that's why I told Quinn to take the trouble himself.
It's true that when I wrote the post and cited links, I didn't expect to be met with accusations and demands, as opposed to questions, and so I didn't provide direct links that documented every single statement I made, but rather "top level" links that could be pursued further to find the relevant material. In any case, here's one subsidiary link that you can visit as a start, and then follow the references within it if you want further details:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5839a3.htm
October 24, 2009 5:49 PM | Reply | Permalink
From The Atlantic:
................
I have no dog in this fight, as I am only beginning to research the topic to determine if there is indeed reason to put faith in flu vaccines and Big Pharma's supposed cures for it.
The record here in this article shows that there is substantial reason to question the status quo, and the charge of "baby killers" is unreasonable hyperbole, at best.
October 24, 2009 6:14 PM | Reply | Permalink
As I interpret the data, SJ, the literature conclusively refutes the cherry picked claims in the Atlantic article, which abounds with falsehoods and/or misrepresentations. Just two examples:
Despite the implication that placebo-controlled trials have been rejected, a multitude of placebo-controlled trials have been conducted, and all show that flu vaccination is efficacious.
Regarding the ability of flu vaccines to reduce flu mortality in the elderly, many epidemiologic studies have demonstrated mortality reductions. In the largest, published in the BMH (I'll have to go back to confirm that source, but I recall it to be the BMJ), hundreds of thousands of UK residents were compared. Mortality was reduced in vaccine recipients during the flu season, but the recipients were actually less healthy rather than more healthy to start with in comparison with the non-recipients because they fared worse than non-recipients outside of the flu season. This disposes of the "healthy user" rationalization cited in the Atlantic article.
To me, the "controversy" about the efficacy of flu vaccination is as manufactured as the "controversy" about global warming, in that they both exist only outside of the science literature where the actual data reside. When one reads the data in the journals, the controversy disappears, and the value of flu vaccination is not seriously in doubt. Ultimately, others would have to make their own judgments, as in all arguments, but I think they will come to the same conclusions if they have access to the actual data.
October 24, 2009 6:45 PM | Reply | Permalink
Addendum - the alarming pediatric death rate from H1N1 is not hyperbole in my view (see the link in my post). Given all current indications that vaccination is effective, it would be irresponsible not to vaccinate children. Ultimately, perhaps a year from now, we'll have direct data on the degree of protection, but at this point we have abundant evidence that vaccination is likely to be lifesaving for some children, along with evidence for vaccine safety. I don't believe this should make whether or not to vaccinate a matter for much deliberation.
October 24, 2009 6:53 PM | Reply | Permalink
Fred, what are your thoughts about the live (nasal) vaccine vs the killed (injection) vaccine?
October 24, 2009 7:12 PM | Reply | Permalink
From the literature I've seen, the live nasal vaccine is contraindicated in older individuals because of their weaker immune response (I don't remember the age cutoff but could look it up). It's also contraindicated in individuals of any age with immune impairments, because it involves a live virus that might cause illness in the absence of an intact immune system. It seems to work well in children and immunologically intact young adults. Aside from the fact that children don't like to be stuck with needles, I'm not sure that it has any clear advantages over the killed virus vaccine, but I'll check to see whether there may be some cases where it might.
October 24, 2009 7:27 PM | Reply | Permalink
Age range for live virus vaccine is 2-49 years. For seasonal flu, the manufacturer claims that the nasal vaccine was more effective than flu vaccine injection in children from 24 to 49 months, but makes no similar claims for adults:
http://www.flumist.com/Professional/Efficacy/Vaccine-Effectiveness-Adult.aspx
They state that full data were published in the NEJM in 2007 but didn't give the exact reference and I haven't bothered to track it down. Apparently, it is more effective up to age 25 than in the 25-49 age range, and I surmise (but don't know) that the flu shot might be better for the latter group.
According to the manufacturer, the nasal vaccine does not contain the preservative thimerosal, while certain types of killed virus vaccine preparations do. While thimerosal in vaccines has been exonerated as a cause of ill effects in humans, some people worry about it, and might prefer the nasal vaccine to a flu shot containing thimerosal.
October 24, 2009 7:48 PM | Reply | Permalink
Make that 24-59 months for the ages of children in whom the manufacturer claimed better results from the nasal than the injected vaccine.
October 24, 2009 8:08 PM | Reply | Permalink
Since this post is about the depart the sidebar, I just want to thank all those who commented for their often insightful and provocative remarks. Also, among the useful links cited in the comments, I think it's particularly worth visiting the links cited by rdrm0000 (at this point in comment #5) for an important perspective on vaccination and the dangers of demagoguery on the subject.
October 24, 2009 4:20 PM | Reply | Permalink
Fred, if you want to pretend this was a moderate piece, and that makes you feel better, by all means pretend. But your TITLE cranks up the emotional level by referencing faith healer parents who let their kid die in agony. Which is a counterproductive as well as emotionally manipulative thing to do. And your very LAST sentence ("condemning children to death") pretty much concludes at the same emotional level. So let's not pretend this is somehow a moderate piece.
You try to defend your stance by claiming the high ground of science, rationality, and evidence - as opposed to the "faith healers" and vaccination deniers. But then you say things like "... none of the evidence supports the claims of efficacy for faith healing or excessive risk for vaccination." Really? NONE? Or when questioned - "... a multitude of placebo-controlled trials have been conducted, and all show that flu vaccination is efficacious. Really? ALL? These all/none terms from a man of science, based on the empirical record? Interesting words. They don't make your argument credible, but they do reveal interesting things about you.
So, you've now raised the emotional temperature, thrown out some all/nothing statements, and then you state, "The guilty parties may ultimately be... those of us with some knowledge of public health who don't do our job." Now, it's an oddity of life, but I happen to have landed in a town and a position where I track a number of public health movements fairly closely. It's a city which has major public health responsibilities relating to epidemics and such, and which has faced real suffering and death amongst its Native people as a result of this flu. And my personal view - as a non-medical person - happens to be that yes, we should vaccinate.
But I also know that making the case is not simply a slam dunk, not all vs none, and that the health profession itself is NOT 100% in synch on this. To pretend otherwise, to pretend it's all us science types versus the faith healers, is just... nonsense. And to frame it your way - as faith healer parents letting kids die - is about as COUNTERPRODUCTIVE as I can imagine.
So, in my opinion, YOU'RE NOT DOING YOUR JOB, FRED. You've hyped up the emotion, you've based your position on a series of all/nothing claims, and then... after raising the stakes so high, and putting us all on a war footing... you produced NO EVIDENCE of whether or not THIS vaccine works, in the field, at protecting people from getting the flu. Even after repeatedly being asked, you come up with blanks.
So. If lives are on the line, and you're writing counterproductive posts, and can't find the very basic evidence which YOU claim is so obviously available to men of science... then, in my opinion, you should withdraw from the field and consider silence. Or, in the shorthand of the day, just STFU for a while.
October 24, 2009 9:24 PM | Reply | Permalink
Quinn - You and I may be the only ones paying attention to this post, so we might have to agree to disagree on some of it. I have cited evidence for the efficacy of vaccination in the field (e.g., the UK study) although that wasn't the focus of a post on H1N1, where epidemiologic efficacy can't yet be assessed. To suggest that anyone can cite evidence in the field for the H1N1 vaccine this early is to attack a straw man, but there's plenty of evidence for immunologic efficacy, comparable to immunologic efficacy of other flu vaccines with proven efficacy in the field.
I would certainly stand by the general statements about the efficacy and safety of vaccination and the inefficacy of faith healing when it comes to rigorous examination, and so, in a sense, vaccination is a slam dunk, although if you provide journal references to the contrary, I'll be glad to read them.
There's a parallel, in my view, between vaccine denialism and global warming denialism - a point I raise because I vaguely recall you have some professional involvement in aspects of climate change. It's always possible to find some claim, somewhere, that purports to refute the strong consensus, but I don't believe it's possible to find convincing evidence in the literature to do the same thing. I hope we get to discuss climate change at some point, because it's a topic of enormous importance that I believe suffers from a battle between ideology and evidence, and I fervently hope the evidence wins out before it's too late.
As to whether my approach here is counterproductive, I know of no objective means to assess that. Until late in the comments thread, much of the commentary was supportive. In fact, I worried that I was preaching exclusively to the choir, which would have made my post pretty much unnecessary. Only later on did it provoke some challenges, which is the reaction that can influence silent bystanders. At this point, my invitation would be for others to read what I wrote, the comments of others, and judge for themselves. I think it will be more productive than counterproductive, if productivity is measured by effects on people who haven't already made up their minds. But I admit I don't know that for sure. One thing I'm fairly confident about is that my post can't reasonably be interpreted as taking an accusatory attitude toward parents reluctant to have their children vaccinated, but again, I'm willing to let others judge.
So there we have it. You think this exercise was counterproductive and will turn some individuals receptive to vaccination into vaccine opponents. I believe it will cause some reluctant but open-minded individuals to pay more attention to the risks of the disease and the virtues of vaccination, but I can't prove that will happen. I don't seem to have converted you into a vaccine denier, but only into someone displeased with me. If displeasing people gets them to take their kids to the clinic for the vaccine - hey, that's a bargain I'll be glad to take.
Peace.
October 24, 2009 10:16 PM | Reply | Permalink
The H1N1 flu vaccine is just as safe as any other influenza vaccine. It is not a new vaccine. Every year public health officials try to forecast the most likely influenza subtypes and then they put the three most likely ones and make a vaccine. If H1N1 had started earlier, they would have just added it to the "standard" flu shot. The influenza vaccine has saved millions of lives.
I am sick and tired of the anti-vaccine people. Vaccines are hundreds of years old and still the most important invention in medical history. People who don't vaccinate their children for stupid reasons put all children at risk.
October 24, 2009 10:22 PM | Reply | Permalink