Mother should I build a wall...

The following post is a response to a discussion started elsewhere. Granted, starting a fight and walking somewhere else and trying to start it again isn't exactly sporting, but Facebook walls, oddly, aren't the best place for extended conversations.

I'll repost the original comment and thread here:

Michael Schoon - "I'm not trying to become a demagogue (although maybe I should), but start here before being antivaccine: http://antiantivax.flurf.net/"

My friend (who I won't name because there has been no consent to that) - "Not that I'm anti-vaccine, but there are always two sides to every story. Like the CDC constantly proclaiming that over 30,000 people die from the flu every year. More Americans are receiving flu vaccines now than ever, but still every year 30,000 people die? This number hasn't decreased since vaccinations have increased? Seems ineffective to me. In actuality, the CDC's hard data show that the highest recorded flu death rate was 826 people in 2006. The other 29,000 'flu' deaths were more likely caused by pneumonia, but these two afflictions are lumped together for the sake of simplicity...and perhaps number skewing. All that to say that both sides of the argument are suspect. The CDC has an agenda, considering that many if its top people are involved with pharmaceutical companies, and the anti-vaxers are alarmists, so it's not such a simple delineation. Do your own research. And with that, I'm done."

And my response, heretofore unpublished:

Couple of points: 1) As far as seasonal flu vaccinations go, sure, take it or leave it. The 20-70% efficacy rate (depending on who you ask) isn't the most amazing. And you can attribute the roughly same number of flu deaths to anything (aging population, better diagnosis techniques, differing methods to collect data, the vaccine just doesn't work in the community as well as in the lab, etc). It could also be that the wrong people are getting vaccinated (young, healthy, middle class adults) while the sick, old, poor folks aren't. [As a side note, it would be interesting to see if productivity rates have remained the same as death rates over the years mentioned. If healthy people are getting vaccinated and then not contracting the flu like they might have in previous years (which wouldn't have killed them anyway), they would be taking less time off work, etc.] Ultimately, I'm not a researcher and I'll let them figure out the math. Until then, high risk people (who have upper respiratory diseases) should probably get the vaccine even if it reduces their chances by only 20-70%. The benefits outweigh the risks for that population.

Yes, CDC numbers show a lot of people dying and they've chosen to include the complications (pneumonia, et al). If they stuck with just counting those deaths that listed flu as cause of death on the death certificate, the numbers might not be accurate, because (in their words) the "influenza virus infection may not be identified in many instances because influenza virus is only detectable for a short period of time and many people don’t seek medical care until after the first few days of acute illness" (1). So the CDC is in a predicament: use an estimation or use the actual printed numbers. I say use the estimation. Why? Upper respiratory infections are fairly closely related in etiology and the inclusion of flu-related deaths allows for a more accurate picture of the number of people affected by the disease. It's similar to including pneumonia in AIDS deaths. It's not the disease that kills, it's the sequelae. How accurate is the estimation? Pretty close, from what I have read.

2) Granted, there is a lot of hype surrounding the flu vaccine. Does the CDC/government/medical profession play on people's fears of dying a horrible death by flu/swine flu? Perhaps. Would most people survive the flu virus? Most certainly. But the claim that the CDC has suspect motives because of links to the pharmaceutical industry is a little unfair. There isn't a lot of money in flu vaccines ($20, once a year at a Mollen Immunization center) and I find it hard to believe that this might encourage the members of the world's most foremost disease research institute to push something on the public that wasn't warranted. Can I prove this? No. It comes down to trust, and when Pink Floyd asks, "Mother, should I trust the government?", I answer with a clear and resounding, "Meh. Why not?"

3) You raise an interesting argument that I rarely hear: don't get a particular vaccine because it doesn't work. That argument should be applied to every medical treatment, from herbal medicine to prostate exams to coronary bypass surgery. All that to say, I appreciate critical thinking.

4) As mentioned previously, if a person doesn't want the flu vaccine, they shouldn't get it. It's the childhood vaccines that people's children should be getting. Those do work, the benefits outweigh the risks, and they are safe.

1. http://www.cdc.gov/flu/about/disease/us_flu-related_deaths.htm


Anonymous said...

Nice counterpoints, Miguel. I must say, I agree with most of what you propose. I know that all forms of medicine have inherent risks, vaccines included, but that the majority have been overwhelmingly proven safe. So the real question is ultimately: Does the benefit outweigh the risk?

I don't think any sane person would argue that it doesn't in the case of polio, MMR, tetanus, and a whole slew of others. But certainly there are instances where the potential risks are too great when compared to very little reward.

For example, the issue of predicting future flu strains for development and distribution raises significant flags when dealing with the aforementioned question. If one gets injected with a vaccine that was created to protect against a non-existent strain, then the reward is exactly zero. The risks, however, remain the same: Guillan Barre Syndrome, Rheumatoid Arthritis, or any other number of awful, albeit rare, ailments that could occur. Clearly it is unlikely that one would experience any of these side effects because it is so rare, but why risk it at all? Sure, there are certain populations who are at risk of developing major complications from simple influenza. But think about how the 'at risk population' has steadily increased in recent years: What started as infants and elderly is now children (0 - 18), adults (45+), and anyone who works with those populations. Seriously? Why don't they just say "Everyone in the whole country needs to get a flu shot." It is simply non sequitur that anyone with an intact immune system submit to an unnecessary vaccination - let's say pretty much everyone between 5 and 60. Ironically, the age group who really is at risk for flu-related death is drastically less affected by vaccination.

Despite all of this, the flu vaccine is becoming evermore prevalent, causing nationwide hysteria when not available, thanks largely in part to the presentation of the subject by our friends at the CDC. I know that there isn't huge money involved in the flu racket, but $20 times 95 million vaccines is nothing to turn your nose up at. And you can believe that the manufacturers are always going to encourage people to get vaccinated out of fear, instead of letting them take their chances with contraction and obtaining a legitimate treatment like Tamiflu. Flu treatments like this have been proven to be quite successful, even in severe cases, which is more than can be said for the hit or miss vaccine. Of course if you're only selling treatments, then you're only getting the people who are actually sick. If you sell 'preventative medicine' you're getting the healthy people, too. And then when they likely contract the flu anyway, you can get them on the back end also. It's a pretty good system for everyone but the patients.

Sorry for ranting, but this is a strange situation in American medicine. But, I do support most vaccinations, just not unnecessary ones. And, I know, that raises a lot more questions as to what can be defined as 'necessary.' Thanks for arguing with me.

PS - we should go get a beer sometime...I miss you.

- Josh

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