Flu Shots

[Dymanic]

It's being pushed because the same manufacturing facilities used to make the seasonal vaccines can be quickly converted to make birdflu vaccines in the event of a pandemic.

The argument I've most often encountered is exactly the reverse: that the pandemic influenza threat is overstated (or even completely fabricated) in order to stimulate sales of seasonal flu vaccines -- an argument which (where it is permitted to do so) may be dismissed as conspiracy theory.

Your logic makes at least enough sense to deserve a closer look. What you are basically saying is that the consensus among a large community of infectious disease experts is that the best hope of marshalling an effective response to an influenza pandemic is a widespread program of vaccination. This consensus rests on the assumption that it is possible to formulate a vaccine capable of providing effective protection against an influenza virus (any influenza virus). Whether you believe that or not is irrelevant; you are (indirectly) arguing that they believe it. If you follow me so far, I wonder if you'd agree that if they believe that a vaccine can be effective against a pandemic influenza, it is very likely that they may also believe that a vaccine can be effective against seasonal influenza, and that while it may be true that stimulating sales of seasonal vaccines might be viewed as the most direct approach to the problem of limited vaccine production capacity (given the constraints of a system in which health care is profit-based), it logically follows that the same experts would also be very likely to view the practice as the most effective way of controlling seasonal influenza? As kind of a bonus?

 

[JEROME DA GNOME]

The argument I've most often encountered is exactly the reverse: that the pandemic influenza threat is overstated (or even completely fabricated) in order to stimulate sales of seasonal flu vaccines -- an argument which (where it is permitted to do so) may be dismissed as conspiracy theory.

Your logic makes at least enough sense to deserve a closer look. What you are basically saying is that the consensus among a large community of infectious disease experts is that the best hope of marshalling an effective response to an influenza pandemic is a widespread program of vaccination. This consensus rests on the assumption that it is possible to formulate a vaccine capable of providing effective protection against an influenza virus (any influenza virus). Whether you believe that or not is irrelevant; you are (indirectly) arguing that they believe it. If you follow me so far, I wonder if you'd agree that if they believe that a vaccine can be effective against a pandemic influenza, it is very likely that they may also believe that a vaccine can be effective against seasonal influenza, and that while it may be true that stimulating sales of seasonal vaccines might be viewed as the most direct approach to the problem of limited vaccine production capacity (given the constraints of a system in which health care is profit-based), it logically follows that the same experts would also be very likely to view the practice as the most effective way of controlling seasonal influenza? As kind of a bonus?

I am beginning to think this should be moved to the CT section.

Are people/groups this calculating?

 

[kellyb]

I wonder if you'd agree that if they believe that a vaccine can be effective against a pandemic influenza, it is very likely that they may also believe that a vaccine can be effective against seasonal influenza, and that while it may be true that stimulating sales of seasonal vaccines might be viewed as the most direct approach to the problem of limited vaccine production capacity (given the constraints of a system in which health care is profit-based), it logically follows that the same experts would also be very likely to view the practice as the most effective way of controlling seasonal influenza? As kind of a bonus?

Well, flushots aren't particularly harmful, and they appear to have some small effectiveness, so it could easily be viewed as a win/win situation.
There's also a lot of research going into ways to make the vaccines more effective, which I think you'd agree is a good idea if the ultimate goal is to save lives, particularly in the event of a pandemic.

 

[Frost]

But mostly the sickly succumb. I found this:

To the original point:

Flu deaths have increased since the advent of the vaccine?
Maybe the distributors also believe that the vaccine mucks with evolution?





No, we have drugs that allow for the elderly to procreate. This goes to the same question. Should we use drugs to allow the elderly to have children? Is this stifling evolution?

Wouldn't sick days due to the flu be something worth preventing too?

 

[JEROME DA GNOME]

Well, flushots aren't particularly harmful, and they appear to have some small effectiveness, so it could easily be viewed as a win/win situation.
There's also a lot of research going into ways to make the vaccines more effective, which I think you'd agree is a good idea if the ultimate goal is to save lives, particularly in the event of a pandemic.

According to the CDC; since the introduction of the flu shot, flu deaths have increased by 4 times.



4 times as many people have died each year since the flu shot began to be implemented.

I suggest a moratorium to see if the flu shot contributes to flu deaths.

 

[JEROME DA GNOME]

Wouldn't sick days due to the flu be something worth preventing too?

Sure, if it is proven to do that. The evidence thus far suggests that the flu shot may have contributed to a 4 times greater death rate due to the flu.

 

[kellyb]

Wouldn't sick days due to the flu be something worth preventing too?

From "Preventing Flu in Healthy Adults", that Katana mentioned earlier;

http://64.233.179.104/scholar?hl=en...eMaterials/5_Overview_Meta_UP/2_Article1.pdf+

Effect of vaccination on other outcomes
Six trials evaluated time off work, estimating that vaccination saved on average around 0.12 working days. This result was not statistically significant.

http://www.bmj.com/cgi/content/full/333/7574/912

The second problem is either the absence of evidence or the absence of convincing evidence on most of the effects at the centre of campaign objectives (table 2). In children under 2 years inactivated vaccines had the same field efficacy as placebo,8 and in healthy people under 65 vaccination did not affect hospital stay, time off work, or death from influenza and its complications

 

[Dymanic]

The evidence thus far suggests that the flu shot may have contributed to a 4 times greater death rate due to the flu.

Statistics isn't really your strong suit, is it?

 

[kellyb]

Your logic makes at least enough sense to deserve a closer look.

Take a look.
(dug up links)
It's not my logic; it's just a fact.

http://www.pharmaceutical-business-...asp?guid=C4410902-FB92-4ADE-89F0-26BADA77D453

Ultimately, an improved vaccination coverage for the common seasonal influenza is a fundamental part of a strategy to enhance global preparedness for the anticipated avian influenza pandemic

.

As part of its pandemic preparedness plan, designed to contain the threat posed by the avian H5N1 strain, the WHO clearly states that adequate manufacturing capacities for pandemic vaccines can best be achieved by increasing vaccination coverage during seasonal epidemics.

http://www.who.int/mediacentre/events/2005/03_WHO_Klaus_Stohr.pdf

Influenza pandemic vaccines: challenges
and opportunities

Influenza Pandemic Vaccines
Production capacity


Increase vaccination coverage of seasonal influenza
vaccine in developed countries to 75%

Now this part is my logic, but I wonder... how do you convince a whole, whole, whole bunch more people to start getting flushots?
What would be an effective way of getting 75% coverage in developed countries?

And I think that's what's up with this:



http://www.ama-assn.org/ama1/pub/upload/mm/36/2004_flu_nowak.pdf

“Recipe” that Fosters Higher Interest and
and Demand for Influenza Vaccine

1.Influenza’s arrival coincides with immunization “season” (i.e., when people can take action)

2.Dominant strain and/or initial cases of disease are:
–Associated with severe illness and/or outcomes
–Occur among people for whom influenza is not generally perceived to cause serious complications (e.g., children, healthy adults, healthy seniors)
–In cities and communities with significant media outlets (e.g., daily newspapers, major TV stations)

3.Medical experts and public health authorities publicly (e.g., via media) state concern and alarm (and predict dire outcomes)–and urge influenza vaccination.

4.The combination of ‘2’ and ‘3’ result in:
A.Significant media interest and attention
B.Framing of the flu season in terms that motivate behavior (e.g., as “very severe,” “more severe than last or past years,” “deadly”)

5.Continued reports (e.g., from health officials and media) that influenza is causing severe illness and/or affecting lots of people–helping foster the perception that many people are susceptible to a bad case of influenza.

6.Visible/tangible examples of the seriousness of the illness (e.g., pictures of children, families of those affected coming forward) and people getting vaccinated (the first to motivate, the latter to reinforce)

7.References to, and discussions, of pandemic influenza–along with continued reference to the importance of vaccination.

(emphasis mine)

That kinda threw me for a loop for a while and had me wondering exactly who the CDC worked for...but the idea that they're doing that to comply with the WHO objective of increasing vaccine uptake for the purpose of saving the world from birdflu makes sense to me.

 

[Ivor the Engineer]

Take a look.
(dug up links)
It's not my logic; it's just a fact.

http://www.pharmaceutical-business-...asp?guid=C4410902-FB92-4ADE-89F0-26BADA77D453

.



http://www.who.int/mediacentre/events/2005/03_WHO_Klaus_Stohr.pdf






Now this part is my logic, but I wonder... how do you convince a whole, whole, whole bunch more people to start getting flushots?
What would be an effective way of getting 75% coverage in developed countries?

And I think that's what's up with this:



http://www.ama-assn.org/ama1/pub/upload/mm/36/2004_flu_nowak.pdf



















(emphasis mine)

That kinda threw me for a loop for a while and had me wondering exactly who the CDC worked for...but the idea that they're doing that to comply with the WHO objective of increasing vaccine uptake for the purpose of saving the world from birdflu makes sense to me.

Hmmm. That sounds ethically dubious. A government agency frightening people to boost sales so the manufacturers don't close their plants down. I suppose the question is: Do the ends justify the means?

 

[Dymanic]

It's not my logic; it's just a fact.

It's your interpretation of (one set of) facts. To be a bit pedantic.

The first of your links was to an article in a business journal. Not sure why you'd consider that relevant to evaluating whatever motivations WHO and CDC might have for promoting flu vaccines.

As for the second, if the quote: "the WHO clearly states that adequate manufacturing capacities for pandemic vaccines can best be achieved by increasing vaccination coverage during seasonal epidemics." appears anywhere, I'm danged if I can find it; I'm not sure if the formatting problems with that PDF are local to my system or what, but it's looking pretty mangled here. I'm able to resolve that it predicts the outcomes of increase vaccination coverage of seasonal influenza
vaccine in developed countries to 75% as:

Significant decrease in death and disease from seasonal influenza
Cost-effective reduction in health implications (cost-saving in some countries)
Increase in global vaccine production capacity by 60%

Which is pretty much what I said above.

As for the third, I think the reason the business about the "recipe" throws you for a loop is that you assume that it is intended to be prescriptive rather than descriptive; you are reading motivation into it. Speaking of a "recipe for disaster" doesn't necessarily imply a desire or an intent to try to cook one up. A clue is this statement: "A large component of consumer demand for flu vaccination is contingent upon things we can’t control"

The CDC doesn't have control over the virus, it doesn't have control over the media, it doesn't have control over individual physicians and care providers, and it doesn't have control over what every public health care person may say in front of a microphone. The article addresses the challenges of effective risk communication in the face of such uncontrollable factors, and basically concludes that people are going to believe what they're going to believe, and behave how they're going to behave, and there really isn't all that much you can do about it.

 

[robinson]

Considering the amount of time and effort required to gain approval for a medicine or drug, how can each years new flu vaccines possibly meet the safety and efficiency test before being used?

How can anyone even know if they are safe? And that the vaccine actually works? Where is the science to back up the claims made?

 

[robinson]

Take a look.
(dug up links)
It's not my logic; it's just a fact.

Wow. Wow. I'm not sure what to think. Can that be true?

 

[kellyb]

As for the second, if the quote: "the WHO clearly states that adequate manufacturing capacities for pandemic vaccines can best be achieved by increasing vaccination coverage during seasonal epidemics." appears anywhere, I'm danged if I can find it;

That's weird...
It's not a PDF.
Can you get to it through a google search?
http://www.google.com/search?hl=en&...an+H5N1+strain,+the+WHO+clearly+"&btnG=Search

As for the third, I think the reason the business about the "recipe" throws you for a loop is that you assume that it is intended to be prescriptive rather than descriptive; you are reading motivation into it. Speaking of a "recipe for disaster" doesn't necessarily imply a desire or an intent to try to cook one up.

You can't be serious!
Nowak is the CDC's "Communicatons" director. He's a marketing guy. Before he went to work for the CDC he worked in advertising.

Look what they say next:

Influenza Immunization
Communication Challenges (2)

•Some component of success (i.e., higher demand for influenza vaccine) stems from media stories and information that create motivating (i.e., high) levels of concern and anxiety about influenza.
•Inducing worry, raised anxiety, and concern in people brings forth a number of issues and presents many dilemmas for health care professionals.

And can leave you searching for the
“Holy Grail” of Health Communication
(Lanardand Sandman, 2004)

The belief that you can inform and warn people, and get them to take appropriate actions or precautions with respect to a health threat or risk without actually making them anxious or concerned. (Remember the quiz?)
This is not possible. Rather. . .
“This is like breaking up with your boyfriend without hurting his feelings. It can’t be done.”

Not prescriptive my butt!

The article addresses the challenges of effective risk communication in the face of such uncontrollable factors, and basically concludes that people are going to believe what they're going to believe, and behave how they're going to behave, and there really isn't all that much you can do about it.

Yeah...you're left with sending media packets out and hoping that just scaring the snot out of people is effective.

 

[ExMinister]

So, would the medical practitioners here posting consider it worthwhile to spend $26 per flu shot to have an otherwise healthy family of four vaccinated, with small children, ages 4 and 5? It's definitely not free in our community. I'm considering it because we all had the flu back in 2003, my 8-month-old's turned into croup and pneumonia, he had to be hospitalized and almost didn't make it. This was serologically tested (type B, if I recall) influenza and we were all sicker than I can ever remember having been. But if the shots aren't all that effective, I hate to spend $26 per shot.

 

[Dymanic]

It's not a PDF.

Whatever. I'm willing to stipulate that the WHO is interested in increasing manufacturing capacities for flu vaccines as a preparedness measure against pandemic flu, and that this increases their interest in promoting seasonal vaccines. I just don't see this as their only motivation for doing so; they also believe in vaccination as an effective measure against seasonal influenza.

You can't be serious!

I am completely serious. I know that you are quite attached to this document, and to a certain interpretation of it. Demand for flu vaccines can vary widely from one season to another. Understanding this fluctuation is a problem for a person with experience in marketing; hence, this evaluation:

"Vaccination demand, particularly among people who don’t routinely receive an annual influenza vaccination, is related to heightened concern, anxiety, and worry."

In other words (ignoring two categories: people who routinely get the vax, and people who never get the vax), demand is not based on critical thinking, scientific literacy, reasoned judgement, careful consideration of evidence, or anything like that; it's based on emotion. This is an observation, being made by someone with experience in making observations about what motivates demand for a product.

Look closely at these statements:

"Medical experts and public health authorities publicly (e.g., via media) state concern and alarm (and predict dire outcomes)–and urge influenza vaccination"

"Some component of success (i.e., higher demand for influenza vaccine) stems from media stories and information that create motivating (i.e., high) levels of concern and anxiety about influenza."

"The combination of ‘2’ and ‘3’ result in:
A.Significant media interest and attention"

These are descriptions of aspects of a process over which the WHO and the CDC have no control. The article's central theme reduces to: "You can't use science to persuade idiots; the threats they will take seriously will be those which the media selects for entertainment value".

 

[ExMinister]

Disregard above question, have found a place offering the shots for free. Even if they're just a little bit effective, they're probably worth getting if free. Having the flu was a wretched experience that I would definitely like to avoid repeating.

 

[kellyb]

"Medical experts and public health authorities publicly (e.g., via media) state concern and alarm (and predict dire outcomes)–and urge influenza vaccination"

These are descriptions of aspects of a process over which the WHO and the CDC have no control.

So after the CDC decides they need their spokespeople in the media stating concern and alarm, and predicting dire outcomes...and they end up in the news doing just that, it's a process they have no control over?
You don't think the CDC ever contacts the media with good stories that need to be told in the interest of health communication?

 

[JEROME DA GNOME]

So, would the medical practitioners here posting consider it worthwhile to spend $26 per flu shot to have an otherwise healthy family of four vaccinated, with small children, ages 4 and 5? It's definitely not free in our community. I'm considering it because we all had the flu back in 2003, my 8-month-old's turned into croup and pneumonia, he had to be hospitalized and almost didn't make it. This was serologically tested (type B, if I recall) influenza and we were all sicker than I can ever remember having been. But if the shots aren't all that effective, I hate to spend $26 per shot.

According to the CDC, flu deaths have increased by 4 times since the introduction of the flu shot.

There should be a moratorium until science determines if the flu shot is a factor in the increased flu deaths.

 

[JEROME DA GNOME]

Disregard above question, have found a place offering the shots for free. Even if they're just a little bit effective, they're probably worth getting if free. Having the flu was a wretched experience that I would definitely like to avoid repeating.

I doubt the shots are "free". Who is really paying for the shots?