Flu Shots

[Dabljuh]

[opinion]Vaccines in general are just as bunk as Homeopathy; The originating theories behind vaccination and homeopathy are related to each other. Vaccination just turned out to make more money (you give "medicine" to the healthy) when for homeopathy as a faux remedy better medications became available. There's way too little high-quality research in that direction, and too much research designed by pharma Marketing teams. More doctors however buy into the vaccination theory (which has some realistic concepts behind it) than homeopathy, but they both don't work other than to give quacks an income. Except that there's a significantly greater risk involved with vaccines than is with homeopathy.[/opinion]

[fact]The pharmaceutical industry is making an assload of money with vaccines. "Shortages" only serve to inflate prices, combined with the annual scaremongering. There's no such thing as a free lunch, vaccines are usually patented and trademarked, if you *appear* to get a free shot, it's government or employer paying for it. Which means, in both cases, in the end you pay, but even if you refuse the shot, you pay. Unfair? Talk to your employer/representative. [/fact]

[flame]All the "zomg the one year I didn't take a flu shot I got the flu" stories are statistically improbable. I consider a mix of the following scenarios: Someone is paying to plant opinion here (Call it the Pharma PR brigade) or the other problem. Someone who has had a flu shot by definition can't get the flu, so the same symptoms are classified and diagnosed as something else. When you go to the doctor with flu symptoms and tell him "Dude I didn't get my flu shot this year" then you have the flu. When you have flu symptoms and had the flu shots, you get diagnosed with something else. Differential diagnosis, baby![/flame]

 

[Deetee]

[opinion]Vaccines in general are just as bunk as Homeopathy; The originating theories behind vaccination and homeopathy are related to each other. Vaccination just turned out to make more money (you give "medicine" to the healthy) when for homeopathy as a faux remedy better medications became available. There's way too little high-quality research in that direction, and too much research designed by pharma Marketing teams. More doctors however buy into the vaccination theory (which has some realistic concepts behind it) than homeopathy, but they both don't work other than to give quacks an income. Except that there's a significantly greater risk involved with vaccines than is with homeopathy.[/opinion]

Well, we know from your previous form that you do not base any of your opinions on facts or evidence, so I am entirely unsurprised that you are talking gibberish.

[fact]The pharmaceutical industry is making an assload of money with vaccines. "Shortages" only serve to inflate prices, combined with the annual scaremongering. There's no such thing as a free lunch, vaccines are usually patented and trademarked, if you *appear* to get a free shot, it's government or employer paying for it. Which means, in both cases, in the end you pay, but even if you refuse the shot, you pay. Unfair? Talk to your employer/representative. [/fact]

Pharmaceutical companies make money from their products. Homeopathic producers make money too. The margins on the former are minimal, on the latter quite huge.
I understand some manufacturers have given up trying to compete in the vaccine market, because profits are not great, and R&D costs are high (homeopaths never have this problem).
Certainly I accept that Pharma companies will try to maximise profits, sometimes using tactics that verge on the amoral/illegal, or rarely even using illegal means.

[flame]All the "zomg the one year I didn't take a flu shot I got the flu" stories are statistically improbable. I consider a mix of the following scenarios: Someone is paying to plant opinion here (Call it the Pharma PR brigade) or the other problem. Someone who has had a flu shot by definition can't get the flu, so the same symptoms are classified and diagnosed as something else. When you go to the doctor with flu symptoms and tell him "Dude I didn't get my flu shot this year" then you have the flu. When you have flu symptoms and had the flu shots, you get diagnosed with something else. Differential diagnosis, baby![/flame]

Strangely, your "flame" about flu diagnosis is probably the only thing you have said which is true. This scenario can often happen.

BTW - Which poster/s do you think are being "paid to plant opinion here" by Pharma?

 

[Dabljuh]

I'm not pointing fingers.* Just the sheer number of posts of the virtually same story is suspicious.

Do you think no one here is paid to plant opinion as a viral marketing scheme? Companies pay 6 digits and more for their web site that no one looks at. Would you think that they didn't pay anyone to plant things at sites that people do look at?

And I'm not even thinking of a gullible doctor who simply repeats whatever marketing crap he was conned with at his seminars. But that's part of viral marketing too. It's fake mouth to mouth propaganda.

I'm just thinking of Wikipedia. What's the percentage of paid, intellectually dishonest marketing folks in the top 1000 editors there?

As someone who has been there both as an observer and participants, I'd say you get close to 30-50% near the top 50 and still a two digit figure in the top 500. Some people are just addicted. But its an addiction to both learning and communication (both are basic drives, instincts to speak) too many are way dishonest. Of course to be good at this, one cannot too stubbornly give away his paid-for stance. It's simple enough to dismiss any counterarguments and go on to discredit the other source.

Or what you also did. You give me right with the false diagnosis problem, saying it was the only thing that was true in my post. Right. The only thing. Incompetent doctors are the problem, not the Pharma industry. <points finger>*

Poor poor pharma companies and their low low return of investments. We should have the government give subsidies to them. Maybe we can force everyone to use their products. Lets make it something that at least sounds sensible. Like forcing every kid to be vaccinated before it can enter a public school?

*Well I guess I am pointing fingers now after all

 

[ZirconBlue]

Do you think no one here is paid to plant opinion as a viral marketing scheme?

Perhaps, but, luckily, must of us have had the vaccine.

 

[Deetee]

The type of forum in which I would expect some Pharma "mole" to be planting information/disinformation would be one of the numerous outlets for medical advice/help/opinion. The JREF is quite a unique board, and the science/medicine threads are not where posters come to seek advice. Indeed, each time someone has raised an issue about medical problems they usually get told to go see a doctor and not rely on information from the net.

I have never encountered anyone remotely promoting any particular pharmceutical company's agenda here.

Or what you also did. You give me right with the false diagnosis problem, saying it was the only thing that was true in my post. Right. The only thing. Incompetent doctors are the problem, not the Pharma industry. <points finger>*

So I get it, because I siad that misdiagnosis and mislabelling of flu-like illnesses occurs, this puts me into the camp of a Pharma mole trying to lay the blame on incompetent doctors not the Pharma industry?

FYI, I actually am a doctor, and have never been in the employ of a Pharma company, and I have just been pointing out bad Pharma tactics in the NHS homeopathy thread, if you care to look.

So come on, which of us are the Pharma moles?

 

[fls]

Someone is paying to plant opinion here (Call it the Pharma PR brigade)

I made six figures last year, just from my postings on the JREF. Skeptigirl makes more posts on this subject because she's a nurse and gets paid less than physicians (for an equivalent amount of work). I'll probably move on to some other forums next year. My oldest child is in high school and I need to be able to pay for university soon.

I also receive support from a few other conglomerates. Nobody in their right mind would willingly support universal health care unless their pockets were lined.

Linda

 

[Ivor the Engineer]

The risk/rationality analogy is not that someone is rational if he will bet £26 hoping the 100 to one shot comes in, but that he is rational betting £26 as insurance against the possibility that the 100 to one shot does come in (an outcome he does not wish to happen), -just in case.

The question then becomes one of choice regarding the percieved risks - Is it really 100 to one? Can I afford to risk having no insurance/protection? What if it is 1000 to one, or 10 to one - will my choice be the same?
What if the risks are slight even if the horse comes in - do I risk death if it does, or just a minor inconvenience?

If the risk of death is high, then I may choose to insure myself against what may be extremely long odds - that is rational. E.g., The risk of catching HIV from a single sexual exposure with someone whose HIV status is unknown is probably something like one hundred thousand to one in the UK. But catching HIV could kill you, so rational(?) people use protective methods.
If on the other hand the illness one risks catching is trivial, then one may choose to entertain quite short odds, say 10 to one, and choose to not have protection.

We continually face a large variety of risks in life. We can choose to run the risk of some things, like driving as opposed to walking. Some risks are necessary to run, just for us to enjoy a decent life on this earth. Vaccinations are mostly actions that protect against risks - for some diseases it's a no-brainer, for others like flu or chickenpox the benefits may be less clear. There is sufficient evidence to point to the benefits of flu vaccine in the elderly, so that is something I would have/recommend. That's my opinion. Having the vaccine costs very little in terms of risks and in the UK it is free.

Sure, other things might work out as more cost-effective interventions in a health care setting. Perhaps the answer is to charge for vaccines, so their costs are covered in some way?

Regarding risks, people also chose to run risks if they feel they can control whether they will experience the adverse event. So people drive, thinking "I'm a skillful driver, if something happens I am in control and can react/avoid the accident". In an aeroplane, there is no control factor, so some are irrationally afraid to fly, but happily drive like maniacs on the road.

This philosophy is often pure kidology, but its a factor in what we chose to do each day. Catching diseases can be viewed in this way too - we might say "But I can chose my sexual partners with care - the chance she has an STD will be very small". But with droplet or airborne infections such as flu, measles or chicken pox it is harder to predict exposure.

Excellent post, Deetee.

With regards to charging for vaccinations, I definitely think for vaccination of under-14's against chickenpox it would be worth while considering.

 

[Professor Yaffle]

I made six figures last year, just from my postings on the JREF. Skeptigirl makes more posts on this subject because she's a nurse and gets paid less than physicians (for an equivalent amount of work). I'll probably move on to some other forums next year. My oldest child is in high school and I need to be able to pay for university soon.

I also receive support from a few other conglomerates. Nobody in their right mind would willingly support universal health care unless their pockets were lined.

Linda

Skeptigirl hardly makes any money from this. She just posts because a doctor ordered her to.

 

[Ivor the Engineer]

I made six figures last year, just from my postings on the JREF. Skeptigirl makes more posts on this subject because she's a nurse and gets paid less than physicians (for an equivalent amount of work). I'll probably move on to some other forums next year. My oldest child is in high school and I need to be able to pay for university soon.

I also receive support from a few other conglomerates. Nobody in their right mind would willingly support universal health care unless their pockets were lined.

Linda

Damn right.

http://www.time.com/time/magazine/article/0,9171,716812,00.html

Monday, Oct. 29, 1923

Fourteen thousand " panel" doctors serving 15,000,000 people under the British national health insurance scheme voted to strike Jan. 1 if a cut in their stipend proposed by the Government is ordered. Under the National Insurance Act adopted when David Lloyd George was Chancellor of the Exchequer in 1911, five parties are concerned—insured workingmen, employers, insurance societies, doctors, the Government.

When employed, workmen contribute five pence a week to the National Health Fund, women four pence. Employers duplicate these amounts. The workmen must join an "approved society"—fraternal or commercial insurance organizations. The physicians who take insurance practice are assigned a panel of patients to whom they undertake to give all necessary medical service. They have been receiving 9s. 6d. a year for each patient, of which the approved societies pay seven shillings three pence, the Government making up the remainder. The Government is now in financial straits and proposes that the panel doctors' fee be 8s. 6d. per patient, the societies to pay all of this. The societies urge a still further reduction to the pre-War figure of 7 shillings.

The panel doctors flatly refuse any cut. They declared they will resign in a body and have appointed a Strike Committee of 200 practitioners. They are backed up in their fight against "medical slavery" by the British Medical Association and its organ the British Medical Journal. Health insurance was initiated in Germany some 25 years ago and has been widely introduced in Europe. But it has generally been opposed by the medical profession, and with particular violence in the U. S.

You physicians can be a testy lot, can't you?

 

[fls]

I made six figures last year, just from my postings on the JREF. Skeptigirl makes more posts on this subject because she's a nurse and gets paid less than physicians (for an equivalent amount of work).

Skeptigirl hardly makes any money from this. She just posts because a doctor ordered her to.

<giggle>

You win.

Linda

 

[Dabljuh]

The type of forum in which I would expect some Pharma "mole" to be planting information/disinformation would be one of the numerous outlets for medical advice/help/opinion. The JREF is quite a unique board, and the science/medicine threads are not where posters come to seek advice. Indeed, each time someone has raised an issue about medical problems they usually get told to go see a doctor and not rely on information from the net.

Right. This forum would not be targeted. Since viral marketing only works in places where you'd expect to be marketed, right.

I have never encountered anyone remotely promoting any particular pharmceutical company's agenda here.

Erectile problems? Buy Viagra! This post has been brought to you by Pfizer!

(Oh and get a flu shot while you're on the way. There's so many different flu shots to choose from...)

FYI, I actually am a doctor, and have never been in the employ of a Pharma company, and I have just been pointing out bad Pharma tactics in the NHS homeopathy thread, if you care to look.

Right, since a marketing outlet specialized on pharmaceuticals would never hire a doctor. Most doctors do... doctory stuff. They wouldn't post in forums, Ever. Especially not to advocate things.

 

[Dymanic]

Most of the research does show large droplet spread and very little aerosol.

Some of the research found aerosol.

Conclusion, some strains can be more infectious, not all strains are.

That looks to me like a hasty conclusion, particularly considering the sparcity of the data.

It isn't a "back and forth" issue. That's what I tried to tell you in the beginning of this exchange.

And what I've tried to tell you all along is that the issue regarding the mechanical details of influenza transmission is viewed as very much a back-and-forth one by a great many well-qualified others. That you could look at the reveres' comments and return with the impression that their statements confirm your position that strong conclusions are justified by the existing science suggests to me that further efforts on my part are more likely to upset you than disuade you, so I'm going to give it a rest. After this last word, of course:

So far, everything you have offered by way of support for the above conclusion has to do with pandemic influenza. That is where a lot of the research action has been recently, and the intensity of this focus has provided new hints toward the solving of some old puzzles, but some of the results are rather subject to overinterpretation, which is what I see you doing. I don't see it as being at all clear how the results of studying pandemic influenza extrapolate to seasonal influenza.

It may very well be that the prevalence of airborne versus droplet transmission does vary markedly from one seasonal strain to another. It may also be that this variation in transmissibility has more to do with genetic variation in the viral genome than with, say, patterns of pre-existing immunity in host populations. I think it would be VERY difficult to conclusively demonstrate either of one of these propositions, and I don't see you as having come anywhere near having done so, not the least reason being the size of the gap between the sequencing of a genome and the application of knowledge thusly aquired toward making predictions at a level of complexity above that of a "live" virus; that is, at the level of the dynamic interaction between a viral swarm and a population of hosts.

But, hypothetically, let's suppose you had.

Does this influence the way we respond to someone like Hardenbergh, whose -- "sincere belief that frequent handwashing equals or surpasses the benefits of a flu shot" -- triggered this cascade of dialogue? Can we easily agree with Deetee, who suggested: "hand washing is highly unlikely to prevent direct infection from a contact"? Isn't that now the sort of thing that's going to vary unpredictably from one year to the next with the degree to which the currently circulating strains are airborne? Given the ever-present realities of finding a balance between what would be ideal and what resources are available, does our new found insight make the task of standardizing infection control measures easier, or harder?


Discussions on seasonal influenza do have a tendency to gravitate toward pandemic influenza, and (obviously) I find it hard to resist that pull myself, but I do think the quality of the discussions can suffer from all the constant toggling between the two. Maybe it would help to return briefly to the questions in the opening post in this thread, started over a year ago:

Are flu shots just another money making gimmick?

Pharmaceutical companies have enormous resources, but they're expensive resources. Decisions must constantly be made as to what are the best (i.e., the most profitable) use of these resources. Because strains of influenza virus are constantly mutating, each year's output of product becomes worthless at the end of the season, at which time millions of unused doses are typically destroyed. Uptake of flu vaccines tends to be somewhat sporadic and therefore difficult to predict, with many people opting out of the flu vax, a surprising number of them basing this decision on one of the most persistent of all urban myths: the notion that you can get the flu from the vax. The end result is that production of influenza vaccine is among the least profitable uses to which a pharmaceutical company can dedicate its resources, and all but a handful of companies choose not to bother with it at all. So if it's a gimmick, it's not a particularly clever one.

Do they protect only against previous years strains and are not effective against yet unknown strains?

That depends on just how 'unknown' the unknown strains are. Exposure to viral antigen (whether it's from vaccination or infection) stimulates a humoral immune response which results in production of antibodies specific to those antigens. Just how much those antibodies will cross-react with other antigens depends on how similar they are to the ones previously encountered.

Is real influenza pretty rare

It is usually estimated that somewhere between 5 and 20 percent of the population gets the flu during a typical season. Is that "rare"?

and when most people say the got the flu the didn't have it and it was not something that would have been stopped by the shot.

I think it's wise to take a cautious approach in general to what most people say, but if what they said was they had the flu, and what they actually had was something else (which is something which surely happens a LOT), then that's hardly an indictment against a vaccine designed to prevent Influenza.

 

[Skeptic Ginger]

Here's what another expert thinks about the evidence for flu vaccination:

http://www.bmj.com/cgi/content/full/333/7574/912
ETA: http://www.ncbi.nlm.nih.gov/sites/e...ez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

Ivor, we've been over that stuff in this thread already. How many times are you going to repost the same stuff?

The Cochrane review is not the magical definitive result in all cases and it's been discussed. Go back through the thread. In addition, research supporting the flu vaccinations has been posted here.

 

[Skeptic Ginger]

I made six figures last year, just from my postings on the JREF. Skeptigirl makes more posts on this subject because she's a nurse and gets paid less than physicians (for an equivalent amount of work). I'll probably move on to some other forums next year. My oldest child is in high school and I need to be able to pay for university soon.

I also receive support from a few other conglomerates. Nobody in their right mind would willingly support universal health care unless their pockets were lined.

Linda

I've thought about changing my profession to 'secret shopper'. I hear they have more fun than information planters.

 

[Skeptic Ginger]

That looks to me like a hasty conclusion, particularly considering the sparcity of the data.

Sparcity of data? Try 100 years of epidemiology. On average every year between 10-30% of the population in North America contract influenza. Just what is it you think you are going to change with this research we have yet to undertake?

I already said I agree with you 100% that health care worker protection is seriously ignored on the research front.

I'll get to the rest of your post later. I need a cookie.

 

[Ivor the Engineer]

Ivor, we've been over that stuff in this thread already. How many times are you going to repost the same stuff?

The Cochrane review is not the magical definitive result in all cases and it's been discussed. Go back through the thread. In addition, research supporting the flu vaccinations has been posted here.

I think the point is that the research is generally of poor quality, but few seem to mind because it supports their existing beliefs about the effectiveness of the flu shot.

Here's what Tom Jefferson had to say to the critics of his article in the BMJ:

http://www.bmj.com/cgi/eletters/333/7574/912

Author’s response (Tom Jefferson, Coordinator, Cochrane Vaccines Field)

The responses by Mandl, Fedson and Nichol, Nicoll et al and Griffith all have one common theme: the authors’ obstinate refusal to look in a dispassionate fashion at the totality of comparative evidence of the effects of inactivated vaccines for seasonal influenza. My analyses was based on 206 studies (several million observations’ worth of data) included in systematic reviews spanning some 40 years. No one so far has challenged my key conclusion that the optimistic WHO statement that vaccination of the elderly reduces the risk of serious complications or of death by 70%-85% is not based on evidence.

The interesting hypotheses by Mandl and Griffith do not fit some of the evidence in the elderly population. They cannot explain how in years of good matching between vaccine antigenic content and circulating viruses the vaccines fail to prevent deaths from all respiratory diseases in elderly community dwellers (1.32, 95% CI 1.25 to 1.39, 426668 observations) while at the same time preventing 42% (25% to 55%, 404759 observations) of deaths from all causes1, presumably including deaths from falls, accidental poisoning, accidents, hypothermia and so on.

Fedson and Nichol deride my choice of example of poor methodological quality of a large number of available cohort studies: failure to report vaccine content, its match to circulating viruses and the level of circulation. The authors of the studies either did not know such details or like Fedson and Nichol thought them irrelevant and would leave a reader -Sherlock Holmes to work them from “official records”. Vaccine matching and level of circulating influenza viruses are the most important predictor of vaccine efficacy and effectiveness. The closer the match and the higher the viral circulation, the better the performance of the vaccine2. Without such knowledge it would be very difficult to give an honest and reliable assessment of the effects of the vaccine. That is one of the reasons why these studies are of poor quality.

I note with worry their statement that decisions should be made on three of the most notoriously biased sources of information: non- randomised studies, expert opinion and economic evaluations3 4. It is precisely because the vast majority of comparative evidence on the elderly comes from non-randomised studies that we are left with the question: are the effects we witness due to the vaccines or are they due to confounding? The tone of the response by Fedon and Nichol (lack of vaccines’ effect in small children is “undoubtedly due to small numbers” and my concern over “lack of vaccine safety data” a statement from which they conveniently omitted the key word “comparative”) would suggest that my review appeared to be questioning a dogma. Heretics like me get short shrift.

I repeat my statement that especially in the elderly there are at present an insufficient numbers of field trials (5, of which only one has been carried out in the last decade) to allow reasonable certainty of the effects of inactivated vaccines. The nature of the evidence from non- randomised designs when analysed critically and exhaustively is weak and contradictory. I repeat my observation that the totality of safety evidence from comparative (i.e. studies in which a proportion of participants were contemporaneously exposed or not to the vaccines) sources is tiny in small children (35 observations) and small in the elderly (2963 observations).

Nicoll and co-authors claim that there is little new in my review. Certainly the evidence I quote has been in the public domain for some time. So why has an independent policy evaluation not taken place before? Such an evaluation is welcome but I fear it may take the guise of a descriptive (e.g. ecological) or non-randomised design (i.e. retrospective cohort). If that were the case, we may have to find out whether inactivated influenza vaccines do protect vulnerable people in potentially the most disagreeable and inhuman way: the hard way.

Tom Jefferson
Coordinator
Cochrane Vaccines Field

1. Rivetti D, Demicheli V, Di Pietrantonj C, Jefferson TO, Thomas R. Vaccines for preventing influenza in the elderly. The Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD004876. DOI: 10.1002/14651858.CD004876.

2. Demicheli V, Rivetti D, Deeks JJ, Jefferson TO. Vaccines for preventing influenza in healthy adults. The Cochrane Database of Systematic Reviews 2004, Issue 3. Art. No.: CD001269.pub2. DOI: 10.1002/14651858.CD001269.pub2.

3. Kunz R, Oxman AD. The unpredictability paradox: review of empirical comparisons of randomised and non-randomised clinical trials. BMJ 1998; 317; 1185-1190

4. Jefferson T, Demicheli V, Vale L. Quality of systematic reviews of economic evaluations in health care JAMA2002; 287 (21): 2809-2812.

Competing interests: TJ owned shares in Glaxo SmithKline and received consultancy fees from Sanofi- Synthelabo (2002) and Roche (1997-1999).

It seems to me, skeptigirl, that you are totally and utterly convinced the flu vaccine is worth the effort, and no amount of evidence would convince you otherwise.

What is quite funny is the way you and a few other "sceptics" here brush off the expert, (peer-reviewed) reviews of the evidence I post links to, often with a single sentence, using my lack of expertise in the area as a flaw of the study, as though the studies are crap simply because I found them!

For example, you are quick to say:

"The Cochrane review is not the magical definitive result in all cases..."

when it refutes your claims for the effectiveness of the flu vaccine, but I'm sure if it had the "correct" conclusion it would be one of the strongest pieces of evidence available.

 

[robinson]

Of course. This is called "evidence based medicine".

 

[Eos of the Eons]

What the FRAC is viral marketing???

Who wants to buy my newly warped chicken pox that no vaccine can protect you from? I mutated it myself with Kryptonite.. and am working on the vaccine right now. Everyone will want my vaccine after my shiny new virus kills some 10 thousand people. Mwah haaaaaa haaaa haaaaaaa!!!

 

[robinson]

Viral marketing used to be called word of mouth advertising. The idea is that if people believe the product is good, they will pass along the marketing message voluntarily, causing it to spread, like a virus.

I'm hoping you already know this, and are just being funny.

 

[Eos of the Eons]

Sure, but how is Dab using the term? I don't get most of his ramblings, especially what he is going on about viral marketing.