Flu shots aren’t good science(scott.wiersdorf.org)
scott.wiersdorf.org
Flu shots aren’t good science
http://scott.wiersdorf.org/blarney/091024a.html
6 comments
People believe what their government tells them. In this case it is the CDC, recommending an influenza vaccine for everyone older than 6 months, and particularly for certain at risk groups. The CDC is representing the science as demonstrating a high effectiveness, which as these review articles point out, is not the case.
This is not just a problem of CDC marketing, though. As the Atlantic article points out, the scientists that are publishing research showing a lack of effectiveness in vaccines are not getting equal treatment among their peers who still believe them to effective.
This is not just a problem of CDC marketing, though. As the Atlantic article points out, the scientists that are publishing research showing a lack of effectiveness in vaccines are not getting equal treatment among their peers who still believe them to effective.
The CDC does not advertise high effectiveness. This seems to be a strawman you are knocking down. If you administer a fairly ineffective vaccine, you will still save hundreds of lives. With a very effective vaccine, you'd save even more.
If you read the Atlantic article, the CDC believes vaccines to be so effective in the elderly that it would be immoral to do a randomized controlled trial.
You can also see statements like this: http://www.cdc.gov/FLU/protect/keyfacts.htm
The purpose of vaccination is not necessarily to save lives- it is most often given to healthy individuals who are not at any kind of risk of death- it is so they can avoid getting sick.
The life-saving claims for the elderly simply haven't been scientifically demonstrated, as the Cochrane review referenced by the Atlantic article points out- studies are below:
doi:10.1002/14651858.CD004876.pub2 doi:10.1093/ije/dyi274
You can also see statements like this: http://www.cdc.gov/FLU/protect/keyfacts.htm
The single best way to protect against the flu is to get vaccinated each year.
The purpose of vaccination is not necessarily to save lives- it is most often given to healthy individuals who are not at any kind of risk of death- it is so they can avoid getting sick.
The life-saving claims for the elderly simply haven't been scientifically demonstrated, as the Cochrane review referenced by the Atlantic article points out- studies are below:
doi:10.1002/14651858.CD004876.pub2 doi:10.1093/ije/dyi274
Your point is good, and I don't see it as a rebuttal of mine. In particular, a vaccine can be both mildly effective AND, yet, so much more effective than placebo that to perform an RCT is immoral.
The above referenced studies point out that the influenza vaccine has not been proven to be more effective than placebo in the elderly, which is one of the groups that CDC thinks it would be immoral to give a placebo.
Can you clarify which "above referenced studies" you are talking about? From the same site that you pointed me to (CDC), I find this page http://www.cdc.gov/flu/about/qa/vaccineeffect.htm stating "How effective is the seasonal flu vaccine in the elderly? ... the seasonal flu shot is 30%-70% effective in preventing hospitalization for pneumonia (a lung infection) and influenza ... In past studies among elderly nursing home residents, the seasonal flu shot was most effective in preventing severe illness and complications that may follow flu (like pneumonia), and deaths related to the flu. In this population, the shot can be 50%-60% effective in preventing hospitalization or pneumonia, and 80% effective in preventing death from the flu."
Now, that is not a study itself, but a summary of prior studies. If you think the CDC has formed an improper conclusion, that's fine.
Here is the Cochrane review on the effectiveness of vaccines in the elderly: http://www.cochrane.org/reviews/en/ab004876.html
The summary: "In long-term care facilities, where vaccination is most effective against complications, the aims of the vaccination campaign are fulfilled, at least in part. However, according to reliable evidence the usefulness of vaccines in the community is modest. The apparent high effectiveness of the vaccines in preventing death from all causes may reflect a baseline imbalance in health status and other systematic differences in the two groups of participants."
In other words, like I said, the vaccine doesn't work all that well - but despite its relatively modest effectiveness, it is still of great importance in the very age group that you singled out as not receiving benefit.
Now, that is not a study itself, but a summary of prior studies. If you think the CDC has formed an improper conclusion, that's fine.
Here is the Cochrane review on the effectiveness of vaccines in the elderly: http://www.cochrane.org/reviews/en/ab004876.html
The summary: "In long-term care facilities, where vaccination is most effective against complications, the aims of the vaccination campaign are fulfilled, at least in part. However, according to reliable evidence the usefulness of vaccines in the community is modest. The apparent high effectiveness of the vaccines in preventing death from all causes may reflect a baseline imbalance in health status and other systematic differences in the two groups of participants."
In other words, like I said, the vaccine doesn't work all that well - but despite its relatively modest effectiveness, it is still of great importance in the very age group that you singled out as not receiving benefit.
The last sentence of that Cochrane review summary points out that no randomized controlled trials have been done, and that the benefit to the elderly may reflect the lack of randomization. The second doi study cited is a study to look at that selection bias, and actually found that the entirety of the protective effect could be due to the bias. This makes it difficult to conclude that the influenza vaccine has any effectiveness in the elderly.
Not perfect, but better than nothing.
http://scienceblogs.com/effectmeasure/2009/10/journalists_si...
http://scienceblogs.com/effectmeasure/2009/10/journalists_si...
That is a whole lot of hand-waving mixed with name-calling to counteract the "story" of the Atlantic article. It basically agrees with the conclusions at the heart of the matter, though, that vaccination has not been proven in the elderly. However the blog seems pro vaccination for those under 50, unlike the Atlantic article.
If memory serves me, yearly flu vaccines are formulated based on predictions about which strains will be most common for a given season. Is it really a surprise that they guess wrong sometimes? Easy, 100%-accurate predictions don't really happen much in science outside of Physics 101 homework.
Also, is influenza vaccination really recommended for healthy adults, anyway? My impression was always that it was only worthwhile for people who would be at high risk from the disease.
As for the whole "it's all misguided groupthink, only a few brave people are sacrificing career success to speak truth to power" thing, I kinda have to roll my eyes. Maybe the author of the article is right, but most of the time when I've heard people say things like that, they don't actually understand the ideas they're criticizing and are being reflexively contrarian because that's a good way to make applause lights blink in the heads of their audience. Really, if most specialists in a field agree on something it's probably because it's true, and if you really think you've seen the light where everyone else has gone astray your point will be stronger if it stands on its own without the rah-rah anti-establishment social signalling.
Also, is influenza vaccination really recommended for healthy adults, anyway? My impression was always that it was only worthwhile for people who would be at high risk from the disease.
As for the whole "it's all misguided groupthink, only a few brave people are sacrificing career success to speak truth to power" thing, I kinda have to roll my eyes. Maybe the author of the article is right, but most of the time when I've heard people say things like that, they don't actually understand the ideas they're criticizing and are being reflexively contrarian because that's a good way to make applause lights blink in the heads of their audience. Really, if most specialists in a field agree on something it's probably because it's true, and if you really think you've seen the light where everyone else has gone astray your point will be stronger if it stands on its own without the rah-rah anti-establishment social signalling.
I think your reflexive anti-reflexively contrarian reaction is blinding you to the point the author is trying to make. The politics surrounding questioning the flu shot, even within the medical research community, are such that Jackson et al were refused publication despite doing verifiably good scientific research.
From the Atlantic article (http://www.theatlantic.com/doc/200911/brownlee-h1n1):
“People told me, ‘No good can come of [asking] this,’” she says. “‘Potentially a lot of bad could happen’ for me professionally by raising any criticism that might dissuade people from getting vaccinated, because of course, ‘We know that vaccine works.’ This was the prevailing wisdom.”
Your career will be damaged if you question the efficacy of the flu shot, because it is current medical doctrine. This kind of thing has happened lots of times before, as the Atlantic article points out.
Really, if most specialists in a field agree on something it's probably because it's true
You're treading dangerously close to an argument from authority here. What surprises me about this is that I would guess from your writing that you've got enough experience under your belt to have realized that in every field, the average person is mediocre. This isn't some tautological nonsense; what I'm saying is that if you were told that "most programmers agree that X," your reaction would probably be "yeah, but most programmers are actually crap at their job, why would I listen to them?"
You'd be right in that case, and you'd be right if you replaced programmers with doctors in the above. That most doctors believe in the flu shot isn't a reflection of the flu shot's greatness so much as a reflection of their training to that effect. Coupled with strong political forces pushing current doctrine, you have a situation where scientific research is being systematically subverted.
From the Atlantic article (http://www.theatlantic.com/doc/200911/brownlee-h1n1):
“People told me, ‘No good can come of [asking] this,’” she says. “‘Potentially a lot of bad could happen’ for me professionally by raising any criticism that might dissuade people from getting vaccinated, because of course, ‘We know that vaccine works.’ This was the prevailing wisdom.”
Your career will be damaged if you question the efficacy of the flu shot, because it is current medical doctrine. This kind of thing has happened lots of times before, as the Atlantic article points out.
Really, if most specialists in a field agree on something it's probably because it's true
You're treading dangerously close to an argument from authority here. What surprises me about this is that I would guess from your writing that you've got enough experience under your belt to have realized that in every field, the average person is mediocre. This isn't some tautological nonsense; what I'm saying is that if you were told that "most programmers agree that X," your reaction would probably be "yeah, but most programmers are actually crap at their job, why would I listen to them?"
You'd be right in that case, and you'd be right if you replaced programmers with doctors in the above. That most doctors believe in the flu shot isn't a reflection of the flu shot's greatness so much as a reflection of their training to that effect. Coupled with strong political forces pushing current doctrine, you have a situation where scientific research is being systematically subverted.
Your career will be damaged if you question the efficacy of the flu shot, because it is current medical doctrine. This kind of thing has happened lots of times before, as the Atlantic article points out.
Yes, it's obviously true that anyone going stubbornly against established consensus will get in hot water. This is the case whether their position is correct or incorrect. In the first case, they're heroes; in the latter case, they're crackpots. It's rarely obvious to people outside the field which is which, and there's a lot more of the latter.
The contrarianism that I object to is when people who don't have enough expertise in the field to tell good ideas from bad seem to hold up going against consensus as somehow inherently noble, because most of the time they're just going to be encouraging the crackpots. This especially includes anything that glorifies the Galileo-esque "persecuted genius" archetype.
You're treading dangerously close to an argument from authority here. What surprises me about this is that I would guess from your writing that you've got enough experience under your belt to have realized that in every field, the average person is mediocre.
Argument from authority is completely valid when the cited authority is authoritative on the subject under consideration. If someone justifies a statement about algorithms with "because Knuth said so" and can cite where he said it, that's a pretty solid basis to go on. The very nature of science is such that "widely held consensus of recognized experts" is the ultimate authority on current knowledge. This is not a guarantee of correctness, but it's a strong argument that it's the most likely, reliable answer we have and there's almost never a good reason for people outside the field to reject such consensus.
The programming analogy falls down a bit in that the bar is somewhat lower for being considered "a programmer" than it is for being a reputable specialist in most scientific fields. If you narrow it enough to filter out the kind of "programmers" who fail FizzBuzz exercises, I expect you'd find that anything that 95% of them agree on is, in fact, far more correct than random chance.
You and I have enough knowledge of programming to be able to evaluate good vs. bad arguments, and can probably identify lots of places where common wisdom is suboptimal. But what would you tell someone who knows nothing about programming but needs to know how to evaluate ideas about programming? Sure, we know that most programmers are stuck in a rut coding in Blub, but someone outside the field can't tell the difference between "overly structured programming is just obfuscation to create job security, simplify things and use gotos for flow control" and "use first-class functions to make code more expressive and eliminate redundancy".
We'd all roll our eyes at the guy promoting goto statements as a route to more effective programming, right? Well, us dismissing "use more gotos" would look, to someone outside the field, exactly how doctors' reaction to the flu shot issue looks to you.
Yes, it's obviously true that anyone going stubbornly against established consensus will get in hot water. This is the case whether their position is correct or incorrect. In the first case, they're heroes; in the latter case, they're crackpots. It's rarely obvious to people outside the field which is which, and there's a lot more of the latter.
The contrarianism that I object to is when people who don't have enough expertise in the field to tell good ideas from bad seem to hold up going against consensus as somehow inherently noble, because most of the time they're just going to be encouraging the crackpots. This especially includes anything that glorifies the Galileo-esque "persecuted genius" archetype.
You're treading dangerously close to an argument from authority here. What surprises me about this is that I would guess from your writing that you've got enough experience under your belt to have realized that in every field, the average person is mediocre.
Argument from authority is completely valid when the cited authority is authoritative on the subject under consideration. If someone justifies a statement about algorithms with "because Knuth said so" and can cite where he said it, that's a pretty solid basis to go on. The very nature of science is such that "widely held consensus of recognized experts" is the ultimate authority on current knowledge. This is not a guarantee of correctness, but it's a strong argument that it's the most likely, reliable answer we have and there's almost never a good reason for people outside the field to reject such consensus.
The programming analogy falls down a bit in that the bar is somewhat lower for being considered "a programmer" than it is for being a reputable specialist in most scientific fields. If you narrow it enough to filter out the kind of "programmers" who fail FizzBuzz exercises, I expect you'd find that anything that 95% of them agree on is, in fact, far more correct than random chance.
You and I have enough knowledge of programming to be able to evaluate good vs. bad arguments, and can probably identify lots of places where common wisdom is suboptimal. But what would you tell someone who knows nothing about programming but needs to know how to evaluate ideas about programming? Sure, we know that most programmers are stuck in a rut coding in Blub, but someone outside the field can't tell the difference between "overly structured programming is just obfuscation to create job security, simplify things and use gotos for flow control" and "use first-class functions to make code more expressive and eliminate redundancy".
We'd all roll our eyes at the guy promoting goto statements as a route to more effective programming, right? Well, us dismissing "use more gotos" would look, to someone outside the field, exactly how doctors' reaction to the flu shot issue looks to you.
Are there any negatives to getting the flu shot? For me, if there's a chance that it could prevent me getting the flu, and there are no potential negatives, then at least I may be prevented from certain strains.
Sometimes weakened strains of the flu can end up giving you symptoms of the actual flu. It costs money to get the flu shot. The needle could be infected. You could get in a car accident on the way to the clinic. You could pick up the flu from a previous visitor to the clinic.
All of which is to say, TANSTAAFL.
All of which is to say, TANSTAAFL.
Generally, symptoms from a vaccine are mild compared to getting the full blown illness, so the upside is still there, even if you suffer the downside.
In the last swine flu vaccination (30 years ago), hundreds of Americans died from receiving the vaccine. You can find the sixty minutes episode on this online.
Vaccines usually come with other toxic substances that will be injected in your body.
The same research articles that show influenza vaccines aren't useful also indicate that the risk of severe side effects (such as death) are low. Those must be weighed against the benefits, which in the case of the influenza vaccine, seem to be mild or unproven.
Vaccines usually come with other toxic substances that will be injected in your body.
The same research articles that show influenza vaccines aren't useful also indicate that the risk of severe side effects (such as death) are low. Those must be weighed against the benefits, which in the case of the influenza vaccine, seem to be mild or unproven.
Hundreds? 48,161,019 Americans were vaccinated, 1098 cases of Guillain-Barré Syndrome (GBS) recorded nationwide by CDC surveillance, 532 of which were linked to the NIIP vaccination, resulting in death from severe pulmonary complications for 25 people
http://en.wikipedia.org/wiki/Swine_influenza#1976_U.S._outbr...
http://en.wikipedia.org/wiki/Swine_influenza#1976_U.S._outbr...
You are quite right, thanks for the correction. However, note that the actual total will always be higher then that which the authorities have officially verified. I will also quote the very next sentence on that Wikipedia article:
... the vaccine killed more Americans than the disease didSeasonal flu kills approximately 36,000 _Americans_ annually. Confirmed deaths worldwide for the 2009 H1N1 flu: 5,382
http://en.wikipedia.org/wiki/2009_flu_pandemic
http://en.wikipedia.org/wiki/2009_flu_pandemic
That number for deaths (5,382) is for influenza in general, not H1N1. If you download the referenced source, it states that in 2009 there were less than 300 confirmed h1n1 cases admitted to intensive care worldwide.
I'm sorry, but the heading on table 2 reads:
Table 2. Reported number of new and cumulative confirmed fatal Pandemic (H1N1) 2009 influenza cases in EU and EFTA countries, as 23 October 2009, 09:00 hours CEST, and in the rest of the world by country, as of 22 October 2009, 16:00 hours CEST.
The total at the bottom of the table is: 5,382
Perhaps you are reading that the total in EU alone is 269?
Table 2. Reported number of new and cumulative confirmed fatal Pandemic (H1N1) 2009 influenza cases in EU and EFTA countries, as 23 October 2009, 09:00 hours CEST, and in the rest of the world by country, as of 22 October 2009, 16:00 hours CEST.
The total at the bottom of the table is: 5,382
Perhaps you are reading that the total in EU alone is 269?
Yeah, that was wrong. I was trying to get some real numbers from the report, and having trouble understanding it. I am still unsure of what the real number is. For example, the Brazil number they use is 1,368, but earlier it states that there were 645 deaths with confirmed pandemic influenza.
So the vaccine was effective in preventing the disease?
On a related note, the US stockpile of h1n1 vaccine has none of these other toxic substances (adjuvants, namely squalene) this time around. Most of the rest of the world uses them, and the side effect profile is either zero or minimal, depending on whom you ask.
Hot News: Bullshit Metascience Calls Bullshit on Science.
"Odds are, it has." If you're going to call out research as pseudoscience, don't write unvalidated statements like this.
"Odds are, it has." If you're going to call out research as pseudoscience, don't write unvalidated statements like this.
The title is completely inaccurate.
If the problem is that "people" believe that a vaccine against one flu strain will protect them from getting sick from a variety of other viruses, it's a marketing problem.