Feb 10 2014

Anti-Flu Vaccine Rants at the HuffPo

The Huffington Post continues to be a venue for all sorts of pseudoscience, alternative medicine propaganda, and anti-vaccine sentiments. Two recent posts by Lawrence Solomon in the HuffPo Canada indicate that the nonsense is international.

His first article claims that the majority of health care workers “resist” or “refuse” the flu-vaccine – therefore it can’t be that great. The second attacks the CDC estimates for the number of flu-associated deaths. Together they demonstrate how a bit of motivated reasoning can seem like actual journalism when in fact it leads to misinformation.

Solomon cites statistics about low rates of flu-vaccine update among healthcare workers:

In the UK, only 46 per cent of health care workers — slightly less for doctors (45 per cent) and nurses (41 per cent) — are vaccinated for the flu, despite concerted government efforts according to Public Health England. This startling failure is similar to that seen in Canadian jurisdictions for health care workers today, and those seen in the recent past in the U.S.

The numbers are actually much more variable, and depend highly on a large number of variables. Solomon did nothing to explore those variables, despite the fact that there is much published on the topic. He simply assumed that not getting vaccinated was “resisting” or “refusing” the vaccine.

In fact, health care workers (HCW) cite a number of reasons – feeling that they are healthy and therefore not at risk and lack of time, in addition to those assumed by Solomon of concerns about the lack of efficacy and safety of the flu-vaccine.

Simple measures, such as simply encouraging HCWs to get vaccinated, increase rates significantly (in this NHS study to 68.7%).

Also, Solomon is making an implied argument from authority (and not an appropriate one). Not all HCWs have any significant expertise in vaccines or infectious illness. The flu and the flu vaccine are a complex topic, and the data is difficult to sift through. HCWs appear to be easy to convince that they should be vaccinated, but left to their own devices may not properly sort through the complex data for themselves.

In fact, a little bit of knowledge can be counterproductive, in that you know enough to ask questions and be scared, but not enough to be reassured by a thorough understanding of the data. In fact, at St. Jude’s Children’s Research Hospital, giving their employees accurate information about the flu and the flu vaccine (without mandating vaccination) increased compliance rates among their HCWs to 93.8%.

HCWs are still people and are susceptible to misinformation and fearmongering just like anyone else. Most of them are also not experts in the flu. However, if you give them accurate information about the flu vaccine, compliance rates can be extremely high.

But how serious is the flu? How many people a year does it kill? This is an admittedly difficult question to answer. First, we can only estimate the number of people who get the flu, since most people who get a flu-like illness are not tested to confirm which virus is causing their illness. However, the CDC uses epidemiological calculations to estimate how many people with flu-like illness likely have the actual flu.

Also, asking, “what is the cause of death” is a complex question. Do you mean the first thing that initiated the chain of events in a person’s death, or the ultimate cause of death, or contributing factors without which the patient would have likely survived?

If we are concerned about the impact of the flu and the potential benefit of the flu vaccine, then the latter definition is most relevant. We want to know how many extra deaths there are in a year due to the flu. If someone has a heart attack, and they get the flu and ultimately die of their heart attack, but would have survived without the extra stress of the flu – it is reasonable to consider that a “flu-associated death.” Of course, we cannot know with certainty who would have survived without the addition of the flu, and that is again why we must rely on epidemiological estimates.

The Center for Disease Control (CDC) estimates that between 3 and 49 thousand people die of the flu each year in the US. Solomon criticizes these estimates, and tries to substitute for these numbers based solely on death certificates, as if this is somehow an absolutely objective measure:

The numbers differ wildly from the sober tallies recorded on death certificates — by law every certificate must show a cause — and reported by the official agencies that collect and keep vital statistics.

Death certificates are prone to massive underreporting and therefore underestimating true causes. For example, if the ultimate cause of death was a heart attack, that may be written on the death certificate without any indication that the patient also had the flu which contributed to their death.

The CDC are also not the only ones to estimate flu deaths. Solomon would have his readers believe the CDC numbers are inflated as part of a conspiracy to scare people into vaccine compliance. However, scientists not connected to the CDC come up with similar estimates. In this study, US flu deaths between 1979 and 2001 were estimated to average 41,400 per year.

Solomon also claims that the CDC is using an inappropriate definition it made up:

“Cause-of-death statistics are based solely on the underlying cause of death [internationally defined] as ‘the disease or injury which initiated the train of events leading directly to death,’” explains the National Center for Health Statistics. Because the flu was rarely an “underlying cause of death,” the CDC created the sound-alike term, “influenza-associated death.”

This is nonsense – the concept of flu-associated deaths is generally accepted, and as I described above is an attempt to capture the most meaningful statistic. If, however, you are unfamiliar with medical terminology and reasoning, you can make anything seem odd and imply it is a conspiracy.

Conclusion

Mark Crislip has written extensively at Science-Based Medicine about the flu vaccine. Here is his recent summary:

As vaccines go, the influenza vaccine is not our best and brightest. It has variable efficacy in different populations and because there are new strains every year re-vaccination is required. Those who need the protection the most are those who are least likely to respond. And we have never had enough of the population vaccinated at any one time to take advantage of herd immunity, even supposing an excellent antigenic match between the vaccine and circulating strains.

Overall it appears to be a modestly effective vaccine when used as part of a nutritious breakfast. It decreases the chances of getting flu, of having a flu-like illness, and of having complications of flu such as heart attacks and the need for hospitalization. It is not a great vaccine but it is better than no vaccine.

The current vaccine is not perfect, but it is a net benefit, and it is far better than nothing (critics often fall for the Nirvana fallacy – it’s not perfect, therefore it’s useless). Despite accusations that those who promote the flu vaccine are all hype, when you read what we actually write it is quite circumspect, balanced, and evidence-based. It’s just that the evidence is very complicated.

When you read what those of an anti-vaccine bent tend to write, that is where you find the hype and distortion.

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11 responses so far

11 Responses to “Anti-Flu Vaccine Rants at the HuffPo”

  1. DavidCTon 10 Feb 2014 at 11:10 am

    As a fan of your resident Quackcaster, I have come to the point of view that as HCWs it is an obligation to do whatever we can to avoid being part of the flu transmission cycle. That includes a flu shot each year along with a reasonable diet and probably avoiding young children. I happen to know someone who died of influenza and am thus very aware of the risk of doing nothing. Unfortunately you don’t get the traffic of the HuffPro.

  2. tmac57on 10 Feb 2014 at 11:36 am

    I really hate to see that kind of misinformation spread by a widely read source. It’s bad enough combating the nonsense spread through social media such as whale.to or Mercola,and this just gives (slightly) more credibility to spurious health information.

    A little anecdote: I have a Facebook friend who wallows in conspiracy theories and right wing nuttery,but also passes along dubious and quack medical “pass this along to everyone you know!!!” articles .
    One of them last December was about why flu vaccines are ‘so dangerous’ and to be avoided. I toyed with the idea of challenging her,but past experience has shown me that she just digs in deeper,and posts even more nonsense to counter my challenge.Plus I have noticed that very few people ‘like’ or ‘share’ her posts,so I think most of her friends are just tolerating her.But here’s the kicker,her son evidently contracted the flu in January,and ended up in intensive care in the hospital for a couple of weeks (hate to see that bill!),and she was begging people to pray to god for his life (no mention of speeding the hands of the medical staff trying to save him though). Happily,the good medical care that he got pulled him through.I wonder if they will get vaccinated next year.

  3. starskepticon 10 Feb 2014 at 1:01 pm

    # DavidCT – not only an obligation but a requirement; I haven’t worked in a hospital the last few years (I’m a traveling Med Tech) that HAS NOT required all it’s employees to be vaccinated. Anyone opting out – whether from choice or allergy – has to wear a mask for the entire flu season.

  4. ZooPraxison 10 Feb 2014 at 1:04 pm

    I discovered skepticism a few years ago thanks to this blog. I read it every day and learn just as much from the comments as I do from the posts. One aspect of skepticism I’d like to read more about is the perennial state of irritability “we” all seem to be in because we’re surrounded by so much scientific illiteracy. I don’t even read HuffPost because of articles like the you mention.
    I wonder though how everyone finds peace of mind while also championing education and advocacy.
    The more you learn and are aware of, the more often you notice logical fallacies all around and, for me at least, the more I grow consternated. I’ve tried to channel some of that frustration into my work. I recently made a short film about the importance of skepticism, Maybe some folks on NeuroLogica will like it: http://www.youtube.com/watch?v=70iBkvQ6Dns

    It’s not as popular as my other work but I’m proud of it and looking forward to making more films that educate and entertain. Anyway, thanks to all the regular participants of this blog and of course to Dr. Novella. My mom always taught me to surround myself with people who are smarter than me. Since I live in a Southern California beach community, this blog is my way of meeting that goal. :)

  5. pdeboeron 10 Feb 2014 at 1:30 pm

    In looking at all the health care organizations he cites as having vaccine concerns. I’ve already looked at the United Nurses of Alberta and the BC nurses union. Both are very clear that they endorse the efficacy of the flu vaccine.

    Lawrence is using the union’s opposition to mandated vaccination to confabulate their denial of efficacy.

    Personally, I think they are wrong to oppose mandatory vaccination, but that is another topic.

  6. Davdoodleson 10 Feb 2014 at 10:03 pm

    #ZooPraxis: “I’ve tried to channel some of that frustration into my work. I recently made a short film about the importance of skepticism, Maybe some folks on NeuroLogica will like it: http://www.youtube.com/watch?v=70iBkvQ6Dns

    That is nice work there. Very impressive in all respects.
    .

  7. ZooPraxison 10 Feb 2014 at 11:13 pm

    #Davdoodles Thanks! I did a science series too, called Fail Lab, trying to reach my young male fanbase, but it was too brainy for them I think and too silly for science folks. Sigh…
    But I’m glad you liked ZooPrep! Makes me happy. :)

  8. Bookeron 11 Feb 2014 at 12:04 am

    You are right about Huffpo Canada. While they do have the occasional science-based blog post, they are filled with alt-med junk. Mr. Solomon has been attacking immunization for a decade in a variety of venues, and seems to have found a home on Huffpo along with fellow Canadian embarrassment, Conrad Black. On Canada’s national right-wing newspaper, The National Post ( founded by the felonious Black) Solomon displays his climate-change denialism.

    http://opinion.financialpost.com/2013/12/19/lawrence-solomon-for-global-warming-believers-2013-was-the-year-from-hell/

    It’s not a necessarily instructive observation, but he does his vaccine-denialism on the modestly left-of-centre HuffPo and his climate-change denialism on the seriously right-wing Post. Solomon’s politics definitely aline with the latter publication, but anti-vax ideology seems to be the one crank idea they don’t tolerate, not even from one of their columnists.

    http://life.nationalpost.com/2014/01/02/vaccinations-a-lifelong-lifesaver/

  9. TBruceon 11 Feb 2014 at 5:27 pm

    Mr. Solomon is deceptive. He boasts that he has founded and chairs several fancy-sounding organizations (Urban Renaissance Institute, Consumer Policy Institute and more). These “institutes”, to be charitable, are extremely obscure. He also claims to be a “leading” environmentalist and a “best-selling” author. He is neither. Interestingly, in all his self-promotion and bragging, there is no mention of any post-secondary education, let alone a degree, in any scientific or medical field.

    His argument about doctors “avoiding” the flu vaccine is just plain stupid. There is a well-publicized problem with a substantial percent of doctors not washing their hands adequately between patients. By Solomon’s logic, this would obviously mean that washing your hands while caring for patients is worthless.

    Small correction: Mr. Solomon is deceptive. He is also dumb.

  10. Newcoasteron 11 Feb 2014 at 7:18 pm

    In BC the issue was more with the way the government, by way of the health authority, mandated nurses to get the vaccine “without consultation”. Since nurse are employees of the HA they can (in theory at least) be told what to do. That did not sit well, and they felt there needed to be more education and collaboration. It created a public relations nightmare last year. This year, there was ample notice, educational opportunities, and a choice: get vaccinated or wear a mask while at work. In my small community hospital there are no mask wearing nurses, but a few allied health workers (a radiology tech and a porter) are quite obviously anti-vaxx. The Scarlet Letter approach seems to have worked well. Even though physicians don’t work for the hospital or HA, our privileges could be suspended if we failed to get vacccinated, and a few people did get “a talking to” from the Chief of Staff.

    On the other hand, it is unfortunately true “in my experience” ( with full knowledge of Mark Crislips 3 most dangerous words….) that nurses are far more likely to have a variety of unscientific ideas than MDs. I’ve lost count of the number of ER nurses who believe we get busier on a full moon, and who regularly get chiropractic or accupuncture, and one who swears by Healing Touch on her cat.

    On another point, mr solomon was impressed with the lack of influenza as a recorded cause of death on a death certificate. Most physicians would probable agree that while we make an effort to be as accurate as possible on death certificates, in many cases the specific cause of death is simply unclear. Or, there are several possibilities and only the “best guess” is listed. I have tried putting “extreme old age” as a cause of death in a 90′s patient with multiple medical issues, any one of which could be responsible, but the Vital Statistics people disallowed it.

  11. pdeboeron 14 Feb 2014 at 2:17 pm

    So, I found it hard to believe that any Nurses’ group would say that vaccines are not safe and effective. So I contacted United Nurses of Alberta, here’s what they had to say:
    It is completely incorrect to characterize UNA’s position on this issue as “anti-vaccine.” UNA President Heather Smith’s comments on this issue can be found at: http://www.una.ab.ca/282/united-nurses-president-calls-for-full-range-of-measures-to-combat-influenza

    I found similar responses from the BC nurses Union and the U.S. National Nurses United.

    However, I contacted my home province’s Union, The Ontario Nurses’ Association.

    They evaded the simple question; do they endorse vaccines as a safe and effective preventative of the flu?

    I can only assume they are relishing in the confused controversy that backs their silly opposition to mandating vaccines. I’ll respond here, if and when they clearly address this point.

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