Oct 01 2009

Homeopaths Are Anti-Vaccine

I try not to let my blog get too focussed on any one topic, but the point of this blog is to engage the public and the media and so at times a hot topic requires increased attention. When the creationists are campaigning to impose their ideology on science education, for example, they will garner my blogging attention.

Perhaps one of the hottest media science topics today is the swine flu/H1N1 pandemic and upcoming vaccine, and the anti-vaccine movement in general. This is a perfect storm of quackery, sensationalism, misinformation, and public concern.

One aspect of the anti-vaccine movement is that those who are proponents for an unscientific medical modality are keen to criticize science-based medicine because they are their competitors (ideological and/or financial). The same is true generally of pseudoscience – in order to promote your pseudoscientific claims you have to simultaneously attack the real scientists who are likely to point out that your claims are bunk.

Which brings me to homeopathy and vaccines. Homeopathy, as I have written many times before, is about as close to pure pseudoscience as you get. They have their own pre-scientific magical notions of health and illness which are incompatible with modern knowledge of biology and physics.

In a recent press release, the Alliance of Registered Homeopaths simultaneously claim that the H1N1 vaccine is dangerous and not effective, while homeopathic treatments are proven effective. This, of course, is the opposite of the truth. They are essentially saying – don’t use that science-based treatment which doesn’t work, use our absurd snake oil instead.

The press release is not completely devoid of media savvy, which means they know when to be coy. They write:

Whilst the seriousness of contracting swine flu seems to be limited, the potential adverse reactions of this new, and hastily tested vaccination, cannot be fully known at this stage. This leads to the important question; are adverse reactions to the vaccination likely to be worse than the potential dangers of the illness?

The art of implication – how to say that the vaccine is not safe without directly claiming it’s not safe. They then go on to – anecdotes – saying that reports have raised concerns, again without having to be tied down to any specific factual claims.

The claim that the seriousness of H1N1 is limited is more uncertain than that safety of the vaccine. So far the overall virulence of this flu strain is no worse than the seasonal flu – but the seasonal flu puts 200,000 people in the hospital and kills 36,000 people in the US every year. Also, while the regular seasonal flu tends to kill the old and the sick, H1N1 kills young and healthy individuals as well as pregnant women. There is probably a genetic susceptibility in about 1% of the populations that get a particularly deadly version of the flu from this H1N1.

And there is the possibility, like with the 1918 H1N1 pandemic, that as this flu strain sweeps around the world it will mutate into a more virulent strain. So it could get worse – we just won’t know until it happens, which is why we have to be prepared before it happens.

After trashing the flu vaccine the press release goes on to make these astounding claims, quoting Steve Scrutton, Director of ARH:

“Homeopaths have been successfully treating people suffering from influenza for over two centuries. The remedies homeopaths frequently prescribe to treat influenza, such as Gelsemium, Bryonia Alba and Eupatorium Perfoliatum, are both highly effective and entirely safe.”

No references were given for these claims. So I did a PubMed search on Gelsemium and Influenza, yielding zero results. I then searched Gelsemium alone which yielded 61 results, none of which were studies of homeopathic Gelsemium and flu or any infection.

Bryonia Alba alone yielded 93 results, no studies of the substance in treating flu or viral illness. I did find a double-blind controlled trial of the ability of dowsing homeopaths to tell homeopathic Bryonia from placebo – dead negative.

Eupatorium Perfoliatum resulted in 11 results. One was an unblinded study of malaria in mice. Another study was an unblinded comparison with aspirin for symptomatic treatment of the common cold. The study found no difference, which they interepreted as meaning that both treatments are equally effective. But this study could also mean that the two are equally ineffective, or that the study was not powerful enough or adequately designed to detect an effect or difference (there was no control group to calibrate the study). There were no studies of Eupatorium Perfoliatum and flu.

I then did a search on homeopathy and influenza, which yielded 24 results. The first hit was a Cochrane review of homeopathic Oscillococcinum, which concluded:

Current evidence does not support a preventative effect of Oscillococcinum-like homeopathic medicines in influenza and influenza-like syndromes.

Interesting that Oscillococcinum was not mentioned in the press release, but is a common homeoapthic prescription for flu. It is also silliness squared, because it is a homeopathic prepration of a nonexistent delusion.

There was another review of homeopathic remedies in general and flu, which concluded:

A meta-analysis stressing the poor methodological quality of trials of homeopathic preparations in influenza concludes that there is no proven preventive or curative effect.

What I did not find are any studies to support the claims being made in this press release, which probably explains the absence of references to such evidence.

In the absence of any actual scientific evidence that homeopathy works for anything, let alone specifically influenza, or even that homeopathic “remedies” are anything but water, the ARH resorts to crappy evidence, namely completely unreliable historical data. They write:

“Homeopathy’s success at treating the Spanish flu outbreak of 1918 is well documented, especially in the USA. The medical records of hospitals across the country consistently show a mortality rate of above 28% in sufferers treated conventionally, as opposed to a mortality rate of just over 1% of those treated with homeopathy”.

What’s worse than anecdotal evidence? Century old anecdotal evidence. All we know is that homeopaths reported lower mortality rates. This is worthless data. We have no idea how these patients were actually treated, if they also received standard medical care, how sick they were, were they comparable to those not treated with homeopathy, etc. This is a  mess of uncontrolled variables – worthless.

If these historical claims of homeopaths were anywhere close to the truth, then it should be a trivial matter to document with a modern randomized placebo controlled trial. And yet they have no evidence to back up these astounding claims. The bigger the therapeutic effect of a treatment, the easier it is to demonstrate in a clinical trial. Where is the evidence? It doesn’t exist because homeopathy is a dangerous fantasy.

Also – if homeopathic treatment for the flu were as effective as homeopaths claim then it would be their duty to study it in such a way that they would convince the scientific community and thereby bring their effective treatment to the masses. They have not done this – either way they are guilty of malfeasance. There is simply no excuse for promoting a treatment for a century without ever bothering to research it in an accepted and compelling way to find out if it actually works.

Conclusion

Homeopaths are dangerous quacks. They promote treatments which not only cannot possibly work based upon the laws of physics and chemistry, the clinical data shows that they in fact do not work. But in order to promote their snake oil they are telling the public that the H1N1 flu is not that bad (which is false) and they are fearmongering about the upcoming vaccine, which is safe and effective.

The degree to which the public actually listens to the absurd claims of homeopaths is directly proportional to a resulting increase in suffering and death from treatable diseases.

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33 responses so far

33 Responses to “Homeopaths Are Anti-Vaccine”

  1. weingon 01 Oct 2009 at 8:13 am

    What was the standard medical treatment for influenza in 1918? It sure wasn’t any of the antiviral agents we have now. There was no flu vaccine either.
    BTW. It looks like the SBM site is down again.

  2. DevoutCatalyston 01 Oct 2009 at 8:41 am

    Systems that can’t learn, brought to you by people who are proud of it. To paraphrase a pithy maxim, “Homeopathy knows as much about medicine as a hog knows about Sunday”.

  3. lalalolaon 01 Oct 2009 at 8:44 am

    As someone that has parents who prefer homeopathic treatments I have to say you’re not helping the “cause” by calling those who choose these treatments “quacks” – it just angers them and fuels the fire.

    I’ve always been on the side of pro-vaccinators, but at the same time it’s frustrating to see all the hate against the homeopathic industry. Manuka honey is the only thing that comes to mind at the moment (i dont really use homeopathic treatments), that has been shown (even proven?) to have healing properties.

    However, on the other side of the coin – my dad’s been diagnosed with a serious stage of prostate cancer and he’s opted for herbal remedies. Personally, I think it’s a mistake and I blame the homeopaths for spreading false hope, but the reason people even consider these approaches is because some of the treatments offered by this industry can and do work.

    I think there’s no harm in dabbling between conventional and alternative medicine as long as people are aware of the risks.

  4. Timmysonon 01 Oct 2009 at 9:20 am

    Speaking of vaccine’s, there’s a business going on in Canada right now about some unpublished studies that receiving the seasonal flu vaccine raises the incidence of infection from H1N1. Apparently there is no theorized mechanism, and this has only been shown in Canada (as far as I know). There’s confusion in the medical establishment about this, and many doctors are recommending that the seasonal flu vaccine not be administered until well after the H1N1 vaccine.

    My first instinct is to say this is quackery, are you at all familiar with this idea?

  5. son 01 Oct 2009 at 12:07 pm

    OK this is nitpicking and off topic, but “young and healthy”? Hardly any victim has been healthy. And the few cases with no previously diagnosed underlying illness/disorder were obviously not healthy or they would not have died. (This is of course a philosphical question of how to define healthy.)

    And please give some evidence for your out of thin air “There is probably a genetic susceptibility in about 1% of the populations that get a particularly deadly version of the flu from this H1N1.” that would be uniqely related to the [swine]H1N1 mode of infection of tracheobronchial epithelial cells or alveolar ditto or the cocncomitant immune reaction.

  6. SidBBon 01 Oct 2009 at 12:16 pm

    I was writing a blog post about this last month, in response to similar claims in the Indian news media.

    I did find one specific study about Oscillococcinum and H1N1 influenza (JP Ferley, et al, 1989) but it was pretty weak. Also, the claims about the drastic efficacy of homeopathy during the flu pandemic of 1918 are hilarious, because the original “paper” by W.A. Dewey is quite literally a collection of brief quotes from assorted homeopaths.

  7. weingon 01 Oct 2009 at 12:19 pm

    s,
    Philosophical question? It reminds me of the old days when they would throw suspected witches into the river and if they were innocent they would drown but if they were guilty of witchcraft, they wouldn’t and were therefore burned at the stake.

  8. Steven Novellaon 01 Oct 2009 at 1:29 pm

    s,

    The virulence of H1N1 is a complex and moving target, but here is some more info.

    When we say that victims were young and healthy we mean healthy other than the H1N1 infection, obviously. We are referring to an underlying existing condition that makes them more likely to have a bad outcome from the infection.

    While having certain chronic diseases does increase susceptibility to H1N1 complications – less than half of those who have died from H1N1 had an underlying condition. That is very different from the seasonal flu.

    The young and otherwise healthy people who have died from H1N1 just developed a very severe version of the infection, with alveolar pneumonia. It is possible they were just unlucky. It is also possible they had some unknown chronic conditions – but neither of these hypotheses would explain why the current H1N1 is different from seasonal flu.

    This has led some to speculate that those who just get a very severe illness from H1N1 and die may have a genetic susceptibility. Right now this is just a hypothesis, but we need something to explain why this virus is behaving differently from other influenza strains.

  9. Steven Novellaon 01 Oct 2009 at 1:34 pm

    lalalola- I have to disagree. First, I think you are conflating herbal or “natural” remedies with homeopathy. These are quite different, but it is a common misconception, often encouraged by homeopaths themselves.

    Homeopathy is the use of water that has had substances diluted in them to such a degree that often no active ingredient remains – none – that means you are left with pure water. That’s homeopathy.

    There is no compelling evidence to support the use of any homeopathic remedy for any indication.

    And there most certainly is harm in relying upon worthless remedies. See: http://www.thenational.ae/apps/pbcs.dll/article?AID=/20090928/FOREIGN/709289988/1002

    For just the latest example.

  10. LinzeeBinzeeon 01 Oct 2009 at 1:39 pm

    This doesn’t have to do with the original post, but it does have to do with anti-vaccine. I saw this today: http://www.ageofautism.com/2009/09/blockbuster-primate-study-shows-significant-harm-from-one-birth-dose-of-a-mercurycontaining-vaccine.html#more

    It’s a study that they say shows that primates who receive one dose of thimerosol causes developmental delays. My skills at reading these studies and figuring out whether they’re well done are very poor, so I was wondering if someone here could help me out.

  11. Karl Withakayon 01 Oct 2009 at 2:08 pm

    Is that “lalalola” as in “la-la-la-lo-la, I can’t hear you; I’m not listening.”?

    Why be frustrated with people who oppose the promotion of remedies not scientifically proven to be effective- remedies which cannot be effective under the laws of physics and chemistry? Remedies that are often recommended INSTEAD of, not in conjunction with, scientifically validated treatment.

    Homeopathic preparations have not been shown to be effective for anything, other than quenching thirst, largely because they are just water. Manuka honey is not a homeopathic product and its use does not follow homeopathic principles. Please don’t equate herbal/natural remedies with homeopathy.

    “I think there’s no harm in dabbling between conventional and alternative medicine as long as people are aware of the risks.”

    Did you read the article? The Alliance of Registered Homeopaths is recommending unproven, ineffective homeopathic preparations in place of vaccination. Can you not see the potential for harm there?

    http://whatstheharm.net

  12. Calli Arcaleon 01 Oct 2009 at 2:27 pm

    I think there’s no harm in dabbling between conventional and alternative medicine as long as people are aware of the risks.

    And there’s the rub, isn’t it?

    Alternative medical practitioners have no professional obligation to obtain informed consent, as long as they are careful to use the right language (at least, not in writing, which could be held up in court). And although a few do actually educate their clients, most don’t. Some are frauds, trying to keep patients from learning that their services aren’t really useful, but I think most just don’t think it’s necessary (or are unaware of the real risks/benefits themselves).

    If people are truly aware of the risks, then yes, they have every right to treat their illnesses however they like. What I object to is the way some practitioners/manufacturers/etc (and I include pharmaceutical companies and medical device manufacturers in this) deliberately try to keep people from learning the real risks. That bothers me a great deal, and it should bother you too. Outright falsehoods should not be tolerated. What the homeopaths are recommending is deceptive, and it makes it harder for people to learn the real risks and make an informed decision.

  13. lalalolaon 01 Oct 2009 at 8:52 pm

    My mistake then, I honestly thought homeopathy covered all forms of alternative medicine. In this case, iI think my entire argument is invalid as I don’t think I’ve even heard of one real homeopathic treatment.

    The only reason I discussed herbal remedies is because whenever there are discussions against anti-vaxers homeopathy is brought up and eventually alternative forms of medicine. I always assumed that it was all under the same umbrella.

    As a young mother whose a member of numerous forums catering to discussion of pregnancy etc, the only reason homeopathic and alternative forms of medicine thrive is because of the concept of the treatments been “natural” which appeals to the “earth mum” trend. If a mother has to decide between something “natural” and something processed by a large corporation driven by $$ they see these alternative treatments as things that probably work (if you had to decide between a large corporation and a small store selling these treatments, you’d choose the small store as you’d be believing that if they chose to open this store they must believe these treatments actually do work). Of course, I’m not encouraging any of this because I think it’s absurd, but I’m trying to get people to see the other side of the coin and why people actually buy into this crap.

    One particular woman in these forums has a subforum where she has a thread named “Ask Dr *****”, which is ridiculous because she’s not even a doctor – just someone that runs a business of selling these treatments. However, she’s not evil or scheming and trying to con these women, she genuinely believes these treatments work.

    The only reason I decided to post here is I’ve never been argumentative that’s why I’m generally a fence sitter and get frustrated when people don’t get along.

  14. Khym Chanuron 01 Oct 2009 at 8:57 pm

    The interesting thing about Oscillococcinum is that the person who invented thought that the flu, herpes, chicken pox were all caused by an oscillating bacteria he called Oscillococcus. But since none of them are caused by a bacteria, by the homeopathic principle of like-treats-like, Oscillococcinum can’t work.

  15. superdaveon 01 Oct 2009 at 11:20 pm

    lalalola, Dr. novella has written about herbal medicine, you should check out his posts, but to summarize, unlike homeopathy, hermbal remedies do contain real ingredients that have potential effects. However, they are much less regulated than standard drugs so they do not need to provide much evidence for there claims or even for their purity. In other words, they can be dangerous.

  16. Caffieneon 01 Oct 2009 at 11:42 pm

    The real irony to me is that vaccines are probably the closest evidence based medicine to homeopathy that homeopathic proponents are ever likely to find…

    Vaccines are, basically, giving a small amount of a substance which has similarities to the problem substance, for a positive outcome against the problem substance.

    The mechanism by which a vaccine works is obviously far different from the hand waving involved in homeopathy, but the superficial similarities are the closest I can think of for an evidence based medical procedure… and yet the homeopathy cranks attack it, instead of applying their supposed criteria for how homeopathy “should” to work.

    Says a lot about their mindsets… Even their own claims are no trouble to throw out, if it allows them to try and attack “the enemy” medical establishment.

  17. glasstreeon 02 Oct 2009 at 1:17 am

    Alternative Science is terrifying.

  18. eiskrystalon 02 Oct 2009 at 3:38 am

    -The only reason I decided to post here is I’ve never been argumentative that’s why I’m generally a fence sitter and get frustrated when people don’t get along.-

    It’s a little hard to get along with people deliberately belittling known and proven medicine in order to peddle their wares to the unsuspecting public.

    Meddling with peoples health, pretending to be a Doctor and not bothering to check if your medicine works. Deluded or quack is a pointless line of distinction sometimes.

    Give these people an inch, and they will run off with your dog.

  19. Joeon 02 Oct 2009 at 6:06 am

    @ lalalola on 01 Oct 2009 at 8:52 pm “If a mother has to decide between something “natural” and something processed by a large corporation driven by $$ …”

    They should understand that AltMed proponents are driven by profits as much as anyone, and profits from CAM are very high since there is no research or quality control. Read Dan Hurley’s book “Natural Causes” (Broadway Books, 2006)- the title refers to people who are seriously harmed, even killed, by “natural” treatments. He documents the fact that the herb ephedra was killing people; but the manufacturers were making so much money that they preferred to pay the survivors rather than take it off the market. That went on for around a decade.

    Rose Shapiro’s book “Suckers: How Alternative Medicine Makes Fools of Us All” is also very good. The author is a journalist, not tied to medicine or AltMed.

  20. SteveAon 02 Oct 2009 at 7:22 am

    lalalola: “My mistake then, I honestly thought homeopathy covered all forms of alternative medicine.”

    My mistake too. For many years I thought that ‘homeopathy’ was a catch-all title that described any form of Complementary or Alternative Medicine (CAM).

    I also used to think that the words ‘complementary’ and ‘alternative’ actually meant something in this context.

    They don’t.

    There’s no such thing as ‘alternative/complementary medicine’: if it works, it’s medicine; if it doesn’t, it’s quackery.

  21. Karl Withakayon 02 Oct 2009 at 10:51 am

    @lalalolaon,

    Things you can tell people when discussing “natural” remedies.

    Arsenic, botulinum toxin and anthrax are all natural; that doesn’t make them good for you.

    Cooking meat is not natural, but it’s generally better for you than eating it raw. Wearing clothes is not exactly “natural” either, but most of us do it.

    The herbal remedy/supplement industry is a multi-billion dollar industry which is just as driven by profit as big evil phamra, without the stringent regulation that the pharmaceutical industry is subject to. “Pharma” is required to prove a medication is safe and effective before they are allowed to market it. The supplement industry is under no such burden.

  22. son 02 Oct 2009 at 12:07 pm

    Weing,
    “suspected witches into the river and if they were innocent they would drown but if they were guilty of witchcraft, they wouldn’t and were therefore burned at the stake.”

    I won’t comment what I think about that comment.

    Defining health/healthy is very much a philosophical question. Where do you draw the line? What is to be regarded a disease and what is to be regarded within “normal variation”? Does health encompass other characteristics than physical health? If 1% die of an infection where the other 99% healthy? And so on.

    WHO defines it as “a complete state of physical, mental and social well-being, and not merely the absence of disease or infirmity.”

    Bircher as “a dynamic state of well-being characterized by a physical and mental potential, which satisfies the demands of life commensurate with age, culture, and personal responsibility”

    Saracchi as “a condition of well being, free of disease or infirmity, and a basic and universal human right”

    And you thought about witches…

  23. weingon 02 Oct 2009 at 1:27 pm

    s,
    Well if you are healthy and get the flu then you just brush it off, but if you die then obviously you weren’t healthy, only appeared to be healthy.

  24. weingon 02 Oct 2009 at 3:41 pm

    I got it. Maybe we can use the H1N1 virus to test if someone is really healthy or just pretending. This is really, really tongue in cheek.

  25. son 03 Oct 2009 at 3:43 am

    weing,
    no, you don’t quite get it

    the idea of health is both a social construct and subjective perception (your witches, pretenses etc)

    on the other hand from an evolutionary point of view you are less fit if you die — ergo not healthy in daily parlance

    got it?

    and to preempt:
    a discussion of senescence can be found in Gaillard J, Bonenfant C, Vertebrate Ageing: An Evolutionary Process with a Genetic Basis, Current Biology, 18(3):R130-R131, 2008 (the paper also contains references to the major works of import)

  26. son 03 Oct 2009 at 4:09 am

    Steven,
    you claim that “There is probably a genetic susceptibility in about 1%” is equally unsubstantiated and a par with homeopath peddling of distilled water. If you fault the opposition for blasphemy, uh sorry, I mean making unsubstantiated claims, please prove your claims. And do not refer to equally nebulous persons unknown having purported hypotheses.

    Re flu vaccines, and this is my main gripe with your not evidence based claims about the flu, the scientific evidence does not support any flu vaccine effect. See Tom Jeffersons reviews (Cochrane specialist in epidemiology and vaccination effectiveness).

    To quote from an interview recently made with him (for hard data see http://www.cochrane.org/influenza/index.html).

    “..how effective are seasonal vaccines? And our reviews either show no effect or limited effect, and poor data.” [poor data is a very kind description of self-fraud, incompetence, intellectual díshonesty and other words that come to my mind]

    “What is interesting is that there has been extensive manipulations of the visibility of the data. [my emphasis] Now, if you take influenza related mortality in the US – deaths related to influenza, bilateral pneumonia and so on – if you take the CDC (Centre for Disease Control and Prevention) data over the past 20 years, the curve is flat. A plateau. That line flattened after the 1950s – but before influenza vaccination started. As in – influenza related mortality crashed for reasons independent of vaccines. But, if you look at the past 20 years, the mean impact factor of journals (how well read, or well cited they are) the line is nearly vertical. These are pharma sponsored studies. But as far as seasonal influenza vaccines go, there is no difference to the level of threat from 20 years ago. But influenza vaccines have become the thing to talk about – they are now the things that journals like to run.”

    “Do we know they are safe, or what the side effect profile is? No, we don’t”

    “Do we know if these pandemic flu vaccines will do better? We don’t.”

    “There is no evidence, looking at seasonal flu vaccines, that [it] is going to do anything – to benefit the elderly or others. There is evidence that healthcare workers may be prevented from symptoms of the flu, but these workers having the vaccine do not show a decrease in mortality. The data are poor.”

    Link to interview with Tom Jefferson
    http://blogs.ft.com/healthblog/2009/09/11/interview-dr-tom-jefferson-and-pandemic-flu-vaccines/

  27. Michael Kingsford Grayon 03 Oct 2009 at 4:23 am

    @lalalola:
    Why not refer to things as they *really* are?

    I detest it when folk, for short-term political gain that never manifests, pull their punches, for fear of alienating those who are criminally negligent, either actively or passively.

    Homeopaths are despicable liars, even if only by dint of active ignorance, although a few are outright willful frauds.
    The means by which they con people are neither here-nor-there.
    They are both dangerously WRONG.

    At least the Australian judicial system recognises this.
    See the case of the “Sams” homeopaths who murdered their infant daughter directly via their homepathic religion and have both been imprisoned for too few years for their adherence to woo.

  28. Calli Arcaleon 05 Oct 2009 at 12:51 pm

    s:

    I doubt very much that there is a Big Pharma conspiracy to peddle flu vaccines. After all, the few companies (I think it’s down to two now) that still make them are already unable to meet demand. Even in non-pandemic years, it is commonplace for flu shot clinics to run out of vaccine. IOW, there is no need for them to drum up extra business. They already have more business than they can deal with.

    Now, if you take influenza related mortality in the US – deaths related to influenza, bilateral pneumonia and so on – if you take the CDC (Centre for Disease Control and Prevention) data over the past 20 years, the curve is flat. A plateau. That line flattened after the 1950s – but before influenza vaccination started. As in – influenza related mortality crashed for reasons independent of vaccines.

    This is exactly the same argument used against the MMR, the polio vaccine, etc: that mortality rates declined before the vaccine was introduced, therefore the vaccine cannot be effective.

    There is one flaw in this logic, and that is that most people who get the disease will not die from it — and furthermore, that in this same time period, hospitals have gotten a lot better at preventing death due to influenza. The invention of the artificial respirator was a big factor in this.

    So deaths went down, but did the actual rate of influenza go down? Did the rate of hospitalizations go down? Did the rate of intubations go down? (Remember, those who get intubated are those who, prior to the invention of the respirator, would have died.) That’s the real question to determining whether or not the vaccine is effective, and your data does not answer it.

    Of course, effectiveness is only part of the question. Even if the vaccine is effective, is it still worthwhile? And the data alone cannot answer that. Personally, I feel that it is worthwhile. I do not wish to spend a month on a ventilator, and am willing to accept the negligible risk of a flu vaccine in order to reduce my risk of that outcome. I know it will not drop my risk to zero, given the flu’s pernicious rate of mutation, but as I have asthma, I have a greater-than-typical risk of serious complications. That makes the decision easier for me than perhaps it is for you, whom I presume to be a basically healthy person. Really, since there’s no hope of wiping the virus out through herd immunity anyway, the decision of whether or not to vaccinate comes down to how important that modest risk reduction is to you, personally. I have asthma, which makes the decision easier. ;-)

    Off-topic: the mention of dunking witches (“trial by water”) is interesting, because it’s not quite what folks tend to think. “Dunking stools” were used more as torture devices (sort of an extreme form of waterboarding) to induce a confession so they could be forgiven of their sins before dying. (As a bonus, it was generally very public, serving as an object lesson for others.) The person was already generally presumed guilty if they were being stuck on a dunking stool. Trials by torment did occur (as did trials by combat), but in those cases, the outcome was the reverse — if you were not harmed (or at least managed to avoid screaming in agony), then it would be a sign that God had protected you, and therefore you must be innocent.

  29. son 05 Oct 2009 at 3:31 pm

    Calli,
    I am talking about EBM. I do not know were you got the Big Pharma conspiracy from, I am definitively not talking about any. Just some cheap and trite debate tactic from you to avoid the issue at hand.

    And if even Cochrane reviews are not good enough to convince you what will suffice?

    You are just moving the goal posts as any good believer in the supernatural. That is what is so tragic with the whole flu and flu vaccine debate on this site. You require scientific evidence, you profess evidence based medicine and when that is offered it is not good enough. You just say “get me the intermediate fossil”…

  30. son 05 Oct 2009 at 3:33 pm

    BTW I would vaccinate against pneumonia if any. Which I have done.

  31. Calli Arcaleon 08 Oct 2009 at 3:36 pm

    I apologise, S, when you quoted Mr Jefferson (I think), I thought you were agreeing with his implication that pharmaceuticals were trying to keep the public from learning some truth about influenza vaccines so that they could keep settling them.

    Here’s the line that had me think you were suggesting a Big Pharma conspiracy to push vaccines:
    “What is interesting is that there has been extensive manipulations of the visibility of the data. [my emphasis]”

    I am not trying to shift any goalposts; only to respond to your assertion that there is no evidence of vaccine effectiveness. You based your assertion purely on a statement that influenza deaths went down before the vaccine was introduced, but remained flat thereafter. I don’t have the data to judge that statement, so I’m assuming it’s true for the sake of argument.

    My point is that you cannot then conclude that the vaccine is ineffective. The vast majority of people who get influenza in the US will not die of it, so the death rate only tells part of the story. What you really want to know is the infection rate, and although it’s hard to compare the general population (since flu rates vary widely anyway), you *can* compare certain at-risk populations with more consistent flu rates. One popular group for these sorts of studies is elderly nursing home residents. They are by nature at higher risk of influenza complications, they live in high density housing which promotes disease spread, they are all being closely monitored medically, and in general their lives are controlled closely enough that many other variables are eliminated. Studies like this have shown that residents who get vaccinated have a much lower rate of influenza infection than those who do not.

    So, the evidence does suggest that the influenza vaccine is effective at what it is designed to do, which is create immunity to three particular strains of influenza. Technically speaking, it’s effective. The bugger about it is that influenza mutates very rapidly; you will become immune to three strains of influenza, but if these go extinct next week it isn’t going to matter in the long run. So ultimately the choice is yours.

    BTW, you are wise to vaccinate against pneumococcus. Bear in mind that this has some of the same limitations as influenza and HPV vaccine — it doesn’t cover all strains (it covers about a quarter of them, which isn’t bad), and just as not all flu-like illnesses are influenza, neither are all pneumonias due to pneumococcus. In fact, most are not, though pneumococcus is a pretty common pathogen.

    My eldest, vaccinated against pneumococcus and receiving annual flu shots, has already had influenza at least once and pneumonia twice. She’s in good health now, but that’s the trouble with these diseases — vaccination is effective, but really all it does is improve your odds.

  32. Calli Arcaleon 08 Oct 2009 at 3:37 pm

    Typo: In the first paragraph, that should read “so they can keep selling them”.

  33. Calli Arcaleon 09 Oct 2009 at 1:54 pm

    It occurs to me that maybe the real problem is that when people ask “is vaccination effective?” they are failing to qualify that. Effective at what? The influenza vaccine is reasonably effective at producing immunity to the target strains of influenza. But that’s probably not what’s being asked.

    S was clear to explain that he/she meant “effective at reducing mortality”. But there may be other factors which other people may have in mind when they’re thinking “influenza vaccine effectiveness.”

    Take the polio vaccine, for instance. This vaccinates against a disease which is nearly extirpated from the United States, and most of the developed world as well. Barring a lot of international travel or interaction with people who’ve done a lot of international travel, the odds of contracting polio are small even for an unvaccinated person. So the polio vaccines being given this year do not appear to be reducing the rate of mortality due to polio (and furthermore, most people in the developed world who do catch polio will survive it, albeit potentially with life-changing complications). And if we look at individuals, if one child remains unvaccinated, realistically his or her odds of contracting polio are very nearly unchanged. Is, then, the polio vaccine “ineffective”?

    Of course not. We know from other research that it reliably produces immunity, and that in countries where polio is still endemic, it vastly lowers morbidity and mortality rates due to polio. What’s more, the only reason the unvaccinated child doesn’t have a serious risk of polio is because everybody around him or her is probably vaccinated against polio and therefore incapable of giving it to him or her. (Assuming the IPV, which is the form used in the US. The OPV, used primarily in developing countries, uses live virus and can cause rare polio cases.)

    So “effective” is a matter of what you expect it to be effective at doing. The influenza vaccine has a decent success rate at achieving what it sets out to do, though it’s sufficiently imperfect (due to factors other than how good it is at creating immunity, such as influenza’s rapid mutation rate) that it has never been included in a universal vaccination campaign, and indeed, manufacturers don’t make enough for that anyway. Basically, it’s not effective enough at eliminating influenza to justify vaccinating everyone to achieve herd immunity. Therefore, the recommendations are much more targeted, aiming at those who have the most at stake in the event of influenza infection.

    I want to emphasize this: I don’t think it’s unreasonable to skip the flu shot. It’s just unreasonable to justify this with “it doesn’t work” or “flu isn’t harmful”, since these statements are untrue. A better reason is “there isn’t a lot of it, and my odds are good enough without it, so I’ll let those who really need it get it”, or even “I don’t like needles and I don’t want a live virus squirted in my nose, but I’m healthy enough that I think I can stand to take my chances without it, especially since there’s no guarantee the actual circulating strains will be good matches for it”.

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