from
TheRefusers Website
The CDC pledges,
But Peter Doshi argues that in the case of influenza vaccinations and their marketing, this is not so. Promotion of influenza vaccines is one of the most visible and aggressive public health policies today.
Twenty years ago, in 1990, 32 million doses of influenza vaccine were available in the United States. Today around 135 million doses of influenza vaccine annually enter the US market, with vaccinations administered in drug stores, supermarkets - even some drive-throughs.
This enormous growth has not been fueled by popular demand but instead by a public health campaign that delivers a straightforward, who-in-their-right-mind-could-possibly-disagree message: influenza is a serious disease, we are all at risk of complications from influenza, the flu shot is virtually risk free, and vaccination saves lives.
Through this lens, the lack of influenza vaccine availability for all 315 million US citizens seems to border on the unethical.
Yet across the country, mandatory influenza vaccination policies have cropped up, particularly in healthcare facilities,1 precisely because not everyone wants the vaccination, and compulsion appears the only way to achieve high vaccination rates.2
Closer examination of influenza vaccine policies shows that although proponents employ the rhetoric of science, the studies underlying the policy are often of low quality, and do not substantiate officials’ claims.
The vaccine might be less beneficial and less safe than has been claimed, and the threat of influenza appears overstated.
Through the 1990s, the key objective of this policy was to reduce excess mortality. Because most of influenza deaths occurred in the older population, vaccines were directed at this age group. But since 2000, the concept of who is “at risk” has rapidly expanded, incrementally encompassing greater swathes of the general population (Box 1 below).
As one US Centers for Disease Control and Prevention (CDC) poster picturing a young couple warns:
Today, national guidelines call for
everyone 6 months of age and older to get vaccinated. Now we are all
“at risk.”
Not to worry - officials say influenza vaccines save lives
As another CDC poster, this time aimed at seniors, explains:
And in its more technical guidance document, CDC musters the evidence to support its case. The agency points to two retrospective, observational studies.
One, a 1995 peer-reviewed meta-analysis published in Annals of Internal Medicine, concluded:
They calculated a reduction of “27% to 30% for preventing deaths from all causes” - that is, a 30% lower risk of dying from any cause, not just from influenza.
CDC also cites a more recent study published in the New
England Journal of Medicine, funded by the National Vaccine Program
Office and the CDC, which found an even larger relative reduction in
risk of death: 48%.13
Perhaps there is a reason CDC does not shout this from the rooftop:
it’s too good to be true. Since at least 2005, non-CDC researchers
have pointed out the seeming impossibility that influenza vaccines
could be preventing 50% of all deaths from all causes when influenza
is estimated to only cause around 5% of all wintertime deaths.14 15
Consider one study the CDC does not cite, which found influenza vaccination associated with a 51% reduced odds of death in patients hospitalized with pneumonia (28 of 352 [8%] vaccinated subjects died versus 53 deaths among 352 [15%] unvaccinated control subjects).16
Although the results are similar to those of the studies CDC does cite, an unusual aspect of this study was that it focused on patients outside of the influenza season - when it is hard to imagine the vaccine could bring any benefit.
And the authors, academics from Alberta, Canada, knew this: the purpose of the study was to demonstrate that the fantastic benefit they expected to and did find - and that others have found, such as the two studies that CDC cites - is simply implausible, and likely the product of the “healthy-user effect” (in this case, a propensity for healthier people to be more likely to get vaccinated than less healthy people).
Others have gone
on to demonstrate this bias to be present in other influenza vaccine
studies.17 18 Healthy user bias threatens to render the
observational studies, on which officials’ scientific case rests,
not credible.
But for those that bother to read the CDC’s national guidelines19 - a 68 page document of 33 360 words and 552 references - one finds that the evidence cited is these observational studies that the agency itself acknowledges may be undermined by bias.
The guidelines state:
CDC does not rebut or in any other way respond to these criticisms.
It simply acknowledges them, and leaves it at that.
But there has only been one randomized trial of influenza vaccines in older people - conducted two decades ago - and it showed no mortality benefit (the trial was not powered to detect decreases in mortality or any complications of influenza).
This
means that influenza vaccines are approved for use in older people
despite any clinical trials demonstrating a reduction in serious
outcomes. Approval is instead tied to a demonstrated ability of the
vaccine to induce antibody production, without any evidence that
those antibodies translate into reductions in illness.
Anthony Fauci, director of the US National Institute of Allergy and Infectious Diseases, told the Atlantic that,
The reason? Placebo
recipients would be deprived of influenza vaccines - that is, the
standard of care, thanks to CDC guidelines.
No evidence exists, however, to show that this reduction in risk of symptomatic influenza for a specific population - here, among healthy adults - extrapolates into any reduced risk of serious complications from influenza such as hospitalizations or death in another population (complications largely occur among the frail, older population).
This fact seems hard for many health commentators to grasp, who seem all too ready to take the largest statistic and apply it to all outcomes for all populations.
At a press briefing this winter, CDC director Thomas Frieden said a preliminary CDC study had found,
He explained that this estimate of relative risk reduction:
On the evening news, the CDC’s message was translated into a claim that influenza vaccines will cut the risk of death by 62%, despite the fact that the CDC study did not even measure mortality (Box 2, far above).
Reflecting on the same CDC study, two authors editorialized in the Journal of the American Medical Association that there exists an irrational pessimism about influenza vaccine:
Here, too, the authors appear unaware that the CDC study they cite did not measure any “serious outcome” like pneumonia, only medically attended acute respiratory illness with influenza confirmed by the laboratory.
In October 2009, the US National Institutes of Health produced a promotional YouTube video featuring Fauci.
Urging US citizens to get vaccinated against the H1N1 influenza, Fauci stressed the vaccine’s safety:
Months later, Australia suspended its influenza vaccination program in under five year olds after many (one in every 110 vaccinated) children had febrile convulsions after vaccination.
Another serious reaction to influenza vaccines - and also unexpected - occurred in Sweden and Finland, where H1N1 influenza vaccines were associated with a spike in cases of narcolepsy among adolescents (about one in every 55 000 vaccinated).
Subsequent investigations by governmental
and non-governmental researchers confirmed the vaccine’s role in
these serious events.22 23 24 25
Selling sickness - what’s in a name?
Early 20th century advertising for the mouthwash Listerine, for example, warned readers of the problem of “halitosis” - thereby turning bad breath into a widespread social concern.26
Similarly, in the 1950s and 1960s, Merck launched an extensive campaign to lower the diagnostic threshold for hypertension, and in doing so enlarging the market for its diuretic drug, Diuril (chlorothiazide).27
Today drug companies suggest that we have under-diagnosed epidemics of erectile dysfunction, social anxiety disorder, and female sexual dysfunction, each with their own convenient acronym and an approved medication at the ready.
Could influenza - a disease known for centuries, well defined in terms of its etiology, diagnosis, and prognosis - be yet one more case of disease mongering? I think it is.
But unlike most
stories of selling sickness, here the salesmen are public health
officials, worried little about which brand of vaccine you get so
long as they can convince you to take influenza seriously.
The CDC’s website explains that,
However, a far less
volatile and more reassuring picture of influenza seems likely if
one considers that recorded deaths from influenza declined sharply
over the middle of the 20th century, at least in the United States,
all before the great expansion of vaccination campaigns in the
2000s, and despite three so-called “pandemics” (1957, 1968, 2009)
(fig 1). Crude mortality per 100 000 population, by influenza season (July to June of the following year), for seasons 1930-31 to 2009-10, US.
Data sources: Doshi
P. Am J Pub Health 2008;98:939-45.
The distinction seems subtle, and purely semantic.
But general lack of awareness of the difference might be the primary reason few people realize that even the ideal influenza vaccine, matched perfectly to circulating strains of wild influenza and capable of stopping all influenza viruses, can only deal with a small part of the “flu” problem because most “flu” appears to have nothing to do with influenza.
Every year, hundreds of thousands of respiratory
specimens are tested across the US. Of those tested, on average 16%
are found to be influenza positive. (fig 2).
It’s no wonder so many people feel that “flu shots” don’t
work: for most flues, they can’t.
Fig 2 Proportion of specimens testing positive for influenza at World Health Organization (WHO) Collaborating Laboratories and National Respiratory and Enteric Virus Surveillance System (NREVSS) laboratories through the United States. Data are compiled and published by CDC.28-43
Footnotes
References
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