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Shooting the Masses

Recently I read an article about flu shots that was recommended by a friend. It is a bit of a long read, but very interesting. You see, I think I am contributing to the healthy-users bias. I lead a fairly healthy life: I don't drink or smoke; I am not overweight; I eat lots of vegetables and a fairly balanced diet in general; I am in a monogamous relationship; I have an enjoyable family life. I probably do eat too many cookies and I could certainly exercise more, but I am mostly healthy. I am vaccinated against the big contagious killers like mumps, measles, pertussis, diphtheria, tetanus, etc. And because I have an aversion to nausea, I get my seasonal flu shot each year. I am not worried that I will die from influenza. I just hate barfing. I see no harm in getting a flu shot. The influenza virus seems to mutate every year and there are so many strains we can't even count them, but I like knowing that every year, I am gaining immunity to three more strains. Four if the CDC guessed wrong and I get the flu anyway.

I found the article fascinating because they are looking at the flu and vaccinations from a different angle. They want to find out the efficacy of vaccinations over the entire population. In other words, could we stop flu-related death in its tracks with the vaccination if *everybody* got vaccinated? They think not. You see, over the years since vaccines were available for influenza, there have been precious few studies that were done that accounted for the healthy-users bias. In other words, the generally healthy population is less likely to die from the flu because we are healthy to start with. Now if I had a compromised immune system to start with, I am easy pickings for the influenza virus and will likely die. This is the most interesting case: does the vaccine really help on immuno-compromised people? This is the sick, the old, and the young (the SOY). Since they have a weak immune system to start with, it is much less likely to respond to a vaccine and generate the antibodies that will protect them from the virus. So my guess is that vaccines really aren't as effective against death on the people who need it most.

Another question to consider is whether or not anti-virals, such as Tamiflu, are effective. The U.S. government has spent billions of dollars to stockpile these anti-virals, and there is a very good chance that 1) they don't really work, and 2) they used to work but the viruses are now tolerant of them because they have been ill-prescribed. We need to consider the healthy-users bias again, because a healthy person will likely get over the flu much faster and with fewer complications than the SOY. Don't forget to take into account the placebo effect as well. When people know they are taking a $10/pill medication, they fully expect it to help them get better. Many times they do get better regardless what the pill contains. So many inter-linked factors make it very difficult to produce a study that will give us statistics that we can really trust. (Don't even get me started on statistics...)

The final question I pose is whether or not these trials to test the medications are ethical. To test the placebo effect, you are giving these sick patients absolutely nothing, when they fully believe they are getting a real drug. What if these patients die when the real drug could have helped them? This is a really tricky situation because unless you really test for the placebo effect, you can't tell for sure if your new miracle drug works better than chewing on tongue of newt. (Well, in reality, it would work better, even if it were a placebo because you would be hard pressed to find a person that believed mind and soul that tongue of newt was an efficacious treatment.) So is it ethical to sentence a few people to death to test new drugs that *might* save millions of lives? As long as it is not me is the common answer.

To wrap things up, I say go ahead and get your flu shot because those who do get flu shots have a 50% better chance of not dying from any cause in the next year than those who don't. I believe that the flu shot is good because building immune systems is always a good thing. And as a bonus, they might help you make it through another year without the uncontrollable urge to pray to the porcelain god. But if you really want to stay healthy this year, we should do what really works: stay away from sick people when you are healthy; stay away from healthy people when you are sick; wash your hands regularly; avoid crowded public places; and use your brain. My favorite quote from the article is this:

"There’s no worse place to go than the hospital during flu season," says Majumdar. Those who don’t have the flu are more likely to catch it there, and those who do will spread it around, he says. "But we don’t tell people this."

Ummm. Too late. You just told us. Now that you know, stay home unless you really are dying.