Why I am Not Getting a Flu Shot This Year

Sep 23 2009

I have been having a back and forth with some of the MDs at Science Based Barfers (oops, I mean BLOGGERS) about the utility of flu shots. I had suspected all along that David Gorski, MD PhD, was behind it all along, as he had been grumbling in the past about me in the comments section of a blog related to a dispute over the diagnosis of PTSD.

David Gorski, MD, PhD, author of "Respectful Insolence"

Dr. Gorski has a one pony show on his “Respectful insolence” blog related to knocking down alternative medicine and vaccine opponents and pals around with other MD bloggers. He started out as the anonymous “Orac” but got revealed by some persistent cyber sleuthers.

Anyhoo it started out with a random strike by Peter Lipson MD who wrote “Before You Trust That Blog” which I responded to here. Gorski later revealed that he had become incensed because my original blog “Flu Shots are for Idiots” (which actually dates back to 2007 but which I reposted as “Flu Shots Are [Still] for Idiots” in December 2008) was being circulated, and had invited the SBM guys to take a swat. Following my response Gorski wrote his own response about why he was getting a flu shot with a response by Rick Lippin MD on my behalf, which he also posted on his own blog, basically saying stop acting like such a, well, troll.

I guess I should feel that I have somehow arrived since the response to my book and later my blog from physicians was, well, to not respond. At least until now.

They start out by saying that I am against the drug industry, that there have been a lot of life saving drugs developed by the pharmaceutical industry, and that I am paranoidly positing a conspiracy amongst drug companies that does not exist. Well first of all as I have said many times before I don’t have anything against drug companies per se and I think there are a lot of medications that have benefits for certain people in certain situations. I am just advocating for the right of people to know the true risks and benefits of prescription medications and to be able to educate themselves and not just take the word of some “I am right” doctors. Which is what these guys look like. To me at least.

Second of all, as for a “conspiracy”, I had to do my usual lookup of the definition and came up with the following.

con⋅spir⋅a⋅cy /kənˈspɪrəsi/ [kuhn-spir-uh-see]

–noun, plural -cies.

1.	the act of conspiring.

2.	an evil, unlawful, treacherous, or surreptitious plan formulated in secret by two or more persons; plot.

3.	a combination of persons for a secret, unlawful, or evil purpose: He joined the conspiracy to overthrow the government.

4.	Law. an agreement by two or more persons to commit a crime, fraud, or other wrongful act.

5.	any concurrence in action; combination in bringing about a given result.

Well I think that the Pharmaceutical Research and Manufacturing Association (PhRMA) headed by Billy Tauzin might qualify, don’t you? Or a pervasive pattern of drug companies to manipulate study results, manufacture publications, market off label, cover up side effect profiles, inflate prices and profits at the expense of the consumers (and tax payers), a pattern that extends across companies, would qualify, don’t you?

When you get behind the fuss and feathers of what the doctor bloggers are saying there is not a lot to their arguments. For instance Gorski points to a blog written on SBM by “revere” which is actually a blog written by a compendium of public health officials talking about why the H1N1 “swine” flu shouldn’t dissuade us from getting vaccinated against the “regular” flu. First of all they don’t give any good reasons to get vaccinated at all, and second of all if you read the comment section in my prior post you see that they admit that the question of whether flu shots are useful is “technically difficult”. I don’t see a reason to panic about either the swine flu or regular flu.

LOLcat anxious over swine flu

Lipson points to a study in NEJM which is in fact a cohort study, meaning that they compared one group of the elderly living in the community in one part of Canada to another group in another part of Canada who didn’t get the flu shot. Any methodologist will tell you that these kinds of studies are potentially rife with errors, which is why the RCT is the gold standard. The other study he points to is also a cohort study.

My original position was based on a bmj editorial by, yes, an epidemiologist, Tom Jefferson, who pointed out that randomized clinical trials (RCTs) had not shown that flu shots prevent deaths, loss of productivity or loss of work days in people who do not have lung disease. Dr. Lipson says that this editorial was “eviscerated” in a letter to the editor. Perusal of the letter, however, merely shows that the author was arguing in favor of using observational data and not requiring randomized trials, not really adding much or pointing out any fundamental flaw of Jefferson’s logic. We have all seen the dangers of relying on observational data which led to the use of hormone replacement therapy (HRT) in millions of women based on the chowder headed idea that these would decrease heart disease and cancer when, in fact, they did the opposite.

[update: Gorski also wrote a a response to my original response here.]

Tags: Alternative Medicine, David Gorski, Influenza, Peter Lipson, Prevention, screening, Vaccines

Filed in Screening & Prevention, Vaccines | Doug Bremner

24 Comments

By Therapy Patient, September 23, 2009 @ 12:02 pm

I’ve been puzzling over the flu shot issue. I read your blog and think about what you say, but for any issue I need to go through the arguments I read, then form my own opinion before taking action.

In the past, I have been getting the flu shot annually (before reading your blog), understanding that the flu virus may mutate and therefore not match the immunity I get from the vaccine. That part is OK with me – that it is imperfect.

I reread your previous article and it seems that your argument boils down to: flu is relatively rare and if you do get it you will be darned sick for a few days but you likely will not die (also that it costs money and hurts your arm).

Isn’t it valid to get the vaccine if you just do not want to be darned sick for 4 days? I have never thought I am a candidate for dying from it, but because of my exposure to hundreds of people weekly I have thought just not getting flu was a pretty nice concept. I am seemingly very healthy, only 58, don’t have lung disease, do not smoke, and my immune system seems up to snuff since I get few colds and have lots of veggies and sleep. I hate the flu, though. I don’t mind the “arm stick” nor the money and really would rather that than the flu. So what is the harm in getting the vaccine other than the $$ and arm stick? Are there health risks? I know some people get mild flu-like symptoms, but I never have. I get it and I am off an running again. I may well not have gotten the flu anyway, but I pay lots more for insurance in case my house burns down, and my house never has burned down. That’s an even bigger pile of money.

I read other information including the CDC and a medical research article the CDC referenced. I did a calculation on the figures provided and determined that of the American populated, only 0.075 percent (0.00075) will be hospitalized for flu or flu related complications. Most of those are people over 85, so that in the over 85 population, 1.2 percent (0.01195) are hospitalized annually for flu or flu-related complications. That’s supporting information for your case

YES, I agree that the pharmaceutical companies do constitute a conspiracy. It’s shameful and needs to be stopped. Also Gorski seems like an idiot. Only big Pharma would want to go after alternative medicine and vaccines so you can see who he’s in bed with.
By Doug Bremner, September 23, 2009 @ 5:28 pm

Yes, to be clear the flu shot does reduce (although not eliminate) your chance of getting flu, and if that is your goal than it is worth it. I am just trying to counter the ‘everybody needs to get one’ prevailing attitude.
By carolyn, September 23, 2009 @ 11:12 pm

i’ve never gotten a flu shot and i never will. i occasionally get the flu, once every few years and its no big deal. i generally get it when i’m run down.
why won’t i get a flu shot? well, my cousin’s wife got one years ago and she had a bad reaction. she spent a year in a wheelchair, paralyzed. i thought spending a few days in bed feeling like crap was far better than spending a year in a wheelchair. call me crazy…
i’m also doing my part to keep health care costs down by avoiding unnecessary medical treatments.
i’m also trying as ahrd as i can to keep my dollars OUT of big pharma’s deep pockets!
By Alan, September 24, 2009 @ 4:15 am

Your comment that “…had not shown that flu shots prevent deaths, …in people who do not have lung disease,” validates my decision to get an annual flu shot because I have COPD – thank you.

If not for the COPD, I’m not part of the “at risk” population for the H1N1 flu, and was not planning on getting that particular vaccination. I’ll have to check with my MD if my COPD puts me “at risk”.

If I decide to get an H1N1 vaccination (a decision I won’t make lightly), I’ll definitely wait a while and see what kind of side-effects a large percentage of the vaccinated “at risk” population experience. I’m leery of the potential side-effects since the vaccine development and production was such a rush job, and who knows if this impending pandemic will really be a disastrous “bring out your dead” scenario, or something much milder.

I guess time will tell.
By Barbara, September 24, 2009 @ 8:04 am

I went with my adult kids to the pediatrician with their new born. I asked the doctor about why babies need all these shots their first year. He said, “You either believe in science or your don’t!” I wanted to say to him, “You either believe in Marketing or you don’t!” But I knew my kids would die of embarrassment so I was quiet. Now my grand daughter is ten months old and she has chronic ear infections and the Doctor is slowly trying stronger and stronger antibiotics. Next, he says, she goes to an ear, nose and throat doctor. So here comes tubes –GFB! My husband and I take care of her all week while her parents work and go to school. Now where did she get ear infections if she’s never around other kids?
By Dr. Rick Lippin, September 24, 2009 @ 9:25 am

see from Stratfor.com- a private credible global intelligence company

The critical factor to bear in mind is that all strains of influenza claim thousands of lives every year. In the United States, on average, some 36,000 people die of flu every year – 1,100 in New York alone. Globally, deaths related to influenza are estimated to range from 250,000 to 500,000 people per year. So far this year, only about 3,000 people have died worldwide in relation to the A(H1N1) outbreak, and most of those deaths occurred during the flu season in the Southern Hemisphere. From a statistical perspective, at present, H1N1 nearly falls into the range of background noise.

Bottom line: While H1N1 is as communicable as the traditional flu strains, it has shown no inclination to be more deadly. In fact, from what can be discerned from the New York City data, the mortality rate lingers on the edge of the statistically insignificant — a 0.00675 percent mortality rate among those contracting the virus, translating into a 0.00064 percent mortality rate among the general population.

Dr. Rick Lippin
Southampton,Pa
By Therapy Patient, September 24, 2009 @ 9:55 am

I wonder if there is risk associated with the presence of Thimerosal in much of the flu vaccine. It breaks down to produce ethyl mercury in the body.
From the CDC:
Yes, the majority of influenza vaccines distributed in the United States currently contain thimerosal as a preservative.
I know that mercury is a neurotoxic and some people have suggested it may cause autism. I wonder the effects in adults. Also I read that the H1N1 vaccine may have MF59/Squalene, and adjvant. Also supposedly the flu vaccine contains a new ingredient, nonoxynol 9. Then there was the problem in 1976 with Guillain-Barre syndrome resulting from the flue shot.
By ChicaDificil, September 24, 2009 @ 10:30 am

Dr. Bremner: I am wondering what your thoughts are about the flu shot for pregnant women. I am 4 months pregnant and also work at a hospital as a clinical psychologist. I would not care so much about passing up the flu shot if I were not pregnant, but I have heard that getting the flu while pregnant can have pretty devastating effects on the fetus. One thing I remember learning in graduate school–and I can’t reference this because I read it so many years ago–is that women who get the flu while pregnant are at higher risks of producing babies who later develop schizophrenia.

I am also wondering about your thoughts of the swine flue vaccine for pregnant women. As you probably already heard, they say pregnant women are one of the most vulnerable populations for developing complications from swine flu. Of course, I also worry about the effects of this very new vaccine on the fetus. My Ob-Gyn assures me that I don’t have anything to worry about.
By Dr. Rick Lippin, September 24, 2009 @ 4:57 pm

IMAGINE…JUST IMAGINE… that all the money and resources we have squandered on H1N1 flu issue (about to fizzle) were spent on putting in basic health centers in poor minority communities.
By Doug Bremner, September 24, 2009 @ 5:26 pm

I’m not sure about the risk/benefit profile for pregnant women and leave others to comment.
By carolyn, September 24, 2009 @ 6:44 pm

my cousin’s wife was part of the 1976 group who got Guillain-Barre syndrome
By Doug Bremner, September 24, 2009 @ 10:09 pm

Oh btw I wrote this because I am giving a lecture of same title tomorrow Emory Hosp 4th floor Hearst room at noon and now have conceded half of the time to an ID person based on emory ‘push back’ who will offer a rebuttal so it should be more interesting than the usual lets fall asleep together lecture format.
By Doug Bremner, September 24, 2009 @ 10:09 pm

oh, open to public
By Doug Bremner, September 24, 2009 @ 10:10 pm

oh and emory healthcare is now mandating flu shots for all employees so that is why there is a fuss.
By trrll, September 24, 2009 @ 11:13 pm

Therapy Patient writes, “I wonder if there is risk associated with the presence of Thimerosal in much of the flu vaccine. It breaks down to produce ethyl mercury in the body.”

I wouldn’t worry about thimerosal in vaccines. The dose is very low, and recent studies have shown that ethyl mercury is eliminated rapidly from the body, so it doesn’t seem likely to hang around long enough to cause harm. With heavy metals, the major concern is that they may build up in the body with constant low-dose exposure: an acute exposure once a year or so is not really a concern. So if you are seriously concerned about mercury, you would accomplish more by avoiding tunafish than by skipping the flu vaccine. No adverse effects of thimerosal in vaccines have ever been identified. A number of countries, including the US, eliminated or greatly reduced exposure to thimerosal in childhood vaccines some years back, with no discernible impact on the incidence of autism, and the mercury hypothesis is no longer taken seriously within the autism research community. It was always a long shot, because while mercury is a neurotoxin, the symptoms of severe mercury poisoning in children are known from industrial accidents, and they do not resemble autism.
By henry, September 25, 2009 @ 2:11 am

How about the risk/benefit profile for children with conditions such as chronic lung disease?
By daedalus2u, September 25, 2009 @ 7:43 am

I went to a talk by Paul Patterson

http://autism.mit.edu/patterson

where he talked about his research on immune system stimulation in utero on neurological development. He mentioned that sporadic schizophrenia is so strongly associated with exposure to flu in utero that if all flu in pregnant women was eliminated that the incidence of schizophrenia would go down by ~25%. He mentioned that at a conference (of immunologists? schizophrenia researchers? I don’t remember) someone asked about flu vaccinations for pregnant women and not one of the attendees would not do it because flu has such bad effects in utero. The in utero effects are mediated through the immune system, vaccination with non-pathogenic agents such as DNA causing the same effects.

I would get both flu shots for myself with no hesitation, but I am male. If my SO were pregnant, I would recommend that she get them too, but probably take a day off to minimize the stress surrounding it (stress acts as an adjuvant) and not take stuff to minimize the symptoms (i.e. Tylenol) because I suspect that some of the symptoms relate to physiology that is balancing adverse effects. If you suppress those symptoms the adverse effects which don’t have symptoms are not balanced. I know this sounds woo-like, but I don’t think it is.
By Michele in Michigan, September 25, 2009 @ 2:07 pm

Barbara, I’m a mom of a kids with ear tubes. Some kids get ear infections, not because they are exposed to a lot of outside bacteria, but because their eustachian tubes are more horizontal than slanted. They do not drain properly, and the moist environment encourages bacterial infections. Many kids grow out of this by age 5 or 6. As their face grows the eustachian tube slant and drain better.

Tubes have been very beneficial to my son. Before tubes mild hearing loss and as least one perforated ear drum. After tubes, no infections, good hearing. He also is a happier more comfortable guy.
By Richard Van Slyke, September 25, 2009 @ 11:17 pm

I just tried to join the FB page “Protest Grady Hospital’s Death Sentence for Dialysis Patients”, but the link is not working.
I’m getting a message that “Face Book still has a few kinks to work out”.
By henry, September 26, 2009 @ 1:42 am

I seem to be one of the few dissenters here. There is an underlying assumption in all the postings about both the HPV and the H1N1 vaccines that we are dealing with a homogeneous population. We forget that there are large numbers of disenfranchised Americans without access to “routine” health care (like pap smears). There are also large numbers of Americans who live in poverty and crowded living conditions. If one looks at the data from the H1N1, a not unsurprising finding leaps out. In large cities such as Boston, the poorer black and Hispanic communities have a much higher morbidity and mortality than average. Likewise, here in Washington State, we have seen a very high rate of severe illness from H1N1 among the native American population living on reservations. Among the pediatric population, we also see a disproportionate effect on children with chronic heart and lung problems and with neuromuscular conditions. Finally, there is a higher risk to pregnant women. While I do not endorse mandatory vaccination for all, I think it is very much a case of throwing out the baby with the bathwater to condemn these vaccines out of hand. It is one thing to disagree with the marketing and profiteering that has become the American way, quite another to disavow any benefits from the vaccines. After all, there is a reason that our infant mortality rate approaches that of a third world country.
By henry, September 26, 2009 @ 1:55 am

Michele,
It is always good to here from the voice of experience. There are many factors that contribute to chronic middle ear problems in young children. The factors you mentioned, plus genetics, exposure, and just plain bad luck all play a part. How quickly people forget that significant hearing loss from middle ear disease was once common. (It still is among the indigenous population in the subarctic and arctic regions.) It has become obvious that repeated courses of antibiotics are not a solution. For a select group of children with truly chronic problems, the “tubes” are a blessing. They buy the necessary time for a child to develop their own defenses and prevent significant misery.
By AZ, October 6, 2009 @ 9:50 pm

What happened to the “Avian” bird flu issue? Must all be a government conspiracy to get our mind and pockets off the real problems that are besotting our country. LIKE THE DEVALUATION OF THE DOLLAR AND THE COUNTRY NEAR SEVERE INFLATION, AND POSSIBLE DEPRESSION! You will be buying your next flu shot with yen, and it will cost a lot more!