Last week I was asked to give a lecture to the Cardiology Department at Emory and since I had been having an online schermish about the topic I offered “Why I Am Not Getting a Flu Shot This Year“. Well, flu shots are mandated for Emory Healthcare employees so I guess that raised some eyebrows, and I got a call at home asking why I wanted to give a talk about that. After some back and forth I said that I would be willing to give up half of my time, and infectious disease expert James Steinberg MD arrived at the lecture. I presented the fact that randomized controlled trials (RCTs) did not show that flu shots reduced time lost at work or mortality, and that the conclusion of the Cochrane Review is that the evidence does not fit with public health policy when it comes to flu shots, as I have written about before. The one group that might benefit from flu shots according to the Cochrane Review is elderly living in nursing homes, although that may due to the ‘frailty bias’ i.e. some are too infirm to get a shot. A recent study in Lancet of the elderly showed that there was a 40% reduction in pneumonia in vaccinated patients that occured during a time when they could not possibly get the flu; it was mostly due to the bias related to functional status. The actual reduction in flu related pneumonia during the peak flu season was only 4%!
He countered with a study showing that they reduced mortality in cardiac patients (he actually presented only one of two, and the combined evidence is negative, as an article in last month’s Lancet shows). He also showed cohort studies, which are prone to bias.
Finally he showed some studies on vaccination of health care workers showing a reduction in mortality of patients when healthcare workers (HCWs) were immunized. I didn’t think we were talking about HCWs, but I guess that is the reason they showed up. We had some discussions about the utility of immunizing all HCWs, even those not around sick patients, so I thought I would research the topic some more.
It turns out that (surprise, surprise) the evidence for the efficacy of flu shots in HCWs is not that great. The only positive studies are in HCWs who are working with the elderly in nursing homes. And even in that group it looks like both HCWs and the patients need to have flu shots. In fact the Cochrane Review concluded that there wasn’t sufficient evidence to conclude that giving flu shots to HCWs was benificial in reducing mortality in their patients.

The vaccine for the human papilloma virus (HPV) vaccine, Gardasil, was mandated for all young girls in Texas in 2006 and there were proposals for mandated vaccination in a growing number of other states. But a flurry of publicity about conflicts of interests by those who were pushing it in Texas and outcries from those who thought Gardasil shots would make girls run wild in the streets led to a shelving of plans to make it mandatory.

But is the HPV vaccine safe and effective? Since we are trying to prevent cervical cancer that will happen 20 years down the road we don’t in fact know the answer to that question. The fact is that noone did a randomized clinical trial to measure long term outcomes, so we simply don’t know if the risks outweigh the benefits. And in this country most women get pap smears which are very effective at preventing cervical cancer deaths, which are relatively rare compared to other cancers. And the women who get pap smears are going to be the same women who get gardasil, which you have to get every ten years.

And given the concerns parents have had about other vaccines, I am not surprised that some parents get nervous. And recent pushes to get boys to take gardasil is simply excess disease and prevention mongering.

A Freedom of Information Act request to the FDA showed that as of October 2007 there were 1,824 adverse events associated with the vaccine Gardasil, including 11 deaths. Known side effects of Gardasil include pain and swelling at the site of injection. Fever occurs in about 1% of cases. There are also recent reports of girls passing out after getting an injection.

Human Papilloma Virus (HPV) is a virus that is spread by unprotected sexual intercourse that affects more than half of the population. HPV can cause genital warts and in rare cases cervical cancer. For 95% of people, however, they are asymptomatic and never know they have an HPV infection. Although almost all cases of cervical cancer are caused by HPV, since HPV is so ubiquitous it is uncommon for HPV to progress to cervical cancer. Cervical cancer kills 4000 women per year, only 1/10th the death rate of breast cancer, for example. If you do the numbers, that means that about 0.002% of women infected with HPV die each year from HPV-induced cervical cancer–not a very impressive number.

Safe sex practices, although not always realistic behavior to expect, especially in young people, are an alternative way to prevent HPV until more is known about the vaccine. However you should know that condoms won’t always stop infection, since HPV can be spread by parts of the genitals that are not covered by the latex.

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] 

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.]

The second swine flu death in the US was confirmed today, in Texas, where the first death occurred which really wasn’t an American death since it was a Mexican who crossed the border and happened to die in Houston. And the true numbers of deaths are unclear, with the original reports of 150 deaths in Mexico being ratcheted down as now only about 20 deaths or so are actually confirmed as swine flu. The 36,000 deaths per year trotted out every year by the Centers for Disease Control (CDC) here in my hometown of Atlanta, GA, are of course a lie, meant to instill paranoia and justify why we are paying for all of these people at the CDC to protect us from this big bogeyman. It is estimated that less than half of those people actually die from the flu, and that the others are usually very elderly who were immucompromised or on their way out from natural causes anyway. And the hand wringing about so many young people dying in Mexico? Well there aren’t that many actually confirmed deaths now that collective officials stopped letting their heads spin around on their necks and started actually looking at the data.

Fact is, that the swine flu contains elements that have been seen in previous versions of the flu, thus there is some immunity already built in in the population. And if you multiply the 403 confirmed cases in the US in the first month of the presence of the virus times 12 months you get a much smaller number than the hundreds of thousands that get conventional flu, and a much lower death rate! Everybody freaked out about the bird flu, but as I have said repeatedly over the past two years, if it mutated from an H5 version so that it could be transmitted to humans it would probably be less deadly.

But that doesn’t stop Richard Besser MD, acting head of the CDC, Janet Napolitano, head of Homeland Security (doesn’t that title give you the chills?) and Margaret Chan PhD, head of the World Health Organization (whom my blogger friend Rick Lippin MD recently called on to resign given her fear mongering in elevating the pandemic rating to Phase 5) from continuing to stir up fear and paranoia in the interest of keeping the public “informed”. I mean after all if there is no world wide catastrophe (as there won’t be) they can always just say better safe than sorry.

But anyhoo since we now have two deaths, that means that swine flu jumps ahead of bear attacks as a cause of mortality in the US. That is if you live in Alaska. Since only one person dies from bear attack every other year and that is usually in Alaska. They have whole magazines about it.

Deaths from swine flu surge past bear attacks

The more interesting question is when the musical chairs are gonna stop and everyone is gonna realize that this is all just one big bs media debacle. Alas, we can always claim that we have to wait until the fall when the ‘big one’ pandemic hits big time.

I’m sure former CDC Director Julie Geberding is glad that she resigned when she did. It was one of those political fall on your swords things, like she was a Bush girl and now time to go. But lets not dwell on many of the CDC trip ups of her reign, like ignoring the fact that the formaldihyde in trailers of Hurricane Katrina was making people sick, or ignoring Hurricane Katrina for that matter, or allowing her report on global warming to be edited by the Bush White House, or distorting research data on obesity to get more funding for her agency, or lying about the case of Andrew Speaker who was trumped up as a drug resistant XDR TB case (he wasn’t) which came about as part of the CDC strategy to get more funding by publicizing XDR TB as reported in the Atlanta Journal Constitution, or distorting obesity research findings for same purpose, or causing massive numbers of competent and respected scientists to leave CDC for her politicies and decisions, etc etc. So she is now riding into the sunset. Bye the bye, Julie.

Goodbye, Julie. Thank you for your years of "leadership" at CDC. You will not be missed.

 See you.. in September…

Here is a nice quote from a secretary of health, education, and welfare:

There is evidence there will be a major flu epidemic this coming fall. The indication is that we will see a return of the 1918 flu virus that is the most virulent form of the flu. In 1918 a half million Americans died. The projections are that this virus will kill one million Americans [this year].

Kathleen Sebelius? Nope! It is F. David Matthews, and the year was 1976. Quoted in this recent article in Salon about the *last* great epidemic of swine flu, when Gerry Ford vaccinated 40 million people, didn’t save anyone from swine flu but killed 30 people with Guillain Barre. Oui oui!

That should provide some calm in the wake of frenetic media activity about the approaching storm. So-called epidemics usually don’t turn out as badly as everyone thinks they will. Remember the bird flu panic? A reader turned me on to google trends, which lets you compare things like the number of google searchs for “swine flu” v “bird flu”. In other words how much people are freaking out about it. Well, this search shows that there were a few bird flu panics in 2005, but swine flu is now approaching its peak “freak out level” if you will (see sharp peak at furthest right side of the graph):

Google trends "freak-o-meter" shows swine flu catching up to bird flu.

Notice that the journalism or “CNN freak-o-meter” is going off the charts.

To help add to the anxiety, the CDC has posted this helpful “flu surge” software to help administrators plot out the growing pandemic. I am sure it is based only on valid assumptions. At least they won’t be losing their jobs in the recession. And, oh, the swine flu is doing a great job of keeping attention away from some of their recent debacles, like the fact that today it was announced that Atlanta attorney Andrew Speaker is bringing a law suit against the CDC for their shameful actions in publicly announcing that he had a drug resistant form of TB while he was getting married in Europe and that he couldn’t travel (even though they gave him permission to leave). He called to ask what to do so they said charter a jet (only $140,000, which he of course could not afford) so he flew back through Canada. They made a big publicity thing out of it which led to accusations that the CDC was hyping the case to generate more funding. Of course this came out in reporting by our local paper Atlanta Journal Constitution, and everyone is glad to see those kind of papers die out, aren’t they. Now, post marriage, with the fact revealed that he did not have a dangerous form of TB, he is pretty pissed off, and who can blame him? All the CDC can say is… thanks swine flu! Or is it H1N1?

Flu surge software from CDC

I couldn’t get it to work. Just as well.

Meanwhile swine flu anxiety spreads throughout the land.

LOLcat anxious over swine flu

At places like my employer Emory University people are flipping out, mailing daily updates on how to identify and treat the flu; yesterday they gave emergency powers in the case of an influenza pandemic to the Governor of the State of Georgia, Sonny Perdue. And yesterday the WHO upgraded the virus to a Phase #5, underwhich he can declare emergency powers. When asked if he was going to do so, he replied “Not when there has not been a single case yet in the State of Georgia.”

ROTFL! You can’t make this stuff up!

Oh, and Vice President Joe Biden told his family not to take ANY planes or subways, which freaked the travel industry out of course. Nice fear mongering, Joe. He should take a page from the CDC.

To put things in perspective, the actual causes of mortality in the US run down like this:

My source here was JAMA, but they didn’t add the 100,000 who die each year from prescription medications or related medical errors. That’s the problem with my fellow doctors, they don’t like to admit that their treatments sometimes hurt people.

I think the psychology of risk is interesting. Like why do people worry about an infection that isn’t even in their state, but not a car accident? I think we are hard wired to freak out over infections. We can smell people and animals who are sick, molecules from them literally enter our noses and impact neurons directly in our smell center that go direct to the emotion part of the brain, the amygdala, bypassing the parts of the brain involved in rational thought. We don’t “smell” car accidents in advance, or if we do it is too late. And what do we do if we smell someone sick? We tell our friends, so they can stay away.

In other news, the Mexican press is reporting local suspicions that the swine flu came from a giant Concentrated Animal Feeding Operation (CAFO) outside of La Gloria, Vera Cruz, Mexico, called Granjo Callas, a subsidiary of Smithfield Foods, where there are large amounts of animal waste and flies that could have been a vector. Mexican government officials, of course, blame Chinese CAFOs.

And although Alice B. Toklas would say that a Rose is a Rose is a Rose, apparently for swine flu you could say that a pig is a pig is a pig is a pig is a pig is a pig is a bird is a human. That’s right, 6/8 of the genetic fragments of the virus come from pigs, one comes from bird and one from human flu virus. That is why several experts are saying that the move to change its name from swine flu to something else is absurd. ”Scientifically it is a swine virus,” one expert said. Nevertheless both Muslim and Jewish groups as well as the Pork Industry are objecting to the name, on the logical grounds that, um, they don’t eat pork, therefore it is somehow unholy for them to get infected (make sense? religion never made much sense to me either). But they didn’t stop the CDC from officially changing the name to “H1N1″ or something like that. Too bad noone told their webmaster to stop calling it swine flu on their website. As for me, I am not changing the name anytime soon.

Don't call ME H1N1, that is if you want to get lucky, honey!

There are now 109 CDC laboratory confirmed cases in the US with one death. And in Congress they are hankering after closing the border with Mexico. All schools and businesses are now closed in Mexico, with the exception of emergency services, and the Fort Worth TX school system has been closed, there are other scattered school closings throughout the US, with a spreading of confirmed cases in 12 US States, including California, New York, Maine, Kansas, Indiana, Ohio, Arizona, Massachusetts, Nevada, Michigan and Washington State. There are also confirmed cases throught Europe and now Peru.

Distribution of swine flu cases in the US

So I guess we’ll all have to move to Africa.

BTW I am getting tired of this swine flu crap and hope to “move on” in the future, unless there is something really earth shattering that develops, other than stupid decisions by government officials.

Hat tip to Rick Lippin and Susie from Europe.

Today there was the first death in the US from swine flu, a 23 month old in Houston, Texas, and the earliest case found so far was identified in La Gloria, Mexico, a five year old named Edgar Hernandez. Schools are closed throughout Mexico, and the virus continues to spread, with over 150 dead in Mexico (20 confirmed), and 91 CDC confirmed cases in California, New York, Texas, Ohio, Kansas, Indiana. Based on this news we have to consider the possibility of school closings here. Some have already started to close in California, South Carolina, Connecticut and Ohio. Protective masks are flying off the shelves in the US. Oh, and Israel said that the name “swine flu” is offensive to Jews.

Check out this nifty graphic for a world wide map of the spread of the flu and what countries are doing about it.

Swine Flu World-Wide Distribution

The biggest death toll so far is in Egypt, where they are slaughtering all 300,000 of their pigs. That’s a real rational move, considering it is mostly human-to-human transmission anyway. But considering the fact that only the 10% Christian minority have pigs there anyway, they probably figured it was no big deal.

Roche and Glaxo, makers of Tamiflu and Relenza, respectively, are watching their stocks shoot upward with beady little eyes, thrilled that they get to pursue their primary aim of making profits while looking like good guys to boot.

Meanwhile Representative Michelle Bachmann (R-Minn.) suggested that swine flu was a plot of the Democrats to foist national healthcare and increased spending on medical research (hmmm, maybe not such bad ideas after all), taking her cue from yesterday’s rants by talk show host Rush Limbaugh and his unemployed white male fan club. And Republican leader Michael Steele defended the previous Republican opposition to spending in the stimulus bill on preparation for pandemics on the grounds that “it couldn’t have been predicted“. Yeah right, like the breach of the New Orleans levees. Go figure.

As I wrote yesterday, current flu vaccines are not effective against the swine flu, and it will take six months to make an effective vaccine. What is more disturbing is that our wonderful war on terror has not resulted in an ability to manufacture vaccines, with only one site in the US, Sanofi Pasteur, currently able to manufacture vaccines. And those are made from hen’s eggs. Go technology, go war on terror. And with current manufacturing capability we will only be able to make 6 million doses by September, which is 10% of the total needed to vaccinate the population of the US. Which introduces the possibility of rationing. Who should get the vaccine first? Well public officials, of course.

Meanwhile acting CDC Director Richard Besser continues to tell the lie that 36,000 people die every year from influenza and that we need to start thinking about the “conventional flu” vaccine. As I wrote here before (”Flu shots are for idiots“) only half of those really had the flu, those who did were often the elderly who might be immune impaired and unable to benefit from flu shots anyway, and since the flu virus mutates by the time they make a flu shot less than half of the bugs are blocked by the current flu shot. In spite of the fact that experts tell us that flu shots for the conventional flu are a waste of time and money, public officials at the CDC and elsewhere continue to tell us to get them. One thing that is sure, though, is that 34,000 people will die this year from car accidents.

We're sure glad we don't live in Egypt!

Another thing that hasn’t been covered in the media which I wrote about yesterday, and have been harping on since last year, is the fact that some H1N1 strains of flu are resistant to the anti-malarial drug Tamiflu. For instance, as I said yesterday the CDC claims swine flu is susceptible to Tamiflu. But on what evidence? It takes them a week to grow out the virus and see what drugs it is susceptible to. And why didn’t it save that 23 month old in Houston? Is the government continuing its pattern of hyping Tamiflu inappropriately? Maybe the same confluence of commercial interest and misplaced concerns discussed in relation to conventional flu shots described by flu expert Thomas Jefferson a few years ago.

Ominously, vaccine expert David Fedson MD, was quoted today as saying countries are likely to ration their flu shots to their own countries. Since all but one are out of the country, we aren’t looking too good. And we haven’t exactly been nice to France, at least during the Bush years. Can you say “s’il vous plait?”

Dr. Fedson is sitting pretty though, living in France with his second wife and consulting to drug companies. I’m sure he will get his flu shot.

My latest update on swine flu and treatment with Tamiflu is on the CNN website AC360 here.

Not from swine flu, though. Got your attention though, didn’t I. The fact is that over 43,000 die before their time in the U.S. each year… not from swine flu, but from car accidents. If you think I am trying to make a point, I am.

I woke up this morning to breaking news that reveals that over 100 people have died in Mexico from a recent outbreak of swine flu, with a 1,000 known cases total, turning Mexico City into a ghost town as people stay at home to avoid contagion, with those on the streets all wearing masks.

Mexico City became a ghost town as swine flu spread.

This morning it was reported that there are currently 20 cases in the US, including New York and California. However Mayor Bloomberg of NYC held a news conference to state that 28 cases were reported from one school in NYC alone. The strain is H1N1 and so far in Mexico it is primarily a pig to human transfer only, not human to human. Although there is some news that the US cases may be transmittable human to human, they probably are less severe cases. The Europeans are recommending travelers to cancel trips to Mexico and the US. Hong Kong is putting everyone coming from Mexico with a fever in quarantine.

Map of distribution of swine flu cases as of April 27, 2009.

The virus does not make it unsafe to eat pork. That does not stop those brilliant promoters of rational thought, the Russians, from telling people not to eat pork.

I'm still safe to eat, and tasty as ever!

I have been writing about bird flu and other topics literally for years (see “Bird Flu Drugs are for Bird Brains“), even since former Chief Weasel in Charge of War Crimes Donald Rumsfeld made a bundle by hyping the bird flu epidemic and then watching the profits from the bird flu drug Tamiflu (oseltamivir) soar (since he was the former CEO of the company that developed Tamiflu he made over a million dollars profit in just a few months). Once the bird flu (type A H5N1) mutated and became transmittable from humans to humans Tamiflu probably wouldn’t work any more. Sure enough, last year there were cases of A H1N1, a form that was transmittable to humans, for which Tamiflu didn’t work anymore. Tamiflu works against type A H3N2 and type B but not against some forms of type A H1N1. Type A H1N1 can be treated with Relenza (zanamivir), an inhaled drug. For people who can’t tolerate inhaled drugs, they can take rimantidine or amantidine, which work against H1N1 but not H3N2 or type B flu. The only place that can test for the flu strain in the US is the Centers for Disease Control, in Atlanta GA.

I guess we are all transfixed with fears of pandemics of the flu because of the 1918 flu epidemic which killed ten million people worldwide, about 10% of those who became infected.

The 1918 flu epidemic killed 10 million world wide

However with modern supportive medicine it is unlikely that so many people will die. Not all forms of H1N1 are Tamiflu resistant and it is unclear what swine flu is best treated with at this point or how deadly it is. You are infectious for one day before getting symptoms and seven days after the onset of flu symptoms so it is possible to infect people before you have symptoms. I wouldn’t be surprised if we have a slew of face masks spreading across the country in the next few days. Stay tuned!

In the news today is an article about the influenza virus which continues to quote the bogus statistics promulgated by the CDC that 36,000 die every year from the flu (half of those are actually “flu-like illness” which is NOT the flu) and panders idiot advice that everyone should get the flu shot. What’s new is that they point out the fact that the number of flu strains resistant to the bird flu drug Tamiflu (oseltamivir) is growing. It’s not just that the makers of Tamiflu, Hoffman LaRoche, are my least favorite drug company, but that I have been predicting for over a year that if and when the bird flu became transmitable to humans, that Tamiflu would no longer be effective because the virus would have mutated (see “Bird Flu Drugs are for Bird Brains” if you don’t believe me). The other anti flu drug in this class is Relenza (zanamivir) which is taken in inhaled form.

The most widely prevalent strain of the flu this year, Type A H1N1, is resistant to Tamiflu. Type A H3N2 and Type B are not. H1N1 can be treated with Relenza if patients can tolerate the inhalation method. If not they can take amantadine or rimantidine, but those drugs don’t work against H3N2 flu or type B flu. Giving two drugs increases the side effects of nausea, nervousness and dizziness.

The actual bird flu, H5N1, was found last year to have been developing resistance to Tamiflu last year, as I had originally predicted, when it was reported that although previously less that 1% of influenza viruses were resistant to Tamiflu, that number increased to as many as 13%. The experts were quoted as saying that they were “surprised” that the virus could mutate to a form that is transmitable to humans and still be viable. However as I had previously pointed out in “Bird Flu Drugs are for Bird Brains” , if bird flu mutated to have human to human transmission, bird flu drugs probably wouldn’t work anymore. But of course that didn’t stop the promotional machine from scaring the living daylights out of people and pumping up sales for Tamiflu.

Our former Chief Weasel in Charge of War Crimes Donald Rumsfeld personally made over a million dollars from the publicity through the stock he owns in the company that developed Tamiflu when the bird flu panic struck, which he promulgated by holding press conferences to tell us that we were all about to die from the bird flu. Remember when, in response to the looting in Iraq a few years back, he said “Henny Penny the sky is falling!” Well he probably said “Don’t worry, Henny, your bird flu drug will protect you.”

Here’s a little virology 101. Bird flu is transmitted from birds to birds, not birds to humans. Actual human infections are pretty rare. And when and if it does mutate into a virus that can be transmitted to humans, the vaccine probably won’t work anymore. What about for the regular flu? Tamiflu (and Zanamivir) are neuraminidase inhibitors; they prevent replication of influenza A and B viruses by interfering with the production and release of virus from cells that line the respiratory tract. They both need to be taken within 48 hours of the onset of flu symptoms to be useful. Although I say “useful” with tongue in cheek; if you get the flu, Tamiflu will reduce the number of days you have symptoms from about seven to about five. Not a very big deal. And in terms of prevention, they cut your risk by about half. I don’t want to take a drug all the time to prevent flu, do you? And if you take it after someone in your house gets sick, it’s too late to prevent the flu.

Not only are drug companies trying get your money, gentle reader, it looks they want to drive you crazy as well. The Japanese drug regulatory agency has reported 64 cases of neuropsychiatric side effects, including “impaired consciousness, abnormal behaviors, hallucinations and other psychological and neurological symptoms” associated with Tamiflu, including two suicides. There have also been reports of seizures. A spokesperson for the manufacturer of Tamiflu, however, denied that there was any association (they always say that—do you ever wonder if they have real people making these comments, or just some virtual online being or avatar or something programmed to say “we see no evidence of an association”)?

In this week’s bmj there is an article by Thomas Jefferson of the Cochrane Vaccine Institute (”Relation of study quality, concordance, take home message, funding, and impact in studies of influenza vaccines: systematic review“) whom I have often quoted before (”Flu Shots are for Idiots“) regarding the dubious evidence behind policy recommendations regarding flu shots. Now he presents data that studies of flu shots funded by pharmaceutical companies are more likely to be published in prestigious journals than those funded by other sources, in spite of the fact that they have the sample sample size and comparable methodology. He goes on to write:

The study shows that one of the levers for accessing prestige journals is the financial size of your sponsor. Pharmaceutical sponsors order many reprints of studies supporting their products, often with in-house translations into many languages. They will also purchase publicity space on the journal. Many publishers openly advertise these services on their website. It is time journals made a full disclosure of their sources of funding.

A position supported by the staff at Drug Safety and Health News. He goes on to discuss the “impact factor”, a metric related to how many times other authors of journal articles cite you in their articles, which is supposed to be a measure of how good or important your study is. However there is a tendency to cite articles in the big journals like JAMA or New England Journal of Medicine just because we all think that if they got in there they must be really good. What this does is give an advantage to those physicians and researchers who are doing the clinical trials funded by pharma, makes them more cited, enhancing their prestige, and hence even more valuable to their pharma friends. Soon everyone is wining and dining, have a good time, and making more money all around.

Yeah! Let's Have Some Drugs with our Wine!

But you can see how this has a corrupting influence on the practise of medicine. As pointed out in a letter to the editor of Houmatoday.com in Terrabonne Parish, Louisiana, by Dr. Randolph M. Howes (”Death by Peanut Butter or Drugs?”) 50% more people die of prescription drugs every hour than have collectively died from peanut butter.

Hat tip to Dan Abshear.