

Flu shots aren’t good science - scottw
http://scott.wiersdorf.org/blarney/091024a.html

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m_eiman
I don't see the problem as a scientific one if the vaccine is effective
against what is't supposed to be effective against.

If the problem is that "people" believe that a vaccine against one flu strain
will protect them from getting sick from a variety of _other_ viruses, it's a
marketing problem.

~~~
gregwebs
People believe what their government tells them. In this case it is the CDC,
recommending an influenza vaccine for everyone older than 6 months, and
particularly for certain at risk groups. The CDC is representing the science
as demonstrating a high effectiveness, which as these review articles point
out, is not the case.

This is not just a problem of CDC marketing, though. As the Atlantic article
points out, the scientists that are publishing research showing a lack of
effectiveness in vaccines are not getting equal treatment among their peers
who still believe them to effective.

~~~
carbocation
The CDC does not advertise high effectiveness. This seems to be a strawman you
are knocking down. If you administer a fairly ineffective vaccine, you will
still save hundreds of lives. With a very effective vaccine, you'd save even
more.

~~~
gregwebs
If you read the Atlantic article, the CDC believes vaccines to be so effective
in the elderly that it would be immoral to do a randomized controlled trial.

You can also see statements like this:
<http://www.cdc.gov/FLU/protect/keyfacts.htm>

    
    
        The single best way to protect against the flu is to get vaccinated each year.
    

More frequently washing your hands is more effective against influenza then
vaccination.

The purpose of vaccination is not necessarily to save lives- it is most often
given to healthy individuals who are not at any kind of risk of death- it is
so they can avoid getting sick.

The life-saving claims for the elderly simply haven't been scientifically
demonstrated, as the Cochrane review referenced by the Atlantic article points
out- studies are below:

doi:10.1002/14651858.CD004876.pub2 doi:10.1093/ije/dyi274

~~~
carbocation
Your point is good, and I don't see it as a rebuttal of mine. In particular, a
vaccine can be both mildly effective AND, yet, so much more effective _than
placebo_ that to perform an RCT is immoral.

~~~
gregwebs
The above referenced studies point out that the influenza vaccine has not been
proven to be more effective than placebo in the elderly, which is one of the
groups that CDC thinks it would be immoral to give a placebo.

~~~
carbocation
Can you clarify which "above referenced studies" you are talking about? From
the same site that you pointed me to (CDC), I find this page
<http://www.cdc.gov/flu/about/qa/vaccineeffect.htm> stating "How effective is
the seasonal flu vaccine in the elderly? ... the seasonal flu shot is 30%-70%
effective in preventing hospitalization for pneumonia (a lung infection) and
influenza ... In past studies among elderly nursing home residents, the
seasonal flu shot was most effective in preventing severe illness and
complications that may follow flu (like pneumonia), and deaths related to the
flu. In this population, the shot can be 50%-60% effective in preventing
hospitalization or pneumonia, and 80% effective in preventing death from the
flu."

Now, that is not a study itself, but a summary of prior studies. If you think
the CDC has formed an improper conclusion, that's fine.

Here is the Cochrane review on the effectiveness of vaccines in the elderly:
<http://www.cochrane.org/reviews/en/ab004876.html>

The summary: "In long-term care facilities, where vaccination is most
effective against complications, the aims of the vaccination campaign are
fulfilled, at least in part. However, according to reliable evidence the
usefulness of vaccines in the community is modest. The apparent high
effectiveness of the vaccines in preventing death from all causes may reflect
a baseline imbalance in health status and other systematic differences in the
two groups of participants."

In other words, like I said, the vaccine doesn't work all that well - but
despite its relatively modest effectiveness, it is still of great importance
in the very age group that you singled out as not receiving benefit.

~~~
gregwebs
The last sentence of that Cochrane review summary points out that no
randomized controlled trials have been done, and that the benefit to the
elderly may reflect the lack of randomization. The second doi study cited is a
study to look at that selection bias, and actually found that the entirety of
the protective effect could be due to the bias. This makes it difficult to
conclude that the influenza vaccine has any effectiveness in the elderly.

------
phren0logy
Not perfect, but better than nothing.

[http://scienceblogs.com/effectmeasure/2009/10/journalists_si...](http://scienceblogs.com/effectmeasure/2009/10/journalists_sink_in_the_atlant.php)

~~~
gregwebs
That is a whole lot of hand-waving mixed with name-calling to counteract the
"story" of the Atlantic article. It basically agrees with the conclusions at
the heart of the matter, though, that vaccination has not been proven in the
elderly. However the blog seems pro vaccination for those under 50, unlike the
Atlantic article.

------
camccann
If memory serves me, yearly flu vaccines are formulated based on predictions
about which strains will be most common for a given season. Is it really a
surprise that they guess wrong sometimes? Easy, 100%-accurate predictions
don't really happen much in science outside of Physics 101 homework.

Also, is influenza vaccination really recommended for healthy adults, anyway?
My impression was always that it was only worthwhile for people who would be
at high risk from the disease.

As for the whole "it's all misguided groupthink, only a few brave people are
sacrificing career success to speak truth to power" thing, I kinda have to
roll my eyes. Maybe the author of the article is right, but most of the time
when I've heard people say things like that, they don't actually understand
the ideas they're criticizing and are being reflexively contrarian because
that's a good way to make applause lights blink in the heads of their
audience. Really, if most specialists in a field agree on something _it's
probably because it's true_ , and if you _really_ think you've seen the light
where everyone else has gone astray your point will be stronger if it stands
on its own without the rah-rah anti-establishment social signalling.

~~~
kwantam
I think your reflexive anti-reflexively contrarian reaction is blinding you to
the point the author is trying to make. The politics surrounding questioning
the flu shot, even within the medical research community, are such that
Jackson et al were refused publication despite doing verifiably good
scientific research.

From the Atlantic article
(<http://www.theatlantic.com/doc/200911/brownlee-h1n1>):

 _“People told me, ‘No good can come of [asking] this,’” she says.
“‘Potentially a lot of bad could happen’ for me professionally by raising any
criticism that might dissuade people from getting vaccinated, because of
course, ‘We know that vaccine works.’ This was the prevailing wisdom.”_

Your career will be damaged if you question the efficacy of the flu shot,
because it is current medical doctrine. This kind of thing has happened lots
of times before, as the Atlantic article points out.

 _Really, if most specialists in a field agree on something it's probably
because it's true_

You're treading dangerously close to an argument from authority here. What
surprises me about this is that I would guess from your writing that you've
got enough experience under your belt to have realized that _in every field,
the average person is mediocre._ This isn't some tautological nonsense; what
I'm saying is that if you were told that "most programmers agree that X," your
reaction would probably be "yeah, but most programmers are actually crap at
their job, why would I listen to them?"

You'd be right in that case, and you'd be right if you replaced programmers
with doctors in the above. That most doctors believe in the flu shot isn't a
reflection of the flu shot's greatness so much as a reflection of their
training to that effect. Coupled with strong political forces pushing current
doctrine, you have a situation where scientific research is being
systematically subverted.

~~~
camccann
_Your career will be damaged if you question the efficacy of the flu shot,
because it is current medical doctrine. This kind of thing has happened lots
of times before, as the Atlantic article points out._

Yes, it's obviously true that anyone going stubbornly against established
consensus will get in hot water. This is the case whether their position is
correct or incorrect. In the first case, they're heroes; in the latter case,
they're crackpots. It's rarely obvious to people outside the field which is
which, and there's a lot more of the latter.

The contrarianism that I object to is when people who don't have enough
expertise in the field to tell good ideas from bad seem to hold up going
against consensus as somehow inherently noble, because most of the time
they're just going to be encouraging the crackpots. This especially includes
anything that glorifies the Galileo-esque "persecuted genius" archetype.

 _You're treading dangerously close to an argument from authority here. What
surprises me about this is that I would guess from your writing that you've
got enough experience under your belt to have realized that in every field,
the average person is mediocre._

Argument from authority is completely valid when the cited authority _is
authoritative on the subject under consideration_. If someone justifies a
statement about algorithms with "because Knuth said so" and can cite where he
said it, that's a pretty solid basis to go on. The very nature of science is
such that "widely held consensus of recognized experts" is the ultimate
authority on current knowledge. This is not a guarantee of correctness, but
it's a strong argument that it's the most likely, reliable answer we have and
there's almost never a good reason for people outside the field to reject such
consensus.

The programming analogy falls down a bit in that the bar is somewhat lower for
being considered "a programmer" than it is for being a reputable specialist in
most scientific fields. If you narrow it enough to filter out the kind of
"programmers" who fail FizzBuzz exercises, I expect you'd find that anything
that 95% of them agree on is, in fact, _far more correct than random chance_.

You and I have enough knowledge of programming to be able to evaluate good vs.
bad arguments, and can probably identify lots of places where common wisdom is
suboptimal. But what would you tell someone who knows nothing about
programming but needs to know how to evaluate ideas about programming? Sure,
we know that most programmers are stuck in a rut coding in Blub, but someone
outside the field can't tell the difference between "overly structured
programming is just obfuscation to create job security, simplify things and
use gotos for flow control" and "use first-class functions to make code more
expressive and eliminate redundancy".

We'd all roll our eyes at the guy promoting goto statements as a route to more
effective programming, right? Well, us dismissing "use more gotos" would look,
to someone outside the field, _exactly how doctors' reaction to the flu shot
issue looks to you._

------
Davertron
Are there any negatives to getting the flu shot? For me, if there's a chance
that it could prevent me getting the flu, and there are no potential
negatives, then at least I may be prevented from certain strains.

~~~
gregwebs
In the last swine flu vaccination (30 years ago), hundreds of Americans died
from receiving the vaccine. You can find the sixty minutes episode on this
online.

Vaccines usually come with other toxic substances that will be injected in
your body.

The same research articles that show influenza vaccines aren't useful also
indicate that the risk of severe side effects (such as death) are low. Those
must be weighed against the benefits, which in the case of the influenza
vaccine, seem to be mild or unproven.

~~~
ikitat
Hundreds? 48,161,019 Americans were vaccinated, 1098 cases of Guillain-Barré
Syndrome (GBS) recorded nationwide by CDC surveillance, 532 of which were
linked to the NIIP vaccination, resulting in death from severe pulmonary
complications for 25 people

[http://en.wikipedia.org/wiki/Swine_influenza#1976_U.S._outbr...](http://en.wikipedia.org/wiki/Swine_influenza#1976_U.S._outbreak)

~~~
gregwebs
You are quite right, thanks for the correction. However, note that the actual
total will always be higher then that which the authorities have officially
verified. I will also quote the very next sentence on that Wikipedia article:

    
    
       ... the vaccine killed more Americans than the disease did

~~~
ikitat
Seasonal flu kills approximately 36,000 _Americans_ annually. Confirmed deaths
worldwide for the 2009 H1N1 flu: 5,382

<http://en.wikipedia.org/wiki/2009_flu_pandemic>

~~~
gregwebs
That number for deaths (5,382) is for influenza in general, not H1N1. If you
download the referenced source, it states that in 2009 there were less than
300 confirmed h1n1 cases admitted to intensive care worldwide.

~~~
ikitat
I'm sorry, but the heading on table 2 reads:

Table 2. Reported number of new and cumulative confirmed fatal Pandemic (H1N1)
2009 influenza cases in EU and EFTA countries, as 23 October 2009, 09:00 hours
CEST, and in the rest of the world by country, as of 22 October 2009, 16:00
hours CEST.

The total at the bottom of the table is: 5,382

Perhaps you are reading that the total in EU alone is 269?

~~~
gregwebs
Yeah, that was wrong. I was trying to get some real numbers from the report,
and having trouble understanding it. I am still unsure of what the real number
is. For example, the Brazil number they use is 1,368, but earlier it states
that there were 645 deaths with confirmed pandemic influenza.

------
slpsys
Hot News: Bullshit Metascience Calls Bullshit on Science.

"Odds are, it has." If you're going to call out research as pseudoscience,
don't write unvalidated statements like this.

------
bcl
The title is completely inaccurate.

