Oh Canada. Look over here. Not there. Not at the press release. Look here. A real study. Published. With methodologies you can evaluate. Something you can sink your teeth into to help guide policy decisions. You know, published epidemiology. Science.
Its called “Partial protection of seasonal trivalent inactivated vaccine against novel pandemic influenza A/H1N1 2009: case-control study in Mexico City.” and published on line in the BMJ on October 6th.
Are you aware of….Oh, Canada, pay attention, your eyes are wandering.
I guess I will be spending the rest the flu season writing about the nonsense that is promulgated about the flu vaccine and the disease. One of the more common laments about the flu vaccine is that it doesn’t work: I got the flu vaccine and still got the flu. Well maybe. Maybe not. It takes a few weeks to get protection, so the flu could have developed before the antibody response to the vaccine. The vaccine does not protect to the numerous other viral infections that circulate each winter, so perhaps you had an adenovirus but thought it was the flu. Then there is the evidence. Some readers of the blog are worried that the literature does not support the use of the vaccine.
“My research for good studies on the efficasy (sic) of seasonal flu vaccines so far has left me wondering if I’ve somehow missed the good research. Tom Jefferson of the Cochrane Institute says that Most studies are of poor methodological quality and the impact of confounders is high. I agree. Please would you refer me to some of the best studies on the efficasy (sic) of seasonal flu vaccines. After a critical appraisal of the best studies you know of I’d like to submit the same for publication in the interest of science.”
Why some readers think I am a research librarian, I do not know. It is not an uncommon request. As an aside, I have a full time job and a family to raise. Don’t be asking me to do your grunt work. It’s called Pubmed. Use it.
But the topic for this post concerns the efficacy of the flu vaccine. I am limiting myself to the use of the vaccine in adults.
My youngest and I often do the “Find 6 Different Things” in the Sunday comics. He is good at finding anomalies. All day at work I showed the picture in the link that follows and asked: What is wrong with this picture?
Almost everyone found at least one thing wrong (I find two) in less than 10 seconds, my 12 year old included.
Click on the link, look at the first photograph and you tell me.
What’s wrong with this picture?
I will post my answer tomorrow in the comments.
This is a quick entry to allow me to have a little spleen venting. And I am cross posting this over at Medscape.
Background for you youngsters. In 1989 two electrochemists Martin Fleischmann and Stanley Pons, announced they had successfully developed cold fusion: nuclear fusion at room temperature. Pons was chairman of the chemistry department at the University of Utah at the time and lent a fair amount of respectability to the announcement.
A great deal of brouhaha followed, but in the end “is heard no more: it is a tale Told by an idiot, full of sound and fury, Signifying nothing.” Cold fusion was and is a bust, although millions were spent in pursuit of that pot of gold.
Fast forward to this week. Here is the data upon which important public health decisions are being made, in its entirety:
“new Canadian study — which has not yet been peer reviewed or published —that found those who receive the seasonal flu vaccine become two times more likely to get H1N1.”
This post is a wee bit of a cheat in that it is a rewrite of a Quackcast, but I have three lectures and board certification in the near future, so sometimes you have to cook the wolf.
What does that mean: boost the immune system? Most people apparently think that the immune system is like a muscle, and by working it, giving it supplements and vitamins, the immune system will become stronger. Bigger. More impressive, bulging like Mr. Universe’s bicep. That’s the body part I am thinking about. What they are boosting is vague, on par with chi/qi or innate intelligence. They never really say what is being boosted.
The other popular phrase is “support”. A product supports prostate health, or breast health or supports the immune system. It sounds like the immune system is sagging against gravity due to age and needs a lift.
The immune system, if you are otherwise healthy, cannot be boosted, and doing those things you learned in Kindergarten health (reasonable diet, exercise and sleep), will provide the immune system all the boosting or support it needs.
In which we try to be smarter than the average bear.
Flu season is upon us (it kind of never left us this year), and there is a new strain of flu, the H1N1, aka Swine flu that adds a wrinkle or two to the usual potential for influenza related morbidity and mortality. And with the new flu is the new woo. I know that others have addressed flu in this forum and some of this may be redundant. Still, we each have our different styles and interests, so I hope the various posts are additive rather than redundant. I am going to wander through some odds and ends about flu in general and H1N1 specifically and compare some of the woo with the reality. At least my reality.
First some background. I was first directed to the Marshall protocol by a reader who wondered about the information the found on the web. So I went to the web and looked at the available information, much as any patient would, and discussed what I found there.
I have subsequently been lead to believe that none of the information on the website http://www.marshallprotocol.com can be considered up to date or accurate. As as result of, I have told that my post is chockablock with errors, although, outside of writing doxycycline where I should have put minocycline, I am left in the dark as to exactly what my errors are. I am told that it is my responsibility to locate the errors in the last post, yet I can find none when compared to the website.
However, to remedy the deficiency of having reviewed inaccurate and out of date material, I have been sent 6 articles that I am informed represent the state of the art in understanding the science behind the Marshall protocol. Ah, the peer reviewed medical literature. An opportunity to carefully read and critique new ideas. It is one of the reasons people publish: to see if their ideas can withstand the scrutiny of others.
Several of these papers concern Vitamin D, the Vitamin D receptor, and olmesartan which I will review, perhaps, another time. I don’t find them a compelling read, but it not an area about which I have more than a standard medical knowledge. The other papers concern the role of infection in autoimmune diseases, which I will discuss here. It is easier as an infectious disease doctor to read this literature as I am, as least as far as the American Board on Internal Medicine is concerned, a specialist in the field. Alternatively, I am a closed minded tool of the medical industrial complex who only seeks to push his own twisted, narrow agenda at the expense of suffering patients (1). We can’t all be perfect.
The more things change, the more they stay the same.
Not every post will be an in-depth, authoritative review of a topic like yesterday’s on Dr. Sears. A change of pace can be nice, and I have always liked history.
JAMA likes to run articles called “JAMA 100 YEARS AGO” and the reprint from the July 24, 1909 issue is interesting. It is called BUTTERMILK THERAPY. They liked all caps at the turn of the century.
1909 was at the very beginning of the biologic sciences and the understanding of disease pathophysiology. Physicians had almost no useful, or more importantly, rigorously tested therapeutic interventions for diseases. So they relied on traditional method of determining what worked: expert opinion and anecdote. And that lead to buttermilk.
“Metchnikoff, Massol and several other authors have recommended fermented sour milk as prepared in Bulgaria, or a similar product, prepared according to Metchnikoff’s method from pure cultures of bacteria, as a panacea for many ills.”
Metchnikoff was a Russian microbiologist who won a Nobel prize in 1908 for discovering phagocytosis and was responsible for many early discoveries in the immune system and in host-bacterial interactions. As a preeminent scientist of the time, his word was respected and carried weight. As a side note, when he tried to commit suicide he did so in a manner that would benefit science: he injected himself with the relapsing fever organisms and proved it could be blood borne, and while he evidently became very ill in the process, it failed to kill him.
Revised 7/23/9 to correct an error.
While there are many taxonomies of alternative medicines, one thing almost all alternative therapies have in common is they are originally the de novo discovery of one lone individual. Working outside of the mainstream, they are the gadflies who see farther because those around them are midgets.
- Hanneman conceives of homeopathy, the treatment of all disease.
- Palmer conceives the cause of all disease and its treatment in chiropractic
- Mikao Usui, while having a mid-life crisis, conceives Reiki.
Virgin births all. These pioneers boldly go where no man has gone before.
Others have been less acclaimed after seeking out new life. An example is Virginia Livingston, MD, the discoverer of the cause of all cancer (1). She discovered a bacterium, the cause of cancer, she called Progenitor cryptocides, which, unfortunately only she could grow. Her therapies include an autogenous ‘vaccine” made from your own urine, which will probably preclude widespread use even in alternative therapies circles. I wonder if Jenny would object to vaccines if there were naturally derived from the patients urine?
Discovering a new form of pathogenic microbiology that no one else can see or grow is not uncommon, since people seem to be unable to recognise artifact on slides, be it Oscillococcinum being seen by Joseph Roy 200 years ago or Virginia Livingston in the 1960s. Sometimes I regret the discovery of H. pylori as a cause of gastritis as it gives the alternative microbiologists a medical Galileo to point at. H. pylori is used as an example, erroneously, of a bacteria causing disease that was laughed at by the medical establishment (Parenthetically, as my flawed memory has it, while I was an Infectious Disease Fellow the data for H. pylori came trickling in. I remember discussing the papers with one of my attendings who was an expert in GI infections. We all thought it was an interesting hypothesis and waited further data with interest. I cannot remember anyone dismissing the idea out of hand with derisive laughter. But then, I remain convinced that infections are the cause of all disease, at least the diseases that matter).
Transcribed minutes of a meeting, provenance unknown.
Chairman: “I would like to call this emergency meeting to order and thank you all for coming under short notice. If there are no objections, I will dispense with the usual formalities and get right to the business at hand.”
Murmur of approval.
Chairman: Ladies, Gentleman and Demons of all kinds, we have been, to use the vernacular of the day, outed.”
Murmur of consternation
Voice from the crowd: “I am most certainly not gay.”
Chairman: “Not gay. We have been outed as a society. The Evil Society of the Evil Medical Industrial Complex, our beloved ESEMIC, is no longer secret. Our works have been discovered. The true meaning of the Caduceus has been published for all to see. And by your fruits you shall be known. Sorry demons”
Louder murmur of consternation.
Loud voice from the crowd: “I demand to know how this occurred. This is impossible.”
Shouts of agreement.
Chairman: “If you will please all remain calm, I will explain.”