Causation is not so simple to determine as one would think. A mantra at SBM is ‘association is not causation’ and much of the belief in the efficacy of a variety of quack nostrums occurs because improvement occurs after use of a nostrum, therefore improvement occurs because of use of a nostrum. It is why vaccines as a cause of autism are so compelling to some. Vaccines are given at the same time autism starts to manifest. It would require more intellectual power than I have not to conclude, wrongly, that vaccines caused the autism. Concluding causation from sequential events is how the human mind works, and reality, as we know and ignore, constantly conspires to fool us into making false causal connections. In Infectious Diseases I see the error almost daily. The patient had a fever, patient was given antibiotics, fever went away. Therefore the antibiotics treated an infection. Well, maybe, maybe not. One of my mantras is ‘antibiotics are not antipyretics’ and you must be very careful before concluding that the fever went away because of the penacephalone. (more…)
It looks like the H1N1 pandemic is fading fast. I am amazed at how lucky we were, at least in the hospitals where I work. A month ago all the ICU beds were full, most of the ventilators were in use and we were wondering how we were going to triage the next batch of patients who needed advanced life support and we had none to offer. Then, right as we reached maximum capacity and had no more wiggle room, the rates plummeted. We skated right up to the edge of the precipice, looked down, and did not have to jump.
The pandemic has not been as bad as expected, but it was still no walk in the park. Nationwide H1N1 killed maybe 10,000, with 1,100 in children and 7,500 among young adults (ref). Oregon has had 1200 hospitalizations and 68 deaths. We had about 8 deaths from H1N1 in my hospital system. We would have had twice that number, but one of our hospitals is a trauma center and offers ECMO (Extra Corporeal Membrane Oxygenation) and we managed to save a number of people who would have died if they had been in a lesser hospital. The national statistics mirror our experience. None of the deaths were in the elderly. Pity the vaccine was slow to be produced as it could have prevented the majority of those deaths.
Are we done with H1N1? Will it become part of seasonal flu? Will it have a third comeback, fueled by holiday travel? Will it mutate and increase virulence? Will it recombine with avian flu to generate a new strain? Is this THE pandemic that comes every 30 years or so, and we will not see another until after I am long dead?
How am I supposed to know? I can’t see the future. Or can I? Mr. Randi, listen up: I am thinking I will be eligible for that million dollar prize. I am receiving future information from the Large Hadron Collider, curiously delivered inside a baguette. I think I can predict the next infection to sweep the US.
Lose weight without diet or exercise? I guess that leaves cancer.
It is the day after Thanksgiving, and I have probably eaten enough calories to support the average family for at least three days. I am hesitant to comment on what my actual weight may be, but others have not been so reticent about discussing my appearance over at RDCT. At least I am not female; then I would get no end of critiques based on my looks.
Now that I am up a few holiday pounds, it would be nice to lose some weight. Of course I do not want to do it the old fashioned way, with diet and exercise. Diet and exercise take time and are fundamentally painful. I want to eat what I want when I want from the comfort of my Lazy Boy. I want an easy way to lose weight. The interwebs, as is often the case, have been kind enough to provide me with numerous emails suggesting all sorts of simple ways to alter my physique for the better, some of which even include weight loss.
I am, I think, the slowest writer in the SBM stable. I start each entry about 10 days before it is due, and work diligently on it through the week. As such, I run the risk that events may make my work pointless. Case in point. I have been slogging away at this entry for the last week and had the final draft up and ready to go, only to find this morning that the Health Care Reform bill no longer carries the language that was the crux of this entire post. So what is a poor, slow, SBM writer to do? Chuck the whole thing? Repost my 12 reasons you are a dumb ass not to get the flu vaccine yet again? Leave a hole in the SBM line up? No.
Lets pretend we are in a parallel universe, perhaps an evil universe where I have a goatee, and the language was not removed from the bill. Lets all pretend that this post is still relevant. Since the Christian Science Church has indicated they will try to get the bill amended to reinstate payment for their services, this post may be relevant again.
Or you could go read Respectful Insolence instead. Don’t say you were not warned.
Reposted on 11/8 with multiple typo corrections.
The Atlantic recently published an article called “Does the Vaccine Matter?.” The quick answer is “yes”. If you want to know more, keep reading. They concluded, based on a narrow interpretation of a small subset of the data, that vaccines probably do not matter. The tone suggests that the vaccine is a vast boondoggle perpetuated on the American people by frightened doctors and greedy pharmaceutical companies. At least that is my take on the article, your mileage may vary. Lets look at that article, and its review of the influenza vaccine, and see whatthe authors say, how they say it, and, perhaps more importantly, what they don’t say.
Unfortunately, I do not have a good story to tell with protagonists and antagonists and lone voices protesting the evil medical industrial complex. I don’t have a morality tale to tell, with good guys and bad guys. I have the medical literature, with its numbers and uncertainties and nuance. I also have patients I have to treat and have to apply the medical literature to as best I can.
This entry may be a bit of a repetition for those who read my previous entry on vaccine efficacy, but my entry hit the blogosphere a few days before the Atlantic article, so I did not get a chance to incorporate it into my entry. (more…)
I was making rounds at the hospital and, for some strange reason, I was being asked about influenza. No, this is not going to be an entry on influenza. But I was asked if there was anything besides the vaccines that can prevent influenza. Masks and good hand washing will help, I said.
A nurse suggested colloidal silver.
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.”