Articles

What are words for?

Do you hear me

Do you care

Do you hear me

Do you care

My lips are moving and the sound’s coming out

The words are audible but I have my doubts

That you realize what has been said

You look at me as if you’re in a daze

It’s like the feeling at the end of the page

When you realize you don’t know what you just read

What are words for when no one listens anymore

What are words for when no one listens

What are words for when no one listens it’s no use talking at all

I might as well go up and talk to a wall

‘Cause all the words are having no effect at all

Missing Persons on blogging. Or so I thought. I was surprised to learn the song was written by the brothers Gibb.

Words are important. I try and choose my words carefully when writing so that they accurately reflect not only my thoughts but reality. When I speak, not so much. My frontal lobe filters often fail if I think might I might get a laugh.

I tell housestaff, precision of writing reflects precision of thought. It is one of the reasons I write; the act of writing forces some coherence into what can be muddled and inchoate thoughts. Even though I have residents who write notes, I always write my own. Often I do not make a final decision as to a plan until I put pen to paper, or electrons to screen. Writing crystallizes thought.

Not, evidently, for everyone, as 10 Facts About the Flu Vaccine and the Flu nicely demonstrates.

Influenza is one the more difficult diseases and the vaccine one of the more problematic interventions. Influenza is tricky, mutating every year, acquiring new DNA, new virulence, reacquiring old genes to infect at risk populations.

Influenza is deadly, a consistent cause of morbidity and mortality since the gasping oppression arose in human populations. I have written extensively on influenza over the years on this blog as part of my goal of reaching a million words on vaccines. Influenza kills people directly, it kills with secondary infections, it kills those with underlying medical problems, it kills with heart attacks. It especially kills the old, the young, the pregnant and now the obese. It kills the unborn; influenza season is spontaneous abortion season. It leads to smaller, less intelligent children. Depending on the year and the circulating strains, influenza is a major cause of human suffering and death.

90% of my practice is in the hospital seeing people who are acutely ill. I see those who got the short end of the influenza stick, those who suffer from influenza, its complications and occasionally die.

Oddly, I take the responsibility to prevent morbidity and mortality very seriously. The pro suffering and death, er, I mean anti-vaccine contingent will often say those of us in the anti-suffering and death, er, I mean pro-vaccine contingent are big pharma shills only in it for the money. I wish.

Early this week I heard someone mention, in response to some unfair experience, that it was nothing personal, it’s business. I realized that for me it is always personal, never business. I take human suffering and unnecessary death personally, an affront that pisses me off. Sometime back someone mentioned my posts seemed angry. You bet I get angry. Preventable illness and death should make you angry.

Preventing disease is always multimodal. I have been the Chair of Infection Control for what seems forever and one clear lesson of infection prevention is there is no magic bullet. Stopping infections is the result of the sum of a multitude of interventions, all important, all critical. When you do everything right every time, hospital-acquired infections almost vanish, much to the disappointment of my bottom line.

Preventing influenza, and other infections, is both simple and difficult. Ameliorate risks by not smoking or being overweight. Wash hands. Don’t inhale around coughers or on airplanes. Be replete in vitamin D. And be vaccinated.

As vaccines go, the influenza vaccine is not our best and brightest. It has variable efficacy in different populations and because there are new strains every year re-vaccination is required. Those who need the protection the most are those who are least likely to respond. And we have never had enough of the population vaccinated at any one time to take advantage of herd immunity, even supposing an excellent antigenic match between the vaccine and circulating strains.

Overall it appears to be a modestly effective vaccine when used as part of a nutritious breakfast. It decreases the chances of getting flu, of having a flu-like illness, and of having complications of flu such as heart attacks and the need for hospitalization. It is not a great vaccine but it is better than no vaccine.

If you read the entire literature on the influenza vaccine I think you would be convinced and if you had a career watching people suffer and occasionally die from influenza, while you might wish for a better vaccine, you would be glad for any weapon you could bring to bear against influenza. “You go to war with the army you have—not the army you might want or wish to have at a later time.

It is part of why cherry picking, half-truths and misleading essays on vaccines annoy me and warrant words. It is what words are for. Let’s see what SafeMinds has to offer with their facts:

According to the most extensive flu vaccine effectiveness review conducted to date, flu vaccines might be effective against influenza A and B, which represents about 10% of all circulating flu viruses each year.

No. I am picky here. Influenza A and B represent 100% of the flu viruses each year. The author points out in the introduction that there are 200 other viruses that can cause a flu-like illness, which is not necessarily the same as flu, the illness of influenza. Any illness with fevers, muscle aches and malaise is called the flu. But the flu is influenza. And I have zero idea what a stomach flu is.

The influenza vaccine prevents influenza. As it should. It does not have effects against rhinovirus, adenovirus, RSV or mimivirus. Nor should it. This is like noting the pneumococcal vaccine does not prevent the several hundred bacterial causes of pneumonia.

That is the type of sloppy writing that drives. Me. Nuts. I see it all the time in the newspaper when reading about topics of which I have extensive knowledge. They often get it wrong in ways that are misleading. Or just stupid. If I see the term “flesh eating virus” applied to Group A streptococcus one more time I will scream.

Under average conditions when the vaccine is a partial match for the circulating strains of flu, 100 people need to be vaccinated to avoid one set of influenza symptoms.

That is from the Cochrane reviews, whose leader has what I suspect is a strong bias against flu vaccine and looks at the effects of the vaccine as narrowly as possible.

Part of the issue with flu vaccine is the beneficial effects that also occur on populations and for diseases other than influenza. While the vaccine prevents infections from influenza, it also prevents other complication in those at risk: secondary pneumonias, heart attacks etc. Not getting influenza is a good way to avoid other illnesses.

And even when there is no match there can be effectiveness in the flu vaccine:

The TIV and LAIV vaccines can provide cross protection against non-matching circulating strains.

Determining overall benefit of vaccination is tricky depending on what goals you consider important. For example, with the H1N1 vaccine, using “societal perspective”:

Vaccination for pH1N1 for children and working-age adults is cost-effective compared to other preventive health interventions under a wide range of scenarios. The economic evidence was consistent with target recommendations that were in place for pH1N1 vaccination.

As the evil CDC notes:

Results of studies that assess how well a flu vaccine works can vary based on study design, outcome(s) measured, population studied and the season in which the vaccine was studied. These differences can make it difficult to compare one study’s results with another’s. As there is interest in how well flu vaccines may prevent illness, hospitalization, and even death with influenza, many outcomes need to be considered.

So when they say next:

Having received the flu vaccines has been found not to reduce hospitalizations or working days lost to flu like illnesses.

You can say it depends. On the study, on the vaccine, on the circulating strain, since others have shown:

Influenza vaccine is effective in reducing hospital admissions for influenza, pneumonia, bronchitis and emphysema, and effectiveness is comparable to that observed for influenza and pneumonia admissions in North America.

It is ignoring nuance of a complicated topic to grind your ax that annoys me. To continue:

In fact, the flu vaccine causes approximately one case of Guillian-Barré syndrome (GBS), a major neurological condition leading to paralysis, for every one million vaccinations administered.

Again, it depends:

After adjusting for antecedent infections, we found no evidence for an elevated GBS risk following 2009-10 MIV/2010-11 TIV influenza vaccines. However, the association between GBS and antecedent infection was strongly elevated.

So the infection is worse than the vaccine for association with GBS. I am not sure of their source, since it SafeMind is not completely referenced, but the Lancet confirms the risk is far higher from influenza infection when compared to the vaccine:

The attributable risks were 1•03 Guillain-Barré syndrome admissions per million vaccinations, compared with 17•2 Guillain-Barré syndrome admissions per million influenza-coded health-care encounters.

Partial words. Misleading words. Not what I would use words for.

Much of the published flu vaccines effectiveness data is funded by vaccine companies so the results may be overly optimistic estimate because company-sponsored influenza vaccines trials tend to produce results favorable to their products.

I do not deny the potential bias in pharmaceutical sponsored studies; it is why it is important to look at the study carefully for flaws that make the results suspect. Many of the epidemiologic studies are not funded by pharma.

According to flu vaccine package inserts, “Safety and effectiveness has not been established in pregnant women or nursing mothers and should only be given to a pregnant woman if clearly needed.”

Who dies from influenza? Pregnant females, although not in all studies (funded by the WHO, part of the New World Order, who get their funding from big pharma):

Some well accepted risk factors such as pregnancy and belonging to an ethnic minority group could not be identified as risk factors. In contrast, women who were less than four weeks post partum had a significantly increased risk of death from pandemic influenza.

Pregnant males are spared. And it kills the fetus as well.

Pandemic influenza virus infection in pregnancy was associated with an increased risk of fetal death. Vaccination during pregnancy reduced the risk of an influenza diagnosis. Vaccination itself was not associated with increased fetal mortality and may have reduced the risk of influenza-related fetal death during the pandemic.

Of course, that study was funded by Norwegian Institute of Public Health, notorious pharma shills (sarcasm, my Norwegian readers).

Not only does the vaccine protect mother and fetus (this time by those shills, the Argentinian Institute for Clinical Effectiveness and Health Policy. Bastards),

This large study using primary data collection found that MF59 adjuvanted A/H1N1 influenza vaccine did not result in an increased risk of adverse perinatal events and suggested a lower risk among vaccinated women.

And women give birth to healthier babies (this time it is Kaiser, man, do they have no shame?), one of many studies to show similar results:

Pregnant women who received H1N1 influenza vaccine were less likely to give birth preterm, and gave birth to heavier infants.

But mothers who are vaccinated pass protective antibody to their children resulting in less ill neonates:

Maternal influenza vaccination was significantly associated with reduced risk of influenza virus infection and hospitalization for an ILI up to 6 months of age and increased influenza antibody titers in infants through 2 to 3 months of age.

Again one of many representative studies, although who could ever trust the Center for American Indian Health? Those guys are known to be at the pharma trough.

SafeMinds continues:

A large-scale scientific study in approximately 50,000 pregnant women over five flu seasons found no difference in the risk for developing influenza illness among those who received the influenza vaccine during pregnancy and those who did not.

My Google-fu fails me. I can find two studies with 50,000 pregnant females and the flu vaccine and neither were efficacy studies. One was a safety study and the other a fetal safety study. Both demonstrated safety of the vaccine.

I know SafeMinds would not make up information, although if I were of conspiratorial bent (I am not), I would suspect that with “facts” such as these that they were in league with the New World Order to help depopulate the earth. Can someone help me out with the reference in question? It occurs to me as I do the final draft I should have just asked SafeMinds for the reference. Silly me.

Flu vaccines stimulate the immune system and product an inflammatory response. These same kind of inflammatory responses in pregnant women have been linked with the development of autism.

Nothing compared to the immune stimulation of infection which kills the fetus. At least autism is not due to mercury…oh wait:

Most flu vaccines contain mercury in the form of thimerosal. All forms of mercury have been found to be dangerous and should be avoided, especially by pregnant women. Simple methods such as good hand washing and avoiding contact with individuals who have the flu are also effective in preventing the flu for everyone.

Most? Try some. From the CDC:

Since seasonal influenza vaccine is produced in large quantities for annual immunization campaigns, some of the vaccine is produced in multi-dose vials, and contains thimerosal to safeguard against possible contamination of the vial once it is opened.
The single-dose units are made without thimerosal as a preservative because they are intended to be opened and used only once. Additionally, the live-attenuated version of the vaccine (the nasal spray vaccine), is produced in single-dose units and does not contain thimerosal.

Of the 145 million doses made in 2012, 62 million were thimerosal-free.

I recognize that people have their biases. SafeMinds certainly does. But still. A little integrity when writing about complicated concepts. Please. SafeMinds are evidently neither HonestMinds nor FuntionalMinds.

What are my words for? My destination is known. Sorry. I so wanted to tie it up with another Missing Persons reference. A million words. In defense of vaccines, in defense of preventing illness. In defense of preventing death. Seem a good use of words to me.

Posted in: Epidemiology, Vaccines

Leave a Comment (89) ↓

89 thoughts on “What are words for?

  1. cphickie says:

    I had the true-blue influenza once, as a teen. Temps of 105 for five days and flat on my back except when I had to crawl to the bathroom. It hurt so bad to move–even moving my eyes. Given I have asthma, I was very lucky I didn’t land in the hospital or even die. I never, ever want to have influenza again. It was the sickest I’ve ever been.

    I’ve been getting flu shots ever since. I’ve been in pediatric practice almost 10 years now, seeing lots of children with influenza–and I’ve never had the flu (I also wash my hands like crazy, too). I’ve seen my patients get extremely sick and land in the ICU from influenza. I don’t see that when parents vaccinate their children against the flu. When H1N1 showed up, it was scary, given the initial reports from Mexico City. For unexplained reasons, my practice got some of the first doses of the vaccine, so we called the local pulmonologists and asked for them to send their highest risk children to us for the vaccine, as well as offering it to the expecting moms whose children saw us.What was scary was that H1N1 was already circulating and spreading by the time the vaccine arrived (just bad luck, that was), so a child would get a flu shot and come back 3 days later with the H1N1

    The 1917-18 influenza epidemic is too far removed to be in the memory of almost anyone alive, so most people don’t realize what influenza can do and how much it can kill. I’m sure SafeMinds could give a sh** less. I wish large medical groups like the AMA, AAFP, AAP and CDC would have an active web page of BS sites that patients need to avoid, sites like SafeMinds and NVIC and AgeOfAutism. But they don’t, and those sites get more professional looking all the time, and people are getting needlessly scared out of flu vaccine every year.

  2. Todd W. says:

    According to flu vaccine package inserts, “Safety and effectiveness has not been established in pregnant women or nursing mothers and should only be given to a pregnant woman if clearly needed.”

    I hate this claim. It is weasely and grossly dishonest. While technically true (the package inserts do say that), the conclusion that people like SafeMINDS and other anti-vaccine activists suggest is far from the truth. They would have you think that safety in pregnant or nursing women has never been studied at all, when all that bit in the package insert means is that the manufacturer has not studied it. If they have not conducted studies, they can’t say in their insert that it is safe, even if other investigators have done the studies.

    And others have studied the safety of influenza vaccines in pregnant and nursing women, as well as the effects on the fetus or newborn, as you have shown.

    Just one of the many deceitful practices among the pro-disease contingent.

  3. Coincidentally, I spoke with someone last night (a nurse by training) who mentioned that she gets her flu shot “after the first frost” (we live in Wisconsin). Really? Advice from her husband’s father’s aging family doctor (now dead) years ago. Yet she takes this seriously in the here and now.

    There is just no limit to the susceptibility to superstition. At least she gets the shot, but we often don’t have “frost” until Thanksgiving. At least her 92 year old mother got the shot yesterday in the hospital, which is why we were talking about it.

    1. Denise says:

      I’ve been trying to decide whether to get it now or wait, because I read that if you get it too early it may have worn off late in the season. Is that true?

      1. Ceridwen says:

        I’ve worried about that too, Denise, but from what I can find, seroprotection rates 6 months from vaccination are still pretty high. I also realized that I would rather have immunity properly developed by the earliest it’s possible for the flu to be showing up and some chance of lessened immunity late in the season than no protection early on and maybe better immunity at the end of the season. One scenario gives me at least partial protection for the whole season, the other leaves a much more obvious gap.

        I went ahead and got my shot this Thursday.

  4. hat_eater says:

    A propos Kaiser, how the antivaccinators explain the fact that the insurance companies recommend vaccinations? After all, unlike big pharma (sarcasm), they are anti-disease as they have to pay for the treatment. I’m asking purely from curiosity.

  5. “And I have zero idea what a stomach flu is.”

    Once I mentioned stomach flu to a family member who haughtily informed me there was no such thing as stomach flu. All flulike illnesses with digestive symptoms are food poisoning. I don’t know, I’m not a microbiologist or doctor (nor is she).

    From personal experience, I have observed that some flulike illness with digestive symptoms seem to spread through a school or family surprisingly like a cold or flu, not like food poisoning (victims come one after another, not all in one day after a particular meal). And that good food prep and kitchen hygiene does not seem sufficient to avoid this illness.

    Maybe it has something to do with rotovirus, which one hears about with such dread. I don’t know. I really try to avoid stomach whatyoumacallits. Twice I have ended up in the hospital due to intense abdomen pain needing IV fluids after extended episodes of stomach ____. Sadly, I’ve never been in the mood to quiz the rather rushed doctor on the exact species of my assailant. So I just, wash my hands frequently, use good kitchen hygiene and try to say stomach virus, hoping to avoid future correction by “helpful” relatives.
    :)

    1. elburto says:

      Norovirus is often the culprit, and it’s awful, not to mention incredibly contagious.

      last time I had it I was even vomiting up my anti-emetics, because of the miniscule amount of water I took them with. Hell, even swallowing my own saliva caused retching so powerful that I was practically pretzel-shaped.

      I ultimately ended up on IV fluids after losing consciousness one too many times. Nasty little virus, but very efficient at what it does.

      Not sure if I’ve had rotavirus, or if it’s as “fun” as its cousin.

      1. Paul Spence says:

        Strictly speaking these viruses are not cousins. Norovirus is a single stranded RNA virus while rotaviruses are double stranded RNA viruses.

  6. ^^And I get a flu shot too – although for other reasons, because I DO actually understand that using a flu shot to prevent stomach ___ is like using garlic to prevent werewolves.

  7. This brings up a question. I was at our pediatrician with the son for an ear infection. At the desk they offered the flu shot, but then my pediatrician recommended actually waiting til later fall, the reason being that there has been so much spring flu (She said it better.) and a later shot will give you more resistance in spring.

    She’s never steered me wrong before, so whether that’s confirmed or denied here, it wouldn’t change my opinion of her as a great doc.

    Getting flu shots in later fall will give you better resistance to flu in spring? True, False or Maybe?

  8. Luara says:

    Since the flu kills a lot of people, getting a flu shot is a matter of ethics.
    People say they don’t get flu shots because they rarely get the flu or they have a strong immune system.
    But according to the CDC,

    Most healthy adults may be able to infect other people beginning 1 day before symptoms develop and up to 5 to 7 days after becoming sick. Children may pass the virus for longer than 7 days. Symptoms start 1 to 4 days after the virus enters the body. That means that you may be able to pass on the flu to someone else before you know you are sick, as well as while you are sick. Some people can be infected with the flu virus but have no symptoms. During this time, those persons may still spread the virus to others.

    1. elburto says:

      Sadly there are some amoral doctors with disproportionate influence who manage to scare people out of vaccinating.

      When pressed they’ll sometimes even casually admit to not particularly caring about the fate of those of us who could be killed by breaches in community immunity.

      They’re far more interested in the tow-headed children of the well-to-do worried-well mommies that fill their pockets, than in the less fortunate members of society who simply want to survive.

      Some people do not deserve the title of ‘Doctor’, such is their absolute lack of ethics, their mercenary selfishness, and their preference for Hollywood over Hippocrates.*

      *Resemblance to any actual doctor, living or dead, is purely coincidental

  9. elburto says:

    Sadly there are some amoral doctors with disproportionate influence who manage to scare people out of vaccinating.

    When pressed they’ll sometimes even casually admit to not particularly caring about the fate of those of us who could be killed by breaches in community immunity.

    They’re far more interested in the tow-headed children of the well-to-do worried-well mommies that fill their pockets, than in the less fortunate members of society who simply want to survive.

    Some people do not deserve the title of ‘Doctor’, such is their absolute lack of ethics, their mercenary selfishness, and their preference for Hollywood over Hippocrates.*

    *Resemblance to any actual doctor, living or dead, is purely coincidental

  10. No, you’re right Norovirus is the one I meant (I mistyped it). That could be it.

  11. Norovirus comment should be addressed @Elburto.

    I never know where my comments will end up, these days. I have to get back into the habit of quoting who I’m responding too.

  12. Luara “Since the flu kills a lot of people, getting a flu shot is a matter of ethics.”

    In the past I think one problem as been availability. The last two years were great for availability (if memory serves) But the first H1N1 year, it was near impossible to find a place to get a flu shot for children* until January, unless you wanted to go stand in a 2 hour line with small children. Before that’s it’s been some shortages, some recommendations of only at risk populations based on availability.

    That said, as someone with asthma, I’ve always been able to get a flu shot, but I haven’t always been able to get it for my children.

    It seems only recently that it has both been recommended and available to all. (excluding people with a contraindication)

    *Some of the drugstores had flu shot, but they’re not licensed to give it to children.

  13. Todd W. says:

    Since the vaccine is formulated for the flu season, whether you get it right when it becomes available or later in the fall, you’ll develop some immunity to whichever strains are in the vaccine. It doesn’t seem that immunity wanes in only a few months, so no matter when you get the shot, you should be protected. The difference between fall/spring influenza would, I imagine, be largely due to mutations between the two periods. If that’s the case, then the vaccine would be somewhat less effective due to only partial matching of the virus.

    I’m not a doctor or immunologist, so, grain of salt, but it shouldn’t matter whether you get the vaccine early or late, except insofar as being vulnerable for a longer period.

  14. Todd W. says:

    @mousethatroared

    The only difference I could see in getting the flu vaccine right when it becomes available vs. waiting until later in the fall is that in the latter case, you’d be vulnerable for longer. As long as the strain you’re exposed to matches one of the strains in the vaccine, you should be immune. Now, the virus might mutate somewhat between fall and spring, rendering the vaccine either less or more effective, depending on if the mutation brings it closer or further away from the vaccine strains. But I haven’t ever heard of the vaccine waning in efficacy in just a few months.

    I’m not a doctor or immunologist, though, so I may be wrong, but I think your doc may be mistaken in her beliefs.

  15. Todd W. says:

    Sorry for the almost-same double-post. Commenting borked on the first try.

  16. arsawyer says:

    Kudos to Dr. Crislip for mixing in an important message about clarity of writing along with relevant flu information. My college adviser used to have a quote posted in the hallway: “Writing is not just the result of research, writing IS research.” It is uncanny how much time can be wasted with too many ideas jumbled up in the old noggin, and how quickly you discard all the noise and nonsense when you force yourself to put pen to paper. I’m sure all the folks at SBM have developed a much better understanding of their specialty simply by writing about it on a regular basis.

    Of course, there are a few folks in the anti-vax camp that are somehow able to hold even more ridiculous conclusions and promote mutually exclusive ideas once they put them in print, but I hope they are the exception to the rule.

  17. Young CC Prof says:

    Thank you for the Seasonal Rant of Sanity, very well written this year.

    Got mine one week ago. The only change I’ve noticed is that Squirrel Baby is kicking a lot harder since then, though that’s probably because he’s finally grown big enough to seriously ripple the womb. :) :) It’ll be time for our TDaP booster soon, too.

  18. Young CC Prof says:

    @Mousethatroared:

    Yes, the universal recommendation for flu shot is pretty new. I was reading the CDC survey of vital statistics one time, and then I understood why: Over the past 20 years, the only years in which the age-adjusted death rate in the USA did not drop were years with worse flu epidemics. To think that an infectious disease is still causing so many deaths that you can actually see the signal through the noise of chronic diseases of old age, that’s chilling.

  19. Calli Arcale says:

    My most memorable experience with what I believe was a norovirus came during a family road trip. None of us were sick at the same time, but all of us got it at some point. My turn came while we were crossing the Beartooth Highway, one of the entrances to Yellowstone. There are places to stop along the way, equipped with outhouses, and I must say, vomiting into one of those is truly a singular experience.

  20. Calli Arcale says:

    cphickie:

    What was scary was that H1N1 was already circulating and spreading by the time the vaccine arrived (just bad luck, that was), so a child would get a flu shot and come back 3 days later with the H1N1

    Here in the Twin Cities, a prominent physician (some sort of director at a local hospital, actually) was in charge of an H1N1 vaccination program, making sure all of his staff got vaccinated. They only had the nasal vaccine at that point, and he was just a smidgeon too old to qualify for it, so he had to wait for the injectable one. Unfortunately, a week later, before the injectable version was available but after he’d patted himself on the back for a successful campaign, he caught H1N1, and it killed him.

  21. Calli Arcale says:

    Mark Crislip:

    My Google-fu fails me. I can find two studies with 50,000 pregnant females and the flu vaccine and neither were efficacy studies. One was a safety study and the other a fetal safety study. Both demonstrated safety of the vaccine.

    Well, since they only claimed the study failed to find a difference in efficacy, then I think you’ve actually found their reference. The detail they inadvertently* omit is that the study didn’t find that because it wasn’t collecting data on that.

    *I shall be generous and assume incompetence rather than malice on this one.

    1. Paul Spence says:

      No, it was malice.

      1. calliarcale says:

        Some days I feel generous. Some days not. ;-)

  22. Luara says:

    It seems like a lot of people don’t get flu shots because the flu is a vacation from work and they don’t like their jobs. ,That is chilling.

  23. windriven says:

    “It is ignoring nuance of a complicated topic…”

    It’s the American way! Nuance requires more than 140 characters, more than a bumper sticker, more than a 30 second spot.

    Simple is better than nuanced; you can tell because simple has only 5 letters while nuanced has 7. Simple is also better because it doesn’t require thinking. One can simply sign on to the positions of their surrogates: their political party (Obamacare = nirvana (D) / painful, lonely death (R)), their religion or their sports team.

    Your words really do matter to the 3.047%* who read and understand them. For everyone else you’ll need to explain that regular influenza vaccination will give them humongous penises (M) and will eliminate cellulite (F).

    *I’ve no idea what the percentage is but I’ve learned that adding precision makes a quoted statistic more believable.

  24. Luara says:

    Bunch of comments including my second on this post, got zapped?

  25. OlegSh says:

    If you get a flu shot for one virus, you will be immune to that virus to the end of your life. The problem with influenza – it changes every year, so you need a flu shot every year designed specifically for that year strains.

    The sooner you get a flu shot the sooner you will be protected from that particular virus to the rest of your life.

    If we had a universal flu vaccine then you would need only one shot.

  26. OlegSh says:

    If you get a flu shot for one virus, you will be immune to that virus to the end of your life. The problem with influenza – it changes every year, so you need a flu shot every year designed specifically for that year strains.

    The sooner you get a flu shot the sooner you will be protected from that particular virus to the rest of your life.

    If we had a universal flu vaccine then you would need only one shot.

    1. Chris says:

      OlegSh: “If you get a flu shot for one virus, you will be immune to that virus to the end of your life.”

      Plus there are about two hundred other viruses that give milder symptoms that are similar to flu. That is what so many think is “influenza”, but they are not.

  27. Windriven – love the satire, but I think I am not your target market. Any shot that will eliminate cellulite scares me (restructuring human collagen pharmaceutically? eek.)

    Really, a lot of people do see a benefit in lowering their risk of illness. Our pediatrician said one reason they started giving flu shots earlier this years was because so many parents were calling to see if they were available.

    1. windriven says:

      “Our pediatrician said one reason they started giving flu shots earlier this years was because so many parents were calling to see if they were available.”

      Isn’t that terrific news mouse? Gives me a glimmer of hope that stupidity doesn’t invariably triumph!

    2. windriven says:

      ” Any shot that will eliminate cellulite scares me (restructuring human collagen pharmaceutically? eek.)”

      Yeah, we’ll, you weren’t part of my ‘target market’ anyway, we’re you?

  28. windriven says:

    “If you get a flu shot for one virus, you will be immune to that virus to the end of your life.”

    I’m not sure* that this assertion is entirely true. Perhaps one of our many experts can weigh in on influenza vaccine persistence. I believe that immunity wanes with time.

    *I claim no expertise. I believe I have read this – perhaps in these pages but it is Friday afternoon and I’m too lazy to check.

    1. Yeah, I’m not so sure. I have gathered that the two things at play are that flu viruses mutation and moving around and immunity from vaccines can be variable and can wane over time (like chicken pox, measles, pertussis, tetanus). But I’m really sketchy on all that microbe stuff.

      On the positive side, my daughter is supposed to be studying microbes and evolution this year in 5th grade, maybe I’ll pick up something useful. :)

  29. Birdy says:

    I’ve had the flu more than once, and secondary pneumonia as I have lung issues. I am immensely thankful that flu shots exist and I’m careful to get mine each year, particularly since I have lovely, adorable, two-legged vectors of disease doing their damnedest to bring home every pathogen that crosses their paths at school/daycare.

    It may not be perfect, but I’ll take any defense I can get.

  30. Carolyn says:

    I got the Old Fart flu shot yesterday, the High Dose injection for those over 65. “The additional antigen is intended to create a stronger immune response.”

    FWIW, my arm hasn’t been this sore since my last tetanus shot.

  31. Chris Hickie says:

    It is nice the 4-strain vaccine is available this year. Sadly, you know how those who hate/distrust vaccines are going to twist it into some fearmongering rumor mill.

  32. Holly says:

    Safe Minds use of “flu like illness” seems a deliberate attempt to deceive people into thinking the vaccine is useless and dangerous when they are essentially saying the Polio vaccine is not shown to be effective against Chicken Pox. Well, duh!? Irresponsible and infuriating. We all get our flu shots every year!

  33. Luara says:

    According to a professor of medicine, on http://abcnews.go.com/Health/ColdandFluQuestions/story?id=5677892

    The immunity from the vaccine actually lasts for a substantial period of time. In past years people used to be concerned that the immunity would fade but we have much better data now that supports that immunity actually can extend throughout the influenza season into the spring, and in many cases actually into the following year.

  34. Alia says:

    I’m going to get my shot as soon as I get rid of the flu-like infection I’m undergoing at the moment. I get a few of them every year but they’re nothing compared to a real, true, full-blown flu – the last one of which I had, I think, in 2000 or so. Then I started getting the shot, which I’ve been doing each fall – and no flu at all. And I’m a teacher at a big school, 600+ students, 70+ teachers. So in a way I’m a walking advertisment for its efficacy. Unfortunately, for me the vaccine is not free but that never stops me.
    On the other hand, my mother had such awful side effects that she does not vaccinate. But my father does – and as an elderly person, he gets his shot for free, lucky him.

  35. TTL says:

    Hi!
    I would like to ask something not directly related to influenza, but vaccine related anyway. Here in Finland, there has been some talk in the media about synflorix, GSK’s pneumococcal vaccine, which is part of our vaccine program. Claims have been made about serious side effects, and even deaths, based on anecdotal case reports. Also, it is claimed that this vaccine has been declined an approval in the US, and the reasons for this have not been revealed to the public (meaning that there is something fishy about this vaccine; more side effects or something, which are concealed). Has anyone any knowledge if this is true? Has GSK even applied for an approval for this vaccine in the US? All I can find (in the internet) are statements that GSK will probably not even apply for an approval for this vaccine in the US.

    But if someone here would know better, I would be grateful for help!

    1. stuastrodog says:

      TTL
      I replied to a “letter to the editor” of our local newspaper about vaccinations. The local astrologer and geomancer, whatever the bleep bleep that is, had written in about the dangers of vaccines So I spoke to my brother, a GP of 30+ years. His comment was that in all his time as a GP he had never seen a severe reaction to a pneumococal vaccine. Not one! Hope this helps.

  36. Pareidolius says:

    Elburto, I was out late last night, hadn’t quite finished my PG Tips, and honestly just spent a few minutes trying to figure out what you meant by “. . . the two-headed children of the well-to-do . . .” Always get enough sleep before reading RI/SBM.

  37. cloudskimmer says:

    Dr. Crislip, your post last year responding to reasons people give for not getting the flu shot was brilliant. I refer to it whenever someone tells me why they don’t get the shot.
    What is stomach flu? Who knows? My mother used that label whenever we were sick and throwing up; that was about 50 years ago, so things may have changed since then.
    Blue Cross/Blue Shield decided that while they would pay for my flu shot last year, they would not pay to have it injected into my arm–another example of the ridiculous American health care system, the one Congress thinks is the best in the world.
    I urge everyone to get the flu shot. My elderly mother’s immunity is fading, and even though she gets the high-dose shot every year, I’m terrified that she may get it from one of the unvaccinated people here in woo-central Santa Monica. Sorry to say she lives about two blocks from the offices of woo-meister Jay Gordon–drat him. His website says that healthy people should not get a flu shot, so obviously he cares not a whit about my mother, nor about the other people his misinformation may kill.

  38. Luara says:

    The “I never get sick” reason for not getting a flu shot is somewhat based on a misunderstanding.
    People colloquially speak of all sorts of respiratory infections as “flu”. But they aren’t.
    In reality people probably don’t get a real flu, all that often.
    A person who hasn’t come down with a respiratory infection in a long time due to a strong immune system, would tend to believe they have natural immunity to the flu.
    But all they have is resistance to various respiratory infections that are going around.

  39. Vicki says:

    I know the flu shot doesn’t 100% guarantee that I won’t get the flu this year. But it certainly improves my odds: not getting the flu shot doesn’t help at all. I’ve had bronchitis more than once, I’ve had pneumonia which started with what sure looked like the flu, I got the flu shot a couple of weeks ago, as soon as it was available locally.

  40. I belong to an encephalitis forum that used to be helpful and informative but has been taking a turn towards the twin devils of anti-vax and assorted woo. Years ago when I first started posting and someone would mention flu vaccine and encephalitis and I would respond it is a physical impossibility to get encephalitis from the flu vaccine it is killed and they only use parts of the virus(my understanding of it back then- I am currently taking Dr. Offit’s vaccine course on coursa) Their response was that they had a bad reaction to the vaccine their own immune system attacked the brain. My personal thoughts, at the time, was how is this a bad reaction since with vaccines auto immune encephalitis is less than the background incidence. I didn’t respond with that because at that time the person was not antivax she was just explaining it as a rare bad reaction. However all this has changed since winning a settlement from the vaccine court. (I don’t begrudge this) She is now defiantly antivax and claiming she had viral encephalitis. I want to call BS on this in the most precise factual manner. Rather than like this rambling post. I had measles encephalitis so word recall, focus and brevity are not my strong points. My question is how do I explain that although temporal correlation of auto immune encephalitis post vaccination does not mean vaccine caused (or triggered) the auto immune encephalitis.
    I want to do it in such a way as to not start a fight. It used to be a good site but now they talk about vitamins and herbals and cranial sacral. It is so sad because people are seeking this out for guidance in such a difficult and scary circumstances. I can understand this. I had 10 minutes of absolute terror when I first read about SSPE then it was ok not that, it would have killed me long before(I had measles E when I was 4 months old thankfully we did not have the internet when I was a child. My family was scared enough as it was)
    My other question, is post acute encephalitis a contraindication for vaccination? I would think the opposite would be true and vaccination would be even more necessary. But people talk of how their immune systems are shot and it would put too much stress on their already stressed systems( I would think being ill with a VPD would be more stressful) Thanks

    1. Luara says:

      Your question about vaccination should be answered by your doctor, they can look it up or ask someone else if they don’t know.
      Online medical forums are full of people who suggest “alternative” remedies. I used to subscribe to a celiac disease mailing list. It was useful to find out about others’ experiences on a subject where so much is unknown – but people were always pushing silly advice on me.

  41. lilady says:

    @ Harriet Huestis: IMO, you should just back off that forum, which has been taken over by the assorted cranks and anti-science/anti-vaccine contingent. Seriously, those posts will rot your brain.

    Good for you for taking Dr. Offit’s Coursera course; he’s a terrific educator and is respected for his knowledge about vaccines and vaccine-preventable diseases.

    A good reference for the diagnosis and treatment of encephalitis, is the IDSA Treatment Guidelines, available on the internet.

    http://www.idsociety.org/uploadedFiles/IDSA/Guidelines-Patient_Care/PDF_Library/Encephalitis.pdf

    If you have been following the SBM blogs and Orac’s posts on the Respectful Insolence blog, you will find that that the anti-vaxxers have glommed on to the recent rare cases of awards for vaccine-induced encephalitis and their “claims” that awards were made for vaccine-induced autism….totally bogus claims, as evidenced by the court papers that are available on the internet about those awards my the U.S. District Court of Claims (VaccineCourt):

    http://scienceblogs.com/insolence/2013/01/15/david-kirbys-back-and-this-time-his-anti-vaccine-fear-mongering-induces-ennui/

    You posed a question about contraindications to received a vaccine/or a series of vaccines, when their is a patient history of acute encephalitis. Frankly, their are no instances that I know of, where a patient has recovered from encephalitis from whatever cause, and the adminstration of vaccines… with the possible exception of Herpes encephalitis (often diagnosed in people who have late stages of AIDS, not just HIV infection), which may be a medical contraindication to being given certain live vaccines).

    A good reference is the ACIP General Guidelines for all V-P-Ds used in the United States, which provides the absolute medical contraindications and the “use with caution” guidelines for each vaccine.

    Hope this helps you…and yeah, I given thousands of immunizations and neve have a child or adult have a serioius immediate reaction to any vaccine …nor have any of my ~ 40 colleagus (nurse and doctors), that I worked with, every seen a serious adverse reactions requiring epinephrine or a a call to emergenices for assistance. (Only one private phjysician has ever reported an anaphylactic reaction to our large public health department and it was to an antibiotic. She rescued the child, with an epi shot, because the child’s physician sent the child home without observing the child for 20-30 minutes after administering the antibiotic shot).

    1. Luara says:

      The question about vaccinating after acute encephalitis still seems like a matter of medical opinion to me (how long ago was it, any other info about medical condition to consider, etc.) I would just go to a doctor for the vaccine, mention the history if concerned. Maybe the doctor would go by a standard reference, maybe not.
      Probably it’s a needless concern, activated by being around a lot of anti-vaxxers.

  42. lilady says:

    ^ ACIP General Recommendations link ommited in my post above:

    http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6002a1.htm

  43. Ben says:

    Can I hold safeminds liable for lost brain cells after reading their article?

  44. Amruta says:

    I was waiting for so long, but after reading this article, I will have it ASAP.

  45. Paul Spence says:

    “acquiring new DNA”

    The influenza virus is an RNA virus.

  46. Egstra says:

    OK, OK… I’ll get my damn flu shot tomorrow, roughly two weeks before my flight, rather than waiting until the end of October.

  47. A person with a well-functioning immune system has no need for flu vaccine
    A patient with a compromised immune system will not benefit from a flu vaccine.

    It’s basically a waste of money. Boosts the share price of pharmaceutical companies selling it, and gives the Crislips of this world something to talk about.

    1. ^^FBA

      Well if some guy on the internet says it…it must be true.

      The only thing more reliable than some guy on the internet is a chain email forwarded by a friend.

      (Does anyone miss chain emails? Does anyone appreciate Facebook for lowering the chain email incidence?)

    2. WilliamLawrenceUtridge says:

      FastBuckArtist, you are an idiot, and an ill-informed one at that.

      Spanish Influenza was most lethal for well-nourished males between the ages of 25 and 45. Spanish Influenza was the H1N1 strain, confirmed through genetic testing of corpses frozen in the permafrost of Siberia. Spanish Influenza killed through a massive over-reaction of the immune system that essentially engaged in scorched earth tactics in the lungs, among other tissues, leading to people choking to death on their own immune systems. Read a book.

      The influenza vaccine can be given to poor-responders in a high-dose version, such as is used for the elderly. For most of us the influenza is a painful, sometimes debilitating infection lasting two miserable weeks, but most of us will be fine. For those who cannot be vaccinated, it is a strong risk of a miserable death. For those who cannot be vaccinated, their only protection is herd immunity. I get the vaccine to avoid getting sick myself, but mostly so I don’t give it to people whom I love but don’t want to die, such as my grandmother, and my friend who has a wife undergoing chemotherapy.

      You should learn something about the subject you are speaking of, before you bother showing up here. And you shouldn’t learn about it from whale.to, because those people are lunatics.

  48. weing says:

    “A person with a well-functioning immune system has no need for flu vaccine
    A patient with a compromised immune system will not benefit from a flu vaccine.”

    Ahh. The bovine scatology artist, demonstrating his ignorance.

  49. A perky recording from my insurance company just left me a phone reminder to get my flu shot. Not really sure why my insurance company would do that unless they thought they’d see some saving due to fewer doctor visits or less medication.

  50. Gemman Aster says:

    Does cost play a big part over with you?

    In Britain you receive the yearly flu vaccination for free if you are in a high-risk group such as Asthmatic or if your immune system is compromized in some way. You also get bi-annual pneumococcal vaccinations, which is not something I have read a lot about in America.

  51. Egstra says:

    Had lunch with some old people yesterday (high school
    classmates) and two mentioned that they are not able to get flu
    shots due to medical problems… they rely on herd
    immunity.

  52. Vicki says:

    Right. That’s the other reason I got my flu shot as soon as possible: to help protect the people I care about who can’t get one for medical reasons, or who it may be less effective for (like my mother, in her 80s). (Health insurers in the US are . As a side benefit, it helps protect the children who live in my apartment building, and whoever I happen to sit next to on the bus.

    How many opportunities are there to do something that is quick and easy, intended mainly for my own benefit, and has the side effect of helping other people?

  53. Andrés says:

    I care about my father. That’s the reason I pay for his vitamin D level tests and for his vitamin D pills. We are not waiting for results of RCTs that I am not aware of having begun to confirm previous ones: this one on children or this one on older women. Yes, I have already talked about it and said that my father is getting the flu shot too (not yet this year): perhaps a good vitamin D level will be useful even there too.

    I am not going to get a flu shot any time soon though. Herd immunity is not a possibility around here in Spain since the flu vaccine is targeted only to high risk population. I am actually not convinced at all that ignoring vitamin D levels and focusing on vaccines alone is a good strategy. At least no-one has talked a word about his/her vitamin D levels (or those of their elderly loved ones) in the comments yet, although Dr. Crislip has recommended “Be replete in vitamin D”.

    I don’t think that you can suppose your level is good (at least 30ng/ml) without measuring it. In my case taking a look at mean levels of children through the year around here (fourth slide) is not reassuring in the least. Elderly people levels are almost guaranteed to be lower (via Vitamin D Council).

    1. “this one on children”

      The confidence interval on that one is pretty entertaining. You realize that you don’t need any research to say: “This could help or have no effect at all” :)

      1. Andrés says:

        From Results Section from the Abstract of Randomized trial of vitamin D supplementation to prevent seasonal influenza A in schoolchildren:

        Influenza A occurred in 18 of 167 (10.8%) children in the
        vitamin D3 group compared with 31 of 167 (18.6%) children in the
        placebo group [relative risk (RR), 0.58; 95% CI: 0.34, 0.99; P =
        0.04]. The reduction in influenza A was more prominent in children
        who had not been taking other vitamin D supplements (RR: 0.36;
        95% CI: 0.17, 0.79; P = 0.006)

        Yes, not perfect. Once those on placebo that had been supplementing were taken out of the equation it gives rise to a tight enough 95%CI though.

        1. As a rule, don’t look at something that is poor and call it “not perfect”. Call it “poor”.

          The CI is (0.34,0.99). Meaning without post-hoc subgroup analysis. We are guaranteed to have somewhere between some effect and zero. Which nobody needed to be told.

          *After* they got that result, they imputed people. Why doesn’t this raise a red flag for you? It’s such an obvious factor why wouldn’t you just reject those people from the study to begin with? They even asked people about using Vitamin D “medicinally”. Now they remove people who are supplementing as little as 200 IU per week?! But did they impute anyone with 200 IU per week more dietary intake? Nope. That’s less than a 4oz serving depending on the fish. Do you really believe nobody’s diet varied by more than 4oz of fish per week . In a country that averages 3oz per person per day?!

          Imputing someone in the placebo group post hoc for such an obvious factor is a sign of either poor study design or desperation especially when it’s done for such small doses.

          Even so you end up with a CI which contains an RR of .79 – How is that “tight enough”? Tight enough for what? So you can shoehorn your beliefs into the data? Be. My. Guest.

      2. Andrés says:

        I will keep my answer at a lower indentation level to keep it under control.

        Perfect studies about endogenous substances are unattainable in practice. Perfect would be an intervention where the population subjects are put on supplementation regimens focused on several calcidiol ranges throughout the study, and results are measured once they are achieved and maintained stable. Perhaps even the population subjects should be classified by their vitamin D receptor gene variant, just to lower the noise.

        The hypothesis that a good vitamin D level prevents influenza A infections has been constructed from epidemiological data. It is supported by physiological actions of calcitriol such as cathelicidin and β-defensin production. I am not looking for a study that proves a good vitamin D level to have a prevention effect on influenza A, I am waiting to see one that clearly disproves it à la Popper. Actually vitamin D effects are so varied that we would be supplementing the same even then.

        Maybe you prefer to wait for more RCTs clearly showing an effect on influenza A before guaranteeing a good vitamin D level year round. Be. My. Guest.

        1. “Perfect studies about endogenous substances are unattainable in practice. ”

          In other words, your calling something “not perfect” is needless since all studies that have been performed are not perfect. Great. Thanks Socrates! Everyone needed to hear that.

          My comment that this study you cited was POOR still stands out. You still have not said why imputing post-hoc didn’t raise a red-flag for you or if you agree that this study was poor then you haven’t supplied much reason for citing it?

          “Maybe you prefer to wait for more RCTs clearly showing an effect on influenza A”

          You can supplement with rhino horn for all I care but a) Don’t cite poor evidence. b) Don’t pretend poor evidence is better than it is.

          1. Andrés says:

            My name is Andrés, not Socrates.

            I will keep citing those RCTs that actually exist. I will keep using the adjectives that I find appropiate.

            There are more potential but indirect studies giving support to the hypothesis like Ultraviolet blood irradiation therapy in acute virus and virus-like infections (via Vitamin D Council) but I can’t access them. Feel free to cite whatever you want to falsify the hypothesis if you care to contribute to the discussion. Or keep qualifying those studies I cite if it lets you feel better, I will just restrain myself from the conversation.

          2. sarkeizen says:

            “I will keep citing those RCTs that actually exist. I will keep using the adjectives that I find appropiate.”

            You will keep doing the least accurate thing even when it’s pointed out to you that it’s the least accurate thing?

            Labeling something that is “poor” as merely “not perfect” is pretty wildly inaccurate. Either you can make a case for the study being “good” or you can’t. If you can, feel free to share that here. If you can’t well doesn’t continuing to deceptively label a study which just happens to agree with your bias make you kind of a bad person?

            “Feel free to cite whatever you want to falsify the hypothesis if you care to contribute to the discussion.”

            Interesting. You seem to think the only contribution is a study that falsifies (to some unspecified degree) your hypothesis. Huh. So to you there’s no value in realizing that the evidence is at best mixed and at worst poor. A you sure I’m the one trying to make myself feel better about what I believe.

            “I will just restrain myself from the conversation.”

            So far you haven’t provided much in the way of conversation. Why can’t you just be honest and say: That study kind of sucks. The other evidence is weak (or maybe it’s strong I don’t know). You could actually *think* about things like what specific kinds of research needs to be done instead of spending so much time trying to bolster your pre-existing belief.

            I don’t have a horse in this race. You clearly do and it appears to be some kind of problem if you’re wrong. Never a good combination IMHO.

    2. WilliamLawrenceUtridge says:

      If you got the flu shot, even if herd immunity didn’t exist, at least you could be sure that you did everything you could to prevent you from giving it to him. I recall having this conversation with you last year – yes, vitamin D is important, yes it is being recognized as borderline deficient in some, but that doesn’t change the fact that the influenza vaccine will protect you from having a miserable two weeks, and dramatically reduce the likelihood that you will give it to anyone else. Even if you don’t get sick yourself or don’t show symptoms because of your vitamin D levels, you could still shed asymptomatically – and your father, even with high levels of vitamin D, might still get sick.

      I don’t get it – there’s never any reason to not get the shot that I can see, why rely on the unproven assertion that vitamin D will protect you from all evils but not the proven statement that the flu vaccine is imperfect but effective? Why not see it as two different ways of converging on the same outcome – your father not dying of influenza?

      1. Andrés says:

        I have serious doubts about the necessity (mortality prevention) of flu shots on vitamin D repleted populations, even the elderly, after reading the paper by Dr. Cannell et alter. As I have already said I would volunteer to an RCT measuring such a thing. Not withstanding my doubts, my father will keep getting his flu shot just in case. I hope his immune response to the vaccine to be good too due to his good vitamin D level (age range in the study 53-79, my father is 78). From there on it is a biased decision of an engineer. I don’t see it efficient to expend any money on vaccinating myself since it would decrease the potential risk of infection by my father ever so slightly if at all, since my father has a very healthy social live and get into contact often with a lot of people. I see more efficient expending money on plan C, where I suppose we are going to disagree big time.

  54. WilliamLawrenceUtridge says:

    The hypothesis that a good vitamin D level prevents influenza A infections has been constructed from epidemiological data.

    Do you know what has been constructed from epidemiological, bench, controlled trial and other types of research converging on a common conclusion? The idea that vaccination can prevent influenza infection. Imperfectly, but effectively. Even if vitamin D does help reduce the risk of influenza infection, it’s not an either-or. Vitamin D reduces the risk of influenza infection? Great! So does vaccination. So why not do both?

    I have serious doubts about the necessity (mortality prevention) of flu shots on vitamin D repleted populations, even the elderly, after reading the paper by Dr. Cannell et alter. As I have already said I would volunteer to an RCT measuring such a thing. Not withstanding my doubts, my father will keep getting his flu shot just in case. I hope his immune response to the vaccine to be good too due to his good vitamin D level (age range in the study 53-79, my father is 78). From there on it is a biased decision of an engineer. I don’t see it efficient to expend any money on vaccinating myself since it would decrease the potential risk of infection by my father ever so slightly if at all, since my father has a very healthy social live and get into contact often with a lot of people. I see more efficient expending money on plan C, where I suppose we are going to disagree big time.

    Jebus, how much does an influenza vaccine cost in Spain? I’m lucky, for me it’s free, but even if it were $20 or so, I would still pay it. By vaccinating yourself, in addition to reducing the likelihood of getting a miserable infection – your low-cost vaccine will add to the list of things you can do, again, with barely any cost or inconvenience, that reduces the threat to your father. Or, if you give a shit about more people than just your father, you’re also protecting your children, your spouse, people on the bus, people in the street, the guy you buy your cheese from, and all their children too.

    Plus, you reduce your risk of getting influenza.

    I mean what, do they administer the vaccine through a severed finger or something? Your loss is low – the cost of the vaccine. The risk likelihood is also low – the chance that you might give your father a fatal infection is probably not that great. But the impact is high – you may give your father the disease that kills him. Is the economy in Spain that bad these days? Your decision continues to appear irrational, as if your car could only have a seatbelt or airbags. Hey, why not get both?

    1. Andrés says:

      I will try to avoid repeating myself.

      Vitamin D will get down the probability of infection. It will have an impact in complications like pneumonia lowering incidence and mortality. I am not convinced at all that flu vaccine is going to make a dent in mortality outcomes over vitamin D.

      Any medical intervention including vaccination has its risks. Perhaps they are low in the influenza A vaccine but certainly they are not null and I don’t believe there is any benefit once vitamin D replenishment is achieved. Moreover when herd immunity isn’t a goal I don’t see the point in getting an annual shot.

      Nevertheless my father will get his flu shot just in case I am mistaken. I would even consider vaccinating myself (and my sister) if my father were mostly at home. It is not the case. All of us are getting good blood calcidiol levels year round though.

      My belief of course doesn’t mean that I am not open to the hypothesis “influenza vaccination doesn’t lower mortality on a vitamin D replenished population (say >40ng/ml year round)” to be falsified though. Whenever it happens I would reevaluate my position.

      As for the guilty and sentimental argument, I am not moved. I prefer being rational. My logic and decision making process doesn’t have to fit with yours though.

      Nor I am entirely a selfish person. I donate blood since I was old enough to do it even before I knew it could be good for my health too. I don’t have any doubt about the utility of blood donation though.

      As for me not getting a miserable infection, I will keep my actual strategy while it works form me. It’s been more than two years and I haven’t taken anything more than lots of vitamin C for any several presumed viral or bacterial illness. No, as I already said vitamin D seems not to be effective against Staphilococcus Aureus, rhinoviruses and Influenza B at least. Yes, I know it doesn’t prove anything apart that it is very likely I was taking a lot of unneeded medication beforehand. Whenever the strategy fails (no resolution of symptoms under saturation —no day off along this time— or duration longer than 5 days) I will reevaluate.

        1. Andrés says:

          I had already read your blog post. My comment is not #5 related. Actually I am acting on point #6:

          If you try a remedy and get better, it’s reasonable on a practical basis to try it the next time you have the symptoms, but it’s not acceptable to cite your experience as proof that “it works.”

          I haven’t said that it supposedly working for me is a proof of any kind just that it is enough for me to keep my present strategy for the time being in accord of your #6 first part.

      1. WilliamLawrenceUtridge says:

        I am not convinced at all that flu vaccine is going to make a dent in mortality outcomes over vitamin D.

        The ‘flu vaccine is unlikely to do so because you would generally need herd immunity to achieve significant drops. Not to mention, the very people most at risk (the very young, the very old, pregnant, immune compromised) are unlikely to benefit. Plus, you would have trouble tracking such outcomes since people don’t usually die of “influenza”, they get influenza, which renders them more at risk for respiratory diseases (which is what their death certificate is marked with), or clotting (ditto).

        I don’t believe there is any benefit once vitamin D replenishment is achieved. Moreover when herd immunity isn’t a goal I don’t see the point in getting an annual shot.

        Your belief about the efficacy of vitamin D is just that – a belief, it’s not truth and it’s not proven. And again, your shot can prevent you from getting a miserable illness – but more importantly, it means you won’t give the disease to your father. Someone else might, but at least you won’t.

        I prefer being rational. My logic and decision making process doesn’t have to fit with yours though.

        Of course, in this case you aren’t being rational. You want to reduce the risk of giving your father influenza, get the flu shot as an added layer of protection. That’s rational. The influenza vaccine prevents influenza infection. Not perfectly, not all strains, but it is effective for the antigens it matches.

        Nor I am entirely a selfish person. I donate blood since I was old enough to do it

        Good for you. More people should. I don’t think you’re being selfish by the way – I think you’re being irrational.

        Vitamin C doesn’t prevent or treat any infection, at best it is a moderately successful antihistamine at high doses.

        1. Andrés says:

          Plus, you would have trouble tracking such outcomes since people don’t usually die of “influenza”, they get influenza, which renders them more at risk for respiratory diseases (which is what their death certificate is marked with), or clotting (ditto).

          I have linked to pneumonia related vitamin D epidemiological evidence. There is also some pieces of evidence of vitamin D effects on clotting like this epidemiological study (via Vitamin D Council).

          As a matter of fact I am not certain that the evidence for the prevention of secondary deaths by influenza vaccine is so strong due to the one Jackson’s paper analyzing the 1997/1998 flu season specifically stating that the major strain finally circulating wasn’t included in that season preventive vaccine.

          Your belief about the efficacy of vitamin D is just that – a belief, it’s not truth and it’s not proven.

          I am not waiting for more* evidence in support of Dr. Cannell’s hypothesis. After a benefit/risk analysis I am acting upon it as being true while taking a look for any evidence that disproves it à la Popper. I am not convinced by the practical implications that actual gradient of evidence used in western medicine giving priority to RCTs brings up in reality. RCTs on non-patentable substances most times don’t get done. I think that any promising clinical experience should be checked (refuted) by RCTs. Usually they are not. They are simply ignored or discredited with either something like a joke of a replication or an overstatement of its presumed toxicity. At least it is not going to be the case for vitamin D. Nevertheless my father doesn’t have the time to wait for it. So I take action now. Of course I take the lead experimenting on myself first. Of course my father gets both aproaches (yes, I always check for possible interactions).

          *A not exhaustive list. I have already pointed out that Calcitriol enhances cathelicidin and β-defensin production. a) Cathelicidins are effective against influenza A in vivo (I know, in mice). b) Lung epithelial cells activate vitamin D and it upregulates cathelicidin production at the same time that it attenuates dsRNA-induced expression of the NF-κB-driven gene IL-8 (perhaps enough to prevent a cytokine storm?). c) Vitamin D effect on the immune system goes way beyond these two effects. d) All of the epidemiological data cited by Dr. Cannell et alter pointing to an strong effect.

          I have already talked about vitamin C natural history. We have already had a conversation about vitamin C potential as an antiviral agent (from this comment downwards).

          Vitamin C doesn’t prevent or treat any infection, at best it is a moderately successful antihistamine at high doses.I suppose you are referring to analysis such as those of Dr. Barret or late Charles W. Marshall. I think that it has positively been refuted that vitamin C prevents colds. I think that it has positively been refuted that 4g/day (even 8g/day) are measurably better than 0.5g/day in treating the common cold. I think that late Linus Pauling confounded following vitamin C research in his passion to defend vitamin C use for anything. I haven’t read any Linus Pauling’s book and I am not going to. This being said, late Charles W. Marshal critique isn’t consistent either:

          They concluded that vitamin C can act like an anti-histamine drug. However many physicians believe that reducing infection-caused inflammation (nature’s defense reaction) slows recovery.

          versus

          Of these, 12 trials showed no prevention and no reduction in duration or severity, five trials showed no prevention and only slight, statistically nonsignificant lessening of severity, and the other five trials reported no prevention and a small but significant in reduction of duration of the colds.

          I don’t see slower recovery anywhere. From there on I am almost at a loss about how having found a reduction of duration of colds with meager doses of at most 8g/day no one thinks about trying bigger doses. “Almost” because obviously it can’t happen blinded while using oral doses. Intravenously administered sodium ascorbate doesn’t have that limitation. Intravenously administered sodium ascorbate clinical success (beginning with late Dr. Klenner) predates Linus Pauling’s love for oral vitamin C and hasn’t been refuted yet, only ignored as I have already said. The only recent intervention study I am aware of is a retrospective cohort one with 3g/day and several other substances for seven days pointing toward a positive effect commented here and here (via Dr. Dach). As I have already commented, 0.4g/kg per day doesn’t bring up any side effect.

          Not being an MD, I restrict myself to oral vitamin C in a dose big enough to have an effect as pointed out by late Dr. Cathcart. Whenever the strategy fails (no resolution of symptoms under saturation —no day off along this two years for me— or duration longer than 5 days) I will reevaluate. I am not optimistic enough to talk about waiting for a refutation experiment to be done on the vitamin C case.

          1. Andrés says:

            Sorry, I failed with the indentation on my last quote from you (I used “/a” instead of “/blockquote”):

            Vitamin C doesn’t prevent or treat any infection, at best it is a moderately successful antihistamine at high doses.

            I suppose you are referring to…

  55. arsawyer says:

    I can’t help but notice that even though Andres has picked the most plausible, science-based vitamin treatment to discuss here, his blog casts a much wider net and falls back on the naturalistic fallacy quite a bit. I think that may be tainting an otherwise rational decision process.

    Unrelated question: what happened to the WordPress login for SBM?

    1. WilliamLawrenceUtridge says:

      It’s gone – see here.

    2. Andrés says:

      Well, I am not an MD. I am an engineer. I restrict myself to experiment on (mainly) vitamins and minerals that I found promising and of enough low toxicity. I am perfectly aware that natural doesn’t mean safe. Even in human endobiotic substances. I explicitly avoid betacarotene and vitamin A outside of food for example.

      Apart of vitamin C and vitamin D, the only other two labels that I use in my Spanish blog are iodine and cholesterol. Iodine as a supplement in milligram doses is certainly the most speculative of the main three substances that I take.

      Respect to cholesterol, I don’t buy neither the diet-heart hypothesis nor the cholesterol-heart one as I have expressed elsewhere. It is a matter that only affects me (last June: CT 368, HDL 97, TG 96), not my father.

      I am not convinced of neither the efficacy nor the safety of exobiotic substances of chronic use like statins. I am not convinced of the efficacy of most screening procedures either. In both cases I like best the analysis and conclusions given by TheNNT group. I think that any other measure than any-cause mortality is almost useless.

      I have selected vitamin C to defend around here because it is so disregarded. I have talked about vitamin D in this thread because although it was included in Dr. Crislip’s post no-one of the commenters said a word about it. As far as it looks no one measures it.

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