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.”
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.