Wrong.
You need to go read Kathleen’s post titled A Not-So-Hidden History. For the best investigative blogging in autism, Kathleen Seidel is the go to person. Once again, it was not the “journalists” of autism (Kirby and Olmstead) who uncovered this information.
What does it mean?
Well, for one, I think that claims to the effect that the Poling case is unprecedented, an event of major significance, with pigs flying and the sky falling, have been rendered completely bogus.
Furthermore, let’s consider whether allowing such an impression to be promoted was an honest thing to do. As Kathleen notes:
In all but one of the above-listed cases with published decisions, the petitioners were represented by individuals who are now or have been members of the OAPPetitioners Steering Committee — including its chairman, Mr. Clifford Shoemaker, counsel to the Poling family.
Now, let’s think about the numbers. It appears that each year in the US about 50 vaccine injury claims are found to be “compensable” (source). What are the odds that at no point in time any of the compensated persons was autistic? We’re talking about very rare occurrences, but statistically they must occur unless autistic persons are specially immune to vaccine injury.
It’s not possible, from available data, to make an accurate determination as to whether autistic persons are more or less likely to suffer vaccine injury than non-autistic persons, and no scientific reasons to lean one way or the other.
Left Brain Right Brain 
“I have to wonder what motivates someone who does not have a “dog in this fight”, so to speak, to invest such a huge amount of time debating this topic online. It indicates a passion for the topic, a passion not often found alongside a neutral stance.”
It’s incredibly rude and insensitive. Just go away.
Ms. Clark,
“I found a study about the flu shot’s use in the Israeli army in preventing flu. The effectiveness (or efficacy, I can’t remember) was about 40%.”
Link please. I’ll bet the efficacy measure was for immune reaction, not actual flu prevention. That’s the wrong measurement as clearly outlined by the Cochrane report.
“You think you are impressing people with your knowledge? I don’t think so. I think you come off like a know-it-all, but you don’t know it all. ”
Black kettles eh? I certainly don’t know everything, and if I’m wrong, I will and have changed my position or stated a correction. Personally, I really don’t care whether people are impressed or not so you got that one wrong too. If anyone thinks this is an effective ego booster, they are greatly mistaken.
“I get the flu shot. Now after reading up on the Cochrane review site, I will continue to get the flu shot and get my ASD kid vaxed every year and encourage everyone to get it if available to them.”
Like I said before, you can keep your faith in the system against the growing body of evidence.
“The Cochrane review found that flu shots helped keep the flu at bay for children and old people, even though in old people they work less well than in younger adults.”
Let’s review what the Lead Author wrote:
NO efficacy of objectives (i.e. the reason the vaccine is justified — including deaths) for healthy adults or children under 2. Small efficacy for seniors, but there were a lot of problems with selection bias in those studies:
Did you notice this small but important point from the study on children:
Note that they are specifically NOT recommending vaccination as public-health policy until the proper trials are executed.
That pretty much runs completely contrary with your position that the flu vaccine should be administered to everyone as public health policy. How exactly are you using this evidence to support your position?
Shwartz,
Once again your anti-vax nonsense is evident. What does any of your misinformed nonsense have to do with autism? Go away.
grenouille,
I like the name.
I think that there is a whole class of vaccines that have completely unproven effectiveness and in some case proven ineffectiveness. These are the ones that target a few specific strains with the goal of eliminating some downstream small percentage side effect. (Gardasil, Prevnar, Pneumococcal, influenza etc). I am upset that public health policy promotes these vaccines and even pays for them in my case without good evidence of efficacy or intervention cost effectiveness. They are using a completely unproven strategy with unknown side effects as well.
Of the rest of the vaccines, I do not doubt their efficacy and my assumption is that they work despite exaggerated claims of efficacy rates. Now it comes down to a risk/reward decision.
I am upset that there is little quality tracking of safety information about vaccines, and a poor record of safety testing. The efficacy rates have proven time and time again to be exaggerated by mainstream medicine, as well as the risks.
So I tend to scrutinize the details because there is good evidence of mis-information. However, as you scrutinize, I find a general lack of both understanding and good data. Based on anecdotal evidence, it appears pretty clear to me, that certain vaccines that work well are far riskier than they need to be (it doesn’t mean the risk is high, but higher than necessary). No one is looking to identify any risks because they just aren’t studied and currently there is no incentive to look. The safety studies are pathetic, and numerous systematic reviews have confirmed this. I find this situation and the justifications for this behaviour to be completely unacceptable.
That does not mean I assume all vaccines are dangerous to everyone. All vaccines are known to be dangerous very small numbers of specific children but we don’t know how many, and no one seems to care or want to figure out why. If someone wants to convince me to apply a medical intervention without being able to quantify the risks or rewards, I have a problem with that.
I post about it when I feel that others are posting misinformation about these topics, or I’m interested in discussing a particular topic.
My first child had a single shot at 6 months, because at the time, I had not yet completed my research and trusted the doctor. After that first shot, I did my research and decided against further vaccination (and discussing it with the doctor) until she was much older. Now she is older (6) and she has received another vaccine. My youngest does not have any vaccines, and won’t get them until she is older as well.
Both of them have contracted extremely mild chicken pox (from their vaccinated cousin!), and have survived several pertussis outbreaks in nearby daycares. The irony of the pertussis outbreaks are that the rules for children in exposed daycares were the same regardless of vaccination status — full course of Anti-biotics or 20 days at home. How ironic is that? The vaccination status had no effect on the infection rate and this was confirmed by the policy.
Steve_D,
“Schwartz, how can you possibly not see how you could be perceived as anti-vaccination?”
I can certainly understand that someone who is not reading carefully could perceive me incorrectly as being against vaccines. However, there is a big difference between honest incorrect perception, and blatent ad-hominem arguments which is exactly what you are reading here. Just follow the logical trail of the debate and you’ll see it. Additionally, if mistaken perception is corrected, then accusations fall under a completely different category — false argument.
“This blog is a highly visible area of discussion for AUTISM. It is common for discussion of vaccines to occur among the autism community doe to the speculation about causation. I don’t know how often you have commented here, but it is certainly more than the average visitor/commenter. And your comments are not about autism, they are about vaccinations.”
That is very interesting because if you review the article postings here, you’ll find that the most frequent topic is vaccination and Autism. Correspondingly, so are my comments as are those of others here. You’ll note again, that I was responding here to a misleading posting by Ms. Clark on flu vaccines. I did not bring that topic here.
“I have to wonder what motivates someone who does not have a “dog in this fight”, so to speak, to invest such a huge amount of time debating this topic online. It indicates a passion for the topic, a passion not often found alongside a neutral stance.”
Sometimes I wonder myself, as I have other things to do. I am very passionate about health care, and I’m especially discouraged by what I find is a general apathy about the state of health care, and people’s knowledge about their own health. Most people I know, listen to their doctor (after giving them extremely limited information) and just accept what is told to them. These same people wouldn’t accept the word of any other professional under those same conditions — I know because I work with them. The difference is baffling.
I have two young children, and so health is of great interest to me. Ironically, the biggest health care debate centers around drugs and vaccines. Vaccines are the centerpiece of health policy and drugs account for some of the highest cost items in healthcare. Autism, and auto-immune disorders certainly appear on the rise, and one can’t avoid interacting with children having these conditions today. My daughter goes to a small school, and caring for children with special needs is a big part of making schools like it work effectively. It is especially challenging for a small school. Boards like AS have many active discussions about Autism, but also other health issues in children and I find it very educational.
What do you consider a neutral stance? Do I have bias? Probably. I am biased to be skeptical of faith in the system — I had a lot of undeserved faith at one time as well. I think I am quite familiar with many aspects of the health system, and I make use of it’s benefits and areas of excellence. However, I am also quite aware of it’s many failings as I’m pretty up front about that. I have no ulterior motive.
“I also have found that your typical casually polite demeanor gives way when someone plays the anti-vax card, and you adorn yourself with a much more aggressive persona that uses more ad hominem attacks, insults, and sarcasm.”
Guilty as charged although I think that ad-hom attacks by me are very rare. I certainly have a bad habit of countering insults and vitriol with nasty sarcasm and returned insults — yes, I get angry too. I should probably go back and study the style of my favourite poster whom I have a great deal of respect for.
“So when Matt asks for you to make clear your stance, maybe he is subconsciously wondering about some of these same things and just asked too narrow of a question.”
Here I disagree. Take a quick sampling of his postings here and on AS forum. You’ll find a very distinct pattern and it’s not one of a poster that asks honest questions for the purposes of understanding. I also know he reads my posts, because when he doesn’t like something, he’ll jab with a short post. He should be quite familiar with my position. If he’s really sincere, he’ll PM me to clarify — but I haven’t heard anything yet and I’m not holding my breath.
Oh those faith-based Germans (shakes head)
http://www.ncbi.nlm.nih.gov/pubmed/18270923?ordinalpos=18&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
Dtsch Med Wochenschr. 2008 Feb;133(8):377-8.
[Vaccination of healthcare workers against influenza]
[Article in German]
Salzberger B, Ehrenstein B.
Klinik I für Innere Medizin, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93042 Regensburg.
Vaccination of healthcare workers (HCW) against influenza is strongly recommended due to its positive effects on elderly patients. In randomized studies vaccination of healthcare workers resulted in lower overall mortality of patients in the winter period. Still, vaccination rates of healthcare workers remain low in many countries, especially in Europe. The rationale for the current recommendations, vaccination rates of healthcare workers, factors influencing these rates, and strategies to improve vaccination rates are discussed.
They only want to vax health care workers because they can’t use Zyclon B anymore….
Oh, those faith based Italians…
Emerg Infect Dis. 2008 Jan;14(1):121-8.
Cross-subtype immunity against avian influenza in persons recently vaccinated for influenza.
Gioia C, ….
Avian influenza virus (H5N1) can be transmitted to humans, resulting in a severe or fatal disease. The aim of this study was to evaluate the immune cross-reactivity between human and avian influenza (H5N1) strains in healthy donors vaccinated for seasonal influenza A (H1N1)/(H3N2). A small frequency of CD4 T cells specific for subtype H5N1 was detected in several persons at baseline, and seasonal vaccine administration enhanced the frequency of such reactive CD4 T cells. We also observed that seasonal vaccination is able to raise neutralizing immunity against influenza (H5N1) in a large number of donors. No correlation between influenza-specific CD4 T cells and humoral responses was observed. N1 may possibly be a target for both cellular and humoral cross-type immunity, but additional experiments are needed to clarify this point. These findings highlight the possibility of boosting cross-type cellular and humoral immunity against highly pathogenic avian influenza A virus subtype H5N1 by seasonal influenza vaccination.
Oh, those wacky faith based docs at the Mayo Clinic
Mayo Clin Proc. 2008 Jan;83(1):77-84.
Flu myths: dispelling the myths associated with live attenuated influenza vaccine.
Tosh PK, Boyce TG, Poland GA.
Vaccine Research Group, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
Live attenuated influenza vaccine (LAIV), commercially available since 2003, has not gained widespread acceptance among prescribers. This underuse can be traced to several misperceptions and fears regarding LAIV. This review examines both the facts (safety, immunogenicity, and effectiveness) and the most pervasive myths about LAIV. Live attenuated influenza vaccine is a safe, highly immunogenic, and effective vaccine. It is well tolerated; only mild and transient upper respiratory infection symptoms occur with LAIV vs placebo, even in higher-risk patients with asthma or the early stages of human immunodeficiency virus. It is immunogenic, especially in induction of mucosal immunity. In certain populations, LAIV is as effective as, and in some cases more effective than, inactivated influenza in preventing influenza infection. It appears to be more effective in preventing influenza infection than trivalent inactivated influenza vaccine when the vaccine virus strain does not closely match that of the circulating wild-type virus. Many myths and misperceptions about the vaccine exist, foremost among them the myth of genetic reversion. Independent mutation in 4 gene segments would be required for reversion of the vaccine strain of influenza virus to a wild type, an unlikely and as yet unobserved event. Although shedding of vaccine virus is common, transmission of vaccine virus has been documented only in a single person, who remained asymptomatic. In the age groups for which it is indicated, LAIV is a safe and effective vaccine to prevent influenza infection.
More wacky faith based research:
Effectiveness of influenza vaccine in the community-dwelling elderly.
Nichol KL, Nordin JD, Nelson DB, Mullooly JP, Hak E.
Medicine Service and Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Medical Center and University of Minnesota, Minneapolis 55417, USA…..
BACKGROUND: Reliable estimates of the effectiveness of influenza vaccine among persons 65 years of age and older are important for informed vaccination policies and programs. Short-term studies may provide misleading pictures of long-term benefits, and residual confounding may have biased past results. This study examined the effectiveness of influenza vaccine in seniors over the long term while addressing potential bias and residual confounding in the results. METHODS: Data were pooled from 18 cohorts of community-dwelling elderly members of one U.S. health maintenance organization (HMO) for 1990-1991 through 1999-2000 and of two other HMOs for 1996-1997 through 1999-2000. Logistic regression was used to estimate the effectiveness of the vaccine for the prevention of hospitalization for pneumonia or influenza and death after adjustment for important covariates. Additional analyses explored for evidence of bias and the potential effect of residual confounding. RESULTS: There were 713,872 person-seasons of observation. Most high-risk medical conditions that were measured were more prevalent among vaccinated than among unvaccinated persons. Vaccination was associated with a 27% reduction in the risk of hospitalization for pneumonia or influenza (adjusted odds ratio, 0.73; 95% confidence interval [CI], 0.68 to 0.77) and a 48% reduction in the risk of death (adjusted odds ratio, 0.52; 95% CI, 0.50 to 0.55). Estimates were generally stable across age and risk subgroups. In the sensitivity analyses, we modeled the effect of a hypothetical unmeasured confounder that would have caused overestimation of vaccine effectiveness in the main analysis; vaccination was still associated with statistically significant–though lower–reductions in the risks of both hospitalization and death. CONCLUSIONS: **During 10 seasons, influenza vaccination was associated with significant reductions in the risk of hospitalization for pneumonia or influenza and in the risk of death among community-dwelling elderly persons. Vaccine delivery to this high-priority group should be improved.**
Faith based Israelis… shame on them…
Reduced hospitalizations and death associated with influenza vaccination among patients with and without diabetes.
Heymann AD, Shapiro Y, Chodick G, Shalev V, Kokia E, Kramer E, Shemer J.
Maccabi Healthcare Services, 27 HaMered St., Tel Aviv, Israel. …
OBJECTIVE: To assess whether the influenza vaccination of community-dwelling, diabetic, elderly individuals is associated with reduced rates of hospitalization and death. RESEARCH DESIGN AND METHODS: In this outcome-research study, we compared mortality and hospitalization rates of 15,556 patients aged >or=65 years followed using a diabetes registry in a large health maintenance organization to that of 69,097 members not suffering from chronic disease who were considered as a reference group. The study outcomes included all-cause death and hospitalization in internal medicine or geriatric wards for any reason over winter and summer (control) periods. RESULTS: Vaccination rates were 48.8 and 42.0% among patients with diabetes and the reference population, respectively. Influenza vaccination was associated with a 12.3% reduction in hospitalization rates for patients with diabetes compared with 23.0% in the reference group (P = 0.08). The reduction in hospitalization rates was similar in both sexes among patients with diabetes. In addition, there was a significant reduction in mortality for the vaccinated group of patients with diabetes when compared with the nonvaccinated group except for female patients aged >or=85 years. CONCLUSIONS: The study results support the use of influenza vaccine among an elderly population. However, there does not appear to be an additional benefit for patients with diabetes.
More faith based health decisions … from those softies in the Israeli military
Clin Infect Dis. 1998 Apr;26(4):913-7.Links
Influenza vaccine efficacy in young, healthy adults.
Grotto I, Mandel Y, Green MS, Varsano N, Gdalevich M, Ashkenazi I, Shemer J.
Medical Corps, Israel Defense Force, Tel-Aviv, Israel.
Findings concerning influenza vaccine efficacy in young, healthy adults are inconsistent. A high incidence of influenza in the winter of 1995 provided an opportunity to study the efficacy of influenza vaccine among young, healthy military personnel. Influenza activity was confirmed by isolation of influenza A and B viruses from nasopharyngeal swab specimens from hospitalized soldiers. Self-administered questionnaires concerning vaccination status and disease symptoms were used in two study groups: recruits and veteran soldiers serving in different camps. Six hundred eighty-four individuals had received influenza vaccine and 652 had not. Vaccine efficacy was found to be 38.1% (P = .002) for preventing febrile illness with or without symptoms and slightly higher (41.6%; P < .001) for preventing fever together with upper respiratory tract symptoms. The current influenza vaccine significantly reduced febrile illness among healthy military personnel.
The flu vaccine has minimal risk and some benefit. There’s no benefit to getting the flu. Flu virus might even contribute to there being more autistic kids, as having circulating antibodies to the flu may be a risk factor for having an autistic kid if those antibodies act like anti-fetal-brain antibodies in women who have had the flu. Also getting the flu while pregnant is just a bad idea, so everyone ought to get the vaccine (if they can) so that they are less likely to give it to a pregnant woman. Women who are of child bearing age can decide if they’d rather deal with a hypothetical risk of getting a flu vaccine that could cause autism in the kid via her IL-6 or something… or the real risk of getting the flu and losing the baby or dying themselves.
This manuscript gives a very interesting perspective on flu vaccine
Review
Realities and enigmas of human viral influenza: pathogenesis, epidemiology and control
Maurice R. Hilleman
Abstract
Influenza A is a viral disease of global dimension, presenting with high morbidity and mortality in annual epidemics, and in pandemics which are of infrequent occurrence but which have very high attack rates. Influenza probes reveal a continuing battle for survival between host and parasite in which the host population updates the specificity of its pool of humoral immunity by contact with and response to infection with the most recent viruses which possess altered antigenic specificity in their hemagglutinin (HA) ligand. HA ligand binds the virus to the cell to bring about infection. Viral survival relies on escape from host immunity through antigenic alterations in nature which arise through genetic drift by point mutation principally of the HA gene, or through genetic shift by reassortment exchange of the HA ligand with that of viruses retained in avian species. Partial control of influenza is by use of killed whole, subunit, or possible live virus vaccines, all of which rely on worldwide surveillance to provide early detection of the altered immunologic specificity of the next virus to come. Future global surveillance may be aided by studies of sampled viral isolates in laboratories having capabilities for accelerated genetic sequencing and for automated rapid throughput analyses as well. Influenza vaccines of the future must be directed toward use of conserved group-specific viral antigens, such as are present in transitional proteins which are exposed during the fusion of virus to the host cell. Chemotherapy, though still primordial, must eventually provide the ultimate solution to vaccine failures. Probing the enigma of the severe influenza pandemic of 1918–1919 is an exciting contemporary venture in which genetic reconstruction of the viral genome from surviving archival RNA is being conducted with great success. Present evidence reveals successive recycling in pandemics, of only 3 of the 15 possible avian viral HAs. Pandemics are believed, conventionally, to be derived solely by rare events in which wild viruses of man acquire a new HA ligand of avian origin. There might be an alternative possibility involving a periodicity in selective control by the host population itself, in its receptivity or rejection at a particular time of particular reassortant viruses which might be created more frequently in nature than we are presently aware. This hypothesis, though remote, provides a different way to view and to probe the enigma of pandemic influenza.
About the author
http://en.wikipedia.org/wiki/Maurice_Hilleman
The unique perspective – including the historic- is very educative. The manuscript is worth the reading, because of the unique perspective of someone who was part of the decisions at different flu crisis.
The author includes in the review I posted above that the split vaccine of Wyeth and Parke Davis against the H1N1 swine flu had a response in the 3 to 5 years old -in 1976 – of only 10 % with higher than 1:20 antibody titer. But it includes a lot of more information about inactivated and live vaccines.
About the author
http://www.njabr.org/njsor/science_superstars/maurice_hilleman/
“He should be quite familiar with my position.”
Schwartz, I don’t think anyone is clear on your position because you’ve never committed to one.
I’ve asked you very matter-of-factly in the past, and you’ve avoided my queston rather deftly – as deft as a bull in a china shop.
You’re constantly seeking clarification, and never satiisfied with anyone’s response – asking for further clarification while simultaneously derailing (through innuendo) any notion that vaccines are beneficial.
In fact, it’s quite perpetual.
So I’ll ask again, “Do you have a point?”
bones,
You’re asking for a single position on a group of topics. I have a very distinct position on specific topics. We’re not discussing one topic, and on each topic, my position should not be unclear. In some cases my position may be undecided but that is itself a position.
On what specific topic do you want more clarity? I think my position on the flu vaccine is pretty clear.
I think my position on the topic of this post was also pretty clear. Do you have a point? If you have a SPECIFIC question please ask.
I rest my case.
Ms. Clark,
This is in the spirit of the following advice from Dr. Jefferson: “Caution in interpretation should thus be the rule, not the exception.”
Did you actually look at the details, or just cut and paste a google search? The majority of these don’t address the evidence I provided at all and are actually good examples of the problems clearly outlined in the Cochrane report.
“[Vaccination of healthcare workers against influenza] — German”
This first one I don’t have access to, so I can only ask a question assuming you’ve read it:
Since this is an article, and not a study, do you have the references they use to justify the following statement? “In randomized studies vaccination of healthcare workers resulted in lower overall mortality of patients in the winter period. ”
“Cross-subtype immunity against avian influenza in persons recently vaccinated for influenza.”
This one is interesting, especially this line: “These findings highlight the possibility of boosting…”
or this: “N1 may possibly be a target for both cellular and humoral cross-type immunity, but additional experiments are needed to clarify this point.”
So this is not evidence of efficacy at all. It is evidence of possible efficacy. Additionally, we also know that actual efficacy of outcomes is less than one third of the quoted efficacy rate of the vaccines itself (measured by immune reaction). So again, this is not actual evidence of efficacy.
Flu myths: dispelling the myths associated with live attenuated influenza vaccine.
This one is of great interest to me, because I tend to believe that vaccines that take advantage of multiple layers of immune reaction (rather than injection) would be more effective overall. They mention this possibility but can’t confirm it.
There is one very interesting reference in this paper (from 2000, so it would have been included in the Cochrane review) that on first glance appears credible. It was a small trial but had positive results. However, single trials alone are not acceptable evidence upon which to base public policy (as clearly repeated by credible sources).
It’s interesting, because near the end, they go through a number of smaller studies that show some efficacy. However, they do not evaluate the studies for selection bias, or other methodology flaws which the Cochrane group illustrated are rampant. None of the studies actually confirmed any efficacy of outcomes (reduced hospitalization or disease) vs placebo. There is one good RCT that shows efficacy aginst influenza of LAIVs.
“Effectiveness of influenza vaccine in the community-dwelling elderly.”
On the surface, this study appears to show a great deal of efficacy of reduction in hospitalization and death in the elderly. However, upon closer inspection, these results must be cautiously interpreted. The primary issue (as raised by the Cochrane group) is that it is not an RCT and thus there is no proper randomization leaving it vulnerable to multiple biases as outlines extensively in the Cochrane report. The authors attempt to correct for the bias, but reading through the letters (several letters pointed to several different problems), it is pretty clear, there is little agreement on the effectiveness of their statistical accounting. These results are still quite controversial in the medical science community and thus standing alone shouldn’t be used as a basis for public policy. RCT’s that are not subject to selection bias and frailty bias should be used as the basis of credible evidence. This must be especially scrutinized due to the high risk of bias given the assocations of the lead author as well.
“Reduced hospitalizations and death associated with influenza vaccination among patients with and without diabetes.”
Again, not a randomized trial and this one didn’t even bother to TRY to account for known biases. Even better, did you notice in the results section that they were not statistically significant? (p=0.08)
“Influenza vaccine efficacy in young, healthy adults.”
This study does not investigate the claims of reduced hospitalizations or deaths. It also has a very small sample size and is not a RCT and therefore does not account for placebo effect. That pretty much rules it out as adding to the body of evidence for this discussion.
1) not able to evaluate without actual references to back up the claims. Doesn’t qualify for public health policy given the limited study group.
2) Experimental in nature and does not add any credible evidence to support the claims of efficacy. Does not qualify for public health policy.
3) Not a study, but is interesting to me nonetheless. One key RCT stands out and it shows efficacy of LAIV against flu symptoms. One study does not justify public policy, especially in light of conflicting studies. Appears to be credible and sufficient to be considered in the body of evidence.
All of the studies referenced would have been reviewed in the Cochrane report and their conclusion is consistent with what I said “There is not enough evidence to decide whether routine vaccination to prevent influenza in healthy adults is effective”.
4) Non-RCT and subject to a risk of bias despite attempts to statistically account for some of the biases. Controversial in it’s methodology, but certainly can’t be used to define public health policy.
5) The first Israeli study contains all of the flaws of non RCTs and isn’t even statistically significant. Not credible evidence of anything.
6) This study was not an RCT and doesn’t account for placebo effect. It is also a very small sample. Not credible evidence for use in public health policy.
I will acknowledge that the information on the LAIV (in the Mayo article) is of interest and offers some evidence of efficacy for live virus vaccines. However, there is no evidence of reduced death, or hospitalizations (as you continually claim) nor is this the vaccine being promoted by the public health policy. There is not enough evidence to determine any public health policy on LAIV.
The rest of the studies add no credible evidence of efficacy for hospitalizations or death, and many fall prey to the flaws I outlined earlier? Why did you bother to include some of them here? Certainly, none of these studies provide credible evidence for the faith based claim of reduced death and hospitalizations upon which the whole program is justified.
bones,
So do I… with specific evidence, questions and answers. You?
“…or the real risk of getting the flu and losing the baby or dying themselves.”
Evidence please? I have not seen any credible studies that say the flu vaccine reduces death in unborn children, or in pregnant mothers.
Schwartz,
Does the flu kill pregnant women and/or their babies?
Is it possible that the flu vaccine could prevent that?
I think the null hypothesis is that the flu can kill people and that the flu shot does not. The null hypothesis is that the flu shot has benefit. Now the question is how much?
The sense I get from reading your stuff is that you personally couldn’t care less if people die when they might have been protected from the flu.
More faith based decision making from the American Heart Association
vScientific Advisory
09/18/2006
Annual flu shot may protect cardiovascular disease patients
American Heart Association/American College of Cardiology scientific advisory
DALLAS, Sept. 19 – The American Heart Association and the American College of Cardiology are asking heart doctors to do something they may not normally do — give flu shots to their patients. However, patients with cardiovascular disease should not get the nasal-spray flu vaccine.
Patients with cardiovascular disease are more likely to die from influenza than patients with any other chronic condition, according to the new AHA/ACC scientific advisory.
Studies have found that annual flu vaccinations can prevent death in adults and children with chronic conditions of the cardiovascular system. But only one in three adults with cardiovascular disease was vaccinated against flu in 2005.
“If we vaccinated at least 60 percent of the 13.2 million people with coronary heart disease in the United States against influenza, we could prevent hundreds of deaths and thousands of cases of flu each year,” said Matthew M. Davis, M.D., lead author of the advisory and associate professor of pediatrics, internal medicine, and public policy at the University of Michigan in Ann Arbor.
“The target goal set by the U.S. Department of Health and Human Services is to vaccinate 60 percent of people with heart disease under age 65, and 90 percent of everyone 65 and over, many of whom have heart disease,” Davis said.
Overall, influenza is responsible for 36,000 deaths and 225,000 hospitalizations in the United States each year. People with cardiovascular disease are particularly vulnerable, because the flu can exacerbate heart disease symptoms directly, and can also lead to conditions like viral or bacterial pneumonia that cause flare-ups of cardiovascular disease, he said.
“A case of influenza tends to make people with heart disease even sicker than others who are healthy, and increases the chance of having to go to the hospital,” he said.
Immunization against seasonal influenza has a critical, but underappreciated, role in preventing death among cardiovascular disease patients. In May 2006, new American Heart Association/American College of Cardiology joint guidelines on preventing recurrent cardiovascular events recommended an annual flu shot for all people with cardiovascular disease.
“Influenza vaccination is now recommended with the same enthusiasm as cholesterol and blood pressure control and other modifiable risk factors for cardiovascular disease,” the advisory noted.
The strongest evidence of a protective effect comes from the FLUVACS trial. In that trial, 301 people hospitalized for either a heart attack or an angioplasty and stent procedure to open clogged arteries were randomly assigned to receive flu vaccine or remain unvaccinated. Over the next year, among those who did not get vaccinated 23 percent had died of heart disease, had a nonfatal heart attack or developed severe ischemia (insufficient blood supply to the heart tissue), compared with only 11 percent of their vaccinated counterparts.
A visit to the cardiologist presents a good, but often missed, opportunity to get vaccinated, Davis said. “Most people with heart disease visit their cardiologists during the time when they should get the flu shot, but only about half of cardiologists in the United States stock the vaccine in their clinics.”
The advisory authors said immunization isn’t perceived as part of a typical cardiology practice. But the most effective way to increase the number of cardiovascular patients vaccinated is to have flu vaccine available in all cardiology practices and to have physicians strongly recommend the vaccine to their patients. Most insurance plans cover flu vaccinations.
The advisory urges:
* Cardiologists to stock flu vaccine for their patients in their clinics and strongly encourage influenza immunization.
* Patients with cardiovascular disease to get a flu vaccination (given by injection) every year by the end of November. Receiving a shot in January or even later should still protect from flu, as the flu season in the United States typically peaks in January, February or March.
* Patients with cardiovascular disease not receive the live, attenuated vaccine given as a nasal spray because it has not been approved for use in these individuals.
Last year’s shot won’t offer protection this year, because the dominant strains of influenza virus change each year. The vaccine, which takes about two weeks to become effective, “is reformulated each year to respond to these changes as best we can,” Davis said.
The Centers for Disease Control and Prevention also recommends annual influenza vaccination for people age 50 and older; children ages 6 months to 59 months; women who will be pregnant during flu season; and adults and children with other chronic conditions.
The advisory is endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation, the American Association of Critical Care Nurses, the American Association of Heart Failure Nurses, the American Diabetes Association, the Association of Black Cardiologists, Inc., the Heart Failure Society of America, and the Preventive Cardiovascular Nurses Association.
The American Academy of Nurse Practitioners supports the recommendations of this scientific advisory. This science advisory is consistent with the recommendations of the Centers for Disease Control and Prevention and the Advisory Committee on Immunization Practices.
Co-authors are Kathryn Taubert, Ph.D.; Andrea L. Benin, M.D.; David W. Brown, M.S.P.H., M.Sc.; George A. Mensah, M.D.; Larry M. Baddour, M.D.; Sandra Dunbar, R.N., D.S.N., and Harlan M. Krumholz, M.D.
The advisory is available online at http://www.americanheart.org and http://www.acc.org; and will be published in Circulation: Journal of the American Heart Association and Journal of the American College of Cardiology.”
Yeah, lets tell pregnant women to forget the flu shot and tell everyone else to forget it, too, even if they might spread it to a pregnant woman. No skin off your nose Schwartz, right? A dead pregnant woman, no big deal.
“Public Health Rep. 1986 Mar-Apr;101(2):205-11.
Risk of acute respiratory disease among pregnant women during influenza A epidemics.
Mullooly JP, Barker WH, Nolan TF Jr.
The medical literature contains little information on the occurrence of excess morbidity among pregnant women during recent influenza epidemics. Rates of medical visits for acute respiratory disease (ARD) among pregnant and nonpregnant members of a large prepaid practice population were examined. Use of medical services for ARD was ascertained for approximately 1,000 pregnant women and 3,000 nonpregnant women during each of four epidemic periods (1975, 1976, 1978, 1979) and a nonepidemic period (1977). Comparing the combined epidemic periods with the nonepidemic period, there were significant excesses of 23.7 (standard error (SE) = 8.1) ARD contacts per 1,000 attributable to epidemic influenza for pregnant women and 10.2 (SE = 3.4) for nonpregnant women. ARD hospitalization rates among pregnant women were low (2 per 1,000), and there were no maternal deaths. The significant ARD excess among pregnant women was concentrated in the 1978 period with reappearance of the A/Russia H1N1 subtype in the community and was confined to those under age 25 who would not have ben previously exposed to this subtype (94.4 (SE = 28.5]. These findings indicate that recent influenza epidemics caused only modest excess ARD morbidity among pregnant women, and significant excess occurred only in association with antigenic shift. These findings support current national policy recommendations with respect to influenza vaccination of pregnant women.”
http://www.cdc.gov/Ncidod/EID/vol12no11/06-1071.htm#1
Historical evidence of deaths of pregnant women or their babies from the flu.
Faith based recommendation from ” Immune deficiency foundation” People who surely are not as well informed as Schwartz is.
http://www.primaryimmune.org/media/advisories/flumist_qa.htm
“Q8: Is the killed virus flu vaccine (flu shot) recommended for those with primary immune deficiencies or their close contacts?
A8: People with primary immune deficiency diseases may choose to receive the inactivated influenza vaccine shot. This is the killed version of the vaccine and will not cause the flu! The only risks of receiving the shot are soreness at the injection site, and less often fever, tiredness, muscle aches, and headache. Those allergic to eggs should not receive the vaccine shot, as there is a risk for more serious reactions. Even if you do not develop antibody titers high enough to prevent influenza, you still might benefit from receiving the shot every year. Receiving the shot may reduce your risk for hospitalization, pneumonia, and other complications. Your family members should seriously consider receiving the killed version of the flu vaccine to reduce the risk of bringing the flu virus home to their family member with primary immune deficiency.”
So people with an immune deficiency can listen to actual **experts** in immune deficiency or they can listen to Schwartz. Hmmm. If my kid had this problem, I’d get my kid a flu shot, and try to avoid antivaxers who avoid the flu shot based on their paranoia derived principles, not on studies, because there are no studies that will convince them that any vaccines are good.
I believe the problem is that there is no possible level of evidence that can convince you of your **faith** in the idea that flu vaccine is worthless. You’ve made up your mind. This is your faith. I think it’s stupid and cruel, but there you go.
“Does the flu kill pregnant women and/or their babies?”
Probably, but I don’t have reliable statistics, do you? (and counting ILI deaths doesn’t count as credible evidence BTW)
Is it possible that the flu vaccine could prevent that?
We need evidence to show us whether the flu vaccine reduces the incidence death in pregnant women. I have not seen any such statistics
I think the null hypothesis is that the flu can kill people and that the flu shot does not. The null hypothesis is that the flu shot has benefit. Now the question is how much?
Actually, the analysis is pretty simple. A RCT of pregnant women looking for a reduction in death and or fetal damage and a comparison of
“The sense I get from reading your stuff is that you personally couldn’t care less if people die when they might have been protected from the flu.”
Why don’t we turn that question around, and maybe you’ll see how wrong it is:
The sense I get from reading your stuff is that you personally couldn’t care less if anyone gets damaged by Thimerosal in vaccines when they might have been unharmed from a Thimerosal free vaccine.
That’s in incorrect statement I hope. You believe investing any money in studying Thimerosal is a waste and consequently you think the money would be much better spent elsewhere. You base this opinion on what you perceive to be credible evidence.
I feel exactly the same way about the flu vaccine. I believe investing large amounts of money in vaccinating people for the flu is a waste of money and consequently, the money could be put to far better use in helping people other ways. I base this opinion on what I perceive to be credible evidence.
So lets stick with the evidence and do away with the pointless accusations and insults.
Going through the evidence again:
“Annual flu shot may protect cardiovascular disease patients”
MAY protect? Clearly they don’t have credible evidence. This is not credible evidence, this is opinion.
“Overall, influenza is responsible for 36,000 deaths and 225,000 hospitalizations in the United States each year.”
We already know these statistics are misleading as descithis is not true since it includes ILI in the mix. They only reference a single study which admited it was small and recommended followup studies. I saw no evidence of a large followup study so clearly there is not enough evidence to justify public policy. Additionally, the study did not compare against placebo.
“ARD hospitalization rates among pregnant women were low (2 per 1,000), and there were no maternal deaths. ”
Did you miss the following line from this one?
“ARD hospitalization rates among pregnant women were low (2 per 1,000), and there were no maternal deaths. ”
There is no evidence of mortal danger to pregnant women, and hospitalization rate was considered low. How exactly does this show that flu is a fatal risk to pregnant women?
“Historical evidence of deaths of pregnant women or their babies from the flu.”
I can’t believe you actually included the CDC guessing game from flu pandemic in 1918. There is not credible evidence here.
So again, you’ve wasted time without providing any credible evidence of harm, let alone efficacy for the indications you’re promoting. The evidence you provided yourself even shows that the flu is not a fatal risk as you continually accuse me of ignoring. I think you need better evidence to convince me to change my position.
Again, you accuse me of faith, while providing evidence that contradicts your own assertions. I’m reading the evidence, you appear to be reading the opinion sections.
No Schwartz,
There is no evidence good enough for you. You have made up your mind that you know what is the case, that the flu vaccine is used for no particular reason (or maybe to pad the wallets of pharma). You are not an MD and you don’t have training in public health. People who do have this training know how to interpret studies and they know what the problems are with the Cochrane review for that matter. There’s a free course on public health that’s available online from UC Berkeley, it’s a masters level course. The professor discussed the inherent problems with metanalyses.
The people who have been given the responsibility for reducing mortality and morbidity are making decisions on who should get the flu shot. There’s no reason for people to listen to you when your expertise is not in this area at all.
At this point the evidence points to there being no risk from thimerosal. The risks from thimerosal come from the ravings and DISTORTED imaginings of people like Sallie/Sally Bernard (not a scientist) who are desperate to point the finger away from what they themselves may have done to increase their child’s chance of being autistic or away from the guilt around having “bad genes”.
Knowing what the flu does to the human body makes me think that it could kill anyone. Knowing that a pregnant woman has a lowered immunity compared to when she is not pregnant makes me think that pregnant women would be more likely than nonpregnant people to die.
Even if the flu shot only prevents flu in 10% of those who get it, since there’s no evidence that it can kill, and evidence that flu can kill. Many people would think that going with the flu shot would be a good idea. You wouldn’t, no.
There is no reason to fear giving a flu shot to most people. If you want the flu outbreaks to continue with no opposition from a vaccine then you will be encouraging more moms to get the flu which may create more autistic people and more schizophrenic people.
In your apparently hating-of-autism view, if vaccinating 1000 people does them no harm, and prevents 3 babies from being those who will be autistic and/or schizophrenic, is that a fair trade off? And what about vaxing for rubella? The rubella vaccine is an anti-autism vaccine. How about getting all warm and fuzzy over the wonders of preventing congenital rubella syndrome?
Fearing thimerosal in vaccine doses is nothing but pathetic. It’s like fearing alien beings will come and get you. How many research dollars should we put into proving that alien beings aren’t going to come and get you, Schwartz? Would there be a limit once you became convinced that alien beings were going to come get you? Mercury is everywhere. It’s in our food, air and water you know. A volcano just exploded in Hawaii, should they evacuate for a thousand miles around? 10,000 miles around. Should we evacuate the planet???? No telling how much mercury folks in Hawaii are breathing in now.
Claiming insight into public health that somehow thousands of trained public health experts are lacking is megalomaniacal. How about you go get a MPH and come back and tell us what you learned.
Ms. Clark,
There is evidence that is good enough for me. I provided you with several references and I even pointed out 2 of the numerous references you cited that IMO added some value to the discussion.
I don’t understand why you can’t stick with an analysis of the evidence? Why don’t you address the issues I raised if you don’t agree with them? Or provide actual credible evidence? If you think the evidence you provided is credible for public health policy, please point out why.
“The professor discussed the inherent problems with metanalyses.”
The Cochrane reports are systematic reviews of the available evidence, and for the most part, they review studies for bias, methodology and credibility. Because the body of available evidence quickly becomes very small on this topic, the import of their analysis is not a consolidated risk factor that you would normally see from a meta-analysis. If you read the reports (which I’m guessing you haven’t) you’ll see that they review many studies in detail, discuss the weaknesses, and identify the overall quality of the studies in question. In the influenza case, I’ve posted the damning summary so you’ve seen the outcome.
Instead you continue to invoke a huge number of logical flaws.
“The people who have been given the responsibility for reducing mortality and morbidity are making decisions on who should get the flu shot.”
Invoking Authority, False Authority (many of the policy makers are policians)
“The risks from thimerosal come from the ravings and DISTORTED imaginings of people like Sallie/Sally Bernard (not a scientist)”
Argument from elitism.
“Knowing what the flu does to the human body makes me think that it could kill anyone. Knowing that a pregnant woman has a lowered immunity compared to when she is not pregnant makes me think that pregnant women would be more likely than nonpregnant people to die.”
Common Sense Fallacy.
It’s certainly a valid subjective opinion. However, I prefer to have credible evidence before creating public health policy and justifying millions of dollars of taxpayer expense.
“Even if the flu shot only prevents flu in 10% of those who get it, since there’s no evidence that it can kill, and evidence that flu can kill. Many people would think that going with the flu shot would be a good idea. You wouldn’t, no.”
Argument to the Gallery, Wishful thinking
There is insufficient evidence of safety as you continue to ignore, so you can’t make that statement from fact, only opinion.
“There is no reason to fear giving a flu shot to most people. If you want the flu outbreaks to continue with no opposition from a vaccine then you will be encouraging more moms to get the flu which may create more autistic people and more schizophrenic people.”
Red Herring.
You are changing the topic. The objective of the public health policy is to reduce death and hospitalizations in the population. That is how it is cost justified. Since there is no evidence of reduced death or hospitalizations in the majority of the target population for the vaccine, the justification for the public health policy has disappeared. My argument here has nothing to do with fear. The lack of safety testing is a whole other issue, but let’s address one thing at a time.
“In your apparently hating-of-autism view, if vaccinating 1000 people does them no harm, and prevents 3 babies from being those who will be autistic and/or schizophrenic, is that a fair trade off? And what about vaxing for rubella? The rubella vaccine is an anti-autism vaccine. How about getting all warm and fuzzy over the wonders of preventing congenital rubella syndrome?”
Ad-Hominem, Strawman, Red Herring
“Fearing thimerosal in vaccine doses is nothing but pathetic. It’s like fearing alien beings will come and get you. How many research dollars should we put into proving that alien beings aren’t going to come and get you, Schwartz? Would there be a limit once you became convinced that alien beings were going to come get you? Mercury is everywhere. It’s in our food, air and water you know. A volcano just exploded in Hawaii, should they evacuate for a thousand miles around? 10,000 miles around. Should we evacuate the planet???? No telling how much mercury folks in Hawaii are breathing in now.”
Red Herring, Strawman, and a whole other slew of problems I won’t bother thinking about.
You obviously completely missed my point around this topic in the my other post.
“Claiming insight into public health that somehow thousands of trained public health experts are lacking is megalomaniacal. How about you go get a MPH and come back and tell us what you learned.”
Appeal to Authority, sweeping generalizations, strawman, non sequitor…
Can we please get back to evidence and logical arguments?
Your arguments are not logical. I see you think they are but they are not. Being able to quote the names of logical fallacies doesn’t mean that you are correct. You are wrong.
Instead of trying to convince parents not to vaccinate their children lest they be harmed by thimerosal, how about if you convince people like those at the Immune Deficiency Foundation that your vast wealth of knowledge and insight will be of great help to them.
How about you tell the American Heart Association that they are wrong to suggest that all heart patients get the flu shot? When I see them respond to your suggestions with new shiny Schwartz approved flu shot guidelines then I’ll listen to you.
The Cochrane Review is just as fallible as any other group of scientists. They are trying to mash together data from studies that are very different from each other in some cases. This does not necessarily help them arrive at some universal truth. Again, when you get some training in public health I’ll start taking your advice a little more seriously. Right now you are nothing but an antivax crank out of Canada with some major egomania issues.
Ms. Clark
“Your arguments are not logical. I see you think they are but they are not. Being able to quote the names of logical fallacies doesn’t mean that you are correct. You are wrong.”
Continuously repeating that I’m wrong without actually addressing any specific points of debate isn’t logical.
“Instead of trying to convince parents not to vaccinate their children lest they be harmed by thimerosal, how about if you convince people like those at the Immune Deficiency Foundation that your vast wealth of knowledge and insight will be of great help to them.”
Why are you changing the topic again? We’re discussing the public health policy on the flu vaccine that isn’t backed up by credible evidence. The current argument has little to do with Thimerosal and has everything to do with efficacy. This is another Red Herring.
“How about you tell the American Heart Association that they are wrong to suggest that all heart patients get the flu shot? When I see them respond to your suggestions with new shiny Schwartz approved flu shot guidelines then I’ll listen to you.”
Please note you did not address any of my points. Instead, you again appeal to authority. This is a flawed argument.
Plus, others have already done that – Dr Jefferson. Their response is to ignore the evidence. Maybe you should ask yourself, why they can’t provide any credible evidence to back up their position? (single small study with recommended followup that never happened)
What are you basing your faith on? Certainly not credible evidence.
“The Cochrane Review is just as fallible as any other group of scientists. They are trying to mash together data from studies that are very different from each other in some cases. This does not necessarily help them arrive at some universal truth. ”
Yes they are human like the rest of us, but that is not a logical argument on its own. Please point out the specific issues you have with their conclusions so we can discuss them.
“Again, when you get some training in public health I’ll start taking your advice a little more seriously.”
But you’ve missing the point again. I’m just bringing forward the advice and conclusions of the experts. Since you obviously ignore them (the experts, the evidence), I hold little hope you’ll listen to anyone that differs from your hardened opinion.
“Right now you are nothing but an antivax crank out of Canada with some major egomania issues.”
LOL. Since you’re either unable or unwilling to have a logical discussion on the topic, there isn’t much point in responding to this.
Wait, I’m sorry, I am a bit lost.
Where did all the stuff on the influenza vaccine come in? It is still not in the normal pediatric vaccine schedule, and little Miss Poling would not have received it during her catch-up vaccine visit.
I have not been following this thread too closely, but I am surprised that there is some kind of “autism” issue with the influenza vaccine. It has only been recommended just recently, and there are versions without the “dreaded” thimerosal, so there is no reason to mention it at all in regards to the subject of this blog posting.
Be it as it may, I will note that my son only started to get the influenza vaccine after he was diagnosed with hypertrophic cardiomyopathy. It seems that those with these kinds of heart conditions are more vulnerable to infections. This is also why he gets antibiotics prior to his teeth being cleaned (though some say it is not needed, this 19 year old kid needs serious cleaning, so the order for prophylactic antibiotics still stands).
So my understanding is that Miss Poling would have had seizures if she had the actual disease, or the vaccines. So, blaming vaccines is kind of pointless.
Well, I would say that anyway, since my kid (the same one with the genetic heart condition) got seizures before any disease or vaccine (his started when he was two days old, and he received antibiotics through an IV to preclude a bacterial infection through birth), AND when he had an actual disease.
Newsflash: diseases can cause seizures!
The seizures are long gone, only to be replaced by the occasional migraine.
Still, it seems it would be safer to keep him from contracting the actual diseases considering his history with: seizures, migraines and hypertrophic cardiomyopathy.
This would also seem to be the case with little Miss Poling.
HCN,
You are right. You have to read the post to figure out how we got here, because it is way off topic.
I believe it started when Ms. Clark published the Thimerosal insert from a flu vaccine and it went from there. No doubt the flu vaccine has nothing to do with Miss Poling.
Out of curiousity, at what age did your sons seizures end?
We have a family friend who I believe has HCM, but she wasn’t diagnosed until college when they discovered it as part of her soccer training. Fortunately, they noticed it and she was able to quit all of her athletic training (scholarship too) before anything fatal happened.
Thimerosal insert???? (laughing) Sorry…. still laughing…. giggling now… wiping my eyes. smirking….. should really just let it go (snerk)