H1N1 flu outbreak

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Henry Vilas
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Re: H1N1 flu outbreak

Postby Henry Vilas » Wed Feb 05, 2014 3:15 pm

Shorty wrote:Also, I've heard some doctors say it's better to get the flu occasionally and build up your immune system naturally, rather than use shots.

Got a link?

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Re: H1N1 flu outbreak

Postby Prof. Wagstaff » Wed Feb 05, 2014 3:33 pm

Shorty wrote:Also, you can avoid the flu without shots by washing your hands, getting sleep and exercise, avoiding hospitals, etc. I haven't gotten the shot since 2007 and I think I've only had the Flu twice since then.
Wait... what? You've had the flu twice in the last six years and you think that's a good record of avoiding the flu? I don't know how to break it to you, but whatever you're doing to not get the flu ain't working.

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Re: H1N1 flu outbreak

Postby Michael Patrick » Wed Feb 05, 2014 3:36 pm

Shorty wrote:
My main worry is whether to get the mercury free shot or not. I'm skeptical of studies done by the CDC which are probably supported by big pharmacies, like Kennedy claims:
http://www.huffingtonpost.com/robert-f- ... 94303.html


I would totally get my information on vaccines from Robert Kennedy Jr.

Oh wait, the article he authored on thimerosal was so riddled with errors that Salon.com retracted it.

The piece was co-published with Rolling Stone magazine — they fact-checked it and published it in print; we posted it online. In the days after running “Deadly Immunity,” we amended the story with five corrections (which can still be found logged here) that went far in undermining Kennedy’s exposé. At the time, we felt that correcting the piece — and keeping it on the site, in the spirit of transparency — was the best way to operate. But subsequent critics, including most recently, Seth Mnookin in his book “The Panic Virus,” further eroded any faith we had in the story’s value. We’ve grown to believe the best reader service is to delete the piece entirely.

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Re: H1N1 flu outbreak

Postby snoqueen » Wed Feb 05, 2014 4:22 pm

Shorty wrote:Also, I've heard some doctors say it's better to get the flu occasionally and build up your immune system naturally, rather than use shots.


Anecdotal evidence: me. I had the flu back in the late 70s once, and that's the only time I know of. I have not had a flu shot since that time.

I just seem to have a good immune system, but giving it some exercise off and on can't have hurt.

The mother of a friend of mine got Guillain-Barre syndrome her doctor attributed to the flu shot, and that sealed it for me. The woman (now deceased) was never able to walk right again. To be fair she wasn't healthy to start with, but she lived at least a decade with the resulting disability. As a healthy person, I'd rather risk the flu.

And no, I won't go out and spread it around if it do get it.

I have read the flu shot, in any given year, is only effective against a small percentage of the viruses out there anyway. I think there's some marketing involved here. You can add that into your risk-benefit analysis. Older people tend to have a wider array of immunities to various flu strains -- maybe that's in effect for me, as well.

Health decisions are highly personal, and that's the way they should stay.

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Re: H1N1 flu outbreak

Postby cloudy » Wed Feb 05, 2014 5:12 pm

snoqueen wrote:Health decisions are highly personal, and that's the way they should stay.


Sure, but they should still be science-based. A decision based on an anecdote of someone getting a rare syndrome isn't science-based. Guillain-Barre syndrome is more closely associated with influenza than it is with the influenza vaccine. From a new review in Clinical Infectious Diseases (Jan. 2014): "In summary, despite the small observed increased risk of GBS after influenza vaccination, evidence is growing in support of an apparent larger benefit of vaccination in regard to the overall risk of GBS in the context of population health."

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Re: H1N1 flu outbreak

Postby Henry Vilas » Thu Feb 06, 2014 1:59 pm

The crazy anti-vaccine movement also is causing kids to die from whooping cough.

The decline in vaccination is in part due to the rise of the anti-vaccine movement, which has found spokespeople in celebrities like Jenny McCarthy and politicians like Michele Bachmann and Rick Santorum. It is a movement that relies on scientific fraud and pseudoscience.

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Re: H1N1 flu outbreak

Postby snoqueen » Thu Feb 06, 2014 4:09 pm

Dear people, I did not say YOU should not get a flu shot, or anybody else should not get a flu shot if they want to. I said whatever I am doing seems to work and I'm not changing it. Those are two quite different things.

If each of us is a sample of one, which is statistically true, it is perfectly valid for me to draw the conclusion I have drawn regarding flu shots. In other words, if in the past 34 years I have gotten zero flu shots and zero cases of flu, what incentive do I have to mess with success?

As I said before I like science as much as the next person. And my evidence-based conclusion here is perfectly sound. It does not extend to other kinds of shots, to anybody else's kids, or anywhere beyond me.

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Re: H1N1 flu outbreak

Postby cloudy » Thu Feb 06, 2014 5:59 pm

Dear sno, I don't think anyone suggested that you were advising against the flu shot. You did, however, say that your mother's friend's case of GBS "sealed the deal" for you and you'd rather "risk the flu." If the risk of GBS from the flu shot was the deciding factor in not getting the shot, your conclusion is not perfectly valid - it's based on a false premise. Now you've changed your position to one based on inductive reasoning and what you see as the odds of you getting the flu. That's a better argument, and a reasonable conclusion, but it's still not evidence-based. BTW, immunizations and vaccinations are population health issues and should be considered in this context.

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Re: H1N1 flu outbreak

Postby gargantua » Thu Feb 06, 2014 6:07 pm

snoqueen wrote:
If each of us is a sample of one, which is statistically true, it is perfectly valid for me to draw the conclusion I have drawn regarding flu shots. In other words, if in the past 34 years I have gotten zero flu shots and zero cases of flu, what incentive do I have to mess with success?


Following your logic, since I have been driving for 40 years and never had a traffic accident, I have no incentive to have auto insurance. Realistically, the absence of a previous accident does not mean it will never happen. The fact that you have not contracted the flu yet doesn't mean you never will.

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Re: H1N1 flu outbreak

Postby snoqueen » Fri Feb 07, 2014 2:10 am

The fact someone else got a flu shot does not mean they won't, either.

I have more skepticism about the long term effects of medical overtreatment and over intervention than most people here, I realize. This does not mean I am on the lunatic fringe, it means I am over to one side of some big bell curve where the other side of the curve is populated by those who get medical treatment for every little thing from a hangnail to a sneeze, and the vast majority are somewhere in between.

I made my decision based on years of observing my own health. The Guilain-Barre thing just scared the shit out of me it was so horrible, but I had already made my decision before it happened. I don't refuse all vaccinations, for heavens sake. I got a tetanus shot just last summer. Those have a much longer track record of effectiveness and safety against a single known pathogen than our flu shots, which are the previous year's best guess as to what the coming year's flu strains might be.

I think we are all well within the realm of rational and responsible choices here. Doing some Google searches, I see in most European countries the shots are suggested for people in various risk groups (different pre existing illnesses such as respiratory problems, old age, etc) instead of for everyone, though in all the countries I checked anybody may get one if they want. The countries vary widely and policies change over time, as well.

And of course everybody's second favorite news site HuffPo has a story about a bunch of children in Europe who ended up with incurable narcolepsy attributed to flu shots of all things.

http://www.huffingtonpost.com/2013/01/2 ... 25192.html

While estimates vary, Stiernstedt [Swedish health official] says Sweden's mass vaccinations saved between 30 and 60 people from swine flu death [in the 2009-10 pandemic]. Yet since the pandemic ended, more than 200 cases of narcolepsy have been reported in Sweden.

With hindsight, this risk-benefit balance is unacceptable. "This is a medical tragedy, " he said. "Hundreds of young people have had their lives almost destroyed."


The linked article is both more thoughtful and more balanced than I am making it sound, so see what you think.

I guess my own position is that given all the risks and unknowns, when I have a reasonable choice as to whether to accept a medical intervention or not, I probably say no where the majority of people say yes. I am not trying to convert anyone else to my view, but it is not any more irrational than a policy of always saying yes to such options, particularly given the distortion of the US medical system due to the fee-for-service model and profit-driven patient care.

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Re: H1N1 flu outbreak

Postby kurt_w » Fri Feb 07, 2014 8:23 am

snoqueen wrote:This does not mean I am on the lunatic fringe,


I don't think you're on "the lunatic fringe" but I do think that this:

snoqueen wrote:If each of us is a sample of one, which is statistically true, it is perfectly valid for me to draw the conclusion I have drawn regarding flu shots. In other words, if in the past 34 years I have gotten zero flu shots and zero cases of flu, what incentive do I have to mess with success?

As I said before I like science as much as the next person. And my evidence-based conclusion here is perfectly sound.


is neither sound nor evidence based.

You're right that public health professionals in different countries take different positions on how heavily people should be encouraged to get flu shots. And you're right that there is some debate over how necessary the shots are for people who aren't themselves in one of the high-risk categories and who don't live or work with people in the high-risk categories. So there are reasons to justify your decision not to get the flu shot.

But the way you explain your own reasons is just terrible. It's dressed up in the language of statistics but is fundamentally anti-statistical. It's no different than Sandi or Ned implying that global warming is a hoax because it was cold and/or snowed someplace today.

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Re: H1N1 flu outbreak

Postby kurt_w » Fri Feb 07, 2014 8:58 am

snoqueen wrote:The linked article is both more thoughtful and more balanced than I am making it sound, so see what you think.


In general, the Huffington Post is not by any means a reliable source on issues of vaccination, though the specific article you link to is actually not bad. But the CDC has a very clear web page about the 2009 Pandemrix incident in Sweden:

CDC statement on narcolepsy following Pandemrix influenza vaccination in Europe

As for the risk of flu ... this past month's mortality rate in the US has been far above normal levels, as was last year's:
Image

The upper black line on that graph is considered to be epidemic level.

In normal years, most people who are hospitalized or die from the flu are those in the high-risk categories. But this year's H1N1 strain is different; a much higher than normal proportion of cases are among the young and healthy. (The CDC says "of the 5,494 influenza-associated hospitalizations that have been reported this season, more than 60% have been in people 18 to 64 years old. This pattern of more hospitalizations among younger people was also seen during the 2009 H1N1 pandemic.")

You seem to have been strongly influenced in your thinking about vaccination by your interpretation of the experience of your friend with GBS. But those kinds of anecdotes cut both ways. Many people in California were shocked this past week by the influenza death of Nancy Pinnella, a healthy 47-year-old woman who was not on anyone's list of high-risk categories.

From the Sacramento Bee:

When Sacramento County public health officer Dr. Olivia Kasirye visited News10 studios last week at the invitation of co-workers concerned about a colleague’s sudden death from the flu, she was hit by a barrage of questions:

“What is this flu?”

“Why is it acting so differently?”

“Why does it take the life of someone so young and healthy?”

[...]

Since then, things have gotten worse. Three more people have died in Sacramento County, bringing the flu fatality count of those under 65 years old to 21. That compares to 16 dead (under 65) in the county last season, and there are several weeks yet to go in the current flu season [...]

In fact, the flu has hit the entire country so hard that saline solutions are in short supply due to H1N1 hospitalizations, health experts say. [...]

Health experts suggested that one reason residents 65 and up may not have been as affected by the flu this year is that they had built up immunity from years of faithfully getting their flu shots.

After Pinnella’s death, her family said she had made a point of not getting a vaccine, and they shared the same philosophy. But in reaction to their loss, they changed viewpoints and all got flu shots, urging friends, co-workers and the public to follow suit.

One of Pinnella’s brothers, John Pinnella, told The Sacramento Bee, “The problem was, in our minds, we weren’t little kids and we weren’t 65 years old,” referring to groups thought to be the most vulnerable. The Pinnellas were taken aback by how quickly Nancy Pinnella deteriorated.

She went home sick from work one day, was hospitalized in intensive care the next day and within three days, suffered three strokes and died. “It just hit all of a sudden,” John Pinnella said. “Within 12 hours, she was really, really sick” with doctors saying she was in bad shape.

[...]

“We are concerned that young and healthy individuals are not getting vaccinated, because their demographic group is not typically severely impacted by influenza,” said Kasirye. “What is different with H1N1, compared to the other strains, is that we are seeing severe disease in young and healthy people.”

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Re: H1N1 flu outbreak

Postby snoqueen » Fri Feb 07, 2014 10:09 am

You're right that public health professionals in different countries take different positions on how heavily people should be encouraged to get flu shots. And you're right that there is some debate over how necessary the shots are for people who aren't themselves in one of the high-risk categories and who don't live or work with people in the high-risk categories. So there are reasons to justify your decision not to get the flu shot.


So I've got the kurt certificate of reasonability, however I got there.

But the way you explain your own reasons is just terrible. It's dressed up in the language of statistics but is fundamentally anti-statistical. It's no different than Sandi or Ned implying that global warming is a hoax because it was cold and/or snowed someplace today.


Ouch, that's baad. I don't think I explained myself well enough, because I did not in any way mean all vaccination for all people is unsound. That's the equivalent of saying all climate research is unsound because it snowed yesterday. and I am not saying anything of the kind. And I never in any way meant to suggest vaccination is a hoax parallel with climate science, in case someone read my comments that way.

What I was trying to say was all the statistics in the world do not predict where I, a single individual, will land on the curve. They predict probabilities. You do have to concede that. I have the right to go with a smaller probability if I choose. I don't even have to justify that choice. Someone has to land in the 10%, or 1%, and if I want to roll those dice, it's up to me. People keep buying lottery tickets even though that's statistically stupid, too. And once in a while somebody hits the jackpot. (I've never bought one.)

In addition, because we do not know everything (or even a fraction) about how the human immune system works, if I have had no flu in 30-odd years and taken no flu shots it is possible some unidentified mechanism is operating and to tamper with that would be unwise. (This is actually what I think is happening.) We know that if a woman for some reason has eight male babies in a row and no females, the probability of the ninth baby being male is higher than 50% because some unidentified mechanism is operating, either in her or her spouse/partner. Why should the same kind of unknown mechanism be nonexistent in the human immune system?

I'm not changing my longstanding plan. It works for me. You don't like my reasons, and I can live with that. I probably should not have told the story about the lady with G-B syndrome, because it occurred in the 90s and I decided not to take the flu shot starting in the late 70s so wasn't a causal factor. Instead it had a big emotional impact because this woman's life was effectively ruined, and her decline was messy and prolonged and unpleasant and profoundly affected her whole family in a negative manner.

I have to say over the years, having watched all my older relatives and most of my friends older relatives die, there exists quite a laundry list of things I would never let the docs do. A long painful life is not necessarily preferable to a shorter but more comfortable one, either for the patient or the survivors. Perhaps others of you who are older have seen the same things and been left with the same kinds of doubts.

Sometimes interventions work, other times they don't, and sometimes in a year or two certain interventions are disavowed and abandoned. Think of hormone replacement therapy for women (discontinued because it was actually causing disastrous illnesses), or think about the "watchful waiting" program certain men with prostate cancers are now advised to try, after years when disabling surgery was the gold standard. There are more other examples than you or I can shake a stick at, so to claim medical advice has reached some pinnacle of appropriateness and no one should refuse to comply with the newest theory is pretty mechanistic.

I believe those of us who take minority positions on certain selected medical choices are well within the realm of rationality. I am old enough to remember when a friend who got hepatitis was told by her doctor that "it doesn't matter what you eat" when she asked if she should follow a particular diet during recovery. This was 1975. Today no responsible doctor would give that advice, but probably would refer her to a professional dietician or nutritionist.

While state of the art in 2014 surpasses state of the art in 1975, the other constant is change. Advice in 2014 will change too, and some 2014 advice will even be found defective. Medicine, in theory if not in actual practice, is doing its best same as climate science. Because medicine is practiced on actual humans, though, what is satisfactory and acceptable to one patient may not be to the next. That goes for individual risk tolerance as much as it goes for individual pain tolerance or acceptance of major disability as a side effect of a "successful" intervention.

On the population level, medicine is treated as a science which is appropriate though it's remarkable how widely protocols and advice vary from nation to nation in the developed world. On the individual level, I think it's an art as much as a science. I would be uncomfortable working with a doctor who did not understand the quirks and preferences of his/her patients were part of the picture, not messy "noise" to be brushed aside.

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Re: H1N1 flu outbreak

Postby gargantua » Fri Feb 07, 2014 10:25 am

We've been talking about this in largely personal terms, which is fine. An element that I hadn't included in my pro-flu shot position is also personal and simple. I've had the same doctor for years. I trust the guy. He recommends getting the shot, so I do. I think part of the reason flu shots are widely recommended, even for healthy individuals like Sno, is that the fewer people who get the flu, the less likely it is that it can spread to more vulnerable populations. But if you don't believe in it, it's abundantly clear that nothing but a bad personal experience will ever change your mind.

Vaccine but not flu-related....I got the shingles vaccine last year. Grab a copy of this week's Isthmus to see why all of us middle-agers who ever had chicken pox should seriously consider getting it.

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Re: H1N1 flu outbreak

Postby kurt_w » Fri Feb 07, 2014 12:12 pm

Henry Vilas wrote:
Shorty wrote:Also, I've heard some doctors say it's better to get the flu occasionally and build up your immune system naturally, rather than use shots.

Got a link?


I don't think there's been a lot of research on this, and the newspaper article I quoted earlier today from the Sacramento Bee claimed that (unnamed) health experts were suggesting that repeated vaccination helps build up resistance and thus offers some long-term protection, in other words the opposite of what Shorty was suggesting.

However ... I do see a 2006 paper that deals with this:

Repeated influenza vaccination of healthy children and adults: borrow now, pay later?

They used a mathematical model to compare natural exposure to flu versus vaccination, in terms of their effects on likelihood of developing flu later in life:

We found that natural influenza infection reduced the risk of being re-infected by 15.4% [...] [R]epeated vaccination at a young age substantially increases the risk of influenza in older age, by a factor ranging between 1.2 (vaccination after 50 years) to 2.4 (vaccination from birth).


So that's interesting. Unfortunately it doesn't seem to have been followed up or cited much by other researchers working on the same topic. This makes me guess that the biomedical community as a whole did not find this an especially interesting study. But I have no particular expertise there...


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