FEAR versus REALITY: THE FLU SHOT DANGERS

As a practicing physician, have I ever elected to receive the annual flu shot? Never.

Has an employer, hospital or office ever given me (or my physician peers) an informed medical talk on all the flu shot dangers? Never.

Have I ever been aggressively persuaded to obtain a flu shot? Always.

Have I ever been forced to get one? Not yet.

Because I work in an emergency room, I am on the front line of the “epidemic” that is often sensationalized in the media each and every flu season. If patients don’t go to their doctor’s office, then they come straight to the ER where even if they don’t have the flu (but they think they do), they inevitably end up exposing themselves and their children to a hospital full of people who do have the flu virus and are actively spreading their germs.

I treat and manage sick people all the time, and it’s always in the patient’s best interests not to become more ill, and my best interest to “do no harm.”

Thus, if I were to adopt a clinical practice or subject myself to an intervention for the sake of my patients, I would need to know (1) if it works and (2) if it is safe. If the answer to both questions is yes, then we have a deal. However, if there are sufficient data to prove the intervention either not to be effective or not to be safe, it should be promptly dismissed, and any attempts to coerce people into action should be immediately terminated.

Does the flu shot prevent you from getting the flu? No. (Most arguments should stop right here, but they don’t.) If you don’t believe me, then visit the Seasonal Flu Information Page of the Centers for Disease Control and Prevention (CDC). Here, it clearly states (with my own italics added),

There is still a possibility you could get the flu even if you got vaccinated. The ability of flu vaccine to protect a person depends on various factors, including the age and health status of the person being vaccinated, and also the similarity or “match” between the viruses used to make the vaccine and those circulating in the community. If the viruses in the vaccine and the influenza viruses circulating in the community are closely matched, vaccine effectiveness is higher. If they are not closely matched, vaccine effectiveness can be reduced.

So, the vaccine can fail, and if it does work, its effectiveness varies among the population being vaccinated. Same vaccine in different people will yield different results.

People at high risk for developing flu-related complications are the elderly (65 years and older), children younger than 5 years (especially those younger than 2 years old), and pregnant women. Others with medial comorbidities (i.e., asthma, chronic lung disease, and the immunosuppresed) also carry an increased risk. In fact, each year, approximately 90% of the deaths related to influenza come from those older than 65 years.

Consequently, the flu vaccine doesn’t prevent you from getting the flu, and if you’re an elderly person, you’re at greatest risk of an adverse event resulting from infection from the virus. One would think then, that those 65 years and older should derive the largest benefit from vaccination. Wrong again. Although the elderly suffer the worst sequelae from influenza, the vaccine has been proven to be less effective in preventing the flu in this age group. The CDC states (italics are mine for emphasis),

Does the flu vaccine work the same for everyone? No … protection can vary widely depending on who is being vaccinated (in addition to how well matched the flu vaccine is with circulating viruses). In general, the flu vaccine works best among healthy adults and older children. Some older people and people with certain chronic illnesses might develop less immunity than healthy children and adults after vaccination.

How effective is the flu vaccine in the elderly? Older people with weaker immune systems often have a lower protective immune response after flu vaccination compared to younger, healthier people. This can result in lower vaccine effectiveness in these people.

How effective is the flu vaccine in children? Reduced benefits of flu vaccine are often found in studies of young children (e.g., those younger than 2 years of age) and older adults (e.g., adults 65 years of age and older).

Those at highest risk from the flu and its subsequent complications are exactly the ones who gain the least protection from the vaccine. As with everything else in the medical world, those who are younger and healthier generally will have better outcomes than those who are older and sicker.

Let us all not forget that “flu season” has been happening for hundreds (likely thousands) of years—the difference now is that instead of a doctor using clinical judgment and saying, “You have the flu,we can now swab your nose and test for it so I can say, “You have the flu. I have the results right here.” More testing leads to more measuring, more measuring to more analysis, and more analysis to more policy change. The ability to test for something can be beneficial, but also can be counter-productive. The fact remains that influenza infects millions each year, existing treatment is still supportive (not curative), and a vast majority of the infected recover completely without any residual effects.

There is also a significant body of evidence that no demonstrable effect exists regarding vaccinating healthcare workers and the subsequent decrease in the development of influenza or influenza-related complications in the elderly.[i],[ii] In other studies, the efficacy of influenza vaccination of healthcare workers in reducing adverse outcomes from influenza showed that medical staff vaccination had a significant effect on influenza-like illness only if patients were vaccinated too. If patients were not vaccinated, staff immunization would have no effect. Thus, vaccinating healthcare workers has been proven not efficacious against influenza.[iii] Influenza vaccines have been proven effective in preventing cases of flu in children older than 2 years, but little evidence is available for children younger than 2 years.[iv] In fact, a systematic review involving 260,000 children aged 6 to 23 months found no evidence that the flu vaccine is any more effective than a placebo. Ironically, among all children, those younger than 2 years are the most at risk.

Besides the objections already mentioned, one should also consider the other forces at play that influence and have shaped the culture toward “I gotta have that flu shot!” (After all, it’s the responsible thing to do)

Financial Incentive

The CDC’s Advisory Committee on Immunization Practices (ACIP) makes recommendations each year on who should be vaccinated with what. The medical world uses their recommendations to guide them on what age group(s) and type of person should receive the annual flu shot. For the 1999–2000 flu season, ACIP recommended that only people older than 65 years and children with medical conditions should have a flu shot. That year, approximately 70 million people were vaccinated. Now, the ACIP recommends that everyone older than 6 months should receive a flu shot. That covers nearly the entire population of the United States, or 300 million people. As one can imagine, there is a lot of money to be made on selling the said vaccines, and almost all the ACIP members who make these recommendations have financial ties to the vaccine industry. Thus, the CDC is under an obligation to allow each member a conflict of interest waiver.

Mathematical Sensationalism

The FastStats page (refer to the preliminary 2011 data PDF link) compiled by the CDC details that in 2011, 53,667 people died of influenza and pneumonia combined. The same year, 1,532 people died of influenza only. More than 2.5 million people died in 2011 of all causes, placing the percentage of influenza deaths at 0.06. Malnutrition, hernias, and “water, air and space, and other and unspecified transport accidents and their sequelae” each caused more deaths than influenza. You would be hardpressed to walk into your local pharmacy and see a sign that says, “Get your hernia fixed now before its too late!”

Vaccination coverage among the elderly increased from 15% in 1980 to 65% now, but there has been no decrease in deaths from influenza and pneumonia.[v]

In statistical analysis, there’s a thing called relative risk reduction and absolute risk reduction. In relative risk reduction, let’s say the risk that something bad happens is 10%. If you get a special intervention, the odds drop to 5%, cutting your chances in half. This seemingly large drop (one-half) is the relative risk reduction, because it is relative to your risk without treatment. The absolute risk reduction would be 5%. Therefore, using the same sets of data, one person could proclaim a risk reduction of 50% (relative) or 5% (absolute). The former does sound much more impressive, although it is misleading and masks the true overall risk.

In an often-quoted study in JAMA[vi], the miraculous effects of the flu vaccine are touted using relative risk reduction. In the study, 1,838 volunteers 60 years and older were randomized to receive a flu shot or a placebo. The flu shot reduced the relative risk of getting the flu by an impressive 50%, but what was not reported is that the risk of getting the flu in the first place was only 3%. Those receiving the vaccine had their rates of contraction drop to 2%. Thus, in this always-referred-to-and-used-frequently-to-justify-the-vaccine study, the overall chance that anyone got the flu was already low at 3 in 100. If you got the flu shot, this dropped insignificantly by 1% to 2 in 100, but using a relative lens, your risk of infection dropped “miraculously” by 50%.

Risk

What else is in the flu vaccine? The flu vaccine contains formaldehyde (a preservative), a known cancer-causing agent, and aluminum, a neurotoxin that may play a role in Alzheimer’s disease. Other additives in the vaccine include Triton X-100 (a detergent), ethylene glycol (antifreeze), and some antibiotics. Would you add Triton X-100 to your infant’s bottle or sprinkle it on your dinner plate?

In one study, people who received the vaccine yearly for more than 3 years had a 10-fold increase of developing Alzheimer’s disease compared with people who did not receive the flu shot.[vii]

The most common side effects of receiving the flu vaccine are innocuous: fevers, bodyaches, muscle soreness, and cough. The most catastrophic side-effect is developing Guillain-Barré syndrome, or a paralyzing autoimmune disease that can harm people several weeks after receiving the vaccine. In essence, the loss of motor function in your legs and arms spreads upward, rendering you totally crippled. Although this reaction is rare (one to two cases per 1 million vaccinated), in light of the previously presented data, is it worth this risk for a little added benefit?

Fear and Public Shame

What actually persuaded me to write this post is reading a “declaration of refusal” from a hospital, as shown in the picture. Here, the institution in question stops just short of coercing its practitioners by using fear and the threat of job loss to gesture its employees to submit, obey, and accept the flu vaccine. If a hospital worker refuses the vaccine, they are required to wear a mask in all patient care areas at all times, and if they are caught three times without a mask, they are automatically terminated. Ironically, because airborne droplets spread the flu, wearing a mask may in fact be the best way to prevent transmission among health care workers and patients during the flu season. What is meant to annoy and frustrate may actually be more beneficial than the vaccine. (Click on the image for greater clarity).

Flu Vaccine Refusal

All of the above-mentioned myths, presented as fact, ave been debunked in this post. However, let’s take a closer look at the first bullet point: even if we accept the inflated figure of 36,000 as the number of deaths resulting from influenza this season, what would cause more deaths during the course of the year? Well, there’s heart disease (597,689 deaths in 2011), cancer (574,743), chronic lower respiratory diseases (138,080), stroke (129,476), accidents (120,859), Alzheimier’s disease (83,494), diabetes (69,071), kidney disease (50,476), and suicide (38,364).

If the medical establishment has resorted to using panic and intimidation, why not up the ante and use the same algorithm to dissuade others from engaging in a behavior that would result in the above-mentioned diseases/situations? We should immediately ban all soda (sugar and then diabetes), chips (salt and then heart disease), and meat (cholesterol and then strokes) from all hospitals everywhere. We should also prevent anyone with a blood pressure higher than 140/90 (hypertension leading to kidney disease) from walking into the hospital.

For the millions of patients with diabetes in hospital wards all around the world, I propose banning all candy in and within 100 feet of any hospital.

After all, it’s the responsible thing to do.

 

Dr. C. H. E. Sadaphal


[i] Cochrane Database Syst Rev. 2013 Jul 22;7:CD005187. doi: 10.1002/14651858.CD005187.pub4.

[ii] Cochrane Database Syst Rev. 2010 Feb 17;(2):CD005187. doi: 10.1002/14651858.CD005187.pub3.

[iii] Lancet Infect Dis. 2006 May;6(5):273–9.

[iv] Cochrane Database Syst Rev. 2012 Aug 15;8:CD004879. doi: 10.1002/14651858.CD004879.pub4.

[v] Am J Respir Crit Care Med. 2008;178:527–33.

[vi] JAMA. 1994;272:1661–5.

[vii] Int J Clin Invest. 2005;1:1–4.

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5 comments on “FEAR versus REALITY: THE FLU SHOT DANGERS
  1. Neil says:

    Great now all I have to do is wear a mask in public from Dec thru Feb. Thanks seasonal viruses!

  2. Mike G. says:

    I don’t have any data but all I can say is the flu knocked me down hard a couple of years back to the point where I lost 5 days of pay. Even if the shot is only partially effective, what’s the harm in getting some protection instead of none.

  3. JP says:

    Reality: fear and public shame work.

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