White Coat Underground

Playing catch up on flu rumors

I was going to try to sleep in this morning but my kid couldn’t find her femur—long story. So I figured I might as well brew up a pot of Pal’s Special, put up some Irish steel cut oatmeal, and review this weeks insanity.

This has been a rough week for the public’s health education. The flu pandemic is still on the rise, and if trends continue, we will hit a record number of cases quite soon. Currently the best primer on influenza is Joe Albietz’s, which I encourage you to read. But rumors about the flu are spreading nearly as fast as the virus, and we need a nearly real-time response to keep up. I’ve been doing quite a bit of tweeting and facebooking, responding to specific questions and concerns, and here I’ll summarize a bit of that.

The disease

This year’s flu is much like any year’s flu—there’s just a lot more of it, and rather than knocking off the old and infirm, it’s hitting young people particularly hard. Few people who get the flu will get a bad case, but a certain number will. Each year, tens of thousands of people die because of the yearly flu epidemic, and this year, since more people are getting the flu, more will die. Since we don’t test every case, we make sophisticated estimates which have worked well. One of the enduring rumors is that these estimates are either not very good, or are intentionally inflated for some nefarious purpose. These rumors are always started and spread by people without the expertise or knowledge to understand them in the first place. A very good, but difficult, summary of how we get these numbers is at the best public health blog on the web, Effect Measure. Many of the scary websites out there call flu death statistics “the big lie” based either on paranoia or ignorance. They make several immoral and dangerous arguments.

  • “Because flu deaths are counted as “flu + pneumonia” deaths, people aren’t really dying of the flu”: this is wrong. We don’t test every single case of flu, and many people who die from flu are killed by a pneumonia that attacks their weakened lungs. If not for the flu, they would not have gotten the pneumonia and died. If they had gotten their flu shot, they would have been much less likely to get the flu, the pneumonia, and died.
  • “Flu only kills the old and sick, so stop saying it’s so bad”: during non-pandemic years, the flu kills mainly the old and sick. I happen to like many old and sick people and do not wish them to die of the flu. In pandemic years, like this one, many of those killed are in fact not the elderly. This one like to hit younger people, as is typical of previous pandemics.

The vaccine

The flu vaccine has been made the same way for nearly half a century. Epidemiologists chase the virus around the globe, trying to see which strains are most likely to hit us during flu season. These strains are then grown in chicken eggs, killed, refined into a vaccine, and injected. The only difference between each year’s vaccine is which strains are in it. Some years we do better than others. Two years ago, a new strain came roaring out of Australia after the shots were made, and while the shots provided some protection against it, more people got the flu than usual. The shot still protected very well against the other strains that year. This explains why several other rumors are not true:

  • “The vaccine is too ‘new’”: No, it’s not. It’s the same vaccine we use every year. If the swine flu had been identified a bit earlier, we could have wrapped it into the usual seasonal flu shot, but we didn’t have the chance, so we’re stuck with two shots.
  • “The swine flu shot is untested”: False. It has been tested, more extensively than most flu shots. But this type of testing only detects common reactions because more serious reactions are very rare. The only way to find more serious reactions is to “test” many, many people. This has been done. Every year, millions are vaccinated and we have yet to see any significant complications. It may well be that a few people every year are seriously injured by the flu shot, but it is so rare that it is nearly impossible to tease out of the background of serious disease. It is also a much lower number than the number of people severely sickened or killed by the flu each year.
  • “This vaccine contains squalene/adjuvants/mercury/other scary sounding name and we shouldn’t take it”: once again, false. This vaccine contains nothing that we haven’t used before. Some doses may in fact contain small amounts of scary-sounding things, but as we’ve seen, most of these rumors are either false or idiotic. When people complain about sodium chloride in vaccines (you know, salt) you realize you’re dealing with someone who is trying to scare people with big words. The water in the vaccine must be the same concentration as the water in your body, which is basically salt water, so what we inject is basically salt water as well. The only ingredient in the vaccine that is biologically active—that is, causes the body to do something—is the flu antigen itself. Everything else is either inert, or present in such a small amount as to make it essentially “not there.”

The most frustrating thing about all of this is that we are dealing with the worst flu pandemic in my lifetime and people are being, well, people. This is serious. I’ve been caring for an inordinate number of flu patients since this hit us in April, and it’s not just “a cold”. Many more people are dying than in a normal season, and this can be prevented by a simple vaccine. There is no other real way to prevent the flu. It is frustrating that people who have spent their entire careers studying, learning, and fighting infectious diseases are having their work discounted and tossed aside, while any idiot on facebook can convince an acquaintance that flu shots are made in dirty factories in Thailand from aborted babies force-fed deadly poisons and injected into poor innocent people in America to sap us of our precious bodily fluids. Really, to a professional, that’s what this stuff sounds like—deranged, psychotic. Please try to remember that we aren’t making this stuff up—we’ve been studying the flu for over a century and we’re getting pretty good at it—except for the public education part.

Comments

  1. #1 Bardiac
    October 11, 2009

    I’ve been looking to get a flu shot, but on campus they ran out, and the local clinic doesn’t do there thing until the end of the month. Looks like walgreens or something?

    (Your second red arrow point is missing a “don’t,” I think.)

  2. #2 Pieter B
    October 11, 2009

    The other day when researching an e-mail whose theme was “Squalene! OMGWTFBBQ! We’re all gonna die!” I discovered that one of the sources of squalene is shark-liver oil. Shark-liver oil is sold by some “natural” websites as an immune-system booster.

    Here’s one that claims it will cure cancer, AIDS and chronic fatigue syndrome

    And this one emphasizes the squalene content

    Those of you who read patent-medicine labels might have already recalled that shark-liver oil is an ingredient in Preparation H. The obvious joke is left as an exercise for the reader.

  3. #3 Passerby
    October 11, 2009

    No sir, this is NOT like last years flu, or any other year of seasonal flu. This virus does NOT dock with typical receptors; it’s very good at invading both upper and lower respiratory tract. It’s highly contagious, carried easily on air and is shed for a week or more after active symptoms subside. The subpopulation that is particularly susceptible to infection will contract this virus several times this winter and spring. The vaccine, ironically, will help those who are least susceptible to infection, but will do little to help those who are most susceptible because of it’s unusual mechanism and cellular targets, which also provides insight into the unusual side effects among those who suffer severe infection.

  4. #4 PalMD
    October 11, 2009

    Passerby, i’m not sure what you’re talking about, but any time someone leave medical/scientific info that’s a bit outside the mainstream, it’s nice to have citations.

  5. #5 khan
    October 11, 2009

    —The most frustrating thing about all of this is that we are dealing with the worst flu pandemic in my lifetime—
    ———————————————————–
    Seriously? Worse than ’57 ’68?

    I will be getting the seasonal flu shot tomorrow.

    I read something that suggested that I might have partial immunity to the new H1N1 because I had the ’57 flu and had the ’76 ‘swine flu’ shot.

    I was born in ’50; should I try to get the new H1N1 shot?

  6. #6 Joe
    October 12, 2009

    For many years I ate instant oatmeal in the winter, then my neighbor suggested “Irish, steel-milled” that you mentioned above. I tried it and it seemed the only difference is cooking time. So, I looked in McGee’s “On Food and Cooking” and it seems the only difference is how finely it is milled. So, I’m back on the “instant” variety because instant gratification isn’t fast enough.

  7. #7 PalMD
    October 12, 2009

    I heart McGee, but are you of the camp that, say, ravioli is the same food whether it’s al dente or liquified in a food processor????

    C’mon…the whole oats have a completely different taste, smell and mouth feel than rolled, parboiled oats.

  8. #8 stripey_cat
    October 12, 2009

    ‘”Because flu deaths are counted as “flu + pneumonia” deaths, people aren’t really dying of the flu”: this is wrong. We don’t test every single case of flu, and many people who die from flu are killed by a pneumonia that attacks their weakened lungs. If not for the flu, they would not have gotten the pneumonia and died. If they had gotten their flu shot, they would have been much less likely to get the flu, the pneumonia, and died.’

    I came up with a good counter-example to this the other day, and the lady I was talking to said she was going to get the vaccine as soon as possible. If you tread on a nail and die of blood poisoning, you’re not actually dying of a puncture wound. You die from a bacterial infection. But you still wouldn’t have died if you hadn’t trodden on the nail. Same with ‘flu and pneumonia.

  9. #9 Pierce R. Butler
    October 12, 2009

    Recently encountered flu rumors:

    People born before 1957 have been exposed to a similar-enough strain (the “Asian flu”) that they are already effectively vaccinated.

    People who received swine-flu shots in ’76 from the lamentable Gerald Ford administration are also protected.

    Any truth to either of these?

  10. #10 PalMD
    October 12, 2009

    The first there is probably a great deal of truth to, and it looks like the CDC is not going to recommend swine flu vax for over 64 years of age.

    The second is not known to be true.

  11. #11 Pierce R. Butler
    October 12, 2009

    Why the 12-yr discrepancy between “people born before 1957″ and “over 64 years of age”? Were those under 13 when the Asian flu was “making the scene, daddy-o” not provided a lasting effect?

  12. #12 Paula
    October 13, 2009

    Pierce Butler, thank you. I’ve been asking the equivalent question, including on Effect Measure, for some time, especially as the serology studies on antibody levels to this virus (MMWR July 30 (n.8), NEJM Sept 10) show only 33 percent of old persons having “immune” levels of the antibodies, and as the NEJM study, at least, shows the percentages form a curve peaking with people alive in or soon after 1918, and persons now in their 60s and early 70s having little more likelihood than middle-aged persons of such antibody levels. The epidemiology levels show older persons are not the prime targets with this virus (so far), as they are with seasonal flus, but they do get struck; one of the victims in the Mexican study released today was 83. No, I think the “over 64″ figure for “last in line for the vaccine” may have lots more to do with old-fashioned agism.

  13. #14 Rev Matt
    October 13, 2009

    ‘Everything else is either inert, or present in such a small amount as to make it essentially “not there.”‘

    So basically everything else in the vaccine is homeopathic…

    I’ll show myself out ;)

  14. #15 Joe
    October 14, 2009

    Well, I am going to do a side-by-side comparison of instant vs steel-cut oatmeal. You may be right that there is a difference that is lost on me. I’ll get back to you …

    But al dente pasta vs pureed is quite a stretch.

    Anyway, I thought I’d get lost in the comments at http://www.sciencebasedmedicine.org/?p=2078 to say that I appreciated that post.

  15. #16 Ling
    October 27, 2009

    read up about colloidalsilver it kills any virus/germ i do not see it nessary to get any of these flu shots, iv’e done fine with CS for many many years, & never plan on changing my health habits. So yes there is another option, use colloidal silver once a day till this whole swine flu pandemic blows over. & say fuck it to getting vaccinated by goverment runned garbage.

    Cheers,
    Ling

  16. #17 Chris
    October 27, 2009

    Hey, Ling… silver compounds have been shown to kill bacteria (not viruses) in vitro, not in humans. There are silver compounds that work on the surface, but not in the blood.

    Big difference.

    Think about it: bleach also kills bacteria in vitro. But are you seriously going to drink the stuff?

    More discussion here: http://www.sciencebasedmedicine.org/?p=2220

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