Flu shot heresy (Read 2153 times)

Princess Cancer Pants

    Shouldn't children, elderly, others at high risk be given preference for the vaccine when there are limited quantities?


    Yep.  I just read something tonite that spoke to the fact that people over a certain age have minimal risk.  Something like only 7% of those who have become ill are over 60 or 70.  The group at greatest risk is pregnant women.  It said that even those with WELL controlled asthma and diabetes (the article made no distinction between type 1 or 2, so I'm not sure if they are talking insulin or oral treatment) are at a greater risk than even with other flu strains, too.  

    But the scary thing is that there doesn't appear to be ANY H1N1 vaccine supply in most areas.  So no one is getting protected.  Even if I got the shot today I'd still be SOL for 10-14 days before the immune protection kicks-in.  That's kind of scary when we have schools closing until next Monday and thousands of people county-wide reporting illness.  My DH's cousin just went to the doctor today and has it.  I think the odds of my household avoiding it are slim to none.  I don't really hold out much hope that we will get through the next 3 weeks without one of us catching it and spreading it.  It definitely seems to be very contagious from the news reports around here.

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    Feeling the growl again

      Not true at all.  Diseases that are typically considered fatal do NOT run placebo-controlled trials except under exceptional circumstances.  The control arm is an active treatment.  Your understanding of randomized trials is very incomplete, I help design them. 

      There are a lot of myths and misconceptions out there about H1N1 and the vaccine, to the point I really don't pay attention anymore.  #1, I have it on good authority through some physicians who have treated large numbers of cases and get the regular updates from CDC and H1N1 so far is less likely to kill you than the seasonal flu.  #2, that this vaccine is "new", and therefore somehow dangerous.  It's produced by the exact same process used to produce the seasonal flu vaccine...which is new EVERY year, as they change the strains it protects against to try and provide immunity against those strains they feel will be most prevalent that year.

      In the spirit of full disclosure, yes, I work for pharma.  But somehow they did not force me to check my ethics, compassion, and human decency at the door in exchange for a heart made of coal in the shape of a dollar sign.  I gave up years of earning potential to get the education necessary to pursue a career where I can make a difference by helping people get new and more effective drugs.  The cold-hearted intentions you ascribe to people like myself are both untrue and insulting.  You believe the gov't is lying to you but the media is telling you the truth?


      I find the arguments against randomized trials really weak.  Every randomized trial risks letting people die.  That's the only way to find out what works.  



      "If you want to be a bad a$s, then do what a bad a$s does.  There's your pep talk for today.  Go Run." -- Slo_Hand


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      Imminent Catastrophe

        The real villains are not Pharma, but the crackpots selling quack "homeopathic flu remedies". Those people belong in prison.

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          I will get the regular flu vaccine today, and the H1N1 vaccine when it's available here.

          What are the expert opinions (Trent) on these other tips I've been given?

          • Wash hands frequently.
          • Keep your hands away from your face. Don't eat with your fingers.
          • Gargle twice a day with warm salt water.
          • Take vitamin C.
          • Drink warm fluids like tea, coffee, and soup.

           I can't speak to the last three. I doubt they'll hurt you, but don't think they'll protect you that much.  But hand hygiene is key.  obsessive use of alcohol based gel.  I was in a meeting where H1N1 was mentioned, and everyone reached in their pocket and pulled out some gel and used it.  It was kind of funny.  Like just talking about a disease might be contagious. 

          A Saucy Wench

             You believe the gov't is lying to you but the media is telling you the truth?


            That part cracks me up. Media is honest. except when they are trying to sell a story, then they are lying.

            I have become Death, the destroyer of electronic gadgets


            "When I got too tired to run anymore I just pretended I wasnt tired and kept running anyway" - dd, age 7

               I gave up years of earning potential to get the education necessary to pursue a career where I can make a difference by helping people get new and more effective drugs. 

               very cool - how is the HIV vaccine coming along?


                Here is what I know from personal experience of managing the sickest of patients (i.e. those ventilated in ICU) throughout the southern hemisphere winter, which obviously has significantly increased the prevalence of H1N1.


                1. Although it is similar to other influenza A virus, it is also significantly different - both in the demographics of those infected and in the underlying pathophysiology. The number one group of people with serious side effects appears to be pregnant women (thus ALL women pregnant women should recieve the vaccine early unless you are a crazy crackpot) followed closely by those with other medical co-morbidities - respiratory illnesses (asthma/COPD etc), obesity and immunocmpromising conditions (DM, HIV, those taking long-term steroids for RA etc) but why it is receiving so much media attention is that unlike the normal seasonal influenzae it affects young, healthy people with no medical problems, which is significantly different to the normal seasonal influenza because no-one usually cares if old people in nursing homes die of penumonia (much like they don't care if the worse genocide in the world is occuring currently in Darfur) but they do care if young people die. ?


                2. In this group of young people it is not necessarily the virus itself that is causing the most problems but your bodies own immune response. Thus because young people are able to mount a much more active immune response to H1N1 than the elderly they shoot themselves in the foot. That is, yes they more readily kill the virus but all the immune mediators also result in significant damage to their own body - in particular they develop an ARDS or stiff lung picture. Thus the problem is conventional Rx of ventilation plus antivirals and Ab's to prevent secondary infection is not adequate and they are requiring high-dose methylprednisolone + rescue ventilation such as NO or HFOV or ECMO - this last bit is really just for Trent in case he has to treat anyone.


                3. All pt's in ICU receive ostelamavir (tamiflu) as the basis of treatment with no adverse effects. Also those who receive tamiflu early were found to have a much less severe course with less hospital admissions overall in the southern hemisphere winter in LARGE studies. But if you don't want it - excellent because there is more for the rest of us.


                4. As for the vaccine - a few points. Firstly I could be wrong, but no sensible doctor would argue that vaccinations have zero side effects, some of which may be serious. The question is what is the greatest risk - and in this I agree wholeheartedly with Trent, there are many RCT's which show that the risk of not receiving the vaccine and dying of H1N1 influenza is MUCH greater than of dying from a serious side effect of the vaccine. That being said there are a number of caveats. 1) Of course it would be better if everyone else received the vaccine and you were the only person who didn't, because then you would have the benefit of having absolutely no risk from the vaccine (as opposed to a miniscule risk) as well as the fact that you would be unlikely to get H1N1 because the virus would die out becasue of everyone else vaccination - i.e. you are protected by herd immunity. The ethics of this I would suggest are fairly questionable and if everyone choose this path then it wouldn't work because there would be no herd immunity - but technically for the selfish that is true. 2) On the basis - that with this particular strain some individuals are dying from an immune reaction - an argument could be suggested that even though the virus is dead in the vaccine you could still mount an overact immune response (i.e. that is how the vaccine works) with some serious consequences - although there are many flaws in this theory but in the basis of completness it is technically possible. 3) Unlike the normal vaccine - the H1N1 vaccine is not being produced in a single vial but different pt's are reveiving multiple doses from a single vial in the vaccination campaign which whilst making ti cheaper has a number of potential drawbacks which I won't go into because I have bored you enough already.


                5. If you are particularly concerned - pretend that Australia is a large testing ground for your lovely country as a national vaccination campaign has already been rolled out here with teh entire population being vaccinated free - that is 21 million test subjects - which to date I have recieved no information that there has been any serious side effect at all. 21 million is what I would call a reasonable sample size.


                BOTTOM LINE - get vaccinated and if you are +ve get ostelamavir early. Or don't - I need someone to come to ICU to keep me employed 

                12 Monkeys


                    Yes - I have changed it. Don't do night's and try to provide insightful advice. Generally it just ends up as gibberish. But then again that is what most people think we speak anyway.

                    Old, Slow, Happy

                      Wow--You two people make me feel like I don't know anything about this stuff.  Oh...that's because I don't.     I appreciate the insight from both of you and also from another area of the world.  I will, likely, still not get the vaccine because I don't think I'm in a high risk group.  If there becomes enough vaccine for everyone that is high risk, then I'll consider it. 


                      Again, thanks to both of you for the information.  I'm not very good at blindly following and now I think I know a little something.


                      By the way: My father was a small town family physician.  I know how hard you guys work and how much you know.  Thanks for all that too. 

                      Feeling the growl again

                         very cool - how is the HIV vaccine coming along?


                        We don't work on HIV.  However for the first time this year it was announced that they created an experimental vaccine with "decent" efficacy.  I forgot the numbers.

                        I'll stick with finding the "cure" for "cancer" (because a likely cure won't be a cure as most people understand it, and there is not one type of cancer but over a hundred).

                        "If you want to be a bad a$s, then do what a bad a$s does.  There's your pep talk for today.  Go Run." -- Slo_Hand


                        I am spaniel - Crusher of Treadmills



                          We don't work on HIV.  However for the first time this year it was announced that they created an experimental vaccine with "decent" efficacy.  I forgot the numbers.

                           yeah - i work in an HIV lab - and there's been some super-excited chit-chat about a possible HIV vaccine - obviously still in the very early experimental stages. Didn't know if pharma had anything in the works for that - I had heard there was a few companies who were developing something...


                          but cancer drugs are cool too.


                            This story probably won't help.

                            The process is the goal.

                            Men heap together the mistakes of their lives, and create a monster they call Destiny.

                            12 Monkeys

                              This story probably won't help.


                              From Wikipedia:


                              One case reported[2] involves a woman who developed dystonia 10 days after a regular flu shot. Doctors at Fairfax Inova and Johns Hopkins diagnosed her with the neurological disorder. They think it was caused by a severe reaction to the flu shot.[3] However, Dr. Leigh Vinocur from the University of Maryland Medical System stated on the October 16, 2009, airing of "The O'Reilly Factor" on Fox News that this case was psychogenic and neurologists were using it as an example of psychogenic dystonia.[4]


                                From Wikipedia:




                                Seems plausible. The video was bizarre... that she could run, run and talk, and walk backwards, but was unable to talk when not doing those things, or walk forward normally.


                                I'm sure the local news station will do a thorough follow up on the story presenting this new information.


                                The process is the goal.

                                Men heap together the mistakes of their lives, and create a monster they call Destiny.