Did I have just get over the swine flu? I guess the answer has to be maybe not, supposedly when you have flu symptoms "at most half, and perhaps as few as 7 or 8 percent, of such cases are actually caused by an influenza virus in any given year". I have to tell you, though, if it wasn't at least the regular flu I got, whatever else that was, was some kind of powerful something. I haven't been that knocked out for that long since I was a child! And I saw or heard more than one reasonably reliable source say if you had the flu in our area, it was probably H1N1 as it really is the only thing going around. So who knows.
What's interesting to me is the fact that had I wanted to get a vaccination, I couldn't have. People are getting in line for it and getting turned away, finding that there isn't enough vaccine and only high-risk individuals (and financial fat-cats) will actually get a shot. You know, it is just the history of that whole business of flu shots: nothing but problems. Some of these problems are soon forgotten seems to me. I distinctly remember a couple of years ago when no U.S. company would make the vaccine and the British company that was supposed to make it screwed it up. Of course the problem was the politicians were trying to control the costs while simultaneously denying proper protection from liability that the vaccine makers wanted. And brother there is liability. People simply will die or otherwise get really horrible complications from getting the shots, sometimes in great enough numbers to be a financial disaster for that vaccine maker if held liable. This was the fiasco that resulted from the 1976 Gerald Ford swine flu vaccination drive. I don't know if the vaccine maker was liable or the government was liable, but in any case the topper for that year was that supposedly only one unvaccinated person died from the swine flu .
A doctor now no doubt banned from the media came on a local radio station about five years ago and said he didn't recommend getting flu shots except for the elderly, infants, or other high risk groups. His reasoning was that for healthy people there is almost zero risk of dying or getting complications, but there was a certain risk from getting a flu shot, and that risk is unknown for each year until, well, the results are in! Furthermore, there is a pretty high chance that you are not getting vaccinated for the strain that is actually going to go around.
Anymore, though, we are not hearing these voices. The regular media seems to be cooperating with the notion that, again, we can't handle the truth, and the truth is the flu shots must be given to everyone possible so the vaccine maker can sell them and also so that there is a theoretical wall of immunity out there amongst those who don't actually need it so that the high risk groups are more protected. It is my civic duty to get the flu shot?
So as not to paint the picture that the government's vaccination drives are wholly useless, I'll give them credit for trying to protect the vulnerable. And, yes, maybe when something more dangerous like H1N1 is becoming epidemic, maybe it is time for all of us to get that flu shot (oh if there weren't all those problems!) I have to confess that the idea of getting in an interminable line to get one may keep me in the uncooperative citizen category forevermore. But unfortunately, it is quite possible all this is misplaced effort anyway. A recent Atlantic Magazine article really lays out the case (the quote above is from that article)
I'd like to hear any other opinions.
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8 comments:
I think the issue should be addressed as individual decisions involving how much risk (of expiring) one is willing to undertake.
For healthy people I don't think the shot makes much difference and some prefer not to take the risk of a shot, which I can understand. In either case, unforeseen results are inconvenient, but rarely deadly. Sometimes the risk of being out-of-commission raises the cost of getting sick - for example, football players during football season.
Certain segments of the population who aren't as resistant probably should get one because the results of getting the flu are more dire for them, and the risk is too great. My wife fits into this category - and I also get the shot mainly to reduce the risk of my giving it to her.
I don't think the inoculation of the general population makes any sense. However, the specter of a uncontrollable pandemic haunts the elected offices - "not on my watch". It is easy for the medical-industrial complex to get them to overreact. The classic case is President Ford.
I won't get the swine flu vaccine unless Linda feels she cannot undertake the risk of getting it. She will consult with her Dr.
FBW
I have not read the Atlantic article but here is what I know.
People mistake various maladies for flu. Influenza is an upper respiratory tract infection. It is never a stomach ailment. So let us first limit the "flu" to what is really influenza.
The problem with any flu is the secondary problems like pneumonia, bronchitis, and other infections that can result and can be hard to control. Raging pneumonia is based on reality. This is what killed so many people in the Spanish flu epidemic. Thus, any population that has a immunity impairment or the simply inability or strength to overcome or live through an infection need to worry about any flu. This would be the elderly, the young and the immune compromised, which is actually a fairly wide ranging group. The statistics are that regular flu kills over 30.000 people per year.
A vaccine is not going to kill you, with the exception of the swine flu of 1976, which I explain below. What will kill you is the flu. Yes, sometimes people end up getting the flu even if they get a shot. Does that mean the shot gave them the flu? There really is no telling if they were exposed to the flu prior to the shot. If it is a live virus vaccine the odds are greater but generally the vaccines are dead virus.
The swine flu vaccine issue from 1976 had to do with a preservative that was used in making the vaccine. Congress enacted a law and referred all lawsuits regarding the vaccine to the Federal Court of Claims. I have read a few of the cases. I have never been clear what the government's involvement was and why they should be sued. Now, as for production, if you notice, the CDC keeps saying that the H1N1 vaccine is made just like the regular flu vaccine. What they are saying is that they are growing the virus and killing it and then mixing it with some background material just like any vaccine. No preservative issues here.
The other issue is, does it work? I never get a regular flu shot. Sometimes I get the flu, sometimes not. Matt always get the shot. Sometimes he gets the flu, sometimes he does not. Does it mean the shot does not work and we have the same odds? Not necessarily. Everyone has been exposed to different viruses so we have unique immune responses. Also, the flu mutates all the time, that is what viruses are good at. So maybe the shot prevents known but does not work on unknown mutants. Maybe the shot makes the flu less nasty than it would have been without the shot. We have an entire population to figure that out-- I do not get the shot and there are lots of folks just like me. I find it hard to believe that they cannot tell statistically whether a vaccine works by asking the simple question--do those who do not get the shot get sick more often? Is the flu worse if you do not get the shot? I think that the general line on that is that the flu ends up being worse without a shot. I do not know about overall effectiveness. Seems like a simple question to answer. But since viruses mutate, it is probably hard to know why any person gets sick.
As for some drug company conspiracy, flu shots make no money and the companies do not want to make the vaccines. That is why we had to ship the process to Britain at one point. No domestic company would take the job. So I do not think this is some hidden way for companies to make money. (I am not referring to tamiflu which is a whole other topic.)
The reality is that the risk from a shot is so small and the cost so little, any gambler would take the bet. I choose not to get the shot for reasons Matt finds perplexing but basically, I want my body to deal with it and develop its own anti-bodies. As Matt points out this is dumb thinking because a vaccine is the exact same process only with a milder reaction to the bug.
Maybe for me it is a matter of principle. But I am telling everyone to get an H1N1 shot if they can. If that would lead to a milder version of what we have been struggling with, it would be absolutely worth it given the low risk and cost.
I did read the article and found it to be very interesting. There are two separate issues that I see. The first is whether vaccination is effective for influenza and the second being the perhaps overuse and over recommending the use of anti-viral drugs like Tamiflu.
On the first issue, I find the position of some people who do not want the shot and the position of the government to promote vaccination, ironically guided by the same motivation. Namely, an aversion to risk.
I am generalizing a bit because clearly Marsha's reasoning for not getting a flu shot does not match this, but I have heard from more than one person that they do not get flu shots because of the risk. Similarly, the government wants to promote this effort in order to head off a major pandemic and save as many lives as possible. Competing priorities driven by the same motivation.
There is a risk to getting any shot or taking any medication. You could die from taking a baby aspirin. The odds though are much more in favor of the baby aspirin doing more good for your heart than causing an aneurism. The reality is the risk to getting a vaccination is incredibly low. The risk for me dying of the flu may be equally as low, but the cost of a shot, usually about $20 in my experience and the low risk of complications, cause me to play the odds that the shot will either prevent me from getting full blown influenza or at least minimize impact.
We know for sure that vaccination works on viruses that are not promiscuous (viruses that don't mutate as quickly or exchange parts of their DNA/RNA with other viruses), such as polio, measles, mumps, etc. We've been inoculating people for hundreds of years and have had tremendous success, smallpox for example. The question of whether vaccination is effective for promiscuous viruses like influenza is certainly one that we should studying, although what I took away from the Atlantic article is that is not an easy proposition. It certainly would be unethical to do placebo tests on what could be a vulnerable population. I would argue that it is an evolutionary imperative for the government's effort and money to figure out how to make an effective or a more effective vaccination for promiscuous viruses. Anybody read The Hot Zone? One bout of Ebola influenza and half of the human population could be wiped out. Low odds, yes, but also relatively low cost to engage in the scientific effort.
Ultimately, I would recommend anyone who can get the H1N1 shot. The risk is low, the cost is low, and this is by far the worst illness I have been through. I have never experienced anything this bad in my life. If there's any chance at all that it would prevent it or make it less severe, it would be worth it.
For the second issue, I agree completely with the Atlantic article. Marsha was explaining to me yesterday about how antibiotic misuse has lead to the proliferation of antibiotic resistant bacteria. I was under the impression that it was over prescribing and over use. Similarly, what I originally took away from the Atlantic article was that there was over prescribing of the anti-viral drugs in this case relative to the risk to the overall population. It sounds like this is happening, but also not clear instructions on use of the drugs as well. This has caused the virus to quickly become resistant to the drugs. This is clearly not in anyones interest. On a side note, I have had two bacterial infections this year, including the pneumonia which was a secondary effect from the H1N1, which were resistant to Azithromycin. That is not good. Drug resistant bacteria and viruses is a major issue that needs way more focus that it is getting.
In my opinion, the swine flu vaccine and the seasonal flu vaccine are two different issues. The seasonal flu vaccine simply vaccinates you against whatever the "most likely" flu virus is that year, so there's more chance that you may be inoculated against a strain that isn't even going around. However, the swine flu contains a specific virus that is indeed going around, so you really are being inoculated against the virus of concern.
That being said, I'm not getting the H1N1 vaccine, even though it will be offered to me. I am not at risk, I don't live with someone who's at risk, and I don't come into contact with at risk people on a frequent basis. I think it's more important to leave my vaccine for someone who is at risk. Also, I don't really believe it's my responsibility to get inoculated to keep it from spreading. Again, the likelihood of my spreading it to an at risk individual is very low, especially if I stay home when I'm sick. And if those people have been inoculated (with my vaccine), then they won't be at risk.
re your comments so far:
>I also get the shot mainly to
>reduce the risk of my giving
>it to her.
interesting
>No preservative issues
>[these days]
I am pretty sure there is not 100% confidence there couldnt be problems any year. Check the link out in the next post, it is a very honest evalutaion by webMd: one statement: "vaccines can trigger rare but serious reactions, even among people with no apparent allergies or sensitivities."
Marsha! you lay out a case for getting the shots and then say you don't get them!
>promiscuous viruses
wouldn't you know the problem with the flu is bad morals!!
>anyone who can get the H1N1 shot
Since I think I got it, I have to say I am leaning this way now for these "novel" strains. But note I can't get one yet.
>antibiotic misuse
as a country we really need to get a handle on this!
>risk aversion [to getting
>the shot]
I am probably sounding too ridiculously risk averse, as this is in the zone of 1 problem for every million. But it is not the only problem. And, it is a little like saying we have had practically no casualties in Iraq and Afghanistan. From the prospective of comparison with most wars, this is actually true. However, everybody knows you can't say this without being misunderstood: for the families involved, soldiers lost in action and victims of vaccine complication, it is always unbearable tragedy. And resultant questioning about decisions that were made.
>I'm not getting the H1N1
>vaccine, even though it
>will be offered to me.
Williams genes kicking in here. [g] BTW are you sure it will be offered to you in the current batches? I guess at some point we will all be offered it.
Uncle Carl, I'm not sure entirely what batch will be offered to me, but I think it's coming very soon. The Feds are offered flu shots every year and we will be offered the swine flu shot this year too. I haven't heard exactly when it's coming, but like I said, it should be soon.
Re: abuse of antibiotics, I never realized until I read the Omnivore's Dilemma and watched Fresh and Food Inc. that a lot of the superbug problem is related to widespread use of antibiotics in the feedlots. It's pretty freaking gross.
I try to avoid antibiotics unless absolutely necessary. And yet, I still know people who believe in getting antibiotics every time they get sick -- even though they may have a virus. I could actually rant and rave about this, but I won't. :)
I got a regular flu shot from my doc during my last appointment with him, but when my wife saw her doc the next week, the vaccine was no longer available. CVS and Walgreen's have also discontinued their flu shot services in our area. Someone in the CVS pharmacy suggested that all the effort was going into the swine flu vaccine, which is not available: now the regular one isn't either!
Anyone know hard numbers on problems caused by flu shots versus problems caused by flu for people who haven't had shots?
David S. ?
>Anyone know hard numbers
for the 1976 event, one dead from the flu and hundreds with complications from the shot and 25 dead from the shot; HOWEVER, my source is wikipedia and there is always the possibility that can't be relied on.
in the case of current vaccine offerings, the Web MD article says the complications/death risk is 1 or 2 per million while risk from the flu is "higher" but seems to be unspecified. Of course, reading between the lines, they don't know any given year what the risk of complications might really be. They've had a good track record lately and are extrapolating from that.
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