Some of our more astute readers may have noticed that we are paying influenza slightly more attention than other topics of late.  That’s because this situation is new, rapidly changing, and covers more areas of science and medicine than one can easily count.  It’s also a subject about which the general public and media are keenly interested.  This is an outstanding learning and teaching opportunity for us as a professional community.  Unfortunately, it is also fertile ground for confusion, fear, and misinformation, and a playground for those who would exploit such things. is a horrible chimera of tabloid journalism, late-night infomercials, and amateur pre-scientific medicine, and is the primary web presence of Joseph Mercola.  Unfortunately, it is also one of the more popular alternative medicine sites on the web and as such is uncommonly efficient at spreading misinformation.  I am not a fan, and have addressed his dross in the past.

Joseph Mercola has recently posted an excerpt from an individual he evidently holds in high regard, Bill Sardi.  Bill published “18 reasons why you should not vaccinate your children against the flu this season.”  Mercola chose his nine favorites (one would assume the nine best reasons), and re-posted it on  There are so many mistakes, so much misinformation in so little space, it’s almost a work of art.  You know, like that crappy art that you might expect to find on the wall at an hourly motel.  Without further delay, let’s examine Mercola and Sardi’s nine best reasons for you not to vaccinate your children against influenza this season:

1.        The swine flu is simply another flu. It is not unusually deadly.

“Not unusually deadly.”  Oh good, then we can expect only ~36,000 people to die from it this year!  Why does that number not reassure me?

One could do an entire post on just this single misleading claim.  Oh wait, we have.   Suffice to say every influenza strain has unique characteristics, some subtle (like the differences between seasonal strains from 2005-2007), some glaringly different (like the pandemic strains of 1918, 1957, and 1968, or the H5N1 “bird flu”).  Saying something is “simply another flu” is nearly meaningless.

I’ll be charitable and assume he meant 2009 H1N1 is behaving like the average seasonal influenza.  Let’s see, it circulated during the Summer, when flu doesn’t circulate, is uncommon in the elderly, is disproportionately infecting and hospitalizing younger people, it has a much higher incidence of ARDS requiring mechanical ventilation and heart-lung bypass (ECMO) than its seasonal counterpart (Australia reported 68 cases requiring ECMO vs. 4 the prior year), and it has a population which under the age of 60 is nearly 100% susceptible.  Yep, sounds like any old flu to me.

Score: 0/1

2.        This is the first time both seasonal and pandemic flu vaccines will be administered. Both seasonal flu and swine flu vaccines will require two inoculations. This is because single inoculations have failed to produce sufficient antibodies. This is an admission that prior flu vaccines were virtually useless. Can you trust them this time?

Yes, this is the first time they will be co-administered because pandemic 2009 H1N1 didn’t exist before now.  Neither seasonal nor 2009 H1N1 vaccines will require two doses; both have been found to generate a sufficient immune response without a second dose.  The exception to this is in children 6 months to 9 years of age, who require a second dose of the 2009 H1N1 vaccine separated by 4 weeks, and two doses if it is their first time being vaccinated against seasonal influenza.

Even when vaccines do require a second dose, this is not an admission that the vaccine is useless.  Basic (and I’m talking 101-level basic) immunology explains why some molecules and microbes are more immunogenic than others, and require repeated exposures to generate an adequate immune response.

Furthermore, administering multiple vaccines against multiple strains of influenza simultaneously isn’t exactly pushing the boundaries of science.  In fact, it’s status quo: the seasonal influenza vaccine is a trivalent vaccine, meaning that it has three different influenza strains in it.  This has been true every season since the last major shift in circulating seasonal influenza viruses.

Score: 0/2

3.        Adjuvants are added to vaccines to boost production of antibodies but may trigger autoimmune reactions. Some adjuvants are mercury (thimerosal), aluminum and squalene. Why would you sign a consent form for your children to be injected with mercury, which is even more brain-toxic than lead?

Adjuvants are indeed added to some vaccines, and that’s a good thing.  But it isn’t needed in this one, so it’s not there.  I think someone both wise and handsome covered this somewhere on this blog before…  Aluminum and squalene-containing compounds are the adjuvants most commonly used, and both are safe.  However, thimerosal isn’t an adjuvant, it’s a preservative to prevent bacterial contamination of the vaccine and keep it safe.  There is a subtle difference between a preservative and an adjuvant.  For those with sarcasm impairment, by “subtle difference” I in fact mean “blatantly obvious and inexcusable difference.”

And while we are on the topic of influenza vaccine and thimerosal, the single-dose syringes have no thimerosal.  Only the multi-dose vials contain any thimerosal, with each dose containing 25 micrograms of ethylmercury.  This 3.5 times less than what you would get from eating a single can of tuna (~87 mcg), is a form of mercury far more rapidly cleared than most environmental mercury exposures (methylmercury), and has been exonerated from suspicion as a cause of autism.

Score: 0/3

4.        This is the first year mock vaccines have been used to gain FDA approval. The vaccines that have been tested are not the same vaccines your children will be given. (Emphasis Mercola’s)

Wait, what?  “Mock” as in “fake?” You are going to claim something like that and give no source?  None?  Awesome.  Were that to be true, it would be beyond a scandal, it would be criminal, and I’d be right there beside you calling for prosecution.  Were it true.  Which it’s not.  The 2009 H1N1 vaccines were approved as a “strain change” to the seasonal influenza vaccine.   We change the strains almost every year, and the 2009 H1N1 vaccine that your child will be given has been subjected to the same testing as the yearly influenza vaccine prior to release.  Oh, and I’ll provide sources.

Score: 0/4

5.        Over-vaccination is a common practice now in America. American children are subjected to 29 vaccines by the age of two. Meanwhile, veterinarians have backed off of repeat vaccination in dogs because of observed side effects.

Over-vaccination!  Don’t you just hate it when you just aren’t susceptible to quite enough diseases? Children are not subjected to 29 vaccines by the age of two, not even by adulthood.  There are 17 discrete vaccines (including 2009 H1N1) against specific viruses and bacteria on the routine schedule.  Some are combined together in a single injection (like Diphtheria, Tetanus, and Pertussis) to reduce the number of injections.

Where did this number of 29 vaccines come from?  If he meant 29 exposures to individually targeted viruses or bacteria or counting individual antigens he significantly undercounts.  He might come close to the highest number of individual injections a child could get if one avoids most combination vaccines, though given number of different combination vaccines available, the actual number varies.  No matter how you slice it, his number is wrong and misleading.

What about the veterinarian story?  He’s referring to “vaccinosis,” which is more or less “vaccines cause autism” for animals.  That veterinary vaccination schedules have changed is primarily due to a lack of good data in animals and the fact that vets care for widely varying species.  As vets learn more about the immunologic response in a particular species, they follow the evidence and alter their schedules.  This has no bearing on vaccination of humans.

Even if it were an accurate or relevant piece of information, the vets would not be alone in stopping the use of a vaccine due to observed side effects.  Emphasis here on the word “observed,” and not “imagined.”  For example, due to our standard post-licensure surveillance, within a year of its release the original rotavirus vaccine was found to cause intussusception in 1/10,000 children, and was rapidly pulled from the market.

Score: 0/5

6.        Modern medicine has no explanation for autism, despite its continued rise in prevalence. Yet autism is not reported among Amish children who go unvaccinated.

Ignorance of medicine, autism, vaccines, and the Amish, topped off by a non sequitur.  Wow.

Though the causes of autism are incompletely understood, modern medicine is making continual progress.   Studies of twins with autism, along with an increasing number of implicated genes show that autism has a very strong though complicated genetic basis.  Given autism’s heterogeneity, it is unlikely that a single cause will be found that explains all cases of autism, and it is possible that other factors beyond genetics may play some role.  Regardless of what etiologies are eventually found, some potential causes have been ruled out, including vaccines.

The apparent rise in autism prevalence is largely explained by a broadening in diagnostic criteria and increased recognition and diagnosis.  This explanation is further supported by studies like the one just published in the UK demonstrating equal numbers of autistic people in all age groups.

As far as the Amish are concerned, they do vaccinate, and they do have children with autism.

Score: 0/6

7.        Researchers are warning that over-use of the flu vaccine and anti-flu drugs like Tamiflu and Relenza can apply genetic pressure on flu viruses and then they are more likely to mutate into a more deadly strain.

So close!  Antiviral drugs do place selective pressure on replicating viruses, and resistant strains can be produced.  However, drug resistance is not equivalent to virulence, and so his implication that use of antiviral medication will induce more deadly strains is unwarranted.

It is also irrelevant to his topic of “Why you shouldn’t vaccinate your children against influenza.”  If anything, his fallacious argument would support vaccination, because fewer children infected will mean fewer children taking antivirals.

It seems to be asking a lot to expect internal consistency.

Score: 0/7

8.        Most seasonal influenza A (H1N1) virus strains tested from the United States and other countries are now resistant to Tamiflu (oseltamivir). Tamiflu has become a nearly worthless drug against seasonal flu.

Again, half-truths.  Here’s the actual data:  Seasonal influenza A (H1N1) is 99.6% resistant to Oseltamivir.  However, seasonal influenza is typically comprised of three circulating strains, and the other two, A (H3N2) and influenza B, are 100% susceptible to Oseltamivir, as is 2009 H1N1.  That’s hardly “nearly worthless.”  Furthermore, seasonal influenza A (H1N1) is highly susceptible to the Adamantanes (though H3N2 and type B are resistant), and we have no resistance of any influenza to Zanamivir.  This is well known to physicians.  We are able to type the influenza a patient is infected with and tailor their therapy when necessary, and continually monitor the susceptibility of circulating strains as you can see on the CDC site.

And again, what does this have to do with vaccination?

Score: 0/8

9.        Public health officials are irresponsible in their omission of any ways to strengthen immunity against the flu. No options outside of problematic vaccines and anti-flu drugs are offered, despite the fact there is strong evidence that vitamins C and D activate the immune system and the trace mineral selenium prevents the worst form of the disease.

“Strong.”  I do not think that word means what you think it means.  While it is true that deficiency in Vitamin C, Vitamin D, and selenium can make you more susceptible to infection, (unlikely in a developed country, but possible), there appears to be no benefit in further supplementation in the general population. Furthermore, we have reason to suspect that blanket recommendations of the use of antioxidants like Vitamins C and D and selenium may cause an increase in mortality.

Public health officials do make recommendations other than vaccines and anti-virals to avoid contracting influenza.  You can find them right here.  The problem (from Mercola’s point of view) is that they only endorse effective interventions based on proper evidence.  When there is limited plausibility for an intervention to work, little evidence in favor of it, and significant evidence suggesting futility or even harm from its use as is the case with these supplements, the appropriate action is to not recommend its use.  Which as Mercola points out, is exactly what public health officials do.  Responsibly.

Score: 0/9

Ooooh, swing and a fumble, 9 strikes, you’re out!  Swing and a line fault?  Whatever, I’m rubbish with sports, kind of like Mercola and Sardi are rubbish at medicine.  Out of their “9 best reasons not to vaccinate your child,” none of them are valid, and two of them don’t even concern vaccination.  Every single point here is utterly wrong, wantonly ignorant, and one would almost think intentionally misleading.

If I sound upset, it is for good reason.  For while Mercola and Sardi, drowning in their arrogance of ignorance, spread their misinformation with the expressed intent of undermining the public trust in vaccination and modern medicine, my colleagues and I will be forced to deal with the aftermath. This season has already been an unpleasant one in my pediatric ICU.  During what is traditionally the slowest part of the year, we are running at near our capacity of 26 beds.  The fraction of our patients who are in the ICU with 2009 H1N1 has steadily increased since the school year began, from roughly 5-10% of our census being flu positive over the summer (which is odd in itself), to now between 30-50%.  The need for prolonged mechanical ventilation is common in these patients, we have needed to place three children on a heart-lung bypass machine (ECMO), and tragically we have had deaths.

My ICU experience is typical rather than exceptional.  If you have any interest in following this influenza season, the single best source of up-to-date information is the CDC’s FluView Weekly Update.  There you will see that the percentage of visits to the ED for influenza-like illness is markedly elevated above the expected baseline, that the number of lab-confirmed influenza hospitalizations has tripled in the last 5 weeks, that at the present, the very beginning of the traditional influenza season, the age groups between 2 and 64 years of age have met or exceeded their average total number of influenza cases usually seen at the end of the season (~May).  Most depressingly, you can see the number of influenza-related pediatric deaths is growing, and growing rapidly.  Furthermore, this month’s JAMA has released studies from Canada, Australia/New Zealand, and Mexico describing their experience with critically ill patients with 2009 H1N1 that are similar to my own.

Most people who contract influenza are miserable for about a week, but recover, usually without the need for medical care.  The ICU experiences I relay here thankfully do not represent the population at large, but are meant to serve as a reminder that while you may not suffer from influenza this season, your neighbor may not be so lucky.  Influenza is a real threat, it deserves our respect, and our fellow citizens deserve to be properly informed and empowered to protect themselves and their loved ones. Influenza is not benign, and neither is the medical advice being distributed by Joseph Mercola.  The stakes are measured in human suffering and human lives, and Mercola bears responsibility for undermining the public health.



Posted by Joseph Albietz