Do you hear me

Do you care

Do you hear me

Do you care

My lips are moving and the sound’s coming out

The words are audible but I have my doubts

That you realize what has been said

You look at me as if you’re in a daze

It’s like the feeling at the end of the page

When you realize you don’t know what you just read

What are words for when no one listens anymore

What are words for when no one listens

What are words for when no one listens it’s no use talking at all

I might as well go up and talk to a wall

‘Cause all the words are having no effect at all

Missing Persons on blogging. Or so I thought. I was surprised to learn the song was written by the brothers Gibb.

Words are important. I try and choose my words carefully when writing so that they accurately reflect not only my thoughts but reality. When I speak, not so much. My frontal lobe filters often fail if I think might I might get a laugh.

I tell housestaff, precision of writing reflects precision of thought. It is one of the reasons I write; the act of writing forces some coherence into what can be muddled and inchoate thoughts. Even though I have residents who write notes, I always write my own. Often I do not make a final decision as to a plan until I put pen to paper, or electrons to screen. Writing crystallizes thought.

Not, evidently, for everyone, as 10 Facts About the Flu Vaccine and the Flu nicely demonstrates.

Influenza is one the more difficult diseases and the vaccine one of the more problematic interventions. Influenza is tricky, mutating every year, acquiring new DNA, new virulence, reacquiring old genes to infect at risk populations.

Influenza is deadly, a consistent cause of morbidity and mortality since the gasping oppression arose in human populations. I have written extensively on influenza over the years on this blog as part of my goal of reaching a million words on vaccines. Influenza kills people directly, it kills with secondary infections, it kills those with underlying medical problems, it kills with heart attacks. It especially kills the old, the young, the pregnant and now the obese. It kills the unborn; influenza season is spontaneous abortion season. It leads to smaller, less intelligent children. Depending on the year and the circulating strains, influenza is a major cause of human suffering and death.

90% of my practice is in the hospital seeing people who are acutely ill. I see those who got the short end of the influenza stick, those who suffer from influenza, its complications and occasionally die.

Oddly, I take the responsibility to prevent morbidity and mortality very seriously. The pro suffering and death, er, I mean anti-vaccine contingent will often say those of us in the anti-suffering and death, er, I mean pro-vaccine contingent are big pharma shills only in it for the money. I wish.

Early this week I heard someone mention, in response to some unfair experience, that it was nothing personal, it’s business. I realized that for me it is always personal, never business. I take human suffering and unnecessary death personally, an affront that pisses me off. Sometime back someone mentioned my posts seemed angry. You bet I get angry. Preventable illness and death should make you angry.

Preventing disease is always multimodal. I have been the Chair of Infection Control for what seems forever and one clear lesson of infection prevention is there is no magic bullet. Stopping infections is the result of the sum of a multitude of interventions, all important, all critical. When you do everything right every time, hospital-acquired infections almost vanish, much to the disappointment of my bottom line.

Preventing influenza, and other infections, is both simple and difficult. Ameliorate risks by not smoking or being overweight. Wash hands. Don’t inhale around coughers or on airplanes. Be replete in vitamin D. And be vaccinated.

As vaccines go, the influenza vaccine is not our best and brightest. It has variable efficacy in different populations and because there are new strains every year re-vaccination is required. Those who need the protection the most are those who are least likely to respond. And we have never had enough of the population vaccinated at any one time to take advantage of herd immunity, even supposing an excellent antigenic match between the vaccine and circulating strains.

Overall it appears to be a modestly effective vaccine when used as part of a nutritious breakfast. It decreases the chances of getting flu, of having a flu-like illness, and of having complications of flu such as heart attacks and the need for hospitalization. It is not a great vaccine but it is better than no vaccine.

If you read the entire literature on the influenza vaccine I think you would be convinced and if you had a career watching people suffer and occasionally die from influenza, while you might wish for a better vaccine, you would be glad for any weapon you could bring to bear against influenza. “You go to war with the army you have—not the army you might want or wish to have at a later time.

It is part of why cherry picking, half-truths and misleading essays on vaccines annoy me and warrant words. It is what words are for. Let’s see what SafeMinds has to offer with their facts:

According to the most extensive flu vaccine effectiveness review conducted to date, flu vaccines might be effective against influenza A and B, which represents about 10% of all circulating flu viruses each year.

No. I am picky here. Influenza A and B represent 100% of the flu viruses each year. The author points out in the introduction that there are 200 other viruses that can cause a flu-like illness, which is not necessarily the same as flu, the illness of influenza. Any illness with fevers, muscle aches and malaise is called the flu. But the flu is influenza. And I have zero idea what a stomach flu is.

The influenza vaccine prevents influenza. As it should. It does not have effects against rhinovirus, adenovirus, RSV or mimivirus. Nor should it. This is like noting the pneumococcal vaccine does not prevent the several hundred bacterial causes of pneumonia.

That is the type of sloppy writing that drives. Me. Nuts. I see it all the time in the newspaper when reading about topics of which I have extensive knowledge. They often get it wrong in ways that are misleading. Or just stupid. If I see the term “flesh eating virus” applied to Group A streptococcus one more time I will scream.

Under average conditions when the vaccine is a partial match for the circulating strains of flu, 100 people need to be vaccinated to avoid one set of influenza symptoms.

That is from the Cochrane reviews, whose leader has what I suspect is a strong bias against flu vaccine and looks at the effects of the vaccine as narrowly as possible.

Part of the issue with flu vaccine is the beneficial effects that also occur on populations and for diseases other than influenza. While the vaccine prevents infections from influenza, it also prevents other complication in those at risk: secondary pneumonias, heart attacks etc. Not getting influenza is a good way to avoid other illnesses.

And even when there is no match there can be effectiveness in the flu vaccine:

The TIV and LAIV vaccines can provide cross protection against non-matching circulating strains.

Determining overall benefit of vaccination is tricky depending on what goals you consider important. For example, with the H1N1 vaccine, using “societal perspective”:

Vaccination for pH1N1 for children and working-age adults is cost-effective compared to other preventive health interventions under a wide range of scenarios. The economic evidence was consistent with target recommendations that were in place for pH1N1 vaccination.

As the evil CDC notes:

Results of studies that assess how well a flu vaccine works can vary based on study design, outcome(s) measured, population studied and the season in which the vaccine was studied. These differences can make it difficult to compare one study’s results with another’s. As there is interest in how well flu vaccines may prevent illness, hospitalization, and even death with influenza, many outcomes need to be considered.

So when they say next:

Having received the flu vaccines has been found not to reduce hospitalizations or working days lost to flu like illnesses.

You can say it depends. On the study, on the vaccine, on the circulating strain, since others have shown:

Influenza vaccine is effective in reducing hospital admissions for influenza, pneumonia, bronchitis and emphysema, and effectiveness is comparable to that observed for influenza and pneumonia admissions in North America.

It is ignoring nuance of a complicated topic to grind your ax that annoys me. To continue:

In fact, the flu vaccine causes approximately one case of Guillian-Barré syndrome (GBS), a major neurological condition leading to paralysis, for every one million vaccinations administered.

Again, it depends:

After adjusting for antecedent infections, we found no evidence for an elevated GBS risk following 2009-10 MIV/2010-11 TIV influenza vaccines. However, the association between GBS and antecedent infection was strongly elevated.

So the infection is worse than the vaccine for association with GBS. I am not sure of their source, since it SafeMind is not completely referenced, but the Lancet confirms the risk is far higher from influenza infection when compared to the vaccine:

The attributable risks were 1•03 Guillain-Barré syndrome admissions per million vaccinations, compared with 17•2 Guillain-Barré syndrome admissions per million influenza-coded health-care encounters.

Partial words. Misleading words. Not what I would use words for.

Much of the published flu vaccines effectiveness data is funded by vaccine companies so the results may be overly optimistic estimate because company-sponsored influenza vaccines trials tend to produce results favorable to their products.

I do not deny the potential bias in pharmaceutical sponsored studies; it is why it is important to look at the study carefully for flaws that make the results suspect. Many of the epidemiologic studies are not funded by pharma.

According to flu vaccine package inserts, “Safety and effectiveness has not been established in pregnant women or nursing mothers and should only be given to a pregnant woman if clearly needed.”

Who dies from influenza? Pregnant females, although not in all studies (funded by the WHO, part of the New World Order, who get their funding from big pharma):

Some well accepted risk factors such as pregnancy and belonging to an ethnic minority group could not be identified as risk factors. In contrast, women who were less than four weeks post partum had a significantly increased risk of death from pandemic influenza.

Pregnant males are spared. And it kills the fetus as well.

Pandemic influenza virus infection in pregnancy was associated with an increased risk of fetal death. Vaccination during pregnancy reduced the risk of an influenza diagnosis. Vaccination itself was not associated with increased fetal mortality and may have reduced the risk of influenza-related fetal death during the pandemic.

Of course, that study was funded by Norwegian Institute of Public Health, notorious pharma shills (sarcasm, my Norwegian readers).

Not only does the vaccine protect mother and fetus (this time by those shills, the Argentinian Institute for Clinical Effectiveness and Health Policy. Bastards),

This large study using primary data collection found that MF59 adjuvanted A/H1N1 influenza vaccine did not result in an increased risk of adverse perinatal events and suggested a lower risk among vaccinated women.

And women give birth to healthier babies (this time it is Kaiser, man, do they have no shame?), one of many studies to show similar results:

Pregnant women who received H1N1 influenza vaccine were less likely to give birth preterm, and gave birth to heavier infants.

But mothers who are vaccinated pass protective antibody to their children resulting in less ill neonates:

Maternal influenza vaccination was significantly associated with reduced risk of influenza virus infection and hospitalization for an ILI up to 6 months of age and increased influenza antibody titers in infants through 2 to 3 months of age.

Again one of many representative studies, although who could ever trust the Center for American Indian Health? Those guys are known to be at the pharma trough.

SafeMinds continues:

A large-scale scientific study in approximately 50,000 pregnant women over five flu seasons found no difference in the risk for developing influenza illness among those who received the influenza vaccine during pregnancy and those who did not.

My Google-fu fails me. I can find two studies with 50,000 pregnant females and the flu vaccine and neither were efficacy studies. One was a safety study and the other a fetal safety study. Both demonstrated safety of the vaccine.

I know SafeMinds would not make up information, although if I were of conspiratorial bent (I am not), I would suspect that with “facts” such as these that they were in league with the New World Order to help depopulate the earth. Can someone help me out with the reference in question? It occurs to me as I do the final draft I should have just asked SafeMinds for the reference. Silly me.

Flu vaccines stimulate the immune system and product an inflammatory response. These same kind of inflammatory responses in pregnant women have been linked with the development of autism.

Nothing compared to the immune stimulation of infection which kills the fetus. At least autism is not due to mercury…oh wait:

Most flu vaccines contain mercury in the form of thimerosal. All forms of mercury have been found to be dangerous and should be avoided, especially by pregnant women. Simple methods such as good hand washing and avoiding contact with individuals who have the flu are also effective in preventing the flu for everyone.

Most? Try some. From the CDC:

Since seasonal influenza vaccine is produced in large quantities for annual immunization campaigns, some of the vaccine is produced in multi-dose vials, and contains thimerosal to safeguard against possible contamination of the vial once it is opened.
The single-dose units are made without thimerosal as a preservative because they are intended to be opened and used only once. Additionally, the live-attenuated version of the vaccine (the nasal spray vaccine), is produced in single-dose units and does not contain thimerosal.

Of the 145 million doses made in 2012, 62 million were thimerosal-free.

I recognize that people have their biases. SafeMinds certainly does. But still. A little integrity when writing about complicated concepts. Please. SafeMinds are evidently neither HonestMinds nor FuntionalMinds.

What are my words for? My destination is known. Sorry. I so wanted to tie it up with another Missing Persons reference. A million words. In defense of vaccines, in defense of preventing illness. In defense of preventing death. Seem a good use of words to me.

Posted by Mark Crislip

Mark Crislip, MD has been a practicing Infectious Disease specialist in Portland, Oregon, since 1990. He has been voted a US News and World Report best US doctor, best ID doctor in Portland Magazine multiple times, has multiple teaching awards and, most importantly,  the ‘Attending Most Likely To Tell It Like It Is’ by the medical residents at his hospital. His multi-media empire can be found at