October 12, 2009

just a tiny prick


As much as I find stories like this the apex of "OH GOD WHAT ABOUT MY CHILDREN" ninnyism, the Powers That Be only have themselves to blame that nobody is giving their kid a flu shot. Sure, part of the reason is due to dangerously-ill-informed numbskulls like Jim Carrey and Jenny McCarthy (who would rather have you listen to them than someone who spent eight years in med school) but pharmaceutical companies have not exactly been bastions of trust.

I get the feeling people would be a lot less squeamish about vaccination if it weren't contained in a needle that gets thrust into your skin. The mere act of impalement, no matter how small, creates fear that is rooted in our caveman ancestry and came of age during the frickin' jousts of the Middle Ages. If the flu vaccine was a jello shot, we wouldn't be having this little chat.

But let's look at recent history - as of a few months ago, your Tylenol dosage is suddenly all wrong, the estrogen therapy my mom was on back in the '90s was classified as "cancer-causing" by the WHO, and apparently the Vioxx that I occasionally took after hoops was givin' folks heart attacks. Companies do whatever the hell they want, whenever the hell they want, with only an actuarial table standing between their product and your untimely demise - I don't say this as an enraged McLeftyShorts with a macramé dreamcatcher helmet, I say it with the acceptance of someone who gives thanks for the warning, but will storm the castle anyway.

The flu vaccine safety record is unparalleled. It'd be awesome for everyone to get the shot and create a herd immunity every winter, even if the term "herd" isn't all that inspiring. I certainly got my flu shot at Target last week, the same day Lucy did the FluMist spray (full disclosure: most of the spray ended up on the pediatrician's ceiling, as my daughter's lungs and will power are not easily sublimated).

The Times did an excellent Q&A piece on the two flu vaccines, but I doubt there's much wiggle room among American parents - either you're going to do it or you aren't. I will say two contradictory things to sum up my feelings, however: first off, if companies in general treated human beings as something more than feed cattle with wallets, those people might be slightly more inclined to believe their products were safe. Secondly, my doctor and I think I had the swine flu in May, and let me tell you that it MOTHERFUCKING SUCKS.

Posted by Ian Williams at October 12, 2009 9:34 PM
Posted by: LFMD at October 13, 2009 5:28 AM

I have some LFMD family history to share.

My mother was on that estrogen therapy, and lo and behold, she ended up with breast cancer. No previous family history. (P.S. - a mastectomy later, she is doing well).

The first anti-depressant I was on, Serzone, was working well for me. Then one day, I got a call from my doc telling me that I might want to consider some other med because Serzone was causing severe liver damage in some patients. I had been taking Serzone daily for 2 years. Who knows how my liver looks inside.

In 1976, my husband's grandfather was a dutiful citizen and got the swine flu vaccine. After all, he was the local postmaster and was in contact with many people on a daily basis. Well, as a result of the shot, he contracted Guilliam-Barre (sp?) and was paralyzed from the waist down. A fiesty midwesterner, he sued the federal government and was awarded a judgement in 1980 of nearly $700,000. That $$ was put in a trust for his grandchildren, and next year it will pay for our new kitchen remodeling.

Given all this, I don't see anything wrong with questioning the "expertise" of the medical community and federal government. We are all guinea pigs in the big scheme of things these days.

Posted by: Jody at October 13, 2009 6:19 AM

Everyone pretty much does get the herd immunity every year (if you're old). I think what creeps people out is that most younger parents and kids don't normally get a flu vaccine. They don't know that these vaccines are produced in an entirely different scheme than some of the developed drugs you mention. They combine the horror stories of drugs with ignorance about "the vaccine is ready in two months" and come out with a reasonable conclusion that "this is untested!"

Like LFMD says, it's not just big pharma; the government/military/research universities/etc. have also done this. I think this is one of those "ignorance issues" that has merit, primordial or not-

Posted by: scruggs at October 13, 2009 6:40 AM

Most friends/parents of young kids I have spoken with are not planning on getting the H1N1 vaccine, and no more than half have gotten the flu one. Selfishly, we wish more in our 2 yr old daughter's class were opting for it. She has asthma and at times a cold has ultimately translated to hospital admittance. However, she is allergic to eggs and can't get any type of flu shot. So, My husband and I, and our 6 year old will get both vaccines this year.

Posted by: Claverack Weekender at October 13, 2009 7:06 AM

Flu vaccine = ok. H1N1 vaccine = questionable. Two of our doctors are saying not to get it even though it is supposedly just a strain change. Note if you do get it that some forms contain thimerisol and FDA seems to have reserved the right to add squalene, too.

Posted by: wottop at October 13, 2009 7:25 AM

My daughter was in the hospital for a week last winter with the Flu. Ever try to entertain a 2 year old in a bed for a week?

She will get the shots. We all will. They try to anticipate the active strains each year when they make the vaccine. Some years they are closer than others.

I understand the mistrust, but this is not a case of a drug company making a bazillion dollars to make sure that 60 year old men can get it up. BTW, would you take Viagra and then go to an island that was only accessable by boat and had no doctor? I love marketing.

Posted by: wottop at October 13, 2009 7:27 AM

My daughter was in the hospital for a week last winter with the Flu. Ever try to entertain a 2 year old in a bed for a week?

She will get the shots. We all will. They try to anticipate the active strains each year when they make the vaccine. Some years they are closer than others.

I understand the mistrust, but this is not a case of a drug company making a bazillion dollars to make sure that 60 year old men can get it up. BTW, would you take Viagra and then go to an island that was only accessable by boat and had no doctor? I love marketing.

Posted by: Anon at October 13, 2009 8:44 AM

From the Washington Post last Saturday:

"The deaths of another 19 children and teenagers from the new H1N1 virus were reported in the past week around the country, including two in Maryland, pushing to 76 the number of fatalities this year among those under 18, officials said. It was the largest number of pediatric deaths reported in a single week since the pandemic began in the spring."

"Between 46 and 88 children died from the seasonal flu in each of the past four years, so the fact that so many have already succumbed is disturbing, Schuchat said."


Posted by: Anne at October 13, 2009 9:02 AM

"...an enraged McLeftyShorts with a macramé dreamcatcher helmet" = One of your finest descriptions. :-)

My teen son just had the flu mist vaccine two weeks ago. He will get the swine vaccine as soon as it's available.

Ian, that's interesting about last May. We think our 18 year old daughter had it then, too. She was incredibly sick for more than a week at college (late April actually) just as finals approached. She had the cough, the fever, lethargy, aches, whole nine yards. It was fierce.

But just in case, she too will get the vaccine when it's available at her university.

Posted by: CM at October 13, 2009 11:31 AM

LFMD, wow. That is scary about your husband's grandfather.

Posted by: Schultz at October 13, 2009 12:02 PM

I still can't understand why all the fuss about Swine flu.

It is so much more mild than seasonal flu and, if treated quickly, is nothing more than a high fever for 1-2 days.

The seasonal flu is the one that always kicks my ass.

I believe all the hype is due to the name "Swine Flu" and nothing more. Or am I confused about this?

Posted by: Amy at October 13, 2009 3:21 PM

We've never gotten the flu shot--and we've never gotten the flu (my kids are 5 and 6). I haven't had the flu since I was 10 years old and I'm unwilling to put a needle in my arm on the off chance that I may get it again this year. Also, my neighbors (and kids' playmates) get the flu shot every year. 2 out of the last 3 years, they have ALSO gotten the flu. What is the point if it might not even work? As for H1N1, there has been an outbreak at our local school--in my son's class, in fact, 5 kids were out with it. Only two were out for more than 2 days, the rest had one day of fever and sniffles and that was it. I can handle a day of fever and sniffles. Though of course I hope we don't get it. So far, so good.

Posted by: Neva at October 13, 2009 4:48 PM

I will reiterate my recent experience with the swine flu. My very healthy 8 year old came home with a fever, headache and sore throat. She was sick for 4 more days with fever as high as 103.6 and terrible croup with enough respiratory distress to need a doctor visit and steroids. She missed 4 days of school at that time. 3 days after getting well she got a return of fever and terrible cough and ended up in the ER with a secondary pneumonia and missed 4 more days of school. I will admit this was more severe than some of her classmates but most were out of school for 3-5 days and pretty sick.

As anon said above, kids are dying and possibly at higher rates than with typical seasonal flu. Or perhaps it seems like a higher rate because more kids are getting sick from the flu this year so the denominator is bigger but any way you cut it - kids are dying. It also may mutate and get more severe as the season goes on.

The most susceptible group this year seems to be the school age kids (and maybe preschool).
I try to weigh the risk from the shot vs. the risk of getting very ill from the disease and it almost all cases, the vaccine wins out and definitely this year I think it does, for me and my family, at least.

Posted by: Neva at October 13, 2009 4:50 PM

Schultz - I think you are confused. I haven't heard anyone say this is milder than seasonal flu and it certainly hasn't been in my family or our friends..

Posted by: asd at October 13, 2009 9:30 PM

two quick things...

Claverak, did the doctors actually recommend against it ? Or perhaps did you ask if you should get it and they said not at this time (becuase you are not in a high risk group)?

Amy ,I hope your string of good luck continues. Risky, I think, to continue to use that logic.

Posted by: Dr. C at October 13, 2009 10:05 PM

Lots of interesting thoughts today. Since my life is all H1N1 all the time right now, may I respond to some posts?

Ian, I so agree that part of the reason vaccines freak people out is the needle. It's one of those lizard brain things, the way we all instinctively fear snakes and falling off cliffs. We are programmed to avoid painful things. Couple a painful thing with NO IMMEDIATELY VISIBLE BENEFIT and it's easy to see why vaccines are scary to people. I think it's basically a premodern suspicion/gut feeling that people then wrap in a vaguely scientific-sounding objection (e.g. "I heard there is too much thimerosal", "what about the squalene?" etc) so as not too appear too superstitious. All the disease and death averted by vaccines is too abstract and diffuse for people to grasp on that basic intuitive level at which this fear operates. Maybe the nasal spray vaccine will help with this a bit.

Other things that contribute to fear of vaccines are the common feeling, call this the parental guilt factor, that if a child gets an extremely rare side effect of vaccines, you the parent did that to him, while if a child gets a vaccine-preventable disease, then that was just sheer bad luck. People consistently prefer errors of omission to those of commission, even if the error omission is demonstrated to be more harmful. It's well known form of cognitive bias:

"Herd" immunity is definitely uninspiring and vaguely bovine. It's unfortunate, because if it could be rebranded as "group" immunity or "protecting the vulnerable" who can't get vaccinated, like Scruggs' daughter, I think it would be much more appealing to people.

I agree, the corporate malfeasance of drug companies and their cozy relationships with doctors (all those professionally flirtatious drug reps with their briefcases full of company-branded loot), the disgusting ghost-written journal articles, and the company names all over every physician's pens and post-it notes... there's enough atrocious conflicts of interest, profiteering and influence-peddling to make anyone suspicious of Pharma and their products.

LFMD: I am so sorry to hear about your husband's grandfather. Guillain-Barre syndrome is a frightening thing. It's important to note that many things cause it, including influenza infection itself, along with a lot of other bacterial and viral infections (and thus, if a flu pandemic was avoided by the vaccine, overall the number of GBS cases is lower than it would have otherwise been!) Over the last 20 years, we estimate that there has been 1 additional case of GBS for every million persons vaccinated for seasonal flu. So is this increase in risk worth it? From a public health perspective, in terms of severe illness and death from flu that has been avoided, definitely. But it's hard to say that when it is you or someone you love who is that one person with the rare side effect.

Claverack Weekender: "Flu vaccine = ok. H1N1 vaccine = questionable." H1N1 vaccine is a flu vaccine, made in the same way by the same methods as the regular seasonal flu vaccine. The only difference is the type of antigen (the H and the N stand for different protein fragments from the outer viral coat) included, which always changes from year to year anyway. In fact, if H1N1 had emerged earlier in the year it would have just been included as one of the strains in the regular seasonal flu vaccine. "note if you do get it that some forms contain thimerisol and FDA seems to have reserved the right to add squalene, too". I discussed this in my post a few days ago. Thimerosal-free vaccine is available. The US flu vaccine does not contain squalene. But we are studying some squalene-containing vaccines -- like the ones approved in Europe -- just in case the flu pandemic takes an unexpected much more severe turn (with 1918 type death rates), because this would allow lower doses of vaccine to be given and let us stretch the vaccine supply to cover many more people.

Schultz, this disease is not "more mild than seasonal flu". It is as or more severe, and affects a population that is not at high risk for severe disease from seasonal flu -- children and young adults. Neva is right, even though most will recover uneventfully and only a small percentage will require ICU care or die from H1N1, this will still be a lot of kids and young adults, since they have no immunity and tons of them are getting sick.

Amy, you don't have to put a needle in your arm. You could get the nasal spray instead. "Also, my neighbors (and kids' playmates) get the flu shot every year. 2 out of the last 3 years, they have ALSO gotten the flu. What is the point if it might not even work?" Actually, the H1N1 vaccine works very well. The thing is, there are lots of viruses that cause colds. People often say they had "the flu" when they mean a bad cold. I doubt that your neighbors' kids were really infected with the flu strain in the vaccine. The same logic applies to people who claim that the flu vaccine gave them the flu. This is just not possible, but it is very possible they were coming down with something at around the time they got the shot.

Posted by: Ian at October 13, 2009 11:11 PM

Dr. C is awesome.

Posted by: MindyB at October 14, 2009 10:29 AM

Haven't commented here too much (though I visit everyday), but couldn't stop myself today. First of all I really appreciate Dr. C's comments. My daughter and I have gotten the flu shot every year and have not gotten the flu. I know some people really don't like needles, but even my 7 year old says that the flu shot is "really no big deal". Tomorrow I'm attending a memorial service for a 9 year old boy who it appears died thanks to H1N1. Yes, he did have some underlying health issues, but it still makes me scared for my kids and other kids out there. I have a nearly 6 month old baby and let me say I have no desire to find out how bad it could be. The rest of our family has had the seasonal flu shot, the baby will get his as soon as he's old enough, and we'll all be getting the H1N1 as soon as it's available. For what it's worth, our pediatrician is recommending it and a good friend of mine who happens to be a physician will be giving it to her own 3 children. So I say get vaccinated, for your own good and for the good of kids like my friend's son who are at a higher risk for complications.

Posted by: Bob at October 14, 2009 9:49 PM

Doggone it, Dr. C, if you're going to present your points so convincingly, how in the world can the rest of us gloss over them when we're trying to rationalize our crackpot preconceived notions?

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