Unhealthy Skepticism about Flu Immunizations

Healthy Skepticism is a website that I have been proud to be a member of and that assisted me greatly in all of my research. I am a member of HS and also of a listserv that includes HS members and generally find it highly informative. So it pains me to have to dissociate myself from a recent thread on that listserv and website that I believe to be quite wrong. I am taking this public stance because I think the issue holds lessons for us Pharmascolds, in terms of how we can go too far in our opposition to the bad practices of the pharmaceutical industry.

My concern is with a piece posted on the HS site, "In the Face of Swine Flu, Common Sense and Science": http://www.healthyskepticism.org/news/2009/Oct09.php

The author is a Spanish GP who also holds a couple of academic posts. As a family physician I have been on the receiving end of attacks due to having dared to speak out on medical issues, when the relevant subspecialists thought that only they were entitled to express opinions. So I might have been expected to immediately identify with the author.

The basic thrust of the piece is that swine flu is an example of "disease mongering"; that the vaccine is unnecessary because the disease is very mild; the vaccine has been rushed into production and so cannot be known to be safe; and anyway, the seasonal flu vaccine has been overpromoted and is not really scientifically shown to be of benefit.

Let me separate my reactions into two parts--seasonal flu and swine flu.

I have followed the literature for many years on the health benefits of seasonal flu vaccines. (I personally always get my flu shot each fall, even though I am not now doing direct patient care.) I have been impressed with the nearly uniform showing in all studies that flu vaccines are highly beneficial and highly cost-effective. Indeed it is one of the most cost-effective preventive interventions available to us. So trying to cast doubt on the wisdom of a swine flu vaccine by attacking the benefits of the regular seasonal vaccine seems completely wrong-headed.

As to the swine flu, we charge the public health authorities with preparing a vaccine each year that will protect us from the dominant strain of flu that is going to appear in the fall. This year, the appearance of a novel strain of H1N1 flu (swine) created great concern because most Americans under age 60 have never been exposed to a similar flu virus, so natural immunity was thought to be very low. And indeed, at this time in the U.S., there are near-epidemic levels of flu, very unusual for this early in the fall, and more than 90 percent of it is H1N1 (though when they started making the vaccine, no one could have known this would necessarily happen). Every year the task of making the flu vaccine with the correct strains of antigen is a crap shoot and any year you could guess wrong. The swine flu is being manufactured using the same techniques as used for the seasonal flu, which has an excellent safety track record ever since 1976, the year of the last swine flu scare.

In short I see no reason whatever to interpret anything related to swine flu vaccination as a public health response, as somehow related to disease mongering by the pharmaceutical industry or its allies or shills.

Now, where the author of the HS piece questions the use of antivirals, I think he is on firmer ground. Antivirals for flu have in the past been significantly overpromoted.

The HS piece ends with this language:

"Note: The only purpose of the author is to transmit the best knowledge about the problem at present, and for that he has reviewed the world literature. This text is an informative one, not for clinical use. Sadly, the information you can obtain from others sources (public organizations, scientific societies, media) is very different; they will know why."

This appears to be a gratuitous ad hominem attack on anyone who disagrees with this author's conclusions, and seems utterly uncalled for.

I may add that I checked into a couple of the authors' citations, and was impressed that the conclusions reached by those articles did not square with the conclusions offered in the HS piece.

So why do I make a big deal of my personal disagreement with this particular piece of writing (one that HS was apparently proud enough of, to have translated into several languages for dissemination)? Again, I need to beware attributing motives to others. But we have to be very cautious that our distrust of the drug industry and its many devious and dishonest practices, and of our physician colleagues who eagerly do the industry's bidding, not spill over into areas where it does not belong. When we decide that any product manufactured by the drug industry is therefore unsafe or unneeded; or that any effort to raise public concern about a disease is therefore commercialized disease-mongering, then I think we have clearly crossed over that line.