Thursday, February 28, 2008

I'm Skeptical

...when I see a headline like this:

Flu shots urged to age 18

No doubt the champagne is being chilled in the posh offices of not a few pharmaceutical companies' CEOs right about now.

I've gotten exactly one flu shot in my life, when I was 16 (or so). In high school, I worked at a nursing home (in the dietary department), and all employees were given the opportunity to get a free flu shot. Not thinking much of it, I got one.

The following year, I decided — for reasons I can't recall — to forgo the shot. It's a good thing I did, as several of the employees who did get flu shots that year got the flu shortly thereafter.

Since then, when people have asked me if I'm interested in getting a flu shot, I say no, precisely because I don't want to get the flu.

1 comment:

The Dutchman said...

I think you’re wrong about the economics of vaccinations. The market for worldwide vaccines is about eight billion dollars annually, less than the 35 billion spent annually on the leading heart medication (and probably less than is spent on life-style drugs like Viagra). The market incentive, therefore, is for drug companies to develop and market drugs that must be taken daily and will thus generate a continuing revenue flow than to develop drugs like vaccines that actually solve the problem once and for all. Most vaccines have been developed through government research and are manufactured by secondary drug companies (that develop few drugs themselves and mostly manufacture “generics”). These are most assuredly NOT the big-bucks drug companies that regularly lobby Congress, and the recommendation for more widespread inoculations probably came from a genuinely disinterested medical review board.

Flu is a highly mutable virus and every years flu shot has about three or four of the most prevalent mutations (or antigenic variants) in it. Each year manufacturers have to choose which strains their vaccine will contain and usually they are pretty good at “picking the winners.” Sometimes, however, they are not. The massive outbreak of Hong Kong Flu (virus H3N2) in 1969 was possible precisely because it was not included in that year’s vaccines and thus had a clear field before it. Your co-workers who got sick despite having been inoculated undoubtedly caught a strain not included in the shots they had received. You were neither more nor less at risk than they were, and it is just a fluke that they got it and you didn’t.

Vaccines are one of our most important public health measures and one that is widely misunderstood. Conspiracy theorists are fond of attacking vaccines, while there are very few parties on the other side interested enough to counter these rumors. Yes, it is true that vaccines are not without risk, but the diseases they prevent are far more lethal. Each year about half-a-dozen people die from flu shots (mostly very elderly people with low resistance to begin with), compare that if you will to the 30,000 Americans who died in 1969 when the H3N2 virus suddenly became prevalent. In 1800 about half of all children died in their first year (infant mortality), and half of those who survived died before age five (child mortality). Today, American child mortality is 1 in 143, and much of this drop is due to vaccination. Small pox, mumps, measles, rubella, whooping cough, diphtheria now kill negligible numbers of children when once they killed their hundreds of thousands.

I am a firm believer in the efficacy of vaccines; in fact, I’m something of a crank about it. I get a flu shot every year, I’ve been inoculated against Hepatitis A and B, tetanus, and meningitis in the last few years, and I’ve participated in test groups for flu and Japanese encephalitis vaccines. My kids have been inoculated against all of the usual stuff (though with the safer, more effective Salk, not Sabin polio vaccines, which they resent, as it’s a shot, not a pill) and get flu shots as well. My oldest daughter had received the HPV vaccine and my youngest will get it at the appropriate time. (In fact, Nola is a pre-med student and, if you want to hear an ear-blistering lecture, ask her about people who are against the HPV vaccine!)

Though flu is highly contagious, it is rarely deadly to people in general good health, so I don’t favor making such vaccines mandatory. I am also concerned, as are you, about the use of fetal tissues in the manufacture of vaccines and I think this process should be banned. Having said that, I favor a government effort to make vaccines as widely available as possible, and massive public funding of vaccine research.

(I told you I was a crank about this.)