Flu Vaccination – shaping the discussion

I have support for both camps – those who are for and those who are against flu vaccinations.

This is a brief discussion touching directly on recent conversations I have had with professionals and patients.  A more detailed report with actual data and references is in progress.

The decision tree for whether to vaccinate not for the flu is not straightforward.  It is a tangled forest.  I offer my patients’ a discussion, and my opinion is on a case by case basis.  Unlike many of their other health care providers who are rather aggressive in their opinions for or against the vaccines.

Some practitioners try to cast doubt on the patient’s sanity for choosing either option, when there is as yet no single answer for everyone.  This is one opinion I am absolutely unwavering in – you cannot berate lay people for making decisions concerning highly complex technical issues.  Especially on this topic, where the risks involved in either course of action are so rare, and the technology is so new.

All we can say for certain is that some people are fine after vaccination, but some are not.  Some don’t even get symptoms from being infected with flu, some people die (even without a pre-existing condition).  In the effort to derive statistics for the two possibilities, the results are still to be determined.  When the statistics do come out, they will not be as accurate as those, say, in 20 years from now when the technology will exist to have the genetic data of the study group included in the analysis.  Our immune systems are the most diverse part of our species’ genome, and scientists are already trying to incorporate genetic data in the decision tree to match the right med with the right patient (not just the right disease).

The pro vaccination argument is simple – if you can remove yourself from harm’s way while preventing your body from becoming a carrier of harm, then you should.

Yet the 2 flu strains in the news are not widespread killers, we are not dealing with Ebola or even HIV.  Taking some time to think it through is not irresponsible. The fear of medication is not devoid of rationale.  There are some cogent arguments to be considered using any technology, especially technology aimed at our DNA (the immune response involves chromosomal changes in cells that produce antibodies).

I will take just one argument against vaccination that has not been widely discussed in my search of the world’s main media sources.  And one that perhaps could be fixed if there is political will to do so.

Fundamentally the reason to hesitate comes down to a simple issue of trust.

The drug companies and the government have really dropped the ball on this one, given the problems known to the public in the healthcare industry:

  1. We are just a few months past the largest criminal fine ever imposed on a company’s bad behaviour.  Pfizer was fined $2.3 billion for misleading people about inappropriate use of a drug.  We are still trying to understand how widespread this corruption is in the industry.
  2. We are in the middle of understanding the extent of how professionals have been influenced by financial incentives to minimize knowledge of problems.  In some areas of technology, completely objective, independent opinion can be distressingly hard to find.
  3. The vaccine makers have legal “immunity” (a very dark irony) from prosecution for any harm that may arise from using the product, removing a fundamental right of consumers to use products under the safety of accountability.
  4. It is very difficult to get an accurate list of ingredients in the bottle.
  5. The product has been rushed to market so there has not been time for excellent science to be used in analyzing the results.
  6. Science regularly takes years before risks in medications come to light.  We appear to have entered permanent guinea pig status.  If we are pro vaccine, what is the effect of getting vaccinated every year for the rest of our lives?
  7. The decision to not test all flu cases for H1N1 may make sense from a cost-benefit analysis, but it is an appalling public relations move.

Science has maintained a party line of “Trust us” since the first modern technologies arrived.  Such an un-nuanced approach is ignorant of history.  All technological mishaps happen after scientists say “there is no evidence for harm.” All mishaps with medication safety occurred because the drugs require years of study and because we are still learning how to get all the work done in the pre-release stage.  Technological success is regularly achieved after the mishaps, but we must remain free to choose what part we wish to play in story of a technology’s development.