6 ms·

Do antivirals and the flu-vaccine even work?

25 points by gnosis 17y ago

hanuman 17y ago
Oh, please. http://scienceblogs.com/effectmeasure/2009/10/journalists_sink_in_the_atlant.php http://scienceblogs.com/effectmeasure/2009/10/journalists_si...
- scott_s 17y ago
  If I could give your comment more points, I would.
- joe_the_user 17y ago
  The tone of this article is far more shrill than the Atlantic article. Dr. Thomas Jefferson is demanding evidence for assertions - that's "methodolotry"? He's betraying the original ideas of evidence-based medicine by demanding that medicine be based on evidence? For shame. In this case his evidence base isn't even relevant, because we aren't dealing with seasonal flu but pandemic flu. Ah, but the epidemiology to back this statement has mostly come from very dubious and biased statistics - specifically, the way that, in Mexico where epidemic originated, the only people they found with the disease were those on the edge of death because of the tendency there to only go to the doctor when you are on the edge of death. Despite the pandemic declaration, we haven't seen death rates above the normal rates of flu season yet (though a slightly different group is dying..). We might see high death rates but ... perhaps ... we should look at evidence before making grand declarations that this like nothing seen before. Note, the original article is a not screaming endorsement of Jefferson's view, just a summary of debate: The most vocal—and undoubtedly most vexing—critic of the gospel of flu vaccine is the Cochrane Collaboration’s Jefferson, who’s also an epidemiologist trained at the famed London School of Tropical Hygiene, and who, in Lisa Jackson’s view, makes other skeptics seem “moderate by comparison.” Among his fellow flu researchers, Jefferson’s outspokenness has made him something of a pariah.
  - Retric 17y ago
    No, he is demanding a specific type of evidence and automatically discounts cohort based research. Anyway, to prevent another 1918 flu pandemic and 50+ million deaths you need to see if your treatment protects vs cytokine storm http://en.wikipedia.org/wiki/Cytokine_storm http://en.wikipedia.org/wiki/Cytokine_storm not the standard symptoms. (http://en.wikipedia.org/wiki/1918_flu_pandemic http://en.wikipedia.org/wiki/1918_flu_pandemic) H1N1 is far from this deadly but doing nothing is playing with fire. PS: You can't compare the results of two studies without looking at their methodology 60% fewer deaths in group A, vs 50% after some adjustments.
- deleted 17y ago
  [deleted]
- fauigerzigerk 17y ago
  I'm surprised how controversial it is to demand placebo trials. The whole thing about ethics is ridiculous as the participants could be told about the uncertainties, about the majority and the minority views. It shouldn't be hard to find enough educated people to volunteer in the interest of the billions potentially affected by the flu.
  - ikitat 17y ago
    Ethics are not ridiculous. Randomized placebo controlled double-blinded studies have the potential to cause harm to humans. A fantastic post on the issue can be found here http://www.sciencebasedmedicine.org/?p=467 http://www.sciencebasedmedicine.org/?p=467
    - fauigerzigerk 17y ago
      Well, let's keep things in perspective. We're talking about the ethics of asking some 1000 volunteers _not_ to get a flu jab in one winter. ([edit] not about nazi death camps as the article you posted does) And I think it is ridiculously un-ethical to vaccinate hundereds of millions of people with a vaccine that has never been tested properly (and I mean the seasonal flu, not the exceptional swine flu situation). These people go out and take risks that may cost them their lives because they have a false sense of safety.
      - ikitat 17y ago
        Did you read the article? The ethical issue is the fact that you are _not_ preventing a vaccine preventable disease. What information do you have that the flu vaccine is not tested properly? edit to your edit: You clearly didn't read the post I linked to above if you think it's about nazi death camps above the ethical considerations of randomized, placebo controlled, double blinded studies.
        fauigerzigerk 17y ago
        Look, I don't doubt that there are difficult ethical situations. But the flu situation is not one of them. The danger of not getting a flu jab just isn't severe enough to throw Dr. Mengele into the debate. And to answer your question, I gather that seasonal flu vaccines have never been tested using a controlled, randomized, double-blind study. If that is not the case, then what are we talking about? And I fail to see how it can be an ethical problem not to use a vaccine of which we don't know whether it prevents anything or not.
alexfarran 17y ago
Yes
dazzawazza 17y ago
I've read some evidence that people who are more likely to die from flu are less likely to get vaccinated for flu thus the vaccinated population 'looks' healthier. Worst this means that flu vaccines are bogus (not likely, we're quite good at creating vaccines and they work in labs) and best it means they are a HUGE waste of time and money (a bit more likely but you can level that argument at most things we routinely do for health). However since I am _not_ a virologist or epidemiologist I tend to follow what my doctor says.
- Locke1689 17y ago
  Uh, what? At worst, that's indicative of nothing, not affirmation of the negative hypothesis. Think of it this way: if you are healthy, you are more likely to get the flu vaccine and less likely to die of any reason. If you are unhealthy, you are less likely to get the flu vaccine and more likely to die of any reason. Notice that neither of these statements say the following, "Patients who receive the flu vaccine are [more/less] likely to die of the flu then they would have been." Instead, it simply makes the statement that you cannot treat statistics as affirmation of flu effectiveness.
dylanz 17y ago
I'll let you know. Neither I or my kids are vaccinated.
- gloob 17y ago
  If you aren't vaccinated, then nothing that happens to you says anything about the effectiveness or the lack thereof of the vaccine.
  - gojomo 17y ago
    Dylanz personal experience alone isn't helpful, true, but what happens to the unvaccinated as a group -- the control group compared to the vaccinated -- is absolutely significant to determining the vaccine's effectiveness.
systemtrigger 17y ago
According to the article, the researcher who "knows the flu-vaccine literature better than anyone else on the planet" calls the vast majority of studies "deeply flawed" and "rubbish." Only four studies were properly designed to pin down the effectiveness of flu vaccine, he says, and two of those showed that it might be effective in certain groups of patients, such as school-age children with no underlying health issues like asthma; the other two showed equivocal results or no benefit.

25 points by gnosis 17y ago

Oh, please. http://scienceblogs.com/effectmeasure/2009/10/journalists_sink_in_the_atlant.php http://scienceblogs.com/effectmeasure/2009/10/journalists_si...

scott_s 17y ago
If I could give your comment more points, I would.
joe_the_user 17y ago
The tone of this article is far more shrill than the Atlantic article. Dr. Thomas Jefferson is demanding evidence for assertions - that's "methodolotry"? He's betraying the original ideas of evidence-based medicine by demanding that medicine be based on evidence? For shame. In this case his evidence base isn't even relevant, because we aren't dealing with seasonal flu but pandemic flu. Ah, but the epidemiology to back this statement has mostly come from very dubious and biased statistics - specifically, the way that, in Mexico where epidemic originated, the only people they found with the disease were those on the edge of death because of the tendency there to only go to the doctor when you are on the edge of death. Despite the pandemic declaration, we haven't seen death rates above the normal rates of flu season yet (though a slightly different group is dying..). We might see high death rates but ... perhaps ... we should look at evidence before making grand declarations that this like nothing seen before. Note, the original article is a not screaming endorsement of Jefferson's view, just a summary of debate: The most vocal—and undoubtedly most vexing—critic of the gospel of flu vaccine is the Cochrane Collaboration’s Jefferson, who’s also an epidemiologist trained at the famed London School of Tropical Hygiene, and who, in Lisa Jackson’s view, makes other skeptics seem “moderate by comparison.” Among his fellow flu researchers, Jefferson’s outspokenness has made him something of a pariah.
- Retric 17y ago
  No, he is demanding a specific type of evidence and automatically discounts cohort based research. Anyway, to prevent another 1918 flu pandemic and 50+ million deaths you need to see if your treatment protects vs cytokine storm http://en.wikipedia.org/wiki/Cytokine_storm http://en.wikipedia.org/wiki/Cytokine_storm not the standard symptoms. (http://en.wikipedia.org/wiki/1918_flu_pandemic http://en.wikipedia.org/wiki/1918_flu_pandemic) H1N1 is far from this deadly but doing nothing is playing with fire. PS: You can't compare the results of two studies without looking at their methodology 60% fewer deaths in group A, vs 50% after some adjustments.
deleted 17y ago
[deleted]
fauigerzigerk 17y ago
I'm surprised how controversial it is to demand placebo trials. The whole thing about ethics is ridiculous as the participants could be told about the uncertainties, about the majority and the minority views. It shouldn't be hard to find enough educated people to volunteer in the interest of the billions potentially affected by the flu.
- ikitat 17y ago
  Ethics are not ridiculous. Randomized placebo controlled double-blinded studies have the potential to cause harm to humans. A fantastic post on the issue can be found here http://www.sciencebasedmedicine.org/?p=467 http://www.sciencebasedmedicine.org/?p=467
  - fauigerzigerk 17y ago
    Well, let's keep things in perspective. We're talking about the ethics of asking some 1000 volunteers _not_ to get a flu jab in one winter. ([edit] not about nazi death camps as the article you posted does) And I think it is ridiculously un-ethical to vaccinate hundereds of millions of people with a vaccine that has never been tested properly (and I mean the seasonal flu, not the exceptional swine flu situation). These people go out and take risks that may cost them their lives because they have a false sense of safety.
    - ikitat 17y ago
      Did you read the article? The ethical issue is the fact that you are _not_ preventing a vaccine preventable disease. What information do you have that the flu vaccine is not tested properly? edit to your edit: You clearly didn't read the post I linked to above if you think it's about nazi death camps above the ethical considerations of randomized, placebo controlled, double blinded studies.
      - fauigerzigerk 17y ago
        Look, I don't doubt that there are difficult ethical situations. But the flu situation is not one of them. The danger of not getting a flu jab just isn't severe enough to throw Dr. Mengele into the debate. And to answer your question, I gather that seasonal flu vaccines have never been tested using a controlled, randomized, double-blind study. If that is not the case, then what are we talking about? And I fail to see how it can be an ethical problem not to use a vaccine of which we don't know whether it prevents anything or not.

alexfarran 17y ago

Yes

dazzawazza 17y ago

I've read some evidence that people who are more likely to die from flu are less likely to get vaccinated for flu thus the vaccinated population 'looks' healthier. Worst this means that flu vaccines are bogus (not likely, we're quite good at creating vaccines and they work in labs) and best it means they are a HUGE waste of time and money (a bit more likely but you can level that argument at most things we routinely do for health). However since I am _not_ a virologist or epidemiologist I tend to follow what my doctor says.

Locke1689 17y ago
Uh, what? At worst, that's indicative of nothing, not affirmation of the negative hypothesis. Think of it this way: if you are healthy, you are more likely to get the flu vaccine and less likely to die of any reason. If you are unhealthy, you are less likely to get the flu vaccine and more likely to die of any reason. Notice that neither of these statements say the following, "Patients who receive the flu vaccine are [more/less] likely to die of the flu then they would have been." Instead, it simply makes the statement that you cannot treat statistics as affirmation of flu effectiveness.

dylanz 17y ago

I'll let you know. Neither I or my kids are vaccinated.

gloob 17y ago
If you aren't vaccinated, then nothing that happens to you says anything about the effectiveness or the lack thereof of the vaccine.
- gojomo 17y ago
  Dylanz personal experience alone isn't helpful, true, but what happens to the unvaccinated as a group -- the control group compared to the vaccinated -- is absolutely significant to determining the vaccine's effectiveness.

systemtrigger 17y ago

According to the article, the researcher who "knows the flu-vaccine literature better than anyone else on the planet" calls the vast majority of studies "deeply flawed" and "rubbish." Only four studies were properly designed to pin down the effectiveness of flu vaccine, he says, and two of those showed that it might be effective in certain groups of patients, such as school-age children with no underlying health issues like asthma; the other two showed equivocal results or no benefit.