Here’s a common complaint about the annual flu vaccine: “The last time I got the shot, I ended up getting the flu anyway!” Epidemiological data seem to back up such anecdotes. According to an American Lung Association report from 2010, there was no sustained decline in influenza-associated deaths over the past decades. Among those older than 65, according to a New England Journal of Medicine review, flu hospitalization rates rose steadily between 1979 and 2001, despite an increase in vaccination rates among seniors from 32 percent in 1989 to 67 percent in 1997.
Such data make the vaccine seem useless. As a result, skepticism has lately moved beyond the usual anti-vaccine, tinfoil-hat crowd. In 2009, the Atlantic published a breathless piece accusing drug makers and doctors of foisting bad science on an unsuspecting public and asked, “But what if everything we think about fighting influenza is wrong? What if flu vaccine does not protect people from dying—particularly the elderly?” Last month, the New York Times called the flu vaccine a “bonanza” for vaccine manufacturers and gave largely uncritical coverage to a University of Minnesota researcher who claimed the vaccine “does not protect as promoted. It’s all a sales job.” Similarly provocative articles have run in Harper’s (“Viral Marketing”), the Boston Globe (“Flu Shots Are Safe, But Do They Work?”), and the Wall Street Journal (“They Shoot Flu-Shot Skeptics, Don’t They?”).
Critics of flu-control efforts got a boost recently when the British Medical Journal accused Roche, which makes the anti-viral drug Tamiflu, of hiding data about the drug’s supposed impotence against the flu. In anticipation of a possible pandemic in 2009, the U.S. government stockpiled $1.5 billion worth of Tamiflu and other anti-flu drugs. Now the editor of the British Medical Journal is concerned those pills were oversold. Among the conspiracy-minded, flu-control efforts now have less to do with public health and more to do with corporate profits. The true threat to us all, proclaimed Helen Epstein in the New York Review of Books, isn’t the virus at all, but the drug companies.
Informed debate over public health is, well, healthy. But it’s wrong to portray the global medical community as a stooge of greedy drug makers. The flu vaccine isn’t useless and neither is Tamiflu. It’s just that they, like all infection-control measures, are not perfect. There is no question that the vaccine does enhance one’s immune response to flu—and it certainly does not give people the flu. It’s likely the shot hasn’t led yet to a dramatic population-wide decrease in flu deaths. But the proper response isn’t for us to finger-point at drug companies and public health officials and call for repealing vaccine efforts.
What critics of flu-control policies don’t get is that any global effort to stop an infection always goes through a process in which doctors learn more over successive battles and refine their strategies. That is exactly what is now happening in the battle against flu. We are not witnessing the work of industry puppet-masters. This is the scientific process in action.
It’s easy to demonize Big Pharma and just call for more and more studies before taking decisive action. But sometimes we have to move. Consider the chicken-pox vaccine, which was first licensed in the United States in 1995. Preliminary data suggested the vaccine could stop the disease, but the studies included only a few thousand children. Arguments against universal chicken pox vaccination sounded similar to those against flu shots—the illness is harmless, the vaccine doesn’t reliably produce immunity, drug companies are running the show, and so on—but authorities persisted and endorsed universal vaccination. Within a few years, we realized that children needed two separate shots, not one, to get stronger immunity, and national policies were changed. Before vaccines, chicken pox killed 100 children and led to 10,000 hospitalizations annually, according to the Centers for Disease Control and Prevention. In school-age children, attack rates fell by almost 80 percent after vaccination began, and deaths were nearly eliminated.
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The Actual World
“Mount Thoreau” and the naming of things in the wilderness.