Flu Vaccine for 4 year old?

snoopydoc said :

HenryBG said :

I’m sorry you don’t like the BMJ. What I’ve demonstrated is that clinicians themselves are calling bullshit on flu vaccination.
Doctors have along history of inflicting non-evidenced and dangerous treatment fads on patients (blood-letting, thalidomide, prostate screening) and this flu vaccination scam obviously is yet another example of that.

I actually quite like the BMJ. One of the things we learn as doctors, though, is how to properly evaluate what we find in the medical literature, rather than just reading an article that agrees with our own point of view and saying “See?! These other smart doctors said XYZ! It _must_ be true!”.

What you have pointed out (not demonstrated) is that _some_ clinicians think that on the balance of evidence, influenza vaccination is not a great idea. What you have _not_ demonstrated is whether those clinicians are likely to be _right_ in their assertions.

For example, a large group of doctors recently wrote a letter / petition to the federal parliament, stating that it is a health risk for children to be raised in a same-sex partnership household and therefore same-sex marriage should not be made legal. Something like 150 doctors put their name to this letter. Whilst their motivation is questionable (people often confuse their personal or religious convictions with what they offer as professional opinion, unfortunately), what is very clear upon reviewing what _they_ regard as the “evidence” in favour of their argument, is that the available evidence supports no such argument… and in fact there is good recent evidence that the opposite is in fact true. This is so clearly the case that a _very_ large majority of doctors, including the representative political body, the AMA, have piped up to point out how flawed their arguments and alleged evidence are.

And while we’re clearing up misconceptions, blood-letting is still an effective treatment for a number of conditions, including severe congestive cardiac failure (though it’s not often used for this indication anymore), haemochromatosis and polycythaemia rubra vera (for which it is routinely used). Thalidomide was a drug with unforseen and very unfortunate adverse effects that, once recognised, were acted upon swiftly. Prostate screening (and indeed many screening programs such as mammography, faecal occult blood, etc.) is a subject on which the evidence and opinions are still somewhat divided / up in the air, though some clinicians have strong feelings in either direction. I fail to see how any of these scenarios constitutes a “scam” of any kind.

I do understand the point you were attempting to make, but perhaps you should choose your terminology, and examples, more carefully next time.

HenryBG said :

At, what? $30 a pop each? Plus the millions of doses that have to be thrown away at the end of the season when they hit their expiry date. It all adds up to a windfall for certain people. Over a quarter of a billion $$$ of our healthcare $$$$ wasted on trying to save 14 old people who were on their death beds anyway.
Completely pathetic.

Yeah, damn those evil pharmaceutical corporations… sitting there plotting against us all and swindling us of our money for no good reason… umm… Oh, wait… $30 a pop versus _how much_ in lost productivity due to people taking a week off work? Especially important people like you with important jobs like yours (what do you do again?) who value their time so highly that they refuse to take time off for things like jury duty unless and until the courts decide to properly compensate you for your time?? Do you think a week away from your job is worth less than $30? Or less than $300 if you were say the 1 in 10 people who came down with influenza during a local epidemic? Or $3,000 if you were 1 in 100? …..

HenryBG said :

And did we have to vaccinate 10 million Australians against Polio last year, this year, and every other year?
No. We didn’t.
The difference is
a) polio is incredibly dangerous. Flu is benign.
b) the vaccine against polio actually works. FLu vaccine is just as likely to make you sick than it is to give you any kind of meaningful protection against any kind of genuine risk.

Every single person in Australia gets vaccinated for polio (with a small number of exceptions due to either valid medical reasons, or objections from parents). That’s WHY WE DON’T SEE IT ANYMORE. Maybe upper case letters will help that particular message sink in, as the lengthy explanation in my previous post didn’t seem to make much of an impression. No, we don’t have to vaccinate people every year for polio, because it’s a different sort of virus and IT DOESN’T MUTATE DRAMATICALLY EVERY SEASON LIKE INFLUENZA; another concept explained in detail previously.

Yes, polio can be incredibly dangerous, though you might be interested to note that only a small fraction of people who contract polio actually have any significant long-term damage from it. Wow… that sounds a little bit like…. measles…. or… yes, influenza.

No, influenza is not benign. It causes large costs to the community due to infected people convalescing. It can also kill, directly and by further weakening those with other underlying medical problems and at risk of complications such as bacterial superinfections (bacterial pneumonia occurring on top of the viral pneumonitis of influenza itself).

Tell you what… next time I admit a critically unwell young adult to ICU with life-threatening influenza, I’ll just sit back and relax, because it’s such a benign illness and surely nothing bad could possibly happen…

Damn. Plus 1,000,000 to this guy, I don’t think there’s anything more that can be said by anyone on this one.

HenryBG said :

I’m sorry you don’t like the BMJ. What I’ve demonstrated is that clinicians themselves are calling bullshit on flu vaccination.
Doctors have along history of inflicting non-evidenced and dangerous treatment fads on patients (blood-letting, thalidomide, prostate screening) and this flu vaccination scam obviously is yet another example of that.

I actually quite like the BMJ. One of the things we learn as doctors, though, is how to properly evaluate what we find in the medical literature, rather than just reading an article that agrees with our own point of view and saying “See?! These other smart doctors said XYZ! It _must_ be true!”.

What you have pointed out (not demonstrated) is that _some_ clinicians think that on the balance of evidence, influenza vaccination is not a great idea. What you have _not_ demonstrated is whether those clinicians are likely to be _right_ in their assertions.

For example, a large group of doctors recently wrote a letter / petition to the federal parliament, stating that it is a health risk for children to be raised in a same-sex partnership household and therefore same-sex marriage should not be made legal. Something like 150 doctors put their name to this letter. Whilst their motivation is questionable (people often confuse their personal or religious convictions with what they offer as professional opinion, unfortunately), what is very clear upon reviewing what _they_ regard as the “evidence” in favour of their argument, is that the available evidence supports no such argument… and in fact there is good recent evidence that the opposite is in fact true. This is so clearly the case that a _very_ large majority of doctors, including the representative political body, the AMA, have piped up to point out how flawed their arguments and alleged evidence are.

And while we’re clearing up misconceptions, blood-letting is still an effective treatment for a number of conditions, including severe congestive cardiac failure (though it’s not often used for this indication anymore), haemochromatosis and polycythaemia rubra vera (for which it is routinely used). Thalidomide was a drug with unforseen and very unfortunate adverse effects that, once recognised, were acted upon swiftly. Prostate screening (and indeed many screening programs such as mammography, faecal occult blood, etc.) is a subject on which the evidence and opinions are still somewhat divided / up in the air, though some clinicians have strong feelings in either direction. I fail to see how any of these scenarios constitutes a “scam” of any kind.

I do understand the point you were attempting to make, but perhaps you should choose your terminology, and examples, more carefully next time.

HenryBG said :

At, what? $30 a pop each? Plus the millions of doses that have to be thrown away at the end of the season when they hit their expiry date. It all adds up to a windfall for certain people. Over a quarter of a billion $$$ of our healthcare $$$$ wasted on trying to save 14 old people who were on their death beds anyway.
Completely pathetic.

Yeah, damn those evil pharmaceutical corporations… sitting there plotting against us all and swindling us of our money for no good reason… umm… Oh, wait… $30 a pop versus _how much_ in lost productivity due to people taking a week off work? Especially important people like you with important jobs like yours (what do you do again?) who value their time so highly that they refuse to take time off for things like jury duty unless and until the courts decide to properly compensate you for your time?? Do you think a week away from your job is worth less than $30? Or less than $300 if you were say the 1 in 10 people who came down with influenza during a local epidemic? Or $3,000 if you were 1 in 100? …..

HenryBG said :

And did we have to vaccinate 10 million Australians against Polio last year, this year, and every other year?
No. We didn’t.
The difference is
a) polio is incredibly dangerous. Flu is benign.
b) the vaccine against polio actually works. FLu vaccine is just as likely to make you sick than it is to give you any kind of meaningful protection against any kind of genuine risk.

Every single person in Australia gets vaccinated for polio (with a small number of exceptions due to either valid medical reasons, or objections from parents). That’s WHY WE DON’T SEE IT ANYMORE. Maybe upper case letters will help that particular message sink in, as the lengthy explanation in my previous post didn’t seem to make much of an impression. No, we don’t have to vaccinate people every year for polio, because it’s a different sort of virus and IT DOESN’T MUTATE DRAMATICALLY EVERY SEASON LIKE INFLUENZA; another concept explained in detail previously.

Yes, polio can be incredibly dangerous, though you might be interested to note that only a small fraction of people who contract polio actually have any significant long-term damage from it. Wow… that sounds a little bit like…. measles…. or… yes, influenza.

No, influenza is not benign. It causes large costs to the community due to infected people convalescing. It can also kill, directly and by further weakening those with other underlying medical problems and at risk of complications such as bacterial superinfections (bacterial pneumonia occurring on top of the viral pneumonitis of influenza itself).

Tell you what… next time I admit a critically unwell young adult to ICU with life-threatening influenza, I’ll just sit back and relax, because it’s such a benign illness and surely nothing bad could possibly happen…

Wow, what a debate! I’m a scientist myself and having looked at an enormous amount of research, I prefer to give my daughter the flu vaccination, especially given her previous medical history. (I’m not trying to convince anyone here – just stating my position.) I particularly appreciate supamum’s suggestion. The Conder surgery (http://belconnenmedicalcentre.com/lhome.html) does give flu vaccines for preschoolers, and it costs $25. We’re happy to pay it.

snoopydoc @ #22! A wonderful piece. I suspect you know something about this topic.

Another great summary of the issue was podcast no. 20 in the ‘Quackcast’ series (Dr Mark Crislip, an infectious diseases specialist, aka ‘The Pus-Whisperer’).*

On an issue as complex as vaccines, I tend to listen to experts who see the big picture rather than surf the web to find bits of research that support my own ‘gut feeling’ on the matter. You can find ‘a’ study or ‘an’ expert to support almost any point of view.

*http://moremark.squarespace.com/quackcast-list-mp3/

snoopydoc said :

@ HenryBG

Firstly, the ability to surf the internet and ooze confirmation bias by selecting snippets of information that support your favoured argument, does not constitute what you refer to as “proper analysis”.

I’m sorry you don’t like the BMJ. What I’ve demonstrated is that clinicians themselves are calling bullshit on flu vaccination.
Doctors have along history of inflicting non-evidenced and dangerous treatment fads on patients (blood-letting, thalidomide, prostate screening) and this flu vaccination scam obviously is yet another example of that.

snoopydoc said :

Secondly, while your point regarding the relative risk vs benefit has a kernel of validity to it (things become increasingly unfavourable the more millions of people we have to vaccinate to apparently protect or save just a handful), I suspect you are suffering from a form of personal incredulity bias.

A “kernel of validity”? You’re too kind. As far as I can see it’s actually the essence of performing a risk assessment.
Subjecting millions to a risky treatment every year to provide poor protection against a virus which is almost entirely benign doesn’t add up from a risk management perspective.

At, what? $30 a pop each? Plus the millions of doses that have to be thrown away at the end of the season when they hit their expiry date. It all adds up to a windfall for certain people. Over a quarter of a billion $$$ of our healthcare $$$$ wasted on trying to save 14 old people who were on their death beds anyway.
Completely pathetic.

snoopydoc said :

Yes, only 14 people died of influenza in Australia last year. And, interestingly, not a single one died of polio.

And did we have to vaccinate 10 million Australians against Polio last year, this year, and every other year?
No. We didn’t.
The difference is
a) polio is incredibly dangerous. Flu is benign.
b) the vaccine against polio actually works. FLu vaccine is just as likely to make you sick than it is to give you any kind of meaningful protection against any kind of genuine risk.

And the cumulative risk of having to undergo this unnecessary treatment every year should be quite worrying.

sweetlibby said :

There is no where that you can get FREE flu vaccine that I know of in the ACT unless you have a specific medical condition.

Gungahlin Doctors (the one on the corner) has a nurse give free vaccinations, or at least it was free for me and I don’t have any conditions that I know of.

@ HenryBG

You are an argumentative little thing, aren’t you? 🙂

Firstly, the ability to surf the internet and ooze confirmation bias by selecting snippets of information that support your favoured argument, does not constitute what you refer to as “proper analysis”.

Secondly, while your point regarding the relative risk vs benefit has a kernel of validity to it (things become increasingly unfavourable the more millions of people we have to vaccinate to apparently protect or save just a handful), I suspect you are suffering from a form of personal incredulity bias.

Yes, only 14 people died of influenza in Australia last year. And, interestingly, not a single one died of polio. I don’t think even a single Australian child died last year of H.influenzae epiloglottitis, either, now that I think about it.

Why might that be, do you think? Do you also complain about traffic lights, red-light cameras and speed cameras at busy and potentially dangerous intersections? Perhaps, if you did, on the basis that: “There are never any accidents at that intersection!! Clearly we don’t need safety measures like traffic lights, etc., there!! It’s a clear case of urban infrastructure contractors over-servicing!”

You underestimate the risk of harm because you live in a particular place and time where severe harm from these sort of infections is _very rare_. I suspect that what you fail to properly appreciate is the fact that the interventions which have helped keep such bad outcomes in the _very rare_ basket start looking more superfluous and unnecessary the more effective they are.

It’s a bit like the wonderful but unrealistic supposition that in an ideal world the Police service and judiciary would be so effective at preventing and discouraging crime that we would have so _little_ crime that we could just about dispense with having a Police service or criminal courts at all anymore. Take them away and oh… look… crime is happening again.

Influenza vaccines are, as mentioned in other comments, limited in their effectiveness in that they are developed to combat, usually, just one (or perhaps two) strains of the virus. This is because the virus mutates at an impressive rate, and the vaccine programs are aimed at trying to play catch-up and effectively protect against the “current” seasonal strain doing the rounds.

The vaccine is still highly effective against the targeted strain(s), and contributes significantly to reducing the extent of seasonal influenza epidemics (and potential pandemics) in this country. This reduction in transmission and subsequent morbidity (and potential mortality) is especially facilitated by the fact that a very high proportion of healthcare workers, compared to the general population, choose to use the vaccine. Apparent ineffectiveness is often the result of people not realising that the _vast_ majority of viral respiratory tract infections they might acquire, even in “flu season”, is _not_ influenza. Having said that, no vaccine is 100% effective (some people don’t mount an appropriate antibody response, or “seroconvert”). If you have the vaccine, however, you are _far_ more likely to be protected from this season’s ‘flu than not.

In short, you live in a bubble where the horizon of your visible universe does not include the spectre of a truly rampant infectious epidemic of, well, anything, let alone something like pandemic influenza. The current risk may be small, but (a) it’s that way at least partially _because_ of the vaccines, and (b) when you stop protecting against these sort of diseases and a _much_ bigger chunk of the population succumb to and/or pass on the infection, even a small fraction of a very big number becomes much… much… bigger, and much much more scary.

Flick through a history book, or go hang out in sub-Saharan Africa or a nicely crowded part of South-East Asia before jumping back on here to tell us all how rare the serious complications of usually innocuous infectious diseases are, and how improving herd immunity even when the individual personal risk is fairly small is such a bad thing.

I think one flough over the cuckoo nest.

I had the injection last year and it didn’t stop me from getting the flew. Same thing the year before. Save your money.

I havnt been to a doctor for a flue for 15 years or more in fact i dont think I ever had. And guess what Ive spent most if the last 15 years in West Africa exposed to Malaria, Yellow fever, and nastys such as Ebola etc. I think I may have malaria as ive had the symptoms but you get that in the big jobs.