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	<title>Philip Alcabes &#187; flu vaccine</title>
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	<link>http://www.philipalcabes.com</link>
	<description>Challenging Myths of Health, Behavior, and Risk</description>
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		<title>Already Apologizing&#8230;</title>
		<link>http://www.philipalcabes.com/2009/10/already-apologizing/</link>
		<comments>http://www.philipalcabes.com/2009/10/already-apologizing/#comments</comments>
		<pubDate>Sat, 31 Oct 2009 15:29:57 +0000</pubDate>
		<dc:creator>Philip Alcabes</dc:creator>
				<category><![CDATA[Disease]]></category>
		<category><![CDATA[epidemics]]></category>
		<category><![CDATA[Health Professions]]></category>
		<category><![CDATA[News]]></category>
		<category><![CDATA[Outbreaks]]></category>
		<category><![CDATA[Physicians]]></category>
		<category><![CDATA[public health]]></category>
		<category><![CDATA[flu vaccine]]></category>
		<category><![CDATA[H1N1 flu]]></category>
		<category><![CDATA[immunization]]></category>
		<category><![CDATA[Medicine]]></category>
		<category><![CDATA[pandemic]]></category>
		<category><![CDATA[preparedness]]></category>
		<category><![CDATA[swine flu]]></category>

		<guid isPermaLink="false">http://www.philipalcabes.com/?p=700</guid>
		<description><![CDATA[We have to wonder why physicians are mounting their defense of flu vaccination, when hardly anyone has been immunized yet. ]]></description>
			<content:encoded><![CDATA[<p>It looks like the Preparedness crusaders, anticipating flak on the swine flu immunization, are already preparing their defense.</p>
<p>In this week&#8217;s <em>Lancet</em>, Dr. Steven Black, from Cincinnati Children&#8217;s Hospital, and colleagues present calculations of the <a title="Black et al. Lancet " href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)61877-8/fulltext#aff1" target="_blank">expected frequencies of adverse consequences</a> (abstract at link; subscription required for full text) likely to result from flu immunization.  The intent being to provide a basis for comparison, so that when events do occur following immunization, the vaccine won&#8217;t be blamed for them.</p>
<p>&#8220;Widespread beliefs that such false associations [of adverse events with vaccination] are true can and do disrupt immunization programs, often to the detriment of public health,&#8221; the authors write.</p>
<p>Testament to the persuasiveness of the rhetoric, an experienced and knowledgeable <a title="Reuters on adverse events" href="http://www.reuters.com/article/latestCrisis/idUSN30427267" target="_blank">Reuters reporter</a> is taken in.  Covering the <em>Lancet</em> article, Maggie Fox writes:</p>
<blockquote><p>People have special fears about Guillain Barre Syndrome (GBS). a rare neurological condition that was linked to a 1976 U.S. swine flu vaccination campaign. Although no case of GBS was ever linked to the vaccine, a belief that the vaccine was worse than the illness remains widespread.</p></blockquote>
<p>Not exactly.  At least <strong>500 cases of GBS were linked to flu vaccine in 1976</strong> &#8212; &#8220;linked&#8221; in the sense that Fox uses the word in the first sentence:  they occurred in vaccine recipients and were in excess of the number of GBS cases likely to have occurred had there been no adverse effect of vaccination.  Thirty-two of those cases were fatal.  That they were not &#8220;linked&#8221; in her second sentence means that the criteria for association have shifted, or can shift.</p>
<p>The method by which the 1976 GBS cases were <em>linked</em> to vaccine was exactly the same as the method Black and his colleagues propose as the test for determining whether adverse events are linked to the 2009 immunizations.</p>
<p>But if the nature of association can shift, then Black and company can play a double game.  On the one hand, no illness or death can be attributed to vaccine if it occurs at a rate less than that expected in normal times, <em>sans</em> vaccination.  That&#8217;s the premise of this week&#8217;s <em>Lancet</em> article.</p>
<p>On the other hand, no illness or death that occurs at a rate greater than expected can be attributed to vaccine unless there is some additional proof &#8212; not just statistics but, we imagine, pathology results from surgery or autopsy &#8212; demonstrating a link between vaccine and illness, or vaccine and death.  That&#8217;s the conclusion that the Reuters correspondent drew after talking with Black and company.</p>
<p>In other words, the vaccine &#8220;scientists&#8221; have already demonstrated that you&#8217;re wrong if you think vaccine has done anything bad.   Don&#8217;t bother alleging that vaccine harmed your child, spouse, or parent.</p>
<p>We have to wonder why physicians (the main authors of the <em>Lancet</em> paper are all MDs, as are the public health officials who are promoting mass immunization as a flu-control strategy) are mounting their defense of flu vaccination, when hardly anyone has been immunized yet.</p>
<p>And we have to wonder why physicians call themselves scientists when they don&#8217;t want to deal with evidence &#8212; only their own certainty that vaccination is a good public health strategy.  A strategy whose inevitable shortcomings they&#8217;re already defending.</p>
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