Get a flu shot or you’re fired

While it can be challenging to keep up with the amount and quality of research coming out every day, having access to studies and the ability to examine the data and conclusions, along with all of the qualifiers, subtleties, uncertainties, flaws and peer debates, can help give us a balanced perspective and better understanding when we’re making informed health decisions for ourselves. The growing controversy over mandatory flu shots is an example of research going against the government’s agenda or today’s political correctness rarely making front page news, or getting any news coverage at all. In fact, foreign news media appears to have more freedom of the press and provide more investigative news than we get here in the States.

Most of our health news is little more than scripted advertising. Finding objective health information on the internet has also become increasingly difficult, especially since Google created its Health Advisory Council — comprised of the largest healthcare powerbrokers and government partners, all who will be advantaged with healthcare reform— to screen out less “relevant” or “helpful” information. It seems to some that information is dangerous.

While the flu vaccine has proven to be safe and much safer than the disease, it’s not 100% effective, nor is the field efficacy ideal, unlike vaccines for measles, mumps and rubella. The effectiveness of flu vaccinations varies depending on the year and the population being immunized. Regrettably, it’s one of the less optimal vaccines because its makers have to guess each year which influenza strains will be around 9 months down the road; it’s not significantly effective among older and sicker people, at highest risk for developing the illness and its complications; and vaccination rates aren’t universal which reduces the herd immunity among populations.

That doesn’t mean the vaccine may not help to reduce deaths and complications from the flu or help to reduce the spread of the disease. But have we been oversold on its benefits, who decides, and should you be forced to get the flu vaccine?

The answers are being debated as nurses in British Columbia fight mandatory flu vaccinations. Last week, the Canadian Press reported:

B.C. Nurses’ Union, health officer continue fight over mandatory flu-shots

Another round of fighting has erupted between British Columbia’s nurses and its health officer after a U.K.-based, non-profit scientific group publicly questioned the evidence used to justify a mandatory flu-shot policy for provincial health-care workers….

“We’re going to base our practice on the best science,” said Debra McPherson, president of the nurses’ union…. “Certainly for health-care workers where the science is not compelling, it should continue to be their choice and they shouldn’t be coerced or punished for choosing, based on their reading  of the science, to not get it.”

…Dr. Tom Jefferson of the Cochrane Collaboration said [Dr. Perry Kendall, B.C.'s health officer] misquoted a 2010 [systematic] review conducted by his organization, when the health officer justified the vaccination of employees as a way to protect patients from the flu and pneumonia.

Jefferson said the Cochrane Collaboration drew no such conclusion…  “It is not my place to judge the policies underway in British Columbia, but coercion and forcing public ridicule on human beings (for example by forcing them to wear distinctive badges or clothing) is usually the practice of tyrants,” wrote Jefferson.

The Cochrane Collaborative systematic review of the evidence, referenced in that story, also found no effect of influenza vaccinations on hospital admissions, transmission or rates of complications. This may come as a surprise to many Americans. While heavily discussed in the medical literature for years, it made little headlining news here in the United States.

Another systematic review of randomized controlled clinical trials by Cochrane Collaboration researchers found no evidence that vaccinating healthcare workers working with the elderly had any effect on reducing influenza or pneumonia deaths among their patients.

The Vancouver Sun in Canada has been following this debate and last week, published the latest responses from Dr. Tom Jefferson of the Cochrane Respiratory Infections Group. He addressed the claims by BC health officials that the vaccine is 60% effective and reduces the chances of getting the flu and passing it on to patients:

Opinion: Scientist fires latest shot in mandatory flu vaccine debate

The figure of 60 per cent is a relative estimate which gives an inflated impression of performance. The best evidence of the performance of the influenza vaccine comes from trials in healthy adults. The relevant Cochrane review was first published in 1999 and has been updated several times since. The review shows that you need to vaccinate between 33 and 99 adults to avoid the onset of symptoms in one person. On average the vaccines prevent the loss of half a working day. There is no evidence in any literature that the vaccine avoids person-to-person spread…

The are many studies in literature that conclude that vaccination of health care workers and healthy adults works well, but bias in these studies is so great that the vaccines appear to work against death for all causes, but not against death from respiratory infections. Following this perverted logic would have inactivated vaccines save lives from accidents, strokes, accidental poisoning, hypothermia and falls, but not from influenza and pneumonia? Either the inactivated vaccines are miracle workers or there is something very wrong with the evidence.

Cochrane reviews weigh the evidence by its quality, not by their conclusions, to allow interpretation of the study results with some confidence — this has nothing to do with “good” or “perfect.” The statement that “the logic is indisputable” reveals a high degree of dogmatism. The inactivated vaccines should work in theory, just like many things work in theory, but real evidence suggests they are not having the desired effect. So far we have distortion of research findings, evidence-free statements and evidence-free policies supporting coercion of human beings. What next?

Another major systematic review of evidence on the efficacy and effectiveness of the influenza vaccine was just published last month in Lancet and reported similar findings. It, too, was not widely reported by our news media. This review was led by Michael T Osterholm, PhD, MPH, Director of the Center for Infectious Disease Research and Policy; Director of the Minnesota Center of Excellence for Influenza Research and Surveillance; and Professor of Environmental Health Sciences and Adjunct Professor at the University of Minnesota Medical School. After examining more than 5,700 studies published over the past 50 years, and conducting 88 expert interviews, it concluded:

Influenza vaccines can provide moderate protection against virologically confirmed influenza, but such protection is greatly reduced or absent in some seasons. Evidence for protection in adults aged 65 years or older is lacking. Live attenuated influenza vaccine consistently show highest efficacy in young children (aged 6 months to 7 years). New vaccines with improved clinical efficacy and effectiveness are needed.

“We have over-promoted this vaccine,” Dr. Osterholm was quoted saying in The Independent last week. “The most striking outcome is that we have over-stated the effectiveness of the influenza vaccine.” Federal vaccination recommendations, which have expanded in recent years, are based on inadequate evidence and poorly executed studies, he added. Recognizing the problems with these vaccines can help provide incentives to improving them.

While noting its record of safety and moderate efficacy during some flu seasons and that it can help reduce deaths from the flu, Dr. Osterholm cautioned: “However, during some influenza seasons, and especially among some age groups, it is questionable if our current influenza vaccines provide even moderate protection.”

Coincidentally, healthcare workers here in the United States are also being forced to get flu shots. While many of us choose to get a flu shot and encourage people to get them, some don’t. Last week, 150 employees by a Cincinnati-based health system were fired when they didn’t get a flu vaccine. Healthcare staff in cities such as San Francisco and Santa Clara are already required to get a vaccine or they must wear a mask at all times. Last month, Rhode Island passed the first-ever full mandate requiring all healthcare employees, even temporary workers and volunteers, to get a flu vaccine. Earlier this year, Colorado’s Board of Health passed a mandate forcing all health facilities to prove by 2014 that 90% of its staff have received the flu vaccine and nearly all major hospitals in the state have already enacted mandates for their employees. The penalty is firing.

There is an important take-away lesson from this controversy that is worth talking about, especially as healthcare reform becomes fully implemented. If healthcare professionals are not able to have control over what happens to their own bodies, how free will they be to advocate for us?

How likely will a doctor and other healthcare professionals be able to follow their consciences and ethical beliefs and refuse to:

  • prescribe a medication or treatment they feel doesn’t work or might harm their patient,
  • deny care to an elderly grandmother or to assist in her suicide,
  • deny life-saving resuscitation for a handicapped newborn, or
  • deny a new knee or kidney to someone with an improper BMI or age?

The costs of doing so is losing their jobs and their medical licensure.

Not only did the Obama administration, during his first weeks in office, eliminate the medical conscience clause, which exempted medical professionals from providing care they felt was morally wrong, such exemptions are denied under Obamacare. Upon taking office, Obama also shut down the President’s Council on Bioethics and appointed a  new commission, eliminating its former role of helping to ensure the ethical practice of medicine and healthcare policies, and giving it the new mandate to establish “defensible government policy.” Medical ethics has also been redefined. No longer are doctors and healthcare professionals to be guided by what is best for their patients and allowing patients to have autonomy over their bodies and choices, they are to follow that which is deemed best for the public welfare and not be costly to society.

Many doctors and healthcare professionals do not want to work for the Department of Health and Human Services and other third-party payers and be forced to participate and comply with its extensive new regulations and mandates, many of which are based on debatable evidence. Nor do they want to be accountable to the government and its new local medical homes, called “accountable care organizations,” which are controlled by industry powerbrokers with significant conflicts of interest. They know the ACOs will be able to simply withhold funding or licensure of any doctor not complying with government mandates. States like Massachusetts are already looking to make participation a condition of medical licensure, essentially making doctors employees of the state. Obamacare also multiplied by five-fold the penalties imposed on doctors for each instance of “fraud, waste and abuse” should they fail to comply with guidelines.

The choice to get a flu shot is a microcosm of the debate over freedom: freedom over your personal health choices versus being told by the government what you must do for the public good.

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11 responses to “Get a flu shot or you’re fired

  1. If all are required to follow the same medical rule, then data will become essentially useless for sorting out which treatments are best for individuals. One size does not fit all, but you will not know it if everyone gets the same treatment.

  2. If a flu shot were some anti-science homeopathy then it would make sense that the science based nurses and doctors would oppose it. But in fact it is the opposite, the flu shot is an effective tool for reducing the flu. So then what is their opposition? why freedom of course. But their choice of carears was health care and if they are home sick with the flu while the health care system is experiencing a dramatic increase in patients also sick with the flu are they doing their job when they refuse to take the very prescription that would have prevented this situation? Who’s freedom had to suffer so they would have the freedom to ignore good health advice? Should they also have the freedom to not wash their hands if they do not want to? Should they have the freedom to not keep their knowledge of new health techniques current? Where does their freedom interfere with others freedoms and with their job? I have zero sympathy having spent 20 years in the military where I had to take the flu shot every year and every other shot you can think of and some you never heard of. Interestingly the reason was exactly the same reason that the health care providers are asked to take the flu shot, i.e. so that in the event of a pandemic or even an epidemic I would be available for duty. I might add that when I recently visited my premature grand daughter in neonatal I was required to wash my hands and arms past my elbows just as the doctors and nurses are. I did not consider this intelligent rule to be infringing on my rights.

    • With your assumptions in place, I am inclined to agree with you.
      However, Gone, read the article in depth and it challenges your foundation assertion in sentence 2 of your post.

      If the flu shot is less than 60% effective and does not significantly reduce the risk of transmission, then it is perfectly acceptable to view it as a poor health choice and decline to take it.

      Compare this to the polio vaccine, which various sources say is 90-99% effective and only has to be given once per lifetime. There’s really no comparison.

  3. GWTW: You have several statements in your post which are contraindicated by the Cochrane Collaboration, starting with “the flu shot is an effective tool for reducing the flu”, and the phrase “the very prescription that would have prevented this situation”.
    Your use of the “freedom of course” argument is a straw man argument – you have no evidence that that is the reasoning used by ANY of the flu refuseniks. As one who refuses the flu ‘vaccine’ I admit it is because the vaccine itself once gave me a life-threatening case of the flu. I understand that vaccines are never risk-free but the evidence casts doubt on the claimed benefits.
    Having done the math, the risk/benefit ratio is simply too high for my comfort.
    Regarding the military-ordered vaccinations, I recommend you research the links between Gulf War syndrome and the ‘secret injections’ that were supposed to protect the soldiers against certain biological and chemical agents.

  4. Until clear evidence to the effects,it would be a HUMAN RIGHTS ISSUE,no one can play “HIM” on personal choice.That is why it is called self responsibility,you get sick,you suffer,let some one stick something up your toy box,you suffer.WHAT DEFENSE is there for most flu stuff like MYCOPLASMA PNEUMONEA?a healthy state,and expectorants,cheap.How about discounts for those that invest in their healthy state of self???????

  5. Seems like the new cell-culture flu vaccines are just coming to market. These should quickly cut out the egg based versions and cut the time to market at least in half. Understandable that the current flu shot is trying to protect a year out from when the decision was made. The cell culture should reduce that to 9 – 10 months for normal distribution (the decision would be made, May-June rather than February) with ample time for a late season shot if predictions go seriously awry.

    I wonder too if some of the reason the flu vaccine “misses” the flu of the year is because it really is effective. If you say flu X is going to be the flu of the year, vaccinate everyone, and then folks get Flu-Y, well that isn’t necessarily a fault in the vaccination system, with near universal coverage, flu X should be wiped out and not make an appearance anyway.

  6. There are many vaccines with wonderful efficacy that have saved countless lives. Sadly, seasonal vaccines don’t yet universally fall into this category.
    Every medical professional, as part of their training, responsibilities, Hippocratic oath and accountability, follows infection control procedures (such as good hand washing), is proficient in safe procedures (such as aseptic technique), and keeps abreast of the medical literature and modern advances in the practice of their profession, for the ‘good of their patients’. This is not about refusing to practice their chosen profession ethically and following sound evidence-based medicine, it’s about being forced NOT to.
    Do you want your doctor or nurse doing what a bureaucrat says, or to be following what is best for you and supports your autonomy over your own body?

  7. “Drug manufacturers routinely release rare and new flu viruses into populations, via vaccination, in order to test the effectiveness of their vaccines.” WHO. (This was their response following the discovery by Czech scientists that thousand of swine flu vaccines, produced by Baxters, and due to be distributed to fifteen countries, had been contaminated,with LIVE bird flu virus. Something the experts maintain could not have happened accidentally,
    Apparently, they are creating new flu viruses, testing them on the unsuspecting recipients, in order to test and then patent a tailor-made vaccine for the strain they intend to release, nice work, if you can get it!
    Now, the effectiveness of the flu vaccine is 3%, that’s right, three people in a hundred are protected, about the same as the measles shots.
    Let me, as a layman, ask a simple question.
    If flu or measles vaccines work, which they don’t . . . well they can’t can they, otherwise, those vaccinated, could not possibly be endangered by those who are not UNLESS the VACCINES DO NOT WORK?
    Could they?

  8. Healthcare workers are vulnerable to flu exposure and also to the accusation that they have exposed patients to flu. I can imagine a healthcare organization requiring flu shots for staff as a self-defense measure: “Hey, we were as diligent as we could be.”

    • I think you may have hit on a point here. Healthcare organizations have their risk avoidance settings heavily loaded towards avoiding law suits. With the number of ambulance-chasing lawyers around, I can easily see a case of a hospital being sued if someone catches the ‘flu while an in-patient for another illness.

      I see most infringements of personal freedom in the US couched in these terms (as opposed to government regulations in European countries) and they can be harder to argue against because the organization can defend themselves by saying they have the right to employ who they like and have a duty to prevent possible damage claims.

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