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:
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:
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.