A related interview and article:http://www.democracynow.org/2009/11/2/shannon_brownlee_does_the_vaccine_matterExcerpts:
Shannon Brownlee is an award-winning journalist, author, senior research fellow at the New America Foundation. Her latest article in The Atlantic magazine, co-authored with Jeanne Lenzer, is called Ã¢â‚¬Å“Does the Vaccine Matter?Ã¢â‚¬Â Shannon Brownlee is also author of the bestselling Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer. She joins me now from Washington, DC.Ã¢â‚¬Â¦
It depends on what weÃ¢â‚¬â„¢re talking about. So letÃ¢â‚¬â„¢s make a distinction here between seasonal flu, which is the flu that we getÃ¢â‚¬â€we see every winter, and pandemic flu or swine flu, what weÃ¢â‚¬â„¢re seeing right now. For seasonal flu, we have a vaccine program, a public health campaign, that aims to get the people who are most at risk from seasonal flu vaccinated. So, we aim our campaign at the elderly, we aim our campaign at people who haveÃ¢â‚¬â€who are immune-compromised, who are ill with other things, who are more vulnerable. And it looks like that these people getting vaccinated is not producing the effect that we want, which is to reduce mortality in these groups. So, does the vaccine matter in the way that weÃ¢â‚¬â„¢re using it? ItÃ¢â‚¬â„¢s not clear.
AMY GOODMAN: But in terms of effectiveness, when you talk about cohort studies, the placebo-controlled studies, etc.?
SHANNON BROWNLEE: Right. That is what we were most concerned with in the Atlantic Monthly articleÃ¢â‚¬â€in the Atlantic article. The magazine has a new name.
The effectiveness of the vaccine is what weÃ¢â‚¬â„¢re questioning. And it looks like when you give young, healthy people flu vaccine, theyÃ¢â‚¬â„¢re able to mount a very good immune response, and they can then resist getting the flu. But when you give vaccine to people who are elderly, who have, say, diabetes or have cancer, are taking chemotherapyÃ¢â‚¬â€there are any number of people who have compromised immune systemsÃ¢â‚¬â€they may not be mounting a very good immune response. So they get the vaccine, but it isnÃ¢â‚¬â„¢t really protecting them.
And thatÃ¢â‚¬â„¢s where the question arises, is how effective is flu vaccine? Because in seasonal flu, weÃ¢â‚¬â„¢re trying to aim our efforts at giving it to the people who are most vulnerable from dying from flu, and they may not be able to mount enough of an immune response to be able to resist flu, even when they get vaccine. So are we wasting a lot of money and a lot of effort in trying to get the vulnerable to get vaccinated, when it may not be doing them any good at all or may do very, very marginal good?
AMY GOODMAN: The Tamiflu, talk about a name from the past, the former Defense Secretary Don Rumsfeld, who you mention in your Atlantic piece.
SHANNON BROWNLEE: Yes. The way we began building up our stockpile of Tamiflu began shortly after 9/11, when there was worry that we might be vulnerable to some sort of a biological attack. And so, the Bush administration and the Congress authorized the stockpiling of Tamiflu and Relenza, these two antiviral drugs, not only for the civilian population, but also for the military.
And at that time, Donald Rumsfeld was the Secretary of Defense. He was also the former chairman of the board of one of the companies that manufactured TamifluÃ¢â‚¬â€manufactured or held the patent, I canÃ¢â‚¬â„¢t remember exactly which. And the decision was made under his watch. And itÃ¢â‚¬â„¢s not clear whether or not he was involved in this decision, but he stood to gain financially, personally, from the stock that he held in this company.
AMY GOODMAN: How investigated has this been, his conflict of interest here?
SHANNON BROWNLEE: It was investigated at the time. A couple of places, other places, other magazines looked at it. I believe Fortune or Forbes looked at it. I canÃ¢â‚¬â„¢t remember which. And it was looked at. And so, it was yet another event that was reported, and then everybodyÃ¢â‚¬â„¢s moved on.
AMY GOODMAN: Ã¢â‚¬Â¦Talk about what you see as what could be a global pandemic.
SHANNON BROWNLEE: If we hadÃ¢â‚¬â€this swine flu does not look to be that pandemic, because it is a relatively mild flu. In fact, the CDC suspects that many people are actually being infected with swine flu and donÃ¢â‚¬â„¢t even know it. They are asymptomatic. So, this is not that really bad flu that people are very worried about.
If and when that flu does hit, there are many questions. One is, could we produce enough vaccine to really stop transmission, to really halt transmission or slow it down? Number, two, who should you vaccinate first in order to reduce that transmission? WhoÃ¢â‚¬â„¢s going to be most vulnerable to dying from that flu, and how can you halt the transmission?
Such comparisons have shown a dramatic difference in mortality between these two groups: study after study has found that people who get a flu shot in the fall are about half as likely to die that winterÃ¢â‚¬â€from any causeÃ¢â‚¬â€as people who do not. Get your flu shot each year, the literature suggests, and you will dramatically reduce your chance of dying during flu season.
Yet in the view of several vaccine skeptics, this claim is suspicious on its face. Influenza causes only a small minority of all deaths in the U.S., even among senior citizens, and even after adding in the deaths to which flu might have contributed indirectly. When researchers from the National Institute of Allergy and Infectious Diseases included all deaths from illnesses that flu aggravates, like lung disease or chronic heart failure, they found that flu accounts for, at most, 10 percent of winter deaths among the elderly. So how could flu vaccine possibly reduce total deaths by half? Tom Jefferson, a physician based in Rome and the head of the Vaccines Field at the Cochrane Collaboration, a highly respected international network of researchers who appraise medical evidence, says: Ã¢â‚¬Å“For a vaccine to reduce mortality by 50 percent and up to 90 percent in some studies means it has to prevent deaths not just from influenza, but also from falls, fires, heart disease, strokes, and car accidents. ThatÃ¢â‚¬â„¢s not a vaccine, thatÃ¢â‚¬â„¢s a miracle.Ã¢â‚¬Â
When Lisa Jackson, a physician and senior investigator with the Group Health Research Center, in Seattle, began wondering aloud to colleagues if maybe something was amiss with the estimate of 50 percent mortality reduction for people who get flu vaccine, the response she got sounded more like doctrine than science. Ã¢â‚¬Å“People told me, Ã¢â‚¬ËœNo good can come of [asking] this,Ã¢â‚¬â„¢Ã¢â‚¬Â she says. Ã¢â‚¬Å“Ã¢â‚¬ËœPotentially a lot of bad could happenÃ¢â‚¬â„¢ for me professionally by raising any criticism that might dissuade people from getting vaccinated, because of course, Ã¢â‚¬ËœWe know that vaccine works.Ã¢â‚¬â„¢ This was the prevailing wisdom.Ã¢â‚¬Â
Nonetheless, in 2004, Jackson and three colleagues set out to determine whether the mortality difference between the vaccinated and the unvaccinated might be caused by a phenomenon known as the Ã¢â‚¬Å“healthy user effect.Ã¢â‚¬Â They hypothesized that on average, people who get vaccinated are simply healthier than those who donÃ¢â‚¬â„¢t, and thus less liable to die over the short term. People who donÃ¢â‚¬â„¢t get vaccinated may be bedridden or otherwise too sick to go get a shot. They may also be more likely to succumb to flu or any other illness, because they are generally older and sicker. To test their thesis, Jackson and her colleagues combed through eight years of medical data on more than 72,000 people 65 and older. They looked at who got flu shots and who didnÃ¢â‚¬â„¢t. Then they examined which groupÃ¢â‚¬â„¢s members were more likely to die of any cause when it was not flu season.
JacksonÃ¢â‚¬â„¢s findings showed that outside of flu season, the baseline risk of death among people who did not get vaccinated was approximately 60 percent higher than among those who did, lending support to the hypothesis that on average, healthy people chose to get the vaccine, while the Ã¢â‚¬Å“frail elderlyÃ¢â‚¬Â didnÃ¢â‚¬â„¢t or couldnÃ¢â‚¬â„¢t. In fact, the healthy-user effect explained the entire benefit that other researchers were attributing to flu vaccine, suggesting that the vaccine itself might not reduce mortality at all. JacksonÃ¢â‚¬â„¢s papers Ã¢â‚¬Å“are beautiful,Ã¢â‚¬Â says Lone Simonsen, who is a professor of global health at George Washington University, in Washington, D.C., and an internationally recognized expert in influenza and vaccine epidemiology. Ã¢â‚¬Å“They are classic studies in epidemiology, they are so carefully done.Ã¢â‚¬Â
The results were also so unexpected that many experts simply refused to believe them. JacksonÃ¢â‚¬â„¢s papers were turned down for publication in the top-ranked medical journals. One flu expert who reviewed her studies for the Journal of the American Medical Association wrote, Ã¢â‚¬Å“To accept these results would be to say that the earth is flat!Ã¢â‚¬Â When the papers were finally published in 2006, in the less prominent International Journal of Epidemiology, they were largely ignored by doctors and public-health officials. Ã¢â‚¬Å“The answer I got,Ã¢â‚¬Â says Jackson, Ã¢â‚¬Å“was not the right answer.Ã¢â‚¬Â