Musings of a Dinosaur

A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Wednesday, October 14, 2009

H1N1 Madness ( or: Crayzee is Relative)

I rarely link to Happy the Hospitalist any more because he's usually such a raving lunatic. However when Happy points out, albeit indirectly, that there are other people out there who actually make him look intelligent, that's saying something for the stark raving crayzee that's making the rounds.

Happy relates his recent experiences with H1N1 flu, and the near death of a previously stable asthmatic. He also links to a study from the Southern hemisphere about the results (not just the "risks", mind you) of H1N1 flu in pregnancy:
While pregnant women make up only 1 percent of the general population in Australia and New Zealand, 66 of the 722 ICU patients, or 9.1 percent, were pregnant women.
Countering this, we have Bill Maher, recent winner of the Atheist Alliance International's Richard Dawkins award (see here for full fisking), claiming that pregnant women should not take the H1N1 immunization, and that anyone who gets a flu shot is an idiot.

Furthermore, the Philadelphia Inquirer several days ago published a letter from not one but two women claiming to be registered nurses proudly proclaiming their plans to refuse the H1N1 flu shot, and encouraging others to do the same.

Listen up already, people:
  • H1N1 is just another flu virus.
  • It will kill many people, especially those with asthma and other underlying medical conditions.
  • The shot is not "untested" any more than introducing a new color of paint for a car and not repeating all the crash testing renders it "untested".
  • The virus doesn't care whether or not you "believe" in it.
  • People trying to spread doubt and fear about the vaccines are not your friends (even if they're your friends).
Flu shot naysayers are like people refusing to leave New Orleans as Katrina comes roaring ashore. Listen to them, and you or your children could die. Period.

13 Comments:

At Wed Oct 14, 06:59:00 AM, OpenID crankylitprof said...

So, Dino...can I get the regular flu shot and the "Hinny" shot at the same time, or must there be a....gap? So to speak.

Gimme the lowdown. When's yer shipment in, so I can give you the opportunity to spear me not once, but twice?

 
At Wed Oct 14, 11:41:00 AM, Blogger Ed said...

As I was getting my seasonal flu shot last week, the RN administering it volunteered doubts that she'd be getting the "untested" H1N1 shot. I kept my mouth shut, since she had a needle in my arm at the time, but I was not impressed.

 
At Wed Oct 14, 12:27:00 PM, Anonymous Anonymous said...

Are people getting measurably stupider or does it just seem that way? I'm certainly getting measurably crankier about it.

 
At Wed Oct 14, 08:57:00 PM, Anonymous Anonymous said...

And the nurse should know better. Maybe it's an evolutionary thing, survival of the less dumb. Course, they'll still expect to be saved on our dime, just like the folks who didn't leave New Orleans.

 
At Wed Oct 14, 11:14:00 PM, Blogger Nurse K said...

Awww...you said 'crayzee'...

 
At Fri Oct 16, 11:57:00 PM, Anonymous Anonymous said...

Ugh. I am both entertained and annoyed by stupid depending on my mood. That is why working in a pediatric ER can either be the best or most irritating job in the universe. I've had my shots, we have to sign waivers if we don't because THE REST OF THE WORLD HAS GONE CRAYZEE and is ignoring truth and science.

In otherwords....Amen sister!

 
At Sat Oct 17, 09:28:00 AM, Anonymous Sietse Brouwer said...

The Reuters article that the Happy Hospitalist linked to is, in turn, about this publication in the New England Journal of Medicine:
http://content.nejm.org/cgi/content/full/NEJMoa0908481

Some points about said article:

* It studies the effect of H1N1 on the Intensive Care system in Australia and NZ — not its effect on ICU patients, nor its effect on the general population.

* Neither does it study what brings H1N1 patients to the ICU, apart from some remarks like "significantly larger proportion of patients with condition X", where X is things like asthma or Aboriginal/TSI/Maori. Also pregnancy, which is what Reuters and the Happy Hospitalist picked up on.

* About the pregnancy thing:
If my math is correct, the odds ratio
(odds of getting flu&ICU if pregnant)/
(odds of getting flu&ICU if not pregnant)
is about 10. That is, among non-pregnant women a proportion p gets H1N1 flu and ends up in the ICU. Among pregnant women, this proportion is ten times as large.

* Said proportion p, back-of-the-enveloped using data from the fine article: of non-pregnant women, 310/25m = 12-per-million end up in the ICU with H1N1 flu. So for pregnant women, this would be 120 per million. Bof.

* Its most important conclusion comes from this table:
http://content.nejm.org/cgi/content/full/NEJMoa0908481v1/F4
"Our data indicate that the greatest effect on ICU resources in a given region occurs approximately 4 to 6 weeks after the first confirmed winter ICU admission and that the extra workload lasts several weeks."

So at the epidemic's peak, expect your region's hospitals to need 7-11 extra IC beds per million people they serve. Caveat lector.

This concludes my daily "more than you needed to know" Internet post. :-)

 
At Sun Oct 18, 01:30:00 PM, Anonymous Anonymous said...

i recognize the need for such a vaccine, but i think people should be taken seriously when they express doubts about it. If one takes the example of the relatively widespread gardasil vaccine, one could point to the case where a 14 year-old-girl died after receiving the vaccine. the article can be found here: http://news.bbc.co.uk/2/hi/health/8279855.stm

 
At Sun Oct 18, 09:47:00 PM, Blogger Amanda said...

True, it isn't an untested vaccine. It's simply an old vaccine from the late 70's which has not been changed, and has a laundry list of risks and side effects. The least of which is GBS. The manufacturing of the current vaccine was rushed, and had barely a glimpse of review by government health agencies. I'm simply not comfortable allowing myself and my children to be the guinea pigs for it. As for the seasonal flu vaccine. The flu virus is constantly mutating, and by the time a decision is made regarding which strains to include in the next vaccine, that virus has mutated its way around the world and back again. There is no way to predict the strains included will have any affect on preventing illness in the people who receive the vaccine. Much like data released about last year's seasonal flu vaccine.

 
At Mon Oct 19, 02:00:00 AM, Blogger Yehudit said...

The girl who died after receiving Cervarix (NOT gardasil) had a tumour in her chest and could have died at any time.

http://news.bbc.co.uk/1/hi/8284517.stm

Lesson No. 1: Temporal proximity is not causation, otherwise the sun would rise because my alarm clock goes off just before break of day.

 
At Mon Oct 26, 08:38:00 PM, Blogger Homebody said...

"Listen to them, and you or your children could die. Period."

Pot, meet Kettle. This is not straight talk, this is fear mongering. Come on! You write better than that. You ARE better than that.

You know, there are stark, raving lunatics on both sides of this one. Right now I am in the middle. And since HALF of all medical pros do not intend to get the H1N1 vax, I think I have some good company.

All I want to know is why we can't have a good double blind, placebo controlled study. The REGULAR flu vax has never had that, we just pretend that the cohort studies show things they do not and then further pretend it would be 'unethical' to actually do a good study. It would be simple to do for H1N1. Just pick 10-20 military bases, and ask for volunteers. Military folks are required to get a flu vax. I know many of them would thrilled to be part of a GOOD study to see if the thing even works.

 
At Tue Oct 27, 10:44:00 AM, Blogger #1 Dinosaur said...

@Homebody:

Listen to them, and you or your children could die. Period.

The operative word here is "could". Note that I didn't say "will", just "could". There is nothing wrong with this completely true statement.

As far as your request for a "good double blind, placebo controlled study", see here for an explanation of the unreasonableness of your "reasonable" request. Remember, there has also never been a placebo-controlled trial of the efficacy of parachutes.

 
At Wed Oct 28, 10:58:00 AM, Blogger Homebody said...

Vaccine = Parachute is the same as Apple = Orange. Not even close to talking about the same thing, even if you don't discuss the relative crazy it takes to exit a perfectly good aircraft mid-air with a piece of cloth tied to your back. ;)

I see nothing in the article you linked to other than that the author is using a guilt by almost association for an ad hominem attack. Not a shred of evidence that the flu vax actually works. Not a bit of evidence that a double blind, placebo controlled study in a healthy, volunteer population is at all dangerous to anyone.

The practice of medicine is imperfect. The harm from a flu vax for most folks is way less than many of the other 'untested but we just **KNOW** it works' things like internal fetal monitoring, bone marrow transplant for 4th stage breast cancer, or Vioxx. The ingredients are very well known, reactions are really rare.

But there is still no good evidence that flu vaccines actually prevent illness or save lives. The cohort studies don't hold up under rigorous scientific analysis. And the studies that would prove or disprove the worth of the flu vax simply have never been done.

For YEARS docs gave antibiotics for every sniffle. Decongestants and expectorants too. No one ever wanted to do the tests, because they just KNEW they worked! Did most of these things cause severe, lasting harm in most people? No. But it was also a colossal waste of money for no real benefit.

We have a unique opportunity with H1N1. It is a clinically mild disease in most populations, and a fair number of folks have immune systems that don't have a bunch of experience with it. Let's answer this question with a good study, with volunteers from the groups least at risk. THAT is the responsible course of action. If it works, we know. If it DOESN'T, we use those millions (billions maybe?) of bucks on things that do.

 

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