What good are clinical trials?

[kathyt]

i know that there are different strains of the flu.
and I know that the flu vaccination is based on whatever the most prevalent strain is that season, which does not preclude you from getting another strain.
and and I know that I got the flu shot from work last year, and a few weeks later came down with the worst case of the flu I have had in years.
and and AND my partner, who did not get the flu shot, managed not to catch the flu at all.

This could entirely be coincidental. I do not know with any degree of certainty that getting the flu shot -vs- not, and the fact that I got the flu and my partner did not, are related in any way shape of form.

im just sayin. next flu season i may rethink getting the flu shot.

The most popular and current form of the influenza vaccine is actually formulated to prevent multiple strands of the Flu. Not just one. From my experience, so many patients state that they got the "Flu" after getting the vaccine, but never actually tested positive for Influenza. They just had flu-like symptoms. Big difference.

well, I dont know since i didnt go to the doctor.
all i do know is that it laid me out for a week, and it didnt matter to me whether it was influenza or just symptoms.

That is my point. The common cold can do the same thing, and can have similar symptoms.

 

[pixmedic]

The most popular and current form of the influenza vaccine is actually formulated to prevent multiple strands of the Flu. Not just one. From my experience, so many patients state that they got the "Flu" after getting the vaccine, but never actually tested positive for Influenza. They just had flu-like symptoms. Big difference.

well, I dont know since i didnt go to the doctor.
all i do know is that it laid me out for a week, and it didnt matter to me whether it was influenza or just symptoms.

That is my point. The common cold can do the same thing, and can have similar symptoms.

Seems like that almost makes the flu vaccine a random shot in the dark. You might still get influenza, might get something just as bad.

 

[Gavjenks]

Regarding the flu strain argument last few posts:

The flu vaccine is roughly 85% effective at protecting you from every single strain it was made for, on average.
This number not being 100%, combined with the fact that they always miss some strains = the final number of about 60% efficacy for protecting you from the flu overall for a season.

 

[BrickHouse]

The common viral upper respiratory infection, what people call "the flu", is not what the flu vaccine is about. True influenza infection can cause life-threatening respiratory collapse, even in the young and healthy (in fact, often in the young and healthy due to a robust immune system and something called cytokine storm). This true influenza that places people in the ICU or the morgue is what the vaccine is trying to prevent. It is an educated guess based on what the prevalent strains are circulating in Asia in the spring time (based on epidemiologic data, we know that most of our flu strains start over there and spread to us by fall). Some years it is very good (see 2 seasons ago), some years it is not (this year and only approx 60% coverage). Bottom line, when it works, it saves lives. Countless lives. For most people, the 1-2 days of feeling crappy (which is a good thing, by-the-way, it means you mounted a good immune response and have better immunity) is well-worth the risk of getting what could be a very debilitating problem.

 

[Gavjenks]

This true influenza that places people in the ICU or the morgue is what the vaccine is trying to prevent.

It is exactly the same virus that makes some people mildly ill and missing a couple days of work, and that kills other people. H1N1, for example, kills some (very very few people, but some) and makes other throw up a few times, and still others almost nothing. I'm not sure what you're really talking about with this language of "true" viruses versus... what? Impostor viruses? There are finite strains, they know what they are, all of them have some small chance of killing, and they simply don't have the time or resources or knowledge or sometimes ability to make a vaccine for all of them every season. Or if they do, not a fully effective one.

Bottom line, when it works, it saves lives. Countless lives.

What data do you have to support this claim? The CDC doesn't even know how many people die of the flu within an order of magnitude of precision (seriously, it's like "I dunno, maybe 500? Maybe 5,000?"). Much less do they know how many would have died without a vaccine, in EITHER direction, because we barely know how effective the vaccines are at even just preventing flu, much less likelihood of saving lives. And we have equally little idea how likely vaccines are to kill you themselves.

So you have an equation you can't solve because it requires 2 parameters and we know neither of them.



Let's say, for example (purely hypotheticals, since again we don't know):
Vaccine is 1/500,000 likely to kill or debilitate you.
Taking a vaccine is 1/750,000 to save your life or prevent debilitation from the flu that you otherwise would have experienced if you didn't take it (see OP).
^
If so, then everybody in America taking vaccines would prevent 466 deaths/disabilities, but CAUSE 700 deaths/disabilities, for a net loss to the country.
Or, it could be the other way around, and cause a net gain.

We have no idea.

 

[BrickHouse]

I'm talking about true influenza viruses versus some of the other couple hundred viruses that can cause influenza-like illnesses. Adenoviruses, parainfluenza viruses, etc etc. None of which are the Influenza A or B strains that are in the vaccine. Those mild infections are extremely rare to actually be Influenza positive when we test them.

 

[Gavjenks]

I'm talking about true influenza viruses versus some of the other couple hundred viruses that can cause influenza-like illnesses. Adenoviruses, parainfluenza viruses, etc etc. None of which are the Influenza A or B strains that are in the vaccine. Those mild infections are extremely rare to actually be Influenza positive when we test them.

Okay, I see. So what does that have to do with the conversation?

 

[BrickHouse]

The conversation was bordering on morphing into a "we don't need the flu shot" string. Just jumping in to describe why we give the flu shot. The floor is now yours.

 

[Gavjenks]

The conversation was bordering on morphing into a "we don't need the flu shot" string. Just jumping in to describe why we give the flu shot. The floor is now yours.

No that is indeed exactly what I'm saying. We (MIGHT) not need the flu shot.
Or we might. I'm saying nobody knows if we do or not.

 

[BrickHouse]

I watch unvaccinated people, perfectly healthy as well as elderly or ill, die from it every single year. I can't even think of a time where I've had a vaccinated person die, or even be admitted, with an influenza infection. I'm sure it happens but I don't know of any.

As a physician, all I make to you are recommendations. I recommend you get a flu shot. I recommend you have your cancer treated. I recommend you have your heart reperfused. What you do with it is your business. If you don't think the literature is there to support getting a flu shot then don't. That's all there is to it. Your body, your life. I don't lose any sleep over what you do to it.

 

[Gavjenks]

I can't even think of a time where I've had a vaccinated person die, or even be admitted, with an influenza infection.

I never suggested they would die from an influenza infection.
I'm suggesting they might die from side effects from their medication (the vaccine shot), that may look nothing like influenza at all. Instead it might look like "random" seemingly unrelated heart attacks, or delayed anaphylaxis, or so on and so forth. Who knows? Medicines have all kinds of crazy side effects. Many are things that you would never guess are related from just looking at one patient in an office or ER. They are things you would need clinical trials and population level statistics compared to controls to detect, not anecdotes.

At the end of the day, a guy (hypothetically) dying from a heart attack a week later caused by a vaccine is just as tragic as a guy dying from influenza that a vaccine would have saved him from. So if we want to judge the overall most benefit to society, we need to know the population rates of both types of outcome. Your observations confirm that one of those numbers is greater than zero, but doesn't tell us the actual population rate, and doesn't tell us anything about the other number.

As a physician, all I make to you are recommendations. I recommend you get a flu shot. I recommend you have your cancer treated. I recommend you have your heart reperfused. What you do with it is your business. If you don't think the literature is there to support getting a flu shot then don't.

But
1) Why are you recommending it if you don't have the opposite literature to convince you of the opposite? Given no literature either way, shouldn't you be neutral in your suggestions to people? and
2) I don't always have time to do all the lit review myself, which is why I would hope that the medical community is doing it for me and only recommending things that are well established to help me more than they hurt me. Yet every single time I do take the time to look into a specific thing (I'm talking about long term drugs, not obviously necessary stuff like trauma surgery), this never turns out to be the case...

 

[BrickHouse]

You are exhausting.

 

[kathyt]

I watch unvaccinated people, perfectly healthy as well as elderly or ill, die from it every single year. I can't even think of a time where I've had a vaccinated person die, or even be admitted, with an influenza infection. I'm sure it happens but I don't know of any.

As a physician, all I make to you are recommendations. I recommend you get a flu shot. I recommend you have your cancer treated. I recommend you have your heart reperfused. What you do with it is your business. If you don't think the literature is there to support getting a flu shot then don't. That's all there is to it. Your body, your life. I don't lose any sleep over what you do to it.

Boom!!!!! That is what I call a BrickHouse. So OP go donate all your extra time at a shelter or something, because you have waaaaaaay too much of it! Love, your nurse and your doctor.

 

[Gavjenks]

You are exhausting.

I'm sorry, but I don't have a ton of sympathy for it "being too much effort" to justify life or death recommendations to patients or the community.

If you don't have the data to support it and/or the time to justify the recommendation, then that's fine. There are only so many hours in the day, I understand. But if so, you simply shouldn't make the recommendation. OR the industry needs to have a centralized system in place that efficiently presents all of the data in one place in a way anybody can understand, so that you can just point to that instead, like I was suggesting earlier in the thread. And I don't mean some website that just says "You should take this medicine." I mean the actual data. Just like nutrition labels do.

One way or the other, it needs to be justifiable. Otherwise I have no way of knowing which recommendations are offhanded guesses and which ones are rock solid, and it defeats the entire purpose and value of a recommendation.

 

[table1349]

Damn, the whole chlorine, strychnie, agent orange thing is going to be really useful for conversations around here in the hopefully near future. :mrgreen: