Afternoon InquisitionAnti-ScienceScience

AI: Pigs and Death and Cheerleaders

Flu season is here. And (I don’t know if you’ve heard) this year we have the added burden of worrying about the pigs getting us sick. And the media is all over the pandemic, and making sure you’re not only terrified of the swine flu, but terrified of the vaccine for it as well. The swine flu is going to kill you… and preventing the swine flu is going to kill you… but relax, no one’s trying to kill you… except the government… and big pharma… and your doctor… and the anti-vaxxers. But besides them, you’ll be fine… as long as you don’t catch the flu… or get a shot… ever. Really. Stop freaking out! The only people who have to worry are people who are babies, pregnant, have suppressed immune systems, lung disease, asthma, allergies, a love of bacon, an aversion to ham or go out in public, use handrails, or touch anything that anyone else has touched or possibly breathed on. Seriously. Everything is fine.

Just make a choice… die of the ham flu, or end up like this gorgeous cheerleader:

What’s your take on this cheerleader story and the media hysteria? Are you worried about either flu? Are you getting vaccinated against the seasonal or swine flu?

The Afternoon Inquisition (or AI) is a question posed to you, the Skepchick community. Look for it to appear daily at 3pm ET.


Elyse MoFo Anders is the bad ass behind forming the Women Thinking, inc and the superhero who launched the Hug Me! I'm Vaccinated campaign as well as podcaster emeritus, writer, slacktivist extraordinaire, cancer survivor and sometimes runs marathons for charity. You probably think she's awesome so you follow her on twitter.

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  1. Cheerleader:
    Correlation does not equal causation. The TV media is just being the jackasses they usually are. I hadn’t heard about this story before now so either I missed it or NPR/BBC don’t find it newsworthy.

    Flu worry:
    Not worried at all. In the time span when people have been worrying themselves silly over 1000 H1N1 deaths 60,000 people have died in car crashes and more have been maimed. Americans spend a disproportionally large amount of time worrying about small risks.

    Flu shot:
    Probably not. You really have to be motivated to find a source this year and I’m just not that excited about it.

  2. Is this real? Has the vacination been positivly identified as the cause of her disorder? Has the disorder been diagnosed? What I am asking is this, is she faking this for publicity or is she actually sick?

    I have had my seasonal flu vaccine which was provided free by my employer. No H1N1 is available in my area yet. I have been trying to find a source for my kids without luck.

    I see no reason to ignore an easily preventable disease or death just because I am more likely to die in a car accident.

  3. what the hell was that? you would think a story of a backwords walking/normal running cheerleader flu-shot story would top every news station. smells kinda like a made-up story to scare people from getting their shots.

    and i totally agree w/ @davew: as there are many other things far more troubling and deadly in the world. this story is just this years version of the shark attack watch after that kid was bitten down in florida or something, and suddenly the media went bonkers for it.

  4. Dystonia tends to appear at that age. It’s too soon to tell but this may be as related to the flu vaccine as autism is to the MMR vaccine (which is to say none – none related).

    I’m getting my shot on Thursday.

    H1N1 isn’t a small risk for some people. We can prevent many deaths by getting the H1N1 vaccine and not being contagious. Speaking of worrying about small risks – that vaccines cause dystonia in 1 in a million (or less) people. An 11 year-old in Ontario died this weekend of the flu. The vaccine won’t do anything to me, the flu might (or might to someone I spread it to). I’m getting my shot.

  5. In the case of the cheerleader, I think her condition is genuine, but not linked to the vaccine. The fact that it emerged shortly after receiving a vaccine is purely coincidence, and could easily be psychosomatic.

    Unfortunately, a lot of the sources I found when this came up last week have changed or gone missing. But last week, everything seemed to point fairly convincingly to psychogenic dystonia. Which could be triggered as a nervous reaction to the flu shot, rather than a side-effect of the shot itself. Nonetheless, I found this which pretty much sums it up.

    If anyone has any more recent information, I’d love to hear it.

  6. The disease is called “dystonia.” The cheerleader “believes” the regular flu shot (non-H1N1) was the cause. There is no proof of any kind that her disease was caused by the shot.

  7. Last time I got the flu I ended up in the ICU for 5 days due to previous respiratory issues. I’ll be getting both shots. I also work in healthcare so they’ll both be provided for me.

  8. @Gabrielbrawley:

    The cheerleader thing I thought was too weird to be real… then I thought it was too obviously fake to be fake. I don’t know.

    It’s unlikely the disorder would be caused by a vaccine, from what I’ve read… but even the pro-cheerleader stories are saying its “one in a million”.

    She’s already paired up with Jenny Mac over at Generation Rescue to make sure that no one gets a shot because of the risk of her one in a million disease.

  9. I think the fearmongering on both sides is really very sad. There is reason to be concerned about both the vaccine and the disease, in that these are both foreign things to our bodies and we should be aware of what we are putting into or exposing our bodies to.

    A little research led me to the answer that I stick with, and that is that the vaccine is as safe as you’re going to find, and that the pandemic flu is worth vaccinating against. The vaccination will not be 100% safe and it will not provide 100% guaranteed coverage against the flu. But the people who argue to the contrary are essentially saying that because body armor doesn’t completely rule out the possibility of being shot, there’s no point in wearing it in a war zone.

    As for the cheerleader and Gardasil, obviously everyone will immediately jump on the casuation and correlation argument. To me, it’s not even the real issue. There are something like 24,000,000 doses of Gardasil that have been given out. There are 28 deaths. That number is too small a percentage to appear on most regular calculators. As for reactions listed as “severe”,, the number is (I believe) 963, which means 0.004%.

    I don’t have data on the likelihood of an unvaccinated person catching HPV and that turning into cervical cancer, but that’s really the question. Which number is bigger. Which option provides the safest results?

  10. Unfortunately, due to my illnesses, getting vaccinated is not recommended for me. (And I don’t mean by frickin Jenny McCarthy.) My husband will be getting both vaccines if possible, and then I just have to hope my jacked-up immune system does its part.

    Were none of this an issue I’d be getting jabbed this season.

  11. LOL. The youtube user who posted that video tried to edit it so that it sounded like the reporter said “Should prevent people from getting the flu shot” when what he actually said was “shouldn’t.” What a jackass. (at the 2:03 mark)

  12. That news report is disgusting, btw: “Look how beautiful she WAS, now that she’s disabled she’s obviously less attractive and desirable. Feel bad for her. Oh and by the way fear the flu shot with every fiber of your being.”

  13. I lost a facebook friend over this story. I think the woman’s condition is psychogenic and not related to the flu vaccine at all. I got the regular flu shot and I’m fine. I will get the H1N1 vaccine as well.

  14. Got both shots from my employer on Saturday, so the Aporkalypse won’t be visiting me! It’s recommended for me, as I’m a health care worker. Plus, I have asthma and diabetes, and no spleen (so my immune system is missing a component). As for the dystonia coming from the flu vaccine, I believe this to be horse hockey. The dystonia is probably real, but I agree with @Peregrine; psychogenic in nature. Of course, we’ll never get a follow-up report.

  15. @Peregrine: Good video. It’s hard for me to say she’s faking it when it seems she’s been diagnosed at Johns Hopkins (according to this reporting). Even then, no one’s demonstrated a causal connection to the vaccine. It’s a great example of the “post hoc ergo propter hoc” logical fallacy.

    I got vaccinated for seasonal flu. My company offers them for free, so why the hell not? Three weeks later and no dystonia.

    @davew: Far as I can tell, the regular flu shot is just as available as in previous years. It’s the H1N1 that’s in short supply. More info on the swine flu vax shortage.

  16. So… the condition was triggered 10 days after she got the flu vaccine… but they didn’t tell you the rest of the story.
    At T-9 days, she had sex.
    At T-8 days, she had a non-organic coffee at a local grocery store. Pesticides, maybe?
    At T-7, she tried a new perfume.
    At T-6, she drank 43.6 ounces of wine cooler.
    At T-5, she ate eggs.
    At T-4, she went swimming in water that approximately 45 people had urinated in within 48 hours.
    At T-3, she took some pills that a friend said would really help her stay awake.
    T-2, McDonalds Cheeseburger.
    T-1, Taco Bell.

    I think it was the cheeseburger. But I could be wrong.

  17. I think a big part of this is that she’s a young, pretty cheerleader. Fewer people would even care if this happened to some average person. This is really the level that our reporters have gotten to.

    As for the disease, I’ll believe it is real until I see some evidence that it’s not. Whether or not it’s related to the vaccine, I don’t know. Of course correlation does not equal causation, but even if this were triggered by the flu shot, so what? Flu shots have minimal risks, just like driving a car, taking a bath, or eating a spoonful of peanut butter. Even if her disease is related, my risk from the flu is still greater than my risk from the vaccine.

    I already got the regular flu shot months ago. I would like to get the H1N1, but I don’t know if it will be available.

  18. @Kimbo Jones:

    And don’t forget her chances for happiness are ruined… now that she’s less hot. She’ll NEVER EVER BE HAPPY… like everyone else who never becomes a sexy professional cheerleader.

    On the plus side, now that she’s less attractive, @sethmanapio has stopped following her around and taking notes on her every move.

  19. This was all part of God’s plan.

    She got this disease so she won’t use that tea kettle, and it breaks. Therefore, she won’t repalce it with the one she would have bought, which would have been defective, and the first time she used it, it would have explosed and sent a shard through her heart.

    She would have been using the tea kettle while she recovers from the flu that she would have gotten if she didn’t get vaccinated.

    See, this disease saved her life.

  20. It’s just mass hysteria over nothing, just because two things might happen to happen at around the same time doesn’t mean that one causes the other.

    I’m not too worried about the either flu myself, but I always do get flu shots if they’re available, as I’m a caregiver of two immune compromised family members, and I wouldn’t want to be a carrier to make them sick.

  21. @Elyse: hey, i can deal with a backwards-walking once-pretty cheerleader, as long as that flu-vacc shot didnt affect her boobies. just saying.

    and yes, i said “boobies”Elyse. wow i feel like upon uttering that word, a whole new world has opened up before my eyes. full of impish immaturity and boobie-mountains of majesty.

  22. @jtradke: Far as I can tell, the regular flu shot is just as available as in previous years. It’s the H1N1 that’s in short supply.

    It’s less available for me — sample size one. My company scheduled then canceled regular flu shots this year. There are some local stores and clinics that have some vaccine, but they run out quickly. I could get it, but I’d have to be very motivated. If someone I had regular contact with had a weakened immune system I would be that motivated. They don’t so I’m not.

    This does seem to be an awful lot of fuss over something that stands less than a 1 in 700,000 chance of killing me. (350,000,00 Americans; 1000 H1N1 deaths in 2 years.)

  23. @daedalus2u: Actually if you are a cheerleader and are drenched in pig blood it amplifies your telekinetic powers.

    I’d like to see the double-blind experiment design to prove this hypothesis. Anyway it seems like you’d go through an awful lot of lab techs.

  24. @davew: The danger isn’t necessarily in your personal fatality risk, but who you might infect (and their fatality risk) and the health care burden of thousands of sick people at once.

    @Elyse: Also, it’s so much more tragic because she was so attractive – you ugly people who get dystonia can die in a fire, cause really what’s the difference? Wow, news. Fail on so many levels.

  25. Oh dear – I got an H1N1 shot last week and now my left hand is numb!!! Clearly caused by the vaccine and not at all by the cortisone/lidocaine shot I got this morning in my palm for the twitchy tendon. /snark

    My doctor only got 100 doses -the vax haters are helping the rest of us by declining to get the shot. More for the people who want/need them.

  26. @myself: Whoops. Sorry, folks, my numbers are irrelevant (though conceptually valid). In the argument I had with the friend of mine who posted this junk on her Facebook, she immediately attacked HPV and Gardasil, and the news report is clearly about seasonal flu. My bad.

  27. My big concern is making sure my two teenage children don’t miss the boat and get their H1N1 vaccine. I’ll get one when it becomes available to the general public which could take a while.

    The whole cheerleader thing is bazaar to say the least. Davew and sethmanapoi got it about right I think. However I would like to hear someone like Novella weigh in on this particular syndrome/disease because of the publicity storm that is likely to get even bigger. I hadn’t herd of this woman before today and while having a nice hot bowl of pho for lunch I overheard the folk at the next table talking about this woman who got a severe neurological disorder after getting the flu shot. I just assumed it was a reference to the purported issues with the swine flu shots back in the 1970’s; but now I find this AI after getting back to my desk. I bet the issue only grows from here.

  28. This is why I wrote about the anti-vax movement for my college essay. Vaccines don’t scare me, people who believe vaccinations will give them disorders and so don’t vaccinate their children do. I feel bad for the woman, but this news story smelled a little too much like an attempt to find a scapegoat for this ‘gorgeous’ woman.

  29. – for all your dystonia questions.

    Strangely, I can not find any description that matches this woman’s symptoms and most adult-onset dystonia seems to be localized (neck, face, vocal chords, etc.) But then again, I am only playing Nancy Drew a la google.

    Since there have been reports of inadequate H1N1 vaccinations supplies, the news has been sort of pro-vax. My hyper-cynical side is wondering if there is a connection since the anti-vax “controversy” is always good for a few sound bites.

  30. What’s your take on this cheerleader story and the media hysteria? I think they are giving too much credence to the flu shot “connection.” If her condition is real (and wow, that is a wild condition), fine. Even if it DOES turn out to be connected to the flu shot, fine. It’s awful and tragic (for ANYone, not just an apparently no-longer-beautiful cheerleader), but that doesn’t mean you shouldn’t get your shot or I shouldn’t get my shot.

    Are you worried about either flu? Yes. Not so much for myself, although perfectly healthy people DO die and get horrible complications from the flu all the time, but for my nieces and nephews, parents and grandparents. If I get sick and get over it but pass it on to one of them and they don’t get over it so easily, well… I’ll leave it there.

    Are you getting vaccinated against the seasonal or swine flu? I already got my seasonal flu vaccine. I will get the H1N1 if I can, but I’m not expecting it. I might be on the risky list because of my asthma, so if I can get it, I will, but I haven’t even heard about any availability here yet, so we shall see.

  31. @Bookitty:
    Its hard to tell much from the video. I did notice that when whe is jogging, she suddenly starts spazzing with no change in gait or posture. What triggered it … proximity to the camera? Anyway, it doesn’t prove anything.

    One thing about Nancy Droogling is that you are less likely to be tied up and thrown in the trunk of a car, which could be a downer if you are into that sort of thing.

  32. I actually caught H1N1 last week because my students’ parents send their kids to school sick all the time. It wasn’t so bad. I’ve only ever had the seasonal flu once, I think I was 9 or 10 and I hardly remember it so I have nothing to really compare it to. I only missed 3 and a half days of work. I still have a little bit of a lingering dry cough and I’m still a little more tired than usual but otherwise I’m doing fine.

    My intense fear of needles has always prevented me from getting the seasonal flu vaccine (I do get all of my other vaccines.) They have the nasal mist now, and I’m still considering it for the seasonal flu vaccine.

  33. The impression I got from this was they wanted some excuse to show footage of this poor girl’s strange neurological disorder, and so to make it relevant they spun some bullshit about it being caused by her flu shot.

  34. @daedalus2u:
    “…it is a very strange neurological disorder that prevents one from walking but allows one to run.”

    Only a little stranger than being unable to speak without stuttering, but being able to sing just fine.

  35. I had my seasonal flu shot sometime in September. I will get the H1N1 shot once it is available.

    My in-laws will not be getting flu shots this year because of fears of Guillain-barre syndrome.

    I found this article interesting about the far left and the far right seem to be of one mind on the anti-vax issue:

  36. I’m not concerned about H1N1. I’m in about as low risk group as it gets. I work at an office where there are no kids. No one who works there has kids. I live in a building with very very few kids (though many hospital employees).

    I may get the shot (or spray) if I can get it without going out of my way.

    The only thing is if I come down with something I wouldn’t be able to go to holiday fun because my sister, my cousin and an aunt all work in health care with very high risk patients and there are lots of little kids. That’d be my reason for getting the shot. I have the time from work and just between us even if I don’t get it I’m totally faking it at some point this winter.

  37. Listen people … it IS possible that the vaccine caused this. Vaccines have caused neurologic side effects before ( Guillian Barre syndrome and seizures ), but the bottom line is this – severe side effects are RARE. So, for argument sake, let’s say this is a story about a real side effect. If so, it’s the equivalent of watching a video of lightning striking the same unfortunate girl and then watching it hit her twice in the same video. Both make sensational news. Both are tragic. Both are rare. Both make better “news” stories ( especially on Fox, who for some unknown reason are trying to undermine vaccinations, as this is one of several Fox anti vax videos I’ve seen on youtube ) than watching a cheerleader get a vaccine shot and then go about her day. Bottom bottom line – we just don’t know – but how cruel it is, WITHOUT knowing, to blame the woman.

  38. Drum roll… the only morally defensible position is to
    (1) get vaccinated giving due concern to priorities
    (2) ensure your underage kids are vaccinated
    (3) advocate everyone else get vaccinated
    The vaccine is almost risk-free (see below). It is effective in 70% + of preventing influenza. It will continue to be effective if other parts of the virus make it more dangerous. Some people vaccinated will not develop a proper immune response including HIV patients and asthmatics (higher doses considered for them). Unlike seasonal influenza, its easy to see that H1N1 is killing people

    Add the obvious, if I’m prevented from getting influenza, I can’t pass it on to those who haven’t gone vaccinated due to supply, stupidity or issues with their immune system.

    At the price of maybe a few bucks and a sore arm and a tiny if not zero serious risk to yourself, you can benefit your community by lessening the chance that others get the flu etc., etc.

    To understand how things were different in the past, read up on the Polio Pioneers.

  39. As a neuroscientist in psychiatry research I think this is a case of a conversion disorder known as psychogenic dystonia. Her symptoms are unlike Guillian Barre syndrome, or the other rare known reactions to the influenza vaccine. In addition her inability to walk forward, but ability to run and walk backwards along with the transient speech problems are not consistent with a direct insult to the nervous system. Like many patients with conversion disorders, she may truly believe her condition is entirely biological in nature. She also fits the most common patient profile for conversion disorders.

    In this case I think the hoofbeats are a horse, a conversion disorder, not a zebra, a reaction to a that has not been documented in the decades of millions of people receiving the influenza vaccine.

  40. @ZenMonkey:

    I’m not aware of any reasons not to get the inactivated ( dead) injected vaccine. Those with a weakened immune system such as lupus should stay away from the nasal spray. See:

    Other than that the concern is that a standard 15mcg shot of dead stuff won’t kick off enough of an immune response in those with asthma or those taking immunosuppessant drugs. So NIAD is comparing immune response in asthma and others of 30mcg vs 15mcg. If I had bad enough asthma or was on some strong immunosuppressant drugs (won’t help with HIV), I’d get a double dose.


  41. Though I’m only an internist, I agree with Schnuder that clinically this looks odd, so I did some homework.

    I did a PUBMED search looking at vaccinations and dystonia. I found one that discussed dytonia as related to vaccines. Here it is:

    Vaccination studies of aspergillosis in turkeys: subcutaneous inoculation with several vaccine preparations followed by aerosol challenge exposure. This was a 1982 study that looked at torticollis ( neck muscle spasm ) in TURKEYS! There were no other studies in this search linking dystonia to vaccines.

  42. Then I did a search on the VAERS ( Vaccine Adverse Event Reopting System ) website. I punched in dystonia. No hits. Guillain Barre? A bunch of hits. Seizures? A bunch of hits.

    I then looked up ataxia ( gait disorders ) and vaccines on PUBMED and found an interesting one, a Dutch 2009 study, but it has nothing to do with flu shots or H1N1. Still … it’s interesting.

    Acute cerebellar ataxia (ACA, sudden onset of truncal ataxia and gait disturbances) usually follows a benign illness (25% varicella). It is also described after vaccination, like MMR and varicella zoster virus (VZV). CONCLUSION: The incidence rates were comparable with other studies. We found no association with MMR, but chickenpox was clearly related to ACA. According to age-specific seroprevalence data the incidence rate of ACA was 5:100,000 VZV infections for children up to 5 years, compared to an ACA-reporting rate of 0.15:100,000 doses VZV-vaccine. Therefore, uptake of VZV-vaccine in the immunization programme will diminish the incidence rate of ACA.

    These are the symptoms of ACA:

    Ataxia may affect movement of the middle part of the body from the neck to the hip area (the trunk) or the arms and legs (limbs).

    When the person is sitting, the body may move side-to-side, back-to-front, or both, and quickly move back to an upright position.

    When a person with ataxia of the arms reaches for an object, their hand may sway back and forth.

    Common symptoms of ataxia are listed below.

    Sudden, uncoordinated movement
    Walking problems (unsteady gait)
    Sudden (nystagmus) or uncoordinated eye movements
    Clumsy speech pattern (dysarthria)

    Does she have all of this? No? Could it be a variant? I must defer to a neurologist to determine this. Could it be vaccine related? Dunno.

  43. @davew:

    What about the hypothetical young man with very bad asthma who used the same door just after you accidentally left H1N1 virus on it.

    It won’t do any harm to you and may help others in your community. That would be enough for me.

    It once was: I took part in a class 3 trial of an IV drug. I hated needles and still ain’t fond of them. I lay down on this small couch in an overheated room for about 90 minutes about 6 times. Took time off work. At the time, I was doing pretty well and didn’t expect a lot from the drug. So when asked, I signed up, as it might benefit me, might benefit fellow sufferers and seemed pretty safe (although much more dangerous than the flu vaccine) .

    I got the drug, not the placebo. Didn’t help much. Drug never went to market as competition worked better even though it had more side effects.

    Maybe 60% for me, 40% for others and a some risk.

    Flu vaccine: Even if 0% for me, the risk is almost zero. Get vaccinated.
    Shel zz66eeaa99ww123

  44. An addendum to dunno – the bottom line in the above study is that the varicella vaccine DECREASED this virus related disease. What I’d REALLY like to know is did the woman have a viral illness 4-6 weeks prior?

  45. I teach first grade, so I’m thinking I’ll get the vaccine(s) this year. I’ve never had a flu shot, but my school district and insurance company are offering seasonal flu shots free, so I figure I should go ahead and get it.

    There have been confirmed H1N1 viruses at my school, and I have friends who have had the virus. While I think people are overreacting in general, I do think protecting oneself is important. Because I work with children, I’m also protecting them.

    Plus, I hate being sick – it means I have to write sub plans and I just don’t have that kind of time/energy.

  46. Okay fellow skeptics. I know it’s fun to deny something at face value.. especially when it seems so unlikely but for something like this you have got to look at the facts.

    According to Wikipedia, Dystonia is a real disease. However, Wikipedia doesn’t mention anything about flu vaccines causing the disease.

    Therefore this is not a hoax, but the media screwed up by implying the vaccine caused it when in actuality all of the evidence suggests it merely correlated.

  47. Swine flu is about as bad as regular flu, you should worry about it as much as you worry about getting the regular flu.

    FWIW, I’ve spent the winter in a global hotspot for swine flu and I only know one person who caught it.

  48. I feel very sorry for this cheerleader having dystonia. It is a horrible disease and can be very challenging to live with. However, the flu vaccine didn’t cause it. Dystonia has no known cause. No one knows why one day you are perfectly fine and the next you can’t walk or talk properly.

    It would have been nice if this news program bothered to do any research on Dystonia whatsoever. Unfortunately, it is more sensational and will get more viewers if they say it was caused by the flu vaccine rather than having a story about a pretty girl with a horrible disease with an unknown cause.

  49. This story is really making the “woo” rounds. I keep hitting it in the most unlikely places.

    I feel terrible that this happened to her…or happens to anyone. I hope that someday there is a cure for it. There are some treatments that help somewhat according to the NIH’s National Institute of Nerological Disorders and Stroke web site:

    I also agree with KimboJones’ take about it. (“Also, it’s so much more tragic because she was so attractive – you ugly people who get dystonia can die in a fire, cause really what’s the difference? “)

    That’s really disgusting and insulting to that poor young woman.

  50. @sheldon101: What about the hypothetical young man with very bad asthma who used the same door just after you accidentally left H1N1 virus on it.

    It won’t do any harm to you and may help others in your community. That would be enough for me.

    The harm to me a 1/2 day off work for each shot. Plus I’ll have to pay for the shots. It’s not a huge cost, but it’s about three times the size of my average charitable contribution. And because these diseases mutate you’ll want me to do this every year.

    The risk is that I’ll get the flu which is obviously low because I never have before, and that I won’t know it and actively be shedding virus (I always stay home when I’m sick), and that I’ll have close contact with someone who can die from the flu who hasn’t already died from it. This sounds very, very unlikely. I do not run my life by one in a million shots. If someone convinces me that my estimate is wrong then I’ll reconsider.

    I think what skeptics some times lose sight of is there are two very different disease types we vaccinate against. There are the stable, but deadly diseases like polio and pertussis that with a wide-spread vaccination campaign we can eliminate. Ban from the planet forever. Then there are the annual diseases that will never be eliminated, the vaccine’s efficacy is always a guessing game, and that aren’t very dangerous. I think these are very different beasts and we should keep the arguments separate.

  51. I will be getting the regular flu shot because it’s only $5 for me, and I really can’t afford to get sick and take time off work (I have no sick time left due to some random infections earlier this year (UTI, strep, and ear infection all at once, woo!)). But I probably won’t be getting the H1N1 because it’s not easy to find in Arizona and there are others who need it far more than I do.

    Thankfully I don’t tend to get sick often (it’s been yearrrrs since I’ve had the flu) and I recover quickly when I do. But like I said, I can’t afford to take time off, so let’s hope I don’t get sick.

    I am SO VERY GLAD I am not taking public transportation anymore, because if I was taking public transportation this flu season, I’d be a LOT more concerned.

    But thankfully I am not around kids like ever, and I work with only roughly 20 people.

  52. @davew:

    FYI, you’ll be contagious before you get sick, so staying home is a nice way to stop the continued spread of the virus, you’re still spreading it while feeling well. And coming into contact with someone who has asthma puts them at serious risk. A person with asthma can have a severe reaction to a cold or flu at during any infection, but not every time.

    My husband was hospitalized in March and almost died from asthma complications brought on by what appeared to be a cold. Had it been something more severe, like the flu, I could very well be widowed right now. The thing is, he’d never had his asthma react to cold or flu before… so while you think it’s nearly impossible for you to spread the virus to someone who could be put in serious danger from it, it’s more likely than you think.

    Honestly, I had no idea that a head cold could kill an asthmatic until that incident.

  53. @Elyse:

    Sorry to hear about your husband. My wife and I have been through similar experiences and they always suck.

    We skeptics are schooled to not reason from anecdote. I have a rough upper bound on my odds of having a bad outcome from these flus and I’m okay with it by at least an order of magnitude. I don’t know my odds of catching it and passing it along.

    I have a very open mind about this. While the shots were cheap and convenient I was signed up. Now the cost to me is a day’s pay. The benefit is unknown. I’ll accept any data anyone cares to provide. For example how long can I shed virus before I’m symptomatic? Also why these particular vaccinations and not HPV or meningitis or any of the other shots that I can get that might be of help to my fellow man? Is herd immunity even a factor when the vaccine is not particularly effective and the vaccination rate is rather pathetic even if all doses of the vaccine that are manufactured are used? Are the odds of me killing someone with one of these viruses higher than me killing someone by eating peanuts in public?

    I’ll take this out of the abstract. I promise everyone here I will get the annual flu vaccine this year and every year subsequent if someone can provide evidence of the odds that me getting the vaccine will prevent serious illness in some else is better than 1 in 500,000. I am mid-40’s and have no regular contact with children, parents, grandparents or anyone with respiratory problems or compromised immune system. (I can’t promise to get the H1N1 because it looks like it will be unavailable for a good long time where I live.)

  54. It’s too late for me. I came down with a fever today. I would have gotten the vaccine if it had been available since I’m five months pregnant… Now it’s just Tamiflu and Tylenol and hoping for a quick recovery.

  55. @sheldon101:

    This model is pretty crude, but in the spirit of open-mindedness I ran the model with 499 susceptible people and then ran it again with 498. The graph didn’t change noticeably. Without data I can’t tell if it changed measurably. This model also can’t answer my basic challenge.

    I understand that there may be no data to answer my basic challenge even though reality has already made up it’s mind one way or the other. I’m just asking for a little evidence-based medicine here otherwise I’m stuck voting between my best guess and @Elyse’s (and a few other people).

  56. @davew:

    You are aware that while anecdote does not mean “evidence” it also does not mean “completely irrelevant”. My point was that asthmatics are everywhere, most don’t wear T-shirts that say “I’M ASTHMATIC!” And they are people who can be killed by the flu. It was something that I, as the wife of an asthmatic, didn’t even realize was a serious risk until my husband almost died.

    Let’s say you actually don’t know anyone with asthma and never come into contact with anyone with asthma and my husband’s case was the only case in medical history of a guy having an asthmatic reaction to a cold or flu virus. And you don’t know any babies. And you don’t know any old people. And you don’t know any sick people. And you don’t know anyone who knows or comes into contact with any babies, oldies or sickies.

    What about pregnant women? Are you out of contact with women of child-bearing age? Remember that just because you THINK a woman isn’t pregnant, doesn’t mean she’s not. Hell, just because a woman thinks she’s not pregnant doesn’t mean she’s not!

    You said that you don’t know anyone who could be anything more than inconvenienced by the flu… I’m just giving examples of people who might be who aren’t people with full-blown AIDS and newborns dying of cancer. People who you may very well be in contact with who you may not realize are at risk.

  57. @Elyse: What about pregnant women? Are you out of contact with women of child-bearing age?

    I was just going down the CDC checklist of people who should be first in line for the flu shot. I’m not on it. The people I know are helping to pay off their baby’s college loans. :-)

    I admit that I could get the flu and I could pass it to someone who could be killed by it. I admit to the possibility that my failure to get a flu shot could kill someone who I have had only the briefest most indirect contact with. What I want to know is the probability. I know this can’t be calculated exactly, but I’m looking for any sort of evidence or data to put a number on it. Something to indicate to me that it is probable enough for me to go out of my way to get a flu shot.

    Maybe an example or two can provide some perspective. Should I give up eating peanuts in public because people I come in contact with might have peanut allergies? I think we can agree that this is unreasonable. The odds of me hurting anyone in this scenario, while non-zero, are very low. Every time you get behind the wheel of a car you might kill someone. Should you give up driving? Collectively we say no. Everyone on the road tacitly accepts the risks of sharing it. Fatal accidents will happen that could have been prevented but they are not worth the inconvenience of not driving for most people.

    At the risk of repeating myself all I’m looking for is some evidence. Friends have asked me if they should get the flu vaccine and unless they fall into a risk group the best answer I can give them is “I don’t know” and direct them to the CDC’s web site. The arguments I have seen here are long on anecdote and emotion, but short on data.

    (I put similar questions to the SGU a couple of weeks ago, but they haven’t addressed them yet. I was really hoping for some insight from the Flying Novella Brothers.)

  58. davew:
    I respect your position. You’re thinking about costs and benefits at the margin, and that’s precisely the right way to think about this.

    I only get a flu shot because they give them away at work. The only cost to me is about 15 minutes and that’s company time anyway.

    By the way, the economist in me feels compelled to point out that the only reason the vaccine is so time consuming to acquire is that your government puts price controls on vaccines, and these controls suppress supply, like price ceilings always do. If you want to make it cheaper, subsidise it, don’t impose a price ceiling its always a bad idea.

  59. My employer sponsored a flu shot clinic, which my insurance would have covered, but I didn’t want to wait until October or November to get the shot so I took ten minutes out of my day, stopped into a Walgreens on my way home from work wayyyyy back in September and plunked down $25. Neither inconvenience or expensive. But I guess they don’t have Walgreens everywhere…

  60. @davew: I think you’re missing the point. Driving is necessary in a modern age, but you can take steps to prevent accidents like driving sober, driving defensively, and being fully alert. With peanuts, not everyone is at risk. With the flu, everyone has the ability to catch and spread it, and you can prevent it. I don’t see how you can equate it with car accidents and peanut allergies. Yes, you always have the chance to kill someone in a car or with peanut dust, but those are largely not preventable without drastic lifestyle changes. A flu vaccine causes no drastic lifestyle changes and adds to the general health of the population by keeping one more possible carrier healthy. Plus it takes only a very small portion of your day.

  61. I know I got my shot already (my university provided it free to many of us). And I’ll be getting the H1N1 vaccine as soon as it is available here (which should be very soon).

    I go to one of the larger research universities in the country…I think I’ll trust the doctors on this one.

  62. @James K: Since the NIH usually pays almost 75% or more of the cost of developing new vaccines and medicines I would say that we are subsidizing the cost of the vaccines. Now if we want to remove the price ceiling we would need to remove all the subsidies and tax breaks they are already receiving.

  63. @Sydust: “I think you’re missing the point. “

    If you don’t like my analogies, pick your own, but I’m still looking for numbers. How about this, why flu vaccine but not yellow fever or meningitis or any of the hundreds of vaccines available to me? If you say it’s a matter of odds then what are the odds?

    (The mild irony here is I actually have been vaccinated against yellow fever so you’re not going to catch that from me… unless I need a booster.)

    Driving is necessary in a modern age…

    On this point you are provably wrong, but this is a tangent.

  64. The problem with numbers and odds is they depend on which disease and which vaccine you’re talking about.

    For example, I think the smallpox vaccine has a relatively high rate of complications. But on the other hand, smallpox is also a relatively obvious disease to spot, and people won’t be walking around with it while contagious without obviously being sick and to be avoided.
    Even though the mortality rate is likely much higher than the flu (not to mention the dammage it can to to pregnant women or their unborn or newly born children in case it doesn’t prove fatal), the risk of the vaccine itself is considerably higher.

    Flu on the other hand is much less obvious, and you’re contagious for quite a while before you even feel really sick, so there’s ample time to go spreading it around before you realise you’ve caught something. Once you’re sick, it’s not that likely to kill you, but as several hundreds of fatalities of H1N1 will attest, even if everyone goes into a flu-scare-frenzy and taking every precaution to keep infection from spreading, people still get sick and die because of it.
    On the other hand, the vaccine against the flu is quite harmless. And I get the impression that the odds of something going wrong with the vaccine are barely more than something going wrong with any other kind of injection (insuline, donating blood, etc…)

    Considering mumps, measles, rubella, polio, I think the odds well in favor of vaccinating. I don’t have exact numbers, but I think I remember hearing adverse reactions ranging somewhere between 1/50’000 to 1/1’000’000, while mortality rates for those diseases in an unvaccinated population were much higher (something like 1/4’000 – 1/10’000? based on numbers collected during epidemics).
    Sorry, but these numbers are from memory and pretty close to simply being pulled from my ass.

    Anyway, it pretty much was a no-brainer to figure out what was the safer bet.
    Risk of dying from vaccine << risk of dying from disease.

  65. @davew: You’re right, I apologize. Driving is necessary to many in a modern age. My aunt, for example, rides a bike to work. My mother is required to go to many different group homes in one day, often to places which are far away and with no public transportation. For her it is necessary. For my aunt it is not.

  66. @spurge: Some other good posts linked through these.

    Yes indeed there were. I found this Atlantic article that sums up my point exactly:
    The author makes a case for an evidence-based approach to vaccines which is precisely what I am asking for too. “In the absence of better evidence, vaccines and antivirals must be viewed as only partial and uncertain defenses against the flu. And they may be mere talismans. By being afraid to do the proper studies now, we may be condemning ourselves to using treatments based on illusion and faith rather than sound science.”

    Hey davew, are you as Libertarian?

    I’m not a party-line kind of guy. I will work for any cause or person I agree with no matter what the source. I haven’t found a Libertarian yet that I want to support, but I would not discount the possibility.

    @exarch: The problem with numbers and odds is they depend on which disease and which vaccine you’re talking about.

    I couldn’t agree more.

    Anyway, it pretty much was a no-brainer to figure out what was the safer bet.
    Risk of dying from vaccine << risk of dying from disease.

    So you’ve gotten every vaccine that has a net positive effect? I hardly think so. And why are you using binary left shift in an arithmetic comparison statement? :-)

    I realize this topic has gone on for a while, but I think this is important. If we are going to, for lack of a better word, evangelize vaccines we should be able to answer the hard questions or at least be able to tell people where to go to look up the answers. I think I can rigorously and effectively support MMR and other childhood vaccines. To me the jury on seasonal flu is out. I can’t accept the “slight possibility of benefit” argument I see here over and over again so I can hardly repeat it.

    If we can do placebo-controlled surgery studies, why can’t we do placebo-controlled vaccine studies?

  67. @davew: It is probably a good idea to get the menigites vaccine as that does occur in America and kills people. Yellow Fever doesn’t happen in the continental US. I have had it a few times but that was because I was traveling to places that have yellow fever.

  68. @davew:

    That Atlantic article has been lambasted for it’s lack of science and the fact that it’s “evidence” comes from a doctor who is known mostly for being contrarian for the sake of being contrarian. @spurge linked to a couple of articles dissecting that piece, and there are more… they’re everywhere. Orac has a good one, too:

    Certainly your reasons are you reasons… and no matter what I think, it is still your right not to get the shot.

  69. @Elyse:

    I read it all much to the vocal complaint of my eyes. However, Mark Crislip on Science Based Medicine had a very complete article ( The slam-dunk study really isn’t out there yet. There is certainly enough evidence to make getting a flu shot justifiable, but the evidence is so nuanced and indirect that I cannot in good conscience recommend a vaccination to people who ask. In this case I’m going to side with the people who think we need more data.

  70. @Gabrielbrawley:
    Why remove the price controls and the subsidies? That would make no sense.

    My point is simply that price controls are an absolutely terrible idea. Price ceilings depress supply by reducing the incentives of manufacturers to produce the good. By contrast a direct subsidy increases the returns to producing the item, thereby increasing supply. If you want people to buy more of something you don’t put a price ceiling on it.

    The way to treat vaccines is to work out how much a vaccinated person benefits others by being vaccinated. you then subsidise the vaccine by this amount. Whether you do this by funding research, an per unit subsidy or some other mechanism doesn’t really matter (it matters a little but that’s beyond what I can discuss in a blog comment).

  71. @davew:
    So you’ve gotten every vaccine that has a net positive effect?

    I don’t know. I think your suggestion is a straw man.
    I haven’t been to the tropical institute yet to get a cocktail against anything nasty that lives in Africa, South America or Asia. Surely, those vaccines are much better than catching the actual disease.
    If you’re planning to go to Africa, South America or Asia.

    I would say that at the very least, the numbers in those vaccines indicate that the risks involved in getting the vaccine don’t outweigh the odds of you catching the disease if you’re not headed to the disease’s natural habitat. Not to mention the side effects of those innoculations tend to include flu-like symptoms afterwards, sometimes even a couple of days I’d say that seriously tips the scales against just taking them for the hell of it. Assuming they’re even lasting.

    So, probably, yes, I actually might have gotten all the vaccines where the benefit outweighed the risk. And possibly some where the it didn’t. But definitely not all the vaccines with a net positive effect. Not by a long shot. Because it wouldn’t be practical or affordable.

    To me the jury on seasonal flu is out. I can’t accept the “slight possibility of benefit” argument I see here over and over again so I can hardly repeat it.

    If even one life is saved because everyone got their shot, would that be worth it? How many lives would make it worth it? It’s one of those things where not doing it is going to result in nothing lost, nothing gained, but getting the shot might result in a benefit, if the scientists guessed right. At least it’s NOT going to result in MORE sick people, and perhaps it ‘ll result in LESS sick people. At no real risk to yourself. I find that worth it. You don’t. To each their opinion …

    If we can do placebo-controlled surgery studies, why can’t we do placebo-controlled vaccine studies?

    Because by the time your double blinded seasonal flu vaccine study is finished, so is the flu season the vaccine is meant to help you with. By the time you’ve got the results, the reason for getting the vaccine has passed. And you’d have to start it all over next year, for the next flu season, and the next flu-vaccine. It would be utterly pointless. Your results would be as useful as yesterday’s trainticket is today.

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