Doctor’s Orders

01.18.13

Get Your Damn Flu Shot

Enough with the truther nonsense—vaccines won’t kill you or give your kid autism, and they’re not a Big Pharma conspiracy. As a nasty flu season hits, Dr. Kent Sepkowitz debunks the myths.

Despite thousands of years of trying, the major medical accomplishments of mankind are few. There’s hand-washing and morphine, ether, and penicillin. And vaccination.

Unlike the others, however, vaccination has never been embraced with untarnished enthusiasm, perhaps because it’s such a messy business. The product is derived from living organisms and must be preserved for distribution. It is administered with needles; once in a while, it can make people sick. But in terms of beneficial public-health impact, nothing Homo sapiens has invented thus far outpaces the vaccine.

The entire vaccine debate has been stirred up for the umpteenth time this week by our national influenza epidemic. States including New York have declared public-health emergencies. Emergency rooms are packed, hospitals more packed, and beleaguered practitioners are gasping for air. No one is certain why this year is so outstandingly awful. Perhaps the vaccine is a poor match, though recent CDC data suggests otherwise; perhaps there was a screwup in the production that will come clear in a few months; or perhaps it’s just the way influenza operates. Last year was a year of lean, and therefore this year is a year of fat.

The only constant in all of this is the sour and insistently dim view of the anti-vaccine crowd, whoe proponents want to use the opportunity of a public-health crisis to score a few more points for the home team. They surely have much to pounce on just now—on the effectiveness side of the ledger. Indeed a year ago, an esteemed group of public-health experts reviewed the evidence supporting the usefulness of flu vaccines and found only that “influenza vaccines can provide moderate protection against virologically confirmed influenza, but such protection is greatly reduced or absent in some seasons.” Like this year.

Yet the focus of the anti-vaccine crowd is not effectiveness, but safety. There are two basic groups. One group feels that, despite countless studies to the contrary, vaccines are to blame for autism and related neurological disorders. The other goes with the notion that vaccines are bad because they are not natural and therefore the immunity they provoke, or the cost to provoke it, will cause the body harm. The latter group is too diffuse in their concern to be met with a specific response, though it might be pointed out that few things are more natural, in the true animals-on-the-planet sense, than dying of polio.

As for autism, vaccines were never a serious candidate as the cause, at least among doctors. The epidemiology never made sense, given that the rise in autism diagnoses occurred many, many years after the current national vaccination program was established. Yet the pressure remained so intense and the issue so emotional that vaccine makers agreed to limit or remove thimerosal, which contains ethyl mercury, because of the known risk of cognitive problems linked to a different form of mercury, methyl mercury. To further address the concern, an Institute of Medicine panel of experts in 2004 reviewed the evidence and found no association.

In fact, the causes of autism recently have begun to be elucidated, with the age of the father appearing to play a large and important role. And yet the topic still has not died; Congress again examined the reputed link only last month, and the Health Resources and Services Administration maintains an active registry of all suits and settlements as part of the National Vaccine Injury Compensation Program.

As for autism, vaccines were never a serious candidate as the cause, at least among doctors.

We remain stuck in public uncertainty because of a basic suspicion that is as longstanding as vaccines themselves. Ever since Jenner scratched cow pox into James Phelps and launched the entire enterprise, people have worried about untoward results. Within a decade of Jenner, the cartoonist James Gillray produced his famous color engraving of newly vaccinated people sprouting cow parts, setting a standard for the irrational but effective assault on vaccines that has little waivered since.

It is not difficult to see why people have their doubts. It often can feel like the entire medical-industrial complex is rigged: the main participants seem unsavory and greedy and too busy to bother with normal people. Big Pharma and Big Science and Big Everything control the drugs studied, the academic sites performing the studies, and the journals that place the studies into the public discourse. This cartel has everything to gain by endorsing vaccines—and also everything to lose. They answer only to each other and live in an inside-the-Beltway self-referenced, self-reverent bubble more dense and annoying than the sybaritic symbiosis between Washington and its journalists.

Yet scientists, though in no way pure or particularly moral, do stand by their work. Some are on the take for sure, either out of profit motive or else a theory they are certain must be true. A recent example of this is Andrew Wakefield, who admitted to fabricating a controversy linking the measles-mumps-rubella vaccine with autism—leading not just to professional humiliation but outbreaks in the U.K. of measles among those who had believed his findings. Surely there are a comparable number of researchers with sticky palms on the vaccines-are-safe side of the ledger as well. But science has a process for all of this—scientists tend to be irascible, doubting, and arrogant if not annoying. No one likes anyone or trusts the other’s work. Therefore, claims are forever reworked and reexamined; the truth eventually is found, as happened with Wakefield.

The anti-vaccine crowd—and the related flat-earthers like those who “disagree” with the evidence supporting global warming or who view evolution as nothing but poppycock—have adopted a very strange angle. They stand squarely on the unstable ice of the irrational and unscientific, yet come at their adversaries by accusing them of flabby science. Those who embrace evolution, the claim goes, can’t explain 100 percent of everything, therefore none of it can be true. And Creationism therefore must be correct. They are using the tools of the rational mind—stepwise systematic review and reconsideration—to make their case while at the same time protecting a total fantasy no more of the current world than the Tooth Fairy or Pecos Bill, a construct that would (and already has) collapsed into dust under the slightest prodding from the same sort of rational inquiry.

We seem to have reached the moment where science, like religion, requires a leap of faith to embrace. Once the crowning achievement of rational man (cf, the Age of Enlightenment), now science, like everything else, is presented as if it were available in bits and pieces and whatever-suits-you portions. But unlike choosing to believe the polls or their unskewed counterparts, or deciding that the Department of Labor is fudging the numbers, for science, there are some rules of the road. They include a belief that studies can be done and truth can be divined—not always giving the results one wants but with credible results insulated from the itchy fingers of Big Bigness. But there is no picking and choosing—you’re either all in or you’re out there hoping that bouncing three times on your left foot will bring rain.