I’ve wanted to write about flu vaccines for a while now, but never quite got around to it. Then, recently, my friend Steve Smith posted on Facebook a quote from the CDC website stating how effective the flu vaccine was. I was startled, because all my reading until that point indicated that the evidence for the flu vaccine being effective was minimal. Had I missed some important recent research?
It turns out I didn’t. Now, before I get into any of this, I need to start with the usual disclaimer that none of what I’m writing here (or anywhere else) should be considered medical advice, or to substitute for medical advice; it’s for educational or entertainment purposes only. I’m not advising you or anyone else to get, or not to get, the flu vaccine. I think it’s a good idea to research carefully before making any big decisions about your health, and always consult your appropriately licensed healthcare professional before making any changes to your health care. I also like to keep in mind that what might be right for me might not be right for somebody else.
The first thing that I want to note is that when most people think they have the flu, they are usually not infected by an influenza virus. Although they have symptoms that they associate with the flu, they probably have what’s called flu-like illness. Only a minority of those who have flu-like illness will actually have the flu, i.e., an infection by an influenza virus; this number is usually around 10 to 30% (https://en.m.wikipedia.org/wiki/Influenza-like_illness). The flu vaccine is designed to stop an influenza virus, so there’s little to no evidence to think the flu vaccine can prevent the majority of flu-like illness. The point is, even if you got the flu vaccine, and even if it worked with 100% effectiveness, it will not help you against the vast majority of pathogens — 70%-90% of them – that will make you feel like you have the flu.
Well, the argument goes, if you can stop 10 to 30% of the people who get flu-like illness from getting sick, why wouldn’t you? It can still prevent a lot of suffering, and perhaps save lives. Fair enough. But IMHO, it’s important to keep things in perspective, and understand exactly what you’re protecting yourself against and what you’re not.
The bigger issue is this: in general, when I consider whether to use some form of medical intervention, I want to know three things. First, what are the likely benefits? Second, what are the risks? Third, what are the risks and benefits of any alternatives, and how do they compare?
When I look at the first question, the suggestion from the CDC and pharmaceutical manufacturers is that the flu vaccine reliably prevents the flu, reduces days off work, and saves lives. However, when I look at the best available evidence, I don’t see how it supports that view. The best studies I’ve seen on the issue are certainly the Cochrane meta-analyses, which assess all studies on a subject that meet certain criteria; methodological quality and funding biases are some of the factors that are taken into account. These studies show little evidence of effectiveness for the flu vaccine. Some studies show a small effect, but overall the studies employ poor methodology and show evidence of bias. For example, this review found a small positive effect, http://www.cochrane.org/CD001269/ARI_vaccines-to-prevent-influenza-in-healthy-adults, but only 10% of the studies reviewed had good methodology, and many were industry-funded, which to my mind throws their conclusion into some doubt. This review showed no benefit: http://www.cochrane.org/CD005187/ARI_influenza-vaccination-healthcare-workers-who-care-people-aged-60-or-older-living-long-term-care. You can examine their entire list of meta-analyses on flu vaccination here.
This evidence for no or very modest effectiveness seems to be almost common knowledge among some physicians, and some have written strong opinions on the matter, for example https://www.medscape.com/viewarticle/855937 and http://www.bmj.com/content/349/bmj.g6182.
The CDC did publish a recent study showing good results at preventing deaths in children from influenza (https://www.cdc.gov/media/releases/2017/p0403-flu-vaccine.html), but the methodology is questionable; also see the earlier meta-analysis on the subject here: http://www.cochrane.org/CD004879/ARI_vaccines-preventing-influenza-healthy-children. What I found especially interesting about the latter review is this statement: “This review includes trials funded by industry. An earlier systematic review of 274 influenza vaccine studies published up to 2007 found industry-funded studies were published in more prestigious journals and cited more than other studies independently from methodological quality and size. Studies funded from public sources were significantly less likely to report conclusions favourable to the vaccines. The review showed that reliable evidence on influenza vaccines is thin but there is evidence of widespread manipulation of conclusions and spurious notoriety of the studies. The content and conclusions of this review should be interpreted in the light of this finding.” As is all too often the case, the influence of big money can corrupt or distort evidence, partly through intentional or unintentional bias.
But, some may object, how can that apply to the CDC? That’s a government watchdog group, and is immune from such dangers, right? This was my question as well – and unfortunately, it was answered in the negative. It turns out the CDC does take industry money, and has been roundly criticized for it in prominent medical journals, for example here: http://www.bmj.com/content/350/bmj.h2362.full .You can read more about it here http://www.thevaccinereaction.org/2015/06/cdc-foundation-ties-to-industry-raise-conflict-of-interest-concerns/ and here (a physicians’ site) https://circleofdocs.com/is-the-cdc-is-sleeping-with-drug-companies-you-decide/
Does that mean I’m going to reject everything the CDC says? No, but it does mean I’m going to take into account that their statements are not objective.
After all that, what do I think about the effectiveness of the flu shot? In my opinion, I think it has at best a small chance of preventing the flu.
OK, what about the risks of a flu vaccine? It is here where we head into a very muddy and controversial area. According to the CDC and pharmaceutical manufacturers, there is very little risk to the flu vaccine. You can examine a manufacturer’s data sheet here: https://www.fda.gov/downloads/biologicsbloodvaccines/vaccines/approvedproducts/ucm263239.pdf About 2% of children have an allergy to eggs, so should not have the vaccine to prevent risk of anaphylactic shock. There is also an increased risk of febrile seizures (https://emedicine.medscape.com/article/1176205-overview) in children, which may increase the chance of epilepsy or other seizures later on. Historically, neurological damage in the form of Guillain-Barré syndrome (which causes progressive paralysis) is associated with flu vaccines (http://www.who.int/immunization/sage/Sejvar_GBS_influenza_2slides_page.pdf). Vaccine apologists note that actually getting the flu has an even greater association with GBS than the flu shot does (see https://www.health24.com/Medical/Flu/The-flu-virus/Does-the-flu-vaccine-cause-Guillain-Barre-syndrome-or-not-2015032), but that’s only a defense if the flu vaccine reliably prevents you from getting the flu, and the evidence doesn’t support that as we’ve seen above, at least in my opinion.
My question is, if the vaccine can cause something as bad as GBS, what about other neurological issues that may not be as obvious or easy to detect? Perhaps increased risk of seizures, cognitive deficits, or other autoimmune disorders might show up some weeks later – and the association with the vaccine might not be obvious, and thus not reported. Even serious cases are often not linked. A neighbor of mine experienced permanent nerve damage to his hands after a flu shot, and someone I know experienced progressive demyelination of their peripheral nerves to the point they could only get around with a walker.
The VAERS system is what’s used to report and track adverse reactions to vaccines (see http://vaxtruth.org/2012/01/flu-vaccine-deaths-just-how-rare-are-they-learn-how-to-find-out-for-yourself/ for a guide on how to check it), but some criticize it for being likely to have a high incidence of false positives. But what about false negatives? Unless you’re very educated about the issue, you’re unlikely to associate an adverse event with a vaccine unless it occurs relatively soon after the injection. Experts suggest that adverse event underreporting is very high: http://www.bmj.com/rapid-response/2011/11/02/underreporting-vaccine-adverse-events
Some studies have shown that the flu vaccine increases your risk of getting other respiratory illnesses: https://academic.oup.com/cid/article/54/12/1778/455098, and maybe even of the flu itself: https://academic.oup.com/cid/article/51/9/1017/292207. The CDC itself found that a flu vaccine can increase the risk of a miscarriage (https://m.theepochtimes.com/cdc-study-shows-up-to-7-7-fold-greater-odds-of-miscarriage-after-influenza-vaccine_2345828.html). It may be that, in susceptible individuals, a flu shot can increase the chance of an autoimmune disease by this sort of mechanism: http://www.plosone.org/article/info:doi%2F10.1371%2Fjournal.pone.0008382#s3; related is: http://het.sagepub.com/content/early/2012/09/12/0960327112455067
So what can we objectively say about the risks of a flu shot? The CDC and pharmaceutical companies say that the risks of a flu shot, although present, are considerably less than the risks of having the flu. I’m less sanguine on the subject, and although I cannot prove that the vaccine apologists are wrong, I’m concerned that the risk of serious complications from the vaccine (especially among susceptible individuals) may be underreported and higher than they purport it to be. What there’s no controversy about is that you do have a high risk of having the common, but less alarming, side effects of pain, body aches, fever, low energy, and nausea; depending on your profession and lifestyle, these may or may not be trivial, and should be taken into account.
OK, suppose we accept the vaccine manufacturers’ claims that the flu vaccine has some positive effect in preventing the flu, and that the risks are as low as they say. It still may not be a good idea for me to get the flu shot. Why? Because I want to know what the alternatives are, and how their risks and benefits compare. If there’s an alternative that decreases my chance of getting the flu just as much, or better, than the flu shot, while having even less risk, then of course I’d choose this alternative. Why take a low risk of something bad happening, if I can take an even lower risk by doing something else?
And indeed there are many ways to enhance your health and lessen your risk of getting sick from a respiratory illness, including from the flu. For example, by taking vitamin C and vitamin D (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3024156/), doing exercise and meditation (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3582749/), doing your Tai Chi (https://www.health.harvard.edu/newsletter_article/In_Brief_Tai_chi_gives_immune_system_a_boost), and avoiding artificial sweeteners (https://www.ncbi.nlm.nih.gov/m/pubmed/24063614/), most of which are good things you ought to be doing anyway, and whose side effects are generally things like increased energy and an improved sense of well-being.
Other strategies include using Chinese herbs (http://www.cochrane.org/CD004559/ARI_chinese-medicinal-herbs-for-influenza), or herbs such as elderberry (https://www.ncbi.nlm.nih.gov/m/pubmed/15080016/related/), Sanicle (Sanicula europaea): https://www.ncbi.nlm.nih.gov/m/pubmed/8769089/?i=3&from=/7838873/related, https://www.ncbi.nlm.nih.gov/m/pubmed/10441789/?i=2&from=/8769089/related, and even lemon balm (https://www.sciencedirect.com/science/article/pii/S2222180816611155).
Mushrooms are so useful for so many things they deserve special mention. See http://mykosan.com/medicinal-mushrooms-viruses-research/, and http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0041399, as well as:
https://www.ncbi.nlm.nih.gov/m/pubmed/21449077/?i=2&from=/22339706/related
https://link.springer.com/article/10.1007/s00253-010-3067-4
As you can see if you check the links, these alternatives show some very impressive results, with few if any dangers. So why are they not mentioned by the CDC or other medical authorities? Why all their focus on vaccines as the only way?
Well, I think the answer is at least twofold: first, there’s a kind of cultural bias among many scientific authorities, that what comes out of a lab through analytical methods and chemical manufacture is what’s real or potent, certainly more potent than a plant growing in your garden or a mushroom in the forest. Second, there’s the obvious point that there’s much less money to be made growing and selling, for example, a combination of melissa, elderberry, sanicle, and mushroom extracts than there is in selling a patented chemical pill. For many of us, this debate in the end comes down to how much you trust the medical and pharmaceutical institutions versus how much you trust the inherent strength of your body and the healing powers of nature.
I’m betting on nature myself.
Manu's Alternative Medicine Blog 