I wrote and posted this last year, but with the respiratory season now gripping local and national stats—and me spending time with my family, including two boys with the flu—I thought I’d repost this for anyone interested. Turns out no new flu research has changed anything below. And for a list of prior dives into flu-related studies (including a treatment that works!) see the links at the bottom of the page. Happy Holidays, everyone!
My boys found our dog, Jazz, earlier this year. She was eating out of a trash can behind an office building. Collarless and homeless, she was also mangy and thin—but somehow pathologically optimistic. On the car ride home her attitude felt contagious, which led me to record her first ever entry into our house. We went inside, Jazz locked eyes with me and, sporting a winsome grin, shat on the couch. The video plays like a teaser for the horror movie Smile.
Jazz’s assimilation into local canine culture has also been rocky. There is, I learned, an unspoken code of behaviors in the dog park. Thankfully she’s not a humper or a poop-eater, traits that can lead to doggy censure. And she’s not a fighter. But she plays rough and, worst of all, looks like a pit bull. Which may be partly because she’s a pit bull.
Mostly this hasn’t been a problem. Dogs don’t mind her style of play, but many owners do and recently we had a hiccup. A bougie Pomeranian pranced into the park wearing a harness. I’m not sure why an owner chooses the asylum-style, thoracic harness with a rubber handle on top, but Jazz knew what to do with it.
Unfortunately, as Jazz shook her new toy the owner screamed. Like, blood-curdling. I practiced emergency medicine for 25 years in the streets, the ER, and combat support hospitals in Iraq, and I swear to you the following: I’ve never heard anyone make that sound.
People ran, men flexed, the dogs were separated. The woman took her pom-pom and left, and there seemed to be broad consensus we should too. Perhaps it was my soft jog as the crisis unfolded. Or the eye roll. In any case, we shame-walked to the gates as breathless owners held their loved ones close.
Jazz never wavered, doing her best Marilyn Monroe.
Naturally, I’ve been hesitant to go back, despite the fact that Jazz mostly loved her time there, and was loved. It’s probably irrational, but even rare bad moments can have that effect.
Which brings me to the seasonal influenza vaccine. Does it work? Should everyone have it? What are the downsides?
The flu vax is, to me, a fascinating case study with lots of defensible arguments on all sides. Here are some facts:
* The Northern hemisphere vaccine changes each year, built on guesses using flu strains found in the Southern hemisphere where flu season starts earlier
* The guesses are pretty good but every five years or so the vaccine uses the wrong strains, like in 2021
* Flu vaccine was intended to reduce deaths and serious illness in the elderly, but randomized trials and lots of good observational data suggest it didn’t work; some argue there aren’t enough trials to know for sure
* In the late 20th century vaccine uptake rose precipitously—along with flu deaths
* In trials, the vaccine consistently reduces getting the flu or a flu-like illness—for kids, healthy adults, elderly people, and even immuno-suppressed adults
* The flu vaccine may have reduced serious illness for heart patients at the highest risk (i.e. people with heart failure or known heart disease)
Okay so let’s accept some easy and some hard realities. First, the good news: getting vaccinated makes a flu-type illness less likely. That’s a good thing.
True, the numbers are small: only about 1 in 30 vaccinated people avoids a flu episode because of the vaccine. But why would anyone not want to reduce their chances of getting the flu?
The answer, of course, is because of the downsides. These include effort, and cost, and inconvenience. Most vaccines also involve a needle (for healthy adults there’s now a nasal spray). Also, about 1 in every 125 people experiences a fever because of the vaccine.
Finally, there are rare serious reactions. Unfortunately, adverse effects aren’t closely tracked partly because the formula changes yearly, and there aren’t new randomized trials every year. So it’s tough to know how much harm the vaccine might be causing. Studies in past years found the vaccine increased non-flu sicknesses, or (rarely—like 1 in 50,000) may have caused narcolepsy. It was also linked to miscarriages in one study, though the CDC says newer data refute that finding.
So… what’s it all mean?
For me, there are a few bottom lines. First, the flu vaccine probably isn’t saving anyone’s life. That’s a claim the CDC makes based on zero rigorous data. Therefore the vaccine probably isn’t accomplishing it’s original goal, and that has led some trustworthy experts to suggest marketing and money are behind the yearly push.
On the other hand I love the idea it might keep me from getting sick—but only if it’s not going to do anything bad. Is the rare fever, or a super-rare chance of narcolepsy or some other bizarre problem, going to keep me from taking advantage?
Not sure yet. But Jazz sure does love playing in the dog park.
The RT influenza library:
-The new mRNA flu vaccine study—and the one STILL unpublished (both)
-A fancy new flu drug, that’s actually not new at all (and doesn’t work) (both)
-A not-at-all fancy, or new, flu drug that works (written)
-A not-at-all fancy, or new, flu drug (podcast/audio)
-Tamiflu (written); Tamiflu (audio)
-Sore throats, and mindless medicine (both)
-Tamiflu and the double-dog placebo (audio only)
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