**October 2012 Focus - Focus Magazine

focus reporting from the frontlines of cultural change
How many diseases are important enough
to have their own season? Not many,
but we do have one, and it strikes every
year: the flu.
Arriving in the fall and exiting in the spring,
flu season strikes with the predictability of
clockwork. For some the flu might be a mild
inconvenience, perhaps embraced as a way to
stay home and get a few days couchside wrapped
in the unpleasantness of high fever, aches, sniffles,
and daytime reality TV. Yet for others,
usually the elderly or those with compromised
immune systems, the flu can be deadly. It can
lead to hospitalizations, pneumonia, and sometimes
death.
Victoria might be on an island but its residents
are not immune to viruses. So we prepare,
stockpiling flu vaccines and drugs, hectoring
the public to get an annual flu shot and, with
a new twist this season, giving an ultimatum
to health workers: either get a flu shot or wear
a mask while at work.
BC’s Provincial Health Officer Dr Perry
Kendall is betting that our province’s health
workers need such strong medicine to stop them passing on the flu to
their patients, and he’s launched the most aggressive flu policy in Canada,
one which could set the trend for the rest of the country.
But Dr Kendall and his public health colleagues around the world are
facing an uphill struggle as their anti-flu policies and public health
mandates are increasingly criticized because of the strong-armed ways
they are being enforced. Add to this the growing cynicism around the
fear-mongering of recent flu pandemics, and the overzealousness with
which vaccines are promoted, and you have a recipe for a cynical public.
But of most concern is the determination by some respected international
scientists and researchers that annual influenza campaigns are
likely an utter waste of time and money.
Half the story
“Don’t be like me, and be taken for a fool.” That’s the advice that
Dr Tom Jefferson offers when I ask him about his research around
flu vaccines and flu drugs. He has spent over a decade examining and
summarizing the evidence around one of the most stockpiled drugs in
the world, oseltamavir (also know as Tamiflu), and tells me over the
phone from his office in Rome: “I can only say that I have acted as an
unpaid salesperson for Roche [the maker of antiviral drug Tamiflu] for
the last ten years!”
Now a researcher with the Cochrane Collaboration, working on
acute respiratory infections and vaccines, Jefferson essentially confirmed
Will a flu shot keep you healthy?
ALAN CASSELS
The Cochrane Collaboration’s examination of flu vaccines in healthy adults, a body of literature spanning 25
studies and involving 59,566 people, finds an annual flu shot reduced overall clinical influenza by about six percent.
Dr Tom Jefferson
what I’d heard from other researchers: that
much of the published research on all kinds
of drugs and treatments found in peer-reviewed
medical journals is incomplete. It only gives
half the story.
In the case of Tamiflu, a drug that is supposed
to prevent the spread and the severity of the
flu, Jefferson and colleagues have proven that
the drug’s published dataset delivers a biased
and misleading picture of the drug because
the company has only released a portion of
it. If your job is to find, summarize and synthesize
what is in the published literature—as
it is for a meta-analyzer like Jefferson—incomplete
data sets are a major problem. Over the
past few years he and his colleagues have
frequently asked Roche to release Tamiflu’s
full data set, but so far the company offers up
mostly “the dog ate my homework”-type of
excuses for why they can’t cough it up.
The scourge of hidden data is not new in
medical research, but this just adds to the sense
of how shaky the global influenza apparatus
might be. When the companies that
study the drug stand to gain billions on how that research is presented,
we have a problem. Jefferson has written that poor science, coupled
with “media business, pharma business, pandemic business and
unaccountable decision-making,” are making a mockery of global policies
around the flu.
The problem starts with a semantic one, where “the flu” is equated
to “influenza,” a falsity which Jefferson writes “is now so ingrained in
the popular and sometimes professional mind that governments and
public fall prey to its greatest consequence: that of overestimating the
impact of influenza, which is usually a benign self-limiting infection.”
Beyond semantics, we need to consider the basic epidemiology of
the flu. There are over 200 viruses that cause influenza and influenzalike
illness and can produce symptoms similar to the everyday flu. It is
estimated that 80 percent of flu-like illness reported during the “flu
season” is not caused by influenza. As well, influenza viruses constantly
evolve and mutate and since it takes up to nine months to develop
the right vaccine, by the time flu season arrives, the flu shot may or may
not match strains circulating.
Which is to say, fighting the flu is largely a hit-and-miss affair.
Jefferson wants to make sure flu policies affecting millions of people
are based on proper, undeniable proof. Of the many health authorities
around the world who support mass flu vaccine campaigns—those he
irreverently refers to as “bioevangelists”—he claims the science shows
they are mostly wrong: “There is no reliable evidence that inacti-
34 October 2012 • FOCUS
PHOTO COURTESY DER SPIEGEL