**October 2012 Focus - Focus Magazine

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MEDIATION
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PATRICIA
LANE
C. Med, LL.B
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more appropriate to call the collection of symptoms
“influenza-like illness.” As Jefferson says,
“the confusion between influenza and influenzalike
illness has led to an obsession with a single
agent [the influenza virus] which is not based
on any sound evidence.” With most of the extra
illness suffered during flu season not caused by
a verifiable flu virus, the situation, says Jefferson,
is “potentially dangerous and misleading”
because even if the best vaccine can prevent a
proven flu virus, you’re only able to help a small
portion of the people who become ill.
Jefferson served with the UN during the
Yugoslav crisis, and reports: “I also observed
the effects of ILI in terms of working days lost
on British and UN soldiers.” In his opinion,
“High rates of ILI were associated with stress,
overcrowding and, of course, combat.”
Just not enough evidence
Nearly two decades later, Jefferson worries
about the absence of quality research around
other potential causes of flu-like illness, including
the role of stress. Compared to the serious
global moneymakers—the vaccines and antivirals
which bring billions to the coffers of drug
companies every year—something as simple
as stress and its relation to the flu is simply not
studied. There are some efforts to study methods
to prevent virus transmission (masks and handwashing),
but compared to the huge annual
drug and vaccine enterprise focused on a virus,
these efforts seem pitifully small.
The fact that a physician steeped in military
tradition and respect for authority would turn
out to be one of biggest anti-authoritarians in
the influenza world is a delicious irony. Jefferson
admits it is “absolutely heresy” to even imply
that stress may play a role in causing the flu.
He adds, it “undermines the living of very
many people, and goes against the dogma of
people selling vaccines and pills.”
The best way to counter the dogma is to
find the most reliable evidence—preferably
from an overview of all relevant studies, known
as a meta-analysis. And that’s Jefferson’s game
as part of the Cochrane Collaboration
(www.cochrane.org), an international organization
of consumers, scientists and researchers,
gathering and systematically examining all the
studies ever conducted to see how well a treatment
works. Cochrane’s work is unique in at
least two ways: it won’t take money from the
drug or vaccine manufacturers to fund its
research, and it uses the highest gold-standard
methodologies when synthesizing research.
The Cochrane examination of flu vaccines
in healthy adults, a body of literature span-
ning 25 studies and involving 59,566 people,
finds an annual flu shot reduced overall clinical
influenza by about six percent. It would
reduce absenteeism by only 0.16 days (about
four hours) for each influenza episode, a small
effect given that the average flu bout lasts five
to seven days. What was most illuminating
was the authors’ conclusion: “There is not
enough evidence to recommend universal
vaccination against influenza in healthy adults.”
Jefferson and his colleagues found that most
influenza studies are poorly designed and fail
to prove the influenza vaccine is effective or
safe for certain groups, such as the elderly and
children under two. (In Canada, parents might
be surprised to hear that Canada’s National
Advisory Committee on Immunization recommends
flu shots for kids six to 23 months old.)
Canada isn’t the only country with recommendations
out of sync with the evidence.
Earlier this summer, the UK’s National Health
Service reported that they needed to find 1000
extra school nurses to give the flu vaccine to
healthy children for the upcoming flu season.
This was in response to government plans to
expand the vaccination program to all children
aged two to 17.
This decision was based on a series of
computer models estimating that if 30 percent
of the population were vaccinated for the flu,
then there could be a reduction of 2000 deaths
and 11,000 fewer hospital admissions. Expanding
the program to children, seniors, pregnant
women, and people who are considered at
“higher risk,” would cost about $150 million
per year, as reported in the UK’s Guardian
newspaper. But will all that money actually
deliver fewer deaths and hospitalizations?
The answer is “probably not.” Jefferson
and others contend that using a computer
model as the justification for an expanded flu
vaccine program is very problematic. Tweak
any of the assumptions in the model and you
get what you want. Such an expanded program
surely would please British-based pharmaceutical
giant GlaxoSmithKline, a big player
in the flu game—and should remind us of the
politics of money behind any large public
health program.
Immunizing BC’s healthcare workers
In late August, Provincial Health Officer
Dr Perry Kendall announced that BC’s health
care workers must either wear a mask or
get the flu shot this season. His stated rationale
was to improve the level of vaccination
amongst health workers, which currently
hovers around 40 percent.
36 October 2012 • FOCUS