Against the Grain with Dr. Chad Edwards | Tulsa Sports Injury| Podcast 6 – Part 4
Chad: Yeah, absolutely.
Bryan: We see a decline in those things because of the care.
Chad: Absolutely. This paper by Langmuir, he went on to say, he was questioning should we be routinely vaccinating people against the flu. The paper further said that routine immunization, he wondered whether it should be continued without better evidence to justify the major costs to the general public. Despite those questions, annual vaccination continued.
In 1968, the CDC performed an actual randomized, double-blinded trial. These are the gold standards of medical evidence trials to examine whether that vaccination made a difference in morbidity and mortality. The authors of that study concluded, “Despite extensive use of influenza vaccines, attainment of improved morbidity and mortality has never been demonstrated.” 1968.
We’re seeing, over time, a trend. 1976, H1N1, the swine flu appeared and large-scale efforts to immunize as many people as possible was launched. We think that immunization is going to be helpful and beneficial. We’ve got to do something. They didn’t see the level of disease that they anticipated, but they did see something else and it was one of the side effects that we can see with some of the flu vaccines and it’s a condition known as Guillain-Barré. Guillain-Barré, basically it’s kind of an autoimmune cross-reactivity of the antibodies and you begin to attack your own system. It produces this progressive paralysis. You are paralyzed, basically starting in your feet and working up. That can be potentially fatal and most of the time we recover from it, provided you receive adequate treatment in the short term. That epidemic of Guillain-Barré led to the cancellation of that widespread vaccination program. In an 1977, the CDC concluded that influenza control had been, “generally ineffective,” and that, statistically, valid community trials were needed. We needed more research.
In 1995, there was a major review by the U.S. FDA, the Food and Drug Administration, which acknowledged the ongoing “paucity of randomized trials”. Again, we don’t have enough data, we don’t have enough data, we don’t have enough data. Now I’m seeing an emerging trend basically suggesting that we’re not seeing evidence from this, so that means we just don’t have the studies to prove that it works. In other words, the underlying theme is, “We know this works, we just don’t have the study to prove it works.” My concern is is your outcome that this works and we try to find the data to fit that or is it being objective and saying, “Maybe this doesn’t really have as much effect as we think and it just is what it is.” That’s something that I want to file in the back of the brain.
They warned about serious methodologic flaws in many existing flu vaccine studies. Now that is a big, big issue today and we’ll talk a little bit more about that. In 2000, the CDC performed a placebo-controlled trial, so we’re again comparing two different groups, and found that vaccination, when compared to placebo, “may not provide overall economic benefit in most years.” Again, starting in the 1940’s up through 2000, we’re seeing some major organizations saying this just doesn’t have that much effect.
Regardless of all of that stuff, in 2004, the American Academy of Pediatrics said that, “Annual influenza immunization for young children, household contacts, and health care providers, should be performed,” in 2004 despite the lack of evidence to support that. Then they continued to expand these vaccine recommendations and said, “Well, we’ve got to get everybody vaccinated.”
You and I have talked about The Cochrane Review. The Cochrane Review is a collaboration. It’s a group of people that review data, that pull the relevant studies. They look for bias. They look for good, quality studies. They look for consistency. For the most part, they do a really, really good job. In 2012, they did a systematic review and meta analysis of all the available flu shot immunization data, examining the efficacy and effectiveness, and that’s another term that we’ll discuss in a second, of these licensed influenza vaccines in patients with confirmed influenza illness. Their original statement was, “Recommendation to vaccinate the elderly was made without data for vaccine effectiveness or efficacy.” Then they went on to say we need a better vaccine and better studies to demonstrate its effectiveness. Again, that same thing, “We’re trying to prove that this stuff works even though we are consistently having difficulty proving that.”
2005, they did a study of 33 seasons. In other words, we’ve got flu seasons. We’re in the flu season now. They did a study of 33 seasons, national data set, and they attempted to reconcile the reduced, all-cause mortality and morbidity found in some observational studies of influenza vaccination, and the fact that “national influence and mortality rates among seniors increased in the the 1980’s and 1990’s as the senior vaccination rate quadrupled.” In other words, their mortality increased, but yet four times as many of them got the flu shot.
Again, you’re taking a big melting pot, you’ve got the people in there, you’re throwing in some vaccinations, and you’re looking at what happened on the other side. We threw in more flu vaccine, yet more people died. We can’t say cause-and-effect. Cannot say that.
Bryan: If you look at the totality from the ’40’s all the way to the present-day, it’s hard to detect any public health impact, right?
Chad: That has not been demonstrated. That’s correct.
Bryan: How in the world, as a doctor, do you look at the landscape of that and say that the rate at which people continue to be immunized from the flu and how does that perpetuate itself? How does the average doctor in a clinic not have availability to these same studies and availability to the same knowledge? What’s the counter? How can they justify their position?
Chad: It’s because we are taught. We are creatures of what we’ve been taught. We’ve been taught. We’re told by the CDC.
Bryan: The CDC is saying that it’s ineffective, though, in some cases.
Chad: If you pull up the CDC’s website and basically just ask the question, “What should we do about flu,” their very first recommendation is, “Get your flu shot.”
Bryan: There’s no overwhelming evidence to suggest that it works.
Chad: Correct, but you have to dig to look for that.