(no subject)

[meganursula]

I think this article is well worth reading.

http://www.wired.com/magazine/2009/10/ff_waronscience/

For the record, i think there is room for people to evaluate their vaccination approach. Something i like about this article is that is discusses many of the details in the debate which i think are too often poorly understood or just plain ignored by people.

There are a number of things i would quote from it, but perhaps the most salient for today is “The choice not to get a vaccine is not a choice to take no risk,” he says. “It’s just a choice to take a different risk, and we need to be better about saying, ‘Here’s what that different risk looks like.’

While people are wondering about flu vaccines, and novel H1N1 vaccines, i think we should keep this in mind. I do fall prey to the tendency to want to avoid the vaccines - both of them - because it is an unknown, and because i am currently healthy under the status quo. Why take a risky action when i can avoid it? The answer, of course, is that inaction is also a decision that carries some risk*, and all the current evidence suggests that for me, and my family, at this time, inaction is far more dangerous than the actual action. But, while my head can accept that, my gut still gives me trouble.

My out, of course, is that H1N1, the vaccine that i, particularly, should have this fall, but which is also more frightening because i haven't had it before, isn't available. So i have to hope that no one with exposed symptoms of swine flu rides the bus with my pregnant self, but i'm saved from a decision so far.

* complete aside - this, of course, applies to other areas in my life. Like my job.

Comments

[angelbob.livejournal.com]

It's worth pointing out that the "15% of third-trimester pregnant women who get H1N1 die!" scare statistic is based on only a single death, at least as of the last time I checked. There just aren't many cases in that category, and one woman had several complicating factors (including asthma, a severe one) and died.

My wife's been doing a fair bit of research on this. If you go to the CDC web site and look up "pregnant" and "H1N1" as of May 2009 (yes, slightly out of date), there have been 20 total cases estimated (15 confirmed), three hospitalizations, and one death with severe pre-H1N1 complications.

There have also been a couple of articles recently, including one in Atlantic Monthly, that actually call into question the effectiveness of flu vaccines generally, though that's more for seasonal flu and less for H1N1 -- that vaccine barely exists, so it's not really studied.

I'm not going to say "so therefore you shouldn't get the vaccine!". Rather, I'm going to say, "common wisdom says to get the vaccine, and research isn't ready to support either side of this issue yet, so consider whether a new and untested vaccine for a disease of unknown danger is a good bet -- and consider it without much actual information :-("

On the other hand, constant hand-washing, staying home if you're sick and avoiding potentially infected individuals are all very well proven methods, and very good ideas.

[bhudson.livejournal.com]

Death is pretty depressing for everyone around you. But hospitalization, and even just being laid-up for a week, also aren't a lot of fun. Compare that with a vaccine that has been used by millions annually for years now without major issue (albeit a different strain, but they change strains annually), and you get...

oh right, a massive shortage.

[mh75.livejournal.com]

1) My local hospital has been recording numerous complications from swine flu in pregnant women. I don't care about whatever scare statistic you quoted - i have not been told that statistic. What i do care about is that women are being hospitalized at relatively high rates to control fever, prevent premature birth, and treat complications ranging from respiratory distress to mental confusion and hallucinations. These experiences have increased in the past month - statistics from May aren't going to cut it.
2) I have asthma
3) Vaccinating myself can help prevent infection for me, my two very young children, and my close friend who is undergoing chemo.
4) Suggesting that the vaccine is untested is as misleading as suggesting that we'll all die without it. This vaccine is similar enough to that normal annual flu vaccine that we can draw some conclusions about its safety and efficacy.
5) Sure, i believe in good hygiene, except that i live in a community where people are prone to choosing not to vaccinate and rely on herd immunity - meaning herd immunity is lower. (Or, if you prefer that i am less inflammatory, i ride the bus to my job at a university. Both Buses and Universities are prone to having sick people wandering around.)

In short, i actually do a fair amount of reading on this stuff, and i ask a number of questions. I recognize that we have no sure answer, but, everything i've read leads me to believe that the CDC's recommendations for vaccinations really are the most conservative bet for retaining long term health - both for myself and for my family.

[angelbob.livejournal.com]

Fair enough. Those are good reasons.

On number 4, there are also some pretty big question marks on the efficacy of the seasonal flu vaccines, though more for preventing hospitalizations and deaths than for preventing spread. One really nice thing about the H1N1 vaccine is that it *is* tailored to a specific strain of flu, which is a lot of where the seasonal ones fall down hard.

[mamagotcha.livejournal.com]

I picked that issue up at my dad's house, and was immediately turned off by the assumption that those who choose to selectively vaccinate were driven by fear (just the damned COVER was enough to make me feel defensive and unwilling to give the article a shot, ahem). I don't think I'm driven by fear, but I DO have a LOT of fear-based "information" shoved at me by doctors ("do you want your baby to DIE?") and relatives ("iron lungs!").

Just like so many other aspects of parenting, vax or no vax is an assumption of risk. As the parent, you choose the risks you're willing to accountability for.

The one piece of advice I do give my clients when they ask is that they MUST do their research and own their decision, and NOT give it over to someone else (doctor or relative), because once you give a shot (or circumcise, or quit breastfeeding, or whatever), you cannot take it back. You MUST be certain of your decision, and willing to accept the consequences. Once you are aware and at peace with your decision, you'll be in a much better position to deal with whatever comes along.

Being uneducated and choosing to do nothing is very different from analyzing your choices and conscientiously choosing a particular path.

There's a LOT of fear-based decisions going on in parenting right now. The biggest reaction I got in KC when Julia started going to college at age 13 wasn't "Wow, that's cool" but rather "You're letting her take the BUS?"

I think there's far more fear involved in the mass marketing of vaccines than there is in the decision to not use them. I suspect that if there was a study done showing the long-term affects of extended breastfeeding and not vaxxing on auto-immune-related disorders (diabetes? Crohn's? asthma? eczema? allergies? autism?), the decision would be a lot clearer for most parents. But there isn't such a study, and until then, parents will just have to piecemeal their decision together based on a patchwork of studies that look at a very tiny window of affects.

[mh75.livejournal.com]

I'm not trying to choose sides here. I think that parents can evaluate the vaccine schedule for their own conditions - i suspect that some modified schedule is going to work best for most people. I think people can evaluate the flu vaccine for their own conditions, and some people may opt out of it.

I have not read the whole magazine, i just came across this article on line. So i can't comment on design decisions about the cover or whatnot. I will say that i am interested in statistics and historical information, which i find easier to come across through medical literature and my doctor's office than in on-line anti-vaccine advocacy groups.

I agree that there is a lot of fear being peddles towards parents - on almost every level, and with every decision. Most of it is unwarranted (as fear - it may be warranted as further information to consider while making a decision). I don't suppose that either side of most arguments is immune to using scare tactics or heart-wrenching (warming) anecdotes to sway people to their side.

All of which leaves me in my original position - i think this article has some interesting discussion of aspects to the vaccine question that i think most people ignore or lack exposure to. I have thought, for a long time, that one reason people are so fearful towards vaccines is that we no longer have a social memory of the types of diseases that these vaccines are protecting us from. I appreciate that this article pointed out that, while vaccines may carry risks, so do those illnesses. Choosing not to vaccinate is not risk free.
There is also a well documented human tendency to stick with the status quo - even when overwhelming evidence suggests that a change in course would be more beneficial. (People who are educated about retirement funds, and convinced that it would be beneficial to them all around to increase their contributions, still tend to stick with the current level because it does not require action.) I think this also weighs into something like whether to get the flu vaccine - we are okay now, we have been okay in past years, perhaps often without the vaccine. Why change? I am far from immune to following the path of least resistance.

In other words, i don't particularly care to have an argument about whether or not to choose a particular vaccine. I suspect i will continue to vaccinate both myself and my children unless conditions change, and you will continue to avoid the procedure. However, i think we can both benefit from remembering the above issues while we are making our decisions.

I also wish that i thought that a greater portion of the population actually had the education and the access to information to do the thorough analysis that makes you and i so comfortable with our decisions.

[cheesepuppet.livejournal.com]

I think I told you once about the friend of mine who didn't vaccinate her child. I'd always supported her, and looked up to her as this kind of brave hippie mama for bucking the status quo. Then, while I was pregnant with Beth, I was notified by her that her pediatrician and some county official strongly suspected her kiddo (whom I loved dearly) had rubella, after we'd all been playing together for a few days. I was told to be on standby basically, that I could have contracted it, and that Beth could end up deformed or miscarried. That changed the whole debate for me.

Thankfully, her kid turned out fine, but it took me a long time to overcome a private resentment I had toward her, that she had put me and my unborn child in that position. I don't think I could have forgiven her had I contracted the disease and Beth suffered complications. I don't know how she could have forgiven herself if her child had gotten sick and suffered permanent damage.

I think Katje is very right; that you choose the risks you're willing to be accountable for. And I think you're right when you say that people today no longer have the social memory of what these diseases can do, and certainly right now we have a lot of distrust around the government and whatever they recommend to us. I am happy to vaccinate my kids for their childhood diseases, but I find myself balking every time I sit down to schedule flu shots for all of us.

I thought the article was right on when it said that throughout history, it's rationality that's the anomaly. It bothers me deeply that this guy is getting death threats from people for basically being a scientist, but that's another issue altogether.

[mh75.livejournal.com]

And yet, flu is probably more likely to actually cause problems than many of the standard childhood diseases, and getting all adults vaccinated seems like it would feel safer than getting your infant vaccinated. I often end up with it because of my asthma, but i've never really been sure that it was necessary. Weird, isn't it?

I think some of the reason that the whole vaccine thing has grown into such a huge issue is that we see a threat to our kid - either way we perceive the threat to be - and respond completely animalistically. But, jeesh, yeah, i find it hard to sympathize with someone who would threaten someone who was really doing their best to do something great.

[cheesepuppet.livejournal.com]

I'm not sure about that. I mean, would you rather contract the garden variety flu as a pregnant mom, or Rubella? Would you rather M got the flu, or polio? I'd go with flu, personally. I agree it would make more sense to vaccinate adults, but logistically that's a much bigger nightmare than vaccinating kids.

I should do my own research about the regular flu vaccine. You guys say above that there is ample evidence of its effectiveness, but I've always heard very mixed things. Which means anecdotes, which means I should actually look up some studies. Whereas, with the childhood disease vaccines, we have years of proof that they work, so I'm much less concerned. Beth has a lot of bronchial problems in the winter (I hear her coughing right now, in fact), so I'm thinking we should go with getting the vaccine this year. :\

[mh75.livejournal.com]

Well, right now, far more people get the flu than get these childhood diseases. Also, because of the symptoms at the onset of contagion, and people's general awareness, it feels like you're much more likely to catch the flu than some of these other diseases. Additionally, you have a renewed risk for flu complications every year. I mean, i don't want the other diseases running rampant, either. I guess i was just thinking that we could really limit the spread of flu just by vaccinating every adult at work, without exposing kids at a sensitive time in their development.
And, in another sense, while i'm perfectly sure that i see value in vaccinating kids against whooping cough (one of the more realistic current concerns), i don't see how i wouldn't extend that conviction to vaccinating myself against the flu? If i want my neighbor to be vaccinated against rubella, shouldn't i vaccinate myself against flu, which could kill my immune compromised neighbor?

eh, maybe something to think about.

As to studies of safety in the flu vaccine - despite the fairly large number of people who don't bother with it, large portions of the population (percentage depending on year) have been getting vaccinated for decades. Evidence shows that it is 70-90% effective in preventing flu, and can reduce complications in those who do get the flu, depending on the year and composition. (The vaccine takes about two weeks to take effect, is less effective if it is the first year it has been received, and occasionally faces a mismatch between which strains of flu are included and which are present in the wild, which is why it is imperfect.) Rates of severe complications are shown to be much lower than rates of complications from flu.

If you do get the flu vaccine you can discuss with your doctor activated vs. inactivated (which have different statistics and uses). If you get your kids vaccinated you can request a single dose (mercury free) version. (You can do that for yourself, too, but, they usually limit who can have them due to manufacturing limitations, and there is compelling evidence that it doesn't matter anyway.)

[angelbob.livejournal.com]

Aren't all US vaccines mercury-free at this point? Or this is one of the (few, and I thought now zero) exceptions where they really need a powerful preservative?

[mh75.livejournal.com]

Seasonal flu vaccines in a multi-dose vial have a mercury preservative in them. The also manufacture the vaccine in a single-dose vial, but because it is harder to produce those in large numbers, they tend to reserve them for children.

[oneroom.livejournal.com]

I love your posts generally, but this one seems to cover so many of the reasons I love them. It's thoughtful, informative, and (I think) balanced. It applies both to the specific situation you're presenting and to broader life experiences.

All this to say: thanks. :)

[mh75.livejournal.com]

wow, that is so sweet of you, and i'm really flattered that you would think so. Thank you!

[hosterman.livejournal.com]

I second the above comment. Thanks.

[cheesepuppet.livejournal.com]

Seen today on a list for massage therapists:

know they want tsave pregnant moms but the mercury level in ANY flu vacc is soooooo high
i again side with dr m
mom of 4 never had vaccines neither have my kids and amazingly have never in 39 years had the flu nor have my kids . My brother and sister are also not vaccinated at all nor are my nieces....


Kellee
www.HolisticSunshine.com

*headdesk*

[mh75.livejournal.com]

I don't know where people get information from. Of course, i can't swear mine is all accurate, either, but, it seems like i can look at a number of reputable sources and come up with the same conclusions...

Aside from the availability of vaccines with out any mercury, the amount of mercury in a flu shot is less than you would normally get from eating a tuna sandwhich...

But, its nice to be lucky enough to never get the flu regardless of what you do.

[cheesepuppet.livejournal.com]

We tried to get vaccinated today, and Virginia Mason is saying that they won't have any more until mid-November. :( I'm really worried about Beth, because of her bronchial issues, but the doctor today didn't seem to think there was anything we could do.

[mh75.livejournal.com]

Yeah, its really frustrating, but i don't think there is much that can be done - aside from normal hygiene practices.

If you know that Beth is exposed at any point the doctor may agree to put her on tamiflu so she doesn't get the illness. They don't want to give it to just anyone, because that would increase the chances that tamiflu resistant flu started to spread, but they will if you have a special reason to be concerned.