Flu Shots

[Skeptic Ginger]

...I highlighted it when I quoted you. I left the rest of the quote to allow for context of your thoughts.

And not knowing which of my two comments you were referring to, I addressed both. I see you are at a loss of words to reply.

 

[JEROME DA GNOME]

And not knowing which of my two comments you were referring to, I addressed both. I see you are at a loss of words to reply.

Are you playing a game?

I quoted you twice now and highlighted what you said!

Are you unable to justify what you wrote?

 

[Skeptic Ginger]

Could you please respond to post #138, Jerome?

 

[Sinope]

Just one question. If the flu vaccine is so obviously ineffective for the elderly, why do the NHS spend money on providing it (free) to over 65s (and a few other risk groups) in the UK? Its not like we just jump on the bandwagon and provide everything that is recommended in the US. We don't include the chickenpox vaccine for example (although they are re-examining that at the moment.

You could probably ask that question about other vaccines too. Look at Prevenar, the most recent addition. Now reccomended to all children despite evidence from the US that there was no real decrease in IPD. Actually since the vaccine has been introduced, pneumococcal meningitis in children under one has increased in the US. Some of the new serotypes are antibiotic resistant - the vaccine could actually do more harm than good. Yet it is now routinely given to most children. Why? "

When Pediacel was introduced in 2004 (after some "iffy" trials), it was recommended to the government by a committee that had at it's head Prof. Langman, who also happens to receive funds from MSD (the vaccine manufacturers) for research at his dept at Birmingham university. Conflict of interests?

Many other members of the JVIC have conflicts of interests with vaccine manufacturers. It really isn't much different here to the US.

I am pretty sure, from the evidence that they will not introduce the CP vaccine here. It is pretty ineffective long term and the increase in shingles is not desirable.

 

[Skeptic Ginger]

You could probably ask that question about other vaccines too. Look at Prevenar, the most recent addition. Now reccomended to all children despite evidence from the US that there was no real decrease in IPD. Actually since the vaccine has been introduced, pneumococcal meningitis in children under one has increased in the US. Some of the new serotypes are antibiotic resistant - the vaccine could actually do more harm than good. Yet it is now routinely given to most children. Why? "

When Pediacel was introduced in 2004 (after some "iffy" trials), it was recommended to the government by a committee that had at it's head Prof. Langman, who also happens to receive funds from MSD (the vaccine manufacturers) for research at his dept at Birmingham university. Conflict of interests?

Many other members of the JVIC have conflicts of interests with vaccine manufacturers. It really isn't much different here to the US.

I am pretty sure, from the evidence that they will not introduce the CP vaccine here. It is pretty ineffective long term and the increase in shingles is not desirable.

What do you base that conclusion on? And welcome to the board.

The recommendations for use of the vaccine here as well as the recommendation of who should get it and the supporting data for the recommendation can be found here in the ACIP report.

 

[JEROME DA GNOME]

Could you please respond to post #138, Jerome?

Sure, but post #138 is not following the quote it references.

 

[JEROME DA GNOME]

Are you referring to a single drug, or to the process of developing and introducing new drugs into the market place?

I was asking you if all benefits outweigh all detriments. This was based on your statement which I quoted.

For a single drug, the evidence is often incomplete until it reaches widespread use. Since one cannot foretell those side effects prescribers are conservative using newly developed drugs. We tend to use them when existing drugs are ineffective.

Agreed.

The alternative would be to never introduce new drugs. So, yes the benefit of developing and introducing new drugs as a whole by far outweighs the risks. We have lengthened the life expectancy and improved the quality of life for countless more people than those who have been harmed.

Agreed.

What would you suggest? Never introducing new drugs? Studying them in hundreds of thousands of volunteers before releasing them to the market? Delaying introduction of drugs with the potential to cure fatal diseases because the research is incomplete?

I would suggest allowing the market to play-out. Currently we have a system in which very well-funded drug companies have a great deal insulation from penalty because the governmnet has approved of potentially dangerous drugs.

As for Thalidomide^WP You are referring to something which occurred almost 50 years ago. Are you aware that the field of evidence based medicine really only began in earnest ~100 years ago? So you are using an example from the time when evidence based medicine was a mere 50-60 years old. Prescribers were not "duped" at that time. They had substantially less evidence to go on. Are you suggesting we should halt the progress we've made in a mere 100 years because for all the benefit there has been some harm?

I am not in any way suggesting that past learning be disregarded.

 

[Eos of the Eons]

I would hope vaccine manufacturers are paying someone to research vaccines before administering them to the entire population. Nobody is going to do it for free.

Prevnar’s effectiveness is not in question, says Davis: It prevents infections by Streptococcus pneumoniae bacteria that cause tens of thousands of potentially deadly bacterial meningitis and bloodstream infections each year, and untold millions of painful ear infections.

http://www.med.umich.edu/opm/newspage/2003/vaccinestudy.htm
http://www.prnewswire.com/cgi-bin/stories.pl?ACCT=104&STORY=/www/story/03-16-2000/0001167064&EDATE=

Better than antibiotics...

 

[kellyb]

I would hope vaccine manufacturers are paying someone to research vaccines before administering them to the entire population. Nobody is going to do it for free.


http://www.med.umich.edu/opm/newspage/2003/vaccinestudy.htm
http://www.prnewswire.com/cgi-bin/stories.pl?ACCT=104&STORY=/www/story/03-16-2000/0001167064&EDATE=

Better than antibiotics...

When it comes to the serotypes in the vaccine, yeah. It's one of the most effective vaccines ever made.
The problem is non-vaccine serotypes filling in the ecological niche left as a result of vaccination (especially mass vaccination) and doing all the things the old serotypes did.
Here in the US we're about to add 6 more serotypes to the vaccine to "fix" it, but there are about 100 pneumococcal serotypes, so more will probably just fill in the hole again. It'll never end.
We're also (here in the US) about to add a 4 valent meningococcal vaccine to the pediatric schedule. So it'll be....interesting...to see what happens next, and what emerges. Something will for sure, and the hope is that the new emergers will be milder than the vaccine types. But who knows?
We'll see, I guess.

 

[Eos of the Eons]

Of course it will never end. You get rid of the more damaging ones, and new ones will emerge. Don't get rid of the more damaging ones and new ones will emerge anyways. Might as well try to stay on top of the current damaging ones and keep up the research and new discoveries and try to keep the damage to a minimum.
Microbes will always be changing. That is what they do. There are far far far far far many more of them than us, and they will always be changing to exploit what others don't. That is the nature of evolution.

So, let's keep up as much as we can and eliminate the current and expected worst of the microbes. Our bodies can deal with the less damaging ones well enough. We do every day.

 

[kellyb]

So, let's keep up as much as we can and eliminate the current and expected worst of the microbes. Our bodies can deal with the less damaging ones well enough. We do every day.

But the ones that emerge do the exact same things as the old ones did. The net benefit, if it's there at all, is very, very small.
Pneumococcal meningitis (the ultimate bad outcome with pneumococcal bacteria) in kids under one has gone up, not down, since Prevnar use became widespread, and it's the non-vaccine serotypes that emerge doing it.
Just adding more and more and more serotypes to the vaccines for forever and ever and ever seems like a strange way of going about things to me.

Like, what's going to happen to the meningococcal B serotype once Menactra is used universally?
It's already been one of the "worst" serotypes. Won't removing serotypes A,C, and Y just make B go bonkers?

 

[Eos of the Eons]

Since when has it gone up? Since they actually began to diagnose them? Not every doc takes a swab, not every doc ever takes a swab. Once something comes on the radar in an area, then they attempt to get more confirmed diagnoses.

And, like I said, microbes are going to change anyways. Let's keep up the research and stay on top of the most harmful ones. Sure doesn't hurt.

TB is still on the radar, but the outbreaks were much much worse 30 years ago. Outbreaks are quarantined and actions are taken much more quickly now. Far less people get it. The vaccine is barely used, but available.

Flu shots are redone each year to keep up with new strains.

The alternative is to just let people die. If that's what you're suggesting, then NO THANKS.

 

[kellyb]

Since when has it gone up? Since they actually began to diagnose them? Not every doc takes a swab, not every doc ever takes a swab. Once something comes on the radar in an area, then they attempt to get more confirmed diagnoses.

.

The CDC has been doing surveillance for a while...
Click through the s.pneumo stats from 2001-2002 to present, and watch deaths in kids under one and 2, and meningitis...

http://www.cdc.gov/ncidod/dbmd/abcs/survreports.htm

Prevnar was approved for use in 2000, but they had manufacturing issues through most of 2001, and in 2002, uptake was still at 40%.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5231a2.htm

In the past few years, the vaccine serotypes have been eliminated more or less, but the non-vaccine serotypes stepped in immediately. The difference is small, but pneumococcal deaths in kids under 2 and meningitis seems to be ever so slightly going up according to the ABC data.

Let's keep up the research and stay on top of the most harmful ones. Sure doesn't hurt.

But it looks like the most harmful ones are whichever ones have "room" to be most harmful, and when you go removing big chunks of the human bacterial flora, you don't really know what's going to happen next. 6 more pneumococcal serotypes plus 4 meningococcal serotypes is a fairly significant change. How does anyone know what emerges next won't be a lot worse?

 

[Skeptic Ginger]

Originally Posted by skeptigirl
Are you referring to a single drug, or to the process of developing and introducing new drugs into the market place?

I was asking you if all benefits outweigh all detriments. This was based on your statement which I quoted.

Again you refuse to answer a simple request for a clarification so I may respond to your answer. I am done trying. If you ever care to answer that simple request for that simple clarification I will answer. Try re-reading the posts. I will not provide further spoon feeding to you on the matter.

Originally Posted by skeptigirl
What would you suggest? Never introducing new drugs? Studying them in hundreds of thousands of volunteers before releasing them to the market? Delaying introduction of drugs with the potential to cure fatal diseases because the research is incomplete?

I would suggest allowing the market to play-out. Currently we have a system in which very well-funded drug companies have a great deal insulation from penalty because the governmnet has approved of potentially dangerous drugs.

This is absurd. Drug companies have been held accountable for outcomes not revealed at the time of marketing on numerous occasions. What country are you in?

Originally Posted by skeptigirl
As for Thalidomide^WP you are referring to something which occurred almost 50 years ago. Are you aware that the field of evidence based medicine really only began in earnest ~100 years ago? So you are using an example from the time when evidence based medicine was a mere 50-60 years old. Prescribers were not "duped" at that time. They had substantially less evidence to go on. Are you suggesting we should halt the progress we've made in a mere 100 years because for all the benefit there has been some harm?

I am not in any way suggesting that past learning be disregarded.

So here you are admitting and agreeing to prescribers not being duped and that the system has great benefits along with recognized risks. What is your beef then? With the exception you think falsely that drug companies are over-protected by government from liability, you have no issues.

There are many things in the pharmaceutical industry which need constant monitoring and continual improvement. But the system, overall, has been beneficial in no uncertain terms.

 

[Skeptic Ginger]

The emergence of resistance is greater/faster with treatment than with prevention. With treatment you have an actively multiplying organism and the potential for resistance to emerge is related to the numbers of replications within the environment adaptation is at issue in.

With vaccine the resistance is dependent upon a susceptible host or niche as the opportunity for a resistant strain to emerge. So there are less organisms competing, but there are not more organisms actively multiplying in the niche or host. Ergo the odds are much lower that a resistant strain will find that niche or host.

In either case the alternative is to not stop the infection, clearly a poor option. So vaccines and prevention remain preferable to treatment or no intervention.

 

[JEROME DA GNOME]

Again you refuse to answer a simple request for a clarification so I may respond to your answer. I am done trying. If you ever care to answer that simple request for that simple clarification I will answer. Try re-reading the posts. I will not provide further spoon feeding to you on the matter.

Let me explain how a conversation works.

When I ask you a question the fact that you ignore the question and question me about something which I did not assert does not give you the right to claim I am refusing to answer.

In fact; I did answer your question, despite you not answering mine. You have still not answered the original question I asked which began this conversation between you and I.

Please read the thread before posting. This will allow for reasoned knowledgeable conversation.

 

[Skeptic Ginger]

I will not spoon feed you, Jerome. Go back and reread the exchange.

 

[JEROME DA GNOME]

I will not spoon feed you, Jerome. Go back and reread the exchange.

I am interested and enjoy your thoughts; I am saddened that we are having a hard time having a conversation.

I hope that you can forgive my incompetence and allow for future conversation.

 

[Skeptic Ginger]

Of course.

And, BTW, I'm not upset you can't clarify your question. I am just refusing to play what I see as a game.

 

[robinson]

Here, let me clear all this for you.

Were not prescribers duped as to effects of the drug thalidomide?

No, not at all. There is a known risk in prescribing any drug that side effects not apparent in drug trials might show up when the drug is released and more widespread use occurs. The overall benefits of bringing new drugs to market by far outweigh the risks that some of those drugs are going to harm people.

Really, so the benefit always outweighs the harm?

Are you referring to a single drug, or to the process of developing and introducing new drugs into the market place?

For a single drug, the evidence is often incomplete until it reaches widespread use. Since one cannot foretell those side effects prescribers are conservative using newly developed drugs. We tend to use them when existing drugs are ineffective.

The alternative would be to never introduce new drugs. So, yes the benefit of developing and introducing new drugs as a whole by far outweighs the risks. ... Are you suggesting we should halt the progress we've made in a mere 100 years because for all the benefit there has been some harm?

I am referring to what you wrote.

I highlighted it when I quoted you. I left the rest of the quote to allow for context of your thoughts.

I wrote about both. Which of the two things I wrote about were you referring to?

Ducking my answer I see. No comments I take it, on what would you suggest be done to correct this injustice you perceive?

And not knowing which of my two comments you were referring to, I addressed both. I see you are at a loss of words to reply.

Are you playing a game?

I quoted you twice now and highlighted what you said!

Are you unable to justify what you wrote?

Could you please respond to post #138, Jerome?

Sure, but post #138 is not following the quote it references.

See? Now it all makes sense.