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SKEPTOID BLOG:

If You Know Anyone Afraid of the Flu Shot, Show Them This!

by Stephen Propatier

October 20, 2016

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Donate Internet memes are constant reminders of how unstructured information sharing is. I see memes through the prism of scientific skepticism and critical thinking and the most frustrating aspect is how they can be used to disseminate dangerous ideology and disinformation. There is no end to the structured disinfo out there—from creationism to anti-vaccine doggerel—everywhere on the Internet. Fear mongering has become an art form in promoting the agendas of ideologues, often using reasonable-sounding but myopic anti-science propaganda. This is especially dangerous during flu season.

Fear mongering plays on our fallible human brain, our innate fear of the unknown,with a dash of the precautionary principle to structure a scare tactic. The anti-science themes and memes are artfully packaged to frame the conversation to their agenda. Facebook popularity makes it ground zero for such nonsense. Given the fact that the Influenza season approaches there is little surprise that the anti-vaccine disinformation machine throws its annual fear pamphlet out on Facebook for all to pass around. Fear mongering about the flu vaccine with exaggerated or false claims. Dressed up nicely with click bait headlines, scary words, and ominous claims of experts and research. Lets turn our skeptical eye to a viral Facebook article that personifies false anti-vaccine arguments.

A salacious listicle from LoveThisPic.com, titled "If You Know Anyone Thinking Of Getting A Flu Shot Give Them This!" [sic] has recently been circulating on Facebook. This is complete and utter bunk, anti-vax propaganda, written with just the right amount of science-y sounding words and tired, disproved vaccine claims to give the average person pause. Since a lay person would most likely Google the claims, they will see an avalanche of anti-vax sites duplicating those false ideas. It raises the likelihood that an honestly concerned person will get inaccurate confirmation of those fears. Let's pull apart this tent of lies and give you the real answers that the anti-vaccine crowd doesn't want you to know.

So here are 11 lies about the flu vaccine, revisited:

1. The flu shot makes you sickMostly wrong. Although live attenuated influenza vaccines (LAIVs), such as flu mist, could possibly give an active but very weak case of the flu, it is almost unheard of. That kind of nasal LAIV is not available this year; all forms of vaccine are either recombinant proteins or a complete killed virus. Although some people feel slightly ill after taking the vaccine, this is just the immune system reacting to the vaccine and making antibodies to destroy the actual disease. It has none of the cell-damaging effects of the actual disease.

2. Flu vaccines contain other dangerous ingredients such as mercury—Wrong! First, it's important to note that almost no flu vaccines even contain thimerosal, and children are not given thimerosal in the vaccines they receive. The only US vaccine left with thimerosal is Fluvirin, from Noventis, which contains 0.0000001 grams mercury per dose. (You inhale more mercury from air pollution than you get from a dose of Fluvirin.) It is only given to adults. Neither single-dose shots nor nasal spray versions of the flu vaccine contain any mercury compounds. The multi-dose flu shot does contain a preservative called thimerosal, which breaks down into 49% ethylmercury and is used to prevent bacterial contamination of the vaccine container. It's important to understand the difference between two different compounds that contain mercury: ethylmercury and methylmercury. They are totally different materials.

Methylmercury is formed in the environment when mercury metal is present. If this material is found in the body, it is usually the result of eating some types of fish or other food. High amounts of methylmercury can harm the nervous system. In the United States, federal guidelines keep as much methylmercury as possible out of the environment and food, but over a lifetime, everyone is exposed to some methylmercury.

Ethylmercury is formed when the body breaks down thimerosal. The body removes ethylmercury from the blood quickly. Low-level ethylmercury exposures from vaccines are very different from long-term methylmercury exposures, such as from tainted foods, because ethylmercury does not stay in the body. Again, you consume more mercury from air pollution than you could from the only vaccine that has thimerosal.

3. The flu shot can cause Alzheimer's disease—A bald-faced lie. All the best evidence at this stage is that Alzheimer's is a genetic disease. There is no credible evidence for this claim at all.

4. The people pushing flu vaccines are making billions of dollars a year—This is wrong in so many ways it's beyond wrong. Even if it were true, so what? If vaccines are profitable it doesn't automatically mean they're useless and deadly. Many products make multiple billions of dollars and are totally safe. Companies don't just recommend flu vaccination—medical professionals do. There are plenty of medically literate vaccine supporters who don't get a dime. I, for example, support vaccines and I have written extensively in favor of vaccines. I am an orthopedist with no financial interest in vaccines in any way. We don't even have them available to give to our patients, any more than I have antibiotics.

But let's ignore the fallacy of the main statement and put this in context of the worldwide sales of all pharmaceutical products in 2013—nearly $1 trillion worth of sales. Various flu vaccines make up less than 0.3% of worldwide sales of "Big Pharma," so from a strategic point of view, they're not that interesting an incentive. Just for context, cholesterol-lowering drugs, e.g. statins, made more than $33 billion two years ago. If I were a Big Pharma executive, I'd be telling my R&D and marketing divisions to invest in new statins, because the potential return on investment could be 10x higher. And that's exactly what they do. In 2013, the top-selling drugs were daily medications, such as for diabetes, pain, inflammation, blood pressure, cholesterol, and depression. A single-dose-per-year medicine doesn't make much difference to the bottom line of drug companies.

Let's examine those sales in context of the three biggest companies in this particular vaccine sector:
Sanofi Pasteur: Total sales $41.6 billion. Flu vaccine sales $1.3 billion. In other words, flu vaccine makes up around 3% of their sales

Glaxo SmithKline: Total sales $32.3 billion. Flu vaccine sales $420 million, or 1.3% of their total sales.

Novartis: Total sales $57.9 billion. Flu vaccine sales $215 million, or 0.4% of their sales.
Note: the remaining $1.1 billion in flu vaccine sales is spread over 15 other manufacturers, none of whom have a major market share. And much of these sales are to public organizations (which cap prices) and to developing nations.

If Big Pharma were run solely for profit over all other considerations, then they would stop making vaccines. (Indeed, some have.) It is far more profitable to treat the disease than it is to prevent it, which, ironically, is a common half-baked claim about modern medicine by the anti-science ideologues. If pharmaceutical companies stopped selling flu vaccines, it is estimated that there would be an extra preventable 78,000 hospitalizations in the USA. In addition, the estimated annual deaths from flu would probably be 6,000 to 100,000 individuals. Setting aside the costs of lost productivity and deaths from the flu (tens of billions of dollars), hospitalizations alone would cost around $4,000 per individual, or a total of nearly $300 million. Furthermore, in a full-blown flu outbreak, millions of individuals would visit their physicians and emergency rooms, adding another $1 billion or more in health care costs. And that's just the USA. These costs would probably be three to five times greater if we looked at the whole planet. And Big Pharma would capture about 30-40% of those healthcare costs, for consumable supplies, drugs, treatments for secondary infections, and other products. And these products have a much higher gross profit than vaccines.

In other words, if we assume that pharmaceutical company decisions are strictly driven by cold blooded profit, it might make more sense to under produce enough vaccine or stop selling the flu vaccine altogether, and sell supplies to the hospitals and physician offices. But that isn't the case, obviously. It would also be extremely short-sighted and dangerous.

5. Lack of real evidence that young children and the elderly even benefit from the flu shots—This is a very harmful lie. The most vulnerable populations are the elderly and children, along with people with compromised immune systems. They have the highest risk of vaccine failure because their immune system is weak or underdeveloped. It's not because the vaccine is ineffective; rather, it is the insufficient response of their weak or underdeveloped immune system. The reason why everyone needs to be immunized is to protect them. They are the weak and need to be protected with herd immunity. That's where the vaccine protects them, by keeping it away from the little babies and the very old. By avoiding the vaccine, you're dooming them to rely on their own defenses. Even if they do not receive the flu vaccine, the benefits for children and the elderly are without question.

6. Vaccines make you susceptible to other diseases—The reverse of this is actually true. Vaccination empowers your immune system, while being unvaccinated is more draining and dangerous. Catching the flu will weaken your immune system, and while you're sick it's easier to become ill from other bugs. But more importantly, pneumonia is among the most common complications to occur as a result of a flu infection. Getting the flu shot reduces your risk of pneumonia, a leading cause of death among those who die from influenza complications.

7. They cause vascular disorders—There is no evidence that the flu vaccine causes vascular disorders. Meanwhile, the vaccine has been shown in multiple studies to reduce individuals' risk of heart attacks, stroke, and other cardiovascular events.

8. They are risky for children under the age of 1—This is an utter falsehood, based on the wrong claim that a young child's blood-brain barrier is underdeveloped. There is no evidence that flu vaccines can hurt children's development or that children's neuro-vascular structures are affected by flu vaccines. A child's blood-brain barrier is formed in utero and is functional from birth in regulating what can and cannot pass into the brain. Researchers at Stanford University and the University of California, San Francisco discovered in 2010 that pericytes, required for blood-brain barrier development, are present in the fetal brain. The physiology of the blood-brain barrier and how it functions at that level of development make it highly implausible that any vaccine components could penetrate the barrier.

9. Increased risk of narcolepsy—This is one of the few myths that is rooted in a small amount of fact, though it's often misrepresented or blown out of proportion. Narcolepsy is a neurological disorder in which the brain in unable to regulate sleep-wake cycles. Several studies, first in Finland and then in other European countries, found and confirmed a link between narcolepsy and the 2009 H1N1 flu vaccine called Pandemrix, manufactured by GlaxoSmithKline Europe and used in several European countries (but not in the US or Canada). It was not used before 2009 or since the 2009—10 season, and no links to narcolepsy have been found for US-manufactured H1N1 or seasonal flu vaccines. The CDC sponsored an international study on the link between the 2009 H1N1 flu vaccines and narcolepsy, it was published in 2014 and doesn't support any danger .

10. Weakens immune responses—Influenza vaccines actually strengthen the immune system, activating a response that leads to the production of specific antibodies against the disease the vaccine is designed to protect against. In fact everyone should actually think about this as an immune system "workout." Training the muscle to fight a future invader. You might get a little sore but no damage is done and in the end you have a stronger muscle not a weaker one.

11. Serious neurological disorders—This claim is also totally, completely wrong. Anti-vax propagandists love to fear-monger about Guillain-Barré syndrome (GBS). Guillain-Barré is associated with influenza, the disease, but not the vaccine, and GBS is rare. Medical events occur regardless of vaccination, and background rates are used to assess vaccine safety by comparing the expected rate of disease or death to the actual or observed rate in any given timeframe. The background rate for GBS in the U.S. is about 80 to 160 cases of GBS each week, independent of vaccination. According to our friends at Science-Based Medicine, "Guillain-Barré syndrome affects 1 to 4 of every 100,000 people around the world every year, and the increased risk from vaccines is currently estimated at no more than 1 in a million." And that was in spite of other problems in the shaky data used to come to that estimate.

So, 11 oft-repeated falsehoods about getting the influenza vaccine. It requires some digging to get at the truth, but there's a lot of evidence against each claim. So here's the truth, no digging. Be sure to pass it around Facebook as generously as the misinformation is being shared. I'm getting my influenza vaccine this week; make sure you get yours!

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You can follow me at Twitter @steveproacnp for a daily dose of skeptical nursing. Please check out the completion of the series Occ: The Skeptical Caveman, which I helped produce with the guys at The Skeptics Guide To the Universe.

Disclaimer: This post is my personal opinion, it is not a substitute for medical care. It is for informational purposes only. The information on Skeptoid blog is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. This post does not reflect the opinion of my partners, professional affiliates, or academic affiliations. I have no financial conflicts of interest to disclose.

by Stephen Propatier

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