Influenza and Low Hanging Fruit

In response to this post about annual influenza (also crossposted here), I received several emails and comments that missed the whole point (I'll take the blame for that). I am not denigrating the importance of 'other' diseases. AIDS and cancer are worth curing and preventing. My point about influenza is that preventing most of the deaths can be thought of as 'low-hanging fruit.'

Unlike AIDS or various cancers (there is no single 'cancer'), we don't need a medical or technological breakthrough that might or might not happen. We also don't need behavioral modification, such as STD awareness or smoking cessation campaigns. And, while behavioral modification is worth pursuing, the number of lives saved is relatively modest compared to vaccination (it's not like AIDS or lung cancer have gone away).

With annual influenza, all we need is more vaccine stuck into the appropriate people. There's no new technology to develop (although cell-based culture would be an improvement). Once a person is vaccinated, there's no behavioral modification needed. We could have an effective vaccination strategy up and running in two to five years (being a pessimist, I'll say five). A couple of years to increase vaccine production facilities, two years to work out the distribution kinks, and year five, it works.

There are very few problems can be solved solely by throwing buckets of money at them (although buckets of money are either helpful or necessary). Annual influenza is one of those problems than can be solved simply by investing more resources. That's why this is so frustrating: it is utterly within our power to save roughly 28,000 lives per year, and yet we fail to do so.

Crossposted at Mike the Mad Biologist

Comments

[M. Gemmill]

I keep reading that we focus our flu resources in the wrong places: that we should be vaccinating the young and healthy, not because they are at high risk of serious flu complications, but rather because they pass the disease on to those at higher risk (for whom the vaccine is less effective).

FYI, I've gotten the stick every time I've had the opportunity, and generally find that I spend less time in the winter feeling sick. And, it pleases the economist in me, knowing that I am a walking example of a positive externality.

[epistemology]

With some exceptions: We are underdiagnosing and treating colon cancer, cervical cancer (vaccine anyone?), etc.

We need a nationwide search for the low hanging fruit.

[Diana]

Influenza kills mostly very old people, typically already sick with something unpleasant and lethal. "Saving" those lives just means saving them to actually die from cancer, as opposed to a quick death during the course of being 90 and suffering from cancer. Give me the influenza any day. We aren't immortal, and not all life-saving measures should be used incessantly.

[rapier]

Viral infections do more than just make you feel bad. They do damage to your body. They can damage every system. Maybe it's a small amount of damage and it's permanence can be debated but if you can avoid a serious infection then do it.

There is an alt. or crackpot idea floating about that viruses cause virtually all chronic disease, in most cases indirectly. There is a pretty solid link to flu and heart disease. More fleeting ones with viruses to cancer and even schizophrenia.

Whenever you get a chance ask a spry 80+ year old if they often were laid low through their life by flu and colds? Almost for sure they will say no.

[cfrost]

I get a flu shot every year now. I’ve had enough serious run-ins with influenza that have progressed to bronchitis to know better than not to get vaccinated. Every fall, I tell people where and when they can get a shot and no one takes me up on it. I almost always hear “I never get the flu”, or “those shots don’t really work”, or “vaccines are full of mercury”, or some other such baloney. This from people who ought to know better. Forget the concept of herd immunity and one’s responsibility to contribute.

No one under fifty remembers a time when communicable diseases were making people sick and then were miraculously stopped with vaccines. Many people don’t even get their cats and dogs vaccinated for rabies anymore. No understanding of disease, no understanding of vaccination, no problem I guess.

[Josh Jasper]

For all the naysayers, what worries actual epidemiologists is an influenza epidemic, which certainly will kill mostly old people, and people who're currently ill, but will also overload all hospital capacity, which will in turn cost more lives. Hospitals have a deficiency of treatment centers for influenza outbreaks, and our national infrastructure is not sufficient for a large scale outbreak.

You personally may not get sick for more than a few days during a nationwide influenza outbreak. But if you, or anyone you know and care about gets into an accident, the hospitals will not be staffed enough to treat you quickly.

But beyond that, what the hell is wrong with you people? Seriously. It's like you walked out of a George Orwell story.

[voxy]

I'm young, I had ... chicken pox when I was three months old and nearly died. Very seriously. I understand the importance of vaccinations and tetanus shots and my dogs are rabies-vaccined. Mainly because they force you to do so. I distrust many local vets.
I just wanted to say that though I sometimes have 'flu-like' symptoms, I'm actually paranoied of that flushot. When they came up with the cancer vaccine and were going to require it for young girls (and then young men) I decried that.
It used to be the big thing to have your tonsils removed. Now, that's looked upon with some ridicule.

I am reading a VERY interesting book in which the 70-some-year-old psychologist and human-behavior-psyche'- extraordinaire (specialized in capgras syndrome) talks of how debunking biology and medical research works from his perspective: (simplified)
One generation deeply believes something -- the next finds evidence to refute it ... , the next refutes the previous again --- you see where I'm going.
Georgia Okeefe did the majority of her life's work in her 80's and 90's.
Many of my friends get the flu-shot. I just don't. My Mom did. I live close to a HUGE research and medical college (university of south florida) My former fiancee' is the lab director of medical research ... he got every EVERY shot that crossed campus.
To me, that's a bit too much like being a lab rat with results you may not even realize are linked to the shot.
Depo-Provera was debilitating women for six and seven years with absolutely HEINOUS side-effects.
An eleven year old points out that on the meds commercials it takes longer to list the side-effects than it does to tell what it 'purports to cure'.
If I got bit by a snake, I'd take the venom-cure. That's the only thing I'm sure of.
To each their own.

[Autumn Harvest]

Influenza kills mostly very old people, typically already sick with something unpleasant and lethal. "Saving" those lives just means saving them to actually die from cancer. . .

Um, what? Gosh, maybe we should just kill everyone once they turn 70, since being elderly is so unbelievably horrible. You are aware that everyone who is saved from a death---excuse me, "saved" from a death---goes on to die of something else later on?

[eRobin]

Aw, brighten up, Diana - certainly some saved-from-the-flu oldies could die by getting hit by buss or by being eaten by wild animals, which would provide entertainment for the masses.

[cfrost]

I had chicken pox when I was three months old and nearly died.
Had the people around you had varicella vaccinations, you wouldn’t have gotten it.

my dogs are rabies-vaccined. Mainly because they force you to do so. I distrust many local vets.
They force you to do so, not because anyone cares about your dogs, but because rabies is 100% fatal and a very grim way to die. Veterinarians have nothing to do with it.

I sometimes have 'flu-like' symptoms, I'm actually paranoied of that flushot.
Sooner or later, 'flu-like' symptoms will be influenza, and for a few days you’ll be happy as a gut-shot dog. If you’re lucky it’ll stop there. The influenza virus however mows, plows, and fertilizes your lungs, preparing fertile ground for opportunistic bacterial, and viral infections. When that happens, prepare for another week of being even sicker yet. If you like bronchitis and pneumonia, you’ll love flu.

One generation deeply believes something -- the next finds evidence to refute it ... , the next refutes the previous again --- you see where I'm going.
I don’t see where you’re going. Now that the details of immunological response are better understood, Edward Jenner’s observation that inoculation with cowpox prevented smallpox is no longer true? The fact that Pasteur knew nothing of the existence of viruses means that the rabies vaccine he developed didn’t work? That John Snow’s observation that shit-contaminated wells in London were associated with cholera was not true because people still believed in the miasma theory of disease at the time?

If I got bit by a snake, I'd take the venom-cure. That's the only thing I'm sure of.
If bitten by a snake, you’d be well advised to get antivenin. Unfortunately though, snakebite antivenins are among the least reliable of immunotherapeutic remedies, as snake venoms are fickle in a way that pathogenic antigens are generally not. A flu shot is a lot surer thing than snake antivenin.

To each their own.
Wrong. To cite a recent example, polio was recently on the verge of being permanently eradicated when a group of people got the notion that the polio vaccine was doing more harm than good. Now we may be back where we started with polio. Which would you prefer, taking your chances swallowing vaccine with vague consequences you’re not even sure about, or a wheelchair or iron lung? Most people infected with polio don’t even know they’ve been infected – a few days of diarrhea and it’s over. You don’t exist in a vacuum however; the diseases you catch are passed on to others. The disease you got because you were uneasy about the vaccine may cripple or kill the person you pass it on to.

[Porlock Junior]

Going backwards, starting with cfrost's excellent remarks: well, on polio we're still a long way from back where we started. Back a few years, though, and lots of money and lots of suffering. The idiot racist religious fanatics in Nigeria managed to keep polio alive and spreading, and it got as far as Indonesia; but people there weren't buying that shit, and were mostly vaccinated already, and the epidemic seems to have stayed contained and won't come to bite us. http://porlockjr.blogspot.com/2005/05/herod-prize.html
Which is sort of the point about mass vaccination, I guess.

On the influenza thing, it's true that the people killed each winter are mostly old and therefore merely a drag on society. However, when (not if) the virus mutates into something capable of killing lots of people, it may well kill the same kind that the 1918 flu did: young, robust people, getting sick today, dead day after tomorrow.

If a working general vaccination setup is established, in five years it will be protecting people; just about the time I may start to need it, so that's nice for me. And in 10 or 20 years when the mutant shows up, it won't be able to produce a truly nasty epidemic because we'll have the prevention in place, which will be nice for -- oh, that's right, you won't be young and robust any more. Silly of me. Forget it, it won't do you much good personally, let's not bother.

[voxy]

Let me preface this by saying I'm not sure I'll get all the italics right so my apologies in advance, if not.
Oh, and since it's not important to me and since it you mistook my meaning I'll just clarify that by 'to each his own' I meant to EACH their own opinion. Not to each their own with no responsibility to another. I deeply believe in our connective-ness to one another --- just not necessarily through vaccines (always)

Had the people around you had varicella vaccinations, you wouldn’t have gotten it. Can't blame that on my family, perhaps the hospital or doctor's office ... my family has always been big on the status quo ... I'm the first one who has strayed off the 'common path' of getting shotted up. And, I enjoy excellent health. Fact of the matter is I attribute the 'flu-like' symptoms to the carcinogens which are sprayed in my yard frequently from those who attempt to steal the property (another subject, sorry but it's prevalent now that you've asked me to expand)

They force you to do so, not because anyone cares about your dogs, but because rabies is 100% fatal and a very grim way to die. Veterinarians have nothing to do with it. Around here, veterinarians have EVERYTHING to do with it. We've raised horses, here, always had dogs and pets of every fur and fin. I take three other people with me and change vets each time I take my animals to the vet. They have run all the 'more senior' vets out of business. The new vets are akin to murderers. Each dog I have taken to a vet has subsequently died. I take them for rabies alone and take the extra watchers to be sure that nothing is done to the animal that I don't see. This time we may have them dipped and clipped again but if one dies then what will I feel??
And, if you believe yahoo news (LOL) they say rabies is wiped out in the United States, now. Sorry, I thought that was funny as I do follow, appreciate and endorse your thinking. I just question many things now as a result of the 'new' vaccines. The SWIFT way that these things are run past the FDA and peoples' sheep-like willingness to sign their children up for a shot that give absolutely NO guarantee that anyone will be better or safer as a result save merck's bottom line.
OH and how fast the Republicans attempted to force this vaccine to be REQUIRED before a child could enter school. hmmm. Got me thinking.

I don’t see where you’re going. Now that the details of immunological response are better understood, Edward Jenner’s observation that inoculation with cowpox prevented smallpox is no longer true? The fact that Pasteur knew nothing of the existence of viruses means that the rabies vaccine he developed didn’t work? That John Snow’s observation that shit-contaminated wells in London were associated with cholera was not true because people still believed in the miasma theory of disease at the time?

I spoke to circumstances such as tonsils being removed and then finding the absurdity of that. What you bring up --- the renowned names of Biology really wasn't along those same lines. We're talking (or I was, anyway) about a 'cancer vaccine' that was brought (rushed) to market in under two years. If another ten years of case studies proves that this vaccine is more harmful than good .... and another ten years proves that nope, actually, it's not ... what I'm saying is there was not enough research done. People much older than you and I have watched this for longer. Some of these things are fads. Two years of research for a preventitive vaccine compared to ALL THE YEARS that have supposedly gone into finding a cure for cancer. I'm calling BULLSHIT because as a nursing student I just don't see that we can prevent something that we can't CURE .. and I don't understand why anyone expects anyone else to believe that. Of course, cholera, shit in wells and rabies effectiveness is proven. That's exactly what I'm saying. Research and time is proving these but research and time has also DISPROVEN many.
I wouldn't like it to be a questionable cancer vaccine that was mandatory for every school age child.
Flu shot? Every other person I know refuses it. Once they get everyone on that maybe it will be a new scare. Perhaps the bird flu for which there is no known cure. But, maybe a vaccine will appear and be mandatory.
At some point others will likely question this just as I am.
I'm always a bit ahead of the curve. Like every other damned nut. Go ahead, say it. LOL.
Anyway ... I'm a nursing student. I might have said. But, I've already wondered how I am going to fit into the field when my first reaction is to always look for a natural cure.
I appreciate the dialogue.

[Trollbait]

[i]I just don't see that we can prevent something that we can't CURE .. and I don't understand why anyone expects anyone else to believe that.[/i]
"An ounce of prevention is worth a pound of cure."
It is easier to prevent something than deal with the medical cure. That's the point of this and the hospital infection post. There isn't any cure for most, if not all, viral infections, but I don't have to worry about polio or small pox thanks to preventing them in earlier generations with vaccines.
You should know not all cancers are equal. In cases where we know what is likely to contribute to cancer developing, we can take steps to prevent it. Don't want lung cancer, don't smoke. Those that are induced by a virus can be prevented with a vaccine.

[dr2chase]

Regarding flu shots, and preparation for the big one, and old people dying of something else -- my father's aunt died at age 92, had the flu in 1918, said that she thought sometimes her lungs were never the same afterwards. Of course, her father smoked packs/day and lived to 94, and his cousins Laura and Arthur made it to 110 and 101.

In terms of what works, and what does not, people are remarkably good at ignoring plain facts right in front of their faces. Exercise works. National health works. Regular dental care works. Vaccines work pretty well, though I have to admit the chickenpox vaccine makes me wonder (because chickenpox has this habit of recurring as shingles, and lies latent, and the vaccine might fade over time, and chickenpox is pretty weak beer compared to rabies, smallpox, tetanus, and polio). All these drugs and diet fads proposed for chronic conditions, not nearly so sure -- but for most people, exercise works.

[voxy]

trollbait: thanks !!

IMO; there we go again. Since Dana Reeve's death they've been working very hard to prove/impress upon us for some nefarious reason ... that smoke, second-hand smoke have little to do with lung-cancer as older research has shown.
In other words, if you don't smoke, you're as likely to catch it.
Herewith I seem to perhaps be misguided ... about tonsillectomies. I had read they were a thing of the past and proven to be ineffective but (very brief) research leads me to think that they're still being used.
Anyway, all I really wanted to say was that sometimes research disproves earlier findings and that isn't good. THEN, they go back later with still further research (and questionably so at several steps IMO) and find the original was correct.
Meantime, it's OUR health. I do my own research and trust my instinct and ... well ... the universe.
What will be will be.
Meantime taking good care of self and loved ones.
Body is the temple and such.