Monday, April 25, 2016

Influenza Week
I've seen a number of cases of the flu--or at least what appears to be the flu--this month. Clinically, the flu is marked by sore throat (usually), high fever (or high-ish, low 100s F), muscle aches, fatigue, and often a cough. However, like any bug, you need a lab test to be sure, and we hardly ever get those, unless lab facilities are close by and insurance is really good. There are innumerable respiratory viruses and many potential bacterial infections. The former must be treated with antivirals within about 2 days, and the latter often do but don't always respond to antibiotics (for example, whooping cough).

Anyway, I had no opportunity to culture anyone anyway. Helpful remedies have been Bryonia and Nux moschata--in the latter case especially sleepy flu cases! (And it is just a few cases.)

"Did you have your flu shot?" People might ask.

In general, I avoid vaccination for non-fatal diseases, and despite what some TV doctors say about it, the flu isn't usually fatal. You just feel like you want to die.

Why? Hmm, I have a sense that we need some sicknesses to maintain some ecological balance to our world. Sickle cell trait confers some protection against malaria. Cancers have been known to recede during periods of fever from infection. My sense is not entirely a random hunch.

A physician assistant writes in The Clinical Advisor, an online, sponsored medical magazine, that there are undisclosed financial relationships between flu committee members at the CDC and vaccine manufacturers. Further, he notes that dangers may be overstated (especially in terms of fatalities, which are low).

One might ask: is any fatality acceptable? A philosophical question, and unanswerable in a practical sense because people value different things. Much of what passes for the "vaccine controversey" is really a discussion about the value of the public good versus the value of the individual's good. This is a discussion--or just a cussin' out sometimes--between those who have set their needle for public good to a point which they believe is good and just, and those who set it a bit farther back. This becomes a very complex equation when you consider all the forces at work in someone. Multiply those "someones" and society's decisions become vexing indeed.

By "forces" I mean those motives of concern, whatever they are: financial, personal, religious, and so forth. Those experts who hammer people about immunization, they forget that people operate as much from the heart and the gut as they do the head. No one's a brainiac 100% of the time either. Fully rational decisionmaking has never been a marked human trait! So I find all the "preachifying" by experts to be a bit tiresome, and I think unproductive.

Immunization makes a certain keen sense when one considers it in the context of industrial medicine: moving lots of people into higher states of health, at least as health happens to be defined at the time. That too is a moving target. However, I can't say I entirely disagree with the premise of today's industrialized, mass medicine. It has a certain achievable efficiency.

Yet at the same time in political reality, that efficiency will reach some natural equilibrium with the crazy, mixed-up human spirit (and by this I mean mind, or consciousness, or perhaps something like a soul). Whatever it is, it's not predictable, and therefore no theory of human phenomena is entirely predictive. In short, no matter what a good idea some people think a thing is, not everyone will, and that will create a conflict.

So back to that PA's comment. I dug out the original journal article. Peter Doshi, of Johns Hopkins, wrote in British Medical Journal in 2013 that low vaccine effectiveness (it's been reported from 25-75% and varies year to year), overstatement of health risks, and poor study methodologies lead him to the conclusion that the annual influenza vaccination cycle is a marketing strategy without any clear benefit and uncertain costs. Doshi accomplishes this simply analyzing the CDC's own publications.

It's not that I didn't think that people weren't making money. It's not that I imagine that every nurse and every doctor that recommends a flu shot has mercenary motives, either. But it is those folks who mean well who I would urge to stop overstating the value of flu shots and the risks of the flu. If I had dollar for every person who I diagnosed with the flu who had their flu shot, I could buy a nice flight to Florida for the worst of the season.

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