“Shocking Report” on flu vaccines is neither shocking nor correct

Flu season is coming, and once again it’s time to get your flu shot (or snort, if you prefer FluMist). It’s not perfect, but the vaccine is your best protection against the influenza virus.

So I was surprised to stumble upon an article titled “Johns Hopkins Scientist Reveals Shocking Report on Flu Vaccines,” which popped up on an anti-vaccine website two weeks ago. Johns Hopkins University is my own institution, and I hadn’t heard any shocking new findings. I soon discovered that this article contained only a tiny seed of truth, surrounded by a mountain of anti-vaccine misinformation. Most of it focused on a report published in early 2013 by Peter Doshi, a former postdoctoral fellow at Hopkins.

First, as Snopes.com has already pointed out, Doshi is not a virologist or an epidemiologist, but rather an anthropologist who studies comparative effectiveness research. He never conducted influenza research at Hopkins. (He’s now an Assistant Professor at the University of Maryland’s School of Pharmacy.) Second, Doshi’s 2013 article was an opinion piece (a “feature”), not an original research article, and it did not report any new findings. Third, it is highly misleading to suggest (as the anti-vax article’s title does) that Doshi somehow represents Johns Hopkins University. At Johns Hopkins Hospital, the flu vaccine is required of all personnel who have contact with patients, as a good-practices effort to minimize the risk that a patient will catch the flu from a caregiver.

But what did Doshi’s article say? Even though it isn’t new, why are the anti-vaccine sites recycling it? His central argument is this:

“The vaccine might be less beneficial and less safe than has been claimed, and the threat of influenza appears overstated.”

Let’s look at this statement. It’s almost obviously true: one only has to find a few overstated claims about the risks of flu, which isn't hard to do. But it’s also completely consistent to state that the vaccine is enormously beneficial and that the threat of influenza is very serious. See how that works? 

Doshi uses this slight-of-hand to suggest that the vaccine may not be beneficial at all. He never says this outright—instead, he just questions, again and again, whether the precise percentages reported in published studies are accurate. For example, he makes a big deal of a CDC announcement in 2013 that the vaccine’s effectiveness was only 62%. He casts doubt with phrases like 

“the 62% reduction statistic almost certainly does not hold true for all subpopulations”

which is almost certainly true, but is meaningless from the point of view of public health. Of course the vaccine doesn’t have the same effectiveness in everyone. The point is that it works most of the time. 

Doshi cites another study that showed a clear benefit for the flu vaccine, only to cast doubt on it with this argument: 

“No evidence exists, however, to show that this reduction in risk of symptomatic influenza for a specific population—here, among healthy adults—extrapolates into any reduced risk of serious complications from influenza such as hospitalizations or death in another population.”

Again, Doshi’s argument doesn’t prove that the original study was wrong, only that it doesn’t apply to everyone. But Doshi’s motivation, as evidenced by the relentlessly negative slant of his entire article, seems to be to convince people that the flu vaccine is bad.

Not surprisingly, the anti-vaccine movement has embraced Doshi (for example, here and here). And unfortunately, he seems to have accepted their acclaim: in 2009, he spoke at an anti-vaccine conference hosted by NVIC, a notorious (and misleadingly named) anti-vaccination group.

Perhaps even more disturbing is that Doshi signed a petition arguing that the HIV virus is not the cause of AIDS, joining the ranks of HIV denialists. He signed this statement while still a graduate student, so I contacted him to ask if he still doubted the link between HIV and AIDS. I also asked him if he supports flu vaccination, if he agrees with the anti-vaccine movement's use of his statements, and if he believes the flu is a serious public health threat.

On the question of signing the HIV/AIDS petition, Doshi responded that "Seeing how my name was published and people have misconstrued this as some kind of endorsement, I have written the list owner and asked for my name to be removed." (He declined to state directly - and I gave him the chance - that he agrees that the HIV virus causes AIDS.)

As for the flu itself, Doshi says "I don’t agree with CDC’s portrayal of influenza as a major public health threat." So he and I have a serious disagreement there. I asked if he agrees with the anti-vaccinationist who are using his writings to claim that the flu vaccine is ineffective, and he replied that while "ineffective" is "too sweeping," he has found "no compelling evidence of hospitalization and mortality reduction in [the] elderly."

Doshi’s argument against the flu vaccine boils down to this: the vaccine is much less than 100% effective. This is undeniably true, and the research community makes no secret of it. In fact, many of us have repeatedly called for more research into better vaccines, in the effort to create a vaccine that is not only more effective, but that (like most other vaccines) only needs to be taken once for lifetime immunity. We’re just not there yet. Meanwhile, though, the annual flu vaccine is usually effective: a recent study showed, for example, that it reduced children’s risk of ending up in a pediatric intensive care unit by 74%.

So get your flu shot (or snort) now, before flu season hits, because it takes a couple of weeks for your body to develop immunity. By getting immunized, you’ll not only increase your chances of getting through the winter flu-free, but (because you won’t spread the flu to others) you might also save someone whose immune system would be overwhelmed by influenza. 

Should a doctor fire an anti-vax patient?

The anti-vaccination movement continues to grow, despite the retraction and thorough discrediting of the 1998 scientific study that spurred much of its growth.  The stubborn persistence of anti-vaxxers shows how difficult it is to dispel misinformation once that information is out there, even after dozens of new studies and millions of dollars in research that demonstrate that vaccines are safe.

One of the most dangerous trends is the growing number of parents who refuse to vaccinate their kids, or who choose "alternative" vaccine schedules, such as the one promoted aggressively by Robert Sears (who goes by "Dr. Bob").  Sears appears to have simply invented this alternative schedule without bothering to conduct any scientific studies, in part to promote sales of his 2007 book, The Vaccine Book: Making the Right Decision for Your Child.  Vaccine expert Dr. Paul Offit explained, in a 2009 article in the journal Pediatrics, why Dr. Sears' schedule was a very poor choice for children and for the public health.  After thoroughly dismantling Sears' anti-science positions, Offit concludes, "Sears has a poor grasp of the scientific method."  That's an understatement.

Other doctors, perhaps jealous of all the attention that Sears has gained through his anti-vaccine writings and television appearances, have created their own alternative vaccine schedules.  One of them, Donald Miller, even goes so far as to say that vaccines cause childhood cancer, despite the complete lack of evidence for this wild claim.  Somehow Sears, Miller, and others like them have managed to convince many parents that their children don't need vaccines.

In response to parents who don't want to vaccinate, many of whom show up with Dr. Bob's schedule in hand, pediatricians have struggled to find an effective response.  Parents can be utterly convinced by the misinformation they find on the Internet, which is all too easy to find.  (For example, Googling "vaccine" brings up the National Vaccine Information Center, a hotbed of anti-vaccine propaganda and pseudoscience, on the first page of hits.)  By the time parents arrive with their babies for the first vaccine, convincing them to change their minds can be nearly impossible.

Perhaps in frustration, doctors have started to "fire" their patients if they refuse to vaccinate.  As reported by Shirley Wang in The Wall St. Journal last week, 20-30% of doctors in two different surveys, in Connecticut and the Midwest, reported having to kick patients out of their practices because of vaccine refusal.  These numbers have roughly doubled over the past ten years, according to the American Academy of Pediatrics.

Is firing a patient the right thing to do? It's a difficult question.  On the one hand, doctors should do everything they can to make sure kids are vaccinated.   If a doctor kicks a parent out, that parent may find another doctor who doesn't insist on vaccinating children, which ultimately harms the children.  Doctors have to spend more time educating parents about the tremendous benefit of vaccines, about the very strong evidence (based on tens of millions of doses) for vaccine safety, and about the frightening consequences of infection with meningitis, hepatitis, measles, polio, and other vaccine-preventable diseases.

On the other hand, unvaccinated children bring diseases into the pediatrician's office, where they can spread them to other children.  Some of these other children are too young to be vaccinated, and childhood infections can be extremely dangerous, even fatal, in the very young.  From this perspective, "firing" a patient might be the only responsible action, after first trying to convince the parents to vaccinate.  I know that I wouldn't want to bring my child to a doctor's office where unvaccinated children were in the same room.

I understand how nervous a parent can be about vaccinations.  I will never forget the day my older daughter got her first vaccine: the needle looked huge compared to her tiny leg, and she screamed when the doctor gave her the shot.  But she was fine a few minutes later, and she'll be protected against a dangerous infection for her entire life.  Vaccines have been so successful at eliminating childhood infections that parents no longer see these infections as a threat.  Ironically, the very success of vaccines has allowed the anti-vaccine movement to sway so many people.

Doctors may have to keep firing the parents of their young patients, but I hope they'll first make every effort to educate them.  They need to explain that vaccines do not cause autism, nor do the ingredients in vaccines, and that scientific studies involving hundreds of thousands of patients support these conclusions.  They should also explain that many of the anti-vaccination claims on the Internet started when Andrew Wakefield published one small study of 12 patients, now retracted, claiming a link between the MMR vaccine and autism.  Investigations later revealed that he was paid by lawyers to recruit patients for a lawsuit against vaccine makers, that he didn't reveal these payments to his co-authors or the patients, and that he manipulated the data.  Since then, the anti-vaccine movement has exploded and we've experienced multiple outbreaks of measles, mumps, and other illnesses linked directly to unvaccinated children.

Doctors interviewed by the Wall St. Journal reported that they had convinced at least some parents to follow the recommended vaccine schedule.  Perhaps that's the best we can hope for.  If we're going to avoid a return to the era when children routinely died from infections, we must keep trying.