Joseph Mercola, along with Rosemary Fischer, are promoting vaccine awareness week this week, Nov 1-7. David Gorski, who edits Science-Based Medicine with me, thought it would be a good idea to go along with this and participate fully in vaccine awareness week. So all week we will be focusing on vaccine issues, and doing our best to counter any misinformation.

Mercola, who runs a highly commercialized website, chock full of health misinformation and anti-SBM propaganda, has started off the week with a broadside against the flu vaccine in an article titled: “New Proof that This Common Medical Treatment is Unnecessary and Ineffective”. He gives a Gish Gallop of error and misdirection – far more bits of falsehood than I have time to counter here. That’s the point of the Gish Gallop, it is far easier to create a misconception than it is to correct it. So if you throw enough mud at a topic you can overwhelm any attempt to defend accurate information, and leave your audience with the uneasy feeling that something must be wrong. In the case of Duane Gish his target was the science of evolution. With Mercola it is accurate health information.

Ironically, he starts off:

Armed with the facts, less than one-third of the US population fell for fear mongering. And together, we can do it again.

He accuses health officials of “fear mongering” – his word for warning people about the risks of the flu and recommending the flu vaccine. Of course, if you are interested in propaganda you can use this term to refer to any and every public health campaign. He picks on the H1N1 Pandemic of 2009 – an easy target. He plays Monday morning quarterback, pointing out that the pandemic was not as bad as projected. Again, it is easy to criticize officials for caution when the worst-case scenario does not unfold. When faced with a possible pandemic officials need to prepare for a plausible worst-case scenario, and then hope it doesn’t happen. What happened in 2009/2010 flu season is that the H1N1 flu showed up, but the regular seasonal flu didn’t, and so the total number of total flu cases was less than a typical year. We still don’t have an explanation for this, but it was completely unexpected. No one predicted this – not even the Mercolas of the world.

After accusing health officials of fear mongering, Mercola then goes on to relentlessly fear monger about an effective public health intervention – the flu vaccine. Remember his fear mongering from last year? Wasn’t the H1N1 vaccine supposed to cause an epidemic of Guillaine Barre Syndrome (GBS)? Well – it didn’t, and there was a careful surveillance program in place in the UK and US to monitor for any increase in GBS and it never occurred.

Now Mercola is at it again, and his stated goal is to scare people off the flu vaccine. He doesn’t expect to be held accountable for his dire predictions and misinformation – he just dumps as many bits of scary misinformation as he can and then moves on. Again – I can’t get to them all, but here are a few:

“Health officials have leapt ahead with recommendations of “flu shots for all” without safety studies—so by getting a flu shot, you are effectively offering yourself up as a laboratory rat. In other words, YOU are the safety study!”

This is a transparent falsehood. Simply put “flu vaccine safety” into PubMed.org and see how many studies come up. There are many studies looking at the safety and side-effect profile of various flu vaccines in the general and in specific medical populations, including the effects of adjuvants, and simultaneous vs serial vaccination. There is a serious attempt by medical scientists to evaluate the safety and effectiveness of flu vaccines. But Mercola needs you to believe that there is a dark conspiracy and you need him to open your eyes and give you the real information – all you have to do is subscribe to his site.

Australia’s flu season precedes ours, so we can look to them for a preview of vaccine issues. By June of 2010, more than 1,000 adverse reactions in children under the age of 5 resulted in the Australian government’s banning of flu vaccines for that age group. High fevers, vomiting and convulsions were the most widely reported reactions, which are also associated with long-term adverse health outcomes. CSL’s Fluvax appears to be the main troublemaker. However, CSL has objected to being singled out, claiming any of the other three vaccines on the Australian market could be to blame.

Notice the spin Mercola puts on this news item – he implies that any trivalent flu vaccine can be to blame, CSL says so (since when does he listen to a vaccine manufacturer?). The real story is that there was an increase in fever and other complications from one brand of flu vaccine in Australia – Fluvax. The increase occurred in that brand only. It was not a single-batch problem, and so this was likely a manufacturing problem. For this reason the vaccine was temporarily suspended until the facts could be sorted out.

What are the implications for the US? The CDC has recommended that the Afluria vaccine – CSL’s vaccine for the North American market, not be used in children 6 months to 4 years old. That seems like a reasonable precautionary measure. And here we can see the difference between reasonable caution and hysterical fear mongering.

Mercola’s cherry picking of facts is epic. He seems to blithely ignore the fact that this episode shows that vaccine safety is closely monitored (despite his own claims), and steps are quickly taken to reduce harm when it does occur, followed by further preventive measures to minimize adverse events. Yes, there is risk in any medical intervention. All we can do is to minimize those risks and carefully study and fairly assess net health outcomes.

The cognitive dissonance inside Mercola’s head must be deafening. He tells us vaccines are not tested for safety, then in the next breath reports the results of safety testing and monitoring. He doesn’t believe scientific information, but will report any rumor or preliminary report that spreads fear of vaccines. For example:

In Finland, France and Sweden, narcolepsy was reported in teenage children in response to Pandemrix monovalent swine flu vaccine, leading the Finnish government to suspend its use.

Again we see that vaccine safety is being monitored, and early reports of possible adverse events are taken very seriously and then followed up. Of course, this creates a lot of noise as most such early reports will turn out not to be true vaccine side effects. This gives people like Mercola the opportunity to report every early report, without providing context or follow up.

In contrast to Mercola’s fear mongering about narcolepsy, here is the actual data as it currently stands. There was an apparent increase in reported cases of narcolepsy, a neurological disorder characterized by excessive sleepiness, in Sweden and Finland. Early estimates are that expected background cases in people 18 and younger should be less than 10 per year, but 30 have been reported.

However, these excess cases occurred equally in the vaccinated and unvaccinated:

The first part of the investigation of the narcolepsy cases shows that the number of cases of narcolepsy in the population has increased in Sweden as well as in the Stockholm County. Concomitantly, data from Stockholm indicates that the increase seems to be of the same magnitude in those vaccinated as in those not receiving any vaccine.

So Swedish authorities conclude there is no link to the Pandemrix flu vaccine, although they acknowledge these results are preliminary and more surveillance is warranted. They also plan to study narcolepsy incidence more carefully to see if this is a real increase, and search for clues as to cause.

Meanwhile, the European Medicines Agency has reviewed the evidence and concluded:

The European Medicines Agency’s Committee for Medicinal Products for Human Use today 23 September 2010 announced that it has reviewed all available data on the suspected link between narcolepsy and Pandemrix and concludes that the available evidence is insufficient to determine whether there is any link between the illness and the vaccine.

In reaction to these reports the CDC reviewed the Vaccine Adverse Events Reporting System data and found:

…no signals or concerns suggesting an association between U.S.-licensed H1N1 or seasonal influenza vaccines and narcolepsy in the United States. CDC has enhanced its surveillance for cases of narcolepsy occurring after 2010-11 seasonal influenza vaccine and will continue to monitor the situation and take appropriate action as needed.

Taken together these reports indicate that there is no evidence for a link between narcolepsy and the Pandemrix vaccine (or any vaccine) but the data is preliminary and more monitoring is prudent. But Mercola can just throw out the possibility of a connection and leave it there without providing enough information to assess the actual situation.

We also see how it takes so much more time and space to correct misleading information than it does to create it.

Mercola goes on to reiterate many canards about vaccines:

All vaccines are immune suppressive—that is, they suppress your immune system, which may not return to normal for weeks to months.

This is the opposite of the truth. Vaccines stimulate and increase the function of the immune system – that’s how they work. They provoke an immune response. Stimulating the immune system is healthy for the system, which needs exposure to antigens to remain active.

But let’s get to the subject of the title of Mercola’s post – is there “new proof” that the flu vaccine does not work? No. He is referring to this Canadian study, which is actually a review of previous studies, not new data. The researchers were looking for data on a specific question regarding flu vaccine efficacy – does vaccinating health care workers reduce the morbidity and mortality from the flu and pneumonia in the elderly residents of long term care facilities.

The authors found mixed results. The flu vaccine did decrease reports and hospitalization for influenza like illness, but not laboratory confirmed influenza. It also decreased all-cause mortality, but not mortality specifically linked to the flu or pneumonia. So they conclude that there is no current evidence for a specific benefit in this case.

This does not mean the flu vaccine does not work. These were studies looking at the secondary benefit of vaccinating health care workers on the patients they care for. There were apparent benefits, just not specifically linked to reduced flu, which can easily be a limitation of the evidence, and we are still left with a need to explain the reduced illness and mortality. Mercola, by the way, cherry picked the negative outcomes of this review, and did not even mention that positive outcomes.

Even still, Mercola tries to dismiss apparent positive outcomes from the flu vaccine as the “healthy user effect” – those who get vaccinated are likely to be more healthy to begin with. This is true – but not relevant to these studies, which looked not at the people choosing to get vaccinated, but the people they cared for. In any case, evidence for flu vaccine efficacy comes from many types of studies and the healthy user effect is not always relevant.

Mark Crislip has an excellent article on the evidence for flu vaccine efficacy. It’s a complicated story, but overall there is adequate evidence for effectiveness to support its use. Read Mark’s article, and compare that to Mercola’s drivel if you want to see the stark difference between science-based medicine and dubious fear mongering.

Conclusion

There is so much more, but we have all week to counter anti-vaccine propaganda. We will be aggregating all science-based vaccine articles at a new page on SBM dedicated to the issue – SBM-VaccineAwareness.