I keep getting asked about the Atlantic Magazine article
, Does the Vaccine Matter? by Shannon Brownlee and Jeanne Lenzer, two reporters whose particular bias is that we as a nation are "over treated." As a generalization that's probably true, and finding examples isn't hard. Unfortunately by taking as their main example flu vaccine during a pandemic, they have not only picked the wrong example but created more confusion at a time when there's already too much.
Brownlee and Lenzer rely upon (and romanticize as a martyr and truth-teller) Dr. Thomas Jefferson, someone who is fast establishing himself as an "Evidence Based Medicine" (EBM) crank who who courts notoriety by being a contrarian. The kind of EBM practiced by the likes of Jefferson and some other randomized trials zealots is far from the judicious weighing of the evidence envisaged by its early proponents. For example, David Sackett, defined EBM as:
"the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research." (BMJ, 13 Jan 96, Sackett, David L.).
There is nothing judicious about Jefferson, whose problem was described by one of my colleagues as "methodolatry," the profane worship of the randomized clinical trial as the only valid method of investigation. In this case his evidence base isn't even relevant, because we aren't dealing with seasonal flu but pandemic flu. For the record, what he is saying about the uncertainties about flu vaccine efficacy in the over 65 age group isn't new. In fact we've discussed it here, several times (here
), going back a couple of years. But it is also clear that the vaccine offers protection in the age groups that matter for this pandemic, the people under age 50.
Nor is Jefferson, as claimed in the article, someone who "knows the flu-vaccine literature better than anyone else on the planet." That's an absurd claim. The literature is vast and he knows only a tiny part of it. But insofar as there is an acknowledged expert on vaccine efficacy, it would be biostatistician Elizabeth Halloran, who reviewed the clinical trial and experimental challenge literature
recently in the American Journal of Epidemiology. We wrote a longish post on the subject here
. There is general agreement, even among so-called skeptics, that the vaccine works in the under 60 age group, precisely the group at issue with the swine flu vaccine........