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Whether it’s the swine flu or the normal flu, there sure is a lot of talk about flus these days. There are signs up all over on my way to work advertising vaccinations, and they offer free vaccinations at my office.
Oddly, though, I don’t know anyone with the flu right now. Also, those I know who have had the flu over the past few years didn’t seem very close to death; they experience more of a “long cold” type of sickness.
There are some scary statistics out there, though. The CDC claims 36,000 Americans die from “flu-related causes” every year. I think this makes everyone (at least initially) ask the same questions: Am I in danger of dying from the flu if I don’t take the necessary precautions? Do I need to get a vaccine? Does my family?
It turns out there are other questions that need to be asked about the CDC’s claims, too—like, “How are flu-related causes different from plain-old flu causes?” and “Where is the CDC getting it’s numbers?”
My brother sent me the full version of an article in BMJ entitled, Are US flu death figures more PR than science? (registration required). It’s a couple years old, but the author presents three main criticisms:
- The CDC’s way of forming a “unique relationship” between flu and pneumonia when citing cause of death statistics is questionable.
- The CDC’s estimated 80% increase in influenza-associated deaths isn’t consistent with the 30% decrease in recorded flu deaths (over the same period).
- The CDC misrepresents estimated influenza-associated deaths as, simply, “flu deaths.”
The comments on the article are particularly interesting, as the author and a number of other scientists go back and forth with some of the very organizations they criticize.
For example, in the first comment, Germany is said to have the same issue: The Robert-Koch-Institut (RKI, Germany’s equivalent of the CDC) cited 15,000-20,000 deaths due to influenza (viral flu) in the winter of 2004. But… Germany’s Federal Statistical Office says there were only “9 deaths caused by viral flu (influenza) (2003: 25; 2002: 10; 2001: 9), and 116 deaths caused by flus where viruses have not been found.” Hospitals in Germany have different numbers (this time for 2003), too: 12 influenza deaths and 165 flu (without virus proof) deaths. Later in the comments, RKI posts a response where they discusses statistical modelling used to find “hidden” cases of flu-related deaths.
Further comments also call the RKI (and sympathetic posters) out on not providing proof that flu viruses exist and are lethal, confusing correlation with causation, not considering that “upper respiratory tract infections (if they are even infections at all) could have a non-infectious underlying cause,” and not addressing the low effectiveness of flu vaccines.
The last comment was made in 2006, so it’s possible these concerns have been addressed. If they have, I certainly haven’t heard about it—and, in the end, I guess that’s the main problem.
Similarly tagged OmniNerd content:
- Twitpics of Disaster in Haiti, by AnonBCA 2 months ago
- H1N1 Swine Flu Hysteria, by VnutZ 11 months ago
- Pattern Analysis of the PowerBall Lottery, by VnutZ about 1 year ago
- Pattern Analysis of MegaMillions Lottery Numbers, by VnutZ over 2 years ago
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There's a certain amount of apples-to-oranges comparison here by scottb :: NR7 :: Show
The CDC numbers are based on this 2003 JAMA article. The research reported there was specifically studying how flu deaths are underreported because they end up being indicated otherwise on death certificates.
The basic structure of the study was to take data on deaths reported to be specifically from influenza, together with those reported to be from more general categories (especially respiratory or circulatory failures), and using statistical models, estimate how many of the broader-category deaths could be reasonably attributed to influenza (and a couple of other sources).
Now, the study is very careful to specify what they’re trying to count — any death to which the flu contributes should be counted. This means that they’re intentionally counting deaths that could also be counted as due to other causes (say, pulmonary edema).
The German hospital and government statistics cited almost certainly are only counting the cases in which the flu is explicitly identified as the cause of death. In practice, though, it’s not usually the flu virus that kills, it’s the complications — and those are given “credit” on the death certificate.
In any case, the JAMA article does point out that 90% of the flu deaths are in people aged 65 and older, as one might expect. Younger people generally throw off the flu much more easily. Older folks often already have other respiratory or circulatory problems, which the flu virus complicates.
On the other hand, none of this can reasonably be taken as justification for forgoing immunization efforts and other precautions. As Mike the Mad Scientist pointed out in a recent blog post, the main purpose of hygiene and vaccination isn’t to protect you, it’s to protect the rest of us. It’s a social responsibility.
An epidemiologist's take on the vaccine by scottb :: NR7 :: Show
Here’s a blog entry by an Assistant Professor of Epidemiology on why she plans on being vaccinated. She does quote the 36,000 deaths per year number, so she doesn’t seem to think it’s wildly wrong.
The worst tyranny. by Anonymous :: NR0 :: Show
Of all tyrannies a tyranny sincerely exercised for the good of its victim may be the most oppressive. It may be better to live under robber barons than under omnipotent moral busybodies. The robber baron’s cruelty may sometimes sleep, his cupidity may at some point be satiated, but those who torment us for our own good will torment us without end for they do so with the approval of their own conscience. – C.S. Lewis
The only way to defeat tyranny is with information.