Autism, Influenza Vaccines, And The Nirvana Fallacy
January 24, 2010 by Do'C 
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Should you be afraid of a Flu shot?
If you’re a hard-working parent with school-aged children (perhaps even children enrolled in a couple of different public schools) who really can’t afford to have sick kids, let alone be sick and miss work yourself, the answer should be pretty straightforward.
A nasty case (or cases) of influenza in the household can create a few to several days of real overall misery (and serious illness in severe cases). And, while not perfect by any means, it’s pretty much a no-brainer to most intelligent people that even a modest reduction in the probability that you or a family member contracts influenza, or spreads it to others, is a good thing. Yes, the common-sense measures like regular hand washing and keeping sick kids at home, etc. are good ideas, and probably help decrease those probabilities quite a bit, but the scientific consensus is that getting vaccinated against influenza is a great way to decrease those probabilities.
Vaccine (and seemingly mainstream medicine) rejectors often parrot the claim that flu vaccines “don’t work”. While efficacy is seasonally variable, and influenza vaccines are by no means perfect, published science on the subject provides a different picture. Anti-vaccination advocates putting forth a claim that flu vaccines “don’t work” in support of not vaccinating, are doing little more that propogating logical fallacy (the Nirvana fallacy). Getting a Flu shot for yourself (or for your children, if you have them) is not an expression of false belief in instant invincibility or unchecked faith in the pharmaceutical industry, rather it is a rational and very simple step to take in order to decrease the odds of getting sick yourself and/or transmitting the flu to others. Just because a flu vaccine may not be perfect, does not mean all the chances that illness could be reduced/avoided should be tossed out.
Perhaps you’re one of those conscientious types who understands contribution to herd immunity, and its importance to infants who are too young to be vaccinated and to those patients who really can’t get a flu shot for medical reasons, and yes its unrecognized and probably denied importance to knuckleheads who refuse vaccines for themselves and their children. If you are that supportive of herd immunity type, there’s a good chance you’re quite capable of an informal, yet reality-based risk/benefit analysis; and that you probably already understand the relative statistical safety of getting a flu shot for yourself or your kids compared to, say, driving (or putting your children in a car and driving them school).
As a skeptic, it’s tempting to state that any discussion of flu shots is completely irrelevant to autism. Nothing could be further from the truth. Flu shots are relevant to all kids, including autistic ones. The bottom line is that both my typical, and my autistic children need to be in school. Among many other very important things, that’s the only place they get a regular and critical component of their education - learning through peer interaction. Missing school due to being nailed by influenza, is something to be avoided. Could my typical kids make up for that lost peer interaction time? Yes. Could my autistic kids make up for that lost peer interaction time? Absolutely yes too, but it will likely be a little more difficult, and may take a little longer. That’s just the way it is.
The reality is that all kids need to be healthy and in school to get the most out of it. The reality is that all kids need parents (or a parent) who is healthy and can provide, parent, and advocate for them. Reality is that increasing the odds of staying healthy, whether a season for modest or great increase in those odds of staying disease-free, is a good thing.
Remember, Nirvana is not the goal of a flu shot, reality is.
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Comment by Socrates — 24 January, 2010 @ 5:38 pm
Imagine you and the kids being sick at the same time…
Anyone who’s ever had a dose of real flu knows it’s not a trivial illness and coping with the whole family down at the same time is not trivial either,
I must’ve got a particularly fresh shot - it gave me a real, bone-fide 2 day mini flu episode and a timely reminder of when I was ill in 1989 - at one point I actually thought ‘if this gets any worse I’m going to die’.
From the New York Times in 1989:
LONDON, Dec. 23— The worst flu epidemic in 14 years has strong-armed its way through Britain, claiming lives, forcing hospitals to postpone surgery and dominating conversation with worries over who has it, how to avoid it or how to get rid of it.
Government statistics released this week showed that 102 people in England and Wales died of illnesses related to flu in the first week of December, bringing the total such deaths so far this year to 276. In the corresponding week last year, there were seven flu-related deaths…
… The virus is said to be similar to the strain that killed a total of 1,283 people in the winter of 1975-76…
…The epidemic has hit doctors and nurses and increased the demand on already scarce hospital beds, forcing most hospitals in this city to cancel thousands of routine operations and accept only emergency admissions….
Comment by Do'C — 24 January, 2010 @ 6:15 pm
Hi Socrates,
Experienced such unpleasantness a few years back. It was awful. I have vivid memories of many of us sleeping in place on the floor a various intervals, because it was too much effort to get back up into bed, let alone move much. We we’re fortunate to have a mother-in-law who came over; donned a mask, gloves, and a gown (and carried disinfectant around with her) and helped out the worst couple of days. She was in her late 60’s and we looked the elderly ones. She did lots of laundry (out of necessity, not because we were changing clothes all that much) My 2 year-old (at the time) ended up in the hospital with pnemonia and dehydration, and still took a good 10-14 days to fully recover after that.
I totally understand that ‘if this gets any worse I’m going to die’. I remember thinking that might have been preferable for at least the better part of one of those days a few years ago.
I don’t remember if any of us got flu shots that year or not.
Comment by MJ — 24 January, 2010 @ 6:28 pm
Well you know, us crazy “anti-vaxers” actually want to know that something we inject ourselves with is actually going to do something before injecting it, we rely on all that junk science, like the Cochrane review who says -
Link
“In children under two, the efficacy of inactivated vaccine was similar to placebo. Variability in study design and presentation of data was such that a meta-analysis of safety outcome data was not feasible. Extensive evidence of reporting bias of safety outcomes from trials of live attenuated vaccines impeded meaningful analysis.”
and
Link
“There is not enough evidence to decide whether routine vaccination to prevent influenza in healthy adults is effective”
and
Link
“In long-term care facilities, where vaccination is most effective against complications, the aims of the vaccination campaign are fulfilled, at least in part. However, according to reliable evidence the usefulness of vaccines in the community is modest. The apparent high effectiveness of the vaccines in preventing death from all causes may reflect a baseline imbalance in health status and other systematic differences in the two groups of participants.”
But you are right, this is yet another area where “published science” has spoken and no more questioning is allowed. I guess it is only us “Anti-vaccination advocates”, like the Cohrane Review, who are just making this stuff up. So the entire world should just role up their sleeve and take it like a man for the good of the herd.
That was that a herd of sheep we were talking about, right?
The reality is that, like with everything involved in modern medicine, you have to do a risk/reward analysis for your situation based on ALL of the available data and make up your own mind. There are some groups that do benefit from a flu shot and then there are groups that don’t. But there is no one-size fits all policy and the question of how effective the flu shot is has certainly not yet been answered, least of all by “published science”.
Comment by Do'C — 24 January, 2010 @ 8:31 pm
MJ,
I didn’t call anyone “crazy”. Are you projecting?
You should really attempt to read more thoroughly before commenting, because apparently in addition to missing the fact that I wrote:
“If you’re a hard-working parent with school-aged children (perhaps even children enrolled in a couple of different public schools) who really can’t afford to have sick kids, let alone be sick and miss work yourself, the answer should be pretty straightforward.”
You left out the relevant portion of the abstract you cited:
“Fifty-one studies with 294,159 observations were included. Sixteen RCTs and 18 cohort studies were included in the analysis of vaccine efficacy and effectiveness. From RCTs, live vaccines showed an efficacy of 82% (95% confidence interval (CI) 71% to 89%) and an effectiveness of 33% (95% CI 28% to 38%) in children older than two compared with placebo or no intervention. Inactivated vaccines had a lower efficacy of 59% (95% CI 41% to 71%) than live vaccines but similar effectiveness: 36% (95% CI 24% to 46%). In children under two, the efficacy of inactivated vaccine was similar to placebo.”
The author’s actual conclusion is similar too:
“Influenza vaccines are efficacious in children older than two but little evidence is available for children under two.”
Don’t forget to read the plain language summary which notes:
“The review authors found that in children aged from two years, nasal spray vaccines made from weakened influenza viruses were better at preventing illness caused by the influenza virus (82% of illnesses were prevented) than injected vaccines made from the killed virus (59%).”
Which is followed by:
“The review of trials found vaccinations against influenza avoided 80% of cases at best (in those confirmed by laboratory tests, and using vaccines directed against circulating strains), but only 50% when the vaccine did not match, and 30% against influenza-like illness, in healthy adults.”
The long-term care facility community? Please. Go comment at the AARP blog or something with this one, it’s probably not relevant here.
Said or implied by no one.
You haven’t heard of FluMist? You don’t have to roll up your sleeve for that.
Exactly MJ. I think we should all have ID numbers on our foreheads too. The reality is that herd immunity helps protect infants who are too young to be vaccinated, or for which as you noted, may not have a vaccine that is as efficacious as it is for older kids. Do you have somehting against babies MJ? What about people who can’t be vaccinated?
Regarding your comment that there are some groups that do benefit from the flu shot, again, I’ll point you to the beginning of my post…
If you’re a hard-working parent with school-aged children (perhaps even children enrolled in a couple of different public schools) who really can’t afford to have sick kids…”
And ask you to go back and actually read the science you so kindly provided.
Comment by MJ — 24 January, 2010 @ 9:54 pm
“You left out the relevant portion of the abstract you cited”
No, I highlighted the fact that the science is not as cut and dried as you implied. I actually have fully read all of the items I quoted plus others we well. The evidence for the flu shot is not clear cut.
“Please. Go comment at the AARP blog or something with this one, it’s probably not relevant here.”
My children are (almost) school aged and visit their great-grandfather in a long term care facility. By your logic he should be doing his part as well.
“You haven’t heard of FluMist? You don’t have to roll up your sleeve for that.”
Which has been found to be less than effective in adults.
“The reality is that herd immunity helps protect infants who are too young to be vaccinated”
Herd immunity is an idea that is thrown about with little in the way of scientific backing, especially when it comes to the flu shot. But if you think I am wrong, please cite the appropriate literature as it relates to the flu shot.
“Do you have somehting against babies MJ”
Ah yes, got me there.
“What about people who can’t be vaccinated?”
What about people who can’t tolerate the flu shot? For example, the one time my twin daughters received the flu shot, they had a bad reaction to it and where sick for about a month. And please don’t try the coincidence argument, it tends to fall about when two separate but identical children have the same reaction to the same event at the same time.
They were under two at that point, which, if you noticed what I quoted previously, is a period in time when the flu shot has NOT been shown to be effective. But we were not informed of this and the doctor in question was pushing the flu shot. We did not yet know better so we went along with the recommendations.
And as a result, my children suffered for about a month for a treatment that has not been shown to be effective for them. High risk, low reward - and most importantly, a lack of informed consent.
Now for every example like my children there are ten others that tolerated the flu shot without problems. But, and this is the important part, I am not willing to sacrifice my children’s well being for some mythical herd immunity.
Would you be willing to sacrifice your child’s well being for something as mild as the flu?
Comment by Do'C — 24 January, 2010 @ 10:43 pm
Here’s what I wrote about the scientific consensus:
“Yes, the common-sense measures like regular hand washing and keeping sick kids at home, etc. are good ideas, and probably help decrease those probabilities quite a bit, but the scientific consensus is that getting vaccinated against influenza is a great way to decrease those probabilities.”
I don’t see any implication that all the science is cut and dried for every possible permutation. In fact, I pointed out that flu vaccines are not perfect. It’s kind of the point of this article, you know, the Nirvana fallacy?
Perhaps you and your children will be do your part to help protect him.
http://www.ncbi.nlm.nih.gov/pubmed/18820568
“The anatomy of an urban influenza epidemic is presented highlighting the role of children in the spread of influenza. The efficacy and safety of the live attenuated influenza vaccine (LAIV) for children are documented and the indirect effectiveness (herd protection) of vaccinating schoolchildren is demonstrated.”
http://www.ncbi.nlm.nih.gov/pubmed/16794746
“Efficacy depends on the primary objective and can range from levels comparable with placebo to up to 91% efficacy against confirmed influenza A infection. Schoolchildren play an important role in the dissemination of the influenza virus, and population studies have demonstrated herd immunity.”
http://www.ncbi.nlm.nih.gov/pubmed/19541255
“Administration of LAIV-T may be a convenient and effective method to mass-immunize students in a school setting and help establish herd immunity within the community.”
http://www.ncbi.nlm.nih.gov/pubmed/11259722
FluMist vaccine is licensed for 2-year olds.
False dichotomy. No one is asking you to sacrafice your childrens’ well-being.
Again, false dichotomy.
Comment by MJ — 25 January, 2010 @ 4:33 pm
“Here’s what I wrote about the scientific consensus”
Since we seem to be disagreeing about what you wrote, what does the phrase “scientific consensus” mean to you as it relates to evidence based medicine? To me, when someone talks about utilizing a treatment under EBM because there is a “consensus” that implies that the consensus is that there is sufficient evidence of efficacy to prove that a treatment works.
“I don’t see any implication that all the science is cut and dried for every possible permutation”
That is not what I am saying - I am saying that whether basic threshold of whether the treatment is effective and should be recommended has been met is questionable.
“Perhaps you and your children will be do your part to help protect him.”
You might want to read what I actually quoted because I read it as the flu shot is most effective in long term care facilities but not necessarily in elderly people living outside of them.
Regarding herd immunity -
After quick reading of the four items you cited I don’t think that any of them provide direct evidence of herd immunity. Sure, they all mention it, as in -
“Several studies have demonstrated herd protection by immunizing schoolchildren”
“population studies have demonstrated herd immunity”
“and help establish herd immunity within the community.”
“it is possible that herd immunity against influenza was achieved in Japan.”
They all seem to start from the premise that herd immunity against the flu exists. But when I have the time, I will take the time to read them more in depth.
“False dichotomy.”
Using a fancy name for a logical fallacy is not an answer. You say -
“If you’re a hard-working parent with school-aged children who really can’t afford to have sick kids, let alone be sick and miss work yourself, the answer should be pretty straightforward.”
Which implies that if you have children in schools and you can’t afford to take time off of work to take care of sick children, the flu shot is a “no-brainer”. And I am saying that it is not. You have to consider other facts surrounding the use of the shot and not just blindly give it.
If you think that taking the time to understand the benefits as well as the risks of a medical procedure is some sort of logical error, well, that is your opinion.
Comment by Do'C — 25 January, 2010 @ 7:14 pm
MJ,
You wrote:
To which I responded with the points:
“False dichotomy. No one is asking you to sacrafice your childrens’ well-being.”
Your reply?
You didn’t ask ask a question, so I don’t know why you would expect an answer. My point is that your statement is a false dichotomy. The implication is that there are only two possible outcomes. No flu vaccine, or guaranteed sacrafice of well-being. I’ll try to use the term “black and white fallacy” (although that’s four words instead of two) for you in the future, if you think it might help prevent overstimulus from “fancy names” for logical fallacy.
Yeah, my wording isn’t necessarily clear with “afford” and “having sick kids.” I tried separating the idea of having sick kids (which entails much more in and of itself, as mentioned later in my post) from having to be sick yourself, with a comma, but that didn’t work out too well apparently. As for the “no-brainer”, either you love straw man arguments, or we don’t necessarily share the same meaning for “no-brainer”. To you, apparently it represents a decision for which zero consideration or thought is made, and action is taken “blindly”. To me a “no-brainer” means that something is very easily understood. While the effort to understand may be less, because something is fairly straightforward, it doesn’t mean zero thinking and acting blindly. It means that it’s easy to understand, that’s it.
That be the straw man’s opinion. See above re: “no-brainer”.
Comment by MJ — 27 January, 2010 @ 7:59 pm
DoC,
I wrote
“Would you be willing to sacrifice your child’s well being for something as mild as the flu?”
You replied -
“Again, false dichotomy.”
I said -
“Using a fancy name for a logical fallacy is not an answer.”
To which you replied -
“You didn’t ask ask a question, so I don’t know why you would expect an answer”
I did ask a question - would you be willing to sacrifice your child’s well being for something as mild as the flu?
You said -
“The implication is that there are only two possible outcomes. No flu vaccine, or guaranteed sacrafice of well-being.”
No, I was clear that I was speaking of the specific example of my children in that I am not willing to give them the flu shot simply for the idea of “herd immunity”.
“if you think it might help prevent overstimulus from “fancy names” for logical fallacy.”
Well, the real problem for me is that you are using words with more than three letters…..
It is not “overstimulus” that is the problem, it is lack of a coherent response. You can say that it is a “false dichotomy” or a “straw man” but that isn’t your real point of your argument.
The real point appears to be closer to a statement like “No flu vaccine, or guaranteed sacrifice of well-being.” and while that statement is a possible illustration of false dichotomy not all false dichotomies are that statement. This is, incidentally, a good example of a common logical fallacy.
“To me a “no-brainer” means that something is very easily understood.”
Which also implies that the “correct” answer is obvious or easy and that the decision should almost make itself. The decision to give the flu shot is not necessarily a “no-brainer” by either definition.
There are many factors you should consider - such as whether you have had a bad reaction before, if you have another medical condition or issue that would preclude giving the shot, if you are pregnant or nursing, your age, whether you commonly catch the flu every season (some people have a higher natural immunity and don’t need the shot), plus many other factors.
That is without even considering whether the shot would work or the form of the vaccination that you should use.
Put all of this together and it is hardly a no-brainer. However, one of the real problems, in my opinion, is that people treat this as a no brainer and don’t take the time to understand what it is that they are doing.
Hardly something that is easily understood
Comment by Prometheus — 29 January, 2010 @ 3:29 pm
MJ complains:
OK, I’ll grant you that - for MJ, this is not a “no-brainer”.
Strangely enough, most people who have not succumbed to the tidal wave of fear promoted by certain anti-vaccine activists find the decision whether or not to vaccinate pretty straightforward.
Unfortunately, the constant repetition of the “vaccines-cause-autism” mantra has led a growing number of people to think that there must be something to it. The message they don’t get - because it doesn’t lend itself to bumper-sticker-sized sound bites - is that there is no data linking vaccines to autism.
Now, some people (e.g. MJ) think that the burden of “proof” is on those who assert that vaccines are “safe” (i.e. don’t cause autism). However, it has to be noted that this question has been investigated already with the MMR vaccine and thimerosal with no evidence suggesting a connection. Now, the goalposts have been shifted (yet again) to all vaccines, or “too many, too soon” or un-named “toxins” in vaccines or insufficiently green vaccines or….. you get the picture.
I think it was reasonable to investigate thimerosal as a potential cause or “trigger” for autism. That has been done - several times - with no correlation found. It may have been reasonable to investigate the MMR vaccine, but that, too, has been found to have no correlation.
Now, we are asked - without any more data than they had when they were positive that thimerosal was the cause of autism - to investigate all vaccines and all vaccine components in any and all possible combinations and permutations.
When does it stop? When can we say that we’ve looked enough and - absent any new data (in truth, any real data at all) supporting a connection between vaccines and autism - we will table this hypothesis?
Face it, the “data” supporting a possible connection was weak to start with and hasn’t gotten any stronger. Autism prevalence continues to rise monotonically, with no apparent correlation to vaccine composition or number. Those who think there is a correlation can provide no better support than their opinion that there is a correlation - and we all know about “opinions”, right? [They're like anuses - everybody has one.]
So, if I agree that the decision to give or get the influenza vaccine is not a “no-brainer” for MJ, can we table the “vaccines-cause-autism” debate until the “does so!” side comes back with some data supporting their position?
That should be a “no-brainer”, but I bet it won’t.
Prometheus
Comment by MJ — 29 January, 2010 @ 3:51 pm
Prometheus you said,
“Now, some people (e.g. MJ) think that the burden of “proof” is on those who assert that vaccines are “safe””
I believe that is part of the foundation of evidence based medicine. Treatments must have evidence that they work AND be relatively safe (or at the very least have an understood risk profile). This has nothing to do with autism.
Each and every shot should have evidence that it works and it is (relatively) safe.
So yes, as a general statement the “burden of proof” is on anyone who says any treatment is “safe” to “prove” it.
“However, it has to be noted that this question has been investigated already with the MMR vaccine and thimerosal with no evidence suggesting a connection”
I am not talking about MMR, thimerosal, or any possible connection of these two to autism. I have no idea what you are responding to because it certainly isn’t anything I said.
“if I agree that the decision to give or get the influenza vaccine is not a “no-brainer” for MJ,”
And if you actually read my comments above you will see that the reason it isn’t a “no-brainer” for me is that -
1. My children had a bad reaction to it.
2. The flu shot has not been shown to be effective at the age when they received it and had the reaction.
3. Even at the ages when it has been shown to be effective, its effectiveness can be very limited.
4. I did not realize any of this until after my children the reaction and started researching the issue for myself.
Before this I took the “no-brainer” approach and blindly accepted the recommendations of my children’s doctor at face value.
And for the record, with the exception of the flu shot, my children are fully vaccinated.
Comment by Do'C — 29 January, 2010 @ 9:19 pm
Off-topic:
Isn’t it nice to post here, make the conversation about you and your kids, share your beliefs, and not have a single comment blocked/censored MJ?
What’s you’re take on a place like AoA?
Comment by Do'C — 29 January, 2010 @ 9:48 pm
MJ,
Regarding this statement…the coincidence argument you seem to be referring to is Post Hoc reasoning. While it’s clear you don’t believe this to be the case, the likelihood of Post Hoc error hardly seems lessened by the fact that you had two kids who were sick at the same time right after a flu shot (unless they lived in separate households). You may be convinced it was the flu shot. It could have been. I don’t require evidence of any kind to acknowledge that possibility.
I’d add that a “month-long” illness seems an unlikely flu shot reaction, but anything is possibile, and we don’t know (nor should we) the specifics. It might also be a possibility that they actually contracted a nasty case of influenza (you know, a few days before they received flu shots). Whether you agree with it or not, and even if your personal certainty is high that the illness was a reaction to the flu shot, would you say that illness contracted prior to the shots was a possibility? Or is there no possibility they actually came into contact with influenza or something else right before the flu shots? How about in the doctor’s office any sick kids in there when they got the shots?
Comment by MJ — 31 January, 2010 @ 7:39 am
DoC,
“Isn’t it nice to post here, make the conversation about you and your kids, share your beliefs, and not have a single comment blocked/censored MJ?
What’s you’re take on a place like AoA?”
If you ever hope to get anywhere, you have to have an open exchange of ideas. I don’t tend to comment anyplace that blocks comments. I don’t censor comments on my blog unless they are personal attacks directed against another commentor (or if you try to challenge me to a duel).
Regarding AoA, well, their comment section is more like a support group than a place to comment and dissent is not allowed. I read some of the posts that interest me and ignore the rest. I never read the comments because they never have anything of value to offer.
“the coincidence argument you seem to be referring to is Post Hoc reasoning.”
One thing that seems to get overlooked when using logical fallacies like this - just because something could be a fallacy doesn’t automatically mean that it is one.
“you had two kids who were sick at the same time right”
The normal pattern with twins, at least mine, is that one of them catches the cold or whatever and then a day or two later the other catches it. This has been the pattern from birth up to and including the slight cold that they have today. So when they both come down with the same thing on the same day it is notable.
” would you say that illness contracted prior to the shots was a possibility”
Of course it is a possibility. I am not completely convinced that it was the flu shots per se that caused the reaction but at the same time I have more than enough doubts to want to avoid the shot in the future.
There were a few other contributing factors here, mainly they received the first flu shot, came down with whatever it was they had. It took a few weeks and then they started to come out from it - and then received the second flu shot in the series. They then came down with what appeared to be the same sickness again, it started clearing up and then they got another (different) vaccine. And guess what, sick again but when they recovered this time they had regressed into autism.
Let me be clear, I don’t think that the vaccines “caused” their autism - I am pretty sure it would have happened at some point regardless. But at the same time I think that the sickness, which appears to have been induced by the flu shot, certainly did set the stage for their regression.
Add to the above my third daughter. We have never given her the flu shot and are more careful when it comes to giving her vaccines - but she still gets them. She too has autism but hers is much, much milder than her sisters. She never had a sickness like the one her sisters did nor did she have a period of regression.
I am not certain that any of this is the truth of what actually happened and I could be seeing meaning where there is none. But, given that two children did the same thing at the same time and the sequence of events I find it at least plausible.
When I learned later that the flu shot hasn’t been proven to be any more effective than a placebo at this age and the fact that you shouldn’t give a vaccine to a sick child, I think you can understand why I am very cautious when it comes to the flu shot.
If I had known then what I know now, I would have acted differently. And, while my twins would still have autism, it is possible that they would be more like their sister and be higher functioning.