November 29, 2009
PANDEMIC PANIC
by Silver Donald Cameron
Soon after her flu shot, a friend I’ll call Joan noticed a tingling in her hands and feet. Then she found her sense of balance deteriorating. Her doctor said it was stress. She had no strength in her grip, and she developed an excruciating back pain. Her doctor said it was flu. Her speech began to fail her. Three weeks out, she couldn’t speak or get out of bed.
Her husband carried her to the car and drove to the Colchester hospital. A smart young doctor recognized the symptoms of Guillain-Barre Syndrome, an auto-immune condition that attacks the myelin sheathing of nerve cells, short-circuiting the signals between the brain and the rest of the body.
Guillain-Barre Syndrome is a rare and mysterious condition, sometimes mild and sometimes lethal, which can be triggered by flu vaccination. In 1976, a massive vaccination campaign in the US was halted when more than 500 cases of GBS broke out, of which 25 were fatal. The vaccine, apparently, produced one additional case of GBS per 100,000 people.
Seasonal flu kills about 36,000 people annually in the US, and the H1N1 version is clearly a killer too, as witness the heartbreaking death this week of Stephen Nolan. So the risk of getting GBS after a flu shot seems acceptably low unless you turn out to be Joan, who is still grappling with the effects five years later.
Watching our rickety flu immunization program, I am struck by the simple-mindedness of our approach to public health. The health establishment pushes the vaccine like a magic elixir, as though it always worked and had no downside. But it does. How many cases of GBS have we generated? How many patients were neglected because medical personnel were giving shots instead of doing their normal work? My next door neighbour was bed-ridden with searing pain in her arm for a week after her flu shot. Where does her suffering and lost income show up in the calculations?
This is all about balancing risks. I am not opposed to vaccination, but I skipped the flu shot because I’m in good general health, and I probably have decent immunity already. My parents lived through the 1918 Spanish flu, and I have witnessed two flu pandemics myself. (“Pandemic” evokes an epidemic of panic, but it only means a widespread disease, not necessarily a vicious one.) The odds that I will get the flu are low — most people don’t, even in pandemic years — and the odds that it will threaten my life are lower still.
The larger point here is well-described in The Literary Review of Canada by Dr. Charles J. Wright, a former surgeon, professor of medicine and Scientific Officer of the Canadian Health Services Research Foundation. Canadians, says Dr. Wright, have developed “high expectations for relief of ailments that in past generations were accepted as normal accompaniments of daily living and aging.” We are “medicalizing” our lives. Baldness, for instance, is not a medical issue. Grief is a natural consequence of love. High-energy kids aren’t necessarily sick.
Furthermore, some widely-accepted programs do more harm than good. Dr. Wright cites recent studies showing that large-scale screening with mammography and PSA testing produces many false positive results. Patients then receive tests, biopsies, surgeries and treatments that inflict “serious harm… to a person who had no medical problem in the first place.”
And that costs big money. Health-care now absorbs 48% of Nova Scotia’s budget, notes Capital Health CEO Chris Power. As Dr. Wright says, there’s a limit, and we’ve reached it. Worst of all, I would argue, the exploding cost of conventional medicine leaves us nothing to spend on prevention and palliation. We could make huge improvements in public health by attacking the fundamental determinants of health identified by Health Canada — housing, nutrition, poverty, unemployment, literacy and so forth.
We need to begin weighing benefits against costs. For example, we should have a dispassionate audit of this colossal vaccination project, in terms of both its cost-effectiveness and its medical efficacy. Was this a good idea? What role did the vaccine vendors play in the decision? What was achieved? Disconcerting questions, but we need to discuss such issues. Right now would be a fine time to start.
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