Why do so few Canadians get a flu shot?

VaccinationThat’s the headline for a recent Toronto Star story. It suggests that as few as one third of Canadians get a flu vaccine, and in some place the number may be as low as 20 percent.

This despite Ontario having the world’s first universal free flu shot program, introduced in 2000. The 2013-14 vaccine is on its way to doctors’ offices now. It’s also available at pharmacists’ offices. It’s free, easily accessible, it prevents and helps stop the spread of many kinds of influenza, it can save the life of anyone at risk – so why don’t people get one?

Superstition and pseudoscience. Gullible people turn to untrained, celebrity wingnuts in the anti-vaccine movement – like Jenny McCarthy – for medical advice rather than to doctors, health care professionals and pharmacists. They turn to dangerous cranks and pseudo-science wingnuts like homeopaths, “faith healers,” astrologers and psychics instead of doctors.*

Many of these people deliberately and purposefully distort or misrepresent the facts about vaccines, disease, scientific research and health. Others are simply ignorant of the facts and accept what others say, without bothering to verify it through independent sources or published research.**

I know, you’re probably thinking like I was when I read this story, “are people this crazy?” And the answer, it seems, is yes.

McCarthy’s anti-vaccine preaching was called “belligerent ignorance” by the Toronto Star earlier this year, noting,

From McCarthy’s point of view, it’s a major victory in her battle to get her message out: vaccines are bad and autism can be cured, if you just ignore the scientists and sawbones who insist on pesky factual data.
It’s David vs. Goliath, Warrior Mom vs. Stuffed Shirt Medical Establishment, New Age Rebel vs. The Man.
Ah, but there’s another side: those who value facts over opinions and view McCarthy as a fear mongering dimwit whose sanctimonious crusade, however well-intentioned, threatens to turn the clock back on medical science.
Given that measles and whooping cough have already staged a comeback as parents panic and vaccination rates drop, it’s also potentially dangerous.
To be clear, there is no medical evidence to support her assertion — based on a discredited study — that vaccines cause autism, no evidence that the alternative treatments she promotes will have any positive effect on this ballooning developmental disorder and no evidence that her own son was, as she insists, “cured” of autism (the diagnosis has been disputed by experts).

The LA Times concluded the same about McCarthy:

She also peddles the discredited, poisonous claims that the way we vaccinate our children against the diseases that were once regular killers of children places our young ones at greater risk of developing autism — the kind of conspiracy theorizing that will draw only more eyeballs.

And the New Yorker wrote of McCarthy:

McCarthy has spent much of the past ten years campaigning against vaccines—which, it must be said, are the most effective instruments of public health in human history, aside from clean water. That does not mean that vaccines carry no risk: nothing is entirely without risk, and there is a small but measurable possibility that any vaccine can cause a serious adverse reaction. Still, the benefits for society so powerfully outweigh the risks that suggesting otherwise is irresponsible at best. It spreads fear and incites the type of ignorance that makes people sick. That is exactly what McCarthy has been doing. By preaching her message of scientific illiteracy from one end of this country to the other, she has helped make it possible for people to turn away from rational thought. And that is deadly.

And The Nation wrote,

Oprah Winfrey’s decision to let McCarthy act as an expert, to dismiss science with alchemy, without asking any tough questions, was unconscionable. The same could be said of the producers of Larry King Live and Good Morning America, both of which hosted McCarthy soon after. Even though they at least asked questions about her views, Larry King had her debate a doctor, as though her disproven ideas should be given the same equivalence as those of a medical expert.

In fact, McCarthy’s beliefs—that vaccines and mercury cause autism, that a good diet cures autism and that “diagnosticians and pediatricians have made a career out of telling parents autism is a hopeless condition”—have been roundly dismissed and discredited by doctors and scientists, who insist that her claims are based on no scientific data or research. McCarthy wasn’t deterred. “The University of Google,” she said to Oprah, “is where I got my degree from.”

Let’s be clear: there is no connection between vaccines and autism.

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Someone is wrong on the internet

From Skeptic NorthI discovered an entertaining site recently called Skeptic North. It’s a Canadian equivalent to several similar sites and blogs I read that are mostly American-based. It challenges popular assumptions, ideas, trends and pseudoscience and other claptrap. In a Canadian way, of course.

Meaning that it’s usually much too polite in how it handles some of the balderdash online. I’m less gracious. Bullshit is bullshit and should be called out.

I discovered it when I was looking for some additional backup material on COLD FX, an over-the-counter, made-in-China product (I hesitate to call it a medicine; is pseudo-medicine a proper word? or should I just call it a commercial placebo?) made from a purified ginseng extract, that claims to boost your immune system and prevent colds and flus. The discussion has raised itself on Facebook again, with the usual “I don’t care what scientists say, it works for me…” comments.

CBC’s Marketplace show did a’ expose that debunked a lot of the claims, but I found the show a little too sensationalist for my own taste. I was glad to see the article on Skeptic North about the show shared my concerns over the presentation*.

…I was turned off by the typical “confrontation TV” drama they included.

The effectiveness of Cold FX has been debated and challenged long before CBC got around to it. UBC professors questioned it back in 2006. They found:

The main purpose of these studies was to see whether the ginseng extract would reduce the incidence of acute respiratory illnesses (flu and respiratory syncytial virus, or RSV, a virus that causes flu-like symptoms), as defined by subjective symptoms such as cough, sore throat and runny nose. The researchers, reporting the results in the Journal of the American Geriatrics Society, found “no significant difference between the placebo and the ( Cold-fX) groups for the number of (acute respiratory illnesses) defined by symptoms.” They also found “no significant difference in the severity or duration of symptoms related to (acute respiratory illnesses) between the two groups in either study.”

The secondary purpose of the studies was to measure the difference in the incidence of laboratory-confirmed (typically by a viral culture) acute respiratory illnesses between the two groups. In the placebo groups, six and 12 per cent of the subjects in the two studies contracted flu or respiratory syncytial virus. In the ginseng groups, these percentages were lower — zero and two per cent — which suggests the ginseng had some therapeutic benefit. However, in each case, the “p value” — the probability that chance explained the difference — was high enough that these differences, by the researchers’ own admission, were not deemed statistically significant.

In 2009, Science-Based Pharmacy published the results of three studies that challenged the product’s claims. Here are the results from the three studies:

Bottom line: If we accept the combining of the two trials, we can conclude the following: In nursing home residents, when taken for 8 to 12 weeks, Cold-fX appeared to reduce laboratory-confirmed cases of colds and flu, but had no effect when considering what patients actually reported.

Bottom line: A healthy adult taking Cold-fX might expect to have 0.25 less colds over a 16 week period. This has led some to question whether this result is clinically relevant.)

Bottom line: Over a 16 week period Cold-fx failed to demonstrate an improvement over placebo. Given the high number of study design flaws, data omissions, the poor quality journal, and long publication delay, it is difficult to draw conclusions from the results. At best, it is suggestive that Cold-fX needs to be taken for at least eight weeks, with a flu shot after four weeks, before it may have any noticeable effect.

And the conclusion in the article?

What if I feel like I’m coming down with a cold? Will starting Cold-fX now have any effect?

There is no published evidence to demonstrate the effectiveness of Cold-fX if started at the onset of a cold.

CV Technologies offers a 300mg form of their product (“Extra-Strength Cold-fX“) with the directions to start “at the first sign of colds of flu symptoms”. There are no published trials documenting the effectiveness of the 300mg dosage strength, or evaluating the dosing instructions of 12 capsules over the first 3 days, in reducing the duration of colds or the flu.

The Ottawa Skeptics site also has a good article critiquing how the studies are presented, and says, for example,

Although this trial was well designed, reviewers have criticized the interpretation of the results. For example, the study team described the combined reduction in lab-confirmed influenza and respiratory syncytial virus (RSV) as “an overall 89% relative risk reduction”[22] (i.e., an 8% reduction compared to a 9% incidence rate), which is true but misleading. In reality, there was simply an absolute risk reduction of 8% points.

Claims that COLD FX has approval for its packaging statements have also been challenged, as this National Post article notes:

Health Canada has not authorized COLDfX’s long-standing claim that consumers can obtain “immediate relief” from colds and flu by dramatically increasing the dosage, the Vancouver Sun has learned.

You can read the company’s own comments about their battle over claims with Health Canada in 2007, here. Back then, the Center for Science in the Public Interest, a well-respected organization, cautiously noted that,

Bottom line: Until more studies are done, it’s too early to conclude that Cold-fx can shorten—or cut your odds of catching—a cold or the flu. Even so, Cold-fx is the only remedy we found with any evidence that it might improve your chances of getting through the cold and  flu season without coming down with something.

This lukewarm endorsement has not been repeated since  to my knowledge (I subscribe to their excellent newsletter, Nutrition Action). In general, CSPINET has been critical of all herbal remedies and done a lot of work researching their claims and effectiveness (which generally is none). Nonetheless, some of the claims made by COLD FX have been the subject of a recent class-action lawsuit, which, as far as I know, is still being decided.

It’s curious to me that people who swear by COLD FX and other non-medicinal products like echinecea - another herbal product proven ineffective – yet will not get a flu shot, which is backed up by considerable research and science and endorsed by every national and provincial health organization and medical association in Canada and the USA. COLD FX is endorsed by Don Cherry. Which do you believe is the more credible? As The Paltry Sapien blogger (another entertaining skeptic) wryly comments.

We like to talk about science and proof and rationality, but in the end belief in hockey and maple leaves and the coldness of winter wins out. Cold FX, this “struggling true-blue Canadian company,” in Cherry’s words — producing a product in China, not Alberta — deserves our allegiance.

Flu shots are free in Canada. COLD FX is expensive (emphasis added):

Over a four-month period, subjects in the ginseng group experienced, on average, one-quarter of a cold less than the placebo group. That means each person has to spend a total of $86 to prevent one-quarter of a cold.

I ascribe a lot of this to the New Age belief that so-called “natural” products (a nebulous term of little value, like “organic,” both degraded by slippery definitions, lax regulations and unscrupulous marketers and – ironically – corporations) are better than manufactured ones. That counterintuitive leap has extended into all sorts of silliness, from belief in astrology and Feng Shui to crystal therapy and magnetic bracelets over astronomy,  architecture, science, and medicine. And let’s not forget UFO abductions, creationism and the Mayan apocalypse – or flu-shot paranoia.

I have yet to find an all-natural computer or iPad on which I can post that observation.

But as for these herbal concoctions – many people want a pill to do for them what they would better get from proper hygiene (frequent hand washing), good nutrition and exercise – without having to do all the work. It’s like the herbal-diet-fat-burning pills: instant gratification without the sweat. Won’t happen.


* For the sake of balance, not everyone thinks the CBC Marketplace show was either accurate or good journalism. For example, blogger Shireen Jeejeebhoy says,

By the end of the twenty-two-odd minutes, Marketplace’s entire piece, when read between the lines and engendering Herculean effort not to be distracted by the bells and whistles, boils down to COLD-FX prevents colds. The claim it provides immediate relief needs further study; the China connection is no different than every other product we buy (have you checked where your frozen veggies are grown lately?), thus is not COLD-FX specific and is a separate topic; the bacterial contamination is old news and a non-starter. In other words, Marketplace told its alert viewers to take COLD-FX daily if you want to prevent colds.