ATOMIC DOG

I met the walking dude, religious, in his worn down cowboy boots
He walked liked no man on earth
I swear he had no name (had no name)
I swear he had no name

— Lyrics to The Stand by The Alarm

We need to go back in time a bit.

We can do it with a plutonium-powered DeLorean, H.G. Wells Victorian time chair, or we can even do it sexy Terminator style, which involves shedding all your clothes and showing up in a different era with a smoking schlong.

Take your pick.

We're going to go back to September, 1918.

Boston, Mass.

The ships are coming back from Europe. They're carrying some of the soldiers that had fought in The Great War, which is what it was called before we started numbering them.

Unfortunately, the ships are also carrying something else — a virus.

This is no mere sniffly, achy, annoying seasonal virus, though.

While it probably was born earlier that year in an Army training camp in Kansas — starting out as a fairly typical, low-mortality flu —it had gone to Europe with the troops and mutated into something terrible.

When it returned to the U.S. that fall in some of the same ships that had initially carried it overseas, it was every bit as lethal and horrific as the Captain Trips virus in Stephen King's The Stand.

Hey! Trashcan where you going boy?
Your eyes are feet apart
Is that the end you're carrying?
Shall I play the funeral march (play the march)
Play the funeral march...

The afflicted would literally appear fine one moment and then be incapacitated in the next, feverish, incoherent, and delirious. Victims would turn bluish-black, so much so that coroners would often be unable to determine the race of the deceased. Their temperature would soar to 104-106 degrees, the lungs would fill with fluid, and blood would gush from all the bodily orifices—eyes, nose, ears....

Death was insanely quick and painful.

Within weeks, it had killed so many Americans that coffins became a scarce commodity. But America wasn't the only country afflicted. The flu raged through Europe and Asia, too.

All told, it killed more people in 24 weeks than AIDS killed in 24 years. It killed more people in one year than the Black Death of the Middle Ages did in 100 years.

And much like the plague of the Middle Ages, priests in some of the world's most modern cities would drive horse-drawn carriages through the streets each morning, calling on people to bring out their dead.

In what must have been a scene that would have appealed to the cinematic senses of Hitchcock or M. Night Shyamalan, American children of the period jumped rope to a chilling rhyme:

I had a little bird and its name was Enza
I opened the window and
In-flu-enza

Modern estimates of the death toll of the 1918 pandemic range from 40 million to a 100 million. Some historians even claim that it was the flu rather than the combined might of the Allied armies that really ended the war.

The influenza became known, inaccurately, as the Spanish Flu. Since over 80% of Spain's population contracted the disease, it was widely assumed that it had started there, rather than in Kansas.

The most terrifying aspect of the Spanish Flu? You mean other than the fact that hardly anyone knows about it and that it could happen again, any time? Well, unlike most flues, the Spanish Flu had an unsettling propensity to kill those presumably in the peak of health, namely men and women between the ages of 15 and 40.

Their vibrant immune systems were so efficient that they'd, in effect, overreact to the flu, quickly killing the body in an immunological onslaught of fever, mucus, and fluid.

Come on down & meet your maker
Come on down & make the stand
Come on down, come on down,
Come on down & we'll make the stand.

The Spanish Flu, along with two other comparatively mild pandemics that struck in 1957 and 1968 are what make epidemiologists nervous when they see something like the H1N1 virus, otherwise known as the Swine Flu, show its segmented-RNA head.

You're probably thanking your luck in the cosmic draw that you're alive in modern times when modern vaccines make catching something like the Swine Flu unlikely.

Uhh, not so fast, influenza boy.

The Center for Disease Control (CDC) has recommended that some 159 million U.S. citizens receive Swine Flu vaccinations, either through traditional shots or the newer intranasal vaccine.

In order to meet demands, companies like biotech company MedImmune in Philadelphia are pumping out over a million doses of flu vaccine a week.

But what if the vaccine provided doesn't prevent people from dying, particularly the elderly who account for about 90% of deaths from seasonal flu? Journalists Shannon Brownlee and Jeanne Lenzer, writing in the November Atlantic, suggest that flu shots have little to no effect, and their painstaking research makes it hard to think they're not right.

Occult or Astral Influence

What exactly is the flu?

It's not as easy to define as you might think. While symptoms of fever, malaise, coughing, and achiness are always blamed on influenza, only about half, and by some estimates only 7 or 8 percent, of patients who report these symptoms are actually suffering from an influenza virus.

It's more likely they've fallen victim to one of the more than 200 known viruses and pathogens that can cause "flu-like symptoms". More mysterious perhaps is that in over two-thirds of cases, physicians can't find any cause at all for the patients' suffering.

Odd, too, is how influenza surfaces in the wintertime. Various theories abound, ranging from people spend more time indoors in winter, where a sneeze or cough can cause infection, to how the virus might just flourish in colder weather.

It's no doubt these mercurial characteristics that caused people in the Middle Ages to coin the term influenza using an Italian word meaning "occult or astral influence."

What is especially mercurial, though, is how the virus mutates easily and often, so much so that each season sees the birth of a virus with a slightly different genetic make-up than the one that affected people the year before.

This creates a perplexing problem for epidemiologists who struggle to come up with new vaccines each year. The traditional course of action is for the World Health Organization and the Centers for Disease Control and Prevention to collect data from 94 countries on the flu viruses that were floating around the previous year.

They then make an educated guess as to which viruses are likely to make the respiratory rounds in the coming year. Based on the information they provide, the Food and Drug Administration issues orders to manufacture vaccines to combat the 3 viruses most likely to circulate.

The trouble is, they sometimes guess wrong, or worse, a new virus pops up for which humans have no immunity. The aforementioned Spanish flu is an all-too chilling example.

Whether the current viral flavor of the month, the H1N1 virus, otherwise known as the Swine Flu, will even begin to compare to the Spanish Flu won't be known until it's over. Current predictions are that between one-third and one-half of all Americans will be affected, with approximately 90,000 dying of the disease, which is roughly double the mortality rate of a regular flu season.

It should be noted, though, that of the Americans who've already died, approximately 70% were immunologically compromised, suffering from AIDS, cancer, asthma, or other serious illnesses.

That's a Miracle

Only a conspiracy nut would argue that vaccines for diseases like polio and whooping cough don't dramatically reduce death rates, but the flu is a different beastie in that it's seasonal. It also often kills the afflicted indirectly. In other words, the flu often allows secondary infections like bronchitis or pneumonia to set in and kill the host.

And therein lies the first statistical problem. Because of these indirectly caused deaths, statisticians and epidemiologists look at deaths from all causes during flu season and then compare vaccinated and unvaccinated populations.

Study after study has shown that people getting a flu shot in the fall are about half as likely to die that winter.

Sounds compelling, right? But it gets a little ugly when you look closer.

What most of the experts are overlooking is that somehow, miraculously, getting a flu shot reduces the chances of dying from any reason.

Consider that when the National Institute of Allergy and Infectious Diseases looked at all the diseases that the flu aggravates, like chronic heart failure or lung disease, the flu accounts for approximately 10% of all deaths in the elderly.

If that's the case, how could flu shots reduce the chances of dying by 50%?

According to Tom Jefferson, a physician based in Rome and the head of the Vaccines Field at the Cochrane Collaboration, a network of scientists that appraise medical statistics, "For a vaccine to reduce mortality by 50 percent and up to 90 percent in some studies means it has to prevent deaths not just from influenza, but also from falls, fires, heart disease, strokes, and car accidents."

"That's not a vaccine, that's a miracle," adds Jefferson.

The Earth is Flat!

The problem stems from how this 50% reduction in mortality rates is derived. Researchers often use what's called "cohort studies" which compare death rates of large groups of people who choose to be vaccinated against large groups that don't.

The trouble is, they often don't take into consideration underlying, mitigating factors like education, lifestyle, income, and other "confounding" factors.

In November of 2004, Lisa Jackson, a physician and senior investigator at the Group Health Research Center in Seattle, Washington, along with three colleagues, set out to find out whether the difference in mortality rates between the vaccinated and the unvaccinated might be caused by something called the "healthy user effect."

Their premise was simple: healthy people are more likely to get vaccinated than unhealthy people and thus less likely to die. The unhealthy may be bedridden or otherwise too sick to head to the vaccination center.

After looking at data on 72,000 elderly people, they noted that the chances of unvaccinated people dying were 60 percent higher than those who did get vaccinated, but they were looking at people outside the flu season.

That meant that the mortality rate of unvaccinated people didn't change, regardless of whether it was flu season or not!

It looked like the "healthy user effect" explained the entire alleged benefit of vaccination.

Perhaps not surprisingly, the top medical journals refused to publish her paper, one of the reviewing experts even going so far as to say, "To accept these results would be to say that the earth is flat!"

The paper was eventually accepted by a lesser-known journal by the name of the International Journal of Epidemiology, but it was almost entirely ignored.

Rubbish is Not a Scientific Term

The authors of the Atlantic article that posed all these questions, Brownlee and Lenzer, point to the history of flu vaccination to lend support to Jackson's findings. In 2004, for instance, vaccine production fell behind demands by about 40 percent, leading to a corresponding drop in vaccination rates. Regardless, the mortality rate didn't change.

Similarly, in 1968 and 1997, epidemiologists and scientists, when making recommendations for the composition of the flu vaccines that would immunize Americans in the corresponding flu season, guessed wrong. The vaccine that was manufactured in those years didn't target the correct viruses. In effect, no one was vaccinated. Again, the mortality rate didn't change.

The aforementioned Tom Jefferson is the most reviled critic of flu vaccinations. His colleagues shun him, but he's unwavering in his views. Jefferson and his team have gleaned over hundreds of flu studies and he thinks they're deeply flawed. "Rubbish is not a scientific term, but I think it's the term that applies," he offered.

According to Jackson, only four of the hundreds of flu studies were properly designed. Of these four, two showed that vaccination might be effective in certain groups of patients, like school-age kids with no underlying health problems, and two showed either no results or ambiguous results.

Part of the reason that the vast bulk of medical experts believe in flu vaccinations is because of the antibody response. It's absolutely true that when you inject a young, healthy person with a vaccine, he or she responds by producing millions of protective antibodies that will presumably protect the body against the onslaught of the seasonal flu; that, or lessen the severity of the flu should he or she contract it.

Unfortunately, the elderly generally don't have good immune responses to the vaccine and they're, of course, the ones most likely to die.

Neither do they elicit much of a response in the two other groups most likely to die from flu: immune-compromised children with severe disabilities, leukemia, or lung problems; and immune-compromised adults with AIDS or diabetes.

(Case in point, as of this past August, only 36 children had died of the Swine Flu in the U.S. and the vast majority of those were already suffering from multiple health disorders.)

But beyond all that, even though the vaccines cause an antibody response in certain healthy populations, there's no solid proof that they confer much, if any, protection.

An Epidemiological Version of Pascal's Wager

So what it comes down to is this: should the elderly get flu shots? Should the young and healthy, the group in which the flu shots are likely the most effective, even bother?

According to Brownlee and Lenzer, we're left with two possibilities. Either the flu shot is in fact highly beneficial, or we're relying on vaccines that simply don't work.

If it's the latter, we're probably neglecting other proven measures that could greatly reduce the number of deaths from any oncoming epidemic or pandemic.

In other words, if you have a strategy that people assume reduces mortality by 50%, people are likely to feel invulnerable; they're unlikely to be as judicious about hand washing and tactics like "social distancing" (school closings, voluntary quarantines, staying home if you're sick) are less likely to be employed.

One strategy, as far as protecting seniors, is to assume the vaccinations work and immunize children, health-care workers (only 50% currently intend to get Swine Flu vaccinations), and people around them to reduce the spread of the flu.

Another strategy, although definitely less comprehensive and less scientific, would be to avoid going to the hospital unless you're close to being on your deathbed. Sumit Majumdar, a physician and researcher at the University of Alberta, Canada, says, "There's no worse place to go than a hospital during flu season. Those that don't have the flu are more likely to catch it there, and those who do will spread it around. But we don't tell people this."

The big problem is that virtually every medical expert believes in the efficacy of vaccinations. That means there's little impetus to begin serious, well-designed studies, leaving us with status-quo treatments that might be based on little more than illusion and faith.

Here is, at least, what appears to be true:

• Vaccinations seem to help younger, healthier people mount a moderately successful immunological attack against flu viruses. This group, however, is also the least likely to die from a flu virus anyhow, regardless of whether they were vaccinated or not. They're also the least likely to bother with vaccination.

• Vaccinations don't seem to help the elderly much, even though they're the group most likely to get vaccinated.

In addition to what appears to be true, there's the question of vaccine safety. While the Swine Flu vaccine appears to be safe, no one knows for sure. Getting a flu shot always involves at least a small leap of faith (and often a small prayer).

And then we have to consider history: what happens if the Spanish Flu is resurrected by nature or by man? What if the Swine Flu, or some other yet unknown flu, mutates into something particularly virulent?

As you recall, most of the deaths incurred by the Spanish Flu were in the 15 to 40 age group, the group with the most vigorous immune systems.

Personally, I'm going to apply an epidemiological version of Pascal's Wager to the question of whether I should get a Swine Flu shot or not. In other words, I can't determine the efficacy of the vaccination or the future of the Swine flu through reason, so I might as well wager that the vaccination works as I've got everything to gain and probably little to lose.

Sources:

1. Barry, John M., The Great Influenza, Penguin Books, New York, New York, 2004.

2. Brownlee, Shannon, and Lenzer, Jeanne, "Shots in the Dark," The Atlantic, November 2009, pp. 44-54.