Interviews

Margaret McCartney

Dr Ann McPherson saw the need for DIPEx – now called Healthtalkonline- not from the doctors’ chair, but from the patient point of view. “Basically, 15 years ago I had breast cancer and although I’d been a GP for a long time, what I wanted was not to hear glamorous or extraordinary stories – you know, climbing Mount Kilimanjaro or whatever – but just the great variety of ways in which people dealt with things. I got talking to Dr Andrew Herxheimer – and he had just had a new knee. Well he was also a doctor, and knew a great deal about medicine and the way the body worked – but he wanted human stories as well. You want to know how other people with this are doing. And we thought – how can we get this working? How can we do this?”

Margaret McCartney

Links to previous interviews by Margaret McCartney:
Professor David Colquhoun, professor of molecular pharmacology and campaigning blogger

Dr Tom Jefferson and pandemic flu vaccines 

Two things in particular made me want to talk to Richard Bandler, the American co-creator of “neuro-linguistic programming”. The first is that an email arrived from his PR agency in London, entitled “Richard Bandler: Shrinks are a waste of money”. It went on:

“His method is to teach the depressed, stressed or disillusioned to dispose of their poisonous memories, their fears and self-doubt, by exploring how we think, communicate and behave, changing negatives into positives by adopting more successful ways of using the mind. Richard, whose techniques have successfully helped millions of people, including billionaires, sports stars, celebrities and the mentally ill, says: ‘… They come to me in desperation – and often, I only need to see them a couple of times to re-program their thinking and give them a whole new outlook on life, success and happiness.’”

Margaret McCartney

Tom Jefferson is a medically trained epidemiologist and Cochrane reviewer who has a specialist research interest in the effectiveness of vaccinations. As the first press releases start to filter through about vaccinations for H1N1, there are numerous questions in my mind as to the usefulness of this vaccine – not just for people in general, but for people at higher risk or who work in the health service and are going to be recommended to have it .

MM: As someone who has examined the evidence on this topic, Tom, I’m wondering what your thoughts are as to the potential role of influenza vaccination in a “pandemic”?

TJ: First, let me say that all our reviews are freely available online at cochrane.org site – click on resources. [Some of the vaccine studies Dr Jefferson has been involved can be found on the Wiley Interscience site]. The question you are really asking is – how effective are seasonal vaccines? And our reviews either show no effect or limited effect, and poor data.

What is interesting is that there has been extensive manipulations of the visibility of the data. Now, if you take influenza related mortality in the US – deaths related to influenza, bilateral pneumonia and so on – if you take the CDC (Centre for Disease Control and Prevention) data over the past  20 years, the curve is flat. A plateau. That line flattened after the 1950s – but before influenza vaccination started. As in – influenza related mortality crashed for reasons independent of vaccines. But, if you look at the past 20 years, the mean impact factor of journals (how well read, or well cited they are) the line is nearly vertical. These are pharma sponsored studies. But as far as seasonal influenza vaccines go, there is no difference to the level of threat from 20 years ago. But influenza vaccines have become the thing to talk about – they are now the things that journals like to run.

MM: Pandemic flu vaccines are currently in development; do we know much about them?

TJ: I have consulted the meta-register of clinical trials which should contain registration and broad outline of all current, recently closed or about to begin clinical trials on (in this case) H1N1 vaccines. I have found nine studies on H1N1 so-called pandemic vaccines using the search string “influenza H1N1″. However none of these studies are completed (except for H1N1 trials for “FluMist”, which is an error as it is another type of non pandemic vaccine). Some of them have not even started. The ones that have, give a completion date of Dec 2010.

I have also consulted the International Federation of Pharmaceutical Manufacturers & Associations IFPMA clinical trials portal and found a further 8 trials of H1N1 all similarly either ongoing or recruiting. These too have delivery dates of late 2009-2010.  Note that the vast majority of these trials are financed by public money. What we would need to do is to go through each entry tabulating the details to be absolutely certain of the facts.

MM: So what kind of testing should there be on new H1N1 influenza vaccines before they are used widely?

TJ: Do we know they are safe, or what the side effect profile is? No,  we don’t. We rely on forecasting with seasonal influenza vaccine – and some safety things – like injection site marks – and on past performance. The best evidence we have is for use in healthy adults - where there’s limited benefit – and there is none for use in pregnancy, yet.

Do we have a mechanism for dealing with vaccines which perform poorly or not at all? Not evidently. Do we know if these pandemic flu vaccines will do better? We don’t.

MM: A number of questionnnaires in the UK suggest many doctors and nurses will decline to receive any new pandemic flu vaccine against H1N1. But doctor and nurse leaders have asserted that they should have it in order to protect patients. I have seen no evidence that leads me to think that me being vaccinated will make much difference – what do you think?

TJ: There is no evidence, looking at seasonal flu vaccines, that is going to do anything – to benefit the elderly or others. There is evidence that healthcare workers may be prevented from symptoms of the flu, but these workers having the vaccine do not show a decrease in mortality. The data are poor.

MM: Thank you: much appreciated.

There are several podcasts featuring Dr Jefferson on the Cochrane website for further information: Cochrane Influenza Resources

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Margaret McCartney is a Glasgow-based GP and FT Weekend columnist. She started writing for the Life and Arts section in 2005 and moved to the magazine in 2008. She also has her own blog: www.margaretmccartney.com/blog

Clive Cookson has been a science journalist for the whole of his working life. He joined the FT in 1987. Clive, the FT's science editor, picks out the research that everyone should know about. He also discusses key policy issues, from R&D funding to science education.

Andrew Jack is pharmaceuticals correspondent, covering the industry and public health issues. He has been a journalist with the FT for 19 years, based in London, Paris and Moscow

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