NEJM should never have published this study in its current state and is culpable for not having strong editorial comments about the many shortcomings Dr. Marine outlined. The editorial comments (by Hana M. El Sahly, M.D. and Robert L. Atmar, M.D) did note the absence of benefit to the younger and elderly population we often look to gain the most benefit from influenza vaccination, but fell short in doing the responsible work Dr. Marine did.
Unbelievable that any honest and informed physician or public health worker could not have learned through compelling evidence about the great harm caused by mRNA "vaccines". We are doomed if we have not, and cannot, learn from history. The means Big Pharma will go to propagate harmful toxins for profit is egregious. And the fact that many physicians still rely on Big Pharma for their "education" is remarkable. No wonder the public is referring to we physicians as legal DRUG DEALERS.
I love this kind of thorough breakdown of a study - thank you!
I'm curious if you have thoughts on how the "anti-fragile" nature of the immune system might impact flu vaccine efficacy. For the serious diseases, I'm 100% behind vaccines. But for flu vaccines in healthy populations, I'm less convinced whether they're worth it. For myself, it's very consistent that every year when I have new germ exposures (e.g. moving to a new area or enrolling kids in a new school), I get sick for the first year and then have an iron immune system the following years. A flu vaccine probably won't hurt, but I'm not sure it's worth the extra hassle.
But I'm not sure if any of these RCTs have follow-up that long or whether there's other research that can inform about this - any thoughts?
Thank you for your interesting questions. I do not have a direct answer, but I think they are worth asking. I have had about 20 years of consecutive flu shots. There are lots of individual studies of the efficacy of the annual shot, but little on cumulative effect on efficacy and (potentially) tolerance. There is a strong bias in medicine to regard any "vaccine" as safe, effective, and necessary for all. This bias may prevent us from asking and answering the kinds of questions you pose. More shots for every infectious disease is not necessarily the best path. I would encourage reading "Fear of a Microbial Planet" by microbiologist Steve Templeton. The basic thesis (which I was taught in medical school) is that we live in a sea of microbes of all kinds, only a small fraction of which are harmful to us. Viewing every microbe as a potential or actual "threat" may lead to overreaction, including psychological harm.
I enjoyed your analysis. I am also required to get an annual flu shot at my hospital. We are seeing quite a bit of flu, patients and coworkers, despite vaccination. Must be this pesky new strain. We are told we'd all be sicker if it wasn't for the shot despite what seems like a mismatch this year. How do the public health experts come to that conclusion, I wonder. Have there been studies proving this? I follow you on X as well. Thanks for all the great content.
The RCTs and systematic reviews suggest that flu shots reduce rate of flu but other endpoints not clear. Retrospective case-control studies of the annual flu shots suggest RRR in hospitalization of 30-60% but there are limitations in this study design. Data on reduction in nosocomial spread (which is the rationale for HCW mandates) is even more ambiguous. Others have pointed out that there has been little change in overall age-adjusted death rate from seasonal influenza over the past 40 years despite wider uptake of annual immunization.
Thank you for that excellent analysis. Would it be fair to say that with efficacy for each vaccine under 1% that both could be considered as placebos (i.e. ineffective)?
Thank you for this excellent analysis. I understand the comments regarding big pharma, however, the fact that this garbage gets published after “peer review” is a scathing indictment of how far the NEJM has fallen-shameful.
Thank you. I agree that much of this problem rests with the physician community of journal editors and manuscript reviewers, to be cognizant of these potential biases in presentation of clinical trial data. We should expect industry to advocate for their products - that is their job. Our job is to advocate for the best interests of patients and the public.
Good question. I have noticed it more in past 5-10 years but perhaps because I am more sensitized to it. I do suspect that commerical interests have become more powerful and sophisticated in their ability to influence the biomedical research agenda. At best, these are positive relationships and partnerships, but it is incumbent on the physician community to be cognizant of these influences in reviewing manuscripts.
Too bad it's not a mandatory course in medical school. At the very least, make 1 year of statistics/combinatorics a mandatory requirement. But thanks for all you do.
Well done. I’ve always taught that from my reading the High dose flu shot for seniors” was misinformation at best and outright fraud at worst in that it was no more clinically effective than the regular dose flu vaccine and has much more in the way of side effects.
So I put my money where mouth was and went to a local drug store for the “senior” shot. Sure enough in an hour my arm hurt and that night fever and chills. Ok for work in the morning. Never a reaction in over 40 years with the standard shot.
Thanks for an excellent appraisal and evisceration of this study (and product).
I sure hope NEJM published a similarly rigorous and scathing accompanying opinion (who am I kidding)….but I suggest submitting this as a letter to editor to at least remind them of their editorial duties.
Thank you to Dr Marine for writing this and for Sensible Medicine for posting it.
I work in healthcare and have been waiting for the mandatory flu shot to be an mRNA product so that I can refuse and finally take a stand against mandatory vaccines in order to work. Because the medical community passively went along with required flu shots all these years, the door was wide open for COVID vaccine mandates in healthcare workers. Let’s stand up and stop bowing down to vaccine mandates. Luckily, my employer removed the flu vaccine mandate this year. I didn’t receive one.
Thank you. I believe that most people involved in healthcare and medical research are trying to do the right thing everyday. Sometimes our biases get in the way. We need a healthy and profitable pharma industry, but the mission of healthcare must always come first.
Thank you, Dr. Marine. This was both fascinating and easy to understand for a non-physician. Critical analyses by physicians such as yourself and many involved with Sensible Medicine continue to give me hope that the standard of care in our country won't be dictated solely by pharma and profits.
Thank you for this thoughtful analysis. We desperately need RCTs to evaluate flu shots. The RCTs need a control group of non-vaccinated individuals instead of a control group receiving a different type of shot.
NEJM should never have published this study in its current state and is culpable for not having strong editorial comments about the many shortcomings Dr. Marine outlined. The editorial comments (by Hana M. El Sahly, M.D. and Robert L. Atmar, M.D) did note the absence of benefit to the younger and elderly population we often look to gain the most benefit from influenza vaccination, but fell short in doing the responsible work Dr. Marine did.
Unbelievable that any honest and informed physician or public health worker could not have learned through compelling evidence about the great harm caused by mRNA "vaccines". We are doomed if we have not, and cannot, learn from history. The means Big Pharma will go to propagate harmful toxins for profit is egregious. And the fact that many physicians still rely on Big Pharma for their "education" is remarkable. No wonder the public is referring to we physicians as legal DRUG DEALERS.
I love this kind of thorough breakdown of a study - thank you!
I'm curious if you have thoughts on how the "anti-fragile" nature of the immune system might impact flu vaccine efficacy. For the serious diseases, I'm 100% behind vaccines. But for flu vaccines in healthy populations, I'm less convinced whether they're worth it. For myself, it's very consistent that every year when I have new germ exposures (e.g. moving to a new area or enrolling kids in a new school), I get sick for the first year and then have an iron immune system the following years. A flu vaccine probably won't hurt, but I'm not sure it's worth the extra hassle.
But I'm not sure if any of these RCTs have follow-up that long or whether there's other research that can inform about this - any thoughts?
Thank you for your interesting questions. I do not have a direct answer, but I think they are worth asking. I have had about 20 years of consecutive flu shots. There are lots of individual studies of the efficacy of the annual shot, but little on cumulative effect on efficacy and (potentially) tolerance. There is a strong bias in medicine to regard any "vaccine" as safe, effective, and necessary for all. This bias may prevent us from asking and answering the kinds of questions you pose. More shots for every infectious disease is not necessarily the best path. I would encourage reading "Fear of a Microbial Planet" by microbiologist Steve Templeton. The basic thesis (which I was taught in medical school) is that we live in a sea of microbes of all kinds, only a small fraction of which are harmful to us. Viewing every microbe as a potential or actual "threat" may lead to overreaction, including psychological harm.
https://brownstone.org/articles/fear-of-a-microbial-planet/
Great analysis Dr. Marine!!
I enjoyed your analysis. I am also required to get an annual flu shot at my hospital. We are seeing quite a bit of flu, patients and coworkers, despite vaccination. Must be this pesky new strain. We are told we'd all be sicker if it wasn't for the shot despite what seems like a mismatch this year. How do the public health experts come to that conclusion, I wonder. Have there been studies proving this? I follow you on X as well. Thanks for all the great content.
Thanks for your comment. Dr. Prasad covers some of this in his recent review which include citations. https://onlinelibrary.wiley.com/doi/10.1111/eci.14286?msockid=3521df60858f6fc11b69cd0784c06ed8
The RCTs and systematic reviews suggest that flu shots reduce rate of flu but other endpoints not clear. Retrospective case-control studies of the annual flu shots suggest RRR in hospitalization of 30-60% but there are limitations in this study design. Data on reduction in nosocomial spread (which is the rationale for HCW mandates) is even more ambiguous. Others have pointed out that there has been little change in overall age-adjusted death rate from seasonal influenza over the past 40 years despite wider uptake of annual immunization.
Thank you for that excellent analysis. Would it be fair to say that with efficacy for each vaccine under 1% that both could be considered as placebos (i.e. ineffective)?
That is possible, but we would need a placebo control to know this. Hopefully Dr. Prasad will be able to encourage these trials!
Thank you for this excellent analysis. I understand the comments regarding big pharma, however, the fact that this garbage gets published after “peer review” is a scathing indictment of how far the NEJM has fallen-shameful.
Thank you. I agree that much of this problem rests with the physician community of journal editors and manuscript reviewers, to be cognizant of these potential biases in presentation of clinical trial data. We should expect industry to advocate for their products - that is their job. Our job is to advocate for the best interests of patients and the public.
Was it always this bad (evil)? Or is it a relatively new thing? Thank you for laying it out for the rest of us.
Good question. I have noticed it more in past 5-10 years but perhaps because I am more sensitized to it. I do suspect that commerical interests have become more powerful and sophisticated in their ability to influence the biomedical research agenda. At best, these are positive relationships and partnerships, but it is incumbent on the physician community to be cognizant of these influences in reviewing manuscripts.
Too bad it's not a mandatory course in medical school. At the very least, make 1 year of statistics/combinatorics a mandatory requirement. But thanks for all you do.
That will never happen because Big Pharma sponsors medical schools.
Ugh. So sad.
Well done. I’ve always taught that from my reading the High dose flu shot for seniors” was misinformation at best and outright fraud at worst in that it was no more clinically effective than the regular dose flu vaccine and has much more in the way of side effects.
So I put my money where mouth was and went to a local drug store for the “senior” shot. Sure enough in an hour my arm hurt and that night fever and chills. Ok for work in the morning. Never a reaction in over 40 years with the standard shot.
Thanks for the advice - I will stick to the regular dose as well.
Thanks for an excellent appraisal and evisceration of this study (and product).
I sure hope NEJM published a similarly rigorous and scathing accompanying opinion (who am I kidding)….but I suggest submitting this as a letter to editor to at least remind them of their editorial duties.
Thank you - I will try.
Some publishers are also corrupt and culpable in the pharmaceutical industry’s shenanigans.
Thank you to Dr Marine for writing this and for Sensible Medicine for posting it.
I work in healthcare and have been waiting for the mandatory flu shot to be an mRNA product so that I can refuse and finally take a stand against mandatory vaccines in order to work. Because the medical community passively went along with required flu shots all these years, the door was wide open for COVID vaccine mandates in healthcare workers. Let’s stand up and stop bowing down to vaccine mandates. Luckily, my employer removed the flu vaccine mandate this year. I didn’t receive one.
I join you in refusing to be a legal Drug Dealer.
Thank you. I believe that most people involved in healthcare and medical research are trying to do the right thing everyday. Sometimes our biases get in the way. We need a healthy and profitable pharma industry, but the mission of healthcare must always come first.
Thank you, Dr. Marine. This was both fascinating and easy to understand for a non-physician. Critical analyses by physicians such as yourself and many involved with Sensible Medicine continue to give me hope that the standard of care in our country won't be dictated solely by pharma and profits.
Thank you for this thoughtful analysis. We desperately need RCTs to evaluate flu shots. The RCTs need a control group of non-vaccinated individuals instead of a control group receiving a different type of shot.
I had published a substack with the same points with a slightly different display of the excess number of each side effect with rthe mRNA vaccine. https://jeanlucszpakowski.substack.com/p/modified-mrna-vaccine-against-influenza?r=3jakc