Myths and Facts Regarding the H1N1 Vaccine

The internet is the great information equalizer, where both large and small news sites are just a click away. Like an open microphone, anyone can step up and speak their mind for the entire world to hear. But this unprecedented accessibility and freedom to speak comes at a cost. Many sites have no supervising editor and no fact checking. Rumors and outright fabrications stand equal to actual news reports. To write online all you need is a keyboard and a modem. Honesty is optional. This is why conspiracy theorists love the internet: it's a giant megaphone with which they can tell the world about their wild theories, with little to separate fact from fiction.

Such is the case regarding the H1N1 vaccine. Many fringe elements, from a kooky Finnish ex-Chief Medical Officer (now better known for her diatribes on UFO sightings and government microchip implantations), to a wholesome-looking Spanish nun (she couldn't possibly be lying to us, no?), have come together to denounce this vaccine as part of an evil plot to take our money and/or kill us in order to substantially depopulate the globe.

While this may strike a cord among those who already fear or resent our government institutions, or who suspect great powers lurking behind the scenes plot against us, it is completely baseless. The H1N1 vaccine is not part of a global conspiracy; it's the logical response to a new flu strain that, though generally mild, can be deadly.

As a physician, it's hard for me to idly sit by and watch people like Teresa Forcades, the Spanish nun, spew distortions and outright fabrications unchecked. Their self-serving message is not only unhelpful, but may actually be harmful. They may end up causing pain or grief to the very innocent individuals they allege to be out to help.

I've compiled a list of myths and facts regarding the H1N1 vaccine, loosely based as a rebuttal to Sor Forcades' hour-long YouTube video on the vaccine. Enjoy!

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MYTH: Teresa Forcades is a Catholic nun and a doctor. She is a person we can trust to tell us the truth about vaccines.

FACT: When Teresa Forcades sells herself as a mere Benedictine nun who studied medicine, she's not telling you the whole story. She's an avid political activist with a feminits/anticapitalist agenda. She's written two books, titled:

Feminist Theology in History
The Crimes of the Great Pharmaceutical Companies

The latter book has on its cover a medicine bottle labeled with a skull and cross bones, and multiple dollar signs. In it, she states, "The great pharmaceutical companies use their riches and power to defend their own interests at the expense of the wellbeing, health, and lives of other people." Is it so surprising she'd be against vaccines, which she alleges only help the "great interests" of the pharmaceutical industry?

The phrase "Catholic nun" doesn't quite fit Sor Teresa. From the Spanish website Infocatolica (translated by me): http://infocatolica.com/blog/germinans.php/teresa-forcades-monja-feminista-abortist

"In reality, with her, religious vestment is only a figure of speech. Because Sor Forcades does not wear the traditional Benedictine vestment, but a simple headcover and normal clothes, pants included. The notion of being a cloistered nun is also just a figure of speech, because she is rarely if ever in the monastery, always traveling around the world (currently living in Germany), in conferences, television interviews, etc.

According to her, abortion is not a crime like that of killing another person, because the fetus is not another life, but simply forms part of the mother, with whom it has a unique and singular relationship. She even goes so far as to say it has been God who has placed the fetus in the mother, and so it is the mother who must decide. When the interviewer noted that this was not the doctrine of the Catholic Church, she answered that she was not speaking in the name of the Church, but only giving her own opinion."

In an interview with "Singularis," a program on Catalan TV ( http://mujercristianaylatina.wordpress.com/2009/06/27/sor-teresa-forcades-justifica-el-aborto-y-afirma-que-le-gustaria-que-la-pastilla-del-dia-despues-estuviera-al-alcance-de-todas-las-mujeres/ ), she asserted she was in favor of the "morning after pill," and later stated we should respect the conscience of women who abort:

"If God has placed at the hands of the mother the life of the fetus, we are not the ones to take this away from her. We can give support at various levels. ... I would not respect the conscience of a person who opts to take another's life, but this is a particular case. It's particular since it's God Himself who puts the life in the hands of the mother, so it carries a special treatment."

In another article ( http://www.forumlibertas.com/frontend/forumlibertas/noticia.php?id_noticia=14299), she states (translated):

"God has placed the life of the fetus -while unviable- in the hands of its mother... the decision to abort is indivisible from the mother's self-determination, from her personal liberty. This intimate relationship between the two lives makes it impossible to save the life of the child against the will of the mother without trespassing upon the mother's liberty." (added emphasis)

A believer of Liberation Theology that has twice attended conferences in Venezuela, Sor Teresa is not simply a "nun," but a political activist. I do not deny her right to form her own opinions. But her opinions contradict those of the Catholic Church, which she represents when portraying herself as a Benedictine nun.

As I show below, Sor Forcades distorts the truth, says half-truths, or fabricates outright lies, all to support her position against the "great pharmaceuticals." Yet as a nun, she promised to serve God by honestly serving others. She subordinates this obligation, as she distorts information to reach her predetermined conclusions and serve her own agenda. Hers is a doubly immoral act, as she not only produces false testimony, but does it from the pulpit of a monastery. She betrays the trust people have placed in her, and betrays her mission in the Church.

As for being a doctor, Sor Forcades has a medical knowledge base. But she has little experience. She may be a doctor, but she doesn't work at a hospital. She does not have the perspective of how this virus can spread, and the damage it can cause.

More importantly, she is severely biased. She drums up potential vaccine faults and minimizes the potential morbidity and mortality of the virus. It's sad how she assumes the worst from the vaccine, and the best from the virus. She's more inclined to believe in the evil of her fellow man working in the drug companies, and the goodness of a virus who wants to destroy us.

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MYTH: For most people, vaccines aren't necessary. They don't work. It's more dangerous to use them than not to.

FACT: The sole purpose of a vaccine is to prevent infections, and thus on an individual level it's difficult to demonstrate its efficacy. If it works, nothing is supposed to happen to the patient! It's difficult to prove a negative! If something does happen, everyone will notice, if nothing happens, nobody will notice. In these cases we must recur to epidemiologic studies to demonstrate how, at a national level, the incidence of a specific infection has diminished. But according to people like Sor Forcades, these studies have no validity, as they are "fabricated" by the great industrial interests.

How can we prove vaccines work? Let's review some history. 100 years ago, people suffered such incapacitating or lethal infections like polio, measles, rubella, tetanus, among others. With vaccines, in the developed world we have practically eradicated these diseases. But this success has made people forget how terrible these diseases can be. Most have never suffered them, or felt the pain of the absence of those who have suffered them and died. Thus, they do not understand that the risk of a needle stick is infinitely less than the risk of suffering these diseases.

But those who do not learn history are condemned to repeat it. During 1988-1990 there was a measles outbreak in California, mostly among children 5 and under, because people were not vaccinating their kids. 16,400 cases were reported, with 3,390 hospitalizations. 75 persons -mostly children- died, killed by an easily preventable disease.

From the Western Journal of Medicine:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1022280/

"The major cause of the epidemic was low immunization levels among preschool-aged children and young adults. Rates of complications, admission to hospital, and death were surprisingly high. Outbreak control efforts met with indeterminate success. Problems with these efforts included insufficient funding early in the epidemic and disappointing public response to community-based immunization campaigns. The cost of medical care and outbreak control for the epidemic is conservatively estimated at $30.9 million. Unless the level of immunization in preschool-aged children is increased, this type of epidemic will probably recur."

"[We had] difficulty motivating parents in target populations to have their children immunized. Special immunization campaigns repeatedly produced disappointing results despite extensive multilingual publicity efforts. The best responses occurred in communities that had just been inundated with news stories about measles deaths. The farther away these messages were, either in time or geographically, the poorer the public response to immunization campaigns." (added emphasis)

Until people did not feel threatened, they would not get the vaccine, with deadly results. From an epidemiological point of view, mortality was "only" 0.5%, similar to the mortality of influenza, which the nun had the audacity to say is something we should not "fear."

The impetus to the swine flu vaccine campaign is precisely to avoid a result similar to that of the measles outbreak. The number of swine flu cases has diminished, but historically the flu has a bimodal incidence: a small peak in summer, followed by a bigger peak in winter. The winter peak has not started yet, but the CDC and the WHO don't want to wait until people start getting sick.

Those alarmists who raise the specter of the 1918 outbreak -where 50 million died - are unhelpful. That's not going to happen. But we could have a flu season like the ones we had with the Asian Flu of 1958, or the Hong Kong Flu of 1968, in each of which over 1 million people died. That's sufficiently concerning to merit the vaccine program.

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MYTH: The H1N1 virus is not new. It's the same virus from the 1918 pandemic, which disappeared in 1957, only to reappear in 1977 after it was resynthesized in a lab, using as a guide the virus recovered from a frozen Inuit woman that died with flu in 1918.

FACT: There are many strains of H1N1 viruses. They are endemic to pigs, that's why they're called "swine flu" viruses. Yes, there was a period between the 1950s-70s where they did not form part of the seasonal flu, but they did not "disappear." Sor Forcades contradicts herself when she says it "reappeared" in 1977, knowing that the 1976 flu scare in the US was caused by an H1N1 swine flu virus. There was a relatively benign outbreak by another H1N1 strain in 1977, which was similar to that of the 1957 outbreak. But this so-called 1977 "Russian Flu" strain was not the same as the 1918 strain. Sor Forcades mixes data to make you believe that the same 1918 strain disappeared in 1957, and then resurfaced in 1977. That's a lie. These were all H1N1 viruses, but they were different strains, just like the 1976 strain was also different. The 1918 strain WAS reconstituted in a lab after being recovered from a frozen Inuit woman by researchers.... in 2005!

"Many theories about the origins and progress of the Spanish flu persisted in literature, but it wasn't until 2005, when various samples recovered from American World War I soldiers and an Inuit woman buried in the Alaskan tundra, that significant research has been possible."
http://freebiotechnology.blogspot.com/2009/04/influenza-virus-subtype-h1n1-and.html

Also, the lab viruses have remained in the lab. The H1N1 virus now in the community is NOT the same one as the 1918 virus.

From Wikipedia: http://en.wikipedia.org/wiki/H1N1
"In the 2009 flu pandemic, the virus isolated from patients in the United States was found to be made up of genetic elements from four different flu viruses – North American swine influenza, North American avian influenza, human influenza, and swine influenza virus typically found in Asia and Europe... This new strain appears to be a result of reassortment of human influenza and swine influenza viruses, in all four different strains of subtype H1N1."

Sor Forcades maliciously wants to make it seem like the virus disappeared, only to resurface to cause new outbreaks after the government recreated it (...as part of a sinister plan...? ) and that from the lab, it jumped out to the community. But her chronology and science are false.

If you think of it, it's laughable to say the same feared 1918 flu is the one we have today. ...if it killed 50 million back then, who many MORE would be dying today...?

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MYTH: The first two cases were diagnosed in California.

FACT: The index case (the first known case) was a child in Mexico, diagnosed on April 2. It's suspected that the virus was already present in Mexico in 2008, but it was misdiagnosed as seasonal flu, until the outbreak began in 2009.
http://edition.cnn.com/2009/HEALTH/04/28/swine.flu/index.html

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MYTH: Swine flu has a low mortality, and thus it should not be feared.

FACT: Swine flu does have a low mortality, about 0.1-0.2%. But that still means that 1 or 2 of every 1,000 infected individuals is going to die. What if 100,000 are infected? 1 million? 100 million? See how the number of dead could potentially escalate? Seasonal flu also has a low mortality, but despite this, about 30,000 still die. That's why we encourage all at risk for seasonal flu to get vaccinated. The problem with swine flu is that it could not only affect the elderly, but also the young and otherwise healthy. That's why the swine flu vaccination campaign is so broad. And even if mortality is low, tens of thousands may require hospitalization, straining our healthcare system.

From NPR: http://www.npr.org/templates/story/story.php?storyId=112683634

"This pandemic virus is not necessarily more deadly than other flu strains, but it is likely to infect more people than usual because few people have immunity against it. People younger than 25 years old, pregnant women and those with certain medical conditions such as diabetes and asthma are at particular risk for becoming sick with swine flu, which is unusual when compared with seasonal flu outbreaks that typically cause complications for the elderly." (added emphasis)

From the Irish Times: http://www.irishtimes.com/newspaper/ireland/2009/1023/1224257294052.html

"Investigators from New South Wales provide perhaps the most comprehensive description of the pandemic using multiple surveillance systems. The pandemic there lasted 10 weeks and had a substantial impact on intensive care units (ICUs), with an increased risk of severe illness, including respiratory failure, in those aged between 35 and 60. Vulnerable groups included pregnant women, indigenous people, those with chronic respiratory disease, and those with morbid obesity." (added emphasis)

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MYTH: A third of the elderly are already immune to swine flu.

FACT: From NPR: http://www.npr.org/templates/story/story.php?storyId=112683634

"It appears that about one-third of adults older than 60 may have some immunity against the new H1N1 virus, according to the Centers for Disease Control and Prevention (CDC). This may stem from exposure decades ago to viruses similar to the new one. Still, it's unclear how much, if any, protection these existing antibodies offer against the new virus. And CDC laboratory studies have found that no children and very few adults younger than 60 have antibodies against the new H1N1 virus. " (added emphasis)

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MYTH: Baxter is guilty of bioterrorism and attempted mass murder, as reported by the journalist Jane Burgermeister.

FACT: Jane Burgermeister did actually report this. But to take this seriously is about as absurd as saying the world is flat because Jane Burgermeister reported that, too. Who is this reporter? According to Wikipedia (in Spanish, translated by me):

http://es.wikipedia.org/wiki/Jane_Burgermeister

"She was the European writer for a news website related to the world of renewable energy, a post from which she was summarily fired from in July of 2009 after she presented a series of criminal charges against Baxter, the WHO... AG, and Avir Green Hills of Austria Biotechnology, for the production of a contaminated avian flu vaccine, together with charges of deliberately provoking and taking advantage of a global pandemic."

But the charges do not end there. From Global Research: http://www.globalresearch.ca/index.php?context=va&aid=14276

"Burgermeister presents evidence of acts of bioterrorism that is in violation of U.S. law by a group operating within the U.S. under the direction of international bankers who control the Federal Reserve, as well as WHO, UN and NATO. This bioterrorism is for the purpose of carrying out a mass genocide against the U.S. population by use of a genetically engineered flu pandemic virus with the intent of causing death. This group has annexed high government offices in the U.S.

Specifically, evidence is presented that the defendants, Barack Obama, President of the U.S, David Nabarro, UN System Coordinator for Influenza, Margaret Chan, Director-General of WHO, Kathleen Sibelius, Secretary of Department of Health and Human Services, Janet Napolitano, Secretary of Department of Homeland Security, David de Rotschild, banker, David Rockefeller, banker, George Soros, banker, Werner Faymann, Chancellor of Austria, and Alois Stoger, Austrian Health Minister, among others, are part of this international corporate criminal syndicate which has developed, produced, stockpiled and employed biological weapons to eliminate the population of the U.S. and other countries for financial and political gain.

The charges contend that these defendants conspired with each other and others to devise, fund and participate in the final phase of the implementation of a covert international bioweapons program involving the pharmaceutical companies Baxter and Novartis. They did this by bioengineering and then releasing lethal biological agents, specifically the "bird flu" virus and the "swine flu virus" in order to have a pretext to implement a forced mass vaccination program which would be the means of administering a toxic biological agent to cause death and injury to the people of the U.S."

Amongst her "evidence," she presents:
"Evidence as to the existence of an international corporate crime syndicate. Evidence of the existence of the 'Illuminati.' Evidence as to the depopulation agenda of the Illuminati/Bilderbergs and their involvement in the engineering and release of the artificial 'swine flu' virus."

Sounds like the plot of cheap novel.... These wild conspiracy charges, which include Obama, Sibelius, Soros, the WHO, NATO, and even the UN, are the product of the sick mind of a failed journalist. If this loon is the only "source" of evidence to make the jump from a Baxter lab error to a grand conspiracy, it's pretty weak.

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MYTH: Jane Burgermeister asserts that in 2009, Baxter's Austrian subdivision distributed 72 kilos of vaccine material contaminated with avian flu. This can be easily corroborated as fact.

FACT: The material involved was NOT vaccine material, and it was NOT intended for the public. It was research material sent to a lab in Austria.

From the Toronto Sun: http://www.torontosun.com/news/canada/2009/02/27/8560781.html

"The contaminated product, a mix of H3N2 seasonal flu viruses and unlabelled H5N1 [avian flu] viruses, was supplied to an Austrian research company. The Austrian firm, Avir Green Hills Biotechnology, then sent portions of it to sub-contractors in the Czech Republic, Slovenia and Germany..... The contaminated product, which Baxter calls “experimental virus material,” was made at the Orth-Donau research facility. Baxter makes its flu vaccine — including a human H5N1 vaccine for which a licence is expected shortly — at a facility in the Czech Republic."

From Bloomberg: http://www.bloomberg.com/apps/news?pid=newsarchive&sid=aTo3LbhcA75I
"The material was intended for use in laboratories, and none of the lab workers have fallen ill."

Clearly, the research material in question did get contaminated. There's no doubt a mistake did occur. Many are quick to point to this as proof of Baxter's plan to spread a pandemic, as the labs involved are just too sophisticated for an error of this magnitude to simply "occur." Well, I'd say NASA's space shuttle program is pretty darn sophisticated as well, and yet one shuttle blew up on take off and another burned in re-entry. Shit happens, eh?

....But no, it the lab material contamination could NOT have been an error, it MUST be part of a conspiracy... How paranoid is that?

Let's assume just for a moment Burgermeister was right, that there was a conspiracy to kill off part of the world with a Baxter-made vaccine contaminated with avian flu. Hmmm... Do you think that out of ALL the batches of vaccine produced last year by Baxter, they would have made just ONE infected batch? ...And that batch was miraculously the exact one tested by the Czech lab tech? Wow, aren't we lucky!! Think of it: a grandiose world conspiracy to annihilate large portions of the population... but nobody died! Ha, ha, ha!

Yet some, like Sor Teresa Forcades, use this flimsy accusation to assert that nobody should Baxter vaccine, implying all its vaccines could be contaminated. Baxter is a multibillion dollar company that produces a wide variety of healthcare products. Though indeed an error could have happened, one which needs an objective investigation, this exceptional case does not prove to be the rule. It's as if we were to say we cannot fly a specific airline because they had an air accident, without understanding that this line of thinking would leave us like "The Rainman," who would only fly Quantas, as at the time of the film, it was the only airline without an accident....

It's actually sad that people like Forcades place greater emphasis on ONE tainted shipment of research material, than on an infectious agent that kills 1-2 of every 1,000 infected individuals; an agent that, according to the CDC, has already infected millions in the US, has generated over 20,000 admissions,and killed over 1,000 Americans.

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MYTH: The WHO was quick to declare level 6 pandemic because this year it actually changed its definition of pandemic to exclude data related to mortality. This change in definition was even reported on CNN.

FACT: Since it's inception, the WHO's 1-6 pandemic scale has NEVER included factors related to mortality, because "pandemic" is an epidemiologic term that relates to spread of a novel infective agent. It has NOTHING to do with virulence of the agent. Hence, a pandemic occurs when a new infective strain develops, one which a large portion of the population has little or no immunity to. Seasonal flu is generally comprised year after year of similar strains, hence they do not require "pandemic" status every year. The current H1N1 swine flu, however, is a new strain, thus the "pandemic" label.

CNN did report the following: http://edition.cnn.com/2009/HEALTH/05/04/swine.flu.pandemic/index.html

"Until Monday morning, the WHO had a definition on its Web site saying that a pandemic flu causes "enormous numbers of deaths and illness." After a CNN reporter pointed this out, WHO spokeswoman Natalie Boudou called back to say the definition was in error and had been pulled from the WHO Web site.

"It was a mistake, and we apologize for the confusion," she said. "(That definition) was put up a while ago and paints a rather bleak picture and could be very scary."

The correct definition is that "pandemic" indicates outbreaks in at least two of the regions into which WHO divides the world, but has nothing to do with the severity of the illnesses or the number of deaths.

Based on lessons from the past, "influenza may cause mild disease in affluent countries, but more severe disease, with higher mortality, in developing countries,"

Again, a simple mistake is taken for proof of a nefarious plan to destroy the world....

Last May, the WHO DID consider changing its definition of "pandemic".... to INCLUDE factors relating to mortality. From the New York Times:
http://www.nytimes.com/2009/05/23/health/policy/23who.html?_r=2&hp

"Bowing to pressure, the World Health Organization announced Friday that it would rewrite its rules for alerting the world to new diseases... Dr. Keiji Fukuda, the deputy director general making the W.H.O. announcement, said that he could not predict exactly what the new rules would be but that criteria would include a “substantial risk of harm to people,” not just the geographic spread of a relatively benign virus." (added emphasis)

Those who say the opposite, like Sor Teresa Forcades, are lying, flipping the truth inside out to fit their anti-pharmaceutical agenda.

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MYTH: The decision to declare "pandemic" by the WHO and by the United States was premature.

FACT: By June of this year, there was already evidence that the virus had spread to 69 countries. A severe crisis was already brewing in Mexico: nations were canceling flights to and from Mexico, universities were closed, public gatherings were cancelled, and the usually congested streets of Mexico City were quiet, as most people stayed home. What would happen if this new strain crossed the border into USA? What would be the human impact? The economic impact? The impact on our already strained healthcare system? Should the US have waited until people started dying? That a full blown outbreak, like the California measles outbreak, develop?

This also obviates the confusion and heightened concern that the original data coming from Mexico created. The first numbers from Mexico implied a much higher mortality (around 7-10%), specifically among young, otherwise healthy individuals. This alarmed many in the global healthcare community, as it would've implied an extremely lethal and rapidly evolving pandemic. But as the disease spread, the data from other countries was nowhere near as bad as the Mexican data. It's now suspected that many of the subclinincal cases of swine flu in Mexico went unreported. As only the sickest cases were detected (among which there is a higher incidence of death), it skewed the data to imply a much higher mortality. This did, in fact, initially scare the WHO, the CDC, and the rest of the world.

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MYTH: Since 2005, the WHO has the legal right to order countries to take actions in the event of a pandemic, and that includes mass obligatory vaccinations.

FACT: This is taking a fact and jumping to wild conclusions. In the event of a pandemic (level 6), the WHO calls on affiliated nations not yet exposed to the infecting agent to take "necessary precautions" to avoid further spread of the agent. This usually means preventive measures, but nobody has ever called for mass obligatory vaccinations.

The WHO cannot "order" countries to do anything, really. It's not a legislative body, it cannot pass laws. It's dictats are not legally binding in any court of law. Think of it this way: would the US (or any other nation) subordinate its sovereignty to the WHO? As for obligatory vaccinations in the event of a pandemic, well, we're already IN a pandemic, and so far no nation has called for this...

From the Wall St. Journal: WSJ: Junio 12 http://online.wsj.com/article/SB124471165680705709.html

"The World Health Organization declared the first flu pandemic in 41 years, even as it stressed there are no signs the H1N1 virus has turned more lethal as it spreads across the globe. The declaration Thursday by the United Nations agency requires countries not yet exposed to the new influenza strain to roll out pandemic-prevention plans and step up monitoring efforts.... WHO Director General Margaret Chan said the "overwhelming majority" of people diagnosed with the virus since it surfaced in Mexico in April experienced mild symptoms and recovered quickly without medical treatment. But Dr. Chan warned that the H1N1 virus, also known as swine flu, is likely to continue to spread and that it could turn more virulent or affect populations differently. "This early, patchy picture can change very quickly," she said. Public-health authorities worry that the new flu strain could prove more dangerous in undeveloped countries with fewer health-care resources and higher rates of chronic diseases that weaken immune systems.

The Geneva-based agency had kept its global pandemic alert level at phase 5 since late April, one level below a full-blown pandemic. A pandemic is declared following significant outbreaks in at least two regions of the globe.... As of Thursday, the WHO reported 28,774 confirmed cases of H1N1 in 74 countries, including 144 deaths. A sharp jump in cases in Australia, where more than 1,300 people have been diagnosed, contributed to the decision to raise the alert level. While the new flu strain has spread rapidly, fewer than 1% of reported H1N1 cases have resulted in deaths.

Thursday's move to raise the alert level to phase 6 isn't likely to alter the way most authorities handle the H1N1 outbreak in countries already exposed to the virus for several weeks. "For all intents and purposes, the U.S. government has been in phase 6 of the pandemic for some time now," said Thomas Frieden, , director of the Atlanta-based Centers for Disease Control and Prevention." (added emphasis)

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MYTH: We cannot trust the H1N1 numbers, as these are all based on estimates, which can be grossly inflated.

FACT: H1N1 is one among hundreds of Influenza A viruses. But that is not to say that all these viruses are going around simultaneously in a community. Typically in a season, one strain predominates. That's why, once the predominant strain is detected, we can assume most, if not all cases, will be from that strain. The flu vaccine works because it's directed at the strains most likely to predominate in any given year.

It's relatively simple to test for Influenza A. But the definitive H1N1 test is expensive and not readily available in many parts of the country. Once an Influenza A outbreak occurs in a community, and the strain is confirmed to be H1N1, it's safe to assume most cases will be H1N1. To keep on performing the test has no real utility, and only makes medical care that much more expensive.

I work in a hospital in Puerto Rico, a place where seasonal flu is rare. At first I was rather skeptical that swine flu would make it onto our island (the avian flu never made it here). But over the summer we suddenly got flooded with patients positive for Influenza A. Other colleagues at different island hospitals had the same experience. Most cases did well, in part because they were treated promptly. If there hadn't been such a heightened state of alertness, many would have not been diagnosed or treated so quickly, and our mortality would have probably been higher.

The first cases of Influenza A were referred to the CDC, to confirm if they were indeed H1N1 or not. Once it was determined that the majority of cases were H1N1, the CDC stopped performing the test, as it was obvious we were in the middle of an H1N1 outbreak. In any case, all Influenza A cases can be treated with the same medications, so patient management is unchanged. We'd still test for Influenza A, but we did not need H1N1 confirmation. When the number of patients positive for Influenza A diminished, we understood the outbreak was ending (for now).

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MYTH: Massachusetts has proposed a fining people $1,000 a day if they do not comply with swine flu vaccination, in the event this is declared mandatory.

FACT: The law being debated in Massachusetts specifically states that you cannot be forced to receive the vaccine. It states that those who pose a health risk to the community (e.g. have acquired a highly infectious disease), may be forced into quarantine.

From a Massachusetts blogger: http://www.bettnet.com/blog/index.php/weblog/massachusetts_is_not_forcing_vaccines_on_you/
"They can’t be forced to be vaccinated, but they can be quarantined or isolated. Later, it says that for purposes of decontamination or diagnosis, the public health authority can seek a court order to force the person to submit. Again, this would be true for any case in which it was believed that a person’s refusal to submit to medical care made him a danger to himself or others." (added emphasis)

There is a news report from a local Massachusetts news program where a reporter mentions that one of the punitive measures being considered for those who refuse to submit to quarantine would be a daily $1,000 fine. Is lack of a vaccine reason to be quarantined? Of course not.

Of course, those who mention the "possible" $1,000 daily fine, like Sor Teresa Forcades, add the caveat that this would only be in the event that the vaccine is declared mandatory. But the law NEVER contemplates this event occurring. The point is moot. So why bring it up? It's a scare tactic, pure and simple, a chance to wave the specter of forced vaccinations in everyone's faces. It's as if I said all pets will be killed in the event the law mandates it so. That's never going to happen, so we can rest assured our dear pets are safe. But it still makes you feel uneasy about the government's power over Fido's future...

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MYTH: The swine flu vaccine is to be offered as a 2 dose vaccine, an unprecedented recommendation which is likely to result in more side effects.

FACT: Regular flu virus vaccine is one dose because each year's virus is generally similar to the one from the year before, hence, many already have some immunity (and only need a "boost"). But when an entirely new strain comes along (whereby very few, if any have any immunity), the general theoretical consensus since the 1970s is that two doses are necessary.

From the New England Journal of Medicine: http://content.nejm.org/cgi/content/full/NEJMoa0907413

"Much of the current global pandemic planning is predicated on previous experience that two doses of vaccine are required to elicit a protective immune response in populations that are immunologically naive to a new influenza strain." (added emphasis)

In fact, the avian flu vaccine developed a few years ago for the novel H5N1 flu also had two doses (and was considered safe). From the New England Journal:
http://content.nejm.org/cgi/content/abstract/354/13/1343?ijkey=f5e31811c7b91c208e997a62b629021dcd159627&keytype2=tf_ipsecsha

" A two-dose regimen of 90 µg of subvirion influenza A (H5N1) vaccine does not cause severe side effects and, in the majority of recipients, generates neutralizing antibody responses typically associated with protection against influenza."

Many non-flu vaccines require multiple dosings, like the one for Varicella, Hepatitis A, and Hepatitis B (the latter requires 3).

There is no evidence that "doubling" the number of flu shots will double your chances of side effects. Reports in the literature have demonstrated the safety and effectiveness of 1 vs. 2 doses of vaccine, and have demonstrated that effectiveness increases WITHOUT evindce of "doubling" adverse events.

There have already been several studies with the H1N1 vaccines on thousands of people, with no significant adverse events, and even demonstrated that in practice, one dose MAY be sufficient. From The New England Journal: http://content.nejm.org/cgi/content/full/NEJMoa0907413

"No deaths, serious adverse events, or adverse events of special interest were reported. Local discomfort (e.g., injection-site tenderness or pain) was reported by 46.3% of subjects, and systemic symptoms (e.g., headache) by 45.0% of subjects. Nearly all events were mild to moderate in intensity. Conclusions A single 15-µg dose of 2009 H1N1 vaccine was immunogenic in adults, with mild-to-moderate vaccine-associated reactions."

From CNN: http://edition.cnn.com/2009/HEALTH/10/30/h1n1.vaccine.available/index.html

"SAGE [Strategic Advisory Group of Experts on Immunization] has concluded that one dose of H1N1 vaccine is sufficient for children older than 10.... the European Medicines Agency (EMEA) recommended that children receive two doses of the H1N1 vaccine, as has the CDC in Atlanta, Georgia. However, the EMEA also acknowledged that one dose may be sufficient, if a child has received a flu vaccine before. Some countries may opt to give one shot in order to vaccinate more people... Not every country is getting the same vaccine... [Some] countries, like the United States, are using non-adjuvanted vaccine. This makes a difference in how the vaccine works and how many doses may be necessary....Trials involving several thousand pregnant women are showing that the safety of the H1N1 vaccine is similar to that of the seasonal vaccine..."

Of course, we would all feel more confident in the vaccine if it had been tested in hundreds of thousands of patients. But the data so far indicates it's safe, and there's no reason why to assume the worst (unless it's because of personal biases). At the end of the day, the important thing is to measure the potential risks of vaccination versus potential benefits. In my opinion, the benefit of taking the vaccine far outweigh the risks.

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MYTH: The vaccine uses coadjuvants to increase your body's immunologic response. Some of the coadjuvants being used, like squalene and polisorbate 80 (Tween 80) are unproven.

FACT: Coadjuvants have been used in vaccines for decades. Why?

From ABC: http://abcnews.go.com/Health/SwineFluNews/story?id=8296948

"By using them... doctors hope to reduce the amount of the vaccine itself that is needed.... The ability to stretch a supply of swine flu vaccine -- and an adjuvant's ability to help to do that -- is not trivial. Fears have arisen about whether there will be enough swine flu vaccine available. Adjuvants can allow dosing to be much smaller. For example,... [in] trials for a bird flu vaccine.... 90 micrograms of an antigen -- a flu virus's "signature" that allows for an immune response -- could be reduced to 3.75 micrograms when an adjuvant was introduced, effectively enabling 24 times more doses."

Drug companies can only produce so much vaccine per day. Adjuvants allow to produce more doses with the same amount of vaccine, and thus avoid the possibility of running out of vaccine in the middle of the outbreak. This usually doesn't happen in the US, but it could be the difference between having or not having enough vaccine in other, third world nations, that depend on US or European vaccine production.

Coadjuvants have been used in Europe in millions of patients, with no major side effects.

From a self-described Spanish "Pharmacy Doctorate, professor of Pharmacology in the School of Medicine of the UB (Casanova Campus)": -Translated from the Spanish: http://www.historiaclasica.com/2009/10/quien-es-teresa-forcades.html

"Squalene is a coadjuvant used in the production of some of the Influenza A vaccines that has been used in Europe for over 12 years without problems (the EMEA, the European drug administration agency, has lots of data on the subject on its website). Sor Teresa Forcades makes reference to possible side effects from squalene-containing vaccines used on Gulf War veterans, but the relationship between the vaccines and the veterans' symptoms has never been demonstrated. Forcades mentions polisorbitol as a coadjuvant. It's not "polisorbitol," but "polisorbate 80" (Tween 80), which may suggest she doesn't really know what she's talking about in relation to these vaccines. By the way, polisorbate 80 is widely used in the food industry, even in the production of donuts!"

In any case, here in the US, the point is moot, as the vaccines to be used will not have coadjuvants.

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MYTH: The swine flu vaccine contains thimerosal, which contains mercury, a known poison. It can lead to neurologic damage, perhaps even autism.

FACT: The ethylmercury found in thimerosal is NOT the same as the methylmercury that pollutes the water supply. Ethylmercury is metabolized much quicker by the body than methylmercury, and does not accumulate in the body either. (see: http://www.ehponline.org/press/042105.html )

More to the point, there's been at least 7 peer reviewed studies that have shown vaccines containing thimerosal do not cause neurologic abnormalities or autism even years down the line:

http://content.nejm.org/cgi/content/full/357/13/1281
http://pediatrics.aappublications.org/cgi/content/full/114/3/577
http://pediatrics.aappublications.org/cgi/content/full/112/3/604
http://jama.ama-assn.org/cgi/content/full/290/13/1763
http://pediatrics.aappublications.org/cgi/content/full/114/3/584
http://pediatrics.aappublications.org/cgi/content/full/118/1/e139
http://archpsyc.ama-assn.org/cgi/content/full/65/1/19

You'll probably get more mercury by eating a high tuna diet, say from NYC restaurants:
http://www.nytimes.com/2008/01/23/dining/23sushi.h

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MYTH: The "plan" is to vaccinate the entire world population.

FACT: Where's the evidence for this plan (whose plan is it anyway?) of implied forced global vaccination? The drug companies physically could NEVER produce the 6-7 BILLION flu doses necessary for this to happen. Even here in the US, the CDC was hard pressed to procure 28 million doses by October (it had hoped to have 40 million by this date) due to manufacturing delays. This doesn't even cover 10% of the US population.

The "plan" has never been for everyone to get vaccinated, but to have enough people vaccinated so that the rest are protected through "herd immunity." If enough people are vaccinated, person-to-person transmission is slowed or stopped, as at least some of those exposed, because of the vaccine, are transmission dead-ends.

From CNN:
http://edition.cnn.com/2009/HEALTH/10/30/h1n1.vaccine.available/index.html

"WHO is donating vaccine to countries unable to buy enough....The goal is to distribute 200 million doses, which should allow 95 percent of the eligible nations to vaccinate at least 10 percent of their population."

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MYTH: Coadjuvants dangerously hyper-excite your body's immune system, producing a response 10 times greater than "normal."

FACT: They make it sound as if they're going to drive your immune system crazy... If someone were to tell you they were going to rev up your car "10 times greater than normal," you'd likely balk. But the reason we can do this with vaccines is because the "normal" body reaction to such a small amount of viral material is miniscule. Going back to the car analogy, it's as if someone were to tell you that your car's "normal" response is to drive at 5mph, and they wanted to "stimulate" it so that it could drive 10 times faster, to reach 50mph.

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MYTH: The vaccine will likely cause thousands of cases of Guillan Barre, just like the vaccine produced in 1976.

FACT: All flu vaccines may carry a small but real risk (about 1 in 1 million) of precipitating a case of Guillan Barre, a neurologic condition where the patient temporarily loses the capacity of using his muscles. The condition can be prolonged (taking weeks to recover), or in a few cases deadly. But usually the patient recovers with little if any sequelae.

The 1976 flu vaccine was a novel vaccine, different from the one being used today. During that flu scare there were NOT thousands of cases of Guillan Barre. 500 cases were reported (with 25 deaths) out of 40 million vaccines administered. The number is still considered unusually high. But when discussing the 1976 vaccine and its relation to our current vaccine, 3 false assumptions are made:

A) All 500 cases of Guillan Barre reported were directly attributable to the vaccine.

Guillan Barre occurs spontaneously within any population. Though certainly some cases could have been attributable to the vaccine, others could have arisen spontaneously, purely by chance, among the 40 million vaccinated persons. Also, the flu virus itself can precipitate a case of Guillan Barre. French investigators recently reported this phenomenon ( http://www.reuters.com/article/healthNews/idUSTRE50R6IK20090128), and concluded:

"Although the occurrence is rare, it is by far more frequent than that following influenza vaccine...The benefit of large-scale influenza vaccination should also be considered as a means to protect against Guillain-Barre syndrome." (added emphasis)

In other words, if you're really worried about the possibility of developing Guilan Barre this winter, you should consider getting yourself vaccinated...

B) The new swine flu vaccine will carry the same risk of Guillan Barre as the 1976 vaccine.

The new vaccine is NOT modeled on the '76 vaccine, but on the regular seasonal flu vaccine successfully used year after year. Why compare this vaccine with one produced 33 years ago? If MILLIONS use the regular flu vaccine every year, why should we now consider this model to be more dangerous than usual?

C) The impact of swine flu is marginal.

It's true that swine flu's mortality is low, similar to that of regular seasonal flu. But because regular flu is so prevalent, it still kills over 30,000 Americans every year. And given swine flu has a greater potential population target, it could be even more prevalent, and thus could kill even more people, despite having a similar mortality. What is the benefit of this vaccine versus the risk of Guillan Barre? As stated above, regular flu vaccine carries a risk of Guillan Barre of about 1 in 1 million. Even in the worst of situations, the feared vaccine from 1976 may have produced roughly 1 case per 100,000 vaccinations. But swine flu can kill about 1 or 2 of every 1,000 persons infected. Which is the greater risk?

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MYTH: In an unprecedented development, the pharmaceutical industry asked the government for immunity from prosecution for any damages caused by the swine flu vaccine.

FACT: This has happened before, in other similar occasions where the government is the one in a hurry (and not the pharmaceutical industry) because of issues of national security or the wellbeing of the nation's citizens. In fact, this occurred in 1976.

"Congress began to pressure the drug companies to work faster toward development of a swine flu vaccine. ...The drug companies suggested that they could work faster if they were given immunity from lawsuits in the event something went wrong with the vaccine. Congress refused. The issue of legal liability remained at an impasse until Aug. 2, 1976.

On that day, two members of the American Legion died of a strange respiratory disease they acquired at the Legion's convention in Philadelphia. Congress collectively freaked. Panicky news reports out of Philadelphia hinted that the deaths were the beginning of the Great Swine Flu Epidemic of 1976. On Aug. 3, Congress agreed to completely indemnify the drug companies against any and all lawsuits they might incur as a result of the distribution of swine flu vaccine. The drug companies got to work."

http://www.informationclearinghouse.info/article22506.htm

Does this mean the current vaccine will produce similar results as the 1976 vaccine? Of course not. Unlike the '76, today's swine flu vaccine is modeled on the annual seasonal flu vaccine. It's already been tested on thousands of patients with no major adverse events. Guillan Barre, in particular, is a condition that appears days or weeks after the initial insult, not years later. If there's been no uptick in the number of Gullan Barre cases noted among test subjects by now, it's because they're not going to get it, at least not related to the vaccine.

I'm not a fan of drug companies having immunity. But this doesn't automatically imply their product is unsafe. Drug companies aren't stupid. Given our litigious society, they know how many lawsuits this vaccine could generate, even if for fictitious reasons. Consider the case of the silicone breast implants. Companies like Dow Corning spent millions defending themselves against thousands of lawsuits relating to systemic illnesses purportedly caused by their breast implants. Yet multiple large-scale medical studies failed to ever show a causal relation between the breast implants and women's complaints. Knowing this, the drug companies aren't going to take any chances. They're going to take advantage to the immense pressure the government has to protect its citizenry, as it knows that if some guy slips and breaks his hip while exiting the vaccination center, he could sue them alleging the vaccine made him dizzy...

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MYTH: We are unlikely to see an increase in the low number of people killed by swine flu. There is no such thing as a "second wave" of infections. If we do see an increase in the number of people dying, it's because the virus has mutated, and so the vaccine won't work anyway.

FACT: A bimodal distribution of cases is precisely what happened in 1918: a moderate number of cases were seen in summer, followed by a much larger "second wave" in winter. The virus did not mutate, it just continued to spread more during winter. There was no change in mortality: proportionately speaking, the same number of deaths were occurring per 1,000 people infected. It's just that as more people got infected, more people ended up dead.

It's unclear why, but the virus replicates better in the colder, drier winter weather. Add to this the greater amount of person-to-person contact seen in winter (as people stay indoors in close quarters), and it's clear why winter provides the opportune environment for viral transmission, increasing the number of people becoming infected.

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MYTH: The vaccine is a potential transmission vector.

FACT: There are only two ways this could happen:
A) The vaccine is tainted
B) Someone with a bad immune system gets a live virus vaccine.

A) Suggesting the vaccine is tainted is usually accompanied by the above mentioned tale of Baxter's attempt to start a pandemic. Again, this is sheer fantasy, cooked up by a failed reporter, and repeated by people like Sor Forcades because it fits their personal agenda. It has never been demonstrated that a flu vaccine transmitted the flu because it was tainted. Never.

This isn't, however, the first time a vaccine is suspected of being tainted. A polio outbreak occurred in northern Nigeria after officials there halted all polio vaccination during 2003. They alleged the vaccine was laced with HIV or hormones to render women infertile. The HIV claim was particularly ridiculous, given that Nigeria used the oral polio vaccine, and HIV is not transmitted orally.

The result? Hundreds of new cases of polio, a crippling, if not deadly disease. "The virus reinfected polio-free areas within Nigeria, and also spread into eight polio-free countries in the surrounding area. " http://www.globalhealthforum.org/poliooutbreak.php

B) The inhaled version of the vaccine being offered in some countries contains live attenuated virus. That is, it has flu virus that has been weakened enough so as to be unable to cause the flu before the body reacts to it. But in theory, those who do not have normal immune systems (e.g. patients with HIV, cancer, or organ transplant recipients) may not be able to effectively fight off the virus, and it could produce an infection. But this should not be an issue, as medical personnel are taught that it's contraindicated for people with these conditions to receive the inhaled vaccine. This is true not only for this vaccine, but for any live virus vaccine, like the varicella vaccine, or the oral polio vaccine.

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MYTH: Doctors know "the truth" about this vaccine, but are scared to come out and say it.

FACT: Medicine, like science, is a constantly evolving field, based on analyzing empirical evidence and comparing it to current theories. Doctors are trained to question what came before, and research new possibilities.

Doctors have risen up in the past and questioned industry giants, as was the case, for example, during the 1980's when healthcare companies were selling blood products potentially tainted with HIV, or in the case of fighting against the powerful tobacco lobby.

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MYTH: You don't have to fear the flu.

FACT: Sure, tell that to the 1,000 Americans that have DIED with swine flu, including otherwise healthy adults, pregnant women, and children. Most people do well, so we certainly do not need to panic. But this can be a deadly disease. To throw caution to the wind is foolhardy.

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So there you have it. I hope this has been of use. I'll finish by saying that people like Sor Forcades all carry a common theme: that there is a secret conspiracy of the great industrial powers to dominate the human race, to rob them of their money, keeping them in a permanent "Matrix"-like state of semi-slavery. But they have uncovered the "truth." They play with your natural fears. They distrust authority, and read into any event the worst possible intentions. But theirs is more a predetermined fantasy grasping for justifications, not evidence that points to a logical conclusion. As such, what they present are distorted facts, coincidences to which they add color, or outright fabrications. Most of those convinced by these individuals already share in their prejudice against government and "large corporations." The try to scare the rest of us, to see if we, too will join them in their wild beliefs.