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What if everything we think we know about fighting the flu is wrong?

An interesting, and sure to be controversial, article in November's Atlantic magazine asks:

"What if everything we think we know about fighting influenza is wrong? What if flu vaccines do not protect people from dying—particularly the elderly, who account for 90 percent of deaths from seasonal flu? And what if the expensive antiviral drugs that the government has stockpiled over the past few years also have little, if any, power to reduce the number of people who die or are hospitalized? The U.S. government—with the support of leaders in the public-health and medical communities—has put its faith in the power of vaccines and antiviral drugs to limit the spread and lethality of swine flu. Other plans to contain the pandemic seem anemic by comparison. Yet some top flu researchers are deeply skeptical of both flu vaccines and antivirals. Like the engineers who warned for years about the levees of New Orleans, these experts caution that our defenses may be flawed, and quite possibly useless against a truly lethal flu. And that unless we are willing to ask fundamental questions about the science behind flu vaccines and antiviral drugs, we could find ourselves, in a bad epidemic, as helpless as the citizens of New Orleans during Hurricane Katrina."

The impetus for this Atlantic piece seems to be sparked by a recent editorial in BMJ's Clinical Evidence by Tom Jefferson, head of the Vaccines Field at the Cochrane Collaboration, a highly respected international network of researchers who appraise medical evidence. Jefferson suggests, after looking at data from the control arms of 95 influenza vaccine trials involving 1 million subjects over the course of four decades, that influenza is a relatively rare cause of influenza-like illnesses and is therefore "a relatively rare disease." He further observes vaccines may not be appropriate preventive interventions for either influenza or influenza-like illnesses.

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