So the other day, I managed to wake up early enough (about two in the afternoon) to put in a call to the Toronto Public Health office.  My mission:  To find out from the chief municipal officer of health, Dr. David McKeown, if the soon-to-be-released swine flu (H1N1) vaccine is safe for pregnant women.  

After swigging down a few glasses of water to clear out the “morning” croak from my vocal cords, I blocked out the caller ID and set out on my very first foray into the treacherous world of investigative journal-ish blogging…from the comfort of my basement.  I had to switch to my contingency plan when they informed me that Dr. McKeown wasn’t in.  They put me through instead to Dr. Sarah Wilson, the senior community medical resident there.  Since this was my virgin investigative quest, I struggled not to sound like some dysfunctional schmuck calling in from his basement. “Hi, I’m uh…Lazar Goldshlager.  I write an investigative journalism…uh…journal-ish…kinda blog.” 

“What’s the name of the company you write for?”

“No, uh, no company.  It’s just me…writing an investigative…uhhh…report…y’know, to inform my…uhhh…readers?”

I would have honestly clarified – had she asked – that those “readers”, to date, are me, myself, and I.  Okay, well, maybe as of yesterday, my blog stats reported one viewer – you know, that one proverbial guy who always seems to stumble his way over to somebody’s blog, no matter how shitty.  He lingers there, maybe a few seconds or so (depending on how bad his ADD is acting up), and then off he goes to inattentively stumble onto some other untrafficked virtual horizons, leaving nary a trace but his blog stat.  He basically shits out blog stats where none have gone before…and leaves.  Not that I don’t appreciate the visit – the one saving turd of a blog stat which ensures I wasn’t pathetically shut out, which confirms that the proverbial tree did fall in this proverbial forest after all. So if you happen to be the one guy who stumbled here today, who has battled through your fog-inducing ADD to get this far into my report, I sincerely thank you for your unintentional support…and for depositing your single turd of a blog stat here with me.  This one’s for you, bud! 

If you must know, I started the interview off as a skeptic.  There would be no Larry King-style softballs from me:  “We hear all over the news that this H1N1 swine flu strain is particularly troublesome for pregnant women, and that pregnant women are now considered a priority to get the swine flu shot when it comes out.  So what information do you have that this particular vaccine will be safe for pregnant women?”  

I’m paraphrasing her response here, since I was too lazy and cheap to run out to Future Shop and purchase a recording device, and I’m an extremely poor note-taker with a highly shaky short-term memory.  So the gist of her initial response was somewhere along the lines of:  “We know from past experience that the seasonal flu vaccines have been very safe for pregnant women, and we have no reason to believe that the upcoming swine flu vaccine will be any different in this regard.   Here in Canada, it will be made by the same company – Glaxo Smith Kline – that has made the seasonal flu vaccines, using similar methods and similar ingredients, with the difference being that the swine flu vaccine won’t have any adjuvants in it.”  

For those who don’t know, an adjuvant is a substance that is put into the vaccine to boost the effectiveness of the anti-body response to that vaccine, thereby boosting the chances that the immunity to the targeted flu strain will “take.”  One such adjuvant is aluminum, which is normally regarded as a neurotoxin, though the medical authorities generally regard it as being of no concern due to the trace amounts that go into the vaccines.  So, what this means, in effect, is that the swine flu vaccine won’t be as strong in the absence of the adjuvants.  She had me stumped for the next question.  

“How about thimerosal?”  I blurted out.  “You know, the mercury that some people are scared of?  I know that thimerosal is used in the seasonal flu shots.  Will it also be in the swine flu shot?” 

“Yes, thimerosal will be in both the seasonal and H1N1 flu shots.”  She went on to explain that thimerosal is needed as a preservative, particularly for multi-dose vials from which up to ten doses can be administered.  She explained that, in the past, before preservatives were used in multi-dose vials, people had died from contaminated vaccine products.  Though she didn’t elaborate, I was following the flow of her logic, since she was so infuriatingly reasonable.  Here was no arrogant family doctor, condescendingly smurking at my ignorance as he sends me scurrying off with Tylenol.  Nor did she adopt the all-smelling asshole tone of a smug editorial page editor (Screw you, Er-Cue-Hart!), wrapping himself in the natty cloak of science, as he badgers us plebes with his exclusive claim to “Common Sense!” 

Hearing the soothing, reassuring responses of Dr. Wilson, delivered in a pleasant cadence, as if to say, “Come along and share this adventure we call science.  Let us all bask together in the mysteries of the wisdom of the ages, accessible to all who prostrate themselves humbly before the portals of knowledge” – yes, yes, you needn’t elaborate any further on this one point, Dr. Wilson.  For indeed, I understood.  Your charity of tone, and patience of demeanor, brought me up to your level, and enabled me to answer my unstated questions with my own imagined responses:  Yes, indeed, a pandemic will, ‘ere long, be upon us.  Shall we do away with the thimerosal and tarry with one-dose vials, exposing ourselves to a consequent vaccine shortage?  Nay, we shall anoint ten in the holy oil of Glaxo Smith Kline – in the time it takes to dose one!  And through communion with thimerosal, shall all be preserved from harm.   

Perhaps, in some strange way, I was beginning to understand the kind of Bond of Reason that can develop between a journalist and their interview subject.  Perhaps Larry King wasn’t just opportunistically sucking up to his guests after all.  Perhaps he was just the victim of an as-yet undiagnosed phenomenon, a kind of journalist’s variant of the Stockholm Syndrome.   

Still, I had questions that needed answering. What about that asshole editorialist Urquhart, who wrote about, and/or signed off on, the fact that “influenza vaccine is effective in preventing illness in up to 90 per cent of immunized adults”?  I asked Dr. Wilson about this.  “Surely, that editorialist can’t be correct,” I queried. “What about those seasons when they guess the wrong flu strain coming in from Asia?  Surely, that knocks the success rates in those years far below 90%?”  

“The editorialist likely got that statistic from the National Advisory Committee on Immunization,” she calmly responded.  “In this respect, he’s correct – the seasonal flu vaccine has been 90% effective in those seasons when the vaccine is a match with the targeted flu strain.” 

Now that’s a class act, I thought.  She’s even making Er-Cue-Hart smell nicer.  At this point, I was starting to feel a bit dirty, unworthy of interviewing such a noble interview subject.  I made a mental note for myself: Do a little spiritual cleansing the next time Yom Kippur comes around, to repent for gratuitously bashing Er-Cue-Hart in the presence of my one ADD-afflicted blog visitor.   

I had other questions to ask, but I was feeling incredibly ambivalent at this point about asking them.  What if she didn’t have a satisfactory answer to offer?  What if the questions were too unduly probing, putting her in a position where she might possibly – though unlikely, as far as I was seeing – come off as less than exemplary?  Trust your guest, I heard my Inner Larry King counsel me.  Let her responses guide you to the home ship.   

“Uhhh…Dr. Wilson?” 

“Sarah.” 

“So, uh, the Ontario government, y’know, kind of…y’know, recommends the swine flu vaccine for pregnant….uhhhh, women?” 

“It does.” 

“And, y’know, the safety trials for the vaccine in general …they’re uh, still ongoing?” 

“They started some time in late summer.  We haven’t received any safety info yet.”  

“But uh, you plan on giving out the…y’know…shots when they arrive in a few weeks?” 

“Hopefully, by early November.” 

“But you know what’s in it, right? Y’know, the exact ingredients, right?” 

“No, we’re still waiting to get the product monograph (the description of the medical components) from the supplier.” 

Oh Jesus, oh Jesus. 

Stay the course, stay the course, Inner Larry advised. I closed my eyes tightly, and imagined myself in a Vulcan mind meld with Dr. Wilson.  Surely Dr. Wilson doesn’t appreciate the kind of audience I am pandering here to.  My one ADD-afflicted visitor needs more to go on before he stumbles out of here, before he stumbles on to some wacko website and deposits a poorly spelled, poorly reasoned comment that will make the rounds on the Conspiracy Theory Circuit:  “Herd the hed of All Health say thay dont no wats in the swine floo vaxxeen becuz their waiting for the telegraf!  DON’T VAXXIN8!!!!!”    

I had to act quickly:  “I think I understand, Dr. Wilson.  It’s an inactivated virus, injected without the adjuvants that might worry some people.  The ingredients you’re expecting to come on the product monograph are likely very similar to the ingredients used in other vaccines by this company in the past – generally, without incident.  We’re dealing with a pandemic here, and ideally, we’d like to have more time to do our due diligence.  But based on our past experience with seasonal flu vaccine formulations, using similar methods – and let’s face it, this is just another formulation of vaccine to match a flu strain – we can reasonably conclude that there is little to worry about here in the way of safety.  Right?  Right?” 

“Yes, I’d say so.” 

“So, uh, who exactly is conducting these safety clinical trials in Canada?” 

“The supplier – Glaxo Smith Kline.” 

“So, uh, the federal government has some kind of input in these trials.  Right?  Right?” 

“Well, our government communicates their expectations, what kind of standards they expect to be employed in the trials.” 

Oh, Christ… 

“But of course, Dr. Wilson, if something theoretically goes wrong during these trials …you know, if bad news from Glaxo came from these trials in the next week or two, the government would theoretically postpone the administration of the vaccine.  Right?  Right?” 

“Well, we haven’t heard anything at all yet. So that’s always a good sign.” 

Oh Jesus, oh Jesus. The No-News-Is-Good -News response.  Larry?… 

You’re doing fine, Inner Larry counseled.  Time to wind this sucker down and primp for the next episode.   

“Well, thank you very much, Dr. Wilson.  Just a couple very quick questions: I’m assuming there have already been past flu vaccine studies showing that the shot is safe for pregnant women?” 

“Yes.” 

Thank G-d. 

Inner Larry:  That’s it, Lazar.  Just one more slow underhand pitch over home plate, and you can take a shower. 

“One last question: Do they have an idea how far apart the H1N1 vaccine should be taken from the seasonal flu vaccine?” 

“No decision has yet been made by the Canadian government, but they’re working on it.” 

“Okay, that pretty much wraps it up.  Thank you very much for your time.” 

Inner Larry:  Proud of you, Lazar. 

And that concluded my very first investigative interview.  I felt good, that I provided my one ADD-afflicted visitor with valuable information he could take away to other sites.  To really “flesh out” the information gleaned from my interview, I thought it would be helpful to see what the American authorities had to say on the subject of pregnancy and the swine flu vaccine. 

So I checked out the American Center for Disease Control (CDC) web page authoritatively titled 2009 H1N1 Influenza Shots and Pregnant Women:  Questions and Answers For Patients.   Maybe they had some answers available, or did some studies to give them even more confidence.  

Here was one Question and Answer that I felt was succinct and reassuring: 

Is the 2009 H1N1 flu shot safe for pregnant women?

The seasonal flu shot has been given to millions of pregnant women over many years. Flu shots have not been shown to cause harm to pregnant women or their babies. The 2009 H1N1 flu vaccine is being made in the same way and at the same places where the seasonal flu vaccine is made.

That was exactly the point made by Dr. Wilson!  If anything, the CDC was guilty of being too succinct.  I found myself thinking that people will miss the main point that the government already kind of knows what to expect with this new vaccine, based on past experience with similarly made flu vaccines. 

Of course, due to the American gung-ho mentality, the web page also revealed that the Americans are going with a live virus, kick-ass nasal vaccine spray.  But to their credit, they said they would advise that pregnant women and children under two should only use the shot that comes with the inactivated virus (Pussies!)

Like Canada, the American flu shots this season – both for seasonal flu and H1N1 swine flu – come without adjuvants, though they also come with thimerosal.  As for possible side effects, the web page had this to say:

The most common side effects after flu shots are mild, such as being sore and tender, red and swollen where the shot was given. Some people might have headache, muscle aches, fever, and nausea or feel tired.

So, if you come to your family doctor this season, complaining that you still have the headaches, the muscle aches, the fever, and nausea from the flu you had before you took the shot, don’t be surprised if he responds, “Look asshole, it’s not the flu you have anymore – it’s a side effect from the shot!  Read the fucking product monograph!” 

As for the conspiracy-minded out there, I detected absolutely no efforts by the CDC to cover up inconvenient facts.  One question on that web page addressed the issue as to whether the upcoming swine flu vaccine would cause the paralytic disease known as Guillain-Barre Syndrome (GBS).  The CDC noted that, back in 1976, a past swine flu vaccine caused “one case of GBS per 100,000 vaccinated.  Some studies done since 1976 have shown a small risk of GBS in persons who received the seasonal influenza vaccine. This risk is estimated to be no more than 1 case of GBS per 1 million persons vaccinated.”

What they’re basically saying is that if every man, woman, and child in the US today (roughly 300 million) were vaccinated with the 1976 swine flu vaccine, about 3,000 would have come down with GBS in one year.  On the other hand, if every man, woman, and child in the US is vaccinated with regular  seasonal flu vaccine each year, it would take as long as ten years to equal the number of GBS cases from one year with the ’76 shot.  Not too shabby a batting average.  Whether the upcoming 2009 swine flu shot cuts into that batting average, I can’t say – because the CDC didn’t actually give us the stats on that particular shot.  We just know that you’re as likely to contract GBS in ten years if you have your regular flu shot each year during that interim. 

But let’s put things in perspective:  over 300,000 people will have died of flu-related complications over that ten-year period (at least according to the CDC).  If they all had their regular flu shot each year, up to 90% of them (assuming a good flu strain match each year) would be alive, with just three of them getting GBS.  So the math looks pretty good here, too.

I am also pleased to report that, unlike our own government, the Americans have gotten their act together and settled that perplexing question as to whether the upcoming H1N1 vaccine can be given with the seasonal flu shot.  Here’s what they had to say:

Seasonal and 2009 H1N1 flu shots can be given on the same day but should be given at different sites (e.g. one shot in the left arm and the other shot in the right arm).

Fuck, yeah!  I could just picture our wishy-washy Canadian leaders arguing with each other for months: “I dunno – it can’t hurt to wait a week or so to give that sore, tender arm time to heal.” 

With the Americans, I could picture a jut-jawed, George C. Scott look-alike Surgeon General bolting up after three minutes and declaring, “Fuck it!  Jab ‘em in one arm…and then jab ‘em in the other!” 

But it was the following Question and Answer that simply dissolved the remaining fragments of my lingering skepticism, and made me a true believer in this upcoming vaccine:

What studies have been done on the 2009 H1N1 flu shots and have any been done in pregnant women?

Studies to test the 2009 H1N1 flu shots in healthy children and adults and pregnant women are being done now. These studies are being conducted by the National Institute of Allergy and Infectious Diseases (NIAID). More information can be found at http://www3.niaid.nih.gov/news/QA/vteuH1N1qa.htm.

Hear that, all you anti-vaccination fanatics?  From the CDC’s own web site – and they even point you to where you can find the studies on pregnant women. Right now, as we speak, scientists at NIAD are probing and jabbing all these pregnant women with experimental swine flu vaccines, to find out if it’s safe for even more pregnant women out there to get ‘em.

With all this clear-sighted information, I’ve finally seen the light.  Turns out that Ian Urquhart wasn’t such an asshole after all.  While the anti-vaccine nutsos go fear-mongering and scaring the shit out of the herd, guys like Urquhart – and now, me – are getting out in the trenches, trying to defend the herd immunity.  This isn’t a case of “choice” or “belief.”  This is about following the dictates of strong scientific evidence – of responding to the clarion call of common sense, as Urquhart puts it. 

So, all you skeptical health care workers, you conspiracy theorists, and anti-vaccine fanatics still want your right to “choose”, huh?  Yeah, well, I’m stoked.  I’m just about ready to be deputized under the Surgeon General and the Chief Public Health Officer.  Tell me where to sign up!

So you don’t wanna take the jab, huh?  Tell it to me when I march in with my andro-juiced, jackbooted Blackwater posse.  Oh, you’ll get the jab, alright: one in the right arm, one in the left, and a double dose of thimerosal…right up the ass!  

And then it’s off to the FEMA camps with your sorry quarantined asses!

Stay tuned as I check out the NIAD clinical studies, and let the rest of you know how it’s all going with the pregnant women…

Swine Flu Vaccine – Part I

The Patron Starlet for today’s post is Carole Landis.

In a bit of a pissed off mood, because the waitress informed me that I’d be charged $1.49 for the extra hamburger bun I ordered (which they would itemize on the bill as “toast”) to accommodate the 10 ounces of charred hamburger meat bursting out of the confines of the small bun it came with, I thought that this would be my inaugural topic for investigation:

“If It’s An Outsized Burger, Why Not Also An Outsized Bun?”

The game plan I mapped out, while waiting for my “toast,” would be to call the corporate headquarters of Wimpy’s the next morning, during business hours – assuming I wouldn’t be pulling an all-nighter and crashing for the rest of the day. 

After putting on the call block (so they couldn’t track me down), I would then proceed to grill any corporate exec who’d field my call.  There, in my booth, I began to formulate the questions I’d ask:

“If you have the courage of your convictions to charge for the extra hamburger bun, why call it ‘toast’ on the bill?  Because your customers would think only a bunch of assholes would charge $1.49 for something itemized as ‘hamburger bun’ in a hamburger joint?  Because you figured that if you called it ‘toast’ instead, most people would say, ‘Yeah, I can see that – the buck forty-nine for the time and effort it takes to toss a piece of bread in the toaster?’”

As an investigative journal-ist, I would have to anticipate the exec’s likely response:

“Well, sir, if you had examined the extra bun qua toast we charged you for, you’d notice that it was slightly grilled…or, shall I say, toasted?” 

That slippery fuck.  But then, as I lowered my head toward the table, contemplating my theoretical rebuttal to that theoretical asshole response, my eyes set upon the headline peeking out from the mustard stain on the editorial page of my newspaper:

“Frontline Workers Need The Flu Shot”

My throat tightened as I read the opening line of the editorial, delivered with an air of smug certainty:  “Strong scientific evidence, backed by simple common sense, dictates that health-care workers should be widely immunized against influenza.” 

My eye skipped to this other nugget of certainty:  “Influenza vaccine is effective in preventing illness in up to 90 per cent of immunized adults.” 

Oh, really? Interesting.  I never knew that.  I recalled reading somewhere that there are around 30,000 “flu-related” deaths in the U.S. each year. If that smug editorialist is correct, up to 90% of them were not immunized.  But he did qualify them as immunized adults.  So maybe most of the reported flu casualties are children? But then I recalled reading somewhere that around 40 to 80 children die each year in the U.S. from “flu-related complications.”.  And didn’t I recall reading somewhere else that, each Spring, they have to guess which flu strain from Asia will be coming our way by the Fall?  That, in some years, they guess wrong, and the resulting flu vaccine for that year has no effect at all, or very little?

My eyes scanned the name of the editorial page editor on the masthead.  Ian Urquhart.  “Screw you, Ian Er-Cue-Hart!” I screamed aloud, startling the guy at the table beside me, who was busy slathering barbecue sauce on his hamburger bun qua toast. 

Not even sure if Urquhart actually wrote this.  Surely he signed off on it, since he’s the asshole credited on the masthead.  Urquhart – or, perhaps, Smug Unknown Asshole Under Urquhart – went on to note that Toronto Medical Officer of Health Dr. David McKeown wants the Ontario provincial government to make “flu shots mandatory for health-care workers if their immunization rates don’t significantly improve over the next three years.”  Urquhart/Unknown Asshole suggested that this proposal “deserves backing.”

He went on to inform us that the Premier of Ontario and the Ontario “nurses’ association have said taking a flu shot should remain a health-care worker’s personal decision.”  And here’s the kicker:  “Ideally,” the editorialist averred, “that should be the case.  But too many have been making the wrong choice when it comes to protecting themselves and their patients.”

Oh, I get it:  You “ideally” support their right to exercise free choice so long as – in your smug, possibly anonymous, asshole opinion – they make the right choice.  “You smug bastard!” I wailed at the masthead. 

No wonder those editorials don’t come with an actual by-line.  You can write like an utter smug asshole and make everyone else look like ignorant assholes when they call up to complain:  “Nope, wasn’t me.  It was…some other guy.” 

Well, I wasn’t going to fall into that trap.  There were larger, more important assholes to grill. Perhaps I’d call Dr. David McKeown at the Toronto Public Health office.  Tomorrow. During business hours.  I figured there was a window open here, since I had been up for over 24 hours already, and was likely to crash out to sleep relatively early tonight, waking up in time tomorrow to make a call when somebody might actually be around to field it.  This would be my cycle to strike!

But then again…do I really care if nurses, interns, and hospital janitors are forced to take a friggin’ flu shot?  Do you?  No, that would not be a gripping topic to inaugurate my investigative journal-ish blog.  I needed something more controversial, more sexy. 

Like…uh…pregnant women and the swine flu vaccine?  Yeah, that could work.  I already knew that they’re struggling to get the safety trials done in time for the swine flu vaccine roll-out here in the next few weeks.  Yet all over North America, you have swarms of Ian Urquharts – or their anonymous underlings – urging pregnant women to rush out and get their swine flu shot. Because the swine flu virus reportedly gets really nasty with pregnant women.  And though these Urquhartians likely haven’t seen  the as-yet uncompleted safety trials for pregnant women, one can presume that they’re guided by a strong whiff of “common sense”.

Okay, so that’s my game plan.  I’ll call up Dr. David McKeown at the Toronto Public Health office tomorrow and ask him what information he has that the swine flu shot is safe for pregnant women.  “Bill, please,” I asked the waitress as she set my slightly toasted “toast” down on the table. 

Who really cares if it’s a buck forty-nine, after all?  I have serious work to do. 

 Stay tuned…

Swine Flu – Part II

The Patron Starlet for today’s post is Mary Martin.