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Ivan Fraser

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Comments (1)

  • Comment on: 'Our own fears can help us understand our patients better'

    Ivan Fraser's comment 23 August, 2011 12:18 pm

    Perhaps nurses are MORE aware than others and more likely to use proper scientific research to support their decisions?

    That may explain why there isn't much uptake.

    In fact, the kind of information upon which we base our own health-promotion is often NOT based on the best scientific evidence.

    Flu vaccine is a supremely remarkable case in point.

    Cochrane reviewed a host of research on flu vaccines and concluded that they have very little evidence to support their use. In fact, they issued warnings that many studies were flawed, biased and misleading. Cochrane and other researchers have found links between such vaccinations and disease. Yes, taking a scientific approach, vaccines cause diseases and the studies that say they are safe and effective cannot be trusted!

    Yet nurses and doctors placate patients all the time with 'party-line' platitudes and reassurances of safety and efficacy, backed up by a presumption that 'scientifically' all is well.

    I am sorry Jenni, but 'scientific fact' when bandied around as a bludgeon to bring others into line with mass consensus should be just that: 'scientific'. We should support our statements rather than repeating mantras - as we are expected to be able to do as practitioners. I am not impugning the author here, and I know that we all have only the best interests of others at heart.

    But how many of us are actually qualified to know for certain that the research upon which we base our 'evidence' for our practice is scientific fact? We are all at the mercy of our sources and rely on trust. And how many of us believe intrinsically in the truth of any number of popular mysths, believing them to be fact and will happily transmit erroneous factoids to others with the confidence of our status, qualifications, and the weight of mass consensus behind us? And we do so because we care.

    We, as nurses have a duty to ourselves, our families and our patients to give them the facts. And if the facts fly in the face of our organization's party-line, then we should challenge it.

    I have to emphasize that there are many sources of varying quality that rail against the uses of vaccines. Many are dubious and unscientific. Many make excellent cases against vaccines (I still cannot get my head around the idea that it's safe to put excipients such as mercury in certain vaccines, when the dangers of mercury are well-known) But when an organisation as respected as Cochrane finds against a case for seasonal flu vaccines, we have to sit up and take note.

    Here's a snippet from Cochrane:

    Main results

    We included 50 reports. Forty (59 sub-studies) were clinical trials of over 70,000 people. Eight were comparative non-RCTs and assessed serious harms. Two were reports of harms which could not be introduced in the data analysis. In the relatively uncommon circumstance of vaccine matching the viral circulating strain and high circulation, 4% of unvaccinated people versus 1% of vaccinated people developed influenza symptoms (risk difference (RD) 3%, 95% confidence interval (CI) 2% to 5%). The corresponding figures for poor vaccine matching were 2% and 1% (RD 1, 95% CI 0% to 3%). These differences were not likely to be due to chance. Vaccination had a modest effect on time off work and had no effect on hospital admissions or complication rates. Inactivated vaccines caused local harms and an estimated 1.6 additional cases of Guillain-Barré Syndrome per million vaccinations. The harms evidence base is limited.


    Authors' conclusions

    Influenza vaccines have a modest effect in reducing influenza symptoms and working days lost. There is no evidence that they affect complications, such as pneumonia, or transmission.

    http://www2.cochrane.org/reviews/en/ab001269.html