Influenza vaccine studies and funding

The following article consists of two parts. The first part is taken from an article by Dr. Roberto Gava,⁽¹⁾ highly esteemed doctor and placed under the ax of radiation for daring to talk about personalization of vaccinations. The second part is the full transcription of the interview given in 2009 to the ASL of Alessandria by Tom Jefferson, a British epidemiologist who has lived in Italy for many years and who worked for the Cochrane Collaboration. Jefferson was an author and editor of the Acute Respiratory Infections Group of the Cochrane Collaboration, as well as serving on four other Cochrane groups. He was also a consultant for the Italian National Agency for Regional Health Services.

These two articles talk about the same topic. Dr. Gava excellently summarizes the interview with Tom Jefferson regarding the profound doubts about the efficacy and safety studies of influenza vaccines. This obvious inconsistency, according to a study published in the British Medical Journal in February 2009 and the central theme of Jefferson's interview, sees a close relationship between the impact factor of scientific journals and the funding by vaccine manufacturing industries of peer-review studies . In essence, faced with little or no evidence on the safety and effectiveness of influenza vaccines, the studies financed by the producers are published in journals with a high impact factor and so is the common doctor, who recommends vaccination to his clients, should he unfortunately wish to deepen the scientific evidence on the product it is offering, you will find yourself reading the articles present only in renowned scientific journals, those with high scientific value, and you will limit yourself to reading only the title, the summary (abstract) and perhaps not everything but only the final part of the conclusions losing the data contained in the article, which is often, too often, lacking or completely absent.

Yesterday as today, those who recommend flu vaccination do so essentially without evidence, confusing (deliberately or out of ignorance) the percentages of cases of infections from influenza and influenza-like viruses (not preventable with vaccination) and this is endorsed by the most prestigious scientific journals through a mechanism where the pharmaceutical industry dictates the rules.

If this is science...

Happy reading, Corvelva Staff

The truth about flu vaccine studies

The flu syndrome that occurs from autumn to the end of winter is caused by many viruses and only 8-9% of these infections are caused by the real influenza virus. So the flu vaccine, even if it were 100% effective, could only protect 8-9% of those vaccinated. In reality, its effectiveness is much lower (40-60%) and therefore it is thought that it protects only 3-6% of vaccinated people (when things go well and when the virus causing the epidemic is among those that have been chosen for give rise to the vaccine, which absolutely did not happen in the winter of 2014-2015 when the effectiveness of the flu vaccine was 23%).⁽²⁾

Yet every autumn we are subjected to strong media pressure to get vaccinated, because we are promised that this winter's new vaccine will be very effective and that it is essential to get immunized.^(3-4-5)

In light of these insistent pressures, I believe it might also be useful to reflect on a study⁽⁶⁾ published in the British Medical Journal in February 2009 (but increasingly valid the more the pro-vaccine battle escalates) in which Tom Jefferson, one of the most famous experts in the vaccination field and member of the authoritative Cochrane Vaccines Field, makes such clear statements and decided how astonishing, given that the interview was published in the Drug Information Bulletin⁽⁷⁾ and can still be read on the AIFA website.⁽⁸⁾

Jefferson clearly states that the main motive of the study was curiosity “trying to understand why, despite little or no evidence of efficacy and a poor safety assessment, influenza vaccines have become a kind of 'sacred cow' in the space of a decade. Also in relation to the complete collapse in mortality – not from influenza – but in influenza-related mortality (e.g. bronchopneumonia) observed from 1945 to today in America. It is a topic that fascinates us because, as readers will know, we have done several Cochrane reviews on this topic and subsequently updated them: and despite these doubts about the validity of the scientific evidence on these vaccines, doubts which are now growing in the scientific community, governments , media, key opinion leaders (i.e. therefore those 'characters' who are seen and heard in the media and who desert the subject) continue calmly to recommend the use of these vaccines without even asking themselves how it is possible to do so in the absence of scientific evidence. Will there be reasons? In the Cochrane Vaccines Field we have a database of studies of all investigations on the influenza vaccine from 1948 to today".

Well, the conclusions of the Jefferson group's study were the following:

There have been studies conducted on the effectiveness of the flu vaccine “in 96% of cases studies of low or very low quality and for us it was not a surprise, because we had almost already read them all previously”.
“In most of these studies there was a relationship between low methodological quality of the works and positivity of the results towards vaccines (in other words: the poorer the study, the better the results for vaccines)”.
Own "according to predictions, there was also a relationship between triumphalist conclusions and the fact that the studies were financed by the industry… all things that had already been seen in other areas of biomedical knowledge”.
“The real surprise concerned the impact factor and the citation factor: with the same sample size and the same methodological quality, the studies financed by the industry were published in journals that had a significantly higher impact factor than those not financed by the industry. 'industry. This was consistent even after removing the 24% of studies that had no funding statements. So it's a very strong relationship. It's the same for citation: the higher the impact factor, the higher the citation, so the citation is also determined above all by who pays for the research and not by its quality".

Generally, doctors who read a scientific study do not read the entire study, but limit themselves to identifying what they are interested in reading based on the title alone and then read the summary (abstract), perhaps not the whole thing but only the final part.

Well, Jefferson reminds us: “remember that someone else has already taken these habits of yours into account. 'Someone else' has already understood that you are only going to read the conclusions of an article and has subverted, is systematically subverting the international biomedical literature to lead you to wrong conclusions".

Therefore, “there is a relationship between who funds the research and where it is published, and naturally also a relationship between the estimates of effect”.

With this Jefferson does not want to question the credibility of the most authoritative medical journals, but he just wants to say that “the most famous medical journals with the highest impact factor are at the same time victims, because they are the targets of this subversion due to economic and commercial pressures”. That is, these magazines are highly courted by the pharmaceutical industries because the greater their visibility, the more promising the result, i.e. the outcome of a publication on their pages. The next step is that of "the pharmaceutical sales representative who carries around the extracts that the company has made: a million extracts in many languages ​​which are paid very handsomely by the industry. They are services explicitly advertised on the websites of multinational scientific publishing companies”.

Tom Jefferson, therefore, ends his interview with these words: be careful of hoaxes.

It may be interesting to remember that the Medicines Information Bulletin, called BIF, was an excellent magazine printed by the State Printing Office and sent free of charge to all Italian doctors until 2009: shortly after the publication of this interview with Jefferson, the BIF it was suppressed, certainly not for this interview, but it was suppressed nonetheless!

Influenza vaccine studies and funding

Interview with Tom Jefferson, Cochrane Vaccines Field
ASL 20, Alessandria, Italy

Among studies on the effectiveness of influenza vaccines, those sponsored by the industry are more likely to be published in journals with a higher impact factor.

Is the quality of a clinical trial a sine qua non for publication in a high impact factor journal? And vice versa, the impact factor is a sufficient parameter to guarantee the quality of the published work? An answer to these questions can be found in a systematic review conducted by a group of Italian researchers from the Cochrane Vaccines Field, financed by the Piedmont Region, and published in the British Medical Journal.⁽⁹⁾

We interviewed Tom Jefferson, one of the authors of the review, on the topic.

We are talking about the article published in the British Medical Journal in February, even judged "subversive" by the English newspaper The Guardian, in a commentary article. Before talking about the method you followed in the research, what was the reason you embarked on this study? Did you perhaps have some suspicions about scientific publishing?

The main motive of the study, the rationale, was curiosity, as usual: trying to understand why, in the face of little or no evidence of efficacy and a deficient safety assessment, influenza vaccines have become a kind of "sacred cow" within a decade. Even despite a complete collapse in mortality – not influenza – but influenza-related mortality (e.g. bronchopneumonia) observed from 1945 to the present in America. It is a topic that fascinates us because, as readers will know, we have done several Cochrane reviews on this topic and subsequently updated them: and despite these doubts about the validity of the scientific evidence on these vaccines, doubts which are now growing in the scientific community, governments , media, key opinion leaders (i.e. therefore those "characters" who are seen and heard in the media and who discuss the topic) calmly continue to recommend the use of these vaccines without even asking themselves how it is possible to do so in the absence of scientific evidence. Will there be reasons? We have, in the Cochrane Vaccines Field which is at the ASL of Alessandria and is financed in part by the Piedmont Region, a database of studies extracted from all investigations on the influenza vaccine from 1948 to today.

What method did you follow to carry out the study?
When you identify a study for inclusion in a systematic review, you summarize it, you try to understand what the authors mean, what the problems are in the study and then you extract a whole series of information; for example the internal relationship between the various sections of the work (objectives, methods, results and conclusions) and other particularities of the research, for example who financed it.

We related all this, then explored all the variables by crossing them with another fundamental variable, namely where these studies had been published and how much they had been cited: "where" means in which type of journal, which impact factor and which citation level following publication the articles had obtained.

Cwhat did you find?
That in 96% of cases these were studies of low or very low quality was not a surprise to us because we had almost already read them all previously. Likewise, it was foreseeable that in most of these studies there was a relationship between the low methodological quality of the works and the positivity of the results towards vaccines (in other words: the poorer the study, the better the results for the products). Again: everything as expected also in the relationship between triumphalist conclusions and the fact that they were financed by the industry. These were all things that had already been seen in other areas of biomedical knowledge.

So, all according to plan…
Not at all: the real surprise concerned the impact factor and the citation factor: with the same sample size and the same methodological quality, the studies financed by the industry were published in journals that had a significantly higher impact factor than those not financed by industry.
This was consistent even after removing the 24% of studies that had no funding statements. So it's a very strong relationship.
It's the same for citation: the higher the impact factor, the higher the citation, so the citation is also determined above all by who pays for the research and not by its quality. And it is this last conclusion that the Guardian considered subversive.

Clearly, in a study of this kind, the final part is dedicated to those that are possible interpretations. We are in the domain however, precisely, subjective interpretations, albeit evidence-based. So, what do you have deduced? What are your conclusions compared what did you find?
I would like to invite Bif readers to remember that if you keep up to date, follow the primary journals, the secondary sources, consulting the summaries of the original articles, but identifying what interests you only on the basis of the title and then reading the abstract and perhaps not all of it. but only the final part, remember that someone else has already taken these habits of yours into account. “Someone else” has already understood that you are only going to read the conclusions of an article and has subverted, is systematically subverting the international biomedical literature to lead you to wrong conclusions.

Another thing to point out is that our observations relating to influenza vaccines were replicated a few months later by another group of "subversive" English psychiatrists and psychologists who used the same method as us to verify studies in the field of interventions for de-addiction from smoking.

And what did they find?
The same thing: that there is a relationship between who funds the research and where it is published, and of course also a relationship between the effect estimates; report that we did not find because it was all mostly of low quality.

Some comments claim that you intend to question the credibility of the most authoritative medical journals…
This is one interpretation. There is also an alternative interpretation: that these more famous medical journals with higher impact factors are at the same time victims, because they are the targets of this subversion due to economic and commercial pressures.

In the sense that they are highly courted by the pharmaceutical industries because the greater their visibility, the more promising the result, the outcome of a publication on these pages?
Absolutely. And then our good pharmaceutical representative carries around the extracts that the company has made: a million extracts in many languages ​​which are paid very handsomely by the industry. They are services explicitly advertised on the websites of multinational scientific publishing companies. “Reprints”, translated into the target language, as they say.

So your suspicion is that the larger the business that a publishing house has to support, the greater the temptation to give in to the flattery of those who intend to turn scientific information into a market?
Perhaps, and the conclusion can be summed up in a single sentence: be careful of hoaxes.