Flu Shots, the Terrain, and Rick Perry

"Flu shots" represent much more than just vaccination against viral influenza. This annual event calls into question germ theory, healthcare delivery, and even politics. As such, every year I enjoy seeing how our handling and perceptions of flu shots change. Let me explain further:

Germ/Terrain Theory: We all understand and appreciate how microscopic organisms cause disease processes and influenza certainly falls into that category. The flu bug has caused widespread morbidity and mortality in the past and every year its arrival brings about the same. As such, the flu vaccine has greatly reduced the flu virus from spreading to epidemic proportions as it has in the past. But why is germ theory so accepted, but terrain theory not embraced? Yes, we get the point about bugs causing disease, but most of us do not appreciate the terrain and environment of the host on equal footing. We all get exposed to the same pathogens, but only some of us get disease. Advocates of widespread flu vaccination argue this is due to the immune effects of the vaccine itself, but this cannot be completely true. Far too many people who get vaccinated also get the flu virus. I think embracing the terrain/host theory of infectious disease is long overdue. The more we, as physicians, can help our patients support their own individual immune systems, the better.

Healthcare Delivery: In just the last couple of years we’ve seen pharmacies standing up as the place to go to get the flu shot. Television and radio commercials abound telling us to go to CVS and Walgreens for our free flu shot. Pharmacists are being trained to deliver the flu vaccine. We, as physicians, really need to keep our eyes on this one because this flu shot movement represents how our healthcare delivery is rapidly changing. It is a slippery slope indeed: Now that we accept pharmacists giving flu shots, why not have them provide other medicine and advice? I am not arguing that this movement is bad for medicine, but it is worth noting how the annual flu shot process represents a shift in how healthcare is delivered.

Politics: Now that we’ve covered the changing flu shot landscape, let’s move on to another related issue: Vaccination. The issue of vaccination is getting much more press this year due to the highlighting of Governor Rick Perry's Texas mandate for HPV vaccination. While clearly different than the flu shot, the HPV vaccine debate is similar based upon the theory of vaccines themselves. Vaccines are embraced by public health because they reduce transmission of disease. Health officials argue that it is in everyone's interest to have more people vaccinated (less disease transmission). Why not do the same with the flu shot? And all vaccines? The crux of this issue, to me, is that no one should have the right to tell someone what they have to do, including (and most importantly) the government. We are all very capable individuals who can decide for ourselves what is best for ourselves. Just because vaccination benefits many people does not in any way, shape, or form mean that everyone has to get vaccinated.

On this note, vaccinations (flu shots included) truly do represent the larger issue of personal responsibility vs. the paternalistic model of medicine. As much as we want our patients to do well, we have to embrace the notion (and the trend) that patients are less accepting of our advice and are more independent minded. I believe this is truly a positive shift for modern medicine as we have become too caught up in statistics and population data at the expense of the individual patient.

So this year as you hear those flu shot commercials and field flu shot questions from your patients, I hope you will consider how flu shots represent so much more than immunization against influenza.

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