First, we acknowledge that the version of the AP story that we found in the Charlotte Observer was less than half the length (327 words) of the AP story as we found it in other newspapers (734 words). So the reporter clearly did a lot more work than what was seen in the Charlotte paper. This is a troubling practice that we've written about elsewhere on the site.
Nonetheless, the article accurately summarizes the availability of flu vaccines and the primary results of the new study in the New England Journal of Medicine — the proportion of children protected from the flu by each of two tested vaccines (i.e. the vaccines’ absolute efficacy). However, the story could provide more information to help readers judge the meaning of these results, the novelty of the “new” live, inhaled vaccine, its potential harms and costs, the overall quality of the research, potential conflicts among the story’s sources, and other health measures readers can take to prevent the flu. The AP report omits mention of costs—a significant feature of any major public health initiative. It’s unfortunate that the article fails to put the data on vaccine efficacy into a meaningful context. To begin with, the advantage of the killed vaccine shots over the live FluMist vaccine was not statistically significant. But the fact the shots were just as good as the inhaled vaccine was surprising. The researchers note that the main virus they were concerned about (type A) had changed or “drifted” from the strain that was in the vaccine. Earlier studies had led them to expect that the inactivated vaccine shots would be less effective in this situation. Instead, the shots and nasal spraywere very effective (74% each, according to the new study). The killed virus was also very effective against two strains of type B virus. More information on potential harms might also allay fears associated with live vaccines. Side effects described in the New England Journal of Medicine study were mostly minor–runny nose, headache, cough, and muscle aches among those receiving the live nasal spray vaccine and sore arms among those receiving the shots. The study authors attributed one serious complication to the live (nasal) vaccine—acute pericarditis, or inflammation around the heart and major vessels—a problem that required hospitalization. A little more information about the story’s sources would also help readers assess the new research. The story (as it appeared in the Charlotte paper) quotes a single university-based vaccine expert, but does not state whether he has any potential conflicts of interest. The story fails to note that two researchers received consulting fees from pharmaceutical companies–including MedImmune, which manufactures the FluMist inhaled vaccine in partnership with the researchers’ employer, the University of Michigan. Finally, the AP report misses an opportunity to explain other measures people can take to prevent the flu. In addition to vaccination, the Centers for Disease Control and Prevention recommend several (http://www.cdc.gov/flu/protect/habits.htm). These include using antiviral drugs and good health habits (e.g. avoid close contact; stay home when sick, cover your mouth and nose; clean your hands; avoid touching your eyes, nose or mouth). It would be unfortunate if readers took away the message that flu prevention is not very effective or that a shot (or snort) has little value for the healthier members of a flu-prone community.
What did the reporter put in the longer version of his story that you didn't read in the Charlotte paper? Quotes from two other physician-researchers. Caveats about interpreting the study results. Information from another flu study that appeared in the same issue of the New England Journal of Medicine. Information from an editorial in that journal. Information on the age groups approved for use of FluMist. Information on the number of flu deaths (36,000) and hospitalizations (200,000/yr.) from the flu. In other words, you missed a lot. So this is more of a review of the editing done by the Charlotte newspaper that picked up the story off the wire than it is of the work of the original AP reporter.
The article omits mention of costs, an important public health issue. A flu shot costs about $11, whereas FluMist costs about $20. Even though equally effective in preventing the onset of flu, FluMist is less efficient than the flu shot.
The AP story accurately reports the proportion of children who benefited from either the inhaled vaccine or shots, i.e. the “absolute efficacy” of the two vaccinations. Although the inactivated vaccine appeared to be more effective, the difference was not significant. The story states in closing that the two methods were similarly effective in preventing type A flu, the historically more common strain. But the headline is confusing and misleading.
The AP report provides no details on potential harms. The New England Journal of Medicine study reported mostly minor side effects of the vaccines and one serious complication attributed to the nasal spray—hospitalization for acute inflammation of the tissue surrounding the heart and great vessels (acute pericarditis). It's also worth noting that pericarditis has also been reported (rarely) with the inactivated vaccine.
The article summarizes the effectiveness of each vaccine in clear, accurate language, but omits important information that would help readers interpret the meaning of these numbers. For starters, the advantage of the shots over the live FluMist vaccine was not statistically significant. But the fact the shots were just as good as the inhaled vaccine was surprising, the researchers note, because the main virus they were concerned about (type A) had changed from the strain that was in the vaccine. Earlier research had led experts to expect that the inactivated vaccine shots would be less effective in this situation. Instead, it was very effective. The killed virus was also very effective against two strains of type B virus that were circulating during the flu season they studied. The news story also neglects to mention methodological strengths of the new study—e.g. that the large trial was randomized and that both the patients and researchers were blinded to the treatment the patients received.
There are no obvious elements of disease mongering.
This story includes a quote from a single university-based vaccine expert, but it does not state whether he has any potential conflicts of interest. The story fails to note that two researchers received consulting fees from one or more pharmaceutical companies–including MedImmune, which manufactures the FluMist inhaled vaccine in partnership with the researchers’ employer, the University of Michigan.
The story does not state whether there are any intrinsic advantages or disadvantages to the “new” vaccine. It also fails to note that FluMist is not approved for use in high-risk patients. Nor does it describe other actions people can take to prevent the flu. In addition to vaccination, the Centers for Disease Control and Prevention recommend several measures (http://www.cdc.gov/flu/protect/habits.htm).
The AP report notes that FluMist was approved in 2003. Most readers will be familiar with flu shots and capable of determining their availability.
The story said that FluMist was "new," approved by the FDA in 2003.
No obvious reliance on a press release.