Connecting the Flu Dots

How dangerous is the flu? Probably more than most people think. Influenza/Pneumonia is regularly among the ten leading causes of death in the U.S.

But there is more to it than that. This paper by Doug Almond makes a broad and interesting argument about the flu. By using the shock of the 1918 influenza pandemic, Almond measured the effect of the flu on the babies who were in utero during that time. He found that those cohorts “displayed reduced educational attainment, increased rates of physical disability, lower income, lower socioeconomic status, and higher transfer payments compared with other birth cohorts.” This underscores the argument that I’ve heard various smart people, including Robert Fogel, make: that the past century’s huge gains in life expectancy are due in large part to small, simple measures like access to flu shots and clean water, rather than the more complicated, expensive, dazzling medical technologies that are more heavily promoted.

So having the flu in utero seems to be significantly damaging to various life outcomes. While in utero development is obviously a vital period, it would follow that the first several years of a child’s life are also vital, and a very good time to avoid the flu. (If I am wrong in this assertion, someone please correct me.)

Which is why a pair of recent articles caught my eye.

This N.Y. Times piece describes a New England Journal of Medicine study which argues that “FluMist vaccine — a live virus in a nasal spray — is much more effective than flu shots in protecting young children against the disease.” FluMist, made by Medimmune, has not yet been approved by the F.D.A. for children under 5, but based on these articles, that sounds very likely. Dr. Robert B. Belshe, the lead author of the study, is excited about the prospects. “As far as I’m concerned,” he told the Times, “you should dispense these [FluMist doses] in machines — you put in $10 or $20, out it comes, and you squirt your own nose. But the C.D.C. and the F.D.A. don’t like it when I say things like that.”

And then there was this announcement that Kaiser Permanente, the California HMO, is using its massive customer base and even more massive database to launch a years-long study to determine how various genetic, environmental, and lifestyle factors combine to produce various diseases and conditions. Much of the data will be gathered by sending surveys to Kaiser’s adult patients to ask them about their eating and exercise habits, past illnesses, etc.

I especially hope that Kaiser thinks to ask these people if they had the flu as a child — and, perhaps even more tellingly, if their moms had the flu when they were in utero.