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.


I wondered why I got that survey from Kaiser. I told them the truth, of course. I am a vegan on a no fat diet. My IQ is 170. I live 200 miles from the nearest EPA superfund site. I exercise 3 hours a day, including 2 hours of cardio. And I have never been sick a day in my life and I have a permanent cheery attitude toward life.

Oh, and I believe that corporations should rule the world. And that Hillary would be bad for America's health care.

I signed my name and sent it on.


In a related thread to this, CalTech recently published an article in their Engineering & Science magazine on the correlation of mothers getting sick and their children having autism or schizophrenia. Link:

Some fascinating discoveries are in that article. Like vaccinations given to mothers while pregnant trigger the same problems in fetus brain development that actually getting the disease can cause. My first thought to that fact was that most mothers can get around this if they A. go see a doctor before getting pregnant. B. getting tested then to see if they are pregnant. C. If the test is negative - get any vaccinations then and there. But I digress. The article also does a great job of explaining how they take statistic correlations and turn that into experiments in mice and then into experiments in humans. Food for thought and further evidence that these small changes have large impacts.



I think 'egretman' is wrong. Corporations ruling the world is not a good thing, people should live free. He was right about Hillary though.



I have a permanent cheery attitude toward life

You probably should also have mentioned your charitable work on behalf of the disadvantaged, and your Nobel Prize in Mathematics. Otherwise they don't have a complete picture.


One question that has to be asked when studying in utero effects, is what medications were given? If the mothers were dosed with many of the common antibiotics and other meds given for flu (at that time), the side effects on the brain development of the fetus may very well have been from the meds. Many of the medicines given to pregnant mothers (up to about 1970) are now known to have serious impacts on brain development.
Likewise, the effects of virus based vaccines on fetuses is not known, although comment #2 suggests that it has been studied (I am not sure where they drew that conclusion from). Many things will make it through the umbilical cord exchange, so the risk should be assessed.


Wouldn't the main reason in utero effects of the 1918 influenza be because of the Great Depression? People born in 1918/1919 would have been in their late teens/early 20s during the Great Depression, at the prime age for starting a career, getting an education, and setting up their lives out in the world. The big problem was that the economy of the time required those same people to resort to vastly different life paths in order to make ends meet and feed their families. Not being able to afford an education because one's family lost all their money in the Great Depression seems like a much more relevant factor than the fact that people in utero during the 1918 influenza suffered educationally.


I'm one of those paranoid individuals that believes self infection is not the best way to avoid the flu. This article helps confirm some of my paranoid fears. :)

By the way so far I've had the flu less than 3 times in my life.


jenn, the paper carefully compared birth periods within a 2 year range and also within the same period using geographical separation. So, a baby born just before the pandemic, during it, or >9 months after it (it lasted only a year) would have an almost identical economic reality during adolescence and early adult years. Further, since the flu was not distributed evenly throughout the country, he was able to isolate similar socio-economic households based on being in a flu area or not. So, the depression would be a similar factor for those in utero in the storm of the pandemic and those not.


They don't give a Nobel Prize for Mathematics. I believe you are referring to my Fields Medal.

Andy from Houston

Yes more people will die from the flu than from terrorism this year.

Far more people will die from heart disease than either terrorism or the flu combined.

Yet, for some reason, we allocate more of our budget to fight terrorism than to fight heart disease.

Talk about misplaced priorities.


I do not know what you are talking about when you say pregnant women should watch out for the flu. My mother had the flu while I was in the womb and I turned out perfectly banana.


"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. "

I am sure this is something everyone can remember.

Innocent Bystander

Relatedly, this is why the ZOMG T3h SUPERFLU!!! panics every couple years really tick me off. Flu already kills millions worldwide every year. No one cares or really notices, since most of those people are in countries with funny names that we can't pronounce. But suddenly some new strain kills a couple more old people than the flu might normally - or maybe their deaths just get PUBLICIZED even though the actual death rate is the same - and the media flips out and the pharmaceutical companies are immediately on their knees in D.C. imitating the action of Oliver Twist.

If people were more educated about the flu in general, we wouldn't have these kinds of silly, wasteful panics - and we might be making more progress towards helping the rest of the world deal with it to boot.


BTW, the Kaiser Permanente survey is specifically referenced in the link I provided earlier.


Just adding my two cents about children under 5 getting the flu-mist: My daughter, 5 now, took part in the flu-mist study at about age 1. It caused absolutely no problem for her at all. She did not get the flu that year either.

Our doctor later told us that one reason the vaccine was not approved for kids under age five was that kids with asthma suffered some pretty nasty complications. I don't know too much about asthma, but it seems to me that you know if your kid has it. Simply don't administer it to them.

Anyway, just my two cents.



Chris Sullivan

As the flu panics hit the media this year, I also started noticing stories about the dangers of flu shots and blogged about it: Warning: Thimerosal Still in Flu Shots ( I don't know how accurate the data are on either side of the argument, but I do avoid the flu shot myself and for my daughter.

Almost everyone I've spoken to about the shot tells me that the shot itself has given them the flu. Add to that the possiblity that the shot contains some potentially damaging ingredients, and I just don't think it's worth the risk. I lean toward good diet, exercise, and stress control to keep me healthy instead, and I've avoided the flu for years.


Andy from Houston must be up for a Nobel Prize for Sophistry.

I spend more on my mortgage every year than I do for health care for my family. Does that mean I value my house over my children? No.

Dollars spent do not equate with priorities.

Furthermore, a terrorist with a nuke or, say, access to the flu strain from 1918 could kill multi millions.

Andy from Houston

bassworks, I am not really sure about what your mortgage or your children have to do with the flu, but since you brought it up...

1. Your children derive a tangible benefit from having a roof over their head. Your children do obtain value from your mortgage payment. I have no idea how much you care for your children in relation to your mortgage.

2. Anything COULD happen. An asteroid could come from outerspace and wipe 5 billion people off the planet. Does that mean we should spend 50% of our GDP on asteroid prevention? No, because the chances of that actually happening are slim. Its called prioritizing risk and acting accordingly. You use the data you have and try to make the best decision you can. A terrorist could kill millions with a nuke. But, right now, more people die of heart disease than war and terrorism combined. Right now, trying to prevent and treat heart disease would be a more valuable use of our resources.

3. There are a limited number of nobel prize categories, and last I checked sarcasm was not one of them. Your attemped wit is duly noted, however.



Chris Sullivan said, "Almost everyone I've spoken to about the shot tells me that the shot itself has given them the flu."

Not me. Not my husband. Not my co-workers in the childcare center where I used to work. Not the children I nanny for now, or their parents.

Fear-mongering doesn't do us any good.

Chris Sullivan

Tesslouise, you're right to point out that personal reporting is bad evidence. Speaking to a few people is not sound data.

But read my blog post, and you'll see that I'm not fear-mongering. There are some serious questions about the risks involved in flu shots.

The information I read alarmed me enough to step back and question whether or not it's a good idea. And I'm not one of those people who doesn't vaccinate his children or use a heavy duty filter on my tap water. I'm generally very skeptical about such things.

Thimerosal seems to be a different thing altogether. Have you read up on it?