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Odds & Sods
Methadone Fails 97% Of Drug Addicts And Flu Vaccines Don't Help Much
Sunday, 29th October, 2006  - Richard Farmer

After 40 years in journalism I am still regularly surprised by what stories become news and what stories do not. Today I thought I should mention a couple that have failed to get a run in Australia but which probably should have because they raise some serious questions about how we spend our rapidly increasing health budget.

The first is a report of research by Neil McKeganey, Professor of Drug Misuse Research at the University of Glasgow, showing that methadone use is only marginally better than doing nothing at all for heroin addicts. McKeganey's report was based on interviews with 695 drug users who began treatment for their addiction in 2001. The majority were given methadone-based care, while a small percentage were placed in residential rehabilitation.

The authors then interviewed them 33 months afterwards to find out whether, over a 90-day period, they had come off drugs. For those on the most common form of treatment - methadone maintenance - only 3.4% were clear. For those who had been in residential rehabilitation or gone 'cold turkey', often for up to nine months and without any methadone, the figure was 29.4%.

Methadone is the most common form of treatment for Australian heroin addicts.

The second story has a more general application as it questions whether those annual flu jabs given to millions of Australia at great cost do any good at all. Tom Jefferson, co-ordinator of the vaccine group at the Cochrane Collaboration in Rome, which reviews health treatments, wrote in the British Medical Journal that most of the research that has looked into the impact of flu vaccines is of poor quality.

Jefferson summarised his findings after reviewing the literature...

Public policy worldwide recommends the use of inactivated influenza vaccines to prevent seasonal outbreaks

Because viral circulation and antigenic match vary each year and non-randomised studies predominate, systematic reviews of large datasets from several decades provide the best information on vaccine performance

Evidence from systematic reviews shows that inactivated vaccines have little or no effect on the effects measured

Most studies are of poor methodological quality and the impact of confounders is high

Little comparative evidence exists on the safety of these vaccines

Reasons for the current gap between policy and evidence are unclear, but given the huge resources involved, a re-evaluation should be urgently undertaken

The optimistic and confident tone of some predictions of viral circulation and of the impact of inactivated vaccines, which are at odds with the evidence, is striking. The reasons are probably complex and may involve "a messy blend of truth conflicts and conflicts of interest making it difficult to separate factual disputes from value disputes" or a manifestation of optimism bias (an unwarranted belief in the efficacy of interventions).

Whatever the reasons, it is a sobering thought that Archie Cochrane's 1972 statement that we should use what has been tested and found to reach its objectives is as revolutionary now as it was then.

Note: Professor Archibald Leman Cochrane, CBE FRCP FFCM, (1909 - 1988) British medical researcher who contributed greatly to the development of epidemiology as a science.

His Rock Carling Lecture entitled Effectiveness and Efficiency was published in 1972. Considered a seminal text for evidence-based medicine, its central argument — "that health services should be evaluated on the basis of scientific evidence rather than on clinical impression, anecdotal experience, 'expert' opinion or tradition" * — continues to have a profound influence on health services research and practice worldwide.

The volume was subsequently translated into several languages, including Japanese and Italian.

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