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women very sick with H1N1 flu. One ended up in our ICU; she eventually died. Her pregnancy had already been complicated by severe asthma and obesity. Serious, sad, and scary things can happen. But the overwhelming data suggests that these are the excep on, not the rule, and the excep ons are usually associated with an already complicated medical situa on (i.e., asthma and obesity way up the ante on pregnancy risk) rather than happening to the average healthy pregnant woman. This is not how the media portrays things. There is a lot of fear mongering in medicine. As a public, we have a skewed, media-driven, fear-based view of our health and of disease prevalence. And it is impossible to ignore the fact that there are massive profits to be made by the very limited number of pharmaceu cal companies producing the influenza vaccine. According to Jennifer Margulis, a controversial and ar culate health journalist, in her ar cle "What the Doctor Isn't Telling You about Pregnancy and the Flu Vaccine," the data generally presented on flu prevalence and severity of outcomes in pregnant women compared to the general popula on is highly inflated, not to men on conflated with reports on pneumonia, which are not separated from influenza data. Not being a girl to take anyone else's word for it, even a brilliant girl's, and a bit of a science nerd myself, I went to the CDC website as well as a major primary source ar cle, "Vaccina on During Pregnancy: A Cri cal Assessment of the Recommenda ons of the Advisory Commi ee on Immuniza on Prac ces (ACIP)" to get the scoop. (The ACIP is the CDC's vaccine advisory group). For starters, I wanted to get actual data on flu death rates in the US. Guess what the CDC website reports? They don't know. No seriously, and I quote them: "CDC does not know exactly how many people die from seasonal flu each year." They give a really, wide range or numbers, hedge a lot, avoid es ma ng, give a lot of reasons that they just can't give an exact number, and then finally state, "CDC believes that the range of deaths over the past 31 years (~3,000 to ~49,000) is a more accurate representa on of the unpredictability and variability of flu-associated deaths." And this is all-comers, not just pregnant women. In fact, a study cited on the CDC website states that "about 90% of influenza associated deaths occur among adults 65 years and older." Clearly NOT pregnant women! In a review of CDC flu-related maternal death sta s cs between 1998-2005, Callaghan et al es mate an average of 5 influenza-related maternal deaths per year. In 2009, with H1N1, this number was considerably higher, with an es mate of 28 in the first quarter of the year, which would encompass about 50% of the flu season. Now I don't want to minimize the death of any pregnant woman – this is a serious event. But to put it in perspec ve, 1,000 women would have to be vaccinated to prevent even just 1-2 pregnant women from being hospitalized for influenza related treatment. (Ayoub and Yazbak) Addi onally, when folks have a fever, aches, and cold symptoms they almost always say they have "the flu." But as a doctor, I know that this is rarely actually the case; most folks with flu-like symptoms, actually just have gnarly upper respiratory infec ons – usually a bad cold. In fact, many cases reported as flu are not the flu, so the actual numbers of people even reported as having the flu are highly unreliable. Confirmatory tes ng is rarely done. Further, according to Margulis, "The scien fic evidence that pregnant women are, actually dying from influenza is all but nonexistent, even when pneumonia and influenza are lumped together." The largest scien fic study to date included 49,585 pregnant women who were part of the Kaiser Permanente healthcare organiza on in Northern California over five flu seasons, as well as 48,639 live births among the same pool during the same me-period. The authors concluded that, "Hospital admission with a principal diagnosis of influenza or pneumonia was an extremely rare event for the women in the study popula on." Only nine women (out of almost 50,000) were admi ed, which is 0.018 percent, or less than one in 5,000; and of those nine women, all had pneumonia. All nine women recovered with no complica ons. (Black) Equally intriguing is that the "Kaiser Permanente study found no difference in the incidence of flu or flu-like illness in those who received the flu vaccine compared to those who did Page 44 | Abby's Magazine - www.AbbysMag.com