Should this elderly lady get the flu vaccination?

I had an email this week from 67-year-old lady asking about flu vaccination. She’s had a phone call recently from her surgery asking her to attend for this. She asks if the “flu threat really worse this year or are the drug manufacturers up to their old tricks again!?”

Flu vaccination is generally promoted as a ‘no-brainer’ interventions by many in medicine. But how much evidence is there that it helps the elderly – the people some claim are most at risk and stand to gain the most from vaccination?

The effects of flu vaccination in the elderly was reviewed by researchers from the so-called ‘Cochrane Collaboration’ in 2010 [1]. The reviewers identified 75 studies, but only one of these was deemed especially relevant in that it was a ‘randomised controlled trial’. This study, apparently, yielded some evidence that vaccination helped protect against the flu, but it did not assess the impact of this on complications. This is important because one could argue that getting the flu is neither here nor there really. What is really important is whether this then leads to an enhanced risk of things like pneumonia and death (particularly important in the elderly).

The authors of the review concluded that “The available evidence is of poor quality and provides no guidance regarding the safety, efficacy or effectiveness for people aged 65 years or older.”

In 2008, the American Journal of Respiratory and Critical Care Medicine published a study that sought to assess the claim that flu vaccination helps stop old people dying [2]. Previous studies have found that if you look at an elderly population, those who have had the flu vaccination are about half as likely to die compared to those who remain unvaccinated. It’s obvious then: vaccination saves lives.

However, the ‘epidemiological’ studies tell us that vaccination is associated with reduced mortality, but they don’t tell us for sure that it’s the vaccination that is the protective factor.

One could argue, as the authors of this recent study did, that people who get flu vaccinations are also more health conscious (and perhaps they eat better, exercise more and smoke less) than those who eschew flu vaccination. Perhaps it is these or similar factors, not flu vaccination, that accounts for the reduced mortality in those who have been vaccinated?

To address this issue, these researchers assessed the mortality in about 350 vaccine recipients and 350 non-vaccinated individuals (controls) who had been hospitalised with pneumonia. The really clever twist to the design of this study was its timing: the study was done outside the flu season. Now, with no flu around to be protected from, any difference in mortality is unlikely to be due to flu vaccination.

What the researchers found was that those who had had the flu shot were (still) about half as likely to die compared to the non-vaccinated. The authors of this study suggest that the apparent mortality benefit in the elderly (as observed in epidemiological studies) is probably not due to the vaccine but, but a ‘healthy user’ effect.

I can’t know whether drug companies are up to their old tricks and over-hyping the need for flu vaccination. I also can’t know whether the lady who emailed me is likely to benefit from this intervention. The fact is the practice of flu vaccination in the elderly is not based on evidence, but an article of faith.

References:

1. Jefferson T, et al. Vaccines for prevent influenza in the elderly (review). The Cochrane Library 2010 (issue 2)

2. Dean T, et al. Mortality Reduction with Influenza Vaccine in Patients with Pneumonia Outside “Flu” Season – Pleiotropic Benefits or Residual Confounding? American Journal of Respiratory and Critical Care Medicine 2008;178:527-533

34 Responses to Should this elderly lady get the flu vaccination?

  1. Jacque 9 November 2013 at 1:41 am #

    Interesting post. I always get my shot, but I’ve also always wondered if it really makes a difference.

    I do quibble over 1 thing–67 is far from “elderly”!

  2. Mark 9 November 2013 at 2:10 am #

    My advice would be to optimise levels of Vitamin D (probably need to be taking about 5000IU daily), eat a nutritious diet and get plenty of good quality, regular sleep.

    That’s just my belief but I’m sure the evidence for the above is more compelling than the results of various studies I’ve read regarding the efficacy of flu shots.

  3. marie 9 November 2013 at 4:55 am #

    All good, but is there a down-side to getting the vaccine? Otherwise, a cautious person can get it just on the chance that it helps.

  4. Dr John Briffa 9 November 2013 at 6:33 am #

    Jacque

    I also do not view 67 as being particularly ‘elderly’.

    In the post, I used this term as in medical research it’s usually used to distinguish individuals over the age of 65.

  5. Jacek 9 November 2013 at 8:08 am #

    About the 67 ‘elderly’ tag, I agree it’s a bit inappropriate these days. There are people in their 90s (even 100+) still driving, so what comes after elderly (80s, 90s and beyond?). Ancient?

    (From a 65 year old great fan of Dr Briffa and his views,)

  6. Roy Procter 9 November 2013 at 9:15 am #

    Dear Dr Briffa,

    I am a reasonably healthy 83 year old and my wife is 81. Neither of us will have flu vacinations, or any other such shots if we can avoid them. We do take regular homeopathic flue protection. We also pay great attention to diet and eat healthy organic food. We believe that this is much more effective than products from big Pharma!

  7. Angela C 9 November 2013 at 9:35 am #

    You dismiss having flu as a trivial complaint but this is not true for everyone. I take the flu jab and would not be without it. I do not have it to live longer or prevent death but to gain some quality of life and not dread the coming of winter. Most years I used to get flu and be SO ill. High temperatures and complete incapacity kept me away from work for up to two weeks at a time. It is not a trivial illness. As well as flu I seem to be highly prone to heavy colds up to three times a year. The jab helps protect me from colds too.

  8. Lyndie 9 November 2013 at 9:47 am #

    67 elderly? I think not. if medical research uses that term for anyone over 65 that covers a vast range of ages. This surely is something that should be changed if research in this area should be taken seriously and using that term to address people in their 60s and 70s seems inappropriate nowadays. Interesting post though.

  9. Dr John Briffa 9 November 2013 at 9:56 am #

    Angela C

    I don’t dismiss flu as trivial.

    What the post questions is the evidence base for flu vaccination in the ‘elderly’. The evidence is weak. You relate your experience with what seems like 100 per cent faith in the flu vaccine. The fact is, we know overall effectiveness of flu vaccines is limited in terms of preventing flu. And we just don’t know how good the vaccine is at preventing the complications of flu.

    This is what the data shows. I don’t want to dismiss your experience, but it’s not what I’d suggest we use to inform the public and decide on policy.

  10. Margo 9 November 2013 at 10:00 am #

    My mother’s doctor always told her “not to bother” with the flu jab; this was in the 1990s. My husband caught “flu” in September 1999 from someone who had recently returned from abroad. My mother caught it from him, developed a bad cough, and a month later had a stroke, and the rest is history. Rightly or wrongly, I always felt that if she had been protected from this flu she would not have died. Superstition? Maybe. But as a young, fit, gorgeous 67 year-old, I always have mine!

  11. Sue Gooch 9 November 2013 at 10:12 am #

    I don’t qualify yet for the flu jab but I have no intention of having it when I do. I’ve reached 62 without ever having flu so I really believe I’m not likely to get it, I seldom hav e colds either, no more than two mild ones in 10 years. My husband regularly has his jab, given because he’s diabetic. Within days he’s coughing and sneezing, he’s never had flu either! As there appear to many different flu virus’s, how effective is it to be vaccinated against just one.

    I might concede that if you’ve had flu, being vaccinated is sensible but a mass inoculation programme is just another instance of misguided medical practice based on what? Faulty research if Dr. Briffa is correct.

    Angela C I’m not sure why you think a flu jab protects you from the cold virus? That’s like saying a Rubella jab would help protect you against measles, it won’t, they are two distinct viruses that are unrelated apart from the fairly similar symptoms.

  12. Gill Dunn 9 November 2013 at 10:19 am #

    5 years ago I blamed the ‘flu jab for my polymyalgea rheumatica which flared up within a few days of the injection and although the pma pain was through hip and shoulder muscles, when I concentrated on the seat of the pain it was always at the jab site. I have not had the flu jab since. However, pma came back this year and I’ve also been diagnosed with non-Hodgkin lymphoma – dilemma – advice is to have the jab (head is saying ‘yes’, heart is saying ‘no’!) What would you do? (I’m over 70, pma and ‘flu jab were both in their infancy at the same time).

  13. Mike Abbotts 9 November 2013 at 11:11 am #

    “One could argue, as the authors of this recent study did, that people who get flu vaccinations are also more health conscious (and perhaps they eat better, exercise more and smoke less) than those who eschew flu vaccination.” Seems to me, that the “healthy user effect” is of little value as an explanation of anything. Problem is that, given the absence of clear evidence, being health conscious is just as likely to cause people to avoid vaccination as to rush to the surgery. As some of the posts above suggest, many “healthy users” avoid flu jabs and other interventions as a matter of principle – me too. I am also persuaded to abstain by the fact that the nurse, whose job it is to fulfil the practice flu jab quota, admits to avoiding it herself.

  14. Jacek 9 November 2013 at 11:36 am #

    OK, now we’ve established who is not ‘elderly’, back on a more serious note.

    As an alternative to vaccinations, what about boosts to immune response – to either not allow the virus to take off in the first place or to see it off swiftly?

    There are numerous claims for ‘natural’ flu remedies, I’m a great believer in chillies, ginger and garlic. Unfortunately, the last one does tend to get noticed but, if you plan carefully, you take it in your non-social intervals. And also if flu strikes the last thing you should be doing is taking temperature lowering pharmaceuticals – surely a good sweat is nature’s way of thermally killing off the invaders?

    And yet paracetamol is routinely advised – lowers the temperature and makes life more agreeable for Mr Flu.

  15. Moy Peralta 9 November 2013 at 2:16 pm #

    I really don’t know what to make of the aforegoing article, primarily from the viewpoint of what is, perhaps, not being said, rather than the article’s chosen content.

    I am not a medic, therefore perhaps Dr Briffa could comment further on whether, in his professional opinion, the ‘ingredients’ in vaccines (usually containing traces of formaldehyde – a known carcinogen, thimerosal – containing mercury, phenol, anti-freeze, detergent, animal cells, and other additives) are actually beneficial to human health? And also whether frequent flu shots may be perhaps partly-responsible triggers for serious conditions (such as arthritis, epilepsy, MS, Alzheimer’s, ALS, or even SIDS) in later years?

  16. Gunnar Isaksson 9 November 2013 at 2:30 pm #

    I agree with Mark about taking D-vitamin. It strenghtens the immune system very much, some says 3 to 5 times. It works against any virus and perhaps best aginst those not in the flu vaccin.

    It takes a few months before the blood stream has reached optimal levels of D-vitamin so it’s time to start right away. The question is just how much D-vitamin to take. I would agree with 5000 IU but if she is a tiny woman, this could be decreased to 4000 IU.

    Don’t stop during summer but just decrease it somewhat since at her age, the body will not produce much vitamin D from sunlight.

  17. Robert Park 9 November 2013 at 3:19 pm #

    The problem with allopathic medicines is that it ignores natural products. There are many natural products that are effective against colds and influenza. Here are my three favourites: coconut (its oil is recommended) also olive leaf extract, and oregano oil. Each are beneficial against viruses but together they act synergistically. If a lump of creamed coconut block is taken it will cure even the severest of symptoms in around 10-12 hours. If added to this olive leaf extract the cure will take between 7-8 hours but when oregano oil (pure organic) is also added then this cocktail will effectively cure the symptoms in around 5 short hours. As viruses are versatile it is best not to use this as a prophylactic otherwise higher dosages will be required to be effective. Whenever my wife and I are in contact with anyone with influenza or if we have the snuffles we take a lump of coconut block which usually stops the infection from progressing. The cocktail is dosage dependent so the more taken the better the cure. During the past 35 years (or thereabouts) I have had influenza for one day only and on that occasion had to take higher dosages of the cocktail to be effective.

    I have also read that the flu-jab contains preservatives which are toxic and hardly appropriate to administer to the elderly whose immune systems are probably compromised.

    Here are some interesting articles:

    http://www.dailymail.co.uk/news/article-1206807/Swine-flu-jab-link-killer-nerve-disease-Leaked-letter-reveals-concern-neurologists-25-deaths-America.html#ixzz0OcsvKaSH

    http://www.whale.to/vaccine/child_flu.html

  18. Valerie McKen 9 November 2013 at 3:31 pm #

    We already have a vaccination against colds and flu, its called our immune system!
    In winter time, we can support our immunity with vitamin D as Mark suggested, although not in such a high doses unless your levels are exceptionally low, vitamin C and perhaps a mushroom complex. There are loads of other natural ingredients that support immunity for everyone, young and er, well, people of all ages since as their are no old people any more! :)

  19. Valerie McKen 9 November 2013 at 3:34 pm #

    We already have a vaccination against colds and flu, its called our immune system!
    In winter time, we can support it with vitamin D as Mark suggested, although not in such a high doses unless your levels are exceptionally low, vitamin C and perhaps a mushroom complex. There are loads of other natural ingredients that’s available to everyone, young and er, well, people of all ages since as their are no old people any more! :)

  20. Vanessa 9 November 2013 at 3:44 pm #

    Being only 55 I’m not that far from being elderly ;-) however have never had a flu jab. It was offered for free at the hospital where I used to work, and several of my colleagues developed flu-like symptoms bad enough to warrant time off work. I have only had a bout of flu once in the last few decades, about 8 years ago I think, and rarely get colds. I take Echinacea supplements for 2 weeks a month over the winter, eat lots of fresh veg daily, and if I feel any sign of a cold developing I drink a cup of Raspberry and Echinacea tea, which kills it off immediately.

  21. Deane Alban 9 November 2013 at 3:50 pm #

    No one should get the flu shot! Here’s a great article written by a chiropractor in the US that explains the shocking amount of junk in them. http://wellnessachiever.net/influenza-vaccine-facts-they-dont-want-you-to-know/

  22. Elizabeth Addison 9 November 2013 at 6:07 pm #

    I am seventy five I cannot remember ever having flu, the odd cold – but that is
    unrelated to the flu virus. I have taken supplements since the age of twenty. I would not have a flu jab.It just makes profits for the Pharma companies & look at what they contain!!
    Keep off repeat medication if at all possible. (I know that is not always possible).
    but repeat scripts are what the companies thrive on & can do much harm.
    Sensible diet & swimming or walking each day will do far more for the immune system
    than drugs or jabs
    I only seek the GP when I need surgery, in recent years that has been for appendicitis,
    a cyst & foot surgery due to wearing stupid heels!! I am now reduced to 2″ max (pity)
    By the way, like others here I do not consider myself elderly!!

  23. Sue hepworth 9 November 2013 at 6:24 pm #

    I’m 65, feel like a 30yr old, never had flu and very few colds, would never entertain flu-jabs as I feel we don’t need such “crutches” to maintain our health. If I feel that prickling in the back of the nose I will reach for the vitamin C powder (mixed 2:1 with bicarb. of soda to make an alkaline drink in water) The problem I have with these promotions by doctors, and even supermarkets these days, is the scare tactics they use and that feeling of guilt that you aren’t conforming to some civilised rule concerning health care.

    There is so much information on this site alone that should give people confidence in their own ability to use natural methods ( boosting vit. D levels as a prime example) to keep themselves healthy and take to responsibility for their own health care. (I’ll probably come down with a dose of flu now for being so self-righteous!)

  24. Sula 9 November 2013 at 9:46 pm #

    Roy Proctor has said it all for me, and in view of vaccinations containing mercury, and other hideous things I would not touch them with a barge pole, I am of the opinion that vaccinations are becoming something very sinister. My mother was given the pneumonia vaccination with the assurance that ‘you’ll never get pneumonia’ after that she was in and out of hospital like a yoyo with pneumonia, her lungs became badly damaged and she developed Wegeners granulomatosis, (something I had never heard of before) eventually she died from pneumonia and gangrene, her deterioration from fighting pneumonia and the damage from steroids for the Wegeners was heartbreaking. I am a T2 diabetic and I know i will stay healthier with homeopathy, herbs and good organic food. I take vitamin D, sit in the sunshine when I can, take black garlic a powerful antioxident and anti biotic and try and do grounding.

  25. m.penney 10 November 2013 at 7:52 am #

    Since adopting low carb, many years ago, my husband and I have had no infections whatever, and my migraines remain as history. We do have some joint pain, arising from wearing out of overworked tissues, though. We don’t have screens or vaccines.

  26. Yossi 10 November 2013 at 9:49 am #

    If taking Echinacea or homeopathic remedies works for you go for it. If not perhaps take another placebo of your choice.
    I have been told by various medics that “boosting your immune system” is medically meaningless and that health is not the result of a superpowered immune system, but is simply the absence of disease. Good health is the baseline. You can’t be healthier than baseline. Once you’re at the baseline, anything that happens to your immune system in either direction is bad.
    Perhaps Dr Briffa can advise us of his view.

  27. Judith Fage 10 November 2013 at 6:48 pm #

    I actually think there is a real problem with the use of the word ‘elderly’, because its medical use seems to lump together everyone from 65 upwards, and this is clearly no longer a single group and therefore surely no longer medically valid. I am a healthy fit 71-year-old (and I certainly do NOT consider myself as elderly!) but I am from the generation in which children died and were disabled by polio and both my parents had siblings who died of diphtheria. Unfortunately a good immune system and a careful diet is not always enough. I appreciate the findings that complications of flu are the same in vaccinated and non-vaccinated people, but surely if you are less likely to get flu you are less likely to get complications! I am thankful for the arrival of vaccines and avail myself of those that are on offer (including the pneumonia vaccine).

  28. Margo 10 November 2013 at 9:17 pm #

    I have a feeling that many contributors to this page are not currently employed. During my last few years at work, I found I had to ask HR if they would distribute posters with the old saying “coughs and sneezes spread diseases”. Sadly they refused , and a great number of employees regularly contracted colds etc from the filthy few who had no idea of hygiene.
    Also, front-line workers like myself were at great risk from meeting infected clients. Once I had left work, I found that I and my retired friends rarely suffered from colds or flu, but the memory of real flu was so horrible that we gladly took up the vaccine we would have liked years ago!

  29. Chris 14 November 2013 at 2:47 am #

    Such an interesting thread with claims being made that are difficult to substantiate. Can you really have the flu for one day, even if you take a rapid dose of a miracle cure? Then if you do catch the flu do you really know the strain, and of course if you don’t know the strain you cannot claim the jab would have prevented it.

    Yossi manages to be so right and so wrong. It isn’t possible to boost the immune system but it is possible that persons immune system may be impaired, and therefore not working so well as it should.

    So what we have is a list of claims claiming to be restorative where impaired immune function may be an issue. The key to unlocking validity rests with cause and effect. What could degrade immune system function? That people may be short on vit-D is a realistic claim, so a good restorative act is to address this factor. And low antioxidant status in general may be a plausible cause.

    I don’t think we heard enough debate about other maladaptive environmental factors, because such factors place the sympathetic nervous system under duress, invite a cascade of alterations to hormonal balances, and invite inflammation, each of thuggish be adaptive physiological and immune responses, but if they linger and become the norm they inhibit immune function.

    In my book stress and cortisol may degrade immune function, hyperinsulinaemia, impaired glucose management and tolerance, glycocilation, free-electron efficiency, and cationic duress. We haven’t really evolved for certain aspects of modern life. To address the aspects we’re not suited to we should:

    Earth
    sleep longer
    be active in the day and be outdoors when wakeful
    sleep in the dark, deep dark
    invest in an earthing sheet or simple band and treat ourselves to blackout curtains
    Don’t suffer overwork or long hours
    eat low carb and high fat
    and challenge the general monopoly of fiat currency.

    The last factor gave rise to many a maladaptive arrangement, including the circumstance of overstating the benefits for many a pill, herbal remedy, old wives tale, and vaccines.

    There, it oughtn’t seem so mysterious here-on.

  30. Yossi 15 November 2013 at 8:55 am #

    Chris.
    I said “Once you’re at the baseline, anything that happens to your immune system in either direction is bad.” I assumed that this would mean that a persons immune system is impaired, and therefore not working so well as it should.
    Interesting points particularly regarding “earthing”. Is there any evidence that it is helpful?

  31. Christopher Palmer 15 November 2013 at 8:07 pm #

    Yossi,
    good point, I stand corrected, I was hampered by reading and commenting from my small-screen smart-phone. If I was casting aspersions it wasn’t with especial intent.
    I take your point about the ‘baseline’ but maybe the intended meaning didn’t find a home in my perception.
    Actually that’s why I challenge the term and perception of ‘baseline’. If unidentified factors are impeding the efficacy of the immune system, and if the unidentified factors afflict the great majority of people, then the common perception of ‘baseline’ will reside in proximity to what’s usual and not in proximity to ought to be the case if unidentified factors were degrading immune function and capacity.
    I was having a pop at the great failing of science lately, the one that gets up Bruce Charlton’s nose, that the integrity of interest in, and curiosity for, relationships of cause and effect is no longer so rigorous as it ought to be.
    Science has ceased to be interested in the low input solution of identifying the cause of undesirable outcomes and fixing them by avoiding contact with the cause. Instead we get offered ‘treatments’, these don’t intervene in the chain of causality so much as trade of it. The supposed science that has attached itself to medicine does this all the time.
    So for clarities sake you cannot raise baseline efficacy of the immune system by compensating with over-supply of antioxidants, but if under-supply of antioxidants may be a causal factor, as many restricted diversity, then addressing this is the way to intervene in a causal relationship.
    Yes, there is lots of evidence that earthing is healthful, and there is lots of evolutionary provenance that directs that chronic isolation is not the norm in biology. The evidence, in the main is theoretical and anecdotal, as opposed to being thoroughly empirical, but rank empiricism brings its own complications.
    However I have come to think, have collected evidence, but haven’t yet established to my complete satisfaction that the species that metabolise sacrifice ions in the discharges that issue (exhaled breath, sweat, urine, poo) and that it is normal that more anions than cations are sacrificed, so this leaves a body with residual cationic species lingering longer than they should, unless the body can draw upon free-electrons from ground. You could take up with the book co-authored by Ober, Sinatra, and Zucker.
    The other book that illuminates a lot is ‘Lights Out’(Wiley and Formby). Dr Briffa recommended it to me,(thanks John) and it is an absolute gem.
    Throughout biology hormones are in tune with the cycles of day and night, and in tune with seasonal variations with day length, and that explains the nature and timing of a lot of behaviour we can witness in the natural world.
    We’re no different, day and night bears on our hormonal balances except we now live, almost, in relentless light. This leads to hyper-cortisol-aemia (too much cortisol about the body) and induces hyper-insuin-aemia. Wiley and Formby have it that cortisol commands a cascade that may bear successively upon a while range of hormones so that in time the bodies endocirne system can no longer re-establish, if you like, those baseline balances we might call the state of homoeostasis.
    Free-electrons, protons, and photons all matter to biology. It is the great revelation emerging in the age in which we live. The revelation was slow arriving, because, duh, we live in a quantum universe, energy is more rudimentary than matter, and it gives rise to matter. We are the children of an evolving quantum universe, Brian Cox says so, if by other words: It must be true, he’s demigod with street-cred. Of course free-electrons, protons, and photons matter. They are manifestations of the ‘energy’, man, and the energy is present in everything.
    God is everywhere and nowhere, However I won’t make a fuss, despite it’s obvious.

    Should this 67 year old woman take the flu vaccine? Heck, I don’t know. The decision can never really be entirely evidence based, there’s a lot of room for judgement.

    However if everybody in the world had baseline levels of immune function that may have existed in the stone age before hyperinsulinaemia and hypercortisolaemia, coupled with free-electron deficiency, became normal, then I’d consider the incidence and consequence of flu pandemics could be much less. Does the timing of pandemics seems to display some seasonal consistency, and if so are we getting hit in our weakest hour?

    The cortisol connection is an interesting take upon the pathogenesis of chronic diseases, The reason being is that seems to me to offer a common link to otherwise quite diverse risk-factors, and if the pathogenesis of many a common disease shares risk factors in common, yet the same factors can result in alternate conditions, or alternate sequencing in which symptoms arise then to me, it equates to nuance in the ‘orchestration’.

    [Heck, I should stick to driving LGVs, that's all my qualifications amount to.]

    If the strain on the horizon really is one that could be as virulent and punishing as ‘Spanish flu, then, yeah, you’d regret not being vaccinated as your experience trends to death, but if the strain is not such a potent one then it becomes an exercise in risk-benefit analysis for the individual. What narks me is that you know their is tendency to encourage the precaution of being vaccinated because that registers a sale and contributes to someone’s swag.
    My GP rings me every year to ‘offer’ and I decline politely. Are GPs rewarded financially for meeting targets?

    The vaccine is dichotomy. It does good sometimes, harbours potential for harm, and most of the time it feels like we’re being ripped off.

    Do you think this 67 years young lady will be following the thread?

  32. Margo 16 November 2013 at 10:09 am #

    No, she’ll be too busy to keep looking at it.

  33. SueG 18 November 2013 at 2:29 pm #

    “Are GPs rewarded financially for meeting targets?”

    I guess only a GP could answer that but I believe that they get a payment for every patient that they advise about the dangers or smoking so I think it’s a distinct possibility.

  34. Chris 18 November 2013 at 11:49 pm #

    The ideas that pass amongst humans, Margo, are an odd mix of assets and liabilities, truth and lies, and bits between. Our species has great difficulty telling one from the other.
    You are quite in what you say, in that people do keep themselves occupied, and this is one reason the liabilities get around with ease while the truth has such a hard time advancing.
    Given the stark choice between simple or true and people will take simple most times. It’s because we don’t think they get away with so much.

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