"When many cures are offered for a disease, it means the disease is not curable" -Anton Chekhov
''Once you tell people there's a cure for something, the more likely they are to pressure doctors to prescribe it.'' -Robert Ehrlich, drug advertising executive.
"Opinions are like sphincters, everyone has one." - Chris Rangel
Smallpox Vaccine Update:The government has reconsidered its postion on smallpox vaccine:
The federal government will soon vaccinate roughly a half-million health care and emergency workers against smallpox as a precaution against a bioterrorist attack, federal officials said. The government is also laying the groundwork to carry out mass vaccinations of the public — a policy abandoned 30 years ago — if there is a large outbreak.
This is a much more reasonable approach than the ring-vaccination and "first responder" approach that the CDC recommended last month. It will avoid the potential risks of mass vaccination unless absolutely necessary in the event of an attack, and it will give us as a society the chance to get used to the riskier vaccine. If a half million people are vaccinated with few collateral complications in the unvaccinated, then mass vaccination, even without a smallpox attack would be more widely accepted, and justified. And, by expanding the use of the vaccine in the event of an attack beyond ring vaccination to mass vaccination, more lives would be saved. The Bush Administration should be applauded for handling the issue sensibly and reaching out beyond the CDC for consultants on the issue. posted by Sydney on
7/06/2002 08:52:00 PM
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Exercise and Hormones: Here's a study that shows that women have to exercise harder to burn calories and fat when estrogen and progesterone levels are low. That's no surprise. Ask any woman who has gone through menopause how much harder it is to keep their weight down. posted by Sydney on
7/06/2002 08:37:00 AM
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African AIDS Update: The Constitutional Court in South Africa has ordered the government to provide an anti-viral drug to pregnant HIV-infected women. The drug in question, nevirapine, can be given as a single dose to the mother during labor, followed by a single dose to the infant within 72 hours of delivery to reduce the chances of transmission of the virus to the baby. This makes it particularly useful for those segments of the population who do not get routine prenatal care before delivering, a subset that also has a higher rate of HIV infection. posted by Sydney on
7/06/2002 08:31:00 AM
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Nevada Malpractice Crisis Fallout: The closing of the Las Vegas trauma center is beginning to have consequences. The saddest observation was this one:
Allen said he's not concerned patients from Las Vegas will overburden the hospitals in Phoenix because most trauma patients will be too injured to survive the hour-long flight. For those that do make it, Good Samaritan has plenty of resources and physicians.
According to this, the malpractice premiums have gone up as high as $200,000 per year. The page also has links to stories that chronicle the crisis in Nevada.
posted by Sydney on
7/06/2002 07:35:00 AM
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Friday, July 05, 2002
Malpractice Crisis Update: The trauma center in Las Vegas closed because surgeons couldn't afford to practice there. The closing leaves a four-state area without any access to top-notch trauma care. The trial lawyers' response was to compare the doctors to terrorists:
Attorneys with the Nevada Trial Lawyers Association denounced the closure. "They just wanted to terrorize the community with this walkout," said Jim Crockett, a Las Vegas lawyer. "These doctors are holding this community hostage."
Don't you believe it. The truth is that malpractice insurance premiums are rocketing, to the point that doctors can't afford them. Especially doctors in high risk specialties like trauma. posted by Sydney on
7/05/2002 08:50:00 AM
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Pharma Sales Mischief: Looks like the Prozac drug reps and Walgreen's pharmacies teamed up for some dubious drug marketing. According the story, a woman in Florida recieved unsolicited samples of weekly Prozac in the mail. She says she took Prozac once before but switched to something else because of side effects. It’s not clear why the samples were sent to her, but here doctor’s role in the whole thing was described this way:
S.K. said her doctor maintains the office physicians signed a blank form letter provided by a Lilly salesman. S.K.'s medical records show no Prozac prescription, said fellow attorney Gary Farmer Jr. of Fort Lauderdale.
I can take a pretty good guess at what happened. The drug rep told the doctor that if he just signed this letter, his patients on Prozac could be offered the more convenient, once weekly form of the drug. Then, the blank letters with the doctor’s signature were given to Walgreen's who searched their computer database for Prozac users to send the letters and the samples to. The woman’s old prescription probably came up, and she got the sample in the mail. It’s just an educated guess, but I’m willing to bet the ranch on it.
This is wrong on so many levels. First, prescription drugs should never be sent through the mail unsolicited. Doing so can reveal sensitive and private information that the patient may not want disclosed, even to family members, as in this case. In addition, anyone could have gotten their hands on the sample. If a child had gotten those and ingested them, or if a family member taking a drug that could interact with them decided to try them out, the consequences could be tragic.
Secondly, pharmacies shouldn’t share patient information with drug companies. This sadly is a fact of life in our country. Pharmacies sell lists of patients to the drug companies so they can target their junk mail advertisements to them. They also sell them information on physician perscribing habits. I’ve had drug reps tell me they know I write prescriptions for a specific disease, but not for their particular product, and once while breakfasting in a restaurant I overheard a conversation between two drug reps in which they were mapping out their sales strategy. It was clear that they knew just how many prescriptions for their drugs were written by each physician in their territory.
Lastly, sending unsolicited prescription drugs through the mail makes the drugs seem more trivial than they are. Even when switching from one form of the same drug to another, the physician should discuss it with the patient first. In this case, form letters and samples were meant to replace regular Prozac with once-a-week Prozac. Although they are the same drug, the rules for taking the two are quite different, and the physician has an obligation to make sure the patient understands that. What if a patient recieves the once-a-week Prozac in the mail but doesn’t take the time to read the form letter? He could end up taking them once a day instead of once a week and suffer serious side effects from them. We have to remember that prescription drugs are available only by prescription for a reason. They can be dangerous as well as beneficial, and for that reason we must be ever vigilant for their misuse. posted by Sydney on
7/05/2002 08:24:00 AM
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From The Euthanasia Frontlines: This article on physician-assisted suicide was inspired by this article in the Journal of the American Medical Associatioin. The link requires a subscription to read it on-line, so I’ll just tell you about it.
The article is part of an ongoing series that JAMA has been publishing, called “Clinicians Corner” The format is similar to a case presentation, but instead of the doctor telling the story, the patient does the telling. This is great, because the patient has the opportunity to share his perspective of the disease or other problem being addressed. The doctor also gives his perspective, and the authors provide commentary.
This particular article was about physician-assisted suicide, and how to address the issue when a patient brings up the subject. The authors and the participants are from Oregon, where the practice is legal. Unfortunately, the patient in this case had Lou Gehrig's disease and was too weak to participate in the format. It's a good article. It avoids the morality issue and focuses instead on the best approach to addressing patient fears about dying.
But, there is one portion of it that left me wondering. It was this exchange:
Ms. T (hospice social worker): Dr. R (the nursing home doctor caring for the patient) was very angry, saying he had "ordered hospice, not physician-assisted suicide." He was very angry at hospice for allowing the conversation to open up. He felt betrayed by our hospice and our advocacy for exploring the patient's wishes. He basically accused me of helping the patient commit suicide.
Dr. R: I was upset. My intention in referring him to hospice was to make sure that he had a comfortable death but not assisted suicide.
The article doesn't explore why Dr. R may have reacted in anger to Ms. T, other than he was opposed to assisted suicide. It doesn't record just exactly what Ms. T said to Dr. R when she called, it only records his response to her as she remembers it. It would have diverted too much from the focus of the article to delve into that issue, but my focus is different, so I'm going to take a guess. I suspect that Dr. R reacted angrily because he felt Ms. T was pressuring him to provide physician-assisted suicide to the patient. This supposition is further backed up by the fact that Dr. R recused himself from the patient's care after the conversation with the social worker.
I can attest that this sort of coercion happens with hospice care, and I don't even practice in Oregon. In my state (Ohio), physician-assisted suicide is not legal, but there is, sometimes, a tendency for the hospice staff to ask for more morphine than is necessary for the patient's problem. I have had requests for morphine from hospice staff when the patient seems quite comfortable and in no distress. I always suspected the requests were more an attempt to hasten death than to treat pain, and recent events have proven those suspicions correct, for those sorts of requests suddenly stopped after Attorney General John Ashcroft issued his directive that prohibited the use of controlled substances in physician assisted suicide. In fact, I now get requests to stop morphine because it is sedating the patient too much, even when the patient does have pain. Ashcroft's target might have been Oregon, but doctors and hospices all over the country took note. posted by Sydney on
7/05/2002 08:21:00 AM
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Life Imitates Commercials: Do you remember that old television commercial for OFF mosquito repellant? The camera would zoom in on the forearm of a man. The man placed his arm in a cage full of mosquitoes and we watched as they landed all over it. Then, the arm was sprayed with OFF. When the man placed his OFF-coated arm into the cage, no mosquitoes went near it. Well, the researchers who designed this study in the New England Journal of Medicine must have remembered it:
Before each test, the readiness of the mosquitoes to bite was confirmed by having subjects insert their untreated forearm into the test cage. Once subjects observed five mosquito landings on the untreated arm, they removed their arm from the cage and applied the repellent being tested from the elbow to the fingertips, following the instructions on the product's label. After the application of the repellent, subjects were instructed not to rub, touch, or wet the treated arm. Repellent-impregnated wristbands were worn on the wrist of the arm being inserted into the cage. Subjects were provided with a standardized log sheet to ensure accurate documentation of the duration of exposure and the time of the first bite. The elapsed time to the first bite was then calculated and recorded as the "complete-protection time" for that subject in that particular test.
The winner of the contest was OFF Deep Woods, coming in with mosquito protection for a mean of 301.5 minutes (give or take thirty) and the loser was Gone Plus Repelling Wrist Bands at 0.2 minutes (give or take 0.09). Skin-So-Soft products and other citronella-based repellants didn’t come out so well, either, ranging from two to twenty minutes of protection, but a soybean-oil based product called Bite Blocker for Kids did pretty well, providing protection for 94 minutes (plus or minus 42). That was comparable to the DEET based OFF product for children, Skintastic for Kids.
Those Wonderful Traditional Medical Practices: A case of camphor intoxication from the traditional Southeast Asian therapy called "coin rubbing." This patient survived, but it could have been fatal. posted by Sydney on
7/04/2002 07:26:00 AM
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Freedom of Commercial Speech Debate: The FDA is seeking comments on the impact of drug advertising on public health and the role the agency should play in regulating it. posted by Sydney on
7/04/2002 06:52:00 AM
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Wednesday, July 03, 2002
Re-thinking Estrogen: Research now suggests that estrogen has no effect on the prevalence of heart disease, and in fact, increases the risk of gallstones and blood clots. The increased risk of gallstones and blood clots makes sense. Those are two of the biggest risks of taking estrogen. The lack of effect on heart disease suggests that aging plays a greater role in heart disease than hormones.
One thing to remember about the HERS and HERS II studies from which these findings come, is that they only included women over the age of 50. It remains to be seen whether or not estrogen protects younger women from heart disease. So, if you're under 50, and you don't have working ovaries, don't throw out your estrogen yet. ( The portion of HERSII that comments on gallstones and blood clots is here.) posted by Sydney on
7/03/2002 10:03:00 AM
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In England's Fields: Britain will be cultivating poppies to make home-grown medicinal narcotics such as codiene and morphine. They are mistaken, though, about this being the first time in history that England has grown poppies commercially. They also did so in the halcyon days of laudanum. posted by Sydney on
7/03/2002 06:14:00 AM
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Drug Company Malfeascence: There's evidence that pharmaceutical researchers hid the risks of liver damage inherent in the diabetes drug, Rezulin:
Whitcomb used an unorthodox method to count the number of liver injuries among patients who used Rezulin while using different criteria to count liver injuries among patients taking a placebo. The result trimmed the number of cases the company reported to the regulators and to doctors nationwide, giving a markedly more benign view of the drug's risks.
Rezulin was pulled off the market after several people died of liver failure while taking it. posted by Sydney on
7/03/2002 06:08:00 AM
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They say that the incentives, which can be worth up to 2,865 pounds per GP, are damaging doctor-patient relationships.
GPs find it hard to persuade parents who argue that money is the main reason for doctors wanting to give the controversial vaccination. They say that parents are not only sceptical about the MMR jab, but are aware that doctors benefit financially from giving it.
Some GPs are also finding it increasingly hard to vaccinate enough children to qualify for the extra payments.
Evidently the doctors have to meet an "immunized patient quota" to qualify for the extra money. Even one lone dissenting patient can make him lose the bonus. Mabe they should try something truly revolutionary, like reimbursing the doctor for each individual shot. posted by Sydney on
7/03/2002 06:06:00 AM
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Shameless Promotion: Here's a report of a miracle drug that makes the blind see. The drug is only available experimentally and hasn't been used yet in that many people, but this article is a paen to it. Only the success stories are covered. Nothing is mentioned of side effects or of what percentage of patients treated respond so favorably. The studies are in too early a stage to determine those vital statistics. Only time will tell if it's really such a miracle cure. This story had to be put out by the Genentech's PR department. posted by Sydney on
7/03/2002 06:02:00 AM
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Hysteria: Is it just me, or does this story seem a bit exaggerated? Granted, AIDS is an enormous health problem in sub-Saharan Africa, but it's a stretch to claim that HIV was responsible for the Rwandan genocides. posted by Sydney on
7/03/2002 06:01:00 AM
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Doctors Responsible for Fat Kids? This story on rising rates of obesity among children, and doctors' frustration in treating it, seems to be suggesting that it is somehow the doctors' fault that kids are getting fat. I just don't buy that, and neither should society. The only people who can fight obesity effectively are the obese. Doctors can't follow their patients home and police their food intake or their exercise. All we can do is make suggestions. It is ultimately the responsibility of the patient (or their parents) to make sure they eat right and get appropriate exercise. As one pediatrician in the article put it:
Dr. Elena Fuentes-Afflick, a San Francisco pediatrician, said it's not unusual to see young patients' weight balloon from visit to visit "and their parents swear to you that they're not eating fast-food and that they're exercising."
"This is clearly not a medical problem like I give them a pill and it will go away," Fuentes-Afflick said. "It's much more complicated, the whole family has to be involved. It's a very frustrating problem and there is no magic bullet." posted by Sydney on
7/02/2002 05:57:00 AM
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Better Drug Info: The FDA is looking to improve the drug information that pharmacists dispense along with medication. Although I don't generally like more regulation, I think this is needed. Too much of the information dispensed by pharmacies is nothing more than a litany of every possible side effect in the vaguest of terms: nausea, leg swelling, shortness of breath - all side effects that could occur with just about any drug if you have an allergic reaction to it. Patients could certainly benefit from more focused information on their particular drug and its most common side effects and potential interactions. It shouldn't be that hard to write guides like that, so I can't fathom why the companies aren't doing that now. Maybe they just aren't paying anyone to check the pamphlets for quality information. posted by Sydney on
7/02/2002 05:54:00 AM
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CDC vs. Just About Everyone:The Washington Post has more on the CDC's turf battles. It seems the folks at the CDC are unhappy with the White House, the Department of Health and Human Services, and the new Department of Homeland Security. The attitude of political partisanship on the part of the CDC was evident last month in this op-ed piece on smallpox by a member of the National Vaccine Advisory Committee. The author complained then that the White House was forcing the smallpox debate and implied that it was doing so purely for political reasons. Keeping that little jibe in mind, yesterday’s complaints by CDC staffers seem particuarly petty and political:
The tensions stem from a variety of factors, including fallout from widespread criticism of how federal health officials handled last fall's anthrax attacks, the absence of a CDC director since March, efforts by the new administration to change approaches to controversial issues such as sex education and HIV prevention, and a campaign to exert more control over the CDC from Washington, health experts said.
In other words, they resent being told where to direct their priorities and are unable to rise above petty differences to concentrate on important tasks at hand. The world has changed since Sept 11, 2001. We are at war. The government has a right to direct the CDC's priorities under these circumstances.
"The whole issue of speaking with one voice has become a major problem, because it means that one voice will be a political voice," said a former CDC official. "Technical agencies remain credible if they are free to act on the basis of the best scientific information available, and not on the basis of what is the most politically favorable option."
I agree that technical agencies shouldn't base their decisions on political considerations, but I have to wonder how much of the CDC's obstinancy on the smallpox vaccine issue is colored by their own perception of being strong-armed by Washington. This is especially true when I read statements like this one:
Other factors have also contributed to the tension between the CDC and HHS, sources said. D.A. Henderson, who joined the department last November as head of HHS's new Office of Public Health Preparedness and is currently Thompson's principal science adviser for public health preparedness, once worked at the CDC but reportedly feuded with the agency on various occasions later in his career.
How many members of the CDC panel on the smallpox have been a part of that feud with D.A. Henderson, and is it affecting their objectivity?
Moreover, since the resignation of Jeffrey P. Koplan as CDC director in March, the agency has been run by a four-person interim team, leaving employees uncertain who will be the CDC's next leader. "If they appoint someone as the next head who is clearly a political hack, people will leave in droves," a former federal health official predicted.
A "political hack" in this context is all too likely to mean "someone who disagrees with my world view." The heart of their discontent, however, boils down to money and turf :
But there is uncertainty at the agency over what impact the emphasis on bioterrorism preparedness -- and the administration's recently announced plan for a new Department of Homeland Security -- will have on the funding of public health programs. Under the proposal, much of the CDC's responsibility for protecting against bioterrorist attacks would be moved to the new agency.
Following the Sept. 11 attacks, Congress passed an emergency supplemental appropriation that boosted the CDC's fiscal 2002 budget to $6.8 billion. It included about $1 billion for terrorism preparedness to be distributed by the CDC to state and local public health agencies, as well as more than $1 billion for purchases of smallpox vaccine and drugs. The president's $5.8 billion budget request for the CDC for fiscal 2003 contains about $1.6 billion for the agency's bioterrorism efforts but would cut overall funding to other CDC programs by about 4 percent.
'Tis a pity the CDC staff can't forget their own special interests and act for the greater good of the public. They leave the impression that they are above all resentful of a Republican administration. None of their complaints manages to rise above petty political grumbling. That is a sad state of affairs when you consider that the agency is charged with protecting public health. We expect them to act free of political bias, but they appear to be doing just the opposite. If this is true, then they deserve a shake-up. They certainly don't deserve to be trusted with the job of protecting us against bioterrorist attacks. posted by Sydney on
7/02/2002 05:49:00 AM
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CDC vs. Dept of Homeland Security:The Bloviator attended a lecture by a CDC staff member on bioterrorism. The most telling comment was this one:
The current state of affairs concerning moving some CDC functions under the umbrella of Homeland Security: it was his opinion that the stockpile of vaccines/medications might be one of the few areas transferred under the Homeland Security agency. A problem with transferring CDC functions over to homeland security is that many of the people working on bioterror issues have not been full-time staffers in that field of work; rather they may work on bioterror issues quarter time or half time. Consequently, you can't just move the bodies over to Homeland Security without signficantly depleting the staff capacity in other areas at the CDC.
Bane of My Existence: Merck-Medco is a pharmacy benefit company and subsidiary of the Merck pharmaceutical company. They contract out to insurance companies to provide drug benefits for patients. Of course, their real objective is to get as many people as possible on Merck drugs. Merck is planning to offer public stock in the company in anticipation of divesting itself of it. The new drug benefit company will be called Medco, but it will still be pushing Merck drugs:
Merck-Medco, based in Franklin Lakes, will change its name to Medco Health Solutions after the spinoff, but will still be beholden to Merck. A five-year contract the two companies are expected to sign as a condition of the spinoff requires Medco to push sales of Merck drugs wherever possible or face substantial payments to Merck.
I hate Merck-Medco, and judging from the email groups I belong to, so do most other doctors. They send annoying letters every month nagging me to change my patients to Merck products, even if it isn't in the patient's best interest, and even if I have made it clear to them that this is the case. They just keep sending the letters, hoping to wear me down. At some point, they realize it isn't working. That's when they really get annoying. They start to call the office. They call, and they call, and they call. Again, and again, and again. And they continue to send the letters, by mail and by fax. Nothing stops them. I've finally come to regard them as I do an annoying insect. I don't take any notice of them except to swat them away with an automatic "no."
It looks like things will only get worse when Medco is spun off into its own company, especially if they are going to have to pay financial penalties to Merck for failing to push Merck drugs. Sounds like a bad investment to me. It certainly is a bad way to practice medicine. posted by Sydney on
7/02/2002 05:41:00 AM
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Responsibility Wins Out in California: California will finally begin tracking HIV cases. It's about time. How can you mount a public health campaign against a disease if you don't track it? We could probably have done a much better job of containing the spread of HIV earlier if AIDS lobbying groups had been more concerned with the greater public good than protecting the reputations of the infected. This, at least, is a step in the right direction. posted by Sydney on
7/02/2002 05:37:00 AM
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Enlightened EBay: EBay is going to offer health insurance to people who sell between $2,000 to $25,000 a month on their site. This is good news. My brother-in-law makes his living selling things on EBay. He does well, but he can't afford health insurance on his own. He has a tendency to call me for advice, then not act on it because he can't afford to see a doctor. Unfortunately, all I can give is advice, not treatment, since we live in different states. Hopefully he, and others like him, will take advantage of this perq. posted by Sydney on
7/02/2002 05:36:00 AM
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While I Was Away: One thing I did catch on the news, was the CDC decision on the smallpox vaccine. It was no surprise. They never actively courted public opinion. They never publicized the risks of smallpox and the risks and benefits of the vaccine. Their public forums were not widely publicized and as a result had very poor attendance. Neither did they widely publicize their website public response form. All of the news reports on the public forums gave the impression that those from the CDC who were present had already made up their minds. Sure enough, they announced that the vaccine would only be given to so-called "first responders," and that they would rely on their "ring vaccination" strategy to contain the disease.(The transcript of the CDC's telebriefing on their decision is available here) To the CDC, "first responders" are the members of the CDC team who will be sent out to the suspected smallpox case and confirm it, then do the vaccinations if the case is confirmed. They will also allow selected health care personnel at hospitals designated to handle smallpox cases to be vaccinated. That's nice, but in the event of a smallpox attack, the CDC and the smallpox hospital personnel aren't going to be the "first responders." The first responders are going to be the spouse, housemate, parent, or co-worker who first notices the funny rash on the patient. The next responders are going to be the people in the waiting room of the pediatrician, internist, family physician, urgent care center, or emergency room where the patient goes to get that peculiar rash diagnosed and who sit around with him waiting for the doctor. The next responders are going to be the nurses or medical assistants in those offices, emergency rooms, and urgent care centers who put the patient in the room. The next responders are going to be the community doctors who see the patient for the first time and make a diagnosis. The CDC team and the personnel at the designated "smallpox hospital" will be the last responders.
The CDC has three main arguments for not offering the vaccine. The first is that the risk of a smallpox attack is small, or at least unknown. This is shortsighted. The Soviet Union experimented with smallpox as a weapon in the 1970's, and there is a good chance that the Iraqis have weaponized it , too. If the Iraqis have it, you can bet the terrorists have it or will have it, too. It is an inexcusable failure of imagination not to take this into account when considering whether or not to offer smallpox vaccine to the public, as Peggy Noonan pointed out in her column.
The second argument is that the vaccine can have serious complications, including death in those who receive it. (See my previous post on the smallpox vaccine for details.) This is certainly true, but people should be given the information about both the disease (much more fatal) and the vaccine and then allowed to decide for themselves whether or not to risk having the vaccine.
The third argument is more valid, and that is the fact that the cowpox virus used in the vaccine can be transmitted from the recently vaccinated to those with compromised immune systems or with eczema. The transmission, however, comes from direct contact with the scab or the site of the vaccination. Once the scab heals, there is no longer any danger of transmission. This can be prevented, or at least minimized, by advising people to take precautions until their scab is gone. That means keeping it covered, and avoiding such activities as swimming. When I received my vaccination as a child, my mother made me wear a plastic shield over the vaccination site until it was completely healed. Surely such measures are not beyond our present technology or know-how.
The AMA supports the CDC panel's position (via The Bloviator), as does the American Academy of Pediatrics,and the American Academy of Family Physicians. (The American College of Emergency Room Physicians doesn't have any comments on the decision on their website.) I doubt that most of the membership of these organizations, however, support the decision. It will be the practicing physicians, after all, who will have to deal with the consequences of a smallpox epidemic. It will be practicing physicians who have to try to explain to the survivors why people are dying from a vaccine preventable disease. So far, our professional organizations have let us down by failing to force more of a discussion within the medical community on the issue. Instead, they have followed the CDC's lead as if this were any other routine immunization issue. It isn't.
The Press Wakes Up: Now that the CDC has made their decision, the mainstream media have finally picked up the issue. It has even made some strange bedfellows. Both the Wall Street Journal, and the New York Times have advocated offering the vaccine to the public. Other good editorials on the subject can be found here and here. Too bad they didn't address it more ardently before the CDC held their public forums. Perhaps the voice of the people would have been better heard. It may not be too late, however. The Bush Administration and the Department of Health and Human Services is going to consider the advice given by the CDC. Hopefully, they have their own set of advisers, like smallpox expert D.A. Henderson, and other bioterror experts to help them objectively evaluate the advice of the CDC. Hopefully, they won't fail us. Hopefully, they will recognize that the American public is much smarter than the CDC is giving them credit for being, and they will let us decide whether or not we want to risk having the vaccine.
UPDATE: A reader who attended two of the CDC public forums sent this observation:
"I attended two of the CDC community meetings on the vaccine and found them pretty predictable. Ironically, while there was a small turnout from the medical community, the public turnout was negligible...not enough publicity is my guess. So it is safe to say that you could not use those meetings as a successful barometer of the publics opinion one way or the other. The perfectly timed release of the Robert Wood Johnson/Harvard School of Public Health study on the topic gives insight to the publics wishes. 59% said they would want to be vaccinated, if it became available."
In Other News:
The National Academy of Sciences advocates a broader anti-bioterror program and hints that perhaps the CDC shouldn't be the ones responsible for the smallpox vaccine program:
The report's authors also urged greater coordination between government agencies with expertise in researching or responding to biological weapons attacks and public health threats. Several vaccine development and disease tracking functions currently centered at the Centers for Disease Control and Prevention and other agencies could be transferred to the cabinet-level Department of Homeland Security proposed by President Bush last week. (emphasis mine)
The administration is considering at least two candidates for the director's job at the CDC. One is an agency insider, the other an outsider.
The Pentagon is going to resume anthrax vaccinations and they plan to share them with civilians in event of a civilian attack, too.
The New York Times says that anti-depressants aren't miracle drugs. (link requires registration) Silly me. I never realized they were miracle drugs in the first place. Still, the newer anti-depressants like Prozac do have far fewer side effects than the older anti-depressants. And for some people, but by no means all, they are miracle drugs.
Woloshin and Schwartz base their findings on a review of 85 news stories about three recent events related to tamoxifen and mammography. In January of 1997, the National Institutes of Health recommended that women in their 40s not receive regular mammograms, an opinion reversed by the National Cancer Institute only months later. The investigators also analyzed print and broadcast stories about a study released in April 1998, which showed that tamoxifen can prevent breast cancer.
The investigators found that 65% of news stories highlighted the debate over tamoxifen, suggesting that women had a choice in whether or not to take the drug, and none recommended that women take the drug.
In contrast, only four of the analyzed stories about mammography implied that women should feel they have a choice in whether or not to be screened, and 96% suggested that women schedule regular mammograms.
The Doctor is In: Sometimes you just need to take time for things like sunsets and seagulls. I only read a newspaper about three times in the past two weeks, and only watched the news on television twice, so I'm pretty much out of the loop on all the breaking news. I can tell you, though, that it was harder to get into Canada than it was to get into the United States. The Canadians weren't worried that we might be terrorists, but they were worried that we might be kidnappers. We failed to take any proof that our children actually belonged to us. We never needed it before and we were too shortsighted to think of checking to see what we needed to cross the border this time. The border guard looked them over. They don't resemble each other, let alone either of us. She asked us for their birth certificates, their social security cards, insurance cards with their names on them. We had none of the above. Finally, I found an old photograph with all of them together when they were about three years younger than they are now. She looked at us doubtfully, then said, "Oh, no one's crazy enough to kidnap four children," and let us pass with a warning that "Canada cares about children."
I can also tell you that Lilo and Stitch is better than you would expect from the commercials. It's the first Disney cartoon I've seen with a troubled heroine rather than a heroine in trouble. Actually, it has two troubled characters. Lilo is a little girl from a dysfunctional family, or as the movie puts it, "a small and broken family," who is more prone to fistfights and biting than communing with small animals. Stitch, on the other hand, is an alien scientist's genetic experiment. Not only are genetic experiments outlawed on his planet, but the scientist has engineered him to be completely destructive. Before he is sent into intergalactic exile, the powers that be ask him if he can say just one thing to prove to them that there might be some little bit of good inside him, but he says something so vile (in their language, so we the audience can't understand it) that it makes the robot in the scene vomit nuts and bolts. He is exiled to a barren meteor, but escapes and makes his way to earth, where he lands on a Hawaiian island, is mistaken for a dog, and gets adopted by Lilo.
What follows is a series of adventures as Lilo tries to dodge the social welfare system and Stitch tries to dodge his fellow aliens who have been sent to take him back into exile. In the course of their adventures, they both learn to be a little nicer, but neither of them ever reverts to the typical Disney forumula of unadulterated goodness. Come to think of it, I can't remember any of those uplifting Disney movie songs from it, either. Instead, it has a lot of Elvis music. (Specifically, Elvis music from Blue Hawaii) All in all, it was a refreshing change from the usual Disney forumula. posted by Sydney on
7/01/2002 05:29:00 AM
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