"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
Automobiles Filled with Children Jammed the Parking Lot: This week has seen an uptick in patients coming in for colds and flu-like illnesses, but the real deluge has been the phone calls requesting flu shots. Everyone wants them. We've been referring people to the health department. So has everyone else. Now, some of my patients are arriving twenty minutes late for their appointments because they were tied up in traffic jams outside the health department, where policemen have had to be enlisted to help control the crowds. And it's happening at other health department offices (our county has many health department offices):
In Akron, parents scurried Thursday to get their children some protection. Typical of a lottery, the first 100 families at the clinic at 66 Merriman Road in West Akron received tickets to get shots.
Just to be safe, nursing supervisor Shawna Anderson said she asked a police officer, who was in the area, to stop by the clinic when it was time to inform parents that the final ticket had been delivered.
There was no riot, but similarscenarios are playing out across the country. People are deluging doctor's offices and clinics to get flu shots. In fact, most of the hectic pace of the past few days has been due to responding to fears about the flu, not treating actual flu cases (at least in my office.) And many, many, more people than usual are asking that their kids be vaccinated. They're frantic after reading stories about the children who have died.
However, most of those kids had other illnesses in addition to the flu:
Several hospitalized children, and a few of the 10 who died, have had secondary bacterial infections, primarily streptococcus, said Dr. James Todd, head of pediatrics at Children's Hospital in Denver.
And in an additional wrinkle, many have been co-infected with drug-resistant strains of bacteria. Once the provence of hospitals and nursing homes, drug-resistant bacteria have lately been gaining a toe-hold in the community-at-large. Having the flu weakens the immune system, which makes it even more difficult for the body to fight off the bacteria, especially if it can't get help from antibiotics.
I can certainly understand the parents' panic. What parent wouldn't want to protect their child against potential death? But, things are not as scary as they seem. According to the CDC's latest available statistics (which are from two weeks ago):
The proportion of deaths attributed to pneumonia and influenza was 6.5%, which is below the epidemic threshold for the week.
I read that to mean that the death rate is about the same or lower than usual. Which is a good thing. And, since there isn't enough vaccine to immunize every man, woman, and child in the country, those at highest risk should still get priority. Which is why my children haven't received the flu shot.
But, all of this panic about flu vaccines for a disease that has in fact killed very few people raises some very serious questions about the feasibility of the current CDC plans for a smallpox bioterrorist attack. (The current plan is to vaccinate the public only after an attack.) If public health clinics and doctor's offices are being over-run now with people wanting vaccines for an illness whose mortality rate is only 6%, imagine what it would be like for a disease whose mortality rate is 30%. And it looks like local health departments are even less prepared for that sort of eventuality. For shame.
UPDATE: I messed up the mortality rate figures, as a couple of readers pointed out:
I'm confused by your latest posting- you mention a mortality rate for the flu of 6%- surely you know it isn't that high or we really would have a reason for panic. The CDC puts the proportion of all fatalities for the week attributable to flu at 7% (up from 6.5%)- that's a very different number than a mortality rate.
And:
The proportion of deaths attributed to pneumonia and influenza was 6.5%, which is below the epidemic threshold for the week." I believe this refers to the % of all deaths related to pneumonia and influenza where as the 30% related to small pox is the % that die of those who have small pox--I would guess that the actuality mortality rate from influenza is much much less that 6.5%
And so it is. Although the mortality rate from influenza varies from year to year, the latest statistics I could find were from 2001 when the mortality rate was 0.1%.
posted by Sydney on
12/12/2003 07:17:00 AM
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Britain's Other Healthcare System: The UK economic blog, Adam Smith, has an interesting post about Britain's private health insurance system. It's more widespread and widely used than you might think:
It's easy to knock private healthcare if you just imagine it as a few toffs having their hip replacements done in some posh hospital - thereby drawing surgeons and resources from the rest of us. But it isn't like that. It's not production-line high-class surgery. It's mostly the Cinderella stuff of residential care, social care, psychiatric care - all the very human things that big state bureaucracies frankly aren't very well equipped to do well. posted by Sydney on
12/12/2003 07:03:00 AM
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I Lied: Things slowed down yesterday, so I've got an unexpected chance to post. posted by Sydney on
12/12/2003 06:59:00 AM
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Thursday, December 11, 2003
"Tis the Season: No time for blogging today. Flu season is in full swing here now, and taking up all my time. Will return to blogging Saturday. posted by Sydney on
12/11/2003 06:47:00 AM
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Globalization: The CDC is looking into importing influenza vaccine to make up for our short fall:
The Federal Centers for Disease Control and Prevention said yesterday that they were exploring ways to import influenza vaccine from Europe and redistribute supplies to meet any shortages in this country.
...Still, the director acknowledged that there was no way that the 185 million Americans deemed eligible to receive flu shots would receive them. Drug companies made 83 million doses for this season, a number based on demand in past years.
Dr. Gerberding added that government rationing of the remaining stocks was not an option, because most vaccine is in the hands of practicing physicians, who dispense it according to patient need and demand.
...Even if the government can import vaccine from Europe, the amount is likely to be relatively small. Dr. Gerberding said the government was exploring the possibility of securing a half-million doses of vaccine from the British unit of Chiron. That vaccine is licensed but not approved for use in the United States, Dr. Gerberding said, and her agency is working with the Food and Drug Administration to determine whether it can be used in time..
They're also working on ways to avoid similar problems in the future:
"The trick here," she said, "is what we can do as a federal agency to assure the manufacturers will make more doses than we need on average."
Dr. Gerberding said the health and human services secretary, Tommy G. Thompson, had asked for recommendations to work on the problem. One option is for the government to pay manufacturers to increase production in the future.
In a study of nearly 21,000 women, researchers found that healthy women with high levels of C-reactive protein, or CRP, in their blood were about 50 percent more likely to develop high blood pressure over the next eight years or so.
A similarly increased risk was found even in women whose blood pressure readings at the start seemed to suggest they had a low risk of hypertension.
And the link between high CRP levels and subsequent high blood pressure held even when researchers took into account risk factors such as excess weight.
The findings could lead to better prevention of high blood pressure well before it starts, researchers said.
....Doctors should consider including CRP tests in routine physical exams for healthy middle-aged adults, even those who appear to face a low risk of developing hypertension, said Dr. Deepak Bhatt, a Cleveland Clinic Foundation cardiologist not involved in the research.
Well, I wouldn't go so far as to say that. The study (available in its entirety for free) does show a definite increase in the incidence of hypertension as values for C-reactive protein increase. Sixteen percent of women with the lowest values of CRP at baseline went on to develop hypertension compared to thirty-five percent of those with the highest CRP values. However, that means that the majority of women with elevated CRP levels did not go on to develop hypertension. Which would make it a very poor predictive tool.
What the study does suggest is that inflammation may play a role in the genesis of high blood pressure. That's not too surprising. High blood pressure is one of those things that happen to many of us as we age. After a life time of pounding and pumping, the blood vessel walls are bound to have some damage, and it's inflammatory proteins like CRP that help the body repair that damage. It's just that, as with anything else, the repairs don't bring the vessel walls completely back to baseline - they become stiffer as result, and thus result in higher blood pressure. (It takes more work for the heart to pump the blood into stiff blood vessels than it does for it to pump into bouncy, elastic ones.)
So, we're left with the age old dilemma. If we're going to prevent diseases of aging, we're going to have to find a way to arrest time. posted by Sydney on
12/10/2003 07:22:00 AM
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Celebrity Medical Watch: Ozzy Osbourne's doctor - "boutique medicine" at its worst:
Kipper charged $650,000 for his services from June 2002 until the couple fired him three months ago, records show. The medications cost them an additional $58,000.
Kipper, a University of California, Los Angeles-trained internist, is not certified as a specialist in addiction medicine or psychiatry. He often socializes with his clients, who include entertainment executives, actors, producers and musicians. Kipper carries a Screen Actors Guild card and has had bit parts in several films, including "As Good As It Gets," "Jackass — the Movie" and "Shallow Hal."
He is known for offering speedy and painless addiction therapy in luxury hotel suites or in patients' homes. Kipper has used a combination of drugs to wean addicts off narcotics. Key to the treatment is buprenorphine, a powerful synthetic opiate that spares patients the agony of withdrawal.
State authorities began investigating Kipper in 1998. The medical-board complaint issued last week accuses him of operating an unlicensed detox program, improperly using buprenorphine for addiction treatment, and overprescribing habit-forming drugs to eight patients from 1999 to 2002.
It seems that good doctor giveth and the good doctor taketh away, all for a handsome profit.
Sending Songs of Home: You can send a song to service members this holiday season for just ten dollars. (It's free for family of the armed forces.) posted by Sydney on
12/09/2003 08:34:00 AM
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Influenza Update: In the face of increased demand for flu vaccine, some doctors are encouraging the young and healthy to forego the traditional vaccine and opt for Flu-Mist, a live virus vaccine that's sprayed into the nose. Up until now, the sales of Flu-Mist have been dismally low, but things may change.
How does Flu-Mist differ from the traditional influenza vaccine? For one thing, it costs more - about $55 for a dose compared to $10 to $20 for the influenza vaccine. For another thing, it's made of live virus particles, whereas the shot is made of dead virus particles. The Flu-Mist virus has been altered, however, so that it can only survive in the nose and not in the lungs. (It doesn't like the warmer temperatures on the inside of the body.) It replicates in the nose and while there, induces the immune system to build antibodies to it.
The problem is, it can also be transmitted to others by sneezing and the like, which is why it isn't recommended for healthcare workers and anyone else who is around the immunocompromised. (It's also, needless to say, not recommended for those who are immunocompromised) It can also cause a mild case of the flu, which is why it isn't recommended for the elderly, the very young, and people with chronic respiratory illnesses - those who are at most risk for complications from the flu.
It is, however, just as effective as the traditional flu shot, and it uses the same strains of influenza virus that are used in the traditional shot. So, if you're young and healthy and you have the money to spare, it might not be a bad choice. That is, if you can find a pharmacy that has it. (It has to be stored at less than -15 degrees Celsius.) posted by Sydney on
12/09/2003 08:30:00 AM
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Monday, December 08, 2003
Nursing Home Gifts: Ever find it hard to come up with an approriate gift for someone in a nursing home? Here's a site that can help solve the problem - NursingHomeApparel.com
This, by the way, is another testament to the power of Google. I had to find a house dress for a "Giving Tree" gift at our church, but couldn't find one in any of our local stores. So, I Googled "house dress" and found this site. Saved the day. posted by Sydney on
12/08/2003 08:37:00 AM
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The study shows 'it would be rare indeed' for a child with a sore threat to benefit from antibiotic treatment, says Dr. Sjoerd Zwart, a general practitioner at the Julius Center for Health Sciences and Primary Care of University Medical Center Utrecht.
Zwart estimates that only one child in 20 with symptoms severe enough to warrant a visit to a physician would be helped by antibiotic therapy.
His estimate is based on a trial in which 156 children who came to family physicians with sore throats were divided into three groups. One group got penicillin for seven days, a second got penicillin for three days followed by a placebo for four days, and the third got a placebo only.
Penicillin is given to fight sore throats caused by Streptococcus bacteria rather than a virus. But 'penicillin treatment was not more beneficial in resolving symptoms of sore throat, neither in the total group nor in the 96 children with group A Streptococci,' says the journal report.
The problem is, we don't give antibiotics to strep throat patients just to make them feel better. We give them to avoid rheumatic fever and all of its sequelae. posted by Sydney on
12/08/2003 08:28:00 AM
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Antique X-Files: In 1910, a young Ohio woman died of a mysterious medical condition, that none of her doctors could diagnose, except one:
`There is absolutely no question about the lizards being found in the girl's stomach, for I have the two largest ones preserved in a bottle in my office,'' McIntosh said.
He also reported finding a batch of eggs in a tiny ball.
The green reptiles had been in her system a long time, he said. Herman's family told him that she had taken a dip in a ``cool, refreshing spring'' near Millersburg a dozen years earlier, and it must have been there that the girl accidentally swallowed tiny lizards or possibly their eggs, he said.
A few days before Herman's death, McIntosh said he had given the woman a strong dose of medicine under the assumption that she was suffering from a tapeworm. That's when, he said, she could feel the reptiles ``crawl up her throat.''
``They are each 3 ½ inches in length,'' he said. ``One lizard is as well formed as any I have ever seen. I also extracted several smaller lizards from Miss Herman's stomach, but I have kept only the two largest ones. The head, mouth and tail on both are to be plainly seen.'
A post-mortem was done, but no evidence of lizards was ever found:
Today, the lizard story is regarded as an urban legend, along with similar folk tales about snakes, frogs and other frightful creatures invading the human body and wreaking havoc.
Lovie Herman's 1910 death certificate can be found on file at the Ohio Historical Society in Columbus.
