Swine Flu 4.97: Natural Remedies

According to the CDC, our Northeast is the least flu-affected area in the US right now.  We are administering seasonal flu vaccines now, and there is a shortage so get yours soon.  Just faxed in my order for the H1N1 vaccine; we are told that Swine Flumist will be the first available, and that leaves out the most vulnerable groups, but it is definitely better than nothing.

Of natural remedies against the flu, two have enough studies behind them to rise above the level of voodoo:

Vitamin D, which in my own experience, and in many studies, is often deficient in both children and adults, can be given safely in doses above the RDA of 400 units/day — 1000 to 2000 units a day are safe, and will raise the levels to normal quicker than 400.  Vitamin D may be the major reason behind flu’s seasonal pattern.

Black Elderberry contains substances that inhibit viral replication.  There have been studies to show that Sambucol (Black Elderberry extract) works in people; the studies weren’t the best quality, and did not address the concern of immune overreaction that may be the reason for swine flu’s (and bird flu and Spanish flu as well) increased danger to healthy young adults, but, as I said before, this is better data than what we have for most alternative medications.

Back to work.  I have a lot of smart people to vaccinate.


Swine Flu 4.96: The Count of Many Tests

I did a quick, preliminary count of positive Flu A tests in different vaccine recipients.  Of about 500 Flumist recipients, 1 had a positive test for Flu A during the “regular” season (Dec 08-Mar 09), and 39  had positive tests for Flu A during the “swine” season (Apr 09-Jun 09).  Of about 1000 Fluzone recipients, 3 were positive for seasonal Flu A, 40 were positive for “swine” flu A.  Without getting all technical about it, looks like the two vaccines are both very effective in protecting against seasonal Flu A.  Since they were never intended against Swine Flu, it is not surprising that that neither has much (if any) of a protective effect against swine flu.

Take home message: use a flathead driver for flathead screws, and Philips driver for Philips screws.  Get seasonal vaccine now, and swine vaccine when available.


Swine Flu 4.95: Famous Penultimate Words

“You can give me all the public health statistics in the world, but I believe based on all I’ve read to date that vaccinations cause a body more harm than good.”

This was posted  on a doctors-only board yesterday, presumably by a doctor.  The sentiment is one I often heard before, and yes, sometimes from physicians; but rarely have I seen a statement that so honestly examines the mindset behind voodoo medicine.

Let’s try this again, slowly:

“You can give me all the public health statistics in the world, but I believe based on all I’ve read to date that vaccinations cause a body more harm than good.”

“You can give me all the public health statistics in the world” — Public health statistics usually come in the format of, “Of 10000 people who received the vaccine, 2 died, and of the 10000 who did not,  20 died”, or similar, and thus speak for themselves.  They also come from places entirely away from any influence from pharmaceutical companies (often blamed for messing with our own statistics) such as Cuba and Iran, and are usually in line with our own.

“I believe based on all I’ve read to date” — I like fiction, too, really I do, but I do not practice medicine according to THE ANDROMEDA STRAIN, and I do not expect our foreign policy to be formulated by Tom Clancy.  A clique of quacks recycling each other’s delusions does not qualify as continuing education.

“vaccinations cause a body more harm than good” — the one thing they have harmed so far is the respect accorded a pediatrician, by taking much of the melodrama out of patient-doctor relationships.  Families look at the doctor differently when the encounter occurs in the Intensive Care Unit — I spent enough time running one at night, as Chief Resident back 20 years ago, to know this very well; and the other thing I know well is how well we vaccinated many of the diseases (that formerly put children in ICUs) into near-extinction (resulting in near-extinction for many of the ICUs, but that’s a different story).  Yes, saving a life in a close call generates more respect than saving 1000 with a shot and a bandaid — which also may be the reason why most people prefer reading fiction to statistics.

In other news:  CDC Flu tracker reports accelerating flu activity in the South but very little here in the Northeast as of yet.  Swine flu mania did at least some good, in promoting awareness that normal seasonal flu isn’t much (or any) better than the novel H1N1 2009, and seasonal flu vaccine demand is subjectively higher than it was in previous years — but, again, all too often, I hear the mantra:

“You can give me all the public health statistics in the world, but I believe based on all I’ve read to date that vaccinations cause a body more harm than good.”

Swine flu vaccines have been approved for adult use, and are being evaluated for pediatric use, with mid-October as the target date (which may be late in the season for some of the hard-hit Southern states).  The US-approved H1N1 vaccines are adjuvant-free, and contain about the same amount of antigen as seasonal vaccines, and are thus not expected  to have a significantly different side effect rate from the seasonal vaccine, but I certainly would not jump into endorsing the H1N1 vaccine for children until some of the data are in — but realizing that in the real world, and for real children, the decision point is very soon, I will continue to monitor the information.

By the way:

Ellen Kushner, SWORDSPOINT

John Scalzi, OLD MAN’S WAR

Samuel R Delany, EMPIRE STAR

These are some of the fiction books I read or re-read lately, and highly recommend — but not as sources of medical information.  I have not found nearly as much amusement and entertainment in the vaccine-related fiction found on the Internet.


Swine Flu 4.94: what if?

Still no sign of swine flu in the neighborhood, but the media are busy fanning the flames of panic.  Well, why not?  We do have a problem, might as well have it be pointed out by something as relatively mild as swine flu.

The problem has to do with the dismemberment of inpatient care in the US.  There is something called the

Milliman and Robertson Length-of-Stay Criteria

(basically a wish list from the managed health industry  about how they would like every disease treated by an outpatient or drive-through procedure).

Then there is the tendency to emphasize preventive care at the expense of curative care infrastructure: the money spent on screening and prevention is being generated by closing hospitals, and fewer physicians are doing hospital care now than ever before.  Which is fine, as long as everything you face is preventable.

As yet, swine flu is not very preventable.  Yes, they are working on the vaccine (it is not clear yet how effective it will be, I am hoping for the best, and it is promised for late October), and, yes, thinning the crowds (in schools and elsewhere), proper hygiene, vitamin supplementation and “social distancing” will be useful — but they fall short of complete prevention.  In the meantime, inpatient and intensive care facilities are pared down to bare minimum. It’s a good thing swine flu is only expected to cause a modest increase in need for intensive care — something really nasty like SARS or Spanish flu would have caused a total health care meltdown.  This is a good time for the powers-that-be (within medicine as well as government) to become unobsessed with preventive care and return to what we are really trained to do: treat the sick.  Preventive care, though important, is a fairly cookbook procedure, time consuming mainly because of the amount of advice and guidance to be dispensed, and, as I said before, having a quota of teenagers to bore today can conflict seriously with caring for the sick children in an epidemic setting — let’s think about that for a minute.