News/Blog

Simplifying Science

Vaccines 101, Redux

I recently discovered this blog post... while the information offered about vaccines isn't revolutionary or new to me, it is one of the most well-written pieces I have found on the subject. 

Vaccines 101: Too Much Too Soon?

There is so much out there about vaccines coming at parents from all sides; new parents are bombarded with an endless supply of opinions, ideas and recommendations...Read More

My View: This is an Important Read

The fact that celebrity often trumps education and work experience makes me profoundly sad. But this has certainly been the case for vaccines. It can be confusing to know whom to listen to when it comes to health advice. In my humble opinion, you are much better served listening to someone who has actually studied medicine. Just sayin'...

JENNY MCCARTHY’S DANGEROUS VIEWS

For decades, Barbara Walters has been described as a broadcast pioneer—and with good reason. In 1974, Walters became the first female host of the “Today” show. In 1976, she became the first woman to serve as a network-news anchor. In 1984, she moderated the first Presidential debate between Walter Mondale and Ronald Reagan. Since then, she has interviewed everyone from Fidel Castro to Kim Kardashian. Her ABC talk show...Read More

From the Prevention Files: Flu Vaccine

This topic is as evergreen as a cypress tree. My latest blog post for Mom.me...

Why Everyone Should Get the Flu Vaccine

Every year, my kids and I get the flu vaccine. We do it because influenza, which is the virus responsible for “The Flu,” can cause more than just an inconvenient cold. It can give you fevers that soar to 105 degrees, muscle aches so profound you feel like you...Read More

A Twist on Entitlement to Health Care: Every American as a Junior Physician

H1N1 Flu vaccine: dangerous or safe? Well if you listen to CDC, the Department of Health and Human Services, the American Academy of Pediatrics among others, it’s safe. And more than that, it’s necessary because it will save lives. But if you listen to some others, including a number of media figures—like Bill Maher—it’s not.

So who to believe? Isn’t the government in cahoots with the pharmaceutical industry, helping big pharma make a big buck at every turn? If so, then you certainly cannot trust them. Forget that these organizations are packed with scientists who have dedicated years of their lives to research in order to help protect and defend the quality of yours. Forget that in order to be a member of an advocacy organization like the AAP you need to have spent years in graduate school and specialty training learning how to care for children. Yes, it makes perfect sense that these doctors and scientists would work hard to snow the general public just so the CEO of a pharmaceutical company can get a bigger bonus this year. That makes lots of sense.

I understand the pessimism; it is reasonable that people question the integrity of the relationships between drug manufacturers and health care providers. But at this point, our healthy sense of skepticism has become infected: patients are willing to listen to—and in many cases take medical advice from—people with no training in medicine. Bill Maher is not the only self-proclaimed doctor out there, he’s just the one to make the biggest splash this week.

Everyone, it seems, is a junior diagnostician. If you go on any number of websites and type in your constellation of symptoms, you too can get a diagnosis. It is downright routine these days for patients to show up at the doctor’s office proclaiming they know what’s wrong with them and what prescription they need. Printed sheets off the Internet, proof in hand, patients know what’s best for them.

But let’s freeze for a moment here. We all saw “Lorenzo’s Oil” and know that there are cases out there that stump doctors, impassion patients, and result in medical victory only at the hands of dedicated—and often sick—individuals. That doesn’t mean that all of us need to rely upon ourselves to diagnose every illness. Physicians do—gasp—still have some utility in this world. If we all become junior physicians and trust only ourselves to figure out what is medically best, we throw out the baby with the bathwater. The next time your child has a fever of 104 degrees or you develop chest pain, you’re just going to look those symptoms up online?

Vaccines occupy an entirely different orbit in this debate because they are medicines that are given to healthy people (or are at least given preventively rather than therapeutically, whether or not the recipient is truly “healthy”). For this reason health care consumers feel even more entitled to take matters into their own hands. Okay doc, you can treat me when I am sick, but don’t try to force something onto me when I am well. Consumers of health care have become skeptical about vaccines for a number of reasons, but one has to do with their profit margins. Just to get the facts straight here, the H1N1 vaccine is free—doctors don’t stand to make any money by recommending it. So when people imply that doctors are just peddling the vaccine as a profit center, their facts are wrong.

To Mr. Maher and all of the other untrained champions of health and well-being, let me suggest that you spend a week or even just a day in a local hospital. Talk to the patients, learn about their illnesses. Find people with vaccine-preventable diseases like H1N1 (or pertussis or pneumococcal pneumonia)—and these people are in the hospital, I assure you—and ask them if they could do it over, would they have been immunized?

Doctors are legally liable for the advice they dispense; you are not. If I tell someone not to get a flu vaccine and they catch influenza, I assume several layers of culpability. The one you might point to is fiscal: the risk of a lawsuit. But the one consequence that makes me lose sleep at night, and the very one that you feel remarkably comfortable glossing over from the studio desk chair, has nothing to do with dollars. That consequence is that someone is no longer healthy. In discouraging a vaccine, I leave a patient vulnerable to an illness. If the patient gets that illness and suffers serious complications or dies from that illness, it is on my conscience. If you really weigh this side of the equation, how can you not feel an inkling of the same?

It is not my job to dictate whether patients get vaccines. All I can do is read every study I can get my hands on, weigh the risks and benefits, and then come to a conclusion. What patients do with that conclusion is their business. Not mine, and not yours either.

With All the Talk About Swine Flu Vaccine... Who is Willing to Give it to Their Child?

According to CDC, to date 9079 people have been hospitalized with novel H1N1 flu (AKA “Swine Flu”) and 593 have died from the disease. Almost everyone in the business of predicting what the winter flu season will look like agrees: H1N1 flu will be back with a vengeance. No one knows—or even knows how to predict—the burden that H1N1 will bring. No one can say with certainty how it will compare to seasonal (AKA “regular old”) flu; whether it will cause mild or serious disease; or whether it will infect by the thousands or by the hundreds of thousands.

The development of a vaccine against novel H1N1 began almost as soon as the virus was identified, and it is scheduled for licensure in October. Because CDC is not committing to a specific release date or to a number of doses that will be available, speculation has taken over traditional and Internet media with reports that the number of doses of the new vaccine will be insufficient to protect against pandemic spread of the virus. Front page headlines last month claimed 90,000 could die of the infection this year.

It is possible that the speculators are right. Epidemiologists say that enough doses of vaccine need to be administered in order to “protect” the sum total of us from a pandemic. But it is not at all clear what this number of doses is, who should be vaccinated first, or how much vaccine can be manufactured (let alone administered) in time for the onset of the winter flu season. In August, CDC published guidelines for vaccine priority. If the H1N1 vaccine supplies are severely limited, then the following groups should get it first: pregnant women, people who live or work with children under 6 months of age, healthcare and emergency medical services personnel, children 6 months to 4 years, and older kids (5–18 years) who have chronic medical conditions.

Here’s the intriguing paradox: there seems to be great public demand for the vaccine and there will certainly be outcry if it is not available in sufficient numbers to protect us all. But one of the top—and probably the largest—priority groups slated to get the vaccine first is not necessarily going to be lining up to get it. This is because the parents of young children have become vocal vaccine skeptics.

CDC has focused their vaccine priority on young children because this population is among the most effective vectors of disease transmission. Infants drool, they spit up, and they put just about everything they can in their mouths. Toddlers pick their noses, rub their eyes, and lick their fingers. Kids under the age of four are very good at sharing the bodily fluids that transmit flu viruses with everyone around them; they are far less good at washing their hands and practicing basic hygiene. If this single group can be vaccinated, not only will they be spared illness from H1N1 but their immunity should limit the rampant spread of the new virus.

So who is going to bridge this gap? Who is going to be able to convince parents already reluctant to vaccinate that they should give their children this vaccine? There cannot be an assumption that just because the vaccine is available, it will be utilized. A tremendous burden will rest with physicians who are going to have to find the time to talk to parents about the risks and benefits of a brand new vaccine that has very little data about its efficacy (does it work?), necessity (is H1N1 even that bad?) and toxicity (what are the side effects?). And this precious time is going to have to be found during the already busy back-to-school and winter flu seasons.

Here’s another hurdle: the majority of H1N1 vaccine will be in multi-dose vials. Any vaccine in a multi-dose vial must have a preservative. Translation: Most of the new vaccine will contain the mercury preservative thimerosal. And in some places—like my home state of California—it is against the law to immunize young children with thimerosal-containing vaccine. There is an aggressive attempt at producing single-dose (i.e. thimerosal-free) vaccine for pregnant women and young children, but there are no guarantees if and when this can be accomplished. The inclusion of mercury in the novel vaccine will undoubtedly present a roadblock.

Meanwhile, seasonal influenza will also reappear as it does every year. There is no reason that the existence of the new H1N1 virus will reduce the burden of seasonal flu.

People always want to know what the pediatrician does for her own kids. Well, I took mine in for their seasonal flu vaccines last month—something I typically do in late September or early October. This regular flu vaccine won’t cross-protect against H1N1, but it should protect my kids against this year’s garden-variety seasonal flu. I did this early so that if the H1N1 vaccine becomes available and if my kids even qualify (by age) to get a dose, they will have the option to get it. No one knows yet how the two different flu vaccines need to be timed; most reports suggest that they can be given simultaneously or they need a 3-4 week interval between administrations. By getting a seasonal flu vaccine early, my kids will pass the 4-week mark before the H1N1 vaccine even hits the shelves. Meanwhile, as the studies of the new vaccine are completed and safety data emerges, I will have another round of decisions to make come October.