Vol. 99 October 16, 2013 Flu Vaccine Update

October 16, 2013

hubSeasonal flu vaccine is effective and should be offered to everyone over 6 months old
who does not have a specific medical contraindication. (1)

Remember how excited we got about swine flu?
And then how concerned we became about the swine flu vaccine?
We began calling it H1N1 flu in hopes of reducing some of the stigma attached to its name.
We thought it might cause much more illness and deaths than seasonal flu, H1N2.
It didn’t.
That was in 2009 and 2010.

There is no such flu excitement this time around, but there are a lot more flu vaccines. There are 20 flu vaccine preparations made by 9 different pharmaceutical companies for prices ranging from $9.50 to $32.00.  (The highest priced one is for people with egg allergy.)

The “flu shot” delivers inactivated (or killed) virus, provides protection against three strains of flu (“trivalent”), and most preparations, but not all, are suitable for any one over 3 yo.

The nasal spray, “Flumist”, delivers live virus providing protection against four strains of flu (“quadrivalent”) and gives excellent protection to children over 2 yo. It can not be given to people over 42 yo. This live virus vaccine may cause shedding of the virus from the vaccinee for a few days, but serious illness from such person-to-person transmission has not been reported.

Children from 6 months to 8 years old receiving a flu vaccine for the first time or who have NOT received at least 2 doses since July 2010 need a SECOND vaccine administration at least 4 weeks later.

The trivalent vaccines protect against influenza A (California strain) which is “H1N1-like”, influenza A (Victoria strain) which is “H3N2-like”, and influenza B (Massachusetts strain) which is “2012-like”. Influenza virus strains are named after their site of origin, and, yes, Massachusetts can now proudly claim a place along other locales that gave their name to diseases; like Coxsackie, N.Y. for hand-foot-and mouth disease and Lyme, Connecticut for…you know. The quadrivalent vaccine adds an influenza B (Brisbane strain) which is “2008-like”.

The trivalent vaccine is the most readily available (at both your physician’s office or a retail store) and there is no compelling reason to seek out the quadrivalent vaccine. The vaccine’s effectiveness in preventing the flu depends on which flu strain is circulating in your area. Effectiveness may be as high as 80% in young adults, but is almost always lower in the elderly. A high dose vaccine that allegedly delivers four times the usual prod to your immune system is being marketed for the over 65ers , but it is not recommended since there is no independent study of its success.

In Massachusetts last year there were 5 flu deaths in children under 17 yo.  None of the five had been adequately vaccinated. Two of the five had no pre-existing health problems. Nationally there were 146 pediatric deaths from the flu last year compared to 34 the previous year.  40% of those deaths were in children who were otherwise very healthy.  90% of them were unvaccinated. (2)

So, don’t be flu-ish, get your flu shot …or spritz in the nose.

References:

1. The Medical Letter, Volume 55, Issue 1425, September 16, 2013
2. Massachusetts Department of Public Health, October 16, 2013

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Vol. 58 January 1, 2012 Top 15 Medical Fun Facts of Hubslist 2011

January 1, 2012

“WHAT IS PAST IS PROLOGUE”
-William Shakespeare, The Tempest

.

.

1. Measles vaccination does NOT cause autism and the author of that study, discredited as a physician in the U.K., now runs a profitable private clinic in Texas without a U.S. medical license. 1/15/11

2. Many hospitals, physicians and more than half of consumers currently favor a single-payer system. 5/1/11

3. Fishermen die at work 15 times more often than policeman and 45 times more than firemen. 5/15/11

4. Four men jogging can produce MORE carbon dioxide emissions than a hybrid car driving them the same distance. 5/15/11

5. 93% of 44 children who were avoiding 111 foods because of non-threatening allergic reactions (eczema, atopic dermatitis, and hives) were NOT allergic to those foods. Milk allergy was the most common over-diagnosis. 5/30/11

6. Your parenting style has less effect on your child’s “success” than your own educational level, income, and where you live. 9/1/11

7. Watching Sesame Street is entertaining for infants and toddlers , but it is NOT educational until they are 2 ½ years old. The educational benefits to the over 30-month old viewers persist to age 17 years. 11/1/11

8. Eating turkey is no more apt to make you sleepy than eating chicken, pork chops, lamb chops, or salmon. 12/1/11

9. The average DAILY number of text messages by a high school kid is 300-500. 11/1/11

10. 85% of teenagers take their cell phone to bed at night. 11/1/11

11. The five-year trial of “managed competition” between private health insurance companies in the Netherlands resulted in increased health care costs, increased percentage of people receiving government subsidy for health insurance, and increased number of uninsured, now called “defaulters”. 8/15/11

12. The many modes of obesity treatment other than surgical gastric bypass are only 4% effective. 8/1/11

13. Ninety million (90 MILLION) swine flu (H1N1) vaccinations were given in China and only 11 cases of Guillian-Barre syndrome (GBS) occurred. This rate was less than the rate expected in a general, unvaccinated population. 5/15/11

14. Baseball players CAN see better than umpires. 2/15/11

15. If your friends on Facebook are obese, you are more apt to be obese. 1/1/11


Vol.45 May 15, 2011 Surprising Medical Fun Facts

May 15, 2011

“Scientists constantly change their minds.
Science is not about immutable laws but provisional
explanationsthat get revised when a better one comes along.
Scientists’ readiness to change their beliefs to align with data
is a source of great strength, not weakness.”
– Daniel Willingham, Prof. of Psychology, Univ. of Virginia
in Scientific American May 2011


Does cranberry juice prevent bladder infections?
NO,
 according to a study of 155 healthy college women in Michigan (the state that produces the most cranberries) who drank two glasses a day of cranberry juice for 6 months after having a bladder infection. The cranberry juice swillers had a recurrence rate of 19% which was lower than the expected recurrence rate of 30%, BUT the control group that drank two glasses a day of a cranberry-like placebo also had a lower than expected recurrence rate at 15%. (1) The study was done to find out if proanthocyanidin, the suspected preventative ingredient in cranberry juice, really worked. The problem is that “tiny little berry that continues to defy science” contains over 200 active substances and several organic acids.Proanthocyanide apparently is not THE one.


Walk fast and carry a big stick .
A study of 35,000 community-dwelling adults with a mean age of 74 showed that life expectancy increased about 12% for each 4 inches per second faster one could walk. A threshold for “higher risk of early mortality” is suggested as “being unable to walk 20 feet in 10 seconds”. (2) In a separate study of 2900 community-dwelling Australian men, 40% of those who were 70-74 years old  reported being sexually active.  43% of those reported having sex less than desired. (3)

The umpires refused to be tested.
Dr. Daniel Laby, a Harvard Professor of Ophthalmology and eye doctor to the Red Sox, reports that the average baseball player’s vision is 20-12. That means they can see at 20 feet what we can’t see until its 12 feet away. The normal standard is 20-20, of course, and the very best a human eye can see is 20-8. He states that seeing the seams on the moving ball is one of the key factors in successful hitting. Dr. Laby offered Major League Baseball the same service for the umpires.  MLB did not respond. (4)

Are they sleeping on the job?
31% of employed Americans take a nap every day, but 39% of UNemployed Americans do too. (5)

Is drinking during pregnancy bad for the baby?
Children born to light drinkers (1-2 drinks a week) were less likely than children born to abstainers to have behavioral problems at 5 years of age and more likely to have higher vocabulary and picture similarity scores. (6)

What about drinking if you are diabetic?
According to “Healthy Eating for Type 2 Diabetes” published by Harvard Medical School, drinking alcohol reduces the risk of diabetes by up to 43%.  It also states that drinking coffee reduces the risk of diabetes by 42%. It does NOT endorse the newly popular Red Bull and vodka cocktails. (7) It does go on to say that losing 10% of your weight is really the best way to reduce your risk of diabetes.

Fishing is more dangerous than being a fireman or policeman.
The U.S. Department of Labor 2009 statistics of fatal occupational injuries per 100,000 full-time workers showed a rate of 200 for “fishers and related fishing workers” and a rate of 13.1 for police and 4.4 for firemen. Non-fatal injuries or illnesses per 10,000 civilian workers that resulted in lost days of work averaged about 117. The police rate of 676 and the firemen’s rate of 512 were soundly topped by the bus driver’s rate of 892. (8)

What’s the cure for the common cold?
Echinacea ain’t it. (9)  Zinc might be. Use of zinc lozenges within the first 24 hours of symptoms reduced the duration of cold symptoms from 7 to 4 days and reduced coughing from 5 to 2 days. (10) BUT, different zinc remedies contain different dosages and different forms of zinc, and too much zinc by nasal inhaler can blunt your taste sense. 200 mg or more of Vitamin C daily will reduce cold symptoms in smokers or seniors, but it won’t prevent colds. (11)

My two favorite cold cures are:
The British cure – Take a cold shower, immediately go outside while still wet, and run around the house without any clothes on. You will probably get pneumonia and “any damn fool doctor can cure pneumonia.”
The Scottish cure – You need a four poster bed, a hat, and a bottle of scotch. Put the hat on the Southeast  corner post of the bed, sit on the bed, and sip scotch until you see two hats. Even if you are not cured, you won’t care.

Another cause of autism?
Researchers in California studied more than 300 preschool children with autism and found that their mothers were much more likely to live near a freeway, and just freeways not other major roads, when pregnant than 260 preschool children without autism. (12) The California real estate market has been hit hard enough without implicating every house within 300 meters of a freeway.

You’re not still worried about bad effects from H1N1 flu shots are you?
A study of nearly 90 MILLION doses of H1N1 vaccine given in China in 2009-2010 were associated with 11 cases of Guillain-Barre Syndrome (GBS, ascending nerve paralysis). That is a rate of 0.1 per million doses which is lower than the normally occurring or “background rate” in China. (13)

Kids getting dirty may reduce later asthma and eczema.
Two studies in Europe showed that kids living on farms developed less asthma and had less eczema than kids living in a city. The kids on the farms were exposed to more bacteria and fungus and to many more types of those two “germs” than the city kids, and that exposure could explain the difference in the asthma rates. (14)

Unintended consequences of the “hot stuff”.
In a study of a 2008 epidemic of food-borne illnesses involving 1500 people in 14 states, 30 out of 35 restaurants (86%) of the associated restaurants were Mexican restaurants. Common ingredients included jalapeno peppers, serrano peppers, and raw tomatoes. Believe it or not, the CDC researchers were able to trace back the peppers through Texas distributors  to just two farms in Mexico. (15)

Some cars are greener than people.
Researchers in physiology at the University of Milan, Italy found that four men jogging produced MORE carbon dioxide emissions than a hybrid car driving them the same distance. (16)

References:
1. Clin Infect Dis 2011 Jan 1; 52:23
2.JAMA 2011  Jan 5;305:50
3. Jour Watch Gen Med vol. 31 Feb. 1, 2011 p. 26
4. Boston Globe Jan. 22, 2010
5.Harpers Index September 2009 p. 13
6. J Epidemiol Community Health 2010 Oct 5
7. AARP Bulletin Nov. 2009 p.14
8. http://www.marketwatch.com, Ruth Mantell, Feb 2011
9. Ann Intern Med 2010 Dec 21;153:769
10. Jour Inf Dis March 2008, Meenu Singh, MD
11. Consumer Reports on Health March 2011 p.4
12. Environ Health Perspect 2010 Dec 13
13. NEJM 364;7 Feb 17, 2011
14. NEJM 364;8 Feb 24, 2011
15. NEJM 364;10 Mar. 10,2011
16. Scientific American May 2011 p.18



Vol. 31 October 15, 2010 Medical Astrology

October 15, 2010

The gravitational influence of the obstetrician is
much greater [on the baby]
than the gravitational influence of Mars.

– Carl Sagan, On the Pseudoscience of Astrology, 2008

The birth of my sixth grandchild on October 10, 2010 ( time of birth was 10:18 so he just missed a perfect “pentafecta”, 10:10-10/10/10) caused me to notice all the hoopla about 10/10/10 and to do a bit of web surfing among astrology and numerology sites. I was disappointed that I didn’t find anything too exciting or illuminating. One of the more popular sites (according to Google) noted that one of three things could happen on 10/10/10:  1) something really good, 2) nothing, or 3) something really bad, and that #2 was the most likely.

I did discover, believe it or not, a site devoted to Medical Astrology or “Iatromathematics” that, among other things, postulated that Carl Sagan’s death in 1996 was predicted by the alignment of the planets in 1994.

Number of E-cigarette distributors recently cited by the FDA for false health claims and for delivering liquid pharmaceuticals not yet approved in the U.S.: 5  (1)

Types of liquid drugs delivered by E-cigarettes: erectile dysfunction and weight loss

  • I guess that is the kind of cigarette you should light up BEFORE having sex.

Whatever happened to the swine flu epidemic and that H1N1 vaccine we heard so much about? (2)

  • Among 483,276 recipients of the vaccine in one study there were NO cases of Guillain-Barre Syndrome (GBS) and NO deaths.
  • Another study showed that receiving the H1N1 (swine flu) vaccine increased the chance of getting GBS by 0.7/100,000 person-years which is tiny and IDENTICAL to the rate of the usual seasonal flu vaccine.
  • Number of 10 patients with swine flu admitted to a Michigan ICU for ventilator support who were obese: 9 (3)
  • Number of the same 10 who were extremely obese: 7

Funny Graphs - How bad they thought it would be How bad it was

Per cent of people in the U.S. with antibody levels high enough to protect them from getting mumps:  90%

Per cent of immune people necessary to provide “herd immunity” (the protection of unimmunized people) :  92%  (4)

Per cent increase in risk of seizures in 400,000 children within 3 days after a diptheria-tetanus immunization:  ZERO (5)

References:
1. Pediatric News, Clinical Rounds, September 2010, p.42
2. Adriana Weinberg, MD, Report given at 2010 Pediatric Infectious Disease Conference, Pediatric News, September 2010, p.11
3. http://www.cdc.gov/mmwr July 7, 2009
4. J Infect Dis 2010 Sept 1; 202:667
5. Pediatrics 2010 Aug; 126:263


Vol. 23 June 15, 2010 Updates on Health Care Reform and H1N1 Virus

June 17, 2010

Our health-care system has been a hodge podge for so long that we actually have experience with all kinds of systems…
We’re not going to get perfection. But we can have transformation – which is to say, a health care system that works.
AND THERE ARE WAYS TO GET THERE THAT START FROM WHERE WE ARE.
– Atul Gawande, MD

Per cent of Americans who think that their health care bills will rise under the new Law: 62% (1)

Increase of annual estimated costs for the healthiest people:  + $800 (2)

Decrease of annual estimated costs for families with largest health care costs: –  $2400 (2)

Date that all people will be required to have health insurance (some with subsidies based on income):  2014

Amount of  your “penalty” in 2014 if you do not have health insurance: $95 or 1% of your annual income whichever is greater (unless you are an American Indian, in prison, or claim a religious exemption…then no penalty!)

Per cent of 500 people in a telephone poll that said that their health insurance premiums were “not a burden at all”:  25% (3)

Per cent in same poll that said that the cost of their health insurance premiums was “not a serious problem”: 66%

Health care spending currently represents 17% of our gross domestic product (GDP). Per cent increase of the 2016 GDP due to  health care spending caused by  the new health care reform bill:  0. 1%  (4)

Increase in the number of insured by 2016: 15%

Estimated increase cost per newly insured person in 2019 due to the health care reform bill: $800

Current cost of average single premium health for employer-sponsored health care insurance: $5,000

Per cent of 2130 physicians polled that agreed with the AMA position of opposing expansion of coverage under Medicare and of supporting expansion of coverage through private means only (rather than “the public option”):  12.5%

Per cent of those polled who agreed with the AMA position AND were members of the AMA : 14.2% (5)

Per cent of Massachusetts physicians that were incorrectly labeled as “low-cost” or “not low-cost” by a RAND test of insurance claim data: 25% (6)

  • This so-called “tiering” of physicians by health insurance companies is touted as a cost control measure, but is obviously seriously flawed since these errors occurred in both directions. Some physicians labeled “low-cost” were not, and some “high-cost” physicians were actually “low-cost”. The range of error was from 10% to 67% among different clinical specialities.

Rate of secondary H1N1 flu cases (“attack rate”) in household cases: 8%

Rate of secondary seasonal flu cases (“attack rate”) in household cases: 9%

Estimated reduction of secondary attack rate using simple hand-hygiene procedures: 50%

Per cent of secondary household cases that had serological evidence of H1N1 infection but did not shed virus nor have symptoms: 39%

  • These were silent or invisible cases of the flu who were not contagious, but who develop antibodies against the H1N1 virus.

Chances that both flu viruses would cause 10 days of symptoms and shedding of virus for 5 to 7 days: 100% (7)

  • The conclusion of this study was that in the United States the H1N1 flu and the seasonal flu had similar severities and transmissibility.

Global death rate annually from seasonal flu: 0.1%  (but that is still over 250,00 people each year)

  • Death rate from 1918 pandemic flu was 2%.

Global death rate  from H1N1 in 2009-2010: 0.05% (8)

References:
1. CNN/Opinion Research Corp.;March 2010
2. the Lewin Group as reported in Money Magazine, May 2010
3. Mass Insight reported in Boston Globe, June 8, 2010, Stephen Syre
4.NEJM 362:22, June 3, 2010,J. Gruber
5. NEJM 362:23 June 10,2010, 2230
6. NEJM 362, 1014, March 18, 2010
7. NEJM 362:23, June 10, 2010, 2175
8. Dr. Mark Lipsitch, Harvard University, quoted by Reuters, September 2009


Vol. 18 April 1, 2010 APRIL FOOL’S ISSUE

April 1, 2010

APRIL FOOLS DAY (according to one theory that ignores the 13th century literature references to “april fools”) was created around 1582 when the Gregorian calendar moved the first day of the New Year from April 1 to January 1. Those who persisted in calling April 1 “New Year’s Day” were often sent phony invitations to  New Year’s parties. Other pranks to fool people, usually performed in the morning, were soon added to the phony party invitations. Someone who pulled a prank after noontime on that day was also called a “fool”.

THE TRADITION CONTINUES.

NIH REPORTS THAT ONLY 20% OF AMERICANS ARE ACTUALLY OBESE.
The NH discovered an error in its formula for calculating Body Mass Index  (BMI), a widely used standard of obesity which is posted on their website. The calculation error results in a grossly overstated BMI which negates decades of provocative research on obesity. The White House spokesperson for Michelle Obama declined comment by saying, “We have other more important health care issues on the front burner right now”. The NIH regrets any inconvenience that this may have caused, reassures researchers that study grant funds will not be reclaimed,  and states, “Hey, we can’t be right about everything.”

LAST SUPPER PORTIONS HAVE INCREASED 69.2% OVER THE LAST MILLENNIUM.
In a related study, and a timely one at that, two researchers studied 52 paintings of the Last Supper and concluded that the size of the main course in the paintings had increased by nearly 70% over the centuries. Plate size increased by 66% and bread size by 23%. The authors of this study published in the International Journal of Obesity just in time for Easter speculate that the increasing sizes reflect the increasing abundance and affordability of food over the years. (Apparently there is nothing new about “Super Size Me”.) (1)

H1N1 (SWINE) FLU PROGRAM A BIGGER STIMULUS THAN THE BANK BAILOUTS
The Government Accounting Office (GAO), the federal government’s premier watchdog agency, reports that the H1N1 (swine flu) epidemic efforts created more of an economic stimulus than the bank bailouts. The amount of money pumped into media outlets by the educational efforts was exceeded only by the amount paid to pharmaceutical companies for manufacturing and distribution of the vaccines, now readily available in excess supply due to underuse. More importantly, much of the trickle down economic benefits occurred in the offices of pediatricians, internists, and family physicians; our lowest income bracket health care providers. When asked by the GAO for comments, the CDC replied, “Hey, we can’t be right about everything.”

VIDEO GAME EXPERIENCE MORE BENEFICIAL THAN HONOR GRADES.
Army recruits with a history of prolonged play on video games have better success records as tank commanders and drone pilots than the valedictorians from the same schools. The study speculates that the better hand-eye coordination and enhanced perception of spatial relationships of the video game players accounts for the large discrepancy in skills between the two groups of students. The study authors speculate that these findings could be generalized to include endoscopic, laparoscopic, angioplastic, and other “minimally invasive”  procedures. “Perhaps it is time we altered our application standards for medical school and post-graduate clinical training.”

VEGETABLES CAN LOWER IQs.
Organic vegetables are suspected of  lowering the IQ in young children by at least 10 points. This result of a study of children in Western Massachusetts, Southern California, Oregon, and other tree-hugging communities surprised the authors who had received funds for the study from the National Association of Vegetable Investors (NAVI). A parallel study in rabbits revealed that carotene (the color in yellow and green vegetables) has a strong affinity for nerve synapse proteins in the brain. The carotene  binds tightly with the nerve protein, slowing the response time, EXCEPT in the occipital lobe which is responsible for vision. (Your grandmother was right after all. Eating carrots can help your eyesight.)

WEARING GALOSHES (OR RUBBERS) IN THE MOVIES DOES NOT HARM YOUR VISION.
This small study revealed no change in vision between children who removed their galoshes while in the movie theater and those who did not. The study authors concluded that “Mothers and grandmothers can’t be right all the time, either”, but admitted that the study result was weakened by its small size since they had trouble finding enough kids who still went to a movie theater to watch movies.

OLIVES IN A MARTINI ARE AS GOOD AS OLIVE OIL IN REDUCING CHOLESTEROL.
“You just have to drink enough of them” say the study’s authors.

PASSAGE OF HEALTH CARE REFORM BILL CAUSES MASSIVE SHIFT OF LOBBYISTS.
Lobbyists for bankers, business groups, hedge funds, insurance firms, Wall Street brokers, and others in the  financial sector are poised to reclaim their historical position as the number one group in expenditures to influence Washington policy now that the health care bill has been passed. The Committee for Truth in Politics, its membership and financing still a secret, has already spent $5 million in advertising opposing proposed financial reforms. The Center for Responsive Politics, which tracks spending by lobbyists, speculates that the financial sector lobbyists want to get back to its spending level of the past decade of $3.9 Billion. (2)

CELL PHONE USAGE MAY INCREASE FERTILITY.
In the midst of the scientific controversy about whether or not the low-level radio frequency (RF) coming from cell phones can cause brain tumors, one study has unexpectedly shown an increase in the birth rate in those women using the cell phone more than an hour a day. The mechanism of enhanced fertility is not known. “We compared the actual time spent on voice calls, texting, twittering, and Facebook and found no fertility differences among them, so we don’t think it is associated with just an increase in social intercourse. Likewise, we found no differences between heavy daytime users and heavy nighttime users.” Dr. Siegal Sadetski, a researcher at Israel’s Gertner Institute, stated, “Scientifically speaking, we don’t have proof yet, but as a public health concern, I’m saying we definitely should adopt precautions.” (3)

References:

1. Believe or not, this fun fact is actually true. Wansink and Wansink from Cornell and VWI are the authors. Look it up!
2. Actually some of these names and amounts are true. Check out Center for Responsive Politics website.
3. This quote is true too, but is wildly out of context. 


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