H1N1 Flu Update

I have seen more children and adults with influenza-like illness: 104 degree fevers, muscle soreness, sore throat and negative tests for strep, than in any summer I can remember. I haven’t used the “flu swab” to test anybody, but I’m sure that many if not most of these sick people had Swine Flu. They all felt miserable, and they are all feeling just fine now.

Preventing outbreaks of this “novel H1N1″ influenza may be a mistake of huge proportions. Yes, sadly, there will be fatalities among the 6 billion citizens of the planet. Tens of millions of cases of any illness will lead to morbidity and mortality, but this is completely (tragically) unavoidable. The consequences of not acquiring immunity this time around, however, could be really terrible and far outweigh a mass prevention program.

Here’s my rationale for not using Tamiflu: If (if, if, if) this virus circles the globe as the rather innocent influenza it now appears to be, but mutates and returns as a very virulent form of influenza, it will be quite wonderful and life-saving to have formed antibodies against its 2009 version. These antibodies may be far from 100% protective, but they will help. This is incredibly important but being ignored in the interest of expediency.

In 1918, it appears that influenza A (an H1N1, by the way) did this globe-trotting mutation and killed millions. The times and state of medical care are not comparable, but a milder parallel occurrence is possible. Perhaps this happens every 100 years or so, perhaps every three million.

Whenever possible, we should form antibodies against viruses at the right stage of their existence and at the right stage of our lives (For example, chickenpox in childhood and EBV/mono in early childhood. There are many other examples.) Getting many viral illnesses confers lifetime immunity, and very few vaccines do.

Tamiflu is a very powerful drug with little proven efficacy against this bug, and with its major side effect being tummy upset. I’m not using it at all. Psychiatric side effects are also possible.

I also won’t be giving the flu shot to the kids and parents in my practice unless there are extraordinary risk factors. I anticipate giving none at all this year. I doubt that there will be any really large problems with the vaccine, but I also doubt any really large benefits. As I said, I think that this year’s version of this particular H1N1 is as “mild” as it will ever be and that getting sick with it this year will be good rather than bad. The chances that a new “flu shot” will be overwhelmingly effective are small.

I consider this, and most seasonal and novel influenza A vaccines, as “experimental” vaccines; they’ve only been tested on thousands of people for a period of weeks and then they’ll be given to hundreds of millions of people. Not really the greatest science when we’re in that much of a hurry. Yes, one can measure antibodies against a certain bacterium or virus in the blood and it may be associated with someone not getting sick, but there are very few illnesses common enough or enough ethics committees willing enough to do the right tests. That is, give 1000 people the real vaccine and 1000 placebo shots, expose all of them to the disease and see who gets sick. Seriously. I know it sounds terrible.

This is, obviously, a difficult public discussion because it touches on the concept of benefits and risks, again, of morbidity and mortality. Few public officials have the courage or inclination to present all facets of this difficult decision. I give vaccines to my patients every single day, but I always err on the side of caution. Implying that this is a dangerous new shot is not scientifically or statistically correct and represents hyperbole and even dishonesty on the part of the so-called “anti-vaccine” camp.

It sure isn’t “sexy” to suggest handwashing, good nutrition, hydration, extra sleep and so on. It’s not conventional to suggest astragalus, echinacea, elderberry and vitamin C. Adequate vitamin D levels are crucial, too.

I just think that giving this new H1N1 vaccine is not the cautious nor best thing to do.


Jay Gordon, MD, FAAP

Goliath and the Gnats

Well, that wasn’t April’s only storm. An April Fool’s joke I posted to a private group of a few thousand doctors, lactation experts and other medical experts triggered alarm in the halls of my club, The American Academy of Pediatrics.

Interestingly, the AAP may actually have dramatically increased integrity under Dr. David Tayloe, our new president, but someone else violated the first rule of publicity: Don’t complain when some one makes you look a lot better than you really are. Even if he does it on April First!!

Dr. Susan E.Burger is one of the world’s foremost experts on international nutrition and epidemiology who shared with me her submission to the New York Times. The Times did not publish this excellent article and I asked her permission to post it here. Thank you very much, Dr. Burger

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Milky Way of Doing Business

By Katie Allison Granju

November 3rd, 2003 was a big day for Alabama emergency room pediatrician, Dr. Carden Johnston. On that date last month, he was installed as the new President of the 66,000 member American Academy of Pediatrics (AAP) at the prestigious organization’s annual meeting in New Orleans. It was also the date that he sparked what has emerged as a major ethical controversy by inadvertently pulling back the curtains on the powerful influence that a particular corporate interest appears to have in shaping AAP policy and action.

“I have to admit that I never imagined that my presidency would start off with such a bang,” Dr. Johnston says, acknowledging the debate now taking place within his organization.

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Poison Ivy, Herbal Treatments for Your Skin

By Dee Negron

The allergen in poison ivy is a substance called urushiol. What urushiol does, to people who are allergic to it, is bind with the skin cells and produce a rash. In order to treat a reaction to the poison ivy what you essentially need to do is “neutralize” the urushiol.

There are several herbs, when applied topically, that can do this. Jewelweed is one of the best. You can also combine this with any herb that contains a significant amount of saponins such as Soapwort, Horse Chestnut, Licorice, or Rose Leaves. Please remember that these are for topical use only as saponins shouldn’t be taken internally while pregnant or nursing, but are perfectly safe when used externally. Some things to help control the itching are aloe vera or plantain. Also, cool baths with powdered colloidal oatmeal can be extremely soothing.

Attention Deficit Disorder

Attention Deficit Disorder (ADD) or Attention Deficit Disorder with Hyperactivity (ADHD) affects millions of children and their families. Currently accepted statistics say that as many as 10% of the school-aged population have ADHD and perhaps another 20% have symptoms of the disorder suggestive of ADHD. Boys are diagnosed three times more often than girls and 30-50% of these children will continue to manifest these symptoms and problems in adulthood.

It’s no wonder that the pharmaceutical industry has made a huge effort to market drugs for ADHD and that a large and intelligent backlash has developed against the widespread use of these powerful chemicals.

I have been a pediatrician for twenty years and for fifteen of those years I completely disdained the use of Ritalin and the other psychopharmaceuticals for ADHD kids. I was probably wrong to “throw out the baby with the bath water.” Denying that a small percentage of children receiving Ritalin actually benefited from the drug was not fair to them. We don’t know enough about brain chemistry to completely understand ADHD, but we do know the impact of untreated ADHD on children: a much more difficult childhood and adolescence with school and social problems which can be nonstop.

I now try “everything else” before resorting to prescription medication, but I no longer rule out that possibility.

Deficiency in central nervous system dopamine probably causes many, if not most, of the problems associated with ADHD. Nutritional problems can cause or exacerbate this deficiency: supplemental tyrosine, B vitamins, vitamin C and copper have all shown a positive influence on improving the school performance of children with ADHD. These can all be combined with conventional therapy with no adverse interactions. Ritalin and similar drugs act by directly increasing brain dopamine levels.

Before I consider anything else, I try to persuade the family to put their child and themselves on an excellent diet. The standard American diet filled with sugar, artificial sweeteners, colors, preservatives, saturated fats, low levels of vitamins and minerals, and too much protein is not good for brain health or health in general. Mainstream medical journals have debated this topic for decades and most medical practitioners don’t like to consider nutritional alternatives in the treatment of any disease because it takes too long to discuss it with their patients.

I recommend whole foods as the backbone of the nutritional regimen. As obvious as this sounds, most children get the bulk of their food in an over-processed form. Whole grain cereals and breads and lots of fresh fruit and vegetables and beans and pasta make for meals which interest children and adults. Counsel your patients to avoid sugar!! Reading labels closely will show parents just how many artificial additives have worked their way into kids’ daily diets. Many chemicals mimic brain neurotransmitters and even conventionally published research admits that sugar has a negative impact on the behavior of ADHD children. Processed cereals and high-fructose corn syrup sweetened drinks add huge amounts of sugar to a child’s day. Even regular unsweetened apple juice in the quantities some children like can be a large source of extra sugar.

There are many alternative remedies which can be used to treat children with ADHD and learning disorders. We must help the families in our practices find these and guide them in their usage.

Ginkgo Biloba dilates blood vessels and improves circulation to the brain. Researchers have shown it’s utility in Alzheimer’s Disease.

Variations are to be expected, and are in no way to be considered a defect.

– Hang tag from Madras shirt

Statistics reflect this confusion. Depending on who you read, some experts say we have about eight hundred-thousand learning disabled children in the country. Others put the figure as high as eight million.

In 1963, when “learning disabilities” were first described, we found very few students with the problem and thought the problem was rare.

Some take a very conservative view and say that 30 – 50% of us will outgrow it, but a growing body of experts think we just learn to cope with it. There’s a certain brain development that takes place at puberty that sometimes makes ADD much easier to live with. I think the jury’s still out but my guess that most of learn to live with it, not outgrow it.

Depression and Herbal Treatment

There are herbs that may drastically alter your feeling of well-being. These may be something you’d like to consider before resorting to medications.

For anxiety, a mix of Kava and Siberian Ginseng is good.

For depression, Gingko Biloba or Borage. There has been a good amount of success with a combination of the two as well.

Keep in mind when combining herbs to treat one symptom or illness to use a proportional dosage. (i.e., two herbs would be half dosage of each, three herbs would be one-third dosage, etc.)

Here is a link that goes into homeopathic remedies for depression. The info given is on postpartum depression simply because all of these are safe while nursing. They are all used to treat general depression as well, so they’re not specific for use for PPD.

Homeopathic Remedies for Postpartum Depression – MotherNature.com Health Encyclopedia

The usual speech applies here. When looking into using herbal or homeopathic remedies, make sure you’re getting them from a good health food store. Avoid commercial places like GNC. Get out the yellow pages and look under health food stores, then call around until you find one with a certified herbalist on staff. This is the store you want to go to.

Exercise should not be forgotten when dealing with depression. It has been shown that regular exercise is the best remedy for depression. There have been patients who’ve suffered repeated bouts of depression who have been able to go off meds completely after starting and maintaining a regular exercise program.

Glucosamine for Joint Pain

For painful joint problems, a combination of glucosamine and chondroitin has shown positive results in many.

The dosage for regenerating cartilage is 1500 mg of glucosamine a day and 1200 mg of chondroitin a day. Take this dosage until you start feeling a relief from the pain. Then drop down to 1000mg of glucosamine and 800 mg of chondroitin until pain disappears. From that point on, take a daily dose of 500 mg glucosamine and 400 mg chondroitin daily to prevent future degeneration.

Patients using glucosamine for osteoarthritis should take 1500 mg per day. It can take up to 4 – 8 weeks to relieve pain. Therefore, continuing on a NSAID during this time period may be necessary.

Patients with type II diabetes should monitor their blood sugar carefully due to concerns that glucosamine might increase insulin resistance.

In considering which supplements will assist you best with joint pain, it may be helpful to know that the absorption rate for chondroitin is 0 to 8% while the glucosamine sulfate is 98%. Glucosamine sulfate is the best source. It is possible to get the relief you are looking are with glucosamine alone.