Category Archives: Swine Flu

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.

Best,

Jay Gordon, MD, FAAP

Swine Flu: Activating Your Pandemic Panic Pause Button

The New York Times reported this week that the World Health Organization raised the Swine Flu alert level to phase 5, one level below all-out global pandemic. “All countries should immediately activate their pandemic preparedness plans,” warns Dr. Margaret Chan, director general of the W.H.O.

Phase 5 hasn’t been declared since the Avian Influenza in 2005.

This should make you feel better, unless you or someone you know came down with the Avian Flu.
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H1N1: Medical Honesty and Integrity

“With all due respect to Dr. Gordon’s article and his opinion posted [on Peachhead2] I would love to hear [another] doctor’s opinion about the H1N1. I talked to a neurologist last week and he mentioned to me the concern being young children and the possibility of being hooked up to a respirator.”

It is exactly this kind of absurd, exaggerated rhetoric (not from our Peachheader, but from the doctor she’s quoting) that is creating anxiety and fear and making it harder to make an informed intelligent decision.

The possibility of your healthy child “being hooked to a respirator” because of Swine Flu is incredibly small. To imply otherwise is an unintelligent scare tactic.

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Influenza: Some Provocative Reading

I’m still seeing one or two children each day with Swine Flu symptoms and can reassure you that the government and the media are engaging in scare tactics rather than presenting the facts.

No lengthy newsletter to read today. Just a couple important medical articles. One from the lay press and one from a serious medical journal.

Please invest 15-20 minutes reading these two articles in full. I’ve given brief summaries of some of their information below.

One article is from a well-respected periodical and the other is from the most respected medical journal (BMJ) in the world and the Cochrane Collaboration which is the “gold standard” in medical information.

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Swine Flu and Tamiflu

Just wash your hands.

Every year, hundreds of viruses pass through the pediatric and adult community. Many of the bugs are disruptive and keep kids out of school and adults away from work. Some of the viruses have unique signs and symptoms, but most just cause amorphous aches, sneezing, coughing or intestinal upset.

Influenza viruses, especially new ones, trigger more news stories and can be made to seem much more frightening and dangerous than they really are. Government agencies and media don’t supply statistical context and make it sound like you’ve got a “fifty-fifty” chance of contracting this new virus. They then make it sound like a lot of people who get this influenza end up in the hospital and may die. Statistically, nothing could be further from the truth: The chance that the new virus is really dangerous is small. The chance that you’ll get it is much, much smaller, and the possibility that you or a family member will be harmed by the virus is so slim that the news should be on page twenty, not page one.

Swine Flu is a virus for which there is no vaccine, little to no threat to your family, and there are undoubtedly tens of thousands of harmless undiagnosed cases throughout the world. The news stories are probably taking a hundred questionable respiratory deaths in Mexico and guessing.

There actually is a very, very small chance that this virus could cause severe illness and whenever this occurs hospitalization and even fatalities are reported. The likelihood of a pandemic is miniscule, but newspapers, government agencies and the manufacturers of pharmaceuticals do their best work and make their biggest sales when people are scared.

Broadcast media get major sponsorship from the pharmaceutical industry and do not always present the “other side” of the story. Tamiflu is recommended for treatment and prevention of this influenza virus. Local pharmacies are already running low on Tamiflu.

Connect these dots.

http://uk.reuters.com/article/governmentFilingsNews/ idUKN2445216420090424

http://www.snopes.com/politics/medical/tamiflu.asp

http://www.reuters.com/article/domesticNews/idUSTRE53O17O20090425

http://www.nasdaq.com/aspx/stock-market-news-story.aspx?storyid= 200904251215dowjonesdjonline000319&title=who-says-initial-findings-show- swine-flu-responds-to-tamiflu

The usual boring admonitions apply: wash your hands, stay well-rested and well-hydrated. You do not need to buy Tamiflu. It is an effective antiviral drug but has possible side effects.

http://health.howstuffworks.com/health-illness/treatment/medicine/ medications/tamiflu-psych.htm

As far as our office prescribing Tamiflu, we would rather not, but we will if you insist. I promise you that I personally am purchasing none for my family and would recommend the same to you.

Jay N. Gordon, MD, FAAP