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

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.

Two salient characteristics of a virus are transmissibility and virulence.

This H1N1 so-called “Swine Flu” virus, like almost all influenza A, is VERY transmissible. Similar to colds, stomach bugs, chicken pox and more

BUT—

Unless it’s a virulent (i.e. vicious, dangerous, killer-type) strain of influenza, the answer for most of us can be “so what?” And the CDC certainly seems to be saying that this virus lacks those characteristics.

Not to be too facile about the 10, 20 or 30 thousand deaths that influenza causes in an average year, but that translates into a very small percentage of our population.

For instance, influenza is fatal to about 35,000 Americans every year. Nine out of ten of these fatalities occur in people over age 65-70, and a huge percentage (nobody quite agrees) occurs in people with underlying medical issues like heart disease, lung disease or immune compromise. Illness and deaths in otherwise healthy people will always occur and make the best news stories, but this is an inaccurate portrayal of influenza.

Stephen Hume’s article in the Vancouver Sun perhaps says it best: “‘Eighty-one dead in Mexico; U.S. declares emergency,’ read one of the headlines Sunday. Yes, 81 dead in Mexico is something to grieve and is cause for public concern. Each one of those dead represents the anguish of a family. Yet, as the aphorism goes, one death is a tragedy, a million deaths is a statistic. It’s confusing the statistic for the tragedy that exaggerates fear.” (Emphasis added.)

This virus will spread all over, create panic, be identified as the cause of many, many, many more deaths than it actually causes and then will fade away with the real data gathered over the next year or more.

Today or tomorrow… phase 6 is expected.

Just to say it again, this flu poses no great threat to you or your family.

Jay N. Gordon, MD, FAAP

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.

I am very much aware of children and adults who have suffered severe and even fatal consequences from Swine Flu. You may know someone or, if you’re a health care professional, you may be caring for one of those patients. There is no way to minimize how devastating this is. 70-90% of those patients belonged to high-risk groups, and it was for them that the H1N1 vaccine was created. Media and government misinformation may actually lead to fewer of these high-risk children having access to a vaccine they need as they are moved aside by people with better access to medical care.

I believe I have seen dozens of children with Swine Flu. This H1N1 Influenza is uncomfortable, inconvenient and could certainly even be life-threatening to a very, very small number of people. A doctor implying that it’s actually anextremely dangerous part of this or any other winter is doing a disservice to you and the community. Many other (non-vaccinable) illnesses pose a far greater threat. And even they should not keep you away from your usual life’s schedule. A related worry is that the community’s focus on Swine Flu might lead to a missed diagnosis of other febrile winter illnesses.

The vaccine is not dangerous but will cause harm to a tiny percentage of those who receive it.
(Youtube videos circulating and scary vaccine-reaction stories are not a fair characterization of the facts.)

The illness will also cause harm to a tiny percentage of those who contract it.

Declaring this a “national emergency” while vaccines are not even available to 99% of people was ill-advised to say the least.

I have practiced medicine through the era of polio, HIB meningitis, and much more. I’ve diagnosed two cases of botulism, one case of diphtheria decades ago and cared for patients with tetanus. I have seen hundreds of children and families survive pertussis–with no whooping cough fatalities in thirty years of practice. I have hospitalized children with RSV many winters in a row. For doctors and the government to imply that we have a dangerous pandemic on our hands distorts the entire community’s approach to health care, scares people and, yes, the anxiety provoked is causing more medical problems than the disease itself.

Below is an interesting new article about the European flu shot. An adjuvant is a chemical which “jump starts” or irritates the immune system and causes it to respond to a smaller amount of actual vaccine. This saves money for the manufacturer and also “stretches” the vaccine supply. There may be unintended consequences to creating that much irritation/inflammation in the immune system and in the entire body. The article below addresses this topic. The American H1N1 vaccine does not contain an adjuvant at the present time, but the President’s declaring a “national emergency” may allow the addition of the chemical discussed in the article.

Med Microbiol Immunol. 2009 Oct 23. [Epub ahead of print]

Possible hidden hazards of mass vaccination against new influenza A/H1N1: have the cardiovascular risks been adequately weighed?

Bhakdi S, Lackner K, Doerr HW. Institute of Medical Microbiology and Hygiene, University Medical Center, Augustusplatz, 55101, Mainz, Germany, sbhakdi@uni-mainz.de.

Programs for vaccination against the new influenza A/H1N1 targeting many hundred million citizens in Europe and the USA are to be launched in the fall of this year. The USA is planning to employ a non-adjuvanted vaccine, whereas European nations are opting for inclusion of MF59, the adjuvant contained in an alternative seasonal flu vaccine, or the related adjuvant AS03 that is contained in a recently developed H5N1 vaccine. We draw attention to unappreciated hazards of using adjuvanted vaccine in Europe. Evidence from animal experiments in conjunction with clinical epidemiological data indicates that, quite irrespective of cause, stimulation of the immune system may accelerate atherogenesis. Application of adjuvanted flu vaccines to individuals at risk may therefore aggravate the course of underlying atherosclerotic vessel disease with all the clinical consequences. The same may hold true for other widespread diseases that are propelled by deregulated immune mechanisms. Safety trials conducted to date have not specifically taken these possible side effects into account, and unexpected serious adverse effects thus may follow in the wake of a general vaccination program. A prudent consequence would be to establish careful survey systems alongside with mass application of new adjuvanted vaccines, or to hold mass vaccination in reserve for use only in situations of true need, such as would arise with the emergence of a more virulent new H1N1 virus strain, or to use non-adjuvanted vaccines in individuals who are potentially at risk for adverse side effects.
PMID: 19851782 [PubMed - as supplied by publisher]

http://tinyurl.com/ygzewsb

This is not a discussion of vaccine safety, autism or similar issues. This is a discussion of medical honesty and integrity.

Jay Gordon, MD, FAAP

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.

We expect H1N1 flu vaccines to arrive in our office in a week or two. I am willing to give them to high risk children. Tamiflu has side effects which give me great pause.

http://www.theatlantic.com/doc/200911/brownlee-h1n1

“Tom Jefferson, a physician based in Rome and the head of the Vaccines Field at the Cochrane Collaboration, a highly respected international network of researchers who appraise medical evidence, says: “For a vaccine to reduce mortality by 50 percent and up to 90 percent in some studies means it has to prevent deaths not just from influenza, but also from falls, fires, heart disease, strokes, and car accidents. That’s not a vaccine, that’s a miracle.”

“Jackson’s findings showed that outside of flu season, the baseline risk of death among people who did not get vaccinated was approximately 60 percent higher than among those who did, lending support to the hypothesis that on average, healthy people chose to get the vaccine, while the “frail elderly” didn’t or couldn’t. In fact, the healthy-user effect explained the entire benefit that other researchers were attributing to flu vaccine, suggesting that the vaccine itself might not reduce mortality at all. Jackson’s papers “are beautiful,” says Lone Simonsen, who is a professor of global health at George Washington University, in Washington, D.C., and an internationally recognized expert in influenza and vaccine epidemiology. “They are classic studies in epidemiology, they are so carefully done.”

“As with vaccines, the scientific evidence for Tamiflu and Relenza is thin at best. In its general-information section, the CDC’s Web site tells readers that antiviral drugs can “make you feel better faster.” True, but not by much. On average, Tamiflu (which accounts for 85 to 90 percent of the flu antiviral-drug market) cuts the duration of flu symptoms by 24hours in otherwise healthy people. In exchange for a slightly shorter bout of illness, as many as one in five people taking Tamiflu will experience nausea and vomiting. About one in five children will have neuropsychiatric side effects, possibly including anxiety and suicidal behavior. In Japan, where Tamiflu is liberally prescribed, the drug may have been responsible for 50 deaths from cardiopulmonary arrest, from 2001 to 2007, according to Rokuro Hama, the chair of the Japan Institute of Pharmacovigilance.”

http://clinicalevidence.bmj.com/ceweb/resources/editors-letter-full.jsp?src=editorsletter_intro

“In summary, evidence presented here points to influenza being a relatively rare cause of [influenza-like illnesses] and a relatively rare disease. It follows that vaccines may not be appropriate preventive interventions for either influenza or ILI.”

Jay Gordon, MD, FAAP

Please don’t be fooled into thinking that this winter is so different from previous winters.

Swine Flu does not pose a realistic risk to your family: There will be millions of cases reported and rare fatalities highly publicized.

Some of us will get high fevers and have to miss school and work for a few days and 99.9999% of us will remain completely unaffected after the flu season except that those who contract Swine Flu this year will be protected if it gets meaner and more virulent in coming years as expected.

Every winter there are dozens and dozens of different viruses. The immune system is built by catching and beating these bugs and acquiring antibodies and “memory cells” for the next time the virus appears.

There is no way around this process and no shortcut. Children, in particular, must suffer through a lot of winter illnesses because their immune systems are so inexperienced.

Colds and coughs have an acute phase of 2, 3 or 4 days during which children are contagious and may need to stay home from school.

Following this contagious period, there can be extra mucus, congestion, cough and malaise for another week or so. By the end of this ten-day period, most children will have been exposed to, and maybe contracted, another 2 or 3 other viruses! It’s really no surprise that your children and many others might seem to be sick for weeks on end.

Some children and adults have allergies which compound the congestion and coughing problem.

A new study showed that when you examine the blood of children who’ve been sick for a couple weeks or more the majority of these kids show antibodies to 2 or 3 different viruses: In other words, children and adults don’t have ten-day viral illnesses, they have a series of 2 and 3 day bugs which might look daunting but are actually just a part of a normal winter viral season.

Why do we get more illnesses in winter? There are more social and school gatherings in confined spaces, the air is drier, more people travel during winter holidays and we eat more junk food during these months.

New viruses get more people sick than older ones and this year the Swine Flu H1N1 virus is the newest common infection.

The media are taking advantage of this situation and are creating more anxiety about winter illness than at any time in recent memory.

Except, maybe, for the SARS scare.

Or the Bird Flu scare.

Or the West Nile Virus scare.
The CDC released fatality data this past week and were quite clear in their assessment of this relatively non-virulent strain of influenza:

75-80% of the 76 children had significant or severe underlying medical problems.

Any child’s death creates an extremely difficult public discussion but of the 300,000,000 Americans there are 45,000,000 children and teens and there have been 76 deaths of younger people. About 15 of these deaths occurred in seemingly healthy children and teens.

Please put all of these numbers in the proper perspective and realize that there are many important lifesaving topics for the media to publicize but none which sell papers and create TV viewership quite as well as this new flu.

In July CDC and World Health Organization officials stopped counting the number of cases of Swine Flu and are now relying on a patchwork reporting system which is reporting both “lab confirmed” cases of H1N1 and fatalities from cases which are associated with symptoms of Swine Flu. The science is terrible but the publicity is geared towards increasing fear, selling vaccines and Tamiflu and keeping us all on edge.

They are reporting deaths from “secondary” bacterial infections and some unofficial sources are even urging people who might be sick with Swine Flu to immediately see their doctors to get vaccines which might prevent bacterial pneumonia. This, by the way, is a serious misinterpretation of certain vaccines’ purpose and an even more serious misunderstanding of how long it takes a vaccine to work.

Vaccines, including the flu shots, should not be given to sick children or adults.

In the past 18 months, budget cutbacks have led to the loss of over 15,000 public health department jobs. It might be overly cynical to assume that a full court press about H1N1 could lead to some of these jobs being restored or, at least, might stem the budget cutbacks and preserve further job loss.

Every winter I tell the families in my practice that winter viruses–including this new H1N1–are very unlikely to cause serious illness in healthy people but you may choose to do your very best to avoid them before a vacation, an important school event or just because you want this to be a quieter winter for your family.

I don’t think that this year’s pair of flu vaccines will create disasters but I also don’t think that they’re a good use of our health care dollars. They are definitely not worth the amount of media and medical attention they’ve received and continue to receive.

Swine Flu vaccines are now available and they may be just as safe as the CDC and others say they are but they are not the most important measure for keeping your children free of viral illness.

Try to get a good night’s sleep!! Somehow.

• Wash your hands. Teach your children to wash their hands. A good long hand washing, about as long as it takes to sing “Happy Birthday” twice or the ABC’s once through is about what it takes. Hand sanitizer is acceptable in moderation when there is no soap and water.
• Work with your children’s schools to have children wash their hands, especially before they eat snacks or lunch. Hand washing is no small benefit in flu and cold prevention but involves a good deal of parental requesting to truly implement at most busy schools.
• When you and your children come home, wash hands again.
• Avoid refined sugars, dairy and fried foods which make you and your children less healthy, replace antioxidant-rich fruits and vegetables and may lower your immunity. Work with your children’s schools to stop serving cupcakes at each and every birthday. If one kid’s mom or dad brings in sweets for celebrating, then everyone’s mom and dad does. Make it a “no one” does policy, so no one feels singled out and everyone stays healthy. Ask your child’s school to not serve sweet sugary snacks at all. Get your Parent/Teacher groups on board. Pack healthy and well-balanced meals for your kids.
• Support your child’s immunity with herbs and supplements (look for brands that are not loaded with additives and sugars) For the most part, they’re not proven effective but most have centuries of safe use behind them and seem to help promote good health and stronger immunity.
  • Astragalus: one dose three times a week will help support immunity during flu season (This herb seems to be valuable only before an illness and not during.).
  • Echinacea and Goldenseal: one dose every day in a liquid or chewable form. My favorite is echinacea tea.
  • Vitamin C and Bioflavonoids: I recommend for children (and take) 500 mg of vitamin C per year of age divided into 3-4 doses each day during cold and flu time. (A five year old would get 2500 mg and a 10 year old 5000 mg. The maximum dose is 10,000 mg–Less if C gives you diarrhea.)
  • Elderberry is a patented and proven viral treatment
  • Probiotics: 5 to 10 billion CFUs each day to build immunity

Fever is one of the immune system’s best tools for fighting viruses and bacteria and should be left alone whenever possible. Higher fever might need to be decreased for a child’s comfort and, mainly, for assessment.

104 degree children all look like they might have a terrible illness. Using a long bath, natural remedies and even Tylenol or Ibuprofen will give you a “window” to look at a child with a much lower temperature. A cooler child will usually smile more, drink more and look more like herself.

You can then see that there might be a pretty big fever but the illness underlying the fever is a small illness. Worry and stress levels can drop.

If your child has an illness which is preventing good hydration or if lowering a child’s fever still doesn’t allow you to adequately evaluate the illness, call your doctor.

Again, this winter is not different than previous winters. Swine Flu does not pose a realistic risk to your family.

Jay Gordon, MD, FAAP

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