In the News Swine Flu Shots

http://www.tsrn.us/blog/2009/09/24/nurses-plan-rally-to-protest-mandatory-swine-flu-shot/


with any pharmaceutical preventative product you want to know the risks and benefits

well with the swine flu shot let's focus on the benefits

less chance of contracting the swine flu
less chance of dying from the swine flu

what are the baseline risks? we don't know how many people have had the swine flu. we have only a tip of the iceberg view since most people are never tested for influenza when they have this mild viral illness and even they are tested our best estimates of the test accuracy is 50%. whatever your risk might be, that number is rapidly dropping as most of the country has outbreaks now effectively vaccinating the population the old fashioned way.

The chance of DYING of the swine flu decreases as the outbreak fizzles out and the mortality numbers just aren't out there that I can find. I saw somewhere the chance of hospitalization with swine flu is about 2 out of 100,000.

So we have 2 unknowns then we give the shot; we have no idea how effective the shot is but assuming it's 100% effective we'll vaccinate all 197 million of the people the government has kindly purchased vaccine doses for and then hope there's more people helped than harmed.

Sound public health spending if I ever heard it

I wonder who makes a profit from all this "medicine" and "science"

I wonder who foots the bill

All this for a medicine that has a small but unknown benefit IN THEORY and an unknown risk; how can we counsel patients on whether to get this vaccine when there's so little to gain and no proof of effectiveness?


http://www.cdc.gov/h1n1flu/surveillanceqa.htm

In the news Mammograms

this article was in the Yakima Herald Republic around July 10th 2009 but i can't find it now online 

LONDON (AP) -- One in three breast cancer patients identified in public screening programs may be treated unnecessarily, a new study says. Karsten Jorgensen and Peter Gotzsche of the Nordic Cochrane Centre in Copenhagen analyzed breast cancer trends at least seven years before and after government-run screening programs for breast cancer started in parts of Australia, Britain, Canada, Norway and Sweden.

The research was published Friday in the BMJ, formerly known as the British Medical Journal. Jorgensen and Gotzsche did not cite any funding for their study.

Once screening programs began, more cases of breast cancer were inevitably picked up, the study showed. If a screening program is working, there should also be a drop in the number of advanced cancer cases detected in older women, since their cancers should theoretically have been caught earlier when they were screened.

However, Jorgensen and Gotzsche found the national breast cancer screening systems, which usually test women aged between 50 and 69, simply reported thousands more cases than previously identified.

Overall, Jorgensen and Gotzsche found that one third of the women identified as having breast cancer didn't actually need to be treated.

Some cancers never cause symptoms or death, and can grow too slowly to ever affect patients. As it is impossible to distinguish between those and deadly cancers, any identified cancer is treated. But the treatments can have harmful side-effects and be psychologically scarring.

"This information needs to get to women so they can make an informed choice," Jorgensen said. "There is a significant harm in making women cancer patients without good reason"

Jorgensen said that for years, women were urged to undergo breast cancer screening without them being informed of the risks involved, such as having to endure unnecessary treatment if a cancer was identified, even if it might never threaten their health.

Doctors and patients have long debated the merits of prostate cancer screening out of similar concerns that it overdiagnoses patients. A study in the Netherlands found that as many as two out of every five men whose prostate cancer was caught through a screening test had tumors too slow-growing to ever be a threat.

"Mammography is one of medicine's 'close calls,' ... where different people in the same situation might reasonably make different choices," wrote H. Gilbert Welch of VA Outcomes Group and the Dartmouth Institute for Health Policy and Research, in an accompanying editorial in the BMJ. "Mammography undoubtedly helps some women but hurts others."

Experts said overtreatment occurs wherever there is widespread cancer screening, including the U.S.

Britain's national health system recently ditched its pamphlet inviting women to get screened for breast cancer, after critics complained it did not explain the overtreatment problem.

Laura Bell of Cancer Research UK said Britain's breast cancer screening program was partly responsible for the country's reduced breast cancer cases.

FAQs

How will you make a living?
I can go without making a living for a couple years, maybe 1000 days; this is too important a time to worry about my retirement account anyway. I Appreciate your concern for my finances, but frankly i'm more concerned with the finances of all potential patients. Because, health care expenses can crush you. My financial wealth is worth less because of bloated health care costs and they help make it impractical to open your own business. Fear of health care costs restricts our social freedoms severely because you are bound tightly to your job for the protection that health insurance affords.

What about malpractice insurance?
I can't afford it; I will continue to do my best but will make errors like anyone else. Since I won't have malpractice insurance, all a prosecuting at tourney would have to gain money wise from me are my meager assets.

What about medical records?
I won't be storing your medical records; if you want a note generated for your records and or your PCP's records then i'll provide a note for you to do with what you wish. I don't think I'll have access to your electronic medical records which further restricts how we'll manage medicines. We'll have plenty of time to work around any problems and gather records when needed. It'll take some getting used to.


Can you order tests?
I think so; but we'll have to have the results sent to your PCP and have you get a copy?

Do you have an DEA license?
yes and I don't believe that will be affected by leaving the clinic setting

Do you have a state medical license?
yes

Are you board certified?
yes but I won't be maintaining that since it's only an insurance billing requirement; CMEs or continuing medical education has traditionally been dominated by pharmaceutical sales reps

How's this going to work?
Well you'll sign on to yahoo instant messenger and open a window and talk to me and we'll go from there.

Participate a little or as much as you'd like; there are no hidden charges and no obligations to purchase anything

More later as the questions roll in

Mammography for breast cancer screening

Ok this is not an endorsement for or against screening mammograms. This is just some information that's important to consider before you decide if mammograms for screening is right for you.

Your risk factors may be high enough that mammography screening makes a lot of sense.

The decision should be based on a good understanding of the risks and benefits.

Here's a rough outline of those risks and benefits:

If 1000 women between the ages of 50-74 get mammograms yearly for 10 years

1 will have her life saved by mammography screening
between 2-10 will be diagnosed unnecessarily with breast cancer
between 10-15 will be diagnosed earlier but it won't affect the prognosis
100 to 500 will have at least one false positive test requiring more testing or biopsy

http://www.bmj.com/cgi/content/abstract/339/jul09_1/b2587?q=w_latest_topic
the british medical journal saying is a little differently


http://www.insidermedicine.ca/archives/VIDEO_One_in_Three_Breast_Cancers_Found_by_Screening_Mammography_May_Be_Harmless_Interview_with_Dr_Karsten_Jorgensen_MD_Nordic_Cochrane_Centre_3638.aspx


http://www.bmj.com/cgi/content/abstract/312/7026/273
talks about false positives ; each mammography center has a "recall" rate. The % of mammograms that are followed by "let's repeat the Xray" results
Our local center in Yakima, Ohana has a recall rate. I don't know the % for sure, but i'm sure we could find out.

http://www.scientificamerican.com/article.cfm?id=knowing-your-chances
this talks about one of the books of required reading if you want to make informed decisions about cancer screening tests

Lame Duck Session

I can not do everything a "PCP" can do, so please go ahead and check out the newly assigned docs and I think you'll like them.

I can provide things the PCP won't have the time for but our common goal will be your health. And like many treatments, combination therapy is superior to monotherapy.

Thank you for your patience

In the News 9/11/9

ok this one is great http://news.yahoo.com/s/ap/20090911/ap_on_go_ot/us_med_swine_flu

notice how the swine flu has hit and is the dominant strain of influenza already all over the country. Ok so that means we basically just vaccinated people all over the country. The outbreak has happened and it's not the end of the world afterall. Since most people are better in 3-4 days, this outbreak is like any unique viral plague with kids missing school and more visits to the doctor's office for reassurance. There are people who get really sick for sure, but this is kinda it. People are getting more and more immune as we speak yet the US government with the full backing of the CDC and major medical societies is the proud owner of 198 MILLION doses of the swine flu vaccine? Who is going to be left to vaccinate?

And notice who is reporting on safety and efficacy data, the companies making the vaccine. Wow sign me up for that shot!

It MIGHT prevent a 3 day illness

It might be safe

Oh and this is a great quote


"Chinese manufacturers gave the first hint a week ago that one dose could be enough. But different manufacturers make different formulations of the vaccine, so more evidence was needed."


Come on! The Chinese vaccine by the way has a different formulation! wonderful

so not only is the vaccine not made by the some people, but there's different stuff you can mix in the shot to make it work better or stay preserved longer

i don't quite remember but wasn't there a deal with chinese made stuff killing pets and poisoning babies?

sheesh

The local medical community should be signing petitions for a city counsel resolution reaffirming the citizen's right to choose and refuse medical treatments including this untested, largely irrelevant vaccine.

Sounds like a good use of the local farmer's market....

A work in progress

Since it's the most timely of the issues we face, I'll be working on influeza vaccinations, testing and treatment for the next few days and post more about the plans for the budding community later.

If anyone has expertise in making a forums, feel free to move the posts I have over and I'll work on further educational materials there.

Health care advice must be individualized, but there is a lot to be learned before getting into the room and making a decision. You are the best person to balance the risks and benefits ; medical professionals are simply here to interpret the language for you.

The information can be a little overwhelming until you get used to filtering out the advertisements from the data.

I'm here to supply information ahead of time so you can have a foundation to making an informed decision.

I welcome your questions and starting 10/1/09 I will be available most of the day to answer questions, provide advice and arange for free evals to help keep you away from the aspects of the medical system that do the least good.

doctorcrafts@yahoo.com to send emails, the same ID (doctorcrafts) will be my screen name for the free yahoo instant messenger service
sign up for yahoo instant messenger for online, instant access to your former PCP

I am resigning from the for profit medical system because it is bankrupting and sickening society. The practitioners within this corrupt system are good people who are fighting the good fight in an increasingly unmanageble financial/political landscape. I want to devote ALL of my time and energy toward helping patients separate the wheat from the chaff, the propaganda from reality. I have no financial incentives. My reward is reducing the harms and profits generated by a corrupt, mindless and heartless system. I am no longer your primary care physician (PCP); I am now your health care advocate (HCA). What I have to offer is free of charge.

PS the remainder of these posts probably make more sense if read from last to 1st...

The Future

http://singularityhub.com/2009/06/08/growing-organs-in-the-lab/

yeah they grow organs in the lab now 

http://www.physorg.com/news165512266.html

nano-tech

Health Care Reform

Here's a great summary of what has been labeled as health care reform which is actually health insurance reform 

http://www.slideshare.net/danroam/healthcare-napkins-all

a lot more to be added to this section later 

This looks interesting http://emptywheel.firedoglake.com/2009/09/08/liz-fowlers-plan/

of course a lot of the folks appointed to overhaul the health care payment systems have ties with the industry they are supposed to regulate 

http://www.nytimes.com/2009/07/28/health/views/28essa.html?_r=1

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Effective July 26, 2009, Washington state law requires that all fees and charges for health care services by health care providers and licensed facilities must be disclosed at the request of the patient. Providers and facilities may refer a patient to the patient’s insurer for specific information on the insurer’s charges and fees, any cost-sharing responsibilities required of the patient, and the network status of ancillary providers who may or may not share the same network as the provider or facility. Providers and facilities must post a sign in patient registration areas indicating that patients may ask about the estimated charges of the health services. This practice will comply with all applicable requirements.

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http://www.nytimes.com/2009/07/28/us/politics/28dodd.html?ref=us

Frequently Asked Questions

This list will constantly be changing as I figure out exactly what can and can't be done through this community.  Think of me as a free supplement to your health care;  sort of like supplemental insurance except without the paperwork.  Or think of me as an eccentric retired uncle physician who enjoys giving away his knowledge and skills to family members.  

I'm still not crystal clear on any limits to prescribing authority and ordering tests and labs,  but the goal will be avoid getting into writing a ton of prescriptions or ordering a lot of routine tests since the infrastructure to collect and store that data won't present.  

What can I do?

Provide advice,  answer questions,  do limited physical exams (check ups,  well child checks, sports physicals) 

Deal with acute problems like colds, flues, bronchitis, sinusitis

Help you manage your chronic medical problems such as diabetes,  high blood pressure (you'll still need to involve your primary care provider)

Home visits

Work visits

Group visits

Walk in the park visits

Hiking visits

Biking visits

Educational lectures to small groups, class rooms etc

Blood pressure checks

What can't I do?

Referrals to specialists (that requires dealing with insurance companies) 

Refills of chronic medicines (requires access to medical records and fax machines)

Prescribe pain medicines, benzodiazepines, stimulants or any other controlled substances (that's just asking for trouble)

DOT physicals or other work physicals that require lab work or other special testing 

Hospital care (requires insurance company credentialing) 

Fill out paperwork for your insurance company 

Deal with nursing home faxes or faxes of any sort

Nursing Home visits ( except to visit;  can't write orders there without insurance credentials )

More on Swine Flu with videos!

Here's an interview from the head of the CDC



http://www.youtube.com/watch?v=OobG8msQ-nc



Stating that what we've seen from this variety of H1N1 in the USA and around the world shows we won't have the 90,000 death toll "if the virus doesn't change"



keep in mind from our past experience with influenza pandemics and epidemics we can reasonably predict:



In their commentary in the Aug. 12 issue of the Journal of the American Medical Association, David M. Morens, M.D., and Jeffery K. Taubenberger, M.D., Ph.D., note that the two other flu pandemics of the 20th century, those of 1957 and 1968, generally showed no more than a single seasonal recurrence; and in each case, the causative virus did not become significantly more pathogenic over the early years of its circulation.
The variable track record of past flu pandemics makes predicting the future course of 2009 H1N1 virus, which first emerged in the Northern Hemisphere in the spring of 2009, difficult. The authors contend that characteristics of the novel H1N1 virus, such as its modest transmission efficiency, and the possibility that some people have a degree of pre-existing immunity give cause to hope for a more indolent pandemic course and fewer deaths than in many past pandemics.





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http://www.youtube.com/watch?v=31yMhpFbaEs



Word from an infamous physician skeptic of mass flu vaccination Dr. Tom Jefferson one of the leaders within Cochrane , more about Cochrane at a later date



The second fellow, I don't know who he is but he brings up good points about how we can not know the effectiveness of the H1N1 vaccine without many months of testing; what will be labeled as testing will be antibody studies ; as far as safety testing goes, well that'll have to come from post mass vaccination surveillance ie the population at large are the test cases



the news folks in the second interview attempt to put the doc in the same basket with autism/mmr folks and otherwise change the subject; and the good doctor throws in the US experience with swine flu vaccination programs back in the 70s but the disease he mentioned (Guillain-Barré Syndrome) it's unclear whether the flu shot caused that or not so everyone in that room is a little guilty of spin (in my humble opinion)



It would make a lot of sense to vaccinate folks at high risk of dying or getting severely ill from the swine flu just as we recommend with regular seasonal flu; it is interesting to note that our vast experience with the seasonal flu shots shows that the benefits are still rather vague and controversial. More on that in another post; mustn't get side tracked



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Just for nostalgia, here's some old commercials from the last swine flu scare



http://www.youtube.com/watch?v=ASibLqwVbsk&feature=related





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There are a couple interesting pieces of legislation being batted around re the swine flu



http://www.washingtonwatch.com/bills/show/111_HR_2596.html



http://www.maine.gov/tools/whatsnew/index.php?topic=Portal+News&id=78666&v=Article-2008



and don't ask me to interpret this next one but i've read interpretations that say this Mass Senate bill authorizes imprisonment and fines for people refusing vaccinations during a declared state of emergency http://www.mass.gov/legis/bills/senate/186/st02/st02028.htm



http://www.cbsnews.com/stories/2009/08/07/earlyshow/health/main5223926.shtml

(CBS) Federal officials say schools should become distribution centers of H1N1 vaccine shots this fall, an idea that has created some controversy.
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more from good ole Doctor Jefferson , this is a really good overview of influenza vaccinations in general

http://www.spiegel.de/international/world/0,1518,637119,00.html

Jefferson: Not particularly good. An influenza vaccine is not working for the majority of influenza-like illnesses because it is only designed to combat influenza viruses. For that reason, the vaccine changes nothing when it comes to the heightened mortality rate during the winter months. And, even in the best of cases, the vaccine only works against influenza viruses to a limited degree. Among other things, there is always the danger that the flu virus in circulation will have changed by the time that the vaccine product is finished with the result that, in the worst case, the vaccine will be totally ineffectual. In the best of cases, the few decent studies that exist show that the vaccine mainly works with healthy young adults. With children and the elderly, it only helps a little, if at all.

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Yeah, by the way, our rapid flu tests aren't terribly accurate. http://www.genomeweb.com/dxpgx/cdc-researchers-find-low-sensitivity-rapid-flu-tests-urge-use-rrt-pcr

Profits from the Swine Flu

http://www.nytimes.com/2009/07/24/business/24roche.html?_r=1&adxnnl=1&adxnnlx=1252335790-lSfZrwg7ZLzVaqkjRhpqTg

New York Times from 7/23/09 article detailing the sales of Tamiflu

Roche, based in Switzerland, said Thursday that sales of Tamiflu in the first half of 2009 tripled to 1 billion Swiss francs ($931 million), spurred by retail sales and the stockpiling of the drug by governments and corporations.
For the second quarter alone, Tamiflu sales reached 609 million francs ($567 million), more than 12 times the level of the second quarter of 2008. The second quarter, from April to June, is not usually a heavy season for flu.

AND

Still, Mr. Schwan said that Roche, in cooperation with outside contractors, would increase its manufacturing capacity to 400 million packs a year by the beginning of 2010, about four times the current capacity.
He said that should be an ample volume, given that the company sold a total of only 300 million packs during the last five years — a period that encompassed a bird flu scare as well as the current swine flu outbreak.

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But back in 2008, things weren't looking so hot for Roche

http://www.globalinsight.com/SDA/SDADetail12237.htm

The Losers
Meanwhile, sales of influenza treatment Tamiflu (oseltamivir) plummeted by a whopping 64% y/y. The plunge is explained both by a high baseline for the first quarter of 2007 and slowing demand as government stockpiles near completion (see Switzerland: 12 October 2007: Roche Braced for Tamiflu Sales Slowdown as Government Stockpiles Reach Saturation)



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http://www.cashive.com/2009/08/14/roche-rosw-swine-flu-stocks-to-watch/

Roche can make money off Tamiflu AND rapid flu tests

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But it does cost money for Roche

http://www.opensecrets.org/pacs/lookup2.php?cycle=2008&strID=C00072769

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here's a press release from Roche disguised as a news story on the front page of yahoo news

http://news.yahoo.com/s/ap/20090907/ap_on_re_eu/eu_switzerland_roche_tamiflu

Pharma Shenanigans

http://www.pharmfree.org/news/

http://finance.yahoo.com/news/Pfizer-to-pay-record-23B-apf-1176280604.html?x=0

Pfizer is not unusual in their marketing practices either 

FDA shenanigans

FDA user fees:
one of many overviews available in the press , this one from the

Washington Post http://www.washingtonpost.com/wpdyn/content/article/2007/04/02/AR2007040201622.html

Industry fees pay for more than half the drug-review program, with funds appropriated by Congress making up the rest. In fiscal 2006, Congress appropriated $219 million for the program, and user fees came in at $304 million.

From the FDA's website:

Fee Revenue Amount for FY 2008, Including Adjustments for Workload The total fee revenue amount for FY 2008 is $459,412,000, based on the fee revenue amount specified in the statute, including additional fee funding for drug safety and adjusted for inflation and changes in workload.

From the Wallstreet Journal

http://www.marketwatch.com/story/drug-industry-funding-of-fda-likely-to-be-renewed

Article from a whistleblower within the FDA
http://www.motherjones.com/politics/2005/05/side-effects-truth?page=1

In August 2004, Graham told his supervisors that, in light of his research, high-dose prescriptions of the painkiller Vioxx, which appeared to triple heart attack rates, should be banned. They told him to be quiet. Their reasoning was circular: That's not the FDA's position; you work here; it can't be yours. Dr. John Jenkins, the FDA director of new drugs, argued that because Graham's findings didn't replicate the drug's warning label, Graham shouldn't be raising the warning. Another supervisor, Anne Trontrell, called Graham's position "particularly problematic since FDA funded this study." Days after Graham's pronouncement, the agency approved Vioxx for use in children.But Graham was right. The following month, Merck pulled Vioxx from the market after its own research found that the drug, even when taken at low dosages, doubled the risk of heart attack. The announcement provided Graham no vindication. With a scandal on the horizon, the FDA brass now saw him as a danger. They couldn't silence the message, so they tried to take out the messenger.

Good Swine Flu Overview

But first a word about vaccines in general. I've found a tendency amongst folks to reflexively think that if someone is skeptical of the benefits of an isolated vaccine then that someone must be "anti vaccinations". This would be like saying if you're suspicious of the benefits of Nexium over Prilosec, you're "anti pharmaceuticals". Just like with a pill, it is only logical to look at the risks and benefits of each vaccine separately.




http://nikhimenon.blogspot.com/2009/08/great-swine-flu-hoax.html

Pretty brilliant


http://jama.ama-assn.org/cgi/content/full/302/7/795#AUTHINFO

Not about the swine flu but it gives you an idea of the conversation we should be having when we review risks and benefits BEFORE mass vaccination

http://www.news-medical.net/news/20090812/Past-flu-pandemics-help-predict-the-future-course-of-2009-H1N1-virus.aspx

this one talks about our past experience with pandemics and off season epidemics of the flu and how usually the second wave is a whimper



I have this next one posted elsewhere but it's such a good flu overview that I couldn't resist posting it again; an interview with Dr Tom Jefferson about influenza in general and the recent H1N1 as well
http://www.spiegel.de/international/world/0,1518,637119,00.html