Sunday, October 25, 2009

Time Magazine Article on Cancer Screening'

It's weird to me how no one wants to say "well since these tests are more likely to harm healthy people than save healthy people from cancer, let's not do these tests."

I mean if this was a pill to prevent cancer and yeah it prevents cancer in 1 person out of 2000 who take it for 10 years but the pill causes cancer to be diagnosed unnecessarily in 10 people out of 2000 who take it for 10 years and it causes almost all of them to have at least one false alarm for having cancer over those 10 years..... That pill would be laughed off the market.

I think it's just too horrible to admit such a large mistake.

We made a mistake. The 1st step is to admit it and stop making it worse by continuing to do the same harmful things just because it's what we've always done.

Saturday, October 24, 2009

National State of Emergency Declared

Health and Human Services Secretary Kathleen Sebelius now has authority to bypass federal rules when opening alternative care sites, such as offsite hospital centers at schools or community centers if hospitals seek permission.

That might be a politically correct way of saying "quarantine camps".  I don't know.  I've read that the US like most countries have signed an agreement with the World Health Organization that gives certain powers to the WHO on a local and state level to implement pandemic plans.  

But digging through the national disaster preparedness plan is like reading the small print on the back of a prescription pamphlet

Section 361 authorizes the Secretary to make and enforce regulations necessary to prevent the introduction, transmission, or spread of communicable diseases from foreign countries into the United States, or from one state or possession into any other State or possession. CDC administers these regulations as they relate to quarantine of humans. Diseases for which individuals may be quarantined are specified by Executive Order; the most recent change to the list of quarantinable diseases was the April 1, 2005 Executive Order 13375, which amended the Executive Order 13295 by adding “influenza caused by novel or reemergent influenza viruses that are causing, or have the potential to cause, a pandemic” to the list. Other provisions in Title III of the PHS Act permit HHS to establish quarantine stations, provide care and treatment for persons under quarantine, and provide for quarantine enforcement. Section 311 of the PHS Act provides for Federal-state cooperative activities to enforce quarantine and plan and carry out public health activities. Section 311 also authorizes the Secretary to make available the resources of the PHS to help control epidemics and deal with other public health emergencies. HHS may also engage in certain international activities under section 307 of the PHS Act. Statute 42 U.S.C. § 97, which provides that the Secretary of Health and Human Services may request that Customs, Coast Guard, and military officers aid in the execution of quarantines imposed by states. 

I don't know folks,  maybe this is nothing but there's some spooky stuff that's now legal to contain this "pandemic".  So far we've had adjuvant free swine flu shots but with this madness plus the shortage of vaccinations,  there might come a day very soon where untested adjuvants are added to the swine flu shot and maybe the average person will be compelled to take the vaccination if they want to travel or work or shop?   

Of course I wouldn't put it past our elected officials to just play games to maintain a sense of legitimacy and appearance of being "proactive" in the face of a "pandemic".   


Thursday, October 22, 2009

FDA Doesn't Stand for Fraud..... eventually

“The F.D.A. views any deviation from its high standards for developing or marketing drugs and devices as a potential threat to patient safety and public health,” Norris Alderson, the FDA’s associate commissioner for science, tells The New York Times. “We will take strong action against anyone who chooses to ignore or flout the legal requirements for the products we regulate.”

In a new report, the GAO found that more than half of the debarment proceedings in its review took 4 or more years, and factors contributing to these time frames included internal control weaknesses in the debarment process and competing priorities among responsible staff (read the report).

See if that works this time... Inside the FDA approval process . spooky just in time for halloween

Wednesday, October 21, 2009

When will Peak Swine be?


kinda weird how they didn't bother to quantify the harms and benefits

"Comments are no longer being accepted."   dang,   I signed up just to comment on this story;  there were already 206 when I first looked after just half a day and now they shut it down.  Interesting 

oh wait it's ok this one got in;  it's pretty accurate 

Of every 2000 women screened with mammos (per Cochrane):

200 will have false positives, with resulting worries and potentially mutilating surgeries

10 will be diagnosed but their outcomes are the same whether they were screened or not. Likely, they all feel they were helped, even though data shows their outcomes are neutral.

1 will have her life prolonged

Overall, 200 women are harmed for every one that is helped. I think your opinion on the benefit of screening depends on whether you are one of the 200 or the 1 (or think you are the 1).

Is it worth harming 200 women to help 1? That's the question.

Screening is a value judgment. How many people is it ok to harm to help the one?

Oh my goodness could it be true?

The American Cancer Society, which has long advocated early cancer screening, is rethinking its message, according to The New York Times. Spurred in part by the new analysis, the cancer society is working on a message — to put on its Web site early next year — to emphasize that screening for breast and prostate cancer and certain other cancers can come with a real risk of overtreating many small cancers while missing cancers that are deadly.

Folks with all the talk about health care reform,  THIS little tid bit here could change the course of medicine and save hundreds of thousands of men and women from a needless diagnosis of cancer whilst saving the country millions if not billions of dollars.  

IF the american cancer society follows through on this and changes their "message" to match the available evidence,  ho boy look out.  

This is seriously deep dogma in medicine and if it changes that my friends will be the beginning of something.

Tuesday, October 20, 2009

A little late for national mammogram day but

This means that for every 2000 women invited for screening throughout 10 years, one will have her life prolonged and 10 healthy women, who would not have been diagnosed if there had not been screening, will be treated unnecessarily. Furthermore, more than 200 women will experience important psychological distress for many months because of false positive findings. It is thus not clear whether screening does more good than harm. To help ensure that the women are fully informed of both benefits and harms before they decide whether or not to attend screening, we have written an evidence-based leaflet for lay people that is available in several languages on

Tamiflu FAIL;_ylt=Aozr.6OAC71WjavAlZIAlumS_aF4;_ylu=X3oDMTE1ZGlwc2w2BHBvcwM0BHNlYwN5bi1jaGFubmVsBHNsawNqdWx5NHN3aW5lZmw-

Many of the cadets were treated with oseltamivir, pills sold by Roche AG under the Tamiflu brand name, but they did not get better any more quickly than untreated cadets.
"We did use it in the hope that we would stem the tide of the outbreak but I don't think the Tamiflu was the key player in the outreak resolution," Witkop said.
"I think it was ... the isolation protocol," she added. Cadets stayed in the sick dorm until they were free of symptoms for 24 hours, or for seven days after first getting sick, whichever was longer.

Our first guest contribution!

Barbara sent me this via email;  it addresses the commonly used statistical trick of touting 5 year survival rates as signs of success within out health care system ;  i'll post that and my response to her just after ;  Thank you Barbara for the contribution! 

Cancer Treatment and Health Care Reform

One argument you may hear against health care reform concerns cancer survival rates. The United States has higher cancer survivor rates than countries with national health care systems, we’re told. Doesn’t this mean we should keep what we’ve got and not change it?

Certainly cancer survival rates are a critical issue for people suffering from the deadly lung cancer  "" mesothelioma. So let’s look at this claim and see if there is any substance to it. 

First, it’s important to understand that “cancer survival rate” doesn’t mean the rate of people who are cured of a cancer. The cancer survival rate is the percentage of people who survive a certain type of cancer for a specific amount of time, usually five years after diagnosis. 

For example, according to the Mayo Clinic, the survivor rate of prostate cancer in the United States is 98 percent. This means that 98 percent of men diagnosed with prostate cancer are still alive five years later. However, this statistic does not tell us whether the men who have survived for five years still have cancer or what number of them may die from it eventually.

Misunderstanding of the term “survivor rate” sometimes is exploited to make misleading claims. For example, in 2007 a pharmaceutical company promoting a drug used to treat colon cancer released statistics showing superior survival rates for its drug over other treatments. Some journalists who used this data in their reporting assumed it meant that the people who survived were cured of cancer, and they wrote that the drug “saved lives.” The drug did extend the lives of of patients, on average by a few months. However, the mortality rate for people who used this drug — meaning the rate of patients who died of the disease — was not improved.

But bloggers and editorial writers who oppose health care reform seized these stories about “saving lives,” noting that this wondrous drug was available in the United States for at least a year before it was in use in Great Britain. Further, Britain has lower cancer survival rates than the U.S. This proved, they said, the superiority of U.S. health care over “socialist” countries.

This is one way propagandists use data to argue that health care in the United States is superior to countries with government-funded health care systems. They selectively compare the most favorable data from the United States with data from the nations least successful at treating cancer. A favorite “comparison” country is Great Britain, whose underfunded National Health Service is struggling. 

It is true that the United States compares very well in the area of cancer survival rates, but other countries with national health care systems have similar results.

For example, in 2008 the British medical journal Lancet Oncology published a widely hailed study comparing cancer survival rates in 31 countries. Called the CONCORD study, the researchers found that United States has the highest survival rates for breast and prostate cancer. However, Japan has the highest survival for colon and rectal cancers in men, and France has the highest survival for colon and rectal cancers in women. Canada and Australia also ranked relatively high for most cancers. The differences in the survival data for these “best” countries is very small, and is possibly caused by discrepancies in reporting of data and not the treatment result itself.

And it should be noted that Japan, France, Canada and Australia all have government-funded national health care systems. So, there is no reason to assume that changing the way health care is funded in the U.S. would reduce the quality of cancer care. 

Barbara O’Brien


Part of the reason the US has a higher 5 year survival rate in breast and prostate cancer is the phenomenon of misdiagnosis and unnecessary diagnosis sprinkled with a touch of early diagnosis.  Most of the men diagnosed with prostate cancer in the US are via screening PSA testing.  These are early stage largely benign prostate cancers that are incapable of altering the natural life expectancy of the individual,  yet when these men live beyond 5 years after their "cancer" diagnosis it's counted as a victory for 5 year survival.  The best estimates with PSA screening say that for every man who has his life prolonged from the test 48 are unnecessary diagnoses. 
Breast cancer screening via mammography does similar things to our 5 year survival rates.  For every women who has her life prolonged by mammography 2-10 have an unnecessary diagnosis while 10-15 were diagnosed earlier without altering prognosis. 
Our mortality rates have been pretty stagnant since the 1980s while our incidence rate have skyrocketed with our screening tests capturing many fold more patients than benefit from the "early diagnosis"
This has little to do with who pays for health care.  Great Britain is home to the second largest pharmaceutical company on earth, GSK,  and participates in the same wasteful and harmful preventative testing and vaccinations as the US.  We all pay for high health care costs one way or another.  In the US we all pay by insurance premiums going up year after year and wages decreasing to match.  We all pay for the tax money wasted through medicare and medicaid.  We all pay when a member of society is bankrupted by health care costs and unable to provide a good environment for their children to grow up.  We all suffer by being inundated with ads telling us we're not healthy unless we "talk to our doctor" about the latest useless expensive drug to treat a symptom of a sick society. 
The health care coverage debate is a distraction from the fact that the western health care system is a for profit industry.  This is true in so called nationalized health care systems or in the USA.  It is a good thing to prevent the bankruptcies from health care expenses but by simply nationalizing some of the costs we simply spread the pain out more evenly. 

Saturday, October 17, 2009

GSK's big bet

LONDON -- GlaxoSmithKline PLC has spent five years fashioning itself into a one-stop pandemic shop. Now, as the swine-flu virus sweeps the globe, the U.K.-based drug giant will find out whether the world is buying.

Thursday, October 15, 2009

Oh man this is long but it's gooooood

try to ignore the political references to hurricane Katrina etc; there's some good incites in this one on how statistics are used to deceive

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.”

The one area where the seasonal flu shot has been shown to reduce mortality (vaccinating the elderly) shows such a dramatic decrease in mortality from ALL CAUSES that some independent thinkers had to dig deeper.

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.”

Vaccine profits

some interesting comments after the article too

This one speaks for itself

An oldie but goodie

2006 study of the practices of the advisory panels for the FDA which are the front lines of the approval process for new drugs and devices

The results indicate that advisory committees recommended approval for 76% of new drugs and 82% of new medical devices. Some committees are more discriminating than others. Many panel members and some committee members recommended approval for every product they considered year after year. For example, 98% of the votes by members of the advisory committee reviewing arthritis drugs over the eight years of the study recommended approval; almost all, like Vioxx®, were recommended unanimously. The committee reviewing medical devices for vision correction and eye diseases unanimously recommended approval for every medical device they considered for the last six years of the study. About 96% of these drugs and devices were subsequently approved by the FDA.

Tuesday, October 13, 2009


Thanks to Joel I've gone twitter crazy. There's still time for people to push back against this mindless swine flu vaccination campaign. There's still the forums to get started (finally) but between seeing sick children and doing sports physicals, I've been working on ways to encourage debate over the swine flu mandates throughout the health care industry. Most of you are aware of Memorial Hospital's decision to force all their clinicians to accept an untested bio pharmaceutical or suffer the consequence of wearing a mask on hospital property for 5 months: A very public questioning of their individual clinical judgement.

I have a slide show to get published looking at the CDC data on the swine flu epidemic.

Join twitter if you haven't already to participate in spreading the knowledge.

Any of you who want to sit down and talk about anything, I'm an email away. I've enjoyed the meetings I've had with folks so far.

Wednesday, October 7, 2009

Wed 10/7/09

I'll be in a cardiology conference most of today; don't know if i'll have internet access there but I bet I will

will be out of that thing and home by 630 if not

still working on the forums deal, getting closer

thanks for all of the great advice and assistance

Monday, October 5, 2009

Slow Money

Slow Money's Mission
• To steer significant new sources of capital to small food enterprises, appropriate-scale organic farming and local food systems; and,
• To catalyze the emergence of the nurture capital industry— entrepreneurial finance supporting soil fertility, carrying capacity, sense of place, cultural and ecological diversity, and nonviolence.

Sunday, October 4, 2009

Conflict of interest

The problems I've discussed are not limited to psychiatry, although they reach their most florid form there. Similar conflicts of interest and biases exist in virtually every field of medicine, particularly those that rely heavily on drugs or devices. It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of TheNew England Journal of Medicine.
--Marcia Angell, M.D. (born 1939) is an American physician, author, and the first woman to serve as editor-in-chief of the New England Journal of Medicine (NEJM). She currently is a Senior Lecturer in the Department of Social Medicine at Harvard Medical School, in Boston, Massachusetts

British doctors plan to refuse swine flu shots

Saturday, October 3, 2009

check out how many folks have high levels of antibodies naturally to swine flu

For all you health care professionals looking at this for Flu info

"There is no evidence to show if regular influenza vaccine is beneficial to people with CF"

Influenza (flu) is a highly infectious disease, caused by viruses. Influenza has been thought to cause asthma attacks. Few trials have
been carried out in a way that tests whether asthma attacks following influenza infection (as opposed to following the vaccination) are
significantly reduced by having influenza vaccination, so uncertainty remains in terms of how much difference vaccination makes to
people with asthma. The included studies suggest that the vaccine against influenza is unlikely to precipitate asthma attacks immediately
after the vaccine is used.

There is no high quality evidence that vaccinating healthcare workers reduces the incidence of influenza or its complications
in the elderly in institutions
There is evidence that vaccinating the elderly has a modest impact on the complications from influenza. There is also high quality
evidence that vaccinating healthy adults under 60 (which includes healthcare workers) reduces cases of influenza. Both the elderly in
institutions and the healthcare workers who care for them could be vaccinated for their own protection, but an incremental benefit of
vaccinating healthcare workers for the benefit of the elderly cannot be proven without better studies.

In long-term care facilities, where vaccination is most effective against complications, the aims of the vaccination campaign are fulfilled,
at least in part. However, according to reliable evidence the usefulness of vaccines in the community is modest. The apparent high
effectiveness of the vaccines in preventing death from all causes may reflect a baseline imbalance in health status and other systematic
differences in the two groups of participants.

Influenza vaccines are efficacious in children older than two but little evidence is available for children under two. There was a
marked difference between vaccine efficacy and effectiveness. No safety comparisons could be carried out, emphasizing the need for
standardisation ofmethods and presentation of vaccine safety data in future studies. Itwas surprising to find only one study of inactivated
vaccine in children under two years, given current recommendations to vaccinate healthy children from six months old in the USA and
Canada. If immunisation in children is to be recommended as a public health policy, large-scale studies assessing important outcomes
and directly comparing vaccine types are urgently required.

Friday, October 2, 2009

these are the same people recommending swine flu shots

when you heard the CDC recommends something, we're talking about this committee


Well folks,

Looks like this weekend we should have a forums site which will be much more organized and searchable

I was thinking we could use a section for stories about the hard economic times made worse or caused by the cost of health care. I've heard over the last 9 years more and more stories of folks stuck with unpayable medical bills that they are forced to deal with in the middle of an illness. Even more frequently I hear about the rising copays, deductibles, insurance denials, hard time affording medicines etc.

The financial stress the system causes sure isn't good for our health.

So I'm looking for contributions and personal stories once the forums is up and running. Everything you contribute can be annonymous.

Those of you who aren't getting email responses from me, check your spam folders. These email programs nowadays love to randomly put email in the spam folder. Yet another reason to get on the instant messenger.

Those of you who are overwhelmed trying to figure out the computer stuff, I can always come over and set stuff up for you when I make home visits.

Thursday, October 1, 2009

Things I Need Help with

ok tons of yall are asking how you can help

here are things I can think of you can give me:

1) Your time and consideration and skepticism for a few of the issues I raise on this blog that grap your attention; ask questions on IM or email or in person , I enjoy explaining this stuff

2) Anyone who can make a forums site out of this hodgepodge of posts here go ahead and set it up

3) I want to plant; I want my front yard to produce food, like a couple fruit trees mixed in with rows of peas and beans and what not; the problem is , i'm clueless on how to turn the water, soil and sunlight into something edible; i know that i probably have to start by rototilling the yard? any expertise or assistance would be appreciated

4) research medical topics and send me the links to good sites and i'll post them up ; politics, science , policy it doesn't matter anything that educates benefits the entire community

5) Request the fee scales from every medical establishment with whom you interact. There's some law that clinics and hospitals and radiology suites have to give you a copy of their services and charges if requested. Get those pieces of paper and give them to me and up they go.

6) Ask every doctor you interact with about their take on swine flu. Ask them the risks of getting the swine flu, getting hospitalized from the swine flu and the benefits of the vaccine to come. Ask them if they believe in mandatory vaccinations of children in the public schools , health care workers, the general population. Ask if they believe this virus warrants forced quarantine.

Your questions have a profound impact on our practice, trust me. It doesn't take many patients asking the answer to something we don't know before we start dusting off our brains.

Thank you

Swine Flu at the CDC

this is really hard to read and there's a ton of "spin" in the reporting but just check out the map at the very bottom of the page

this was for the week ending 9/19

you can see how most of the country has widespread flu activity; most of that if not 99% of that activity is the 2009 H1N1 AKA swine flu

the outbreak is happening yet the news doesn't talk about it for some reason; probably because people will naturally ask "why give the vaccine after the danger has passed?"

they are being a little sneaky with the reporting of hospitalizations and deaths from the swine flu since that's limited to confirmed cases ; see at least half the time when you have swine flu you test negative , so we don't get a clear picture of how many people are really infected making it seem like a larger % of the people infected are getting hospitalized or dying


Three influenza-associated pediatric deaths were reported to CDC during week 37 (Texas [2] and Virginia). These deaths were associated with 2009 influenza A (H1N1) virus infection, and occurred between August 30 and September 19, 2009. Since September 28, 2008, CDC has received 117 reports of influenza-associated pediatric deaths that occurred during the current influenza season (25 deaths in children less than 2 years, 12 deaths in children 2-4 years, 35 deaths in children 5-11 years, and 45 deaths in individuals 12-17 years). Forty-nine of the 117 deaths were due to 2009 influenza A (H1N1) virus infections, and four of these have occurred since August 30, 2009.
Of the 50 children who had specimens collected for bacterial culture from normally sterile sites, 19 (38.0%) were positive; Staphylococcus aureus was identified in 13 (68.4%) of the 19 children. Six of the S. aureus isolates were sensitive to methicillin and seven were methicillin resistant. Seventeen (89.5%) of the 19 children with bacterial coinfections were five years of age or older and 12 (63.2%) of the 19 children were 12 years of age or older. Nineteen (38.8%) of the 49 children with confirmed 2009 influenza A (H1N1) infection had a specimen collected from a normally sterile site; five (26.3%) of the 19 children had a positive bacterial culture (methicillin sensitive S. aureus [2], methicillin resistant S. aureus [2], and Streptococcus constellatus


so in the middle of a wide spread outbreak (between August 30 and September 19, 2009) when the population is an unimmune to the swine flu as they can get we had 3 pediatric deaths nationwide

it then goes on to talk about staph bacteria coinfecting children with the flu; our problems with rampant resistant staph infections probably has more to do with the deaths caused from viral infections like the swine flu than the virus itself

our food supply being supersaturated with live stock antibiotics and one of our childhood vaccines (prevnar) exacerbate the antibiotic resistance problem

"The use of the vaccine created an ecological vacuum, and that combined with excessive use of antibiotics to create this new superbug," Pichichero said.

“Being a carrier of MRSA has increased a lot, especially among school-aged kids,” said Lyn Finelli, chief of influenza surveillance at the CDC. “And being colonized may put them at risk for a severe staph aureus infection when they get the flu.”

Whether the current increase in severe community-acquired S. aureus infections, including methicillin-resistant S. aureus (6), is partially caused by the recent introduction of the pneumococcal conjugate vaccine is yet to be determined.

Wyeth Sees Prevnar Vaccine Sales Reaching $3 Billion In 2009 –
NEW YORK -(Dow Jones)- Wyeth (WYE) expects sales of its Prevnar vaccine to rise to $3 billion in 2009, driven by overseas growth and new launches,

A trial with a 7-valent pneumococcal-conjugate vaccine in children with recurrent acute otitis media showed a shift In pneumococcal colonisation towards non-vaccine serotypes and an Increase In Staphylococcus aureus-related acute otitis media after vaccination. We investigated prevalence and determinants of nasopharyngeal carriage of Streptococcus pneumonlae and S aureus in 3198 healthy children aged 1-19 years. Nasopharyngeal carriage of S pneumonlae was detected In 598 (19%) children, and was affected by age (peak Incidence at 3 years) and day-care attendance (odds ratio [OR] 2.14, 95% Cl 1.44-3.18). S aureus carriage was affected by age (peak incidence at 10 years) and male sex (OR 1.46, 1.25-1.70). Serotyping showed 42% vaccine type pneumococci. We noted a negative correlation for co-colonisation of S aureus and vaccine-type pneumococci (OR 0.68, 0.48-0.94), but not for S aureus and non-vaccine serotypes. These findings suggest a natural competition between colonisation with vaccine-type pneumococci and S aureus, which might explain the Increase in S aureus-related otitis media after vaccination.