Friday, October 30, 2009
Sunday, October 25, 2009
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
Thursday, October 22, 2009
Wednesday, October 21, 2009
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?
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.
Tuesday, October 20, 2009
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 www.cochrane.dk.
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.
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 "http://www.maacenter.org/mesothelioma/" 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
Saturday, October 17, 2009
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
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.”
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
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
Monday, October 5, 2009
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
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
Saturday, October 3, 2009
check out how many folks have high levels of antibodies naturally to swine flu
"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
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
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.
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  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 , methicillin resistant S. aureus , 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 – CNNMoney.com
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.