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
Thursday, October 1, 2009
Swine Flu at the CDC
http://www.cdc.gov/flu/weekly/
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
http://www.washingtonpost.com/wp-dyn/content/article/2007/10/16/AR2007101601392_pf.html
"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,
http://cat.inist.fr/?aModele=afficheN&cpsidt=15841788
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.
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
http://www.washingtonpost.com/wp-dyn/content/article/2007/10/16/AR2007101601392_pf.html
"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,
http://cat.inist.fr/?aModele=afficheN&cpsidt=15841788
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.
Monday, September 28, 2009
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
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.
Sunday, September 27, 2009
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
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
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
Friday, September 25, 2009
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
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
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