Follow my blogs  

Spotlight on Sports Medicine

Medical Minutes

Health Headlines

October 30th, 2009

H1N1 News for Pregnant Women

If you’re pregnant, and you’re unsure, as nearly all pregnant women about what to do about the H1N1 vaccine, if you can even get the vaccine, of course, you might be interested to k now that an article published online in the journal, the American Journal of Obstetrics and Gynecology, concluded that the risks from an H1N1 infection are much greater – both to the pregnant woman and to the baby she is carrying – than any potential – and largely unproven – risks from an H1N1 vaccine.

In fact, the bottom line for these authors - who reviewed the experiences from 3 past flu pandemics - is that pregnant women are the HIGHEST risk group for H1N1 infections, and thus have the most to benefit from the vaccine.

October 30th, 2009

Statins and H1N1

Amidst all the gloom about not having enough H1N1 vaccine to satisfy all those who want to get it, here is a bit of heartening news: a small study from the US has shown that people who take statin drugs (those drugs to lower LDL levels, such as – sorry, trade names here because those are the most familiar to most people -  Lipotor, Zocor, Crestor, and others ) have a significantly lower risk (about half) of dying from a severe case of H1N1 compared to people not on statins.

No one knows the reason, of course, but statins are known to have a pretty potent anti-inflammatory effect (in fact, that’s probably an important part of the reason – along with their LDL-lowering effect – that they statins lower the heart attack risk in people who take them), and perhaps it’s that trait, namely, dampening down the severe and occasionally lethal inflammation that happens in rare cases of H1N1 infection – the so-called cytokine storm, that is responsible for their beneficial role in H1N1 infection.

Interestingly, if these results are actually found to hold true in larger studies, it may also help explain (in part) why people over 65, so many of who take statins these days, have an overall lower death rate from H1N1 than do younger people.

Bottom line: although no one should start taking statins to treat an H1N1 infection, if you’re already on one of those drugs for other reasons, hey, you may be getting an extra benefit from them.

October 28th, 2009

The Kids Are Not All Right

With everyone spending every spare sou of their medical attention allotment on H1N1, so many other (way more?) important stories are getting buried without people paying them the slightest heed.

One of the scarier reports this week came out of the Canadian Cardiovascular Congress in which a pretty detailed analysis of the health of several thousand teenagers is going downhill rather than getting better.

Thus, among these kids aged 14-15, over the last 6 years, 21 % now have at least one major risk factor for heart disease (it was 17 % 6 years ago) and an amazing 9 % more of them have high cholesterol (it's gone from 7 % to 16 %), while obesity has only gone up 2 % (to 13 %).

And make no mistake: studies have shown clearly that kids who already have risk factors for heart disease in their teens are much more likely to persist (even to raise the number and severity) in their risk factors into adulthood, when they start to pay the costs of those abnormalities.

What's happening out there?

Well, anyone with even a single functioning brain cell can figure this one out: they are sitting way too much and not being active nearly enough.

And if we - governments, educators, responsible adults, and most of all, parents - don't start doing something about it, those kids will end up living fewer years in poorer health than we do.

Is that what we really want to leave them?

October 28th, 2009

I got my H1N1 shot (and my seasonal flu shot) on Monday on the first day of its release.

I am asthmatic, and lately my asthma has been acting up, resulting in the need for more meds, so I guess I'm in the higher-risk category, although I am also over 60, so that's supposed to lower my risk somewhat, although no one really knows if it's true or why it's true.

So far, no problems with the shot - a bit of discomfort in the arm is all, but hey, as a world-class neurotic, I check every day.

So, for the dozens and dozens of people who've written in to ask what I'd do, that's what I did.

Am I worried about squalene (the adjuvant): no more than I worry about chlorine in my drinking water, medications in my drinking water, low-level contaminants in my food, radiation from plane trips, cancers from my wife calling me every day on my cell phone, because bottom line is that we're surrounded by low-level chemicals, toxins, pollutants, and I figure that if those low-levels are going to make a large difference in our lives, especially as in the case of an adjuvant in a one-off vaccine, then we're surely all pretty screwed and merely waiting in God's waiting room for our pretty-soon meeting with whomever we end up greeting up (or down) there.

And by the way, I'm a celiac, meaning that I have an "altered immune" response (to a protein called gluten, found in wheat, rye, barley), but that played no consideration in my march to get my vaccines.

Finally, I can't believe how many people have sent me a viral email claiming that this h1n1 vaccine is the "worst" ever and that it will cause (here you can fill in the blanks), and that all you need to do to prevent getting sick is to stay healthy by thinking healthy and by eating some combination of foods and taking some vitamin D.

So here's my advice: common sense tells me that if that were true, nearly every second person would be doing that because hey, who wants to get sick if all you need to do to stay healthy is eat onions, garlic, and vitamin D.

I sure would cuz eating beats a needle in my arm any day.

Only trouble is, the h1n1 virus doesn't really seem to care if you’ve just been eating bushels of onions and garlic, and swimming in vitamin D or even if you eat 3 bowls of Aunt Em's sure-fire anti-flu remedy of cornbread/mackerel andouille with shrimps straight from Louisiana: if the virus can land in your respiratory tract, you're going to get sick, although happily, most people who get sick get a mild case (many probably get no symptoms).

A few, however, get very sick, some severely sick, and a rare few (so far) will die.

And no one knows who those few will end up being?

So, do you feel lucky?

October 20th, 2009

AIDS: the much-publicized AIDS vaccine trial has now been found to have "only modest" results

The results from a very-hyped AIDS vaccine trial, the largest one yet done, was released early a few weeks ago because, according to the researchers highly-publicized data, the vaccine showed a "31 %" success rate after 3 years, which would make this the first AIDS vaccine trial to show any positive result.

The researchers said at the time that they didn't really understand why they got such good results, seeing as they were using a combination of two vaccines that had failed to show positive results on their own.

But a few days later, it also came out that the researchers had "massaged" the data to show the results in their best light, and that with different - but euqally-valid - calculations, teh results weren't nearly as good; in fact, some people calculated that based on the new way of looking at the numbers, the results could be explained entirely by chance.

Now, the reseach has been presented formally at a conference and the results seem to be somewhere in between those poles - not spectacular, but probably not due to chance alone.

So, is that a good thing or a bad thing?

The good part of this is that for the first time in a very long time, there is real hope and optimism in the AIDS vaccine community that the goal of finding an AIDS vaccine may not be impossible, after all.

The bad news, I think, is that this kind of vaccine with these kid of results (even at the high-end) would really have no utility for the public for the main reason that it doesn't offer enough protection to enough people.

We desperately need a workable AIDS vaccine, but this isn't yet the one.

October 17th, 2009

The attitude of Canada...

The attitude of Canada’s top public health people towards ordinary citizens’ concerns about the H1N1 vaccine is at best puzzling to me, at worst their answers to some important questions are disingenuous.

After all, we read and hear that H1N1 vaccine is available in the US, Australia, Sweden, and China, and will be available next week in the UK.

But when asked about why Canada is still waiting at least 2 weeks to roll out its vaccine supply, especially seeing as there’s been a clear – and worrying - spike in cases in British Columbia, we’re told to hold on because Canada is really not far behind anyone else.

Thus, according to one top expert I head on the radio yesterday, don’t worry because:

1. the US is not ahead of us really because American authorities have only provided live-virus vaccine (which is just not true; the US has shipped millions of doses of dead-virus vaccine, although they haven’t been as efficient at distributing those vials as they’d like, but hey, they’re dealing with 50 states and 340 million people, so you’d expect a few problems having enough vaccine and getting it out);

2. the UK has still not started its vaccine program (which is true as far as that goes, but UK authorities have promised that their program will be going full blast by next week, which will still be at least 2 weeks ahead of Canada);

3. yes, although Australia got a much earlier start that we did, that’s mostly because they had such a huge problem with the H1N1 pandemic during their winter season (our spring and summer), a rationale that I simply can’t comprehend (it seems to me that spending resources and effort and time making vaccines available to the population might be much harder, not easier, if you are also battling a huge pandemic at the same time; and besides, pharmaceutical companies make vaccines so why would their manufacturing processes be affected by what was happening in the community at large?)

And then there’s China, which has apparently been busily immunizing its population (of over a billion) for several weeks, and Sweden, which I believe started its program Monday of this week.

In Canada, however, the authorities tell us that we will be getting the vaccine out in “the first week of November” which could of course be either November 1 or November 7, so even a best case scenario puts us at least 2 weeks behind these other countries (and at least one neat study has argued that the earlier we get this vaccine out there, the better it will be for everyone: fewer people getting sick, fewer complications, less subsequent tax on overburdened intensive care units, and obviously far lower overall health care costs).

On top of that, even if we assume an atypical government-program efficiency in getting this vaccine to where it needs to go (I am not holding my breath), it still takes at least a week after a shot to develop immunity for this virus, so that means that it’s at least 3 more weeks (probably 4 or, I’ll bet,  5) for a large number of high-risk Canadians to worry about their health (and judging by the email I get, there’s a hell of a lot of people out there who are very worried), on top of which, unlike the situation in all the countries mentioned earlier, In Canada, there seems to still be a lot of debate about what to recommend for pregnant women give them the vaccine that will be shipped early in November, which has an adjuvant in it? Or should they wait for a non-adjuvant vaccine, meaning at least 2 more weeks after that).

And also unlike all those other countries, here in Canada, we still don’t have wide access to seasonal flu vaccine here, which many of us at high-risk for flu complications would like access to but can’t get.

The implication, I think, in all the answers I’ve read is that Canada is being safer than those other countries and we won’t rush a vaccine out until we know it’s totally safe?

Does that mean, then, that American, British, Australian, and Swedish authorities are more reckless?

Luckily, the H1N1 virus has still not mutated, and - this is terribly important to underline - most people who contract H1N1 get over it in a few days.

However, a small number get very sick, and a few even die.

And the way this mess has been handled – by the media, by WHO, by health authorities – seems to have made a lot of people very anxious that they will be among the few who get very sick.

So the sooner there is a vaccine available to give to those people who want one, the better, something that health authorities in every other democracy seem to have acknowledged, which is why I just don’t get it: why are we in Canada responding more slowly (more nonchalantly?) than those other countries?