This year’s influenza season is unique in that there are additional strains circulating, with unclear medical implications for the US population. I interviewed Dr. Joseph Stubbs, president of the American College of Physicians, to get the inside scoop on what to expect this year with the H1N1 and seasonal flu strains. You may listen to the podcast or read a shortened version of the interview below.
Dr. Val: Why are younger people and pregnant women more susceptible to H1N1 flu?
Dr. Stubbs: What we think is going on with younger people is that some of the genetic material of the H1N1 flu virus was part of the seasonal flu before the 1960’s. Older individuals may have an enhanced immune response to the novel H1N1 virus because their bodies can recognize it and fight it more effectively. Since younger people have never been exposed to this virus before, they’re more susceptible to it.
As far as pregnant women go, we’re not exactly sure why they’re at higher risk for complications from the H1N1 flu, but it’s possible that their susceptibility is related to changes in the immune system associated with carrying a baby. The immune system has to tolerate and accept the growing fetus – which happens to make it less effective at fighting off viruses.
Dr. Val: What’s the latest on the timing of vaccine availability? Do you think we’ll get it in time to head off an epidemic?
Dr. Stubbs: HHS Secretary Sebelius recently announced that the FDA has approved the novel H1N1 flu vaccine, and it appears that it will be effective with one shot. They’re hoping to make it available within the first 2 weeks of October, which is ahead of schedule. However, we still don’t know how much of the vaccine will be available, and how hard we’ll have to ration it. We hope that this will ward off a major pandemic. But here in Georgia, we’ve already been seeing a large number of cases.
Dr. Val: Should physicians prioritize their patients and give the vaccine to the at-risk groups first?
Dr. Stubbs: Right now we are planning to ration the vaccine initially to those who are at risk, which includes: healthcare providers, pregnant women, people who provide care for infants who are less than 6 months old, children 6 months to 24 years of age, and those ages 25-64 who have chronic illnesses that might cause them to have a more severe case of the flu. If we have enough supply then we’ll also vaccinate healthy adults and seniors. But seniors should make sure they get the seasonal flu vaccine this year.
Dr. Val: How does the H1N1 flu differ from the usual seasonal flu?
Dr. Stubbs: The seasonal flu vaccine continues to kill 30,000 of our citizens every year. The people who most need the seasonal flu vaccine are individuals over age 65, immunocompromised, and young infants. We expect the seasonal flu vaccine to be widely available and we recommend that almost everyone get that as soon as possible.
Dr. Val: Is the novel H1N1 flu virus related to the deadly Spanish flu of 1918 in any way?
Dr. Stubbs: They do share some genetic features, but not all.
Dr. Val: Are you concerned about the H1N1 flu virus mutating?
Dr. Stubbs: We certainly are, though we’re concerned about that with any virus. We’re most concerned about the flu becoming resistant to the anti-viral medicines that we have now like Tamiflu – which we use for people with serious cases of the flu.
Dr. Val: How do people know if they have a “serious” case of the flu?
Dr. Stubbs: If someone is experiencing severe shortness of breath within the first 48 hours of getting the flu, or if they have a severe headache and are not acting themselves or if they have uncontrollable diarrhea or vomiting, that requires medical attention.
Dr. Val: What’s the most important thing for Americans to know about the H1N1 flu?
Dr. Stubbs: The most important thing is not to panic. People should not crowd the ERs just because they think they might have the H1N1 flu – they should only go if their illness is severe as I described before. They should wash their hands frequently, and if anyone gets sick, stay home so you don’t spread it to others. The vast majority of people will get better within a few days.
I recently joined SVP of the Boys and Girls Clubs of America, Judith Pickens, at ABC News to discuss the childhood obesity crisis and what can be done about it.
Because of obesity, this generation of children may be the first in US history to have a shorter lifespan than their parents. The CDC reports that teen obesity rates are growing exponentially, having tripled in the past 20 years. We also know that 70% of obese children become obese adults, and that 75% of our healthcare dollars are spent on chronic disease management – diseases that are 80% preventable with lifestyle modifications. Efforts to curb healthcare costs are unlikely to succeed without addressing America’s obesity epidemic.
So who is addressing the obesity crisis now? One shining example is the Boys & Girls Clubs of America (BGCA). They recognized the impact of obesity on their club members and looked for ways to increase physical activity levels, encourage healthy eating, and repair self esteem in America’s underprivileged youth. After consulting with the Department of Health and Human Services (and obtaining funding from the Coca-Cola company), the BGCA created a multi-faceted initiative, called Triple Play, to combat overweight and obesity. The results are very encouraging.
After 2 years, an analysis of over 2,250 club members suggests that 90% of youth enrolled in the program met the daily, federal physical activity recommendations while a significant number improved their nutritional status, choosing to eat significantly more fruits and vegetables. Perhaps most interestingly, the participants also scored higher on tests of “self-mastery” which are correlated with self esteem and social skills. Overall, girls were impacted more strongly by the program than boys, though the reason for this is unclear.
I had the honor of moderating a panel of experts who discussed the impact of Triple Play on BGCA members. In attendance were Olympic gold medalists Shawn Johnson, Dominique Dawes, and Dr. Tenley Albright in addition to SVP of BGCA, Judith Pickens, former Club kid and Youth of the Year, Stacey Walker, and Chris Spain from the President’s Council on Physical Fitness and Sports. It was heartening to see that there are programs that can bend the obesity curve – because success in this area of disease prevention has been hard to come by.
I hope that healthcare reformers will carefully consider the impact of obesity-driven chronic disease, and look to program success stories like Triple Play as a means to affect long-term improvements of America’s health. Our kids’ lives and the future productivity of our country are dependent upon the implementation of prevention programs that work. Cheers to BGCA for leading the charge against childhood obesity!
House Majority Leader Steny H. Hoyer offered the keynote speech at the Youth of the Year awards for the Boys & Girls Clubs of America (BGCA). Rep. Hoyer was himself a member of the club in his late teens, and credits it for turning his life around and setting him up for career success.
Rep. Hoyer reminded the audience about how critical it is for young Americans to have positive role models, a safe place to socialize, and adults who believe in them. The BGCA is also involved in reducing and preventing childhood obesity – a national crisis of great medical importance.
Carolina Correa & Dr. Val
Young Carolina Correa, the 2009 Northeast Region Youth of the Year, introduced herself to me at the event. She was bright and confident – and it was only during her speech to the crowd that I discovered that she had survived a triple family homicide in Colombia, moved to the US with her mom and ailing step dad, and worked as a child laborer to provide for her family and younger brother. Thanks to the Boys & Girls Clubs, she managed to overcome all her obstacles and find peace in the midst of her personal storm, achieving academic and athletic excellence in the process.
Dominique Dawes & Dr. Val
Olympic gymnast Dominique Dawes is a strong supporter of the BGCA – and helps to inspire young members to get fit and pursue athletic careers.
Tomorrow I’ll be moderating the Be Healthy event on behalf of the BGCA. A panel of experts will be revealing promising new research results – demonstrating how BGCA’s Triple Play program has dramatically reduced obesity rates among those who enroll in the program.
With 70% of obese children becoming obese adults, and obesity itself costing at least 10% of all healthcare spending – any program that bends the obesity curve is welcome news. So stay tuned for more coverage on BGCA’s approach to helping kids get fit – and developing lifelong character in the process.
I myself am humbled to spend time with youth (like Carolina) of such character and perseverance. They are truly inspirational.
Patrick Swayze, the popular actor perhaps known best for his role in the 1987 hit movie “Dirty Dancing,” died today of pancreatic cancer. My thoughts are with his family in this time of grief.
Pancreatic cancer is among the more deadly forms of cancer. I asked GI oncologist, Heinz-Josef Lenz, M.D., professor of medicine and professor of preventive medicine in the Division of Medical Oncology at the Keck School of Medicine at the University of Southern California, to explain why that’s so.
Dr. Val: Why is pancreatic cancer so much more deadly (i.e. less treatable) than many other forms of cancer?
Dr. Lenz: Unfortunately we don’t have very effective drugs for pancreatic cancer, which makes it one of the deadliest cancers of all. The median survival is about 8 months with metastatic disease. Even when the tumor is successfully removed there is a very high risk for tumor recurrence. We need more funding to better understand the risk for pancreatic cancer and identify and develop more effective therapies.
Dr. Val: Can you describe the typical course of metastatic pancreatic cancer?
Dr. Lenz: Unfortunately, the 5 year survival rate for pancreatic cancer is only 15 to 20%. The average survival after diagnosis is 12 to 19 months. The best predictor of long term survival is if the tumor is found and removed before it reaches 3 cm in size. Patients with metastatic pancreatic cancer are usually treated with a combination chemotherapy consisting of gemcitabine, tarceva, xeloda or oxaliplatin. However the response rates are (despite using aggressive combination therapies) low. Large clinical trials recently did not show any benefit from erbitux or avastin, again demonstrating that pancreatic cancer therapy is a difficult clinical challenge.
Dr. Val: Are certain populations at higher risk than others for pancreatic cancer?
Dr. Lenz: Age is the most important risk factor for this cancer. It is most common in individuals over age 50 and increases in frequency with age. Black men and women are slightly more likely to get pancreatic cancer (though the reasons for this are unclear), and men are slightly more likely than women to get the cancer. Other risk factors are smoking, diabetes, and obesity.
Dr. Val: If you suspect that someone is “high risk” for pancreatic cancer, what tests should he/she have?
Dr. Lenz: Patients with a genetic predisposition for breast cancer known as BRCA are also at higher risk for pancreatic cancer. There is also a familial form of pancreatic cancer. These high risk families are being followed up with specific screening plans. However there is not a reliable test for pancreatic cancer. Imaging with CT or MRI can miss pancreatic cancer and there is no reliable blood marker. The most common used is CA 19-9, which can be used for monitoring and diagnosis but is not elevated in all patients.
Dr. Val: What if the cancer is caught very early? Does that increase likelihood of survival?
Dr. Lenz: Absolutely. The best chance of survival is when the cancer is limited to the pancreas, and is surgically removed before it reaches a size of 3 centimeters. There are certainly people who have been cured this way, but unfortunately it’s very rare to catch the cancer at such an early stage since it usually has no symptoms until it’s quite advanced.
***
There is a wonderful advocacy group for those whose lives are touched by pancreatic cancer: PanCAN. One of PanCAN’s founders, Paula Kim, is a friend of mine and was inspired to create the organization after her dad was diagnosed with pancreatic cancer in 1999. At that time there was very little advocacy for this deadly disease. PanCAN helps people with pancreatic cancer find help and support.
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This year’s influenza season is unique in that there are additional strains circulating, with unclear medical implications for the US population. I interviewed Dr. Joseph Stubbs, president of the American College of Physicians, to get the inside scoop on what to expect this year with the H1N1 and seasonal flu strains. You may listen to the podcast or read a shortened version of the interview below.
