September 4th, 2008 by Dr. Val Jones in Uncategorized
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This interview is a continuation from part 1.
Dr. Val: How did Simon contract the MRSA infection?
Dr. Macario: That will remain the biggest mystery of my life. No one knows how he picked it up. In Simon’s case there was no entry via the skin – he had no cut or boil or surface evidence of infection. He contracted the community associated strain of the bacterium, which is much more virulent than the kind people get in hospitals. It seems that the MRSA superbug somehow got into his body via his lungs. It’s possible that he touched something with MRSA on it and put it in his mouth and then breathed it in. Unfortunately, there’s just no way to know where he got it.
Dr. Val: How many children die of MRSA infections/year in the US?
Dr. Macario: According to the Centers for Disease Control and Prevention, in 2005, nearly 19,000 Americans died from MRSA infections. During the same year, there were 134 cases of MRSA in children. Actually, more people in the US die from MRSA every year than from AIDS.
Dr. Val: Tell me what you’re doing to promote awareness of MRSA.
Dr. Macario: I have a Ph.D. in Public Health, and when I received the autopsy report stating that Simon’s death was caused by community-acquired MRSA, I was dumbfounded. I hadn’t even heard of MRSA before. In fact, in my career in Public Health I thought that infectious diseases were no longer much of an emphasis because of the terrific job we’ve done in eradicating most diseases through vaccine programs and antibiotics. I assumed that lifestyle issues (nutrition, physical activity, early detection, and safety precautions) would be the focus of my career.
It was a real eye-opener to me to live through the loss of a child to a menace I thought we had under control. Sixty years ago families had large numbers of children, knowing that some would be lost to infectious disease. That just isn’t the way we think anymore. But MRSA is a threat that could essentially take us back to a time when Americans died of infections quite commonly. MRSA is a superbug that is highly resistant to most antibiotics we have. It’s only a matter of time until it’s resistant to everything.
I’ve begun working half-time with Dr. Robert S. Daum at the MRSA Research Center at the University of Chicago Medical Center, Department of Pediatrics, Section of Infectious Diseases (Chicago, Illinois). Not only are we studying how contagious MRSA is (in home and jail settings), we are also studying the most effective way to treat MRSA infections.
Dr. Val: What should doctors know about MRSA and children?
Dr. Macario: There are 506 new drugs approved by the FDA for development… only 6 are new forms of antibiotics. That’s because the antibiotics are not so profitible. Antibiotic customers are short term users – they need the antibiotic for a short time and then they’re healed. Contrast that with a drug like Lipitor, something that people need to take every day for a lifetime, and you’ll see why statins are more of a priority for drug company development than a new antibiotic that could combat MRSA.
Doctors need to realize that MRSA is a growing threat, and we may not have a good treatment for it in the near future. There is a new strain of MRSA (the “community associated” strain) that can be found anywhere – schools, homes, locker rooms, and gyms. This strain is more virulent and more resistant to antibiotics than anything we’ve seen before.
Dr. Val: What advice do you have for parents to protect their children from MRSA?
Dr. Macario: Wash your hands frequently and thoroughly, clean surfaces with bleach, don’t share personal items like towels and razors. Parents should NOT run to antibiotics for any possible illness their child may have. Don’t use antibiotic soaps. Antibiotics should be considered the absolute last resort. If we keep using them for viral illnesses or when we don’t really need them, we’ll just fuel the drug resistant MRSA.
Dr. Val: What’s the most important thing you’d like to tell Americans about MRSA?
Dr. Macario: This new strain of MRSA (community associated MRSA) can affect anyone. Young, old, middle aged, healthy or sick. It can attack a person as healthy as basketball star Grant Hill. It happened to my healthy baby, and it can happen to your family. People must view antibiotics as a sacred last resort to treating disease. If they overuse and misuse them, MRSA and other resistant strains of bacteria will continue to mutate and become even more prevalent and dangerous.
My husband and I are both highly educated, I keep my house immaculate, I vaccinate my kids, and they never went to daycare centers. It doesn’t matter what socioeconomic strata you’re in, race, gender, ethnicity or age – MRSA doesn’t discriminate. It can happen to you.
But to leave this on a brighter note: my husband and I had another son after Simon died. His name is Dylan, and has brought a lot of joy to our lives.
***
For more information about MRSA, please check out StopMRSAnow.org
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
September 3rd, 2008 by Dr. Val Jones in Uncategorized
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I once heard someone say that the primary difference between humans and animals is that humans learn from others’ mistakes. Animals, by contrast, only learn from their own personal experience with their environment. As I reflected on this observation, I realized that we humans certainly do value personal experience, but that we’re also capable of modifying our perceptions of reality with new information gathered from others. And best of all, we have the flexibility to change our minds about our conclusions when we repeat our observations under controlled conditions.
Smallpox is a deadly virus that kills about 33% of its victims, and badly disfigures the rest. In the 1700’s this scourge was greatly feared throughout Europe. Thanks to a keen observation by a British farmer (Benjamin Jesty), a new mechanism of protection against smallpox was discovered. Jesty noticed that people who milked cows infected with a similar disease (cowpox) did not seem to come down with smallpox. He theorized that exposure to pox-infected cows was a key to immunity against smallpox, and his theory was proven correct by physician Edward Jenner about 20 years later. Dr. Jenner created a reliable means of exposing people to the cowpox virus (called a vaccine – “vacca” meaning “cow” in Latin), introducing a tiny amount of cowpox-infected fluid under the skin to confer immunity against smallpox. This whole process of observation, careful experimentation, monitoring results, and further refining procedures led to the world-wide eradication of a deadly disease. Similar principles were applied to other illnesses, further reducing the global disease burden of polio, measles, mumps, rubella, and many other viral infections.
I suppose that one could thank cows for advancing the field of immunology more than any other animal – and thank a certain farmer for being so keenly aware of his cows’ health and their impact on humans (you know I have a soft spot for cows). But the story didn’t end with Jesty’s anecdotal observation – his theory was born out by science. His observations were repeated again and again in successful innoculation trials, and refined to a point where millions could benefit from vaccines.
Nowadays people are very impatient. We have short attention spans, we want instant gratification, and we are prone to jumping to conclusions about pretty much everything, especially medical news. I can’t tell you how many quantum leaps I’ve observed in health reporting – like the case where a scientist noted that breast cancer cells express a different protein in the presence of olive oil extract (in a Petri dish) and then reporters translated that news into “olive oil cures breast cancer.” All this ignited by the instantaneous availability of information via the Internet, curious minds, and lack of proper scientific vetting.
What happens today is that a plural of anecdote becomes “evidence” of cause and effect. These false assumptions then become entrenched, and end up as “public knowledge” long before they’ve been tested for reproducibility. The cart is well and truly before the horse in most health reporting, and this has done incredible damage to us as a society. Our insatiable desire for answers has outstripped our patience for finding truth.
Consider the recent scare about vaccines and autism. A few people noticed that clinical signs of autism occur at around the same time that some vaccines are given to children. They wrongly assumed that vaccines caused autism, and that misconception has traveled so far and wide that parents are actually choosing not to vaccinate their children against preventable diseases. Measles have made a resurgence, and some are warning of the return of polio. These diseases are absolutely preventable – and it’s tragic that we may have to relive these scourges to remind people of the value of vaccines.
The best part of being human is that we can learn from others’ mistakes. We do not have to live through the mistakes ourselves to change our behaviors. I do worry that the anti-vaccinationist movement represents a regression backwards towards animal type thinking. Will it take a wave of paralyzed children to wake us up to the value of vaccines? Will Jesty’s cow have to tell us “I told you so?”
I’d like to think that we’re beyond that. But I guess only time will tell if people will fall for the plural of anecdote in lieu of truth. Our country’s health hangs in the balance as the Internet fuels both science and folly. Hold on to your skepticism, folks. It could save your life.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
August 29th, 2008 by Dr. Val Jones in Uncategorized
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Here’s my weekly list of things that caught my eye in the medical blogosphere:
Vaccines
With all the misinformed parents opting out of vaccinating their kids, could polio make a comeback the way measles has? Dr. Doug Farrago speculates about the new wave of paralyzed children that may be on the horizon.
Bloggers
What kind of person blogs? A new study suggests that bloggers are more likely to be both “open-minded” and “neurotic” by nature.
Drugs of Abuse
Steroid abuse can lead to a severe form of disfiguring acne. KevinMD found this example.
How NOT to forge a prescription for pain medicines. Thank you, Dr. White Coat.
The Healthcare System
Barack Obama says that a government-run single payer healthcare system makes sense for America. Now THAT’s scary.
Thousands wait in line for a free health clinic, staffed by volunteer physicians in Apalachia.
The government clamps down on pharmaceutical gift pens and paper to doctors while welcoming millions in sponsorship from them for political causes. Wow.
Gadgets
How about this new gadget? A clock that you can wear on your thumb nail.
Weird Anatomy
Would you like a vase shaped like your elbow or knee? Why not?
Are men with wider faces more likely to be violent? Dr. Joe presents the latest research.
This artist takes old fashioned anatomical drawings and makes them “joyful.”
Some serious exophthalmos from Happy Hospitalist.
The Cutest Animal Photo EVER
Sorry, I couldn’t resist. Thanks, Medgadget.com
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
August 28th, 2008 by Dr. Val Jones in Uncategorized
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Faithful readers of my blog know that one of the things I hate the most is when the public is purposefully misled by false medical claims. This year, we have been fortunate to see the beginning of a new trend: a snake oil crackdown.
First it was the successful lawsuit against AirBorne, a supplement that claims to protect its users from catching colds on airplanes. They agreed to pay $23.3 million to settle a class-action lawsuit brought against the company for falsely claiming its vitamins prevented colds.
Then, the FDA came right out and named names in fraudulent cancer treatments.
And now smiling Bob’s Enzyte “male enhancement” CEO is going to jail for conspiracy, fraud and money laundering.
Well, thank goodness! It’s about time that we begin calling out the fraudsters who prey on vulnerable Americans who seek help with their diseases and conditions. I hope we can also hunt down the supplement hucksters who put arsenic, mercury, and lead in their “alternative medicines.”
This serves as just another warning to Americans to be VERY careful about how you spend your money and what you put in your body. And as for the FDA – I hope this emboldens them to do more than ever to protect the public from snake oil.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
August 28th, 2008 by Dr. Val Jones in Uncategorized
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There is no doubt that vaccines are life-saving, and their development is one of the most important contributions to medical science in the past century. There are about a dozen regularly recommended adult vaccines, and kids in the US receive about 16 shots before the age of 2. New vaccines are being developed all the time.
With this year’s flu season just around the corner, a recent poll suggests that only 44% of parents have their children vaccinated against influenza. I decided to interview two pediatricians about the influenza vaccine, to find out more about it.
Dr. Ben Spitalnick is Assistant Clinical Professor, Mercer University School of Medicine, Savannah, Georgia. Dr. Stacy Stryer is Revolution Health’s pediatric specialist in private practice in Virginia. She offers a post-script at the end of the interview.
Dr. Val: What is the AAP’s current recommendation regarding vaccinating children against influenza?
Dr. Spitalnik: This is the first year that the AAP (as well as the ACIP) has recommended flu vaccination for all children age 6 months to age 18 years, regardless of whether or not they fall into the “high risk” medical categories that have been used as screening parameters in recent years. In addition, they recommend vaccination of pregnant women and all health care providers. Finally, they recommend vaccination of household contacts and out-of-home providers of all children under 5 years of age, and similar contacts of children older than 5 with high risk health conditions.
Dr. Val: What percent of parents vaccinate their children against influenza?
Dr. Spitalnik: While over 80% of parents recognize that there is an influenza vaccine available, data show that only about 44% of parents have had their child vaccinated against influenza in the past. In addition, despite the AAP’s broader recommendations regarding flu vaccination, still less than half (about 48%) plan to vaccinate against the flu this coming year. While there are plenty of possible reasons why vaccination rates are so low, health providers owe it to their patients to continue to find ways to improve delivery of and education about the influenza vaccine.
Dr. Val: What did the National Parent-Child Survey uncover about parents’ attitudes towards flu vaccines?
Dr. Spitalnik: The National Parent-Child Survey certainly provided some eye-opening data. While experts recognize that getting an annual flu vaccine is the single best way to protect yourself or your child from catching influenza, the survey shows that parents rank the flu vaccine sixth in importance to prevent the flu. Specifically, parents in this survey believe that hand washing, adequate sleep, balanced diet, avoiding sick contacts, and taking vitamins are better ways to protect against the flu. This helps emphasize the point that the health care community must continue to find ways to educate the public about influenza, and more importantly, its prevention.
Dr. Val: If someone has the flu, how can they help to prevent their child from getting it?
Dr. Spitalnik: Chances are this year, as with most years, almost every child will be in close contact with someone that has the flu. While hand washing, avoiding sick contacts, and getting adequate rest and nutrition may help against the flu, the single most effective way to prevent a child from getting the flu is having the child vaccinated. While protection after vaccination is fairly quick, it is not instantaneous, so waiting until your child is exposed to the flu is not the best approach. Instead, follow the recommendations of your health care provider and get vaccinated at the right time, and don’t wait until it may be too late.
Dr. Val: How dangerous is the flu virus to children? Are there any subgroups of children at higher risk?
Dr. Spitalnik: The flu is a significant danger to children, though the public doesn’t seem to appreciate the risk, which could be why vaccination rates are so low. While many feel the flu is nothing more than a severe form of the “common cold”, in reality it can lead to very high fever, dehydration, pneumonia, and can even be fatal. In fact, Influenza is the single leading cause of vaccine-preventable disease in the U.S., with estimates between 15 million and 60 million cases in the US a year among all age groups. Influenza leads to 200,000 hospitalizations and about 36,000 deaths a year in the U.S., mostly in infants and the elderly.
There are certain subgroups of children that are at higher risk for complications from the flu. These include children with asthma or other chronic lung conditions, certain heart diseases, patients who have weakened immune systems including HIV, sickle cell anemia, kidney disease, diabetes, and others. These are groups that we offer flu vaccines to first, when the vaccine is in short supply. The list above is not comprehensive, and any patient with a specific question about their own child’s medical conditions should contact their physician.
Dr. Val: Does the recent resurgence of measles tell us anything about parents’ attitudes towards childhood vaccinations?
Dr. Spitalnik: Yes, it certainly does. Cases of measles in the U.S. are at their highest level in more than a decade, with half of these cases in patients from families that rejected the measles vaccine. Many of the other cases were from exposures to these unvaccinated patients, but in children who were not yet old enough to receive the measles vaccination. I know that some physicians are asking parents (who refuse to vaccinate their children) to find a new doctor. They’re worried that other families’ infants may be exposed in the waiting room to kids with measles.
While some parents are refusing vaccines for their kids, there is impressive data from Japan clearly demonstrating the life-saving value of vaccinating children against influenza. In the 1960’s, the death rate in Japan from pneumonia and Influenza (P&I) was approximately 10 per 100,000. Over the next decade flu vaccination in the schools was made optional and then mandatory, and by the 1980’s the death rate from P&I showed a steady decline, eventually down to 4 in 100,000 – a significant reduction. In 1987, however, parents were allowed to refuse vaccination, and in a decade death rates quickly rose back up to near their 1960’s levels.
There is clearly more we need to do to help educate our patients about vaccines, not just with influenza. Specifically, however, flu vaccine education has its own hurdles, and I hope this year we all do a better job protecting our patients from this dangerous disease.
Dr. Val: What’s the most important thing that parents should know about the flu vaccine?
Dr. Spitalnik: If I had to choose one it would be that the flu vaccine, in any form, is the single best way to protect your child from the flu, which can be a serious threat to their health, and is now recommended for ALL children age 6 months to 18 years.
In addition, parents need to know that the flu vaccine is better than ever this year: First of all, there does not appear to be any shortage of supply. Second, all 3 strains of the vaccine have been changed to help ensure stronger protection. And finally, there is more than one way to get the flu vaccination, both the traditional shot and an intranasal spray, both of which should be available from their health care provider early this flu season.
P.S. By Dr. Stacy Stryer: Dr. Spitalnick offers some very good information and advice regarding the flu vaccine. While certain high risk groups, such as infants (ages 6 months and up), children with asthma and other chronic diseases, and those who are immunosuppressed are all at a greater risk of developing severe complications if they contract the flu, it is also possible for healthy children to develop complications from the influenza virus. Dr. Spitalnick discussed the best way to prevent children from contracting the flu, which is by receiving the vaccine. There are two forms of influenza protection available, the nasal spray and the traditional injection. The nasal spray, FluMist, may only be given to children ages 2 and older, and is contraindicated for children with asthma, several chronic diseases, and severe egg allergies, yet is more protective than the injection. Good hygiene, such as frequent handwashing and keeping hands away from the face, can also help reduce the risk of contracting the flu.
*Dr. Spitalnik has been a speaker for Glaxo Smith Kline and MedImmune. Dr. Stryer has nothing to disclose.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
