Ok - I'm up to date: the H1N1 flu shot is worth it!

A little more research (between my daughter’s volleyball tournament games) has revealed some reassuring referenced statements about Thimerosal.

The official CDC statement is here:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4843a4.htm

And the official Canadian Statement is here:
http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/07pdf/acs33-06.pdf

WHO’s official statement on Squalene is here:
http://www.who.int/vaccine_safety/topics/adjuvants/squalene/Jun_2006/en/index.html

A REALLY good and well referenced review of Squalene appears to be this one:
http://www.mdpi.com/1420-3049/14/9/3286/pdf


Bottom line is that it was a good exercise to go through: being asked by a patient to do a mini-lit review on this subject – with additional online discussion through a Physician's newsgroup list. Accepting the popular opinion just isn’t enough....going through the exercise of finding/evaluating/reading well referenced material has been invaluable.

The components of the H1N1 vaccine that are causing concern are the Thimerosal (Mercury) and the Squalene (the stuff blamed on "Gulf War Syndrome". The articles detailed above are very well written, researched and referenced. The bottom line is that - while it is probably preferable to not have these things in the vaccine, having them present in the H1N1 vaccine is not sufficient to exclude the vaccine from your "to do" list.

This is really a question about "RELATIVE RISK". After everything is said - your risk of morbidity or death is higher WITHOUT the H1N1 vaccine than it is WITH it!

I am now a lot more confident in recommending the H1N1 flu shot. At least now, I’ll be able to have a lot more familiarity with the increasing onslaught of questions I’ve been getting about the safety of these components of this vaccine.

This has been a great exercise!

JF

Ps. The Tom Baines Boas got Silver!

The safety of the H1N1 Swine Flu Vaccine - We can always trust the Government, right?

Patients have been emailing me about the safety of the H1N1 vaccine. The concern is that it is the first vaccine made for the civilian population to contain an adjuvant called "Squaline".

There is not a lot of information on the effect of Squaline on OVID - but the "independent" research appears to be quite chilling.

As a result - I am not comfortable recommending the H1N1 vaccine until this issue is more fully answered.

Does anybody out there have any additional wisdom to add? Read on:

Because there is no listing on the safety or efficacy of squaline on OVID, I have conducted an online literature review on the subject - which is surprisingly interesting. The bottom line is that the Swine Flu vaccine is the first to have Squaline included as an ingredient. Only three other vaccines for civilian use have been developed that contain this molecule - and two of them did not earn FDA approval in the U.S.

If you need to get immunized against the Swine Flu, it is possible that a better alternative will be the vaccination with the AstraZeneca nasal vaccine "MedImmune" - which more closely mimics a natural "real life" inoculation that does not use squaline.

Bottom line is that this is, I believe, the first time a vaccine has been allowed to escape proper FDA approval processes. It is interesting to note that "official published studies in prestigious medical journals have revealed that Squaline is safe in humans". The "studies", however, were published by the "makers" of the vaccine - a new conglomerate of Novartis and Chiron. This is in DIRECT contrast to "profound and lasting autoimmune effects" of Squaline found by independent researchers.

Experience has revealed in abundance that Drug Companies do not necessarily provide unbiased data to the public and to Doctors (remember Viox, Baycol, Naprosyn, Tequin, etc., etc.).

That being the case - I don't believe that I can recommend the H1N1 vaccine to anybody until a repository of reliable information has become available. The Cochrane review people are great resource that does exactly that - and they haven't entirely caught up to the safety of H1N1 vaccine yet. Their official statement about H1N1 flu vaccination is in the following:

Some public-health officials have described flu vaccines as “highly effective,” but the internationally recognized Cochrane Collaboration (which accepts no money from the pharmaceutical industry) did a systematic review of all high-quality randomized trials (25 in all) studying influenza vaccination. They concluded that “the evidence does not support universal immunization of healthy adults.” Period.

An interesting and reasonably referenced article without special interest ties is listed here:

http://www.foodconsumer.org/newsite/Opinion/Comments/180720090846_squalene_the_swine_flu_vaccine_s_dirty_little_secre.html

and here:

http://www.newsmax.com/health/vaccine_swine_flu/2009/07/07/232717.html

Hope this helps somebody.....

I'm between a rock and a hard place. If I recommend the H1N1 vaccine - I could be sentencing patients to significant morbidity as a result of potential dangers from Squaline. If I don't recommend the vaccine, I could be sentencing people to morbidity or mortality from H1N1 infection. This is a tough position to be in - and the old Hippocratic oath of "Doing no Harm" is a seemingly impossible challenge in the absence of good and reliable information.

Do I believe, so called, "Officials"? I know that my Professional knowledge of the issues with this vaccine vastly surpasses that of most "Officials". Also - as a Professional, I've learned to trust my caution when it comes to advice from "Officials". I still remember Tequin, Vioxx and Baycol being bandied about in my office by a small army of Drug Reps that assured me (with less than half of my education and knowledge on the subjects) that all of these drugs were effective, safe and "properly studied".

None of that turned out to be the case.....but then if we had applied the same amount of rigorous concern to ASA - it never would have won FDA approval! The wisdom of the ages has taught us how to handle and recommend the use of ASA. It certainly has its risks and benefits.....but the information gleaned from dozens of years of experience with the H1N1 vaccine is simply not available to us.

So - we are left with inadequate and suspect data.....and patients literally entrust their lives and well beings to my advice!

So - for now, I'm saying "no" to H1N1 vaccinations until I can get better and better referenced, unbiased and properly questioned information.

ps: another good synopsis is at: http://www.digitaljournal.com/article/280927

Bottom line: Wait for unadjuvinated H1N1 vaccine that is devoid of Thioresal (Mercury).

The challenges of practicing Family Medicine

I am certainly maturing in my ability to treat patients - and I'm probably more up-to-date, skilled, energetic and enthusiastic than I have ever been in my life. I'm pleased to say that I've been able to help patients through some of the toughest times of their lives, discover deadly diseases early while they are curable and provide support for devastating physical, social and interpersonal traumas.

I go to work smiling every day....but this is only because I know that I will eventually prevail in my ongoing struggles with Alberta Health.

It appears that for a Family Doc, there is always an assault upon you. Whether it is patients with boundary issues, Insurance Companies not paying you, staffing and business challenges, government and regulatory College intrusion into your daily operations - it seems as if some person or entity is always trying to stab you in the back.

Add all of this on top of operations costs that exceed your capability to earn money, and a culture engineered by Alberta Health to make Physicians feel like criminals if they earn more than a 7-11 employee.....and it is no wonder that out of over 36 Physicians in my "Medical Building" just 3 years ago - there are now only 6 left. Once the leases mature in 2 years, there will be only 4 Physicians left in my building.

90% of all my stress and concerns of operating as a Family Physician would disappear if I simply chose to stop participating in government insured medicine. But then I would only really be able to treat rich people that don't mind paying personally to see me, and I don't want to abandon my patients.

For example - somewhere in Northern Alberta a couple of years ago, it was found that a few nurses were using the same needle to mix up medications. No patients were contaminated and it should not have been a great big deal. But the government went nuts due to misperceived public pressure - and threatened the College into an unreasonable action.

Physicians in Alberta now have to follow this new "Infection Prevention Standards Protocol". To implement to new protocols, each Physician's clinic will need to invest at least $10,000 in capital costs, never mind staffing costs - which would easily double that figure.

For example - to simply remove sutures, a Physician has to use sterile tweezers. No problem, right? Seems simple. The problem is that the tweezers now have to be sterilized using both biological and chemical indicators ($10 each for a test and control), quarantined for 24hr before use (means you need at least 3 sets of tweezers) and you have to go through a very meticulous audit system to sterilize a simple set of tweezers.

According to the law in Alberta - you cannot charge the patients the cost of the tray....you are supposed to personally take the loss as the Physician.

Physicians have been taking out sutures in Alberta for over a century without any problems - but the now the College (ie. "Government") is telling us how to do it better.

Only the cost was never considered.

How foolish!

To sterilize a simple set of tweezers now costs the Physician about $60 (probably more). An office visit earns a Physician about $30. Therefore, the Physician has to pay about $30 out of their pocket to take a patient's sutures out.

Can you guess what is happening?

That's right - Physicians are sending patients to the E.R. to wait 20 hours to get their sutures taken out. Others are saying "screw the College - they've totally lost their minds and I no longer respect their decrees" and are doing what they've always done.

More disturbing, however, is that lots of Docs are going back to the 1700's and are resorting to trying to pick up the ends of sutures with their fingernails and using a handheld disposable scalpel to take out sutures.

Patients are returning to my office weeks after sutures were supposed to be taken out - with retained sutures that have to be surgically debrided. And no, as a Physician you will not be paid to do the surgical debridement (which needs another tray).

So what is a Physician to do?

Moronically implemented governmental and collegiate policy appears to have cast one aspect of medicine in Alberta backwards in time by over 300 years.

Many Family Physicians in Alberta are doing the only thing they CAN do - they are closing shop and leaving. It is increasingly hard to find a Family Doc in Alberta that will take you on and will be there for you for the next few decades.

But I still go to work smiling because of something that should be obvious to Alberta Physicians........

Each one of us has thousands of people supporting us that would much rather get rid of a bad Government than a Good Doctor!

Leadership review of the current Government happens in November....will be interesting!

;-)