Akeena Solar

Nice Jewish Doctor

November 20, 2009 | 3:14 pm

New Mammogram Recommendations Betray Women, Doctors and Science

Posted by Albert Fuchs, M.D.

This week the US Preventive Services Task Force (USPSTF) revised their recommendations for screening mammograms.  Their recommendations have ignited much controversy and have weakened the credibility of a formerly objective scientific body.

This post is longer than usual.  It deals with an important subject in some detail.  For the readers who like to delve into the details and see the data, set this aside for when you can give it some time, follow the links, and check out the articles yourself.  If you just want an executive summary, skim for the bold face type and read the conclusion.

What did the USPSTF recommend?

My regular readers know that the USPSTF is a national body of scientists who periodically assess the medical literature and provide recommendations about preventive tests and treatments.  Because they are unaffiliated with any specific interest group, the USPSTF developed a reputation as the most objective and unbiased source of medical recommendations.  For every test or therapy they reviewed, they weighed patient benefit against the potential for patient harm (regardless of cost) and reported whether the intervention was beneficial, harmful or that there is insufficient evidence to decide. I personally looked to their recommendations and wrote about them frequently.

The USPSTF’s last review of the literature regarding mammograms was in 2002.  At that time they recommended a mammogram every one to two years for women aged 40 and older.

This week, in the Annals of Internal Medicine they published their new recommendations, supported by two articles detailing the scientific evidence that was reviewed to reach their conclusions.  Their current recommendation (link 1 below) for mammograms is

The USPSTF recommends against routine screening mammography in women aged 40 to 49 years. The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take into account patient context, including the patient’s values regarding specific benefits and harms.

The USPSTF recommends biennial screening mammography for women between the ages of 50 and 74 years.

The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years or older.

So the major changes from 2002 are that

  • mammograms are no longer recommended between the ages of 40 and 49,
  • between 50 and 74 mammograms are recommended every two years, rather than every one to two years, and
  • there is insufficient evidence about the benefits and harms of mammograms in women 75 years and older.

Shockingly, the first two points are entirely contradicted by the scientific evidence on which the recommendations are based.

What are the benefits and harms of mammograms for women in their 40s?

The article which examines the harms and benefits of mammograms in different age groups can be found at link 2, below.  Table 1 (Pooled Risk Ratios for Breast Cancer Mortality From Mammography Screening Trials for All Ages) is a very helpful review of the pooled data from all the randomized trials for mammography in different age groups.  The table shows how many women are needed to be invited to undergo mammograms in each age group to prevent 1 death from breast cancer.  The numbers for women in their 60s are terrific.  377 women in their 60s need to be offered mammography to save 1 life from breast cancer.  (The lower the number of women who must undergo mammograms to save one life, the more beneficial the intervention.)  In their 50s 1,339 women must be screened to save a life, and in their 40s 1,904 must be screened.  So mammography is still life-saving for women in their 40s it just saves fewer lives than for women in their 50s and 60s. In fact, the abstract of the article concludes

Mammography screening reduces breast cancer mortality for women aged 39 to 69 years.

So if mammograms have a life-saving benefit for women in their 40s, albeit a much smaller one than for women in their 50s or 60s, why would they not be recommended?  Perhaps the harms caused by mammograms in that age group outweigh the benefits.

The article also methodically reviewed harms caused by mammograms.  The risk posed by radiation exposure due to mammograms was studied without conclusive evidence of significant harm.  The pain, anxiety and distress associated with undergoing mammograms and being told about potentially abnormal results were also studied.  Most women surveyed reported that the pain and anxiety would not deter them from future mammograms.  The most important harms that may result from mammography is a biopsy to determine if an abnormality is benign or malignant, additional imaging that may be required, and overdiagnosis, which means the diagnosis of breast cancer that is so slow-growing it is unlikely to shorten the woman’s lifespan.

Table 2 (Age-Specific Screening Results From the Breast Cancer Surveillance Consortium) summarizes the potential harms by age per 1,000 women screened.  We would expect the harms in women in their 40s to outbalance the benefits and lead to the recommendation against mammograms at that age.  The left column in the table deals with women in their 40s.  Recall that it takes 1,904 women to be screened to save one life from breast cancer in that age group.  Since the table shows the harms per 1,000 women screened, if we multiply each number by 1,904/1,000 we discover the harms that result from saving one life in this age group.  So to save one life from breast cancer by screening women in their 40s with mammograms we would have to inflict 186 women with false positive mammogram results (abnormal mammograms without any cancer present), 161 women would have to undergo additional imaging and 18 women would have to undergo biopsies.

Now, I don’t want to minimize the misery involved in an unnecessary breast biopsy (unnecessary only in hindsight, of course).  The procedure itself is uncomfortable and waiting for results is torture.  Still, 18 biopsies to save one life strikes me as a wonderful trade-off, especially given that saving a life in the 40s yields many years of additional living.  How can the USPSTF possibly judge that these harms outweigh the benefits?  They hedge their recommendation by saying that the decision should be individualized for each patient, but that’s true for all medical decisions.  Why then recommend against it?

Because it’s sometimes difficult to understand the numbers involved, I ask you to do the following thought experiment.  You are a physician addressing an auditorium of 1,904 women in their 40s.  You tell them “If you all have mammograms before you turn 50 one of your lives will be saved from breast cancer compared to just waiting until you all turn 50.  Some of you will get breast cancer and die of it whether you get mammograms or not, and most of you won’t get breast cancer.  If you start mammograms now, 18 of you will get biopsies, and a lot of you will get incorrect initial mammogram results requiring more mammograms or ultrasounds or MRIs.  But only one of you will have her life saved from breast cancer.”  Each woman can and should decide for herself but they’d like a recommendation from you.

I can’t imagine not recommending mammograms under this circumstance.  Of course some women may choose against mammography, but to me the harms seem minor compared to the benefits.

How frequently should women have mammograms?

The decision to recommend biennial mammograms is based on a study published in an article at link 3, below.  The study uses various models to compare the harms and benefits from different mammogram frequencies.  But this article does something that has generally been outside the purview of the USPSTF.  It considers cost.

The results state that having a mammogram every two years had 81% of the benefit of annual mammograms with far fewer false-positive results, unnecessary biopsies and additional imaging.  And they state explicitly that annual mammograms consume more resources than mammograms every other year.

There are two important objections to this.  First of all, getting only 81% of the life-saving benefits of annual mammograms may not strike many women as a victory.  Why not capture all the benefits by having the test annually?  The answer might be the additional harms, but as we’ve seen in the previous section, the harms are quite modest and most women would not be deterred by them.  The second objection is that previously the unique value of the USPSTF was that it advised physicians about the value of tests regardless of costs.  That allowed us to give patients the best advice we could, and allowed patients to decide if the cost was worth the benefit.  Now, the USPSTF is deciding for us that annual mammograms are too expensive.

Conclusion

So, I and many other physicians will advise women to have annual mammograms starting at age 40.  And in my opinion they should continue to do so until they are ill or frail enough that a new diagnosis of breast cancer would be unlikely to shorten their lives.  For some women this might be in their 70s, for others, in their 80s.

But the broader outrage is that a group that I used to turn to without hesitation for objective review of the scientific data, a group that informed my daily advice to patients, has provided recommendations inconsistent with their own data and motivated by economics.  Patients and physicians have neither the skills nor the time to scour the world literature on important topics.  Who will fill the role that the USPSTF abandoned?

Learn more:

Scientific articles:

(1)  Screening for Breast Cancer: U.S. Preventive Services Task Force Recommendation Statement

(2)  Screening for Breast Cancer: An Update for the U.S. Preventive Services Task Force

(3)  The Annals of Internal Medicine article studying how frequently mammograms should be done:  Effects of Mammography Screening Under Different Screening Schedules: Model Estimates of Potential Benefits and Harm

Media coverage:

New York Times article:  Panel Urges Mammograms at 50, Not 40

LA Times article:  Mammogram guidelines spark heated debate

Wall Street Journal Editorial:  A Breast Cancer Preview

Important legal mumbo jumbo:
Anything you read on the web should be used to supplement, not replace, your doctor’s advice.  Anything that I write is no exception.  I’m a doctor, but I’m not your doctor despite the fact that you read or comment on my posts.  Leaving a comment on a post is a wonderful way to enter into a discussion with other readers, but I will not respond to comments (just because of time constraints).

1 Comments — Leave your comment

Share this post: del.icio.us Favicondel.icio.us Digg FaviconDigg Facebook FaviconFacebook Google FaviconGoogle Reddit FaviconReddit StumbleUpon FaviconStumbleUpon Technorati FaviconTechnorati YahooMyWeb FaviconYahooMyWeb

  • Vertebroplasties:  Not Very Valuable

    I was the Australian interventional radiologist who performed the vertebroplasties in Kallmes et al trial. The Kallmes et al trial is essentially meaningless. Vertebroplasty is a means of internally fixing acute vertebral fractures. It ameliorates fracture pain by preventing the abnormal motion of ...

    By Dr william Clark on 2009 10 03

  • H1N1 Flu:  Potential Pregnancy Problem

    Hello there, Excellent article and When do pregnancy symptoms start acting up. Is it different for everyone? I just want to know. Do women usually get their pregnancy symptoms the first few ...

    By Fertility on 2009 10 28

  • The Healthcare Meltdown – Part I

    Good piece of writing, almost 43 million Americans had no health insurance, which translates into nearly 15 percent of the American population. This might be attributed to the fact that health care costs can be very expensive, and the cost of even the most basic care is steadily rising. Today, the ...

    By insurance on 2009 08 28

November 13, 2009 | 2:44 pm

H1N1 Flu Update

Posted by Albert Fuchs, M.D.

I want to write another post about H1N1 flu about as much as I’d like to pour lemon juice on my paper cuts.  But there’s absolutely no other medical news to report and many of you are still much attuned to this developing story.

Today’s Wall Street Journal summarized the most recent data well (link below).  Since the virus first spread to humans in April, swine flu has sickened 22 million Americans.  That’s about 7% of us.  The vast majority of illnesses have been mild.  Still, 98,000 people have been hospitalized.  That sounds like a lot, but it’s fewer than 1 in 200 people who have contracted swine flu.  3,900 have died so far, a terrifying number until we compare it to the approximately 36,000 who die annually of garden-variety seasonal flu.  That means that, on average, fewer than one in 75,000 swine flu patients die.

Having said that, flu activity both nationally and in California are very high, not just high for this time of year, but higher than some previous flu seasons at their December-January peaks.  That means a lot of people are getting sick.  (Among them are several of my patients and my wife and my son.)  The best advice to minimize transmission is still to stay home if you’re sick, wash your hands frequently and cover your cough.

So the most important bit of good news to keep in mind is that for most people, swine flu is a mild illness.  The second bit of good news is that both Google Flu Trends and the CDC (links below) suggest that the peak of new cases may have happened two weeks ago.  If that’s the case, then the rate of new infections is on the decline and the worst may be behind us.  Only time will tell.

Take a big breath.  We’ll get through this.

Learn more:

Wall Street Journal article:  Swine Flu Sickens 22 Million

Google Flu Trends

If you really want to dive into the latest data, there’s no better place than the Centers for Disease Control H1N1 Flu Situation Update page

Important legal mumbo jumbo:
Anything you read on the web should be used to supplement, not replace, your doctor’s advice.  Anything that I write is no exception.  I’m a doctor, but I’m not your doctor despite the fact that you read or comment on my posts.  Leaving a comment on a post is a wonderful way to enter into a discussion with other readers, but I will not respond to comments (just because of time constraints).

0 Comments — Leave your comment

November 6, 2009 | 11:10 am

Should You Have a Pap Smear?

Posted by Albert Fuchs, M.D.

Last week I lamented that we can prevent so few cancers.  Cervical cancer screening is one of the success stories of prevention.  Regular pap smears can drastically decrease the risk of cervical cancer and makes death from cervical cancer virtually unheard of.

Cervical cancer is a sexually transmitted disease, caused by human pappilomavirus (HPV).  Pap smears check for telltale changes in the cervix that happen after HPV infection.  Over many years these changes lead to cervical cancer.

But while potentially life-saving for some women, other women can not benefit from pap smears and should not have them.  A study in this issue of the Annals of Internal Medicine interviewed physicians about the kinds of patients to whom they would recommend pap smears and found that many doctors perform pap smears on women for whom it is not helpful.

Below is a summary of the U.S. Preventive Services Task Force recommendations for pap smears.  More details are available by following the links below.

  • Women who have been sexually active and have a cervix should have pap tests. Pap tests should begin within 3 years of onset of sexual activity or age 21, which ever comes first, and should be repeated at least every 3 years.
  • Women older than 65 who have had recent normal pap smears should not have further pap tests. This is because cervical cancer this late in life is very rare and would have already caused abnormal pap smears.
  • Women who no longer have a cervix because of a hysterectomy for a benign disease (that is, not for cancer) should not have further pap tests. That’s because it’s impossible to get cervical cancer without a cervix.

Like all good things, the benefit is derived from judicious use.  Even though in other women the test is crucial, performing pap tests on women who can not benefit from it is just bad medicine.  It falsely reassures women that they are taking care of themselves.  It wastes patients’ time and scarce resources.  And it ultimately decreases physician credibility.

Learn more:

U.S. Preventive Services Task Force recommendations for cervical cancer screening

Wall Street Journal Health Blog:  Who Should Get a Pap Smear?

Annals of Internal Medicine article:  Specialty Differences in Primary Care Physician Reports of Papanicolaou Test Screening Practices: A National Survey, 2006 to 2007

Important legal mumbo jumbo:
Anything you read on the web should be used to supplement, not replace, your doctor’s advice.  Anything that I write is no exception.  I’m a doctor, but I’m not your doctor despite the fact that you read or comment on my posts.  Leaving a comment on a post is a wonderful way to enter into a discussion with other readers, but I will not respond to comments (just because of time constraints).

1 Comments — Leave your comment

October 30, 2009 | 2:41 pm

Proactive or Paranoid?  When Vigilance is Valueless

Posted by Albert Fuchs, M.D.

What a better topic for Halloween than fear?

All of us when hearing of a coworker or loved one who has been diagnosed with a life-threatening illness wonder if we could be next.  “What if I have lung cancer?  Should I get checked out?  There must be some tests I can get to make sure I’m OK.”  Those who take an active role in staying healthy are confident that they could do more to make sure they don’t get some dreaded disease.  Most cancers, after all, are preventable, right?  Or at least they can be caught early?

The scary truth is that most cancers are not preventable and can not be caught early by any test we currently have.  What’s even worse, for many cancers there is no evidence that an earlier diagnosis makes any difference in outcome.

That doesn’t mean that no prevention is effective.  For a few cancers (breast, cervical, colon) there are proven tests that are recommended periodically for everyone.  That’s why I’m an enthusiastic advocate for colonoscopies for people over 50.  Also, testing blood pressure and cholesterol in healthy people helps prevent strokes and heart attacks.

So how can we know what we should be doing to stay healthy?  Should I get a head-to-toe CT scan?  What about that “executive physical” with the fancy heart tests that my neighbor says I should have?

This is the job of the U.S. Preventive Services Task Force.  They are the most unbiased national group that evaluates the evidence for preventive tests and treatments.  Check out the links below to see what you should be doing to prevent what’s preventable.  Just as important is learning what tests are unproven (or proven to be worthless).  The second link, the Electronic Preventive Services Selector is especially handy.  You enter some simple data about yourself and it displays all the proven preventive services for you.

That’s how you can have the confidence of knowing that you’re doing everything you can.  Having tests that have been proven to be useless isn’t being proactive; it’s making an irrational decision based on fear.

There are plenty of terrible diseases out there that outmatch our best tests and treatments.  But after a moment of reflection, this is not a reason to panic.  It’s a reason to do what is sensible to stay healthy and then to focus on your life, not your health.  The rational fear is not “What if I have pancreatic cancer?” but rather “What if I’m healthy and spend the next decade worrying about pancreatic cancer?”

Have a happy and calm Halloween.  And face the future unafraid.

Learn more:

U.S. Preventive Services Task Force recommendations

Electronic Preventive Services Selector

Important legal mumbo jumbo:
Anything you read on the web should be used to supplement, not replace, your doctor’s advice.  Anything that I write is no exception.  I’m a doctor, but I’m not your doctor despite the fact that you read or comment on my posts.  Leaving a comment on a post is a wonderful way to enter into a discussion with other readers, but I will not respond to comments (just because of time constraints).

0 Comments — Leave your comment

October 23, 2009 | 3:57 pm

Vaccines: Fighting Fear with Information

Posted by Albert Fuchs, M.D.

Diversity of opinion is a mark of any free society.  Whenever I hear the latest conspiracy theory, see a commercial for a ghost-investigating “reality” show, or hear the latest quack cure advertised on radio, I remind myself that the spread of wacky fringe ideas is a consequence of liberty.  And, though I wish my fellow citizens would develop a bit of skepticism, I wouldn’t want anyone preventing them from hearing, watching or believing all that nonsense.

So it’s a major victory when facts finally win out in the court of public opinion—rare but sweet instances when science scatters away panic, rumor and superstition.  This seems to be happening about vaccines.  The fact that vaccines are very safe and that they save lives is gaining popular traction.  This is very encouraging.

It means that people who believe that organic food has health benefits (it doesn’t) or that vitamin C helps treat colds (it doesn’t) are at least rejecting the fear-mongering of the anti-vaccine movement.  A recent article in the Atlantic (link below) is another step in spreading the truth.  It’s not long.  Please read it.

Of course, none of that matters because the Mayan calendar predicts the end of the world in 2012.  I better stock up on vitamin C.

(Thanks to my friend, Tom, for pointing me to the Atlantic article.)

Learn more:

The Atlantic article: The New Pandemic of Vaccine Phobia

My previous posts about vaccine refusal:

Vaccine Refusal: Turning Back Two Centuries of Progress

U.S. Measles Cases at Highest Numbers Since 2001

Important legal mumbo jumbo:
Anything you read on the web should be used to supplement, not replace, your doctor’s advice.  Anything that I write is no exception.  I’m a doctor, but I’m not your doctor despite the fact that you read or comment on my posts.  Leaving a comment on a post is a wonderful way to enter into a discussion with other readers, but I will not respond to comments (just because of time constraints).

0 Comments — Leave your comment

October 16, 2009 | 2:14 pm

A Dose of Realism about Advanced Dementia

Posted by Albert Fuchs, M.D.

Dementia isn’t one disease.  Like cancer, dementia is a family of different diseases that have important similarities.  The diseases that cause dementia all lead to progressive memory loss and brain dysfunction.  Dementia is caused by Alzheimer’s disease, vascular dementia, Parkinson’s disease and several other rarer brain disorders.  The different diseases that cause dementia cause different symptoms initially and have different treatments.  But unfortunately all the treatments are temporary and only slow the progression of dementia.  Advanced dementia has the same constellation of symptoms regardless of the cause – profound impairments in memory, language and mobility.

Dementia is a progressive incurable fatal illness. I learned that in my residency over ten years ago, and the newer treatments haven’t changed this fact.  On average, patients survive for 4.5 years after diagnosis, but some live as long as a decade.  There are incurable cancers with better survival rates.

Even though the poor prognosis of dementia isn’t news, apparently the word hasn’t spread.  An important study in this week’s New England Journal of Medicine studied the prognosis of patients with advanced dementia and followed the care they received, their family’s expectations and their medical complications.  Over 300 patients with advanced dementia who were admitted to nursing homes were followed.  They all were unable to recognize family members, had minimal verbal communication, were completely dependent for all daily living activities, were incontinent and were unable to walk independently.

The results of this study were depressing.  Over half of the patients died within 18 months.  In their last 3 months of life over a third had distressing symptoms like breathlessness and pain.  Only a fifth of the patients were referred to hospice care.  Despite their terrible prognosis, over a third of the patients underwent a hospitalization, emergency room visit, tube feeding or intravenous feeding.  The one bright point was that patients whose families understood the poor prognosis of dementia were less likely to receive intensive intervention.  Though the study doesn’t state this, I pray this translated to earlier hospice referral and better symptom relief.

As we all live longer and as we are better able to treat and prevent heart disease and some types of cancer the incidence of dementia will increase.  Families deserve honesty about the course of this terrible illness, and patients deserve comfort.

Learn more:

Time article:  Redefining Dementia as a Terminal Illness

New England Journal of Medicine article:  The Clinical Course of Advanced Dementia

The source of the statistics about survival after dementia diagnosis is this Medscape article:  Survival After Dementia Diagnosis Depends on Age, Sex, Disability (click on the first search result)

Important legal mumbo jumbo:
Anything you read on the web should be used to supplement, not replace, your doctor’s advice.  Anything that I write is no exception.  I’m a doctor, but I’m not your doctor despite the fact that you read or comment on my posts.  Leaving a comment on a post is a wonderful way to enter into a discussion with other readers, but I will not respond to comments (just because of time constraints).

0 Comments — Leave your comment

October 9, 2009 | 3:13 pm

The Challenge of Trusting Science

Posted by Albert Fuchs, M.D.

Around the turn of the last century medical practice was in a sorry state.  Despite dramatic advances in physics, chemistry and physiology, the day-to-day practice of medicine was still entirely estranged from the scientific method.  Medical training and medical practice was still what it had been for thousands of years – an apprenticeship in which treatments were passed down from teacher to student and applied by doctor to patient for generations without rigorous testing.  At about that time leaders in medical education sought to bring the scientific rigor of other disciplines to medical education and medical practice.  We can’t say that their work is complete.  The rigorous testing of therapies in randomized trials and the deliberate attempt to base clinical practice on the results of those trials (what we now call evidence-based medicine) is only a few decades old.  And even now, many physicians are deeply skeptical of evidence-based medicine, preferring to rely on their own experience or on traditionally accepted treatments.

I have no objection to relying on my experience or my judgment in the many cases for which scientific evidence is lacking.  Every day doctors face clinical situations for which no large randomized trials provide data.  That is the time for experience, improvisation, the art of medicine.  But some physicians resist relying on science even in cases in which studies exist and are clear.  They assert the importance of their autonomy and experience and refuse to follow “cookbook medicine”.  The problem with that approach is that our experience frequently fools us.  We remember best the cases that conform to our biases and expectations, and tend to forget the ones that challenge us.  We overestimate the frequency of dramatic outcomes and underestimate the more common boring cases.  We deceive ourselves to maintain our preconceptions.  That’s why to get at the truth studies have to be blinded and randomized.  The experience of every living person suggested that the sun revolved around the earth.  It was only Galileo’s data that convinced him otherwise.

Though medicine has a long way to go, we’re moving in the right direction.  But there’s another field which is now approaching the scientific revolution that medicine started a century ago – psychology.  Much of clinical psychology remains the transmission from teacher to student of untested but long-used therapy methods.  At the same time, the last few decades have seen remarkable progress in the science of mental illness and psychotherapy.  A specific kind of psychotherapy called cognitive behavioral therapy has been proven in many studies to be helpful for many disorders, especially in the family of anxiety disorders.  This scientific proof is startlingly lacking for many other forms of psychotherapy.  But there is a schism between the scientific findings and the education and practice of psychology.  Most psychologists have not been trained in cognitive behavioral therapy and most do not practice it, relying instead on unproven techniques.

This is not my criticism.  It is the criticism of three psychologists led by Dr. Timothy Baker in the University of Wisconsin who authored an article in Psychological Science in the Public Interest.  (See link below.)  The article details the many evidence-based psychotherapy techniques available and then shows how infrequently these techniques are used in practice.  The editorial that precedes the article is a clarion call for the field of psychology to reform itself if it is to continue serving patients.

I have the pleasure and honor to take care of several psychologists and have psychologists as friends.  (I look forward to their emails about this.)  My intention in this post is not to point fingers or criticize.  It is to highlight an important positive development in psychology and to encourage psychologists to trust science.

Learn more:

Newsweek article:  Ignoring the Evidence.  Why do psychologists reject science?

LA Times Booster Shots:  Do therapists know what they’re doing? Don’t bank on it, 3 psychologists say

Psychological Science in the Public Interest article: Toward a Scientifically Principled Approach to Mental and Behavioral Health Care

Important legal mumbo jumbo:
Anything you read on the web should be used to supplement, not replace, your doctor’s advice.  Anything that I write is no exception.  I’m a doctor, but I’m not your doctor despite the fact that you read or comment on my posts.  Leaving a comment on a post is a wonderful way to enter into a discussion with other readers, but I will not respond to comments (just because of time constraints).

0 Comments — Leave your comment

October 2, 2009 | 2:18 pm

The H1N1 (Swine) Flu Vaccine

Posted by Albert Fuchs, M.D.

Photo

Countless of you (well actually, several of you) have asked me in the last few weeks “What about the swine flu vaccine?”  “Should I get it?”  “When will it be available?”  “Is it safe?”  “Does it not herald the coming of the zombie apocalypse?”  Well, your long wait for answers is finally over.

So far the H1N1 infection has caused symptoms very similar to garden variety seasonal flu, except that diarrhea and vomiting have been more common and that most hospitalizations have been in people younger than 65.  Remember, this is overall not a worse disease than the regular flu, though some groups have been particularly vulnerable.

Physicians will begin receiving shipments of the H1N1 vaccine later in October.  The H1N1 vaccine is prepared the same way as the regular influenza vaccine, so it has the same side effects and is just as safe.  Fortunately (despite conflicting reports a few months ago) one dose of the vaccine is sufficient.

The vaccine is recommended for the following five groups.

  • Everyone 6 months through 24 years of age
  • People who live with or care for infants younger than 6 months of age
  • Pregnant women
  • Healthcare workers
  • People 25 years through 64 years of age with health conditions associated with high risk for medical complications from influenza

If you’re in one of the above groups, see your doctor later this months and get the vaccine.  If you’re not, don’t.  Our office expects to receive the vaccine in the next few weeks.

Learn more:

Centers for Disease Control recommendation for H1N1 vaccination

Important legal mumbo jumbo:
Anything you read on the web should be used to supplement, not replace, your doctor’s advice.  Anything that I write is no exception.  I’m a doctor, but I’m not your doctor despite the fact that you read or comment on my posts.  Leaving a comment on a post is a wonderful way to enter into a discussion with other readers, but I will not respond to comments (just because of time constraints).

1 Comments — Leave your comment

Page 1 of 4 pages  1 2 3 >  Last »

About this Blog

Blog Home
About the Blogger(s)
Contact

RSS


Blog Archive