Here are some of the most common questions I encounter regarding vaccines and my answers. I’m writing this post, from a parent to a parent, because I want to equip you with accurate information to protect your child.We give so many vaccines now and it seems like we are constantly adding more. Isn’t this too much for my child’s immune system? Isn’t it antigen overload? The immune system is very complex, ...
Meds
A look behind the growing cost of cancer drugs
Julie Gralow, an oncologist at the Fred Hutchinson Cancer Center in Seattle, recently prescribed an exciting new therapy for a 60-year-old woman with metastatic breast cancer. Three-and-a-half years into her battle against the disease, the patient had already exhausted three different anti-estrogen therapies, each of which only put a temporary check on the spreading tumors.The newly prescribed drug, Novartis’ Afinitor, is one of the recently approved targeted therapies that have ...
Complementary and alternative medicine need more randomized trials
Since I dedicated an entire issue of JAMA on Nov. 11, 1998 to the theme of Complementary and Alternative Medicine in an effort to move CAM into the mainstream, I keep hoping that some of the numerous CAM offerings will make it out of the realm of anecdotal and placebo-healer-effect, and successfully through randomized controlled clinical trials.So I got excited when I saw the BMJ Evidence Centre via ...
An American ER doctor in Tasmania
Beginning work at Launceston General Hospital in Tasmania, orientation really, I noticed a lot of things missing: places to sign my name.For any given patient I’d sign: the completed chart note, perhaps a lab (sorry, pathology) and imaging slip, a prescription form (in triplicate – ok, so that was weird), and a GP letter.I didn’t have to sign (physically or electronically) multiple different "attestations," I didn’t have to generate multiple ...
Is it ethical to prescribe a placebo for a patient?
Betty was complaining at an escalating rate. She'd been in her nursing home for four years and wasn't happy. She kept coming up with new symptoms like aching, fatigue, nervous stomach, tingling, dizziness, etc. Her daughter Nancy was getting daily calls from Betty and the staff at the nursing home. Multiple trips to the doctor for diagnostic tests had ensued: blood counts, liver functions, x-rays, thyroid function, plus many others. ...
Abbreviate your med list with caution
People who regularly take medicine should know what we’re taking. To me, this seems obvious, but there are always those who need everything stated explicitly. People taking prescriptions, vitamins, herbs, and any other treatments should know what’s being taken and why.It’s pretty easy to make yourself a list and stick it in your wallet so that it’s always available. If you need medical assistance (for instance, if you’re in a ...
Learning valuable public health lessons from influenza vaccination
In response to low immunization rates in my community, I served on a task force to develop a community-based pilot to increase influenza vaccination. We worked in collaboration with the NYC Department of Health and Mental Hygiene, Department for Aging, Visiting Nurse Services of New York (VNSNY) and a local church health ministry.On a Sunday morning in late November (during the CDC's National Influenza Vaccine Week) nearly 100 African-Americans received ...
Why I vaccinated my sons against HPV
I knew it was more than a tragic coincidence when two of my friends, middle-aged men without the usual risk factors of tobacco and alcohol use, developed late stage (IV) tongue cancer, reportedly the identical condition with which actor Michael Douglas was diagnosed last year. Cancers of the mouth and throat are growing so quickly that experts in the medical and scientific community are calling this an “epidemic,” for which ...
Vaccines, preventable disease, and the nature of risk
Two nights ago, I was watching, with my family, an old episode of Dr. Quinn, Medicine Woman, in which a young woman is bitten by a rabid wolf, develops rabies, and dies. That same night, I read a post on Facebook decrying the dangers of immunizations, with a link to an online “news” article blaming immunizations for everything from spreading cancer to HIV.My mother, as a girl, was bitten by ...
How medications are like vehicles
I usually cringe when I see a pharmaceutical company ad on TV. I think most pharma commercials do more harm than good. The ads scare patients out of taking medications they need.Actor: Do you have uncontrollable diarrhea? I did, and then my doctor prescribed “No-More-Poop!” Now I feel great and don’t have to worry about embarrassing accidents.Commentator: Clinical studies done at a leading university prove that “No-More-Poop” cures 99% of ...
Taking the knife to doctor-drug company relationships
With health care industry reaching unsustainable lows, media attention is on physician's relationship with the pharmaceutical industry. A Google search will give results that paints doctors as culprits, leading to a prejudiced opinion where doctors are thought of as co-conspirators with drug companies. This article teases this tainted relationship, from a typical doctor's perspective.Pharmaceutical companies have strategies not only to survive, but also to grow with general public investing in ...
Let’s close the chapter on statin safety
There was important news recently on statin drugs. As one of the world’s most effective and commonly used medications, statins provide great writing topics. Lots of people have high cholesterol–including cyclists. Lots of people are interested in avoiding our mostly deadly disease.I’d like to tell you about a recently-published landmark study in the Lancet that should quell safety concerns over statin drugs.The punch line after I tell you the study’s ...
Explaining Propofol to patients after Michael Jackson and Conrad Murray
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.Since the passing of Michael Jackson and the recent trial of his physician, Dr. Conrad Murray, I have been frequently asked by patients whether they will receive the drug that killed the singer. As have many of my anesthesiologist colleagues, I have taken this opportunity ...
I eat lunch with drug company representatives and I’m proud of it
Today, I want to review another article I wrote in last year. That article started with a confession: "I confessed that I ate lunch with a representative of a pharmaceutical company."I must now confess that I often eat lunch with representatives of pharmaceutical companies and I’m proud of it. At this stage of my career, I can well afford my own lunch. I could sit quietly and relax over a ...
Delta Air Lines goes anti-vaccine
I have many, many patients and their families who are very active travelers. Business flights, vacation trips … some of you really rack up the miles.It is with shock and disappointment that I must report; Delta Air Lines has made a very poor choice.An ad, produced by the National Vaccine Information Center (NVIC), is currently being shown to passengers on Delta flights through the month of November. The ad encourages ...
Immunization before radiation to avoid complication
Radiation oncologists offer curative cancer treatment to many. Despite irradiating the spleen for over 50 years, why don’t we routinely offer pneumococcal vaccination to avoid complications after treatment? Since we just had World Pneumonia Day to raise awareness for children, I want to do the same for cancer patients.A healthy spleen helps fight off pneumonia, sepsis and meningitis. Publications on infection from spleen radiation date back at least thirty years, but were ...
Can vaccine recommendations be based solely on individual and public health?
Have you heard the parable about the blind men and the elephant? Each is holding a different part of the animal and comes to a different conclusion about what he’s dealing with. The man holding the tail is sure it’s a rope; the one with the trunk fears a snake; the one holding the tusk is certain he has a spear. It’s all in their perspective. They’ll need to share ...
How pain as a vital sign contributed to prescription pill mills
At this point, few would argue against the need for increased oversight of the legions of so-called pain management clinics that have sprung up in the past decade.After all, an annually increasing majority of them are nothing more than lucrative cash and carries for the legal sale of prescription narcotics to anyone with a need or want -- and the cash in hand. They have become a public mental health ...
When FDA fines become the cost of doing business
A recent $3 billion settlement between drug giant GlaxoSmithKline and the FDA really got me thinking. On one hand, it’s a breathtakingly huge number, breaking the old record of $2.3 billion set by Pfizer a couple years back. And there are some initial indications that the pharmas may be cleaning up their act a bit, expanding their compliance departments and reining in their sales forces in order to avoid ...
Targeted therapies improve cancer treatment
The revolution in medicine brought about by greater understanding of genomics has led to a number of targeted therapies in cancer care.The basic concept is to first find the genomic change or mutation that leads to a disease, then learn its gene product and then develop a drug that inhibits the action of the aberrant gene product. The first was imatinib (Gleevec) for chromic myelocytic leukemia (CML.) When a ...
