Grand Rounds #4
Best of the week from the medical blogs. Come visit and spread the word.

With the influenza vaccine shortage, it is now being urged that seniors at least get the pneumonia vaccine - which is not in short supply:

The flu-shot shortage makes it more imperative for elderly Americans to get a second, often overlooked vaccine that protects against a type of pneumonia germ thatÂ’s a common complication of influenza.

Called pneumococcal vaccine, itÂ’s a one-time shot for anyone 65 or older. ...


The USPSTF has revised their grading system for recommending periodic health examinations. In the past, only the quality of evidence was weighed. Now the magnitude of the benefit is incorporated. Here are the revised definitions for the rating grades:

The codes for the current USPSTF recommendations include A (strongly recommended, good evidence, and substantial benefit), B (recommended, fair evidence, and moderate to substantial benefit), C (no recommendation, fair to good ...


Drug exports threaten supply, group warns
Growing Canadian resistance for "allowing the U.S. to raid our medicine cabinet".

Newsweek: Bad Medicine
Newsweek with a critical look at our health care system. It comments that neither candidates' proposals gets to the root of the problem:

But that doesn't address the real driver of medical inflation: your demand for more and more care, especially high-tech treatments.

Knowledge is Health
Much has been written here about banning direct-to-consumer advertising. This article presents an alternative view.

Vaccines, lottery-style
I know it's the fairest thing to do, but it's sad that it had to come down to this.

Vaccine liability
Carey Cuprisin writes more on the tort system being one of the factors causing the flu vaccine shortage.

Hospital using liens to collect from patients
It seems mercenary and places both the hospital and patients in a difficult position. However, if the hospital can't collect and the patient can't afford the bills, who pays for the medical care?

What primary care needs now
A look at addressing the problems in primary care.

Lessons from the withdrawal of rofecoxib (Vioxx)
BMJ with their view.

Why did Chiron Flu Crisis Affect USA more than England?
Some observations:

Last August UK officials, with the same information the US officials had, decided something had to be done in case the Chiron supplies, 14% of UK supplies, went belly up. The US officials decided to believe Chiron and gamble 48% of their supplies on an assurance that everything would turn out fine despite some worrying set backs.


NY Times: With Few Suppliers of Flu Shots, Shortage Was Long in Making
A detailed look at the flu vaccine shortage.

What to do if you are taken hostage
BMJ with some tips for physicians who want to work in dangerous areas. An interesting read.

Dr. James Baker with a psychiatrist's opinion on the black-box antidepressant warning by the FDA yesterday.

Where there’s smoke

Keeping a close eye on this: Pfizer Warns of Risks From Its Painkiller

Gaining attention

Almost a month ago, some Maryland physicians protested a 33 percent increase in malpractice premiums. It seems like they have brought about some action:

Maryland leaders raised hopes yesterday for a special session of the General Assembly next month that would focus on curbing insurance rate increases for doctors, but they acknowledged that key details -- including how to pay for new initiatives -- remain unresolved.

Don’t believe it

With the popularity of anti-bacterial soaps and cleansers, I have been asked - do they really work? No.

No sharing

Canada isn't sharing their flu vaccine supply: "The stuff that's sitting in my fridge isn't for them."

Waiting some four hours for the flu vaccine caused someone to collapse and die.

You can blame the lawyers for the flu vaccine shortage (via Medpundit):

Whether doctors are quitting the profession because of an out-of-control tort system, whether malpractice premiums are the cause of health care increases--such ...


BMJUSA with a comprehensive look at the role of email consultations (in two parts).

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