Obama Administration Discusses Lessons Learned from Swine Flu

Public health officials did much to alleviate spread of swine flu in 2009, but more needs to be done.

Too many people still mistrust vaccines – health care providers included – and vaccine production technology needs a shot in the arm. That’s the takeaway from the swine flu experience of 2009, U.S. Health and Human Services Secretary Kathleen Sebelius said last week at the 44th National Immunization Conference in Atlanta. And while communication systems were strong during the early days of the swine flu outbreak, more needs to be done to reach out to some communities, especially minority communities, and above all physicians, Sebelius said.

“We shouldn’t have to convince health providers that vaccines are safe and that they work. But, despite the fact that we had more health providers than ever getting vaccinated last year, there was still a sizable number who did not. We need providers on the front lines. We need to make sure that the vulnerable people they work with aren’t at greater risk,” Sebelius said.

Sebelius’ address comes one year after the panic of last April, when public health officials were still puzzling out the new, aggressive strain of flu that had clearly invaded the New York City public school system. Later dubbed swine flu, the virus appeared to hop-scotch over typical influenza victims – the elderly and those with compromised immune systems – and instead was striking down and even killing young, otherwise healthy people and pregnant women with a vengeance.

The unknowns surrounding the swine flu – and the rapidity of its spread – created simultaneous panic over its origins and effects and suspicion over the vaccine that arrived on the scene. The World Health Organization declared an official pandemic in April of 2009, and has since had to defend itself against accusations that the declaration was motivated by a desire to enrich the pharmaceutical companies that were working on the vaccine. Too many people, including those whose medical conditions made them susceptible to swine flu complications, refused to take the vaccine out of fear it had been rushed and had not been properly vetted. Sebelius’ own agency, the HHS, had to admit that original estimates of the country’s ability to produce the vaccine had been overstated. This in particular is troubling to Sebelius, who used the confusion around vaccine production to illustrate the need for better vaccine production methods.

“This flu season has made us even more committed to ensuring that vaccine production—and all of our medical countermeasures—are state-of-the-art. Our experience with the ups and downs of the vaccine manufacturing process has made clear the need to enhance our country’s influenza vaccine manufacturing capability,” Sebelius said, adding the HHS was already working with vaccine companies to move past the “egg-based” technology, in which vaccines are basically grown in eggs, to more advanced and reliable method.

Sebelius is right. We need to learn the lessons provided in 2009 and then do it better next time. Some southern states are already showing swine flu activity, though it’s too soon to know if that will develop into a true outbreak. But if and when swine flu does return in greater numbers, we want there to be plenty of vaccine to give, and plenty of people willing to receive it.

Photo Credit: Justin Hourigan

Erectile dysfunction predictor of health, and death

Erectile dysfunction is more than an issue of sexual health. It is a strong predictor of death and cardiovascular health.

We’ve been lulled by the commercials into believing that erectile dysfunction is a mere annoyance, a minor blip on the sexual health screen that can be easily remedied by a pill in various convenient dosing options. But researchers warn that those sultry, idyllic, twin-bathtub-in-the-middle-of-nowhere images mask more sinister health threats associated with erectile dysfunction (ED). In fact, ED is a strong predictor of death from all causes and of heart attack, stroke and heart failure in men with cardiovascular disease, German researchers reported this month in Circulation: Journal of the American Heart Association.

Researchers found that men with cardiovascular disease and erectile dysfunction (compared to those without ED) were twice as likely to suffer death from all causes and 1.6 times more likely to suffer the composite of cardiovascular death, heart attack, stroke and heart failure hospitalization. More specifically, they were:

• 1.9 times more likely to die from cardiovascular disease;
• twice as likely to have a heart attack;
• 1.2 times more likely to be hospitalized for heart failure;
• 1.1 times more likely to have a stroke.

As if that weren’t bad enough, researchers said, too many men with ED don’t realize how poor their heart health is and how great their risk of death is because they don’t know they also have cardiovascular disease. They don’t learn of the other condition because they are successfully treated for erectile dysfunction by their primary health care provider or urologist. They aren’t referred to a cardiologist for an evaluation until their cardiovascular disease is advanced.

“Men with ED going to a general practitioner or a urologist need to be referred for a cardiology workup to determine existing cardiovascular disease and proper treatment,” study author Michael Böhm, M.D., lead author of the study and chairman of internal medicine in the Department of Cardiology and Intensive Care at the University of Saarland, Germany, said. “ED is an early predictor of cardiovascular disease.” Usually, though, that doesn’t happen, especially if the ED treatment was successful. “The medication works and the patient doesn’t show up anymore,” Böhm said. “These men are being treated for the ED, but not the underlying cardiovascular disease. A whole segment of men is being placed at risk.”

The study is an important reminder of how inter-related health conditions can be. Neglect one aspect of your health, and you may unwittingly make another worse. More importantly, too many people diagnosed with Condition A don’t realize their diagnosis puts them at significant risk for developing Condition B. While the link between ED and heart disease seems logical – both involve blood vessels, for instance – that’s not true for all linked conditions. Asthma and depression, for example. Some linkages may seem downright counter-intuitive, so it’s important to be an informed health care consumer.

Gentlemen, that goes for you: If you have ED, ask your doctor if a cardio workup is right for you.

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Some “male enhancement” products can harm your health

Some “all natural” male enhancement products contain undeclared ingredients that can harm your health.

You’ve seen the campy commercials: One member of a golf foursome scores a hole in one. Women at an office party scuffle for a chance to be near that certain man. But public health officials say beware: Many of the so-called all natural male enhancement products contain undeclared ingredients that can harm your health or even kill you. The federal Food and Drug Administration issued yet another warning this week about the products, many of which are sold online. The FDA says that despite its repeated warnings, consumption of these products is increasing – as are the reports of harmful health effects.

Public health officials say many of the products that are supposed to be all natural, dietary supplements actually contain various amounts of the ingredients found in prescription drugs such as Viagra, Cialis and Levitra. Public health officials warn that taking products that contain these kinds of ingredients can be particularly dangerous for people who are also taking prescription drugs that contain nitrates, such as nitroglycerin. That's because they can interact to cause dangerously low blood pressure. Furthermore, people with diabetes, high blood pressure, high cholesterol, or heart disease often take nitrates. And since erectile dysfunction is common in men with these conditions, public health officials say they may seek out these sorts of products.

Rather than classifying these products as a drug – which of course would put them under much closer scrutiny – these products are marketed as “dietary supplements,” which are barely regulated. Plus, as public health officials point out, these so-called supplements are not likely to be made under the same quality controls as prescription drugs, so the identity or the amount of the Viagra-like ingredients could vary greatly. The FDA has actually found the prescription materials in much higher quantities in the so-called all natural products than what a doctor would prescribe in a regulated medication. Many of the male enhancement products that are catching the eye of public health officials are imported from other countries. Numerous shipment have been seized and tested, which is how officials know how much of the prescription medication has been found in the so-called natural products.

While steps have already begun to be taken, these warnings serve as a reminder why we need to beef up regulation of dietary supplements. And while I’m at it, let’s talk about setting real standards for organic foods so that people who are chemically sensitive don’t accidentally ingest harmful contaminants in foods that are supposed to be clean and organic. So many people take different supplements of different varieties in hopes of becoming better, faster, more energetic or simply to destroy free radicals. Yet it’s nearly impossible to know if you are getting the potency the supplement makers claim their product has – or even if it’s advisable to take that level of the vitamin. Please correct me if you disagree, but I have a hard time believing that taking 2,667 times the recommended daily dose of any vitamin or mineral is a good idea. What do you think?

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Public health panel recommends flu vaccine for everyone

Global experiences with swine flu convince health panel to change recommendation and urge everyone to get flu vaccine.

An advisory panel to the nation’s chief disease tracker is urging all people above the age of 6 months to get the regular flu vaccine starting with the 2010-2011 flu season. Right now, the official flu shot recommendation is for children age 6 months to 18 years, the elderly, and anyone in between who is otherwise at risk for complications, such as people with asthma or HIV. The new recommendation would be for all persons 6 months and older to get the regular flu vaccine regardless of the otherwise healthiness and hardiness of their immune system. The recommendation needs official approval from the directors of the Centers for Disease Control and Prevention and the Department of Health and Human Services, which is expected to happen next month.

Members of the advisory committee who voted for the change were particularly concerned about the need to protect people 19 to 49 years of age, who were hard hit by the 2009 swine flu pandemic. Another reason panel members gave for universally recommending the flu vaccine is that many people who are considered “higher risk” are unaware of their vulnerability or that they are recommended to get the vaccine. The panel also said that the world’s experience with the 2009 swine flu pandemic taught them that some people who don’t currently fall into one of the specific recommendation categories for the vaccine may also be at higher risk of serious flu-related complications, including those people who are obese, post-partum women and people in certain racial or ethnic groups.

But lastly, and perhaps most importantly, the vaccine advisory panel said it is important to issue a “simple and clear” message about the importance of the flu vaccine in order to “remove impediments” and encourage more people to protect themselves. This is a good thing, especially after a year of watching, awe-struck, as young and healthy people not historically considered at risk for flu complications were struck down and hospitalized within hours of contracting swine flu. Seasonal and swine flu are different creatures, but the experience appears to have taught public health officials not to assume the relative immunity of healthy people against the flu.

We need less confusion surrounding the need for flu shots; we also need more flu shots. Any confusion eased by the new recommendations will just be compounded if public health officials fail to make enough vaccine to cover the people they recommended for the shot. Last year it took longer that expected to create the swine flu vaccine, which led to long angry lines of people and even panic. Many people were turned away, some tearfully, by public health officials who were forced to ration to the shots for the most vulnerable populations. Those people were assured that more vaccine on the way, and indeed it eventually arrived.

In releasing the news of its new recommendation, the advisory panel acknowledged that more doses will be required to cover all adults. However, the panel said more licensed types and brands of seasonal flu vaccines will be available in the 2010-11 flu season than has ever been available before.

Let’s hope so. Will you get the shot?

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Health care experts warn against “ear candles”

Using hot wax to cure ear ailments is dangerous and can harm your ear, health care officials warn.

Does dripping hot wax into your ear sound dangerous? American and Canadian health care officials thinks so, and they have teamed up to warn consumers against so-called “ear candles.”

These candles, which are hollow cones about 10 inches long and made from fabric soaked in beeswax or paraffin, are being marketed as treatments for a number of ear ailments. Yet health care agencies, including the American Food and Drug Administration (FDA), say they have received a number of reports of people, including children, being burned or suffering ear injuries from the devices. In at least one case surgery was required.

In an era when technology is changing the way we care for our health, ear candle companies claim their products are a solid alternative to traditional health care techniques and can treat a variety of ear problems. These conditions include ear-wax buildup, sinus infections, hearing loss, headaches, colds, flu, and sore throats. Ear candling involves placing the candle in the outer ear, usually while the ear ailment sufferer lies on his or her side. It is also done with the person sitting upright. Then, the end of the “candle” is lit. Marketers claim that the warmth of the flame produces suction that draws wax and other impurities out of the ear canal.

"Some ear candles are offered as products that purify the blood, strengthen the brain, or even 'cure' cancer," says Eric Mann, M.D., Ph.D., clinical deputy director of FDA's Division of Ophthalmic, Neurological, and Ear, Nose, and Throat Devices. Some of the manufacturers even suggest the candles be used on children – who are particularly vulnerable to ear infections. But Mann warns that the candles can cause serious injury even when used exactly according to the package directions. Also, Mann added that there is absolutely no scientific evidence to back manufacturers’ claims of health care benefits.

Specifically, the FDA warns that ear candle users are at risk for

• starting a fire,
• burns to the face, ear canal, eardrum, and middle ear
• injury to the ear from dripping wax
• ears plugged by candle wax
• bleeding and puncture of the eardrum
• delay in seeking needed medical care for underlying conditions such as sinus and ear infections and other ear problems

The FDA is teaming up with other agencies, including the Canadian public health regulatory agency Health Canada, to act against manufacturers of ear candles. The two health care agencies have issued import alerts, injunctions, and warning letters. They also have seized shipments of the product.

Black and Hispanic infants far more likely to contract HIV

Although overall cases of infant HIV are down, Black and Hispanic rates of infection still outpace that of whites.

Rates of HIV infection in infants are still significantly higher among blacks than whites, and public health officials need to act to close that gap, a new study says. Although the number of HIV-infected infants has declined overall, the rate of perinatal HIV infection among black babies is still 23 times higher than the rate for whites. (Perinatal infections are transmitted to babies at birth). The study, published in Thursday’s issue of the Morbidity and Mortality Weekly Report from the U.S. Centers for Disease Control and Prevention, also found that the rate of infection was four times higher for Hispanic babies than for whites. Yet not all was bad news: researchers noted that overall the number of perinatal HIV infections has dropped 90 percent since 1990. The study analyzed data from 34 states from 2004 to 2007, and noted that transmission from an HIV-infected mother to her child can be significantly reduced through preventive measures. “To further reduce perinatal HIV transmission and racial/ethnic disparities, HIV-infected pregnant women, and particularly black and Hispanic women, should receive timely prenatal care, early antiretroviral treatment, and other recommended interventions,” researchers said.

The CDC report coincides with the release of another report Thursday that analyzes public health officials’ efforts to reduce HIV transmission among African Americans, particularly men. That report gave credit to community-based organizations for providing front-line services to individuals and feedback to federal agencies on the need for those services. However, the report found that African Americans continue to account for an inordinately high number of new HIV cases, and that efforts to reach members of the African American community have fallen short of where they need to be. Most of those new cases are triggered through sexual contact, especially among men having sex with men (MSM), while fewer cases are being spread through intravenous contact, according to the report.

“Blacks and Hispanics in the United States have been disproportionately affected by HIV and AIDS, compared with non-Hispanic whites, since the early days of the epidemic...Although the CDC’s efforts to combat HIV/AIDS among Blacks have achieved some success, more must be done to address this crisis,” CDC officials wrote in the report.

Meanwhile, other agencies are doing what they can to destigmatize the disease and reflect its growing status as a disease that can be managed, rather than an automatic, if eventual, death sentence. Last month the CDC and the federal Department of Health and Human Services removed HIV from the list of communicable diseases that prevent non-citizens from entering the United States.

Have public health officials done enough to protect at-risk populations from the spread of HIV? What do you think?

Public health panel urges routine obesity screening for children

One in six American children is overweight, and all kids, beginning at age six, should be checked.

Kids entering the first grade can now add a new test to the vision and hearing tests many schools require them to get: an obesity test. Public health officials want doctors to screen all children for obesity beginning at age six, and to refer overweight children to “intensive” weight management programs. The recommendation was announced this week by the U.S. Preventative Services Task Force, the same group that caused an outcry late last year when it urged baseline mammograms for women beginning at age 50 instead of 40.

The health policy panel said doctors should use height and weight measurements to calculate children’s body mass index (BMI). Kids whose BMI is over the 95 percentile for their age and gender are considered obese and should receive weight management treatment, members of the task force said. That treatment should include three parts: counseling, physical activity and behavioral management training for goal-setting and self-monitoring.

One possible problem, public heath officials acknowledged, is that there aren’t many juvenile weight management programs that are both effective and affordable. The existing programs that are comprehensive enough to help kids change eating and activity patterns generally are private and can be quite expensive. Still, the growing problem of childhood obesity has led more hospitals and other health care facilities to offer weight management programs for kids.

Public health experts have called childhood obesity everything from an “impending catastrophe” to a “massive tsunami” threatening the American health care system. Already, obese children and very young adults are showing signs of developing Type 2 diabetes, hypertension and high cholesterol. Approximately 15 percent of kids age 6-15 are overweight, according to the National Center for Health Statistics, and a 2005 report in the New England Journal of Medicine suggested obesity could shorten the lifespan of today’s kids by two to five years.

Worried that your kids are in danger of becoming overweight? Here are some things you can do:

• Involve your kids in meal planning and preparation. There are plenty of cookbooks for kids available, and many emphasize healthful eating. Tape the food pyramid to the refrigerator, and then have your kids plan a meal a week. Also, have your kids pack their own lunches based on the pyramid guidelines.
• Look for community programs, such as the YMCA, that offer after-school sports, recreation and sometimes even nutrition programs. Go for a family walk or bike ride after dinner. If you’re having trouble tearing your child away from the computer screen, consider investing in one of the popular video game exercise programs.
• Talk to your child’s doctor. He or she can refer you to a nutritionist for help on meal planning and a counselor for tips on how to support your child emotionally during the weight management journey.

What ideas do you have for helping kids achieve and maintain a healthy weight and attitude?