By S. Humphries, MD
January 22, 2010
original link with references www.medicalvoices.org
H1N1 and seasonal influenza vaccines are now being given to sick hospital patients with or without their doctor’s consent. This is being done despite there being no data on the safety of doing so.
I am a licensed, board-certified nephrologist, otherwise known as a kidney specialist, working in a large, city-based hospital. Because I rarely admit patients to the hospital other than for specific procedures, such as a kidney biopsy, I only recently became aware of my hospital’s policy regarding flu shots for sick people. Waking up to this new rule made me realize that Big Pharma is getting closer and closer to bypassing doctors completely to deliver direct patient “care”.
We have an elaborate electronic charting system at our hospital. All of the medications and procedure orders are placed into the patient’s record by doctors and nurses so that every person has access to all that is happening with the patient. A few weeks ago, I arrived to see my first patient of the day, a patient with a kidney ailment that leaks protein and usually progresses to complete kidney shutdown. When I opened her electronic chart, I expected my section to be empty. Instead, I saw an order for an influenza vaccine with my name on it. Even more shocking was that the order was highlighted bright blue, meaning, the shot had already been given. I thought perhaps I had opened the wrong chart or some sort of mistake had been made. But it was the right file; her name in the upper left hand corner. And my electronic signature was on the page after the order. My patient, with kidney failure and an autoimmune disorder had been given a flu shot without my consent.
I was informed that according to a hospital policy that had been in effect since 2007, a pharmacist is permitted to visit a patient and offer them a flu vaccine. If the patient agrees, the RN is instructed to administer the shot and document the event in the chart. The attending physician’s signature stamp is used to complete the order. No one called to ask, “By the way, your patient wants a flu shot; can we give her one?” I’m not sure what was said to her, but she obviously agreed, and I didn’t need to be involved. The pharmacist had written an order for an injectable substance that I considered toxic and inappropriate for my patient, and it was administered by the RN before I even got to the floor.
My dissatisfaction eventually made it to the Chief of Internal Medicine who challenged me to produce peer-reviewed journal articles in support of my objection. There were dozens of case reports of kidney disease or small blood vessel inflammation following influenza vaccination. In fact, one paper cited 16 patients in its written report(1). Under-reporting of adverse vaccine reactions is a known phenomenon. The National Vaccine Information Center estimates that only about two percent of adverse vaccine reactions ever get reported. It would follow that written and published case reports found in medical journals represent a miniscule sampling of the totality of vaccine injury cases. These implications should evoke at least some curiosity on the part of doctors and health care advocates.
The peer-reviewed literature was delivered to the department head. His initial response was to suggest that future vaccination orders be signed off by another physician so I didn’t have to be involved with the process of a nurse giving a “routine” flu shot. But the point had been missed; flu shots should not be given to sick patients.
I was challenging “routine orders” that had been in place since 2007. The defense for supporting the policy was that no side effects had been reported since the standing order had been instituted. I wondered to myself and then later inquired: How do you know that is true? Is it because nobody filed a formal report? If a patient became more ill after the shot, did you consider his condition to be a side effect of the vaccine, or was it simply called an unfortunate complication to the patient’s current illness? What if the patient was discharged from the hospital but readmitted several weeks later. Was the reason logged simply as a progression of his existing disease…or was the cause an overlooked, delayed side effect of the vaccination? If vaccine reactions are not considered as part of a patient’s differential diagnosis, how do you know? Without taking a vaccine history when considering a timeline of events, how could anybody possibly make the connection between a vaccine and a subsequent illness? How does anyone else know for that matter – that there were no side effects from the “routine” administration of flu shots, ordered by a pharmacist and given by a nurse, without doctor consent? The truth is, there is no real tracking and reporting system in place. And nobody is enthused about trying to start one. What has essentially happened is that the guards have all been told to go home and nobody is thinking to even look for the wolf.
I am sure there are thousands of unreported cases of kidney failure – and a wide range of other serious health conditions – because doctors fail to ask a very simple question as part of the admission evaluation: “When was your last vaccine?” And few doctors suspect any connection because the party line screams, “Vaccines are safe, effective and harmless. They keep people healthy and prevent infection.” If nobody looks, vaccine-related side effects and complications won’t be found.
There was a law passed in 1986, the National Vaccine Injury Compensation Act, that made vaccine manufacturers and administering physicians immune from legal recourse in the event of a vaccine injury. This has given manufacturers a dangerously long leash and has enabled them to push vaccines through FDA approval with little need to create a safe product. Now drug companies have extended their reach into the hospital right past doctors, and put the power to vaccinate in the hands of pharmacists and executive committees, allowing them to make decisions about what is best for a patient.
By DONALD G. McNEIL Jr.
Although federal health officials decline to use the word “peaked,” the current wave of swine flu appears to have done so in the United States.
Flu activity is coming down in all regions of the country, the Centers for Disease Control and Prevention said Friday, though it is still rising in Hawaii, Maine and some isolated areas.
The World Health Organization said Friday that there were “early signs of a peak” in much of the United States.
On Wednesday, the American College Health Association, which surveys over 250 colleges with more than three million students, said new cases of flu had dropped in the week ending Nov. 13. It was the first drop since school resumed in the fall, and it was significant — new cases were down 27 percent from the week before.
And on Friday, Quest Diagnostics, the country’s largest laboratory, said its tests of 142,000 suspected flu specimens since May showed that the flu peaked in late October.
Nonetheless, Dr. Anne Schuchat, the director of immunization and respiratory diseases at the C.D.C., chose her words carefully, saying: “I wish I knew if we had hit the peak. Even if a peak has occurred, half the people who are going to get sick haven’t gotten sick yet.”
Dr. Schuchat also noted that even when new infections topped out, hospitalizations and deaths were still on the way up, because most took place days or weeks later.
Privately, federal health officials say they fear that if they concede the flu has peaked, Americans will become complacent and lose interest in being vaccinated, increasing the chances of another wave.
In New York, where cases peaked last May, vaccine clinics have gone begging for takers as long lines form in the rest of the country.
Epidemiologists expected a peak about now, because flu waves typically last six to eight weeks.
Sneezing, coughing, fever, aches and pains…
Worried about flu symptoms like these? As winter approaches, most of us are.
But this year, the flu seems even more alarming, thanks to increased health concerns about the H1N1 influenza strain, also known as the swine flu. Even though this strain doesn’t appear to be particularly threatening, it has the potential to mutate into a more dangerous form.
The main question my patients have been asking is whether they should get vaccinated against H1N1 or against the regular flu.
This is not a simple yes or no answer. The guiding principle of functional medicine is personalized care, not the one-size-fits-all belief that everyone should have the same treatment. This applies equally to vaccines. There is risk and benefit to every medical treatment or procedure.
That is why in today’s blog I want to review what you need to consider if you are thinking about vaccination, discuss some of the risks involved, and provide you with a comprehensive 7-step plan for preventing swine flu and staying healthy all winter long.
Should You Get Vaccinated?
The choice to get vaccinated is an individual one. Selective vaccination may be helpful for some groups of people–but not everyone. Here are the facts as I see them:
• The current strain of H1N1 is a generally mild strain of the flu. It sounds scarier, but, so far, fewer people have actually died from it than from the traditional flu. It may mutate but it hasn’t yet. Pushing widespread vaccination on low-risk populations exposes them to unnecessary risks.
• If the H1N1 mutates, the current vaccine may not be effective against it.
• The studies on the H1N1 vaccine have been limited in the rush to market.
• The 1976 swine flu vaccine was linked to a serious neurological disease called Guillain-Barré syndrome, which causes severe (but usually temporary) paralysis.
• The government has agreed to protect vaccine manufacturers from any lawsuits due to side effects of the vaccine, otherwise pharmaceutical companies would not make it.
by Tom Philpott via www.grist.org
Why isn’t the federal government seriously investigating the possible CAFO-swine flu link?
I’ve posed that question several times recently, most recently here. Now let me venture an answer.
The USDA is the federal agency tasked with ensuring that practices on farms, including factory animal farms, are safe. But it’s also the agency that exists to promote U.S. agricultural interests. In other words, the USDA has an inherent conflict around overseeing conditions on factory-style farms. For example, training a cold eye on the systemic safety hazards of factory farming isn’t likely to do much to promote the pork industry.
from the start of the novel H1N1 outbreak, the USDA has tilted decidedly in the direction of promoting U.S. ag interests. Even though virologists and veterinary scientists have been warning for years that large hog farms create ideal conditions for the generation of dangerous new flu viruses—as this Environmental Health Perspectives article definitively shows—-the USDA still isn’t systematically testing swine herds for H1N1. It continues to rely on a voluntary—and little used—testing program.
Nor is it doing much, from what I can tell, on the problem of MRSA, the antibiotic-resistent staph infection that claims more lives every year than AIDS. MRSA has been pretty definitively linked to factory hog farms—specifically the dubious practice of dosing pigs daily with antibiotics.
If the USDA has been limp in its attempts to examine safety conditions on factory farms, it’s been downright zealous in its efforts to promote the pork industry.
The latest: The USDA spent a cool $50 million on pork last week, in an explicit attempt to “assist … struggling producers.” That brings total 2009 federal spending on pork—the “other white meat,” that is, not pet projects for cronies—to $105 million. The latest $50 million worth of pork will be shunted into the National School Lunch Program, playing its traditional role of sinkhole for unwanted ag commodities.
While America is still in the grips of swine flu mania, let me use this opportunity to clear up a few things about my beliefs concerning the flu shot, vaccines, and health in general. I do this because there is obviously a lot of curiosity about this subject of vaccines — it comes up in every interview I do these days, and I’ve been finding that people, including doctors, are privately expressing a skepticism that is still not very prevalent in public. I feel like I’ve become a confessor for people who want someone to be raising questions about vaccines.
But I don’t want the job. I agree with my critics who say there are far more qualified people than me — its just that mainstream media rarely interviews doctors and scientists who present an alternative point of view. There is a movement to stop people from asking any questions about vaccines — they’re a miracle, that’s it, debate over. I don’t think its that simple, and neither do millions of other people. The British Medical Journal from August 25 says half the doctors and medical workers in the U.K. are not taking the flu shot — are they all crazy too? Sixty-five percent of French people don’t want it. Maybe its not as simple as the medical establishment wants to paint it.
Vaccination is a nuanced subject, and I’ve never said all vaccines in all situations are bad. The point I am representing is: Is getting frequent vaccinations for any and all viruses consequence-free? I feel its unnecessary and counterproductive to try and silence people with condescension. Michael Shermer wrote me an open letter and felt I needed to be told that “vaccinations work by tricking the body’s immune system into thinking that it has already had the disease for which the vaccination was given.” Thanks, Doc, I thought there might be a little man inside the needle. Yes, I read Microbe Hunters when I was eight, I have a basic idea how vaccines work.
That’s not — or shouldn’t be — where the debate is. I admit, its hard to get as clear a picture of my beliefs, as you could, say, if I had written a book on vaccines, versus someone in the setting of a talk show. So I understand why its easy to take bits of things I have said and extrapolate into something I actually have never said. I understand it, but its not exactly “scientific.”
But rather than responding to every absurd thing said, let me just tell you want I do think — because I will admit, I have gone off half cocked on this issue sometimes, and often only had time on my show to explain a fraction of what needed to be explained, and for that I am sorry. Some of it can’t be helped, some of that is the nature of the show we do: live, off the cuff, lots of interruptions. Some of it was just from me being overexcited about finally finding a health regimen that actually made me healthier and feel better. And many a time I have wanted to stop the show and clarify a point or provide the nuance I think it deserves, but I am serving many masters, and you have to get out of the way as much as you can so the guests can say their piece.
But some of it I would do differently. For example, I recently joined Twitter Nation — what can I say, Demi Moore is a very convincing salesperson — and what everybody told me about Twitter was that it was supposed to be whatever stray thought or thing just happened to you — you know, for people who find blogging too formal and stuffy.
But apparently it’s taken very seriously, because there was Scott Pelley on 60 Minutes asking the Secretary of Health and Human Services what she thought about the fact that “Bill Maher told his viewers anyone who gets a flu shot is an idiot.”
Well, not quite. It was twittered, which I guess doesn’t make a huge difference, but as 60 Minutes is the last bastion of TV journalism, accuracy is appreciated. And I see that counts for Twitter, too — my bad — so yes, some people are not idiotic to get a flu shot. They’re idiotic if they don’t investigate the pros and cons of getting a flu shot. But, come on — it was a twitter from a comedian, not a treatise in the New England Journal of Medicine, that’s not what I do.
I’m just trying to represent an under-reported medical point of view in this country, I’m not telling a specific pregnant lady what to do. With unlimited air time, I would have, for example, added to my discussion with Dr. Bill Frist on October 2 that, yes, any flu or health challenge can be dangerous when you’re pregnant, and if your immune system is already compromised by, for example, eating a typical American diet, then a flu shot can make sense. But someone needs to be representing the point of view that says the preferred way to handle flus is to have a strong immune system to begin with, and getting lots of vaccines might not be the best way to accomplish that over the long haul.