In the old days doctors traded clinical pearls and experience face to face at medical meetings. With the internet and online publication we sometimes forget how important those personal information exchanges can be and often still are. Canadian Press's Helen Branswell (still the world's best flu reporter) now tells us that about 100 doctors with the most experience actually treating H5N1 infections will be meeting this week in southern Turkey to swap experiences:
Doctors who have treated H5N1 avian flu patients are meeting in a Turkish seaside town to try to find answers to the myriad mysteries that remain about what the brutal virus does to its human victims and how dismal survival rates might be improved.The World Health Organization hopes that by pooling patient data, the meeting will answer critical questions such as whether all lineages of the H5N1 virus cause the same severity of disease and how best to treat pregnant women who become infected.
Based on what it learns at this meeting, the WHO will update H5N1 treatment guidelines, so that doctors who face cases in the future can benefit from the successes -- and missteps -- of those who have treated patients in the past.
"There's a real deficit there,'' says Dr. Frederick Hayden, a WHO influenza expert and a key organizer of the meeting.
"We don't have basic information at hand to try to give the best advice. We're going to address that gap.''
The meeting will also seek buy-in from doctors for a new patient data collection system the WHO hopes to get up and running.
Doctors treating H5N1 patients -- past, present and future -- would be asked to submit a couple of pages of standardized clinical and treatment information so that the global health body can track patterns of disease and treatment efficacy on an ongoing basis. (Helen Branswell, Canadian Press)
It's not the first such meeting. The first was held in May 2005 in Hanoi. That was less than two years ago, but it seems like longer. The original human infections with H5N1 were eight years earlier, with 18 cases and 6 deaths in Hong Kong but then there was a pause of six years. In 2003 the virus resurfaced in Southeast Asia. At the time of the Hanoi meeting it was confined there, with only Vietnam, Thailand and Cambodia reporting cases. But it was picking up speed, with 89 confirmed cases and 52 deaths. Not long after the Hanoi meeting the virus burst out of Asia with bird and human cases in the Middle East and Africa and wild and domestic birds in Europe. As of today there are 279 confirmed cases with 160 deaths. Instead of three countries there are twelve, and more than fifty have reported the disease in birds. So this second meeting to harvest clinical experience is more than timely. It is probably overdue.
But it will be a closed meeting and the reason is troubling:
The meeting is taking place behind closed doors to encourage doctors who may be working on scientific articles to share their findings before publication. Hayden says he's been told some large, unpublished sets of patient data will be presented in Antalya.
"They'll tell us what's been done and what's happened. That may allow one to say: `This does not work and we shouldn't be doing this.' That's sometimes just as important as saying: `This does work,'" Hayden notes.
This is not the kind of data that should be withheld to build a resumé. WHO should be constructing a clinical information system where data on each treated case is deposited and results monitored and experience disseminated on a continuous basis. It sounds like they are moving in that direction, which is good. I am an academic and understand the pressures of that career. But at some point one has to say, "This is different. If this kind of behavior is the way I am going to get ahead, I need to find another line of work. The stakes are too high." Flu scientists should take a stand and say that as matter of ethics and as a social norm of their scientific community they do not approve of sequestering valuable data for whatever reason. One way they might do this is by insisting that as of a certain date, de-identified data be entered into a pooled clinical registry and data not so registered is not eligible as basis for a publication.
Maybe there are other mechanisms. Whatever is done, the practice of withholding these data until accepted for publication is unacceptable and should be considered reprehensible. If a scientist doesn't like those constraints, he or she shouldn't work on pandemic influenza. Scientists who work in this field benefit all of us, for which we are grateful, but they also benefit themselves. It is much easier to get a mediocre paper on H5N1 published than one on another virus of less current interest. You should have to pay for that edge with some obligations. One is that you don't withhold data until you are ready to publish. Not for this stuff.
There's clearly a lot to learn about how to treat patients infected with this virus. At the meeting in Turkey some people will have a chance to find out what other people already know. How long will before the rest of us find out, too?
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geez, reveres, it DOES feel like longer than two years. Bird flu is making me old....
Vaccine provides no protection from BIRD FLU???
There have always been many objections to the practice of mass vaccination of poultry against H5N1 and other viruses, including the fact that vaccination can mask the onset of infection in poultry.Now it seems that even the idea of a perceived protection from the H5N1virus is not true, as reported by Caroline Lovell writing for the Farmers Weekly Interactive.
can any of the experts on this blog please comment on this? Here is the full article :
Vaccinated flocks infected by avian flu 19/03/2007 12:40:00 Farmers Weekly Interactive
Egyptian poultry flocks have tested positive to H5N1 avian flu despite being vaccinated against the virus, reported Reuters this month.
According to an animal health official, who remained anonymous, 12 different locations in Egypt have had outbreaks in vaccinated flocks in 2007.
The official said: "We have outbreaks in vaccinated chickens in many places. This puts a question mark on vaccination procedures. It is dangerous."
The official blamed the outbreaks - on poultry units and in household flocks of chickens and ducks - on inadequate inoculation procedures instead of a resistance to the vaccination.by Caroline Lovell
Amen Revere. We will still be haggling price for vaccine when the shit hits the fan and by the time they get the fan turned off it will have either mutated away from the vaccine and killing in a whole new way, be gone, or their customers will be gone (physically) and no one will be around to read their effing papers.
On March 6, in China, the female patient was injected with serum "donated" from a male survivor.
Since then, DEAD silence from China.
Of course, the Chinese are despicable, aka inscrutable. We know nothing. Maybe the nurses and nurse practitioners there are trying to earn PhD's? China must think that as they are the center of the world, they have all the brain power as well?
GR-Does that mean that the female didnt make it? Or does it really mean dead silence. I hadnt read that one, you got a posting or news article. I am interested because that was one of the treatments in 1918. Blood transfusions?
As the experiance with BF grows I'm glad to see the word is getting out.
Meeting behind closed doors bothers me sum but understand the reasons. Both professionals and laymen are more open in private with friends than in public or the internet where things are recorded.
As mentioned, talking behind closed doors allows for the protection of intellectual property. "Give credit where credit is due"
Now if they meet behind closed doors and then a month later still withhold vital life saving information is that a crime against humanity?
Kobie
"A good deed hurts no one"
There has been silence by the Chinese doctors re: serum transfusion. This is now 2 weeks later and we don't even get an update.
Just like the sequences, the same dilemma... either save the useful, leading edge info for the patent office and the PhD committee or apply it when the data will flower more thinking on the topic.
In this case, I agree with Revere. Require the data be posted to a secret database with a short release date (as this is science, not a liberal arts or soft science area where PhD these development drags on for years, where PhD's are awarded with merely 3 - 6 months of research). Then, if not in that database, no PhD! That would scare'em. But they'll cheat, too. Not register until "later"; re-register with a slightly different angle to buy more time.
Academe protects its own. Remember what Webster said? In essence, he said he'd die on a cross before he let his grad students lose their research data to others who could and would jump the research forward. And look at China's response to Webster's lab who failed to recognize the Chinese PhD's as the source of the H5N1 data. It's a nasty business, and it's ugly underbelly is being exposed by the needs to know and act quickly on that knowledge.
Heck, but after all it's just a stunningly high CFR pre-phase-6 pandemic virus; so what are we all concerned about anyhow? Time for a double latte and a good on-campus lecture/movie/performance. Yawn.
The farmer from East China's Anhui Province, who contracted the deadly H5N1 strain of bird flu last December but was later cured of the avian disease, was called in to donate his serum for treatment of another rural Chinese woman who was confirmed last month to have been infected of the same virus.
Xu Longshan, spokesman and chief of the Fujian Provincial Professional Panel for Prevention and Control of Human Infection of Bird Flu, told Xinhua Saturday health workers from Anhui Province Thursday escorted the farmer, identified by his surname as Li, to Fuzhou, capital of Fujian Province, where experts from the blood center affiliated to the Fujian Provincial Bureau of Health got serum from him the second day.
Li has returned back home.
"The serum was brought to Jian'ou on the same day, and so far, medical workers have carried out the first round of injection on the woman who was just confirmed of being infected of the lethal strain of the avian disease," said Xu.
"The method is new but is for sure to be of some effect in improving the woman's capability of fighting against new rounds of infection," said Xu, who admitted it would take some time before the woman could develop immunity of her own against the avian disease.
Li from Fujian, 44, is a native of Damiao Village, a marketplace in the mountainous township of Xiaosong. The woman, who kept five chickens at her home, developed symptoms including fever on Feb. 18. She had visited village clinics and township hospitals before being hospitalized on Feb. 24 in the Jian'ou City hospital.
She was confirmed to be infected with the virus by the Chinese Center for Disease Control and Prevention on Feb. 27. She is known to have eaten two chickens she had raised, but her husband and son, who also ate the chicken, have not developed bird flu.
According to Xu, the woman patient was found with inflammation on her left lung when she came to the hospital on Feb. 24, but her pneumonia symptoms developed quickly and she went into a coma the next day. A chest X-ray on Feb. 25 shows large shadows on her lungs.
As of Thursday evening, Li's body temperature and pulse had returned to normal, and her lungs and breathing appeared to be functioning better but she was still breathing with the help of a respirator, Xu said.
Doctors say Li is still in a critical condition and they are trying to boost her immunity to prevent further organic infection.
Over ten doctors and medical experts from local hospitals, and Beijing-based Chaoyang Hospital and Ditan Hospital are trying to work out a detailed treatment plan to save Li, said Xu Yongxi, head of the hospital.
Policemen and hospital staff have been seen guarding the ward where the patient is staying and doctors are wearing thick, disinfected suits.
The patient's husband is with her in the hospital, and her 13-year-old son, who now stays in her four-storey house with his grand-mother, looked saddened, and said he hoped his mother could recover soon.
Li from Fujian is the country's first human case of bird flu in seven weeks since China reported on Jan. 10 that the other Li from Anhui, 37, had contracted bird flu last December but had recovered.
The deadly H5N1 strain of bird flu has killed 14 people in China since 2003.
Source: Xinhua
http://english.people.com.cn/200703/03/eng20070303_354016.html
The official blamed the outbreaks - on poultry units and in household flocks of chickens and ducks - on inadequate inoculation procedures instead of a resistance to the vaccination.
One wonders whether "inadequate procedures" include a failure to conclusively verify the source and quality of the supposed vaccine.
The number one product for global counterfeiters is not pirated DVDs or knock-off designer fashions. It is bogus pharmaceutical medicine. At which the counterfeiters have become amazingly skilled at producing versions that are, from packaging to pill, identical to the real thing except in the single key aspect of active ingredient. It is literally impossible to detect the fakes by visual examination in most cases -- you have to send a sample out for gas chromatography.
Over the past few years, there have been hundreds of reports of human fatalities in Third World countries from fake medicine. It is not a leap to think that at some point, fake animal vaccines will enter the loop. Anything for a buck. Or yuan.
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