revere | November 13, 2009We're writing this at an altitude of 20,000 feet, being on the road again and except for a few minutes here or there, without access to the internet most of the day. This means a lot of comments will probably go unanswered, so we'll say what we usually do in circumstances like this: talk amongst yourselves. Lots of smart people read this blog. Help each other.
A quick look at today's flu news tells me that CDC has updated its estimates, using the methodology we discussed in a previous post. And a survey at Arizona State University (ASU) released Monday shows the expected: that opting to…
revere | November 12, 2009I don't know if the rest of the world laughs at the US, but I feel quite sure they at least shake their collective heads when they hear how we lack one of the most important non-pharmaceutical measures against pandemic flu: paid sick leave. Of course only those countries with a policy of paid sick leave would be shaking their heads. It turns out, though, that's just about everybody:
The United States is one of only five countries in the world without a national policy on paid sick leave, Dodd said.
"We're in the company - and I say this respectfully of these countries - of Lesotho, Liberia,…
revere | November 11, 2009This is an exact repeat of a post one year ago today. Except for this preamble about how disgusted we are that we have to repeat it:
The Reveres, November 11, 2009, year six of the War in Iraq and year eight of the War in Afghanistan
revere | November 10, 2009Nursing homes (Long Term Care Facilities, LTCFs) are a favorite hunting ground for respiratory viruses, including flu. They are open to the general community, where visitors and employees mingle freely with the residents. The residents are usually of an advanced age, have other sicknesses that make them vulnerable and often have less active immune defenses. So when the swine flu pandemic began at the end of April, the Public Health Laboratory at Ontario's Agency for Health Protection and Promotion ramped up their respiratory infection outbreak registration system with the prospect that LCTFs…
revere | November 9, 2009We only just got to the surgical/N95 mask article in the Journal of the American Medical Association (JAMA). We've been traveling and haven't been able to keep up with what others were saying, but we're sure it's been well covered by the usual suspects. So we'll just add our take here, for what it's worth.
As most readers here know, what kind of mask (if any) will best protect a health care worker or anyone else at high risk of exposure to people infected with influenza virus is a difficult question. We still remain unsure whether flu is transmitted mainly by large or small droplets. If most…
revere | November 8, 2009It looks like there's going to be some kind of health care reform bill, but we're not celebrating. It's legislation that could have been important and meaningful and instead is a neutered industry-friendly cup of weak tea with a Draconian anti-choice amendment. That Obama would disappoint us is no surprise. We expected it and predicted it during the presidential campaign. And we said we'd complain. And we are. Expecting it, though, doesn't prevent us from being disappointed and angry he has turned out to be lousy on things that count. He's not George Bush, we'll give him that. But no…
revere | November 8, 2009Richard Dawkins has taken a lot of abuse himself for having the temerity to suggest that some kinds of religious upbringings can be considered abusive even if no physical harm is involved. We know that Catholic children suffered abuse at the hands of priests and nuns, and that some fundamentalist Christians have also engaged in extremely abusive practices. We don't usually think of Jews as routinely engaging in this, but there is something non-sectarian about the fundamentalist mindset. You could do a 'global search and replace' and this sad tale of escape from orthodox Judaism could be…
revere | November 7, 2009I first read Barbara Ehrenreich in 1971 when she wrote The American Health Empire: Power, Profits, and Politics with her (then) husband John Ehrenreich (Health PAC, 1971). She was by then a PhD in cell biology (Rockefeller University) and anti-war activist. We traveled in the same circles and I knew her slightly at the time. Her next book, Witches, Midwives, and Nurses: A History of Women Healers (with Deirdre English) was a new reading of women in medical history. It was an influential text in the emerging women's health movement. Since then she has published many books, several making the…
revere | November 6, 2009Helen Branswell, the Canadian Press's extraordinary flu reporter, is one of the few reporters who could have written the article, "Flu dogma being rewritten by a strange virus no one pegged to trigger a pandemic". She's been following flu for years and has watched as one thing after another we thought we knew about flu has been shown wrong -- by the flu virus. It's a theme we have been sounding as well for almost as long. As scientists we've seen one alleged flu truism after another was stood on its head. A couple of years ago we began to assume anything said about flu was provisional. Some…
revere | November 5, 2009For somebody so out to lunch on so many issues there is something undeniably likable about Ron Paul. As congressthings, he and Dennis Kucinich (there's an odd couple) had the clearest and best positions on the Iraq debacle. And as a principled libertarian (there seem to be some big chinks in Paul's libertarian armor -- like reproductive choice -- but his passion is undeniable), there is something admirable about him. It almost makes you forget his principles are self-centered, wrong-headed and inhumane. Little gnome-like figures aren't supposed to be that unfeeling toward others. Anti-science…
revere | November 4, 2009It's being described as a "dramatic settlement" that will set a pattern for the nation. Let's hope so, because the agreement reached yesterday by the California Nurses Association/National Nurses Organizing Committee (CNA/NNOC) and hospital player Catholic Healthcare West (CHW) sounds like just what the doctor ordered. It covers 32 CHW facilities in California and Nevada, where CNA/NNOC represents 13,000 registered nurses.
Some details:
A centerpiece of the agreement is the creation of a new system-wide emergency task force, comprised of CNA/NNOC RNs and hospital representatives following…
revere | November 3, 2009A reader asked an offline question that is general enough to post about (NB: I try to respond to as many questions as I can, but I'm traveling and can't keep up, so in most cases I won't be able to respond. I also don't hand out personal medical advice over the internet, something I consider bad practice). CDC says on the basis of clinical trials with the unadjuvanted vaccine used in the US that two shots, 21 days apart, are needed for children under 10. WHO, on the other hand, is telling its member nations that one will suffice. Why the confusion?
We may be comparing apples and oranges. Many…
revere | November 2, 2009Some people find posts like this tiresome. There are so many things that need doing and so little time and resources to do them. Adding to the list makes our eyes glaze over. I understand. But that doesn't make this any less of a Big Deal.
Last week CDC was notified of another 22 pediatric deaths from swine flu. They didn't all occur in the same week, but the total for this flu season is now 74. At this rate hitting 200 pediatric deaths -- deaths insomeone under the age of 18 -- seems likely. Most of the flu season is still ahead of us. These swine flu deaths are pneumonia deaths. Each is a…
revere | November 1, 2009When swine flu began there was a hue and cry in some quarters to shut the border to prevent the virus from taking root in the US. It seems fairly clear, now, that by the time we detected the virus, in late April, it had already situated itself in the US -- assuming that it didn't start here in the first place. We don't really know where the jump from pigs to humans occurred, although the best guess is Mexico. Closing the borders would have done no good and would have stranded thousands of students and other tourists in Mexico. Since the US has more world travelers than Mexico, it was in fact…
revere | November 1, 2009We are otherwise occupied, but fortunately DemFromCT has a great status report on swine flu up at DailyKos. I suggest you also follow the first link to his piece at The Arena, although reading after his astute observations is not for the faint-of-heart. The politicization of this issue by Republicans is to be expected and typically unfair (not to mention uninformed). As Dem points out, the Bush Administration did a lot of the heavy lifting that made dealing with this much easier and deserves credit for that. We took them to task here for not shoring up a badly deteriorated public health and…
revere | November 1, 2009So what about the good things we owe to religion? Architecture. Painting. Atheism. But especially music. I happen to be especially partial to Bach's B-minor Mass, but what follows isn't exactly chopped liver. Rory Gallagher was an Irish blues guitarist who lived hard and died hard, at age 47 of methicillin resistant staphylococcus aureus (MRSA). Here he is, age 24, at The Marquee Club in London, April 1972:
revere | October 31, 2009Statins for influenza are in the news again, this time because of a paper given at the Annual Meeting of the Infectious Disease Society of America (IDSA). We'll get to it in a moment, but first a little background.
Statins are cholesterol lowering drugs that are taken by tens of millions of people (including me; I take 20 mg of generic simvastatin a day). The statins are a group of drugs that competitively inhibit an enzyme, 3 hydroxy 3 methylglutaryl coenzyme A reductase (HMG-CoA reductase). They are quite effective in lowering cholesterol and have an excellent safety profile (not perfect,…
revere | October 30, 2009One frequently hears claims that the current swine flu pandemic has been exaggerated because there are "only" 1000 or so deaths, while seasonal flu is estimated to contribute to tens of thousands of deaths a year. There are two reasons why this is not an apt comparison. We've discussed both here fairly often. The first is that the epidemiology of a pandemic and seasonal flu are very different. Epidemiology studies the patterns of disease in the population and swine flu is hitting -- and killing -- a very different demographic from seasonal flu. Its victims are young and many are vigorous and…
revere | October 29, 2009One of the by-products of the brouhaha (here, here) over The Atlantic article on vaccines was some interesting issues raised by the way the Knight Science Journalism Tracker handled it (here, here). If you aren't familiar with KSJ Tracker, it's a site that does "peer review" of science journalism. It's goal "is to provide a broad sampling of the past day’s science news and, where possible, of news releases or other news tips related to publication of science news in the general circulation news media, mainly of the U.S." I don't get a chance to read it as often as I'd like, but when I do I…
revere | October 28, 2009Medical institutions in the US northeast have always been competitive, and Harvard has always been toward the top of the list in that category. I don't mean just competitive to get into. I mean competitive, period. I went to another big research medical school in the northeast in the sixties and we used to joke that at Harvard if someone put on his dorm light (it was pretty male in those days) in the middle of the night to go to the bathroom, all the other lights on the floor would go on, too, on the theory someone was getting ahead of them. Put that down to prestige envy, perhaps, but as a…