Another 2.6 million doses of flu vaccine are on their way, although we won’t be seeing them until January. A little late, but better late than never.

Aventis Pasteur, the only company now making flu vaccines for the U.S. market, announced that they would be able to produce another 2.6 million doses, for a total of 58 million doses. Our guys in DC are still talking to the Canadians, about getting another million or so vaccines. But that’s provided that they meet our regulatory standards, and acting FDA commissioner Lester Crawford says that the FDA would inspect the Canadian facilities to see if they meet U.S. standards. Yup, third world countries like Canada certainly couldn’t meet our standards. Just look at all the Canadians dying in the streets from substandard drugs and vaccines.

I know, this is really a pet peeve of mine, that we treat Canada like it is some backwater hole in the ground. Anyway, why don’t they just go there and look at the facility, and buy the damn vaccine already? Those million plus Canadian doses could have already been on their way over here. But all they keep doing is whining, and talking about what they “might do” or are “going to do.” How about just doing it?

I just received an assignment to write an article about biomedical waste management. You know, disposing of trash that is loaded with microbes and potentially lethal critters. I can’t even begin to imagine how many tons of waste are generated each year from medical facilities. In Florida alone, for example, there are an estimated 30,000 biomedical waste generators in Florida. These include hospitals, clinics, nursing homes, laboratories, funeral homes, dentists, veterinarians, and physicians.

But I was thinking of another problem, and that of the unnecesscary waste generated by nurses, doctors and other workers during the course of their average work day. I’d like to think that in this day and age of cost cutting and penny pinching, that maybe things have changed a little. Improved. Then again, since most items are charged to the patient, and not the facility, there is little incentive to curb our wasteful ways.

A Society of Disposables

We love disposables. Use it once, throw it away. Everything from diapers to cameras. In the medical world, some disposables are essential, such as needles. But other items, even though they are labeled as such, as not. Prepackaged trays, to be used for certain procedures, contain a number of reusable items labeled “disposable.” These include perfectly good metal clamps and scissors, which have a long life ahead of them. But according to the package, they are disposable.

Very often, the physician didn’t use half of the equipment in the tray. Still sterile and packaged sutures, sterile syringes, sterile packets of gauze–were all chucked at the end of the procedure. The scissors and clamps were dumped as well. It’s bad enough that hospitals generate so much “real” waste, but do we have to throw out perfectly good equipment and supplies? And besides the environmental factors, there are doctors, clinics, hospitals, schools, etc., all over the world who are desperate for equipment. Shouldn’t we share perfectly good supplies, even if we consider them somewhat tainted?

I happened to read about an operating room nurse who collected unused supplies designated for the trash, and then sent a weekly package to a non-profit organization. She inspired me to do something, other than watch helplessly. I began to wash off used clamps and scissors, the “disposable” kind, and send them downstairs to be autoclaved. I also began collecting the still sterile and wrapped supplies that also could be used.

One of my coworkers then asked me if she could take the now autoclaved clamps and scissors and send them to her nursing school in Chile. They’re always very short on supplies there, she said. Not only did she take those items, but added sutures, gauze packs, and other unused odds and ends. What her school didn’t need, they would give to the local hospital.

After a few months, virtually none of the previously “tainted” items were trashed. Nurses began taking the scissors and clamps and making them permanent bedside items (this was in a newborn intensive care unit). Bottles of formula which were reaching their expiration dates were somehow spirited off to a battered woman’s shelter. Gauze, syringes, sutures, tubing, and so on, were either used in our unit or sent to Chile.

When I went to work at a military facility a few years later, the same system was already in progress. One of the nurses collected whatever she could get her hands on, and sent it to her home in the Philippines. In both these instances, imagine the savings in waste and cost if the hospitals had implemented this throughout the facility. Imagine if all hospitals mandated this? To say nothing of the people who benefitted from our clean trash….

Of course, not every experience was this successful. At a large teaching facility in Florida, not only was waste rampant, but the nurses didn’t see anything wrong with it. Stay tuned for the story of the evil nurses, who were in desperate need of a crash course in infection control.

Image: Courtesy of Stock.XCHNG

I was a little bit busy today, but I am in the fortunate position to have editorial help. My guest blogger, Cosette, very nicely agreed to fill in today. And of course, she had the help of my very efficient editor, Pixie.

I promised to be back with more links and here I am. Unfortunately, one of the best stories that I read about this was in the Wall Street Journal, which is not accessible on the Internet unless you subscribe. It went into detail about a presumed cover-up at the FDA.

In brief, the association between SSRI antidepressants and suicide has been a controversial topic since Prozac, the first drug in this class, was introduced. In 1991, an FDA advisory panel concluded that there was no association but questions continued to persist, particularly with pediatric patients. The FDA began an investigation of Paxil in late 2002, and the following June, issued an advisory to physicians which cautioned against its use in juveniles because of a possible increase in suicidal thinking. In October they broadened their advisory, stating that evidence from clinical trials showed that Paxil, along with several other SSRIs, was not any more effective than a placebo.

The Plot Thickens

While a number of recent studies have suggested an association between SSRIs and suicide in children, many of these trials were funded by the pharmaceutical industry and left unpublished. Andrew Mosholder, MD, an epidemiologist with the FDA, analyzed 22 studies involving seven antidepressants and over 4,200 children. He concluded that pediatric patients using SSRIs were almost twice as likely to become suicidal as those given a placebo. About the same time that Mosholder reached his conclusion, the Committee on Safety of Medicines in Great Britain banned the use of all SSRIs for patients under the age of 18 except for Prozac, the only one formally approved for this age group.

But Mosholder found himself with duct tape across his mouth. He was not permitted to present his analyses at the hearing on this, and critics accused the FDA of trying to conceal negative information and protect the drug industry. In a confidential report which was later leaked to the press, ie, the Wall Street Journal, Mosholder said that the FDA should follow the Britain’s lead and discourage usage of these agents.

FDA officials wrote in internal memorandums that Mosholder’s analysis was “unreliable,” and so hired researchers at Columbia University to essentially conduct the same research (good use of money, n’est-ce pas?). Much to the dismay of the FDA, I’m sure, the study out of Columbia reached an almost identical conclusion.

The Empire Fights Back

In April 2004, Rep. Joe Barton (R-TX), Chairman of the House Energy and Commerce Committee, issued the following statement upon receiving the Food and Drug Administration’s response to a March 24 letter from the committee seeking information on the use of antidepressants by children:

“Oversight and Investigations Subcommittee Chairman James Greenwood (R-PA), has been dogged in his pursuit of the antidepressant issue, and in response to our letter, the FDA admits important facts for the first time.

“FDA’s primary medical reviewer believed that the available data were sufficient to conclude an association exists between the use of antidepressants and suicidal behavior in children. He also recommended that action occur without further delay, although others at FDA disagreed with his recommendation. There are troubling questions of whether FDA supervisors inappropriately suppressed significant information that would have been of consequence to their own advisory committee, not to mention the public.”

About six months ago, the FDA did finally ask the manufacturers of 10 major antidepressant drugs to add a warning to drug labels about the risk of suicidal behavior, but many critics felt that they were doing too little too late. On the other side of the coin, other critics believed that the data linking suicide and SSRIs is weak and inconclusive, and there are too many other variables involved.

Anyway, some links. Here is a good one from the International Herald Tribune that tells a little bit about this saga’s history.

Another good article at the Post Gazette

NPR did a whole series of stories about this.

And last but not least, an interesting story from the American Medical Association’s AMNews which points out that an American College of Neuropsychopharmacology task force concluded that SSRIs do not increase teens’ risk of suicidal thinking or suicide attempts.

Image: Courtesy of Stock.XCHNG

After several years of debate, controversy, accusations that the FDA was dragging its feet and reluctant to move on this, antidepressants will now be bestowed with a “black box” warning. It is the strongest warning the United States can put on prescription drugs, and no drug company likes having to put one on–for obvious reasons. When you take medicine you like to think of the curative effects, not see a skull and crossbones glaring at you.

Okay, the black box warning is not quite skull and crossbones, but it indicates that there could be a severe reaction to a drug. In the case of antidepressants, the warning is that there may be an increased risk of suicide among teens and children.

The UK has banned the use of nearly all antidepressants in children and adolescents, save for Prozac, which is the only one that has been extensively tested in this population and declared not to raise the risk of suicide. The U.S. has not gone that far, as the new warning language does not expressively prohibit antidepressants from being prescribed in children and adolescents. It just warns that the danger exists.

Some say that this is more hype than science, and others say that the FDA is not going far enough. There were a number of stories about this, one notably in the Wall Street Journal. Sorry, don’t have a link to it–but here’s a short update that appeared from Reuters

I’ll check and see if there are any other good links, which give more of a history about this.

The CDC and Aventis Pasteur, the only company now providing flu vaccines, have announced a two-phase plan to distribute 22.4 million doses in a way they hopefully will be aimed at those who truly need it.

During the course of the next two months, 14.2 million doses will be distributed directly to “high-priority vaccine providers.” Part two of the plan will then dole out the emaining 8.2 million doses to areas identified as being in “high need” of influenza immunizations. How high need is defined has not been elaborated upon.

Juliie Gerberding, MD, MPH, the director of the CDC, did not have any kind words for those who are using the shortage to shore up their private bank accounts. In an article on Pharmacist.com, she is quoted as saying that price gouging is immoral, and “we are working with the state governments and hope to be able to tell you in the future that these people have been prosecuted to the full extent of the law. There’s no room for this kind of behavior in an environment where we need to pull together as a country to protect our vulnerable populations.”

Them’s fighting words, but I do think that the CDC should have been on the forefront of vaccine shortages years ago. If manufacturers were assured that they would not be taking a loss every year that they produced influenza vaccines, we would no doubt have several companies all ready and willing to make vaccines, and have a healthy supply. There is no reason that this situation should have occurred. Absolutely none.

Read more at Pharmacist.com

Yeah, I know. Shipment was stopped, the health regulators rushed in and screamed, ranted, and raved, but there still was hope that some of Chiron’s vaccine stock could be salvaged. But as of today, the conclusion is that the Chiron vaccine is a lost cause. Not one single dose that was manufactured for the U.S. market can be used, due to contamination.

So back to square one. Half the doses are still missing.

But rather than wringing hands and making public announcements, like ” we unfortunately wound up reaching our final conclusion this afternoon that none of it could be used,” which was uttered by the FDA’s acting commissioner Lester Crawford, how about taking some real action?

First, many people are not willing to surrender their dose to those who really need it. A few states have pushed through some legislation about this, and the CDC has made a “request,” but this really has to be a mandatory thing. And it has to be done quickly. Doses should only be delivered to places where they are likely to be utilized by those who really need it, and penalties/fines implemented to those dispensing it and receiving it. Our nation seems to be a little bit short on the idea of voluntary sharing, it seems.

Second, the policy towards vaccines has to change. They talk the same talk every year, and every year it’s the same thing. We were short on flu vaccine last year, because the season started very early, with reports of a few healthy children dying from it. But nothing happened. The government needs to work with the pharm companies, and be willing to buy up leftover vaccine doses. Unlike other types of vaccines, the flu shot is made up fresh every year and cannot be stockpiled. Unused doses are chucked into the trash, and its the manufacturer’s loss. This is one of the primary reasons why there are only two company’s willing to make the flu vaccine for the U.S. market.

None of these things will help for this year, though. Of course, we can swallow our pride and seriously look into purchasing vaccine doses from other countries. Like our neighbor, Canada. That clean and shining first world nation, with a stellar healthcare system and a standard of living that tops our own. Or how about those other dubious nations, such as Switzerland, Sweden, Germany or Denmark? Their healthcare systems can run circles around ours. As an example, in case you were interested, the U.S. has the highest rates of infant mortality, teenage pregnancy, unwanted pregnany, sexually transmitted diseases, and HIV infection, than any other industrialized nation. We may be running neck to neck with Greece or Portugal as far as infant mortality, I haven’t checked this year’s statistics, but our rating is deplorable.

And we’re afraid of these other nations not meeting our standards? They’re the ones who should be afraid of buying anything from us.

The questionable safety of Canadian approved drugs, which are often made in the U.S. and approved by our FDA before being sold to Canada, is the pathetic argument for not allowing Americans to buy their medication north of the border. Never mind that they may be making minimum wage and have no health insurance or prescription plan; our government wants them to pay the price gouging rates charged in this country.

Okay, fast forward. Suddenly, Canada has become safe. Government officials are in the midst of contacting companies that make flu vaccines for other countries to see whether they have any excess doses lying around. Strangely enough, this includes a Canuk company (you know, the place that makes and sells drugs too lethal for Americans) called ID Biomedical. This heathen Canadian company may just be the savior to our current influenza vaccine crisis, in that they might have about 1.5 million excess doses lying around and gathering dust.

Bush vaguely referred to this phenomenon in his debate with Senator John Kerry on October 13, which is a complete turn around of his previous opposition to tapping the Canadian market. So what it boils down to is that Canadian drugs and medical products really are safe enough to give to Americans. Afterall, we wouldn’t be giving a contaminated and unsafe flu vaccine to our tiny tots, now would we?

However, this changes of course, if the Canadian drugs and medical products might be competing with those sold in the U.S. Then their safety is dubious, and cannot be guaranteed.

There’s an interesting article about this in the New York Times, that appeared today. However, this link will only be good for seven days, and then it goes into archives, never to be seen again. Unless you purchase the article, or are a subscriber.

I hope I’m not insulting the fair city of Seattle, or my fellow Seattle-dwellers, but I have to say, the prevalence of public spitting in this city is just atrocious. While I can’t say for sure that Seattle ranks number one in terms of spit-per-capita, I have never seen public spitting to this degree in any other American city that I’ve either lived in or visited.

So what is it about spitting as a public past time? Certainly, it doesn’t fit the image of Seattle, as a clean, environmentally conscious, and politically correct city. The emerald city, which sits sandwiched in between the snow-capped Cascades and Olympics, beneath the sinister persona of Mt. Rainier (in case you’ve forgotten, a giant and active volcano), saturated in brilliant greenery and breathtaking views, is a mecca for spitters.

When I first moved here, a neighbor pointed out that insidious little habit, but I thought she was just being nit-picky. Perhaps she was one of those super-clean fanatics who scrubbed her walls down daily with bleach, in the hopes of destroying microbes before they got to her. But then soon afterwards, as I ventured out into the streets of my new home, I nearly got hit in the face by a wad of spit. I happened to be downwind from two very nice and normal looking men, when suddenly the head of one turned and out flew the glob. I jumped, just in the nick of time, as the wind scattered that slimy bits of goop around the street.

Yeech. Yuck. Disgusting. Absolutely disgusting.

It’s one thing if you’re choking and got to spit, just to avoid suffocation. That’s excusable. But the people I see spitting range in age from one to 100, dress in suits, rags and everything in between, appear to have all degrees of mental ability (from the seemingly sane to the ones screaming at phantom figures), and comprise both genders. Nope, and it’s not just a guy thing. Sweet faced girls with apple red cheeks can shoot a mean spitball and paint our sidewalks with biological graffiti, same as any male. I’ve seen ‘em do it, and it’s no less distasteful.

I also see people casually walking along, then just turn their heads and spit, not caring where it goes or where it lands. Yes, the rest of us just relish the thought of having to make sure that we don’t step in your pile of mucus. Not that you can even aim for the gutter.

Besides just being a disgusting habit, influenza and other respiratory viruses are spread by spitting. But since we are about to enter the flu season, with a shortage of flu vaccine, let’s take a look at influenza. It is spread from person to person by direct contact, large droplet infection, (i.e. from sneezing, coughing, spitting), or articles recently contaminated by nasopharyngeal (the stuff in your nose and throat) secretions. The flu is highly contagious.

The 1918 Pandemic and Sars

Not very many of us remember the Spanish Influenza pandemic, which caused between 20 and 40 million deaths between 1918 and 1919. Seattle was hit with the Spanish flu on October 3, 1918, and 1,600 people eventually died of it. Because Seattle was hit with the flu about two months later than the east coast, health officials here had time to prepare, and thus, managed to keep the death toll light. In addition to closing theaters and schools, banning public gatherings, and encouraging the use of gauze masks, public spitting was banned. And the ban was strictly enforced.

The same thing happened in China, during the SARS epidemic in 2003. Public spitting, very common in Beijing and other cities, became taboo. Plastic bags were handed out for people to spit in (if you can’t cure a habit, at least contain it), and fines were implemented for public spitting. In Singapore, fines were also levied against spitters, to the tune of about $260.

I don’t think it would be a bad idea to implement here. Either be required to clean up after yourself, much as you do with dog poo-poo; carry a plastic bag to spit into, or face a fine. Sound harsh? Not really. If you saw someone pissing on the street, would you think it’s okay? Piss doesn’t carry any germs by the way, it’s sterile when it comes out of your body, unless you’ve got an infection. So in that sense, it really is less detrimental than spitting.

Well, the Motowner’s are none too happy with that accolade, but apparently, that’s how they were labeled in the October issue of Men’s Health magazine. The magazine said that, “In fact, if it were possible to hold a microscope up to Detroit, you’d see that it’s literally crawling with the critters. The Motor City is now the easiest place for an STD to hitch a ride.”

In a story that appeared in the Detroit Free Press, Dr. Noble Maseru, health officer and director of Detroit’s Department of Health and Wellness Promotion, referred to the article as “tabloid science.”

So how does Detroit really measure up? Well, in 2002, the city reported 384 cases of syphilis. The number decreased to 178 in 2003, and this year, only 92 cases have been reported.

Detroit had 6,849 cases of gonorrhea in 2002, 5,556 in 2003. and so far, 4,090 cases have been reported.

There were 11,523 reported clamydia cases in 2002, 10,389 in 2003, and so far, 8,000 this year.

I would say that they’re doing a good job. The numbers have been steadily dropping over the past two years, so why pick on Detroit?

Actually, several cities have been seeing increased rates of syphilis. In 2002, 6,862 syphilis cases were reported in the U.S., an increase of 12.4% over 2001. That number may be higher, as many cases go unnoticed and undiagnosed. Estimates show that about 40% of all syphilis cases are among gay or bisexual men, and the cities where outbreaks have occurred include Los Angeles, Seattle, New York City, Chicago and Miami Beach. Not Motown.

An interesting twist to the nursing shortage is the growing lack of qualified teachers. No other profession seems to be suffering, to such an extent, from a lack of instructors, so why is nursing so beleagured?

The shortage of nursing instructors is nationwide, but this particular article appeared a few days ago on MSNBC.com, and is from the Dallas Business Journal, focusing on the situation in Texas. But really, it is not much different elsewhere.

According to a new report by the Texas Higher Education Coordinating Board, a lack of qualified faculty applicants, as well a lack of budgeted faculty positions, were common problems. Without enough faculty, more students cannot be admitted to nursing programs. No teachers, no students. No students, no new nurses.

Of course, if you read this article, it is not surprising why there is not a mad rush to sign up to work as a nursing instructor. You need to have at least a master’s degree, and preferably a PhD, to teach nursing at a four year university. If a nurse does decide to get a higher degree, she can make a helluva lot more money working in clinical practice, than as a teacher.

A nurse practitioner can earn $80-$90,000 a year in private practice. A nurse educator working in a hospital can earn around $55,000, a director of nursing about $90,000. In Texas, a nine month instructor’s contract at a four year university was $49,054 in 2003, and a 12-month contract averaged $65,242. Salaries in community colleges were even lower. So do the math–why would anyone, after putting in the time and shelling out a fortune to get a master’s degree or higher, work as a teacher?

Plus, working as a nursing instructor is a headache. You have to teach lectures, plus take clinical groups into the hospital, where you are responsible for each of your students. Some people do love to teach, but the lure of autonomy (as in working as a practitioner, consultant or nurse anesthetist) plus the higher salary, generally wins out.

This particular article points out that the Tarrant County Community College District has three full-time faculty positions open for psychiatric nursing instructors. They are looking for nurses with ten years experience and a master’s degree. For that they are willing to pay $45,000. Is it any wonder that these positions have been vacant for months?

Nursing schools are going to have to offer something more than the glory of educating future nurses, if they wish to attract quality teachers. But so far, it’s just been whining and complaining about the lack of teachers, and not much in the way of offering more money. It would seem that their best bet, for now, is to just stock up on part time instructors who may want to teach, but who have other sources of income. Or another route may be to offer more perks with the job, if they can’t come up with cold cash–like free tuition at their university for the instructor and her family, a stellar pension plan, or something to that effect.

Sure beats whining and bitching.

As far as vaccines go, today’s focus is on the influenza vaccine, or the lack of. But whatever happened to the smallpox vaccine, that ill-fated venture that has quietly slipped into the past, and hasn’t been heard from since.

I mean, weren’t we on the verge of a bioterrorist attack? Didn’t some loony have their hands on a vial of smallpox virus, and was about to unleash it on millions of unsuspecting innocents? And wasn’t that the reason for the government spending about $800 million to get this vaccine rolling, which included relieving the pharm company of any liability?

Not Without A Risk, My Dear

The smallpox vaccine is a live vaccine, which means that after receiving an injection, you can possibly infect other people from the scab that forms over the injection point. There is a rather high probability of adverse reactions, so you would most probably lose a few days of work because of it. If you had a severe reaction, you may be laid up for a much longer period of time. Perhaps for good.

About one million American with weakened immune systems, or a history of skin conditions, faced a much higher risk and in fact, were advised against the vaccine. Because of this risk, anyone who would want the vaccine would need to be screened.

Between 1 in 4,000 to 1 in 10,000 healthy people, who receive the small pox vaccine, experience side effects that are severe enough to require treatment with a product called vaccinia immune globulin. This is made from blood taken from individuals who have been vaccinated with the live vaccinia virus.

Estimates were that of healthy vaccine recipients, one to two, per million, would die. The risk for serious conditions such as encephalitis, progressive vaccinia and eczema vaccinatum, was estimated at about fifteen per million people.

Now, those numbers don’t sound like a great many people would drop dead, or suffer from severe reactions but…why on earth should even one person die, in order to receive a vaccine against a disease which has been eradicated for over 20 years???? And when the “evidence” that an attack is imminent, is vague at best?

First Responders

The Bush administration’s plan was for half a million health care workers to receive the vaccine. They were stunned when the expected response just didn’t happen. For one thing, there was no evidence that we were going to be attacked with a bioengineered version of smallpox (and then you’d have to wonder if the vaccine would work, in the case of an altered virus).

Second, relatively no money was given to local communities and hospitals to implement this. Screening programs would have to be set up, in order to make sure that no one at risk received the vaccine. Nurses would also have to be trained in how to even give the vaccine, since it is quite different from other types of injectibles. Many employees would need sick days because of adverse reactions. Nurses, doctors, and other workers who are in contact with immunosuppressed patientst and/or those with skin diseases, could not go near that population until their scab healed. Plus, the pharm company making the vaccine was granted immunity against liability. So who was going to bail out the poor nurse who contracted encephalitis as a result of the vaccine? Or had to miss several weeks of work?

The Dept of Health and Human Resources was forced to take this back to the drawing board, and come up with some kind of compensation plan. When they finally did rustle up a compensation plan, you really didn’t know whether to laugh or cry. It was basically an insult to each and every healthcare worker, and once again, shows the “high regard” in which healthcare workers are held. Their pathetic little proposal, which was blasted by just about every related workers union and professional organization, decided that it would pay $262,100 for workers who die or suffer permanent and total disability as a result of a smallpox shot. Wow. Your life for $260,000, and considering that you took this vaccine simply because the government decided that you should. And if you’re permanently disabled, how long will that money last?

The most insulting was that the plan also said it would pay people two-thirds of their lost wages after their fifth missed day of work, up to $50,000. Isn’t that nice of them. So you get no money for days 1-5, and then only two thirds after that. And since most reactions would only cause less than five days of missed work, the government gets off free and clear, while the poor nurse gets no pay.

Oh, and they would also cover medical expenses for major reactions to the vaccine, to the extent that those weren’t covered by health insurance. What about minor reactions? And who decides if its major? The list of “reactions” to be covered was never published.

And most important, no one could exactly say what the threat was, or what the exact risk was. Or who it would be coming from. Or why we were suddenly at risk for smallpox.

Many hospitals refused to have anything to do with it. Public health authorities in many states pointed out that they needed their money to deal with, uh, real diseases. You know, stuff like TB, AIDS, sexually transmitted diseases, and other public health problems like drug addiction, alcohol abuse, pregnant teenagers, and so on. Since they weren’t getting any money to implement this grand smallpox scheme, they really couldn’t afford to waste valuable resources on this nonsense.

A Monumental Failure

I suppose that the Bush administration expected that the half million “first responders” would be bitten by some blind patriotic fervor, and rush up to the plate to get vaccinated by a potentially lethal vaccine. They would be good and obedient soldiers, not ask questions, and be willing to accept any consequences.

But that isn’t what happened. The plan was rolled out in December 2002, and by August 2003, less than a tenth of the planned number had been vaccinated. A report from the US Institute of Medicine, criticized the plan and pointed out that a collossal waste of time and money had been put into this. Instead, they argued, why weren’t we developing a real plan for a bioterrorist attack? The time and money might have been spent on more important defensive measures such as disease surveillance and response plans.

The first phase, as it was known, quietly came to an end.

Phase two, in which the vaccine was to be offered to millions more healthcare workers and the public, was put to bed by the CDC with little fanfare. Reports were now pouring in about how recently vaccinated soldiers and civilians had developed serious complications, including 52 cases of pericardial or heart inflammation, 8 heart attacks with three fatalities. And for what? To protect against a phantom disease?

So back to my original question. Surely if we were really in danger of a smallpox attack, the idea of vaccinating the public would not have been put to rest so quickly. So what was this really about?

Acambis, a European vaccine manufacturer, was paid $771 million to develop 209 million doses of smallpox vaccine by the end of 2002. Just think if that money had been spent on real biodefense, on a real program. We might be prepared now for an emergency, instead of being sitting ducks. But hey, we’ve got 200 million doses of smallpox vaccine.

Image: Courtesy of Geekphilosopher.com

I was in complete shock to find out that Christopher Reeve had died. Stunned is a better word to describe my feelings. Reeve had gone beyond being poster boy for advocating improved benefits and care for people with paralysis, and was determined not to let the limitations of doctors or the status quo condemn him to a completely immobile life, where even a machine was required for him to breathe.

His recovery was nothing short of amazing. Right up until a few days ago, before he became ill, he was able to go for extended periods without a respirator. The gift of breath had been returned to him, slowly but surely. I was positive that the time would come when Reeve would say adios to that machine, and be free of it.

He had also publicly declared the unthinkable; that one day, he would walk again. I believed him, and anticipated the day that he would get up and prove victory over the status quo.

But alas, that is not meant to be. The man who helped bring paralysis out of the closet, so to speak, focus the public eye on this neglected area of medicine, and help bring to the forefront the topic of stem cell research.

Dying From a Bed Sore

It may seem confusing to some, that one can die of a bedsore. Perhaps if you’ve had a relative in a nursing home, or been laid up in bed yourself, you understand what, exactly, a bedsore is. Constant immobility, ie, sitting or lying in place for a long period of time, puts pressure on the skin., which in turn, diminishes or completely cuts off the blood supply to the skin. When the blood supply to the skin is cut off for more than two to three hours, it will begin to deteriorate and die. First the area becomes red and sore, then turns purple. Left untreated, the skin will eventually break open and become infected.

Once the skin barrier has been broken, bacteria can freely enter the inner cavity of the body–invading muscle, bones, or the bloodstream. Bedsores are often slow in healing, as they tend to occur in people who are somewhat compromised to begin with, and may not be in the best of health to begin with.

I guess I am a little surprised that Reeve had a bedsore which reached this point. Under the best of circumstances, you can still get them, but considering the care he was getting, it is hard to believe that no one noticed this bedsore as it began to blossom and grow. A full blown bedsore can be prevented, and again, that no one noticed an angry red spot forming on Reeve’s skin is a little difficult to comprehend.

Bloodstream infections have high mortality rates, and while I don’t know what type of bacteria he had growing in his bedsore, I imagine that it may well have been Staphylococcus aureus, which is one of the most common types of bacteria to cause skin infections. Staph can be completely harmless while it’s just hanging around on unbroken skin, but once it gets inside your body, it can be a devil to treat. It can be quite virulent, and many strains are multidrug resistant.

Anyway, this wasn’t meant to blame any of the people who helped Reeve take care of himself. Just an observation, that’s all. And just a farewell to a courageous and inspirational man, whose work, I hope, will continue.

The nursing shortage over? A thing of the past? Well, considering that we have had a chronic nursing shortage over the past five decades, that would be a major announcement. But an interesting article appeared in a Cincinnati newspaper on September 30, 2004, indicating that hospital vacancies have dropped from 19% to 9% in about a year’s time. That is a major difference, and being the skeptic that I am, my first reaction was, “What’s the catch?”

These numbers came from a report issued by the Greater Cincinnati Health Council. A spokesperson from the council announced that the change “reflects numerous recruitment and retention efforts at hospitals and nursing schools, from hospitals paying for scholarships and hiring bonuses to area tech schools promoting health careers.”

Beneath that paragraph was a one liner which quickly mentioned that people “living in a tough economy” were seeking out “relatively” well paying health care jobs.

Now let’s do a quick translation. Nursing has always fared well during times of economic recession. It’s one of the few professions where it is almost always possible to find work of some type. When times are hard, nurses who might have otherwise left the field remain, waiting it out, chewing their fingernails, and biding their time until the economy picks up. And then they bolt.

People who have been downsized, rightsized, and outsourced out of jobs have also turned to health careers as a second start in life. Many really have no idea what a nurse actually does, but have seen these glitzy ads all over the place, telling them to try nursing ’cause it’s a lot of fun. Or that they can get to do so much. Or that they make a difference. And so on. All they see in ads are grinning faces, toothy smiles, people who are absolutely estatic that they can get to be a nurse.

Next, the recruitment bonuses. That’s an old ploy that hospitals have been doing since the late 1970s-early 1980s, every time a nursing shortage gets really bad. The trouble is, many nurses go from job to job so they can get a bonus. A hire-on bonus may attract someone to a job, but if the job sucks, as a huge number do, then the nurse is out of there as soon as her year is up. Ditto for scholarships. Many kids join the military so they can an education without going in deep debt–that is, if they can even secure a student loan. This works on the same basis. Be a nurse, and we’ll pay for your school. Or the government coughs up some money.

But what this article hasn’t told us is if the nurses are actually staying on the job. Have any of the area hospitals instituted changes in the work environment that may convince nurses to remain there, and stay in nursing? How is the retention rate? Are nurses quitting as soon as their “bonus time” is up, or are they staying? Is the staff generally happy at these hospitals, satisfied with their job and/or a nursing career, or are they just waiting for the economy to move foreward and new industries to open up?

So many questions, and no answers. An article like this is absolutely meaningless. All it says is that Cinicinnati hospitals, through tricks of the trade, have managed to stuff some people into the holes. That’s it. And unless any of these facilities made some real changes to the work environment, I doubt those holes are going to remain filled for very long. The hallways may start looking very lonely, very soon.

Images: courtesy of Stock.XCHNG

Shame, shame. There’s a shortage of flu vaccines, so what happens? Do we all try to gather together and figure out a solution? No, of course not. Instead, the shortage has become an ideal way for someone to reap a fortune.

Price gouging. How pathetic can you get? Really, this is one of the sorriest things that I have ever heard of. But yet, sad but true.

Reports are coming in that 10-dose vials are selling for as much as $1,000, 10 times the normal price. I’ve seen this story in several different newspapers across the nation, that drug distribution companies are offering the vaccine at hugely inflated prices.

But then, why should I even be mildly surprised? In 2001, vaccine prices also skyrocketed after a shortage was announced then. And when disasters hit, and people are rushing to buy bottled water and other supplies, those prices instantly skyrocket as well. Is this the American way? Should we be proud of ourselves for ripping eachother off?

I started reading a book today called the Okinawa Diet Plan. I don’t really need to lose weight, and I already eat fairly healthy–at least, healthy compared to most other people I know. It’s been better than 20 years since I’ve set foot inside a McDonald’s, to do anything other than use the bathroom, and the smell emanating from a Kentucky Fried Chicken store makes me positively nauseous.

Anyway, this book did intrigue me because Okinawans have an incredible rate of longevity, and I believe the highest concentration of centurians in the world. But most important, these people aren’t just being kept alive, they are living active and healthy lifestyles. Like working in the fields at 105, cooking a feast for friends and family at age 103–that sort of thing. They have bodies that remain unriddled by arthritis, heart disease, obesity, senility, dementia, cancer, osteoporosis, etc. All those things that we think are part of getting to be an old geezer, are absent from this group of people.

And it’s not genetics. Please, it is so irritating everytime I see the blame put on, “Well it’s just my genes that I weight 6,000 pounds. It runs in my family. It has nothing to do with my steady diet of super meals from McD’s, or the dozen Krispy Kremes that I have for dessert on a daily basis. Exercise? Well of course I exercise. I get in and out of my car.”

In the brief portion of the book that I read, genes are not responsible for the traditional Okinawan long healthy life. The researchers, who have been studying this population for 25 years, also looked at 1st, 2nd and 3rd generation Okinawans who were living in Brazil and who had also abandoned their traditional food and lifestyle. Turns out that there was no difference between the Brazilians and the Okinawan Brazilians. As soon as the diet changed, so did their ability to live long, disease-free lives.

I have read of similar studies in the U.S., especially among Japanese women who emigrate to this country. Japan has a much lower rate of breast cancer than the U.S., so again, genes is automatically the magic word. But as soon as Japanese women adopt the US lifestyle and diet, the breast cancer rates rapidly become equal. There is no protective barrier in being Japanese. It is almost entirely a matter of what you eat, drink, and how much activity you care to include in your life.

I am curious if anyone has tried this diet. It looks like it’s full of foods that I will enjoy, since do I eat a lot of Asian-type foods anyway. I surely wouldn’t mind getting to be 105, looking 40 years younger, and remaining independent, mentality sound, and in good health.

Images: courtesy of Stock.XCHNG

Now that the flu vaccine has become a hot property, the available doses are being reserved for those that need it the most. Which isn’t to say that everyone is going to abide by that. Vaccines, for the most part, are doled out by the private sector, and there is no guarantee that the piddly supply will be saved for people who fall into the high risk category.

So be a sport. Be a boy or girl scout, and do a good deed. Give up your flu vaccine if you fall between the ages of 2 and 65 years, have no health problems, are not pregnant, and are not a health care worker.

Martin G. Myers, MD, Executive Director of the National Network for Immunization Information (NNii), issued the following statement in a press release:

In addition to there being insufficient vaccine for all who need it, there is likely to be a problem with equitably distributing the available vaccine to those who need it the most. As influenza vaccine is ordered well in advance of vaccine availability, it is likely that some healthcare providers will have their full supply of vaccine while others will have none. Because influenza vaccine is almost exclusively in the private sector, the Department of Health and Human Services’ plea for “the help of the public, the public health community and the medical community to make sure that the vaccine goes to those who truly need it most” will be especially important.

No we have to wonder, why do vaccine shortages exist? This isn’t the first time this has happened. Over the past 5 years, according to the NNii, the United States has experienced shortages of influenza, diphtheria-tetanus-acellular pertussis (DTaP), tetanus and diphtheria (Td), measles-mumps-rubella (MMR), varicella, and pneumococcal conjugate vaccines.

Very few pharm companies are involved in manufacturing vaccines. They’ve either left the business entirely, have cut down on their involvement, or are phasing it out. Vaccines are a pain in the butt, to put it mildly. They are not that profitable, there are liability issues, and so on. The influenza vaccine is a particular tricky one. A company can only estimate how many doses to make in any given year. Sometimes they don’t make enough, sometimes they make too much. If they manufacture too much, well, tough luck. They have to eat the loss because no one reimburses them. Flu vaccines can’t be stockpiled and saved for the next season because the vaccine changes every year, depending on what is predicted to be the dominant strain of the virus. As a result, there are very few companies making flu vaccines and as we are witnessing, when a single company’s supply was declared off limits, half of the supply is suddenly lost.

We could have a better system. Perhaps if the government were willing to buy up the excess doses, that would encourage more manufacturers to produce it, and thus reduce the dependency on just one or two.

At any rate, the best defense against the flu is to stay healthy. You know, all that stuff you keep reading about. Eat your fruits and veggies. Cut out the junk food. Get plenty of sleep, fresh air, exercise. Take your vitamins. Tell your sniffling co-workers to stay home until their nose stops dripping.

Images: courtesy of Free Images and Stock.XCHNG

Now in the latest vaccine saga, fully half of the available flu vaccines have been abruptly pulled from the market. Better to have them pulled from the marketplace if there is any question about vaccine production, contamination, or dubious manufacturing practices that are not up to standards. But still, this is certainly not the first time that vaccines have been held up to scrutiny.

If you were living on this earth from 1955 onwards, in the US or any other Western nation, chances are good that you received a polio vaccine. A great event, no doubt, when the vaccine was tested, found to be effective, and polio epidemics gradually became relegated to history. But the downside is that millions of doses of the polio vaccine were contaminated with the monkey virus SV40. Perhaps 30 million people were innoculated with this contaminated vaccine, and it has been been detected in some human tumors. The question arises; is the SV40 virus responsible for causing those cancers?

In 1960, SV40 was discovered in the Salk vaccine, and in 1961, experiments with lab animals found that it caused malignant tumors. A huge body of literature now reveals that traces of SV40 have been found in a variety of cancers, including those of the brain, bone, and lung. They match the tumors which formed in lab animals.

Okay, now the plot thickens. I came across this intriguing news on Dr. Mercola’s website. Supposedly, contaminated polio vaccines were removed from the marketplace by 1961, and at that point, injections were being replaced by the oral Sabin vaccine. So no more contamination, right? But another problem unfolded, and that was the disturbing news that the SV40 virus has now been found in malignant tumors in people who never received the contaminated Salk vaccine.

Theories popped up. The virus was spread through sexual activity (when in doubt, blame it on sex!), breast milk, mother-to-fetus, through the air, and so on. However, the question has also been raised, now that certain documents have been revealed (read the story on Dr. Mercola’s site) that the oral vaccine may also have been contaminated.

Ah, food for thought, no doubt.

Does SV40 Cause Cancer?

Now that’s a good question. Some researchers have concluded that SV40, despite being found in tumors, did not cause them, while other studies are far less conclusive and in fact, point more towards a link between SV40 and human cancers. There have been several lawsuits over this, with people claiming that the vaccine caused their cancer, or caused cancer in their child.

Some more things to think about. One of the cancers that SV40 has been linked with is mesothelioma, a rather rare and deadly cancer involving the tissue surrounding the lungs. Very few cases of this disease were reported prior to 1950, but currently, there are about 2,000-4,000 a year in the U.S. The rate is higher in Europe. The rise of this cancer coincides with the advent of the polio vaccine, and SV40 has been found in these tumors. But then again, the world is a very different place now, then in pre-1950. These days, we suffer from an onslaught of pollutants too numerous to be named, pollutants which are everywhere–in food, water, air. We are indundated with synthetic materials, our food are slathered in toxic pesticides, hormones, antibiotics. Our diets in the U.S. contain carcinogens, dyes, preservatives…you get the picture. Any number of things could be responsible for the rise in mesothelioma, and no one has conclusively linked it to the SV40 virus. On the other hand, no one has conclusively, without a shadow of a doubt, exonerated SV40 either.

Yet another vaccine story. It seems that nearly every day, there is another study trying to either prove or disprove links between assorted vaccines and assorted illnesses. And now, as the flu season is upon us, Chiron Corp., who makes half of the influenza vaccines sold in the U.S., has been forbidden to sell its vaccines. The problem? British regulators say there are “sterility problems at its plant in Liverpool.” In other words, the vaccine is contaminated. Yuck. Best to risk the flu than a contaminated vaccine.

At any rate, I wasn’t planning on getting a flu vaccine, but for a lot of people, coming down with a case of influenza can really put them at risk for serious respiratory diseases like pneumonia. So what is the problem with these vaccine makers? It’s not the first time that vaccines have been contaminated, or there have been “problems” in manufacturing. We are trusting them with our health. Is it that difficult to maintain high standards?

Here are a few links to the story:

From Yahoo News: Major Supplier Won’t Make Flu Vaccine This Season

From the International Herald Tribune: Fears of flu vaccine shortage after suspension

From abc7.com: Flu Vaccine Shortage, Half of Nation’s Supply Wiped Out

Image: Courtesy of Stock.XCHNG

A few days ago, I began a post about nurses and angels. Or angels and nurses. Or the hybrid nurse-angel, that has been born of myth and legend, and continues to haunt and infect the nursing profession like an Ebola virus.

The dictionary gives a long list of definitions for angels, and not surprisingly, the word “nurse” is not mentioned once. A few of the definitions are as follows:

• A spiritual, celestial being, superior to man in power and intelligence. In the Scriptures the angels appear as God’s messengers.
• In both Hebrew and Greek, a word meaning “messenger,” and one employed to denote any agent God sends forth to execute his purposes.
• A celestial being, who is generally good as opposed to evil, that acts as an intermediary between heaven and earth.

Nurses do not have powers that are superior to anyone else, they do not act as God’s designated messengers, and certainly, no one I ever worked with acts as an intermediary between heaven and earth. Some nurses think and act like they are God’s gift to the healthcare profession–those afficted with the supernurse syndrome–but I’d hardly refer to that group as angelic. Demons might be a closer analogy.

Nurses are also not saints, not all sweet and good, and do not exist on a higher plane simply because they take care of the sick.

Blame it on Florence

I can’t say for sure that this angel nonsense began with Florence Nightingale, for certainly she was no angel and never aspired to be one. However, the image and myth (amazing how much mythology there is in nursing) of Nightingale propelled this idea forward full steam.

Traditionally, the sick and infirm have been cared for by religious orders. Nightingale changed that by creating a new type of nurse. Mind you, she was not the first nurse ever to walk the earth, although amazinging enough, I have seen her described as such, but rather, she believed that nurses should have degree of formal training, in schools run by, and taught by nurses. This was a revolutionary concept, to separate nursing and medicine, and in some ways, Nightingale was way ahead of her time. In contrast, however, she was very much a woman of her era, and mired in Victorian thinking and mentality.

But one thing for sure is that Nightingale was no angel. She is famous for leading a band of nurses to the Crimea, to care for sick and wounded British soldiers between 1854-1856. Conditions at the hospital were horrendous, and without a doubt, Nightingale and her nurses did work wonders. While in the Crimea, Nightingale battled with the army administration, and her behavior was anything but angelic. Also, the dramatic drop in the death rate, which was about 42% in the winter of 1855, has been falsely attributed to Nightingale. There was a defect in the sanitation system, and the number of deaths due to cholera and dysentary was far greater than those due to battle wounds. But Nightingale didn’t “fix” the problem. It was only after the War Office sent engineers to solve the problem, did the death rate decline to 2%.

Anyway, Nightingale became famous as the lady with the lamp, a semi-angelic figure who silently wandered the hospital hallways after dark, lighting her way with a little lantern. Nightingale cured fevers by just a touch of her hand on a fevered brow, the wounded men kissed her shadow, and never did a harsh word ever emanate from those sainted lips. Yes, Nightingale would be nauseated from reading that description of herself. There was nothing romantic about her two year stay in the Crimea, and in fact, she became quite ill herself.

But she was now an “angel of mercy” an “angel of the battlefield” and so one. Other angels of other battlefields followed, such as Clara Barton during the Civil War in the U.S. Again, I’m sure that Barton would have been just as miffed to hear herself described in such a manner. For starters, she was not a nurse but a patent clerk (the first female one in the U.S.), working in Washington DC when the war broke out. She was motivated to load up a wagon with supplies and take it out to the battlefield, not because she deeply desired to be canonized but because she was horrified at the red tape which was keeping those very supplies from the men who needed them. So acting in a very unangelic way, as in bucking the system, she took things into her own hands. And her nursing career finished as soon as the war ended.

So it is ironic that we have two very independent minded, strong willed women, and somehow they have been transformed into sugar pie angels. Instead of marveing over their strength, ingenuity, resourceful, and accomplishments, we shower them with celestial accolades.

Nightingale is responsible for both helping to create the nursing profession as well as making it into a lowly, poorly paid job. An angel’s job. She didn’t do it intentionally, and certainly, things could have changed in the 96 years since her death. But they didn’t. Why not? Well, because what could a hospital like better than being staffed by angels. What a great marketing scam, what a way to convince the help that they don’t deserve to paid, don’t need to take breaks, don’t need food…I think you get the idea.

Stay tuned for my continuing attack on the nurse-angel.

Angel image courtesy of Royalty Free Clip Art