Antibiotic Resistance and Healthcare: A Telling Statistic

I have refrained from commenting on healthcare reform until now because there wasn’t much I could add to the debate. That said, while reading an article in a local paper on bacterial antibiotic resistance and how to minimize it, the author—an infectious disease doc—offered a telling statistic that identified the root problem with our current healthcare system. According to the article, 65% of the time, physicians will prescribe antibiotics to patients suffering from upper respiratory tract infections who demand them, whether or not they are warranted. In marked contrast, 12% of patients with upper respiratory tract infections who don’t ask for antibiotics receive antibiotic prescriptions. The bottom line: physicians give patients the drugs and treatment they demand because they are afraid of losing them as customers knowing full well the patients will go to another physician who will give them what they want! After all, physicians are in business and to stay in business they need to make enough money to cover their overhead and make a profit. However, over prescribing antibiotics is one of the main reasons why we are in the midst of an epidemic of infections caused by multiple drug resistant bacteria. In my opinion, business outcomes should never supersede or trump medical or public health outcomes.

Don’t get me wrong, I am an entrepreneur and believe that people with good ideas ought to be rewarded for their efforts and make as much money as they can. However, in my opinion, for profit business practices and healthcare haven’t historically worked well for the American healthcare system. Removing profit incentives from healthcare would be an important first step to begin to repair our broken healthcare system. Can anybody say public option?

Until next time...

Good Luck and Support the Public Option!!!!

 

The Importance of Digital Communications During Infectious Diseases Oubreaks

As we all know, the H1NI pandemic has been raging on for close too 10 ten days now. Curiously, “Fear & The Flu: The New Age of Pandemics” is the title this week’s cover story in Newsweek magazine. From an informational standpoint point, “this may be too little, too late”—as the old saying goes. While the Internet has been around for over twenty years now, government agencies, most notably the US Food and Drug Administration (FDA) and the Centers for Disease Control (CDC) continue to rely almost exclusively on old media to communicate with the American public during infectious disease outbreaks. Apparently, the administrators who run these government agencies haven’t been listening closely enough to President Obama’s assertion that “we live in the digital age.”

Communications between the public and government health officials is vital when trying to manage and control infectious disease outbreaks. “Every single government agency as well as companies and non-profits need to be digitally literate and competent in a time of pandemic” asserts Eye on FDA blogger Mark Senak. For their performances in recent infectious disease outbreaks, Mark gives CDC an “A” for effort—although there is substantial room for improvement. FDA on the other hand didn’t fair as well. “The FDA is not nearly as sophisticated in terms of digital. Their only Twitter account is for food recalls.  And their YouTube channels are all confusing and unorganized. They have a long way to go.”

The Internet was originally designed as a digital tool to transmit and move large amounts of information from one place to another. That said, it is also a powerful communication vehicle that can be used to broadcast valuable, scientifically-accurate information during infectious disease outbreaks by leveraging social media tools like Twitter, Facebook and instant messaging. To that end, it’s time for public health agencies to recognize the power of digital media and craft communication plans that can be implemented in the next infectious disease outbreak.

Until next time...

Good Luck and Good Job Hunting!!!!!!

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The Swine Flu Pandemic of 2009: Much Ado About Nothing?

A quick perusal of the media coverage of the swine flu outbreak of 2009 would lead many to conclude that this outbreak has the potential to rival or surpass the 1918 flu pandemic—widely regarded as the worst influenza outbreak in history. While the emergence of a new H1N1 swine flu variant is significant note worthy— and has possible public health implications— the unrelenting, often scientifically-inaccurate media coverage did little to quell the fear and anxiety of many Americans.  Once again, the media—rather than physicians, public health officials and influenza experts—“got out in front of the story” and managed to create enough panic, fear and anxiety, the likes of which haven't been seen since the 2003 SARS pandemic. It wasn't until last Friday, when the Wall Street Journal published an interview with Dr. Peter Palese—a leading scientific expert on influenza A infections— did a clearer picture emerge about the severity and public health implications of the current swine flu pandemic.

According to Dr. Palese, there are several reasons why people and public health officials ought to be optimistic about the current pandemic:

  • In 1976 there was a an outbreak of an H1N1 swine virus in Fort Dix, New Jersey, which showed human to human transmission but did not go on to become a highly virulent pandemic strain
  • The presently circulating swine virus is most likely not more virulent than the other seasonal strains we have experienced over the last several years
  • The current swine virus lacks an important molecular signature (the protein PB1-F2) which was present in the 1918 virus and in the highly lethal H5N1 chicken viruses.  If this virulence marker is necessary for an influenza virus to become highly pathogenic in humans or in chickens, then the current swine virus doesn’t have what it takes to become a major killer
  • Since people have been exposed to H1N1 viruses over many decades, we likely have some cross-reactive immunity against the swine H1N1 virus. While it may not be sufficient to prevent becoming ill, it may very well dampen the impact of the virus on mortality.  I would postulate that by virtue of this “herd immunity” even a 1918-like H1N1 virus could never have the horrific effect it had in the past.  The most likely outcome is that the current swine virus will become another (fourth) strain of regular seasonal influenza

The landscape of vaccines and anti-influenza drugs has dramatically improved over what it was just a few years ago. Based on what we know of the structure and sequence of the swine virus, these FDA-approved drugs and FDA-licensed vaccines (modified to include the swine strain) would be highly effective against this new virus.  Also, present technologies as well as manufacturing capacities will allow us to make sufficient quantities of a swine virus vaccine for the winter 2009-10 influenza season in the US.

In other words, there is reason for concern but no need to panic beyond typical public health precautions that are taken during “normal” influenza outbreaks.

Dr. Vincent Racaniello, a viral disease expert who writes the Virology Blog, reported that as of Monday there have been laboratory confirmed cases of H1N1 infections in 30 US states with a total of 226 cases and one death in Texas. Globally, 20 countries had reported 985 cases of infection. The highest numbers are in Mexico, with 590 cases and 25 deaths. While there have been 26 deaths to date, the severity of the infection appears to be waning and person-to-person transmission appears to be low.

Unfortunately, there has been some fallout from the news media’s oft times “over the top” coverage of the pandemic. Many US hospital emergency rooms (most notably in Texas and California) have been overwhelmed and overburdened by visits from people who think they may have swine flu. Also, while some schools and daycare center closures were warranted, others may not have been. Finally, and perhaps most important, it is becoming increasingly apparent that the lay public's understanding of infectious agents and the outbreaks that they cause is grossly deficient and must be improved. 

We live in a world where viral pandemics, food poisoning outbreaks and infections caused by multiple-antibiotic resistant bacteria are becoming commonplace. While vaccines, antivirals and antibiotics can afford some protection against many viral and bacterial disease, the best way to fight infectious diseases is to understand what causes them, how they are spread and what public health measures can be implemented to prevent or control their transmission. Until the world becomes better educated about infectious diseases, we will continue to be overly-dependent on the news media during future outbreaks and epidemics.

Until next time....

Good Luck and Good Job Hunting!!!!!!!!!

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The Swine Flu Epidemic: It Isn't The First and Won't Be the Last!

Do you lie awake a night overwhelmed by the possibility of another infectious disease outbreak? Well, if you want to get a good night’s sleep, I highly recommend that you take a look at a brief history of American epidemics that was published in this past Sunday’s New York Times. According to the article, history shows that the number of American epidemics has been relatively small. In fact, the author suggests that there were only nine major epidemics in the US since 1892. 

While there were several major outbreaks in the early to mid 1900s (Spanish flu, 1918; smallpox, 1947 and polio, 1952), the US has been relatively unscathed in recent years—with the possible exception of the HIV/AIDS epidemic and possibly the herpes and HPV epidemics. This is because of America’s outstanding infectious diseases surveillance networks, its comprehensive vaccination programs and modern medical and hospital infrastructures.

However, no matter how vigilant we are, there is no way to prevent infectious disease outbreaks unless the pathogens that cause the diseases are eradicated from the planet as was the case for the smallpox virus. That said, the best way to manage infectious disease epidemics is to be prepared for all contingencies.  In my opinion, the recent swine flu outbreak—this was its second appearance, the first taking place in 1976—was a practice run. And I think the world did “pretty, pretty good” as Larry David, my former NYC softball teammate and co-creator of Seinfeld would say!

Until next time...

 

Good Luck and Good Job Hunting

 

Dr. Margaret Hamburg Tapped As New FDA Commissioner

According to a report on NPR’s All Things Considered program, the Obama Administration has nominated Margaret Hamburg, MD to head the US Food and Drug Administration. Dr. Hamburg is a former health commissioner in New York City who has worked on issues surrounding infectious diseases and bioterrorism. In New York, she instituted a needle-exchange program to help prevent the spread of HIV. She also set up a program, in which health workers went to tuberculosis patients’ homes to help them manage their drug regimens.

A Harvard Med School graduate, Dr. Hamburg was an assistant secretary of health and human services during the Clinton administration and now works at the Nuclear Threat Initiative, which tries to cut the threat from nuclear, chemical, and biological weapons. She opposes abstinence-based sex education in public schools and has been a critic of the marketing practices of the pharmaceutical industry. Further, Dr. Hamburg is a leading advocate for changes in the nation’s public health policies and infrastructure, from local health departments to the highest levels of government. Finally, after eight years of mismanagement and poor leadership, the agency has somebody at the helm with intelligence, experience and is an advocate for change. 

Kudos to Team Obama!

Until next time...

Good Luck and Good Job Hunting (FDA is hiring)!!!!!

 

A Web-Based Map Application that Track Infectious Diseases Outbreaks

Vincent Racaniello, my partner at BioCrowd, and I were chatting the other day about how cool it would be to develop a web-based map that was able to track infectious diseases outbreaks in real time. After a spirited chat, we both thought that we were on to something REALLY big. And, as is frequently the case, somebody else also had the very same idea.

For those infectious disease aficionados out there, you must check out the Health Map: A Global Disease Alert Map. The map was developed by Clark Freifeld and John Brownstein and is based on an algorithm that is beyond my comprehension. It is not as robust as the map that Vincent and I envisioned, but it is pretty cool and it works very nicely.

Until next time…

Good Luck and Good Disease Hunting!!!!!!!

 

 

This Week In Virology (TWiV) Rocks!!!!!!

Vincent Racaniello, Professor of Microbiology at the College of Physicians and Surgeons at Columbia University and co-founder of BioCrowd ,has created a weekly series called This Week In Virology (TWiV). Each week Professors  Racaniello and Dickson Despommier (another Columbia virologist) discuss the latest developments and public health concerns for a variety of viral diseases.

The weekly discussions are packaged as podcasts, posted on TWiV and Science Podcasters.org and can be downloaded from iTunes. Dr. Racaniello eventually wants to offer TWiV in a vcast format and use it to inform the public and teach students about viral diseases.

So far, Vincent and Dick have created nine TWIV podcasts. Some of viruses that they have discussed include: HIV, Polio, Lassa fever, Rabies, West Nile Virus and even video game viruses. The podcasts are interesting, informative and a good way to learn something about virology—something that may liven up your daily commute!

Until next time,

Good Luck and Good Job Hunting

 

New Technology: Using Google to Track the Flu

No matter what you may think of Google, you gotta love the brilliance and innovative moxy of the guys who run that company. In today’s New York Times, there was a story about a new web tool called Google Flu Trends. This tool is being evaluated as a new early warning system for fast-spreading flu outbreaks in the US.

Tests of Google Flu Trends, suggest that it may be able to detect regional outbreaks of the flu a week to 10 days before they are reported by the Centers for Disease Control and Prevention (CDC). It works by tracking and quantifying number of Americans who enter search phrases like “flu symptoms” into Google and other search engines. By analyzing these searches as they come in, Google Flu Trends creates graphs and maps of the country that show where the flu is spreading.  For example, in early February the CDC reported that the flu cases had recently spiked in the Mid-Atlantic States. But Google says its search data showed a spike in queries about flu symptoms two weeks before the CDC report was released.

According to public health experts “The CDC reports are slower because they rely on data collected and compiled from thousands of health care providers, labs and other sources. The Google data could help accelerate the response of doctors, hospitals and public health officials to a nasty flu season, reducing the spread of the disease and, potentially, saving lives.” Researchers have long contended that information published on the Web amounts to a form of “collective intelligence” that can be used to spot trends and make predictions.

Google Flu Trends appears to be the first public project that uses the powerful database of a search engine to track a disease. This could be the beginning of a new trend in epidemiology. Google hopes to publish the results of its study in Nature.

Until next time…

Good Luck and Good Job Hunting!!!!!!!!

 

Nobody is Recession Proof

As the old saying goes, nobody is indispensable.  On the heels of Friday's report about US unemployment reaching 6.1 per cent, I learned that my contract medical writing position would be ending 4 months sooner than expected.  I worked at the company for 1.5 years and was excepting to finish out a two-year stint.

Of course, given the precarious financial state of the pharmaceutical industry, I had been looking and was able to find several opportunities that may translate into freelance gigs or possible employment. That said, if anybody out there is looking for an experienced medical/science/promotional writer, please feel free to contact me by sending a comment to this post or via e-mail: cmintz@bioinsights.com.

I hope that your luck is better than mine!!!!!

Until next time....

Good Luck and Good Job Hunting (I will be looking too)!!!!!!!!!

Vaccinations, Public Health and American Science Education

There was an alarming article in today’s New Times which reported that greater numbers of parents are rejecting vaccination for their children. You may ask, “How is this possible. Aren’t childhood vaccinations mandatory?  Well, yes and no. As it turns out, 20 states including California, Texas and Ohio allow some kind of personal belief exemption from otherwise mandatory childhood vaccinations. And, more and more parents are opting out every year. In 1991, less than 1% of children in states with personal belief exemptions went without vaccinations. By 2004, the most recent year for which data are available, the percentages swelled to over 2.5 %. Frighteningly, according to a 2006 article in the Journal of the American Medical Association, exemption rates of 15% to 18% has been found in certain areas of Oregon, Washington and California.

So, what is responsible for this startling increase? Unfortunately, misinformation on the Internet promulgated by American news media outlets has caused some parents to question the safety of many childhood vaccines including those for measles, mumps, rubella, and diphtheria and whooping cough. Although parents who opt to not vaccinate their children believe that they are protecting them from serious vaccine-induced side effects, they are, in reality, increasing the risk that their children and others may contract these diseases. Surprisingly, many parents who choose not to vaccinate their children are aware hat they may be placing other children at risk. For instance, in the NY Times article, one mother chose not to vaccinate her child said, “I cannot deny that my child can put someone else at risk” 

The growing US anti-vaccination movement has caused serious alarm among many infectious disease specialists and public health officials– and with good reason. This year, there was an unusual outbreak of measles in California in which 12 unvaccinated children contracted the disease. In 2005, there was a mumps outbreak in Iowa that infected 239 people (many of whom were vaccinated) and in 2006 there was a measles outbreak in Indiana that affected 28 unvaccinated children. Ironically, the success of the US childhood vaccination program may be its “Achilles heel.” according to some epidemiologists. This is because most American parents, unlike their counterparts in developing countries where childhood disease like measles are rampant, have never seen measles and don’t understand the seriousness of the disease. According to one public health official “They do not perceive the risk of the disease but perceive risk of the vaccine”. Also, unvaccinated children can serve as disease reservoirs or carriers and unwittingly infect older people (whose immunity has waned over time), immunocompromised individuals (cancer, autoimmune and HIV/AIDS patients)
 and even vaccinated children who failed to develop sufficient immunity.

So what does the anti-vaccine movement have to do with American science education?  Simply put, most Americans don’t understand the basic principles or fundamental concepts of biology and medicine. This should come as no surprise. According to recent surveys, 40% of Americans don’t graduate from high school. .Further, many college-educated non-science professionals have trouble discerning fact from fiction when it comes to science. Their lack of concern or disdain for science is frequently expressed in financial terms. Why should I become a scientist (with an advanced degree) and make $65,000 to $75,000 when I can make $75,000 to $100,000 a year with an undergraduate degree in business or finance? I don’t know–call me crazy– but sometimes there are more important things in life to consider than money–like vaccinating our children so that they are protected against potentially life-threatening diseases!

Until next time….

Good Luck and Good Job Hunting!!!!!!!!!