Shouldn't This be Manslaughter?

[Just Steve]

Again, where is all this research about the flu vaccine? No one has posted anything yet...

 

http://www.cdc.gov/flu/professionals/vaccination/effectivenessqa.htm

[Fat Albert]

There is a need for modern medicine, like in this case (trauma), but in preventative and health maintenance, I would rather see a N.D. or a MD/DO that practiced homeopathy, instead of western medicine.

 

Show me an allopath/osteopath who seriously believes in homeopathy and I'll show you someone who should be stripped of their license.

[flyingsquirrel]

You have a article on that? Google Hoax of H1N1 and buy some books and read about this "H1N1" scare...not true at all

 

I would love to leave you in a room with the families of all of my (pediatric) patients who died from H1N1 before we had a vaccine. Maybe they could talk some sense into you.

[Craigk]

yea, well as I stated in the 1st 4 words, "Just my own observation". This is what we noticed with the big push for everyone to get flu vac's that year, regardless of H1N1 hoax, people were getting both vac's and we noticed a considerable drop that year during flu season in patient census. No need to do research or read a book on it, I lived it, saw it with my own eyes.

[Fat Albert]

There are several MDs around me that practice homeopathy and left their practice to do so.

 

I would hope so. Magic water is not part of evidence-based medicine.

[Craigk]

Patient census does not = flu...

 

Evidently you have never worked in an ER during flu season, there is a reason they beef up staffing ratios during this time of year.

[True Anomaly]

..... et you literally read my mind....

 

Mr "Et", although was very much holier-than-thou and had trouble trying to see things from someone else's perspective, will probably be a decent clinician in the end.

 

This guy, however, is completely out to lunch. He's either a confused PA student who should've gone to ND school and had a more fulfilling career, or he is the greatest troll in quite a few years on this board. My vote is for the latter.

[vaston]

Again, homeopathy has been around for thousands of years and there are tons of research articles out there stating the validity of these treatments...look them up

 

I LOVE this argument! Homeopathy has been around for thousands of years and YET life span did not improved significantly until the last 100 years or so. Lets see, die at the age of 40 because I followed medicine that is thousands of years old OR........live comfortably until the age of 80, able to see my kids and grandkids grow up. Tough choice.

 

I noticed that you didn't have the intestinal fortitude to respond to my vaccination link from the WHO. You didn't read it did you. Your initial argument was about vaccinations in general, but you did not get specific about the flu vaccine until after my post......maybe you DID read it but you don't have the ability to refute the years of research that are cited within.

 

In case you missed it the first time:

http://www.who.int/bulletin/volumes/86/2/07-040089/en/

[surgblumm]

Interesting and mainly because of the integrity and the forwardness of those that recognize truth versus fiction. Some like to venture on the "long walk" but science prevails and EBM reflects the final word. Nice dialogue folks.

Bob

[Ridiculopathy]

discharge her from the practice. non compliance is one of my reasons to discharge patients.

[mdebord]

Mr "Et", although was very much holier-than-thou and had trouble trying to see things from someone else's perspective, will probably be a decent clinician in the end.

 

This guy, however, is completely out to lunch. He's either a confused PA student who should've gone to ND school and had a more fulfilling career, or he is the greatest troll in quite a few years on this board. My vote is for the latter.

 

You know...all this ridiculousness in the past few days has got me thinking. When people apply to and interview for PA schools, it's all about their stats and their history, and "why do you want to be a PA." But I can't think of a single filter in place to identify those who might reject EBM to the detriment of their future patients. I'd hate to suggest some sort of litmus test, but the mere thought that this guy MIGHT be an actual PA student does not rest easy. I realize that is a total change of subject, and I don't mean to detract from the OP's valid concern, but it's just been bugging me.

[Contrarian]

Been "Bugging ME" also... but since I know my strengths and weaknesses...

I've been purposely avoiding responding to this idiot to avoid being banned.

[Craigk]

no your statement is saying that patient census reduction was due to the flu...i have worked ed for many years...

 

ok once again because evidently you did not understand the previous 2 post. Everybody in the town i was working in of about 100,000 people with only one emergency room got flu vac's that year. They had such a big push in our town to encourage people to get the vac and we noticed a drop in patient census during flu season due to this increased in vaccination rates during this time period. Ok, let me restate that, our flu season census dropped because of the increased vaccination rates for the flu and h1n1 so we did not see the number of patients in the er c/o uri type symptoms or flu that year. In my own meager observation i would attribute this decrease in overall er visits being directly related to the improved compliance with vaccination recommendations.

[True Anomaly]

You know you want in on this....This guy is throwing "evidence" and nobody is hitting back with both barrels. It's Contrarian time.

 

It's not really worth it. No matter what data is thrown back, and there is plenty of it out there, he'll either refute it or mock it or come back with other data to try to counter, and this thread will devolve into something else and ultimately cause it to be closed.

 

From a macro perspective, he's already done enough to show his hand of what he's really holding, and has lost the argument for everyone else here. If you're trying to prove your point, you don't go and refute every government agency out there and rely on a rogue physician and his "natural website" and websites like it as the only source for valid info, and citing studies that only help prove their point....then taking it a MONSTER step further with logical fallacies about other conclusions.

 

The biggest fail on this entire thread is the claim that H1N1 was a hoax. Obviously he wasn't practicing medicine in 2009, particularly in the fall when the numbers were at their absolute worst, where at places such as my facility we were admitting an abnormally high number of complications from influenza, and these patients who had laboratory-confirmed H1N1 influenza nasal and bronchial washes and literally nothing else. But now I know that the lab was lying to me, because it was an elaborate conspiracy with the pharmaceutical companies to sell more Tamiflu.

 

One thing I will say about him though- at least he can be taught to use the "quote" function.

 

And now I await him to return to make 5 posts in a row which disproves everything I just said, as expected, because that's how people like him operate.

[rcdavis]

TO GET BACK TO MIKE's post.

The moral dilemma is twofold, the naturopath/homeopath issue complicating or negating allopathic Treatment.. And 2. What should mike do?

Should he document the hell out of the encounters, and keep beating against her wall of (what we presume to be) ignorance? Hoping she will come around?

Or, should he discharge her?

At a certain point, I maintain he is a commodity which can be wasted, and she is certainly seems to be wasting his time and efforts. So I would drop her. But I reconize there is a good argument against doing tat.

(Of course, I have dropped families from a moonlighting FP Job if they refuse to get their kids Vaccinated... previously posted that)

[jmj11]

I have the tendency of keeping these patients around. Typically they show up just once a year. I keep them for several reasons. One, I am a business man and I don't turn away customers unless they are obnoxious. Secondly, some times they do come around.

 

I remember a lady that had serious pharmacophobia and was followed by every CAM practitioner in the region (and she even traveled out of state for some odd treatments). While she felt better about herself she still had disabling migraines 20 days out of the month. Each time I saw her I explained the mechanism and cause of migraine, which has been worked out by really smart people (like Dr. Michael Moskowitz at Harvard) in great detail and we discussed safe and effective treatments that went to the heart of the cause. Having exhausted all CAM therapies she agreed to try a medication (one that addresses the genetic error that makes one prone to migraines). I was very, very lucky because the first thing we tried completely changed her life. Usually it takes a process of trial and error over a couple of months. She checks in once a year. She still feels guilty about taking a medication and has tried to stop it several times, only to have her headaches come crashing back.

 

So, like the lady that started this story, maybe she will show up for her 1 month follow up (she usually cancels) and maybe she will be on the nadolol and maybe she will be better and maybe she will live longer (with controlled HTN) to enjoy her grandchildren for another decade. One can only hope.

 

But I do warn these patients who do nothing I say (they won't even take the supplements I recommend, those that have evidence-based studies showing that they might be helpful because their CAM provider put them on something they sell at their office instead) that we must be clear, they can't go around saying that "The guy at the headache clinic did nothing for me." That would be very unfair. They can tell their friends that they CHOOSE not to do what I recommended so they don't know if I could have helped them or not. I don't want the unfair negative publicity either.

[jsfelder0417]

I think this guy trumped the 'et' man. This thread is classic.

[jsfelder0417]

There was a guy a while back that would type 'et' instead of 'and' that displayed a holier-than-thou patronizing attitude. Your posts remind me of that thread. I am enjoying the banter between you and others. Unfortunately, I don't have the time to add meaningful words, numbers or articles to this discussion. I am in class right now, and even though I am not really into epidemiology and statistics, I do need to pay attention.

[Planteater]

My apologies to Mike (the OP) for being sucked in to this OT conversation, but I cannot watch this flood of copied and pasted information continue with no response. tah731- you want to know why you aren't getting good replies? Because you are EXHAUSTING to deal with. You want people to listen to your point of view and actually consider what you are saying? Derailing thread after thread with multiple posts and over-emotional brow-beating is not the way to convert people. Saying things like "get real" give off attitude that most of us don't want to deal with. Most people appreciate real conversation, not just argument and "fact" throwing. I do believe you are the one without the proper understanding of relative vs. absolute risk WITH REGARDS TO LARGE POPULATIONS!

 

Maybe physasst can correct me if I'm wrong, since he has such a good grasp on statistics and research studies; but my understanding of relative risk vs. absolute risk is not that it is a way to manipulate numbers to make things look better.

 

My understanding is that relative risk is a way to put things in context. So, when you are talking about the flu vaccine, the absolute risk of contracting the flu is one number, but the relative risk of contracting the flu is how you compare your risk of contracting the flu if you do not vaccinate vs. if you do vaccinate. So, your absolute risk numbers may be small, but when you are talking about a world population of 7 Billion people, all of the sudden a 1% risk means a lot of people are affected (you know, just 70,000,000). If you can cut that number by 1/3 then you have actually made a difference in about 23,000,000 people's lives. (rounded to easier numbers to explain).

 

Please enlighten us as to where you attend PA school and what your previous Master's is in. Somehow I do not think it is in public health.

 

Listen, I don't give a flu vaccine to my kids. I don't get the flu vaccine (except when required by the hospital I am at or the PA school I am starting). I've only had the flu once (yes it was confirmed) and it was horrible. I know that the flu vaccine is not the greatest thing since sliced bread since they don't always match the strains well. However, it IS a great thing when they get it right and it is given to populations that are at risk of death from influenza. When you approach things from this all-or-nothing place (like the misguided ND that Mike's patient has been seeing), all you do is alienate people and cause them not to want to hear a word you say- even if SOME of your words are true.

[vaston]

*Sigh*

 

You seem to like the CDC, which is good, so here you go:

http://www.cdc.gov/flu/professionals/vaccination/effectivenessqa.htm#estimates-vary

 

"How effective is the live attenuated influenza vaccine (LAIV)?

 

This vaccine currently is licensed only for healthy, non-pregnant people between 2 and 49 years of age.

Healthy Children

 

Because LAIV (nasal spray) vaccine was licensed more recently than inactivated vaccines, there are more data available on its effects from large randomized trials. For example, a RCT conducted among 1,602 healthy children initially aged 15–71 months assessed the efficacy of trivalent LAIV against culture-confirmed influenza during two seasons (Belshe et al., 1998; 2000). In season one, when vaccine and circulating virus strains were well-matched, efficacy in preventing laboratory-confirmed illness from influenza was 93% for participants who received two doses of LAIV. In season two, when the A (H3N2) component was not well-matched between vaccine and circulating virus strains, efficacy was 86% overall.

Healthy Adults

 

A randomized, double-blind, placebo-controlled trial among 4,561 healthy working adults aged 18–64 years assessed multiple endpoints (i.e., targeted outcome measures), including reductions in self-reported respiratory tract illness without laboratory confirmation, absenteeism, health care visits, use of antibiotics, and use of over-the-counter medications for illness symptoms during peak and total influenza outbreak periods (Nichol et al., 1999). The study was conducted during the 1997-1998 influenza season, when the influenza vaccine and circulating A (H3N2) viruses were poorly matched. Vaccination was associated with reductions in severe febrile illnesses of 19%, and febrile upper respiratory tract illnesses of 24%.

Vaccination was also associated with fewer days of illness, fewer days of work lost, fewer days with health care provider visits, and reduced use of prescription antibiotics and over-the-counter medications. Among a subset of 3,637 healthy adults aged 18–49 years, LAIV recipients (n = 2,411) had 26% fewer febrile upper-respiratory illness episodes; 27% fewer lost work days as a result of febrile upper respiratory illness; and 18%–37% fewer days of health care provider visits caused by febrile illness, compared with placebo recipients (n = 1,226). Days of antibiotic use were reduced by 41%–45% in this age subset.

A randomized, double-blind, placebo-controlled influenza virus challenge study among 92 healthy adults (LAIV, n = 29; placebo, n = 31; inactivated influenza vaccine, n = 32) aged 18–41 years assessed the efficacy of both LAIV and inactivated vaccine (Treanor et al., 1999). The overall efficacy of LAIV and inactivated influenza vaccine in preventing laboratory-documented influenza from all three influenza strains combined was 85% and 71%, respectively. These results were obtained after study participants, all of whom were susceptible to recently circulating influenza viruses before vaccination, were experimentally exposed to viruses. The difference in efficacy between the two vaccines was not statistically significant."

 

From the same site:

 

"How well do influenza vaccines work during seasons in which the vaccine strains are not well matched to circulating influenza viruses?

 

When vaccine strains are not well matched with circulating influenza viruses, the benefits of vaccination may be reduced. For example, inactivated influenza vaccine effectiveness against laboratory-confirmed influenza was 60% among healthy persons and 48% among those with high-risk medical conditions in a case-control study among people 50–64 years old during the 2003-2004 influenza season, when the vaccine strains were not optimally matched to viruses in circulation (Herrera et al., 2007). However, in a year when the influenza vaccine and predominant circulating influenza viruses were poorly matched, researchers were not able to measure an effect of influenza vaccination against the respective vaccine component (Bridges et al., 2000). It is not possible to predict how well the vaccine and circulating strains will be matched in advance of the influenza season, and how this match may affect vaccine effectiveness."

 

I obviously was only able to include a FEW of the talking points they address. I highly recommend you read the entire thing.

 

Here are some of their citations, enjoy:

Ashkenazi S, Vertruyen A, Arístegui J, Esposito S, McKeith DD, Klemola T, Biolek J, Kühr J, Bujnowski T, Desgrandchamps D, Cheng SM, Skinner J, Gruber WC, Forrest BD; CAIV-T Study Group. Superior relative efficacy of live attenuated influenza vaccine compared with inactivated influenza vaccine in young children with recurrent respiratory tract infections. Pediatr Infect Dis J. 2006;25(10):870-9.PDF Link

Belshe RB, Mendelman PM, Treanor J, King J, Gruber WC, Piedra P, Bernstein DI, Hayden FG, Kotloff K, Zangwill K, Iacuzio D, Wolff M. The efficacy of live attenuated, cold-adapted, trivalent, intranasal influenza virus vaccine in children. N Engl J Med. 1998;338(20):1405-12. PDF Link

Belshe RB, Gruber WC. Prevention of otitis media in children with live attenuated influenza vaccine given intranasally. Pediatr Infect Dis J. 2000;19(5 Suppl):S66-71.

Belshe RB, Edwards KM, Vesikari T, Black SV, Walker RE, Hultquist M, Kemble G, Connor EM; CAIV-T Comparative Efficacy Study Group. Live attenuated versus inactivated influenza vaccine in infants and young children. N Engl J Med. 2007;356(7):685-96 .

Beran J, Vesikari T, Wertzova V, Karvonen A, Honegr K, Lindblad N, Van Belle P, Peeters M, Innis BL, Devaster JM. Efficacy of inactivated split-virus influenza vaccine against culture-confirmed influenza in healthy adults: a prospective, randomized, placebo-controlled trial. J Infect Dis 2009;200(12):1861-9. PDF Link

Bridges CB, Thompson WW, Meltzer MI, Reeve GR, Talamonti WJ, Cox NJ, Lilac HA, Hall H, Klimov A, Fukuda K. Effectiveness and cost-benefit of influenza vaccination of healthy working adults: A randomized controlled trial. JAMA. 2000;284(13):1655-63. PDF Link

Fleming DM, Crovari P, Wahn U, Klemola T, Schlesinger Y, Langussis A, Øymar K, Garcia ML, Krygier A, Costa H, Heininger U, Pregaldien JL, Cheng SM, Skinner J, Razmpour A, Saville M, Gruber WC, Forrest B; CAIV-T Asthma Study Group. Comparison of the efficacy and safety of live attenuated cold-adapted influenza vaccine, trivalent, with trivalent inactivated influenza virus vaccine in children and adolescents with asthma. Pediatr Infect Dis J. 2006;25(10):860-9.

Govaert TM, Thijs CT, Masurel N, Sprenger MJ, Dinant GJ, Knottnerus JA. The efficacy of influenza vaccination in elderly individuals. A randomized double-blind placebo-controlled trial. JAMA. 1994;272(21):1661-5. PDF Link

Herrera GA, Iwane MK, Cortese M, Brown C, Gershman K, Shupe A, Averhoff F, Chaves SS, Gargiullo P, Bridges CB. Influenza vaccine effectiveness among 50-64-year-old persons during a season of poor antigenic match between vaccine and circulating influenza virus strains: Colorado, United States, 2003-2004. Vaccine. 2007;25(1):154-60. PDF Link

Hayward AC, Harling R, Wetten S, Johnson A, Munro S, Smedley J, Murad S, Watson JM; Effectiveness of an influenza vaccine programme for care home staff to prevent death, morbidity, and health service use among residents: cluster randomized controlled trial. BMJ 2006;333:1241.PDF Link

 

[Planteater]

*sigh* I should have know better. I do not have time to point out the many holes in your logic and that is just what you want, isn't it? Are you a politician perhaps? OK I'm done here.

[vaston]

*sigh* I should have know better. I do not have time to point out the many holes in your logic and that is just what you want, isn't it? Are you a politician perhaps? OK I'm done here.

 

Agreed. He continues to dodge anything I have posted. I'm done here too.

[d2305]

Back to the migrainuer, why does she waste her money when she doesn't take her meds?

[Just Steve]

So back to the OP.. your patient is buying supplements that her ND sells.. has she tried other CAMs such as acupuncture? Or does the ND have her rapt devotion? Is she sucked into whatever quackery the ND is selling or is she just not interested in evidence based medicine on a whole and spreads her money throughout the CAM realm?

[True Anomaly]

So back to the OP.. your patient is buying supplements that her ND sells.. has she tried other CAMs such as acupuncture? Or does the ND have her rapt devotion? Is she sucked into whatever quackery the ND is selling or is she just not interested in evidence based medicine on a whole and spreads her money throughout the CAM realm?

 

It's amazing to think back, 100 years ago before vaccines and public health, which rescued us from high morbidity/mortality rates, and thus gave birth to problems that can only occur when the most basic public health needs are met...such as huge buy-in to CAM and naturopathy.

 

There's a term for this...."First World Problems"