Rhiza Labs FluTracker Forum

http://www.cfnews13.com/Health/YourHeal ... cines.html

I feel sorry for the Md's if someone does get a severe or fatal reaction. The government won't cover it. So I can see some their point.

If I had an MD who was afraid to administer a requested FDA approved drug, I would quickly change MD's. These guys are morons.

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www.twitter.com/hniman

I do not think they are morons. Md's are always getting sued, so I would be cautious too. My own MD who I think is wonderful and is great, will not give it out until she is absolutely 100 percent sure it is ok to give to her patients. She gives out the seasonal like crazy. She said she needs more proof first. She is a very bright MD and actually has people come from all over the state to see her. So that is your opinion. I wonder what the other Md's that are having the same reservations would like to know you called them morons. i totally disagree with you. Sorry

MD's don't get sued for prescribing an FDA approved product for the approved indication, especially when the product is requested by the patient and also sold in supermarkets!
The MD would be MUCH more likely to be sued for refusing to give the approved treatment. MD's make risk/reward calculations all the time, and some are clearly data analysis challenged (which in this case would be EXTREMELY challenged), which is why in this example I would change MD's in a heartbeat.

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Most MD's are going to be bright, because obtaining a degree is a long and difficult process that requires a high level of intellegence. However, that doesn't always translate into data analysis and the description above is an example. Prescribing seasonal flu, but withholding pandemic flu really doesn't make much sense because both vaccines are made using the same formula.

For flu shots, the carrier is a virus from 1934 that has its H and N genes replaced with the target. For seasonal flu, there are three different targets (H and N from H1N1, H3N2, and influenza B). For the pandemic vaccine there is only one (H and N from swine H1N1). The same is true for the nasal spray (except the carrier is a 1980 cold adapted virus).

Moreover, each time the seasonal flu target is changed (and for 2008/2009 all three tragets were changed), a new virus is created, just as the pandemic target was created, and in fact the seasonal flu targets for 2010 actually includes the pandemic target, which will replace seasonal H1N1. Thus, it will still be a trivalent vaccine, but will have H and N from swine H1N1, human H3N2, and influenza B.

The current pandemic vaccine was made over the same time frame as seasonal flu. For seasonal flu, targets are selected in February, and the vaccine ships in September. For the pandemic target the virus was first isolated in March, selected in April, and much will ship in October (most will be in mid to late October or later - the spray is ready earlier becasue that virus grew quicker in the lab).

Moreover, the pandemic vaccine only has one target instead of 3, so the shot just has 15 mcg of virus, instead of 45 mcg, which might be why some have had less localized reactions (swelling or pain at the site of infection).

The pandemic strain did go though additional clinical trials, in case the virus H and N sequences created a unique problem, and none have been found. However, problems caused by the virus sequence would likely be MUCH greater in a live swine flu infection, than in a killed or atenuated injection or spray.

This is why I would not use a physician who thought seasonal flu shots were fine, but pandemic flu shots were a problem for the general population. I really don't see the logic and would assume the physician is either uniformed or has a serious data analysis limitation (inability to make accurate risk/reward calculations) .

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www.twitter.com/hniman

Physicians are people, too. Not all opinions people hold are based on evidence. In the case of MDs, while we receive training in the basic science of influenza and can quickly and accurately discuss the H and N of the virus, we do not get trained in the nitty gritty details of vaccine manufacture. Most docs will know that the H and N are different in different flu vaccines and are the antigens being used to promote immunity. They'll also know that an inactivated carrier strain is used, but they wouldn't necessarily know WHICH carrier or that the carrier strain in the pandemic vaccine is the same as the carrier strain in the seasonal flu shot. The physician's who take an interest in the subject or are avid journal readers will likely know more than those who aren't. We typically rely on safety and efficacy data to advise our patients, a practice called evidence-based medicine.

Right now, the data are strongly in favor of recommending the pandemic influenza vaccine in patients who do not have a medical contraindication for getting it. The medical risks associated with getting the flu itself outweigh the risks associated with getting the vaccine by quite a wide margin, and there is a high likelihood of being exposed to and contracting the flu. Both are important in the decision-making process. There is more data coming in daily, so we will need to keep an eye on it, lest something come up that would change the recommendation.

I can empathize with the concerns expressed regarding who will pay for or cover medical treatment for someone who develops a complication associated with the vaccine. It's a legitimate concern; but it isn't a reason to suggest not getting the vaccine. The same concerns (who pays if something goes wrong) would not be used as a rationale for suggesting a person with cancer not get chemotherapy or a person with a broken arm not have the arm fixed. It wouldn't be used to even suggest someone not take a cold medicine.