Entries for April 2009

By Bernadine Healy, M.D.

At least eight countries around the globe now have confirmed cases (91 in the United States) of the never-before-seen strain of influenza virus that appears to have only recently jumped from swine to human in a small rural village in Mexico bordering a pig farm. It is so far suspected to have claimed some 160 lives and infected approximately 2,500 people, though only a small number have been confirmed by viral typing. Thanks to rapid genetic analysis, scientists from Mexico and Canada not only identified the microbe as a new strain of the H1N1 type of influenza in a matter of weeks but have shown that this is no ordinary form of influenza, which is typically a mild virus when it has circulated in people for a long time. That this novel strain of swine flu has been carried to so many countries by travelers and has shown signs of human-to-human transmission in Mexico and the United States has prompted the World Health Organization to elevate the risk for a global pandemic from where it had been, a stable 3, to a 4 earlier this week and, today, a 5. This denotes a "a strong signal that pandemic is imminent" if not inevitable, as one WHO official said. All countries should now activate their pandemic preparedness plans, the WHO cautions, emphasizing increased surveillance and early detection.

It is still way too early to tell how the swine flu pandemic threat will play out, since most of the cases have a Mexican connection, and most infections outside Mexico have been mild. And there's not a lot of evidence yet of rapid and sustained human-to-human transmission. So it's good to stay informed and heed public-health advice about sensible hygiene, but don't panic. Still, the wily ways of the new swine flu virus, which so quickly tripped off emergency public-health alerts, identify a big hole in our medical preparedness for fast-moving outbreaks: the ability to rapidly diagnosis the specifics of a pathogen-induced illness when a patient first seeks care. Despite many successes in developing gene-based technology that can quickly and precisely identify microbes in the air and in people since the anthrax hit after 9/11, we have not deployed microbe detection technology in doctors' offices and clinics, where such outbreaks—natural or nefarious—first show up.

By Bernadine Healy, M.D.

When Larry King used the word debate to describe his April 3 program on vaccines and autism, he might just as well have said war; the airways smoked as activist Jenny McCarthy, mother of a child diagnosed with autism who blames vaccines, and her partner, Jim Carrey, faced off with two distinguished pediatricians representing the American Academy of Pediatrics. McCarthy and Carrey and two colleagues from the autism advocacy group she founded, Generation Rescue, took the AAP to task for its unwillingness to give at all in the controversy over vaccine safety and, while holding up a vaccine ad in its journal, accused the group of shilling for vaccine manufacturers.

The academy's goal is to get every child in America—that's 4 million born per year—vaccinated fully and on time in order to avoid perilous consequences such as a recent deadly outbreak of hemophilus influenza that could have been prevented with the Hib vaccine. The pediatricians took umbrage at the criticism and insisted that vaccine safety issues have been resolved to the fullest. I was there in the crossfire, arguing as I have many times that, yes, vaccines are eminently safe—and parents are raising legitimate concerns, yet unanswered. This controversy might be resolved if we can focus on a few big questions, with an open mind.

By Bernadine Healy, M.D.

It's humbling to see medical dogma overturned, but that is exactly what happened when, contrary to deeply embedded thought, scientists led by Jonas Frisen from the Karolinska Institute in Stockholm reported in Science today that the heart can grow new muscle cells, and does so regularly, albeit slowly, in the course of a lifetime.

To cardiologists, this is a blockbuster discovery, since the heart has been pegged as a disadvantaged organ in terms of injury, healing, and repair. Susceptible to coronary blockages that can cut off blood and destroy major hunks of heart muscle at one time in a heart attack, the heart can only heal itself slowly, often leaving behind thinned and baggy scar tissue devoid of healthy, beating muscle. And the distortion and remodeling of the heart that comes with this muscle loss sets the patient up for cardiac failure, blood clots, and nasty heart rhythms. It was always assumed the heart could do no better. But that does not seem to be so.

By Bernadine Healy, M.D.

One of the most sobering pieces of information from a recent prostate cancer screening study—one of two studies released last month that involved the blood test for prostate-specific antigen—is that to save one life, more than 1,000 men would have to be screened and 48 treated. That's a lot of screening, expense, and potentially unnecessary treatment. Is it all worthwhile? As these PSA studies show, answering that question—the question at the heart of what medical researchers call comparative effectiveness—is not nearly as easy as we might wish. Yet comparative effectiveness is critical, not just in evaluating cancer screening tests but in achieving successful health reform.

The new prostate studies are relevant for patients trying to decide whether to get PSA screening. But they give neither a simple thumbs up nor thumbs down. That underscores the need for clinicians and patients to make many subtle judgments, based on the evidence available. For example, urologists have developed criteria to identify which prostate cancer patients could safely pursue watchful waiting, delaying treatment if not eliminating it altogether. But a one-size-fits-all approach to screening and treatment, which is a feature of socialized healthcare systems, does not always allow those nuanced judgments. Should we continue with the imperfect and keep plugging to make it better or suspend the good until the perfect arrives? These are not scientific decisions but ones of policy. They are sure to stir debate.