Thursday, May 8, 2008

US Government Report Answers Who Lives, Who Dies in Flu Pandemic,3566,354135,00.html

Government Report Answers Who Lives, Who Dies in Flu Pandemic

Monday , May 05, 2008

Should doctors be allowed to play God?

In the case of a flu pandemic — yes, say government officials in a new report.

Doctors know some patients needing lifesaving care won't get it in a flu pandemic or other disaster. The gut-wrenching dilemma will be deciding who to let die.

Who will die in the event of a pandemic? The very old, seriously hurt, severely burned and those with severe dementia, according to an influential group of physicians.

The group has drafted a grimly specific list of recommendations for which patients wouldn't be treated.

The suggested list was compiled by a task force whose members come from prestigious universities, medical groups, the military and government agencies. They include the Department of Homeland Security, the Centers for Disease Control and Prevention and the Department of Health and Human Services.

The proposed guidelines are designed to be a blueprint for hospitals "so that everybody will be thinking in the same way" when pandemic flu or another widespread health care disaster hits, said Dr. Asha Devereaux. She is a critical care specialist in San Diego and lead writer of the task force report.

The idea is to try to make sure that scarce resources — including ventilators, medicine and doctors and nurses — are used in a uniform, objective way, task force members said.

Their recommendations appear in a report appearing Monday in the May edition of Chest, the medical journal of the American College of Chest Physicians.

"If a mass casualty critical care event were to occur tomorrow, many people with clinical conditions that are survivable under usual health care system conditions may have to forgo life-sustaining interventions owing to deficiencies in supply or staffing," the report states.

To prepare, hospitals should designate a triage team with the Godlike task of deciding who will and who won't get lifesaving care, the task force wrote. Those out of luck are the people at high risk of death and a slim chance of long-term survival. But the recommendations get much more specific, and include:

— People older than 85.

— Those with severe trauma, which could include critical injuries from car crashes and shootings.

— Severely burned patients older than 60.

— Those with severe mental impairment, which could include advanced Alzheimer's disease.

— Those with a severe chronic disease, such as advanced heart failure, lung disease or poorly controlled diabetes.

Dr. Kevin Yeskey, director of the preparedness and emergency operations office at the Department of Health and Human Services, was on the task force. He said the report would be among many the agency reviews as part of preparedness efforts.

Public health law expert Lawrence Gostin of Georgetown University called the report an important initiative but also "a political minefield and a legal minefield."

The recommendations would probably violate federal laws against age discrimination and disability discrimination, said Gostin, who was not on the task force.

If followed to a tee, such rules could exclude care for the poorest, most disadvantaged citizens who suffer disproportionately from chronic disease and disability, he said. While health care rationing will be necessary in a mass disaster, "there are some real ethical concerns here."

James Bentley, a senior vice president at American Hospital Association, said the report will give guidance to hospitals in shaping their own preparedness plans even if they don't follow all the suggestions.

He said the proposals resemble a battlefield approach in which limited health care resources are reserved for those most likely to survive.

Bentley said it's not the first time this type of approach has been recommended for a catastrophic pandemic, but that "this is the most detailed one I have seen from a professional group."

While the notion of rationing health care is unpleasant, the report could help the public understand that it will be necessary, Bentley said.

Devereaux said compiling the list "was emotionally difficult for everyone."

That's partly because members believe it's just a matter of time before such a health care disaster hits, she said.

"You never know," Devereaux said. "SARS took a lot of folks by surprise. We didn't even know it existed."

— The Associated Press

Wednesday, May 7, 2008

Changing patterns in vaccine era pose questions about durability of immunity

I will take my risk with natural exposure to the childhood diseases over vaccination any day.


Changing patterns in vaccine era pose questions about durability of immunity

TORONTO — We call them the diseases of childhood - measles, mumps, rubella and chickenpox, to name a few.

But now that these diseases seldom circulate in countries that immunize against them and immune protection is rarely being naturally refreshed or "boosted" by sporadic exposure, is there a risk that in the future, older adults may find themselves unexpectedly vulnerable to these disease pests from their past?

As we head into a world where an ever growing - and aging - proportion of the population only has vaccine-acquired protection, what is really known about how long immunity is likely to endure? For that matter, can science be sure that immunity generated by infection - thought for many diseases to be lifelong - will actually hold true in the vaccine age?

"I don't think we know much at all," acknowledges Dr. Samuel Katz, co-inventor of the measles vaccine and a pediatric infectious disease expert at Duke University in Durham, N.C.

Figuring out answers about the durability of immunity - naturally and vaccine-acquired - in a time without natural boosting won't be easy.

But the last generation to have routinely suffered through most of these diseases is crossing through mid-life and the first generation to have avoided them is hovering around 40.

As both groups head toward the so-called golden years when possible waning immunity may be exacerbated by the age-related decline of the immune system, gauging the levels of society's disease defences could become key to keeping these nasty invaders out of our communities, experts say.

Dr. Michael Osterholm says scientists should be doing long-term immunity studies - following groups of people for decades - in the way cancer researchers track groups of people to try to discern what causes cancer.

"That would help us understand at what point does the level of protection drop for a population. Not any one individual. But a population norm where you would now recommend that a booster shot should occur as a standard of medical practice," suggests Osterholm, director of the Center for Infectious Diseases Research and Policy at the University of Minnesota.

Before vaccination became commonplace, adults often came in contact with youngsters suffering from mumps, measles and the other childhood diseases. That remained the case in the early days of vaccine administration when these diseases still commonly circulated.

If people had protection - natural or vaccine-acquired - those exposures were actually helpful. They acted as a sort of natural booster shot, reminding the immune system to be on guard for this threat.

Some experts now suggest these unrecorded natural boosts may have led medicine to overestimate the durability of immunity generated by childhood vaccinations and maybe even natural infection, though it is thought to be more enduring than vaccine-acquired infection.

These days, few people are getting natural boosting to these diseases.

"What's happening if we don't have these exposures? I don't know," Katz admits.

These questions about the durability of immunity are on the minds of public health authorities in countries where childhood vaccines have been in longest use, says Dr. Jane Seward, an expert in vaccine-preventable diseases with the U.S. Centers for Disease Control in Atlanta.

"It's certainly a reasonable hypothesis that immunity might wane more quickly in the absence of external boosting. Whether that's the case or not, we don't know. But it's a reasonable thing to postulate," she says.

Seward's group at the CDC is following people who were vaccinated with the measles-mumps-rubella vaccine about 15 years ago to track how well their protection is holding up. They hope to mount a similar effort to study chickenpox vaccine, which was only put into broad use in the U.S. and Canada in the mid-to late-1990s.

Others, though, acknowledge the long-term studies needed to assess immunity levels generated by the range of childhood vaccines haven't been undertaken in a systematic manner.

"We have not methodically - we being the field of public health officials, scientists - we have not methodically measured the level of immune responses to standard childhood diseases vaccines that people have received one, two, three, four, five decades earlier," says Dr. Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases.

"It has been done mostly in a reactive mode," he says, pointing as an example to work done to understand a large outbreak of mumps in Iowa in 2006.

The full picture of the durability of immunity in the vaccine era will probably take decades to come into sharp focus. And the answers will likely vary from disease to disease, Fauci and others say.

For instance, U.S. studies done to test whether smallpox vaccinations given decades ago offered any current protection showed that those who had been vaccinated probably still have protective immunity. "We were stunned," Fauci says.

But a soon-to-be published study by some of Seward's CDC colleagues - done as part of the Iowa mumps investigation - shows antibody levels to the mumps virus had declined markedly in people who had received the recommended two doses of vaccine 15 years or more earlier. That suggests the vaccine's protection is less enduring than would have been hoped.

The fact that the protection may not be lifelong should not be characterized as a failure of the vaccines, public health experts say. The years of protection they have already conferred have dramatically slashed rates of once common diseases.

Consider measles: Where 300,000 to 400,000 Canadian children used to contract the disease every year, now an outbreak of fewer than a handful of cases - such as a recent cluster in Toronto - makes the news.

Given that measles has a complication rate of 20 per cent and that the World Health Organization estimates measles killed 242,000 children around the globe in 2006, proponents term vaccines as a modern day medical miracle.

Experts also warn that the fact that immunity may not be lifelong should not be used to argue for natural infection over immunization.

"Never forget natural infection comes at a great cost, both potentially to the individual and definitely to society," Osterholm insists. "Each infection is a crapshoot as to whether it's going to be mild, moderate, severe or fatal. And those are odds none of us should have to take."

The end result of the investigation into the durability of immunity in the vaccine age could be a recognition that adults need booster shots to prevent outbreaks of what we now consider childhood diseases. Osterholm, for one, thinks that's likely.

Fauci isn't sure, suggesting the lack of natural boosting highlights the fact that exposures to the viruses and bacteria that cause these diseases are rare in North America.

"There is a potential risk. I mean you'd have to say that. I'm not so sure how great a risk it's going to be."

Should emerging data show adults will need booster shots for childhood diseases, vaccine delivery programs will have to be reorganized to look at issues of who pays and how best to ensure adults actually get the shots, says Dr. Bonnie Henry, chair of the Canadian Coalition for Immunization Awareness and Promotion.

"Adult immunization is woefully neglected," notes Henry, an infectious diseases expert with the British Columbia Centre for Disease Control.

"And I don't know what the answer's going to be in that but it does pose a whole bunch of challenges because we don't have the access to people (adults) in the same way that we do when you're in school."

CDC lies about MEASLES outbreak

More proof the CDC is spinning this outbreak out of control in an effort to scare people into the MMR vaccine. When will the madness end?

Deja Vu: Spinning Measles

by Barbara Loe Fisher

Last week, CDC officials began spinning the significance of 64 cases of measles reported during the past four months in contrast to the 37 to 508 cases of measles reported annually between 1996 and 2006 in the U.S.. One-quarter (14) of the 64 children and adults who got measles in the past four months were hospitalized but there were no deaths.

A CDC press release and Fact Sheet revealed that nearly half of the 64 measles cases occurred in those too young to be vaccinated or whose vaccination status was not known. Only one fifth (14) of the cases were American children whose parents claimed a religious or personal belief exemption. This fact didn't stop CDC officials from trying to blame the measles "outbreaks" on the exemption-takers by stating "These cases and outbreaks resulted primarily from failure to vaccinate, many because of religious or personal belief exemption."

In addition, the CDC made the following undocumented statement: "Before the measles vaccination program, about 3- 4 million persons in the U.S. were infected each year, of whom 400 to 500 died, 48,000 were hospitalized, and another 1,000 developed chronic disability from measles encephalitis." A quick look at the MMWR historical tables shows that the highest number of measles cases reported since 1945 in the U.S. was 763,094 cases reported in 1958.

What is the real story behind the hyping of 64 cases of measles and attempting to demonize parents who have taken religious or personal belief exemptions to vaccination? Are government health officials trying to deflect attention from the reality that even with a 95-100 percent measles vaccine uptake for children entering kindergarten in two- thirds of the states and a 92 to 95 percent vaccine uptake in all but four states, two doses of measles vaccine does not prevent measles from circulating in the population? Are they softening up the public for a future announcement insisting that a third dose of MMR vaccine must be mandated to "eradicate" measles?

After the first measles vaccine was licensed in 1963 and began to be used on a mass basis in the U.S., health officials estimated the herd immunity threshold was as low as 55 percent vaccine coverage in a population receiving one dose of measles vaccine. (free registration to Medscape required, or click here to view the Abstract in Pediatric Infectious Disease Journal. 25(12):1093- 1101, December 2006) When that belief failed to "eradicate"measles, in 1971 the herd immunity estimate was raised to more than 90 percent coverage and the 1977 Childhood Immunization Initiative was launched with an aggressive enforcement of mandatory vaccination laws. However, by 1989 it was obvious that even with a 95 percent plus vaccination rate for children entering kindergarten in most states, measles was still circulating with about 55,000 cases reported between 1989 and 1991.

Without conducting a thorough investigation to find out why there were measles increases between 1989 and 1991 in a highly vaccinated population or why the measles being seen was unusually virulent, CDC officials announced that all children must get a second dose of measles vaccine. But measles infections persisted and, in 1995, the National Vaccine Information Center reported on informed consent violations and child deaths in a large worldwide high titer measles vaccine experiment in which a very potent experimental measles vaccine was given to children under six months old to try to over- ride maternal antibodies. By 1998, eight distinct genetic groups of wild type measles were identified worldwide in vaccinated and unvaccinated populations.

By 2006, vaccine developers had raised the estimated herd immunity coverage rate for measles eradication to between 93 to 95 percent but obviously even that extremely high coverage rate in most states is not enough to do the job. So what comes next? Will the CDC call for the National Guard to go door-to-door armed with syringes containing measles vaccine to make sure there is not one unvaccinated person in the country?

Measles vaccine, which is part of the combination live virus MMR (measles-mumps-rubella) vaccine can cause brain inflammation and permanent brain damage. There have been nearly 45,000 reports of health problems associated with MMR vaccination made to the federal Vaccine Adverse Events Reporting System (VAERS) . However, there is gross underreporting to VAERS and it is estimated that, for example, fewer than 4 percent of all cases of thrombocytopenia (potentially fatal blood disorder) following MMR vaccination are ever reported to VAERS.

In 1997, Andrew Wakefield, M.D. and his colleagues published findings indicating that the MMR vaccine may contribute to the development of inflammatory bowel disease and autism in a subset of children, a scientific debate that continues today.

Parents contact the National Vaccine Information Center every week to file MMR vaccine reaction reports in the NVIC Vaccine Reaction Registry and describe how their children are suffering high fevers, seizures, brain inflammation and regression into autism after MMR vaccination. To view some of these reaction reports, go to the International Memorial for Vaccine Victims .

The CDC's one-size-fits-all, no-exceptions MMR vaccine policies allow almost no contraindications to MMR vaccine use. According to the CDC, a child can be sick at the time of vaccination or recovering from an illness; have a fever; be taking antibiotics; have a history of allergies; or have experienced a seizure or regression after a previous MMR shot and still be eligible for more MMR vaccine.

With oppressive "no missed opportunities" vaccination policies in place, it is no wonder more parents are filing religious and personal belief exemptions to vaccination. Some have no other choice, especially if their children have experienced previous serious health problems following vaccination and they cannot find a doctor to write a medical exemption. Others want to choose less toxic alternatives to vaccination to maintain health and wellness.

Non-medical vaccine exemptions for religious and personal beliefs are all that stand between the people and tyranny when doctors inside and outside of government take an extreme, utilitarian approach to infectious disease control and write off vaccine casualties as acceptable losses. Today, 1 in every 6 highly vaccinated American child is learning disabled, 1 in 9 is asthmatic and 1 in 100 to 150 develops autism while measles and other childhood diseases persist no matter how many doses are given or how high the vaccine coverage rate.

It is time for parents and legislators to take a hard look at whether trying to eradicate many diseases with forced use of multiple vaccines is a fundamentally flawed policy that has failed to achieve better individual or public health. It is time for vaccines, which are pharmaceutical products made and sold by corporations for profit, to be subject to the law of supply and demand rather than be financially subsidized and forced by government on the people.