Pandemic Vaccines May Not Arrive in Time!

Pandemic Vaccines May be Too Little, Too Late

If the swine flu outbreak develops into a pandemic — and that’s a big if — the earliest the public would see a vaccine against the disease would be September, a researcher said here at the conference on Influenza Vaccines for the World.

And that’s if the government asks industry to start production today, said Klaus Stohr, D.V.M., vice president and global head of Novartis Vaccines and Diagnostics and former head of the World Health Organization’s global influenza program.

“What we have seen the last two or three days is that the current pandemic vaccine system is not ideal not only in terms of timing . . . but also in terms of vaccine production,” he said.

A Lot to Consider in Healthcare Reform

Few Hospitals Meet Mortality-Reducing Quality Goals

Most hospitals in the 2008 Leapfrog Group quality survey did not meet standards shown to reduce mortality, researchers said.

Of the 1,282 hospitals taking part in the voluntary survey, which represents 48% of urban medical centers, many are falling short of mortality-reduction measures and are not delivering care efficiently, the nonprofit’s annual report said.

“As the Obama administration and Congress consider healthcare reform options, it is clear we have a long way to go to achieve hospital quality and cost-effectiveness worthy of the nation’s $2.3 trillion annual investment,” said Leapfrog CEO Leah Binder.

The new survey comes just weeks after the Journal of the American Medical Association published a study showing that adherence to National Quality Forum safety standards — including hand washing and having a competent nursing staff — do not result in lower mortality rates. (See: Hospital Mortality Not Linked to Safe Practices Score )

But the new survey focuses on factors that are known to reduce mortality, such as physician staffing levels in intensive care units and meeting prescription order-entry standards, said Binder.

Hospitals are not doing a good job of following recognized protocols for high-risk procedures, procedures that can reduce the risk of death significantly, said Barbara Rudolph, Ph.D., of the Leapfrog Group.

The State of Economy Doesn’t Help Either!

More Americans Report Frequent Mental Distress

State of mind may have a lot to do with state of residence — people who live in Hawaii have the lowest “frequency of mental distress” (6.6%), while Kentucky residents have the highest (14.4%), according to the CDC.
Action Points

* Explain to interested patients that this report is an analysis of self-reported survey data, which need to be cautiously interpreted because the findings are subject to a number of limitations.

But overall, more Americans have been experiencing more bad days in recent years — 10.2% of adults reported frequent mental distress in the period from 2003-2006, up from 9% in 1993-2001, wrote Matthew M. Zack, M.D., M.P.H., of the division of adult and community health at the National Center for Chronic Disease Prevention and Health Promotion at the CDC in Atlanta, and colleagues.

Those findings, published online today by the American Journal of Preventive Medicine,emerged from an analysis of responses from 2.4 million adults collected by the ongoing, random-digit-dialed telephone surveys conducted by the Behavioral Risk Factor Surveillance System. The analysis was performed in 2007 and 2008.

Dr. Zack and colleagues used 14 mentally unhealthy days as the threshold to define frequent mental distress.

The final analysis included results from 3,112 counties representing all 50 states and Washington, D.C.

“For the 1993-2001 period, the smoothed [frequent mental distress] prevalence was less than 8% in 989 (31.8%) of the 3,112 counties analyzed and was ≥12.0% in 148 (4.8%) of counties,” they wrote.

By comparison, in 2003-2006, “the smoothed [frequent mental distress] prevalence was <8% in 494 counties (15.9%) and ≥12.0% in 502 (16.1%) of the counties.”

The researchers excluded counties in which there were fewer than 30 responses to this question: “Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the previous 30 days was your mental health not good?”

Among the findings:

* During 1993-2001, 15 states had at least one county where the prevalence of frequent mental distress was ≥12.0% and by 2003-206 that number had doubled to 30 states.
* The prevalence of frequent mental distress tended to decrease in contiguous parts of the upper Midwest (Minnesota, Wisconsin, and Michigan), and to increase in the Four Corners area (Utah, Arizona, Colorado, and New Mexico), the Mississippi Valley (Missouri, Arkansas, Tennessee, Mississippi, and Alabama), and the central Appalachian region (Pennsylvania, Maryland, West Virginia, Ohio, Kentucky, and Virginia).
* Alabama and Kentucky were the only states that remained in the top five for frequent mental distress prevalence in both time periods — 9.8% and 12.7% for Alabama in 1993-2001 and 2003-2006 and 14.4% in both time periods for Kentucky.
* In addition to Hawaii, other states with low rates of mental distress were South Dakota, Iowa, Nebraska, and North Dakota.

The authors pointed out that the survey has a number of limitations, including the fact that “risk factors do not respect state boundaries.” Moreover, states that have large urban populations “tend to reflect the [frequent mental distress] prevalence in those areas due to their sheer numbers, potentially obscuring the detection of high or low [frequent mental distress] prevalence in less-populated areas of the state.”

Additionally, they said, because the Behavioral Risk Factor Surveillance System excludes homeless persons, people who reside in institutions, households without landlines, and those who are unable to complete the survey because of language problems, the survey might underrepresent people with frequent mental distress.

Moreover, the prevalence rates might reflect factors such as age, gender, race/ethnicity, employment status, occupation, educational background, natural disasters and a number of other factors that were not controlled for in the study.

Nonetheless, the authors concluded that because the data do indicate “potentially unmet health and social service needs, programs for public health, community mental health, and social services whose jurisdictions include areas with high [frequent mental distress] levels should collaborate to identify and eliminate the specific preventable sources of this distress.”

No financial disclosures were reported by the authors.

Primary source: American Journal of Preventive Medicine
Source reference:
Moriarty DG, et al “Geographic patterns of frequent mental distress U.S. adults, 1993-2001 and 2003-2006” Am J Prev Med 2009;

We Have Come a Long Way…

Tort Reform Sounds Good, Smells Bad

When I came to the bar in 1959, there were a whole series of immunities, bars, evidentiary rules and canons of ethics that prevented injured people from having their day in court. These roadblocks originated around 1840 with the rise of the Industrial Revolution. At that time, the courts recognized the natural tension between the litigious nature of Americans and our burgeoning system of free enterprise. So, they set out to help big business by preventing injured people from suing.

For instance, you couldn’t sue the government because of “sovereign immunity.” Certain charitable institutions were granted immunity from lawsuits.

The law of “privity,” which meant you had to have direct contact with the party you were suing, effectively granted immunity to manufacturers of defective products. If you bought a car, and it blew up and killed your family, you couldn’t sue anyone, unless you could prove it was the dealer’s fault.

Until the 1960s, there was no uninsured motorist coverage to protect you in case you were hit by someone with no auto insurance. Then, in the 1970s, we added underinsured motorist coverage in case someone with too little insurance hit and injured you. Even with all of that insurance, if you and your wife were in a car accident and you were at fault, she couldn’t recover any compensation from your insurance company because of “spousal immunity.” You would have to bear the financial burden of your wife’s recovery.

A lawsuit on behalf of an infant had to be brought within two years after birth, regardless of the circumstances; wrongful death suits had to be rifled within 12 months, before enough investigation could be done; and recoveries that included loss of future income had to be reduced to present worth. The deck was stacked against the average person.

But with the rise of the consumer movement in the 1960s, the courts recognized the injustice of making victims bear the cost of their injuries. The great changes in liability law that ensued came about because capable and dedicated trial lawyers recognized that the law is never settled until it is right and it is never right until it is just.

Today’s “tort reformers” want to return us to the late 19th and early 20th century.

Watch that Bulge!

Bulging Waistline Boosts Heart Failure Risk

Every 10-cm increase in waist circumference raised the risk by 15% to 20%, Emily Levitan, Sc.D., of Beth Israel Deaconess Medical Center in Boston, and colleagues reported in Circulation: Heart Failure.

In women, rising BMI, independent of waist circumference, did not predict the risk of heart failure hospitalization or mortality.

Among men, however, both a greater waist circumference and greater BMI posed an increasing heart failure hazard.

“We found that waist circumference was predictive of heart failure events regardless of BMI, but there was a suggestion of an association with BMI only at high waist circumference among women,” the authors said. “In contrast both abdominal and overall adiposity appeared to be associated with heart failure events among men.

“For all participants, the strength of the association between adiposity and heart failure events appeared to weaken with age.”

The worldwide incidence of obesity and heart failure has increased in parallel, and several epidemiologic studies have associated obesity and overweight with heart failure.

Product Defect

Removing Medtronic Heart Cable

Pulling a medical device off the market is one thing. Removing it from the bodies of thousands of patients is a lot more complicated and dangerous.

Consider the Sprint Fidelis, a heart defibrillator cable. In 2007 its maker, Medtronic, stopped selling it after five patients who had the cables died.

But only now is the full scope of the public health problem becoming clear for the Sprint Fidelis, which is still used by 150,000 people in this country.

In the next few years, thousands of those patients may face risky surgical procedures to remove and replace the electrical cable, which connects a defibrillator to a chamber of the heart.

Medtronic estimates that the cable has failed in a little more than 5 percent of patients after 45 months of being implanted. But as a preventive measure, some patients with working cables are having them removed.

Already, four patients have died during extractions. Experts fear that the toll could quickly rise if such procedures are not performed by skilled doctors at medical centers that have performed many of the operations.

“I think we are just seeing the tip of the iceberg,” said Dr. Charles J. Love, a cardiologist at Ohio State University Medical Center in Columbus, who specializes in cable extractions.

For many of the patients around the country who may need the procedure, finding the right medical center will not be easy.