Back in Order- repairs in the office

Back in Order-

Pipes to be Repaired this Friday, March 27

In contrast to our usual post- information you can use, and that is useful across the community, this post is just about some repair work taking place in the office.

As those in the practice know, we have had to hang an Out of Order sign on our bathroom too frequently over the years.

We are very pleased to let everyone know that our landlord has identified faulty pipe paths as the reason for this inconvenience, and will be repairing it this Friday, March 27.

The good news is that our bathroom should be back in order by next week!

But we want everyone to know that for the repairs to take place, our office needs to close early this Friday.   So, the office will close at Noon, this Friday, March 27.  

Please be sure to get all requests for prescription refills in by Noon this Friday.

Dr. Lavin will remain available throughout Friday afternoon and the weekend by phone, without interruption at our usual number, 216-591-1515.

We will be open as usual first thing Monday morning at 9AM next week.

Sorry for any inconvenience this may cause, but we look forward to our bathroom working for years to come.

To your health,

Dr. Lavin

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*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

In Celebration of LEGO'S

In Celebration of LEGO'S!

This weekend, I came across a fascinating history of the powerful tool for imagination, LEGOS.

An unlikely source of poetic inspiration, I came across the article while waiting at my favorite barber's, in the April 2015 issue of Popular Mechanics (it also has Corey Kluber on the cover!).  The article, by Michael Paternini, tells a rather extraordinary story.

It began inland, in Billund, Denmark, in 1916, with Kirk Christiansen when he started a furniture business. Wood scraps from making furniture started his toy making business in 1934, which he called Lego, from the Danish leg godt, which means play well.  More on that later.

About 11 years later, after WWII, he visited England and came across a plastic molding machine.  He was the first person in Denmark to buy this machine and run it in Denmark.  The machine at first made hollow rectangular bricks of plastic.  But in 1958, Lego patented a plastic brick with internal tube and studded surface that allowed for instant stability, clutch power, and yet a young child can join and separate them.

In 1958 the Lego group has 150 employees, by 1960 the number was 450, and today they employ 14,000 people.  The company makes about 55 million separate Lego pieces a year.  Paternini goes on to observe that right now there are about 100 Lego bricks for every human on earth.  The company has been very successful.  Kirk Christiansen's grandson, the current head, is estimated to have personal worth of $10 billion.

So, the numbers are very impressive, but even more so is their celebration of play.  Play is fun, of course, but human play is also the highest level of cognitive functioning too.   There are few, if any, significant advances in human history that did not rely on play.   And play, sadly, is under tremendous pressure, if not assault, in the childhood of American children today.  From the first day of kindergarten through the first day of college, today's American child can expect to take over 100 standardized tests, experience thousands of hours of homework, and be subjected to tremendous pressures to conform to very narrow definitions of success.

And so, not only are Lego's a great toy, but a highly unusual opportunity for children to play.

One fact jumps out beyond all others in this recounting of the Lego story:  If you are given just six Lego bricks, each with 8 studs, the number of possible combinations of those six bricks, is over 900 million!!  

That's right, 6 Lego pieces can generate nearly 1 billion different constructions!

The makers of Lego blocks have since teamed up with cognitive scientists of play at MIT and together they discuss the interesting balance of constraint and creativity.  The constraint is that each Lego block has a fixed shape, and none are round.  The creativity comes from the staggering variety of shapes, including round shapes that the blocks can form.

Children enjoy Lego constructions in a wide variety of ways.  They enjoy mastering reading the non-verbal construction manuals that accompany kits, and they enjoy making up their own designs.  Again a great range of possibilities.

Some families have raised concern that their child(ren) focus too much attention on Lego play.   Sometimes the issue of hyperfocus which is a symptom sometimes seen in children who struggle with paying attention to school work have, is raised as a problem of play with such toys as Lego blocks.

The evidence to date suggests that having fun with toys such as Lego blocks in not the cause of disinterest in school.  More likely, many children simply prefer play to homework.

Bottom Line

Lego blocks, like many fun activities that promote play, are great fun and terrific opportunities for our kids to play.  

Play is in short supply for many children,  and should be celebrated!

To your health,

Dr. Arthur Lavin

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*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

Illusions should pass, but people should not be attacked

Illusions should fall, but it's still good to be reasonable

Over the last few days, I have been sent a link by a number of people to a recent piece by the late-night talk show host.  It is his take on the recent concern about the threat of measles, but also a very harsh attack on families who have struggled with the issue of immunization.

Given the number of people who have sent this clip to me, it is clearly catching a lot of attention, and I thought a response was in order.

The clip highlights two rather striking realities about our national conversation on immunizations:

1.  A dramatic shift in our thinking and feeling on the measles vaccine is happening right now.

2.  Much of the feeling associated with this shift is unnecessarily belligerent and mean-spirited.

Our Affair with False Claims
In 1998, a physician with transplant medicine experience published a paper in one of the world's oldest and most prestigious medical journals, The Lancet, in which he raised concern that the MMR vaccine caused autism.  He later went public calling for the MMR vaccine to stop being used.  Fairly rapidly, other scientists took a look at Wakefield's claims and found they had no basis in fact.  The London Times conducted an extensive investigation and exposed Wakefield's work as fraudulent.

Science began exposing Wakfield's work as early as the year 2001, and by 2004, enough evidence to expose Wakefield has accumulated that serious steps began to be taken against his credibility.

In 2010, England revoked his license to practice medicine.

But none of the exposure of how fraudulent Wakefield's claims have been have had any impact on the public mood, until now, some 11 years after his work was first exposed.

For me, what is most interesting about the Wakefield hoax is not that it happened, but how we the public relate, because such processes are common when it comes to immunizations.

Some time ago, we posted a blog and post on the remarkable book, On Immunity, by Eula Bliss, a gifted writer.  This is easily the most thoughtful and profound book on the issues we all face when considering medical decisions, and a tremendous reference on the story of immunizations.   This story goes back well beyond Edward Jenner and his work on smallpox inoculation in 18th century England.   The work of immunization can be traced to at least a century before that in India, thence to Turkey, and from Turkey, remarkable, to the United States via Cotton Mather whose family remains prominent in Cleveland to this day.   The gift of immunization, namely the eradication of deadly diseases, has always been met with worry and resistance, now for centuries.

More recently, in modern America, the questions raised about immunizations have led to two movements against immunizations that each lasted about 15-20 years.  One was quite strong in the 1970's and 1980's and it was based on the claim that the DTP vaccine caused mental retardation.   As with our more recent movement against immunization, the claim was rapidly disproven, but it took nearly two decades for the claim to vanish.   And this claim has clearly vanished.  There is essentially nobody around today who really believes that if a child gets a tetanus shot it will cause them to become mentally retarded.   But this was a hotly held feeling for a very long time, and it actually led to a change in the DTP, the creation of the now used DTaP, a weaker vaccine with fewer side effects.

And so it was with this current claim, that the MMR causes autism.  Within a few years, evidence was at hand that the claim was untrue.  But the power the claim had on our minds remained quite powerful for another decade.

Equally fascinating to us is how a very passionately held claim suddenly evaporates.  No one knows what triggers the claim vanishing, but these false claims always end up collapsing.  The fact that false claims collapse is no surprise, but it is intriguing that they persist, and intriguing that the moment of their collapse never bears any relation to any new facts emerging.  It is as if the passion surrounding a controversial claim needs 10-20 years to go through its process, and only then will it collapse.

One dramatic illustration of what we are talking about is the fact that in 2000, measles had been eliminated from the US.   In response to worries about MMR, the number of people protected by the MMR against measles began dropping, and measles outbreaks started up again in our country in 2007.  From 2007-2014 there have been twenty measles outbreaks.  But for 19 of these 20 outbreaks, the fact that measles caught fire again here had no impact.  The outbreaks were reported, but essentially no one cared.   During this time, in our public imagination, the worry that the MMR might cause autism trumped the worry that measles could cause harm.

Not this time.  This 20th outbreak came after the claim that MMR could cause autism really began collapsing.  And now this time, the measles epidemic has caused a furor, a firestorm.

As recently as early 2014, no late night comic would touch on public worries about measles, no one cared.  But now, it is all the rage.

So, just as the claim that the DTP vaccine can cause mental retardation suddenly disappeared from public imagination in the United States, the claim that the MMR vaccine can cause autism is also, but it's happening right now.

Being Thoughtful During Reactions in Any Direction

And so, we are living through a very dramatic shift in public mood and perception.

Again, anyone really interested in this subject would greatly enjoy the masterful treatment of it in the book On Immunity.

Curiously, the shift has moved our country from one strongly held feeling to another.   Initially the feeling was a sense of unease, and for many, a sense of dread that the MMR vaccine might cause autism.  Now the feeling is a sense of unease, and for many, a sense of dread that measles could present a danger.

I would propose that at any time, no matter what the nation is upset or worried about, that a minimum of respect for the concerns of others be honored in practice as well as intent.

As the book On Immunity so beautifully illustrates, there is complexity in medical decision making, particularly when it comes to being a parent who imposes a treatment on their child.

Many parents over the years have expressed concern for the presence of various preservatives in immunization materials.  These have included such ingredients as mercury.  As a result of these concerns, nearly all immunizations used in our office arrive in single dose syringes that contain no mercury.   Other ingredients of concern have included formaldehyde and aluminum.  The aluminum is necessary to stimulate the immune system to react to the vaccine, no aluminum, no immunity from the vaccine.   The formaldehyde is in extremely tiny amounts left over from the processing of the vaccine and not an active ingredient.  Both the formaldehyde and aluminum have been studied and found not to cause harm since the amounts are so low.

The reason I review these three ingredients is twofold:
1.  To let people know that the vaccines we recommend have been used after very careful scrutiny and enormous studies of risk, and found to be very, very safe.
2.  The second is to let people know that people in the community who raise questions of course have a right, and duty as parents, to raise questions.

The swing from one strong feeling to another strong feeling has led to a shift from a very strongly held worry about vaccines, to a very strong held worry about those who do not vaccinate.

This swing has led to the emergence of a whole new discussion across the nation- should actions be taken against families that delay, or do not immunize their children?  Some have even called for doctors to not see families who make these choices.

It is at this point that we call for calm and respect.

A closer look at the controversy about what doctors should do will hopefully encourage us all to be both calmer and more respectful.

As we think about it, several reasons come up, many of them compelling, for seeing the decision to exclude people for their medical choices from doctors' offices as not helpful to anyone:

1.  The doctor's office is a place of help.   The last thing a doctor should do is turn away someone who wants to be helped.   Most families have questions about immunizations, it's one of the more helpful things pediatricians do, it does not make sense to turn away people looking for answers.  Excluding people from care because others object to decisions or perceive harm could lead down a very odd road.  Imagine doctors telling people who smoke that they can no longer come see them, or people with any complex health choices to weigh.   Not only is that a bad idea, but it violates a very key principle of the profession:  the doctor's office is a place of help.
2.  If there is a disagreement or point of discussion around a subject, it usually does little good to respond to that by cutting off the conversation.   For families that have concerns about immunizations, it does little good to respond by not allowing the conversation to take place.  It doesn't help the doctor understand the concern, and it doesn't help the family explore their concern.
3.  For those who feel strongly about everyone getting immunized, pursuing a policy of not allowing people who question immunization to come to the doctor actually will increase the number of children not immunized.  Cutting people off tends to reduce opportunities to discuss options rather than expanding them.
4.  The doctor's office is not the main source of exposure to any illness.   Take the current measles outbreak.  Most of the cases were caught in Disneyland, not the doctor's office.  Many families are currently concerned that if unimmunized children come to the doctor's office, their child will be at heightened risk of catching preventable illnesses, like measles.  But keeping access to a doctor limited to those unimmunized does not really change the risk of anyone catching those illnesses.
5.  When an outbreak of a preventable illness occurs, immunized children spread it too.  In the last measles outbreak, about 1 in 6 of those walking around with measles were immunized.  When an outbreak occurs, there really is no safety in isolating those who are not immunized, we are all one community living together, whatever our choices are.

So, as one might suspect, it turns out the only way to protect a community from vaccine preventable, serious infectious diseases is to have as much of the community be immunized as possible.  Infections spread across great areas, and that transmission can only be stopped if enough people are immune and unable to spread the illness.

Taking actions on an individual level has no impact, and the actions recommended all tend to be counter-productive as noted above.

BOTTOM LINES
1.  We are all living through a rather amazing transition in perception.  The MMR, and other immunizations, are moving from items of some worry, to highly valued protectors.  Worry is shifting from the vaccine to the disease.

2.  Right now, there is an incredibly sharp spike in feeling about immunization, this time the worry is with not getting immunized.  Blogs, late night comedians, daily conversations are seeing a sharp rise in calls for action to demand everyone be immunized, including calls to restrict access to medical care.

3.  It turns out the only way to keep one from catching a vaccine preventable disease is to have the whole population reach a safe level of rate of immunization.  If a whole population dips below that rate, then everyone can spread it, even immunized people.  There is no protection in trying to avoid people who have not been fully immunized.

3.  As during the time when most worries were directed at the vaccine, this time calls for being reasonable and thoughtful.   To that end, it is worth keeping in mind that our primary purpose as doctors is to help.   And it simply does not help anyone to deny help to those with questions.

4.  Those interested in perhaps the best, most thoughtful treatment of this issue might greatly enjoy On Immunity, a comprehensive treatment of the subject.

5.  Putting it all together, we at Advanced Pediatrics will continue what we always try to do- be available, be helpful, answer questions, offer disease prevention.   I have full confidence this approach is the safest, most helpful, and most informative approach we can imagine.


And to that end, we again thank you for the honor of being asked to help,
Dr. Arthur Lavin

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*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

Top 5 Recommendations Go International!

Top 5 Recommendations Go International!

In May, 2011 a paper was published presenting the results of a process called the Good Stewardship Project.  In this Project, five doctors gathered in each of three specialties- internal medicine, family medicine, and pediatrics- to develop a list of five actions each specialty should stop doing.   Each recommendation had to improve the quality of care and reduce the cost of care.

Dr. Lavin was honored to lead the group of 5 pediatricians, who came from practices from across the nation.

Our five recommendations were published in the Annals of Internal Medicine:  http://www.ncbi.nlm.nih.gov/pubmed/21606090 

Now, nearly 4 years later, we have just been informed that our work has inspired a similar set of processes across the world.  Similar groups have published or begun similar work in the following countries, across 4 continents:  Canada, Australia, Germany, Italy, Japan, Switzerland, and the Netherlands.

Dr. Lavin is honored to have led the original pediatric team in this project and pleased the idea has spread across the world.

The top five recommendations were:

1.  Do not prescribe antibiotics for a sore throat unless it is proven to be a strep throat.

2.  Do not do CT or MRI scans for minor head injuries.

3.  Do not seek an ENT consultation for uninfected fluid in the ear early in the course of fluid present.

4.  Advise families not give their children cough and cold remedies.

5.  Use inhaled steroids in asthma when indicated.

These recommendations are now standards of good pediatric care and have been followed at Advanced Pediatrics for many years.

BOTTOM LINE

Advanced Pediatrics is pleased to see the approaches we take to care endorsed not only by a US paper in 2011, but now featured in the work of doctors in countries around the world.

To your health- 

Dr. Arthur Lavin

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*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

Say Nuts to Allergies: Another Illusion is Overturned

Say Nuts to Allergies, Another Illusion is Overturned--

Feeding Peanuts Early to Infants Actually Prevents Allergy to Peanuts

For many years, the ruling wisdom has held that if you expose your baby to various foods early, especially peanuts, you will increase the chance your child will develop an allergy to that food.

The advice based on this idea has been to ask pregnant women to not eat peanuts, for nursing mothers to not eat peanuts, and for all mothers to protect there infant and child from any exposure to peanuts for 3-4 years.

We have always been skeptical of this advice, mainly because the premise was invented, not actually observed.

About 5 years ago, in December, 2009, we posted a blog that presented the first indication that if you avoid foods, you do not protect your child, you actually make things worse:      https://www.blogger.com/blogger.g?blogID=6797182962943872595#editor/target=post;postID=2888210640457764870;onPublishedMenu=allposts;onClosedMenu=allposts;postNum=12;src=postname

Since 2009, we have reassured families that not only is it OK to eat any foods during pregnancy, including peanuts, it was a good idea to introduce solids as early as 4 months of age.

Now comes a major new study in The New England Journal of Medicine, the world's leading medical journal:  http://www.nejm.org/doi/full/10.1056/NEJMoa1414850?query=featured_home#t=articleTop
(summarized in the NY Times here:  http://well.blogs.nytimes.com/2015/02/23/feeding-infants-peanut-products-could-prevent-allergies-study-suggests/?ref=health

This study not only proves that exposure to peanuts in infancy does not lead to peanut allergy, it prevents it.

The numbers are rather dramatic.  In the group of children that were fed peanuts during infancy, 1.9% developed peanut allergy by age 5 years.   Now, consider the children who were not exposed to peanuts , by age 5, 13.7% were allergic to peanuts at age 5.   Feeding an infant peanuts dropped the chance of becoming allergic to peanuts by 86%!

And this in a group of infants selected to be very prone to allergy- they all had either severe eczema and/or egg allergy.   The group just described had negative skin testing to peanuts in infancy.    But even in infants who tested positive for peanut allergy on skin test in infancy had less allergy at age 5 if they were fed peanuts: if not fed peanuts, 35% had peanut allergy if not fed peanuts, only 10% in this group were allergic if fed peanuts.

The findings are so dramatic that experts commenting on these findings are calling for a new approach to introducing solids to infants.   There is now real hope that if we feed infants peanuts (in a swallowable texture), we could stop the rise of peanut allergy in the developed world.

Five years after we called for a new look at the very suspect notion that avoiding a food in infancy would reduce the risk of allergy, the evidence appears to be convincing:  feed early, feed peanuts, and you can truly reduce the risk of your child developing food allergies, almost certainly to peanuts.

BOTTOM LINES
1.  For many years we have been told that it is best to "protect" your baby from exposure to various foods.  We were told that if you do this, your child is less likely to develop allergies to foods.  And, that this is all especially true in the case of peanuts.
2.  Starting in 2009, Advanced Pediatrics began questioning this concept, noting there was no actual evidence to support it.  And important studies actually proved that it was not true.  We began advising it was not only safe, but a good idea to introduce solids as early as families were comfortable doing so, as early as 4 months old.
3.  Now comes a powerful study that demonstrates that giving infants peanuts to eat sharply reduces the chance they will be allergic to peanuts at age 5, even amongst highly allergic children, whether skin test positive to peanuts early in life or not.
4.  The evidence has reached a level that experts are now moving official advice on infant feeding to one step beyond what we promoted in 2009:  that the introduction of solid foods earlier in infancy, and in particular, the introduction of peanuts into infant diets, could change the face of peanut allergy in the US.
5.  Very importantly: if an infant of any age is fed peanuts, the peanuts must be in a texture the infant can swallow without choking- a thin puree or paste, never a whole peanut.

To your health-
Dr. Arthur Lavin

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*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

HPV Immunization Update- 2015

HPV Immunization Update- 2015

HPV is an abbreviation for a particular species of virus called Human Papilloma Virus.   A papilloma is a small lump, the most common papillomas we have are warts.  So the HPV is the virus that causes all warts in people.

Warts

Warts are a usually harmless lump that is the product of a relatively quiet viral infection.  So a wart has a virus and on top of the viral infection, a lump.  For common warts on hands and feet, the wart infection is so quiet that no redness, or warmth occurs.  All the virus does is make that spot make more skin.  The extra skin piles up and the lump is the wart.  The virus does not go into the body, and the body tends to leave it alone, that's why warts sit there so long.

HPV Subtypes

There are many, many dozen subtypes of HPV, and the subtypes determine if the wart will be on your hands or feet, or genital area.  And of the ones that infect the genital area, the subtype will determine if the wart infection will cause cancer or not.

The vast majority of HPV subtypes do not cause genital warts and do not cause cancer.  But some do both.

The only subtypes the HPV immunization protect against, are the subtypes that cause genital infection and cancer.  Originally the HPV immunization protected against 2 subtypes, then 4.  The 4-subtype version was the standard until this year when a 9-subtype version came out.   

How Common is HPV genital infection?

Very.

Studies have found about 70-75% of all adult Americans, male and female, are infected with at least one HPV subtype.

It is the most common STD, by a very, very wide margin.

Preventing Cancer

The 4-subtype version, which is what everyone who has gotten an HPV immunization series prior to 2015 has had, protected against 70% of all cervical cancers.  It also protected boys and girls from genital warts, and protected males against throat cancer (which has gone up 30% in the US in the last 5 years).

Now comes the 9-subtype version, and it protects against over 95% of all cervical cancers.

When is Best to get HPV immunization?

The HPV immunization only works before one can get an HPV infection.   So it works best if you are immunized before you begin sexual activity.

It can be given in later elementary school, but we think it best to get it in later middle school or early high school, a bit closer to the onset of sexual activity, to increase the protective levels of antibodies closer to the time in your life when you need them.

What is the Timing of an HPV immunization series?

Currently the HPV is a 3 shot series.   You get your first shot, and the second then has to be at least 2 months later, but can be much later than that, just not sooner than 2 months.  The third dose has to be at least 4 months after the second.   Many families have their child get dose 1 at a check-up, come back 2 or months later for the second dose, and then get the third at the next annual check-up.

There is a new look being taken at a 2 dose HPV immunization schedule, where the two doses are at least 6 months apart, but studies that will measure if that works are still pending.

Cost of the HPV immunization

When HPV immunization was first started, many insurers did not cover it, and then when they did, they only covered girls.

For the 4-subtype HPV immunization that has all changed.  Most insurers cover this as they would any other immunization.

The 9-subtype HPV immunization costs about 15% more than the current 4-subtype one.  It is included as an immunization that any ObamaCare compliant plan has to cover, and is covered by Medicaid.  Any new insurance plan has to be ObamaCare compliant, but if you have a plan that you have used for many years, it might be grandfathered, exempt from being ObamaCare compliant, and not cover the new 9-valent HPV immunization.

What to Do

We see the 9-valent HPV immunization as an improvement on the old 4-valent HPV, boosting protection against cervical cancer to very high levels.

But it may be more costly if not covered.

We will have both the 4-subtype and the newer 9-subtype available.  If you want the newer 9-subtype version, we recommend you talk to your health insurance company first to see what your cost will be.

What if You have been Immunized with the 4-subtype version already?

This question is currently under review, clear recommendations are not yet available.

I suspect that if you are already sexually active and have been exposed to HPV (remember about 75% of Americans have HPV genital infection and almost all have no symptoms at all), that getting the new HPV immunization won't help.

If you have not yet begun sexual activity, it might help, but we await further information to see.

BOTTOM LINES

1.  HPV is the virus that causes all warts.  There are lots and lots of subtypes.

2.  Some subtypes only cause warts in the genital area and about 9 of these cause over 90% of all cervical cancers in women, and a rising number of throat cancers in men.  All 9 cause genital warts in males and females.

3.  HPV is a very, very common genital infection, about 70-75% of all adult Americans have HPV genital infection.

4.  The HPV immunization can prevent over 90% of all cervical cancers in women, a vast number of genital warts in all adults, and throat cancers in men.

5.  A new 9-subtype HPV immunization is now available, and increases protection against cancer.  It may or may not be covered by your insurer.  

6.  We will continue to carry the older 4-subtype HPV until insurance coverage of the 9-subtype version is widespread.

7.   We recommend immunizing your children against HPV genital infection before onset of sexual activity, and getting it in later middle school or early high school is good timing for this goal for most children.

To your health,
Dr. Arthur Lavin

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*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

The Influenza Epidemic of 2014-2015 is Ending: Overall an Unremarkable Epidemic

The Influenza Epidemic of 2014-2015 is Ending:  

Overall an Unremarkable Epidemic

Every week the nation's Centers for Disease Control and Prevention, the CDC, publishes a rich set of statistics on the course of the influenza virus in the United States.  It has done so for years, so we can both track the current progress of every winter's influenza virus, and compare it to prior years.

The good news is that, as with every other recorded influenza epidemic, this one is ending too, and it is ending now.  Very soon the winter epidemic if influenza viral infections will be over.

And so, we are also ending our administration of this winter's influenza vaccine.   We are very pleased at the level of protection it offered, and looking over the nation's experience, very pleased this year's influenza epidemic was very much like most years, it was not severe in any sense.

Reminder on what is the influenza virus

Readers of our postings on the influenza virus will be familiar with the nature of the virus.  The influenza virus is a specific species of virus that comes in various strains.    There is much confusion in the word flu.   Flu can mean a cold that is severe, it can mean the stomach flu, it can also mean the influenza virus.   To be clear, the influenza virus is a virus that can cause colds, achy respiratory flus, achy fevers, even ear infection and pneuomonias.  But in any winter, it is the cause of only about 1/3 of such illnesses.   So if you have the "flu" you have a 66% chance of it being caused by another virus, even at the height of the appearance of the influenza virus.

We also know that the influenza virus has a the odd pattern of only causing infections in the United States in the winter, except for rare pandemic forms of it.

Typical patterns of the influenza virus epidemics

Here are the typical patterns the influenza virus causes:

• It typically appears in mid to late December, peaks around New Years Day, and fades in February.
• It changes form slightly every year, so getting it in 2012 offers little protection in 2016.
• Even during its peak times, that is December-February, it causes only about 1/3 of all the colds and flus in the United States.
• It can be very deadly to the frail elderly, but the vast, vast majority of healthy people weather an influenza viral infection safely.
• There are tragic childhood deaths caused by the influenza virus each year in the United States, but the total numbers of these tragedies tend to be in the range of 100 out of millions of infections.
• The influenza vaccine works, even on off years, has reduced the number of deaths from this infection, and helps 

This year's epidemic was notable for how typical it was

This year, the media attention to the influenza winter epidemic suggested something very dangerous, ominous, and quite extraordinary was going on.  We all were made to feel frightened.

Well, now that the influenza epidemic of 2014-2105 is nearing its end, we can look at the actual data, and guess what, this year's epidemic was in nearly all respects very much like all the others, in a word, it was typical.

How so?

• The influenza epidemic of 2014-2015 began right on time in December, and is fading away as most do, right now in February.  In fact if you look at week to week incidences, the epidemic tracks remarkable just as the epidemic of 2012-2013.
• The influenza epidemic of 2014-2015, like all other influenza epidemics, featured subtypes the were different from prior years.   
• At its peak, which again was around New Years Day, only about 1/3 of the nation's colds and flus were due to the influenza virus.
• Much was made of the tragedy of young life lost to the influenza virus this epidemic, and each such death is indeed beyond understanding, the very definition of tragic loss.   But the influenza epidemic of 2014-2015 caused no more child deaths than expected in the United States.  As of February 7 the count stands at 80.  Last year the count was 109 and the year before 170.  This year's influenza epidemic was actually less deadly to children than the last two winter's influenza epidemics.
• The one aspect of this year's epidemic that was notable was that the most prevalent strain was not fully matched in this year's flu vaccines.  Even so 50% of those who got the flu vaccine never got infected with the influenza virus this winter.

Bottom Lines

1.  The influenza virus epidemic of 2014-2015 is coming to a close.

2.  It was a very typical influenza epidemic.

3.  The influenza vaccine, although missing an exact match with one of the prevalent strains, worked once again.  The number of childhood deaths from influenza actually dropped, so far this round.

4.  With the end of the influenza virus epidemic we are ending administration of influenza vaccine until next season, starting up again sometime around September, well before the time the germ will return, December.

5.  Of course, the influenza virus causes very few colds and flus in the spring and summer, but other viruses still do.  So, even though the influenza virus epidemic of 2014-2015 is ending, colds and flus will continue.

Be well,
Dr. Arthur Lavin

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