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BBC & Nuffield Trust: Merck’s MMR more convenient for working mothers

20 Aug

 

Health experts are particularly concerned about the UK’s 87% uptake of the second MMR vaccination, which is far below the WHO’s 95% goal.

A remedy?

Some doctors have refused to administer the MMR vaccine and Dr Michael Jarmulowicz (FRCPath, MBBS) seeks a compromise, writing in the BMJ:

“What I find puzzling is the adamant refusal of the authorities to facilitate the availability of the single measles vaccine, to the point that the Department of Health has banned its use within the NHS. How does this fit with the growing acceptance of patient autonomy and patient choice? . . .

“Other countries with equivalent medical and ethical standards make them freely available.”

Meanwhile Merck’s influence increases as its profits soar, giving $1,481,549 during the US presidential 2018 Election, according to the Center for Responsive Politics.

A new advantage of the MMR vaccine was heard on Radio 4 or 5 Live this morning (19.8.19). Extensive ‘listening again’ failed to find the precise time and location, but It was stated at some length that the MMR vaccine was more convenient for working mothers as they would only need to attend one appointment.

This ‘convenience’ factor was also traced to the website of the Nuffield Trust:

“The availability of a single, combined vaccination may have simplified the childhood vaccination schedule for children and parents.”

Mothers for whom convenience is a priority could continue to enable their children to have the MMR and those who have seen or heard of adverse effects could thankfully return to the earlier practice.

For wider coverage, as Dr Jarmulowicz suggests, “the medical profession should support a parent’s wish for single dose vaccine, however irrational the establishment might view that wish”.

 

 

 

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MMR: why not allow the single vaccine option, in use elsewhere and widely accepted in ‘60s & ‘70s Britain?

30 Apr

 

As Dr Michael Jarmulowicz (FRCPath, MBBS) wrote in the BMJ:

“What I find puzzling is the adamant refusal of the authorities to facilitate the availability of the single measles vaccine, to the point that the Department of Health has banned its use within the NHS. How does this fit with the growing acceptance of patient autonomy and patient
choice? . . .

“Other countries with equivalent medical and ethical standards make them freely available.”

Other countries with equivalent medical and ethical standards do indeed make single vaccines freely available – indeed, Japan, a country with an excellent child health record, completely stopped using the MMR vaccine in 1993 after 1.8 million children had been given two types of MMR and a record number developed non-viral meningitis and other adverse reactions

The Merck measles, mumps and rubella (MMR) vaccine is a mixture of live weakened viruses of the three diseases. The first dose is generally given to children around 9 to 15 months of age and a second dose at 15 months to 6 years of age, with at least 4 weeks between the doses, according to PubMed (US government document – though the country’s National Center for Biotechnology Information (Centers for Disease Control and Prevention) states that the vaccine is only licensed for use in children who are 12 months old.

The scientific argument for immunising infants against measles is to establish a good herd immunity, protecting unvaccinated babies, children and adults who could not be given the vaccination.

Doctors and parents are urged to acquire and carefully read the information leaflets relating to whatever vaccine they are considering and an online search of medical journals finds material which would make a thoughtful parent pause before agreeing to have their baby injected with the MMR vaccine.

The World Health Organisation (a UN affiliated body) reports that Live Attenuated Vaccines (LAVs) raise some general safety and stability concerns and lists six. A snapshot of the measles section follows:

Mass measles immunization campaigns – reporting and investigating adverse events following Immunization – notes that seizure risk is age-dependent, and lower for children over six years, who are unlikely to have febrile seizures. Allergies (especially to gelatine) and general illhealth is a contraindication to vaccination with MMR vaccine.

The most common programme error is an infection as a result of non-sterile injection. The infection can manifest as a local reaction (e.g., suppuration, abscess), systemic effect (e.g., sepsis or toxic shock syndrome), or blood-borne virus infection (e.g., HIV, hepatitis B).

Establishing a profitable monopoly

In the U.S. more than a million dollars has been paid in compensation over the last ten years to parents alleging their children were harmed by the MMR jab, Merck and Co USA. Despite this, the manufacturers of Mumpsvax (Jeryl Lynn strain) announced in January 2010 that it would no longer provide mumps vaccines as single doses. The single dose rubella vaccine has also been halted. Single measles vaccines and a combined measles/rubella vaccine are still available.

Prolonged legal action in its tenth year against Merck, the manufacturers of the MMR vaccine.

The Wall St Journal and many other news outlets have reported that Stephen A. Krahling and Joan A. Wlochowski, former Merck virologists, filed a lawsuit in 2010, accusing the drug maker of falsifying data about its mumps vaccine. The case has not yet been settled nine years later and the virologists complain that the company is not making some documents available to the court.

Single vaccines are used privately in Britain

Although separate vaccines for measles, mumps and rubella are now unlicensed in Britain, it is not illegal for doctors and clinics to import the vaccines as long as they inform the Medicines Control Agency (MCA) that they are bringing the vaccine into the country.

Dr Richard Halvorsen, a GP with over 20 years’ experience and the author of OK Vaccines: Making the Right Choice for Your Child (2017), has written widely on the subject. He runs an immunisation service in Britain that offers parents a choice of buying single and small combination vaccines which includes the single measles and measles/rubella vaccines.

Should not all parents have the right to request the single vaccines for measles, mumps and rubella under the NHS system?

 

 

 

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Report research results separately to ensure new medicines are safe and effective for both sexes

19 Mar

“Women are not small men,” said Jeanine Roeters van Lennep. of the Erasmus Medical Centre in Rotterdam (right):

“There are biological differences in hormones and body composition. Women have smaller kidneys so it’s more difficult to clear medication. They have a different fat and water composition.”

A study published in February showed that trials were more likely to report results for women separately if they had a female lead author, with only one in three papers reporting results separately. The Lancet, which published that research, is one of the few major journals that tell researchers to analyse separately.

Research on drugs withdrawn from the market published by the United States General Accounting Office found that eight out of ten drugs withdrawn from the market between 1997 and 2001, after approval in the US, turned out to have higher health risks for women.

One example was Posicor, which was approved for the treatment of hypertension and angina and slowed or stopped the heart rate in otherwise healthy people, especially elderly women, and interacted with 26 different drugs.

Cholesterol-lowering statins are Britain’s most commonly prescribed medicine but in 45 trials Dr van Lennep analysed, 82% of those studied were men and only five trials made data available on men and women separately. This meant that there was not enough data to show statins prevented heart attacks, strokes and deaths in women with an acceptable number of side-effects, unlike for men.

She said it was probable that statins did work for women, with previous studies suggesting a similar benefit for both sexes, and is not advising women prescribed them to stop. However, she argues, doctors cannot be certain because of sexism which is largely unconscious:

“It’s shocking. Men forget to do sex-specific analysis, to be really polite about it. If 50% of the population is female you can’t just say it’s an optional extra. It’s a blind spot because right now the triallists are generally men. I don’t think it’s malice that they don’t want to perform this analysis; they just really don’t think about it . . . We think journals should make it compulsory to report results for men and women separately.”

A Times article summarises the problem: doctors argue that an absence of women in clinical trials and failure to report results by sex have resulted in an evidence gap that is likely to be hampering treatment. They insist that medical journals should force researchers to report results for men and women separately to be sure that new medicines are safe and effective for both sexes.

 

 

 

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Medic’s warning: prescribed medication caused a 50% increase in emergency admissions & nearly 100,000 hospitalisations a year in England

10 Feb

 

An article by Dr Mark Porter (December 2018) opens, “The first thing I do when faced with a poorly patient is to look at their medication to see if it could be responsible. You would be surprised how often it is”. Polypharmacy is rife: 1 in 18 of the population is taking ten medicines or more and potent pharmaceuticals carry risks as well as benefits. Millions of people are taking medication such as blood pressure pills and statins to prevent problems they may never have.

The really important message that reducing your risk of heart disease is best done by an improved diet and lifestyle is getting ‘crowded out’

Repeated campaigns have advocated mass medication – for example the February 2014 drive by the National Institute for Health and Care Excellence (the ‘health watchdog’) saying that the vast majority of men aged over 50 and most women over the age of 60 should take the drugs to guard against strokes and heart disease – though studies have suggested that up to one in five patients taking statins suffers some kind of ill-effect, including muscle aches, memory disturbance, cataracts and diabetes.

The Times reported on February 1st that a study published in the Lancet says all men over 60 and women over 75 are at high enough risk of cardiovascular problems to be eligible for the drugs. Professor Colin Baigent from Oxford University, a ‘co-investigator’, says “The risk of heart attacks and strokes increases markedly with age, and yet statins are not utilised as widely in older people as they should be”.

Dr Porter writes: “it is not illegal drug use in older people that concerns me most. I am embarrassed to report that prescribed medication exacts a far bigger toll on the nation’s health. Since 2008 there has been a 50% increase in the number of emergency admissions to hospitals for adverse drug events caused by medicines. In England alone such reactions are responsible for nearly 100,000 hospitalisations a year”.

He explains that anti-inflammatories such as ibuprofen and naproxen can work wonders for aches and pains from arthritic joints, but they have worrying side-effects and don’t mix well with many drugs commonly prescribed to treat high blood pressure (BP). They can damage the lining of the stomach, causing life-threatening bleeds (responsible for thousands of admissions every year) and can lead to kidney failure (on their own and when taken with BP drugs).

More subtle reactions impairing the quality of life are far more common and much easier to miss. Dr Porter gives a few examples from an ‘endless list’:

  • Blood pressure and heart pills that cause coughs (e.g. ramipril) and erectile dysfunction.
  • The prostate drug tamsulosin that can make you light-headed and increase the risk of falling.
  • Statins that cause aches and pains and reduce mobility.
  • Sleeping tablets that lead to addiction.
  • Cramp pills (quinine) that can cause heart problems.

He gave a striking case history:

“An elderly man with “early dementia” and diabetes was admitted to a residential home on our patch, where the staff reported that their new resident just sat in the corner all day looking vacant. His drug chart revealed he was taking an old-fashioned treatment for diabetes (gliclazide) that was pushing his blood sugars too low. It was stopped and two weeks later he was a new man and back in his own home. It is a lesson I have never forgotten”.

In October, an analysis in the British Medical Journal cautioned against any expansion in prescribing. One of its authors, Dr John D Abramson, clinical lecturer in primary care, from Harvard Medical School, last night said: “I think we have become victims of the drug companies. All the research is funded by them, and the really important message – that reducing your risk of heart disease is best done by an improved diet and lifestyle – is getting crowded out.”

 

 

 

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Following today’s news about emergency admissions & hospitalisations a year in England due to medical error, we turn to iatrogenic disease and death

10 Feb

Up-to-date figures for iatrogenic disease and deaths (inadvertently caused by a surgeon or physician or by a medical or surgical treatment or a diagnostic procedure) are not readily available in UK or USA. the US Department of Health and Human Services Office of the Inspector General examining the health records of hospital inpatients in 2008, reported 180 000 deaths due to medical error a year among Medicare beneficiaries alone.

Paul Wearn from the Office for National Statistics – 9 June 2011 – finally answered a FOI request for information about the number of iatrogenic deaths each year: “ONS do not have a National Statistics definition for iatrogenic The causes most closely fitting this concept are ‘complications of medical and surgical care’, ICD 10 codes Y40-Y84. Table 5.19, from the annual ‘Mortality Statistics’ publication shows that there were 236 male deaths and 226 female deaths where the underlying cause was a complication of medical and surgical care, in England and Wales, for 2009”.

In the British Medical Journal (2016, sometinmes requires reader to login) Professor Martin A Makary, department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA explains that a major limitation of the death certificate is that it relies on assigning an International Classification of Disease (ICD) code to the cause of death so causes of death not associated with an ICD code, such as human and system factors, are not captured. can directly result in patient harm and death.

  • communication breakdowns,
  • diagnostic errors,
  • poor judgment,
  • and inadequate skill

Currently, deaths caused by errors are unmeasured and discussions about prevention occur in limited and confidential forums

Hospital committees undertake internal root cause analysis and departments hold morbidity and mortality conferences but these review only a fraction of detected adverse events and the lessons learnt are not disseminated beyond the institution or department.

Strategies to reduce death from medical error should include:

  • making errors more visible when they occur so their effects can be intercepted;
  • having remedies at hand to rescue patients
  • and making errors less frequent by following principles that take human limitations into account
  • death certificates could contain an extra field asking whether a preventable complication stemming from the patient’s medical care contributed to the death.
  • hospitals could carry out a rapid and efficient independent investigation into deaths to determine the potential contribution of error.
  • Standardized data collection and reporting processes are needed to build up an accurate national picture of the problem. 

World Health Organisation statistics show that strategies to reduce the rate of adverse events in the European Union alone would lead to the prevention – on average – of more than 750 000 harm-inflicting medical errors per year, leading in turn to over 3.2 million fewer days of hospitalization, 260 000 fewer incidents of permanent disability, and 95 000 fewer deaths per year.

 

 

 

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Over 159 American cities oppose section 9101 of the Federal Farm Bill blocking local pesticide controls

15 Dec

More than 150 U.S. cities and counties have created “organic-first” policies and in some cases banned the use of specific chemicals that may harm people or the environment.

PR Newswire refers to a letter sent by local officials to Congresswoman Nancy Pelosi    noting that research has increasingly connected some pesticides with Parkinson’s disease and honey bee die-offs, A rapidly growing body of evidence links pesticides to a wide range of diseases and conditions including Parkinson’s disease, diabetes, leukemia, lymphoma, lupus, rheumatoid arthritis, dementia, reproductive dysfunction, Alzheimer’s disease, and variety of cancers including breast, colon, prostate and lung cancer.

Recognizing these risks, many communities have passed progressive policies to restrict the use of pesticides and protect our residents before any harm comes to them.

Some local officials in Irvine have opted to go further than federal or state laws and have restricted pesticide use on public land such as parks, sports fields and landscaped central road reservations. The city now uses organic products with ingredients such as corn gluten meal and oil from soybeans, lemongrass or rosemary.

Detailed information and photograph (above) may be seen in https://ocweekly.com/how-irvine-became-socals-first-non-toxic-city-7317638/

However, though the bill has attracted attention by legalizing hemp, bolstering farmers markets and rejecting stricter limits on food stamps pushed by House Republicans, California’s Orange County Register reports that a four-page provision (Section 9101) tucked away in the 748 page 2018 federal farm bill could block local governments in the United States from making their own rules about pesticides, ‘effectively neutering’ local control over pesticides, blocking cities, counties and school districts from restricting the use of on playgrounds and parks.

Felicity Arbuthnot draws attention to a report by the Environmental Working Group, commenting: “It truly says it all when government attempts to force people to eat cancer causing poison and feed it to their families and friends”. The EWG report records that:

  • the National League of Cities and
  • the League of California Cities, sent letters of opposition to congressional leaders.
  • The National Association of Counties – representing all 3,069 U.S. counties – and
  • a diverse coalition of over 170 organizations dedicated to public health urged Congress to reject the rider.
  • The National Audubon Society and
  • the American Academy of Pediatrics also sent letters.
  • A lettersigned by over 60 local officials in 39 communities from 15 different states, urged the conference committee to reach an agreement on a final 2018 farm bill that does not include this rider.

Despite all these representations, on 12th December, the U.S. House of Representatives passed the 2018 Farm Bill by a vote of 369 to 47. The next step to permanent legalization is the President’s signature.

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Will any British city follow Irvine’s lead? 

In 2017 Horticulture Week reported Edinburgh City Council’s decision to pursue an herbicide-reduction policy at the end of 2016 followed a year-long trial of alternatives to chemicals run by the council’s parks department. An online search revealed that similar moves have been proposed and discussed by councils in Dundee, Bristol and Belfast.

Today, the Times reported that Dublin city council is to use alternatives as part of a move towards a “herbicide and pesticide-free city” in the spring.  In 2015 Kaethe Burt-O’Dea (above) started a campaign to stop Dublin City Council from using a weedkiller. She is seen above near the community garden started up more than 10 years ago as a place for the street’s residents to compost their organic waste.

 

 

 

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Mass-medication 3: is compulsory fortification of all flour with folic acid imminent?

17 Oct

The Guardian reports that senior government sources say compulsory fortification of all flour with folic acid will be introduced within weeks.  

Theresa May, who was opposed to the measure, has been persuaded to back a plan to add folate supplement to food after a campaign to reduce the number of babies born in the UK with the neural tube defect (NTD). The Independent adds that the Department of Health and Social Care said the proposal is still being considered.

Two years ago, when the second reading of the above bill was debated, Lord Prior quoted from a report by the UK government’s Scientific Advisory Committee on Nutrition (SACN):

“The fortification of white bread flour with folic acid should be introduced only if it is accompanied by a number of preconditions: for example, action to reduce folic acid intakes from voluntary fortified foods, to ensure that individuals do not substantially exceed their safe maximum daily intake of folic acid . . . It also told us that there is inconclusive evidence on several possible adverse health effects of the mandatory fortification of flour with folic acid. For example, for people aged 65 and over, folate fortification of flour may result in cases of vitamin B12 deficiency not being diagnosed and treated”.

Clinical Education reports that Dr Edward Reynolds from King’s College, London has researched this matter, reviewing the literature from the 1940’s. He maintains that the recommended current upper limit of folate -1 mg – is too high.

In the 2016 debate, however, Lord Prior said the dangers of over-medication are small: “The issue is one of balancing the scientific and medical arguments with issues around choice and whether or not it is right to medicate the entire population for the benefit of a fairly small part of it”.

All women are recommended by the NHS to take a daily supplement of 400 micrograms of folic acid while they’re trying to get pregnant and during the first 12 weeks of pregnancy, when the baby’s spine is developing. The BDA asserts that very few women take this advice and according to research published in a 2015 paper in the British Medical Journal, the prevalence of NTD pregnancies was 1.28 per 1000 total births.

A reader comments on the Independent article: “70 million people to be mass-medicated for the sake of 1000 women… well that makes sense doesn’t it?”

 

 

 

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