With the latest firestorm in the media around Dr Oz, we decided to ask our members if they agreed that Dr. Oz should be removed from his position at Columbia University.  The results were definitive..

Of the 2,029 physicians who participated in our poll as to what Dr. Oz should do next, more than 1,500 physicians (78%) voted that he should resign from his faculty position at Columbia University.  More than 450 (24%) believe he should have his medical license revoked.  The poll is as follows:

Dr Oz should:

57% – resign from his faculty position at Columbia University (1128/1979)

3% – have his medical license revoked (66/1979)

21% – do both, resign from his position at Columbia and have his license revoked (411/1979)

19% – do nothing, I respect Dr Oz as a physician (374/1979)

Dr Oz can’t laugh this claim off as easily as he did on his show.  1,500 physicians is nothing to scoff at.  They’re not backed by big food or representing special interest groups, as he claims.  These are the clinicians and medical thought leaders across an entire spectrum of specialties and practice backgrounds, from rural generalists to his peers in cardiology.  These physicians are speaking up because they care about the information their patients get – PCPs who regularly combat all sorts of misinformation in the marketplace about vaccines and “magic pills”, ER doctors who drop everything to save anyone who’s coming in, with no secret agenda or undue influence from industry , surgeons  and other specialists who are caring for people with a wide variety of chronic ailments and are helping manage complex co-morbidities, or pediatricians who calm our fears as parents.  These doctors are the researchers who tirelessly work to cure MS and rare diseases (most of which affect children), the family practitioner who fights for patients when their insurance companies deny their claim, and perhaps less visible, they are the doctors advocating for truth and transparency about the information you’re fed from other physicians, their own peers, when they think someone of influence has it wrong.

Think viewers don’t take Dr Oz’s advice as gospel?  Think again.  One OBGYN shared:

“I have a patient with…menorrhagia, which she has been trying to manage with herbs over the last year.  So, while she refuses transfusion for no clear reason (not a {Jehovah’s} Witness), I am trying some tricks to get her ready for hysterectomy. When my nurse called to speak with her about other medical clearance the patient said…that YOU [Dr. Oz] are her managing doctor! So, my question is, where can I call to get her records and can you give her pre-op medical clearance?”

This is not uncommon.

We asked Dr Linda Girgis, SERMO member and Family Medicine physician for her thoughts.  She shared:

 “As doctors, patients trust us to pass on the best medical advice to them to enable them to make the best healthcare decisions. We have spent many years studying and training to learn the science behind what we are doing.  Legally, we are expected to practice within a certain standard of care (what other doctors are doing).

It is not acceptable for doctors to invent their own science. We have researchers and organizations that carry out clinical trials in order to keep patients safe. When we throw out that data, we are ignoring patient safety.”

It wasn’t all negative though.  19% of the SERMO doctors polled respect Dr Oz as a physician.  Most of the support voiced was because of his advocacy for GMO labeling.  Even his critics called for him to speak on behalf of physicians more, using his celebrity status for good.  Other physicians are torn, like one of his Cardiothoracic colleagues…

“I have watched Dr Oz operate and he is a good surgeon, seen him interact with patients and he truely cares about them, and performed well done medical research with him. As a heart/lung surgeon I respect him. However, when I watch his show I just cringe when he talks about a pill containing a combination of herbs/roots/chemicals to solve one or any problems or when he talks about womens’ orgasms! Does he (or anyone) really know what that pill does, it’s side/long term effects are, or alternatives to this pill? No good studies have been done on half those pills, and the other half maybe good science but of questionable or no benefit. Which to believe when he speaks? He is using his good and well deserved surgical reputation to mute any criticism or questioning of the promotions on the “show”. It truely is sad. Shame on Columbia for supporting this bad behaviour. Freedom of speech does allow snake oil salesmen to practice but it should not allow a trusted physician to do the same thing while being a physician or supported by a great medical school. Mehmet- if you really want to promote unproven therapies then resign from Columbia and us the small remaining medical capital. If you want to continue to be a trusted doc, then promote RESEARCH that proves these pills work and tell the truth about these products.”

We also asked SERMO doctors to share questions they’d ask Dr Oz, if given the chance.  Then we gave them the chance!  These questions were tweeted @DrOz and can be found at #SERMOasksOZ.

Here is a taste of what you’ll find:

It’s not easy to be a doctor and make money any other way because of the level of scrutiny you’re put under.  Our doctors understand that better than anyone else.  What is unacceptable is when unsubstantiated advice is given to the public, as a physician, for financial gain.

Dr Girgis shared:

 “A celebrity doctor should be held to the same standards as all doctors. Maybe even more since they are reaching a larger audience. When someone in that position starts giving advice that is not founded on science and has not been proven safe, it is not in the best interests of the well-being of the health of the viewing population.”

We’d like to invite Dr Oz to come in and do a Q&A with our community.  We’re not wielding pitchforks…we’re your colleagues and just want to separate fact from fiction, advocacy from advertisement and ensure that physicians are empowered to deliver the best, clearest, most responsible information we can to patients everywhere.

We discuss this and a myriad of clinical topics inside SERMO. If you’re an M.D. or D.O. in the US or UK, please join us.

The post More than 1,500 Physicians Call for Dr. Oz to Resign appeared first on Sermo.

The American Medical Association (AMA) and the Centers for Disease Control and Prevention (CDC) announced the launch of their joint initiative, Prevent Diabetes STAT today.  The incidence of diabetes is rising at an alarming rate, with nearly 90% of the 86 million Americans living with prediabetes unaware they have it.

Dr. Linda Girgis, MD echos this urgency, saying “There are many people out there who are diabetic that we have just not diagnosed yet. Diabetes, as a natural course of its progression, gives rise to complications the longer a patient has it. For example, changes in the eye and kidney can take place within 5 years of onset of the disease. That is why it is imperative to diagnosis diabetes early.”

“It’s time that the nation comes together to take immediate action to help prevent diabetes before it starts,” said AMA President Robert M. Wah, M.D. “Type 2 diabetes is one of our nation’s leading causes of suffering and death—with one out of three people at risk of developing the disease in their lifetime. To address and reverse this alarming national trend, America needs frontline physicians and other health care professionals as well as key stakeholders such as employers, insurers, and community organizations to mobilize and create stronger linkages between the care delivery system, our communities and the patients we serve.”

“The time to act is now. We need a national, concerted effort to prevent additional cases of type 2 diabetes in our nation – and we need it now,” said Ann Albright, Ph.D., R.D., director of CDC’s Division of Diabetes Translation. “We have the scientific evidence and we’ve built the infrastructure to do something about it, but far too few people know they have prediabetes and that they can take action to prevent or delay developing type 2 diabetes.”

Girgis, a family physician in South River, New Jersey, shared that 20-30% of her patients are diabetic or prediabetic, putting them at a much greater risk of heart and kidney disease.  Research shows that the progression of the disease can be slowed if action is taken in the prediabetic stage.

The AMA and CDC have co-developed a toolkit that includes information on screening high-risk patients, engaging them (including resources you can share with them), referral forms and documents about how to integrate these into their practices.  There are also resources for patients to help them know the risk factors and determine their own risk for type 2 diabetes at www.preventdiabetesstat.org.

Other resources available from the CDC and AMA are the National Diabetes Prevention Program (National DPP) and the Improving Health Outcomes initiative respectively.

“Our health care system simply cannot sustain the continued increases in the number of people developing diabetes.” said Dr. Albright. “Screening, testing and referring people at risk for type 2 diabetes to evidence-based lifestyle change programs are critical to preventing or delaying new cases of type 2 diabetes.”

Read more about this partnership and Prevent Diabetes STAT here.

Our physicians are discussing this and a myriad of clinical topics inside SERMO. If you’re an M.D. or D.O., please join us.

The post New Diabetes Prevention Initiative from AMA, CDC appeared first on Sermo.

~ by James M. Wilson V, MD

Each year, our team at Ascel Bio monitors a variety of reporting from foreign countries, the World Health Organization, and the U.S. Centers for Disease Control and Prevention (CDC) in an effort to determine whether we may be entering a season at-risk for vaccine mismatch.

The key type of influenza virus we focus on is type A due to the greater level of mortality and medical infrastructure disruption associated, versus types B or C. Within the type A influenza viruses, we mainly focus on which virus will dominate: type A/H3N2 or A/H1N1.

All seasons considered and excluding the first wave of the 2009 A/H1N1 pandemic, type A/H3N2 is the main concern. The reason is A/H3N2, which is an echo of the 1968 influenza pandemic, drifts quickly and tends to cause more medical infrastructure disruption than A/H1N1. It dominates influenza seasons in the US at a baseline frequency of 80% since the 1999-2000 season. About half of these A/H3N2-dominant seasons are associated with vaccine mismatch. This leaves the US with a current baseline probability of about 1/3 chance of seeing a vaccine “issue” on any given season.

Does vaccine mismatch automatically equate to “a bad season?”

The reasons for vaccine mismatch with A/H3N2 relate to several factors including; availability of isolates for consideration by the World Health Organization’s international body that decides the seasonal vaccine composition, whether or not the choice made by the decision group was the correct one, whether the virus drifts again after vaccine production, and so on. Most importantly, A/H3N2 has proven more difficult to grow in culture over time.

Right now, the CDC reports 1) dominance of type A/H3N2, and 2) that 70% of the A/H3N2 isolates do not match the strain chosen for the vaccine. So now everyone is, understandably, concerned about the prospects for this season. So the key question, again, is, “Does vaccine mismatch equate to a ‘bad season of influenza?’” Let’s take a look at the current season in context with prior seasons of influenza:

credit: CDC | click to enlarge

Credit: US Centers for Disease Control and Prevention.[1]

The above graph for influenza activity from the perspective of outpatient clinics shows a current picture of activity that follows the activity seen in 2012-13 fairly closely. Time will tell if this season is ultimately better than, similar to, or worse than 2012-13. But the real question with this figure is which of these seasons was the vaccine mismatch year (excluding the pandemic season of 2009-10)?

The answer is 2011-12, not 2012-13.

In the 2011-12 season, A/H3N2 was dominant. Of those viruses, 22% were associated with mismatch.[2] In the 2012-13 season, A/H3N2 was again dominant, however matched to the vaccine strain.[3]

On the other hand, 2007-8 was another vaccine mismatch season where A/H3N2 was dominant, but associated with a high percentage (73%) of the isolates mismatched to the vaccine. There was also a minority percentage of A/H1N1 mismatched to the vaccine that year as well. This was a moderately severe season of influenza.[4]

During the 2003-04 season, we observed another A/H3N2 dominant season with 89% mismatch with the vaccine strain. This was a severe season considered worse than the 2007-8 season.[5]

For the 2003-4, 2007-8, and pandemic 2009-2010 seasons, the early warning indicator was early seasonal influenza activity in the pediatric population[6] [7]:

credit CDC | click to enlarge

Pediatric hospitalization rates per CDC for the 0-4 year-old age group, 2003-4 to 2007-8 seasons.[8]

Now let’s take another look at the current season to help put things in perspective, focusing on the key indicator for influenza season severity: pediatric disease.

credit: CDC | click to enlarge

Pediatric hospitalization rates per 100,000 population for the 0-4 year-old age group, estimated, by CDC as of 12 Dec 2014 (Week 50).[9]

credit: CDC | click to enlarge

Pediatric hospitalization rates per 100,000 population for the 5-17 year-old age group, estimated, by CDC as of 12 Dec 2014 (Week 50).[10]

Hospitalization rates for the 0-4 year-old age group are approximately 90% of that seen in 2012-13 for Week 50. The hospitalization rates for the 5-17 year-old group, however, are higher than that seen in 2012-13: currently at 3.7 compared to 2.7 per 100,000. The hospitalization rates for the 18-49 year-old age group are currently reported to be equivalent to the 2012-2013 season.

To put all of these observations in perspective, the 2009-2010 pandemic season was associated with a 0-4 year-old pediatric hospitalization rate of 65.1 at Week 50. In other words, seven times what we are currently seeing.[11]

Early season activity with high rates of pediatric hospitalizations is an early warning indicator the country may see a season of high activity. Currently, we are seeing it is approximately proportional to that seen in the 2012-13 season when the vaccine was well matched.

There is an important caveat: influenza seasons affect different age groups in different ways. In the 65+ year-old age group, we are seeing hospitalization rates that exceed the estimates during the 2009-2010 pandemic season: 23.5 per 100,000, compared to 21.9 per 100,000. The pandemic was known to effect the pediatric patient population worse than the older adult population.[12]

In short, in pediatrics this season is so far shaping up to a roughly equivalent severity to the 2012-13 season. For our older adults, this season is looking severe.

The take home messages

1. The phrase “vaccine mismatch” or “vaccine failure,” by itself, does not guarantee a severe season of influenza. That said we are seeing a high percentage (70+%) of mismatch this season associated with prior seasons of at least moderate severity.
2. Different influenza seasons affect different age groups differently. So far this season, the older adult population is being hit the hardest. Activity in the pediatric population is similar to that seen during the 2012-13 season.
3. Both the World Health Organization and the CDC recommend influenza vaccination.

Biography

Dr. James Wilson, a pediatrician and infectious disease expert with AscelBio, he is a frequent contributor to the SERMO blog.

Season flu and it’s movements in the US are discussed frequently inside SERMO.  If you’re an MD or DO please join us for the latest news shared by your peers.

Resources

[1] CDC FluView. http://www.cdc.gov/flu/weekly/

[2] CDC FluView. http://www.cdc.gov/flu/weekly/pdf/1112_Season_Summary.pdf

[3] CDC FluView. http://www.cdc.gov/flu/weekly/pdf/12-13%20Season%20Summary.pdf

[4] CDC FluView. http://www.cdc.gov/flu/weekly/weeklyarchives2007-2008/07-08summary.htm

[5] CDC FluView. http://www.cdc.gov/flu/weekly/weeklyarchives2003-2004/03-04summary.htm

[6] CDC FluView. http://www.cdc.gov/flu/weekly/weeklyarchives2007-2008/07-08summary.htm

[7] CDC FluView. http://www.cdc.gov/flu/weekly/weeklyarchives2009-2010/09-10summary.htm

[8] CDC FluView. http://www.cdc.gov/flu/weekly/weeklyarchives2007-2008/07-08summary.htm

[9] CDC FluView. http://gis.cdc.gov/GRASP/Fluview/FluHospRates.html

[10] CDC FluView. http://gis.cdc.gov/GRASP/Fluview/FluHospRates.html

[11] CDC FluView. http://gis.cdc.gov/GRASP/Fluview/FluHospRates.html

[12] CDC FluView. http://gis.cdc.gov/GRASP/Fluview/FluHospRates.html

The post The Coming 2014 – 2015 Flu Season: What to expect appeared first on Sermo.