Jacob and all, unpalatable as it may seem I have come to the
conclusion that WHO and industry are one and the same.
How else can you explain their obsession with antivirals and vaccines
which poor countries cannot afford and their shunning of public health
interventions which can be life savers in places like Karachi, Accra
or Dharan (Nepal)? In the most recent 62-page guidance document on
planning for pandemic influenza from the World Health Organization,
handwashing and masks were mentioned only twice and gloves and gowns
once each, but vaccines and antivirals were cited 24 and 18 times,
respectively. (World Health Organization. Pandemic influenza
preparedness and response: a WHO guidance document. Geneva: WHO,
2009).
How else can can you explain their changeable definition of influenza
pandemic? (http://www.attentiallebufale.it/qualita/pandemia_3.html
click on the two pdfs)
God help us all.
Tom.
On 25/09/2009, Puliyel <[log in to unmask]> wrote:
> Dear Ben
> Tom has written about various Evidence-defying-recommendations from the
> 'experts' in CDC and WHO.
> But this continues as if they are answerable to no one (at least not to
> people who ask for the evidence)
>
> The list may be interested in an article that appeared in Vaccine recently
> on the WHO recommendation for the Pneumococcal conjugate vaccine.
>
> “WHO considers that it should be a priority to include this vaccine in
> national immunization programmes, particularly in countries where mortality
> among children aged <5 years is >50/1000 live births *or* where >50,000
> children die annually”.(WHO position paper. Wkly Epidemiol Rec 2007;82:pp.
> 93–104.)
>
> Wondered why the second recommendation "or where >50,000 children die
> annually” was included. After all the larger the country the larger the
> total number of deaths and that has little to do with pneumococcal
> pneumonia.
>
>
>
> Mathew points out (Mathew JL Pneumococcal vaccination in developing
> countries: Where does science end and commerce begin? Vaccine 27 (2009)
> 4247–4251) that the first criteria of under five mortality >50/1000 live
> births was met by 32 countries but the total population to be vaccinated was
> 18 million. By including the criteria dependent on population size of
> ‘where >50,000 children die annually’ only 7 additional countries were added
> but it added 161 million to the numbers eligible for vaccination (in
> populous countries of India, China and Brazil). The WHO recommendations seem
> dictated by needs of increasing demand for vaccines and profits for
> manufacturers rather than the needs of public health.
>
>
>
> How best can we respond to this situation?
>
> Jacob
>
>
>
> Jacob Puliyel MD MRCP M Phil
>
> Head of Pediatrics
>
> St Stephens Hospital
>
> Delhi 110054
>
>
> On Fri, Sep 25, 2009 at 7:04 PM, Djulbegovic, Benjamin <
> [log in to unmask]> wrote:
>
>> Tom, I understand from your work that evidence is poor...but all experts,
>> including CDC recommend vaccination (
>> http://www.cdc.gov/flu/professionals/vaccination/). So, what is one to do?
>> Thanks
>> ben
>>
>>
>> -----Original Message-----
>> From: Tom Jefferson [mailto:[log in to unmask]]
>> Sent: Friday, September 25, 2009 9:22 AM
>> To: Djulbegovic, Benjamin
>> Cc: [log in to unmask]
>> Subject: Re: News release 1 hr ago: In wake of study concerns, Ontario
>> delays seasonal flu shots for all but +65
>>
>> Hello. Please read the relevant Cochrane reviews.
>>
>> Thank you and all the best,
>>
>> Tom.
>>
>> On 25/09/2009, Djulbegovic, Benjamin <[log in to unmask]> wrote:
>> > Paul, this is really awful...I am not sure what was motivation of the
>> > Ontario officials, but this reminds me of crying the "fire" in a crowded
>> > theater... or of a manipulation of uncertainties, which was so
>> successfully
>> > exploited by the tobacco industry in the past and now being increasingly
>> > done by big pharma [The lack of "definitive" scientific proof that
>> smoking
>> > is harmful to one's health resulted in postponement of tobacco
>> legislation
>> > for decades, with the unfortunate consequences of much avoidable
>> > disease;
>> > see Michaels D. Doubt is their product, Sci Am 292 (6):96-101, 2005.
>> > Michaels D. Manufactured uncertainty: protecting public health in the
>> > age
>> of
>> > contested science and product defense, Ann N Y Acad Sci 1076:149-162,
>> 2005.]
>> >
>> > An increasing number of patients have asked me whether it is safe to
>> > have
>> > both a seasonal flu and swine flu shots. We all know that the evidence
>> > is
>> > not there, but decisions/recommendations have to be made. This is where
>> > experts/expertise (the second part of the famous EBM definition) come
>> into
>> > play. Our local experts concluded that it is OK to give both vaccines
>> (the
>> > swine flu is not available yet, but I told my patients that when it
>> becomes
>> > available it is OK to have it). Now, if the evidence speaks to
>> foolishness
>> > of this advice, this has to be worked out promptly...Why the findings
>> could
>> > not be posted or released for everyone to see them instead of releasing
>> the
>> > news that creates further confusion? I realize that the Ontario
>> > officials
>> > may have worried that they will be accused of hiding data, and this does
>> > raise an important question when and which evidence should be shared
>> > with
>> > the public. Only reliable evidence? Everything and anything, even if it
>> > later turns out the be false?
>> >
>> > ben
>> >
>> > Benjamin Djulbegovic, MD, PhD
>> > Professor of Medicine and Oncology
>> > University of South Florida & H. Lee Moffitt Cancer Center & Research
>> > Institute
>> > Co-Director of USF Clinical Translation Science Institute
>> > Director of USF Center for Evidence-based Medicine and Health Outcomes
>> > Research
>> >
>> >
>> > Mailing Address:
>> > USF Health Clinical Research
>> > 12901 Bruce B. Downs Boulevard, MDC02
>> > Tampa, FL 33612
>> >
>> > Phone # 813-396-9178
>> > Fax # 813-974-5411
>> >
>> > e-mail: [log in to unmask]<mailto:[log in to unmask]>
>> >
>> >
>> > ______________________
>> >
>> > Campus Address: MDC02
>> >
>> > Office Address :
>> > 13101 Bruce B. Downs Boulevard,
>> > CMS3057
>> > Tampa, FL 33612
>> >
>> >
>> > From: Evidence based health (EBH)
>> > [mailto:[log in to unmask]] On Behalf Of Paul Elias
>> > Sent: Thursday, September 24, 2009 8:48 PM
>> > To: [log in to unmask]
>> > Subject: News release 1 hr ago: In wake of study concerns, Ontario
>> > delays
>> > seasonal flu shots for all but +65
>> >
>> >
>> > I share....
>> >
>> > TORONTO - Faced with puzzling but unconfirmed evidence that suggests a
>> > seasonal flu shot may raise the risk of catching swine flu, Ontario
>> > announced Thursday it is rescheduling its seasonal flu vaccine program
>> > to
>> > delay most of it until after pandemic vaccine has been administered.
>> > At a news conference in Toronto, Dr. Arlene King, the province's chief
>> > medical officer of health, said the seasonal and pandemic vaccines will
>> be
>> > delivered in three waves, starting in October.
>> > People 65 and older, who have been largely spared by swine flu but who
>> are
>> > at greater risk from seasonal flu, will be offered seasonal shots then.
>> All
>> > residents of long-term care facilities will be included in that group.
>> > When the pandemic vaccine becomes available in November, all in Ontario
>> who
>> > want to be vaccinated will be given access to those shots.
>> > Once the pandemic vaccination effort is completed, Ontario plans to
>> resume
>> > the seasonal flu shot program, which offers free vaccination to anyone
>> who
>> > wants it. By then, said Dr. Vivek Goel, president of the Ontario Agency
>> for
>> > Health Protection and Promotion, the questions about a possible link
>> between
>> > seasonal shots and swine flu infection may have been answered.
>> > Drawn from a series of studies from British Columbia, Quebec and
>> > Ontario,
>> > the findings appear to suggest that people who got a seasonal flu shot
>> last
>> > year are about twice as likely to catch swine flu as people who didn't.
>> The
>> > findings haven't yet been published and few people have actually seen
>> them.
>> > But they have been looming like a spectre over decisions about vaccine
>> > delivery timing in Canada and are a source of consternation
>> internationally.
>> > "This has been a very difficult decision," King said in an interview.
>> "This
>> > has been difficult for everyone across the country."
>> > The head of the World Health Organization's vaccine research initiative,
>> Dr.
>> > Marie-Paule Kieny, said Thursday that researchers in the U.S., Britain
>> and
>> > Australia have looked for the same effect and have not observed it.
>> > People who have seen the unpublished scientific paper say the elevated
>> risk
>> > - if it exists - is only that people who've had flu shots catch swine
>> flu.
>> > It does not suggest they get more severe disease.
>> > King admitted adjustments had been made, both to deal with the concerns
>> > raised by the unpublished study and the worries that there may be a
>> double
>> > pronged flu season, with swine flu hitting children and adults under 60
>> or
>> > so and seasonal flu viruses targeting people over 65.
>> > "Is it typical that we adjust our program? No it isn't typical. But we
>> are
>> > not dealing with a typical flu season this year," King said.
>> > Influenza expert Dr. Allison McGeer said the compromise makes sense.
>> > "It's a reasonable balance," said McGeer, who is head of infection
>> control
>> > at Toronto's Mount Sinai Hospital. "(But) it has some obvious logistical
>> > challenges."
>> > McGeer acknowledged there was discussion about whether giving seasonal
>> shots
>> > to seniors in October might actually spark more infections in that age
>> > group, if the effect seen in the unpublished paper is valid. But she
>> > said
>> on
>> > balance it was thought that the risk seasonal flu viruses pose to this
>> group
>> > outweighed the theoretical risk the studies showed.
>> > And King noted that in the troubling data, the effect was not seen in
>> people
>> > 65 and older.
>> > Earlier in the week when it first emerged that some provinces were
>> thinking
>> > of delaying their seasonal flu shot delivery efforts, a number of
>> provinces
>> > expressed hope a pan-Canadian approach could be adopted.
>> > King said that would have been desirable, if it were possible, but it
>> became
>> > apparent that different jurisdictions were weighing factors differently
>> and
>> > a one-size-fits-all solution seemed out of reach.
>> >
>> >
>> >
>> > Best,
>> >
>> > Paul
>> >
>> >
>> > --- On Thu, 9/24/09, Piersante Sestini <[log in to unmask]> wrote:
>> >
>> > From: Piersante Sestini <[log in to unmask]>
>> > Subject: Re: Do the antivirals reduce mortality in flu?
>> > To: [log in to unmask]
>> > Received: Thursday, September 24, 2009, 11:41 PM
>> > At 18.07 24/09/2009 +0100, Owen Dempsey wrote:
>> >
>> >> Thus: The idea that all views on e.g. use of Tamiflu; [i.e. the
>> competing
>> >> views that either everybody should have Tamiflu (as under the criteria
>> of
>> >> the guidelines) versus the decision/choice that Tamiflu is too risky
>> >> for
>> a
>> >> given healthy individual and shouldn t be prescribed or taken] are of
>> >> equal moral status, is flawed.
>> >
>> > I don't see the them as the only options available. In fact, the options
>> > could be just the opposite: on the community perspective, it would be
>> better
>> > *not* to use antiviral drugs to prevent the emergence of resistance
>> > (possibly at the cost of a few casualities) and of side effects, while
>> > individuals could prefer to have it to reduce the small risk of serious
>> > disease, despite the risks of side effects and of inducing resistance.
>> >
>> >> This liberal all views are fine by me stance assumes that everybody
>> has
>> >> equal access to and understanding of the real state of affairs when it
>> >> comes to the risk benefit ratio of this intervention. This is akin to
>> >> pretending that we live in a real democracy (which is of course an
>> >> impossible fiction to attain) instead of an organised democracy where
>> the
>> >> outcomes e.g. of elections are preordained and the people misinformed.
>> >
>> > It is the doctor's responsibility to get the best information available
>> and
>> > to pass it to individual patients in a way that they can understand and
>> > decide. And, by the way, this is just what EBM is all about. It is not
>> > in
>> > the possibilities of EBM to make politicians or patients to behave
>> > rationally, although it might help to make the choices more explicit.
>> >
>> >
>> >>
>> >>
>> >> With Tamiflu, the government, health spokesmen and the drug industry
>> with
>> >> the help of the corporate media conspire to mislead the public by
>> >> over-egging the dangers of e.g. Mexican/Swine Flu and overstating (even
>> if
>> >> it is by implication i.e. simply by recommending its use) the benefits
>> of
>> >> Tamiflu.
>> >
>> >
>> > Politicians (and public health managers are often just that) probably
>> just
>> > anticipate what they expect to be "typical" reaction of the laymen: as
>> Ben
>> > explained, omitting of doing something that could possibly prevent a
>> serious
>> > bad event is often considered more undesirable that having a side
>> > effect,
>> no
>> > matter how little is the chance of getting a benefit.
>> > I agree with you that this behavior (of politicians) is incorrect (in
>> fact,
>> > most of the business of "EB-recommendations", as far as it fails to
>> > integrate individual circumstances, is flawed), but I maintain with Neal
>> > that is the patient, the owner of the problem, that has to be informed
>> > of
>> > the possible consequences (and uncertainty) of different choices and
>> > then
>> > assisted unjudgementally in thinking and deciding which stance to
>> > assume.
>> >
>> > In this context, both choices are acceptable.
>> >
>> > regards,
>> > Piersante Sestini
>> >
>> >
>> > ________________________________
>> > Looking for the perfect gift? Give the gift of
>> > Flickr!<http://www.flickr.com/gift/>
>> >
>>
>>
>> --
>> Dr Tom Jefferson
>> Via Adige 28
>> 00061 Anguillara Sabazia
>> (Roma)
>> Italy
>> tel 0039 3292025051
>> Ti sei iscritto alla newsletter di Attenti alle Bufale? No? Vai sul
>> sito www.attentiallebufale.it e digita il tuo indirizzo di posta
>> elettronica in alto a sinistra dove dice "Vuoi ricevere in anteprima
>> le migliori dritte di Sun Tzu?"
>>
>
>
>
> --
> ___________________________
> Jacob M. Puliyel MD MRCP MPhil
>
>
> eFax 00 44 7092-124285
> Phone 00 91 11 23946388
> 00 91 9868035091
>
--
Dr Tom Jefferson
Via Adige 28
00061 Anguillara Sabazia
(Roma)
Italy
tel 0039 3292025051
Ti sei iscritto alla newsletter di Attenti alle Bufale? No? Vai sul
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