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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?"