ACPM Message Board

Flu Math: Summing the Unseen

Administrator — Tue, 17 Nov 2009 16:57:39 GMT

Preventive Medicine Column

October 30, 2009

Flu Math: Summing the Unseen

As a nutrition guy, I suppose it would be nice to claim that my kids like Swiss chard better than French fries- but alas, it isnt so. I settle for my kids eating well overall, and certainly far better than most. Similarly, as a preventive medicine specialist, it would be nice to claim that my whole family enthusiastically practices what I preach about flu prevention. But here, too, weve hit a snag.

One of my daughters, away at college, texted her mother, who in turn told me, that she is ambivalent about getting the H1N1 vaccine. This relates in part to the prevailing sentiment among her closest friends that those of us currently overseeing planetary operations are doing a pretty lousy job and are not to be trusted. Frankly, its pretty hard to argue with that.

I can argue about the flu vaccine, however, because my daughters ambivalence- like that of so many others- is based on what she has heard, and what she hasnt seen. And both are misleading.

What she has heard- in the guise of widely circulating conspiracy theories I have recently addressed in this column- is that the flu vaccine is dangerous. What she has not seen is any serious case of the H1N1 flu. In fact, her note to my wife indicated that the several students at her school with flu had quite mild cases.

Lets address both concerns, as I did in the letter I sent to my daughter.

Regarding vaccine hazards, thus far there dont appear to be any worth noting. That is to say, the H1N1 vaccine has not been associated with any side effects not seen routinely with annual flu shots. These, in turn, are generally very mild- such as soreness at the injection site. Anything more serious is exceedingly rare. There have been no serious adverse effects of the H1N1 vaccine reported to date.

The second issue- not seeing serious cases of flu- invites a common fallacy, and a false sense of security.

Imagine that my daughter has, as advertised, seen a few cases of the flu among her classmates- and all such cases have been mild. What does it prove?

As widespread as it already is, H1N1 has thus far infected far less than 20% of the population. If there are 30,000 students at my daughters university, widespread flu activity there would mean 6,000 infections. They are clearly not there yet- but that threat looms.

Now imagine that this flu is serious enough to cause a truly serious infection about 1 time in 10,000. In fact, it is probably worse than that, since there have been an estimated 21,000 hospitalizations for flu-related illness thus far. But that number will do for our purposes. And further, lets assume that roughly 1 in ten of those serious cases turns lethal. That number looks to be about right.

Even if fully 6,000 of my daughters fellow students were infected, the odds would be against her seeing a serious case- since those occur less often than 1 time in 6,000. And she would be extremely unlikely to know anyone who died from influenza.

This low rate of disaster would seem an argument against immunization, but it is just the opposite! Because the best path to follow is the path of least risk.

A vaccine with a serious side effect one time in 10,000, and lethal effects one time in 100,000 would be totally unacceptable. The worst flu vaccine in history caused one death per 2 million people immunized!

So even if this flu causes one serious case per 10,000, and one death per 100,000; and the current vaccine is as dangerous as the most dangerous flu vaccine in history- the virus would still be more dangerous than the vaccine by well over an order of magnitude! And these are assumptions that are quite favorable to the threat of the flu, and equally unfavorable to the entirely theoretical dangers of vaccination.

Like my daughter, I suspect most of you haven't seen a serious case of this flu yet. But you haven't seen a vaccine side effect either! Somehow, most people take the former to mean the threat of flu is small, and the latter to meannothing. Conspiracy theory or no, thats cooking the books.

I simply recommend applying the same math in both cases. Whether or not you have personally witnessed any adverse vaccine effects, you can follow the tally on the CDC website (http://www.cdc.gov/h1n1flu/). So far, it adds up to just about zero. Similarly, you can track the toll of unseen flu on-line as well. Those numbers, unfortunately, are much larger.

You have probably never seen a shark attack or lightning strike, yet you know they occur and can be lethal. The flu deserves similar respect.

I hope neither you, nor my daughter, ever does see a fatal case of this flu. But to help make sure it doesnt happen, you should base your decisions for self-defense on a valid summing of unseen events. That math overwhelmingly favors immunization.

It does also leave room for some reassurance if you want the vaccine but cant get it. The odds of coming through the pandemic intact are very much in your favor either way. And since my daughter apparently hasnt made her mind up yet, I thank goodness for that!

-fin

Dr. David L. Katz; http://www.davidkatzmd.com

Forum: H1N1 Forum

Room Share at ACPM Board Review 2009

Samy — Thur, 12 Mar 2009 15:07:47 GMT

Hello There,

If anyone is interested in room share at ACPM board review course 2009 in Crystal City, VA, please leave me a message here or use the above e-mail.

Thanks,
Samy

Forum: ACPM RESIDENT PHSYSICIAN SECTION

Clinical Work

DJT — Mon, 26 Jan 2009 20:25:14 GMT

I am very interested in preventive medicine, but I feel like I have a hard time getting a straight answer on the question of how much and what type of clinical work can be done if you are board certified in preventive medicine with only an intern year in internal medicine. So I am hoping if I describe what I want to do someone will give me an answer as to whether I can meet my goal with a PM residency. My main interest is in mind body medicine and stress and how it factor's into illness. I want to do research in psychological stress and psychology and how they factor into disease prevention and disease outcomes. I also do hypnosis ( I was trained by the American Society of Clinical Hypnosis) and I want to see patients not to practice internal medicine but rather as part of a mind body clinic. I think there is a huge need out there for medically trained doctors who help their patients explore the relationship between health, psychology, neuroscience and behavior. I would like the focus of my career to be research in disease prevention through the lens of stress, psychology and mind body relationships (say 75% of my time) and also spend the rest of my time seeing patients in a mind/body alternative way. Can this be done with the right PM residency?

Forum: ACPM RESIDENT PHSYSICIAN SECTION

Preventive Medicine 2009

Andrew Gorchs — Wed, 24 Dec 2008 00:20:52 GMT

I'm just wondering who else from Central Texas or the VA (especially VISN 17) might be attending.

Forum: ACPM

PM throughout all specialties

chris — Sat, 06 Sep 2008 15:32:51 GMT

Hi, i am a geriatric physician, and the gero society has this program where there is a geriatric curriculum model infused in every specialty.

Would someone out there want to help me design a similar curriculum in PM for other specialists, infusing PM in specialties from cardiology to proctology?

Forum: ACPM RESIDENT PHSYSICIAN SECTION

Recommeded books for ACPM (GPM) Board Exam

Camila Romero — Wed, 18 Jun 2008 17:09:22 GMT

Hi,
Aayone have any recommendations for books with question and answer section in preparation for GPM Board Exam in October?
Thanks.

Forum: ACPM

Waiver jobs

thomas — Tue, 03 Jun 2008 09:07:24 GMT

Folks,

Is there any waiver jobs for J1 doctors available after completing the residency?

Forum: ACPM RESIDENT PHSYSICIAN SECTION

Competition in Preventive medicine residency application

thomas — Wed, 21 May 2008 12:33:55 GMT

Friends,

I am Dr. Thomas currently finishing my first year residency in Internal Medicine. I am strongly considering doing Preventive Medicine residency after completing my Internal Medicine residency. My background; I graduated in India and then worked in the UK for 2 years, following which I completed a "Diploma in Tropical Medicine & Hygiene" from the Liverpool School of Tropical Medicine, UK and as I mentioned early I am currently completing my first year as an IM resident.

I have been going through several websites regarding the PM residency. I would be grateful if somebody could answer couple of my questions.

1. How competitive is PM residency application process? Roughly, how many people would apply for one post and how many get interviewed?

2. I am interested in tropical and travel medicine. Is there a rotation in this field during the practicum year?

3. I would like to do an elective month in preventive medicine during my second year in Internal Medicine. Could anybody tell me where to go and what all preparations should I be doing for that and by doing this would it improve my chances of getting into a PM residency program?

4. Is a research experience necessary for getting into a PM residency?

I would appreciate your help.

Forum: ACPM RESIDENT PHSYSICIAN SECTION

Bring your running shoes to Austin!

Sara Brenner — Tue, 05 Feb 2008 14:01:21 GMT

Hello all!

For any runners out there coming to Austin, bring your shoes! Thurs, Fri, and Sat from 6-7am (yeah, I know that's really early) we're going to do some running. We'll probably meet at and leave from the Hilton - different paces and distances can be worked out to accommodate all. Check for details when you register at the APMR registration table!

Cheers,
Sara =)

Forum: ACPM RESIDENT PHSYSICIAN SECTION

Getting your yoga fix at ACPM - Part 3

Jennifer E — Tue, 05 Feb 2008 03:50:37 GMT

Finally, here are some of the Austin yoga studios that sounded interesting.

Jennifer

Yoga Studios
Ruta maya (www.rutamaya.net) yoga classes free with purchase
Bodhi Yoga - (www.bodhiyoga.com) hot yoga and vinyasa $12 student drop in rate.
Breath and Body (www.breathandbodyyoga.com) $10 studio fee for the WEEK for new students. This is in Rosedale, so youre driving/busing/biking from downtown
Dharma Yoga - http://www.dharma-yoga.net$12/ class (by the university)
Yoga Groove (www.yogagroove.com) Bikram Yoga - $12/class (student rate)
7th Street Yoga (www.seventhstreetyoga.com) student drop in rate is $10/class

Forum: ACPM RESIDENT PHSYSICIAN SECTION

Austin Bound - Part 2

Jennifer E — Tue, 05 Feb 2008 03:42:13 GMT

Just in case you're hungry outside of the lunch or dinner hours.. Again, recommendations from various sources. Please feel free to add your own.

Jennifer

Breakfast
Kerby Lane (www.kerbeylanecafe.com, 2606 Guadalupe St., by UT) and Magnolia Cafe too (see below). Both are great places. Great pancakes and a variety of other things too.
The Omelettry on Burnet is another great breakfast place with other dishes as well. Avocado omelettes - yum!

Coffee Places and Late Night Eats
Magnolia Cafe (www.cafemagnolia) has Hibiscus tea (no mint) that's fantastic.
Genuine Joe http://www.genuinejoe.com/ a very local Austin Coffee house open late with free wireless located on Anderson Lane
Katz's Deli Bar and Art Gallery (www.katzneverkloses.com/) is a great late night place to go for food, I think it is on 6th street, not near the bars

Forum: ACPM RESIDENT PHSYSICIAN SECTION

Austin Bound for ACPM? Part 1

Jennifer E — Tue, 05 Feb 2008 03:29:20 GMT

This is a 3 part series for those of you Austin bound for ACPM.

It's a compilation of information from a couple locals, some buddies who went to UT, other dudes and chicks going thru flight school in Texas who went there to blow of steam, and my fellow LYP yogi's and yogini's, as well as review sites such as yelp and insider pages. Thanks guys - you rock!

A lot of these things aren't walking distance from downtown, but reportedly well worth the trip. If anyone has anything else to add, please do!

Adios -

Jennifer

Austin Eats, in general
Hula Hut - http://www.hulahut.com Not near downtown, but off of Lake Austin. Totally worth the trip.
Chuy's (www.chuys.com) is a great Tex-Mex restaurant, but it is somewhat of a Texas Chain (Houston, Dallas, Austin). The original is in Austin on Barton Springs Road. I think it is one of the better restaurants in that area.
Rosie Tamale House (www.rosiestamales.com) BYOB and the food rocks.
Eat Zen - (www.eatzen.com) - I cannot say enough about this place! Local eats, delicious and so healthy and they are growing with 4 locations working on their 5th!
El Arroyo - (www.ditch.com) Off 5th street near downtown is good texmex
Juan in a Million (www.juaninamillion.com) East Austin Classic mexican food.
Salt Lick - It is an all you can eat BBQ family style, BYOB place. not close to downtown (20 min drive middle of nowhere)
Texacalli Grille is good for lunch and is on Oltorf. It is in an old Tacobell building, but is not fastfood (open mainly for lunch and it is all types of food, but has a fifties feel, Great place!
Trudy's Tex-Mex just north of the school is also another good place to go. There are a few of these in the area, but the one Just north of the school is the best.
Z Tejas (www.ztejas.com) West 6th/Downtown. South by Southwest food. Yum

Forum: ACPM RESIDENT PHSYSICIAN SECTION

Joining the USPHS Commissioned Corps

Tamara Johnson — Mon, 28 Jan 2008 15:17:56 GMT

As I have explored government jobs for preventive medicine physicians, I often am asked if I considered joining the US Public Health Service commissioned corps. I was wondering if anyone has information about the advantages of the commissioned corps over a civilian role, or the reasons why they chose to join the corps themselves.

Thank you!

Forum: ACPM RESIDENT PHSYSICIAN SECTION

Room share at PM2008

Sara Brenner — Mon, 28 Jan 2008 03:26:52 GMT

Hello out there!

If you are interested in room share at the meeting in Austin, please feel free to use this message board to get in touch with one another!

Happy hunting and see you in Austin!
Sara

Forum: ACPM RESIDENT PHSYSICIAN SECTION

clinical practice

jacks — Thur, 25 Oct 2007 00:50:29 GMT

I have a few questions on the clinical practice opportunities available for Board certified Preventative Medicine physicians.

I've seen some job postings by Urgent Care centers for Preventative/Occupational medicine physicians, and am wondering, can you also do general "primary care"? Or even emergency medicine?

How about hospital privileges? Would you be able to do general inpatient medicine if you wished?

I like many of the policy components of Preventative Medicine and am just wondering if you could also provide more conventional clinical medicine if desired.

Forum: ACPM RESIDENT PHSYSICIAN SECTION