Herb Denenberg
More Questions Answered About The Flu
The Advocate
By Herb Denenberg, The Bulletin
My recent article on vitamin D and the flu generated an extraordinary response and a barrage of questions. (“H1N1 Linked to Vitamin Deficiency,” Nov. 15-21, 2009, www.thebulletin.us). So, this column is a response to that and related columns and some answers to important questions about the flu, its effect on heart disease, and on the heart condition called atrial fibrillation.
One frequent question is whether there is really enough evidence to take a vitamin D supplements to minimize the chances of getting the flu. It is true that more studies need to be done, but there is a convincing array of evidence showing a correlation between low levels of vitamin D and infections such as the flu.
The Harvard Heart Letter (November 2009) explained it this way: “Preliminary trials suggest that too little vitamin D can leave the body prone to infection, and having enough in circulation can help the body fight off the flu, tuberculosis, and infections of the upper respiratory tract.”
“A deficiency in vitamin D has been linked to some types of cancer, type 2 diabetes, depression, osteoporosis, falls, asthma, memory loss, and other chronic conditions.”
I find the evidence for vitamin D supplementation convincing. But I also found some other facts convincing -- that two experts on vitamin D both told me they take a supplement of 2,000 International Units of vitamin D daily. If in doubt, consult your health care provider, but I am no longer in doubt.
Other questions related to what to do if you suspect you have the flu. Keep in mind you may want advice and treatment without delay, as some of the anti-viral drugs used to treat both seasonal and Swine Flu should be taken within 48 hours after the onset of symptoms of the flu. What’s more, if you are at high risk for complications, you want prompt medical advice. In view of 48-hour window, longer delay could limit treatment options and their effectiveness.
A recent issue of The Medical Letter (November 2009), a reliable and respected newsletter on drugs and therapeutics, has a discussion of the antiviral drugs for the flu. It notes most flu encountered now, as of the date of its publication, is H1N1 (Swine Flu), but that the seasonal flu will soon appear. It also stressed that the susceptibility of circulating flu strains “has evolved rapidly and treatment recommendations have changed during the influenza season.” So, the CDC influenza Web site provides updated information on antiviral resistance (www.cdc.gov/flu).
There isn’t enough space in this column for a complete discussion of antiviral drug treatment options, but I’ll include enough to give you a sense of the issues.
Here are approaches to treating the seasonal flu, recommended by The Medical Letter: “Oseltamvir (Tamiflu), which is taken orally, and zanamivir (Relenza), which is inhaled, have generally been about 70-90 percent effective for prophylaxis after exposure to susceptible strains of seasonal influenza A or B.” That’s to prevent the flu in those who might be exposed. Treatment raises different issues than prophylaxis. If the patient is infected, the two drugs just named can, according to The Medical Letter, “decrease the duration of symptoms by 1-1.5 days when treatment is started within 48 hours after the onset of illness.”
Treatment with the drugs can also decrease the risk of complications. Studies show that treatment of infected patients with those drugs cuts the rate of complications from about 5 - 10 percent. Studies also show treatment with the drugs for hospitalized patients reduces the duration of hospitalization and the risk of death.
Even if the drugs are administered more than 48 hours after commencement of the symptoms, they may decrease the spread of the disease to contacts of the infected patient.
The Medical Letter also discusses other issues, such as adverse effects, resistance, and other drugs that might be used.
Finally, here’s the way The Medical Letter explains who should receive treatment with antiviral drugs for flu: “Until seasonal influenza strains are detected, influenza infection will presumably be due to pandemic 2009 influenza A H1N1 and a neuraminidase inhibitor (oseltamivir or zanamivir [the two drugs discussed above]) will remain the drug of choice for treatment of patients at high risk for influenza complication and to anyone hospitalized with presumed influenza. Oseltamivir is preferred for treatment of pregnant women. Healthy persons with uncomplicated influenza infection generally do not require treatment.”
And here are a couple of items on heart disease, in response to questions on recent columns. One question about the impact of the flu on someone with heart disease is answered in the Harvard Heart Letter (December 2009): “Infections of any kind can affect the heart and circulatory system. Influenza (the flu) is no different. It can make breathing difficult, boost blood pressure, make the heart beat faster, and rev up inflammation. All of these force the heart to work harder. A healthy heart usually weathers these changes without a problem, a damaged or weakened heart may not. Infection can also cause a vulnerable, cholesterol-filled plaque inside a coronary artery to break apart. The blood clot that forms to seal the break can block the artery, causing a heart attack or sudden death.” That’s why people with heart disease should be sure to get both flu shots and should get medical advice if they have flu symptoms.
As we reported earlier, the U.S. government has totally botched handling of the flu vaccines, so getting the shots may be easier said than done. Dr. Daniel Hussar, of the Philadelphia College of Pharmacy, and a leading national authority on pharmacy practice has documented how the federal government has failed the tests posed by this year’s H1N1 pandemic.
The U.S. government has already botched the vaccine program, but Congress is determined to further wreck it. The Senate’s Obamacare health reform places a $2.3 billion tax on drug makers who sell their products through government programs. That would mean we would be taxing those who are essential to fight a pandemic. Of course, the so-called health care reform is a 2,000-plus page of the wrong incentives that will raise costs, lower quality, and wreck our health care delivery system as well as our economy.
There was also a question on a recent column about atrial fibrillation (“Atrial Fibrillation Deserves Better Attention,” The Bulletin, November 22-28, 2009). That column focused on how major medical institutions downplay the risk of catheter ablation as a treatment for that condition and also downplay the fact that there is no solid evidence of its long-term effectiveness. Nevertheless, the treatment has a role. Here’s the way Dr. Peter Kowey, a leading authority on atrial fibrillation and Chief of Cardiology at the Main Line Health System, put it: Despite the risks and questions about catheter ablation as a treatment of atrial fibrillation, Dr. Kowey says this procedure does have a place. He says, “For now, catheter ablation is useful for patients who are having severe symptoms and have failed drug therapy. Complications are real but, fortunately, are less than five percent.”
Herb Denenberg has served as Pennsylvania Insurance Commissioner, Public Utility Commissioner and the Loman Professor of Insurance at the Wharton School of the University of Pennsylvania. He has been a member of the Institute of Medicine of the National Academy of the Sciences since 1973, and has often testified before Congress on insurance, health care, and consumer protection. Herb Denenberg can be reached at advocate@thebulletin.us.
One frequent question is whether there is really enough evidence to take a vitamin D supplements to minimize the chances of getting the flu. It is true that more studies need to be done, but there is a convincing array of evidence showing a correlation between low levels of vitamin D and infections such as the flu.
The Harvard Heart Letter (November 2009) explained it this way: “Preliminary trials suggest that too little vitamin D can leave the body prone to infection, and having enough in circulation can help the body fight off the flu, tuberculosis, and infections of the upper respiratory tract.”
“A deficiency in vitamin D has been linked to some types of cancer, type 2 diabetes, depression, osteoporosis, falls, asthma, memory loss, and other chronic conditions.”
I find the evidence for vitamin D supplementation convincing. But I also found some other facts convincing -- that two experts on vitamin D both told me they take a supplement of 2,000 International Units of vitamin D daily. If in doubt, consult your health care provider, but I am no longer in doubt.
Other questions related to what to do if you suspect you have the flu. Keep in mind you may want advice and treatment without delay, as some of the anti-viral drugs used to treat both seasonal and Swine Flu should be taken within 48 hours after the onset of symptoms of the flu. What’s more, if you are at high risk for complications, you want prompt medical advice. In view of 48-hour window, longer delay could limit treatment options and their effectiveness.
A recent issue of The Medical Letter (November 2009), a reliable and respected newsletter on drugs and therapeutics, has a discussion of the antiviral drugs for the flu. It notes most flu encountered now, as of the date of its publication, is H1N1 (Swine Flu), but that the seasonal flu will soon appear. It also stressed that the susceptibility of circulating flu strains “has evolved rapidly and treatment recommendations have changed during the influenza season.” So, the CDC influenza Web site provides updated information on antiviral resistance (www.cdc.gov/flu).
There isn’t enough space in this column for a complete discussion of antiviral drug treatment options, but I’ll include enough to give you a sense of the issues.
Here are approaches to treating the seasonal flu, recommended by The Medical Letter: “Oseltamvir (Tamiflu), which is taken orally, and zanamivir (Relenza), which is inhaled, have generally been about 70-90 percent effective for prophylaxis after exposure to susceptible strains of seasonal influenza A or B.” That’s to prevent the flu in those who might be exposed. Treatment raises different issues than prophylaxis. If the patient is infected, the two drugs just named can, according to The Medical Letter, “decrease the duration of symptoms by 1-1.5 days when treatment is started within 48 hours after the onset of illness.”
Treatment with the drugs can also decrease the risk of complications. Studies show that treatment of infected patients with those drugs cuts the rate of complications from about 5 - 10 percent. Studies also show treatment with the drugs for hospitalized patients reduces the duration of hospitalization and the risk of death.
Even if the drugs are administered more than 48 hours after commencement of the symptoms, they may decrease the spread of the disease to contacts of the infected patient.
The Medical Letter also discusses other issues, such as adverse effects, resistance, and other drugs that might be used.
Finally, here’s the way The Medical Letter explains who should receive treatment with antiviral drugs for flu: “Until seasonal influenza strains are detected, influenza infection will presumably be due to pandemic 2009 influenza A H1N1 and a neuraminidase inhibitor (oseltamivir or zanamivir [the two drugs discussed above]) will remain the drug of choice for treatment of patients at high risk for influenza complication and to anyone hospitalized with presumed influenza. Oseltamivir is preferred for treatment of pregnant women. Healthy persons with uncomplicated influenza infection generally do not require treatment.”
And here are a couple of items on heart disease, in response to questions on recent columns. One question about the impact of the flu on someone with heart disease is answered in the Harvard Heart Letter (December 2009): “Infections of any kind can affect the heart and circulatory system. Influenza (the flu) is no different. It can make breathing difficult, boost blood pressure, make the heart beat faster, and rev up inflammation. All of these force the heart to work harder. A healthy heart usually weathers these changes without a problem, a damaged or weakened heart may not. Infection can also cause a vulnerable, cholesterol-filled plaque inside a coronary artery to break apart. The blood clot that forms to seal the break can block the artery, causing a heart attack or sudden death.” That’s why people with heart disease should be sure to get both flu shots and should get medical advice if they have flu symptoms.
As we reported earlier, the U.S. government has totally botched handling of the flu vaccines, so getting the shots may be easier said than done. Dr. Daniel Hussar, of the Philadelphia College of Pharmacy, and a leading national authority on pharmacy practice has documented how the federal government has failed the tests posed by this year’s H1N1 pandemic.
The U.S. government has already botched the vaccine program, but Congress is determined to further wreck it. The Senate’s Obamacare health reform places a $2.3 billion tax on drug makers who sell their products through government programs. That would mean we would be taxing those who are essential to fight a pandemic. Of course, the so-called health care reform is a 2,000-plus page of the wrong incentives that will raise costs, lower quality, and wreck our health care delivery system as well as our economy.
There was also a question on a recent column about atrial fibrillation (“Atrial Fibrillation Deserves Better Attention,” The Bulletin, November 22-28, 2009). That column focused on how major medical institutions downplay the risk of catheter ablation as a treatment for that condition and also downplay the fact that there is no solid evidence of its long-term effectiveness. Nevertheless, the treatment has a role. Here’s the way Dr. Peter Kowey, a leading authority on atrial fibrillation and Chief of Cardiology at the Main Line Health System, put it: Despite the risks and questions about catheter ablation as a treatment of atrial fibrillation, Dr. Kowey says this procedure does have a place. He says, “For now, catheter ablation is useful for patients who are having severe symptoms and have failed drug therapy. Complications are real but, fortunately, are less than five percent.”
Herb Denenberg has served as Pennsylvania Insurance Commissioner, Public Utility Commissioner and the Loman Professor of Insurance at the Wharton School of the University of Pennsylvania. He has been a member of the Institute of Medicine of the National Academy of the Sciences since 1973, and has often testified before Congress on insurance, health care, and consumer protection. Herb Denenberg can be reached at advocate@thebulletin.us.
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