Finally some clear-headed thinking about flu shots

Just as the media frenzy is reaching a fever pitch about the swine flu (variant H1N1 influenza), the Atlantic has a well-researched and thought-out story about the holes in the data supporting the utility of the flu shots in the first place. Mike Adams has a reasonable, point-by-point summary of the story as well. However, allow me to summarize the fundamentals of the story:
  • While the influenza vaccines have become a ritual in the fall, there is no reasonable evidence that they do any good.
  • The studies that the influenza vaccine supporters use to justify the shots is quite lousy. On one hand it claims a 50% reduction of total death rates (which is patently absurd since it would then have to also prevent heart attacks, traffic accidents and other things that have nothing to do with the flu), and on the other hand they refuse to do any quality studies on the vaccines since they claim it would be unethical. (The 50% reduction is based on cohort studies, so it compares people who voluntarily got the shot to those who didn’t. At the time of the studies, not that many people got the shot and they were mostly people who were trying to stay healthy and avoided doing risky things and thus had a lower mortality rate at baseline.)
  • By examining death rates during times when there was a shortage of flu vaccine (2004) or there was a completely ineffective vaccine (the strains that hit the US weren’t any of the strains that were in the vaccine in 1968 and 1997) we see that the lack of effective vaccination does exactly nothing to the death rate, ergo the vaccine doesn’t affect the death rate.
  • In a best case scenario, the vaccine would only build up antibodies in people with robust immune systems. These are not the people who are at risk from the flu.
  • Evidence for benefit of antiviral medications is about the same quality and timbre as for the influenza vaccine. On average it only knocks 1 day off the time someone’s sick with the flu (at $10/pill taken twice daily), and Gilead (who makes Tamiflu) was required to take back its earlier claim of benefit for the medication by putting this up on their website: “Tamiflu has not been proven to have a positive impact on the potential consequences (such as hospitalizations, mortality, or economic impact) of seasonal, avian, or pandemic influenza.” (Also note that Donald Rumsfeld, a major stockholder of Gilead’s, was Secretary of Defense when the military got $1.8billion to stock up on Tamiflu and then his president asked congress to approve legislation for another $1billion to stockpile more–all of which led to a greater than 50% jump in the stock’s price.) All this for a 20% incidence of medication side effects that seem to be worse in children. Also, viruses mutate so quickly that using lots of antivirals when not absolutely necessary will only lead to widespread resistance and a loss of whatever benefit they might give.
  • The medical establishment has decided that flu shots are good despite the lack of decent evidence for it and will attack anyone saying otherwise. Mr. Adams labels this as quackery (a fair turnabout of when orthodox medicine accuses others of practicing things not supported by evidence).
There are a few dots that the article fails to connect, however:
  • The writers say that no one knows why there’s more flu in the winter, which is technically true. However, a good deal of evidence points to less sun exposure and lower vitamin D levels as a major component of the increase in incidence. Read point 3 at the end of my last article on swine flu to see some of the evidence or go read more at the vitamin D council’s website.
  • The 1918 “Spanish Flu” that killed 40-100 million people is the pandemic flu that everyone is worried about. It’s thought that if we had another like it we would be in trouble and this is why everyone gets so excited about H1N1. However there are several differences between then and now. 1918 was near the end of WWII, so health care and nutrition were pretty bad across the world. In 1918 there were very few antibiotics, so the secondary pneumonias that would kill people were left unchecked. Finally (as pointed out by Dr. Starko in Clinical Infectious Diseases and discussed in the NYT science section), 1918 was when global marketing for that new “wonder” drug aspirin was in full force (the patent had just expired and Bayer fought to preserve its marketshare by using massive advertising campaigns while other manufacturers pushed to build their markets) and the surgeon general and the US Navy both recommended using aspirin for the flu (we now know that using aspirin in a viral illness can cause Reye’s syndrome and so discourage it’s use during viruses) while the recommended dose was double the maximum dose used today. These massive doses of aspirin can cause the symptoms exhibited by the people who died early in the course of the disease. So, with late deaths looking like bacterial pneumonia and early deaths looking like aspirin overdose, it’s certainly reasonable to think that even if the same 1918 Spanish Flu virus came around again there would be much lower rates of complications and death.
Finally, the article in the Atlantic offers a useful sidebar with answers to questions about H1N1 influenza and immunity. It does a good job of delivering the basic information about the flu, treatment and vaccination, including the tidbit that nearly all the current flu is H1N1 so the current seasonal vaccine is essentially useless even if it did work.

Swine flu over the cuckoo's nest

Nearly every patient is asking me these days if I have any thoughts about the new novel H1N1 flu, also known as the swine flu. Yes, I do have some opinions. Of course, like everything else, this should not be construed as medical advice, talk to your doctor, blah blah blah.
First, let me apologize to Chicago magazine for baldly stealing the title of this article from an article they had back after the 1976 swine flu vaccination fiasco. In case you don’t remember, in 1976 there were 2 strains of a swine flu that hit the US but only resulted in one death (they were fairly limited in how much they spread). Public-health officials got alarmed (remember that the 1918 influenza that killed 10-20% of those infected (over 500,000 Americans died) was thought to be a swine flu) and recommended immunizing the entire population of the country. The vaccinations started in october and the first day three seniors died shortly after receiving the shot (though they were never proven to have died from the vaccine and there didn’t seem to be any further events like this reported) and then there were some cases of Guillain-Barré Syndrome (GBS), a few of which resulted in death. By the time the vaccination program ended, over 48 million people had been vaccinated (over 20% of the population). There were 1098 cases of GBS reported, though only half of those were linked to the vaccination, and 25 people with GBS died. This means that a little more then 1 in 100,000 people got GBS and one in twenty of them died. So, the vaccine wasn’t especially dangerous, but it was more dangerous than the swine flu that year.
Now, the swine flu this year is clearly nowhere near as deadly as the 1918 influenza. Recently, it’s been estimated that 10% of New York City has already had the flu and there no reports of large numbers of empty apartments cleared out by the flu. Also, England recently
downgraded their estimate of the number of people who will die from it to as low as 3,000 (if only 5% are infected) or more likely around 19,000, while the regular flu kills 6-8,000 each year.
So, while this novel flu is clearly more dangerous than the regular flu, it’s not the plague that was being predicted. As for the various conspiracy theories about the virus being man-made because it contains DNA common to other flu viruses, they conveniently manage to neglect the fact that this is how viruses normally adapt and rearrange themselves.
The current swine flu is susceptible to treatment with oseltamivir (Tamiflu) or zanamivir (Relenza)
according to the CDC, but they only trim 1-2 days off the duration of the illness (amantadine seems to be ineffective against it). Neither of these have ever been tested on pregnant women, Tamiflu has been tested on kids down to 1 year of age while Relenza is only approved for children 7 and over, and you may recall the report of some kids in Japan jumping off a building during a Tamiflu-induced delirium during the bird flu craze. Generally, however, the drugs are well-tolerated but will only do their trimming of 1-2 days off the total duration of the flu if the drugs are started in the first 2 days of the flu. Also the drugs should be limited to only those at high risk for complications: the ill and infirm.
The vaccine is supposedly safe and effective (at least, in so much as
any influenza vaccine is safe and effective) despite not being available yet (actually, there are reports of it just starting to become available). I’m not a fan of the regular flu vaccine and not much more of a fan of this one. Of course adding any thimerasol (ethyl mercury) containing vaccine to your body should only be done for sound benefit, realizing that the effects of the mercury may not manifest for years. While there have been some alarms sounded about squalene in the vaccine causing GBS and worse, the only official information I’ve found about squalene in the vaccine suggests that it isn’t being used now and would only be used if the vaccine supply suddenly needed to be expanded massively, however it’s listed under various names so it may be in there and people may not know it.
So, on to the big question: what can you do to prevent yourself from getting swine flu? It’s fairly elementary:
1. Wash your hands. The virus gets into you usually by contact, so keep ‘em clean.
2. Keep your fingers out of your face. It needs to get into your body and your face has the most enticing routes of entry. 2 lines of defense: a moat and a wall.
3. Take some vitamin D. A
recent article shows the clear association between season and latitude (and therefore vitamin D status back when people went outside) and 1918 influenza pandemic survival: more vitamin D led to less death. Reports by 2 physicians who keep their patients’ vitamin D up to good levels shows a profound reduction in influenza among those replete with vitamin D. If you can get your 25-OH vitamin D level checked, take enough to get it up to 50 ng/ml (it generally takes 1,000 iu daily to make it go up 10 points and can take 3 months to level off, so you could double the dose for the first week). If you can’t get your level checked, take 2,000 iu daily (you could double it the first week). Remember all these guides are for normal sized adults and vitamin D does have some toxicity at higher levels (over 150 ng/ml), so don’t go crazy with it.
4. Take some vitamin C every day. White blood cells need vitamin C to do their jobs. Give them what they need, at least 1,000 mg daily, spread it out if you can manage it.
5. Get enough sleep. I can’t say enough about the importance of sleep for the immune system.
6. If you do get sick, IV vitamin C may knock the flu back quite a bit (if not completely eliminate it). Read
dr. Klenner’s papers about his experience with using IV vitamin C for various illnesses. See also dr. Weeks’ article on using vitamin A at the onset of the flu.

The Triple Crown and then some

I was just getting ready to announce that I had achieved the Triple Crown of physician recognition (featured in Hour Detroit’s Top Docs issue, appearing on TV, and the Patients’ Choice Award) when a got a Google alert that I am the runner-up in the Current Reader’s Choice Awards for “Place to get alternate healthcare”. (Yes, half of these spelled my name wrong: Malcolm Sickel and Malcolm Sickles, but it’s not a big deal.)
So let’s recap:
Hour Detroit, an oversized glossy of all things fabulous around Detroit, starts the ball rolling by featuring me as the first holistic physician ever in their magazine.
Fox News Detroit, the big local TV station, has me come in for a spot on their morning news.
3., the main website that scores doctors, gives me the Patients’ Choice award for doctors who have “received near-perfect scores as voted by patients.”
Current, Ann Arbor’s monthly newspaper of events and all things hip, has an annual reader survey and in the category for “best place to get alternate healthcare” (which I didn’t know existed), I get the runner-up position after Castle Remedies, a great retail store for homeopathics and supplements. The fact that I landed first place after a retail shop that gets a lot more traffic than I do is quite flattering.
Of course, I must give credit to the
Crazy Wisdom Journal for featuring me first back in 2006. A nice way to get the ball rolling.
thank you to everyone who has put their faith in me and voted for me. I’m honored. A friend of my brother’s said that I should write a book, but I’m already pretty busy. Maybe if I had a better idea of what people wanted to read...

New wheat-free page

I added a new page on wheat/gluten-free resources around Ann Arbor. So far, it has some links to a few places to get hooked up for good information and some information on local shopping. I’ll be adding more about restaurants and things as well.

In addition, this is as good a time as any to announce the website my daughter and I are working on:, a home for people who can’t eat wheat. She has big plans for it, but neither of us has the technical skills to bring all those plans to fruition any time soon. Right now, it’s fairly sparse, but it will grow in time.

The Fosamax facade is starting to crumble

After years of hints that all the bisphosphonates (medications used for osteoporosis) caused jaw osteonecrosis (destruction of the jaw bone after dental work), a new article shows that the risk of jaw osteonecrosis when the person gets dental surgery who has been on Fosamax is one in 23, or around 4%, 1600 times higher than the 0.0005-0.0025% Merk “estimated” in 2007.
While 4% may not seem like a big number, it seems a lot more problematic when realizing how devastating jaw osteonecrosis can be. The jaw bone near the surgery breaks down, leaving a broken jaw, and it can continue to expand. Any attempt to bridge the gap will cause further destruction, as drilling into the bisphosphonate saturated bone will only trigger more breakdown. With no known way to remove the bisphosphonate from the bone once it’s in there, all the dentist can do is watch helplessly as the jaw falls apart.
Hyperbaric oxygen therapy is the only treatment that has shown any promise in stemming the collapse and even that isn’t stunningly effective.
Understandably, dentists are reluctant to operate on people who may be at risk due to the devastating effects on the patient, and are also reluctant to report it happening due to the devastating effects on their reputation and office. So, the condition is dramatically under-reported. Even with less loaded conditions, 90% are never reported.
Of course, this is on top of the risk of erosions and cancer of the esophagus from these medications.
The companies making the bisphosphonates (Fosamax, Actonel, Boniva, Aredia, Zometa and Reclast) have been attempting to portray these medications as safe and effective for the treatment of osteoporosis as well as attempting to expand the market to include the treatment of osteopenia (milder bone loss). Clearly, if one in 23 of people on the oral form of these medications (the IV form is much worse) will have their jaw disintegrate if they get dental surgery, it’s not safe. Whether it’s effective is open to debate.
When trying to prove that putting their new chemical into people is a good idea, drug companies and the researchers that work for them have a lot of tricks to make the chemical that they’ve dumped a pile of money into producing look good enough to produce the serious return on investment they need. Drug companies like to use intermediate markers rather than outcomes since they are easier and cheaper to measure and easier to game than the real outcomes we care about. With cardiac disease, the outcome we’re concerned about is dying or having a hospitalization, while cholesterol or LDL levels are an intermediate marker that may not translate into the outcomes I mentioned. With bone loss, the real outcome is fractures, while an intermediate marker is bone density. By strapping a lead rod behind your leg, it can look denser to the machine, but it won’t do a thing to reduce fractures. While a medication may increase bone density (remember that density is mass per volume, so heavier bones), it may not actually make them stronger (they can be dense and brittle, or lighter but with just enough give to resist breaking: think glass compared to titanium).
While the drug companies have been doing their typical attempt to brush it all under the rug, they also engaged in their typical pastime of trying to get doctors to prescribe it to people for whom it isn’t indicated. As I
discussed 18 months ago, the evidence doesn’t support the idea that this drug is beneficial for osteopenia. Perhaps the only thing that does support the idea is the money the drug companies spend on lunches for physicians so they can whisper these sweet nothings in their ears.

Contact form changes

I made some changes to the contact forms, and you will now have to enter a security word to submit a message. While it has benefits for you and me (you get your message read sooner since we don’t have to wade through spam to find it, and we don’t have to pick the real messages out of the pile of spam), it also helps humanity by helping convert old books into machine-readable form. This video explains how it all fit together. It’s enough to make you look forward to filling in those forms.
I’m also cleaning out old pages, so if you can’t find a page, I’ve probably changed the location. Follow the links to get to it.

Where did the testosterone go?

Back when I was giving talks on men’s health, I would talk about testosterone and how it goes down with age and that there is also a decline from one generation to the next: the testosterone levels in a 60-year-old in 1988 were higher than a 60-year-old in 1996, which were higher than one in 2003. Understandably, the men were shocked and demanded to know why. At that point, all I could say is that no one knows for sure, but it’s probably some chemical we’ve been adding to the environment and mentioned the feminized male alligators in Florida where PCBs had been dumped in the lake years earlier.
Well, we finally do have a candidate for a cause of the lower hormone levels in men: phthalates, specifically DEHP. The
Journal of Andrology published a study showing that higher levels of the DEHP metabolite MEHP consistently accompanied lower levels of testosterone and estrogen. This also implies that it will cause similar hormone disruption in women (earlier studies have shown an association between phthalates and genital defects in infants), making it a good thing to avoid.
These phthalates are mostly used in making flexible vinyl for flooring, wall coverings, “food contact applications” (food packaging, though this is illegal in Europe), and medical devices. Other, lighter, phthalates (DEP and DBP) are used in lotions, perfumes, cosmetics, lacquers, coating, varnishes, acetate, and in some time release medications.
Interestingly, DEHP is relatively insoluble in water, so little will migrate from the plastic (DEHP doesn’t become a permanent part of the plastic) into a mainly water containing liquid. Because of this, US law permits DEHP in packaging of food that is primarily water. However, since DEHP accumulates in fat over your entire lifespan and persists in the environment it is likely the only safe level of it is none.
One this stuff gets in you, how do you get it out? Well, there’s no good answer for that right now. Sadly, the only sure way to be sure to move it out of a human is to have a baby: some of those phthalates will leave inside the baby. There have been some attempts to do it with Olestra (the non-absorbed fat in Wow chips), but it didn’t work (though it might work if you have just been exposed to the fat-soluable chemicals before they have gotten into your fat).
I had switched to phthalate-free medical supplies (mostly IV tubing) long ago, so applying the precautionary principle in my office has paid off. I wonder when the government will put the health of its citizens over corporate profit. Right now, they hear more from the corporations’ lobbyists (paid for out of the money we pay for their stuff) than from us, so as long as we sit on our hands and keep quiet it won’t change.

In case you need another reason to avoid corn syrup

High fructose corn syrup (HFCS), a very pervasive ingredient in american foods, may well be the lynchpin of our obesity epidemic. It doesn’t trigger satiety (feeling full) like regular sugar, so people eat more of it (and its empty calories), and it’s processed differently that normal sugar leading to higher triglycerides and fatty liver disease (also known as NASH or non-alcoholic steatohepatitis). In addition, it’s sweeter than sugar, so normally sweet things taste less sweet in comparison, triggering the dietary arms race of adding sweeteners to foods just so they taste sweet compared with everything else (have you noticed that “no-added sugar” fruit juice popsicles now have aspartame in them?). That the corn it’s made from is grown from frequently genetically modified stock and uses large amounts of fertilizers (mostly petroleum based) to grow just adds to the reasons to avoid it. Now, news just came out that adds another reason to the pile.
Environmental Health published an article (as did the Institute for Agriculture and Trade Policy) showing that 30% of the foods they tested with large amounts of HFCS had detectable levels of mercury in them. Mercury is, of course, a potent neurotoxin and not something you want in your diet, especially when you’re not exposing yourself to it for any good reason (since there’s no benefit to eating HFCS).
Why is there mercury in HFCS? Making HFCS uses numerous chemicals including chlor-alkali based sodium hypochlorite, hydrochloric acid, and caustic soda, all of which have mercury involved in their manufacture. Every year the plants that make these report that they end up with less mercury than they started with (including mercury from plant emissions) and that a substantial amount is “missing”: escaping the plant in the products they produce. So, when these chemicals with mercury are used in the manufacture of other products (like HFCS), some of the mercury ends up in them.
As usual, the industry trade group (the Corn Refiners Association) tried to muddy the waters about the article, claiming that the methods of making hydrochloric acid and caustic soda (notice they didn’t mention sodium hypochlorite) that involve mercury are outdated and mostly not used in the US any more. However, some is still produced in the US with mercury today and some is imported from countries with even less stringent laws than ours. So, despite the Corn Refiners Association’s protestations, this is still very much a current issue.

Web problems

Between our web host changing server locations and our wholesaler redesigning their website, there’s been some problems. It took me a bit to figure out how to fix things, but the website shouldn’t have any problems now and the link to the wholesaler is functional now. You’ll need to get an access code to order. Please let me know if there are any other problems.