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Title: Blog by Novelist William S. Frankl, MD

Archive for May, 2009

The Swine Flu

Wednesday, May 20th, 2009

The so called Swine Flu is spreading through North America and to a lesser extent through other parts of the world. The World Health Organization and the Center for Disease Control in the United States have not yet labeled this outbreak a pandemic. Nevertheless, many observers in the field believe it is only a matter of time. The origin of this new influenza strain, called A H1N1, has a peculiar genetic make up: 34.4% of the genes are North American avian; 30.6% are classical North Americans swine; 17.5% are Eurasian swine; and 17.5% are human. This genetic pattern is quite unusual although such diverse patterns have been seen in the past. The virus is also unusual because swine flu is rarely transmitted from person to person, which is occurring at this time.
The best treatment is prevention through a vaccine, which can provide significant protection. Such a vaccine can be made and produced in moderate quantities in up to 22 weeks, but clearly insufficient to meet the needs of large effected populations. And its manufacture would interfere with seasonal flu vaccine production. Once the disease hits, it can be treated with antiviral agents, but this might lead to the development of resistant strains that pose an even greater danger.
At present, a number of decisions need to be made, most importantly on whether to produce an A H1N1 vaccine, whether to declare that this is a pandemic, and if so whether to use quarantine as a method to combat the spread of the disease. So far, the illness produced by this virus has been mild, but could come back quite virulent in the winter in a manner similar to the pandemic of 1918 during which millions died.
Is there anything the public can do to help prevent a pandemic, or if one occurs provide individual protection? There are some simple steps as follows:
1. Keep your hands away from your mouth and nose through which the virus can enter the respiratory tract.
2. Wash your hands before touching food or your face. You must scrub your hands for at least 30 seconds with soap and hot water. This is important not only to remove dirt that might contain viral particles, but also soaps contain surfactants that damage the lipid layer that protects these viral particles.
3. If soap and water are not available, use hand sanitizers such as Purell instant hand sanitizing wipes.
4. Cover your nose and mouth when you sneeze or cough! When one sneezes or coughs, liquid droplets loaded with flu viruses can travel through the air and enter someone else’s nose or mouth. To protect others, cover your mouth and nose with a tissue whenever you cough or sneeze, and wash your hands afterward since viruses remain infectious for hours when they’re on the skin or other surfaces such is keyboards, doorknobs, handrails, and keyboards.
5. The use of surgical masks might be helpful. At present they are not required, but in a pandemic might be helpful in reducing the spread of the disease..

In time we will know more about this virus and how to respond to it. Governments around the world are working on this problem. And although this has not been mentioned, let us hope that the emergence of this peculiar virus is not a bioterrorist attack.


Wednesday, May 13th, 2009

As promised, the Obama Administration is off and running to ” reform ” the health care system in the United States. And save money doing it (if you believe that, I’ve got a bridge I’ll sell you, cheap).  It’s not necessary to compare his projected program with the nationalized health systems in Canada or the U.K. Compare it to the V.A. program right here in the United States.
Visit a VA Hospital in your area, sit-down in the outpatient area or in a hospital ward, and you’ll learn what Obama medicine is likely to be ––– a lack of sufficient funds to operate especially at the end of the year;  a lack of many of the most advanced pharmaceuticals in their pharmacies; long waiting lines in the outpatient areas; long waits for admission to the hospital; overworked, underpaid physicians and nurses; lack of cutting edge technologies to handle acute-care; lack of cutting edge technologies to handle chronic care (except those VA hospitals that are medical school teaching affiliates. And much more.
Oh, yes ––– and when 130 million or more citizens are ultimately enrolled in the program (see my blog post Medicare for All, April 20th, 2009) the complexity of the system will  become overwhelming. If you think it’ll work smoothly, efficiently ––– well, there’s that bridge . . .
In fact, the entire system will collapse. Taxes to rescue the medical system will reach astronomical levels, and a significant degree of rationing will be required to hold down costs ––– chemotherapy, hip/knee replacements, coronary bypass surgery, cardiac valve replacements, coronary angioplasty, pacemakers, dialysis, and cataract surgery will not be allowed for patients over the age of 65 or 66; and kidney/ cardiac/ lung  and other transplantation procedures will be forbidden for those over the age of 55.
Will this occur overnight? Of course not.  It will take a decade or more, a slow steady deterioration of a marvelous health care system that really only needed a rational change in the way it functioned financially, structurally, and bureaucratically to remedy most of its perceived ills.
And the annual cost of Obamacare will likely exceed a  trillion dollars a year.

William S. Frankl, MD, All Rights Reserved