We're No Doctors but

...we know doctors. There is something we can do. It's not Center for Disease Control and Prevention (CDC) approved but even the CDC believes that using some alternate means other than waiting on the vaccine isn't unacceptable behavior.
Our doctors are the international physicians from the World Health Organization (WHO) because they haven't been wrong yet. Tracing their actions and suggestions the CDC has lagged behind in suggestions made by the WHO.

Studies show that early treatment, preferably within 48 hours after the first sign of symptoms, appear associated with better clinical outcome.

For patients who initially present with severe illness or whose condition begins to deteriorate, WHO recommends that treatment with oseltamivir should start immediately, no matter when illness started and without waiting for laboratory results.

For patients at risk for serious disease, including those with certain underlying medical conditions, WHO recommends treatment with either oseltamivir or zanamivir as soon as possible after the onset of symptoms and without waiting for the results of laboratory tests.

In all cases, where oseltamivir is unavailable or cannot be used for any reason, zanamivir may be given.

Or we can just wait our turn to either get sick and survive which is the most likely scenario. We mean, after all, who expects to die. The Washington Post and the local jurisdictions Departments of Health (DC, MD, VA) each have their own schedules and neither the three (3) small meet.

Total Doses Shipped as of*	10/28/09
District of Columbia Maryland Virginia	49,000 306,900 489,700
TOTALS	579400

There is open reciprocity - meaning you can wait in line in three (3) states for the vaccine without being a resident of state of the line you choose. We're of course, overlooking the other alternative which will go without saying. But you know what it is!

One of the great things about this nation is the ability to choose. That's what makes this the greatest nation on the face of the planet. The second thing that makes this the greatest nation on the face of the planet is that we can and often DO do better!

That's a Fact, Jack! (or Jill)

...as the case may be. We're not sexist! Just paraphrasing Bill Murray from STRIPES (1981). We heard pandemic when the World Health Organization (WHO) said it. We knew what the word meant and when everybody said don't worry and don't panic we knew different. We knew not to panic but concerned we were and said. In that vain we have to call you attention to the numbers that some might be frighten by in the latest report from the online journal Emerging Infectious Diseases gave Associated Press (AP), Reuters, Wall St Journal, and WedMD which had the very scary headline: "140 Times More Early Swine Flu Than Reported."

"Here's the thing" to quote Monk. As scary as the headlines might be we think it's worst than that. Two things happened. One the Center for Disease Control and Prevention (CDC) changed its graphics concerning the numbers and how the numbers are reported. They reset their figures and started only publicly counting the deaths of children. The numbers were worst than reported.

"Through July 2009, a total of 43,677 laboratory-confirmed cases of influenza A pandemic (H1N1) 2009 were reported in the United States, which is likely a substantial underestimate of the true number. Correcting for under-ascertainment using a multiplier model, we estimate that 1.8 million–5.7 million cases occurred, including 9,000–21,000 hospitalizations." (PDF)

The latest report is based on figures that are restricted based on the suggestions of the CDC. Under what you can do to stay healthy: "Stay home if you get sick.

JURISDICTIONS 2009 2008 2007 District of Columbia Baltimore, MD Richmond / Norfolk, VA 97 627 208 67 680 179 54 541 191 DEATH TOTALS WEEK 41 932 926 786

CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them." It's right under their first suggestion: "Get vaccinated." No where does the CDC suggest that you go to your local hospital for treatment or to report your illness. Their suggestion is to hide yourself. Do not disclose your illness. Keep it quiet.

The report deals with estimates from "April–July 2009" this was when the pandemic was at is smallest. Stories abounded on the how "much ado about nothing" although every such story ignored the fact that this virus started earlier than flu ever starts. The CDC and history showed that the apex for infections occur in February so even having a vaccine available by October would protect more American than ever before. You'd be ahead of the game. It was wrong.

The CDC has changed its charts only once before in reporting the number of deaths as a result of the H1N1 flu. The first time they reported only verified number of infection. Now they admit "virtually everything that's circulating now is the 2009 H1N1 influenza strain." (CDC).

That's why we say and agree with the report that the numbers are larger but we think that a pandemic is a PANDEMIC and the number will be worst IF we don't get the vaccines distributed much sooner. Pregnant women and children are important. Extremely important - unfortunately in a sinking boat (a pandemic) every man / woman for themselves. To remind everyone the government only has ten (10) per cent of the available vaccine.

Notice the second change by the Center for Disease Control and Prevention (CDC) the charts used to show the reported infections makes it difficult to determine the weeks reported and makes no comparison to prior years as earlier charts showed. The report is based on the smallest amount of reported cases. The actually numbers are consistent with pandemic numbers.

(O)ver the next several weeks it should become more easily available. And as I've been saying each day we are seeing forward progress. We're expecting a lot of vaccination effort this is weekend in a number of places. - Anne Schuchat, the CDC Director Of The National Center For Immunization And Respiratory Diseases (HEAR)

There are shortages because the for profit industry has sufficient supplies. The general public has shortages. We're in line for the discount vaccines, the left overs.

"The commercial sector is increasing production of the Tamiflu and, of course, there is also Ralenza available. Important to say that capsule production is what is -- has really been increased. There are more and more capsules being made or shipped out. And what we want parents to know is that capsules are fine for kids, even kids that can't swallow pills because there's a way for the pharmacist or for you at home to convert that capsule into a liquid." - Anne Schuchat, (CDC) the Director Of The National Center For Immunization And Respiratory Diseases (HEAR)

This isn't any kind of conspiracy and we don't mean to even suggest such a thing so: "Calm Down!" We love conspiracies but we agree most (read most) people will survive their infections. Our suggestions has been to tell someone for your own protection and have someone to check on you when infected. To which we'd like to update that information with IF you have private insurance and IF your doctor has access to Tamiflu the "antiviral" get it! Recent research shows that the antivirals reduce the symptoms and speeds recover. Yes it can create other problems and indeed this H1N1 may be a result of that (speculation - ignore).

We could be wrong but we don't think so!

Diet and Exercise - You Still Die!

Right after our live lazy and be happy complaint from yesterday comes another study pushing lifestyle changes and diet to live a healthier life. Our argument used to be that the evidence wasn't conclusive. We admit that Diet and Exercise is a better way to live a healthier life. It's not always easier or convenient but yes it is better. But that's just more blah, blah, blah! Tell us something that we don't know something that doesn't just point the finger at us. Blaming the victim isn't what the victim wants to hear. We weren't born not exercising. Lifestyle changes is how the latest research in THE LANCET puts it.

The US News and World Report examines the full report in todays edition and we were praying that they'd get it wrong. They didn't. Thanks reporter Steven Reinberg kids! Thanks Mr. Reinberg! Ignoring us they report: "(N)ew research, published in the Oct. 29 online edition of The Lancet, shows that losing weight and exercising can delay or prevent the onset of diabetes more effectively than the prescription drug metformin or a placebo."

What's the difference between exercise and sloth: "58% with intensive lifestyle intervention and by 31% with metformin" (a diabetic drug).

We like the idea of intensive lifestyle intervention because it doesn't just say exercise you fat lazy bum. For instance winning the lottery is an intensive lifestyle intervention. Vacations are intensive lifestyle interventions. Where are studies showing how working forty (40) hours a week or five (5) days is bad for your health? We've railed against diets in past articles and will probably continue to do so.

We've also shown how our jurisdictions aren't very well regarded in the areas of health. Even included in yesterdays articles is information showing that the things that are killing us other than accidents are largely preventable. We're rather think of the problem as ours rather than ours. Is that understandable? Rather than "me blaming you" and "you blaming us" that we all have a responsibility to create an arena where we all can tackle the problem and reach a mutually agreeable solution.

Maybe its the word "die" in the word diet that really gets our gall! Nawww. It's just that food that's bad for you just taste so good!

Walk You Lazy Bums Walk

When we were younger we walked everywhere. I think we did it because we couldn't afford a car to drive or just didn't have the patience to wait on an elevator. We're the generation that invented moving sidewalks. They're not just for airports any more. Then we'd really be interested in walking or exercise. When we can slow down and still keep moving other than our bellies and thighs we'd be all for it.

We constantly rail against solutions/suggestions that calls us fat lazy pigs that are going to die because we don't exercise. We know we need to exercise. We are the generation that invented the La-Z-Boy lounger and the microwave. We have loungers with built-in refrigerators now we just need couches with built-in toilets and we'd be in hog heaven. Hey if its good enough for the cats its good enough for us. Anyway here's a suggestion from Wendy on how we all can get ourselves in shape as part of a design suggestion.

Now we can get behind that - that doesn't say that we're the problem. The problem just might need another way of looking at a problem to reach a solution. Sometimes when your hands are full and you're carrying bags or whatever at the end of the day after a very long day we'll need to take the escalator.

All that exercise - we think we might need a nap!

Autism Isn't Epedemic

Which brings us to the point of the local news station WJLA-TV 7. They're reporting on the epidemic called AUTISM. It's another not quite true news report that's had us doing the search and checking our facts. We had to leave the comfortable confines of the Center for Disease Control and Prevention (CDC) and run all over the National Vital Statistics which directs me to the EXCEL spreadsheet that we don't completely understand but gave us the information we needed to compile the table of deaths in the District of Columbia, Maryland and Virginia jurisdictions.

All while investigating the connection between Autism and the flu vaccine. The unrealistic fear is giving your child the vaccine will give them autism. Of course the Center for Disease Control and Prevention (CDC) says there is no connection. Their the government and their distributing the vaccine. "Since 2001, with the exception of some influenza (flu) vaccines, thimerosal is not used as a preservative in routinely recommended childhood vaccines."

Speaking of getting things wrong the big boys at the New York Times (or rather reporter Roni Caryn Rabin) misreported the story that The Philadelphia Inquirer correctly reported connecting autism with higher mercury levels. The Philadelphia Inquirer gets it completely right while they leave it out: "The children with autism actually had lower levels of mercury. When researchers adjusted the results for fish consumption - autistic children tend to be picky eaters and so consume less fish, which contains mercury - their levels were comparable to those with typical development, as well as a representative national sample."

The epidemic that WJLA-TV 7 is reporting comes from a report that estimates in excess of the numbers given by the CDC. "It is estimated that between 1 in 100 and 1 in 300 with an average of 1 in 150 children in the United States have an ASD." To support WJLA the CDC uses from 2000 data in its 2007 opinion.

To be critical of WJLA the report uses parent-reported diagnosis and we accept that it doesn't matter how infrequently a piano falls on a persons head if you're the person that has a piano falling on your head. The odds don't matter when its happening to you. From the Official Journal of the American Academy of Pediatrics (AAP): "The prevalence of parent-reported diagnosis of ASD among US children aged 3 to 17 years was estimated from the 2007 National Survey of Children's Health (sample size: 78037). A child was considered to have ASD if a parent/guardian reported that a doctor or other health care provider had ever said that the child had ASD and that the child currently had the condition. The point-prevalence for ASD was calculated for those children meeting both criteria. We examined sociodemographic factors associated with current ASD and with a past (but not current) ASD diagnosis. The health care experiences for children in both ASD groups were explored."

Since the report is published in AAP we thought they might be the source of epidemic fear but a search of recent documents from the Official Journal of the American Academy of Pediatrics (APP) doesn't produce those results. APP considers childhood obesity and asthma at epidemic levels but not autism.

The real death statistics are the standards: cancer, heart disease and Cerebrovascular disease (CVD) in Maryland and Virginia. The number three (3) cause of death in the District is accidents CVD (strokes) are fourth. Accidents are the fourth (4) cause of death in Virginia based on 2006 data. Though they actively kill more residents than anything other causes none are considered epidemic. That's the real news.

Not Quite True News

We often cite Reuters as our news source. It's a very normally reliable source of information. When we saw this story (U.S. may end up discarding unused H1N1 vaccine) and only on Reuters we were concerned because we knew the information to be untrue. So we went to the source and lo and behold it wasn't true.

The Center for Disease Control and Prevention (CDC) knows there is a problem and is extremely aware. This agency is doing all it can with what it has to work with. Their awareness should mean we won't be having these problems in the future. The Reuters headline is a result of reporter Reuters Maggie Fox's question: "I want to follow up on this question about the perceptions about the vaccines, is it frustrating to you that people on the one hand are saying, hey, we can't get this vaccine but then there's plenty of people saying don't get the vaccine it's dangerous. I know the last time that there was a shortage of vaccine, you ended up throwing doses away. Is there a risk of that happening here?"

The director of the CDC Dr. Thomas Frieden answered in this way: "I think the likelihood is that we are currently in a situation where we too little vaccine in the community. It's quite likely that that too little vaccine is one of the things that's making people more interested in getting vaccinated, frankly. Were we have shortages we see an increase in demand. It is likely also as we produce more vaccine and as both people are given the opportunity to get vaccinated, and as disease maybe wanes in the future, we will have significant amounts of vaccine that can't be used. The challenge at this point is to get what vaccine we have out now available to people, provide it to doctors offices, school, health care facilities and others as rapidly as possible so that as much as is available can be used. One of the messages for states, localities and health providers is not to reserve vaccine that they have available, to give it out as soon as it comes in, because more is on the way. And the production is now in a scaled up mode, so more being produced, not as much as we would like, but more is being produced and made available as soon as it can be."

Maybe you heard what Maggie Fox heard but the entire exchange is available at the CDC website from yesterday. (LISTEN to the entire news conference)

Verify Verify Verify

When we're not posting we're researching and following up stories and responding to questions posed by friends and other interested parties. We're here. We're just not here. Mostly we're investigating two reports. When volunteering and two different times we were distributing two (2) different vaccines. We're still awaiting the Department of Health's (DOH) for the District of Columbia response to the current distribution of vaccines. Whether its seasonal or the actual long delayed H1N1 (swine flu) vaccine. Our experience contradict each other.

Opponents to the vaccine said they weren't going to take the vaccine because the Obama children haven't taken it. We can report that they have taken both vaccines provided by the District of Columbia's Department of Health (DOH). " President and Mrs. Obama have not yet been vaccinated for H1N1, and they will wait until the needs of the priority groups identified by the CDC – including young people under the age of 24, pregnant women, and people with underlying conditions – have been met. The girls' H1N1 vaccine was administered by a White House physician, who applied for and received the vaccine from the DC Department of Health using the same process as every other vaccination site in the District."

What we have problems with is the waiting on the supplies if you're not in a high risk group. The problem is those in the "high risk" group don't think of themselves as high risk. Children and their parents are a high risk group and there's no way to prevent your getting the flu that's approved by the Center for Disease Control and Prevention (CDC). Their solution in the absence of the vaccine: "Take these everyday steps to protect your health."

• Cover your nose and mouth with a tissue when you cough or sneeze.
• Wash your hands often with soap and water, especially after you cough or sneeze.
• Avoid touching your eyes, nose or mouth. Germs spread this way.
• Try to avoid close contact with sick people.
• Stay home if you are sick until at least 24 hours after you no longer have a fever (100°F or 37.8°C) or signs of a fever (without the use of a fever-reducing medicine, such as Tylenol®)
• Follow public health advice regarding school closures, avoiding crowds and other social distancing measures.

Here's what the CDC said at their answer line concerning an email received suggesting ways of actually preventing the virus: "Thank you for your inquiry to CDC-INFO. In response to your request for information on H1N1 influenza (flu) and the use neti pots and sinus rinse kits, we can provide you with the following information. CDC does not test, evaluate, or endorse consumer products. Product safety and efficacy testing is under the purview of other Federal government agencies including the Food and Drug Administration (FDA) and the United States Consumer Product Safety Commission (CPSC). You may contact the FDA at 1-888-INFO-FDA or through their website at: http://www.fda.gov You may contact the Consumer Product Safety Commission at 800-638-2772 or through their website at: http://www.cpsc.gov/ The spread of 2009 H1N1 virus is thought to happen in the same way that seasonal flu spreads within homes or communities. Flu viruses are spread mainly from person to person through coughing or sneezing by people who are sick with flu. People may become infected by touching something with flu viruses on it, and then touching their mouth or nose before washing their hands.

Until a vaccine is available, the best way to help fight novel H1N1 flu is to cover your nose and mouth with a tissue when you cough or sneeze, then throw the tissue away. Wash your hands often with soap and water, especially after coughing or sneezing. Stay home if you're sick, and limit contact with others to keep from infecting them."

We didn't ask about NETI pots. We sent them the email we received. Their stock answer isn't very comforting. So we go with eating OLIVES available from your local dollar store or grocery for less than $1.00 a can. Added to your meals. The CDC might not endorse the method but we do!

NO DC FLU Deaths in Week 41

We should say no reported DC flu deaths in Week 41. We keep forgetting and the news hasn't done a good job or reporting it as well. Thanks to the New York Times for telling us what we too often forget: "The only flu circulating now is swine flu — seasonal flu is not expected to emerge for another month — but most of the vaccine available is against seasonal flu, because it was ready first; vaccine companies started making it in February, and swine flu emerged in April."

Percentage of Visits for Influenza-like Illness (ILI) Reported by the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet), National Summary 2008-2009 and Previous Two Seasons (Posted October 16, 2009, 7:30 PM ET, for Week Ending October 10, 2009)

Which is why we disagree with US News' expert's (Jon Andrus of the Pan American Health Organization) assessment concerning the flu and the flu numbers. What we have now is not a peak and it has exceeded last years high although the flu season has not yet begun. It has already eclipsed last years highest totals and its just getting started. All of the most recent research contradicts their experts findings. We hope you'll ignore it as well.

We are volunteering at the District of Columbia's Department of Health's H1N1 Mass Vaccination Program at their Mass Vaccination Clinics. We thought it the easiest way to get vaccinated. We were wrong. Volunteers get water and lunch but that's about it. We aren't allowed to answer questions, medical or otherwise. All information must be provided by the Public Information Officer (PIO) so we have to keep our mouths shut and defer all questions to the appropriate person. Only official forms may be used. Computer downloaded forms may not be used.

What we would have said was this isn't the H1N1 vaccine. That vaccine isn't available currently. Not that there is anything wrong with the vaccine. There isn't. That's why we will need to receive two shots. The first to prevent what isn't currently affecting us and second to catch up with the virus that is currently affecting us. The two strains are similar enough that we might have enough protection from the first to keep us from succumbing to the second. "(V)irtually everything that's circulating now is the 2009 H1N1 influenza strain" according to the Center for Disease Control and Prevention (CDC).

WJLA-TV 7 reports "US Swine flu deaths surpass 1,000" as their headline adding: "60 million people have been vaccinated already - an unprecedented number for October. Most seasonal flu shots usually aren't given until later in the fall."

NBC TV 4 went to Grundy, VA to find free health care provided by American relief organization charity called Remote Area Medical featured in 2008 in a 60 minutes report on health care in America called Lifeline.

		Pneumonia/ Flu Deaths	WEEK 41 2009	WEEK 41 2008	WEEK 41 2007
		District of Columbia Baltimore, MD Richmond / Norfolk, VA	95 611 202	55 661 172	48 530 185
		TOTALS	908	888	763

FOX News 5 improperly titled their story: Drive Through Clinics "They must remain in their cars and no immunizations will be given to pedestrians." Which isn't true but we do learn that in Virginia residency isn't a requirement in the national capital area to receive the vaccine.

WUSA-TV 9 reports: "The way the system is working at the Alexandria Health Department however, is new. Health officials gave out numbers to people. The Health Department Director Lisa Kaplowitz tells 9NEWS NOW the number system reduced confusion for people in line. So if people are handed a number, they are assured they will get inside the clinic." Hopefully all the jurisdiction will operate this way though some individuals may line up to sell their numbers to the more desperate among us. What's unfortunate is that "no injectable vaccine will be available at this site at this time."

These are the official numbers as reported by the Center for Disease Control and Protection (CDC).

Sick Ain't Dead

Most of the seasonal flu effort is a private sector entity. The public sector only buys about 10% of the vaccine. - CDC's Dr. Anne Schuchat.

2,904 People in District of Columbia May Need To Be Hospitalized Due to H1N1, if 35 percent of Americans get sick from the H1N1 virus. This would mean 47 percent of the state's hospital beds could be filled during the height of the outbreak, based on estimates from the FluSurge model developed by the U.S. Centers for Disease Control and Prevention (CDC). In addition, 207,142 people in District of Columbia could get sick if 35 percent of Americans get H1N1.

26,691 people in Maryland may need to be hospitalized. This would mean 143 percent of the state's hospital beds would be filled at the height of the outbreak, exceeding the state's available number of beds. In addition, 1,971,759 people in Maryland could get sick if 35 percent of Americans get H1N1, if 35 percent of Americans get sick from the H1N1 virus.

36,530 people in Virginia may need to be hospitalized. This would mean 100 percent of the state's hospital beds would be filled at the height of the outbreak, exceeding the state's available number of beds. In addition, 2,719,181 people in Virginia could get sick if 35 percent of Americans get H1N1.

When its us it doesn't matter what the number are the most important number is ours. What the figures suggests is that IF we get sick - The District of Columbia is the place to go - for now! How long that holds true is anyone's guess.

They call it sick care we call it disease care. Maybe its a copyright thing? Prevention is expensive and conceding the expensive does not necessarily mean it should be attempted. The choice is not an prohibitively expensive prevention or cost savings by allow us to die. Dying costs and death is prohibitively more expensive. An alternative to dying from an prohibitively expensive prevention program is developing or utilizing ways to not enrich the nation or our jurisdictions by our deaths. Is it cheaper to keep us or let us succumb? We can't prevent our illnesses but we can prevent our deaths.

We've been extremely critical of former Democratic VP candidate and now independent Connecticut "Senator Joseph Lieberman (who to the HHS Secretary Kathleen Sebelius) said during a hearing with public health officials on Wednesday - “Your departments have worked very aggressively and to the best of your ability. My concern is that this flu, the H1N1 virus, is moving very rapidly. While it seems to be affecting most people mildly, it is clearly affecting a small percentage quite seriously, so I am worried that the virus is getting ahead of the public health system’s capacity at this moment to prevent it and respond to it,” he said.

I want people who are trying hard to find seasonal flu vaccine to know there's time, we know this is frustrating. Keep looking. More vaccine is coming out every week.- CDC's Dr. Anne Schuchat.

Not only can the Center for Disease Control and Prevention (CDC) not keep up with the demand for the vaccine the agency can't keep up with the demand for information. See: Novel H1N1 Flu: CDC Response - Updated: August 19, 2009. Again to quote the still unseen movie 2012: ""When they tell you not to panic that whens you run!"  See the graphic below. The real facts are alot more startling.

Again it is not our intention or mission to frighten you. We seek only to educate and inform. With the most accurate information we can make the most informed decisions about our health care and treatment.  Click on the graphic to see the real and startling infections numbers in the United States. So the next time you read and article saying that we're making "much ado about nothing." Just look at the facts. 

Here is the entire segment we've been quoting from the Center for Disease Control and Prevention (Read or Listen)(8:00 into the 32:26 min press conference) with Dr. Anne Schuchat who says: "Most of the seasonal flu effort is a private sector entity. The public sector only buys about 10% of the vaccine. So I'm report reporting to you where we are with that but it's not something we're directing or in the middle of just something we care deeply about and want to facilitate the uptake of. I want people who are trying hard to find seasonal flu vaccine to know there's time, we know this is frustrating. Keep looking. More vaccine is coming out every week. We know there's time to get your seasonal flu shot or flu spray. We don't usually see the seasonal flu disease increase until September to May so there is more time with that of course, virtually everything that's circulating now is the 2009 H1N1 influenza strain and that's why we're so keen to get vaccine out as quickly as we can with that."

For profit health care means if your HMO doesn't protect you - you could die. When you make your health care choices make certain that one

1. your health choice has access to all the available options and
2. that you're actually receiving the real thing.

In desperate times too many unscrupulous people are all too willing to take advantage of our fears and desperation. This is true on the web and off. How you make certain you've received what you paid for - we're not certain. It's a question we'll put to the CDC and let you know their answer. In this pandemic the government is only a ten (10) percent participant.

Lassen Medical Group of Red Bluff, CA offers flu advice according to a press release 10/21/2009:

1. "Stay at home if you are sick. 
2. Keep sick children home. 
3. Do not return to work or send children to school until fever-free for 24 hours without using fever-reducing medications..." 
4. "...Do not let your children near sick people. Keep them three feet away. 
5. Stay away from shopping malls, movie theaters and other places where there are large groups of people."

In other words - Stay at home and die just don't give it to us. We don't agree. Stay monitored and if you don't feel better in four (4) days get the vaccine. We tend to listen to the relatives of dead whom wished they'd done more than listened to their doctors or the Center for Disease Control and Prevention (CDC). The CDC which now maintains: "(V)irtually everything that's circulating now is the 2009 H1N1 influenza strain.."

Flu Lines

During the riots in the 60s the national guard was called out and a curfew was established. Now might be the time to enact such a measure. Why? Long lines of people queuing up to receive a limited number of flu shots seems counter productive. While most people are not infected allow for such a large congregations seems to us, whether waiting outside or inside for the vaccine, to be breeding ground for infection. We would discourage anyone from lining up excessively to receive treatment though we must admit awaiting further supplies to arrive seems extremely dangerous.

According to the manufacturer of the vaccine, Sanofi Pasteur, "Production of seasonal influenza vaccine for both Northern and Southern hemispheres is still a priority as seasonal influenza is a very serious illness, causing an estimated 250,000 to 500,000 deaths per year, according to WHO global figures."

Only the protected can be certain of survival. While the figures are worldwide the Associated Press (AP) reports: "Since April, swine flu has killed more than 800 people in the U.S., including 86 children, 39 of them in the past month and a half, according to the Centers for Disease Control and Prevention. More than half of all hospitalizations since the beginning of September were people 24 and under." Locally we know the number to be to date in our jurisdiction as reported to the Center for Disease Control and Prevention (CDC) to be in excess of 858 in our area alone. These are the actual figures reported to the CDC by our health department not reported to the public.

AP quotes the CDC as saying: "Federal officials counsel patience, saying that eventually there should be enough of both vaccines for everyone who wants them." The CDC reported through Dr. Anne Schuchat: "Influenza is widespread in the country and illness, hospitalizations and deaths continue to increase. 41 states are now identifying widespread disease from influenza, that's up from 37 last week. The other states are all seeing either regional or local activity. It's unprecedented for this time of year to have the whole country seeing such high levels of activity." (Listen)

The Associated Press added: "Flu vaccines are not nearly as profitable as other kinds of drugs, and most of the biggest vaccine makers have little incentive to switch from a method with which they are familiar. At its two plants in the Pocono Mountains town of Swiftwater, Sanofi Pasteur, the top U.S. supplier of seasonal vaccine, is churning out more than 75 million doses of swine flu vaccine and 50 million doses of the winter flu variety."

Sanofi Pasteur not getting with the party line reports: "For U.S. Residents Only - The $150 million, 140,000 square-foot vaccine facility is part of the company’s commitment to support public health and to protect individuals against seasonal and pandemic influenza. When operating at full capacity, the new influenza facility is expected to produce 100 million doses of seasonal influenza vaccine annually. In total, sanofi pasteur will have a capacity of approximately 150 million does of trivalent seasonal vaccine per year in the U.S. – 50 million doses from the existing facility and 100 million doses from the new facility when operating at full capacity." (Video)

We love the Los Angeles Times (LA Times.com) but they (actually reporter Thomas H. Maugh II) gets it wrong: "(C)oncern is growing that the vaccine may arrive too late to do much good. Statistician Sherry Towers and Zhilan Feng of Purdue University reported last week in the journal Eurosurveillance that a mathematical model of the swine flu pandemic predicts that the disease will peak this week."

What Eurosurveillance report actually states first off: "(I)t should be noted that the actual periodic function underlying seasonal forcing of influenza has not been well studied, and the uncertainties in the model predictions arising from seasonal forcing assumptions are difficult to quantify."

Total Doses Shipped as of	10/14/09
District of Columbia Maryland Virginia	14500 130700 265100
TOTALS	410300

There are people infected and recovering. Our warnings are to those who aren't feeling well enough after four (4) days when you've taken care of yourself as soon as you've felt more miserable than you ever have. Get treatment and get it right away. Have someone with you - don't make an appointment - it's too late for that get the shot. Demand the shot. IF YOU'RE ILL. We know you won't be able to do this yourself but have someone available to fight for you. Get someone to fight for you. Demand treatment regardless of whether or not your physician believes you need it or not. What will getting the treatment do to hurt you? It will save your life.

New LOGO

Here it is for your consideration! The logo for PearlieMae's. We hope you approve.

Blacks Breast Cancer

“We don’t know for certain
why black women are less likely to have mammograms,
but many women tell us they just don’t want to know.
They don’t want to think about having a life-threatening illness
or they don’t believe they have access to the care they need to beat it,
so they decide they’d just rather not know.”
- Ann Greenhill, executive director of Susan G. Komen for the Cure Tarrant County (Texas)

"Targeted interventions to increase breast cancer screening and treatment coverage in patients with lower socioeconomic status (SES) could reduce much of socioeconomic disparity." BMC Cancer 2009

GERD! James Gerd!

We used a college homecoming weekend dinner to hold a staff meeting and the question of why no GERD stories arose. We couldn't think of any reason other than the lack of recent studies on the subject. Lo and behold we find a recent H1N1 death attributed to symptoms that included GERD:

"A 52-year old man is Santa Rosa County’s first confirmed death associated with H1N1 Swine Flu, according to the county’s health department."

"The man died September 11, according to information released Tuesday from the Santa Rosa County Health Department. Health officials were notified of his death September 28, when the results of additional lab tests were received. The man had hypertension and GERD (gastroesophogeal reflux disease). In keeping with Florida Department of Health policy, no additional information was released."

“The death of a loved one under any circumstances is always a tragedy,” said Sandra Park, A.R.N.P., interim administrator for the health department. “Our hearts and prayers go out to his family and friends at this difficult time.”

"The man was admitted to the hospital on September 4. At that time, a rapid flu test for H1N1 was performed and the result of that test was negative. Additional testing, however, confirmed that the man was ill with H1N1."

We're not trying to be the "flu police." We're concerned about the lack of information being presented to us by our local jurisdictions when we have proof positive that the information is false in relations to the flu. What we don't understand is why the jurisdictions refuse to give us the full and unvarnished truth. Reading daily obituaries shows deaths that the local health departments don't or refuse to report. Most disturbing are the reports that the standard H1N1 test return negatives when autopsies reveal positives results. That type of information is better presented to the living than the dead.

CBS News reports what a doctor tells his patients in this two (2) week old report from Dr. Jonathan LaPook: "Smoking and obesity both increase acid reflux and must be addressed. I tell my patients to limit alcohol, caffeine, chocolate, peppermint, and fatty foods (I know, basically anything that gives them even an iota of pleasure in life). I also suggest keeping a food diary to try to identify culprits such as tomato-based products or certain spicy foods. If their symptoms resolve then they can try to reintroduce the things they miss the most. Elevating the head of the bed can sometimes help."

Research physician, Dr. Ronnie Fass, reported in Renal and Neurology News on the latest drug treatment for GastroEsophageal Reflux Disease: “Patients with diabetic gastroparesis and symptomatic documented GERD may have trouble adhering to treatment because of difficulty swallowing, the need for treatment when they do not have water available, or the need for a portable way to take medication...”

The new drug treatment evaluated by the doctor: "...Metozolv ODT, which rapidly melts on the tongue, gives these patients a new choice that may be more convenient than traditional metoclopramide tablets, Ronnie Fass, MD, Professor of Internal Medicine at the University of Arizona added. “Patients with diabetic gastroparesis and symptomatic documented GERD may have trouble adhering to treatment because of difficulty swallowing, the need for treatment when they do not have water available, or the need for a portable way to take medication.”

The National Post's Dr. Yoel Abells writes that: "Gastroesophageal reflux disease (GERD) is quite common. Epidemiologic studies suggest incidence rates are increasing and that up to 20% of the adult population suffers from this condition to varying degrees..."

"...Complications associated with acid reflux disease arise from the irritating effect the stomach contents have on anatomical structures. For example, the acidic contents can inflame the vocal cords, resulting in hoarseness, or spill into the lungs causing hyperreactivity of the airways and an ensuing cough. Asthma can worsen as a consequence of GERD. Up to 5% of individuals suffering from chronic GERD develop Barrett's esophagus, characterized by changes in the cells lining the esophagus. Although rare, over time, this condition can lead to esophageal cancer."

That such a common occurrence can be present in an uncommon virus seems more than a matter of chance. From its first typing by the World Health Organization (WHO) and the Center for Disease Control and Prevention (CDC) have maintained that pre-existing conditions can present opportunities for the relatively harmless virus can cause complications that could lead to death. Originally the time line for infections to complications that could lead to death was over ten (10) days. Current deaths have reduced that timeline from ten to five (5) days with the fifth day being the date of death for some individuals. Most individuals do survive - this isn't about the relatively healthy - this is about those who are most susceptible. You and I.

Three Little Pigs

It's a story that can't be true - it more of a fairy tale than a news report but from Denise Grady of the no less than the New York Times wrote: "Three pigs at the Minnesota State Fair tested positive in late August for H1N1, the flu virus that is causing the current pandemic, the Agriculture Department reported Friday." The little is our addition but you understand how we couldn't help ourselves.

It's not quite a biblical pronouncement but it's a sign that hard to ignore. So we revisit the story for you. OK maybe that's going too far. To continue the story from only the New York Times and Monica Davey from Chicago will make us contact the Minnesota Department of Agriculture. We'll keep you informed.

"Infected pigs have been found in eight other countries. The virus does not seem to make pigs very sick. Of 103 pigs tested at the Minnesota fair, in St Paul, only three were found to be carrying the virus, and all appeared healthy. They probably caught the virus from infected people, researchers said." Follow the link and read the story.

From the Associated Press (AP) this bit of info: "In a conference call with reporters Friday, Minnesota Agriculture Commissioner Gene Hugoson said officials don't know what happened to the three pigs, but that they probably were sent to slaughter soon after they were shown at the fair, which ended on Labor Day."

It's not what you know - it's what you can prove in a court of law. Maybe that's true as a defense for charges against the "balloon boy" family. When it comes to the health of you and your family that might not be necessarily so true. We heard the story of the three (3) little pigs and thought we'd heard it or knew the story until we did the researched. Whether this story is true or not the original and the current can still serve as a cautionary tale for us all. What we knew or rather thought we knew of the original story is indeed the basis of the many variation that race to get to the end of the story and leave out much of the story. However the original tale as shown by "A Ladybird 'easy-reading' book" illustrated on the web is probably the best method for a healthy survivable pandemic season - if we like the first pig accept the first available treatment available. While others might think themselves smarter by waiting until other options are exhausted what happens in real life might not emulate what happens in fairy tales.

In the tale the first pig took the first offer, the second big took the second offer and the third pig took the last and historically speaking best offer. In real life the wolf is no longer one (1) huffing and puffing creature but an institution that has no time for press or publication. In the tale the wolf died, boiled alive in the third pigs pot - or did it?

Not according to the follow-up as told by on A. Wolf in his trail transcripts in defense of his actions in the "Defendant Testifies."

In reality all three (3) pigs were sent to slaughter, we contacted the Department of Agriculture (DOA) for verification of the "three (3)" pigs story after finding the press release on their site about the outbreak. We followed up our telephone call with an email to their contact person. In actuality the individual who answered the telephone was not allowed to answer our question: "Were there really three (3) pigs?" They were NOT permitted to do anything other than answer the telephone and take our information for a return call from the appropriate individual.

We understand the need to manage the media. We aren't media. Are we? We report but that doesn't make us reporters. Does it? We seek to understand. Our understanding of all things government is that it doesn't matter who is in office. Governments operate in secret. Secrets get people killed. Transparency by our leaders - whom ever they are does not nor ever has existed. Hence our raison d'etre. That's no fairy tale.

Get the vaccine - don't wait. If ill you MAY pull through without hospitalization. You may even show improvement but if you don't receive the proper treatment you can die. Not will die - but your death is "no skin off their nose." Protect yourself and protect your family. Trust but verify!

Smoke Attacks

Knowing is not enough; we must apply.
Willing is not enough; we must do" - Goethe

Maybe its just us but we like to go to the source and maybe only "squints" can get away with submitting a "uncorrected proofs" prepublication copy. We were never allowed to submit such a thing when we were in school but that was a long time ago. The Goethe quote comes from the pages of the report. What they found and published as a scientific evidence was the title "Secondhand Smoke Exposure and Cardiovascular Effects - Making Sense of the Evidence" concludes that: "...that data consistently demonstrates that secondhand-smoke exposure increases the risk of coronary heart disease and heart attacks and that smoking bans reduce this risk. Given the prevalence of heart attacks, and the resultant deaths, smoking bans can have a substantial impact on public health."

This might be news to smokers and the paid defenders of the "right to smoke"campaign but for those of us challenged breathers this isn't news. While some people might remember the movie Basic Instinct for Sharon Stone's legs - for us it was the lighting of her cigarette that preceded the crossing. That kind of smoke attack strikes us whenever we see a dangerous gang of smokers crowding the entrance of some public building. You have to take a deep breath before crossing their path and holding it until you can clear the area. This same type of physical reaction can occur whenever a person is terrified of being attacked.

The Center for Disease Control and Prevention (CDC) issued a statement in support of the report saying:

• "Exposure to secondhand smoke could cause acute coronary events, such as a heart attack.
• Evidence suggests that even brief secondhand smoke exposure might trigger a heart attack.
• Smoke-free bans decrease acute coronary events."

One of the wonderful things about our smokefree DC though there is no smokefree MD or VA. Whenever we travel south and stop through VA we have to share air space with smokers separated only by a door or partition. Whether or not Virginia adopts or makes any changes to current laws or not is yet to be determined. To those of us desperate to breath we'll just have to hold our breaths until then.

Bill Maher who we credit with the "thinning the herd" comment smoked up until a few (more than nine) years ago. Who knew that he was actively pursuing that goal. Now we know!

While we certainly felt attacked and all but the most dense of smokers thought somehow blowing their smoke in the air was effort enough for us as long as it wasn't in our faces. It's doubtful that even this report will be received with any more belief. To again quote Maher not as long as our Government "is a Mafia that wants a cut."

Warning Signs

It's tomorrow over there today. We thought we'd highlight the ways of staying safe and when you need to be overly concerned. We do it in the midst of the news reports of four (4) dead in Spokane Washington two (2) (a man and a woman) in their homes, one (1) woman in the hospital and the other man's location is unreported. All but one supposedly with no "underlying conditions." For their jurisdiction that is five deaths since September 1st.

Associated Press (AP), Atlanta Journal Constitution (AJC), Bloomberg report: "Giving Kids Tylenol Makes Vaccines Less Effective, Study Finds" - "[U]nless your doctor specifically recommends it, do not administer fever-reducing medicines at the same time as vaccination to prevent your child from developing a fever," said Chen, who wrote an editorial accompanying a report in the Oct. 17 issue of The Lancet."

The article isn't online as of yet but by the time you read this it may be. So we have to take their word for it and as we say this is one of our warning signs.

The AP adds: "It is the first major study to tie reduced immunity to the use of fever-lowering medicines. Although the effect was small and the vast majority of kids still got enough protection from vaccines, the results make "a compelling case" against routinely giving Tylenol right after vaccination, say doctors from the U.S. Centers for Disease Control and Prevention."

Warning signs
The Spokane Regional Health District advises seeking medical care if the following symptoms develop:

Children
• Fast breathing or trouble breathing
• Bluish or gray skin color
• Not drinking enough fluids
• Severe or persistent vomiting
• Not waking up or not interacting
• Being so irritable that the child does not want to be held
• Flu-like symptoms improve but then return with fever and a worse cough

Adults
• Difficulty breathing or shortness of breath
• Pain or pressure in the chest or abdomen
• Sudden dizziness
• Confusion
• Severe or persistent vomiting
• Flu-like symptoms improve but then return with fever and a worse cough

"Difficulty breathing; pain or pressure in the chest or abdomen; sudden dizziness; confusion; severe or persistent vomiting; and the easing of flu symptoms followed by a return with a fever and worse cough."

"In children, emergency warning signs also include rapid breathing, bluish or gray skin color, not drinking enough fluids, not waking up or interacting with others; extreme irritability."

"Anyone experiencing those symptoms should seek medical care, the Health District says."

"Those are signs that the illness is outpacing the body’s ability to fight it, said Bill Edstrom, an epidemiologist with the health district. As the illness becomes severe, it moves from the upper respiratory system – the nose and throat – into the lungs and lower respiratory system, making breathing difficult and reducing the oxygen a patient is taking in. As it progresses, it begins weakening other organs and can lead to complications like infections and other illnesses."

“The body starts shutting down,” Edstrom said. “The kidneys might go. Other organs also might fail, and eventually the heart would fail.”

Fore armed is forewarned. Live your life.

Staying Alive!

We don't want to be accused of promoting fear. What we have always asserted is information is power. The more you know the less fear you should have. To contribute to less fear we thought we'd highlight the positive as well as the negative in yesterday and today's news. We also don't wish to be the "flu police!" Our concern is health care not disease care. Focusing on the disease of the season isn't our raison d'etre.

First things first, in our jurisdiction, the District of Columbia still publicly maintains no deaths to the H1N1 virus though privately the number of deaths reported to the Center for Disease Control and Prevention (CDC) for flu or pneumonia from the first week of 2009 to the thirty-ninth week of 2009 (last week) is 94 as compared to 60 in 2008 during the same week and 44 in 2007. That's the official report to the government. While Maryland seems to be the hotbed of flu reporting to the feds 585 though the official count is ten (10). It's the unreported that begs to be counted.

Baltimore adds three more infections in a single location from their police department. Again we have to point out this isn't the beginning of the flu season which "officially" begins in November. This is indeed a pandemic. Though not unexpected.

Current news reports from other parts of the country suggests that seniors are largely immune to this virus and need no be concerned with it because they've developed an immunity because the strain (H1N1) isn't substantially different from previous strains. Following the report released yesterday from Canada - that would appear to hold true:

"Unlike some previous flu pandemics, which saw high death rates among the very young and the very old, "severe disease and mortality in the current outbreak is concentrated in relatively healthy adolescents and adults between the ages of 10 and 60 years," the authors write. The observation that Canadian women were at higher risk of severe illness is "striking," the authors said, noting that other swine flu studies have not noticed such a pattern." "The explanation for increased risk of severe disease and death among females in this report is unclear but the role of pregnancy as a risk factor has been noted in previous influenza pandemics," the authors noted. While the authors call the patients studied "healthy," it should be noted that 95 per cent had some underlying risk factor, such as asthma, smoking, obesity or high blood pressure. The researchers found that once swine flu patients were sick enough to need hospital care, they declined very fast, usually requiring ventilators and advanced "rescue" treatments. Patients who become severely ill had symptoms for about four days before going to hospital and then often required intense care in the ICU within one or two days; their average ICU stay was 12 days. Shock and multi-organ failure were common; 81 per cent of the patients they studied needed to be put on ventilators."

Using our "every living individual is sacred" credo playing a numbers game isn't good enough. While the stats may be in your favor you might not "want to be in that number." Get the shot - don't take the risk.

BizJournal was the ONLY article written about the affect of the flu on the non-human "corporation" - which in theory we find distasteful. In practice we can understand and would even suggest, distasteful, the loss of employees due to the virus could or would create new employment opportunities for the current and large numbers of unemployeed. Seeing the pandemic as a natural way of "thinning the herd" to paraphrase Bill Maher is in direct opposition to our very existence.

We do support the South Florida's publication's "warning." We just wish it was more humanly rather than fiscally addressed. Though in their defensive that's how a corporation shows its concerns. It just survive so that the people whom it employs can continue to thrive.

Believe it or not some paper's columnist are prompting the people should just say NO to vaccine - from California no less. Promoting oxygen therapy as a pancea for all things that ail you Lynne Gordon's article says:

Just Say NO to The Swine Flu Vaccine of 2009! & Ten things you're not supposed to know about the swine flu vaccine "I personally am NOT going to take the Swine Flu vaccine for several reasons. There are too many 'firsts' with this vaccine and because it contains Squalene..."

"...This is the third vaccine made with Squalene. (The first was the Swine Flu Vaccine of 1976 which killed 25 people and paralyzed and crippled thousands. Lawsuits from the after-effects reached 1.3 billion dollars)"

Thankfully the "informer" is misinformed and one commenter to the article point by point refutes Gordon's accusations. Most glaringly in error is that the vaccine contains "Squalene." When critics are so much in error it makes it easier to dismiss the quackery of the uninformed.

What's noteworthy of the article is that we've found a kindred in the commenters blog with which we hope to develop an association and that squalene ingested orally in olives can actually be a preventative and makes our list as what you can do for a dollar to protect yourself in this viral season. While your flu shot might not be the real deal - olives are a natural. A/H1N1 Influenza Outbreak Timeline which we highly recommend for an international view of the flu.

"...[T]he current stock of U.S. swine flu vaccines does not contain adjuvants, according to Anne Schuchat, MD, in an informational video produced by the Centers for Disease Control and Prevention (CDC). Schuchat does acknowledge that there is an emergency provision to use them — should the pandemic accelerate.

Adjuvants are being used in swine flu vaccines in countries outside of the United States, including Canada, Europe and Australia. However, even though Canada is using an adjuvanted vaccine, it has also ordered 1.8 million doses of the unadjuvanted vaccine for use in pregnant women and children under the age of 3."

Protect yourself - be informed and forearmed. You can survive this! Let's let not be apart of the thinning herd. But do NOT be afraid. You know what to do and now what must be done - and OLIVES plenty of olives! What could it hurt? Buy 'em from the dollar store and pop 'em like grapes!

If you feel ill or if your children are ill take your: "...children to the hospital if they have difficulty breathing, their skin turns gray or blue, are difficult to wake up or become irritable and can't stop crying."

"Warning signs, respiratory symptoms and high fever are reasons to seek care or talk to your health care provider," Schuchat said."

How Long Before You Die - Updated

We don't really want to be the flu police. We were tempted to raise alerts from the news from Las Vegas on KTNV-TV connecting obesity and the flu. What it did point up was that we'd have to change our UK suggestions.

What caught our eye was the age and sex of latest death from sin city: "Nancy Simon says she was completely blindsided by her husband's death back in May. She says their family doctor thought it was bronchitis and UMC thought it was pneumonia or a pulmonary embolism..."

"...Only five days after coming down with what initially seemed like a bad cold, Gary Simon died with no preexisting medical conditions other than high blood-pressure..."

"According to Simon, her husband was in fact tested for the H1N1 virus the day before he died. She says the culture later came back as negative. It wasn't until after his autopsy that she learned the truth. "The fact that there are so many false negatives from these tests, you can't settle and say okay, the test came back negative. You have to keep pushing to be retested." She says her husband's death is proof that the healthy aren't immune to the complications that can come with swine flu."

When we saw his photo and found this article on the Associated Press (AP) and reported by the SunTimes and the Examiner we thought we'd investigate: "In Mexico and Canada people who are obese are having a difficult time with the H1N1 swine flu virus, and are having rapidly worsened breathing problems. The death rate for the obese with H1N1 swine flu is higher than other people inflicted with the virus, and the recovery was more difficult. In Mexico and Canada many inflicted with the flu were younger than in a regular flu season. The death rate in Mexican patients is 41% which is much higher than other countries."

The story was also carried by the TwinCities: "It's unclear whether obesity itself causes more complications, but the rate of deaths and hospitalizations among obese people is notably higher, said Dr. Ruth Lynfield, a Minnesota epidemiologist. This trend is surprising because obesity hasn't been a risk factor with previous seasonal influenza, Twin Cities reported."

From Vegas to Minnesota across the border to track down: "A new study suggests many of the Canadians who have died of swine flu or were placed in intensive care during the "first wave" were relatively young, healthy women whose condition deteriorated quickly. While the number of patients studied for the research was small, the lead researcher, Dr. Anand Kumar of St. Boniface Hospital in Winnipeg, Man., said the results shocked him." What kept us from making the leap from flu to obesity to death was this statistic: "17 per cent died within 90 days."

Which is fine if you're a part of the 83 per cent who live past the 90 days. We believe every life is sacred and living shouldn't be percentage game. Our solution - new guidelines. We've said in the past that after ten (10) days head to the hospital and demand the shot. We'd like to amend our timeline.

• Select a someone to fight for you now while you're well
• Don't be sick in secret - have someone check on you.
• You've got four (4) days to feel better
• The H1N1 test can be negative and you still have the H1N1 swine flu
• Find a facility that has or will overnight the treatment to you
• Demand appropriate care - Or have your someone do it
• Day five (5) you must be feeling better

You Are Where You Live

Where you live can determine how long you live? Maybe and we're not talking "Three Mile island" or "Love Canal" locations but when you're considering schools system, recreation facilities, parks, bike paths, crime rates you might want to add the availability of "fruit and veg" stands to your list of neighborhood home purchase considerations.

What we love is this blame the environment studies rather than blaming the victim. It's not that we are anti-earthers we don't hate the planet. We don't! We love mother earth. What we don't like is old useless suggestions that ignore prior failures of implementation. Failures aren't what we should be studying successes are.

ABC News does it again. Call it reporting on truly environmental (sustainable) planning: "[T]he risk of diabetes associated with living in such a "healthy" 'hood was 38% lower than for people who lived in the unhealthiest places, Dr. Amy H. Auchincloss of Drexel University School of Public Health in Philadelphia and her colleagues found. The findings raise the possibility, Auchincloss told Reuters Health, that changing people's environments could help improve their health. "There's certainly a lot of potential for making an impact," she added, pointing to initiatives like improving public transportation, increasing green space, making sidewalks safer, and opening farmer's markets in urban neighborhoods where supermarkets are scarce."

The LA Times does it better and we recommend you read their story asking: "Can your neighborhood make you sick? Type 2 diabetes may not be contagious, but it certainly appears to be spreading. In 1958, the prevalence was 0.9%. By 2000 it had climbed to 4.4%, and it’s projected to hit 7.2% in 2050. What accounts for this? Perhaps it’s the way residential neighborhoods have evolved to accommodate car rides to fast-food restaurants instead of walks to corner grocery stands."

MSN is not a normal source of information for us adds: "People who live in neighborhoods that promote physical activity and offer access to healthy foods may be less likely to develop type 2 diabetes, researchers say. Their study included 2,285 people, aged 45 to 84, living in neighborhoods in Baltimore, Forsyth County, N.C., and New York City/Bronx. Their neighborhoods were assessed by asking residents questions, such as whether it's easy or pleasant to walk in their community, and whether local stores carry a large, high-quality selection of fruits, vegetables and other low-fat foods. Average neighborhood scores were 3.68 for physical activity and 3.36 for healthy foods, the researchers found."

We have to take their word for it but we did ask Assistant Professor Amy H. Auchincloss of Drexel University if any of the above mentioned three got it right. We'll let you know what she says.

While the stories focused on type 2 diabetes the LATimes incorporates a PearlieMaes style of investigation of multiple studies that reached similar conclusions. One of the reasons we love the LATimes is reporting that goes beyond the obvious to real reporting. The National Heart, Lung, and Blood Institute's (NHLBI) "Multi-Ethnic Study of Atherosclerosis (MESA) - (which) investigated the prevalence, correlates, and progression of subclinical cardiovascular disease (CVD) and risk factors that predict progression to clinically overt CVD, and that predict progression of subclinical disease itself, in a population-based sample of 6,800 ethnically diverse men and women."

The green elements of the solution to our health issues include a "Whole Foods" philosophy of using products and produce locally produced to reduce the transportation and energy cost associated with bring items from longer distances to reduce our carbon foot print. Less expenses mean more savings in our pockets and to our planet. Its easier being green than you thought when we think and better plan.

We're Not Number 1! We're Not Number 1!

Maybe to ABC News health care is a game that can be won or lost. When they treat health care as something with a scorecard they ignore the report. While we as a jurisdiction may be ahead of the curve none of us as a nation are winning.

Oh, sure Maryland is ahead of District of Columbia and Virginia it doesn't mean Maryland's got the best care in the US. All the jurisdictions are above the norm and better than most in the situation and in this game that's not saying a whole heck of a lot. As you would expect Virginia is better than the DC when it comes to health care. In a game of health its more disease care than health. We're number twenty-six (26) with a bullet. We're number twenty-six! Doesn't just fall off the tongue does it?

• District of Columbia    Overall   -   26
• Maryland   Overall   -   17
• Virginia   Overall   -   22

"The Commonwealth Fund (CF) is a private foundation that aims to promote a high performing health care system that achieves better access, improved quality, and greater efficiency, particularly for society's most vulnerable, including low-income people, the uninsured, minority Americans, young children, and elderly adults."

We recommend that you read the original report from the CF. "Among the states that moved up the most in the overall performance rankings, Minnesota rose within the top quartile to become the fourth-ranked state, with significant improvement on multiple indicators. In three states—Arkansas, Delaware, and West Virginia—plus the District of Columbia, at least half of the performance indicators improved by 5 percent or more. Leading states set new benchmarks for 20 of the 35 indicators with trends."

2009 Ranking	Revised 2007 Ranking
1   Vermont     2   Hawaii     2   Iowa     4   Minnesota     5   Maine     5   New Hampshire     7   Massachusetts     8   Connecticut     9   North Dakota    10   Wisconsin    11   Rhode Island    12   South Dakota    13   Nebraska	1   Hawaii     2   Vermont     3   Iowa     4   Connecticut     5   New Hampshire     6   Massachusetts     7   Maine     8   Rhode Island     9   Minnesota    10   Nebraska    11   Wisconsin    12   North Dakota    13   South Dakota

There is room for improvement across all states.
"All states have substantial room to improve. No state ranked in the top quartile across all performance indicators. On some indicators, even the top rates are well below what should be achievable. In each of the states with the highest overall rankings, several indicators declined by 5 percent or more; each also had some indicators in the bottom quartile or half of performance. At the same time, in each of the lowest-ranked states, there were certain areas of performance that improved—some quite significantly."

Week 39 Flu Deaths

Can you imagine that the District of Columbia Department of Health still maintains that there is only one confirmed case of the H1N1 swine flu virus and they have completely removed the number zero number of deaths? While the Center for Disease Control and Prevention (CDC) maintains that: "The proportion of deaths attributed to pneumonia and influenza (P&I) based on the 122 Cities Report has increased and now exceeds what is normally expected at this time of year. In addition, 19 flu-related pediatric deaths were reported this week."

That the DC Department of Health (DCDOH) hasn't released a press release this month it shouldn't be surprising that the source for information in the city is less than current. It shouldn't surprise us that the nation's capital city is considered twenty-six (26) in the United States for health care when compared to the other fifty (50) jurisdictions.

Twenty-six (26) according to who: "The Commonwealth Fund (CF) is a private foundation that aims to promote a high performing health care system that achieves better access, improved quality, and greater efficiency, particularly for society's most vulnerable, including low-income people, the uninsured, minority Americans, young children, and elderly adults."

Pneumonia/Flu Deaths	2009	2008	2007
District of Columbia	94	60	44
Baltimore, MD	585	618	507
Richmond / Norfolk, VA	179	167	175

Is it all bad news? No, there is still cause for hope - we asked the DC DOH for their plans but according to the same CF DC was: "Among the states that moved up the most in the overall performance rankings..." Should we celebrate? No DC still has one of the "highest mortality rates" and "(r)eadmission rates in 2006–07 ranged to highs of 21 to 23 percent in the worst-performing five states" which includes DC.

Need a procedure? Worried about the costs? You might consider number seventeen (17) - Maryland. "By 2008, only three states (Colorado, New Jersey, and Maryland) had premiums averaging under 14 percent of median income." Virginia might have the reputation as the better care system but independent evaluations finds more to praise Maryland for than the Old Dominion.

Virginia was ranked but see if you can discover any praises for our southern neighbor. We were unable to mine any praise other than its twenty-second (22) better than Washington rank. It's number two but according to the Commonwealth Fund number three (DC) tries harder.

Be informed. Stay informed.

Doctor Fool - Fool Patient

Doctor, Don't Treat Thyself
"A physician who treats himself has a fool for a patient."—Sir William Osler

More old news - we were looking for some video of a local physician posted on the web to which we could link this story and warn against self diagnosis. We found something in time from Little Rock but that's not this jurisdiction. We thought that even though the doctor looks and sounds competent you might NOT have thought so. Dr. Robert Hopkins, UAMS We are NOT saying that this doctor or any doctor is a fool! Repeat we are NOT saying that Dr. Hopkins is a fool!

The Associated Press (AP) and every other news outlet reported: "Microsoft Corp. unveiled the site Wednesday at H1N1ResponseCenter.com. Type in your age — it's only for people over 12 — and answer questions about fever, other symptoms and your underlying health. The program may conclude you've probably got swine flu — known as the 2009 H1N1 strain — but that rest and fluids should be enough care, or that you need a non-emergency call to your own doctor."

For some reason, maybe its the power of the Microsoft dollar but the stories didn't mention all of the other "fix-yourself" sites nor did the mention the dangers. Here's our quick find of such sites followed by our caveat. eCureMe's Self-Diagnostic Center, YourDiagnosis asks questions about every body system. No symptom will go undetected. Your allergies, medications and immunizations are recorded.

DON'T DO IT - If you think you're sick - you're sick! Are you the type of person who are constantly ill? If you are it's doubtful that you'll ever self-diagnose because you're sick and tired of doctors and hospitals. The Microsoft site asks if its for you or someone else so it maybe possible to diagnosis a hard headed friend.

We support and agree with WrongDiagnosis.com: "Self diagnosis is a dangerous practice. In fact, it is one of the most likely ways to get a misdiagnosis, which is the one thing we want to avoid. We recommend you always seek prompt professional in-person medical advice from your local qualified medical professional. In practice, self diagnosis is common for many of the most common symptoms and ailments. When you feel the symptoms of a common cold coming on, you don't always rush to the doctor to confirm it. We nevertheless urge you to consult with your doctor about any symptoms, particularly if there is any doubt or concern, or if the symptoms concern a child, infant, elderly, ill, infirm, pregnant, or otherwise at-risk patient."

What we are is an educational service and you're probably already inclined to use such a service anyway. So if you must - here's the link. We took the test and said we had a fever over 100.4 degrees - what they don't tell you is that you need the following information including a thermometer: "Enter your zipcode, your sex - Male or Female? Your age - How old are you? How many days have you felt like you might have the flu? (With the following limited choices - 24 hours or less, 1-2 days, 2-3 days, 5 or more days). Has your temperature been higher than 100.4º F (38º C) within the last 24 hours? Do you have a cough or a sore throat? Is it hard to breathe, or do you feel short of breath, since you got sick? Can we store and share your answers with health officials and researchers?"

Our fake results brought this answer - "Based on your answers, you probably have the flu and you might be very sick. Call your doctor now! Call your doctor now. Tell your doctor you might be very sick from the flu. Ask if you need to be seen right now. If you need to be seen right now, ask your doctor where to go (doctor's office, walk in clinic or the emergency room). When you see the doctor, ask if you need medicine for the flu. If you can't reach your doctor, go to the emergency room. If you think you have an emergency, call 9-1-1."

The cost of health care and the cost of vigilance is an increasingly expensive health care system. That's a legitimate cost which IF it resulted in our receiving the best care with us being the healthiest citizens in the world would have to be addressed in a more than cost cutting fashion. We don't have the best health care in the world because we have too many dead citizens. What we do have are individuals seeking to make our system better. That's the American way - that we can and must be number one!