Wednesday, May 20, 2009

What are the doctors / pediatricians reading ?

Here is what we doctors are reading in April 2009

Top 10 Most Read Articles by Pediatricians:
1. Rocket Fuel Chemical Found in Infant Formula
CDC scientists find perchlorate in samples of powdered infant formula.
2. A 5-Year-Old Boy With an Abnormal Left Eye
3. Adenoidectomy and Tonsillectomy Linked to Subsequent Overweight in Children
4. Clinical Assessment of the Crying Infant Should Guide Decision Making
5. US Declares Swine Flu Emergency
6. Cephalosporin Use in Treatment of Patients With Penicillin Allergies
7. Presentation, Prognosis, Treatment of Most Common Newborn Rashes Reviewed
8. Parenting Practices and ADHD
9. AHA Updates Advice on Strep Throat, Preventing Rheumatic Fever
10. Pacifier Use May Not Adversely Affect Breast-Feeding Duration or Exclusivity

Top 10 Most Read Articles by All Physicians:

1. Efalizumab Withdrawn From US Market
Efalizumab (Raptiva), used for the treatment of psoriasis, will no longer be available in the United States because of the risk for progressive multifocal leukoencephalopathy.
2. Hidden Malpractice Dangers in EMRs
3. The Case of the Missing Shaving Blade!
4. US Declares Swine Flu Emergency
5. Stimulus Package Could Convert More Physicians to EHRs
6. Dealing with the "Disruptive" Physician Colleague
7. A 5-Year-Old Boy With an Abnormal Left Eye
8. Progressive Neurologic Deterioration in a 23-Year-Old Man
9. WHO Raises Pandemic Level for Swine Flu, Mexican Death Toll Mounts
10. Less Is More: Simplified 4-Step Algorithm Improves BP Control

These articles are from Medscape from WebMD and may require free registration for viewing.
I specifically enjoyed tonsillectomy, crying infants, and newborn rashes amongst the articles for pediatricians, and the article on BP control among the physician read articles.

Monday, May 18, 2009

The Three C's of Medical Marketing

The other day I had a very interesting experience with a pharmaceutical company representative from a leading Indian Vaccine manufacturing company.
He came to me, and showed me a document, extracted from the WHO website, claiming that their Tetanus vaccine was the ONLY WHO approved Tetanus vaccine in India.
After looking at the document, I pointed out that the same document clearly showed that this was not true, and another older Indian Vaccine Company also had WHO approved Tetanus vaccine!
He coolly said, “Sir, but our vaccine is Air couriered to the destination, whilst there vaccine comes from Land Transport!”.
This was quite beside the point and I told him so. Similar misleading statements / outright lies have been made by other Medical Representatives.
At this point of time, I said, “ I believe that all Med Reps go to the same school, wherein you are told to change the topic / confuse the doctor as soon as you are caught out”.
He smiled and revealed a trade secret, he said, “Sir, it is the case of 3 C’s”.
What are these 3 C’s?
CONVINCE a Doctor.
If that does not work CONFUSE him.
And if that fails too, CORRUPT him, by offering incentives to him.
I found this amusing and worrying at the same time, like many truths, I suppose.
Is this how one of our most closely allied profession views us?
And more importantly, are they wrong?
Isn’t it we who have helped create this image?

Saturday, May 16, 2009

Reducing pain during vaccination - order of vaccines may make a difference too!

The commonest cause of induced pain in infants is due to multiple vaccines being given by the pediatrician.
This excellent study shows that infants given DTaP combination vaccine BEFORE the Pneumococcal Pneumonia vaccine, have less pain than those who are immunized in the reverse order.
Given the fact that both these vaccinations are being routinely administered by pediatricians in India, I think this is a really useful study that can change office practice.
I would be interested in knowing if this holds true for the normal DPT vaccine too. Also would this hold true if any other vaccine (like Inj Polio) is given separately too.
I guess that would have to wait for another study though!
As far as I am concerned, I would be giving the DTaP BEFORE any other vaccination if more than one injections are needed.

Sunday, May 03, 2009

All the brouhaha about swine flu

How important is Swine Flu really?

Is it likely to be a pandemic?

Is it going to kill millions of people like the infamous flu pandemic of 1918?

Unfortunately no one has the answers. Lots of speculations, guesses, and opinions. However a few regularly asked questions that have specific answers are what I am going to answer here, and provide a couple of excellent resources for self reading.

What are the symptoms of Swine Flu? Symptoms include at least 2 of the following:

  • Rhinorrhea or nasal congestion;

  • Sore throat;

  • Cough; and

  • Fever.

In addition, persons with swine flu may have other typical symptoms of influenza, including body aches, headache, chills, fatigue, and possibly diarrhea and vomiting.

Can you get this from eating cooked pork? No.

Can my pets get this? No.

Should I avoid traveling to swine flu affected areas at present ? Yes if you can avoid it.

Should I postpone my trip to US/ Mexico? It's too soon to know; follow travel-advisory information from the CDC closer to the event.

Will there be a vaccine? Work is under way to make a safe and effective vaccine that hopefully will be available by next flu season.

Is there enough medication? For those who may truly need it, yes, but most infected persons in the United States & worldwide (except Mexico) have not required intensive medical intervention.

What should I do to protect myself and my family? Take these everyday steps to protect your health:
  • 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 for 7 days after your symptoms begin or until you have been symptom-free for 24 hours, whichever is longer. This is to keep from infecting others and spreading the virus further.
    • Is the nation/state/city prepared for a pandemic? Public health authorities are more prepared than ever before, supported with some (more is needed) government funding and shaped over time by events, including the 1918 flu disaster, 2001 anthrax attack, the ongoing threat of avian flu, and Hurricane Katrina. The global community, however, is far from ready.
Is it time to panic? It is never time to panic. While it's no surprise that a circulating, airborne, invisible virus causes anxiety for many, panic serves no useful role in public health.

I am planning to travel to USA, what should I do? Avoid it if possible, otherwise take regular precautions like washing hands, covering mouth and avoid crowded places and report to a doctor if you have flu like symptoms. Talk to your doctor about carrying Tamiflu as a preacutionary measure if traveling to an area with high incidence of Swine Flu.

Should I take prophylaxis with TAMIFLU if am traveling to the USA? Chemoprophylaxis is recommended for 7 days after the last known exposure to a confirmed case of swine influenza A (H1N1) virus. The CDC recommends that the following populations receive chemoprophylaxis:

  1. Household close contacts of a confirmed or suspected case who are at high risk for complications of influenza (persons with certain chronic medical conditions, elderly).

  2. School children who are at high risk for complications of influenza (persons with certain chronic medical conditions) who have had close contact (face-to-face) with a confirmed or suspected case.

  3. Travelers to Mexico who are at high risk for complications of influenza (persons with certain chronic medical conditions, elderly).

  4. Border workers (Mexico) who are at high risk for complications of influenza (persons with certain chronic medical conditions, elderly).

  5. Healthcare workers or public health workers who have had unprotected close contact with a person with confirmed swine influenza A (H1N1) virus infection during the infectious period. (Detailed guidance on this topic is available at

So the answer to that question is NO, if you are a healthy person traveling to USA, you may not take prophylaxis, because the risk of serious disease is virtually negligible.

What is the dose for Tamiflu? Tamiflu is NOT recommended for children less than 1 year. While a syrup form is available in the USA, I believe that none is available in India.
The dose is 2.5 mg/kg twice a day for treatment, while it is 2.5 mg/kg once a day for prophylaxis. For adults the dose is 75 mg once a day for prophylaxis and twice a day for treatment.

Here are a few excellent resources that will provide updated information about Swine Flu.

Medscape Resource Center for Clinicians

CDC Swine Flu Website


UPDATE: NEJM has created a new center of H1N1 virus, the one causing Swine Flu. You can get latest news about this here
NEJM H1N1 Influenza Center