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November 12th, 2009
01:41 PM ET

H1N1 vaccine safe with egg allergy?

As a feature of CNNhealth.com, our team of expert doctors will answer readers' questions. Here's a question for Dr. Gupta.

From Kali in Florida:

My 4-year-old daughter has egg and peanut allergies. Can she still take the H1N1 vaccine? If not what are her choices. I've been getting conflicting answers.

Answer:

Kali thanks for writing in. We’ve received several questions like yours since the H1N1 vaccine became available. Let me start by saying that if your daughter has a true egg allergy, and not just a sensitivity, then she can not have the H1N1 or the seasonal flu vaccine. The two types of H1N1 vaccine, the shot and the nasal spray, are made with eggs so it is not recommended for people with severe egg allergies.

However, allergists we spoke with said people with mild reactions to eggs can get vaccinated. Keep in mind that the amount of egg protein in a vaccine is often less than you would find in most baked goods. So if your daughter has been able to eat bread or cake, she may have a more mild allergy.

Consider going to an allergist and ask about getting a skin-prick test. The allergist will have a diluted and non-diluted version of the vaccine. Their first step will be to do the skin-prick test with the undiluted version. If your daughter does not break out in hives or have a strong reaction, then she can have a stronger test with a small, diluted injection. If your child doesn’t have a strong reaction to that test, then her allergy may not be severe and your allergist may give her a flu shot.

If your child does have a strong reaction and your doctor believes she shouldn’t get the flu shot, then talk with your health care provider about strategies for keeping her healthy. These steps are basic hygiene, such as washing hands for the count of singing the “Happy Birthday” song twice and staying away from sick friends plus, avoid wiping your eyes and touching your face if possible.

I hope this helps and your daughter has a flu-free season


Filed under: Allergies • Expert Q&A • H1N1 Flu • H1N1 Flu Vaccine

November 11th, 2009
02:06 PM ET

The changing debate over medical marijuana

By Stephanie Smith
CNN Medical Producer

The national conversation about medical marijuana - in particular smoked marijuana - is complex and often polarizing.

I liken it to having a conversation with my father-in-law about politics/race/religion/poverty/health care – you name it. We start off meaning to have dignified conversation, but we inevitably spiral into growling matches peppered with words like, “those liberals…” and “c’mon, you’re smarter than that…” or “that’s crazy! That’s insane.” In reality, we are not so far apart on the issues, but somehow we can muddy the conversation so that it seems like we are.

The medical marijuana debate has been historically cast in equally polarizing terms: Groups are either for or against legalizing it.

That is what makes a subtle, nuanced move by the American Medical Association at a board meeting on Tuesday such a remarkable twist in the dialogue. The AMA shifted a 72-year-old policy about smoked marijuana, acknowledging that there could be some medical benefits, and urging reconsideration of the drug’s Schedule I status (Schedule I is a drug of abuse with “no accepted medical use.” Heroin and ecstasy are also Schedule I).

The AMA’s new policy language suggests that “marijuana’s status as a federal Schedule I controlled substance be reviewed with the goal of facilitating the conduct of clinical research and development of cannabinoid-based medicines.”

What that means is that marijuana should be reconsidered as a Schedule I drug so that wider studies can be conducted that may establish that it is worthy of prescription drug status.

The organization is quick to add that it is by no means endorsing state-based cannabis programs or legalization. It also does not go as far as to say there is evidence that cannabis meets the rigorous standards met by prescription drugs on the market now – yet.

But that “yet” is key. What the new policy - and a forthcoming study - concede is that several short-term trials have shown that smoked cannabis is effective to treat neuropathy (nerve pain) in patients with HIV and hepatitic C. It is also effective, again, in a small number of trials, for stimulating appetite for people on chemotherapy; it may also be useful for patients with multiple sclerosis, to ameliorate pain and spasms.

The idea behind this policy shift is to widen the berth of studies about smoked marijuana, and to conduct them in a controlled manner, just as is done with prescription drugs, so that the debate can quiet down and give way to scientific evidence.

Now if only I could quiet down those debates with my father-in-law.

What do you think about the AMA’s new position on medical marijuana? Do you agree that it should be taken off of Schedule I status to make way for more studies in this area?

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.


November 9th, 2009
12:18 PM ET

The Wall and health care

By Miriam Falco
CNN Medical News Managing Editor

20 years ago today, the Berlin Wall began to come down. I vividly remember standing in the CNN newsroom with tears rolling down my cheeks, watching images of people crawling on top of the wall. It was something I never imagined I would see, having spent the first half of my life growing up in West Berlin. Now a lot has happened in the past two decades – on both sides of the pond. But one of the things that sticks in my mind as a person, as the journalist in me continues to cover health reform in the U.S., is that growing up as a child in West Germany, I always had health insurance. Now it wasn't the upper-echelon, "you'll get a private room in the hospital" kind of coverage. But if my siblings or I were sick, we went to the doctor – it was as simple as that. Not so in the United States, where over 45 million Americans lack any kind of health insurance and many million more may be covered, but are one major illness away from bankruptcy.

The reunification of Germany didn't come cheap and the German government is facing fiscal crises too, including a health care system that is going broke. But as the years have gone by my friends in Deutschland who needed treatment for cancer or multiple sclerosis or the common cold – got it, no matter if they had a job or not. Now the U.S. Senate has been tossed the health reform hot potato, after the House of Representatives narrowly passed its health care bill this weekend. We’ll see what happens next.

Do you think every American has a right to health coverage? Or does the ongoing political battle cause your eyes to glaze over? Tell us what you think.

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.


November 6th, 2009
02:46 PM ET

The echoing pain of traumatic news events

By Caleb Hellerman
CNN Medical Senior Producer

Yesterday I gave a short talk at a meeting for psychologists and others who work with people suffering from psychological trauma. Our panel was about how the media handles stories about mental illness. It’s a topic that felt especially poignant a few hours later, when a gunman shot and killed at least a dozen soldiers at Ft. Hood, a U.S. Army post in Texas. The alleged gunman: a military psychiatrist. At this point we don’t know what led to the shooting – was it a premeditated terrorist attack? A case of workplace rage? Was the gunman unhinged by fear of his upcoming deployment? Did he suffer some kind of a breakdown after hearing too many stories from traumatized soldiers?

Those are mysteries we’ll have to unravel in the coming days. What’s clear is that many people at Ft. Hood – a virtual city of more than 30,000 people – have just been through a terrifying experience. That doesn’t mean they'll develop a pathological condition – like post-traumatic stress disorder – but especially if they witnessed the shootings or lost loved ones, they are at risk for lasting problems.

Beyond that, news coverage of a violent event can itself be deeply painful for readers and viewers, especially if they’re trying to recover from an unrelated trauma of their own. At our panel yesterday, people raised some issues that I hadn’t much thought about. Reader comments, for instance. Two clinicians pointed out that people sometimes post hurtful comments online, which can re-traumatize the people being written about – for example, a rape victim in a crime story.  A handful of news organizations, including CNN, moderate message boards and eliminate comments that are overtly offensive or full of profanity. But one very animated audience member – he described himself as a former reporter – said that’s not nearly enough. He thinks it’s a disgrace that any news organization would publish anonymous reader comments – that it only encourages damaging words.

What do you think? How should news outlets like CNN strike a balance between telling the story, getting feedback from you and not making life worse for the people we cover?


November 5th, 2009
10:52 AM ET

Should I be charged for the H1N1 vaccine?

As a feature of CNNhealth.com, our team of expert doctors will answer readers' questions. Here's a question for Dr. Gupta.

From Robert in Kansas:

“I heard this week that the H1N1 virus has now turned up in pigs. Does this mean it can get into our food supply and I’ll get sick if I eat it?”

Answer:

Great question. The U.S. Department of Agriculture did recently announce that a commercial herd of pigs tested positive for swine flu. The USDA continues to stress that you will not infected with the HIN1 virus from eating pork. In fact, the infected pigs in Indiana weren’t destroyed. Once they recover from the flu, they will go to slaughter according to the USDA. Officials experimentally infected pigs earlier this year to see whether their blood and meat also became contaminated. They concluded that the H1N1 virus stayed contained in the respiratory tract of infected pigs and the virus did not infect the meat. The World Health Organization and World Organization for Animal Health have also concluded that humans can not be infected with the H1N1 virus from consuming pork. For more information about H1N1 and food safety, click here.

From Cheryl:

“While at my doctor's office, I asked about the H1N1 vaccine. I was told it will be very expensive, like $300. Since I do not have health insurance, the expense of the H1N1 vaccine will factor into whether I get it.”

Answer:

$300 is an excessive amount to pay for a free vaccine! That’s right – it’s free. The federal government has purchased the H1N1 vaccine and is shipping it out to states free of charge. They’re even picking up the tab for the syringes, needles, sharps containers, and alcohol swabs. Centers for Disease Control and Prevention has also stated private clinics may not charge patients a co-pay or other out-of-pocket charges for the vaccine. The only thing you should be paying is perhaps an administrative fee for your office visit but in many cases that fee is being waived as well. I would double check with your doctor again on the price. If the office still attempts to charge you $300, I would decline and instead contact your state’s health department to locate public clinic administering the vaccines near you. You can also track the vaccine’s shipments in your state through the CDC’s Web site. Check it out by clicking here.


Filed under: Expert Q&A • H1N1 Flu • H1N1 Flu Vaccine

November 3rd, 2009
01:49 PM ET

Ramping up global efforts to defeat childhood pneumonia

By Andrea Kane
CNNhealth.com Producer

Last winter, I was told that my young daughter had walking pneumonia. Walking pneumonia? My mind, fueled by alarm, raced: What is walking pneumonia? (A very mild inflammation of the lungs.) Is it serious? (While it can become serious, it is not usually a problem and often heals on its own.) Is she going to be alright? (Of course.) She had very mild symptoms – a cough, a fever – and she wasn’t all that uncomfortable. Her pediatrician said some people let the walking pneumonia resolve itself (that’s how mild it is!), but that I might want to opt for a course of antibiotics. Not wanting to risk complications, and wanting to ease her symptoms sooner rather than later, I quickly agreed (antibiotic-opposed husband be darned). Thanks to access to medical care, my daughter was well within a couple of days; she and I quickly put the episode behind us.

The story ends differently for the more than 2 million children who die of pneumonia – walking pneumonia’s much more deadly cousin - every year. Save the Children, an international humanitarian organization, reports that pneumonia (which can be cause by bacteria, viruses, fungi or parasites) kills more children under 5 worldwide than measles, malaria and AIDS combined. Pneumonia accounts for 20 percent of all deaths in this - the youngest and most vulnerable – age group. That’s one child dead from pneumonia every 15 seconds. The vast majority of deaths – 98 percent – occur in South Asia and sub-Sahara Africa.

A great many of these deaths could be prevented with existing inexpensive vaccines or treated with inexpensive antibiotics. But the families of children in the 68 countries most affected by pneumonia either don’t know about available vaccines and antibiotics, don’t have access to them or can’t afford them. And that’s a tragedy.

But the flip side of tragedy is hope. Global health authorities, including WHO and UNICEF, are recognizing November 2 as the first-annual World Pneumonia Day and have outlined a six-year action plan to take the first steps in beating back this beast. The GAPP plan, as it is called, includes education, protection, prevention and treatment efforts, targeting both governments and individuals.

Dr. Bill Frist (the former U.S. Senate Majority Leader and a trustee of Save the Children) and Dr. Richard Sezibera (Rwanda’s Minister of Health) write in this week’s edition of The Lancet, “… lives continue to be lost from this preventable and treatable disease, and, until recently, there was little outcry.”

I for one am glad there is new attention being brought to bear on an old adversary. No parent should have to mourn the death of a child from a preventable and treatable illness.

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.


Filed under: Caregiving • Children's Health • Global Health • Parenting

November 2nd, 2009
12:30 PM ET

Deciding whether or not to get the H1N1 vaccine

By Rebecca Leibowitz
CNN Medical Intern

I had H1N1. It started with a cough, which quickly progressed to a headache, body aches and a 102-degree fever. A rapid flu test came back positive, confirming my diagnosis. Although this nasal swab test for H1N1 is not very reliable, so much so that it is no longer being used, I had all of the symptoms of the flu. H1N1 was pretty much the only strain circulating in late August, so chances are very high that I did indeed have it. I spent the next three days isolated in my apartment, pumping my body with vitamin C and chicken soup. Then I was fine. I felt great and I was no longer contagious; I could go to class, to the grocery store and to the gym without fear of infecting others. To my friends, I was finally “swine-free.”

My decision whether to be vaccinated against H1N1 has been made for me. Since I most likely already had H1N1, and therefore have built up immunity to the virus, I will not be getting a vaccination. However, millions of Americans are facing the decision of whether to vaccinate themselves and their children against the novel influenza A virus.

The Centers for Disease Control recommends the following high-priority groups get vaccinated: pregnant women; people who live with or provide care for infants younger than six months; health workers; people aged six months to 24 years old; and people 25-64 years old with certain pre-existing conditions.

So, when my mom told me that her doctor recommended she not get the H1N1 vaccine, I was confused. As a chronic Lyme disease sufferer (who is well under 64) and a social worker who works with very young children, my mom fits into one of the high-risk groups. Why, then, did her doctor advise her against getting it?

As I later discovered, there are several reasons why people are apprehensive about getting the H1N1 vaccination. My mom’s doctor told her that he did not see the evidence that the H1N1 inoculation protects one from getting the virus, a concern he also raised regarding the seasonal flu vaccine. This contradicts what the CDC has been saying for weeks. CDC Director Dr. Thomas Frieden recently told reporters that the vaccine should work very well because “it is an excellent match with the strains of the virus that are circulating.”

There is also widespread concern about the safety of the vaccine. During the 1976 swine flu epidemic in the United States, those who received the vaccine for that strand of swine flu were proven to have an elevated risk of contracting Guillain-Barré syndrome. Guillain-Barré syndrome is a disorder in which the body’s immune system attacks part of its nervous system. The most common complications from Guillain-Barré syndrome are breathing-related, and patients are often placed on respirators. The majority of people who contract the disorder recover, but it can be fatal.

The CDC says that it expects the H1N1 inoculation to follow a similar safety profile as the seasonal influenza vaccine, which has not been associated with increased risk of Guillain-Barré. Officials also say that this new pandemic vaccine is much “purer” than the 1976 inoculation. The expected side effects from the 2009 H1N1 vaccine are similar to those from the regular flu shot, including soreness or swelling at the point of injection, low-grade fever and body aches. The CDC and the Food and Drug Administration will be closely monitoring the safety of the immunization. The Vaccine Adverse Event Reporting System exists so that health care providers can report vaccine concerns directly.

And then there are those who think natural immunity is better and safer than any vaccine and are suggesting “swine flu parties” are the way to go – get yourself infected with H1N1 and your body will build up immunity. Most doctors and the CDC strongly advise against this method of protection.

What factors have influenced your decision whether or not to get the H1N1 vaccine? What advice has your doctor given you? Have you come to a decision whether to vaccinate you or your children?


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Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.

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