Public Health Policy = Incessant Dysfunction

It is hard to contain the anger and disappointment we felt this week after taking the pulse of science and media. There were so many dismaying story lines that it was hard to encapsulate them into one commentary. Part of us vehemently dislikes making you aware of this incessant dysfunction. But simply, we feel that it has always been our job as public health professionals to bring you the truth, however disappointing it may be, so that you and your family can make the best, most educated health care decisions. Bonnie and Steve

Number Flu Deaths Reported Are Too High Says CDC.
36,000 - you have seen this number every year for decades in connection with flu deaths. This is the number the CDC trots out every year to scare the public into lining up to get the flu vaccine. As we have said for over two decades, this number is grossly overestimated. In fact, it really exposes the CDC's entire flu policy. This administration said it would really push hard for transparency, and in this case it is true. We are shocked the CDC released this data because they have hung their hat on 36,000 for so long.

The mean average deaths from 1976-2007 was 23, 607, 90% of those occurring in persons 65 and over. Every year was different depending on the dominant influenza strain. The lowest number of deaths was 3,349 and the highest number was 48,614.

What is startling is that if you look at the chart which lists deaths year by year, the number of deaths are much higher on average between 1997 to present. Alarmingly, this coincides with the CDC's recommendations to increase the number of Americans being vaccinated, not just the elderly. Furthermore, the flu strain believed to cause the highest rate of flu deaths from year to year (influenza A H3N2) has been most prevalent from 1997 to present.

This begs the question: if the number of vaccinated Americans has steadily increased during this period, and the H3N2 strain was included in each year's vaccine, why does it continue to be so deadly?

Dr. David Shay of the CDC's National Center for Immunization and Respiratory Disease said it best at his news conference: "Flu really is unpredictable. H3N2 mutates more rapidly. Even if you have been sick with it in the past, you are more likely to get a subsequent infection." Shay went on to say that there is no way to tell when flu season begins - or even a few weeks into the start of the season - which strain will predominate.

This is a disturbing comment because the World Health Organization is responsible for deciding (or should we say predicting) which strains will go into the flu vaccine nine months to a year before the flu season actually begins.

At the press conference, nobody pushed Dr. Shay on the H3N2 issue: if the strain is added to each year's vaccine formula, why does it still cause more deaths? Shouldn't we become more immune? If we go by Dr. Shay's initial comment that H3N2 mutates so rapidly from year to year that it is near impossible to catch to it, what does that say about the flu vaccine program?

Morbidity and Mortality Weekly Report 8/27/2010

FDA Review Finds Antidepressants Only Marginally Efficacious Compared With Placebo and "Document Profound Publication Bias That Inflates Their Apparent Efficacy."
We take great umbrage with the tardiness in which the FDA made this statement. Not to mention that while Reuters reported on this, it received very little mass media attention.

When the researchers analyzed the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial, the largest antidepressant effectiveness trial ever conducted, they found that "the effectiveness of antidepressant therapies was probably even lower than the modest one reported...with an apparent progressively increasing dropout rate across each study phase."

The researchers found that out of the 4041 patients initially started on the SSRI [selective serotonin reuptake inhibitor] citalopram in the STAR*D study, and after 4 trials, only 108 patients had a remission and did not either have a relapse and/or dropped out by the end of 12 months of continuing care.

"In other words, if you're trying to look at sustained benefit, you're only looking at 2.7%, which is a pretty jaw-dropping number," added lead author Dr. Ed Pigott. Overall, "the reviewed findings argue for a reappraisal of the current recommended standard of care of depression," write the authors. "I believe there are likely some people where [antidepressants] are truly beneficial beyond placebo. The problem right now is that we simply have no way of knowing who those people are," noted Dr. Pigott. "My hope is that this kind of analysis creates 'more oxygen' for looking at other kinds of approaches to treatment." The study was published in the August issue of Psychotherapy and Psychosomatics and was passed along to officials at the Food and Drug Administration.

How will the public react to the fact that the billions of dollars they have spent on antidepressants do little more than placebo in most? It is hard to react when the story is non-existent. This topic is especially frustrating when we know there are natural alternatives to antidepressant therapy.

Giving Up Gluten To Lose Weight? Not So Fast.
Diet Is Effective in Treating Celiac Disease, Wheat Allergies, But Not for Shedding Pounds
This story by Melinda Beck of the Wall Street Journal made our blood boil. The article said people can gain weight on a gluten free diet with no evidence to back up her statement. I am quite certain that if you ever got to the bottom of who pitched the idea for this article, the Wheat Council would be our first guess.

During meetings of the new USDA Dietary Guidelines Committee, they discussed focusing more on fruit and vegetables and less on grains. The two committee members vehemently against this recommendation had ties to the dairy and wheat councils. When wheat and corn growers found out what the committee was discussing, the hate mail started flowing in like a tidal wave. Thus, you will probably not see any changes in this regard, even though the committee knows that nutritionally it's the best thing to do.

We would like to know how you feel after digesting these topics. You can comment below.