Sunday, April 26, 2009

Swine Flu, 04/26/2009

Investigation and Interim Recommendations:

Swine Influenza (H1N1)

CDC, in collaboration with public health officials in California and Texas, is investigating cases of febrile respiratory illness caused by swine influenza (H1N1) viruses. As of 11 AM (EDT) April 25, 2009, 8 laboratory confirmed cases of Swine Influenza infection have been confirmed in the United States. Four cases have been reported in San Diego County, California. Two cases have been reported in Imperial County California. Two cases have been reported in Guadalupe County, Texas. Of the 8 persons with available data, illness onsets occurred March 28-April 14, 2009. Age range was 7-54 y.o. Cases are 63% male.

The viruses contain a unique combination of gene segments that have not been reported previously among swine or human influenza viruses in the U.S. or elsewhere. At this time, CDC recommends the use of oseltamivir or zanamivir for the treatment of infection with swine influenza viruses. The H1N1 viruses are resistant to amantadine and rimantadine but not to oseltamivir or zanamivir. It is not anticipated that the seasonal influenza vaccine will provide protection against the swine flu H1N1 viruses.

CDC has also been working closely with public health officials in Mexico, Canada and the World Health Organization (WHO). Mexican public health authorities have reported increased levels of respiratory disease, including reports of severe pneumonia cases and deaths, in recent weeks. CDC is assisting public health authorities in Mexico by testing specimens and providing epidemiological support. As of 11:00 AM (EDT) April 25, 2009, 7 specimens from Mexico at CDC have tested positive for the same strain of swine influenza A (H1N1) as identified in U.S. cases. However, no clear data are available to assess the link between the increased disease reports in Mexico and the confirmation of swine influenza in a small number of specimens. WHO is monitoring international cases. Further information on international cases may be found at:

Clinicians should consider swine influenza infection in the differential diagnosis of patients with febrile respiratory illness and who 1) live in San Diego or Imperial counties, California, or Guadalupe County, Texas, or traveled to these counties or 2) who traveled recently to Mexico or were in contact with persons who had febrile respiratory illness and were in one of the three U.S. counties or Mexico during the 7 days preceding their illness onset.

Patients who meet these criteria should be tested for influenza, and specimens positive for influenza should be sent to public health laboratories for further characterization. Clinicians who suspect swine influenza virus infections in humans should obtain a nasopharyngeal swab from the patient, place the swab in a viral transport medium, refrigerate the specimen, and then contact their state or local health department to facilitate transport and timely diagnosis at a state public health laboratory. CDC requests that state public health laboratories promptly send all influenza A specimens that cannot be subtyped to the CDC, Influenza Division, Virus Surveillance and Diagnostics Branch Laboratory.

Persons with febrile respiratory illness should stay home from work or school to avoid spreading infections (including influenza and other respiratory illnesses) to others in their communities. In addition, frequent hand washing can lessen the spread of respiratory illness.

CDC has not recommended that people avoid travel to affected areas at this time. Recommendations found at will help travelers reduce risk of infection and stay healthy.

Clinical guidance on laboratory safety, case definitions, infection control and information for the public are available at:

* Swine Influenza A (H1N1) Virus Biosafety Guidelines for Laboratory Workers:
* Interim Guidance for Infection Control for Care of Patients with Confirmed or Suspected Swine Influenza A (H1N1) Virus Infection in a Healthcare Setting:
* Interim Guidance on Case Definitions for Swine Influenza A (H1N1) Human Case Investigations:

Morbidity and Mortality Weekly Reports Dispatch (April 24) provide detailed information about the initial cases at

For more information about swine flu:

Tuesday, April 14, 2009

Drug Dealers in a White Coat

Miami Herald, Letter To The Editor

Posted on Mon, Apr. 13, 2009
Public health should be legislative priority

Re the April 8 editorial Belatedly, Florida takes on prescription-drug dealers: The unprecedented concentration of ''pain clinics'' in our community contributes to out-of-control opioid abuse, narcotic-drug dealing and endangers public health. It requires the concerted efforts of law enforcement, political leadership and the medical community to root out this problem. Several steps can be taken right now:
• Impose a moratorium on dispensing narcotics in physician's offices unless the prescribing physician is board certified in anesthesiology and pain medicine and operates within a licensed and certified facility to be approved by a designated agency.

• Make mandatory monthly inspections of all pain clinics in South Florida. Skilled inspectors can be trained to randomly audit charts and on-site pharmacies and monitor patient flow.

• Conduct criminal background checks of all operators and their financial backers, which will be reviewed and updated quarterly.

• Implement a prescription-drug monitoring system to identify drug-seekers and doctor-shoppers.

• Require the Board of Medicine to suspend the license of any physician who violates the standards of care as it pertains to inappropriate prescription of narcotics.

Let's act together to rid our community of these narco-cowboys. Let's protect our families, friends and patients from such predators. We can't be afraid to call them by their name: drug dealers in white coats.

BERND WOLLSCHLAEGER, MD, president, Dade County Medical Association, North Miami Beach

Saturday, April 04, 2009

Every American is entitled to affordable healthcare!

Saturday, April 4, 2009

Letter To The Editor

“Every American is entitled to affordable healthcare!”

The Miami Herald Editorial Board is correct: every American should have access to affordable healthcare delivered by a physician of their choice. But expanding coverage only increases the volume of healthcare services and costs! This shortsighted focus misses the bigger picture.
We have to realign our payment system and reward quality and not the quantity of medical services rendered. The current reimbursement system is centered on a volume-based model and must shift towards a value-based system instead. We have to rebuild our primary care system and reward family physicians who spent valuable time with patients teaching healthy lifestyle and nutrition to prevent the incidence of chronic diseases. We should motivate and reward physicians to integrate their practices within collaborative practice models or groups. Utilizing shared Electronic Health Records based on Web 2.0 technologies physicians can communicate easily and securely. Such systems can measure and compare their performance, create a framework for quality and not quantity based reimbursement. Furthermore, physicians will learn to work within a team of medical professionals to optimize the treatment outcome for their patients.
As a result of the above outlined steps we can finally provide a Patient Centered Medical Home with a high degree of personalized care coordination, access beyond the acute care episode, and identification of key medical and community resources to meet the patients’ needs.
We as physicians have the choice to proactively change the delivery of healthcare today! We have the tools available to make this happen. Lets not miss this opportunity!

Bernd Wollschlaeger,MD,FAAFP,FASAM - President, Dade County Medical Association
16899 NE 15th Avenue, North Miami Beach, FL 33162
Phone: (305) 940-8717



Posted on Fri, Apr. 03, 2009
Health insurance out of balance

Among the many issues on America's healthcare-reform agenda, one deserving a high priority should be to level the playing field for people looking to buy health insurance. As it now stands, insurers have most of the advantages. Example: rejecting potential customers because of ''preexisting conditions.'' Congress and President Barack Obama should put a stop to this practice. Meanwhile, Florida Insurance Commissioner Kevin McCarty should ask the Legislature for reforms.
Patients blacklisted

In a Page One story last Sunday, Miami Herald reporter John Dorschner described how some insurers use secretive underwriting guidelines to blacklist people with certain ailments or who take certain drugs. For example, one insurer's guideline recommends rejecting people who have diabetes, multiple sclerosis, schizophrenia, Parkinson's Disease, Hepatitis C or AIDS/HIV. Other guidelines suggest automatic denial of people who take the anti-clotting drug Plavix or Seroquel, of those who use prescribed anti-psychotic medications, and anyone who uses certain medications for sleep apnea.

Insurers should not be expected to automatically enroll anyone who applies for a policy. They must be able to determine the amount of risk they are taking on in order to price policies appropriately and to earn a profit. Insurers also need to be able to protect themselves from people who lie about ailments in order to get coverage. At the same time, though, honest consumers should get a fair shake, which means not having to demonstrate a level of pristine health that virtually no one can attain. Without the right rules in place, insurers would cover only healthy people and have no risk at all.

Insurers say that their underwriting rules are based on standards set by the industry and by the state and federal governments. This is where change should begin. President Obama has said he wants to make insurance much more affordable and that having nearly 50 million Americans without health coverage is unacceptable. He stops short, however, of embracing universal healthcare.

A bit of progress

In December, some of the country's top insurers said they were willing to stop using preexisting conditions as a basis for pricing policies in return for laws requiring universal coverage. This, at least, is a start. Universal healthcare may, or may not, be the best solution, but it is clear that too many Americans have been squeezed out of the insurance market -- and that must change.

Commissioner McCarty can get the ball rolling by asking the Legislature to adopt underwriting guidelines that protect consumers. Congress should help President Obama make health insurance available to every American.