Faculty Bibliography

My answer was always the same. 'No. Tamiflu is an antiviral drug that has not yet been proved effective against bird flu. And even if it worked, there's still no bird flu to treat.' The facts are these: The current H5N1 avian influenza virus has not mutated into a form that can easily infect humans, and the 60 people in the world who have died of this bird flu have done so not because this bug is on the road to mutation but because millions of birds throughout Asia have been infected, and the more birds that have it, the more likely that an occasional human bird handler will be infected. With bird flu, scientists have been working on the structure of the viruses in an attempt to protect us. Studies published in the journals Nature and Science over the past six years have given scientists a road map with which to track the current bird flu and alert health officials if it mutates further. It is reasonable to try to control the bird flu while it remains in the bird population. There is great value in improving our emergency health response system and upgrading our vaccine-making capacity. Government subsidies in these areas could make the public safer

The avian flu virus, or H5N1, has killed millions of birds in China and Russia, either directly or because they've been destroyed to prevent its spread. The virus has infected around 112 humans, fewer than 60 of whom have died. Despite the small numbers, public health officials in Russia, Germany, and the United States -- along with the media -- have loudly sounded the alarm: Avian influenza is about to transform into a massive human killer that could kill 50 million to 100 million people. Yet the science behind all the worry is questionable. It rests on the unproven claim that the avian flu will develop exactly like the strain that caused the flu pandemic of 1918. A March 2004 article in Science showed that the 1918 flu -- which infected close to a billion people and killed 50 million or more -- made the jump from birds to humans through a slight change in the structure of its hemagglutinins, the molecules by which the virus attaches itself to body cells. This mutation allowed the virus to kill more World War I soldiers than weapons did, effectively ending the war when forces on both sides became too sick to fight. I recall one patient who was filled with fear about West Nile virus, SARS, mad-cow disease, bird flu -- everything that came down the media pike. He extended this worry to every test a doctor ordered for him. When I took over his care, it took me a long time to learn how to inform him without scaring him. Gaining his trust meant being careful not to sound false alarms

Anabolic steroids were developed in the late 1930s, primarily to treat hypogonadism. Scientists discovered these steroids caused muscle growth in animals, which led to use of the compounds by bodybuilders. In Germany in the 1930s, experiments were conducted on dogs; steroids were subsequently given to German soldiers and prisoners during World War II. In the 1950s, Russians began to dominate the sport of power lifting, and it was shown that most of these athletes were using steroids containing testosterone. An American physician, Dr. John Ziegler, then created a selective form of anabolic steroids that was available on the open market. Not all bulking up comes from anabolic steroids. Human growth hormone, which is made by the pituitary gland in the brain and does not contain sex hormones or steroids, can cause increased muscle mass and weight gain. [Gary Wadler] says that one of the main motivations for abusing synthetic human growth hormone is that no urine tests exist, so a user may elude detection. There is a blood test for growth hormone but it's rarely used and is not mandated in professional sports. The only true medical indication for growth hormone is a deficiency in either childhood or adulthood. Studies have shown that the unregulated use of the drug as an anti-aging agent carries an increased risk of developing diabetes

Even if we accept the Spanish flu scenario, health conditions in 1918 were far worse in most of the world than they are now. Many people lived in squalor; 17 million influenza deaths occurred in India, versus about half a million deaths in the U.S. There were no flu vaccinations, no antiviral drugs, and containment by isolating infected individuals wasn't effective, largely because of poor information and poor compliance. Today's media reach could be a useful tool to aid compliance. Of course, the concern that air travel can spread viral infections faster may be valid, but infected migratory birds were sufficient in 1918. With bird flu, scientists have been working on the structure of the viruses in an attempt to protect us. Studies published in the journals Nature and Science over the last six years have given scientists a road map with which to track the current bird flu and alert health officials if it mutates further. It is reasonable to try to control the bird flu while it remains in the bird population. There is great value in improving our emergency health response system and upgrading our vaccine-making capacity. Government subsidies in these areas could make the public safer

The facts are these: The current H5N1 avian influenza virus has not mutated into a form that can easily infect humans, and the 60 people in the world who have died of this bird flu have done so not because this bug is on the road to mutation, but because millions of birds throughout Asia have been infected, and the more birds that have it, the more likely that an occasional human bird handler will be infected. With bird flu, scientists have been working on the structure of the viruses in an attempt to protect us. Studies published in the journals Nature and Science over the last six years have given scientists a road map with which to track the current bird flu and alert health officials if it mutates further. It is reasonable to try to control the bird flu while it remains in the bird population. Photo: ASSOCIATED PRESS / Romanian health workers carry domestic birds in Ceamurlia de Jos, Romania, to be slaughtered. Romania's first suspected bird flu cases were reported Friday and some 40,000 birds are being slaughtered. Authorities are giving thousands of people a standard flu vaccine to prevent them from getting human flu. Laboratories have not confirmed bird flu, let alone the presence of the H5N1 strain that experts are tracking. Experts fear the bird flu could mutate to become a dangerous human virus

Tysabri, which was a promising treatment for multiple sclerosis, Crohn's disease and rheumatoid arthritis - devastating illnesses that affect millions of people - appears to have led to two cases of deadly progressive multifocal leukoencephalopathy. The correct decision is to return the drug to the laboratory and look for a way to reintroduce it safely to the market,

'No. Tamiflu is an antiviral drug that has not yet been proved effective against bird flu. And even if it worked, there's still no bird flu to treat.' The facts are these: The current H5N1 avian influenza virus has not mutated into a form that can easily infect humans, and the 60 people in the world who have died of this bird flu have done so not because this bug is on the road to mutation but because millions of birds throughout Asia have been infected, and the more birds that have it, the more likely that an occasional human bird handler will be infected. For one thing, direct comparisons to the Spanish flu of 1918, a scourge that killed more than 50 million people worldwide, has alarmed the public unnecessarily. In fact, there are many scenarios in which the current bird flu won't mutate into a form as deadly as the 1918 virus

At a time when drug safety is being questioned, and side effects of common drugs are often magnified, it is reasonable to question whether antidepressant medications are being properly utilized. Depression and anxiety are prevalent in an internist's practice, and in fact generalists diagnose and treat most of these conditions. The art of medicine is helping a patient distinguish between a sad mood and a clinical depression requiring medication. And with depression, the effects of the illness are often more severe than the side effects of the drug being considered

Prescription drugs have certainly been taking a hit lately in terms of public perception. Drug safety has become a popular topic, and many classes of drugs, from COX-2 inhibitors to psychiatric drugs like SSRIs and Adderall, for ADHD, have been repeatedly criticized. Any substance, whether in pill or herbal form, has an effect on the body and must be studied. It is wrong to assume that a prescription drug is automatically toxic, while untested alternative medicines are presumed safe