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Friday, October 31, 2014

Not All Halloween Candies Are Created Equal

Here’s a scary fact: One fun-size Snickers bar packs 72 calories ― but who’s stopping at just one, especially on Halloween? An infographic created by The Daily Meal illustrates just how many calories, grams of sugar, and grams of fat lurk in America’s 29 most popular Halloween treats. Where does your favorite rank?

For “healthier” candy options, check out the entire article at The Daily Meal.

 Click to enlarge


Thursday, October 30, 2014

You might owe your life to Maurice Hilleman. So why don’t you know who he is?

By Robyn Correll Carlyle and Jane Huston

Editor's Note: This article originally appeared on HealthMap’s Disease Daily on June 10, 2014. It has been reposted here with permission by the authors.

“If I had to name a person who has done more for the benefit of human health, with less recognition than anyone else, it would be Maurice Hilleman. Maurice should be recognized as the most successful vaccinologist in history.” -- Robert Gallo, co-discoverer of HIV 

When you think of famous names in immunization (assuming you’re a vaccinerd, and prone to thinking of such things), you probably think first of Edward Jenner, creator of the smallpox vaccine. The next name might be Jonas Salk, the celebrated scientist who developed the first polio vaccine. You might have to think for quite a while before Maurice Hilleman comes to mind… or you might be thinking Maurice Hille-who?

Maurice Hilleman, photo by Walter Reed
Army Medical Center via Wikimedia Commons
Yet Hilleman is a veritable superstar in the world of vaccines, with more vaccines to his name than BeyoncĂ© has #1 hits. While Hilleman never won a Nobel Prize or had his name in lights, he was revered by his peers in the scientific community and is credited for saving tens of millions of lives — maybe even yours.

And it all started on a farm in Montana.

Hilleman was born in 1919. Having lost his mother days after his birth, he was raised by his uncle and worked on the farm. He took an early interest in science and graduated first in his class at Montana State University with a degree in chemistry and microbiology. Later, he earned his doctoral degree in microbiology from the University of Chicago, where (fun fact) his graduate work led him to determine the true cause of chlamydia and laid the groundwork for discovering its treatment.

He helped develop his first human vaccine in 1944 to protect American soldiers overseas from Japanese encephalitis. The vaccine would eventually be replaced by others, but Hilleman was just getting started with what would be a long career in vaccinology.

We won’t tell you his full story — you can get the cliff notes here or a more detailed account in his biography. But trust us, it’s impressive.

He developed eight of the 14 currently routinely recommended vaccines and is the reason we are protected from measles, mumps, hepatitis A, hepatitis B, chickenpox, meningococcal disease, pneumococcal disease, and Haemophilus influenzae type B (Hib). Thanks to him, diseases that once claimed children’s lives or left them with severe disabilities are now largely a distant memory. During his career, Hilleman developed a total of 36 vaccines, making him perhaps the most successful vaccinologist in history.

So why haven’t you heard of him?

Hilleman was not one to brag. He didn’t name any of his discoveries after himself. He never sought recognition. He accepted praise humbly and quietly.

But perhaps the greatest reason why his name is largely unknown is because the successes that he achieved were silent. When public health practitioners do their job, the results look like… nothing. No one gets sick. Diseases don’t spread. Children don’t die. Life pretty much goes on as normal. But behind the scenes, there’s actually lot of work that goes into preventing kids from getting measles, or containing an outbreak of hepatitis A, or delivering clean drinking water to your home. All of those things are public health, and all of them are easy to take for granted.

And we have taken them for granted.

Right now, we’re in the midst of a cascade of vaccine-preventable disease outbreaks. Measles, a disease once declared officially eliminated from the United States, is popping up left and right. According to the CDC, there have been over 334 cases this year in the United States alone, the most in a single year since the disease was declared eliminated in 2000 — and we’re not even half way through the year yet. Ninety percent of those cases occurred in unvaccinated people or people with unknown vaccination status. Measles may not be circulating in the United States the same way it was pre-2000, but we’re still vulnerable to travelers importing the virus from other countries, as what’s happened so far in 2014 clearly shows.

That vulnerability is why it’s so important to keep our vaccination rates high, and to bring up coverage in any corners of this country where rates are low. Encourage your friends and family to check to see if they’re up-to-date on their vaccinations. If some of them have concerns, guide them to trusted, science-based resources like the CDC, World Health Organization or the American Academy of Pediatrics, and encourage them to speak with their primary care provider.

Every time you think, speak or advocate for measles immunization, you’re shining a little light on Maurice Hilleman and his amazing career. And while he may not have received as much recognition as he deserved while he was alive, we can still honor him and his accomplishments by protecting the hard-fought progress made in the fight against preventable disease.

Jane manages the Vaccine Finder project at Health Map, the host site of the Disease Daily. Robyn is a contributing writer for the Disease Daily and works as a project manager for The Immunization Partnership. Both are fully up-to-date on their immunizations.

Wednesday, October 29, 2014

“Hey, Doc:” What Exactly is This Marketplace, Why Should I Care, and How Do I Get Ready to Sign Up?





The Texas Medical Association’s (TMA’s) “Hey, Doc” education campaign wants to make sure Texas patients have the information they need to purchase health insurance through the new insurance marketplace. The re-enrollment period to purchase coverage through the marketplace starts Nov. 15.

Each week over the new few months, TMA will answer the most frequently-asked questions. This week, TMA’s “Hey, Doc” education campaign explains the marketplace, why Texas patients who need insurance should care, and how they can get ready to sign up for marketplace insurance.

You can find each week’s Q&A and more information at Heydoc.texmed.org.

Q: What Exactly Is This Marketplace and Why Should I Care?

A: The ACA says most individuals must have health insurance as of 2014. So the law required that health insurance exchanges — or “marketplaces” — be established in every state as a way for individuals to buy private health insurance on their own.

Most people get insurance through their jobs. But if you don’t have that option, you can shop in the marketplace instead of buying directly from an insurance company. Or maybe you have a certain health problem that in the past prevented you from getting health insurance because it was too expensive or simply hard to get. Now you will have options in the marketplace.

All individual and small-group health plans must provide a minimum package of “essential health benefits,” which include a basic set of services like physician visits, hospital and emergency care, preventive services like vaccines and screenings, and prescription drugs. So any health plan you purchase inside or even outside the exchange must cover these services, and the insurance company cannot deny you coverage because of a pre-existing condition.

Instead of having to search out health plans on your own, the marketplace is designed to be a one-stop-shop where you can go online to check out your coverage options, get easy-to-understand information, and compare plans before you make a decision — kind of like Orbitz or Travelocity, but for health insurance instead of travel. You also can find out right then and there if you can get a tax break on your private insurance premiums or if you qualify for state programs like Medicaid or the Children’s Health Insurance Program.

The time to sign up for plans offered in the marketplace is approaching fast: Open enrollment begins Nov. 15 for coverage beginning Jan. 1, 2015. Unless you qualify for an exemption under the federal law, you must get insurance or you could have to pay a fine.

Q: How Can I Get Ready to Sign Up?

A: You will have some decisions to make and important information to gather to sign up for health insurance coverage when the marketplace opens again on Nov. 15. But there are a few things you can do now to get ready:

  • Learn about different types of health coverage so you know what kind of plan fits you or your family. 
  • If you already have a marketplace plan from 2014, you can keep your current one or shop around to change plans.
  • Make a list of questions you may have before it’s time to choose a plan, such as whether you can keep your current doctor.
  • Make sure you understand how coverage works, including things like premiums, deductibles, and copayments. This will help you determine what you have to pay and when. HealthCare.gov and BeCoveredTexas.org can help you understand these and other insurance terms.
  • Gather information about your household income, for example, pay stubs, W-2 forms, or tax returns. You will need this information to determine what kind of plan you may want, and whether you qualify for tax credits or subsidies. When you enroll, you also will have to provide information on any insurance you currently have, such as policy numbers and employer coverage.
  • Set your budget.
  • Ask your employer if it plans to offer health insurance coverage in 2015. If not, you may have to find insurance through the marketplace or other sources. 

Stay tuned for more answers to frequently asked questions about the Marketplace.

Tuesday, October 28, 2014

Bicycling Deaths on the Rise

U.S. bicycling deaths have increased for the first time in more than 40 years, reports Governing Magazine.

Seven hundred twenty-two American bicyclists died in 2012, 56 of them Texans. Only California and Florida reported more deaths. And it’s not just adults who are dying from cycling accidents. Boys 20 years and younger make up 14 percent of the fatalities, according to the Governors Highway Safety Association (GHSA). Many of these deaths may have been avoidable ― the GHSA reports 65 percent of bicyclists killed were not wearing a helmet.

Bicycling can be a great way for children (and adults) to get the exercise they need, and TMA encourages kids to be safe while bicycling. Since 1994, TMA’s Hard Hats for Little Heads helmet giveaway program has donated nearly 200,000 helmets to Texas children.

Texas physician Charles Barker, MD, fits a helmet on a boy during a Hard Hats for Little Heads event this month.

Thursday, October 23, 2014

Texas Physicians Look to TMA on Ebola Guidance

Texas physicians looking for guidance on how to handle Ebola patients aren’t turning to the Centers for Disease Control and Prevention (CDC) for recommendations, they’re turning to the Texas Medical Association, reports The New York Times. That’s because CDC guidelines have been focused on hospitals, leaving guidance for doctors’ offices and outpatient facilities “spotty and vague.” The New York Times reports it’s a similar situation in other states as well ― physicians are turning to their state associations for recommendations. And the advice is differing among associations.

In Texas, TMA recommends “every patient who calls for an appointment at a doctor’s office should be asked about symptoms and travel history before arriving and mingling with other patients. If Ebola is suspected, the patient should be sent immediately to a hospital emergency room.” Read more.

Read TMA’s Ebola guidance for physicians: What if Someone Walks Into My Office With Ebola?

Wednesday, October 22, 2014

Ebola: Lessons from Dallas and Facts about Ebola

By James L. Holly, MD
CEO, Southeast Texas Medical Associates

The problem with information about Ebola is that simple answers are not helpful in public health and personal safety for avoiding contracting an Ebola infection. A statement by U.S. Sen. Rand Paul may true, but if it is not the whole truth, it is not helpful in to the public. The senator said, “If someone has Ebola at a cocktail party, they’re contagious, and you can catch it from them.” On the face of it, this statement is true, but it is not the whole truth about the spread of Ebola.

First, to address Ebola contagiousness, you must distinguish between contagious patients and asymptomatic patients — those who have the virus but at very low viral load, are not spreading their body fluids with sneezing or coughing, and are not manifestly sick — who are not contagious in the ordinary use of the term. It is probable, if you received a blood transfusion from this asymptomatic person with a low viral load that you would develop Ebola, but it is also probable that the casual exposure of being in the same room with this asymptomatic person would not result in your becoming infected.

While we cannot make dogmatic statements without random-controlled or double-blind studies, which are not possible due to the seriousness of the Ebola infection, we can draw inferences from the “natural experiment” that took place in Dallas. Every human death is a tragedy, but every human death does not result from culpable action or inaction on the part of a health care worker or professional. When Thomas Eric Duncan manifested Ebola and when he subsequently died, his family and other contacts were quarantined appropriately.

The good news is that no one that who casual contact with Mr. Duncan has contracted Ebola. Those who were in the emergency room when Mr. Duncan presented, those who took care of him in the emergency room, and now even Mr. Duncan’s family have completed the quarantine period without having contracted an Ebola infection. While they have not completed the 21-day observation period, no one who was on the airplane with the nurse from Dallas has developed an Ebola infection.
Being in the same room with an asymptomatic person who has Ebola is not desired and is not to be recommended, but it also is not as dangerous as some would like to say.

Fact

Ebola is a dreadful and dangerous disease. Even with the best of care, many with the infection will die. Ebola can be spread by contact with bodily fluids of an infected person, but even that must include contact with a mucous membrane or a break in the skin. Also, the infectivity of Ebola is not 100 percent. If a person with Ebola coughs on you, and if any fluids from that cough fall on intact skin, and if you wash that skin with soap and water, the probability of your contracting Ebola is very low. You will not contract Ebola simply by being in a social setting with someone who is in the early, asymptomatic stage of an Ebola infection.

Real Life Experiences

At one time there was a great fear of HIV infectivity. HIV is a much different disease from Ebola, and we are at a much different point in the history of the treatment of HIV disease. There was a time, however, when many people made statements about the infectivity of HIV like Rand Paul’s statement about the infectivity of Ebola. They were wrong, also. Children who had HIV infection were refused admission to school; people would not shake hands with those who were HIV positive. We shortly learned that casual contact with an HIV-positive person was not dangerous.

Many years ago, a physician friend called me in a panic. He had punctured himself with a needle that had been used with a patient who was HIV positive. I encouraged him to clean the wound carefully with an antimicrobial soap and copious amounts of water, and I assured him that the probability of contracting HIV from a single needle stick was very low. Twenty-five years later, he is still HIV negative. This does not mean we should be casual about needle sticks, but it does support our contention that everyone who has a needle stick will not contract HIV.

Some years ago, my wife and I had a dear friend who was HIV positive. He developed HIV-AIDS and became very ill. This was before there were good treatments for HIV. Carolyn and I were with our friend when he was actively dying at home. She held his left hand, and I held his right hand as we comforted him. When he breathed his last breath, I looked down and saw that the cuticle of the thumb of his right hand was bleeding and that the blood was dropping on my hand. Without panic, I went to the bathroom and scrubbed my hand with soap and water. I was confident that I would not contract HIV, and I did not.

The Power of Skin

I would not recommend intentional contract with blood from an HIV positive person, but I would affirm that one of the best barriers to viral illnesses is intact skin. Whether it is the highly contagious, airborne Influenza virus, or the less contagious but much more dangerous Ebola virus, skin is the first and best barrier to infection. The problem comes when a person has had exposure to a viral illness that resulted in viral contact on the hands, and then the person touches his or her eye, nose, or mouth. This by-passes the skin barrier and carries the virus straight to a mucous membrane and from there into the body.

This reminds us that the most important viral-infection prevention is frequent, vigorous washing of the hands with an antimicrobial soap and copious amounts of water. It also reminds us that if we can diminish or eliminate the spread of aerosol virally infected particles from a cough or sneeze, we can decrease the spread of viral infections. We can do that by covering our mouth and/or nose when we sneeze or cough and then by washing the body part used for that purpose immediately. If you are young enough and can bend that far, coughing or sneezing into the bend of the elbow is the best tool. This technique is not adequate protection from Ebola, but it is a first-aid means of addressing all viral infections until isolation can be achieved.

Conclusion

If a person does not have an Ebola infection, he or she cannot spread an Ebola infection. I recently heard a public health official include this in a list of high-risk situations: “if you have contact with someone who had contact with an Ebola-infected person.” The reality is if you have contact with someone who had contact with an Ebola infected person, if your contact did not have Ebola, you have nothing to worry about. And, while we Baptists would not be at a cocktail party, even if you are but no one is sick, coughing, or sneezing, you have very little, if anything, to worry about.

Dr. Holly is a Beaumont family physician, CEO of Southeast Texas Medical Associates. He is adjunct professor at The University of Texas Health Science Center and clinical associate professor Texas A&M Health Science Center.

Tuesday, October 21, 2014

Texas Doctors and Nurses Jointly Prep for Ebola

Thousands of Texas physicians and nurses last evening took part in a joint education program to learn as much as they can about the Ebola virus.

Listen to the entire program here.

Sponsored by the Texas Medical Association (TMA) and the Texas Nurses Association (TNA) — the state’s two largest health care professional organizations — the Tele-Town Hall Meeting on the Ebola virus included updates from Texas Department of State Health Services physicians and a lengthy question-and-answer session with public health experts.

“We come together tonight both as citizens of this great state and as professionals charged with protecting the health of our fellow Texans,” TMA President Austin King, MD, said as he opened the event. “As parents, friends, and neighbors, we were understandably concerned by the news from Dallas over the past several weeks. But as doctors and nurses, it is our job to know and stay up to date on the science surrounding Ebola, and it is our job to impart that information to our patients. It is our job to make sure that we … and they … are aware and prepared, but not paralyzed by fear.

“Tonight, it is our job — the job of TMA and TNA — to empower you with the information that you need.”

Using the Tele-Town Hall technology, more than 22,000 TMA member physicians and 8,000 TNA member nurses were called simultaneously and invited to join the conference.

“Every day, Texans rely on a health care team to care for them,” Dr. King added. “[Last night], the key members of that health care team came together to remain vigilant in educating and informing our members of the most current information in responding to Ebola and infectious disease.”

Since Thomas Duncan’s Ebola diagnosis was confirmed on Sept. 29, TMA has worked closely with Dallas County Medical Society (DCMS) leaders and public health experts to educate physicians statewide about Ebola and to provide accurate information about the virus to the public. Those activities included:

  • Don’t Close Schools Because of Ebola Fears — a science-based letter of guidance and reassurance that DCMS sent to North Texas school officials and that TMA is working to distribute to schools statewide.
  • Protect Yourself From the Ebola Virus — an easy-to-understand patient flyer, in English and in Spanish.
  • What If Someone Walks Into My Office With Ebola? — science-based guidelines to prepare physicians’ practices and protect staff and patients if someone presents with Ebola symptoms.
  • “Facts, Not Fear” — an outstanding town hall meeting that DCMS hosted with WFAA-TV. Watch the replay.

“We will work with elected officials and our designated public health authorities to control the immediate disease threat of Ebola,” Dr. King said. “And we will continue to advocate on Texans’ behalf at the state and federal level for policies that improve our public health system and abilities.”

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