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I suppose I could just load up on the anti-viral drugs and head for the compound in the woods. But after sitting and thinking about it for awhile, I decided that maybe a medical heretic point of view might be in order. For the last few weeks, my neck has gotten stiff from being dragged into the corner where quietly whispered questions about the avian flu are being awkwardly asked by slightly embarrassed yet nervous patients. We citizens of First World countries live in the new C.C. World (World of Computers and Cable). In this world, we have instant access to events around the world at our fingertips but yet our busy lives result in involuntary force-feeding of certain information repeatedly. Subliminal fear is often the result. The main reason that you worry about the avian flu is that news services think you should be exposed to it over and over again many times a day. They do not feel it newsworthy to tell you about the ongoing epidemics of tuberculosis and malaria, but all efforts concentrate on speculating on what might happen with bird flu. This is made worse when comments made by isolated scientists living in ivory towers are taken out of context and are widely publicized as "newsworthy." Recently, I was amused when one microbiologist divulged that drugs were being hoarded for his family. Another solemn-looking fellow played with numbers for the cameras and concluded by letting us all know that the world could not be vaccinated during a pandemic.
So, what follow are the dirty little secrets that many of us docs on the front lines do not want you to know. First of all, we live in a First World country and thank the good Lord for that. Despite our problems, 98 percent of the planet would probably welcome the opportunity to live here, but can't. With all this good fortune, we often find ourselves making wonderful statements about what would be good for the planet. Take immunization for example, most of the children on this globe are not immunized against anything. What would make anyone think that we could get flu shots to these masses even if our private industries dropped the prices substantially and could produce enough? The Avian Flu is simply that. It is an influenza virus that affects birds and not humans. There is nothing new about this. Viruses are very small particles of protein and DNA or RNA. They do not think and certainly have no ability to diabolically plot. They simply exist and multiply by borrowing the reproduction facilities of their host, until the host cells call for their big brothers in the immune system who show up and destroy them or kick them out of the house. It is not in the best interest of any virus to kill the host that it relies on for survival. Sometimes things get out of hand and the host dies, but so will most of the viruses. Generally, viruses do not cross the species barrier. The theoretical worry is a small one in my mind. The current avian flu virus is pretty nasty to birds, but in a land of a billion people it has only affected a small handful of souls probably by accidental contact of bird feces. The excitement is that the genotype of the virus H5N1 resembles the one that caused the human Spanish Flu of 1918. To state that this virus will spontaneously mutate to a highly contagious human virus is pure speculation. It is akin to playing the Wheel of Fortune. If you land on the spot next to the Jackpot, excitement starts to brew, but there is absolutely no guarantee that the next spin will get you the Jackpot. The odds are against it.
Getting a flu shot this year will not protect you against the avian flu, or will it? It has no direct protection against the avian strain, but some people believe that getting a flu shot every year enhances their long term immune memory. For example, if you took the shot over the last ten years you might have the ability to ward off over 25 versions of influenza. There is a theoretical possibility that some cross-activity to a newly mutated strain may afford you a better ability to survive infection. However, a somewhat effective vaccine against the avian strain has already been developed and is undergoing clinical trials. Let us not forget that in the First World, despite romantic visions of impoverished scientists working by candle light for the good of mankind, the production and manufacturing of vaccines are largely driven by the potential for immense profit. My daughter Lara is enrolled in an immunology course, and I am happy to see that the next generation is stimulated to think outside of the box. I have always accepted the need for a new vaccine every year. It never occurred to me that it may be theoretically possible to develop a long-term vaccine active against an entire virus family, similar to the polio vaccine. In any event, you can be assured that First World countries with money and resources will always receive the newest vaccines and drugs ahead of everyone else, and effectively block the spread of disease into these countries.
I also challenge the idea that we are "due" for an influenza pandemic. For the last 25 years, someone has emerged every fall to predict it and it has not happened. There have been three in the last one hundred years, but we always make reference to the 1918 Spanish Flu. The two flu pandemics since that time were much less devastating. It happened almost a century later. We deal with a huge onslaught of influenza cases with thousands of deaths on a yearly basis. Canadians have access to a host of anti-viral medications, immunizations, sanitation, communication, education and other "-tions" that make a difference. I have yet to see any convincing evidence free of speculation that can convince me that Canada will be ravaged and devastated by influenza this year. I have not stockpiled any medications for my family, and have no intention of leaving the country any time soon. But it would be nice to know why family doctors have so much difficulty obtaining flu vaccine for their patients. Again this year, one staff member had to be torn away from a busy practice and assigned to vaccine procurement. After numerous calls, missed opportunities for vaccination, discussions, excuses and then personal travel, we ended up with enough stock to vaccinate barely 10 percent of our practices. Things work, but too often they work slowly and inefficiently in a public system, so relying on the intriguing manner in which Mother Nature functions is sometimes a safer bet. Enjoy the woods, but front line docs are staying put!
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