How to Know When a Child’s Flu Turns Serious(nytimes.com)
nytimes.com
How to Know When a Child’s Flu Turns Serious
https://www.nytimes.com/2018/02/07/well/family/children-flu-infants-deaths-influenza-complications-fever-breathing-symptoms.html
126 comments
I have a much lesser scare story of my own that taught me this: you just have to be your own [family's] diagnostician.
Fortunately in the age of the Internet and advanced search engines, you actually can be your own diagnostician.
You have to learn to decide when you must have medical attention, and you must not accept dismissiveness from doctors. Yes, you must also not be a hypochondriac -- that will cost you money and crowd out others who need the care. But this is why you must... become good at being your own diagnostician.
This is very much not what doctors want. It's not what the FDA wants. It's not what anyone should want. But the quality of care is so variable, and so dependent on someone noticing in less than the only five minutes they want to spare you, some detail that you have days to notice... that you just have to be your own diagnostician.
Arm yourself with knowledge before you get to the doctor's office or ER.
Fortunately in the age of the Internet and advanced search engines, you actually can be your own diagnostician.
You have to learn to decide when you must have medical attention, and you must not accept dismissiveness from doctors. Yes, you must also not be a hypochondriac -- that will cost you money and crowd out others who need the care. But this is why you must... become good at being your own diagnostician.
This is very much not what doctors want. It's not what the FDA wants. It's not what anyone should want. But the quality of care is so variable, and so dependent on someone noticing in less than the only five minutes they want to spare you, some detail that you have days to notice... that you just have to be your own diagnostician.
Arm yourself with knowledge before you get to the doctor's office or ER.
When I first started my internal medicine rotation at the latter end of med school, I was quietly scandalized by how many diagnoses I caught that other doctors missed. These weren’t clever diagnoses to be proud of - given time and careful thought, the worst med student in the country could have done the same. I caught one diagnosis that had been missed by three other EDs in the past week, and just required asking the patient two questions beyond their chief complaint.
The doctors I was working under weren’t bad. They were, however, forced to run ragged all day without a break for a shit, allowed no more than a few minutes per patient. They didn’t like it any: they’d openly say “don’t emulate this,” while running to the next room.
The funny thing is, surgeries and pharmaceuticals and medical equipment are expensive. A doctor’s time? If he’s not a top renowned specialist, not much. But people have gotten so used to insurers playing the middleman retailer (buying healthcare services cheaply and reselling them to patients at a premium...), they’ve forgotten they can just -pay for the doctors time-.
It doesn’t require playing amateur medical sleuth. It just requires admitting that a highly skilled worker that had to train for a decade to do the job costs more than 20$.
The doctors I was working under weren’t bad. They were, however, forced to run ragged all day without a break for a shit, allowed no more than a few minutes per patient. They didn’t like it any: they’d openly say “don’t emulate this,” while running to the next room.
The funny thing is, surgeries and pharmaceuticals and medical equipment are expensive. A doctor’s time? If he’s not a top renowned specialist, not much. But people have gotten so used to insurers playing the middleman retailer (buying healthcare services cheaply and reselling them to patients at a premium...), they’ve forgotten they can just -pay for the doctors time-.
It doesn’t require playing amateur medical sleuth. It just requires admitting that a highly skilled worker that had to train for a decade to do the job costs more than 20$.
It is basically the same problem business people get when hiring developers.
You just can't know if you are receiving competent service if you have no level of competence on practicing it.
You just can't know if you are receiving competent service if you have no level of competence on practicing it.
It is very difficult to make such assessments. I don't think it's impossible, though the time to make an accurate assessment may take a while.
Solving a problem may be a useful guide. Find someone who can complete some specific task reasonably well, and even if you don't know how to do that task yourself, you may be able to make an assessment amongst various practitioners. This is easier to accomplish for simple tasks than hard ones (say: running a 100m sprint, or deadlifting 250 kg), but is the principle at the heart of, say, Jakob Nielsen's usability testing.
The problem is that there are domains in which tasks are complex, the time to determine successful conclusion is long, etc., etc. In this case, you may need to farm out the evaluation process, or look to evaluate institutions rather than individuals (say, in education, or medicine -- and there are reasons that the collective evaluation approach has validity for each, though also for adjusting for student population / case mix). The general problem of audits or programme assessment exhibits this.
My point isn't that assessments are easy, simple, straightforward, or not prone to their own issues. Only that there does exist a possibility in many cases for making valid assessments of service competence without specific competence in the service being assessed.
Solving a problem may be a useful guide. Find someone who can complete some specific task reasonably well, and even if you don't know how to do that task yourself, you may be able to make an assessment amongst various practitioners. This is easier to accomplish for simple tasks than hard ones (say: running a 100m sprint, or deadlifting 250 kg), but is the principle at the heart of, say, Jakob Nielsen's usability testing.
The problem is that there are domains in which tasks are complex, the time to determine successful conclusion is long, etc., etc. In this case, you may need to farm out the evaluation process, or look to evaluate institutions rather than individuals (say, in education, or medicine -- and there are reasons that the collective evaluation approach has validity for each, though also for adjusting for student population / case mix). The general problem of audits or programme assessment exhibits this.
My point isn't that assessments are easy, simple, straightforward, or not prone to their own issues. Only that there does exist a possibility in many cases for making valid assessments of service competence without specific competence in the service being assessed.
Yes, quite.
Ditto, say, accountancy. You have to have a clue.
Ditto, say, accountancy. You have to have a clue.
I think this problem exists in just about every job. If you aren't cut out to do it, you can't do a good job. No matter if you clean a school or build bridges.
I lost my daughter 6 years ago this month to a very, very similar scenario. Multiple visits to doctor over the week, small improvements, then on Sunday a decline. Went to ER, where she fought the nurse enough such the nurse wasn’t too concerned. She went into shock while getting chest X-rays.
I am so very sorry to hear that. I don't really know what else I can say. We were so lucky in comparison, we have nothing to complain about.
I'm so sorry.
So sorry to hear of this.
Holy fucking shit! I'm so sorry to hear that man :(
My firstborn is 2 months old and I'm always afraid of things like this!
My firstborn is 2 months old and I'm always afraid of things like this!
What an incomprehensible nightmare, I can’t imagine what you’ve gone through.
Sorry to hear that.
I'm so sorry
Oh, God. Bless you, :-(
My sincere commiserations.
Very similar experience, and what I was thinking about as I read this article. The signs it says to look out for are essentially standard flu symptoms crossing a poorly-defined subjective line of severity.
We had extreme lethargy and high fever for a couple days, and our threshold was crossed when the vomiting started. The boy walked into the ER with us, collapsed during chest x-rays, and was diagnosed with pneumonia a few minutes later.
Having had the pleasure of dealing with a (different) child experiencing febrile seizures, I'm not sure I'd want to wait for seizing before getting a diagnosis and supportive care. Seizure protocol involved multiple LPs.
I'd love better criteria than "extreme discomfort" and "clammy skin". Persistent high fever is one (but apparently flu can take a turn within 48 hours, so that's out the window). Relapsing fever is a good one. What else are the clear signs?
We had extreme lethargy and high fever for a couple days, and our threshold was crossed when the vomiting started. The boy walked into the ER with us, collapsed during chest x-rays, and was diagnosed with pneumonia a few minutes later.
Having had the pleasure of dealing with a (different) child experiencing febrile seizures, I'm not sure I'd want to wait for seizing before getting a diagnosis and supportive care. Seizure protocol involved multiple LPs.
I'd love better criteria than "extreme discomfort" and "clammy skin". Persistent high fever is one (but apparently flu can take a turn within 48 hours, so that's out the window). Relapsing fever is a good one. What else are the clear signs?
There’s no good criteria for an unstable child. Nor for adults - that’s the “clinical gestalt” docs spend 80+ hours a week developing in training. That said, a few things to look out for (I steal the below list from Dr Tim Horeczko):
Appearance:
“TICLS” Tone – the newborn should have a normal flexed tone; the 6 month old baby who sits up and controls her head; the toddler cruises around the room.
Interactiveness – Does the 2 month old have a social smile? Is the toddler interested in what is going on in the room?
Consolability – A child who cannot be consoled at some point by his mother is experiencing a medical emergency until proven otherwise.
Look/gaze – Does the child track or fix his gaze on you, or is there the “1000-yard stare”?
Speech/cry – A vigorously crying baby can be a good sign, when consolable – when the cry is high-pitched, blood-curling, or even a soft whimper, something is wrong.
If the child fails any of the TICLS, then his appearance is abnormal.
Work of Breathing: Children are respiratory creatures – they are hypermetabolic – we need to key in on any respiratory embarrassment.
Look for nasal flaring. Uncover the chest and abdomen and look for retractions. Listen – even without a stethoscope – for abnormal airway sounds like grunting or stridor. Grunting is the child’s last-ditch effort to produce auto-PEEP.
Stridor is a sign of critical upper airway narrowing.
Look for abnormal positioning, like tripodding, or head bobbing
Circulation to skin:
Infants and children are vasospastic – they can change their vascular tone quickly, depending on their volume status or environment.
Without even having to touch the child, you can see signs of pallor, cyanosis, or mottling. If any of these is present, this is an abnormal circulation to the skin.
Failing any one of these is worth a serious doc visit. And, I’ll add one of my own: any infant that works so hard at sucking down milk that it makes them sweat gets a free trip to the ER.
Appearance:
“TICLS” Tone – the newborn should have a normal flexed tone; the 6 month old baby who sits up and controls her head; the toddler cruises around the room.
Interactiveness – Does the 2 month old have a social smile? Is the toddler interested in what is going on in the room?
Consolability – A child who cannot be consoled at some point by his mother is experiencing a medical emergency until proven otherwise.
Look/gaze – Does the child track or fix his gaze on you, or is there the “1000-yard stare”?
Speech/cry – A vigorously crying baby can be a good sign, when consolable – when the cry is high-pitched, blood-curling, or even a soft whimper, something is wrong.
If the child fails any of the TICLS, then his appearance is abnormal.
Work of Breathing: Children are respiratory creatures – they are hypermetabolic – we need to key in on any respiratory embarrassment.
Look for nasal flaring. Uncover the chest and abdomen and look for retractions. Listen – even without a stethoscope – for abnormal airway sounds like grunting or stridor. Grunting is the child’s last-ditch effort to produce auto-PEEP.
Stridor is a sign of critical upper airway narrowing.
Look for abnormal positioning, like tripodding, or head bobbing
Circulation to skin:
Infants and children are vasospastic – they can change their vascular tone quickly, depending on their volume status or environment.
Without even having to touch the child, you can see signs of pallor, cyanosis, or mottling. If any of these is present, this is an abnormal circulation to the skin.
Failing any one of these is worth a serious doc visit. And, I’ll add one of my own: any infant that works so hard at sucking down milk that it makes them sweat gets a free trip to the ER.
There are not any clear signs. Normal flu is the same as deadly flu, until it is not. That is the frightening part. We are helpless against bad luck.
In college, a friend of mine got what appeared to be the flu. None of us (including him) worried about it, figuring he'd be fine in a couple days. He started getting a bit weaker, so one of us decided to drive him to the ER, just in case. He didn't feel bad or anything, just tired.
The ER physician took one look at him and admitted him, shocking us by saying he was within hours of death. He spent a couple days being pumped full of antibiotics, and recovered, but it was a close call. The doctors never did figure out just what it was.
All these years later, and it still distresses me.
The ER physician took one look at him and admitted him, shocking us by saying he was within hours of death. He spent a couple days being pumped full of antibiotics, and recovered, but it was a close call. The doctors never did figure out just what it was.
All these years later, and it still distresses me.
you saved his life.
How were you supposed to know a tiered guy was at death’s door?
You got lucky, but in the end you did well.
How were you supposed to know a tiered guy was at death’s door?
You got lucky, but in the end you did well.
Almost that same exact thing happened to me when i was 11. The Dr's all said it was the flu, but I couldn't eat and my chest hurt so bad that i could barely breath.
The old Dr's refused to send me anywhere, and immediately got their lawyers when my parents asked questions. The asshats also gave me milk of magnesia at 10pm because "I didn't eat anything for a few days." So that was a great night...
My dad made the call to the other hospital and they arranged an ambulance. I spent a week at the first hospital, and after 3 hours at the new one, I was already under the knife. That was the first time I saw people at a hospital run because of what they were seeing on scans.
The new Dr told my parents (after i was OK) that the only thing he could think about once he initially saw me was that he was "operating on a dead boy."
Scary stuff.
I can't remember exactly what I had, but it was different than what your child had. Very similar experiences though.
The old Dr's refused to send me anywhere, and immediately got their lawyers when my parents asked questions. The asshats also gave me milk of magnesia at 10pm because "I didn't eat anything for a few days." So that was a great night...
My dad made the call to the other hospital and they arranged an ambulance. I spent a week at the first hospital, and after 3 hours at the new one, I was already under the knife. That was the first time I saw people at a hospital run because of what they were seeing on scans.
The new Dr told my parents (after i was OK) that the only thing he could think about once he initially saw me was that he was "operating on a dead boy."
Scary stuff.
I can't remember exactly what I had, but it was different than what your child had. Very similar experiences though.
Jesus fucking christ at giving an 11yo milk of magnesia.
I have stomach issues and occasionally use that on a day when I know I can spend the entire next day sat near a toilet, that stuff is absurdly effective as a laxative almost dangerously so.
I have stomach issues and occasionally use that on a day when I know I can spend the entire next day sat near a toilet, that stuff is absurdly effective as a laxative almost dangerously so.
At age three I was diagnosed with the flu in the morning and by dinner time my heart stopped and my dad performed CPR. My heart stopped two other times that day. I had meningitis and my mom keep calling the doctor's office to say I was getting worse. After nine days in coma I actually pulled through. My sister got diagnosed with brain cancer after having a headache that kept getting worse for three days. Our new doctor said he looked at my mom and he knew it was more serious than a headache. He stood by his belief that moms were the best indicator of serious medical problems. I say get a new doctor that can spare the time to listen to a kids lungs and other vital signs.
This also highlights the counter-intuitive fact that being struck by an extremely rare, corner-casey malady isn't necessarily uncommon, simply due to the sheer number of different rare, corner-casey maladies that exist in the long tail of possible things that can happen.
Yeah my doctor didn't notice the last time I got pneumonia. A lot of doctors will just do a quick listen to the chest for the rattling but you don't get that in some cases. Luckily the Urgent Care I went to when my fever spiked later did a chest X-Ray. Kept me out of the hospital thankfully.
Kinda makes me want to get back into optics. Imaging like that should be as routine as taking a temperature. Be nice to see stuff like diffuse light and ultrasound get super cheap so it's used routinely.
Kinda makes me want to get back into optics. Imaging like that should be as routine as taking a temperature. Be nice to see stuff like diffuse light and ultrasound get super cheap so it's used routinely.
Will an ultrasound show it, perhaps one could book in for a "baby-scan", cheapest scan in UK is about £40. Is ultrasound not supercheap already?
They sent my son for an ultrasound to work out where exactly the fluid was laying on his chest, so yes, they do get some useful info from it.
I've no idea how disruptive technology like cheap ultrasound compares with "traditional" medical equipment. It may be possible to do it cheaply now, but I'd assume the big equipment manufacturers will try to justify their six or seven figure prices for as long as they can, and those in charge of the hospital budgets will probably not be totally unbiased when it comes to making purchasing decisions. It may take some time to filter down into hospitals (like the internet).
I've no idea how disruptive technology like cheap ultrasound compares with "traditional" medical equipment. It may be possible to do it cheaply now, but I'd assume the big equipment manufacturers will try to justify their six or seven figure prices for as long as they can, and those in charge of the hospital budgets will probably not be totally unbiased when it comes to making purchasing decisions. It may take some time to filter down into hospitals (like the internet).
It's not even that it's that hospitals use xrays, ultrasounds, and MRI's as cash cows.
Consider a $40k higher end ultrasound machine. Now consider the capital cost of the machine over 10 years. $4000/yr or $10 a day. Yeah the bill you get for an ultrasound is all pork.
Consider a $40k higher end ultrasound machine. Now consider the capital cost of the machine over 10 years. $4000/yr or $10 a day. Yeah the bill you get for an ultrasound is all pork.
No, the bill you get for an ultrasound is a tech or a PA to run it and a doc to properly interpret it.
It’s funny how popular the Wizard of Schenectady story is on HN when it’s about engineers, but somehow fails to be applied to non-engineers.
It’s funny how popular the Wizard of Schenectady story is on HN when it’s about engineers, but somehow fails to be applied to non-engineers.
I'm sure lots of people have had the experience of paying a bill for the expensive test and also a bill for the doctor to interpret it.
Kind of focuses one's attention on the expensive test.
I guess if utilization is low the technicians can end up costing a lot. But say they cost $200,000 a year and do one scan each working day. That's something like $1000 of labor, but it also assumes that they only manage to do 1 thing each day they work.
Kind of focuses one's attention on the expensive test.
I guess if utilization is low the technicians can end up costing a lot. But say they cost $200,000 a year and do one scan each working day. That's something like $1000 of labor, but it also assumes that they only manage to do 1 thing each day they work.
> No
It was my point was that the 'expensive' isn't due to the capital or maintenance cost of an ultra sound machine.
Although portable units do have the advantage that in a lot of cases the attending physician can bypass the cash cow radiology department completely.
As for the rude tone of your comment, I have a tens of thousands worth of test equipment on my bench and I'd never dream of billing a client an 'oscilloscope fee', a 'logic analyzer fee' or a 'spectrum analyzer fee'. And every other industry works like that, except medicine.
It was my point was that the 'expensive' isn't due to the capital or maintenance cost of an ultra sound machine.
Although portable units do have the advantage that in a lot of cases the attending physician can bypass the cash cow radiology department completely.
As for the rude tone of your comment, I have a tens of thousands worth of test equipment on my bench and I'd never dream of billing a client an 'oscilloscope fee', a 'logic analyzer fee' or a 'spectrum analyzer fee'. And every other industry works like that, except medicine.
Good point. Not to mention a radiologist bills separately from the procedure. I have a $1M antenna near field scanner at work. It looks just like a CT scanner, but I don’t bill $6k per use, then another $1k on top to process the measurements. It’s capital equipment, and I bought it since it saves measurement time, which allows me to take in more work. What a load.
When we had our first kid, my wife had a “fun scan” done. A fancy 3D color ultrasound. It was $120 for a 1/2 hour session. Same diagnostic ultrasound cost $1000 on a much older machine, same person running it.
There was an article on here a couple of years ago about cheap, hand held ultrasound. I was downvoted for saying youl’ll never see it in use.
When we had our first kid, my wife had a “fun scan” done. A fancy 3D color ultrasound. It was $120 for a 1/2 hour session. Same diagnostic ultrasound cost $1000 on a much older machine, same person running it.
There was an article on here a couple of years ago about cheap, hand held ultrasound. I was downvoted for saying youl’ll never see it in use.
> I have a $1M antenna near field scanner at work.
tingle
Just add if one thinks a bit one can find a lot of industries that depend on renting out expensive capital equipment. Consider a taxi. A taxi might cost $25,000. Smog machines that auto shops have are not cheap. An Boeing 787 costs around $600,000 a seat. Rent a hotel room lately?
tingle
Just add if one thinks a bit one can find a lot of industries that depend on renting out expensive capital equipment. Consider a taxi. A taxi might cost $25,000. Smog machines that auto shops have are not cheap. An Boeing 787 costs around $600,000 a seat. Rent a hotel room lately?
I'm unsure about ultrasound machines utility for diagnosing fluid in the lungs but despite what medical professionals claim ultrasound machines are cheap. Some portable models are under $5k. Low end Chinese made units are sub $1000.
You're always the one in charge of your own medical outcome, because as you've seen, your doctor can always leave you holding the bag -- and is lawsuit your recourse?
Agreed. Hard to sue from the grave. Keep asking for second opinion. By the time most people go to the doctor it is getting serious.
The right answer for your son would have been for them to jump right into surgery (or whatever you Brits call it, seeing as you apparently call a doctor's office a "surgery"... the act of cutting into skin for medicinal purposes) for something which looked like a flu complicated by an ear infection. Reaching that diagnosis would likely have involved magic on the part of the MD (or whatever you call a physician) and MDs don't get their licenses from Hogwarts, not even in the UK.
Yeah, we call the doctor's examination room a "surgery", and the place you get the actual surgery done is an "operating theatre". Divided by a common language and all that... but obviously it comes from a time when your local doctor would have performed surgery (presumably with leeches) in his front room.
But he ended up in surgery pretty quickly after we arrived at the hospital. It took them a day to analyse his X-rays and realise he was not responding to regular antibiotics, and the decision was made to transfer him to the larger hospital for the operation. As for the misdiagnosis made by our family doctor (G.P. or General Practitioner, we call them), I'm not qualified to comment on whether it was a reasonable error or not.
But he ended up in surgery pretty quickly after we arrived at the hospital. It took them a day to analyse his X-rays and realise he was not responding to regular antibiotics, and the decision was made to transfer him to the larger hospital for the operation. As for the misdiagnosis made by our family doctor (G.P. or General Practitioner, we call them), I'm not qualified to comment on whether it was a reasonable error or not.
> our family doctor (G.P. or General Practitioner, we call them)
We have the same term and abbreviation in the US for the same people, but I never know how many people who didn't grow up around medical people know it.
> As for the misdiagnosis made by our family doctor (G.P. or General Practitioner, we call them), I'm not qualified to comment on whether it was a reasonable error or not.
Sometimes it is, and it still goes to court. I'm biased towards the US in my knowledge, but a doctor or nurse can be legitimately afraid of, essentially, the precise kind of case your son was the victim of: The extremely rare serious problem masquerading as a very common and not-very-serious problem. That road goes directly into malpractice lawsuit territory, and when you're on that road everyone goes a bit insane.
Everyone in the medical field carries malpractice insurance because, as I've implied, some malpractice lawsuits are inevitable, due to a confluence of reasonable judgement and an unreasonably uncommon malady. Does this mean malpractice law needs to be reformed (read: done away with)? No, because some people out there practicing medicine are really incompetent, or lazy, or just go a bit weird and start cutting their initials onto livers like some deranged Zorro. We need some way to get those people out of the profession.
I guess I'm not really leading anywhere with this. The fact innocent people will have to go to court over reasonable judgment which leads to a bad outcome because of blind chance is just magnifying the unfairness of the whole event, increasing it and spreading it around. Will it make the MD more likely to correctly diagnose next time? It might make them more likely to order a test that's probably not warranted statistically. That's not the same thing. Everyone's human, and humans are sometimes incompetent and malicious, so we need malpractice law, but humans sometimes make honest mistakes and always use limited evidence to reach conclusions which are sometimes wrong, so malpractice suits catch innocents and send them through a wringer.
We have the same term and abbreviation in the US for the same people, but I never know how many people who didn't grow up around medical people know it.
> As for the misdiagnosis made by our family doctor (G.P. or General Practitioner, we call them), I'm not qualified to comment on whether it was a reasonable error or not.
Sometimes it is, and it still goes to court. I'm biased towards the US in my knowledge, but a doctor or nurse can be legitimately afraid of, essentially, the precise kind of case your son was the victim of: The extremely rare serious problem masquerading as a very common and not-very-serious problem. That road goes directly into malpractice lawsuit territory, and when you're on that road everyone goes a bit insane.
Everyone in the medical field carries malpractice insurance because, as I've implied, some malpractice lawsuits are inevitable, due to a confluence of reasonable judgement and an unreasonably uncommon malady. Does this mean malpractice law needs to be reformed (read: done away with)? No, because some people out there practicing medicine are really incompetent, or lazy, or just go a bit weird and start cutting their initials onto livers like some deranged Zorro. We need some way to get those people out of the profession.
I guess I'm not really leading anywhere with this. The fact innocent people will have to go to court over reasonable judgment which leads to a bad outcome because of blind chance is just magnifying the unfairness of the whole event, increasing it and spreading it around. Will it make the MD more likely to correctly diagnose next time? It might make them more likely to order a test that's probably not warranted statistically. That's not the same thing. Everyone's human, and humans are sometimes incompetent and malicious, so we need malpractice law, but humans sometimes make honest mistakes and always use limited evidence to reach conclusions which are sometimes wrong, so malpractice suits catch innocents and send them through a wringer.
Why should litigation be the first option for relief? This would have a chilling effect on practitioners coming forward. Taking from devops, having a blameless review would be in order to see what kind of assumptions/biases caused the poor decision and improve going forward not sue them out of practice. Sidney Dekker speaks about in the context of the aviation industry and how humane practices leads to safer flights for everyone.
It would be very psychologically difficult for someone whose relative just died to accept a "blameless review", and if that review lead to a decision that a lawsuit was unwarranted, well, that might make the relative angry enough to do something regrettable.
I agree that it's the right answer in a cold-blooded "improving the practice of medicine" sense, but laws have to take human behavior into account.
I agree that it's the right answer in a cold-blooded "improving the practice of medicine" sense, but laws have to take human behavior into account.
> It would be very psychologically difficult for someone whose relative just died to accept a "blameless review",
Yet that's precisely what the aeronautic industry does.
Yet that's precisely what the aeronautic industry does.
I agree with you. This is the main reason we did not go down the malpractice route. It is far less common here in the UK than it seems to be in the US, but still fairly common. But as you said, everyone goes a bit insane. As it turned out, our doctor probably dodged a bullet because of the sheer chance that I got a second opinion and the fact that the hospital system worked flawlessly thereafter.
If, god forbid, our son had not recovered, it would have been a different story, there would have been anger to vent and likely a court case.
If, god forbid, our son had not recovered, it would have been a different story, there would have been anger to vent and likely a court case.
The difference between the UK and the US is that UK healthcare professionals have a legal duty ("Duty of Candour") to tell you when they've made a mistake; what they're going to do to fix the mistake; and what they're going to do to prevent the mistake from happening again.
This is enforced by all of the HCP registration bodies (GMC for doctors; NMC for registered nurses and midwives; HCPC for allied health professionals). It's also supported by the NHS Litigation authority (the body who'll pay out for negligence claims, or defend those in court), and various medical protection organisations (the legal organisations that represent HCPs in court cases). The MPTS (the tribunal service that holds hearings in fit-to-practice cases) also strongly recommends that HCPs apologise in full.
In England and Wales we have a bit of law ("The Compensation Act") which means an apology outside a court for something that went wrong isn't an admission of liability, which makes it a bit easier for HCPs and their employers to apologise.
I've collected a bit of information here: https://medium.com/@dan.bealecocks/advice-to-doctors-about-s...
This is enforced by all of the HCP registration bodies (GMC for doctors; NMC for registered nurses and midwives; HCPC for allied health professionals). It's also supported by the NHS Litigation authority (the body who'll pay out for negligence claims, or defend those in court), and various medical protection organisations (the legal organisations that represent HCPs in court cases). The MPTS (the tribunal service that holds hearings in fit-to-practice cases) also strongly recommends that HCPs apologise in full.
In England and Wales we have a bit of law ("The Compensation Act") which means an apology outside a court for something that went wrong isn't an admission of liability, which makes it a bit easier for HCPs and their employers to apologise.
I've collected a bit of information here: https://medium.com/@dan.bealecocks/advice-to-doctors-about-s...
all doctors should be able to hear large amounts of fluid in the lungs and, furthermore, should be on the lookout for pneumonia when someone had flu and then got worse. Your doctors, in this case, performed terribly.
Seconded. This is an insane story. You don't need a second opinion, you need a better doctor.
I suspect you are correct. The fact that the second doctor I saw immediately sent him to hospital makes me think the first doctor was not doing her job properly. I guess that's why they say you should always get a second opinion.
The second doctor shouldn't make you second guess your first doctor. The second doctor had the advantage of time. Pneumonia generally doesn't manifest in the span of hours.
It's not like a liter of fluid is just dumped into the lungs immediately... couple that with Rhonchi or Rales due to (what I presume) bronchitis that WAS diagnosed. You can't treat everyone that is Flu-like symptoms as if they are going to die of pneumonia. Doesn't make sense.
but people with neck pain + fever + general sickness after a flu? that could also have been meningitis!
I am so glad I was able to be home with my kids. My oldest was also really hard to place with a babysitter, so I rarely got a break. I spent enormous amounts of time with him. This meant that I knew what he ate or drank and what was normal for him. I knew when it was serious.
Dehydration kills a great deal faster than starvation. Sunken eyes is a sign of serious dehydration in a child. The child either needs to be fed fluids orally by the spoonful until this improves, which can take two hours of devoted care, or they need an IV. I once treated serious dehydration at home with spoons of fluids to prevent my 4 year old from being subjected to an IV. This is a technique taught in developing countries where IV fluids may not be available.
If a child is vomiting but keeps drinking, they are much less likely to dehydrate, even if it does not stay down. When my youngest son had Winter Vomiting, a deadly flu from many years ago, I told him to drink or I would take him to the ER for an IV. He had had an IV once when he had been sick while relatives watched him.* He didn't want another. So he would drink a whole lot of water and eat a few crackers, go projectile vomit it back up and go back to bed.
* That is not a criticism of my relatives. It is just another example of how much of a difference it makes for a child to have a devoted full time caretaker who knows them well. Children are not good at explaining that they have a serious issue. It is vastly better if there is an adult who is in a position to just recognize that their behavior is seriously off and something is just not right. People who don't take full-time care of a child are just less able to recognize that the problem is serious, even when they are otherwise very competent and devoted caregivers.
Dehydration kills a great deal faster than starvation. Sunken eyes is a sign of serious dehydration in a child. The child either needs to be fed fluids orally by the spoonful until this improves, which can take two hours of devoted care, or they need an IV. I once treated serious dehydration at home with spoons of fluids to prevent my 4 year old from being subjected to an IV. This is a technique taught in developing countries where IV fluids may not be available.
If a child is vomiting but keeps drinking, they are much less likely to dehydrate, even if it does not stay down. When my youngest son had Winter Vomiting, a deadly flu from many years ago, I told him to drink or I would take him to the ER for an IV. He had had an IV once when he had been sick while relatives watched him.* He didn't want another. So he would drink a whole lot of water and eat a few crackers, go projectile vomit it back up and go back to bed.
* That is not a criticism of my relatives. It is just another example of how much of a difference it makes for a child to have a devoted full time caretaker who knows them well. Children are not good at explaining that they have a serious issue. It is vastly better if there is an adult who is in a position to just recognize that their behavior is seriously off and something is just not right. People who don't take full-time care of a child are just less able to recognize that the problem is serious, even when they are otherwise very competent and devoted caregivers.
I'm not a doctor, but AFAIK it's best to just get an IV straightaway if you're really dehydrated and continually vomiting. The pain from an IV is not bad at all and it seems beneficial for children and everyone else to be able to tolerate a minimal amount of harmless pain.
I didn't want my 4 year old unnecessarily traumatized. He was frequently sick and had to see doctors regularly. He had enough baggage over that, and was later diagnosed with a genetic disorder.
I knew what I was doing. If a parent doesn't know, sure, get the IV. But if a parent does know and wishes to spare their child some pain, I see no reason that should not be supported. The comfort of my children mattered to me. I cannot imagine that it wouldn't matter to most other parents.
I knew what I was doing. If a parent doesn't know, sure, get the IV. But if a parent does know and wishes to spare their child some pain, I see no reason that should not be supported. The comfort of my children mattered to me. I cannot imagine that it wouldn't matter to most other parents.
I think 3131s's theory is that the amount of pain from a needle is much less than say scraping your knee, hardly traumatic, and is guaranteed to work better, faster, and more reliably than a spoon. Why risk the spoon not working (and therefore further dehydrating the child and increasing risk of something really bad happening) when all we are talking about is an IV, not something actually traumatic like an amputation.
Every IV carries the risk of thrombosis. So I would avoid it, if I can.
If the IV reduces or eliminates the discomfort of dehydration faster (which it seems it would do faster than hours of spoon-feeding?), that might also actually reduce the overall trauma level.
This varies a lot. Some people seriously don't deal well with needles. Your cavalier attitude towards them is not universally shared.
This is odd to me - how would a four year old develop a fear of needles? At worst they're an instantaneous sharp pain that lasts milliseconds, most of the time they aren't even felt...
I believe the moral of the story is that with education and encouragement, kids should not get dehydrated enough to ever require an IV.
Oseltamivir. (Tamiflu)
My ex-girlfriend (7years) is a big deal chemist at GILD. So I share some under the covers knowledge here. GILD produces some of the best anti-virals on the market [i] (HIV is now a condition). When GILD discovered the power of Oseltamivir it knew they would not be able to produce the scale needed. They sold their rights to Roche. Roche being a sick pro-profits-first company basically shelved the product. Roche wasn't interested in the 'cure' for the flu they were interested in treating the symptoms. But, as it turns out, china was impacted with bird flu during this period -- and gave no shit about patents and wanted to just save their population. Phone calls were made and china basically was going to produce it at at massive scale. Thus, Roche quickly started producing the product. Oseltamivir is amazing at fighting the flu virus. The original purpose was to take Oseltamivir when you have sick family members or know you might be coming down with symptoms. Recently, I came down with the flu (I had the vaccine), I took 4 pills over 2 days and it was turned into a slight cold. It could save lives. Doctors know this and are reluctant to prescribe it -- since they know it is in short supply and critical populations should get it first. Ironically, doctors reluctance to prescribe it - actually reduces the supply. I say to you, get it, keep it in your refrigerator -- when your 65+ year old dad gets the flu give it to him immediately.
[i] https://www.bizjournals.com/sanfrancisco/news/2018/02/07/gil...
My ex-girlfriend (7years) is a big deal chemist at GILD. So I share some under the covers knowledge here. GILD produces some of the best anti-virals on the market [i] (HIV is now a condition). When GILD discovered the power of Oseltamivir it knew they would not be able to produce the scale needed. They sold their rights to Roche. Roche being a sick pro-profits-first company basically shelved the product. Roche wasn't interested in the 'cure' for the flu they were interested in treating the symptoms. But, as it turns out, china was impacted with bird flu during this period -- and gave no shit about patents and wanted to just save their population. Phone calls were made and china basically was going to produce it at at massive scale. Thus, Roche quickly started producing the product. Oseltamivir is amazing at fighting the flu virus. The original purpose was to take Oseltamivir when you have sick family members or know you might be coming down with symptoms. Recently, I came down with the flu (I had the vaccine), I took 4 pills over 2 days and it was turned into a slight cold. It could save lives. Doctors know this and are reluctant to prescribe it -- since they know it is in short supply and critical populations should get it first. Ironically, doctors reluctance to prescribe it - actually reduces the supply. I say to you, get it, keep it in your refrigerator -- when your 65+ year old dad gets the flu give it to him immediately.
[i] https://www.bizjournals.com/sanfrancisco/news/2018/02/07/gil...
Your ex-gf's story seems a bit off. First, Gilead didn't license it to Roche until 1996 and it was approved in 1999. About the time it takes to conduct clinical trials and get FDA approval - no apparent delay.
The major Asian bird flu epidemic was ~2005, after it was already brought to market.
Tamiflu isn't a "cure", the effects are pretty limited, but it's used because we have nothing else.
Tamiflu has been wildly successful product for Roche, why would they not develop it and instead try to treat "symptoms"?
Tamiflu is not in short supply by any means, Roche produces huge stockpiles for the US gov't and the shelf life is pretty long. There is plenty to go around.
To summarize, your ex-gf's story sounds like a could-be-true story (for those who don't know better) that plays to the typical stereotypes for "big pharma".
I'll also add that the cost to treat someone with Tamiflu before it went generic was ~$100. Pretty reasonable considering what drug costs are like in general.
The major Asian bird flu epidemic was ~2005, after it was already brought to market.
Tamiflu isn't a "cure", the effects are pretty limited, but it's used because we have nothing else.
Tamiflu has been wildly successful product for Roche, why would they not develop it and instead try to treat "symptoms"?
Tamiflu is not in short supply by any means, Roche produces huge stockpiles for the US gov't and the shelf life is pretty long. There is plenty to go around.
To summarize, your ex-gf's story sounds like a could-be-true story (for those who don't know better) that plays to the typical stereotypes for "big pharma".
I'll also add that the cost to treat someone with Tamiflu before it went generic was ~$100. Pretty reasonable considering what drug costs are like in general.
First, the CDC recommends Tamiflu:
https://www.cdc.gov/flu/professionals/antivirals/summary-cli...
Second, in 2003 Roche upped production. So yes they sat on it. SARS was in 2003 - and it takes 12 months to produce. What Roche was producing pre 2002 would prove or disprove the story, but I can't find this information anywhere -- I would gamble not much.
"It's pointless to look at ways for outsiders to produce Tamiflu, Roche's Reddy says. He notes that Roche can meet demand expectations faster than anyone else because it is familiar with the challenging production process. To meet current orders, Roche has quadrupled production capacity since 2003,"
http://pubs.acs.org/cen/news/83/i35/8335tamiflu.html
https://www.cdc.gov/flu/professionals/antivirals/summary-cli...
Second, in 2003 Roche upped production. So yes they sat on it. SARS was in 2003 - and it takes 12 months to produce. What Roche was producing pre 2002 would prove or disprove the story, but I can't find this information anywhere -- I would gamble not much.
"It's pointless to look at ways for outsiders to produce Tamiflu, Roche's Reddy says. He notes that Roche can meet demand expectations faster than anyone else because it is familiar with the challenging production process. To meet current orders, Roche has quadrupled production capacity since 2003,"
http://pubs.acs.org/cen/news/83/i35/8335tamiflu.html
Your answer does not address the criticisms in the comment you are replying to. If the Asian bird flu epidemic was in 2005 there is no correlation to an increase in production in 2003. Could reduced production in the first 4 years of the drug's approved existence be explained by a challenging production process?
He did actually, but he used the medical term SARS (severe acute respiratory syndrome) [1] in place of "Asian bird flu". However, they refer to the same thing, and SARS does appear to have only been a major problem from late-2002 to mid-2003, a timeline that is consistent with his claims.
[1] - https://en.wikipedia.org/wiki/Severe_acute_respiratory_syndr...
[1] - https://en.wikipedia.org/wiki/Severe_acute_respiratory_syndr...
Ah, I understand the argument a bit better then, but I don't think that's really a valid substitute. Avian flu is H5N1, whereas as that article describes SARS is caused by SARS coronavirus. I suppose oseltamivir may be used to treat both, since it's an antiviral, but I'm not able to find much online indicating that. Regardless, I think the medically accurate term to substitute for "Asian bird flu epidemic" would be "the H5N1 epidemic in Asia."
Roche upped production so that's your claim that they "sat on it"?
Production is dependent on demand, which is dependent on how bad the flu season is and how many are treated with Tamiflu. Otherwise a company produces a ton of product that just expires.
Predicting what the next flu season will be like is hard as hell. I haven't seen anyone do a decent job of it. Even Google tried and failed miserably.
I don't see that as "sitting on it". Also, the drug was already approved. Why would Roche not just sell more Tamiflu, it's easy money? What benefit is there to "sitting on it"?
Production is dependent on demand, which is dependent on how bad the flu season is and how many are treated with Tamiflu. Otherwise a company produces a ton of product that just expires.
Predicting what the next flu season will be like is hard as hell. I haven't seen anyone do a decent job of it. Even Google tried and failed miserably.
I don't see that as "sitting on it". Also, the drug was already approved. Why would Roche not just sell more Tamiflu, it's easy money? What benefit is there to "sitting on it"?
[deleted]
Your girlfriend is overstating the case. In tissue culture, almost 100% of circulating strains of flu are susceptible to oseltamivir. However, clinical and epi studies have shown, at best, a very modest effect on disease in otherwise healthy adults. It may reduce transmission, but it comes with an increased likelihood of vomiting and diarrhea. It is far more critical for those at risk of complications (the elderly, those with underlying respiratory conditions).
Widespread usage of oseltamivir will almost certainly lead to widespread resistance, and there aren't many other options for future, particularly nasty flus. This is the reason for the US stockpile--even though the data wasn't conclusive on its benefits, oseltamivir was the best plan for pandemic flu.
http://www.bmj.com/content/358/bmj.j3266 http://www.bmj.com/content/348/bmj.g2545 http://www.thelancet.com/journals/lancet/article/PIIS0140-67...
Widespread usage of oseltamivir will almost certainly lead to widespread resistance, and there aren't many other options for future, particularly nasty flus. This is the reason for the US stockpile--even though the data wasn't conclusive on its benefits, oseltamivir was the best plan for pandemic flu.
http://www.bmj.com/content/358/bmj.j3266 http://www.bmj.com/content/348/bmj.g2545 http://www.thelancet.com/journals/lancet/article/PIIS0140-67...
Cochrane Collaboration is a network of independent scientists. They analyzed the evidence and said that Tamiflu is no more effective than Paracetamol: http://www.cochrane.org/news/tamiflu-and-relenza-getting-ful...
A little more info:
"Tamiflu (the antiviral drug oseltamivir) shortens symptoms of influenza by half a day, but there is no good evidence to support claims that it reduces admissions to hospital or complications of influenza."
https://www.sciencedaily.com/releases/2014/04/140411091937.h...
Or the complete review: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008965...
"Tamiflu (the antiviral drug oseltamivir) shortens symptoms of influenza by half a day, but there is no good evidence to support claims that it reduces admissions to hospital or complications of influenza."
https://www.sciencedaily.com/releases/2014/04/140411091937.h...
Or the complete review: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008965...
YMMV.
On my trip to Japan I came down with a flu (Influenza-B). Got 40c fever, full-body muscle pain, the whole shebang. Slept through two whole days, occasionally taking ibuprofen to knock the fever off enough to be able to eat something. Then finally went to a doctor, who without any hesitation prescribed Tamiflu, a stock of which they keep in the office at all times. Two tablets later - the fever is gone, replaced with some dry cough and a bit of a runny nose.
I know my flu. I had plenty of them and if I have one, it lasts for 3-4 weeks before the temp drops below 38c. There is no doubt in my mind that I recovered from the last flu in 2 days exclusively because of Tamiflu and seeing it compared to Paracetamol makes no sense.
On my trip to Japan I came down with a flu (Influenza-B). Got 40c fever, full-body muscle pain, the whole shebang. Slept through two whole days, occasionally taking ibuprofen to knock the fever off enough to be able to eat something. Then finally went to a doctor, who without any hesitation prescribed Tamiflu, a stock of which they keep in the office at all times. Two tablets later - the fever is gone, replaced with some dry cough and a bit of a runny nose.
I know my flu. I had plenty of them and if I have one, it lasts for 3-4 weeks before the temp drops below 38c. There is no doubt in my mind that I recovered from the last flu in 2 days exclusively because of Tamiflu and seeing it compared to Paracetamol makes no sense.
The flu doesn't last 3-4 weeks
That's a fair point, actually, and I should clarify that.
From where I'm from there's 36.6c, 37.7c and 39c temperature marks that respectively denote the "ok", "basic cold", "bed regime" and "burning hot" ranges. It does take me several weeks after getting a flu to get back to the "basic cold" level. With this antiviral thing I got there in 2 days flat.
From where I'm from there's 36.6c, 37.7c and 39c temperature marks that respectively denote the "ok", "basic cold", "bed regime" and "burning hot" ranges. It does take me several weeks after getting a flu to get back to the "basic cold" level. With this antiviral thing I got there in 2 days flat.
Your story is why we don't run single patient clinical trials. In fact, Tamiflu has pretty limited efficacy if not taken in the first 24-48 hours.
Do you mind clarifying who are these "we"? It might be my old BBS habit kicking in, but I really don't appreciate a random person on the Internet taking on themselves to speak on behalf of others with no apparent reason.
And it is a single anecdote, so, no, it'd be indeed very strange to base the results of a "clinical trial" on it alone. It does however mean that in at least one case the drug worked and it worked very well. As I said above "YMMV".
And it is a single anecdote, so, no, it'd be indeed very strange to base the results of a "clinical trial" on it alone. It does however mean that in at least one case the drug worked and it worked very well. As I said above "YMMV".
There is not strong indication that the drug worked well or even at all. It was taken long outside the window where its best applied.
Chances are that in your case, the illness has run its course and the pills were taken at the time you would have gotten better anyways. I’d bet that sleeping two days had a much stronger effect on your recovery than two doses of tamiflu.
That’s why we - as a society - do not accept clinical trials that do not conform to a minimal scientific standard, statistical significance being one of the requirements.
Hey, random HN poster.
I too went to the kindergarten and know what statistical significance is. Surprise. So thanks a bunch, but no need for lecturing on the basics of scientific method. I am also a part of a rational part of the society, which you appear to be trying to exclude me from if I'm reading your comment correctly.
> I’d bet that ...
You can bet whatever you want. I had numerous flu's in my lifespan of almost 50 years. All but one were the same, and the exception ended in less than a week. It was lab-tested to confirm that it was in fact a flu virus. It was the only one when I was taking an antiviral med.
I too went to the kindergarten and know what statistical significance is. Surprise. So thanks a bunch, but no need for lecturing on the basics of scientific method. I am also a part of a rational part of the society, which you appear to be trying to exclude me from if I'm reading your comment correctly.
> I’d bet that ...
You can bet whatever you want. I had numerous flu's in my lifespan of almost 50 years. All but one were the same, and the exception ended in less than a week. It was lab-tested to confirm that it was in fact a flu virus. It was the only one when I was taking an antiviral med.
Hey, random HN anecdote teller. (Aren’t we all a bit random around here?)
You may have learned about statistical significance in kindergarten (props for the kindergarten for great education, I didn’t get there till high school) Still you’re displaying coincidence in a single case as correlation.
Neither did I question whether you had flu or not, you’re attacking a straw man there. I question that tamiflu was a strong factor in your speedy recovery.
You may have learned about statistical significance in kindergarten (props for the kindergarten for great education, I didn’t get there till high school) Still you’re displaying coincidence in a single case as correlation.
Neither did I question whether you had flu or not, you’re attacking a straw man there. I question that tamiflu was a strong factor in your speedy recovery.
"we" - the entire scientific establishment (a.k.a. the scientific method).
"It does however mean that in at least one case the drug worked and it worked very well." - unsubstantiated.
Ironically, you've (again) drawn a conclusion based on only your own experience. Which is why, as pointed out above, "we" don't run single patient clinical trials. Your recovery after using the drug simply cannot be attributed to the drug. In addition, it should be obvious (considering the contents of the comment chain to which you are responding) that it likely was not the drug that accelerated your recovery in this case. Does that makes sense?
"It does however mean that in at least one case the drug worked and it worked very well." - unsubstantiated.
Ironically, you've (again) drawn a conclusion based on only your own experience. Which is why, as pointed out above, "we" don't run single patient clinical trials. Your recovery after using the drug simply cannot be attributed to the drug. In addition, it should be obvious (considering the contents of the comment chain to which you are responding) that it likely was not the drug that accelerated your recovery in this case. Does that makes sense?
> "we" - the entire scientific establishment
Obviously. It was a rhetorical question.
This is getting meta, but as an old Internet adage goes "Try and not speak on behalf of others", meaning that throwing around "we" in a discussion is counter-productive. It automatically pits a person against this implied "we" group, be it actually applicable or not.
The above comment is the perfect example of that - by using "we" the "refurb" person put me and the rational scientific community on the opposite sides of a line, implicitly invalidating whatever it was that I said. This is not an acceptable way to phrase arguments or even to express an opinion. "We" has no place in a public discussion unless there is in fact a group of people that one's qualified to represent.
PS. And don't put words in my mouth - I've drawn no conclusions except for the fact that based on _my_ prior experience with _my_ flu infections, this case was resolved in a very prompt manner and the only difference was the presence and the timing of taking in an antiviral med.
Obviously. It was a rhetorical question.
This is getting meta, but as an old Internet adage goes "Try and not speak on behalf of others", meaning that throwing around "we" in a discussion is counter-productive. It automatically pits a person against this implied "we" group, be it actually applicable or not.
The above comment is the perfect example of that - by using "we" the "refurb" person put me and the rational scientific community on the opposite sides of a line, implicitly invalidating whatever it was that I said. This is not an acceptable way to phrase arguments or even to express an opinion. "We" has no place in a public discussion unless there is in fact a group of people that one's qualified to represent.
PS. And don't put words in my mouth - I've drawn no conclusions except for the fact that based on _my_ prior experience with _my_ flu infections, this case was resolved in a very prompt manner and the only difference was the presence and the timing of taking in an antiviral med.
And your conclusion mistakes coincidence and correlation, which is the cardinal sin in medical trials. Quote “in at least one case the drug worked”. This is not a valid conclusion. All you can conclude from your singular experience is that in at least one case, taking the drug was followed by speedy recovery, but other factors were not controlled for.
Ah, you again. Yes, "correlation is not a causation". I am aware of that one too, believe it or not.
You say you are yet you make a strong definitive claim above that seems at odds with it.
I really wonder why you’re so hellbent on defending “but it worked for me” if you’re acutely aware of “I tried it once and at the same time I go better” does indeed bear all hallmarks of falling into the classic human trap of mistaking correlation for causation. It’s literally one of the easiest mistake to make. We humans are just wired for it. I’m certainly guilty of making that same mistake at least a thousand times and more. I’m actually glad if people point out to me when I make that same mistake.
From context, "we" is the drug company running the clinical trial. And his first sentence did read very strangely, as you clearly weren't talking about anything other than an anecdote. :)
Having said that, his point other point seems to be valid. Tamiflu does not make a claim as to helping someone in your case, afaik.
Having said that, his point other point seems to be valid. Tamiflu does not make a claim as to helping someone in your case, afaik.
If you have flu regularly, every few years, and they are all exactly the same, that is not the flu. That is something else, like Malaria kicking in.
It's the limited efficacy for all users? Isn't it possible some users+strain pairings respond markedly better, or are their studies showing that's not true either?
Please tell me what aspects of life must be held to scientific standards and what should not. If you had to have a scientific study before every decision you made, you wouldn't be able to walk 3 feet. Why is personal health something in which every judgement and decision must be backed by a double blind study? If you eat something and feel bad, don't eat it anymore. You don't need to wait for a test or study to tell you that. Please don't misinterpret me - science is incalculably valuable at saving lives, but it's not the only tool in our belt.
>Recently, I came down with the flu (I had the vaccine), I took 4 pills over 2 days and it was turned into a slight cold
A much more convincing explanation is that your symptoms were ameliorated by your vaccination, which is a thoroughly-documented effect.
A much more convincing explanation is that your symptoms were ameliorated by your vaccination, which is a thoroughly-documented effect.
Actually, this is interesting as an explanation.
My toddler woke up yesterday with fever and I was starting to feel like I was coming down with something as well (no fever yet), so we went to the clinic. They tested her, flu confirmed, gave us all Tamiflu. I started feeling markedly better about 6-8 hours after first dose. Today, we’re all completely normal except for mild cold symptoms. And this happened basically exactly the same last year. So I find all these studies about how Tamiflu basically does nothing to be pretty hard to take seriously...
EXCEPT that we were all vaccinated, which I didn’t even consider until now. I had assumed that getting the flu was a binary thing, and the vaccination just protected you from coming down with it, but wouldn’t ameliorate the symptoms or cause you to recover faster. That’s a much more compelling story if true.
My toddler woke up yesterday with fever and I was starting to feel like I was coming down with something as well (no fever yet), so we went to the clinic. They tested her, flu confirmed, gave us all Tamiflu. I started feeling markedly better about 6-8 hours after first dose. Today, we’re all completely normal except for mild cold symptoms. And this happened basically exactly the same last year. So I find all these studies about how Tamiflu basically does nothing to be pretty hard to take seriously...
EXCEPT that we were all vaccinated, which I didn’t even consider until now. I had assumed that getting the flu was a binary thing, and the vaccination just protected you from coming down with it, but wouldn’t ameliorate the symptoms or cause you to recover faster. That’s a much more compelling story if true.
The CDC discusses moderation of the illness some:
https://www.cdc.gov/flu/about/qa/vaccineeffect.htm
I guess they don't want to get too far out ahead of the science.
https://www.cdc.gov/flu/about/qa/vaccineeffect.htm
I guess they don't want to get too far out ahead of the science.
I’m no doctor
But a vaccine is basically giving your immune system a new toolbox for fighting diseases, so it would make sense to me that even if it didn’t stop you from getting the disease, it still equips your immune system to ease the severity
But a vaccine is basically giving your immune system a new toolbox for fighting diseases, so it would make sense to me that even if it didn’t stop you from getting the disease, it still equips your immune system to ease the severity
It makes sense, but I just never hear about that as a reason to get the vaccine, which seems crazy. The flu is miserable, so if the actual benefit of the vaccine is that you probably won’t get sick, and if you do, it’ll be for 36 hours instead of ten days, that seems to be a huge benefit they’re underselling.
It works that way yes, especially for the flu that changes so fast that its vaccination is no immune guarantee but rather helps to have milder symptoms. I guess how it's promoted depends on where you live. Also don't forget that not everyone has good cognitive capacities and such probabilities (you might still get sick with the vaccine, but symptoms might be milder) are not easy to grasp for everyone. I guess they just wanna keep the public message straight and simple.
> Recently, I came down with the flu (I had the vaccine), I took 4 pills over 2 days and it was turned into a slight cold.
A couple months ago, I came down with the flu. I, too, had a flu shot. I didn't take antivirals. 18 hours later, I was fine.
Anecdotes aren't terribly useful in medicine.
P.S. If you look up the latest studies and CDC guidance, you may learn that (a) the flu shot seems to cause a decent fraction of people who subsequently get the flu to get over it very quickly and (b) Tamiflu, while probably effective in the "statistically determinable to be better than nothing" sense is only very slightly better than nothing.
A couple months ago, I came down with the flu. I, too, had a flu shot. I didn't take antivirals. 18 hours later, I was fine.
Anecdotes aren't terribly useful in medicine.
P.S. If you look up the latest studies and CDC guidance, you may learn that (a) the flu shot seems to cause a decent fraction of people who subsequently get the flu to get over it very quickly and (b) Tamiflu, while probably effective in the "statistically determinable to be better than nothing" sense is only very slightly better than nothing.
My ex (5 years) is a clinician who works the ER, pediatrics, and urgent care, amongst other things. She has the opposite view: Tamiflu reduces the length of the flu by a total of 12 hours and most people don't need it. Wish she was on here to defend this view, since I am not qualified to debate it.
That's the generally accepted view on Tamiflu. Modest effect that you only see if started early on in the disease.
However, it's one of the very few options we have, so if the shit does hit the fan with a severe flu, it will save lives.
However, it's one of the very few options we have, so if the shit does hit the fan with a severe flu, it will save lives.
> Doctors know this and are reluctant to prescribe it -- since they know it is in short supply and critical populations should get it first. Ironically, doctors reluctance to prescribe it - actually reduces the supply.
Yet during the swine flu scare, Roche handed out massive amounts of oseltamivir (Tamiflu) like it was candy to their employees (at least at the SF Genentech campuses). You'd call into a doctor, who would do nothing but verify your identity and issue a prescription. You'd then pick up the drugs on campus. Unfortunately pretty typical for Roche-Genentech, which is prone to fairly disgusting levels of spending on excesses.
Yet during the swine flu scare, Roche handed out massive amounts of oseltamivir (Tamiflu) like it was candy to their employees (at least at the SF Genentech campuses). You'd call into a doctor, who would do nothing but verify your identity and issue a prescription. You'd then pick up the drugs on campus. Unfortunately pretty typical for Roche-Genentech, which is prone to fairly disgusting levels of spending on excesses.
> I came down with the flu (I had the vaccine), I took 4 pills over 2 days and it was turned into a slight cold.
What makes you think you had a flu in the first place and not just a cold?
What makes you think you had a flu in the first place and not just a cold?
Lol, post the studies not some business journal.
What you find, as you try to dig actual medical results up, is that it maybe knocks as day or two off the course of the flu, has side-effects, and is less effective than the vaccine.
Having some knowledge about both subjects, this is surrealistically close to the difference in how experts vs nonexperts think will keep them safe online (https://www.usenix.org/system/files/conference/soups2015/sou...)
What you find, as you try to dig actual medical results up, is that it maybe knocks as day or two off the course of the flu, has side-effects, and is less effective than the vaccine.
Having some knowledge about both subjects, this is surrealistically close to the difference in how experts vs nonexperts think will keep them safe online (https://www.usenix.org/system/files/conference/soups2015/sou...)
Tamiflu will shorten flu by 1 day in Most good studies.
In Aus Tamiflu is often prescribed. In fact, significantly over prescribed. $100+ for a box of tablets, that someone needs to start taking before we even have actual PCR confirmation of flu virus? Does the benefit outweigh the costs? Probably in elderly or in situations with decreased immunity.
For the rest of people, it is probably good to go through a fever cycle once in a while. Your immune system needs something to run at, or else it can end up attacking itself, or missing cancers. The firm evidence base for this is low but my belief (as a biochemistry major and doc with heavy interest in immunology) is that if you are otherwise healthy and you get the flu, then it is probably doing ok for you. We need to stop pathologising all sickness. It’s normal to be sick sometimes, in fact it’s probably necessary for optimum function.
[0] - quick link from google as I am on mobile but well known to me in my professional capacity - http://www.center4research.org/tamiflu-not-tamiflu/
In Aus Tamiflu is often prescribed. In fact, significantly over prescribed. $100+ for a box of tablets, that someone needs to start taking before we even have actual PCR confirmation of flu virus? Does the benefit outweigh the costs? Probably in elderly or in situations with decreased immunity.
For the rest of people, it is probably good to go through a fever cycle once in a while. Your immune system needs something to run at, or else it can end up attacking itself, or missing cancers. The firm evidence base for this is low but my belief (as a biochemistry major and doc with heavy interest in immunology) is that if you are otherwise healthy and you get the flu, then it is probably doing ok for you. We need to stop pathologising all sickness. It’s normal to be sick sometimes, in fact it’s probably necessary for optimum function.
[0] - quick link from google as I am on mobile but well known to me in my professional capacity - http://www.center4research.org/tamiflu-not-tamiflu/
On the other hand, a lot of diseases (including lifelong, autoimmune ones) are triggered, at least in part, by infections[0]. Without ever experiencing even a common cold, it stands to reason that some cases of those diseases could be precluded. Also, for the elderly, respiratory illness should be avoided because it puts undue stress on the cardiovascular system[1].
We need to be come robots[2]!
[0] https://www.labroots.com/trending/health-and-medicine/4999/a...
[1] https://www.cbsnews.com/news/flu-tied-to-heart-attack-risk-i...
[2] http://i.dailymail.co.uk/i/pix/2015/12/02/00/2EF55A550000057...
We need to be come robots[2]!
[0] https://www.labroots.com/trending/health-and-medicine/4999/a...
[1] https://www.cbsnews.com/news/flu-tied-to-heart-attack-risk-i...
[2] http://i.dailymail.co.uk/i/pix/2015/12/02/00/2EF55A550000057...
And there’s also strong evidence that infection with ie. parasites decrease lifetime autoimmune infections, and fevers have been known to send cancer into remission
You maybe down voted because people here want links and proofs.
My doctor gave me a flu test recently, which involved swabbing my sinuses with a cotton swab and putting it in a plastic test kit about the size of a matchbox. Within 5 minutes she was able to tell me that I am positive for Influenzea B. What test is this that it is so much faster than the one you've mentioned?
I'm not aware of this test. In Aus last winter we were peforming nasal swabs but results weren't available for at least a day.
i've just come across [0] which describes roughly what you're talking about.
a bit further digging shows it was available at the hospital I work at according to their press releases. I assume it worked via some sort of compartmentalised ELISA which is pretty awesome.
[0] https://www.nsw.gov.au/your-government/the-premier/media-rel...
i've just come across [0] which describes roughly what you're talking about.
a bit further digging shows it was available at the hospital I work at according to their press releases. I assume it worked via some sort of compartmentalised ELISA which is pretty awesome.
[0] https://www.nsw.gov.au/your-government/the-premier/media-rel...
> Your immune system needs something to run at, or else it can end up attacking itself, or missing cancers.
This is patently untrue.
This is patently untrue.
Whilst this is not a clear-cut case yet, it is certainly not patently untrue, and on the balance and from my position observing evidence and with the weight of the building evidence, I have no problem giving a hat-tip to this.
Observe the hygiene hypothesis as a starting point
[0] DOI: 10.1126/science.296.5567.490 - Allergy, Parasites, and the Hygiene Hypothesis
Observe the hygiene hypothesis as a starting point
[0] DOI: 10.1126/science.296.5567.490 - Allergy, Parasites, and the Hygiene Hypothesis
My family came down with the flu right before I was scheduled to return from a business trip and turn around two days later to spend two weeks out of the country. We took as many precautions as possible to avoid spreading it to me (frequent hand washing, not sharing food, all of that) but I also got a preventative Tamiflu prescription. It didn't seem to be in short supply or hard to get -- I literally just described the situation over my healthcare provider's chat app and they sent a prescription to the pharmacy for me to pick up on my way home from the airport. Cost me $10.
Whether the stuff works or not is a different question. I read some of the research and meta-analyses and meta-meta-analyses and it didn't seem cut and dry. I can say I didn't get the flu, but there are many other times I didn't get the flu without taking anything.
Whether the stuff works or not is a different question. I read some of the research and meta-analyses and meta-meta-analyses and it didn't seem cut and dry. I can say I didn't get the flu, but there are many other times I didn't get the flu without taking anything.
IMO this is technically criminal. States should be able to buy the rights and make a steady supply.
Roche is low on this.
Roche is low on this.
Though China can be criticized on many fronts, I'm a little envious over the pragmatic strong arming of Roche with a "produce it or we will" approach in order to secure a supply.
There are serious things wrong with our system when the best allocation of capital is to acquire and park IP. "Non practicing" IP should have strong incentives to make it accessible. What are possible policies for that: taxation incentive, compulsory licensing, or others?
There are serious things wrong with our system when the best allocation of capital is to acquire and park IP. "Non practicing" IP should have strong incentives to make it accessible. What are possible policies for that: taxation incentive, compulsory licensing, or others?
I can accept a dose of business cynicism, but viruses are outside this box.
Also, it reminds me the allegedly Chinese proverb saying doctors there weren't paid, but would pay if they didn't cure you. Different cultures ...
Also, it reminds me the allegedly Chinese proverb saying doctors there weren't paid, but would pay if they didn't cure you. Different cultures ...
If at 65 sombody dies from flu, the problem was not the flu. 65 is not old age anymore.
You simply can not say this. Medical history is super important here.
Then the medical history is the problem, not the flue. A sane robust body is not supposed to be killed by the flue. If our society produce people that the flue kills, let's focus on those causes. Not the flue.
It's like focusing on making all houses flood proof. Most houses don't need it. If one needs it, relocating the house is probably a better idea that trying to make a new law saying all house should have floaters. The problem is that our society let us build houses on floodable area, not the flood.
It's like focusing on making all houses flood proof. Most houses don't need it. If one needs it, relocating the house is probably a better idea that trying to make a new law saying all house should have floaters. The problem is that our society let us build houses on floodable area, not the flood.
Paracetamol is something to be careful with, along with it's ease of overdose, we are still learning about it's neurological effects. I stick to Ibuprofen.
https://www.theatlantic.com/health/archive/2013/04/whats-tyl...
https://www.theatlantic.com/health/archive/2013/04/whats-tyl...
The thing is to know when your child (or you for that matter) have the Flu and not just a Cold.
Those who can't get Tamiflu/Oseltamivir: http://journals.plos.org/plosone/article?id=10.1371/journal....
You can buy it anywhere on web to make you own spray (100 g will be enough for whole family for at least year). Just 2 things:
1.Use only boiled water.
2.Spray throat and nose.
From my personal experience - it's really helpful also from other viral infections.
Sadly if virus already in blood and lot of time has passed - it's not gonna help :( Zinc might help a bit... depends on person and Vit B6 status.
my elderly mother (70 yrs) who was visiting, came down with very bad flu symptoms. Having a newborn at home I took her to urgent care to get Tamiflu. They did the rapid test that came negative so they sent her off with nothing.
Considering her age, the fact that I had a newborn and that rapid testing has a high false negative rate, I was pretty upset that they didn't give her tamiflu as a precaution. Maybe reports that it was in low supply are true
Considering her age, the fact that I had a newborn and that rapid testing has a high false negative rate, I was pretty upset that they didn't give her tamiflu as a precaution. Maybe reports that it was in low supply are true
We used to give antibiotics "just in case", because of reasons like this and we now have antibiotic resistant bacteria. We've seen the same thing with antiviral drugs. Shortage or not, giving antivirals to make a caregiver feel better seems like a dangerous way to make people in the future sicker. It really would have been more prudent to put one or both of them in the hospital for observation, and it is awful that we don't have such wards available (I imagine they wouldn't need staffing greater than a nursing home because most are simply there just in case).
The test having a high false negative rate isn't actually a good enough reason to treat folks, rather a reason to develop a better test.
The test having a high false negative rate isn't actually a good enough reason to treat folks, rather a reason to develop a better test.
But this statement: "fevers that abate only to flare up again after the child seems to be over the worst of the illness" reminded me of something that happened to my son.
When he was 7, he came down with a flu-like illness that lasted a week, and because it was a bad flu season we were told to stay away from the doctor's surgery. After about 4 days of fever and no eating my wife railed against the advice and took him along, only to be fobbed off by her regular doctor who said there was nothing to worry about, he had an ear infection, and prescribed some antibiotics.
So for the next day or two he seemed to improve. Then, on the Sunday, he suddenly faded away again and seemed to lose all interest in getting better. The only thing he complained about was a perpetual pain in his neck. I took him back to the surgery, and because it was a weekend I saw a visiting doctor rather than our regular one. The guy took one look at him and phoned the hospital, told me to get him there urgently.
It transpired he had a very advanced pneumonia, and had to be transferred to a bigger hospital for an operation to remove 1 litre of fluid from his lung. That was what had been causing the neck pain: the sheer weight of the fluid on one side of his chest. After the op, they managed to treat the infection with about the fourth antibiotic they tried (I think there were only a couple left after that, which was scary). Another week later and he went home, and made a full recovery, thankfully.
When questioned, our family doctor very defensively said she had never come across such an advanced case of pneumonia in "someone who could still stand up", and so she had discounted it. This fact seemed to be borne up by the fact that our son was a prize exhibit at the teaching hospital he'd been transferred to, surrounded on a daily basis by medical students listening through stethoscopes and being told "this is what a pleural empyema sounds like in a child - note the lack of the classic rattling noise you associate with pneumonia" ... so maybe our doctor was correct. Anyway, we were just glad to have our son well again and were not interested in lawsuits.
But every time either of our kids gets a fever or anything that seems like the flu now, we play extra close attention and refused to be fobbed off by over-worked doctors.