Miss Dx sure is a loose woman! Not only does she run around pokin’ her needle into every arm that crosses her path, but she also wants to have a hot make-out party once everyone is immunized against H1N1. Apparently she’s all hot and bothered over some new CDC report demonstrating the vaccine’s safety.
I’m sure that today’s headlines will mature into fodder for tomorrow’s brilliant Woody Allen film-cum-social commentary on love and happiness within the larger misery of the human condition –I mean, I can picture the scene where Cate Blanchett, impersonating Woody Allen, throws her hands in the air while exasperatedly pondering the absurdity of an American military psychiatrist opening fire on a crowd of U.S. servicepeople, killing a dozen and injuring scores more. How do these things happen? How are we supposed to receive, process, and reflect this information with our subsequent behavior, our ability to keep going and to find meaning in the broken world that surrounds us? Somehow methinks Cate Blanchett’s character will learn to love in the end, will accept the yin with the yang, will realize that for every violently deranged gunman, there are a hundred sensitive, kindly bloggers out there trying to make the world a better place. But meanwhile, back here in non-movieland, the forces that be continue to tiptoe around the fact that military suicide rates are climbing, and active and veteran servicepeople are at substantially higher risk for committing suicide than civilians (Kuehn, 2009, JAMA, 301(11), 1111-1113). As per violence, even the DOD admits that domestic violence against spouses of servicepeople is “a problem.” Unfortunately, data on rates of military suicide, homicide and other noncombat-related violence is hard to come by: searching CDC, NIH, PubMed, PsycheInfom, CINAHL and PMC databases didn’t yield much. Kuehn (cited above) determined suicide rates by extracting data from general CDC surveillence reports. I couldn’t find anything specific to the military. If you’ve got a source, lemme know!
Mental health is a hot topic for military PR right now, and the rising rates of active-duty and veteran violence and suicide has them Army boys sittin’ around scratchin’ their balls asking, “why?” That’s right. The NIH, the Army, and $50 million in taxpayer money are teaming up to investigate why soldiers commit suicide!!! Don’t get me wrong: I theoretically support suicide research and figuirng out why it happens. But in the case of young men and women participating in and subjected to extreme violence, I think the answer is a little bit self-evident. Still, okay, okay, it’s good to study factors that protect servicepeople against suicide, because if we know what the protective factors are, we can keep asking “non-suicidal” people in the service to do our dirty work in intolerable environments without worrying that they’ll just kill themselves first. Ok, maybe that’s pessimistic of me. Maybe we’ll use the knowledge to screen for mental illness and treat suicidal ideation, or change military policy to accomodate those prone to suicide or mental illness (uh, yeah right). Or we can pile “protective factors” onto those at risk for suicidal ideation. Like how some of the first meth addicts were military pilots who were given meth in order to protect them against combat fatigue.
Today’s other headlines weren’t the counterbalancing pick-me-ups I’d hoped they’d be. Anti-abortion, anti-immigrant democrats (forgive my extreme ignorance, but I didn’t know there was such a creature) may jeopardize health reform, and H1N1 vaccines magically reached Wall Street before other needy clinics. Hey, you people who think the “honor system” is alive and well in the medical industry: I have already seen H1N1 vaccine go to members of non-priortitized groups, because someone asked nicely or somebody knew somebody or somebody was a VIP or whatever. I have objected, but some providers seem to be of the opinion that a little bit off the top won’t hurt. My most esteemed government, next time you can keep your honor system and instead hold providers accountable for each and every dose of vaccine you ship to them.
FYI: Hoarding of the swine flu vaccine isn’t just a domestic issue. It’s projected that there will be about a billion doses for the world’s six billion people.
Looking at today’s headlines makes me shake my head, and I can only borrow the thought of a visionary born a century before me (no, not Woody Allen): Shine, perishing republic.
I don’t know about you, but my birth control experience isn’t satisfying unless I can be confident that my own immune system will be used to destroy my ability to harbor new life. Enter the promising up-and-coming antifertility vaccines, some of which target either the infamous pregnancy-sustaining hormone called human chorionic gonadotropin (hCG) or the libidinous hypothalamic henchman known as gonadotropin releasing hormone (GnRH) (Talwar, Vyas, Perswani & Gupta, 2009). Essentially, these vaccines work by stimulating your immune system to wipe these endogenous hormones from your system. Without these hormones, becoming pregnant or maintaining pregnancy is impossible. Furthermore, since cancerous cells can develop fun party tricks like hormone production and secretion, some cancerous cells (such as certain T-cell leukemias) are known to produce GnRH and/or hCG. Antibodies that target these hormones seem to help neutralize some of these cancers. Prostate growth is also stimulated by GnRH, and phase I/II clinical in Austria and India show atrophy of the prostate and improvement of prostate cancer in vaccinated patients.
As far as I can tell, interest in an antifertility vaccine began in the late ’60s/early ’70s. Significant gains were made in the ’70s and ’80s, and much of the work on the actual hCG/GnRH vaccines seems to have been done by various members of a small team of researchers out of India headed by our good friend G. Talwar (cited above.) If clinical trials continue to go well, Mr. Talwar’s baby (no pun intended) may live to see the light of the free market within the next five or ten years.
Objections to the vaccine are obvious: Groups or governments will abuse the vaccine; vaccines treat pregnancy like a disease; the vaccine is intended to impact populations and therefore supports a woman-blaming approach to population control; the H1N1 vaccine is actually the antifertility vaccine; since hCG is produced by a fertilized egg, the vaccine kills babies; babies conceived despite vaccination may be harmed by the antibodies; etc.
Some concerns are valid, though women’s advocacy groups will be happy to know that researchers are also making progress on an anti-sperm vaccine as well (Naz, 2009). And the rather one-sided focus on the cautionary arguments overshadows the possibility that this technology will be of enormous use in battling cancer and inexpensively, harmlessly controlling animal populations (Fayrer-Hosken, 2008). Still, one wonders whether the forty years worth of immunocontraceptive funding would have been better spent supporting sociopolitical and economic liberation of women and girls, or efforts aimed at environmental health and sustainability. Perhaps. Perhaps not. It takes more time and money to tackle population control by addressing overarching global problems like inequality, poverty, cultural and social rot, and systematic poisoning of the planet than it does to teach my immune system to bounce any pesky hCG-secreting embryos hoping to get into my hot uterine nightclub.
For all you parents of trick-or-treaters worried about creepy neighbor Jerry popping a roofie into your kid’s “fun-sized” glucose glob, I’d be more concerned about Junior’s little costumed friends and the sticky, slobbery, flu-infested mucosal secretions all over their chubby hands. Why? Because swine flu doesn’t seem to understand that it’s supposed to kill off old, sick people languishing in nursing homes instead of healthy little children and glowing pregnant women. That’s right. 95% of hospitalizations have occurred in those under 65 years old, with 45% occurring in children under 18. Believe it or not, the situation isn’t all just media hype and scare tactics. It’s ugly out there. True, not everyone dies or ends up in the hospital, but even an uncomplicated course of swine flu will park your ass in bed for a week or longer. So these days, I’m more worried about kids catching H1N1 than swallowing a razor blade hidden in a popcorn ball.
So there’s the usual “I don’t trust the government/science/western medicine/drug companies” grumbling over the H1N1 vaccine. Yeah, I get it. Sure, sure. Whatever. You’re not going to blow my freakin’ mind with the argument that the pharmaceutical industry WANTS us to be scared and WANTS us to get the vaccine because that means lotsa cash for them. I understand that profit is a motivating factor. That doesn’t really change the risk/benefits analysis all that much, nor does it change the fact that both the H1N1 shot and nasal spray are safe and effective, even for pregnant women (Tamma, Ault, del Rio, Steinhoff, Halsey, & Omer, Sept. 2009). So, if you’re able to, I’d toss a dose of H1N1 vaccine into your Halloween treat bag this weekend. Here’s info on how to pay for it. Here’s info on who should get vaccinated first. If you live in New Mexico, you can try these clinics, or contact your regular health care provider (if you’re lucky enough to have one). While you’re there, consider getting a seasonal flu vaccine as well (seasonal flu is different from H1N1 swine flu, and you’ll need a separate vaccine for each one.)
Hey, you also might want to throw a pneumococcal vaccine into your goody bag as well, since many viral flu deaths occur in people who develop bacterial pneumonia in addition to the flu.
And while you rot your enamel with sweet sugary Halloween candy, ponder the fact that we’ll soon have a vaccine against cavities (Li et al., 2009; Nui et al., 2009; Lui et al., 2009; etc., etc. Apparently Asia is all over this one.)
Too old to need anti-party vaccines? Keep holdin’ out for that vaccine against Alzheimer’s!
But whatever you do, don’t toss the condoms just yet. The new HIV vaccine was only 30% effective (which is still a major breakthrough).
There’s a whole exciting world of novel vaccines out there. From anthrax to cancer, the boring ol’ CDC vaccine schedules are about to get a whole lot more interesting. For now, though, I’ll be happy if I’m able to get immunized against the dreaded swine flu before I catch it from one of my germy little patients. Secretly, though, I’ll keep my fingers crossed for an anti-cellulite vaccine…
Although I don’t want SEMI to go the way of KevinMD with superficial news blurbs lacking any hint of personality and hawked from other blogs or the Associated Press, I am short on time this week and thus unable to provide anything other than content-poor headlines right now. I must leave it up to my dear reader(s) to discuss.
This week in wealth care reform health care reform:
Hey, Obama, everybody knows that secrets don’t make friends. Money, maybe, but not friends.
Ralph Nader and Amy Goodman should just make a baby already. If Amy’s concerned that she’s past her prime, I’m happy to offer my youthful womb as a surrogate. Anyhow, I think Nader is using the term “harmony ideology person” as a euphemism for “pu**y.” (No, not puffy! Or puppy! Or puddy! Or pushy! Or pully! Or pukey! Or pudgy! Ok, maybe pudgy.)
Someone over at T.C. wags a finger at the left for its failure to keep its eye on the prize. To any regular ol’ nurses (as in, not published numerous times over in academic journals) interested in policy advocacy out there, can you name your state’s senators and congress people AND their voting records on issues related to health care reform like T.C.? I’ll just go ahead and take one for the team by admitting that I can’t either. Let’s get crackin’. Stay tuned for a piece I’ll be posting next week on policy advocacy within nursing.
Jon Stewart spearheads public health campaign raising awareness of ideology-associated amnesia (IAA). John Oliver combats national health care discrepancies by advocating for equal access to death panels.
U.S. Dept. of Health and Human Services attempts to bolster support for health reform with a report on how Big Insurance leaves millions behind. A more comprehensive report on health disparities may be found here. Guess what? People living at or below the poverty level and racial/ethnic minorities receive the shittiest care! I am shocked. For those of you who think they deserve it, perhaps you need a little work expanding your social consciousness (by the by, anybody who is actually interested in that article can “borrow” my copy if you send me an e-mail address).
I’ve encountered a lot of provider disillusionment regarding a public option or universal coverage via expansion of Medicare/Medicaid because many of us in the biz know that reimbursement is a big hairy ugly issue with lots of twisting dark tunnels in which to descend without hope of rescue (For example, I sat down with utilization review a few weeks ago in order to understand how much money our hospital loses because of services that would not be reimbursed by Uncle Sam.) I know providers and patients waste endless time, engergy, money and lives strugging with Big Insurance too, but anybody who wants to see quality improvement of Medicare/Medicaid before a “public option” goes live may be interested in venting your opinions here. I’m no expert on this stuff, so I’d love to see a little lively debate going here on SEMI as well.
Business man Dr. Andrew Weil does a bad job of making a decent argument about the misdirection of the health care industry and the medicalization of socioeconomic problems here. I sure hope we see more “wrong diagnosis” puns in the debate over health care reform!
And finally, a few random tid bits:
Ever wonder how much vaccines cost?
Anybody want to meet in Chicago on Sept. 22 for a sexy weekend of healthcare-associated infection debate (see above section on Medicare/Medicaid reimbursement)? Fellow nurse friends, I’m talking to you.
As an RN and an FNP student, it only makes sense that I don’t have health insurance. I’m due to get my cervix scraped, Pap-style. Any fellow (legally licensed and practicing) med folks out there feel like doing me a professional courtesy? C’mon. I’ll get you back when I’m licensed to hand out prescriptions.
Safe driving, y’all.