The Two Faces of Dr. Marc Siegel

Today, we were treated to yet another article about the terrible dangers of panicking about the pandemic.

From the Atlanta Journal Constitution, September 22, 2009:

With all the warnings and preparations, dire predictions and hastily ordered vaccines, could the growing worry about H1N1 swine flu prove more disruptive than the actual outbreak?

That notion is weighing on the minds of more than a few infectious-disease experts as the fall and winter flu season looms.

Not only does societal panic not help during a public health situation, such as the current H1N1 flu pandemic, it can actually backfire, creating its own set of problems, the experts said.

“We have limited resources in the U.S. — if this [swine flu] captures our negative imagination, it’s going to hurt our health-care system,” said Dr. Marc Siegel, associate professor of medicine at New York University School of Medicine in New York City. “Our emergency rooms will be flooded with worried people, doctors’ phones will be hanging off the hook, everyone will be afraid of every sniffle and wanting to get tested for the flu.”

Dr. Siegel’s concerns were given support by Dr. Dean Blumberg, at the University of California, Davis Children’s Hospital.

From the same AJC article:

A rush for flu drugs has its own dangers, Blumberg said, because “people stockpiling Tamiflu or taking it inappropriately for the current swine flu might create [viral] resistance so the drug might not work well when we really need it.”

Yeah, giving Tamiflu to just anyone who wanted it would be pretty bad. What kind of nut would do that? Well, maybe this guy (from Slate, July 10, 2009):

For three summers, my 12-year-old son, Joshua, has attended Camp Modin, a beautiful camp in rural Maine. This year, when we dropped him off at the northbound bus, something was different: The counselors were taking children’s temperatures before letting them onboard. It seemed a wise precaution, as the new influenza A H1N1 swine flu strain continues to spread and the weather in Maine in June was cool this year, which would facilitate an outbreak of the virus. But as a physician who has studied the flu for many years, I was still worried. An infected person can be contagious even if he doesn’t have a fever.

My concern was justified. Three days after camp started, I called the camp director, Howard Salzburg, and discovered that he was beside himself. One of the parents, another physician, had used Tylenol to deliberately suppress his child’s fever so he wouldn’t be held back. There were already 16 cases of the flu, confirmed by the Maine Center for Disease Control and Prevention to be the H1N1 swine flu strain. Desperate to contain the infection, Howard had created a quarantine bunk for the sick and was having all the bunks cleaned with hospital-grade disinfectant. One other tool could help stem the spread of infection—but using it would go against CDC protocol.

The Centers for Disease Control has a national policy to reserve the anti-flu drug Tamiflu, which works by blocking the flu virus from detaching from one human cell and spreading to the next one, for only severe cases. But with the new pandemic strain circling the globe and more than 1 million people already infected, it seemed to me it was time for our public health authorities to employ a more aggressive strategy. Clinical trials have shown that Tamiflu, when taken within 48 hours of exposure, is 92 percent effective at preventing flu in adults and 82 percent effective in children. Since we don’t yet have a vaccine, it was clear that the best strategy was to use the drug, which decreases the severity and the duration of the illness and helps prevent people who are in contact with flu patients from getting sick themselves. I e-mailed the camp parents to let them know that Tamiflu is well-tolerated and safe and that I was starting my son on a 10-day course of it; it would be wise, I recommended, for them to do the same. Prescriptions were soon flooding the camp’s fax machine; out of the 350 campers, 250 campers were started on the drug, as were more than 100 staffers.

So let me get this straight. One doctor who knew his kid might be infected with pandemic flu, gave his child a fever reducer to get him into the camp, even though he knew that this put the other kids at risk. And another doctor, the author of this article, prescribed his child Tamiflu and urged all the other parents, many of whom appeared to be physicians, to do the same. And they did. The camp was flooded with prescriptions.

We have members at PFI_Forum who are desperately trying to get Tamiflu prescriptions for their children. But, they are being told no, presumably on the advice of people like Drs. Blumberg and Siegel.

By the way, want to know the name of the doctor who broke CDC protocol and got a special exemption to flood the summer camp his child attended with Tamiflu?

Dr. Marc Siegel.

Yeah, the same Dr. Marc Siegel who is telling other people not to be concerned about this pandemic. The same Dr. Marc Siegel who is concerned about conserving scarce resources, you know, like Tamiflu.

Some animals are more equal than others.

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