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To Vaccinate or not Vaccinate: That is the Question

To Vaccinate or not Vaccinate: That is the Question

Should I vaccinate against the current CoronaVirus (SARS CoV2)?  That is my most frequently asked question in the last few weeks.  It is easy for me to answer.  It may be difficult to hear.  Can we have a discussion or a critical look at m-RNA coronavirus vaccines dispassionately?  Without being labeled an anti-vaxxer?  Without the hype or invoking conspiracy theories.  That is the critical question.

I have often stated there is good science, there is bad science and there is science denial.  There is a lot of happy talk today from notable “authorities” or “experts.”

So let me give you some very critical bullet points.  After which you can decide for yourself.  Ideally, I would like you to make this decision based on the facts and not out of fear.  However, we know there is a concerted effort to convince you all that vaccination is not only medically necessary but a patriotic duty.  I see this as happy talk propaganda – newly formulated groupthink.

  • This is not a classic vaccine.  It is an entirely new technology.  They are injecting m-RNA fragments into your system whereby your cells are instructed to manufacture coronavirus antigenic spikes. Then your (intact) cellular immunity hopefully reacts by producing protective antibodies.  What could go wrong?
  • Operation Warp Speed is a Rush-to-Market biological without adequate phase 3 trials
  • This is the first product Moderna has ever produced.  They have no track record
  • All these “vaccines” are not FDA “approved.”  They are FDA “authorized” (EUA or Emergency Use Authorization).  They will eventually need to reapply to the FDA for final approval.  If you have ever asked whether a drug or nutritional is “FDA approved” then consider this.
  • Be concerned about the stability of the Pfizer vaccine distributed and stored at -70º and secondarily of the Moderna product.
  • There is a real concern being voiced about a delayed hyper-immune response. Anyone with an autoimmune condition beware.
  • The companies did not prove the vaccines competently prevent disease or death.  Only to mitigate symptoms.   Otherwise, why do they insist that you still wear a mask — even after vaccination?
  • The 95% effectiveness rate is bogus.   It is not 95%.  More statistical chicanery
  • No pandemic has ever been cured with a vaccine.   Only after the disease is endemic is it eventually “cured.”    i.e. smallpox
  • And just organizationally, how is this going to work?  They gave all of the pharmaceutical companies blanket immunity against all liability.  So they derive all the profits without any risk.  But they never set up the necessary infrastructure.  Large-scale vaccination centers, trained nurses, technicians, backup physicians for any “vaccine reactions.”  There was no command or implementation structure.
  • When we were kids we all eventually took the Sabin vaccine.  Not the Salk vaccine.  It was very simple.  Tiny pink sugar cubes.  We all marched in lines.  This is far more complex.

Now I think the most critical oft-quoted “fact” is 95% effectiveness.  I often emphasize the difference between relative and absolute risk reduction.  So let me quote from a BMJ opinion section in November 2020:

In the United States, all eyes are on Pfizer and Moderna. The top line efficacy results from their experimental covid-19 vaccine trials are astounding at first glance. Pfizer says it recorded 170 covid-19 cases (in 44,000 volunteers), with a remarkable split: 162 in the placebo group versus 8 in the vaccine group. Meanwhile Moderna says 95 of 30,000 volunteers in its ongoing trial got covid-19: 90 on placebo versus 5 receiving the vaccine, leading both companies to claim around 95% efficacy.

Let’s put this in perspective. First, a relative risk reduction is being reported, not absolute risk reduction, which appears to be less than 1%. Second, these results refer to the trials’ primary endpoint of covid-19 of essentially any severity, and importantly not the vaccine’s ability to save lives, nor the ability to prevent infection, nor the efficacy in important subgroups (e.g. frail elderly).

[my emphasis added]

Once again, this is a triumph of marketing, not science.

Even Stephane Bancel, the CEO of Moderna, has said the Coronavirus is never going away. It will remain endemic.   And it will mutate.

Mr. Bancel’s remark echoes warnings from public health officials and infectious disease experts that COVID-19 will become an endemic disease, according to CNBC. As Becker’s reported previously, an analysis published Jan. 12 in Science said that once COVID-19 becomes endemic, it may be no more virulent than the common cold.

Given all of the above, I find it quite disquieting that we are on the verge of mandating vaccination in all hospital personnel, nursing facilities, air travel and more.  While masking, social isolation and fitful lockdowns continue indefinitely.

So the answer to my initial question is do I recommend vaccination?  No.  I have written previously on the ineffectiveness of flu vaccination.  I do not recommend these vaccines at this time.  This is an individual choice to be taken only if you feel more reassured or comfortable.

Be filled with knowledge not fear.

 

Philip Lee Miller, MD

Carmel, California.

January 2021

 

 

CoronaVirus: The Unintended Consequences

CoronaVirus: The Unintended Consequences

The Set-up

CoronaVirus aka SARS-CoV-2 aka Covid-19.  It has become everything.  It has consumed our daily lives.  The constant daily, nay hourly, haranguing of “breaking news.”  The media talks about nothing else.  As if life had stopped.  I want to give you a different view and projection.   A medical / epidemiologic / economic view.  A more global and comprehensive take.  The view from 10,000 feet as it were. This is going to be a longer blog.

This Virus is Striking High Density Cities

Is there a Middle Path?  We know the stories about China, Italy, and now the United States.  When in reality, statistical analysis tells a more sophisticated story.  It is never black-and-white.  In China 80% of all cases were in the city of Wuhan – Hubei Province.  Virtually no cases in Beijing or in Shanghai.  In Italy the vast majority of cases were confined to Lombardi.  And now the United States, the vast majority of cases are confined to New York City.  What is common to all of these?  High density populations.  In fact,  there is a paucity of cases and fatalities in the entire Southern Hemisphere.

Background Resources and Historical Perspective

I want to give you more specifics about this CoronaVirus with a list of resources and technical details. This is a variant of the CoronaVirus group which has been well studied since the 1960’s.  It is not new. The current mutation is the Novel CoronaVirus, SARS-CoV-2. The disease caused by this virus is Covid-19.  Do you remember the SARS and MERS epidemics?   Sudden Acute Respiratory Syndrome.

Let’s revisit my previous blog by putting this in proper historical perspective.  This pandemic is here.  It is worldwide.  It is real. It has been predicted. But we must see it in perspective.  Because you are being overwhelmed and I want you to see some daylight and hope.

This is not to ignore or in any way diminish the current suffering or stresses on our health delivery systems.  But the world has suffered from far greater pandemics and plagues in the past.  Watch this brief YouTube video from South Front – a necessary overview.  You can barely see Covid-19 in this graphic.  It’s like comparing Mercury to the Sun.  You will have a difficult time even finding Covid-19 in this graphic.

Major Plagues throughout history

Now look at another fine series from The VisualCapitalist worth bookmarking.  It illustrates the same.  Just how massive previous pandemics and plagues have engulfed the world.

And here is an up-to-the-minute link for real-time stats from WorldOMeter.

Finally, another long video graphically detailing the apocalyptic Spanish flu of 1918, following the end of World War I.  It was a time of massive troop movements between America and Europe associated with widespread poverty and the devastation of war throughout Europe.

Why am I showing you all the videos links?  To give you a sense of how pervasive and absolutely devastating prior pandemics were.

So why are we so fearful?  How did we become so subordinated, freaked out and frantic over this current pandemic, as opposed to previous pandemics that were manifestly larger and more deadly?

Because we are overwhelmed with a sense of the unknown.  Heightened by a pervasive media and social amplification.  We are developing an entirely new lexicon.  Newspeak.  Social distancing.  Shelter-in-place.  We want zero risk in our daily lives.

The Bottom line: this is still a minor pandemic compared to the Black Death Plague of 1348, or the Spanish Flu Pandemic of 1918, and even more recent epidemics such as the cumulative deaths worldwide from HIV/AIDS.

What Exactly is this CoronaVirus – SARS-CoV-2?

SARS-CoV-2 originates from an animal vector – bats.  We suspect it travels to Pangolins whose scales are prized in Traditional Chinese Medicine.  Then humans are infected.  That seems to be characteristic of so many modern flu-like and viral pandemics.  Jumping from an animal reservoir to humans.  Like swine flu, bird flu, SARS (civet cats), MERS (camels) and now Covid-19.

We know that this virus spreads rapidly.  Scientifically and epidemiologically we look at R0 values, how many people are infected by a single person.  In other words, its multiplication factor.  The ideal is R0 = 1.  That flattens the curve. The current R0 is assumed to be about 2.5.   But these numbers are estimates, subject to complex differential mathematical models.  We do not know how accurate these models are.

80% of all cases are considered mild cases.  That is the source of herd immunity.  Let me return to this concept later.

This may be a sidebar but highly recommended.  If you really want to know the science beyond the headlines here is the best lecture series I have seen.  He explains and shows you all aspects of this viral origin and pandemic spread.  It is produced by Ninja Nerds, an unlikely face of academic knowledge.  But if you watch this Ninja Nerds series on Covid-19 you will learn everything you need to know about the epidemiology and the pathology of this virus. You will be well schooled after finishing this series.

Controversies in Containment Strategies

I always look at the outliers.  Why are there so few cases in India, Australia, Africa, South America, and Scandinavia?  And why the differences in approach?  We are told the approach in China and in Korea was draconian.  Cell phones were being monitored.  And yet look at this recent story showing Korea did not shut down their entire economy like we have.

Korean Containment

from NPR news:

How South Korea Reined In The Outbreak Without Shutting Everything Down

We’ve seen examples in places like Singapore and [South] Korea, where governments haven’t had to shut everything down,” said Mike Ryan, head of the World Health Organization’s Health Emergencies Programme. “They’ve been able to make tactical decisions regarding schools, tactical decisions regarding movements, and been able to move forward without some of the draconian measures.”

An article in Science:

Mathematics of life and death: How disease models shape national shutdowns and other pandemic policies

“Long lockdowns to slow a disease can also have catastrophic economic impacts that may themselves affect public health. “It’s a three-way tussle,” Leung says, “between protecting health, protecting the economy, and protecting people’s well-being and emotional health.”

I’m not really sure whether the theoretical models will play out in real life.” And it’s dangerous for politicians to trust models that claim to show how a little-studied virus can be kept in check, says Harvard University epidemiologist William Hanage. “It’s like, you’ve decided you’ve got to ride a tiger,” he says, “except you don’t know where the tiger is, how big it is, or how many tigers there actually are.”

And more from the New York Times.  Dr. Katz is president of True Health Initiative and the founding director of the Yale-Griffin Prevention Research Center.

Is Our Fight Against CoronaVirus Worse Than the Disease?

“So long as we were protecting the truly vulnerable, a sense of calm could be restored to society. Just as important, society as a whole could develop natural herd immunity to the virus. The vast majority of people would develop mild CoronaVirus infections, while medical resources could focus on those who fell critically ill…

A pivot right now from trying to protect all people to focusing on the most vulnerable remains entirely plausible. With each passing day, however, it becomes more difficult. The path we are on may well lead to un-contained viral contagion and monumental collateral damage to our society and economy. A more surgical approach is what we need.”

If you are still with me, you will find this YouTube with Dr. Jay Bhattacharya, professor of medicine at Stanford University most enlightening.  Subsequent to his editorial in the Wall Street Journal.  He is asking the right questions.  Is our draconian approach based on faulty assumptions? 

Sweden and Holland have taken a different approach.  What I call the middle path.  Isolate and quarantine known cases.  That is what is traditionally done.  That is how you treat infected patients in a hospital.  Isolate and contain.

Adverse Consequences of Flattening the Curve

What has been missing in the United States is the mobilization of a centralized strategic plan.  It was all in place.  Now we have a patchwork of federalized responses.  These are tactics, with states scrambling for limited resources. This is not a strategic plan, which flows from a designated and recognized incident commander.  What we used to call a Czar. One who directs and executes the strategic plan.

Dr. Anthony Fauci is a vaunted virologist and epidemiologist.  Epidemiologists are not policymakers.  He should not be the face of this pandemic.

There are some very sophisticated models of viral spread based on R0 values.  This is illustrated below, with an animated graphic. Here is the link the more interactive dynamic graphic model.  Please take the time to play with the interactive graph for a few minutes.

If you look at this model of increasing isolation (shelter in place) 3 critical questions arise.  What is the goal?

  1. Reduce all cases – incidence?
  2. Reduce and mitigate hospitalizations and stress on our entire EMS system?
  3. Reduce and mitigate fatalities — mortality rate?
Containment Time line
Containment Duration — Light color is incidence, medium color is hospitalizations, dark color is fatalities

The answer to each of these questions might lead to entirely different strategic plans.

The incidence decreases the most.  Then you see a decrease in hospitalizations.  But the mortality rate decreases the least.

Our Ultimate Goal in Increasing Herd Immunity

As counter-intuitive as this may appear, decreasing the case incident rate may have negative consequences.  Our goal with natural wild type immunity antibody production vs. acquired immunity through vaccination programs is to increase “herd immunity.”  That is, increase the greatest number of people who have been exposed to a virus and are now immune.  They can no longer spread the disease to other people.  It is a firebreak. The current policy of “dampening the curve” actually diminishes herd immunity.  In the long run, that is the real goal.  That is what prevents the spread – enhancing herd immunity.

Dampening the curve will lower the incidence of new cases, lower hospitalizations, and slightly lower fatalities.   But lengthening this curve is at the expense of prolonging  economic and financial distress.  That is the key concept.   That is why you are seeing Congress hurriedly passing historic and unimaginable emergency legislation.  Remember Andrew Yang’s promise to give us each $1000?  How ridiculous that sounded?  Here we are.

What is missing from these epidemiologic models is a balance between containing the viral spread and prolonging economic dislocation and total financial/economic collapse.

The Economic Fallout will Dwarf the Medical Tragedies

We will see a rise in unemployment to historic levels.  Look at this graphic representation of the most precipitous DJIA slide in the stock market in history.  Even if you have no interest in the stock market or have nothing invested, it is an indicator of financial distress and a prediction of economic calamity.

DJIA precipitous drop

The more important statistic is the VIX indicator.  The VIX is a measure of volatility — of panic.  And this level is equal to or greater than 2008.  It is a perfect storm with other indicators that I will leave to later.

VIX volatility index

What is the point?  It is a plea for a middle path.  What is the least amount of time of widespread quarantining vs. a disastrous total shutdown of local commerce, business and economic vitality?  This cannot go on much longer.  So many small businesses will fail as unemployment figures skyrocket.

This will exceed our experience of 2008. The economic consequences will eventually dwarf the medical consequences.

Prevention, Treatment, and Therapeutics

This is what all my patients are asking.  What can I do for prevention?  What can I do if I become sick?

The most important set of preventatives is concentrating on your optimal health and immune support.  7 to 8 hours of sleep daily.  Some degree of day exercise.  Healthy eating.  Decreasing carbohydrate intake.  Increase in your protein intake.  A good nutritional supplement program.  This includes adequate a quality multivitamin, Vitamin D, Vitamin K, extra selenium, extra zinc, and a good probiotic at the very least.  All my patients are taking much more. as part of a robust daily routine.

Good hormonal balance, which includes optimal thyroid balance.  Thyroid is the seat of your immunity.

I am not convinced that wearing masks are effective.  The most effective N95 masks are in short supply and should be saved for medical workers.  Washing hands and possibly wearing surgical gloves may be beneficial.   I have always been wary of ATM pin pads and handle bars on shopping carts.  These are simple precautions that are easy and beneficial.   Avoiding all possible contaminated surfaces.

I now recommend stop watching the news!  It is no longer healthy, educational or informative.  You will see your stress levels fall immediately.  Watch all your old favorite movies or all those new ones you have not seen yet.   Read more.   Take the time to do those things you have been putting off for years.

There is no definitive drug treatment for this virus except for pulmonary support, fluid resuscitation, and some possible advanced therapies directed to the loss of alveolar surfactant and accumulation of alveolar consolidation.

Many of you have asked me about the combination of Chloroquine and Azithromycin.  There have been very limited studies that show some promise.  But these are more anecdotal.  Although I personally favor empirical approaches to medical problem solving, I do not support the use of these drugs for casual and unsupervised use.  This combination should be limited for very sick hospitalized patients.

There are a number of problems with Chloroquine.  Hydroxychloroquine (Plaquenil) is less toxic than Chloroquine.  And in the mad rush to sequester and hoard Chloroquine or Hydroxychloroquine you are stealing vital medications from patients with advanced rheumatoid arthritis, lupus, scleroderma, or CREST syndrome who rely on these drugs for their significant disease modifying benefit.

And by the way, behind the scenes, there are conflicting policy decrees.  The CDC is trying to approve “off label” use of Chloroquine and Azithromycin for life-threatening disease.  On the other hand, the Medical Board of California has issued warnings that physicians using these drugs off label are being warned.  We do not know whether that includes sanctions or some other bureaucratic intervention.  It all muddies the waters further.

It is very interesting that in the medical profession, we have been chided for the last 20-30 years not to use antibiotics for viral syndromes.  The standard dogma is “antibiotics do not treat viruses.”  And yet the addition of Azithromycin is now being advocated as an adjunct.  There are some theoretical aspects of Azithromycin and Chloroquine enhancing zinc absorption which enhances antiviral activity.

There is also a theoretical discussion in medical journals regarding the potentially harmful effect of ACE inhibitors and ACE blockers.  This would include Lisinopril, Vasotec, Cozaar (Losartan), and Valsartan (Diovan) to name a few.  It is postulated that the CoronaVirus attaches to ACE2 receptors facilitating viral penetration and cellular infection.  This ultimate effect of this mechanism is an unknown at this time.  But you may hear various discussions regarding this mode of activity.  Do not stop these anti-hypertensives.

I fall back on my anti-viral routine which has been successful in the past.  At the very first sign of any viral infection.  I highly recommend:

  • Vitamin D 50,000 units for five days.
  • Astragalus 1000 mg daily for five days.
  • Thymic protein A (Pro boost) 2 packets 3 times daily for 5 days

Now having made that recommendation, I am seeing major backorders for virtually all nutritional supplements and most especially, zinc, Astragalus and Pro boost.  My recommendations still stands as soon as they are available.

In Summary:

It did not have to be this draconian.  So many missteps and failures of leadership.  But here we are.

One more quote from Max Brooks, son of the great Mel Brooks and Author of World War Z :

I think right now we have to be so careful about who we listen to, because panic can spread much faster than a virus. And I think in addition to social distancing, we have to practice good fact hygiene.

Take care of your own health. Don’t watch the news any longer.  Watch great movies.  Be with your family.  Read my past blogs on nutritional routines.  Support clear thinkers.  You will be OK.

Send me a list of your favorite movies or books.   Every one will have their own.  If enough people respond I will publish later.

For sure another CoronaVirus blog will follow soon.

Philip Lee Miller, MD
Carmel, CA
April 2020

Influenza and CoronaVirus: A Thoughtful Response

Influenza and CoronaVirus: A Thoughtful Response

How should you respond to the spread of the Coronavirus?  Renamed COVID-19.  What is the most rational and sane response?  Should we close off all the borders?  Should we cancel all conferences and outdoor events?  Should we cancel the Olympics?  What is the real prevalence and mortality rate?  The answer: this is a time for vigilance, preparation, with calmness.

This is your grand sweep of time overview.  This series will be updated as this is a fast moving story.

CoronaVirus Requires Organized Incident Command

Great leaders exhibit calmness and reassurance while at the same time exhibiting  the qualities of a effective incident commander.  That is how massive wild land fires are fought.  An incident commander is identified and the command structure is assembled. Plans are coordinated and executed purposefully with determination.

So the problem with the Coronavirus is the fear of the unknown.  In the end this will portend far greater economic, commercial and societal consequences than epidemiologic or medical outcomes.  We have already seen a precipitous fall in the stock market, amounting to $5 trillion ($5,000,000,000,000) in paper losses.  It will rebound, but will fall again.

We should heed the words of Franklin Delano Roosevelt.  The only thing we have to fear is fear itself.  You will not die.  You simply need to take modest precautions.

Disease Outbreaks — Four Horseman of the Apocalypse

We are always faced with the Malthusian Four Horsemen of the Apocalypse.  War, famine, pestilence and disease.  They will never fully disappear.

Throughout all of human history we have witnessed great epidemiologic challenges and disasters.  Leprosy, tuberculosis, the plague (the Black Death), smallpox, the pandemic flu of 1918, AIDS, SARS, swine flu, MERS, Ebola virus and now Coronavirus.  It will never end.

There were numerous recurrences of the plague through out the middle ages.  The worst in 1348 where an estimated 40% of population throughout Europe succumbed.  That must have seemed like the end of the world.  It was centuries before the germ theory of contagious disease.  No one knew the source.  So there were religious incantations.  There were whole groups who were shunned or dispossessed.  And then it stopped.

Half of Paris’s population of 100,000 people died. In Italy, the population of Florence was reduced from 110,000–120,000 inhabitants in 1338 down to 50,000 in 1351. At least 60% of the population of Hamburg and Bremen perished,[81] and a similar percentage of Londoners may have died from the disease as well.[67] In London approximately 62,000 people died between 1346 and 1353.[19]  — Wikipedia

1918 spanish Influenza pandemic

During the Spanish flu Pandemic of 1918, it is estimated that nearly 1/3 of the world’s population contracted the flu.  More than 500,000,000 people.  It followed the end of WWI, with mass troop movements.  With massive shifts in human populations.  The flu actually lasted 2 years.  There was a ping-pong effect between America and Europe.  The stories are legion of physicians working around the clock, tending to patients without antibiotics or antivirals as we have today.  That also was a draconian period of time.

But we survived.

Annual Influenza Review

Each year I compose a blog detailing the ineffectiveness of the influenza vaccine, because the flu mutates each year.  The vaccine is always based on last year’s virus.  It is always a guess.  Effectiveness varies between 10-60%.  But a more detailed look at vaccine effectiveness shows a distinct stratification according to age.  Where the effectiveness of the vaccine is even dramatically less in older and frail individuals.  That is why we are now giving triple or quadruple strength vaccines to older individuals.

And currently the number of fatalities from the flu, even this year, far exceeds the Coronavirus.  But the flu has become displaced as the topic du jour.

CoronaVirus in Perspective

Even last week a more detailed look at the viral spread in China is quite revealing.  At least 80% of all cases originated in one province.  From Wuhan.  Virtually no fatal cases in Shanghai or Beijing.  High density populations where you expect higher incident and mortality rates.  You never hear about this.  And with draconian infection control the rate of spread is beginning to diminish.CoronaVirus StatisticsIt’s interesting a whistleblowers complaint about known Coronavirus patients disembarking from a ship in Vallejo may have been the source of the recent death.  But what about all of the unprotected team members who were sent home?  As far as we know none of these have succumbed.

In the end all viral and bacterial infections are a host response.  If you are healthy and vigorous, your chances of contracting any illness are diminished.  Those that are older and frail are more subject to pneumonia and perishing.

I am not reassured by the current administration’s haphazard and amateurish approach.  This appears to be a Keystone Cops approach. There are some stars.  Dr. Anthony Fauci is highly respected at the CDC.

Treatment Modalities

So here are my annual recommendations.

These were formulated for the flu but may pertain to the Coronavirus.   Influenza vaccines are ineffective.  Anti-virals such as Tamiflu and Relenza have immediate value if taken within the first 48 hours.

My recommendations each year are effective.  [Although the usual FDA disclaimers for advocating treatment therapies are acknowledged.]

At the first sign of the flu or any viral syndrome:

  • 50,000 units of vitamin D daily for 5 days.
  • Astragalus 1000 mg daily for 5 days.
  • Thymic protein A (ProBoost) 1-2 packets 3 times daily for 5 days.

The effectiveness of vitamin D against viral syndromes is well demonstrated.  Similarly should there be any doubt of high dose vitamin effectiveness, the only known cure for severe life-threatening measles is – vitamin A.

Wash your hands.  As Ignaz Semmelweis demonstrated in the mid 19th century, washing the hands prevents dissemination of disease.  He was able to decrease the rate of postpartum death  (Puerperal Sepsis)  from 40% to 1% simply by washing hands (in carbolic acid).

Stay calm. Get plenty of rest and sleep.  Don’t panic.

Let me know your own observations.

 

Philip Lee Miller, MD

Carmel CA

March 3, 2020

2018-2019 Flu Vaccine, Prevention and Treatment

2018-2019 Flu Vaccine, Prevention and Treatment

This is my seasonal flu post.  One that I update each year.  Here are current recommendations and controversies regarding influenza vaccinations, prevention and treatment.  I am going to give you a slightly expanded version this year related to last year’s flu vaccine post.  In short, I have never been a proponent of flu vaccinations.  I am middle of road on vaccinations.  You really want polio, measles and mumps and tetanus every 10 years.  For high risk exposures you want Hepatitis B vaccination. But we are over vaccinating our children and even pets.

Influenza is a seasonal epidemic viral syndrome that usually starts in December and lasts until approximately February or March.  In the past, I would begin to see large number of acutely ill patients pouring into my Urgent Care clinics in October and November. I eventually termed this the “pre-flu” syndrome.  Something approximating the flu but not the full-blown symptom complex.  The true flu is manifest as fever, shaking chills, severe achiness (myalgias), and malaise.  You feel really sick.  This is more than a common cold.

Now the problem with flu vaccination recommendations is dependent on who makes the recommendation and for what population.  I am going to make a recommendation for you specifically.  This is in contradistinction to a public health official who epidemiologically makes decisions for large populations.   They are concerned about “herd immunity.”  Higher rates of immunized people decreases the spread.  At least that is the theory.

There is no universal flu vaccine

The challenge has always been how to formulate this year’s flu vaccination.  There is no universal flu vaccination.  That is the basic dilemma.  Influenza A is the more virulent strain mainly affecting adults.  Influenza B affects mainly children.  Influenza mutates by “antigenic drift” from year to year.  It can even mutate during incubation. In most years, there is a “minor antigenic drift.”  In some years there is a “major antigenic drift,” in which case far more people fall ill because they have not never been exposed to the current strain.   And thus it is more virulent. A pandemic.

Flu Strains

Epidemiologists classify influenza with two attributes.  H attribute (hemaglutinin).  And N attribute (neuraminidase).  H1N1 and H3N2 are targeted this year.  So the recommended quadravalent (4 strains) flu vaccine being manufactured this year targets:

  • A/Michigan/H1N1
  • A/Singapore/H3N2
  • B/Colorado 2017 B/Victoria 87
  • B/Phuket 2013 B/Yamagata 88

Because we do not know the precise strain that will prevails this 2018-2019 season, it becomes our best educated guess.  What is the most likely strain based on recent world wide observations.  The selection process may begin in February of the current year.  This gives enough lead time for sufficient vaccination stocks to be replenished each year.  This takes time.  It is all the guess.  Again, the primary dilemma is – there is no universal flu vaccine.  That is the holy grail.  Research scientists are busy trying to develop this.

Vaccine Effectiveness Rates

CDC Seasonal Flu Vaccine effectiveness
Seasonal Influenza Vaccine Effectiveness, 2004-2018

Last year it was said that the flu vaccine was only 10% effective.  In retrospect, the CDC published an average for all age groups of 40%.  Here are the reported rates of effectiveness for the last 14 years [link is no longer available].  A more detailed breakdown by age for 2016-2017 shows even more variability.  All these statistics are somewhat irrelevant.  What is more relevant is the flu vaccination most often less than 40% effective.  So the recommendation is based on, “well, it’s better than nothing.”  I can’t think of hardly any other medication in use today were the rationale is, “well, it’s better than nothing.”  Surely there must be a stronger argument and rationale to the widespread public campaign to “get your flu shot now.”

Recalling my days in Urgent Care once again in the early 1990s, it was common knowledge that “there is no medical treatment for the flu.”  So you must get a flu vaccination.  This always puzzled me because there was indeed a medication that treated the flu.  Symmetrel (Amatidine).  This was discovered by happen stance when so many Parkinson’s patients who were treated with Symmetrel for “the shakes” had a much lower incidence of the flu.  I began using Symmetrel with rewarding success.

Anti-Virals now available

Today, we have a developing stable of anti-influenza virals.  That is Tamiflu, Relenza, Rapivab and the newest Xofluza (Baloxavir).  So you have a choice.  You can have the flu vaccine in various forms.  You can defer any vaccination and be treated with any of a number of antiviral drugs.  Or there is a natural routine that I have developed over the years.  Empirically quite effective.

My recommendation for a natural approach

Miller Anti-Viral Regimen ™

  • Vitamin D 50,000 daily x 5 days
  • Astragalus 1000 mg daily x 5 days
  • Thymic Protein A (TPA) 1-2 packets 3 times daily x 5 days

So what do I recommend?  I have been a proponent of aggressive doses of vitamin D which is known to prevent seasonal flu syndromes.  At the first sign of any viral illness or especially the flu, start taking vitamin D 50,000 units for 5 days.  Yes that is high dose.  Astragalus 1000 mg daily for 5 days and a proprietary product called Thymic Protein A (ProBoost).  One packet 2-3 times daily for 5 days.  This is a highly effective routine.  And most effective when started in the first 48 hours.  Sometimes this routine is so effective that after one or day, you may feel totally resolved and stop the routine.  2 to 3 days later, the virus is even stronger.  So a 5 day routine is highly recommended.

Now let me know your thoughts and experiences.

Philip Lee Miller, MD
Carmel, CA 93923
Nov 2018

Flu Vaccine 10% Effective

Flu Vaccine 10% Effective

getting your flu vaccineFlu vaccine may only be 10% effective this year?  That means 90% ineffective.  Tell me more.

I am asked frequently by my patients, “do you suggest or advocate the flu vaccine.”   My simple answer is no.  I do not recommend flu vaccines.   I am middle of road on vaccines.  Some vaccines are essential.  No argument.  Tetanus boosters, MMR for measles, mumps and rubella, polio vaccine.  In my day we all had smallpox vaccination.   That is now history.

 

Sabin oral poio vaccine

I can vividly remember lining up at my high school for the first series of oral polio vaccinations.  It was a new era.  Based on the original Jonas Salk vaccine and later refined as the Sabin Vaccine.   It was the Sabin vaccine that we all eagerly took on sugar cubes.  [many years later Larry Sabin, his son, was one medical school graduating class behind me]

Now the problem with the flu vaccination is quite different.  Every year the current strain mutates or originates in a different vector or region.   It is subject to antigenic drfit.  There is minor antigenic drift and major antigenic drift.

Vaccine Effectiveness by Varies by Year

flu vaccine effectiveness over timeMajor manufacturers of the vaccine only have 6-8 months lead times.  The current stock is always based on last year’s strain.   With the assumption that there are only minor changes.  The minor antigenic drift.  But it is never identical.  In the best of years, the vaccination is 40-60% effective.   Or contrariwise, 40-60% ineffective.

This year, CDC experts are admitting it will only be 10% effective.  90% ineffective or not worth the bother.

So I am greatly puzzled why all hospitals and large institutions mandate the flu vaccination.  “It’s better than nothing.”  10% effective is not “better than nothing.”   It gives rise to a false sense of security.  Staff and patients are protected.  No they are not.  This is where public safety and good epidemiological policy making collides with individual choice.

Here is a news story from 2004.   We have not seen significant change since then.

 

WASHINGTON – The influenza vaccine that many Americans clamored for this year was not very good at protecting people against influenza, colds and similar viruses, a preliminary report published Thursday shows.

The study is the first attempt to show whether the vaccine that many sought after a flu scare this autumn and winter actually worked.

The study of hospital workers in Colorado, a state that was hit early and hard by influenza, showed the vaccine had “no or low effectiveness against influenza-like illness,” the U.S. Centers for Disease Control and Prevention said in its report.

Reporting this year:

What’s more, this year’s flu shot may not be up to the task. It is the same formulation that was used during Australia’s most recent flu season — which typically sets a pattern for what the U.S. will face — and it was only 10 percent effective there.

…  But Sabeti says even though the effectiveness of this year’s vaccine is particularly low, it’s still worthwhile to get a flu shot.

“Even 10 percent effective is better than nothing, and a lot of it has to do with herd immunity — the more people are protected from it, the more other people will also be protected,” she said. “In fact, in a year where it’s low effectiveness, it’s even more important that everybody get it so we can get as much resistance and we don’t allow the virus to thrive and grow and keep changing.”   — CBS news

Searching for the Holy Grail — the Universal Vaccine

Researchers are avidly seeking the “universal vaccine.”  That is the Holy Grail.  An admission that the current crop of vaccines has been admittedly inadequate.

Recent efforts have focused on the development of a new generation of influenza vaccines that could provide broad spectrum, “universal” protection against a wider range of influenza variants including strains with pandemic potential. DNA vaccines possess a number of characteristics that make them particularly well suited for a universal influenza vaccine [36]. In the event of a pandemic threat, DNA vaccines offer an important advantage of accelerated vaccine development and production since the DNA vaccine sequences can be obtained directly from the clinical isolate and rapidly constructed and propagated using well-established molecular techniques without the need for cell culture or eggs. DNA vaccines induce both antibody and T cell responses, and both arms of immunity contribute to cross-protection against different influenza variants [78].  — PLOS One

Anti-Viral Medications and Treatment

As recently as 1990’s the common wisdom offered was, “there is no treatment for the flu.”  That was not true.  And it always puzzled me.  It was quite well known even then that Symmetrel (Amantidine) used for Parkinson’s Disease was effective against the flu.   From empirical observations it was noted that Parkinson’s patients treated with Symmetrel were far less likely to suffer the seasonal influenza.   I began treating patients in walk-in clinics appropriately.

Today we have a new series of anti-viral flu treatments.  The most effective is oseltamivir (Tamiflu).   A second choice is zanamivir (Relenza).  These need to be started in the first 48 hours for maximal effectiveness.

The authoratative and erudite source The Medical Letter concludes:

A neuraminidase inhibitor, either oseltamivir (Tamiflu) or zanamivir (Relenza), remains the drug of choice for treatment of patients with influenza who are at high risk for complications of the disease, and for anyone hospitalized with presumed influenza. Oseltamivir is preferred for treatment of pregnant women. Otherwise healthy persons who are not in a high-risk group generally do not require antiviral prophylaxis or treatment for influenza

A most interesting conundrum.  If anti-viral prophylaxis is not indicated for healthy individuals then why is the flu vaccine indicated for everyone?   And the debate continues.  While there is policy decision-making consensus on flu vaccination, the debate as to the appropriateness of anti-virals continues.   I argue here that anti-viral treatment is far more effective per case than vaccination.

Dr. Miller’s Novel Approach

Which finally leads me to a more novel and less toxic approach that has been effective across a wide variety of viral and flu syndromes:

  1. High dose Vitamin D — 50,000 units daily for 5 days (yes, that is high dose)
  2. Astragalus 1000 mg daily for 5 days.  A most potent Chinese herb known for its potent immune boosting properties
  3. Thymic Protein A — 1-2 packets three times daily for 5 days.   Activates anti-viral t-cell and b-cell immune activity.

thymic protein A -- immune booster

Philip Lee Miller, MD

Jan 09 2018

Carmel, CA

 

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