I have been writing articles lately about the reasons for the H1N1 vaccine shortage and what to do about it. You can find these pieces in Forbes.com, Slate, and most recently as an oped in Wednesday’s NY Daily News. I believe that fear has played a major role in governing our public health response to H1N1 swine flu and the pressing need for a plentiful pandemic vaccine. I realize that it is easy to bludgeon our officials with the retrospectoscope, on the other hand, many of these nervous responses are chronic, and require significant adjustment going forward:

• Vaccine fear mongers do significant harm. Fear of thimerosal (a mercury-containing preservative that is used to bundle doses and has been shown not to cause autism) led to too much time spent trying to produce single vaccine doses without it.
• The CDC’s fear of overreacting to a possible pandemic, as they did in 1976 when 40 million people were vaccinated unnecessarily for a pandemic that never came, led to too much caution here, where instead a shift in vaccine production to the H1N1 vaccine could have led to many more million doses available now.
• Fear of seasonal flu, which doesn’t peak until much later, if at all (maybe crowded out by the H1N1 pandemic strain), led to 115 million doses of seasonal flu vaccine produced, when there is no seasonal flu around.
• Fear of new vaccines in the U.S. has led the FDA to fail to approve several new vaccines which use more up to date technologies such as mammalian cell culture instead of hen eggs, or additives known as adjuvants which make vaccines more potent so a smaller supply can be used for more inoculations. One American company, Baxter, makes a mammalian cell vaccine that will be used extensively in Europe, especially for those with egg allergies, but is not approved for use here.
• Fear of vaccines has led to poor compliance, especially for children, the group that currently seems to be most at risk for complications of the disease.
• Fear of admitting error has led our public health officials to delay in acknowledging the shortage or in correcting it, delay in accepting that it is H1N1 that is the predominant flu this year, not the seasonal strains.
• Fear of the spreading flu may be useful to combat fear of the vaccine, but a better approach would be a rational discourse based on statistics and real risk.

Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News medical contributor and writes a health column for the LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel’s new Ebook: Swine Flu; the New Pandemic, will be published in early October. Dr. Siegel is also the author of “False Alarm: The Truth About the Epidemic of Fear“ and “Bird Flu: Everything You Need to Know About the Next Pandemic.” Read more at www.doctorsiegel.com

With concern over the H1N1 flu reaching an all-time high – Americans are scrambling to find ways to either prevent the virus, cure it if they get it or try to get out of getting the flu shot. And as a result, many people are turning to the Internet for help.

I have said it a thousand times and I’ll say it again: It’s not safe to buy medication over the Internet from sources that are not reputable!  There are thousands of medications available on the Web, and more and more companies are popping up each day offering fast access and delivery of both over-the-counter and prescription medications. We know the dangers associated with buying drugs online, but for some reason, people continue to do it!

In fact, it poses such a problem, that in the midst of the H1N1 flu pandemic and the hysteria it’s created, the FDA felt the need to warn consumers about purchasing products over the Internet that claim to diagnose, prevent, treat or cure the H1N1 flu virus. Trust me — nothing could be more dangerous than thinking that you can fight the H1N1 virus with unregulated medications available on the Web.

The FDA issued the warning after the agency purchased and analyzed several products online that were marketed as Tamiflu, which is an antiviral drug that slows the severity of the flu. After checking out the products, many of them were found to be unsafe.

Here is an excerpt taken directly from the FDA press release:

“One of the orders, which arrived in an unmarked envelope with a postmark from India, consisted of unlabeled, white tablets taped between two pieces of paper. When analyzed by the FDA, the tablets were found to contain talc and acetaminophen, but none of the active ingredient oseltamivir. The Web site disappeared shortly after the FDA placed the order. At the same time, the FDA also purchased four other products purported to diagnose, prevent, treat or cure the H1N1 influenza virus from other Web sites.”

The products that the FDA analyzed contained varying levels of oseltamivir, and were not approved in the U.S. And furthermore if you’re ordering medications from other countries, most of them will not even arrive in time to treat someone suffering from the H1N1 flu! It’s just not worth it, people! When you order medications that are not regulated, you’re putting yourself and/or your loved ones at risk for getting counterfeit or contaminated products, and the effects can be deadly.

So instead of logging onto the Internet the next time you need a prescription drug – pick up the phone and call your doctor. After all — that’s what we’re here for.

 Click here for more information from the FDA on how to protect yourself.

Here is the latest about the novel A(H1N1) swine flu pandemic virus, and what we are doing about it. Also check out my new Ebook: “Swine Flu; the New Pandemic.”

The best way to decrease the amount of circulating AH1N1 flu virus is to vaccinate as many people as possible. This is known as herd immunity.

The current H1N1 though mild, has infected millions and hospitalized more than 10,000 here in the U.S., killing close to 1000, so mass vaccination is warranted.

Unfortunately, once the vaccination program starts, it will be TOO easy to blame ANY deaths on the vaccine. This happened in Great Britain with the HPV Vaccine, where Cervarix is expected to cut deaths from cervical cancer by 650 and 1.4 million women have already been vaccinated, the vast majority with no problems. Yet a single death which was later found to be unrelated to the vaccine caused hysteria.

Though the 1976 swine flu vaccine was linked to several hundred cases of Guillain Barre Syndrome (paralysis) for a pandemic that never happened, this time there is a real pandemic, and the vaccine has been well studied in clinical trials and found to be very safe and has not been linked to GBS.

This vaccine is made the same as the yearly flu vaccine, with hen eggs, and will be just as safe, with the major complication in the vast majority of cases being local irritation around the injection site.

In discussions with senior officials at the CDC I have determined that it is acceptable to give both the seasonal flu shot and the H1N1 swine flu shot at the same time.

The CDC also recommends H1N1 vaccines even for those who believe they have had the disease. Serological tests to confirm immunity are considered unreliable and are not readily available.

The flu mist inhaled vaccine is being released this week. Since it is using an attenuated (weakened) live virus, it should not be given to pregnant women, those with chronic conditions, or those who are immunocompromised. It has also not been tested in the elderly.

The injectable inactived H1N1swine flu vaccine will start becoming available in two to three weeks. It uses an inactivated (dead) virus, and can NOT give you the flu. It is safe in all except for those with severe egg allergies. It should be given first to health care workers, pregnant women, children, and those with chronic conditions. 250 million doses should be available by sometime in November, and I will be recommending it for all.

Swine flu parties are a bad idea. They are an example of deliberate infection to provoke immunization. Since flu is so easily transmissable, it can easily get beyond the party and spread to someone who is more likely to have a severe outcome, such as a pregnant woman, a young child, or someone with a chronic condition.

The risk of the flu is far greater at this point than the risk of the vaccine. It is still a very mild virus, but must be taken seriously, as flu is tricky, and can kill. Coming out of the southern hemisphere, whose winter just ended, the prevailing strain of H1N1 swine flu is a good match for the vaccine.

For daily updates on the H1N1 swine flu strain, twitter me at marcsiegelmd.  I will post my latest articles, updates, and answer questions.

Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News medical contributor and writes a health column for the LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel’s new Ebook: Swine Flu; the New Pandemic, will be published in early October. Dr. Siegel is also the author of “False Alarm: The Truth About the Epidemic of Fear“ and “Bird Flu: Everything You Need to Know About the Next Pandemic.” Read more at www.doctorsiegel.com

I’ve been getting many e-mails over the past couple of days concerning swine flu.  So I’ve decided to answer a few of them here.

Dear Dr. Manny,
If I had the swine flu in 1976 after I received the swine flu vaccine as a college student, do I have any anti-bodies that may help ward off this version of the virus?
                  —Amy Gorman
                  Lutherville, MD

Probably not. This current swine flu’s genetic makeup is different from the swine flu from the ‘70s, and therefore the vaccination won’t be protective for you. But the silver lining is that this current swine flu is less lethal, and there may components in it that more Americans have been exposed to. So you may have a greater chance of being protected already which can minimize the symptoms.    

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Dear Dr. Manny,
We have friends who have returned from a trip to Mexico City two weeks ago. How long would it take for swine flu symptoms to show up if they were infected?
Thank you for your time,
—Alan

The typical incubation time for a virus is 48-72 hours.  So if your friends have been back for two weeks, and don’t have any symptoms, you can feel confident that they are safe. 

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Dr. Manny,
My wife and I are very concerned of the complications swine flu/treatment would pose to her pregnancy. Are the approved drugs for treatment approved for use during pregnancy?
Thanks,
Ben Demaline
Jacksonville, FL

Yes, all of the current flu treatments can be given to pregnant women. As a matter of fact, we tend to be more aggressive in treating the flu in expectant mothers because pregnancy can make flu symptoms worse and put the patient at higher risk. That’s why it’s recommended that all pregnant women get flu shots annually.

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Dr. Manny,
I will be flying to Las Vegas next week with a two-hour layover in Atlanta. I had a liver transplant five years ago and have done really well. Do you think that I should wear a mask at the airport and on the plane? I am very concerned about the large crowds and would like your opinion.
Thank you for any answer!
G. Savage

As a liver transplant recipient you are probably taking immunosuppressant therapy drugs and therefore you do have to take precautions to avoid exposure to the swine flu ― or any kind of flu. Even though I’m not a big advocate of wearing masks, I do feel that you should wear one. But remember: Not all facial masks are created equal, so get one that has been proven to protect against viruses. There are many supply stores that carry this specific mask for viruses. Also, try to wipe down all the surfaces on your airplane seat with antibacterial wipes. Be sure to wash your hands before, during and after the trip. And avoid any contact with anyone who you suspect might be sick. I know that this is a big stretch, but until we know exactly the extent of the spread, in your particular case, I would be extra cautious. I hope that this doesn’t ruin your vacation! 

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Dr. Manny,
I have no choice but to commute using public transportation everyday.  How should I take precautions against the swine flu?
                  Thanks,
                  —Paul

If you can avoid public transportation, especially crowded subway cars, then do it.  But if you can’t here’s what you can do:

• If you are a healthy individual you can just use antibacterial products, including wipes and gels, chronically throughout your trip.
• Avoid contact with people who are coughing or appear sick.  If they are in your car, move to another one. 
• As soon as you get home or to the office wash your hands, wipe down your cell phone, iPod or any device that you used during your trip. 

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Dear Dr. Manny,
I’m a chronic nail biter and I’m really concerned about the swine flu.  What should I do?
Best,
                  —Mel

First and foremost — wash your hands. Your hands are the most common tool for picking up germs and viruses in general. So if you are a nail biter, this would be the perfect incentive for you to quit. Also, biting your nails can make you ingest things other than viruses that you don’t want to have in your body.

The following statements are where I think we are currently on the new swine flu H1N1 influenza A strain. I’ve also communicated with Drs. Ann Schuchat and Nancy Cox at the CDC, who responded that they agree with these comments.

• The H1N1 influenza A is a new strain — a swine flu strain — with some genetic components that are characteristic of human and bird flu viruses. It bears watching and tracking, as any new influenza does.
• It is spreading human to human, and may have the attack rate of a typical yearly influenza A, but this is particularly difficult to determine because of both the overreporting (everyone thinks they have it), and under reporting (we are not really tracking the full spectrum of disease as we are not testing those with mild symptoms). It is also too early to really determine transmissability, because there are too few cases.
• Virulence appears to be low and if this continues, it will be a mild pandemic at worst. It currently appears to be very transmissible, but the outbreak could wane further if transmissability decreases. A severe pandemic will likely result only if it mutates into a more virulent strain. But assessment of the strain’s virulence is also based on a limited number of cases.
• It is worthwhile to begin preparing a vaccine, but we don’t yet have the upgraded technology (mammalian cell culture, reverse genetics) in regular use for flu, so we may have to rely on the older technologies (using hen eggs to provide a medium for growing the dead virus). This has yet to be determined.
• It is likely to wane soon due to summer weather, but bears watching carefully over our summer in the southern hemisphere, and mapping carefully for resurgence in the fall.
• Since the WHO designations for pandemic alert don’t include severity of illness or even true extent of illness, raising the pandemic alert levels have led to the public misperception that massive deaths are about to occur, which is part of the reason why the fear level is so high. It is best to provide calm accurate contexted information to avoid this, as I point out in “False Alarm; the Truth About the Epidemic of Fear.”

Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News medical contributor and writes a health column for the LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel is the author of “False Alarm: The Truth About the Epidemic of Fear“ and “Bird Flu: Everything You Need to Know About the Next Pandemic.”  Read more at www.doctorsiegel.com

Cases of swine flu, or H1N1, are climbing and spreading to more states.  At least 141 people in the U.S. have been infected, and one Mexican boy visiting Texas has died.  Many more cases will be diagnosed—likely many thousands—before the spread of the illness ebbs.  Public health officials and journalists warn of a pandemic, an epidemic of infectious disease that sweeps across a large geographic area, such as a continent, or around the whole world.
 
The toll of this new flu may turn out to be disastrous, but there’s no current evidence that a calamity is brewing.  Thus far, every American who has contracted the illness has survived.  Even if there turns out to be 250,000 cases this year, the number will still be dwarfed by the toll of diseases like cancer, heart disease, diabetes, asthma, depression and alcoholism on our population.
 
What the 141 cases of H1N1 flu have already proven, however, is how vulnerable we are to panic.  Americans are on edge, uncertain about the economy and uncertain about the direction our President is leading us.  Ultimately, for all but those with the steadiest of nerves and most solid sense of self, we are a nation collectively experiencing a sense of impending doom—one of the hallmarks of panic disorder.  H1N1 may or may not cause serious physical suffering for our population, but its emergence will cause serious psychological suffering for a nation already traumatized by deep doubts about whether the solutions to our collective problems reside in bailouts, embracing dictators and apologizing for our national shortcomings.
 
 Some might say that connecting our reaction to H1N1 flu to the economic crisis and cultural crisis at hand is too great a leap, that we are as steady on our feet emotionally as a population as ever.  I don’t think so.  I’ve been at my work 16 years, seeing adults and adolescents facing every imaginable twist and turn of fate.  Never before I have seen as many individuals who feel disempowered, unable to mount any resistance (words intentionally chosen) to the stressors impacting them.
 
Our psychological resistance to trauma of any kind is down right now.  That’s one reason that Air Force One flying low near Ground Zero was such a grand faux pax:  It re-traumatized thousands of people who don’t have emotional bandwidth to spare.  It’s even possible that our psychological stress could reduce our resistance to physical illnesses, including H1N1.
 
 It’s time for a real public health initiative, rolled out through private health care providers and, perhaps, community health educators, that targets two certain epidemics already sweeping the nation:  anxiety and depression.  They may not be spread by coughing and sneezing, but they have the capacity to paralyze us emotionally and cost our nation dearly.

Dr. Keith Ablow is a psychiatry correspondent for FOX News Channel and a New York Times bestselling author. His newest book, “Living the Truth: Transform Your Life through the Power of Insight and Honesty” has launched a new self-help movement. Check out Dr. Ablow’s website at livingthetruth.com.