Thursday, August 21, 2008

Gardasil Vaccine- Is it right for you??

I have been asked by many patients about the Gardasil vaccine from Merck, so here goes.
Gardasil is a vaccine that has been recommended for females starting at age 12 to protect against certain strains of HPV (human papilloma virus) that if infected, can lead to a higher risk of cervical cancer. Gardasil is the first HPV vaccine to be released in the United States and has been actively and aggressively marketed by Merck. In fact , Merck has been lobbying many state legislatures to make their vaccine a MANDATORY requirement for school.
The vaccine works by getting the body to produce antibodies to certain select strains of HPV, thereby preventing the actual virus infection which could lead to cervical cancer. In theory, that is just what the vaccine could do. In reality, we do not know what will happen. My hope is that the vaccine will work as advertised, but as has happened in the past with vaccines, we find out other effects many years later.
I have attached a few links to this newsletter.
1) From Good Morning America-
2) From the New England Journal of Medicine-
3) Also form the New England Journal of Medicine-
4) Gardasil website from Merck
What I find interesting from the second link is the discussion of cost effectiveness as a population instead of the effectiveness in an individual. This happens to be a pet peeve of mine. When I am in a room with a patient, I do not think of how treating this patient will affect the population. I am solely considering my individual patient's health and the most cost effective.
It seems that our government and insurance plans are more worried about overall costs than about individual's health. That is just plain and simple wrong and it is not how I practice.
But getting back to Gardasil. My hope is that the vaccine is proven effective long term. Preventing cervical cancer would rank up there with eradicating polio and measles. However the data proving Gardasil's effectiveness is a long way away. I am also waiting for more safety data before I recommend the vaccine. I will, however, administer the vaccine if you believe it is warranted for your own personal or individual needs. Just please refer to more than just the data given by Merck, as their financial interests and your individual health interests may not be compatible.
Steven Horvitz, D.O.
Board Certified Family Medicine
Founder of The Institute for Medical Wellness
For past issues of the newsletter please click here.


The following is a link to a Judicial Watch report on the Gardasil-FDA Approval process.

Monday, August 18, 2008

Are you getting sick from your food?

Many patients come to my office and complain of Food Allergies. Depending on the symptoms, it may be a food allergy or more commonly a food intolerance.

A Food Allergy occurs when your immune system sends out antibodies to protect you from what it perceives as harmful, in this case to food. The result can be as simple as an annoying runny nose to as serious as life threatening anaphylaxis.

Food Allergy symptoms may include trouble swallowing, swelling of the face or tongue, itchy eyes and skin, and difficulty breathing. These symptoms usually strike within the first few minutes of eating the offending food, and it may only takes a small portion. The most common foods to be allergic to are eggs, wheat, soy, peanuts, cashews, pecans, walnuts or seafood.

If you have a Food Allergy you will need to completely eliminate that food from your diet

A Food Intolerance is a condition that involves your digestive system but not an antibody response. Common food intolerances include Lactose Intolerance and Celiac disease. Intolerances are usually not life threatening, but can be somewhat limiting.

Food Intolerance symptoms may include heartburn, bloating, belching, indigestion or diarrhea. They will usually develop within the first 1-3 hours after eating. It usually takes a good amount of food at one sitting or over a couple of hours of eating. Common foods include garlic, onions and artificial sweeteners. Dairy foods can be causes of an intolerance or an allergy.

If you have a Food Intolerance, you do not have to give up the food completely. You just have to eat lesser quantities until you find the amount that your body can tolerate.

Keeping a food diary can help to spot foods that do not agree with you. The information to chart includes:

  1. Date
  2. Symptoms
  3. How soon after eating did the symptoms occur?
  4. List the foods eaten
  5. Did you eat a lot of one particular food?

In a perfect world we would know all the ingredients in the foods we eat. If anyone reading this newsletter lives in a perfect world, please contact my office. My family could use a good vacation! But many foods have hidden ingredients, that we would not suspect.

Some examples:

  • Egg Rolls- peanut butter may be used to help seal the roll
  • Hamburgers- my contain Casein (a milk protein) to hold the meat together
  • Ice cream- may contain nuts such as cashews, walnuts and pecans in the mixin ingredients
  • Salad dressings- may contain fish; ceaser salad dressing may contain anchovies
  • Pasta- may contain eggs
  • Peanut butter- may contain soy
  • Hot dogs- may contain wheat

I recently had a phone call from a patient who was not feeling well after eating an apple. They complained of their tongue and throat feeling irritated and itchy. There are a few potential causes. The reaction could have been to the pesticides used in the farming of the fruit. The peel of the fruit also contains a protein that's similar to ragweed and pollen. To avoid these symptoms, wash and then peel the fruit before eating.

So when in doubt, become a food detective. Steer clear of foods you believe do not agree with you. If you believe the food to be an intolerance only, eliminate the food for a few weeks to see if your symptoms subside. Then add the food back gently into your diet and watch for a return of the symptoms. You can also go the medical route.
There are tests that check your blood for elevated levels of antibodies to individual foods. These are available at local labs and can be drawn at our office.
Steven Horvitz, D.O.
Board Certified Family Medicine
Founder of The Institute for Medical Wellness
For past issues of the newsletter please click here.