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Does anyone remember the old old Disney movie “Old Yeller”? I was just a kid when I watched this tear jerker, but what I remember most about it was that Old Yeller got rabies and died. Rabies was one of the first serious diseases I ever learned about as a kid. My first medical word was “hydrophobia”.

In the U.S. and Canada, rabies is really rare. In Canada, only 24 cases of human rabies have occurred since 1924 and since 1970 six of the seven cases have been attributed to bats. In the U.S. 40 cases have been reported since 1990. Of those, 37 were caused by bats.

If a person is exposed to rabies, post exposure prophylaxis (PEP) is given. It consists of rabies immune globulin and a 5 dose series of rabies vaccine. An exposure is a bite, scratch or exposure of non-intact skin or mucous surface to saliva, tears or brain tissue. If the PEP is not given before the onset of neurologic symptoms, it will not work. After exposure, the usual incubation period for rabies is 20-60 days.

There is only ONE unvaccinated rabid patient that has survived. She was a 14 year old girl in Milwaukee who was diagnosed in 2004. She was placed in a chemical coma to slow down metabolism in the brain and given massive anti-viral medications and high dose Vitamin C. She was tested daily for levels of virus neutralizing antibodies in serum and over weeks she survived. The same protocol has been tried on other rabies victims without success.

So the take home message is that any contact with bats carries a risk of rabies. If you are bitten, immediately wash the wound with soap and water and capture the animal if it can be done safely. Local animal control services can assist and test the bat. The Emergency Department will evaluate regarding the need for PEP. Rabies is fatal but preventable with early preventive treatment.

Additionally, clinicians need to recognize that a majority of patients with rabies transmitted by bats might have no recollection of a bat bite so any patient with an unexplained acute, rapidly progressive viral encephalitis needs to have rabies in the differential diagnosis.

BTW…I re watched “Old Yeller” and it doesn’t stand the test of time. It wasn’t nearly as sad or shocking or interesting 40 (or more) years later.

Image via WikipediaPain Therapeutics, Inc. recently announced the successful completion of its first clinical study utilizing a novel melanoma treatment, which the company licensed from Albert Einstein College of Medicine of Yeshiva University. The treatment consisted of dosing patients with a monoclonal antibody labeled with a radioisotope.

I read this morning that a celebratory concert is bring prepared for Nelson Mandela’s 90th birthday in London. He has had a glorious and influential career and is a master statesman known all over the world. How wonderful that he is being honored!

With so many talented performers to choose from, why is Amy Winehouse selected to sing at that concert? Her drug addiction and arrests are also known all over the world. Her husband is awaiting sentencing for attacking a pub owner and it is always a media event to guess if she can perform without falling off the stage.

I know addiction is a disease that progresses without treatment. I am sorry for the waste of talent and the problems Ms. Winehouse faces. She is now reported to have emphysema that will affect her ability to sing.

I’m just tired of seeing impaired “girls gone wild” held up as a shining example of success and to have her on the same stage with a hero like Mandela is just plain wrong.

Health costs and insurance premiums are rising at a rate that is completely unaffordable to companies, the government and to patients who buy their own insurance. We’ve seen these escalating costs for years and everyone who is connected to health care, either as a provider or a buyer knows we are standing at the edge of a cliff with a steep drop off.

So how is it that in 2007, HMOs in California spent $6 billion on administrative costs, which included large CEO salaries? (and that is in addition to billions of dollars in profits) . Talk about waste. That is 6 billion dollars in high premiums. Six billion dollars that did not go toward vaccinations, or mammograms or surgery or nursing care.

UnitedHealth Group, the largest health insurer in the nation, paid it’s CEO $124.8 million in 2004. After an outcry, his salary went down to a paltry $12 million in 2006. Anthem Blue Cross (previously Wellpoint) paid its CEO total compensation of $52.4 million in 2006. That’s enough to provide about 29,000 California children with health insurance. He also gets the use of the company jet and travel for his wife.

HMO plans are only part of the story. For enrollees who buy coverage in Blue Cross PPO plans, only 51 cents of every premium dollar is spent on health care. Profits account for 27% and that is on top of “administration”, which I presume is those juicy salaries and perks.

These HMOs are for-profit, meaning they answer to wall street shareholders who want a return on the dollar. Is that where we want health premiums to go?

The next time a test or doctors visit is denied or you realize your out of pocket deductible is the only amount that is being paid, think about these salaries. Don’t think health care reform is going to come easily. With these amounts of dollars, the incentive for change is a long way off.

Image via WikipediaThe US Food and Drug Administration (FDA) announced yesterday that it had given approval for the first new combination vaccine for protecting 4 to 6 year old children against diphtheria, tetanus, pertussis and polio diseases in one shot, made by GlaxoSmithKline (GSK).

The vaccine is branded as the trademarked name KINRIX, and its official long name is Diphtheria and Tetanus Toxoids and Acellular Pertussis Adsorbed and Inactivated Poliovirus Vaccine.

It is sad when a patient is dealing with a diagnosis of cancer and believes there is a cure out there that the doctors don’t know about or are keeping from them.

The internet provides more opportunities for a cruel form of greed where fake cancer cures can be dressed up as “scientific” and sold to desperate patients. Bogus cancer cures have been around for decades, but online searches can bring them right to the patient.

The FDA has published a list of “125 Fake Cancer Cures Consumers Should Avoid”. Check it out here.

Firms that engage in cancer treatment fraud often use exaggerated claims that should be red flags to patients and families. Some of them are:

• “Treats all forms of cancer”
• “Skin cancers disappear”
• “Shrinks malignant tumors”
• “Non-toxic”
• “Doesn’t make you sick”
• “Avoid painful surgery, radiotherapy, chemotherapy, or other conventional treatments”
• “Treat Non Melanoma Skin Cancers easily and safely”

There is a big difference between investigational drugs that are being tested for efficacy and fraudulent products that have never been clinically tested or reviewed.

The medical blogosphere writers have been prolific in their speculation about Tim Russert’s untimely death from a myocardial infarction last week. Did he have the right tests? Could more have been done to evaluate and prevent? How could a wealthy, intelligent guy who was under doctor care die from a disease we know so much about?

The best overall summary can be found today in The New York Times. Check it out.