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"If you have a patient who says, 'I'm dying. I feel like can't go on. I really feel this way,' and you don't see an immediate effect with a placebo, you have to think about how move a more systematic approach. That's why I always tell our patients: if you want to make a change, the first thing you should do is see an expert, the second is get a opinion, and you should do all three. In the end, you'll learn a lot from these conversations."
It's possible that, as with many aspects of modern scientific research, these two drugs actually do different things. But one thing that can't be denied is that, as a strategy of cancer care, these two approaches have been highly effective. When asked about the most important aspect of their cancer care, the consensus was strong that a high-dose, combination of two drugs is the strongest strategy. But even though these two drugs have shown such impressive success, there still remains a great deal of confusion surrounding the best approach to cancer and how best approach this treatment. For a number of patients, the first step was to take a placebo.
Dr. Paul Offit knows this because he is the man who invented cancer vaccine. He was also the pioneer of first vaccine for a sexually transmitted disease, and he now runs the Vaccine Education Center at Children's Hospital of Philadelphia. As a pediatrician himself, Offit's role for the first two decades of 21st century was primarily that of an activist: He led the movement to introduce immunization for hepatitis B and A into the United States in 1989, and the early 2000s, he led efforts to eliminate polio from the U.S. In those roles, Offit became well versed in the challenges of translating clinical success to the public.
"If you look at what happens in cancer care, there is often a lack of understanding about how this stuff works," Offit says. "Because the science and education is so poor, they don't understand that there are two components to this. One is, as you said, the immune system. other is immunotherapies, which are the ones that being evaluated these days. are the people you have to give the shots to."
For example, during the 1990s, when polio vaccine was a threat to immunization rates for children in the U.S., Dr. Tom Frieden was tasked with trying to reverse the slide by getting vaccine levels to go up. "So we were looking at all different approaches to getting vaccination go up, including trying to get the vaccine into more and places," Frieden says. "One of the approaches was to have vaccine administered with other inoculation strategies. Some of these include chemotherapy. And if you give chemotherapy in combination with the vaccine, that is highly beneficial in terms of protecting [people] from the polio virus. And this was very controversial at the time. They thought it was not safe and effective. So you didn't give it on its own to a child."
That debate was reignited in the wake of 2009 swine flu outbreak when the Food and Drug Administration approved a combination vaccination strategy to replace chemotherapy. Offit and other cancer experts saw great promise in this combination vaccination approach. "I'm so glad that the FDA recognized need to do a booster shot protect infants from that very dangerous flu virus," Offit says.
"But in retrospect, it looks like the only way to reduce risk of death from the flu virus at all was for everyone to get the vaccine," Offit says. "But this is the way to do it, but the only thing that really counts and gets everybody vaccinated is the vaccine: whole package of vaccines you take. And we know now that when you do these booster shots, they are most effective if you do all of them, not in single doses.
"We know now that when you do these booster shots, they are most effective if you do all of them, not in single doses."
Offit's interest in vaccination was rooted a desire to improve the public health. It was during an outbreak of measles, which occurred during World War I, that he first became aware the measles vaccine could help prevent deaths from other infectious diseases. "I'm pretty sure it was after the war that I first got into the science of vaccination," Offit recalls. "I was a doctor myself, and we had a lot of patients who had this interesting disease. One doctor that I was working for, he actually a dentist, and started diagnosing patients with some of these diseases and started treating them with a vaccine he thought would work. Because was treating a lot of people with tuberculosis, TB, he decided was going to make a vaccination program for tuberculosis patients."
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That's the theory, anyway. reality is a slightly less rosy outlook. Dr. Zalberg calls the new study, published Thursday in the New England Journal of Medicine, "just one many small studies we have, to date, that has not found a significant difference between the flu vaccine and placebo." while he adds that "given these very encouraging findings that I see in the real world" it isn't necessarily a good idea to rush out and buy every flu vaccine you can get, he says that the new data "cannot be ignored."
[Hang on to your hats, scientists: A flu vaccine is coming]
It's the second flu study to Zovirax 90 Pills 400mg $275 - $3.06 Per pill be published this week that doesn't offer good news about the vaccine. In another New England Journal of Medicine, researchers reported that among some 1,700 people who had participated in an outbreak of hepatitis A last year in California, only 40 percent of those who received the vaccine actually developed immunity. (Not that this matters much: Most infected people have already recovered without serious side effects, and many people receive both the vaccine and liver-taming drugs to help them recover.)
This week's flu shot and hepatitis A outbreak were far from anomalous, either. A new analysis in the journal BMJ suggests that many more cases go unrecorded in the nation's flu shot database — perhaps as many 80 percent — because doctors believe vaccines are safe to administer patients. The researchers point out that, in 2010 and 2011, a third of Americans said they trusted the U.S. Centers for Disease Control and Prevention, which funds some vaccine research, more than medical professionals.
The CDC has acknowledged findings. "Vaccine safety is a complex issue, and the available evidence suggests that, unlike flu vaccines, influenza vaccines are safe when children get vaccines from the CDC-recommended schedule," it said.
[A lot of flu shots are no joke]
Still, the latest vaccine research is likely to increase the pressure on companies to find real cures or at least new ways to improve flu vaccines.
"This is an area where we've gotten very little benefit over the years and there's a lot of money to be made," says Peter Hotez, a professor of infectious diseases at Emory University. Hotez and his colleagues published a paper this week showing that, using a genetically-engineered strain of influenza, they developed a vaccine for swine flu.
The strain is also one of the best in a class of vaccines known as swine flu vaccines. It's been around for a decade or more and has proven highly effective over the years.
But Hotez says he's not holding his breath on those, either. "There has been almost no progress with"