PCV13 may no longer be recommended to all immunocompetent older adults. Instead, “shared clinical decision-making” will likely become the guideline, based on the plummeting rate of invasive disease in those over 65 due to pneumococcal immunization of children. Great coverage here by Dr. Abigail Zuger, right here in our own NEJM Journal Watch. But big question — how best to engage in this process, a patient-driven strategy I suspect we’ll see increasingly in all sorts of guidelines going forward. And will it influence insurance coverage for the vaccine?
The Truvada lawsuit may be hindering PrEP uptake. People notice the ads soliciting cases from personal-injury legal firms — both patients on HIV treatment (including several of my own, who have asked about it), and individuals considering PrEP. Here’s a sample, on autoaccident.com (of course, where else). Hard to imagine this will be a good thing for anyone.
Even small measles outbreaks cost public departments a lot. Infuriating, because these government funded programs are not exactly swimming in money, or just sitting around waiting for other things to do. This outbreak in a Clark County, WA cost nearly a million dollars; the one in New York is pushing 20 million. If only there were a solution to the problem of measles … oh wait.
This New Yorker piece summarizes some of the origins of the anti-science views fueling the anti-vaccine movement. It’s exceptionally well-written — I particularly like this tally: “Suspicion of authority, rejection of expertise, a fracturing of factual consensus, the old question of individual liberty versus the common good, the checkered history of medical experimentation (see: Tuskegee, Henrietta Lacks, Mengele), the cynicism of the pharmaceutical industry, the periodic laxity of its regulators, the overriding power of parental love, the worry and suggestibility it engenders, and the media, both old and new, that feed on it—there are a host of factors and trends that have encouraged the spread of anti-vaccination sentiment.” As for the media, I can’t resist posting this brilliant cartoon:
Should serum β-D- glucan testing be used for the diagnosis of Pneumocystis jiroveci pneumonia? Two papers take opposite sides on this question, including one led by our former fellow (and now ID attending at Maine Medical Center) Dr. Jed Pilkington. (I was co-author.) I won’t divulge what side we took, but here’s the bottom line: The test is great if ordered in the right clinical context — but too often that’s not the case, and the results are frequently impossible to interpret!