Generic vs. Brand Name Pills (Ask Dr. Laura Berman)

Q: I recently went to a new pharmacy to fill my birth control prescription, and they gave me a pack of pills I've never used before. The pharmacist told me it was a generic, and it was the same as the brand name, but when I called my gynecologist, she told me she'd never heard of that generic and that I shouldn't take it. Who's right?

— Elissa, New Jersey 

A: By law, the generic form of birth control pills and brand-name birth control pills must be have the same active ingredients, and they must have similar bioavailability (which is the amount of time it takes for the active ingredients to begin working on the body.) The only difference that might exist between generic and brand name medicines are the inactive ingredients, but these differences are immaterial, unless you should happen to be allergic to one of them. This might have been one of the reasons your gynecologist advised you not to take the pill. Otherwise, a generic birth control pill and a brand name birth control pill react no differently in your body — so take advantage of the savings whenever you can!


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Pregnant? Get a flu shot - but it may be a hassle

It's hard for pregnant women to escape the message: You're at extra risk from swine flu — it could trigger premature labor, hospitalize you for weeks, even kill you — so be among the first in line for vaccine next month. But only about one in seven pregnant women gets a flu shot each winter.

While federal health officials are working hard to raise that number this year, repeated swine flu warnings won't automatically overcome a key obstacle: Many obstetricians don't vaccinate. And not only are many women reluctant to go hunting for flu shots elsewhere, historically some pharmacists and other providers have been wary of vaccinating them.

"Maybe this year we can change that culture," says Dr. Anne Schuchat of the Centers for Disease Control and Prevention. "It's not supposed to happen that you, when you are pregnant, are fighting for your life on a respirator."

Yet getting simple vaccine information took Charla Bason of Washington, D.C., repeated requests, as she was bounced between her obstetrician's office and her primary care doctor a few weeks ago.

"I feel like if I hadn't brought it up, they never would have mentioned it to me," says Bason, 30, who is seven months pregnant with her first child.

Bason decided to seek vaccination after watching a CDC Webcast about pregnant women and talking with a physician in the family. But she still has no clear answer about where to get one.

"It's been incredibly frustrating. There's a terrible disconnect between the message that was getting out and, once you decide you want it, how do you get it?" she says.

Any kind of flu is risky during pregnancy, and pregnant women have been on the get-a-flu-shot priority list for years. Their reluctance to take any medication during pregnancy is part of the reason for the low vaccination rates.

With swine flu, what doctors call the 2009 H1N1 strain, pregnant women seem at particular risk for complications. Pregnant women make up 6 percent of H1N1-confirmed deaths even though they account for only 1 percent of the population, according to the CDC. They're at least four times as likely to be hospitalized as other flu sufferers.

Vaccine is a two-for-one deal during pregnancy: It can protect not just mom but the baby, too, for the first few months after birth. The mother's body makes flu-fighting antibodies that easily cross the placenta to be carried by the fetus, explains Dr. Neil Silverman of the University of California, Los Angeles. That's important because flu can easily kill newborns, yet babies can't be vaccinated until they're 6 months old.

Once women get that vaccine advice, where do they get the shot?

The American College of Obstetricians and Gynecologists has no count of how many OBs offer flu vaccine. It's still considered a minority although recent surveys suggest many more may be starting this year, especially in large cities.

An extra complication: Each state's health department ultimately will decide who gets to offer the H1N1 vaccine, aiming for locations that vaccinate the most people. Those decisions haven't been made public yet. Even if your OB requested swine flu shots, he or she may not get any, at least from initial shipments.

So the CDC and ACOG are urging obstetricians to partner with a nearby site — a hospital or drugstore, for example — to guarantee their patients a flu-shot source, a message the government will reiterate Tuesday in a swine flu training seminar for obstetricians nationwide.

Yet providers who don't routinely treat pregnant women may not understand flu's risk and the shot's safety record, says Silverman, who helps set ACOG practice guidelines.

Take pharmacists, expected to be key H1N1 vaccinators. Silverman gets occasional phone calls from women who say a pharmacist won't fill the flu-shot prescription he wrote.

"They act like the doctor who prescribed it didn't know what he or she was doing," says Silverman, who settles the standoff by getting the pharmacist on the phone. For every patient who calls, "I know there are at least two who just say, 'Well, OK, I'm not going to do this,' and just walk away."

The American Pharmacists Association is urging its members to follow the CDC's pregnancy guidelines but can't mandate that, and a few stores may still balk, says association chief of staff Mitchel Rothholz.

But some are embracing the potential customers. The large Walgreen's drugstore chain told states that if picked as an H1N1 shot site, it might put get-vaccinated-here signs next to the pregnancy tests, or print vaccine reminders for people who bought prenatal vitamins.

And Louisiana this month lifted its requirement that pharmacists vaccinate by prescription only, making it easier for everyone to get a drugstore flu shot.

Why don't more OBs vaccinate? Largely it's the expense and hassle, but it's not part of routine obstetrician training, says Dr. Stanley Gall of the University of Louisville, an OB and longtime vaccine provider. That's changing as more stock a different vaccine — against the virus that causes cervical cancer — and decide they might as well offer flu vaccine, too.

Because so few pregnant women even have another doctor, "the OB office should be a one-stop shop," he says.

On the Net:
CDC info: http://www.cdc.gov/h1n1flu/pregnancy/

After a tragic loss, family steps up in flu vaccine trials

Sean and Ryan Moise played "rock-paper-scissors" to see who would get their flu shot first. Faith bravely stepped up after her older brothers.

Unlikely pioneers though they may seem, Sean, who turns 13 Monday, Ryan, 11, and Faith, 4 "and a half," are among just 600 children in the USA in government-sponsored pediatric trials of the vaccine for H1N1, or swine flu.

The children are more motivated than most to fight flu. They know how serious it can be. In 2003, their brother Ian, a robust 6-month-old, died of seasonal flu. He lived less than 30 hours after symptoms set in.

INTERACTIVE MAP: Track swine flu by U.S. region

Q&A: All about the flu vaccines

"That's why, when I heard the vaccine trial was coming to Kansas City, I was so eager to get my children into it," says Julie Moise, 42. "I'm more afraid of the flu than the vaccine."

Sean fretted on Facebook that he was signing up to be a pincushion. He decided to go ahead with the trial, anyway. "The first time I was a little, kind of, freaked out because I didn't know what to expect," he says. "After a while, it's not really all that bad. And it's good to know I should be resistant to H1N1 if it comes around."

Flu can kill

An early peek at the trial's results appear to justify the family's confidence. The findings released Sept. 21 show that H1N1 vaccine appears to protect most kids 10 to 17 years old, who are among those hit hardest by the new influenza.

As in seasonal flu, younger children are likely to need two doses. "The response in young children is less robust, but this is not unexpected," Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, the study's sponsor, said when the results were released.

In 2003, Julie Moise made sure all three children had had their flu shots. Just 10 days after Ian had the first of two vaccine doses he would need for full protection, he came down with the flu. Soon he was feverish and short of breath. A pediatrician confirmed the diagnosis and recommended treating his symptoms.

"That night he didn't want to lay flat in his crib," Moise says. "I held him in the recliner all night."

By morning, Moise developed flu symptoms, too. Her husband, Glenn, agreed to get Sean and Ryan off to school. Ian took a turn for the better, or so the family thought. His fever dropped from 104 to 100 degrees. His panting had turned into a sigh, Moise says. Still, she worried. And later that day, she called her husband at work. "I said, 'I don't like how Ian looks. Can you come home?' "

He found Ian sitting in his bouncy seat and picked him up. "At that moment," Julie Moise says, "he stopped breathing."

A postmortem showed his airway was plugged by mucus, which caused respiratory failure and cardiac arrest. Two things still nag at Julie Moise: First, how often doctors and nurses said "it's just the flu." More troubling is the guilt Moise feels because she and her husband weren't vaccinated. "You have to wonder," says Moise, a flight attendant, "did I bring it home?"

Ian's death turned the family into activists. They joined a group of other parents who've lost children, called Families Fighting Flu, to call attention to the risks of neglecting vaccination. They launched Ian's Rainbow Flu Foundation, which sponsors flu walks and vaccination clinics. And when the chance popped up to enroll their children in the vaccine trial, the Moises grabbed it. So did Laura Jaworski, Julie Moise's best friend, who enrolled her sons Zach, 3, and Nick, 6.

Children help out

Christopher Harrison, the lead investigator at Children's Mercy Hospital, says the Moise and Jaworski children were among 121 children from the Kansas City area in the trial. A parent's consent is sufficient to enroll a youngster, but all children sit in on the conversation with doctors as they explain the nature of the trial and ask parents to sign the consent form.

Children who've reached "the age of reason," Harrison says, sign a consent form, too. "It felt kinda cool," Sean says, "like I was taking responsibility for what I was about to do."

Harrison says most people enrolled their children in the trial to protect them from swine flu, especially with school approaching, but many also took into account the good that can come from the research. Most know that the vaccine is similar to standard flu vaccines, so it is likely to be safe and can't transmit the flu. As the trial was enrolling, he says, flu began spreading widely in Kansas City. In the past month, he says, half a dozen children with H1N1 have needed intensive care. A 16-year-old has died.

Moise notes that 36,000 people die each year of seasonal flu and says one death is too many. She begins reciting names of children who have died and whose parents banded together in Families Fighting Flu. "All these children were healthy. Every one had insurance," she says.

"How many times did I say in a 24-hour period, 'Oh, it's just the flu'? I didn't know flu kills healthy children. That's what's so scary."

Second wave of swine flu pandemic begins to hit US

After months of warnings and frantic preparations, the second wave of the swine flu pandemic is starting to be felt around the country. Doctors, health clinics, hospitals, and schools are reporting rapidly increasing numbers of patients experiencing flu symptoms.
While most cases so far are mild, and the health care system is handling the load, officials say the number of people seeking treatment for the flu is unprecedented for this time of year.

In Austin, so many parents are rushing their children to Dell Children’s Medical Center of Central Texas with swine flu symptoms that the hospital had to set up tents in the parking lot to cope with the onslaught.

In Memphis, the Le Bonheur Children’s Medical Center emergency room got so crowded with feverish, miserable youngsters that it had to do the same thing.

And in Manning, S.C., a private school where an 11-year-old girl died shut down after the number of pupils who were out sick with similar symptoms reached nearly a third of the student body.

“It just kind of snowballed,’’ said Kim Jordan, a teacher at Laurence Manning Academy, which closed Wednesday after Ashlie Pipkin died and the number of ill students hit 287. “We had several teachers out also.’’

“H1N1 is spreading widely throughout the US,’’ said Thomas Frieden, director of the federal Centers for Disease Control and Prevention in Atlanta. The CDC reported last week that at least 26 states are now reporting widespread flu activity, up from 21 a week earlier.

Even though some parts of the Southeast that started seeing a surge of cases first now seem to be showing a decline, that could be a temporary reprieve, Frieden said. And other parts of the country are probably just starting to feel the second wave.

“Influenza is perhaps the most unpredictable of all infectious diseases,’’ Frieden said.

The pandemic has prompted scattered school closings around the country in recent weeks, including 42 schools that closed in eight states Friday, affecting more than 16,000 students.

Many colleges and universities have been hit particularly hard, forcing some to open separate dorms for sick students. Ninety-one percent of the 267 colleges and universities being surveyed by the American College Health Association are now reporting cases.

The government is starting an unprecedented system to track possible side effects as mass flu vaccinations begin next month. The idea is to detect any rare but real problems quickly, and explain the inevitable coincidences that are sure to cause some false alarms.

In just a few months, health authorities hope to vaccinate well over half the population against swine flu, which doctors call the 2009 H1N1 strain. No more than 100 million Americans usually get vaccinated against regular winter flu, and never in such a short period.

The last mass inoculations against a different swine flu, in 1976, were marred by reports of a rare paralyzing condition, Guillain-Barré syndrome, a sometimes fatal paralysis. Other possible side effects could potentially include heart attacks, strokes, seizures, and miscarriages.

On top of routine vaccine tracking, these government-sponsored monitoring projects are planned:

■ Harvard Medical School scientists are linking large insurance databases that cover up to 50 million people with vaccination registries around the country for real-time checks of whether people see a doctor in the weeks after a flu shot and why. The huge numbers make it possible to quickly compare rates of complaints among the vaccinated and unvaccinated, said the project leader, Dr. Richard Platt, Harvard’s population medicine chief.

■ Johns Hopkins University will direct e-mails to at least 100,000 vaccine recipients to track how they’re feeling, including the smaller complaints that wouldn’t prompt a doctor visit. If anything seems connected, researchers can call to follow up with detailed questions.

■ The Centers for Disease Control and Prevention is preparing take-home cards that tell vaccine recipients how to report any suspected side effects to the nation’s Vaccine Adverse Event Reporting system.

“Every day, bad things happen to people. When you vaccinate a lot of people in a short period of time, some of those things are going to happen to some people by chance alone,’’ said Dr. Daniel Salmon, a vaccine safety specialist at the Department of Health and Human Services.

Masks may help prevent flu, but aren't advised

The visible symbol of the H1N1 flu outbreak last spring seemed to be face masks. Suddenly, they were everywhere -- in airports and waiting rooms, on buses and trains. Many drugstores sold out of masks. As the nation girds itself for a renewed fall outbreak, however, masks may make a reappearance.

Should I wear a mask? In general, the Centers for Disease Control and Prevention does not recommend use of face masks or respirators in non-health care settings. But there are exceptions. Because the novel strain of H1N1 influenza has led to a pandemic, people who are ill with the virus should consider wearing a mask around other people, if tolerable.

People who are at risk for severe illness from the flu should wear a mask or respirator if they are caring for someone with the flu and should consider wearing one if there is an outbreak of flu in the community. People who are not at high risk for flu complications could consider wearing one if there is an outbreak in the community, but it's not recommended.

What kind is most effective? There are two types of protection -- face masks and respirators. Masks are loose-fitting and designed to stop the spread of droplets from the person wearing the mask, not to protect the wearer from viruses. Respirators are close-fitting and more expensive. They are designed to reduce exposure to airborne particles. The CDC recommends N95 respirators for health care workers. The Food and Drug Administration has approved four models of respirators for use by the general public to help reduce exposure during a flu pandemic: 3M respirators models 8612F and 8670F, and Pasture Pharma respirator models F550G and A520G. These masks have been tested and shown to achieve a satisfactory fit for most adults. It's easiest to find them online.

But do they really work? It's still unclear how influenza is largely spread, whether through direct contact, the spray of droplets from an infected person to an uninfected person (within a proximity of 6 feet) or through inhaling smaller, airborne particles.

Do the cheap ones offer any protection? If a mask fits tightly around your face, it can reduce the chances of breathing in germs and stopping the spread of germs from the wearer.

The key is fit. They are designed to fit tightly over the mouth and nose, with no gaps. Gaps allow air to pass without being filtered. Masks are probably most useful in crowded settings, such as classrooms and airplanes or if you are in close contact with an infected person (within 6 feet). Masks shouldn't replace other precautions such as hand-washing.

Is there a correct way to wear a mask? Wash your hands with soap and water before putting on a mask. Make sure it fits tightly and that no hair, clothing or jewelry comes between the mask and your face. Inexpensive masks have a limited life span -- only about 30 minutes -- because they become moist and may lose shape and allow particles in. They should be removed if they become wet or damaged. Never reuse a mask.

When a mask is removed, throw it away in a closed waste container, wash your hands and put on a new mask.