Somehow, it seems a bit odd that classical microeconomic theory should apply to the price of a flu shot. After all, the jab has proven to be effective in reducing mortality from an infectious disease that kills about 36,000 Americans each year. But it does. Perfectly.

Flu shot providers from retail drugstores to physician’s offices are slashing prices for this year’s seasonal flu vaccine in response to consumer demand that has been much weaker than expected.

Just one year ago, enormous media coverage and public uncertainty surrounding a burgeoning pandemic of H1N1 flu motivated 110 million Americans to get the H1N1 vaccine. Nearly equal numbers of people took the seasonal flu vaccine as well.

Those in charge of planning and producing this year’s seasonal flu vaccine figured that people would remember the hysteria from a year ago, and those memories would drive up demand for the jab this winter. They also took into account new CDC recommendations, which call for everyone over the age of 6 months to get vaccinated.

They eventually decided to produce 163 million doses of the vaccine, a 50% increase over last year’s supply. Commercial outlets and doctor’s offices stocked-up on the vaccine in anticipation of the rush.

But the predicted increase in demand never materialized, at least not so far. Why? To date, the flu season has been mild, and press coverage of the annual flu season has been sparse. It seems that when flu is out of sight, it’s also out of mind.

And with vaccine demand in the tank, flu shot distributors have responded by cutting prices on flu shots, just as economists would predict.

For example, Rite Aid is distributing discount coupons for beauty items to folks who come in for a shot. The retail giant told the Wall Street Journal last week that it has dispensed 635,000 vaccines so far this year, and that it now expects to inoculate 300,000 less people than originally planned. Walgreen’s is also on record as saying its initial goals for flu vaccines were “aggressive.”

For its part, Kroger, the nation’s largest grocer, recently cut the price of its flu shot by $5 to $19.99 in most areas of the country.

Physicians’ offices haven’t been immune to the fall-off in demand. “We can’t give them away,” Thomas Haugh, a practice administrator in Raleigh, N.C. told the Journal. Demand is off 25% at his clinics, and that prompted a price cut from $25 to $15.

In normal years, the flu shot is a financial winner for retail distributors and doctors alike. They usually charge between $20 and $30 per shot, and achieve profit margins of 30-50% on the service. But the downside is that the shots must be ordered months before they’re needed, and they can’t be returned because the vaccine changes each year in response to never ending mutations in the virus that causes seasonal flu.

Of course, it’s not too late for suppliers of the flu shot. Flu season isn’t half-way over yet. An upsurge in reported cases, perhaps associated with some press coverage could result in a sudden surge in demand for the vaccine.

Economists have already told us what that would do to the price of a flu shot.

One year ago, researchers at the National Cancer Institute published a paper that linked Chronic Fatigue Syndrome with an obscure retrovirus known as XMRV. The article caused a stir because 4% of the supposedly healthy people in the study were infected with the virus. That could mean nearly 12 million Americans are infected with a poorly understood virus that potentially causes a poorly understood disease.

There has followed a mad dash to commercialize a blood test for XMRV, since arguably, the nation’s blood supply needs to be screened for the virus. Unfortunately, progress on this endeavor has been slow.

Like HIV-the virus that causes AIDS-XMRV is a retrovirus. XMRV has also been associated with prostate cancer, although no one really knows whether the virus causes diseases of any kind in humans.

Labs involved the effort to develop an XMRV blood test include those at the CDC and the National Cancer Institute, as well private sector programs at Roche, Abbott and Gen-Probe.

Scientists at Abbott are working with the Cleveland Clinic and Emory University. They have created unequivocally positive blood samples from monkeys that were deliberately infected with XMRV. The infected monkeys produced antibodies to 3 proteins on the surface of the virus, but blood levels of these antibodies became undetectabe within weeks after the infection. Tests based on these antibodies can therefore generate false negative results. False negative results can also be caused by the unusually long delay between the time the monkeys were infected with the virus and the time the antibodies appeared.

Even if these issues can be overcome and the antibody test subsequently proven to be useful on human blood, there would remain additional challenges in commercializing the test. For example, the elapsed time between when the blood is obtained and when it is tested could impact test results.

“When there is a new agent that we don’t know a lot about, it’s always a process,” Michael Busch lamented in an interview with the Wall Street Journal. Bush is the director of San Francisco’s Blood Systems Research Institute and a participant in the working group tasked by the Feds to study the potential impact of XMRV on the nation’s blood supply.

Final Thought: It’s hard to criticize a proactive effort to commercialize a blood test for a virus that could be contaminating our nation’s blood supply, but it sure would be nice to know that XMRV actually causes human disease, and that it actually can be transmitted through a blood transfusion. #CartBeforeTheHorse?

Scientists have discovered a new, highly transmissible gene that could, quite easily in fact, open a frightening new front in the ongoing global war against superbugs.

The antibiotic resistance gene, NDM-1, was first identified in 2008 a Swedish patient that had received hospital care in New Delhi. NDM-1 produces an enzyme that allows bacteria to destroy most antibiotics. It exists on plasmids, which are pieces of genetic material that are easily shared between bacteria including E coli and other species that can cause pneumonia, urinary tract infections and blood stream infections.

NDM-1 probably evolved in parts of India where poor sanitation and overutilization of antibiotics provide a perfect environment for the creation of antibiotic-resistant bacteria.

The gene has been identified in 3 US patients. All had received medical treatment in India, and all recovered from their infections. It has been found sporadically in Britain, Australia and nearly a dozen other countries as well. Most affected patients were “medical tourists,” that is, people seeking less expensive medical care in India.

“We need to be vigilant about this,” said Arjun Srinivasan, an epidemiologist at the CDC told the Washington Post. “This should not be a call to panic, but it should be a call to action. There are effective strategies we can take that will prevent the spread of these organisms.”

The NDM-1 gene does not appear to be transmitted by coughing or sneezing, but rather through exposure to contaminated sewage, water and medical equipment. Inadequate hand-washing also likely plays a role. The CDC has advised doctors to look for it and isolate patients that have it.

The scientists who discovered NDM-1 warned that it had become endemic in many areas of India and Pakistan.

“What we saw (in south-Asian hospitalized patients) is the tip of the iceberg,” Timothy Walsh, a Cardiff University professor of microbiology told the Post. “For every person in the hospital, you can imagine there are a vast majority of people out there carrying NDM around.”

Meanwhile, the Indian government denounced the news as a scare tactic designed to discredit the nation’s exploding medical tourism industry. That industry attracts 450,000 patients per year and will likely generate $2.4 billion in revenue in 2012.

Nearly 300,000 people per year in the US collapse suddenly and die as a result of cardiac arrest, in which a heart attack or something else causes the heart to cease pumping blood effectively. The condition is fatal in minutes unless afflicted individuals receive cardiopulmonary resuscitation.

The vexing public health problem with cardiac arrest is that many witnesses hesitate to administer CPR because they don’t want to get involved with the “mouth-to-mouth” part of the process. Some won’t do it because they are grossed-out by vomitus that may be in the patient’s mouth. Others worry that they might catch an infectious disease from the patient. Tens of thousands of lives are lost each year because of this hesitation.

That’s why the results of a new study by Bentley Bobrow and colleagues at the Arizona Department of Health Services were a cause for celebration after being released last week. The results of the study showed that cardiac arrest patients that received only chest compressions (not mouth-to-mouth) from witnesses had higher survival rates than patients who received CPR the old fashioned way (compressions plus mouth-to-mouth).

The study was published in the Journal of American Medical Association. It included 4,415 adults that sustained cardiac arrest between 2005 and 2009. In the study, survival rates (measured at hospital discharge) were 13.3% in the chest compressions only group, 7.8% in patients that received conventional CPR, and 5.2% for those who received no CPR.

“Anybody can do hands-only CPR by pushing hard and pushing fast in the center of a person’s chest,” Michael Sayre, an associate professor at Ohio State University and a CPR expert told the Wall Street Journal.

Responding quickly to the findings, the American Heart Association modified its CPR recommendations. The new recommendations call for adults to emphasize chest compressions rather than mouth-to-mouth resuscitation. The AHA recommendations can be seen here.

Note that when kids are found unresponsive, they do indeed need mouth-to-mouth resuscitation since the causes for the condition in kids is usually respiratory, not cardiac.

Drivers who were distracted by talking or texting on cellphones killed approximately 16,000 people between 2001 and 2007 according to an scientists at the University of North Texas Health Science Center.

To make their estimate, Fernando Wilson and Jim Stimpson compiled data on deaths attributed to distracted driving from the National Highway Traffic Safety Administration. For ancillary analyses, they also used FCC data concerning cell phone ownership and text messaging volume.

The scientists found that in 2002, Americans sent about 1 million text messages per month. By 2008, this figure had exploded to 110 million per month. “Our results suggest that recent and rapid increases in texting volumes have resulted in thousands of additional road fatalities in the United States,” they wrote in the American Journal of Public Health.

The shocking statistic comes at a time when overall traffic fatalities are actually down in the US. In fact according to the Transportation Department, the number of traffic fatalities in 2009 (33,963) was lower than at any time since the mid-1950s.

“Distracted deaths as a share of all road fatalities increased from 10.9% to 15.8% from 1999 to 2008, and much of the increase occurred after 2005,” wrote the scientists. “In 2008, approximately 1 in 6 fatal vehicle collisions resulted from a driver being distracted while driving.”

Numerous studies have shown that talking on a cell phone distracts drivers, even if they use a hands-free set-up. Of course, texting, emailing and other smartphone applications provide an even greater distraction since users must take their eyes off the road in order to carry out those functions.

Approximately 30 states have made it illegal to text message while driving. In other jurisdictions, hands-free devices are required for drivers who use cellphones.

In the wake of the recent nationwide outbreak of salmonella that sickened 1,000 people and triggered the recall of a half-billion eggs, people have begun wondering just what that “USDA Grade A” badge on the sides of egg cartons actually means.

Remarkably, some believe the badge means a rabbi has blessed the eggs as kosher. Others assume it signifies the eggs are safe to eat; perhaps they even passed a test for pathogenic bacteria like salmonella.

Both suppositions are wrong, it turns out. What the badge actually means is that a “grader” from the US Department of Agriculture has checked the eggs at an egg-packing plant for size and color and assured that their shells were not cracked. That’s it.

Since the salmonella outbreak, officials at the USDA have redoubled their efforts to remind the public that their agency isn’t responsible for assuring the safety of the nation’s egg supply. That responsibility, the officials insist, belongs to the Food and Drug Administration

So what does the USDA do, exactly? Well, it regulates the safety of meats consumed in the US and it promotes US food products here and abroad. That badge on the egg cartons is a product of the second, marketing function of the USDA.

Commenting on the seemingly obvious idea that one government agency should be responsible for food safety, Connecticut Democrat Rosa DeLauro had this to say to the Wall Street Journal: “The USDA stamp should have a clear and consistent message to consumers—not a stamp of quality assurance that may be misinterpreted as a stamp of safety.”

Meanwhile, the FDA and the Justice Department are gathering outside the doors of the egg producers at the center of the recall. The FDA hasn’t decided whether it ought to have a badge of its own, by the way.

Levels of cancer-causing nitrosamines are higher in US-made cigarettes than those from other countries, according to scientists at the Center for Disease Control.  That means they can potentially cause more cases of lung cancer.

To reach these conclusions, David Ashley and colleagues group measured mouth levels of a highly carcinogenic substance known as NNK, and urinary levels of its major metabolite, NNAL in 126 smokers from New York, Minnesota, Australia, Canada and England. The US smokers used several popular brands including Camel Light, Marlboro, Newport and Newport Light. The scientists counted butts to assure smokers from each location consumed the same numbers of cigarettes.

It turned out that 24 hour mouth levels of NNK (in nanograms) were 1,490 in New York, 1,150 in Minnesota, 1,010 in England, 449 in Canada and 350 in Australia. There was a direct correlation between mouth levels of NNK and urinary levels of NNAL.

Of note, 2 recent studies have shown a direct relation between urinary NNAL levels and lung cancer risk.

Together, these findings suggest that “higher levels of tobacco-related nitrosamines in the smoke of US cigarette varieties lead to higher mouth-level exposure to NNK and increased NNAL, which may be associated with excess lung cancer burden,” wrote the scientists.

The scientists also hypothesized that high levels of NNK in US tobacco products result from domestic curing processes and the blends of tobacco used during production.

Unfortunately, lowering nitrosamine levels in US cigarettes might not make them safer because that may increase the amounts of other carcinogenic substances.

As well, the scientists “did not look at the two dozen other cancer-causing toxins,” according to John Spangler of Wake Forest University. “And it did not examine chemicals that might affect heart disease, stroke, emphysema, and other diseases caused by tobacco use,” he added.

The findings appear in Cancer Epidemiology, Biomarkers & Prevention.

Paying people to avoid sexually transmitted diseases effectively reduces their spread, according to a proof-of-concept study carried out by scientists at UC Berkeley, the Development Research Group at the World Bank and the Ifakara Health Institute in Tanzania.

The study involved young adults in southwestern Tanzania. Subjects were randomly assigned to a high-payment group, a low-payment group and no-payment control group. Participants in the high payment group received $20 every 4 months–up to $60–if they tested negative for STDs. Those in the low-payment group received half that amount.

Participants in all groups received individual counseling and could attend monthly group counseling sessions as well. Any participant that tested positive for an STD received free care for the condition.

By the end of the year, 9% of participants in the high-payment group had tested positive for an STD. That was significantly better than the 12% rate seen in both the control group and the low-payment group. The cash reward had the same impact in men and women. It had a more pronounced effect in people with lower incomes.

“For many of our study participants, $60 represented about one-fourth of their reported annual income, so it was a significant incentive,” says Will Dow, a study author and a health economist at Berkeley. “The question we tested is whether the cash reward was enough of an incentive to reduce risky behavior. The fact that disease prevalence decreased suggests the incentives worked.”

Participants were tested for chlamydia, gonorrhea and syphilis. HIV/AIDS status was not tested, but the same sexual behaviors that increase the risk of the STDs increase the risk of HIV.

Continuing a trend that began more than 2 decades ago, the death rate from cancer in the US dropped 1.3% year-over-year in 2010. It now stands at about 178 people per 100,000 per year.

The news is contained in a report prepared by epidemiologists at the American Cancer Society and published in CA: A Cancer Journal for Clinicians. The scientists estimate there will be about 1,530,000 new cancer cases in the US in 2010 (790,000 in men and 40,000 in women), and 569,000 deaths due to cancer (299,000 in men and 270,000 in women) in the US in 2010.

According to the report, cancer death rates have dropped 21% in men, and 12% in women since 1991. The report attributes the fall-off to fewer people smoking, improved treatment, and better screening.

In men, cancers of the prostate, lung, and colon will be the cause of 52% of all newly diagnosed cancers this year. Prostate cancer alone will cause 28% of these, and 90% of these cases will be discovered at local or regional stages, for which the five-year survival rate is nearly 100%.

In males who are less than 40 years of age, leukemia is the most common fatal cancer. In older men, lung cancer becomes the leading killer.
 
For women, cancers of the lung, breast and colon account for 52% of newly diagnosed cancer cases. Breast cancer alone will cause of 28% of all new cancers in women this year.

Leukemia is the leading cause of cancer death among women less than 20 years old. Breast cancer ranks first for those between the ages of 20 and 59. After that, lung cancer becomes the leading cause of cancer death.

Lung cancer surpassed breast cancer as the leading cause of cancer death in women in 1987. It will be responsible for 26% of all cancer deaths in women this year.

Almost 9 years after letters laced with weapons-grade anthrax spores killed 5 people and inflamed fears about bioterrorism, the US still relies on a single anthrax vaccine maker that uses expensive, impractical, decades-old technology.

The company is Emergent BioSolutions, and its BioThrax vaccine is its only product. Emergent has copped $1.4 billion in federal contracts for the vaccine in the last decade alone.

Twice before, the Feds tried to find cheaper anthrax vaccines and increase the number of vaccine suppliers. In 2004, it awarded an $877 million contract to VaxGen, but aggressive lobbying by Emergent and manufacturing problems at VaxGen forced the Feds to void that contract.

A second RFP that was released last year by Barda–the Biomedical Advanced Research and Development Authority–was halted after officials determined that no supplier could produce a vaccine quickly enough.

That was a setback for PharmAthene, a rival to Emergent. PharmAthene claims that heavy lobbying by Emergent scuttled what it thought was a sure win. Emergent spent $4 million in lobbying during 2009 to maintain its monopoly.

BioThrax requires the administration of 5 doses over 18 months, and costs the Feds $120 per person immunized. PharmAthene’s SparVax would cost $45 per person. That vaccine remains in testing, however. In fact, PharmAthene has no products on the market right now.

Barda is also hoping to lure some large consortiums into the field, including one involving Merck, GE and and the University of Pittsburgh, but they remain leery of the risks.

“The country needs an anthrax vaccine that requires fewer injections, produces fewer side effects and is made using modern techniques,” said former Sen. Bob Graham, who co-chaired a federal commission that questioned the nation’s bioterror readiness earlier this year.

UPDATE: At the time this post is being scheduled for publication, the Washington Post is reporting that Emergent BioSolutions will soon announce that it “received a contract worth up to $107 million to ready its anthrax vaccine for large-scale manufacture.

According to Emergent, the contract will pay for the company to develop and obtain regulatory approval for large-scale manufacture of BioThrax.

The award is based on an Emergent proposal that says the company can produce 26 million doses annually, a significant increase from the roughly 7 million to 9 million it generates today.”