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YCQM - Dr. Harry Chen - April 20, 2014 - WCAX.COM Local Vermont News, Weather and Sports-

YCQM - Dr. Harry Chen - April 20, 2014

Posted: Updated:
You Can Quote Me -- April 20, 2014 -- Dr. Harry Chen, the Vermont health commissioner, joins Darren Perron and Bridget Barry Caswell to discuss opiate addiction and other Vermont health issues.

TRANSCRIPT:

>> Announcer: FROM VERMONT'S
MOST TRUSTED NEWS SOURCE, WCAX
BRINGS YOU YOUR NEWSMAKERS, YOUR
NEIGHBORS.
THIS IS "YOU CAN QUOTE ME."


>>> AND GOOD MORNING, EVERYONE.
OUR NEWSMAKER THIS SUNDAY IS
VERMONT HEALTH COMMISSIONER
DR. HENRY CHEN.


>> WE'LL TACKLE THE FLU, OPIATE
ABUSE, WEST NILE VIRUS AND A
RECENT EMERGENCY RULE PUT IN
PLACE.


>> THE COMMISSIONER AND THE
GOVERNOR WORRY A NEW DRUG WILL
INCREASE OVERDOSE NUMBERS.


>> A SMALL BUT POTENT PILL
CAUSING BIG CONCERNS.


>> ONE MIGHT WONDER IF THEY'RE
ON THE SAME PLANET.


>> THEY BEING THE FOOD AND DRUG
ADMINISTRATION.
IT'S APPROVAL OF A NEW PAIN
KILLER LED TO A NEW EMERGENCY
RULE IN VERMONT.


>> AND I THINK THEY GOT THIS ONE
WRONG.


>> MAYORS OF CITIES ACROSS
VERMONT AND THE STATE'S HEALTH
COMMISSIONER JOINED GOVERNOR
SHUMLIN TO ANNOUNCE NEW
REQUIREMENTS FOR DOCTORS
PRESCRIBING ZOHYDRO.


>> WE HAVE TO GET AHEAD OF THIS
NEW HIGHLY POTENT DRUG.


>> IT'S A HIGH DOZE, EXTENDED
RELEASE NARCOTIC, UP TO TEN
TIMES MORE POWERFUL THAN OTHER
DRUGS LIKE VICODIN AND OXYCONTIN
AND IT ISN'T TAMPER PROOF.
MEANING CAPSULES CAN BE CRUSHED
AND MORE EASILY ABUSED.


>> THIS JUST DEFIES COMMON
SENSE.
WHY WOULD WE APPROVE AN EVEN
STRONGER OPIATE WITH NO TAMPER
RESISTANCE WHEN WE KNOW THAT
THAT'S HOW WE GET INTO THIS MESS
IN THE FIRST PLACE?
IT REQUIRES ALL OF US TO TAKE
ACTION BEFORE THE QUALITY OF
LIFE THAT WE CHERISH SO MUCH IS
COMPROMISED.


>> GOVERNOR SHUMLIN MADE
FIGHTING OPIATE ABUSE HIS TOP
PRIORITY DURING HIS STATE OF THE
STATE ADDRESS, CALLING IT AN
EPIDEMIC.
SINCE 2000, VERMONT HAS SEEN AN
800% INCREASE IN OPIATE DRUG
ABUSE, AND IN 2012, 54
VERMONTERS DIED FROM ACCIDENTAL
OPIATE OVERDOSES.


>> WE'VE GOT AN OPIATE CHALLENGE
IN VERMONT AND IN AMERICA.


>> HE REITERATED HIS CONCERNS
AND LAID OUT THE NEW RULES
VERMONT DOCTORS MUST NOW ABIDE
BY OR FACE LOSING THEIR
LICENSES.
THE NEW EMERGENCY RULES TIGHTEN
DOCTORS' PRESCRIBING POWERS, SO
HYDRO CAN ONLY BE GIVEN TO
PATIENTS IF THERE ARE NO
ALTERNATIVES.
DOCTORS MUST COMPLETE RISK
ASSESSMENTS AND PATIENTS MUST
SIGN AN AGREEMENT SUBMITTING TO
REGULAR MEDICAL EVALUATIONS,
INCLUDING URINE SCREENING.


>> WE FEEL THAT THIS IS THE
FASTEST WAY THAT VERMONT CAN
EFFECTIVELY ENSURE THAT WE DON'T
CREATE ANOTHER OXYCONTIN-DRIVEN
OPIATE CRISIS WITH THIS
PARTICULAR FDA APPROVED DRUG.


>> AND DR. CHEN JOINS US NOW.
THANKS FOR BEING HERE.


>> DR. CHEN, LET'S START WITH
ZOHYDRO.
WHAT IS IT YOU FEAR ABOUT THIS
DRUG?
IS IT ITS POTENCY, THE WAY IT'S
RELEASED?
WHAT IS YOUR BIGGEST FEAR?


>> I THINK THE BIGGEST FEAR IS
THE WAY IT'S RELEASED AND THE
FACT THAT IT CAN BE EASILY
TAMPERED WITH, AND IF YOU
ACTUALLY READ THE PACKAGE
INSERT, IT SAYS THIS MUST BE
SWALLOWED, YOU CAN'T CHEW IT,
YOU CAN'T DISSOLVE IT, OTHERWISE
YOU MAKE IT A FATAL OVERDOSE.
SO I'M NOT SURE IT MAKES A LOT
OF SENSE TO CREATE A DRUG THAT,
A, IS SO DANGEROUS, B, IS SO
EASILY ABUSED AND FROM MY
PERSPECTIVE, IT'S GOES AGAINST
WHAT WE'RE TRYING TO DO IN
PUBLIC HEALTH TO DEAL WITH THE
OPEN CRISIS.


>> THE SITUATION IS BAD ENOUGH
RIGHT NOW.
DO YOU THINK THIS COULD
POTENTIALLY EXACERBATE THE
CRISIS IN VERMONT WITH OPIATE
ABUSE?


>> I THINK SAW THAT AS A RISK
AND THAT'S WHY WE ACTED QUICKLY
AND WE CHOSE NOT TO, AS YOU
KNOW, TAKE THE ROUTE THAT
MASSACHUSETTS DID AND JUST
YESTERDAY, ACTUALLY, THEIR BAN
WAS OVERTURNED BY THE COURT, SO
I'M REASSURED IN CONVERSATIONS
WITH OTHER STATES THINKING ABOUT
DOING THE SAME THING.


>> LET'S TALK MORE ABOUT THATS
IF AS YOU MENTIONED,
MASSACHUSETTS BANNED THIS DRUG
AND A FEDERAL COURT IS NOW
SAYING THAT THAT BANNED HAS BEEN
STOPPED.
I SPOKE WITH THE GOVERNOR ABOUT
THIS AND HE SAID THERE WAS FEAR
THAT THERE COULD BE COSTLY
LITIGATION.
IS THIS GETTING AROUND
LITIGATION THEN BY PUTTING THESE
RESTRICTIONS ON DOCTORS?


>> WELL, I THINK, TO SOME
EXTENT, IT IS.
I THINK, AS I SAID, WHAT WE
WANTED TO DO WAS TO ENSURE THAT
WE WERE AHEAD OF THIS PROBLEM
RATHER THAN TRYING TO CATCH UP
WITH IT, A NEW, STRONG, EASILY
ABUSED NARCOTIC, AND SO TO THE
EXTENT THAT WE CAN PUT THESE
BEST PRACTICES IN PLACE TO
ENSURE THAT THE RIGHT PEOPLE GET
IT, THAT THE RIGHT PRECAUTIONS
ARE IN PLACE, THE RIGHT
MONITORING, THE RIGHT DISCLOSURE
IN TERMS OF PATIENTS AND
DOCTORS, I THINK WE'LL BE ALL
BETTER OFF FOR IT.


>> DO WE NOT HAVE RESTRICTIONS
RIGHT NOW AND GUIDELINES FOR
DOCTORS PRESCRIBING OTHER THINGS
LIKE OXYCONTIN?


>> WELL, THERE ARE A TON OF
GUIDELINES OUT THERE, BUT THE
REALITY IS, IN THAT 15-MINUTE
INTERVIEW WITH -- IN THAT
15-MINUTE APPOINTMENT WITH THE
DOCTORS, THEY MAY OR MAY NOT GET
TO ALL THOSE GUIDELINES, SO WE
THINK IT'S, GIVEN THE SITUATION
WITH OVERDOSES AND TREATMENT
COSTS RELATED TO ADDICTION, WE
THINK IT'S IMPERATIVE THAT
PHYSICIANS DO A BETTER JOB OF
MONITORING, PRESCRIBING, AND
TAKING CARE OF PEOPLE FOR THEIR
CHRONIC PAIN.


>> COULD THESE RULES THEN BE
EXPANDED TO OTHER DRUGS TO MAKE
SURE THAT DOCTORS AREN'T EITHER
OVERPRESCRIBING OR THAT PATIENTS
AREN'T DOCTOR-SHOPPING,
PRESCRIPTION-SHOPPING?


>> THE ANSWER TO THAT IS YES.
AS A MATTER OF FACT, WE, UNDER
ACT 75 IN 2012, WE IMPLEMENTED
REQUIREMENTS FOR DOCTORS TO USE
THE VERMONT PRESCRIPTION
MONITORING SYSTEM.
WE IMPLEMENT THE IT AND WE ALSO
STARTED WORKING ON RULES VERY
SIMILAR TO THIS.
NOT QUITE AS STRINGENT AS THESE
RULES, THAT WE WOULD REALLY WANT
TO APPLY TO ANYBODY IN VERMONT
GETTING A NARCOTIC FOR CHRONIC
PAIN.


>> THAT A REGISTRATION
VOLUNTARY?


>> UP TO 2012 IT WAS VOLUNTARY
AND WE FOUND THAT NOT ENOUGH
MANAGESES WERE USING IT, AS --
PHYSICIANS WERE USING IT AS YOU
MIGHT EXPECT, AS WELL AS
REGISTERED.
WE GOT EVERYBODY REGISTERED LAST
FALL AND NOW THEY'RE REQUIRED TO
USE IT IN FOUR SPECIFIC
INSTANCES AND WHAT WE WANT TO DO
IS INCORPORATE THAT INTO NEW
RULE-MAKING WHICH WILL BE MORE
EXPANSIVE IN TERMS OF MORE
NARCOTICS AND OPIOIDS.


>> THE MANUFACTURER'S WEBSITE
FOR ZOHYDRO, EVEN ON THE WEBSITE
IT SAYS THERE'S AN INCREASED
RISK OF OVERDOSE AND DEATH FOR
THE DRUG.
WHAT DO YOU THINK WAS THE FDA
ALSO RATIONALE FOR APPROVING
THIS, EVEN TO GO AGAINST THE
ADVISORY COMMITTEE'S VOTE.
WHAT COULD THEY BE THINKING?


>> THE FDA IS IN A TOUGH SPOT
BECAUSE THEY'RE A REGULATOR, SO
MAYBE THEY MADE A DECISION BASED
ON WHAT THEIR REQUIREMENTS ARE,
THAT THEY COULDN'T REFUSE THIS
PARTICULAR DRUG, BECAUSE IT
WAS -- IT COULD BE USED SAFELY
AND THERE MAYBE PATIENTS OUT
THERE THAT COULD BENEFIT FROM
IT.
SO I THINK THEY MADE THAT
DECISION GOING AGAINST -- I'M
BAFFLED PERSONALLY THAT THEY
WENT AGAINST THEIR OWN ADVISORY
BOARD 11-2, AND THEY WENT
AGAINST THE CDC SAYING WE HAVE
AN EPIDEMIC OF DRUG OVERDOSES
AND GEVENS THE PRESIDENT'S --
AGAINST THE PRESIDENT'S DRUG
CZAR, SAYING PRESCRIPTION ABUSE
IS THE NUMBER ONE DRUG PROBLEM
IN AMERICA.
IT DEFIES COMMON SENSE.


>> THE DRUG MAKER, WE SHOULD BE
FAIR IN SAYING THAT THE DRUG
MAKER SAYS THAT THIS MEDICATION
IS NEEDED FOR PEOPLE WITH
CHRONIC FEIGN AND IT IS
COMMIT -- PAIN AND IT IS
COMMITTED TO ITS SAFE AND
APPROPRIATE USE.
THAT'S TALK MORE ABOUT HOW IT
CAN BE ABUSED.
WE DISCUSSED IN THE STORY WE
JUST SAW THAT IT COULD BE CRUSH.
HOW ARE PEOPLE GOING TO
AFFORDABLY ABUSE THIS DRUG?


>> WELL, TO BE PERFECTLY HONEST,
I'M NOT REALLY AN EXPERT ON HOW
THEY USE THEM.
I WOULD PRESUME THEY EITHER CUT
THEM OPEN, TAKE THE PELLETS OUT
OF THEM, CRUSH THEM UP AND THEN
USE THEM.


>> BUT THERE ARE SYSTEMS IN
PLACE TO PREVENT THAT, LIKE
OXYCONTIN IN THE UNITED STATES
NOW HAS TAMPER RESISTANCE.


>> RIGHT.


>> HOW COULD -- COULD THAT BE
APPLIED TO THIS DRUG?


>> ABSOLUTELY, AND SO ONE OF THE
THINGS THAT WE KNOW THAT
MANUFACTURERS OF ZOHYDRO IS
ACTUALLY IN THE PROCESS OF
MAKING AN ABUSE DETERRENT
FORMULATION OF ZOHYDRO.
WE KNOW THAT THE FDA HAS GIVEN
GUIDANCE TO DRUG COMPANIES TO
USE ABUSE DETERRENT FORMULATIONS
FOR THEIR BRAND NAME DRUGS AND
WE ALSO KNOW THAT THE FDA THIS
PAST YEAR REQUIRED THAT THE
MAKER OF OXYCONTIN, WHEN THEY
WENT GENERIC, USE AN ABUSE
DETERRENCE FORMULATION, SO IF
YOU -- DETERRENT FORMULATION, IF
YOU TAKE ALL THE THINGS THEY
SAID IN THEIR GUIDANCE AND THEIR
ACTIONS, AGAIN, I'M BAFFLED BY
THEIR DECISION.


>> DO YOU IT THIS SHOULD BE A
PAIN KILLER -- THINK IT SHOULD
BE A PAIN KILLER OF LAST RESORT,
IF YOU WILL?
ARE THERE ALTERNATIVES FOR
PEOPLE WHO DEAL WITH CHRONIC
PAIN?
WHAT'S THE TARGET AUDIENCE FOR
SUCH A POWERFUL DRUG?


>> WELL, I THINK YOU'RE RIGHT,
IT'S FOR PEOPLE THAT IT SHOULD
BE, PEOPLE WHO FAILED OTHER
MEDICATIONS THAT WE HAVE
AVAILABLE TO US NOW THAT HAVE A
PROVEN SAFETY RECORD.
AND I THINK JUST TO REALLY
ADDRESS WITH THE FDA, WHAT THE
MANUFACTURER SAYS, IN VERMONT I
THINK TO SOME EXTENT, WE AGREE
THAT THERE MAY BE A FEW PEOPLE
THAT THIS WILL GENUINELY HELP,
BUT WE WANT TO MAKE SURE THAT
WE, A, SELECT THE RIGHT PEOPLE,
B, THAT THEY UNDERSTAND THE
RISKS, AND C, THAT THEY'RE
CAREFULLY MONITORED FOR PROGRESS
AND ABUSE.


>> HAS THE STATE BEEN CONTACTED
BY THE DRUG MAKER AFTER THE
RESTRICTIONS WERE PUT IN PLACE?


>> I HAVE NOT HAD STICK CONTACT
WITH THE DRUG MAKER.
AS I SAID, I'VE BEEN CONTACTED
BY AT LEAST TWO OR THREE OTHER
STATES TO UNDERSTAND WHAT WE DID
WITH SOME INTEREST ON THEIR PART
FOR DOING THE SAME THING.


>> AS WE SAID, THERE'S A VERY
SERIOUS OPIATE ABUSE CRISIS IN
VERMONT.
THOSE NUMBERS IN DARREN'S PIECE
AT THE OPENING OF THE SHOW,
THOSE ARE QUITE ALARMING
NUMBERS.
HOW DO YOU SEE THE ROLE OF THE
VERMONT HEALTH DEPARTMENT?
IT'S A CRISIS THAT AFFECTS SO
MANY FACETS OF LIFE IN VERMONT.
WHAT'S YOUR ROLE?


>> I THINK OTHER THAN THE ACTUAL
LAW ENFORCEMENT AND CRIMINAL
JUSTICE SYSTEM, I THINK I'M
FRONT AND CENTER, AND SO I'VE
BEEN DEVOTING A LOT OF MY TIME
TO THAT, AND IT GOES -- I THINK
GIVEN THE CRISIS, GIVEN OUR
APPROACH THAT IT'S A PUBLIC
HEALTH CRISIS, TO BE
COMPREHENSIVE IN HOW WE APPROACH
IT, SO IT REALLY GOES TO WHAT'S
HAPPENED IN THE SCHOOLS WITH OUR
SUBSTANCE ABUSE PREVENTION
COUNSELORS TO WHAT HAPPENS AT
THE 12 DISTRICT OFFICES WHERE WE
HAVE PREVENTION COUNSELORS AND
ALCOHOL, DRUG ABUSE PREVENTION,
TO WHAT WE'RE DOING IN THE
DOCTOR'S OFFICE WITH SCREENING
PEOPLE, ROUTINELY SCREENING
PEOPLE IN THE PRIMARY CARE
OFFICES TO TREATMENT, SO
TREATMENTS FOR DRUG ABUSE AND
OPIATE ABUSE COMES THROUGH THE
HEALTH DEPARTMENT PRIMARILY AND
THEN FINALLY, AS THE OTHER END
OF THE SPECTRUM IN TERMS OF HARM
REDUCTION, WHETHER IT BE NEEDLE
EXCHANGES TO ENSURE THAT DAICTS,
PEOPLE WHO ARE ADDICTED DON'T
GET HEPATITIS AND AIDS IN
ADDITION TO ADDICTION, AND
FINALLY THE ANTIDOTE.
WE'RE RESPONSIBLE FOR PUSHING
OUT THAT PILOT.
WE PUSHED OUT HUNDREDS OF DOSES
OF NARZONE THROUGHOUT VERMONT
BOTH IN THE NEEDLE EXCHANGES AND
NOW IN THE HUBS AND WE'VE HAD
GOOD REPORTS OF ANYWHERE FROM 12
TO 15 REVERSALS.


>> NARCAN IS SORT OF THE NAME
BRAND OF THIS ANTIDOTE DRUG,
CORRECT.


>> CORRECT.


>> SO WHEN FOLKS HEAR THAT,
THAT'S WHAT THEY ASSOCIATE --


>> I HAVE BEEN TRAINED THROUGH
MEDICAL SCHOOL TO NOT USE BRAND
NAMES AND IF WE PULLED OUT THE
BOX, IT WOULD NOT SAY NARCAN.


>> LET'S TALK ABOUT THIS
TREATMENT.
IF SOMEBODY IN THE MIDDLE OF AN
OVERDOSE, IT IS ADMINISTERED
NASALLY, IS THAT CORRECT?
HOW DOES IT WORK?


>> IT'S USED IN HOSPITALS,
ADVANCED LIFE SCHT, AND
BASICALLY IT'S A DRUG THAT HAS
NO INHERENT EFFECTS OTHER THAN
TO REVERSE NARCOTICS.
IT WORKS RAPIDLY, WITHIN A
MINUTE, SECONDS TO MINUTES, AND
IT'S LIFE-SAVING IF THEY HAPPEN
TO BE UNDER THE INFLUENCE OF AN
OVERDOSE.


>> SO IT'S BEEN OKAY FOR MEDICAL
PROFESSIONALS TO USE IT.
YOU HAVE OTHER PEOPLE, LAW
ENFORCEMENT, RECOVERY CENTERS,
PEOPLE LIKE THAT IN THOSE AREAS
CAN ADMINISTER IT THROUGH
TRAINING?


>> WELL, THERE IS TRAINING, SO
WE HAVE AN ONLINE VIDEO ON
TRAINING.
WE HAVE A BROCHURE THAT IT
PRETTY STRAIGHTFORWARD.
PUT IT TOGETHER, SQUIRT IT IN
THE NOSE, CALL 911, SO REALLY,
IT'S NOT A DIFFICULT THING TO
ADMINISTER AND GIVEN THE
PARTICULAR CIRCUMSTANCES, IT CAN
BE LIFE-SAVING.


>> IS IT QUICK?


>> YES, IN TERMS OF THE REVERSAL
CAN HAPPEN, AS I SAID, WITHIN 30
TO 60 SECONDS.
YOU COULD PROBABLY PUT THE KIT
TOGETHER.
ANYBODY WITHIN 10 OR 15 SECONDS.


>> HAS IT SAVED ANY LIVES?


>> AS I SAID, WE'VE HAD PROBABLY
UP TO 15 REVERSALS IN VERMONT.


>> THAT'S LIFE-SAVING?


>> THAT'S AFFORDABLY
LIFE-SAVING.
IT'S NOT EXACTLY CONTROLLED
CIRCUMSTANCES, SO I CAN'T SAY
WITH CERTAINTY THAT THEY SAVED A
LIFE, BUT WE KNOW THAT PEOPLE
HAVE BEEN -- IT'S BEEN
ADMINISTERED SOMEWHERE BETWEEN
12 AND 15 TIMES, AND PEOPLE HAVE
WOKEN UP.


>> YOU GAUK A TREATMENT.
EASIER SAID THAN DONE.
IN VERMONT, WE HAVE NEARLY A
THOUSAND PEOPLE ON A WAITING
LIST TO GET TREATMENT, IS THAT
CORRECT?


>> WELL, AGAIN, APPROACHING
TREATMENT AS A SPECTRUM, A
COMPREHENSIVE SPECTRUM STARTING
WITH RESIDENTIAL TREATMENT ALL
THE WAY DOWN TO RECOVERY CENTERS
TO AFTER PEOPLE ACTUALLY HAVE
RECOVERED, WE'RE REALLY BUILDING
A SYSTEM AND I THINK THAT'S
IMPORTANT TO DO.
WE'RE BUILDING A SYSTEM WITH THE
HUBS PROVIDING METHADONE AND THE
SPOKES PROVIDING OTHER
TREATMENTS.
WHAT I CAN SAY HERE, I CHECKED
THE WAITING LIST, WE'RE DOWN TO
568, SO WE'RE MAKING PROGRESS
AND WE'RE EXPANDING OUR CAPACITY
RATHER IMPRESSIVELY, DOUBLING
THE TREATMENT SLOTS, AT LEAST
THE METHADONE BETWEEN JULY 2012
AND JULY 2014.


>> AND HOW ARE YOU DOUBLING
THAT?
ARE YOU ANTICIPATING MORE
CLINICS OR EXPECTING TO EXPAND
THE ONES CURRENTLY IN PLACE?


>> WELL, AS WE CREATE THE SYSTEM
KNOWN AS THE CARE LINES, THE HUB
AND SPOKES, WE'VE JUST GOTTEN A
COUPLE OF THEM ONLINE, SO ONE
JUST STARTED IN NOVEMBER.
THE NORTHEAST KINGDOM STARTED
THIS PAST JANUARY, SO A LOT OF
THAT IS YOU CAN'T GO FROM ZERO
TO 60 IN A DAY.
YOU CAN GET TO ABOUT 30 PEOPLE A
WEEK, SO WE'RE JUST BUILDING UP
TO OUR CAPACITY NOW AND WE
EXPECT THAT WE'LL BE CLOSE TO
CAPACITY BY SUMMER.


>> ALL OF THIS COSTS MONEY AND
I'M ASSUMING A LOT OF IT.
WHERE DOES IT COME FROM?
STAYED, LOCAL, FEDERAL, ALL --
STATE, LOCAL, FEDERAL, ALL OF
THE ABOVE?


>> IT COMES FROM STATE AND
FEDERAL GOVERNMENT AND I WOULD
SAY THAT THAT SAMSA IS IMPRESSED
WITH THE MODEL, SO WE'RE ONLY
PAYING 10% OF THE KORSES THE
FIRST TWO YEARS AND THEY'RE
PAYING 90%.
IN THE END, WE'RE SAVING MONEY
IF WE KEEP PEOPLE OUT OF JAIL.
KNOWING THAT 80% OF PEOPLE IN
JAIL RIGHT NOW ARE PROBABLY
RELATED TO DRUGS ONE WAY OR THE
OTHER, I THINK WE CAN SAVE MONEY
IN THE LONG-TERM.


>> WE NEED TO


>>> WELCOME BACK, EVERYONE.
WE'RE TALKING THIS MORNING WITH
VERMONT HEALTH COMMISSIONER
DR. HARRY CHEN.


>> SO DR. CHEN, LET'S SWITCH
GEARS HERE A LITTLE.
LET'S TALK ABOUT THE FLU.
H1N1 WAS THE PREDOMINANT STRAIN
HERE IN VERMONT.
HOW DOES THIS SEASON COMPARE TO
TWO YEARS PAST?


>> ACTUALLY, I WOULD INVITE
VERMONTERS TO GO TO OUR WEBSITE
BECAUSE WE HAVE A FLU
SURVEILLANCE WEB PAGE AND YOU
CAN ACTUALLY WATCH WHAT HAPPENS
WEEK BY WEEK WITH THE FLU.
THIS YEAR HAS BEEN A LITTLE
ABOVE AVERAGE, BUT NOT AS BAD AS
LAST YEAR AND CERTAINLY NOT AS
BAD AS THE H1N1 PANDEMIC, SO IT
WAS AN AVERAGE YEAR, MORE OR
LESS.
AND WE FOUND THAT WE'RE
ACTUALLY -- WE HAVE LOCAL SPOTS
OF FLU ACTIVITY IN THAT WE'RE
ACTUALLY DECLINING.


>> YOU KNOW, WE'VE HEARD STORIES
ABOUT RELATIVELY YOUNG PEOPLE
GETTING SERIOUSLY ILL.
WE HEARD ABOUT A
HOSPITALIZATION, PEOPLE IN THE
ICU ON BASICALLY LIFE SUPPORT,
INTUBATED.
WERE THESE PEOPLE -- IS THERE A
LACK OF IMMUNITY?
WERE PEOPLE NOT GETTING FLU
SHOTS?
WHAT DO YOU ATTRIBUTE THIS
SEVERE ILLNESS TO?
IS IT THAT YOUNGER PEOPLE JUST
HAVE NOT BUILT UP ANTIBODIES?


>> IT'S A COMBINATION OF THINGS,
BOTH UNDERLYING DISEASE, WHETHER
THEY HAVE ACTUALLY HAD THE
VACCINE.
THE VACCINE IS NOT PERFECT, BUT
IT'S PRETTY GOOD, BUT NOT
PERFECT.
AND FINALLY THE STRAIN OF FLU
INVOLVED.
WE KNEW WITH H1N1, THERE WERE
YOUNG PEOPLE THAT WERE INVOLVED.
WE KNOW THAT THIS YEAR, THERE
WERE A FAIR NUMBER OF DEATHS
ACTUALLY IN CALIFORNIA RELATED
IN YOUNG PEOPLE, BUT WHAT I
WOULD SAY IS GETTING A FLU SHOT
IS A PROVEN PREVENTION,
IMMUNIZATIONS ARE REALLY ONE OF
THE BEST WAYS WE CAN PREVENT
ILLNESS.
WE KNOW NATIONWIDE THAT VACCINE
A COUPLE YEARS BACK PROBABLY
SAVED ANYWHERE FROM 10 TO 30,000
LIVES AND PREVENTED ABOUT 80,000
HOSPITALIZATIONS.


>> YOU MENTIONED THAT THE
VACCINE IS PRETTY GOOD.
IS THERE A WAY TO GAUGE THAT?
IS IT LIKE 60, 70% SUCCESSFUL IF
FOLKS GET IT?


>> THERE ARE WAYS OF GAUGING IT
AND THAT'S ONE OF THE THINGS
THAT THE CDC DOES EVERY YEAR TO
TRY TO FIGURE OUT HOW DID WE DO
LAST YEAR BOTH IN TERMS OF THE
STRAIN AND IN TERMS OF THE
VACCINE.
I THINK THAT PROBABLY 60% IS A
REASONABLE NUMBER AND IT'S HARD
TO REALLY SAY PREVENTION, BUT
WHAT THEY DO IS THEY ACTUALLY
TRACK DOCTOR VISITS.
YOU KNOW, IF YOU GET A SHOT, ARE
YOU 60% LIKELY TO GO TO THE
DOCTOR FOR A FLU-LIKE ILLNESS.


>> YOU MENTIONED THERE IS STILL
SOME AREAS WHERE THERE'S
LOCALIZED FLU, SO THIS INOVER
YET.


>> IT'S NOT OVER YET.
WE MAY GET ANOTHER BUMP IN A
WEEK OR TWO.
AGAIN, WE BOTH MONITOR SENTINEL
SITES, MEANING WE HAVE DOCTORS
DO CULTURES WHEN THEY SEE PEOPLE
WITH A FLU-LIKE ILLNESS AND WE
ACTUALLY MEASURE, WE MONITOR
HOSPITALS SO WE KNOW WHEN
HOSPITALS GET SPIKES OF PEOPLE
WITH FLU-LIKE ILLNESSES, AND
FINALLY, WE ACTUALLY MONITOR
DRUGSTORES TO SEE WHAT'S GOING
OFF THE SHELF.


>> JUST THE OTHER DAY I READ A
REPORT ABOUT ANOTHER STRAIN OF
THE FLU THAT'S CIRCULATING RIGHT
NOW.
ARE YOU STILL TESTING SO YOU
KNOW IF IT'S H1N1 OR PERHAPS
ANOTHER STRAIN THAT IS HITTING
PEOPLE RIGHT NOW?


>> IN THE SENTINEL FIGHTS, WE'RE
STILL TESTING AND THEY DO THAT
EVERY YEAR.
WE'RE STARTING TO SEE MORE.


>> I'M CURIOUS, SINCE THE
PANDEMIC, H1N1 HAS BEEN INCLUDED
IN THE FLU SHOT EVERY YEAR.
DO YOU SEE THAT CONTINUING?


>> A LOT OF IT IS DONE ASSESSING
THE SIGNS.
THEY KNOW THE FLU WE'RE GOING TO
GET NEXT YEAR IS THE FLU THEY
WILL SEE IN ASIA THIS SUMMER, SO
THEY WILL DO THE TESTING OF FLU
IN ASIA THIS SUMMER TO PREPARE
THE VACCINE FOR NEXT YEAR.


>> AND IS IT TOO LATE ON GET A
FLU SHOT?


>> IS IT TOO LATE?
I THINK GIVEN THAT THE SEASON IS
NOT OVER, IT WOULDN'T BE THE
BEST SOMETIME TO GET A FLU SHOT,
BUT IT WOULD BE HARD NOT TO
RECOMMEND THAT IF SOMEBODY WAS
AT RISK FOR SIGNIFICANT ILLNESS.


>> WE JUST SAW A CLIP OF
MOSQUITOES.
THAT'S THE NEXT BIG SEASON THAT
WE CAN ANTICIPATE, OBVIOUSLY,
YOU KNOW, THERE'S THE THREAT OF
TRIPLE-E, WEST NILE VIRUS, STILL
A THREAT ANTICIPATED THIS COMING
SEASON?


>> I WOULD SAY YES.
I THINK IT'S CLEAR THAT EVEN
THOUGH WE'VE KIND OF STARTED OFF
TRIPOLI WITH A BANG IN 2012 WITH
BOTH MOSQUITOES AND TWO,
UNFORTUNATELY, TRAGIC DEATHS,
LAST YEAR WE DIDN'T HAVE ANY --
OKAY?
KNOCK ON WOOD -- ANY DEATHS.
I WAS UP IN SWANSON LAST WEEK
AND WE HAD A COMMUNITY MEETING
WHERE WE DISCUSSED TRIPLE-E
BECAUSE AGAIN, IT'S REALLY
IMPORTANT THAT AREAS WHERE WE'RE
LIKELY TO SEE IT OR WE THINK WE
MIGHT SEE IT NEXT YEAR OR AT
HIGH RISK, THEY KNOW BASICALLY
WHAT IS TRIPLE-E, THEY KNOW TO
PAY ATTENTION AND THEY KNOW WHAT
THEY CAN DO INDIVIDUALLY TO
PROTECT THEMSELVES.


>> WHAT CAN THEY DO?


>> WHAT IT IS IS AVOIDING --
TRIPLE-E IS AVOIDING THE BITE OF
AN INFECTED MOSQUITO.
SO IF YOU KNOW YOUR AREA HAS
ACTIVITY, AND WE NEW LAST YEAR
IN HIGHGATE AND SWANSON, WE HAD
TWO HORSES DIE, SO WE DEFINITELY
KNEW THEY WERE AT HIGH RISK, SO
I THINK IT'S TIME TO PAY
ATTENTION TO DO WE WANT TO HAVE
THE PICNIC GO ON AFTER DUSK OR
AFTER-SCHOOL ACTIVITIES AFTER
DUSK BECAUSE WE KNOW THE
MOSQUITOES ARE MORE ACTIVE
BETWEEN DUSK AND DAWN.
THERE ARE GREAT INSECT
REPELLENTS OUT THERE AND THERE'S
A GREAT EPA WEBSITE THAT CAN
MATCH THE LEVEL OF THE REPELLENT
TO ACTIVITY.


>> WHAT ARE THESE TWO ILLNESSES,
THESE TWO VIRUSES?


>> WELL, THEY'RE WHAT ARE CALLED
R-BO VIRUSES AND THEY'RE AN
INTERMEDIATE HOST, MEANING
THEY'RE CARRIED BY BIRDS
OFTENTIMES AND OTHER MAMMALS,
AND THEN THEY'RE -- THESE
INTERMEDIATE HOSTS WILL PROVIDE
THE VIRUS TO THE MOSQUITOES THAT
IN TURN BITE HUMANS.


>> YOU DID HAVE SOME POSITIVE
PULLS, AS YOU MENTIONED, IN
FRANKLIN COUNTY.
THAT WAS A POSITIVE POOL, I
BELIEVE, IN ADDISON COUNTY WHERE
IT WAS PREVALENT.
DO YOU FORESEE THAT SPREADING
THIS SUMMER TO OTHER PARTS OF
THE STATE?
IS THIS GOING TO BE A STATEWIDE
ISSUE OR IS IT ALREADY A
STATEWIDE ISSUE?


>> I THINK IF YOU LOOKED AT OUR
DEER SURVEYS, IT IS ALREADY A
STATEWIDE PROBLEM, SO WHAT WE DO
IN THE HUNTING SEASON IS WE
HAVE -- WE GO TO DEER STATIONS
WITH THE PROVERBIAL MASS OF
VOLUNTEERS.
WE ASK HUNTERS IF WE CAN DRAW
BLOOD FROM THEIR DEER AND WE MAP
IT OUT TO SEE BOTH IF THEY'RE
POSITIVE FOR TRIPLE-E AND WHERE
THE DEER WAS ACTUALLY TAKEN, AND
WE FOUND THAT PROBABLY 10% OF
DEER THROUGHOUT -- AND MOOSE
THROUGHOUT VERMONT NO MATTER
WHERE YOU ARE ARE POSITIVE FOR
EASTERN EQUINE ENCEPHALITIS.
DEER GET IT, BUT DON'T DIE FROM
IT.


>> THAT WAS GOING TO BE MY NEXT
QUESTION.
IF ANIMALS DON'T GET SICK, IF
PEOPLE EAT INFECTED MEAT, ARE
THEY AT RISK AT ALL?


>> THEY'RE NOT AT RISK AT ALL.
AT LEAST FROM DEER, NOT AT RISK.
THERE IS A POTENTIAL RISK
RELATED TO IF YOU HAPPEN TO HAVE
A PHEASANT FARM OR AN EMU FARM
AND THEY GET VERY SICK, THERE'S
A POTENTIAL YOU CAN GET SICK
FROM THE SECRETION AND BLOOD
THAT HAPPENS, THAT MAY BE A
BY-PRODUCT, BUT NOT FROM AN
ANIMAL.


>> MORE TRACKING THIS SUMMER?


>> OH, ABSOLUTELY.
WE'RE PLANNING TO INCREASE OUR
MONITORING OF MOSQUITOES UP IN
FRANKLIN COUNTY, AS YOU MIGHT
EXPECT.
WE'RE GOING TO CONTINUE DOWN IN
RUTLAND-ADDISON COUNTY WHERE WE
CONTINUALLY HAD THE ACTIVITY AND
WE'RE GOING TO DO OUR BEST TO,
AGAIN, KEEP PEOPLE INFORMED
ABOUT WHAT THEY CAN DO, WHAT THE
MOSQUITO POOLS ARE SHOWING IN
TERMS OF THE RISK LEVELS AND
THEN GET THE WORD OUT OTHERWISE.


>> QUICKLY BEFORE WE RUN OUT OF
TIME, IF WE COULD TALK ABOUT
LYME DISEASE FOR A MINUTE.
THE SENATE JUST ADVANCE ADD BILL
THAT WOULD PROVIDE IMMUNITY TO
VERMONT DOCTORS, HEALTHCARE
WORKERS, TO PROVIDE LONG-TERM
ANTIBIOTICS.
YOU'RE OPPOSED TO THAT?


>> WHAT I WOULD SAY IS LYME
DISEASE AS BIG PROBLEM IN
VERMONT.
I WON'T ARGUE WITH ANYBODY ABOUT
THAT.
I THINK THAT -- SO I THINK IT'S
IMPORTANT THAT WE FIND THE
THINGS THAT WE AGREE ON AND THAT
WE EMPHASIZE WHAT WE ALL WANT
VERMONTERS TO DO, WHICH IS BE
CAREFUL ABOUT TICKS, TO KIND OF
INSTITUTIONALIZE THIS WHOLE
CONCEPT OF A TICK CHECK AFTER
YOU COME BACK INSIDE.
IF YOU HAVE KIDS, MAKE SURE YOU
SHOWER THEM AND CHECK FOR TICKS
IN THE BATH, SO WE WANT TO RAISE
THAT AWARENESS ABOUT TICKS.
WE WANT TO RAISE AWARENESS ABOUT
THE RASH RELATED TO TICKS AND IF
YOU DO GET THE RASH OR GET SICK,
TO GO SEE A DOCTOR, AND I ALSO
THINK WE WANT TO ENSURE THAT
DOCTORS KNOW THE APPROPRIATE
TREATMENT OF LYME AND THAT THERE
IS A CONTROVERSY ABOUT HOW WE
TREAT LYME.


>> DO DOCTORS NOW PRESCRIBE
LONG-TERM OR IS THAT NOT
SOMETHING THAT'S PROVEN TO BE
EFFECTIVE?


>> WELL, AGAIN, THIS IS A
SCIENTIFIC CONTROVERSY.
ONE SIDE OF THE SCIENTIFIC
CONTROVERSY REALLY ARE BASICALLY
MOST OF THE TRADITIONAL MEDICAL
EXPERT ORGANIZATIONS LIKE THE
CDC, THE NIH, ALL THE EUROPEAN
ONES THAT SAY THAT A LONG-TERM
TREATMENT HAS NOT BEEN
EFFECTIVE, VERSUS ANOTHER --
THERE'S A GROUP OF THE IFDA, THE
LYME -- ANOTHER LYME
ORGANIZATION THAT SAYS THAT WE
SHOULD BE DOING DIFFERENT
TESTING, WE SHOULD BE TREATING
LONG-TERM, PEOPLE LONG-TERM.
SO WHAT THE CONTROVERSY CENTERS
AROUND IS A GROUP OF PEOPLE THAT
ARE UNFORTUNATE AND HAVE CHRONIC
SYMPTOMS.
WHAT THE DISAGREEMENT IS IS
WHETHER THOSE CHRONIC SYMPTOMS,
WHICH EVERYONE AGREES REALLY ARE
REAL AND DO EXIST, WHETHER
THEY'RE RELATED TO AN ONGOING
INFECTION AND, THEREFORE,
WHETHER THEY'RE AMENABLE TO
ANTIBIOTICS.


>> VERY QUICKLY, OBVIOUSLY A
VERY COLD WINTER THIS YEAR.
DID THAT HELP WITH EITHER THE
TICKS OR THE MOSQUITOES, DO YOU
ANTICIPATE?


>> I CAN ASSURE YOU THAT THERE'S
FOR WAY TO PREDICT THE MOSQUITO
ONE, BUT I CAN ASSURE YOU THAT
TICKS ARE GOING TO BE OUT AS
SOON AS THE WEATHER GETS WARM.


>> DR. HARRY CHEN, THANK YOU SO
MUCH FOR JOINING US THIS
MORNING.


>> SURE.


>> AND THANKS FOR WATCHING,
EVERYBODY.
WE'LL SEE YOU SOON.
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