1. The statistics on the severity of the disease are considerably skewed, because the number of cases collected by the department of health reflects only people who ended up in the hospital, and there were millions of other sick people who had relatively mild cases of the flu that went unreported –the media never printed or broadcast these qualifying facts.
   
2. It has been clearly demonstrated that in-office testing for influenza consistently misses 50% or more of actual cases.
   
3. Each year the seasonal flu vaccine provides only partial or no coverage for influenza strains not targeted by the most recent vaccine. Furthermore, we’re being told by health officials that this year’s ‘seasonal’ flu vaccine will not confer protection against the new Swine Flu, which is why the CDC and local Departments of Health insist that we need a Swine Flu vaccine.
   
4. The justification for fearing the Swine Flu and mandating a national Swine Flu vaccination program is founded upon the projected, but as yet unknown, viral mutations that may occur in the coming year. However, there is no evidence that the new vaccine will protect us from those mutated flu viruses, since it is being developed to target only the H1N1 viral strains that appeared this  spring (2009), a vaccine that has yet to be adequately  tested for effectiveness in the United States.
   
5. This year’s Swine Flu has been a relatively mild illness with considerably fewer cases that required hospitalization than this year’s ‘seasonal’ flu. While it is important to recognize that any flu related illness can potentially result in death, the number of mortalities resulting from the “new flu” (Swine Flu) has been impressively low, based on recently updated statistics. There is the distinct possibility that millions of people who have already been exposed to or become ill with this year’s seasonal flu might actually have gained some protection against another flu outbreak in the fall or winter or the spring of 2010—if it does not mutate. (indeed it is even possible that they may have partial protection even if it does mutate though it’s too early to tell!)
   
6. The irresponsible overuse of Tamiflu and other antiviral drugs as “preventive” treatments only serves to encourage mutations and mounting viral resistance, which only makes us more vulnerable.
   
7. The 24 hour news media will continue to capitalize on the public’s fear of the unknown, unpredictable, “evil virus” because it’s good for business.
   
8. The stress generated by fear mongering, lowers individual and community  resistance (this is well-established science), which may actually make us more susceptible to the flu!
   
9. When people’s judgment is jaded by fear, they will demand any antiviral treatment whether it is warranted or not, effective or not, regardless of the consequences.

This is the doctor's dilemma for anyone working on the ‘front line’ of health care, particularly in a crisis where fear is fueling the debate. Has the humane practice of medicine become one driven by policy-making or will it be a tradition that fosters individual relationships? Is it political or personal?  Can one sustain both in the midst of a crisis?  A wise man once said, “At the doctor’s gate, many sick people wait.”

People are not looking just for mandates and policies when they're sick. They are seeking an intelligent, sympathetic and trustworthy companion when the fear of illness knocks at their door.  While decisions in emergencies typically require following generally effective protocols, it is the wise clinician that sees beyond statistics and engages the 'whole' patient with calm attentiveness.  We must be careful not to get caught treating data at the expense of actual people. Trust can only be generated when the standards of care that a doctor follows do not constrain the bonds he makes with those who come for help.  This is real, “participatory” medicine. But the legal pressures on physicians reach far beyond “scope of practice” legislation.  These days, the standard of care tends to preserve the status quo, discouraging “thinking outside the box”. Rigid adherence to such standards as if they were legal mandates greatly limits our creativity in finding solutions to the problem at hand.  But what's more worrisome, is how these standards undermine the personal trust we've developed with our patients.  This can be very dangerous in a crisis. 

Can we envision a standard of care that is not grounded in fear, but rather in the mutual respect and trust between physician and patient?  Standards of care were originally meant to be rational guidelines, not tools to measure liability; and yet, that is exactly what they have become. Indeed, this is why so many physicians are afraid to incorporate alternative therapies in their practices. The result is that current standards of care create a generic, impersonal medical assessment and treatment protocol.  In an acute emergency, like the Swine Flu or any infectious disease outbreak, what we need—and what most of us want—is a personalized medicine that addresses the different affinities, strengths and weaknesses of the individual patient –a medicine that recognizes the amazing resilience of our intrinsic immunity, and embraces it as the body’s bridge to the outside world, rather than a barricade needing constant fortification.  The viral “xenophobia” we're now seeing runs counter to the way we actually exist in nature. Our immune system is much more like a brain hungry for learning that is being shaped by our environment, than an armed militia. Perhaps it’s time to begin looking at ways to make ourselves more resilient rather than more resistant.  As I watch how "well" the children in my practice recovered from this past flu, the discussion with parents naturally turns to what lessons we've learned and what we can use from this experience to strengthen ourselves in the coming year. This kind of dialogue is personal, reasonable and educational.  Ultimately this is what each family desires, and it is rewarding to both patient and physician. This is compassionate medicine.