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December 9, 2003

Host: Michael Grant
Topics:
· Improved Hip Replacement Surgery
· Flu Shots
· Open Primary Ruling
In-Studio Guests:
Barry Hess, plaintiff in Libertarian lawsuit;
Dr. Larry Sands, Maricopa County Department of Health;
Dr. Janice Blair, Mayo Clinic in Scottsdale.


>> Michael Grant: Tonight on "Horizon," hundreds wait hours hoping to get flu shots. Are people making too much about the need for immunization? We'll talk to a couple of health experts about what you need to know about the flu season. Plus hip surgery today is nothing like when it was even ten years ago. A look at how technology has improved that procedure. Good evening, I'm Michael Grant. Welcome to "Horizon." A ruling by the 9th circuit court of appeals will keep independent voters from casting their ballots for the independent candidates. Voter as proved an open primary initiative in 1998. It allows independents and third party voters to cast ballots for Republicans or democrats or Libertarians in the primaries. Libertarians sued saying hundreds of thousands of voters could interfere with their party. A district court judge in Tucson agreed and threw out the system a year ago. A three-judge panel agreed Monday that allowing non-members to vote for precinct committeemen violates the party’s associational rights. The 9th circuit sent it back to the district court to consider separately whether it's unconstitutional and if not whether the provisions related to the election of Libertarian precinct committeemen are severable. Here now is Barry Hess one of plaintiffs in this the lawsuit. Arizona Libertarian party. Mr. Hess may look familiar of course he ran for governor in 2002. Great to see you again.

>> Barry Hess: Great to be here again.

>> Michael Grant: Interesting decision. The court saying well, independents shouldn't be able to come in and vote basically for your party officers but we're quite sure yet if those same independent voters shouldn't be able to come into your primary and decide who your party's nominee is for a particular office.

>> Barry Hess: You just stated it very well is what part of the problem is. The reason that the Republicans and democrats weren't too vocal about this is Frankly we have seen how they have meshed together a matter of degree. To them it's not a concern; To us, it is. A party that commands a principle and adherence to that means we have to have control, people of like mind picking those people who would be our standard barriers in elections and internal offices. We believe it would be found unconstitutional to allow outsiders non-committed to pick and choose our candidates.

>> Michael Grant: Why did the court draw a distinction at least for the time being between outsiders if you will picking your party officers and picking your party candidates? How did they see your party officers as being different under the first amendment?

>> Barry Hess: In that part they got it right. Other than that, it seems to be their collective head is other than on their shoulders in this opinion which doesn't seem to make a lot of sense. What it came down to is outsiders as we call them, the independents, 350,000 of them versus 16 and growing now to growing Libertarians.

>> Michael Grant: It's 23% of registered voters are independent.

>> Barry Hess: It's significant. The kind of thick that reek havoc on our party and maintaining our platform without deviation they recognized that was essential to maintaining our identity as a separate and distinct party. They got it right. The reality is that realistically why would a independent be able to be a democratic candidate for instance, if they are not committed to the democratic principles then it certainly doesn't make sense.

>> Michael Grant: What in your opinion do you have to prove before the district court now when the case comes back down there? What do you have to prove to the court to demonstrate that hold it, you also ought to bar independent voters from voting for our parties nominee?

>> Barry Hess: Well, I think that we will -- we will successfully be able to know that -- that basic on its face idea that we will maintain our own identity. This is tied up with our idea of getting the state completely out
of the primary business. This is a multimillion giveaway to basically the democrats and Republicans for preference. We will prefer our own candidates and choose them as we see fit which happens to be at convention. Being able to show that we cannot simply because we're outnumbered by independents that we will not change who and what we are and what we stand for.

>> Michael Grant: Theoretically the 9th circuit court of appeals left open the possibility that democrats and Republicans could bring their own suit to attempt to overturn the primary law although the court's opinion leaves in doubt whether or not the democrats or Republicans could in fact do that. Do you know -- they have never indicated any interest to attempt to attack this in court. Do you know if it's changed?

>> Barry Hess: They are not going to raise a finger against it. They like things the way they are. It favors the two parties. It would be nice to see a little bit of character come out of parties saying we'll pick our own candidates as well as internal officers.

>> Michael Grant: In a convention setting?

>> Barry Hess: In a convention or however they decide to it.

>> Michael: What the Supreme Court coming down to the district court. Libertarians given any thought to taking this to the U.S. Supreme Court?

>> Barry Hess: We'll take it this as far as it takes to get the appropriate
ruling which is to get the state out of primary business and most specifically out of our primary business. It's a swindle on the tax payers to pay the bill on this.

>> Michael Grant: Barry Hess thank you.

>> Barry Hess: I appreciate it. Thank you very much.

>> Michael Grant: You can't turn on your TV, your radio or open your newspaper without hearing or seeing a headline about the flu epidemic and a need for flu shots. Many a moment we'll talk to experts but first we look at the mad rush for flu shots.

>> Reporter: People began lining up at this Safeway several hours before the shot clinic opened at noon.

>> Lonnie Diaz: My wife needs it because she has asthma problems. She wanted to make sure she was well protect as much as possible. Since I had to come down I may as well get it too. I usually get it every year.

>> Reporter: Brian leach is one of dozens of kids who got the flu shot thanks to his mom's persistence.

>> We came early and my friend picked them up and brought them when we got close to the time. They say the flu is so bad this year, I didn't want to risk it.

>> Reporter: This time of year long lines such as this one are usually associated with St. Nick at the mall but throughout the valley hundreds are waiting for flu shots and this line is no different. You'll find lots of folks who waited hours only to find out there is none left leaving Mayor
Menino without the holiday spirit.

>> Bill Devers: It must have been 500 people I think and told them go home we don't have enough vaccine.

>> Reporter: What do you think about that?

>> Bill Devers: It's aggravating when it was supposed to have ran from 12-6 today. I think they should let people know how much vaccine they have and what -- not make people wait. I mean --

>> David Rich: There were people getting really angry out here. There were people saying others cutting in line. The comment is if you wait until the middle of December to get a flu shot when they were offering them since the beginning of October they run out of everything.

>> Reporter: This location had only about 160 flu shots to give. Prompting those who might miss out to wonder if there's a better way to decide who should get the precious immunizations.

>> Linda Devers: Ultimately they should have handled having the elderly and the children coming forward first since they are at risk instead of just this mirage of people. You are getting a lot of animosity and bad feelings among people because people feel that others are cutting in. That may not be the fact but you have a lot of people here frightened.

>> Michael Grant: Joining me now is Dr. Larry Sands at the Maricopa County Department of Health. Also here is Dr. Janice Blair chair of the infectious disease division at the Mayo clinic in Scottsdale. Thanks for joining us. Dr. Blair, why are we seeing lines like that? Was it the death of the child perhaps that --

>> Janis Blair: The CDC and others who track the flu have been saying for several weeks if not a couple of months that this was going go to be a bad flu season. I think the increases cases earlier in the year and I think it was the death of the child that really brought it home that this is an infection that is a very serious one.

>> Michael Grant: How do you know in advance Dr. Sands that it is going to be a worse flu season than formal?

>> Lawrence Sands: Some of the ways that it's done is something from the centers of disease control and working with the world health organization they monitor influenza activity throughout the world and look at other places with flu to see what kind of activity they are going to have. There have been reports from South America and New Zealand that they had particularly severe flu seasons during their wintertime this year and anticipating the similar experience here.

>> Michael Grant: Put this into perspective here. How many confirmed cases have we had? How many deaths?

>> Lawrence Sands: We see flu every year. We expect to see it here every winter and again we have started seeing it here earlier and in higher numbers. Flu is not a reportable disease in Arizona. The way we know about what it arrives here in the community and that in the beginning of September we develop surveillance system where we contact certain sources in the community to basically identify when flu arrives in the community and then to track the trends. The number itself really is not as important but what is important is the trend to see whether it's -- when it's in the community and what direction it's going.

>> Michael Grant: What the trend from Mayo Clinic's standpoint? Is it a heavier year than normal? An earlier year than normal?

>> Janis Blair: Not yet. We have seen a lot of evaluations in the emergency department and have run a lot of tests looking for it but as far as what is in the hospital right now we have had a few hospitalizations but not anything that -- early in this flu season I don't think we have seen anything but the beginning of it.

>> Michael Grant: So is the vast majority of the population and by that I'm not including the at-risk groups, the young children and elderly, that kind of thing, are they overreacting?

>> Janis Blair: The flu can be a significant illness that can take healthy people out of work either caring for their children or just because they are sick themselves. So you know, when you have an illness that will take someone out three days, five days in a whole workweek it is something that is something to be at least contended with.

>> Michael Grant: Sure.

>> Janis Blair: If it's -- are we overreacting? We have always been recommending vaccination, and this is just, you know, the tail end of the vaccination season.

>> Michael Grant: Normally we would get that like in October and November and of course there have been these long lines. Have you ever seen anything like we have seen?

>> Lawrence Sands: In other outbreaks we have. Where we have had similar circumstances and limited supply of the vaccine or medications. What is also interesting though is here that there is still a lot of other ways that people can protect themselves in addition to vaccination. Even if you do get vaccinated these are still good measures for people to take in terms of good infection control or good hand hygiene, making sure they cover their mouth and nose when they cough or sneeze as well as being aware of what the symptoms are of the flu and being able to distinguish that from the cold.

>> Michael Grant: What kind of symptoms are we talking about?

>> Lawrence Sands: With the flu, usually the hallmark of it is sudden onset of illness. A high fever, headache, muscles, aches and pains, exhaustion, respiratory symptoms like a running nose and often times a dry cough.
With children other symptoms that may be more subtle. Their behavior may change. They may not be as playful as they usually are. They may not eat or drink as well or be able to keep fluids down. They may have a high fever that doesn't go away. The fever pattern may be different. Coming one day and go away and coming back. May not be able to respond to unusual treatment.

>> Michael Grant: Of run of this typically three or four days something in that vicinity?

>> Janis Blair: The symptoms last typically three or four days. They can go five to eight days and be in the normal range.

>> Michael Grant: If you think you have got it should you go to the doctor or suffer there it?

>> Janis Blair: People at increases risk of having severe infection such as the elderly or people with heart disease, lung disease, and little children, we would want them to go to the doctor. There is medication that can be provided if they come to the doctor within the first 1-2 days that can decrease the severity of the symptoms and decrease the length of the illness. That would be something we would want them to come to the doctor for.

>> Michael Grant: Certainly the at-risk groups. If you are me or maybe if you are us that kind of thing do you tough it out?

>> Janis Blair: You can with some Tylenol or Ibuprofen. You can go that. If things get severe, you get shortness of breath, chest pain or dehydration and you can't care for yourself go to your physician to seek treatment.

>> Michael Grant: Two kinds of vaccine, the tradition and there's also a new nasal vaccine?

>> Lawrence Sands: Correct. The vaccine that most are familiar with is an nerve kill virus sax seen that is injected that people get every year. There's a new vaccine that has been used here in the United States called flu mist is the trade name, that has -- is just as effective and safe as the injectable vaccine. What is different it's a live virus, a weaker form, it's only indicated for healthy people age 5-49 years of age. It's important that particularly with the concerns of the flu vaccine being available that that certainly is an alternative for helping individuals so that the injectable flu vaccine that is available cannot be used to vaccinate the high risk individuals.

>> Michael Grant: The nasal mist one as I understand it is more expensive than the traditional?

>> Janis Blair: It's relatively new so it has a lot of research and developments costs I'm sure tagged on to the price. A good old flu shot, shot in the arm is $15-20. The flu mist is probably nicer for healthy person to take because they don't have the shot in the arm but it is more expensive.

>> Michael Grant: Okay. No real distinction in terms of efficacy between the two?

>> Janis Blair: Not in terms of efficacy but in terms who was can take it. We would only want the healthy people from 5-49 taking it.

>> Michael Grant: I thought that I had heard last week there always is this sort of guessing game that is played in the spring as to precisely what kind of flu strains will be showing up in the fall and winter season. I thought I heard something last week that indicated that perhaps at least one of strains had been misguessed. Did I hear that roughly correctly?

>> Lawrence Sands: More than had been anticipated that one of the strains the strain most have been hearing about on the news and has been seen in different parts of the country and we have evidence we have that like strain circulating in the state that that is not part of the current formulation of the flu sax vaccine for this year because it wasn't anticipated but the flu vaccine does contain other activated forms of flu viruses that we do expect to see circulating and some that are. We expect that even though it doesn't contain the strain it can provide good protection against those that it does protect against as well as some activity that anybody who might be exposed to that strain.

>> Michael Grant: What about just the supply of the vaccine? Is there adequate supply and we have a distribution problem or is there not a sufficient supply?

>> Lawrence Sands: It's important to remember that I think most of the vaccine that has ever been used in the United States 80 million doses, which is a lost doses and that manufacturers in previous years have been using 75 million doses have been used. The manufacturers have manufactured I understand according to the CDC up to 83 million doses. We have been began encouraging people to get vaccinated in October and particularly reaching the very high risk populations, those who are the highest risk for the severe complications of flu in October and November. By December most flu vaccine providers have wound down. We're winding down at the same time because of the increased interest that there's increased demand for vaccine.

>> Michael Grant: Let me assume that I haven't gotten a vaccination, what is the best way to ward the thing off at this point in time?

>> Janis Blair: Could you still be very careful with hand washing and hand hygiene, you know, if you are -- if there are people around you that you think you may have been exposed to, be very careful about washing your hands before you get your hands in their face and nose area. And good health, you know getting good sleep and good exercise and good nutrition they are going to keep you health good and better able to defend what viruses you can. Even when we have a flu epidemic not everyone is going to get it. Some of sit because some people are doing the best they can in other means.

>> Michael Grant: Dr. Janice Blair may you be healthy and Dr. Larry Sands thank you as well. Hip replacement surgery involves weeks and sometimes months of recovery but a new minimally invasive procedure can shorten recovery time and lessen the amount of scarring.

>> Reporter: Attorney general chuck Davies had his first hip replacement in 1996.

>> Charles Davies: I had the old fashion way, the big cut surgery. It went all the way up my hip. I was in the hospital for a week. I was in significant pain for some time, probably a month. The rehab was slow.

>> Reporter: A month ago he had his other hip replaced and this time the operation was much less invasive and painful.

>> Charles Davies: It was like night and day over the old one. I was in the hospital three days and they didn't throw me out. You know what I mean? I could have walked out. They had me on my feet walking on a walker about four hours after surgery.

>> Reporter: 30 million people in the U.S. suffer from osteoarthritis where cartilage in the joints shrink as way.

>> Jay Katz: there's supposed to be a space between the ball and the socket. You have bone against bone. It was very painful, very limited motion because the ball wouldn't turn.

>> Reporter: Replacing the hip joint is major surgery. For the last year orthopedic surgeon has within using a less invasive method. With new technology, especially new instruments, surgeons can perform hip replacements with literally less wear and tear on the body. It's called the mini incision hip replacement surgery.

>> Jay Katz: I thought this balloon would be a good model. The conventional incisions usually about 8-10 inches long. So -- it's usually some what curved. It's usually about that long. The new incision is usually about that long. So much less muscle. Much less bleeding. A lot faster recovery.

>> Reporter: Traditional hip replacement surgery cuts through more muscle. There's more blood loss. More days in the hospital and weeks of recovery time. Because it's so invasive much more painful.

>> Jay Katz: The new operation is done through a about a three-inch incision. You put in the same ball and socket, but it's much less trauma to the soft tissues. No muscles cut, no tendons. And so the pain after surgery is much less.

>> Charles Davies: When I got home I was virtually pain-free. I didn't have -- I didn't have to take pain medication from about the fourth day on.

>> Reporter: The smaller incision Dr. Katz says causes less complications. The operation takes an hour and a half to perform. No scopes are used. It's open surgery.

>> Jay Katz: They’re are always amazed at how much they can see. I had a surgeon come down from Phoenix a couple weeks ago. I was amazed. He said I can't believe how well you can see and how much extra incision I have been making all these years but what allows you to do is get some special instruments to do it. Special small retractors and things that allow you to expose what you have to see through a very small space.

>> Reporter: There are a variety of hip prosthetics but all of them can fit in this three-inch opening.

>> Jay Katz: We put this in first and the ball in second. It goes through a small incision. This is two pieces as well. The plastic cup fits inside the metal socket once it's in the bone.

>> Reporter: Most patients the doctor says are candidates for the mini incision surgery unless they are very overweight. The fact that there's almost half the recovery team, people are back on their feet before they know it.

>> Charles Davies: I was on a walker for about a week. Then I went to a cane after a week. And I'm walking now without -- without anything.

>> Jay Katz: We're doing this with a mini incision on younger and younger people because they can get back to work faster. They can take the time to have this fixed whereas to be out of work for months they couldn't.

>> Reporter: Dr. Katz says 20% of surgeons across the country are using the incision and it's becoming more popular as more people hear about it.

>> Jay Katz: This is a procedure, a hip replacement that has been done for 30 years, very, very with a 95% success rate. It's hard to get surgeons to take the time and it's stressful for them when they feel comfortable doing it one way to do it another way. Because of patient demand. As patients read about it and learn about it and hear about it, they demand it. That forces the surgeons, even though -- it's hard when you are learning something new and stressful when you feel comfortable doing it the other way. It's evolving. I think that eventually anyone doing hip replacements will be doing it this way.

>> Michael Grant: If you would like more information on the hip replacement surgery check out our web site. Click on "Horizon". You'll find links to more information on the flu scare. Thank you very much for joining us on this Tuesday evening. I'm Michael grant. Have a great one. Good night. .

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