Sunday, January 25, 2009

Shingles: the avoidable disease - by Judge Jim Gray

Recently I went up to San Luis Obispo to visit my aunt. One basic rule in life is that family is first, and I try to gauge my actions accordingly. My aunt is experiencing some medical problems, including Parkinson’s disease and the maladies of old age, because she is blessed to be 90 years old. But she also has shingles.

Before she got this disease, I did not know much about it. Now I find that it can be a truly debilitating illness that involves mild-to-severe tingling, itching, burning, or even shooting pain. My aunt is one of those who is experiencing severe pain from it, which she equates to a strong elastic band that is stretched too tightly around her waist. And it hurts her to do everything, including just lying in bed.

Technically this is known as the varicella zoster virus, and it comes from the herpes family. It is the same virus that caused our chicken pox when we were children. In fact, only those who earlier had chicken pox can get shingles. That same virus stays dormant in humans for many years, but can become active again, usually after we turn 50 years old. Medical science’s best estimate of the reason for the flare-up is increased tension and stress.

Fortunately the disease can be avoidable, because now there is a vaccination for it. At the end of 2006, the Centers for Disease Control and Prevention officially recommended that all adults ages 60 and older get that vaccination. I was told that people under 60 can obtain the shot only with a prescription, but for those over 60 a prescription is not required.

People who are most at risk to contract the disease are those over 60, and those who have medical problems that affect the immune system, like HIV or cancer, and those who take drugs that suppress the immune system, such as steroids and medications given after organ transplants. People who never contracted chicken pox will not get shingles, but of course they are still at risk for the chicken pox.

Shingles is usually first evident as a rash or blisters on the skin, typically on just one side of the body. It can rarely lead to really severe complications like blindness and death, and about one in five people who contract the disease will experience severe pain. According to the CDC, about 1 million people in the United States contract the disease each year, and the vaccination is about 50% effective. Once contracted, the disease is treatable, but the earlier it is detected and treated, the better.

Just to be sure about whether I should get the shot myself, I contacted both my family doctor and another medical doctor who is a personal friend and asked them for their recommendations. Both of them told me that they recommended that I get the shot, and the one who is over 60 said he himself had already been vaccinated. So I got it too.

The problem is that the vaccination is expensive. I heard that it was being offered at the pharmacy at a Vons grocery store, so that was where I went. But even that cost me $210. My doctor told me it would have cost $250 at his office. Both doctors told me that my insurance wouldn’t cover it, but the pharmacist gave me the forms to submit anyway.

Given my aunt’s experience, I believe the vaccination is a deal even at four times the price. But why are vaccinations like this so expensive? Well, the simple reason is that it costs a pharmaceutical company hundreds of millions of dollars to perform the required studies before the FDA will certify almost any new drug. And it almost always takes more than a decade for that process to be completed. Often other countries have new medications available to the public many years sooner than we do, and those medications are reducing pain, curing diseases and even saving lives. But our FDA basically justifies the delay and expense by saying that “we can’t be too careful.” My explanation is that “the bureaucracy must be served.”

It may be true in some cases that some new medications could cause harm to the users. But, like anything else in life, there should be a balance. Yes some new medications could cause harm, but waiting those long extra years will also bring harms of their own. Why? Because many of the new medications will themselves save lives and alleviate suffering.

So how can we strike the best balance? Hold the pharmaceutical companies responsible for putting any medications on the market without sufficient research and study by allowing the person harmed to bring a lawsuit for negligence. That is the best way to maximize the benefits and reduce the harms. And this will also significantly reduce the cost of all medications, such as the vaccination for shingles.

Although I am not a medical doctor, based upon what I have learned, I recommend that anyone older than 60 who has had chicken pox get the vaccination. I also suggest people younger than 60 with health problems that put them into any of the categories of greater risk expressly consult with their doctors about getting the vaccination as well. I have passed this information on to you because this disease can be so painful and debilitating that I thought you would want to join me in taking all reasonable steps to avoid it.

JAMES P. GRAY is a retired judge of the Orange County Superior Court, the author of Wearing the Robe – the Art and Responsibilities of Judging in Today’s Courts (Square One Press, 2008), and can be contacted at or via his website at

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