Vaccination Stats are Terrifying

Pediatricians recommend for almost every child a series of routine vaccinations which are meant to prevent the contraction of disease. The United States, however, has seen a growing trend in parents ignoring this prescription. As parents opt out of vaccinations, pediatricians are starting to react.

By the time children are one month old they begin receiving hepatitis vaccinations, followed soon after by diptheria, tetanus, and pertussis, pneumococcal, poliovirus, measles, mumps, and rubella, varicella, and plenty more. 1 Once, an annual trip to the doctor’s office undoubtedly meant another prick in the arm for young children. For many children today, however, “the shot” has gone unseen, as more parents opt to wait to have their children vaccinated or refuse to have them vaccinated at all. While this decision may be a dream come true for five year olds everywhere, it is a disaster waiting to happen for pediatricians.

The United States has seen a recent trend of parents refusing to have their children vaccinated because of a fear of how the live virus will interact with the infant’s developing mind and body. The large number of vaccinations given to infants can put a heavy load on young immune systems. 2 The most common new fear associated with vaccinations, however, is that they will trigger the development of autism.

Before 2001, many vaccines had a mercury-containing component to them called thimerosal. Since 2007, about 5,000 families have made legal claims that this preservative triggered autism in their children. 3 Though no definitive research has proven this element to be associated with autism, thimerosal was removed from vaccinations in 2001. Although vaccinations no longer contain thimerosal, and the Department of Health and Human Services has stated that there is no known association between vaccinations and autism, a growing number of parents remain unconvinced. 4

Doctors provide waivers for parents of children who either can’t receive immunizations because of contraindications or for those who would rather not take a chance that the risks of vaccines may outweigh the benefits. According to Saad Omar, a scientist at the Johns Hopkins Bloomberg School of Public Health, the number of children whose parents have taken doctors up on this offer has risen since 1990 from 1% to 2.54%. 5 According to another study published in the Archives of Pediatric & Adolescent Medicine, 85% of 302 pediatricians surveyed said that they had experienced refusal of some vaccines, and 54% had received refusal of all the recommended vaccines. 6 Just because doctors are offering this waiver, however, doesn’t mean they are happy about it. As the number of children unvaccinated for non-medical reasons continues to rise, many doctors are refusing to treat unvaccinated children at all. According to the survey of 302 pediatricians, 39% would deny care to families of fully unvaccinated children. Children who are not inoculated could pose a threat to other unvaccinated children, children who are too young to be vaccinated (for certain diseases), and even those who have already been inoculated.

The fear of increased spreading of disease has in fact become a reality. Within the past few years, for example, the number of children contracting measles has increased. This disease that can be guarded against by the MMR vaccine, which covers measles, mumps, and rubella. In 2008, a total of 11 unvaccinated children came down with measles after a 7-year-old unvaccinated boy brought the disease back from a family trip abroad. Hundreds of others were exposed.7 In a similar case, a 17-year-old unvaccinated girl in Indiana brought measles back with her to the US after traveling abroad. She infected only 3 out of 465 vaccinated people at a picnic, but 31 out of 35 unvaccinated children at the same picnic. 8 Measles is not the only disease that has sprung up amongst unvaccinated children. There have also been outbreaks of pertussis, mumps, varicella, and the bacteria that causes meningitis, just to name a few. 9

vaccinations

Doctors, therefore, continue to advocate for the vaccination of children in order to prevent possibly fatal diseases. Dr. William Schaffner of Vanderbilt University, for example, explained that so far no link has been found between vaccinations and autism, as evidenced by the millions of children who receive vaccinations with no problems. This evidence, however, does not rule out the possibility of a connection either in the population as a whole, or in an isolated group of children with a certain genetic susceptibility. On the other hand, it is also possible that children with a genetic vulnerability who developed autism after being vaccinated would have developed autism anyway after a bout of serious illness.10 Most doctors, including Dr. Schaffner, admit that much more research is needed to determine if a link of some kind may exist. At this time, however, vaccines are considered completely safe and extremely important in preventing children from falling ill with potentially life-threatening diseases, and in preventing these germs from spreading to other vulnerable bodies.

Craig Venter – 8 Years On from his Research

Craig Venter and his lab created an organism with entirely synthetic DNA. The lab, in 2010, created a cell with a synthetic genome. As exciting as this breakthrough is, it has many concerned about the implications of this experiment. 1How will this scientific breakthrough affect the way we live tomorrow?

Venter suggests that this technology will usher in a new industrial revolution where man-made organisms can produce flu vaccines or become effective tools in treating disease. 2 He is hopeful that he and his fellow scientists can modify the genetic code of algae to “…vary the 50 to 60 different parameters for algae growth to make superproductive organisms [in the production of biofuels].” 2 However, critics of this approach are concerned that new bio-weapons could be created from synthetic organisms and that they could be particularly devastating in the hands of terrorists.

That said, it’s important for people not to overreact to the either the potential benefits or dangers of this research. For one thing, reaping the benefits of synthetic life is going to be difficult. For example, scientists would like to create an organism that can absorb carbon dioxide. They are going to have to overcome immense challenges to perform this task. First, they would have to find a gene or a series of genes that absorbs carbon dioxide in plants, algae, or some other organism. They would then have to understand many of the biochemical aspects of carbon-fixation in order to produce an organism that could perform the given function (CO2 absorption) more efficiently than its natural counterpart. Needless to say, it’s an extremely complicated and costly process.

That’s actually why it is highly unlikely that you will see synthetic organisms being used in a potential terrorist attack. It takes a tremendous amount of resources to create an organism that might or might not kill people as effectively as something that isn’t already out there (it cost the J. Craig Ventor Institute $40 million to finance the creation of the first synthetic cell). 1 It is much easier to fill a few envelopes with anthrax than to hire a bunch of mad scientists to create a deadly synthetic organism.

There is another concern with this line of research, however. The ecological impact of unknowingly introducing synthetic organisms into the environment could be potentially devastating. Humans have introduced the Asian carp in the United States and it became highly detrimental to the environment and later became known as an invasive species.3 People also bred two different sub-species of bee in an effort to create a bee that could produce more honey, an effort that gave rise to the killer bee, 5 an organism that is far more aggressive than its bee cousins6. We don’t know the ecological impact of creating organisms through artificial selection, so how on earth would we know the impact of introducing man-made organisms into the environment? How will we simulate the conditions organisms will live under in order to understand the impact they will have once they have been released into a natural habitat? It’s a question that currently seems beyond the scope of science, and therefore all possible preventative measures must be taken to ensure synthetic organisms do not escape from a controlled environment.

With quandaries like this, it’s unlikely that humanity will see the benefits (or dangers) of synthetic life for some time. However, we shouldn’t focus on the fact that we might not see any potential benefits. The marvel of this experiment is that it provides essentially indisputable evidence for the underlying principle of all biology: that an organism’s DNA determines its form and function. Dr. Venter and his fellow scientists removed all the DNA from the cell of one bacterial species and inserted synthetically made DNA of a different bacterial species. 7 After the synthetic DNA was inserted, the cell began to proliferate and exhibited none of the qualities of the host cell. In fact, it behaved like any other organism with natural DNA7 All of these experimental observations allow us to understand that the only thing that truly determines what every living thing will become is its genes and the manner in which its genes are expressed.

Why New York Needs More Organ Donors

It is no secret that organ donations in New York. do not meet the needs of the public; there are generally 100,000 people waiting for donor organs at any given time. 1This remains true despite both the efforts to make registering as an organ donor easier and the widespread publicity of the multiple lives a single organ donor can save. By all accounts, the main way this shortage can be alleviated, and the thousands of people in the U.S. who are waiting for life-saving transplants can be provided for, is through a dramatic increase in organ donors. For example, Spain and Norway, international leaders in the proportion of organ donors in the population, have seen their waiting lists remain consistent or even shrink. 2 Spain’s high rate of organ donors is in large part due to their “opt out” program, where individuals are organ donors unless they specifically request not to be, and there are bills to adopt just such a policy in states in the U.S. (note that the National Organ Transplant Act of 1984 gives states the prerogative to determine their own organ donor policies). 3

However, even with a dramatic increase in organ donors, there would remain another key challenge: 95 percent of deaths happen outside of a hospital,4 and there is only a 20-30 minute window after death in which organs can be saved. 5Consequently, current policy is that only those who die in hospitals are eligible to be organ donors. Thus even if organ donor rates rose prodigiously, a large share of life-saving organs would not be preserved in time.

But New York City has proposed a unique plan to address this challenge: an “organ preservation vehicle.” The sole responsibility of the vehicle would be to monitor police and ambulance radio frequencies to identify individuals who are declared dead but have no chance of reaching a hospital in time for their organs to be preserved. Then, when such an individual is found, the vehicle would rush him or her to the hospital. In this manner, a greater proportion of donor organs could be saved, at least in situations where an ambulance or police officer arrived shortly after an individual died. This would provide a much-needed increase in efficiency for life-saving transplants.

Just as it seems every organ donation policy has, the organ preservation vehicle has created controversy. First and perhaps most alarming is the myth that individuals will be prematurely declared dead on scene in order for the organ preservation team to take that person’s organs. This is just a variation of the myth6 that permeates all organ donation: that doctors do not work as hard to save the lives of organ donors. Nevertheless the organizers of the organ preservation vehicle project have addressed the issue by requiring the preservation team to remain out of sight of the paramedics and police until an individual has been declared dead. Consequently, those on the scene would not be certain that the organ preservation vehicle would arrive even if they were to declare an individual dead. The second major challenge to the organ preservation vehicle is that it could impede effective investigations by the police. When the cause of death is unclear and unusual, the police are required to turn the body over to a medical examiner to investigate the cause of death. At that point, only the medical examiner can release the body and allow its organs to be preserved. However, with such a short window of time, critics of the organ preservation vehicle are concerned that police officers will have to make the decisions usually under the jurisdiction of the medical examiner.

Despite these concerns, the police and medical examiner’s offices in New York City have agreed to a pilot program of 4-6 months to evaluate and tweak the organ preservation vehicle program if necessary. Given that no new issues arise, the program is expected to expand and perhaps be adopted by other regions. While progress on an opt-out organ donor policy remains piecemeal and roughshod, progress is being made on the second major challenge of organ donation, which is to conserve the organs of the 95 percent of donors who die outside hospitals.

Why I love Michelle Obama

On Tuesday, February 9, 2010 First Lady Michelle Obama announced her campaign, Let’s Move,in an effort to combat the growing problem of childhood obesity.1 The campaign’s goal is ambitious, to say the least: eliminate childhood obesity in a single generation so that today’s kids grow up to be adults of a healthy weight.

The Problem at Hand

Childhood obesity must be addressed both because it negatively impacts our children and because we know that obese teens are more likely to be obese adults. There is a definite need for action considering the statistics concerning childhood obesity rates in the United States: the rate of childhood obesity has tripled in the last thirty years so that today one-third of children in the United States are overweight or obese. Think about what that number means: one in every three children suffers from the effects of an elevated BMI. Additionally, the effects of childhood obesity have long-term health consequences including heart disease, high blood pressure, diabetes, cancer and asthma. 1 These chronic illnesses cost the economy $147 billion per year,^1^ linking the issue of childhood obesity to the ongoing debate of health care reform. 3

Previous Endeavors

The First Lady’s announcement in February does not represent the first time the Obama family has expressed an interest in fighting childhood obesity. In March 2009, along with fifth graders from the D.C.’s Bancroft Elementary, the President began an organic garden on the White House’s South Lawn, the first vegetable garden since Eleanor Roosevelt’s Victory Garden during World War II. 3 In looking for a solution to this problem, the First Lady surely looked at the efforts of those around her. There have been smaller movements throughout the country which have been successful and could offer a template for “Lets Move”. Take for example, Shape Up Somerville, a program promoted by the Mayor Joseph A. Curtatone of Somerville, MA. The program aims to make small changes that all policymakers can support , such as repainting crosswalks with reflective paint to make it safer for children to walk to school. 2 By making it safer for children to walk to school the program hopes that it will encourage walking and a healthier lifestyle. The program also pays close attention to the foods which are available in and around schools, working with Tufts University to make small, but significant changes to lunch menus and cafeteria practices. Through these small changes the program has been able to slow the rate of childhood obesity. In keeping with this philosophy of small changes, the First Lady has said her “Let’s Move” program is “about balance and really small changes that can add up, like walking to school when you can, replacing soda with water or skim milk, trimming portions just a little”. 1

Changing a Nutritional Environment

The “Let’s Move” Campaign is based on four pillars:

  • providing access to more nutritional information
  • increasing children’s physical activity
  • providing easier access to healthy food
  • issuing a call for personal responsibility.

President Obama has recognized the fact that in order for a program against obesity to be effective, proposed changes need to be manageable and respect families’ schedules, budgets, needs and tastes. Therefore, a primary goal of the campaign is to give parents and children the tools they need to make healthy decisions. For example, the President’s Council on Physical Fitness & Sports will shift its focus from athleticism to a focus on health and well-being. 3 Additionally, the website “LetsMove.gov” provides tips on eating well and staying fit which can be easily integrated into any lifestyle. 2 Lets Move also plans to use celebrities to target the younger demographic. The program is enlisting the help of professional athletes who will promote “60 minutes of Play a Day” public service announcements, as well as spokespeople like Mo’Nique and Nelly Furtado. 1,3

While these increases in information are essential, the campaign also admits that, regardless of the amount of information available, a child’s “nutritional environment” must be changed in order to achieve tangible results. These changes would include easier access to fresh fruits and vegetables in local cafeterias and supermarkets. Lets Move also hopes to see cooperation from beverage makers with the creation of consumer-friendly labeling on cans, bottles, and vending machines within two years. 1,3 In order to encourage physical activity, the campaign will also promote community projects such as new bike paths and playgrounds. 3 The promotion of bike paths and playgrounds was an important aspects of the Shape Up Somerville campaign as these improvements increased family-friendly physical activities available in local communities.

In order to fulfill the goals of increasing information and changing nutritional environments, the First Lady has gathered the support of many individuals. At the time of the announcement, both a Republican and Democratic mayor were present in order to show bipartisan support of the campaign. 3 Additionally, Dr. David Ludwig, Director of the Optimal Weight for Life Program at Children’s Hospital in Boston, has applauded First Lady Michelle Obama’s efforts, saying that “never before has the childhood obesity epidemic become a high priority of both the President and the First Lady.” 1

In order to implement the four pillars of the program, various organizations have been recruited. Sodexo, Chartwells Schools Dining Services and Aramack, suppliers of school lunches, have all pledged to reduce fat, sugar and salt in their meals over the next five years. Additionally, the American Academy of Pediatrics has agreed to encourage physicians to measure body mass index as an indicator of obesity. 1 At the government level, the First Lady has received Presidential support in a variety of forms, including $1 billion per year for the next ten years, a Childhood Obesity Task Force, a Let’s Move website, the reauthorization of the Child Nutrition Act, and $400 million over the next year for the Health Food Financing Initiative in order to build healthy food outlets in urban and rural communities. 3,4

Too Much, Too Little, or Just Right?

However, for every supporter there is a critic. The criticisms of this campaign include its funding, the feasibility of its implementation, and comparisons to failed past attempts at curbing childhood obesity. One of the key goals of the campaign is to provide healthier lunches in schools. However, healthier usually means more expensive; therefore,the healthier lunch choices may be met with resistance from school boards worried about cost. 1 Additionally, despite $1 billion allocated to the campaign to bring healthier lunches to schools, this is a mere ten percent of the $9.3 billion4 that is currently spent nationally on public school lunches. 5 The task force which has been assembled to help carry out the campaign is also under scrutiny. Although this task force is composed of individuals from many different departments, all of these departments have many other projects and responsibilities. Because the Task Force’s role is strictly advisory, the actual influence they could have is debatable. 5 Many people also want the First Lady to take an even more drastic stance against childhood obesity. The Center for Science in the Public Interest wants President Obama to remove all junk food from schools as well as advertisements for junk food in children’s programming. Others want the government to address the farm subsidies, which currently allow for the artificially low price of chips and other snack foods. 3 These changes are met with resistance as they will have large scale economic impacts as well.

Despite the hype that Lets Move may be a revolutionary change , there are also doubts that this campaign will be enough. Previous administrations have tried to address this issue to no avail. For example, the second Bush administration set up the Task Force on Media and Childhood Obesity, which was headed by the Federal Communications Commission 6 in order to reduce childhood exposure to unhealthy eating habits. However, it saw little success possibly because of the members’ close ties to companies such as Coca-Cola™ and McDonald’s™. Additionally, the FDA’s Obesity Working Group, which attempted to tackle obesity in both adults and children, only managed to affirm that “calories count.”

The current Interagency Working Group on Food Marketed to Children, which consists of four agencies set up to determine which foods can be marketed to children, has yet to make any significant changes.5 The Let’s Move website bears signs of committing the same mistakes as these early programs. For example, the two programs listed to help promote healthier schools ,the Healthier US School Challenge and the Team Nutrition Program are both under the US Department of Agriculture, whose main goal is to promote industrial agriculture, which has inherently opposing goals to those of the Let’s Move campaign.5 Therefore, despite the revolutionary changes that this campaign hopes to make, the high hopes are dulled by a less-than-successful history as well as the current campaign’s dependence on the old organizations.

Finally, despite the First Lady’s assertion that “there is nothing Democratic or Republican, there is nothing liberal or conservative about wanting our kids to lead active, healthy lives,” any program that is sponsored by the First Lady has inherently political underpinnings. 4 With Republicans already accusing President Obama advocating big government, the First Lady has been cautious to ensure that she doesn’t “ruffle [the] feathers of the food industry.” 1 The First Lady has repeatedly assured us that the campaign does not tread on constitutional issues but rather advocates individual responsibility. When speaking at the annual winter conference of the National Governor’s Association, she maintained that the campaign was not treading on states’ rights. Despite her insistence, parallels are being drawn between her view of “moderation and perspective” concerning a healthy lifestyle and the President’s message of personal responsibility when speaking to Wall Street bankers and the CEO’s of health insurance companies. 4Additionally, she introduces a pre-existing debate on conventional production versus organic sustainable production. Her lack of criticism of the billions of dollars spent on advertising junk food to parents and children has people questioning the political influences on the First Lady and the Campaign. 5

First Lady Michelle Obama’s campaign against childhood obesity has definitely spurred debate on this widespread and worsening epidemic. The goals of the campaign are ambitious; however, the success of Lets Move would be a great thing for our youth. Whether the skeptics are correct in doubting the effectiveness of the structure of the campaign or if this campaign will ultimately succeed despite past failures to address obesity, remains to be seen. We may not agree on the methods and Lets Move may or may not prove to be adequate; however, the one issue that no one is arguing is the weight of the problem and the absolute need for change.

References

A New Model to Reduce Health Disparities

Across the country, millions of Americans are dealing with social and economic hardships that prevent them from achieving good health. Take, for example, the case of a teenager with asthma named Jane*, who was being treated at the Boston Medical Center. Jane lives in a low-income neighborhood with substandard housing conditions and a mold infestation that exacerbates her asthmatic condition. Jane’s doctor at the hospital could prescribe her medication to take home, but her asthma would keep recurring if her living environment did not improve.

But, Jane’s physician did more than prescribe medicine – he asked her questions that led to recognition of the underlying cause of her asthma. He then referred her to the Medical-Legal Partnership (MLP) office on-site, which assigned a lawyer who worked with Jane and her family to have renovations done, including mold removal from her apartment building. Following the MLP intervention, Jane’s health was restored and her asthma came under better control.

Jane is one of an increasing number of people benefiting from a new model of care that closely links healthcare providers with legal advocates. As David Williams et. al. explains in his article “Moving Upstream: How Interventions That Address the Social Determinants of Health Can Improve Health and Reduce Disparities,” Medical-Legal Partnerships bring together healthcare providers and lawyers to collaboratively devise legal remedies to previously unaddressed issues impairing the health and well-being of vulnerable individuals. In an MLP, healthcare providers are trained to recognize adverse social conditions that have legal remedies. MLP lawyers provide legal assistance that the person would be otherwise unable to access. MLP lawyers also become an integral part of the healthcare team, advising staff on the wide variety of resources that may be available to their patients.

Jane was lucky enough to have access to the resources of health and legal professionals because of the MLP program. Similar programs have been developing across the country, part of a broader movement to address health disparities among vulnerable, low-income, largely minority populations with high rates of disease, disability and premature death. According to the Office of Minority Health, these disparities typically exist because of inadequate access to healthcare and other resources, as well as a substandard quality of care.

Vulnerable populations often have trouble getting the care they need because of social, linguistic and economic barriers. For example, many people have trouble understanding the complex rules regarding eligibility for public benefits and are unaware of the availability of professionals who can help them. They need support in confronting those who may improperly deny them resources, entitlements, and equal rights.

Social determinants of health play a major, though largely unaddressed, role in health disparities. According to the World Health Organization, social determinants of health are the circumstances in which people are born, live, and work, including the health system. The distribution of power, money and resources globally, nationally, and locally influence these conditions and are influenced by policy choices. Those with less means have a harder time accessing the resources they need and therefore have worse health outcomes than those with more resources. By enlisting the help of healthcare and legal professionals, disadvantaged populations can improve their situation, even if it is just by attaining food stamps to feed their families.

Founded upon this idea, MLPs help individuals and families get and stay healthy by addressing social conditions in their lives. The goal of MLP is to ensure that individuals’ and families’ basic needs, such as food, housing, education and health-care, are met. MLPs seek to reduce health disparities through three core activities: health systems improvement, direct assistance to patient-clients, and systemic advocacy.

MLPs improve health systems by training healthcare providers, helping case management staff to become more effective, and helping to prevent otherwise unnecessary visits and hospitalization.

Direct legal advice and assistance is provided to patient-clients regardless of their ability to pay. As a result, they may have improved access to income support and food stamps, insurance and medication coverage, appropriate living conditions, and educational opportunities. On a broader level, the MLP model is also effective as a systemic advocate for reduction of health disparities. When healthcare and legal professionals join together, they are a powerful voice in the setting of policy. They are better able to push for legislation, policy changes, and improved benefits. The result of MLP activities is healthier lives.

This summer, I worked at the National Center for Medical-Legal Partnership, which supports the expansion, advancement and integration of the MLP model across the country according to their website. There are now MLPs in more than 225 hospitals and health centers in 38 states. Through the training I received and the research projects that I completed, I gained an in-depth appreciation of the MLP model.

As a Community Health major I can tell you that the Tufts Community Health Program shares many of the same values and goals of MLP. Both are part of a movement in healthcare towards preventive and more comprehensive care. The Community Health Program teaches students from their first class about the importance of addressing social determinants of health. MLP educates medical and law school students, along with residents, attending physicians, and support staff about the relationship between basic legal needs and health.

While many papers have been written about the benefits of MLP, the full extent of the model and its cost-effectiveness have not been rigorously studied. There are presently bills pending in the House and Senate to fund a nationwide demonstration project for MLPs and more fully evaluate its effectiveness.

Medical and legal communities, including the American Medical Association and the American Bar Association, have already stepped up to support MLPs. There remains a great opportunity for the public health community to also get involved. Public health professionals could help to further evaluate the benefits and effectiveness of MLPs, promote the model more widely if further study is supportive, and partner with MLPs to reduce health disparities and improve the health of vulnerable populations.