The lectionary for this week includes John 20, the story of “Doubting Thomas.” As the story has it, Jesus’ disciple Thomas didn’t see an appearance of post-resurrection Jesus and declared that he wouldn’t believe in the resurrection until he could stick his hand in Jesus’ side. Thomas is often criticized for his lack of faith; but could his original doubt of the power of God have made his resulting faith stronger? The last thing we hear from him when Jesus appears to him and proves his resurrected self is “My Lord and my God.” I translate this roughly in modern parlance to “God Almighty, it’s true!”
The reality of disease and death is stark and frightening. Vaccines must seem to her like a miracle now. I imagine that mother is thinking along the lines of the father who exclaimed to Jesus, “Lord, I believe; help my unbelief!”
Prince Charles is paying us a visit soon. Sadly, he is a notorious public health menace. I feel sorry for the Brits. This guy will be the British Monarch one day.
Worse, he has endorsed homeopathic vaccination. That’s where I draw the line. According to some homeopathy practices, natural materials are diluted many fold and then consumed. In the Slate article, the writer estimates the concentration of some of the ingredients is around 10 to the -36th power. That’s a concentration well less than one molecule per liter. Chemists refer to that as practically infinite dilution.
Thus, Prince Charles effectively encourages travelers to take highly diluted placebos and then expose themselves to extremely dangerous pathogens. This would presumably substitute for getting an actual, effective vaccine. I think a homeopathic medicine adherent is more at risk of water toxicity in order to get any effective dose of whatever it is that is being consumed. (See my prior post on the fundamentals of acute toxicity)
I am sure that many will listen to Prince Charles for the same reason they like Downton Abbey. I suppose that seeing the polish, the structure, the certainty, of the British upper class lends some type of cultural credibility to an underlying message. Nonsense. With respect to public health, Prince Charles is Jenny McCarthy in a fancy foreign suit.
Like Downton’s servants, I bet the working classes of Britain actually have their collective heads firmly planted on their shoulders and get their vaccinations regularly. Let’s hope so, and that they ignore their Prince’s foolishness.
(The caricature is by Andy Davey – see AndyDavey.com)
I don’t believe the average consumer understands the basics, much less any subtleties, of toxicity. Sadly, the word “chemical,” or something that sounds chemically suspicious, is synonymous with “toxic” among many in America. Here is a very good example:
Penn and Teller do a darn good job at exposing this nonsense. But how did we get to this state of anxiety and ignorance? I don’t know, but I will try my best to help. I feel like Sisyphus. The concept of toxicity is common sense. A fundamental rule of toxicology, the study of toxicity, is that toxicity depends on dose. That is not hard to understand. Many people take aspirin (an acetylsalicylic acid), for example, to ease headaches, to prevent heart attacks, etc. There are many medical uses for aspirin, e.g., two 325 milligram tablets every 4 hours to relieve pain. Most people can tolerate this therapeutic dose. Any less, and the therapeutic effect might not take place, or a different effect might be manifested. However, if the dose is exceeded, for example, six 325 milligram tablets every 4 hours, the body may start reacting differently. Aspirin at this dose might have a greater chance of causing stomach upset, emesis (vomiting) and/or an ulcer, all toxic effects.
The reaction of a human body to a chemical or composition is best expressed on a continuum from “no effect” to “lethal.” Every chemical I know of can be classified this way. So it is imprecise to say that a chemical or a composition is inherently toxic. Fundamentally, the precise question is “what’s the dose that manifests a toxic effect?”
Oversimplified, there are two ways to measure toxicity, acute toxicity (single dose), and chronic toxicity (repeated exposure over time). For the purpose of vaccines, I am limiting this blog post to acute toxicity. There’s a good reason: Most vaccines are given in discrete single doses separated by at least a month, sometimes years. So the toxicity of a single vaccine is likely best measured this way.
The most common measurement is probably “LD50.” An LD50 is the dose in grams of ingredient per kilogram of body weight (g/kg) that kills (Lethal Dose) 50% of a population of test animals. Sounds horrible, right? Yes, mice, rats, pigs, or whatever test animals chosen, are dosed until they die. That is the way we humans are protected from our own stupidity (“More is better,” for example) under federal law. Be thankful for the creation of the FDA and EPA, who are our first lines of defense. The lower the LD50, the more acutely toxic the substance. Many substances we ingest or use have some low LD50’s. Here are some examples I pulled from the medical literature freely available on the internet.* I weigh 141 kg, so I’ll calculate how much it might take to kill me.
Caffeine: 0.2 g/kg, thus, 28 grams might be lethal for me.
Table Salt: 3 g/kg, thus 420 grams might be lethal for me.
Water: 90 g/kg, thus about 13 kilograms might be lethal for me.
Thimerosal (preservative in some vaccines): 0.08 g/kg, thus 11.3 grams might be lethal for me. A typical vaccine has about 1 microgram (0.000001 g)
So let’s turn our attention to caffeine: A good espresso will have 100 milligrams (0.1 g) caffeine per espresso cup. I’d have to have 280 espresso cups in a single sitting to kill me. Really. On the other hand, powdered pure caffeine has now found its way on the market (see this advertisement). For a person 1/3 my weight (47 kg = 103 pounds), it would not take much to kill him, about 9 grams – so little a measuring error can be lethal, or at least put some ripped dude in the hospital with acute caffeine poisoning.
Are you getting my point? Thanks to all those mice, rats, pigs, and dogs that help us humans be safe by determining what doses of medicines, cosmetics, and other common substances we can tolerate. You may not like it, but you’re alive because of their deaths. These were honorable sacrifices.**
**Some companies may claim they do not test their products on animals. I have no doubt that’s true, but it is an empty claim and frankly meaningless. It turns out that most drugs, pesticides, soaps, cosmetics, and the like are EPA or FDA registered ingredients. That is, many ingredients in such “non-animal-tested” products were tested on animals, to determine their toxicities, prior toproducing and marketing the “non-tested” products. For example, The Body Shop sells a product with the following ingredient list (This is copied literally word for word from their website):
Let’s take coumarin (highlighted in red). Coumarin has an LD50 of 293 mg/kg (rats). In other words, somebody had to feed this compound to rats to determine the number. Thus, while the “product” that contains coumarin may not have been tested on animals, coumarin was. For whoever has bought into this “non-animal-tested” malarkey, I’m sorry to burst your bubble. Maybe a nice hot bath with some Body Shop soap will help.
Just to be clear: I am not saying that The Body Shop performed the rat test on coumarin, far from it. I am stating that The Body Shop necessarily must rely on toxicity data that somebody generated before including coumarin in a product for humans. Think about it: otherwise, the product liability could be extraordinary if someone is poisoned.
You might ask whether this post is an express statement of political conservatism. Definitely maybe. But this post is fundamentally about our relationships and our duties to each other, the essence of (democratic) politics.
Last week a good friend and I were discussing raising children. On helping them come to terms with their relationship to the world, he said, “what is it, God, family, country?” Me: “I’ve always understood it as God, country, family.” In the movie American Sniper, Chris Kyle responds with this formulation to the question of whether he actually read the Christian bible. My friend and Chris Kyle are correct: we have a supreme moral duty that directs and informs other duties below it. In whatever order, country and family are neck and neck.
This ancient formulation is familiar to and ingrained in many military personnel. Seemingly simple, it is not: God commands one’s allegiance and one is inherently in relationship with and in community with country and family. In the book on which the movie is based, Chris Kyle wondered out loud whether family or country should be second, and he suggested the allegiances might be in flux depending on the moment. It’s an informed and nuanced comment.*
But one thing is for sure: we are all in this together and we have a duty to help and protect one another. In my faith, the greatest commandment is to love God with all your heart, and soul, and mind. The second greatest is love your neighbor as yourself. (Matthew 22:38). Thus, love of God has a correlative duty: you are bound to your neighbor, e.g., family and country, because God said so. “Family” and “country” symbolize the need for these relationships that seem lost on many, and the failure to vaccinate is an embodiment of that loss.
To state that a parent’s choice not to vaccinate children only affects that family is nonsense. It’s just a fact that we carry a ton of germs that can infect others. This is undeniable, and if you don’t believe it, look at my prior post on pertussis for an example: humans are the only carriers of the pertussis bacterium. This fact, coupled with the moral imperative to protect those around us – we are our brother’s keeper – compels us to protect our family’s children and the country’s as well. To do otherwise is heresy to the ancient formula. It is pure selfishness, a childish trait.
I realize that many who read this blog may find it difficult to relate to my worldview, particularly the God part. But if you have a better moral framework to address relationships, please bring it on. Peace be with you.
*For the record, I think American Sniper was unfairly snubbed at the Oscars – it is a testimony to the flux I am speaking of here, and a monumental, brilliant, moving, apolitical film.
Yesterday’s post was a comment on potentially deep cultural changes that might affect us due to the sharp clash between an anti-vaccination movement and the rest of us. Here’s another take on that.
About 10 of you sent me the Jimmy Kimmel video from his February 27 show. I resisted watching it for a while, but finally broke down this morning. Here it is, and there are a couple of parts that are really funny, especially the Breaking Bad references (I also am only through the end of season 2), but it is more complex and disturbing than you may realize.
Kimmel is a brilliant comedian, although his style and delivery have never captivated me. Clearly drawing from anger and disgust, he belittles the anti-vaccine movement and parents who choose not to vaccinate their children. He is not invoking mere risibility.
As you know, I advocate vaccination. But since staring this blog, I have had to confront in myself the source of my anger at anti-vaccinators. I am a trained scientist like the doctors in this video, and formerly thought that folks just understood a need for vaccines and the power and liberation they bring to modern life. Alas, I was completely wrong.
If I adopt a mentality that I “know” what’s right and the anti-vaccinators are know-nothing fools, exactly what Jimmy Kimmel implies, I can laugh along. But Kimmel is very harsh: he wants you to think the anti-vaccine movement is made up of “fucking idiots.” And that’s where it stops being funny.
Really, this is an assault, a frontal assault, that will entrench the anti-vaccine movement more than change it. The belittling jokes create a greater divide from the rest of society. I am very sympathetic to those who might perceive this as an elite class jamming these policies down their throats. The response is to immediately pull back and retrench, because the joke is actually a threat. For someone, perhaps irrationally, perhaps being ignorant of science, who believes that any vaccine can deliver a horrible autism-inducing side effect to their child, there is no other reflex. It is fight or flight.
And really, modern medicine is its own worst enemy about side effects. Our everyday news and advertising media train us to know that modern medicines have powerful side effects. The FDA requires pharmaceutical companies to do this due to a “truth-in-advertising” policy, and Jeff Foxworthy, a much more approachable comic than Jimmy Kimmel, puts his finger on that fear-induced pulse. He’s not belittling, he’s sympathetic:
To all my friends in low places, gone are the days of Campho-Phenique. It’s a lot more complex and baffling world out there, but with some fact checking and reasoning, we can overcome and then make jokes about Jimmy Kimmel.
Lepers, that politically incorrect term, have long served as a metaphor for showing mercy to society’s outcasts. Jesus commanded 10 lepers to show themselves to the priests and the Luke 17 narrative says they were healed. Healing a bunch of lepers was an outrageous act. Lepers were supposed to stay in isolation to prevent spreading their condition. Once declared unclean, it’s hard to shed that label. I can hear the question put to Jesus now: “How do we know these guys are healed?”
I am reminded of this story because of the current backlash against those parents who refuse to vaccinate their children or insist on controlling the vaccination schedule. In an article about pediatricians refusing to treat unvaccinated children, the number of doctors taking such a stance seems to be increasing.
A decreasing level of child vaccination coupled with an increase in pediatricians refusing to treat unvaccinated children implies we may be headed for a two-tier healthcare system. There might be one for the unvaccinated, and one for everyone else. But the bigger question is whether this is the tip of the iceberg if preventable disease outbreaks become deadlier and more frequent. What if daycare centers, church nurseries, babysitting services, church schools, youth soccer clubs, youth swim teams, etc. are forced to choose between unvaccinated children and vaccinated children?
Children share a lot, and germs are at the top of the list. Children are also highly attuned to status and can be outrageously cruel to those of “lower” status. To kids excluded from common sports and social events due to lack of vaccinations, the word “unclean” or something like it could re-enter the urban dictionary pretty quickly. Imagine the damage this can do. This is an uncomfortable thought, but not far-fetched. Once so labeled, it’s hard to shed it. Could these kids become a de facto leper colony?
It is a real challenge to show mercy and forgiveness, as Jesus did, under these circumstances. I think Jesus could say to these children GO TO YOUR DOCTOR AND GET VACCINATED, just as he told the lepers to go show themselves to the priests. and they would be healed. But Jesus also might caution the children’s parents as he did at the beginning of Luke 17, “Things that cause people to stumble are bound to come, but woe to anyone though whom they come. It would be better for them to be thrown into the sea with a millstone tied around their neck than to cause one of these little ones to stumble.” As for the rest of us, forgiving these folks 7 x 7 might be the hardest burden to bear.
Finally, a brief word about how foreign, or new, this topic is. The WordPress spellchecker does not recognize the word “unvaccinated.” It’s a such a foreign concept, the dictionary hasn’t caught up. But with the unvaccinated increasing, maybe it’s time for a revision.
It’s no secret that autism concerns are part of the genesis of vaccine skepticism. The story of Dr. Andrew Wakefield is well-known and well-documented. His reports, combined with a general ignorance of scientific method and clinical trials, created a perfect storm that set back public health for a generation or so.
Emotionally, I would like to see him held responsible for his misdeeds. But in the end, I can’t sanction criminal prosecution merely for publishing his “research.” Dr. Wakefield is entitled to a great degree of free speech in this country. The rest of us have to sort out his claims. And that leads me to the story of Dr. Stephanie Seneff.
Dr. Seneff is an MIT-educated electrical engineer who is no doubt a math whiz. And she has taken it upon herself to claim that glyphosate, the active ingredient in Roundup® herbicide, is responsible for the increase in autism cases in the US. Here’s a picture of the dastardly “pesticide”
Looks evil enough, right? But this is one of the greatest herbicides ever invented and is a major reason genetically modified plants can be used in agriculture. It’s considered essentially non-toxic to human beings, but kills plants efficiently. But that word “non-toxic” is loaded. Toxicology is a science unto itself and is subtle. I’ll get to that in another post.
Perhaps over-simplistically summarized, Dr. Seneff’s argument is that glyphosate antagonizes the enzyme 5-enolpyruvylshikimate-3-phosphate synthase (EPSPS), present in plants but not in humans. Dr. Seneff claims EPSPS is present in many human gut bacteria, and this bacteria is inhibited or killed upon eating plants treated with glyphosate. As such, bacteria colonies in our guts are upset, leading to alterations in essential amino acid production, which in turn is linked to autism. Dr. Seneff has produced a multitude of powerpoint presentations on this. One of the key pieces of evidence is a graph indicating a statistically airtight correlation between the increased rate of autism and an increase in glyphosate application in agriculture. That seems solid right?
Not so fast. While tantalizingly attractive, a graph does not indicate causation. One of the fundamental rules of toxicology is that toxicity is a function of dose. I haven’t seen any controlled dose-related studies she or fellow researchers have conducted that have been subjected to peer review. I guess I’d ask how do human gut bacteria react to the doses of glyphosate found in human food? And regarding the second part of the assertion, what amino acids, or lack thereof, correlate with an increased chance of autism? I’ve never heard what those are, nor have I ever, ever heard of an obstetrician, GP, or internist recommending additional doses to an expectant mother, tiny infant etc. So the entire claim is mystifying to me.
I think her conclusions are attractive to many for the same reason Dr. Wakefield’s were. Nobody wants a child with autism. But many parents bear the terrible burden of raising and caring for one. We want to find and stop “autism” whatever the source, because the burden is so unbearable. And those children and parents deserve and need our care and support.
There is no short cut to finding answers to hard questions. It is creativity, patience, hard work, and public debate. Pay attention to those whose work is reviewed and undramatically debated. That way, we may actually find a “cure” for autism.
A couple of loyal readers today sent me this cartoon they found informative and amusing. While I strive to be more detailed and immersed in hard science, like my prior post today, I admire the creators’ excellent storytelling. It’s effective.
Please keep sharing the story of vaccines. I hope one day we can get pertussis and measles under control again.
Thank you for your interest in my blog at patlowder.com. I have noticed the linked “headlines” in Facebook, LinkedIn, and Twitter occasionally reflect titles I did not choose. I cannot preview what goes to these social media sites, so I end up surprised by how the posts are published. I will try to resolve the problem as quickly as I can. In the meantime, please let me know what you think.
In the last post, I discussed the importance of mucus and cilia. In short, cilia in the trachea and other airways combine with a river of mucus to clean the air we breathe and move it up (yes, against gravity) out of the trachea.
Pertussis is caused by the bacterium Bordetella pertussis. This organism basically destroys cilia and the epithelial cells from which cilia grow. Here’s a picture of the bacteria lodging themselves between cilia. The beasts are in greenish-yellow, and the cilia are salmon-colored. Conveniently rod shaped, see how the pertussis bacteria fit between individual cilia?
(Picture from WebMD.com) The pathology of B. pertussis is well-understood. As the bacteria develop, they a) emit specific toxins that kill the cilia and b) induce a cascade of biochemical responses to further screw up the body’s ability to heal. Entire regions of cilia are shredded. Here’s a picture to illustrate this response:
(NB: This pic came from here) As you can see, the non-ciliated epithelial cells are useless to assist in mucociliary clearance. I bet you can guess what happens next as the disease develops. Here it is in an infant girl, courtesy of the Mayo Clinic’s archive. Warning: This video is disturbing. But don’t look away – it dishonors those innocents who suffer and die from this terrible, cruel disease. Sit with her; count the seconds between her breaths.
Imagine coughing all the time if your cilia couldn’t work. Really: imagine it. Your diaphragm could collapse. After all, that is the muscle that controls breathing. Just like any muscle, it has its limits before it is so exhausted it cannot go on. In a weeks-old infant, that’s exactly what happens.
Here’s what childrens’ hospitals sometimes do when an infant can’t take it anymore. They have to breathe for them. Here’s a picture of a baby getting cardio-pulmonary assistance after an attack of pertussis. (You can visit the source page here.)
Image via the CDC. Infant being treated for severe pertussis infection. She received extracorporeal membrane oxygenation (ECMO), a procedure that can take over the work of the lungs and heart. She also received dialysis to help her kidneys keep working.
You know what is really interesting about B. pertussis? Humans are the only known hosts. The implication is clear: an infant contracts pertussis by exposure to another human harboring it.
Fortunately, the pertussis vaccine is effective in preventing transmission. However, newborn infants can’t be vaccinated against pertussis until about 6-8 weeks old, and then the infant needs booster vaccinations at 4 months and 6 months to increase immunity. See this vaccination schedule (the vaccine is called the DTaP vaccine).
So here’s the takeaway risk analysis: In my humble opinion, these simple facts indicate anyone in contact with infantsmust have the most pertussis immunity they can get. Breaking it down, those in contact with infants shouldn’t have the germ in them (detectable using modern biotechnology), and they should have detectable pertussis antibodies. That is a very high level of care. But while the actual chances of an infant contracting pertussis may be perceived to be low, the consequences of getting it may be fatal, absent extreme medical intervention.
That’s why I advocate universal vaccination. Otherwise, there are significant, perhaps upsetting, social consequences. Family members or friends who are not immunized or refuse to be vaccinated may need to be excluded from contact with a newborn. This can lead to some very tough conversations. But when the life of an infant is at risk, the limits of these relationships have to be considered.
I conclude by asking this question: by not adhering to some simple rules like those suggested, are we knowingly exposing innocent infants to suffering and death? I say we are. So getting a pertussis vaccine is tantamount to “doing unto the least of these my brethren.” I’d like to not have to explain otherwise on the day of judgment.
Vaccines - Simplified 
