Misinformation

The New Food Pyramid – Confusing and Not So Healthy

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FEB 11, 2026

New dietary guidelines were released in January by the USDA and Department of Health and Human Services titled Dietary Guidelines for Americans 2025–2030. In this post I’m going to illustrate the clear deficiencies of the new guidelines by comparing them to two older versions of Dietary Guidelines for Americans. I will begin the description of each guideline with the visual diagram used to summarize the guideline.

Dietary Guidelines for Americans 1995. These guidelines introduced the image of the food pyramid. The pyramid suggests daily servings for each of the food groups. Serving size is defined in the full text of the guidelines. The most servings are at the base of thy pyramid (bread cereal rice and pasta group) and the least number of servings at the third level of the pyramid, which include dairy and proteins. Note that the very top of the pyramid, which includes fats, oils and sweets, does not include serving sizes but just advises to use sparingly. 

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The full version of the guidelines is 40 pages long and includes the names of a 12 member expert advisory committee. This committee included many famous experts in nutrition, especially Marion Nestle.

Dietary Guidelines for Americans 2020-2025

By 2020 a lot more information was available about foods that increased or decreased the risk of chronic diseases such as diabetes, heart disease and stroke. The image was changed from a food pyramid to an image of a healthy eating plate. The generic image did not include serving sizes except suggesting no more that 1-2 servings a day for dairy products. 

The guidelines included a My Plate Plan calculator that makes calorie recommendations and serving sizes based on age, gender, height, weight and average activity level. Try out the calculator using the above My Plate Plan link. It’s fun to see how many calories you should eat and how they should be distributed.

Note the proportions of food groups on the Healthy Plate image. Vegetables (not including potatoes and french fries) and fruits make up half of the daily calories. Whole grains and protein make up the other half at roughly 1/4 each. Healthy protein emphasizes fish, poultry, beans and nuts with advice to limit red meat and cheese.

That does not mean you should eat no red meat at all, it just should not be your main source of protein. An excellent guide to limited healthy meat and poultry eating is a book by Matthew Evans titled On Eating Meat: The truth about its production and the ethics of eating it.

The guidelines also recommend eliminating processed meats like bacon and cold cuts. Limited quantities of healthy oils (both olive oil and vegetable oils) were recommended for salad and for cooking. It recommended avoiding trans fats

The full text of the 2020-2025 guidelines is 140 pages long. As with the previous guideline it lists the names of a 20 member advisory committee. It also includes a detailed description of how the guidelines were developed. Here is a particularly relevant quote from that description:

“The Guidelines must be grounded in the body of scientific and medical knowledge available at that time, not in individual studies or individual expert opinion.”

2025-2030 Dietary Guidelines for Americans

The new image for the 2025-2030 is an upside down version of the 1995 food pyramid. Things you should eat the most of are at the top and things to eat the least of are at the bottom. This image says nothing about actual quantities of the foods recommended. It has red meat (including an image of a steak), cheese and poultry at the top and whole grains at the bottom. This is the complete reverse of the 1995 pyramid, which had whole grains at the base of the pyramid with meat and poultry and dairy limited at the top. It is also almost the reverse of the 2020 Healthy Eating Plate. The 2025-2030 inverted pyramid does at least have vegetables at the top, but fruits are somewhere in the middle. 

The full version of the new guidelines consists of only nine pages. there is no listing of an advisory committee or any scientific reviewers. The only authors listed are Robert F. Kennedy Jr (Secretary of HHS) and Brooke Rollins (Secretary of Agriculture).

The 2025-2030 guidelines have a little good advice (eat mostly unprocessed foods and avoid added sugar ), and a great deal of very questionable advice. See below

Fats

The 2026 guidelines advise eating (or drinking) full fat dairy (all saturated fat), They advise that healthy fats include beef tallow and the fat in red meat (all saturated fats). Here is a quote from the 2025-2030 guidelines:

“Healthy fats are plentiful in many whole foods, such as meats, poultry, eggs, omega-3–rich seafood, nuts, seeds, full-fat, dairy, olives, and avocados. When cooking with or adding fats to meals, prioritize oils with essential fatty acids, such as olive oil. Other options can include butter or beef tallow.”

Note that meats, poultry and eggs are listed before nuts, seeds olives and avocados and full fat dairy is mentioned in the middle of those much healthier polyunsaturated fats.

Another interesting quote from the 2025-2030 guidelines: 

“More high-quality research is needed to determine which types of dietary fats best support long-term health.” 

This is absolutely not true. There is plenty of research showing polyunsaturated oils and fats lower the risk of cardiovascular disease. I suspect this statement is a veiled reference to Kennedy’s completely unsubstantiated idea that seed oils, which are polyunsaturated oils are bad for you. Seed oils are polyunsaturated oils and have been shown to lower the risk of cardiovascular disease. Even polyunsaturated fats should account for no more than 20-35% of daily calories.

The 2025-2030 guidelines do say that saturated fats should be limited to no more than 10% of total daily calories. This is the same as recommended in the 20020-2025 guidelines. It is not clear how you would do that by eating full fat dairy, using beef tallow for cooking, and eating red meat for protein. We know that eating too much saturated fat increases the risk of heart disease and stroke. The American Heart Association recommends limiting unsaturated fat to only 5-6% of total daily calories.

Protein

The 2026 guidelines suggest protein intake of 1.2 to 1.6 grams of protein per kilogram of body weight. This is the amount of protein recommended for very active people (i.e. long distance runners and weight lifters. People who are more sedentary need only 0.8 grams of protein per kilogram and moderately active people only need about 1 to 1.5 grams of protein per kilogram of body weight.

The average American eats about 20% more than the recommended amount of protein (see this link from BBC Science Focus). Not only do we eat more protein than we need, two thirds of that protein comes from animals (Department of Agriculture Food Surveys Research Group).

Alcohol

Previous versions of the Dietary Guidelines for Americans have recommended a maximum of 1 drink a day for women and 2 drinks a day for men. A change to 1 drink per day for both men and women was proposed for the 2020-2025 guidelines, but any change in this recommendation was actively opposed by the alcohol industry so the advice remained unchanged. 

The best current science shows that there is no totally safe level of alcohol intake. Alcohol at any level increases the risk of cancers of the GI tract, high blood pressure, cardiomyopathy, sleep disturbance, and dementia. The more alcohol consumed, the bigger the risk. Another problem is that “drink” means different things to different people 

The UK national health service uses a measure called a “unit” of alcohol. A unit is 10 ml (about 1/3 oz) of pure alcohol. That is the amount that most people can metabolize in 1 hour. The NHS recommendation is that no more than 14 units per week is a low (not zero) risk level of alcohol consumption. Here is a chart showing what 14 units of alcohol is in common alcoholic drinks:

A shot of spirits is 25 ml (.8 oz) of 80 proof alcohol, which is equal to 1 unit. 

The 2025-2030 guidelines recommendations just say “Consume less alcohol for better overall health.” This guidance is not very helpful.

Bottom Line

The 2025-2030 Dietary Guidelines for Americans are poorly researched and contain much advice that is contrary to current nutritional science. I strongly recommend that you ignore them. The 2020-2025 Dietary Guidelines for Americans remain the most comprehensive and well researched nutritional advice and I would advise that everyone continue to use them.

Alcohol intake recommendations are not current in either guideline. Although there is no absolutely safe level of alcohol intake, the UK NHS alcohol guidelines using units of alcohol as the measure make the most sense.

Water Fluoridation

This is another post responding to misinformation promulgated by HHS Secretary Robert Kennedy Jr. Misinformation seems to proliferate faster that true science-based information. Perhaps one way to combat this is for readers of these blog posts to share them as widely as possible to people they know.

Secretary Kennedy is opposed to adding fluoride to public water supplies. He maintains that adding fluoride to public water supplies causes lower IQ’s in children. Two states, Utah and now Florida have already banned fluoridation of public water supplies, mostly in response to his claims about the evils of water fluoridation. I will examine the evidence for these claims in this post

Positive effects of water fluoridation

The US Public Health Service recommends public water fluoridation at a level of 0.7 mg per liter. This level of fluoride in water reduces tooth decay in children by 25% even in children who do not brush or floss regularly. This therefore most benefits poor and marginalized populations for whom dental hygiene can be difficult. Public water fluoridation at this level is one of the most effective public health interventions. Tooth decay can lead to chronic inflammation, which can lead to many other diseases including heart disease.

Sources of natural fluoride

Fluoride occurs naturally in almost all water supplies through the erosion of rocks and soil containing fluoride. The levels of natural fluoride are usually too low to prevent tooth decay, but some water supplies have much higher levels of natural fluoride up to as much as 50 mg per liter in some mountainous and volcanic regions.

Adverse effects of high natural fluoride

Fluorosis

Fluorosis has two components. At fluoride levels greater than 1.5 mg/L children who have growing teeth can develop brown discoloration of teeth. This is called dental fluorosis and is mostly a cosmetic problem. Long term exposure to fluoride levels greater than 10 mg/L can lead to skeletal fluorosis, which is a much more serious condition.  In skeletal fluorosis the bones are generally weaker than normal with stiffness and pain in the joints as the early symptoms. In severe cases, muscles are impaired and bones in the central skeleton are irregularly thickened.

Lower IQ in children

In January of 2025 JAMA (Journal of the American Medical Association) published an analysis of combined data from many international studies that showed lower IQ scores in children exposed to higher levels of fluoride from all sources: Fluoride Exposure and Children’s IQ Scores. The study found that the higher the exposure to fluoride, the lower were the children’s IQ scores. This finding was statistically significant for levels above 1.5 mg/L but not at or below this level. None of these studies were done in the United States. The US Public Health recommendation of 0.7 mg/L is well below the threshold for association of lower IQ in children.

Other sources of fluoride

The most significant other sources of fluoride are supplements, toothpaste and oral rinses. For children who have fluoride at 0.7 mg\l in drinking water, fluoride containing supplements should not be given. Most toothpastes contain fluoride, so children with fluoride in the water supply should use only a pea sized amount of toothpaste per brushing and should be encouraged to spit out the toothpaste after brushing. If the water supply has not been fluoridated and contains only trace amounts of natural fluoride, then supplements should be given to children.

Bottom Line

Fluoridation of public water systems at the recommended concentration of 0.7 mg/L is safe and effective at markedly reducing tooth decay in children. There is no evidence that fluoride in water at this level has any adverse effects. There is some evidence that concentrations of higher than 1.5 mg/L are associated with modest decreased IQ in children. Elimination of fluoride from public water systems will increase tooth decay in the most vulnerable populations and will not have any benefit. Children who live in communities with fluoridated water should not take fluoride supplements, should use only small amounts of fluoridated toothpaste, and should be encouraged to spit out toothpaste after brushing and not swallow it. Communities who have high natural levels of fluoride in drinking water can reduce fluoride to safe levels by reverse osmosis or charcoal filter systems.

Is Sugar Poison? Do Food Dyes Cause cancer and ADHD?

In a March 28 speech in West Virginia, HHS Secretary Robert F. Kennedy Jr. said “So the loneliness, the dispossession, the crisis that we have in mental health, in suicide, in ADD, ADHD, all of these are linked — and particularly to the dyes,” Kennedy also said in that same speech, given alongside Gov. Patrick Morrisey, “It’s very clear the dyes that Gov. Morrisey is banning, all of them are linked in very, very strong studies to ADHD and to cancers. So we’re seeing an explosion in cancers in this country.” At a recent press conference he also said “Sugar is poison”

As usual, there is almost no evidence to back up these claims. There are some reasons to eliminate food additives and limit sugar intake. In this post I will talk about those reasons without making up spurious associations that have no real evidence.

Sugar

It is clear that too much sugar is not good for you. It can lead to tooth decay in children (which water fluoridation helps prevent). It can also lead to liver disease, increased triglycerides, obesity and heart disease. A modest amount is fine. High fructose corn syrup is a bigger problem, which Kennedy does not even mention. See my previous post Sugar and High Fructose Corn Syrup. Sugar in excess is not good for you. Modest amounts are not associated with any health problems. Sugar is not poison!

Food dyes and food additives

There are a number of food additives that have been proven to be safe. These include:

  • Guar Gum: A thickening agent derived from guar beans, used in various food products like ice cream and yogurt. 
  • Xanthan Gum: A thickening agent and stabilizer used in salad dressings, soups, and sauces. 
  • Inulin: A fiber substitute derived from chicory root, offering a smooth and creamy texture and supporting gut health. 
  • Vinegar: A natural preservative, used in pickling, canning, and other applications. 
  • Ascorbic Acid: The synthetic form of vitamin C, used as an antioxidant and preservative, also beneficial for immune support and iron absorption. 
  • Monosodium Glutamate (MSG): Used as a flavor enhancer, generally considered safe. 
  • Citric Acid: Naturally found in citrus fruits and used as an acidity regulator and preservative. 
  • Beta-Carotene: A natural colorant used in various foods.
  • Riboflavin: riboflavin is just vitamin B2. It is a food additive used for both fortification and coloring. It’s a yellow to orange-yellow crystalline powder that is naturally found in many foods and also produced synthetically for use as a food additive.

Most other food dyes and additives have not been tested adequately to prove they are not toxic. There is no real evidence that they cause cancer or any other health problem, but there is also not adequate evidence that they are safe. Removing these dyes and additives is a good idea, but is going to be difficult to accomplish because they are used in highly processed foods that are the biggest money maker for the big food industry.

Plastics

Microplastics and chemicals that leach from plastic containers are a much bigger health hazard than food additives. There is good evidence that chemicals from plastics cause harm, including affecting the endocrine development of children. See my previous post Toxic Chemicals We Regularly Consume and How to Stop Consuming Them. Secretary Kennedy has not even mentioned the health hazards of plastics.

“Explosion of Cancer”

In fact the incidence of most cancers, particularly lung cancer have decreased in recent years. The incidence of some cancers have increased minimally. See this report from the National Cancer Institute: Annual Report to the Nation 2025: Overall Cancer Statistics. There is not an explosion of cancer in the US as Secretary Kennedy claims.

Bottom Line

Sugar is not poison. Too much sugar is bad for you but modest amounts are not. You should avoid as much as possible foods that have added sugar or especially high fructose corn syrup. Quite a few food additives have been proven to be safe. Many others have not been adequately tested for toxicity in humans, but there is no evidence for a specific health hazard for any of them. There is no convincing evidence that they cause mental illness, cancer or ADHD. Removing these dyes and additives would be a good idea but will be difficult. Chemicals leached from plastics in food containers have proven health hazards. People should switch to glass containers where possible. There is no “explosion of cancer” in the US.

Autism: Is There Really An Epidemic?

Robert F. Kennedy Jr has reported that there is an epidemic of autism. It is clear that autism is being diagnosed more frequently in the last 10 years, but does that represent an increase in the incidence of autism or better diagnosis? In this post I will review the literature about autism in order to give an evidence-based answer to that question.

Diagnostic Criteria Changes Over Time

There is an excellent paper describing how the criteria for diagnosing autism has changed over time: Update on diagnostic classification in autism. The following information is taken from that paper.

The diagnosis of autism was first described in 1943 by Kanner. Prior to that children with severe autism symptoms were diagnosed as “schizophrenia of childhood.” In 1944 Ausberger reported on a group of children who had similar symptoms to the children Kanner described, but they had no intellectual deficits.

It was not until 1980 that the diagnostic criteria for autistic disorder were included in the Diagnostic and Statistical Manual (DSM)-III). Core features were onset prior to 30 months of age, pervasive lack of responsiveness to others, gross deficiencies in language development, peculiar speech patterns, and bizarre responses to the environment, including resistance to change and fascination with objects. This led to a marked increase in the diagnosis of more severe autism. In 1987, DSM-III-R expanded the menu of symptoms supporting the diagnosis of autism, and formally separated core features into three domains of impairment in social interaction, communication, and restricted or repetitive behaviors.

The next significant change occurred in the DSM -IV in 1994 with the introduction of the diagnosis of Asperger’s disorder. Aspergers’s disorder included what used to be called high functioning autism (autism without intellectual disability). The addition of diagnostic criteria for less severe forms of autism led to another increase in the diagnosis of autism.

In the years since the introduction of the DSM-IV criteria, advances in genetics found that all of the autism disorders had a strong genetic component and that the different forms of autism-like illnesses probably were manifestations of the same condition. In 2013 in DSM V, all of the the autism like illnesses including Asperger’s syndrome were combined into something called autism spectrum disorder.

Subsequent research showed that autism could be diagnosed as early as 18 months of age. This led to the recommendation by the American Academy of Pediatrics that all children should be screened for autism at 18 and 24 months of age. This universal screening has resulted in finding many more cases of autism at an early age that would have been missed previously, or the diagnosis delayed.

Causes of Autism

Genetics is a causal factor in 60%-90% of Autism. Autism is also is associated with prematurity, older parents, low birth weight, air pollution, and perhaps other environmental factors. Autism is not associated with any vaccines or with thimersol. Multiple large well designed studies have found no association between any vaccine, multiple vaccines, and thimersol with autism.

Neurodiversity

An alternate way to view the autism spectrum is not as a disorder, but as an example of neurodiversity. In the neurodiversity perspective, there is natural variation in human brains and minds and there is no single “normal” way to think, learn or behave. Neurodiversity encompasses the wide range of neurological differences, including those often associated with conditions like autism, ADHD, and dyslexia. The neurodiversity paradigm views these differences as strengths and not deficits, promoting acceptance and inclusion of all individuals. Organizations of persons with autism like the Autism Self-Advocacy network promote autism as neurodiversity rather than the medical model of a disorder.

Bottom Line

It is clear that the increased sensitivity to diagnosing autism as well as the universal screening of children at 18 and 24 months has led to the increase in the diagnosis of autism from one in 150 in 2000 to one in 36 in 2020. There is no evidence that there is an epidemic of autism, but rather that diagnosis has improved tremendously. Children on the autism spectrum, even the ones with the severe form of the condition do much better when diagnosed early. There is no cure for autism (and the autism advocacy movement would say that no cure is needed), but the earlier it is diagnosed and interventions begun, the better the long term outcomes.

MMR Vaccine Risks in Perspective

This post is a follow-up to my recent post about measles and MMR vaccine. The purpose of this post is to compare the risk of adverse effects from the MMR vaccine to other risks that we take with our children every day.

Annual Deaths of children under 18

In the US 37,000 children under the age of 18 die every year. In 2022, the last year for which we have complete data, 604 children were killed in automobile accidents. This figure includes those killed as passengers, walking to school or in their neighborhoods, or riding their bicycles. Here is a table from the New England Journal of Medicine showing the most common causes of death of children since 1999.

As you can see from the graph, motor vehicle deaths of children have gone down significantly since 1999, but are still the second leading cause of death in children. Firearm injuries have now surpassed motor vehicle deaths as the leading cause of death in children.

All of these risks are small, the highest being 4.5 deaths per 100,000 Children. These are risks we take with our children every day. There is a risk when they ride in your car. There is a risk when they walk in their neighborhoods. There is a risk when they ride their bicycles. There is a risk that they will be killed by a mass murderer when they go to school. The risks of adverse reactions to vaccines are actually lower than the risks that we take with our children every day. Adverse reactions to vaccines almost never kill children

Deaths of children due to MMR vaccine

There have been only two documented deaths due to MMR vaccine in the 62 years it has been available. Both of these deaths were in children with Severe Combined Immunodeficiency Syndrome (SCIDS). You may remember a movie about a child with this syndrome. It was called “The Boy in the Bubble.” These children should never have received a live virus vaccine, such as MMR.

MMR Vaccine and Autism

Robert F. Kennedy Jr, the current head of HHS, has contended that MMR vaccine causes autism. There was a paper published by Andrew Wakefield in the medical journal, the Lancet, that studied 12 children and concluded that MMR vaccine was linked to autism. It was later discovered that he had falsified his results and the paper was retracted by the Lancet. This discredited paper, plus another one by the same author are still cited by people, including our current head of HHS, as evidence that MMR vaccine causes autism.

Study by Brent and Taylor

Brent and Taylor and colleagues examined the records of 498 children with autism. Cases were identified before and after MMR vaccine became available in the UK. They compared the incidence of autism in vaccinated and unvaccinated children and found no difference.

Study by Madsden and Colleagues

Madsden and colleagues did one one of the best and most rigorous studies. The study included 537,303 children representing 2,129,864 person-years of study. Approximately 82% of children had received the MMR vaccine. The risk of autism in the group of vaccinated children was the same as that in unvaccinated children. Furthermore, there was no association between the age at the time of vaccination, the time since vaccination, or the date of vaccination and the development of autism.

Other studies

Many other well designed studies have shown no association between the MMR vaccine and autism.

Bottom Line

We daily accept small risks of injury and death of our children. There are no activities involving children that are without some risk. The risks of MMR vaccine side effects (or any other vaccine) are no larger than the risks we take with our children every day. See my last post for a list of possible side effects of MMR vaccine. Severe side effects of MMR vaccine are very rare. When given appropriately to children with normal immune systems, death is not one of the risks. The one study by Andrew Wakefield that showed a connection with MMR vaccine and autism was shown to be fraudulent and was retracted. Multiple well designed studies have definitively shown that MMR vaccine does not cause autism.

Antivaxxers – What Motivates Them?

The scientific evidence is clear that vaccines, starting with the smallpox vaccine developed by Edward Jenner in 1796 have saved millions of lives. Mild adverse reactions such as fever, sore arm and fatigue are relatively common. Serious adverse reaction to any and all vaccines in use today are extremely rare, on the order of one in a million. These serious reactions are almost always severe allergic reactions that occur immediately and can be treated successfully.

Despite the overwhelming evidence of the safety and efficacy of vaccines, there have always been people who were opposed to vaccines starting with the smallpox vaccine in the 1790’s. Recently, perhaps due to the influence of social media, there are an increasing number of people who think that vaccines are harmful and refuse them for themselves and their children. These beliefs tend to be strongly held and not very amenable to change even when they are presented with the scientific evidence.

In this post I’m going to write about the reasons antivaxxers give for refusing vaccines and explore some possible reasons that it is so hard to change these erroneous beliefs.

Concerns about Safety of Vaccines

Autism

In 1998 Andrew Wakefield and twelve other authors authored a paper that was published in the New England Journal of Medicine suggesting that the MMR vaccine was associated with autism. The paper was eventually found to be based on fraudulent data and it was retracted. In the aftermath of the Wakefield article several large well designed studies showed no evidence of a connection between MMR or any other vaccine with autism. Nonetheless many people opposed to vaccines continue to site the discredited Wakefield paper.

Pertussis Vaccine

In the 1950’s there were some reports of children developing seizures after pertussis immunizations. An extensive review of these cases found no evidence that pertussis vaccine was the cause of the seizures. Because of public concern, the pertussis vaccine was reformulated so that it did not contain dead pertussis bacteria. This is now called acellular pertussis vaccine so that the combined diphtheria tetanus and acellular pertussis vaccine is abbreviated DTaP.

Thimerosal

In the 1960’s some people became concerned that some of the components of vaccines were toxic. The biggest concern was about a preservative called thimerosal, which contained a small amount of mercury. The vast majority of studies showed no evidence of any association between thimerosal exposure in vaccines and any adverse neurologic outcomes, but a few studies showed a slight association. Since 2001, no vaccines contain thimerosal.

Aluminum

Many vaccines contain a small amount of aluminum which serves to as an adjuvant, which means it increases the effectiveness of the vaccine. In large doses aluminum can cause neurological problems and autoimmune diseases. Some people have been concerned about the safety of aluminum in vaccines. Some people think Aluminum in vaccines causes autism. Aluminum is present in food and water in much higher doses than that present in vaccines. It is poorly absorbed and what is absorbed is quickly excreted in the urine.  An FDA analysis shows that the body burden of aluminum following injections of aluminum-containing vaccines never exceeds safe US regulatory thresholds based on orally ingested aluminum even for low birth-weight infants. As noted previously a possible link to autism has been disproved by several large well designed studies.

Formaldehyde

Some people have expressed concern that formaldehyde in vaccines is toxic for children. Formaldehyde has a long history of safe use in the manufacture of certain viral and bacterial vaccines. It is used to inactivate viruses so they don’t cause disease and to detoxify bacterial toxins, such as the toxin used to make diphtheria vaccine. Almost all the formaldehyde is removed in the manufacturing process, but tiny amounts can remain. The body actually makes more formaldehyde which it uses in DNA synthesis than the tiny amount that remains in vaccines.

Lack of Trust

Although all of these concerns about toxins in vaccines have been addressed or disproved, there are still some people who lack trust in the vaccine manufacturers, the medical system and the CDC whose Advisory Committee on Immunization Practices (ACIP) makes recommendations for vaccine administration. Because of this mistrust, no amount of evidence from these groups will convince these people that vaccines are safe.

Religious Objections to vaccines

Although no major religions are opposed to vaccines, certain religious groups refuse vaccination. One common religious objection is that certain vaccines are manufactured by growing virus in fetal fibroblast cells from an aborted fetus. These cells were originally obtained from two aborted fetuses in the 1960’s. The cells have been cultured since then, so it is not necessary to obtain any more cells from fetuses. The viruses are separated from the cells, so that vaccines contain no fetal tissue. The vaccines that are grown in fetal fibroblast cells are the live virus vaccines including measles, mumps, rubella, chicken pox, the Imovax vaccine for rabies and the Janssen vaccine for COVID-19.

Opposition to Mandates

Americans are overwhelmingly supportive of all vaccination mandates with support ranging from a high 90 percent of respondents for DTaP, polio, chickenpox, and MMR to a low of 68 percent for COVID-19. Support of the HPV vaccine is somewhat lower, but still more than 50%. A smaller number of people feel that they should not be forced to vaccinate themselves or their children through state mandates. Some of this group may be willing to receive vaccinations if they feel they have a choice.

Philosophical Objections

There is a group of people who see some benefit in having their children contract certain preventable diseases. Some parents believe that natural immunity is better for their children than is immunity acquired through vaccinations. Others express the belief that if their child contracts a preventable disease, it will be beneficial for the child in the long term, as it will help make the child’s immune system stronger as he grows into adulthood. Some parents believe that the diseases for which we vaccinate are not very prevalent so their children are at minimal risk of contracting these diseases. For this reason, they also believe that the possible negative side effects of vaccine administration outweigh the benefits of the vaccines. Many parents do not see the preventable diseases as serious or life-threatening and would prefer to not put extra chemicals into their children’s bodies. Other parents think if their children have healthy diets and lifestyles they are at a decreased risk of contracting preventable childhood diseases. They also are under the assumption that if they were to contract one of the diseases that it would be easily treatable. Although all of this sounds reasonable on the surface it is absolutely wrong. See the good reasons to administer vaccinations in one of the sections below.

Conspiracy Theorists

Some people have a worldview that it’s commonplace for groups of elites to conduct elaborate and sinister hoaxes on the public, and to do so in near-perfect secrecy. They think this is just how the world works, and to believe anything else is naïve. There is a very strong correlation’s between conspiracy thinking and vaccine resistance.

Beliefs about conspiracies are very difficult to change. Evidence presented against the conspiracy by health care professionals are seen as part of the conspiracy. Conspiracy beliefs about vaccines can include believing the pharmaceutical companies or the CDC are covering up adverse effects of vaccines including that they cause autism.

Desire for Additional Information

Some parents are concerned about what they have seen on social media about vaccines and just want more information from health professionals about the safety and reasons for vaccines. This type of vaccine hesitancy is the most amenable for change by providing honest and clear information about the safety of vaccines.

The Good Reasons to Give Recommended Vaccines

It is true that many (but not all) of the diseases preventable by vaccines were relatively mild in most children. Prior to vaccines, however, 30 per cent of children died before the age of 5 from infectious diseases that are treatable or preventable today. Parents today have never seen a child with diphtheria, whooping cough, or tetanus. These were diseases that killed children prior to the vaccines and they could recur if enough people refuse vaccines.

Polio

The polio virus attacks the nervous system in children. It was a feared disease in the late 19th and early 20th century. In an outbreak in the early 1950’s. Over 2000 people died and many children had permanent paralysis. Paralysis of the respiratory system led to many children being placed in external respirators called iron lungs. Epidemics tended to occur in the summer. Parents kept children away from public gatherings like swimming pools and movie theaters. On April 12, 1955 the Salk vaccine was introduced and mass immunizations began, often in schools. Cases dropped dramatically. Several years later the Sabin oral polio vaccine was introduced. It was so effective that polio was completely eradicated in the United States. Polio vaccine is therefore no longer recommended for children in the US. Pockets of polio virus infection remain in other parts of the world. The most recent cases were in Gaza during the Israeli invasion of Gaza. Emergency vaccination of children in Gaza were carried out and the disease was brought under control.

Measles

Although measles is a relatively mild disease for most children it can be very severe and cause death for some. Before the introduction of measles vaccine in 1963 and widespread vaccination, major epidemics occurred approximately every two to three years and caused an estimated 2.6 million deaths each year.

Mumps

Mumps prior to the mumps vaccine was very common and mild in most children. Complications of mumps include inflammation of the testes, ovaries and pancreas, hearing loss, meningitis, and encephalitis. These are more common in adults than in children. Mumps was one of the most common causes of aseptic meningitis and hearing loss in children in the United States prior to the introduction of the vaccine.

Rubella

Rubella (German measles) is a mild disease but if contracted by a pregnant mother can result in severe fetal deformities and sometimes still birth. The rubella vaccine prevents rubella infection.

Influenza

Influenza occurs in epidemics. One strain in 1918 caused a pandemic with millions of deaths. There are always deaths from influenza in unvaccinated people every year. Influenza vaccine is effective in preventing or reducing the severity of illness. The influenza virus develops new mutations easily, so the vaccine has to be changed every year. The flu season in the southern hemisphere occurs during our summer, so flu vaccines for the northern hemisphere are developed based on the strains found to be circulating in the southern hemisphere flu season. This process can cause some variation in the effectiveness of the flu vaccine from year to year, but it always offers some protection and reduces the severity of illness from influenza virus.

Haemophilus Influenza

Before the Haemophilus influenza vaccine, this bacteria was the leading cause of bacterial meningitis, joint infection and ear infection in children. This vaccine was introduced after I was already in practice. I treated one case of bacterial meningitis in a child and several joint infections caused by H-flu. After widespread vaccination, I never saw another case.

Varicella (Chicken Pox)

Varicella is a very infectious disease in childhood. There are a few people, especially young infants who have severe disease requiring hospitalization. In the 25 years before the varicella vaccine was available there were over 2000 deaths from varicella. Giving the vaccine at 12-15 months of age protects vulnerable infants, and older people with chronic disease.

Human Papilloma Virus

The human papilloma virus (HPV) , which is transmitted by sexual intercourse, causes cervical cancer in some infected women. The HPV vaccine, given to preadolescent girls and boys prevents 90 % of cervical cancer in women.

Respiratory Syncytial Virus (RSV)

Most children and adults with RSV have mild cold-like symptoms with cough. About 3 per cent of babies with RSV have severe disease and require hospitalization and sometimes have to be placed on a mechanical ventilator. Young infants are more at risk as well as older adults, especially those with chronic disease. There is a vaccine for both babies and adults that is very effective at preventing RSV.

Rotavirus

Rotavirus is a highly contagious virus that infects the lining of the intestines. Symptoms include: High fever, Severe and persistent vomiting, and Diarrhea. It can usually be treated at home, but can cause severe dehydration. Prior to the availability of the oral rotavirus vaccine rotavirus was a leading cause of severe diarrhea in infants and children. There were 70,000 hospitalizations a year for rotavirus and 20-60 deaths per year. The oral vaccine is very effective at preventing rotavirus infection.

Hepatitis b

Hepatitis b can be contacted through sexual intercourse or by contaminated needles. Unlike hepatitis C, there is no effective treatment for hepatitis b. Hepatitis b can cause cirrhosis of the liver as well as liver cancer. Initially the vaccine was given only to high risk people, but it turned out that we were really bad at identifying who was at risk. Hepatitis b vaccine is now given to all babies and it has essentially eliminated hepatitis b.

Pneumoccocus

Before the vaccine, every year pneumococcus caused about 700 cases of meningitis, 17,000 cases of bloodstream infections, 200 deaths and 5 million ear infections in children. The pneumococcus vaccine is very effective at preventing these infections.

Meningococcus

Meningococcus is a bacterium that can cause meningitis or blood stream infection (sepsis). When it occurs It can be treated with antibiotics if caught quickly enough but it progresses so rapidly that people are deathly ill by the time they make it to the doctor. There is now a vaccine to prevent meningococcus infection. It is recommended for all adolescents between ages 11 and 12.

Shingles

Shingles is a reactivation in adults of childhood infection with chicken pox. It is a painful blistering rash along the distribution of a nerve on one side of the body. It can occur on any part of the body. Some people have persistent pain long after the rash is gone. This is called post herpetic neuralgia. Two doses of the vaccine called Shingrix is 98% effective at protecting adults from developing shingles. It is recommended for all adults age 50 and over.

Bottom Line

People can be opposed to receiving vaccines for themselves or their children for many reasons. Some people who just want more information can often be convinced of the safety of vaccines and then agree to be vaccinated. Other reasons such as mistrust of medical and public health sources of information and conspiracy thinking are very resistant to change. Philosophical objections including the belief that getting childhood illnesses gives better immunity and the low risk of infection of vaccine preventable diseases obviates the need for vaccinations are also resistant to change. The diseases that current vaccines prevent, although often mild in most people all have caused hospitalizations and deaths in the period prior to vaccine availability. All current vaccines have been shown to be very safe and associated with only mild transient side effects. Serious reactions to vaccines are extremely rare (on the order of one in a million) and are almost all amenable to treatment.

Longevity – Health Span vs Life Span

Longevity is the newest health buzzword. There are an increasing number of so-called longevity experts. They say, just read my book and follow my instructions and you can live past 100 years. Some of these “experts” focus on health span. They say follow my instructions and you will stay healthy and die suddenly at an advanced age. As of 4/21/2024 there are 34 books on longevity listed on Amazon.

In this post I will do my best to distinguish the hype from the science with regard to living a long and healthy life.

Hype

  1. Calorie restricted diets – Some people have extrapolated mouse and rat experiments that show that animals fed restricted calorie diets live a lot longer than animals fed a normal diet. There is not one shred of evidence that this works with humans, and is more likely to lead to diseases of malnourishment.
  2. Nutrtional supplements – Recommendations range from vitamins, to protein powder, to collagen powder, to herbal preparations, to encapsulated fruits and vegetables. There is absolutely no evidence that any of these things or any other supplements including multivitamins work to extend your life. Anecdotal reports of feeling better on these supplements are almost certainly a placebo effect
  3. Anti-aging medicines – reservetrol, metformin, rapamycin have all been shown to prolong life in some experimental animals. In humans Metformin and reservetrol decrease the ability to exercise and rapamycin suppresses the immune system. There is no evidence whatever that these compounds increase life or health span in humans.
  4. Extensive lab tests – Other than lipid (cholesterol) tests, there is no evidence that otherwise healthy non-obese people benefit from any blood tests. More about screening tests later.
  5. Imaging tests – One of the most popular longevity “experts” ,Dr. Peter Attia, recommends full body MRI scans for his patients. Imaging tests in people who have no symptoms are much more likely to lead to over diagnosis and unnecessary treatment than to find things that really need to be treated,
  6. Very intense exercise regimens – The only thing very intense exercise regimens accomplish that moderate exercise regimens do not is that the intense regimens are more likely to cause injury.

Science

Genetics

Up until into the 80’s, lifestyle is the major contributor to healthy aging. There are some people, however who remain healthy well into their 90’s and a few to past 100. Genetics is the main contributor to these “super centenarians.” There is not a single or even a few aging genes. Super aging is caused by hundreds of genetic variants called SNP’s (single nucleotide polymorphisms). We cannot alter our genes (yet), so there are no lifestyle changes you can make in order to live to 100 if you don’t have the rare combination of all these genetic variants.

That is not to say that lifestyle is not important to healthy aging. In the US, the average person’s last birthday in good health is age 65! Lifestyle changes will almost certainly help you do better than that.

Exercise

Regular exercise decreases your risk of chronic disease and therefore increases your chance of living healthier longer. To accomplish the maximum health benefit the CDC recommends 150 minutes of moderate exercise per week. Brisk walking or cycling at a moderate pace on level ground would qualify. If you choose high intensity exercise like jogging or running or high intensity cycling, you only need to do 75 minutes a week according to the CDC. The CDC also recommends activity to strengthen your muscles two days a week. For a population of adults doing this exercise regimen the risk of death is decreased by 17%. This regimen decreases the risk of heart disease, diabetes, certain cancers and decreases the risk of hospitalization or death from infectious diseases like COVID, flu and pneumonia. This regimen also increases bone and muscle strength and thus decreases the risk of falls and fractures. This exercise regimen also helps maintain a healthy weight.

Any amount of walking or activity decreases risk somewhat. The CDC recommended regimen decreases risk the most.

Nutrition

Eat mostly unprocessed foods and avoid ultra-processed foods. The best way to identify ultra-processed foods is to look at the ingredients label. If there are more than four ingredients, and/or if there are some you don’t recognize, then put that food back on the shelf. It is best to keep nutrition advice simple. The most concise recommendation I know comes from author Michael Pollan. “Eat food (food is anything your grandmother would have recognized as food), not too much, mostly plants.” I can’t do much better than that. Most of the evidence about the beneficial effects of good nutrition come from studies of the Mediterranean style diet. The Mediterranean diet adheres to Michal Pollan’s advice. It has lots of fruits, vegetables, fish, olive oil and very little meat. Adherence to this type of diet showed a 46% increase in living healthfully until 70 or greater.

Social Connectedness

The CDC defines social connectedness as the degree to which people have and perceive a desired number, quality, and diversity of relationships that create a sense of belonging, and being cared for, valued, and supported. An analysis of multiple studies showed that high social connectedness as defined above decreases the risk of premature death by 50%! High social connectedness also decreases the risk of heart disease, stroke and dementia.

Social Determinants of Health

The main reason that the US average health span is 65 years is the tremendous inequity of resources in the US. People who live in substandard housing (or no housing at all) do not have the opportunity or resources to do all of the things above that tend to extend life. That is why life expectancy at birth is related to zip code more than any other factor. My feeling is that we should expend our resources working on improving health equity, which will increase both life and health span for everyone rather than focusing on helping wealthy people live to 100.

Screening Tests

There are a few screening tests recommended by the US Preventive Care Task Force for healthy people. These tests are meant to find disease, especially cancer early so it can be more successfully treated and thus prolong healthy life. The absolute risk reduction of death for these tests is small, most around 1%, but that ends up saving a lot of people when you apply it to the whole US population. The recommended screening tests are listed below.

  1. Mammograms for women beginning at age 50. Recommended every two years. Absolute risk reduction about 1%.
  2. Pap Smears beginning at age 21 every 3 years through age 29 and then every 5 years from age 30 to 65. The absolute death risk reduction is .0009%, which means your would need to do pap smears on 11140 women to prevent one death from cervical cancer.
  3. Colorectal cancer screening. There are three different tests: colonoscopy, the most invasive (recommended every 10 years), Cologuard (a stool sent to a lab in a box recommended every 3 years) and fecal immunochemical test (done on a stool sample and either tested at home or sent to lab recommended every year). All three tests reduce deaths from colon cancer with an absolute risk reduction of around 0.6%. Only colonoscopy can prevent some cancers by removing precancerous polyps.

Vaccines

There is no question that vaccines save lives by preventing some serious life threatening diseases, or making them less severe. Vaccines are especially important for infants and children, who are most at risk from the infectious diseases prevented by vaccines. Childhood vaccines prevent diptheria, whooping cough, tetanus, measles, mumps, rubella, polio, rotavirus (which causes severe diarrhea and dehydration in infants), hemophilus influenza (which caused joint infections and meningitis), hepatitis b, RSV (which causes severe respiratory illness), pneumonia caused by strep (the most common kind of bacterial pnuemonia), COVID (also for adults), meningitis, chicken pox, and HPV (the virus that causes cervical cancer in women).

Adults can get any of these vaccines, but also a vaccine to prevent shingles.

Bottom Line

Living in good health to past 100 depends on genetics, not lifestyle. Many things recommended by so called longevity experts do nothing to prolong life and may increase risk. There are a number of lifestyle changes including exercise, good nutrition, social connectedness, certain screening tests and vaccines that increase you chances of remaining healthy well into your eighties. The main cause of early death in the US is poverty, homelessness and systemic racism. Addressing these inequities is a lot more important than helping wealthy people try to live to 100.

Drug Company Direct to Consumer Advertising – Costly and Dangerous

Television viewers in the United States watch an average of nine drug advertisements per day, or about 16 hours per year, far in excess of the time spent with their physician. That is because pharmaceutical companies spend huge amounts of money on direct to consumer advertising. In 2022 pharmaceutical companies spent 6.88 billion U.S. dollars on direct to consumer advertising! Pharmaceutical companies claim that these ads educate patients about treatment options they might not know about and foster conversations with their physicians. Pharmaceutical companies, however, are in the business of making money and these ads do a great deal to increase their revenue or they would not spend billions of dollars on them. This post will examine the claim that the ads are helpful to patients and doctors and will document the substantial harm that these ads do to both the health system and to individuals.

Almost all other countries besides the United States ban direct to consumer advertising of prescription medicines. The only other country that allows them is New Zealand.

History of Direct to Consumer Advertising

In the 1960’s congress granted the FDA the authority to regulate prescription drug labeling and advertising. The FDA was to ensure that prescription drug ads were: not false or misleading; presented a fair balance of drug risks and benefits; included facts that are material to a drug’s advertised use; included a brief summary that notes every risk described in the drug’s labeling. Because of these requirements, almost all drug advertising was directly to physicians.

In the late 90’s, the FDA changed the required risk information by stating that only major risks must be disclosed in ads and that they must provide resources that consumers can be directed to for full risk information. Because of this change, direct to consumer advertising has exploded since the late 90’s.

Compliance with FDA Requirements

Pharmaceutical companies are not required to submit ads to the FDA before they are used. They are required to submit ads to the FDA for review after they are in use, but the FDA lacks resources to review these ads in a timely manner. Many times the ad has already stopped running by the time the FDA gets around to reviewing it. A 2018 study published in the Journal of General Internal Medicine evaluated all broadcast direct to consumer pharmaceutical ads for 6 months for compliance with FDA regulations. The study found that only 26% of the ads were fully compliant with FDA regulations.

Online Direct to Consumer Advertising

Pharmaceutical companies have markedly increased online advertising through social media including FaceBook, Twitter (now X), YouTube and blog posts. This advertising reaches consumers in English speaking countries who ban direct to consumer prescription drug advertising. The FDA can only review a small portion of these. Here is a link to an article from an international policy journal about online direct to consumer ads by pharmaceutical companies: The Tip of the Iceberg of Misleading Online Advertising.

What the FDA does not require in direct to consumer advertising

Here is a list of important things that pharmaceutical companies are not required by the FDA to include in direct to consumer advertising.

  • Cost – Many of the medicines advertised are very expensive, especially cancer drugs. Pharmaceutical companies are not required to tell you anything about cost in their ads
  • If there is a generic version of the drug (a drug with the same active ingredient that might be cheaper) -Many times there is a generic version of the brand name drug that will do exactly the same thing as the drug advertised
  • If there is a similar drug with fewer or different risks that can treat the condition – There may also be a similar drug with fewer risks that could treat the condition advertised. The pharmaceutical companies are not required to tell you that in their ads
  • If changes in your behavior could help your condition (such as diet and exercise) – Eighty percent of chronic disease could be treated with life style changes. Ads are not required to tell you that
  • How many people have the condition the drug treats – The percentage of people who have the condition the drug treats may be very small. They don’t have to tell you that either
  • How the drug works (its “mechanism of action”)
  • How quickly the drug works
  • How many people who take the drug will be helped by it – It could be that only a small percentage of people who take the advertised drug will improve. Ads are not required to tell you that.

Evidence that direct to consumer drug advertising is helpful

There is evidence that direct to consumer drug advertising is beneficial for patients and their doctors. Here are the claims that have at least some evidence. This list come from a paper in the journal Pharmacy and Therapeutics: Direct-to-Consumer Pharmaceutical Advertising – Therapeutic or Toxic? The paper also summarizes the evidence for each of these claims

  • Informs, educates, and empowers patients. 
  • Encourages patients to contact a clinician. 
  • Strengthens a patient’s relationship with a clinician
  • Encourages patient compliance. 
  • Reduces underdiagnosis and undertreatment of conditions. 

I don’t find the evidence for any of these particularly convincing. None of the papers cited in the article disclose whether any of the authors have financial relationships with pharmaceutical companies.

Evidence that direct to consumer drug advertising is harmful

Despite pharmaceutical companies touting the educational benefits of direct to consumer advertising, remember that the main purpose of these ads is to sell a product, not to educate consumers. Here is a list of well documented harms of direct to consumer drug advertising:

  • Present incomplete or biased information – Most ads either leave out risk of the disease the advertised drug treats or use vague terms (like millions) Ads for drugs for which lifestyle modification is a viable alternative did not mention lifestyle changes. Over half of ads presented the advertised drug as a scientific breakthrough. See this paper from the Annals of Family Medicine: Creating Demand for Prescription Drugs: A Content Analysis of Television Direct-to-Consumer Advertising
  • Spur people to ask for medications they don’t need - A study published in the Journal of the American Medical Association found that “Fewer than one-third of the most common drugs featured in direct-to-consumer television advertising were rated as having high therapeutic value, defined as providing at least moderate improvement in clinical outcomes compared with existing therapies” (Therapeutic Value of Drugs Frequently Marketed Using Direct-to-Consumer Television Advertising, 2015 to 2021)
  • Promote medications before long-term safety is known. In the case of Vioxx, a new pain relief drug, it was pulled from the market due to an unexpected rise in heart attacks and strokes — but not before millions of people saw the ad and began taking it. (Merck to pay $950 million for illegal marketing of Vioxx)
  • Create conflicts between patients asking for a drug and doctors who don’t recommend it – An article in Consumer reports reported that 78% of doctors report that patients at least occasionally ask them for medicines they saw in drug ads. 54% of those doctors said they often decline these requests (Consumer Reports Survey: Patients and Doctors Disagree on Some Essential Issues)
  • Drive up healthcare costs without adding health benefits – New drugs are much more expensive than generic drugs that may do the same job. Also, unfortunately doctors are much more likely to prescribe the medicines that patient’s ask for rather than an alternative less expensive and/or more effective treatment. This is the biggest societal harm of direct to consumer prescription drug advertising. See this paper: Effects of Patient Medication Requests on Physician Prescribing Behavior.

Bottom Line

The FDA simply does not have the resources to adequately regulate pharmaceutical company direct to consumer advertising. Even if they did, it is unlikely that the FDA could even partially mitigate the well documented harms of the tremendous spending by pharmaceutical companies on these ads. I agree with my friend and mentor Dr. Kurt Stange that the only viable recourse is to ban direct to consumer drug advertising as almost every other country in the world has done. Here is his editorial in the Annals of Family Medicine: Time to Ban Direct-to-Consumer Prescription Drug Marketing.

Immunizations: What You Need to Know

This is an update and modification of an old post titled Immunizations. It seems particularly relevant now given the politicization of the whole subject of immunization in the last few years.

Many parents are concerned about the number of immunizations that are recommended for their children and whether all these shots may have some serious long term side effects. Public health recommendations that ignore these concerns have created an adversarial situation that is not helpful for parents or for their children.

To put this in perspective, lets look at the current immunization recommendations for infants and children Number of shots will be placed in parenthesis.

Newborns: Hepatitis B (One shot)

Two Months: Hepatitis B, Tetanus-Diphtheria-Pertussis, H-flu, Pneumonia, Polio, Rotavirus (Six  shots). That’s a lot of needle sticks for a baby! Fortunately there are combined vaccines that reduce the number of shots.  Using the combined vaccines reduces the number of shots at two months from six shots to three shots.

Four Months: Same as two months  except no Hepatitis B (three shots using combined vaccines)

Six Months: Hepatitis B, Rotovirus, Tetanus-diptheira-Pertussis, H-flu,  pneumonia, Polio, flu shot, COVID-19 (four shots using combined vaccines) Another COVID-19 vaccination is recommended 4 weeks after the first one.

One Year: Polio, flu shot, Measles-Mumps-Rubella, Chicken pox, Hepatitis A (Four shots using combined vaccines).

Four Years: Tetanus-Diphtheria-Pertussis, Polio, Measels-Mumps-Rubella, Chicken pox (three shots using combined vaccines).

Nine Years: HPV vaccine. Second dose in 6 months to 1 year. HPV vaccine prevents infection with the wart virus also called human papilloma virus. HPV is the main cause of cervical cancer in women. It is transmitted through sexual intercourse. Given at age 9, the immunity is lifelong so immunizing children (girls and boys) means that as adults, when they become sexually active, there will be much less transmission of HPV and much less cervical cancer in women.

That’s a lot of shots, even with the combined vaccines, not even counting the HPV vaccinations recommended at age nine..  So one question is: Is the benefit of all these shots worth the discomfort to the children (not to mention the parents)?  Another question is: Are there risks (other than temporary discomfort) to giving all these immunizations?  A third question is: Does delaying immunizations for babies reduce any risks?

Let’s take these questions one at a time.

Vaccines clearly save children’s lives, so the answer to the first question is an unqualified yes!  Most parents have never seen a case of polio, or diphtheria, or tetanus (lock jaw).  The reason is that vaccines prevent them.  These were devastating diseases that killed or paralyzed many infants and children. They have not gone away.  If the immunization rate falls, we will see them again. We already have in communities where the immunization rate has fallen below a critical level.  In times past, many children died from pneumonia caused by a class of bacteria called pneumococcus.  The pneumonia shot has virtually eliminated this disease.

I have my own story about the Hemophilus influenza vaccine (Hib).  Until this vaccine came out, I saw at least one child a year with a serious infection from this bacterium. It caused meningitis, joint infections and pneumonia.  The sickest child I ever cared for had H-flu meningitis.  Since the vaccine came out, I have never seen another case.

Rotavirus is a common cause of severe diarrhea and dehydration in infants, and some die from this.  The rotavirus vaccine prevents this disease

Some parents wonder why we give vaccines for measles, mumps, rubella (german measles) and chicken pox.  Most adults over 60 had these infections in childhood and recovered just fine. Unfortunately, lots of people did not do just fine.  Measles can cause infection of the brain and pneumonia, Many people actually died or were permanently disabled by measles. The same story holds for chicken pox.  Rubella (german measles) is a mild, self-limited illness except if a pregnant mother catches  it.  In that case it causes severe birth defects in the baby.

Another question parents often have is why we give hepatitis B vaccine to all children.  Hepatitis B is transmitted by sexual intercourse or by needle stick, but it can also be transmitted to a baby during birth.  The recommendation used to be that we gave hepatitis B vaccine only to babies of high risk mothers. That did not work very well because it was impossible to reliably identify high risk mothers.  If you know for sure that neither parent has a chance of having hepatitis B, then it is reasonable to delay this vaccine until the child is older.  The only way to be sure is for both parents to test negative for hepatitis B antibodies. Since you don’t know and cannot control what sexual experience your child will have later in life, this vaccine should at least be given before puberty.

A final question that parents have is about the COVID-19 vaccine for children. Why do we need to give the vaccine when most children have only mild disease? There are two reasons to give the COVID vaccine to babies. One reason is that although most children have only mild disease, some children get very sick and have to be hospitalized. The other reason we immunize babies and children for COVID-19 is to protect vulnerable adults that they may be exposed to. Most hospitalizations for COVID-19 now are older people and people who have other risk factors such a suppressed immune system, diabetes, COPD and other chronic diseases.

Now lets talk about risks of vaccines.  I’m not talking about mild reactions such as a little irritability, low grade fever, or mild swelling at the site of the shot. That type of reaction is fairly common and self limited.  The real question most parents have is about long term serious risks to immunizations. Here are some questions frequently asked by parents.

1. Do immunizations increase the risk that my child will get autism?  The answer is no.  There is one study often quoted by anti-vaccine groups that reported an association between childhood immunizations and autism.  It turns out that the author of the study faked a lot of his data.  It has been thoroughly discredited and in fact the journal that published it retracted it.  Several very large well designed studies that were designed to answer this question found absolutely no connection between childhood immunizations and autism.

2. Do all these immunizations overstimulate children’s immune systems and increase the risk of autoimmune diseases later in life? The answer again is no.  In order for the immune system to work properly, it is stimulated by literally thousands of environmental substances called antigens during a child’s life.  It makes antibodies against these antigens so that children develop immunities to viruses and bacteria in the environment.  The vaccine antigens represent a tiny fraction of all the antigens in the environment, certainly not enough to cause overstimulation. Studies have shown no connection between immunizations and autoimmune diseases such as multiple sclerosis, lupus, or rheumatoid arthritis

3. What about the mercury preservative in vaccines. Does that cause any long term problems?  The preservative thimersol, which does contain some mercury, has been removed from all vaccines since 1992.  There was no evidence that this caused any problems, but it is nonetheless not an issue anymore.

4. Did some children have severe reactions to the pertussis (whooping cough) vaccine?

The old pertussis vaccine was called a whole cell vaccine. It contained the entire inactivated pertussis germ. There were very rare serious reactions with this vaccine, including high fever and sometimes seizures. Now the pertussis vaccine does not contain the whole germ. It is called an acellular vaccine. Since the acellular vaccine was added to the diphtheria and tetanus vaccines (now called the DTaP vaccine), serious reactions were eliminated.

5. Can COVID-19 vaccine cause decreased fertility or other long term chronic disease?

A tiny number of adolescents who received the COVID-19 vaccine developed some inflammation of the lining around the heart. None of these children were hospitalized and all recovered completely. This did not happen when 6 month old children got the vaccine. There is no evidence whatever that COVID-19 vaccines decrease fertility in women or men. That is one of those pieces of misinformation that grow on the internet like weeds. We have seen no ill effects from the COVID-19 vaccine in infants.

6. Is there any benefit to delaying vaccines until children get older?  Once again the answer is an emphatic no.  There is no evidence of any health benefit to delaying immunizations.  All of the diseases we immunize children against are most dangerous in infancy.  Pertussis (whooping cough) and diphtheria killed many infants before we had vaccines to prevent them.  All the other diseases we immunize against have a much higher chance of causing death in infants.  If you delay your child’s immunizations, you are depending on everyone else getting immunized to protect your child.  Not only is that not fair, but in some communities the immunization rate for infants has gotten low enough that you don’t even have that protection.

Bottom Line: Immunizations for infants and children are safe and effective.  They prevent diseases that used to kill or maim many infants and children. The only downside is the discomfort of multiple shots, which can be significantly ameliorated by using combined vaccines.  Delaying vaccines until children are older is dangerous for the child and provides no health benefits.

Omicron Variant of SARS-COV-2

I will continue the series of posts on healing relationships, but I think we have enough information about the omicron variant of SARS-COV-2 to spend some time talking about it. In this post I will discuss infectivity, vaccine resistance, and some prevalent misinformation which continues to complicate rational measures to combat the virus.

Infectivity

First a little review on epidemiology. Those of you who want a more complete review can look at my previous post Epidemiology Made Simple. The potential infectivity of any virus or bacteria is described by a number called R0. R0 is the average number of other people that one infected person infects. R0 for the original SARS-COV-2 virus detected in Wuhan, China was about 2.5. That means that on average one infected person infected between two and three other people. The delta variant of SARS-COV-2 has an R0 of about 7. That means that on average one person infected with the delta variant infects 7 other people. The delta variant is almost three times as infectious as the original virus!

So far it looks like the omicron variant has an R0 of about 10. To put that in perspective, the most infectious virus that we know of is the measles virus. It has an R0 of 13. That means the omicron variant is almost as infectious as measles. That is why it is spreading so fast. Cases in the U.K. where omicron is predominant are doubling every two to three days! That makes it almost impossible to limit the spread by contact tracing.

R0 refers only to the potential infectivity of the virus in people who have no immunity. This potential infectivity can be reduced by measures that either increase immunity (such as vaccination or previous infection) and/or that limit the spread of the virus in people such as masking, social distancing and avoiding small, poorly ventilated indoor spaces.

Effectiveness of vaccines for omicron

Effectiveness of vaccines is measured two ways. First is the effectiveness of the vaccine in prevention of infection in the first place. Second and much more important is the effectiveness of the vaccine in preventing hospitalization and death.

Omicron has more than thirty mutations in the spike protein. This means that it looks very different from the original virus isolated in Wuhan. The previous definition of fully vaccinated was two immunizations. Those people who had two vaccinations had about 70% protection from infection with the delta variant, but so far in the U.K. it looks more like 10% protection from omicron infection. Protection from being sick enough to be in the hospital, though is still very good, even without a booster. Having a booster gives about 80% protection from symptomatic infection and about 99.9% protection from hospitalization and death.

Does the omicron variant cause milder disease?

It is too early to be sure about that. Hospitalization rates for people infected with the omicron variant are lower so far, but that is in countries such as the U.K. with very high vaccination rates, or like South Africa that has high numbers of people who have had COVID previously. We don’t yet know the hospitalization rate for the unvaccinated, but hospitalizations are starting to go up in the U.K. and in much of the U.S. What we can say so far is that the omicron variant does not seem to cause more severe disease, but that is all we can say at this point. Because omicron is so contagious, we will see huge increases in case numbers and therefore hospitalizations no matter what the severity of illness omicron causes.

What about children?

There have been a number of articles in the press recently about hospitalizations going up for children with COVID. While that is true, the numbers are still tiny compared to hospitalizations for adults. Children are still at substantially lower risk of symptomatic infection even with the omicron variant. That does not mean that they don’t get infected at all, just that their infections are much more likely to have no symptoms. In a recent large antibody study in Texas (more about this later) a third of the children in the study showed evidence of previous COVID. Over half of those children had no history of any symptoms at all. That is good news for the children, but bad news for adults exposed to them. It appears that infected children without symptoms could be major spreaders of COVID.

Vaccines protect children five to twelve years old as well as they protect adults. The only serious side effect for children is mild inflammation of the heart called myocarditis. This occurs in about one in one million doses, almost never requires hospitalization and goes away by itself.

There has been a great deal of misinformation about the risk of vaccination in children. A U.S. virologist, Dr Robert Malone, has posted a video claiming that the spike protein fragments created by the vaccine are toxic and cause damage to multiple organs in children. This is utterly false. Millions of children have received the Pfizer vaccine and there is not one shred of evidence that there is any organ damage other than the mild transient myocarditis that occurs in one in a million.

Is having had and recovered from COVID as good protection as having a vaccine?

There definitely is some protection from having COVID in the past. It is not as good as protection from the vaccine though, and it tends to wane more quickly than protection from the Pfizer or Moderna vaccine. In the Texas study that I mentioned earlier, called Texas Cares, the University of Texas Health Science Center recruited over 87,000 people in Texas ages 8 to 80. I was a participant in that study. Every participant filled out a survey asking about symptoms of COVID and dates of vaccinations. Then blood was drawn at a local lab at baseline and every 3 months for two more times. The survey was repeated before each blood draw.

Two antibody tests were done on each sample. One test measured the N antibody. People who were positive for N antibody had COVID at some previous time. The other test measured antibodies to the SARS-COV-2 spike protein. The spike protein antibodies are the neutralizing antibodies that protect you from severe illness with COVID. People who had only the spike protein antibody had been vaccinated but had never had COVID. The preliminary results were recently published. What they found was that spike protein antibodies in unvaccinated people with a previous infection peak at 120 days after infection and then decrease. Unvaccinated people with a previous infection overall had lower levels of spike protein antibodies than people who were vaccinated. People who had a previous infection and were vaccinated had the highest levels of spike protein antibodies.

As an example I will use my own data from this study as well as the data from a friend who had COVID but had not been vaccinated. My initial spike protein antibody level was over 300. His was 30. Three weeks after my booster of the Pfizer vaccine I went for the second blood draw. My spike protein antibodies at that blood draw were over 2,500.

This study clearly suggests that COVID vaccines give better protection than previous COVID infection and that boosters cause a big increase in neutralizing antibody. The combination of previous COVID infection and vaccination gives the best protection of all.

Should I wear a mask even if I am vaccinated and boosted?

The omicron variant is so contagious that even vaccinated and boosted people could still get infected even though that infection is likely (but not guaranteed) to be mild. My personal feeling (and the CDC recommendation) is that everyone should continue to mask indoors in public places, like grocery stores, department stores or any other public place indoors where multiple people not known to you congregate. U.S. made N-95 masks are now readily available and provide much better protection than cloth masks.

Bottom Line

The omicron variant is extremely contagious, almost as much as measles. Vaccines, especially with a booster give 80% protection from symptomatic infection and 99% protection from hospitalization and death. Children frequently get infection without symptoms and may serve to spread infection to others. Vaccinating children five to twelve is safe and effective. Having had a COVID infection in the past gives some protection but is less than protection from vaccines. Because omicron is so contagious N-95 masks should be worn in indoor public places regardless of vaccination status.