Sometimes it’s not easy being a pro-vaxxer

Despite the fact that vaccines have saved uncountable lives and virtually wiped out smallpox, polio, tetanus and rabies, vaccine risks exist. When those risks result in death, people lose trust in all vaccines.

image: Skeptical Raptor

Look at what happened in the Philippines. In 2015 they purchased three million doses of a new dengue vaccine.

Dengue is not as deadly as it might seem. Three-quarters of people infected by the mosquito-borne virus don’t notice anything. The remainder fall into three groups – symptoms similar to the common cold; or a fever accompanied by headache, pain behind the eyes, aching joints and bones that sometimes leads to internal bleeding; or the most deadly, dengue hemorrhagic fever and dengue shock syndrome where plasma seeps out of capillaries, liquid pools around organs, massive internal bleeding ensues. The brain, kidneys and liver begin to fail (Scientific American, April, 2018).

In the Philippines with a population of 105,000, dengue kills an average of 750 people a year. Any death is one too many but that number doesn’t even put dengue-deaths in the top ten list of killers. Of infectious diseases, many more die from pneumonia and tuberculosis.

The dengue vaccine wasn’t cheap. Made by the pharmaceutical company Sanofi Pasteur, Dengvaxia cost more than the entire national vaccination program for 2015, which covered pneumonia, tuberculosis, polio, diphtheria, tetanus, pertussis, measles, mumps and rubella. And it would reach less than one percent of the population.

Some wondered if the vaccine Dengvaxia had been oversold to the Philippine government in a panic mode.

Here’s where the nightmare for pro-vaxxers comes in.

Internist Antonio Dans and paediatrician Leonila Dans at the University of the Philippines Manila College of Medicine discovered some startling results: young children who were vaccinated were more like likely to suffer from dengue that those who weren’t vaccinated.

They found this out by studying publications by the makers of the vaccine, Sanofi Pasteur. While it worked for older children, for younger ones, the vaccine made things worse.

The two Dans warned the Philippine secretary of health in 2016 of their findings but in the meantime, the World Health Organization said that there was no problem.

“It was either believe us or believe the WHO,” said Antonio Dans. “If I were them, I’d believe the WHO. I mean, who were we? We were just teachers in a small medical school.”

The Philippine secretary of health responded with her own warning: doctors who engaged in “misinformation” on the vaccine would be responsible for every death from dengue that could have been prevented.

Then Eva Harris, a dengue expert at the University of California, Berkeley, found strong evidence in 2017 to support the Dans:

Harris’s evidence made the world take notice. Now Sanofi Pasteur and the WHO don’t recommend Dengvaxia for young children who have not been previously infected.

The reasons why Dengvaxia makes matters worse for children who have not been infected and better for those who have is puzzling. There are a few theories but it’s debatable.

The confusion has led to lack of confidence in vaccinations. In 2015, 93 per cent of Filipinos strongly agreed that vaccines are important.  In 2018, less than a third thought so.

Now, Filipinos suspicious of vaccines aren’t getting kids vaccinated and several outbreaks of measles have occurred.

Vaccines save lives but in a rush to save lives at any cost, the rollout of Dengvaxia was too soon and the cost was a loss of confidence of all vaccines.

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Persuade, don’t malign anti-vaxxers

 

If we really want to convince parents to vaccinate their children, name-calling and vilification is not the way to go.

image: Wired

Yet, that seems to be a common tactic. You don’t have to go far on social media to find out. Here’s an example from Twitter:

Craig Levine @AstronomerXI “Let’s call #antivaxxers what they are: pro-disease, pro-death, pro child-suffering, ignorant, arrogant, stupid, fanatical, brain-washed, pathetic, selfish.”

Having lived through polio epidemics as kid, I don’t have to be convinced of the benefits of vaccination. Polio vaccines not only saved lives, it removed my fear of going to movies and school, and of going out to play.

The danger is real. A measles outbreak in the U.S. is at a 25-yar high. Three-quarters of those who caught the extremely contagious disease are children or teenagers.

Canada has large pockets of unvaccinated children. In Ontario, they have things in common:

“Those students tended to have things in common. For instance, unvaccinated children with non-medical exemptions were more likely to go to private or religious school, or be home-schooled, live in a rural area or a community with a small- to medium-sized population and be located in the southwest and central west regions (Globe and Mail, April 30, 2019).”

The Vancouver area is also experiencing a measles outbreak this year. And in neighbouring Washington a state of emergency was declared due to a measles outbreak -although no cases have been linked to B.C.

As is typical of character assignation, reluctant parents have been unfairly grouped together. But they are not monolithic say professors Julie Bettinger and Devon Greyson of UBC and the University of Massachusetts, respectively:

“While dismissing non-vaccinating parents as anti-science, uneducated, conspiracy theorists might be tempting, we find these stereotypes represent only a small minority of this population (Globe and Mail, April 22, 2019).”

Professors Bettinger and Greyson found that these stereotypes represented a minority of non-vaccinating parents. They surveyed, interviewed, and observed more than 2,000 parents to understand what causes vaccine hesitancy and how to address it.

First, despite the characterization of non-vaccinating parents as “pro-death” and “pro child-suffering,” they have the best interests of their children at heart. Additionally, they care about other children who can’t be vaccinated and who are at risk.

Yes, they may fear the safety of vaccines as a result of what they have heard from people they trust. Some lack of knowledge of the extensive testing and safety monitoring that ensures our safe vaccine supply. Sometimes their reluctance is born from a lack of trust and a perceived betrayal by the health care system -they don’t believe anything medical researchers tell them.

Some indigenous people don’t trust the colonial system that decimated their communities by purposely introducing disease.

They may live in remote areas and face barriers of getting to clinics. Access can be a problem for urban dwellers, too, for those who can’t get time off work to take in their children.

Some fear talking to health-care providers about their concerns because they’ll be labelled as “one of those parents.”

The remedy to vaccination-resistance is not easy. Trustworthy relationships must be developed. Mobile clinics with extended hours will help. Name-calling and the failure to address the genuine concerns of parents will only deepen the divide.

 

 

We’ve evolved to move

Herman Pontzer’s discovery defied common sense. He found that exercise doesn’t result in weight loss.

image: Best Health Magazine Canada

Defying logic, upsetting the plans of many to lose weight through exercise, and threatening exercise industries -there is no connection between exercise and calories burned.

Pontzer, an anthropologist at Duke University, lived with the Hadza people of northern Tanzania. He wanted to find out how many calories these hunter-gathers burned. It’s a grueling, energy-intensive lifestyle. He compared the calories burned by the Hadza with those burned by average adults in the US and Europe. They were the same. Even comparing average and sedentary adults of the Western world, they were the same. Pontzer was astonished:

“When the analyses came back from Baylor [university], the Hadza looked the same everyone else. Hadza men ate and burned about 2,600 calories. Hadza women about 1,900 calories as day -the same as adults in the US or Europe, We looked at the data every way imaginable, accounting for effects of body size, fat percentage, age, and sex. No difference. How was it possible? What were we missing (Scientific American, February, 2017)?”

I was astonished, too, when I read the article two years ago. Isn’t the obesity epidemic caused by lack of exercise? Can’t I eat that piece of cake and work it off in the gym? If exercise doesn’t reduce weight, why bother exercising?

I’m no anthropologist but both the fuel and the exhaust of our bodies are basic -oxygen in, carbon dioxide out. If we can measure CO2 output, that’s a measure of calories burned. A clunky way of measuring CO2 would be to have subjects wear a mask that collected CO2 while they exercised or sat around: not very practical.

Pontzer used a simple but elegant method employing “doubly labelled water.” This otherwise ordinary water has two tags, one isotope of hydrogen and one of oxygen. Subjects simply drink the special water and pee in a cup later. They are not confined in any way; they go about their daily business. Their urine now contains both isotopes in different amounts. The number of hydrogen isotopes is used as a reference. The number of oxygen isotopes indicates the amount of CO2. Subtract the two numbers and you have calories burned. The results were confirmed later using a device similar to a Fitbit.

Two years later, Pontzer wrote another article with some answers. (Scientific American, January, 2019).

This time he wondered how our close relatives, the apes, can live a sedentary lifestyle and not suffer from the the diseases we get from lounging around all day. In the wild and in zoos, apes sit around most of the day but don’t get carido-vascular and metabolic diseases. Humans who lounge around as much as apes suffer from type 2 diabetes, heart and brain disease.

Using doubly labelled water on apes (they are surprisingly cooperative in the collection of urine), he found that apes had evolved so that their calorie consumption matched their activity. They had evolved to lounge around.

Long ago when we were hunter-gatherers, our calorie consumption matched our daily activity. Now we don’t have to exercise and so we don’t. The problem is that calories not burned in exercise gum up the works. When we don’t exercise, calories are burned anyway. In a way not understood, calories not burned in exercise lead to an unhealthy outcome: carido-vascular disease and poor brain health.

Pontzer’s message is clear: “Exercise is not optional; it is essential.”

Big Food vs. Canada’s Food Guide

The interests of the food industry don’t always coincide with healthy eating. What’s at stake is Canada’s new Food Guide. It’s a big deal.

image: Globe and Mail

Canada’s Food Guide is widely respected. Seventy-five years after its first launch, it’s the second most requested government document after income-tax forms. It’s distributed to dieticians and doctors for patient advice and to schools and hospitals for creating meal plans. The new guide will be around for a long time, so it’s important to get it right.

Understandably, big food lobbies want the new guide to endorse their products. Even intergovernmental departments disagree on what should be recommended. One agency, Health Canada, wants the new food guide to “shift towards more plant-based foods,” less red meats, and to limit “some meats and many cheeses” high in saturated fats.

Another agency, Agri-food Canada, disagrees. They are in the business of promoting the sale of red meat and dairy industries. Last year, AAFC officials wrote a memo marked “secret” in which they worried:

“Messages that encourage a shift toward plant-based sources of protein would have negative implications for the meat and dairy industries.”

The pressure on Health Canada comes from other food manufacturers as well. Recently, the “Canadian Juice Council” surfaced. Nutritionists had never heard of them before their bright orange booth appeared at the annual conference of the Canadian Nutrition Society. Nutritional biochemist Dylan MacKay said: “I’d never seen or heard of them before and I’ve been going to CNS conferences for years (Globe and Mail, November 23, 2018).”

The origin of the Canadian Juice Council was obscure despite the presence of a web page and a Twitter account (with 2 followers). Food reporter Ann Hui isn’t surprised at the obscurity:

“And no wonder. The Juice Council doesn’t exist in the way you might expect: as an institution disseminating impartial facts and information about juice. Rather, it was created by the lobbying arm of the beverage industry – in a practice known as ‘astroturfing,’ used by lobbyists in all kinds of industries to create the appearance of a grassroots movement and a larger chorus of voices than actually exists.”

Ann Hui found that the Canadian Juice Council was an invention the Canadian Beverage Association whose members include Canada Dry Mott’s, Coca Cola Canada, and PepsiCo Canada. The industry supports 60,000 Canadians workers, 20,000 of those directly.

The Canadian Beverage Association is worried about changes in the Canada Food Guide that would remove the equivalency of whole fruit to juice. The old guide says that a half-cup of juice is a substitute for one portion of fruit.

The new guide, to be released soon, will advise Canadians to avoid drinks high in sugar. One 12-ounce bottle of orange juice contains about the same amount of sugar as 12 ounces of Coke – more sugar than the World Health Organization recommends for the average adult in a single day. Excess sugar consumption is linked with heart disease, obesity and diabetes.

The government is in a hard spot –do they support an industry that employs thousands of workers in the making of an unhealthy product or the health of Canadians who consume it?

Three profiles of opioid users

The fish-bowl lives of drug users on the streets of downtown East Vancouver provides an easy, but distorted, window to drug use. That picture is as distorted now as it was 139 years ago when B.C.’s second premier, Amor De Cosmos, headed a commission to investigate opium use.

The window to most drug overdose deaths is closed. Typical victims are single men, in the prime of their life, who die alone from opioids containing fentanyl according to a report from the BC Coroners Service released last Thursday.

Michael Strange. image: Globe and Mail

Even reports of typical deaths are somewhat distorted. For some opioid users, the drug is a godsend. Take the case of Michael Strange. He injured his back while working as a cameraman and found opioids to be the only treatment that provided relief.

“I’ve tried so many different things for my pain,” said Strange. “People say, ‘Have you tried acupuncture?’ Yeah. I’ve had two different kinds of laser therapy. I had doctors and friends say I had to try marijuana. I got the vaporizer and it did nothing for my pain (Globe and Mail, September 7, 2018).”

It wasn’t easy but Michael Strange finally found a doctor who would treat him. Many doctors were “running scared” because they didn’t want to be seen to be contributing to addiction. Now his pain specialist gives him a two-month prescription and before renewing, asks: “Michael, how are you? Are you OK with the drugs? Do you need more? Do you need less?”

Self-medication turned deadly for Chris Willie, a university lecturer with a PhD in environmental physiology from UBC Okanagan. He wrote memoirs about his recovery from fentanyl addiction but he died from an overdose before they were published. With the approval of his family, his memoirs were published in the September, 2018, edition of the Walrus. He describes his mental pain as a child and the calm he found in taking dangerous risks:

“I have never excelled at coping. I was that infant child who hammered his head on the ground when frustrated by anything at all. It must have been embarrassing to parent the son with the ever-present forehead scabs. Perhaps I found it soothing, because, thirty years later, I still find serenity in chaos and derive calm from risk. By fighting to live through near-death situations, I could find the high I needed to briefly escape the pain.”

Like Michael Strange, Emily Wharton lived a productive life with opiates. The twenty-year old opium smoker from Victoria, told a House of Commons Select Committee on Chinese Immigration of her use. The federal committee was initiated by John A. Macdonald in 1879 and headed by B.C.’s second premier, Amor De Cosmos (a.k.a. William Alexander Smith).

Back then, the stereotypical opium user was Chinese. They lured good white women into lives of depravity in opium dens. The real agenda of the committee was to rid Canada of Chinese immigrants.

Wharton’s testimony 139 years ago is recorded in Dan Malleck’s book, When Good Drugs Go Bad. She told the committee that she had been using opium for four years and suffered no ill effects. Wharton testified that opium’s “somnolence and complete rest” left her productive. Chinese men in opium dens treated her well and she objected to the characterization of the dens as depraved. She suggested that if the government legalized opium, “one need not have to come into such holes as this to smoke (p. 102).”

Medical-grade opioids are not the problem. The social stigma of drug use that drives users to overdose, and the lack of pain-treatment specialists, leads mostly young single men to self-medicate, and to die, alone.

Normalizing the voices in our heads

Hearing voices is often regarded as a sign of mental illness. But maybe voices are just part of a spectrum.

image: The Atlantic

Professor T. M. Luhrmann says the idea of a continuum of voices is gaining recognition:

“This is the new axiom of the psychotic continuum theory: that voices are not the problem. The problem is the way people react to their voices.” says the professor of Anthropology at Stanford University (Harper’s magazine, June, 2018).

Luhrmann has been studying voices for decades and found people with intense experiences who aren’t psychotic.

One of them is Sarah, who was only four when a “spirit guide” appeared to her. When she told her mother of what she was seeing and hearing, her mother warned: “Cut it out. This is what they put people in psychiatric hospitals for.”

Sarah grew up otherwise normal, went to college and became a nurse. She began to see souls as they left the bodies of dying patients. They often gave her messages to give to people they’d left behind. While she could hear them, she realized that no one else did.

At sixty-two, Sarah is married and still working. One of her voices, “Tom,” is friendly. Other voices, “the council,” not so much but Tom helps mediate between the two.

“But Sarah is not psychotic,” says Luhrmann, “To use the language of psychiatric nosology [classification of diseases], she has no ‘functional impairment.’ She can work and care for herself and others; her marriage is good and stable. She has never been hospitalized.”

Sarah describes the council’s voices as if they are coming from a radio which would tune in and out.

My mother used to describe something like that: voices that that seemed to be coming from a radio; indistinct and sometimes with music. She would try turning off the radio only to find it was already off.

As an electronics teacher, people sometimes approach me with what I call the “radio phenomena.” They would wonder what the electronics were behind the indistinct voices they heard, seeming to come from a radio. While people can pick up strong radio signals as a result of metal oxides in tooth fillings, it’s rare and only works with strong AM signals. I was generally at a loss to explain the phenomena but it’s starting to make sense now.

Sarah has learned to live with her voices but others struggle. Schizophrenics have traditionally been prescribed antipsychotic medications with limited results.

One grassroots movement called Hearing Voices is offering an alternative approach to medication. They encourage those who are tormented with voices to address them. It’s difficult because the voices are frightening.

Luhrmann met one man at a Hearing Voices workshop. “His voices would yell at him for hours, cursing him, screaming that they should drag him out to the forest and leave him to die in the leaves.” He was encouraged to placate them. One of his voices was obsessed with Buddhism, so he agreed to read Buddhist texts and offer prayers during an allotted hour. Within a year, he had almost completely transitioned off medication.

Rather than treating voices as a disease, a better plan might be to treat them as part of rainbow of voices -some relatively benign, some requiring therapy.

“The central insight of these methods is that the way people respond to their voices can change the course of their lives,” says Luhrmann.

Advice to TRU: educate, don’t prohibit cannabis

Thompson Rivers University plans to prohibit the recreational use of cannabis on campus. This, despite the failure of prohibition to deter use for the last 95 years in Canada.

image: SchoolFinder

Cannabis is not harmless. Inhaling smoke, be it from wildfires, tobacco, or cannabis carries risks. But banning cannabis is not the way to control those risks.

Education is. Education has reduced the consumption of tobacco. Reductions have been especially greater for those with a higher education according to a report from Statistics Canada.

TRU has nine designated locations where tobacco and medical marijuana can be smoked. Once cannabis is legalized on October 17, those locations would be a logical place for recreational cannabis smokers as well.

TRU’s Joint Occupational Health and Safety Committee voted on March 5, 2018, to ban all smoking of recreational marijuana on campus for health and safety reasons. Chris Montoya, committee member and Senior Lecturer in Psychology, says not all of the 20-member committee agreed:

“Pro-marijuana smokers on the TRU committee argued that marijuana smoke is no different than cigarette smoke and that smoking areas designated for cigarette smoke should also be used for marijuana.”

But they were apparently swayed by arguments  presented by Montoya: cannabis is more potent than ever before, bystanders can get stoned from second-hand smoke, and marijuana has been linked with psychoses.

Montoya is a member of the National Advisory Council (2016-18) and the Partnership for a Drug Free Canada. He repeated some of his claims to Kamloops This Week:

“A student cannot get drunk walking next to another student drinking a beer. However, students, staff and faculty can get stoned breathing in second-hand smoke.”

Ian Mitchell, Kamloops Emergency Physician, disagrees:

“There have been a series of studies in which non-smokers are shut into a small room with cannabis smokers and tested for both impairment and positive urine tests. While these things can happen, it is only under the most extreme circumstances,” he told me by message.

A doctoral student in clinical psychology at UBC Okanagan also disagrees with Montoya:

“Researchers at John Hopkins University have been conducting studies on the effects of cannabis smoke exposure to non-users and have found that, under regular indoor conditions, non-smokers did not experience changes in cognitive ability –i.e. ’get high,’” says Michelle Thiessen in a letter to KTW.

There are places on campus for students and staff to drink alcohol as well as smoke cigarettes. TRU spokesperson, Darshan Lindsay, told CFJC Today: “There are a lot of regulations, systems in place to promote responsible use of alcohol. We just don’t have that in place for cannabis. For the university, recognizing that we are a place of education and that we want to promote an environment that’s safe and healthy for everyone, our position is that recreational cannabis should not be present on campus.”

Failing to have a “place for cannabis” perpetuates the notion that prohibition will reduce cannabis use. Banning cannabis has a predictable effect -it simply drives consumption into the shadows and prevents dealing with the risks.

TRU should become a model in harm reduction, as “a place of education.”

Prohibition is futile: TRU might as well prohibit wildfires -it would be as effective.