The Vaccinations-Cause-Autism Fraud

Anyone who still persists in believing that childhood vaccinations have anything to do with the development of autism should read the three well-documented articles by investigative reporter Brian Deer published recently in the prestigious British Medical Journal. The first article is presented here. For those who don’t have the time, here’s a brief synopsis:

The original research article allegedly showing a causal link between vaccinations and autism was later shown to be a deliberate fraud. The paper, published in 1998 by the Lancet, was retracted in 2010 after it was shown to contain numerous misrepresentations. The paper’s author, Dr. Andrew Wakefield, was investigated by the UK General Medical Council and ultimately lost his license to practice medicine. Records released during the investigation show that Dr. Wakefield was paid nearly $700,000 by a British lawyer who was preparing a class-action lawsuit against vaccine-makers.

Since 1998, study after study has failed to validate Dr. Wakefield’s work and failed to show any causal link between childhood vaccinations and autism. And yet, some parents of autistic children still believe in that there may be a causal link. Actress Jenny McCarthy, herself a mother of an autistic child, is one of them. Ms. McCarthy has appeared on the Oprah Winfrey show to promote the vaccination-autism “cause” and has written several books about autism. I have yet to see an admission from her that she may have been wrong about vaccines.

Sorry, Ms. McCarthy, you lose on this one. Give it up before you look even more foolish than you already do.

(Topic for debate: Why do some people continue to believe in something despite overwhelming evidence in favor of just the opposite? What does that continued belief do for them?)

Smallpox - Gone Forever?

A deadly viral disease called smallpox killed several hundred million people in the 1800s. Thanks to the development of smallpox vaccines and a concerted effort worldwide, the disease was finally declared eradicated in 1979. To this day, smallpox is the only infectious human disease ever wiped out completely.

Nevertheless, the spectre of a return of smallpox remains. That’s because more than 500 vials containing the smallpox virus remain in tightly guarded, allegedly secure facilities in the U.S. and Russia. The question is, what to do with these vials? Some scientists and politicians (particularly in the U.S. and Russia) argue that stocks of the smallpox virus are still needed for research and for the development of new diagnostics, safer vaccines, and effective antiviral drugs. Others argue that over the past several decades we’ve learned just about all we can about the virus, and that the mere existence of these vials represents a risk that some day the disease could return, particularly if a vial were to fall into the hands of terrorists.

The World Health Organization (WHO) will decide in May whether to recommend a firm deadline for the final destruction of all remaining vials. But don’t count on the elimination of every last smallpox virus from the planet any time soon, even if a deadline is announced. An earlier deadline of 1990 was postponed indefinitely when both the U.S. and Russia argued against it. It’s more likely that a compromise will be reached to reduce stockpiles without eliminating them completely.

Eradicating a Disease

How hard is it to eradicate a disease from the planet completely? In all of history, that goal has been achieved only once – smallpox disease was eliminated finally in 1980. The smallpox virus now exists only as frozen samples in government laboratories in Russia and the U.S. It’s worth noting that it took 180 years to eradicate smallpox!

Other eradication programs, most notably one for malaria begun in 1955 and abandoned in the 1960s, have failed miserably. A few, like the ongoing $8 billion polio eradication program, have sharply reduced the economic burden and number of deaths from their respective diseases. But achieving complete eradication has proven elusive. A recent outbreak of polio in West Africa is one of the deadliest since the polio eradication program began 22 years ago.

It may be time to re-think whether eradication of any disease is a feasible goal. Perhaps containment and treatment make more sense. In all likelihood, future disease eradication proposals will be subject to careful cost-benefit analysis before they are launched.

Why Did Swine Flu Kill Healthy Adults?

One of the most intriguing questions about the swine flu epidemic last year was why most of the deaths occurred in healthy young adults. Why were the very young and the very old generally spared?

A recent paper in Nature Medicine provides a clue, according to a news article in Science magazine. The gist of it is that the immune system of most adults is not very effective against first exposure to the H1N1-type virus. Unable to kill the virus initially with just a normal first immune response, the immune system in some patients mounted an all-out “do or die” effort to kill the virus. The result was a severe inflammatory reaction in the lungs that ultimately killed the patient instead of the virus.

The theory of a hyperactive but ineffective immune system would explain why the very young and the very old were spared by swine flu. The very young do not have a fully developed immune system with which to mount even a normal immune response, much less an exaggerated one. And many older persons may have had at least some effective antibodies against H1N1 by virtue of having been exposed to the previous H1N1 strain that was around until the late 1950’s.

Using Bacteria to Fight Bacteria

A recent article in the New York Times is a good primer on the astonishing variety of bacteria that colonize our bodies, and what they may be doing there. It turns out that our individual microbiomes (all of the microbes in a defined environment within our bodies) are quite different. And at any one time, each of us probably has only about 20% of the species of bacteria that can inhabit the human body.

An interesting new idea is that the “good” bacteria in certain people’s microbiomes might actually be used to treat certain diseases. Doctors have actually cured several stubborn cases of severe diarrhea caused by a particularly difficult bacterium to treat (Clostridium difficile) by transplanting human fecal matter from a healthy person into the patients’ colons! Granted, having a fecal transplant in order to cure disease sounds a bit strange. But apparently the “good” bacteria in the fecal transplant outcompete the C. difficile and wipe them out.

Someday maybe there’ll be ointments or pills containing especially “good” bacteria for treating certain antibiotic-resistant infections such as flesh-eating Staphylococcus aureus or diarrhea-causing C. difficile. Using bacteria to kill bacteria – like using fire to fight fire.

Reference: Zimmer, C., How Microbes Defend and Define Us. New York Times, July 13, 2010.

Do Skin Sutures Need to be Kept Covered and Dry?

I’ve always heard that skin sutures should be covered and kept dry for a couple of days in order to prevent infections – at least that’s the usual standard medical advice. But does getting recent sutures wet really lead to more infections?

To answer that question, a couple of years ago a team of Australian researchers randomly assigned over 850 patients who needed skin sutures into one of two groups. Patients in one group were asked to keep their sutures dry and covered, while the patients in the other group were allowed to remove their bandages and get their sutures wet within the first 48 hours.

The results of the study indicated that there were no differences in the incidences of infection between the two groups. The results indicate that it would be perfectly okay to take a shower without increasing the risk of infection of recent skin sutures. But I wouldn't suggest going swimming in a scummy lake or river....

Antibiotic-resistant Gram-Negative Bacteria

You’ve probably never even heard of Acinetobacter baumannii or Enterobacter aerogenes. But these and other little-known gram-negative bacteria are killing tens of thousands of hospitalized patients every year, according to some estimates.

Gram-negative bacteria (so-called because of the way they are stained during the Gram staining protocol) have a cell wall structure that makes them more difficult to kill with antibiotics in the first place. But some strains of these bacteria are now resistant to every modern antibiotic we have.

In an ironic twist, two antibiotics (colistin and polymyxin B) that are somewhat effective against these resistant bacteria are still effective only because they were essentially abandoned decades ago, when it was learned that they can cause nerve and kidney damage. Now it’s become an unpleasant trade-off at times; risk death from the bacteria, or risk possible nerve and kidney damage from the antibiotics.

New antibiotics are needed, but so far there do not appear to be any “magic bullet”-type antibiotics on the horizon. This is a battle we’re slowly losing.

Bacterial Resistance to Antibiotics

The prevailing thought has always been that bacterial resistance to antibiotics comes about by a process of natural selection. When antibiotics kill most but not all of a bacterial population, the bacteria that survive are those that were most resistant to the antibiotic. These resistant bacteria then flourish, passing their resistance genes on to other bacteria and outcompeting their more vulnerable kin. The more times an antibiotic is used, then, the more likely it becomes that the surviving bacteria will be resistant to it.

But now researchers have found another mechanism for bacterial resistance to antibiotics. It turns out that antibiotics induce the formation of toxic molecules within bacteria called reactive oxygen species, or free radicals, that help kill the bacteria. But if the concentration of antibiotic is below the threshold for killing the bacteria outright, the free radicals cause mutations in the bacteria, some of which by random chance may confer drug resistance. In other words, antibiotics speed up the process of bacterial evolution in the surviving bacteria.

The finding opens a new avenue for research – finding molecules that prevent this bacterial mutagenesis, thus perhaps delaying the development of antibiotic resistance.

H1N1 Flu Deaths Update

The Centers for Disease Control and Prevention estimated this week that between 7,000 and 14,000 people have died of swine flu in the U.S. through mid-November, out of the 34-67 million people who had the swine flu so far.

Deaths caused by the flu are notoriously hard to estimate because most people are not tested for the flu when they have it and because people may die of a combination of causes, including the flu. The usual estimate is that the regular seasonal flu causes about 30,000 deaths each flu season (the winter months), so these latest swine flu numbers aren’t too bad. In fact they’re well below the government’s estimate back in August of 30,000 to 90,000 deaths from swine flu this season.

The big question is what will happen in January/February – will swine flu reassert itself in a third wave, as happened in the pandemics of 1918 and 1957? Will the H1N1 virus change to become more lethal, or more resistant to the vaccine? If either of these things happens the situation could change quickly. Most people in the U.S. are not yet immune to the swine flu because they have not had it yet and they have not been vaccinated against it.

Apparently many people think the danger is passed. We’ll hope they’re right. But if you still haven’t gotten your swine flu shot, it’s not too late. The vaccine supply seems to be pretty good these days.

New Strategies Against Superbugs

Antibiotic-resistant bacteria are cropping up everywhere. There hasn’t been a major breakthrough in the development of antibiotics since the 1960s. Are we losing the battle against antibiotic-resistant bacteria?

There aren’t any new weapons in the arsenal just yet, but some scientists remain optimistic. According to a recent article in Scientific American, strategies currently under development include: 1) developing “narrow spectrum” antibiotics that target just one bacterial species at a time, 2) preventing pathogenic bacteria from causing disease in humans without actually killing them, 3) searching among bacterial species for antibiotics that bacteria use against each other in nature, and 4) genetically modifying antibiotic-producing bacteria so that they can be grown easily in culture.

We’ll probably never win against the bacteria, but we can keep trying to stay one step ahead.

REFERENCE: C.T Walsh and M.A. Fishbach. New Ways to Squash Superbugs. Scientific American pp. 44-51, July, 2009.

Swine Flu Takes Hold in Argentina

Swine flu just won’t go away. A recent a sharp uptick in the number of deaths from swine flu in Argentina has moved that country into third place for the most swine flu deaths, after Mexico and the United states. And the timing couldn’t be worse; it’s winter in South America, the season when influenza viruses typically spread the easiest. Of special concern is that the death rate in Argentina (1.6%) is more than three times the world average.

We need to keep an eye on this pesky bug. Who knows what it could do in North America NEXT flu season? For the latest information on swine flu (also now called Pandemic H1N1), see the World Health Organization website.

The Pandemic of 2009

The World Health Organization has officially declared a pandemic as a result of the rapid worldwide spread of Influenza A (H1N1), formerly known as swine flu. But that does NOT mean that a lot of people will die. By definition, a pandemic is simply a widespread outbreak of a new human flu virus that spreads rapidly from human to human, causing human illness.

Some flu pandemics cause only mild symptoms and few deaths – others can be quite deadly. The best-known pandemics of the last century were the deadly Spanish flu of 1918 (20-40 million deaths), and the milder Asian flu of 1957 (1-4 million deaths) and Hong Kong flu of 1968 (also 1-4 million deaths). In contrast, the milder seasonal flu that many of us get nearly every year kills “only” about a quarter of a million people each year.

Pandemics are of concern to public health officials (and the public!) because the virus spreads so quickly and because the consequences of the spread cannot always be predicted in advance. Fortunately, it now appears that this pandemic will be no more deadly than the typical seasonal flu that many of us get nearly every year. Most people who become infected with Influenza A (H1N1) are recovering without the need for medical care. But it could have been otherwise, and that’s why health officials were so concerned at first and why they are still watching it closely.

The other flu we worry about is avian flu (see Human Biology 5th ed., pp. 540-541). Avian flu is VERY deadly in the few cases in which it has been caught from birds, but human-to-human transmission is still exceedingly rare.

What to Call Swine Flu

What should be the proper name for swine flu, now that we know that people are catching it from infected people, and not from swine? The World Health Organization has stopped calling it swine flu in favor of “influenza A (H1N1)”. But that name also applies to one of three strains of seasonal flu and to the deadly 1918-1919 Spanish flu (which didn’t even originate in Spain!) The U.S. Centers for Disease Control (CDC) calls it both “novel influenza A (H1N1)” and “H1N1 flu (swine flu)” on its website. Of course the Mexican government objects to calling it “Mexican flu”.

An article on what to call this virus appears this week in Science.

Swine flu

It first appeared in Mexico in March. Popularly called swine flu, the H1N1 virus turns out to have a strange mixture of viral genes; 48% of its genes are from swine flu viruses, 34% are from avian flu viruses, and 17% are from human flu viruses. A key feature of the H1N1 virus is that it can be transmitted from human to human. By yesterday, swine flu had infected nearly 2,400 people, mostly in Mexico and the United States, killing 44. Where it came from, how far it will spread, and whether it will cause a pandemic remain unanswered questions. The World Health Organization’s influenza pandemic alert is currently at phase 5, just below a phase 6 full-alert.

There have been plenty of reports in the popular press about swine flu, some true, some not. For example, initial reports of a very high death rate from swine flu had to be revised downward once it was determined that many of the deaths attributed to swine flu were not caused by H1N1. Still, a death rate of nearly 2 % in healthy adults is quite high for any flu virus. Two percent of the world’s population is how many million people???

For authoritative updates about swine flu, try the news section of a magazine such as Science (see this week’s report) or the website of the World Health Organization.

If Not Bird Flu, Then.....What?

In Human Biology 5th ed. (pp. 540-541) we discuss the possibility that a human pandemic might be caused by the bird flu virus, H5N1, if the virus evolves to become easily transmissible between humans. But so far it hasn’t happened. Where will the next great human pandemic come from, if not from the bird flu virus? No one knows for sure, but the smart money is on pathogens living in animal species closely related to humans, such as non-human primates. In fact, that’s precisely how HIV developed – an evolving virus in monkeys jumped to chimpanzees and then to humans.

Knowing this, how might we prevent the next pandemic, or at least have some warning that it was coming? One intriguing possibility would be to keep a close eye on diseases that develop in humans who are in close contact with wild animals. To learn more, read “Preventing the Next Pandemic”, by Nathan Wolfe (Scientific American, April, 2009, pp. 76-81), and then check out the website of the Global Viral Forecasting Initiative. In fact you can download a .pdf file of the Scientific American article directly from the the GVFI website.

Antibiotic-Resistant Bacteria

Researchers have recently uncovered more evidence of an increased trend toward antibiotic resistance by Staphylococcus aureus infections, this time in infections in children. As you may know, staph is a nasty little bacterium that can lead to severe skin lesions. According to the report, the percentage of staph infections that were resistant to methycillin, the antibiotic most commonly used against staph, rose from 11.8% in 2001 to 28.1% in 2006.

Health workers worry that someday our current antibiotics just won’t be very effective any more. For more on this topic, see (See “The Growing Threat of Antibiotic-Resistant Bacteria” in Human Biology 5th ed., p. 18).

REFERENCE: Naseri, I., et. al. Nationwide Trends in Pediatric Staphylococcus aureus Head and Neck Infections. Archives of Otolaryngology - Head and Neck Surgery 135:14-16, 2009.

Bird Flu: The Pandemic That Hasn't Happened (Yet)

When was the last time YOU thought about bird flu? These days the public and the news media are treating the continued threat of a worldwide pandemic with a great big yawn. Bird flu is so yesterday!

Here’s an interesting exercise you could give your students: Ask them to search a key phrase such as “bird flu”, “avian influenza” or “H5N1” in any major newspaper with a searchable archive (such as the New York Times), arrange the retrieved documents by date, and count them. I searched “avian flu” in the New York Times recently and found that references peaked at 181 in 2006 and have since fallen to a paltry 18 in the first eight months of 2008.

Psychologists surely would have something to say about how long we can sustain our fear of a perceived threat that doesn’t materialize quickly. Health officials worry that if we become convinced that bird flu is not a threat any more, we will begin to make political and economic choices that direct our resources away from preparedness programs. And no one knows whether or not that would be a good idea at this point.

What do you think?

Measles is on the Rise

According to the Centers for Disease Control and Prevention (CDC), there were more cases of measles in the U.S. in the first 7 months of 2008 than at any comparable time in the past 12 years. There have also been measles outbreaks in Switzerland, Italy, Israel, and Britain in recent years. The most likely reason is that an increasing number of children have not been vaccinated against the disease because some parents believe that vaccinations cause autism. Health officials contend that there is no connection between vaccinations and autism, but many parents remain unconvinced.

Measles is highly contagious, so it is no surprise that it may be among the first vaccine-preventable diseases to reappear when vaccination rates decline. Fortunately, measles is not very virulent; most patients are treated at home and recover without any long-term consequences. But if the return of measles is an early indication of lower vaccination rates, it may only be a matter of time before other vaccine-preventable diseases return as well. And that has health officials worried.

How do you feel about childhood vaccinations?

Losing the Battle Against Bacteria

Bacterial resistance to antibiotics is increasing and there are too few new antibiotics in the drug discovery pipeline. Nevertheless, more than half of the major pharmaceutical companies have shut down their antibiotics R&D divisions entirely within the last 20 years. Read about it in the current issue of Science (“The Bacteria Fight Back”, Science 321:356-361, July 18, 2008). The article documents the history and the biology of bacterial resistance to antibiotics. It also and suggests some reasons why pharmaceutical companies seem disinterested in developing new antibiotics, even as the human death toll rises.

This would be a good article to share with your students in support of the Health Watch box on page 18 of Human Biology, 5th ed. The article could also be used to kick off a class discussion of the economics of developing and selling pharmaceutical drugs.

Your Bacterial Friends

How many bacteria normally live on or in your body, and what are they doing there? The government wants to know, with the goal of better understanding their roles in health and disease. So last year NIH launched the Human Microbiome Project. The early results show that bacteria and other microbes colonizing human tissues outnumber the body’s cells by ten to one! Over 600 different bacteria have been identified in such places as the vagina, belly button, nose, mouth, and digestive tract, not to mention all over the skin. And would it surprise you to know that there are more bacteria in your belly button than between your toes? Different bacteria influence our ability to fight infections, digest nutrients, and produce vitamins, plus there may be many other functions that we don’t even know about yet.

See the brief news article on this subject in Science magazine (“Bacteria are Picky About Their Homes on Human Skin”, Science May 23, 2008, p. 1001.)