Thursday, April 24, 2014

Happy World Immunization Week!

This week the international public health spotlight is on you.* World Immunization Week called and they want you to make sure everyone in your home is up to date on immunizations. Their slogan could use some bling but at least its short:

Immunize for a healthy future. 
Know. Check. Protect.

If you have done so, you can either sit back and try to get to Candy Crush Level 453 or you can do something about the 2 to 3 million people out there without access to disease-preventable vaccines, a figure that includes 1 in 5 kids around the globe. The good news, vaccines save the lives of 2.5 million kids every year.

Why spend a few minutes improving children's health rather than unlocking fictional sweets and characters? I'll give you one reason: measles.

This year the CDC has documented 129 cases so far in the United States spread over 13 states. Now that number might not sound like a lot to worry about but for every 1,000 children who fall ill, 1 to 2 die. In a community, a high school perhaps, that could be devastating.

Right now the Philippines alone has over 20,000 cases. Just Google "measles outbreaks" and you will find many recent reports about US travelers abroad coming into contact with measles, not the kind of souvenir to bring back to the kids or anyone. Last year a man sickened 21 other parishioners at his church in Texas after a trip to Indonesia. Most had not been vaccinated because the church's minister preached against vaccination.

Here's the part that should concern all of us, even those of us who have been immunized. Vaccination though highly effective doesn't fully protect everybody. As much as 5% of vaccinated children and adults can contract the highly contagious disease. So even if you follow through and get all the required immunizations, your child can still get measles. That's why it's important to keep the vaccination rates high, to achieve the unfortunately termed "herd immunity." Then there are babies who haven't yet been immunized and others people who cannot receive the immunizations due to health issues. There now is evidence of a vaccinated adult, "Measles Mary," contracting and infecting other people, including others who were vaccinated.

What You Can Do Now

1. Join the United Nations Foundations' Shot At Life campaign. I'm not a joiner by nature but it's such a great cause I've been an advocate with the campaign since its inception in 2011. Sign up. Be part of this movement to protect children worldwide by providing life-saving vaccines where they are most needed. 

2. Send your elected official an email advocating for support of global vaccine funding. Go to Shot At Life and click on the Tell Congress button. Fill in your info and press "send." How easy is that? 

3. Check out the Global Moms Relay Challenge, a campaign by the United Nations and their partners to improve maternal and child health around the world:

From International Women’s Day through Mothers’ Day–March 7 through May 11–a celebrity or community leader, from New York to Nairobi, will share a personal story of how a mom has changed his or her life, and then “pass the baton” to the next person. Read these inspiring posts and share them with friends through your social networks–each time you do, Johnson & Johnson will donate $1, up to $250,000, for each share on each network, to help moms and babies around the world stay healthy and happy. You can also Donate a Photo* once each day to help raise another $100,000.

4. Read this post by my friend Public Health Rants. Justin Bieber knows something about polar bears? Seriously, PHR, let's reframe the conversations on vaccines (and polar bears). Cute babies. Healthy babies. Laughing babies. Smiling babies.

5. Make a documentary correcting misinformation about vaccines. Or check out the high school students who've already done it. Watch the trailer for Invisible Threat courteous of my friends at Every Child By Two. 

You are now free to reach level 454 of Candy Crush. Good luck.

*And not that blonde Playboy model-cum-health expert who shall go nameless on this blog.

Wednesday, April 16, 2014

Spotting Bad Science: Kindly ignore the playmate and the pediatrician

I refuse to write about the recent op-ed from the Playboy model-cum television host and parenting expert who learned everything she needs to know at Google University and one suspects Hugh Heffner's famed grotto. Girlfriend knows how to get media attention even if it means re-branding herself as a vaccine advocate, a defender of public health who had absolutely nothing to do whatsoever what in the world are you talking about? with the return of measles, an illness that as recently as 1989 to 1991 sickened thousands while killing 123 kids in the US.

I also refuse to write about the Santa Monica-based celebrity pediatrician who supports vaccines in general (i.e. in theory if not practice) but doesn't recommend the MMR and sent a letter to his families that they needn't vaccinate against measles or worry about the current outbreak in California.

Instead thanks to my new and improved mature perspective, I will focus on the positive. Here's something you can do to prevent the spread of pseudoscience or botched media coverage of science. Check out A Rough Guide to Spotting Bad Science, a piece of visual journalism sure to delight the evidence-seekers in the crowd. Thanks to Compound Interest for sharing this aesthetically-pleasing checklist that should appear in fine print below any health article or claim. Now if only there was a guide for spotting the flawed claims that comes out of the mouths of celebrity pediatricians, I could rest more easily and maybe run a marathon for charity or build a school in Africa.

Oh and here's something you can do to help children stay healthy who don't have a celebrity pediatrician or really any pediatrician or access to vaccines - sign up at Shot At Life, the UN Foundations grass-roots campaign to raise awareness, funding and access to vaccines in the developing world. Join the Global Moms Relay. 

Monday, April 07, 2014

Personal Health 2.0

Everybody seeks health and medical information online now, that's old news. According to Pew Research adults not only seek out details about health conditions but other people living with similar experiences and illnesses. So we need to talk about the social life of health information.  As my own personal social life sputters and burns, it's reassuring my health might soon have one. That's right, health information now has a social milieu and it's Twitter, Facebook and Google+:

Our latest national survey on the topic finds that seven-in-ten (72%) adult internet users say they have searched online for information about a range of health issues, the most popular being specific diseases and treatments. One-in-four (26%) adult internet users say they have read or watched someone else’s health experience about health or medical issues in the past 12 months. And 16% of adult internet users in the U.S. have gone online in the past 12 months to find others who share the same health concerns. Pew Research Center

If that sounds dry and boring, here's some social health up close and personal. Warning, it's not always if ever pleasant. The NPR host, Scott Simon live tweeted his mom's final breaths from the hospital. More of you might be familiar with Lisa Adams, the mother blogging through her late stage breast cancer who became the target of negative media attention earlier this year when she got bashed by two well-known journalists married to each other. Sharing has its costs, it doesn't always bring compassion or applause. Adams became the subject of articles written individually by Bill Keller over at the New York Times and Emily Keller at the Guardian. Basically Bill jumped in to defend his wife and ultimately editors at the Guardian removed her article because it made them queasy (read more about the saga at Salon). Ms. Adams' is an unusual case for sure but there are countless blogs, forums and chat rooms devoted to less extreme illnesses and disorders for example, autism, infertility and allergies. A person could spend all day and night perusing personal stories.

However beneficial the effects of sharing and reading personal health experiences online, there's another darker issue besides personal attacks dogging the phenomenon and that's the accuracy of the advice and evidence. I probably don't need to remind anyone here that health news in general, even the supposed better sites and better studies, suffer from botched reporting. A 2012 study found 51% of news articles  exaggerate or "spin" the results of medical trials to make them appear more important and dramatic. If health journalists can't get it right, if major media can't get it right, then I'm not sure we can expect parents to do any better - to say nothing of observers that chime in with their own insights or biases. Not that a mother struggling with an illness can't become knowledgeable and share highly accurate information but the odds are not good. There are simply too many examples of flawed health claims (see Jenny McCarthy). Sure readers might not seek a fellow mother for medical knowledge per se, but it comes with the territory. It leaks out. Anyhow, this is just one more thing to wonder about when seeking comfort, compassion or understanding on the Internet.

Tuesday, April 01, 2014

Breastfeed Past Menopause, Study Says

The American Academy of Pediatrics has released new guidelines today recommending mothers continue breastfeeding through childbearing age, middle-age and well into menopause as long as mutually desired*. This policy change comes amidst a growing body of evidence that sustained breastfeeding protects women from a number of illnesses, conditions and cumbersome familial, social and employment obligations throughout their lifetime. Research published last month in the journal Suboptimal Studies of Breastfeeding found women who continued lactating well after their children left home reported they weren't totally exhausted, depressed or stressed by social isolation. "Our study shows breastfeeding has a positive effect on women" said lead research Sharon Hamm, Ph.D., M.D., M.P.H., Director of the Breast Is Best Institute in Berekely, California. "These results amazed me. I was surprised how fit and happy breastfeeding would keep these women. I didn't anticipate it." Dr. Hamm will present these findings as the keynote speaker next month at the Breastfeeding For Social Good Symposium in Brooklyn, New York, where she will also lead the Breastfeed 4 Life Rally. Although she and her colleagues have not yet published further findings from their Post Menopausal Lactation Project, she noted "our data show not breastfeeding for decades puts women at risk."

Women choose sustained breastfeeding for a variety of reasons. Some continue lactating for the health benefits, some for the financial benefits and others simply the satisfaction of helping others. "I find it's a good way to give back to the community" explained lactation expert Sylvia White, a grandmother of three who donates her supply to Mama Latte, a local human milk bank. "Besides, after nursing my own children and grandchildren, I didn't really have many hobbies, friends or marketable job skills."

Although the FDA has not yet confirmed the safety of consuming human milk from older women including post-menopausal ones, according to experts there is not much reason for concern or caution."I might not give it to a premature infant" said pediatrician Robert Peters who was not involved with the study,"but I would drink it myself, maybe" though he declined to specify whether he'd give it to his own children.

Others voiced more enthusiasm to put post-menopausal milk to good use. Health-conscious consumers have started seeking out breast milk for its natural, organic, raw properties. "We've been noticing more interest in expressed post-menopausal breast milk among adults who are eager to try it themselves" reported Jessica Burley of advocacy group Lact Up. Jennifer Finebody, a wellness consultant and owner of the online boutique Udder Heaven highly recommends women and men introduce some breast milk into their regular diets. "It's not just for babies. Breast milk makes a great smoothie."

Experts urge women to consult their health care provider, life coach or Facebook friends before deciding whether to continue or start lactating beyond the prime childbearing decade.

*Mutually desired by the mother's overworked mammary glands.

Monday, March 31, 2014

I Want My (Teen Mom) MTV?

Sure to please parents and sex educators everywhere, MTV has solved the teen pregnancy crisis. Since the cable network started filming "16 and Pregnant" fewer teens have gotten pregnant. Sure the teen birth rate has fallen 44% from 1991 to 2010 but after the show aired in 2009, the numbers dropped 9% from 2009 through 2010. Naturally it must have been the show.  As Nicholas Kristof at the New York Times declared in the headline of a recent column, "TV Lowers Birthrate (Seriously)." 


At least there's a study behind this claim and it's a cutting edge, social media savvy, Big Data, Research 2.0, TED-talk-ready one, linking MTV's fine oeuvres to Twitter and Google: 
Tweets containing the words “birth control” increased by 23 percent on the day after each new episode of “16 and Pregnant,” according to an analysis by Melissa Kearney of the University of Maryland and Phillip B. Levine of Wellesley College. Those tweets, in turn, correlate to increased Google searches along the lines of “how get birth control pills.” 

Kearney and Levine find that regions with a higher audience for “16 and Pregnant” and the “Teen Mom” franchise had more of a drop in teenage births. Over all, their statistical analysis concludes that the shows reduced teenage births by 5.7 percent, or 20,000 fewer teenage births each year. That’s one birth averted every half-hour. via New York Times
Before you make your daughter binge watch 4 seasons of Teen Mom, it's worth noting the current study does not directly link watching television to any behaviors including ones related to the actual prevention of pregnancy. 

Yes lots of young viewers appear to tune in to these shows. Yes they seem to tweet a lot about pregnancy and such afterwards. Yes they seem to Google a lot about pregnancy and such afterwards. As they likely do in response to any number of other tv shows, songs, commercials, YouTube videos or random happenings at school, home, the bus stop. At this point it's not certain if they go on to act on this curiosity or information. No one was surveyed on their screen time use or birth control use. It's not clear if any young women, as a result of the no doubt riveting drama, procure condoms let alone learn how to use condoms, use said condoms or otherwise take measures to not get pregnant including the family-values-loving one (the a word). 

One thing I do know, the current study doesn't merit the frequent causal language in the media coverage (even you, NPR?, no skepticism?), the journal article or its title: Media Influences on Social Outcomes: The Impact of MTV’s 16 and Pregnant on Teen Childbearing.To beat the unglamorous correlational/causation drum, there is no causal evidence here. Not even evidence it's the same kids watching as tweeting and not getting pregnant. Hopefully the next installment of this VIP investigation won't land in the journal National Bureau of Economic Research, not exactly a hot bed of human sexuality however many quants as a result now follow Farrah Abraham on Twitter (or watch her sex tape). I know, the authors are economists and the financial consequences of teen pregnancy are severe, long-lasting, etc. I should be glad someone cares enough to do  the work. A better study though would survey teens about the shows they watch then follow them over time to see if the show seemed to influence their actual behavior (e.g., contraceptive use, condom use, pregnancy). Investigators then wouldn't need to rely on Nielsen and Twitter to test the hypothesis. Maybe someone's doing that study right now.

Until then, no disrespect to Billy Idol but it's too early to declare I Want My MTV. The Teen-Mom-TV-Birth Control Theory, however provocative or prophylactically promising, remains too speculative to warrant a change in my Tivo line up (seriously). 

Friday, March 28, 2014

Autism on the Brain (Literally)

Two new autism studies out this week. One shows brain abnormalities among children with autism. The other, rising rates of autism. Before you get too excited about either one, take a closer look.

The first, a post-mortem examination of brain tissue in children who'd been diagnosed with autism landed in the New England Journal of Medicine but don't be too terribly impressed just yet. It included a mere 22 kids, half with autism, half without. Researchers found similar rough "patches" in the top cortical layer of 10 of the 11 children with autism suggesting something went wrong during cortical development which happens early in the prenatal period. This no doubt valuable study suggests pregnancy is a critical time for the development of autism.

The media, however, generally declared it incontrovertible evidence.

Researchers have published a study that gives clear and direct new evidence that autism begins during pregnancy. Science Daily 
Study: Autism Starts in Pregnancy UPI
Autism Begins as Brain Cells Altered in Womb, Study Finds Bloomberg

Some outlets fortunately summoned some constraint in their headlines and more nuance in the articles (faint!).

Brain Changes Suggest Autism Starts In The Womb NPR 
Autism May Originate During Pregnancy, Study Says Fox News 

The media often didn't attempt to explain why this study isn’t conclusive evidence that autism starts in pregnancy or that it stems from these cortical disruptions. At this point, it's not clear how these rough spots might be linked to autism. They might not be responsible for the numerous symptoms associated with the disorder. They could be a result of other changes or abnormalities related to autism.*

Now for the CDC report. Here's the news in brief: 

Autism rose almost 30% between 2008 and 2010. Since 2000 rates have more than doubled. Take a look at the numbers:

1 in 88 kids "autistic" (2008)
1 in 68 kids "autistic" (2010)

Few media outlets bothered to highlight or even mention one of the most striking aspects of this study. Who those 1 in 68 included -  children without official autism diagnoses. Researchers scoured medical and school records for signs of autism including autistic-like symptoms/behavior. The last few national estimates have employed this same wide net, so remember this every time you read about rising autism. 

CNN was the only major media source I could find that quoted an expert who was concerned about the inclusion of children that might not have autism:
"This report tells us that there's a significant number of children in the states where they were assessed that have social differences and a pattern of behaviors that can be represented by ASD, but may also be due to other conditions that superficially can have similar features, such as social anxiety, ADHD with social immaturity and intelligence problems," [Dr. Max Wiznitzer, pediatric neurologist at Rainbow Babies and Children's Hospital in Cleveland] says. 
Is it any wonder autism appears to be rising? Not to the experts. 
Despite their concern, experts said they were not surprised by the increase, because other data had suggested the numbers would continue to climb. In New Jersey, for instance, autism rates were 50% higher than in the rest of the nation in 2000, and they remained that much higher in 2010 – suggesting the national rates will continue to rise to catch up, said Walter Zahorodny, a psychologist who directs the New Jersey Autism Study. "To me it seems like autism prevalence can only get higher," he said. USA Today

For now I'll disregard the possibility Walter might have a vested interest in seeing those numbers soar. I will also ignore his comment that racial discrepancies in diagnoses might reflect true differences in incidence of autism and not other factors (e.g., access to health care). As a mother who gestated and birthed three babies in Jersey, I am interested in these autism numbers:

1 in 45 kids in New Jersey

1 in 175 kids in Alabama

1 in 42 boys, 1 in 189 girls

New Jersey is the only state to find all the children with autism? The rest of the country should catch up with them? I'm not sure anybody should be holding up New Jersey as an example of accurate autism assessment. One has to wonder whether the state might be stretching the diagnosis a bit.

Questions remain, duh. Chief among them is whether the actual incidence of autism increasing. It's not clear at all to what extent expanded criteria (both in the DSM and national incidence rates) have contributed to rising rates of autism. 

The Washington Post, for one, isn't so convinced these numbers reflect a true rise in autism:

“We can’t dismiss the numbers. But we can’t interpret it to mean more people are getting the disorder,” said Marisela Huerta, a psychologist at the New York-Presbyterian Center for Autism and the Developing Brain in suburban White Plains, N.Y.
Sure the media sought out the usual autism experts and advocacy organizations this week, including the omnipresent Autism Speaks. But I only came across one that quoted Alison Singer, the co-founder and president of the Autism Science Foundation, the one that never championed the harmful vaccine theory. Singer, who has a severely autistic child, attributes the rise in autism to more high-functioning kids getting the diagnosis: 

“The likelihood of a child having an autism record is higher, but that’s not because more of them have it,” says Singer. “The community health care providers are more likely to diagnose a child with autism than they would have been in previous years. There is more awareness of the disorder and that you don’t need to have an intellectual disability [to have ASD].” The Daily Beas

She worries that autism is now more recognized as a social disorder, a more mild set of symptoms instead of one of with more profound deficits in speech and intellectual abilities, also repetitive, sometimes self-injurious behavior. She worries that kids with more classic autism will be deprived of resources and research attention.

But that doesn’t play nearly as well in the media as that 1 in 68 kids!

*UPDATE: Check out this great analysis of the relative risks of factors related to autism. Sam Wang at Princeton wrote it and the New York Times published it. Why hasn't anyone done this before? 

Monday, March 24, 2014

A Debate over Childhood Vaccinations? The View From the Mudroom

As if there simply hasn't been enough drama, opinion or celebrity-mom tweet-hating over vaccines in the last decade, The New York Times has thrown vaccines up for debate once more, this time in their Room for Debate feature. No not that debate. Technically this debate is not over the efficacy or safety of childhood immunizations.  Thank goodness. Fortunately the venerable news source didn't slog through that quackmire but instead turned their considerable platform to the issue of religious and personal exemptions, specifically the question of whether vaccination should be mandatory.

Oh there's room for debate over vaccine exemptions but it's not cavernous, it's more mudroom than ballroom. With vaccination rates above 90% the New York Times or their peers can still debate this issue or at least entertain such debates. This particular discussion though wouldn't be possible without the success of childhood vaccinations.

As for the actual debate, the content, well, you can probably guess most of it. You could have written the arguments. So in lieu of actually reading the article, why not try to match these opinions with the right expert(s)?

A. No Exemptions for Anybody

B. Exemptions for Anybody

C. Religious Exemptions Only (out of respect to the religious folk)

D. Exemptions Are Okay for Now Because We Don't Want to Upset/Coerce Anyone (unless we inadvertently export more childhood diseases)

1. The infectious disease physician at Children's Hospital of Philadelphia (Paul Offit's stomping grounds).

2. The anti-Big Formula/anti-Big Pharma/anti-Big Medicine/anti-Consumerism journalist.

3. The former US Surgeon General (i.e. a political appointment).  

4. Two British pediatric professionals.

You probably could match 1A and 2B pretty easily.                

The last two are probably the hardest. C3 and D4 (yes I made it very challenging). I don't completely buy the Brits' argument that mandatory vax might backfire and create more anti-vaccine sentiment and hence reduced vaccination rates. It is interesting though. Even as a somewhat rebellious type, I can't endorse this without some more evidence. Is there any evidence axing exemptions would reduce vaccination rates? I'm trying to think of any public health legal measures that have backfired.*

Seat belts. Are there drivers out there who stopped wearing seat belts because of mandatory seat belt laws? Motor cycle helmets, probably yes but all my evidences comes from Sons of Anarchy (Season One - seriously how many times let alone seasons can Jax not get killed?)

Child car seats. Any parents not strapping their kids in a booster out of some rebellious, government-go-to hell attitude?

True the risks of non-compliance are hefty in those above legally mandated examples. The risks of not using a car seat appear plentiful even if we discount the possible exaggeration of safety features on today's models.

I suspect mandatory vaccination might also deter some of the parents who might be tempted to turn down vaccines. I know these adults comprise a small but ardent and vocal group but it's possible some might just go ahead and endur the MMR and others just as some who seem to embrace vaccines then might fall into the anti-vax camp.

How about other public health recommendations that could possibly result in oppositional defiance?

The Back To Sleep Campaign. I haven't noticed a backlash, no pun intended.  Pediatric occupational therapists and others have pointed towards its adverse effect on motor development and thus, given us Tummy Time but I've yet to encounter any complaints about parental freedom vis a vis infant sleep position. True mothers have been known to let their kids sleep on their stomachs (guilty) but it's not out of defiance but the simple fact some infants prefer sleeping sunny side up.

Breastfeeding? The latter recommendations aren't mandated by law not yet anyhow but somehow nobody seems particularly worried that strong recommendations might encourage rebellious non-compliance.

Why don't we worry about the blowback from these campaigns?

*Another possibility: my anonymous friend at Public Health Rants (no it's not me, look at the cool graphics) suspects that "going DefCon" on parents who don't vaccinate actually turns people off vaccination. Now that's something to consider. In her post How Not To Not Get Autism: The Kristin Cavallari Story, she argues it's the public outcry against anti-vaccine sentiment that spawns anti-vaccine sentiment:
I know, I know, when people don’t vaccinate it doesn’t just affect them, it affects all the immunocompromised people and babies too young to be vaccinated.  I get it.  Which is why we need to stop going DefCon whatever on celebrities who don’t vax.  Because someone is listening and is choosing NOT to vax because of what they may perceive as unjustified personal attacks.  You don’t catch any flies by hurling acid.  Well maybe you do but you’d kill them.  Or something.  Just be nice is all I’m saying.  What kind of a person do you trust?  Someone who is hateful or someone who listens and doesn’t judge?  What kind of people do vaccine-hesitant parents trust?  So for the sake of the immunocompromised, please let’s not hurl acid.  If that approach worked than everybody would vaccinate.  But they don’t.  So we’re doing something wrong.
Okay PHR, this is me turning nice. Very nice. Stay tuned..


Can you imagine this debate in say Uganda, Nigeria and other countries where parents walk miles to health clinics? As if they're sitting in their mudrooms wondering about the possible negative repercussions of mandated vaccination. As long as I'm on the topic, the United Nations Foundation's Global Mom's Challenge is here again this spring. Here's how it works:

From International Women’s Day through Mothers’ Day–March 7 through May 11–a celebrity or community leader, from New York to Nairobi, will share a personal story of how a mom has changed his or her life, and then “pass the baton” to the next person. Read these inspiring posts and share them with friends through your social networks–each time you do, Johnson & Johnson will donate $1, up to $250,000, for each share on each network, to help moms and babies around the world stay healthy and happy. 

You can sign up to get the Global Mom's daily posts. The Queen of Jordan chimes in on March 26th, Melinda Gates, the 31st.

Of course you can also join the UNF's Shot At Life Campaign, a grass-roots movement to increase awareness, funding and access to life-saving childhood vaccines in the developing world.  It's not just the more economically depressed nations plagued by these diseases. Check out this map of vaccine-preventable diseases compiled by the Council on Foreign Relations and yes, it illustrates these illness are in the United States. The sizes of the circles/dots are not great, the graphics make it seem like entire states are engulfed by measles and whooping cough. Edward Tufte, the grand poobah of graphs would not approve but you can click on the individual circles for the exact # of cases and you can check by disease. NPR has a good description of the map too.

UPDATE: Check out this graphic analysis of the relative risk factors linked to autism. Love it, from Sam Wang at Princeton.