You Can’t Save Kids Just With Vaccines.

This post is in response to a blog post I read titled Dear Parents You Are Being Lied to…

At no time in history have we succeeded in making, in a timely fashion, a specific vaccine for more than 260 million people.


Yes, it may be true that vaccines are one of our greatest public health achievements, and one of the most important things you can do to protect your child. But, the number of young children who are not fully vaccinated for preventable diseases has been steadily increasing over the last decade. More and more, parents are claiming nonmedical exemptions from routine vaccinations.  Are they really crazy? Is there a legitimate fear? Can we find a balance?  Can parents recognize that no matter which side you are on we all want our children safe?

No matter which team you are on, one things for sure; whether you understand biochemistry or not, we would be crazy not to question the sudden increase in the number of vaccines needed or required despite our innate fear of disease.

Let’s remember that human beings are protected against infectious diseases by various physical and biochemical factors. Our first level of protection against disease is our skin and its acidic secretions, tears and the mucous membranes that line our nose, mouth and other passages connecting our internal and external environments. These factors and others, when functioning properly, keep pathogens at bay.

If an infectious agent, a pathogen, gets past the first line of defense, our bodies have a second tier of defense provided by natural or innate immune mechanisms. In this case, our own cells and the chemicals they produce seek out, identify and eliminate the pathogen. These very general and non-specific responses are critical to the maintenance of good health.

On occasion, a pathogen can get past our bodies’ primary protective mechanisms if it is present in very large numbers or if it has evaded or suppressed these processes. Stronger protection is needed and we respond by mounting an acquired immune reaction specific to the pathogen. These responses involve a variety of types of cells found in the blood and tissues, and can require a week or more to become established. Acquired immunity consists of antibody and cell-mediated responses.

An acquired immune response can result in either short-term or long-term protection against a specific pathogen and, perhaps, against some of its close relatives. In the case of long-term protection, re-exposure to the same pathogen weeks, months or years later reactivates the response mechanisms laid down during the original exposure.

This reactivation leads to rapid, effective elimination of the agent, often without clinical symptoms or signs of infection. When specific immunity results from unintentional exposure to agents in the environment, we refer to the resulting protection as being passively acquired immunity. Intentional exposure to such an agent or its components through vaccination is known as actively acquired immunity.

There’s always been some controversy surrounding vaccines, but in the past that was usually overridden by fear of the disease itself.

Take the polio vaccine, for instance. When it was first tested, families lined up for the trials. These were people who had no idea if the vaccine itself would cause polio. They didn’t even know if they’d receive a vaccine or a placebo. But they were so terrified of polio that they were willing to try anything. Ordinary people were also willing to pay for the development of the vaccine. That’s what got the March of Dimes started; it was an effort to pay for the research privately since the government wasn’t willing to fund it with public money. The point is that when people are terrified of a disease, they are far more willing to take risks.

The idea of inoculating people against disease dates back to 1796 when British doctor Edward Jenner noticed that milkmaids appeared to be immune to smallpox because of their exposure to a mild form of pox carried by cows.

Dr. Jenner took puss from a lesion on the hand of a milkmaid and inoculated a young boy. When the child didn’t become ill with smallpox, Dr. Jenner deduced that a small dose of a disease could protect a person from a more serious illness (the word vaccine is derived partly from “vaca,” the Latin word for cow).

More than two centuries later, making vaccines on a large-scale remains challenging.

Understanding how vaccines work requires some appreciation of the cells and other factors that play a role in the acquisition of immunity. The immune system is a complex network of molecules, cells and tissues that is widely dispersed throughout the body. Each of these entities has a distinct role to play, and all interact in a coordinated and orchestrated manner to generate a timely and specific immune response to a pathogen or to a vaccine.

When a pathogen or vaccine reaches the internal environment through inhalation, ingestion, a wound or injection, the cells in the surrounding tissues release chemicals called chemokines and cytokines that attract various types of white blood cells to the area of injury, leading to the destruction of the pathogen. White blood cells are found in everyone’s blood and are responsible for keeping our bloodstream and tissues free of pathogens, abnormal cells and other unwanted material.

Several types of white blood cells are critical to the natural immune response. One type of white blood cell is called a macrophage. It is among the first of the responding cells to arrive at the site of injury where it engulfs and destroys the pathogen.

Other types of white blood cells, called lymphocytes, also are attracted to the site. These cells, along with the macrophages release other chemokines and cytokines that direct the immune response. The local accumulation of the various types of cells contributes to the inflammation or redness that is often observed at sites of infection and injury. These cells and processes constitute the natural immune response and are often sufficient to clear or eliminate the infection.

Natural immunity is neither specific nor long lasting. This response occurs each time there is a threat of infection, and is virtually identical for each pathogen that gains entry. Natural immunity is also independent of the number of times to which we are exposed to any single agent, that is, even if we are exposed to a single agent many times, our response to each exposure is the same.

Vaccines on the other hand contain a number of substances, which can be divided into the following groups:

1. Micro-organisms, either bacteria or viruses, thought to be causing certain infectious diseases and which the vaccine is supposed to prevent. These are whole-cell proteins or just the broken-cell protein envelopes, and are called antigens.

2. Chemical substances, which are supposed to enhance the immune response to the vaccine, called adjuvants.

3. Chemical substances which act as preservatives and tissue fixatives, which are supposed to halt any further chemical reactions and putrefaction (decomposition or multiplication) of the live or attenuated (or killed) biological constituents of the vaccine.

All these constituents of vaccines are toxic, and their toxicity may vary, as a rule, from one batch of vaccine to another.

The desired immune response to vaccines is the production of antibodies, and adding certain substances to the vaccines enhances this. These are called adjuvants (from the Latin adjuvare, meaning “to help”).

The chemical nature of adjuvants, their mode of action and their reactions (side effect) are highly variable. Some of the side effects can be ascribed to an unintentional stimulation of different mechanisms of the immune system whereas others may reflect general adverse pharmacological reactions, which are more or less expected.

There are several types of adjuvants. Today the most common adjuvants for human use are aluminium hydroxide, aluminium phosphate and calcium phosphate. However, there are a number of other adjuvants based on oil emulsions, products from bacteria (their synthetic derivatives as well as liposomes) or gram-negative bacteria, endotoxins, cholesterol, fatty acids, aliphatic amines, paraffinic and vegetable oils.

The discovery of adjuvants dates back to 1925 and 1926, when a doctor showed that the antitoxin response to tetanus and diphtheria was increased by injection of these vaccines, together with other compounds such as agar, tapioca, lecithin, starch oil, saponin or even breadcrumbs.

The term adjuvant has been used for any material that can increase the humoral or cellular immune response to an antigen. In the conventional vaccines, adjuvants are used to elicit an early, high and long-lasting immune response. The issue with the newly developed purified subunit or synthetic vaccines used today using biosynthetic, recombinant and other modern technology are poor immunogens and require adjuvants to evoke the immune response.

To explain the action of adjuvants, we should look into immunology. The theory of vaccine efficacy is based on the ability of vaccines to evoke the formation of antibodies. This is of varying efficacy, depending on the nature of the antigen(s) and the amount of antigenic substance administered.

However, the mechanisms for the diversity of immune reactions are complex, and to this day are not quite known and understood. There are numerous theories, the favored one being antibody response as the sign of immunization (acquiring immunity).

Specific immunity to a particular disease is generally considered to be the result of two kinds of activity: the humoral antibody and the cellular sensitivity.

The ability to form antibodies develops partly in utero and partly after birth in the neonatal period. In either case, immunological competence—the ability to respond immunologically to an antigenic stimulus—appears to originate with the thymic activity.

The thymus initially consists largely of primitive cellular elements, which become peripheralised to the lymph nodes and spleen. These cells give rise to lymphoid cells, resulting in the development of immunological competence. The thymus may also exert a second activity in producing a hormqne-lilce substance, which is essential for the maturation of immunological competence in lymphoid cells. Such maturation also takes place by contact with thymus cells in the thymus.

Stimulation of the organism by antigen results in proliferation of cells of the lymphoid series accompanied by the formation of immunocytes, and this leads to the antibody production.

None of the theories for antibody formation comprehends all the biological and chemical data now available.

With a few exceptions, adjuvants are foreign to the body and cause adverse reactions.

This is where we should be paying attention!

The use of adjuvants enables the use of fewer antigens to achieve the desired immune response, and this reduces vaccine production costs.

So is it reasonable, to consider the aggregate effects of the increasing number of vaccinations given to babies? Are we totally satisfied that aggressive modulation of the immune system in healthy children has no significant risks? We can just keep adding vaccines? The more the better? I’m just wondering out loud.  Less is more in almost every other aspect of medicine, just not in infectious disease?

Vaccines are still made primarily from tiny bits of pathogens, the disease-causing agents of a virus. It can take months to get the formula right, and flu viruses are always changing. The manufacturing process is also clunky and relies on techniques developed 50 years ago in which a virus is injected into chicken eggs to multiply.

Here’s how the process works: Like any virus, flu will only grow in living cells. One of the best places to grow it is in fertilized chicken eggs. (Pigs and humans are also good, but less practical.) Eleven days after the egg is fertilized, a hole is drilled into the eggshell and the virus is injected into the fluid surrounding the embryo. After the virus infects the embryo, it multiplies. Machines then crack open the eggs and the virus-filled fluid is removed.

The virus is chemically inactivated, usually with formaldehyde, and used as the “antigen” of a flu shot. Antigen is short for antibody generator. When injected into the body, it’s the antigen that provokes an immune response that remembers the code of the virus that is attacking the body.

The antigen-making process can take months because the eggs have to be at the right maturity. The virus also grows slowly and it can take as many as three eggs to make one shot of flu vaccine. Then there are the chickens that produce the eggs – they have to be kept in steady supply, and healthy, since producing enough vaccine for an entire country can take millions of eggs.

 “It’s very cumbersome to make flu vaccine.”

Heavy regulation and a lack of a broad customer base left many drug companies with little incentive to make vaccines. Why spend time on such a low-margin business as vaccines when a company could make a fortune developing a new blockbuster drug?

But all of that began to change with the first hint of a pandemic on the other side of the world.

The outbreak of H5N1 in Hong Kong in 1997 was relatively small – just 18 people who handled birds – but six of them died. Such a high death rate drew immediate attention from medical experts around the world. Fears of a much bigger death toll began to percolate at government levels.

Like many countries, Canada began working on a pandemic preparedness plan. Led by John Spika, a senior infectious disease official at Health Canada, federal and provincial bureaucrats began drawing up models of a potential outbreak that could kill up to 58,000 Canadians and do $30-billion worth of damage to the economy. The key to fighting such an outbreak, they believed, was securing an abundant supply of vaccine.

Dr. Spika and others in the vaccine community warned that if a serious pandemic broke out, countries would close their borders and hoard vaccine. Governments began setting aside money in federal budgets for pandemic preparations. Ottawa also began negotiating a long-term vaccine supply agreement with BioChem, which had the only flu vaccine facility in Canada.

For Mr. Vezeau at BioChem, pandemic planning was a godsend. Suddenly, he had the attention of government officials. “We were losing money, so we went to the government and said, ‘Listen, for this to be a viable manufacturer, we need to increase the price of our vaccine,” Mr. Vezeau said. They got a higher price.

The government pursued contract negotiations with BioChem on a deal that was potentially so lucrative it began to push the value of the company higher. Before it was even signed, Shire Biologics stepped in and purchased BioChem in 2001. Soon after, the company signed a 10-year pact with Ottawa that would see the Quebec facility responsible for producing flu shots for every Canadian in a pandemic.

Dr. Spika called the deal “a cheap insurance policy” for the country. At a price tag of $300-million, it was more money than the vaccine maker had ever seen before.

Other vaccine companies began to negotiate similar large-scale contracts in dozens of countries, from Switzerland to France and even such smaller nations as Iceland.

However, one problem remained for the vaccine manufacturers as governments around the world began doling out money for contracts. The process was slow and hard to use on a mass scale. “They have to use chicken embryos and there isn’t enough supply of those readily available to be able to make tons of vaccine.

Fighting pandemic flu with vaccine made from eggs alone would be a losing battle, many believed. Companies needed to find a way to increase the amount of vaccine that could be produced in order to capitalize on the growth. And that particular discovery was already in the works.

For years, scientists had tried to find a faster way to make vaccines. They chased a variety of theories, including isolating the DNA of a virus, which many researchers believed would unlock new ways to fight infections. But at its main vaccine facility in Rixensart, Belgium, Glaxo had found a way to make vaccines more potent using another kind of technology: adjuvants.

Like we said, adjuvants are like superchargers for vaccines. They are mild contaminants that cause the body to respond with a more intense immune response. When paired with antigens, the adjuvant liquid can make the vaccine’s impact stronger. This allows for more doses to be produced from less antigen.  Not a good long-term strategy but highly profitable.

The word itself comes from the Latin “adjuvare” which means to help or aid. But adjuvants, like so many scientific discoveries, were stumbled upon almost by accident.

Testing on different batches of vaccines often found that some worked better than others. In cases where there was a slight contaminant present in the mix – something as simple as using dirty lab materials :-/ – researchers found there was an enhanced immune response from the body to that dose of vaccine.

Thus the adjuvant industry was born, with contaminants such as oils, salts and virosomes (which are bits of influenza virus that do not replicate) added to vaccines.

“It allows us to decrease the antigen content, which allows us to multiply the capacity,” said Philippe Monteyne, senior vice-president of global vaccines development at Glaxo. “And of course, multiplying the capacity has some impacts on the business side,” boosting profits.

Adjuvants allowed companies to pump out more, but it is also a higher-margin business than antigens.

Significantly more than half the price of a dose of flu vaccine is attributable to the adjuvant, though Glaxo doesn’t disclose the exact figures. “That’s why vaccines became so attractive,” Mr. Monteyne said. “Most of the value in our case is put on the adjuvant technology.”

For the drug companies, the new interest in vaccines by governments looking to get as many flu shots as they could buy, and the scientific advances of adjuvants, came at an opportune time.

Many drug makers were starting to worry about the long-term viability of mega drugs like Lipitor, a cholesterol fighter, and Zantac, an ulcer treatment, that have a finite period of patent protection. When the patents expire, the market is flooded with cheaper generic versions. The big drug companies needed a new source of revenue, and the advent of large-scale vaccine manufacturing looked promising.

With the value of vaccines on the rise with the fears of avian flu, the drug companies also liked something else about the resurgent business: they had it to themselves.

Because vaccine making is so expensive – a new plant can cost up to $1-billion (U.S.) – companies like Glaxo, Novartis and Sanofi-Aventis didn’t have to worry about a rash of new entrants cutting into the flu vaccine business as governments ordered millions of doses.

“The barriers to enter the market are extremely high,” said Mr. Monteyne in Belgium. “You don’t become a vaccine maker over night. That’s why we have a few big players, and very few only.” That meant the giants could push hard to increase prices. And they did.

Sanofi-Aventis expects to earn close to $6-billion (U.S.) in vaccine revenue next year and double its sales by 2013. This quarter, sales of H1N1 vaccine alone will top $500-million. It is suddenly a good time to be a flu shot maker.

“Vaccines, vaccines, wonderful business,” Chris Viehbacher, the Canadian-born CEO of Sanofi-Aventis, told investment analysts on a conference call a few months ago.

It didn’t take long for such calculations to be made in other boardrooms around the globe. The companies began acting quickly to expand: Novartis spent $5-billion to buy U.S.-based flu vaccine maker Chrion. Britain’s Astra Zeneca paid $15-billion for Medimmune, and Glaxo purchased the old BioChem vaccine operation in Quebec for $1.4-billion.

With 22 per cent of the market, Glaxo was now the global leader in vaccines. And with that clout came the power to influence governments, who were already fearful about not having enough vaccine supply in the event of a pandemic.

In the summer of 2008, Canadian Finance Minister Jim Flaherty’s staff prepared a briefing note for an upcoming meeting with the head of Glaxo’s Canadian operations, Paul Lucas.

Glaxo had been lobbying several governments around the world to get higher vaccine prices and access to massive cash reserves countries were setting aside to cope with a pandemic threat.

“We understand that Mr. Lucas would like to discuss how GSK could further contribute to Canada’s pandemic preparedness, including [Ottawa] setting aside $400-million as a contingency fund,” the note said, according to documents obtained by Ottawa researcher Ken Rubin.

Mr. Flaherty held the purse strings on any national pandemic plan and subsequent vaccine purchase from Glaxo. The company had a message for the minister: “GSK has been critical … contending that the proposed vaccine price is too low,” Mr. Flaherty’s staff told him.

Indeed, the company had already been lobbying governments well before then. Since the late 1990s, prices for flu vaccine in North America have soared from $2 per dose to as high as $12 in 2007. The price has recently fallen back to about $8 as buying volumes increased in the face of H1N1. But that’s still a healthy margin, as some analysts estimate it costs about $1 to make each dose.

The company does not discuss its costs, but Mr. Monteyne said the cost of a flu shot is flexible depending on whether the buyer can pay more. “We have a tiered pricing strategy,” Mr. Monteyne said. “It is mainly based on the level of income of the country.”

Beyond just selling crates of vaccine, Glaxo also wants to sell full-service protection – pandemic readiness packages. And the industry’s desire to build a stable business out of vaccines, along with the emergence of adjuvants, has led to perhaps the most significant shift the industry has seen in decades: the creation of vaccine stockpiles.

Switzerland was the first country to jump in. In October 2006, with fear over H5N1 at fever pitch, the Swiss signed a contract with Glaxo on a stockpiling deal that called for 8 million doses of avian flu vaccine, slightly more than one shot for every citizen.

Then, in a new kind of move for the industry, the Swiss reserved future space on the production line for another 8 million doses if needed. That meant Swiss health authorities had priority in line at Glaxo’s factories if a second dose were needed.

This emerging business – pre-pandemic treatment – was rounding into shape. Glaxo began trademarking the names of vaccines along those lines, registering its vaccines as Prepandrix.

Other nations soon followed the Swiss with deals of their own, locking up huge sales for Glaxo.

There was just one problem: the H5N1 pandemic never happened. The virus stayed mostly with animals. The Swiss were left with one of the world’s largest stockpiles of unused H5N1 flu vaccine. Glaxo’s sales of avian flu vaccine fell 54 per cent in 2008, as countries realized their stockpiles weren’t needed.

This was a problem for the vaccine makers, who were looking to build an enduring revenue stream rather than simply capitalizing on flu fears to gain a temporary spike in sales. Glaxo’s new CEO, who had been elevated from the ranks of the company’s vaccine division, understood this.

Barely a year into his tenure as Glaxo’s chief executive officer, Andrew Witty outlined the company’s achievements during a conference call in October. Quarterly profit was up 30 per cent from a year earlier, orders for H1N1 flu vaccines had topped 400 million doses and the company was close to becoming the world’s largest vaccine maker.

“I think the momentum of this business is going in the right direction,” Mr. Witty told analysts. In short, Glaxo’s big bet on vaccines was bearing fruit. And perhaps most surprisingly, the Swiss were buying again, despite having spent millions on H5N1 vaccine it never used.

This, Mr. Witty explained, was the brilliance of the new vaccine market. Glaxo had turned the Swiss situation into an opportunity to sell more vaccine.

Because adjuvant could be paired with any antigen, the leftover stockpiles could be used for other outbreaks by simply plugging in a different antigen, depending on which virus looked most threatening.

Once a country bought a large supply of adjuvant, it was locked in as a buyer for Glaxo’s antigen for years to come. Countries were not just vaccine buyers now; they were subscribers, coming back annually to the company for more and different types of shots.

“If you go with an adjuvanted technology, you can actually keep a stockpile of your adjuvant and then simply rotate a new antigen in at the last minute,” Mr. Witty said.

That is basically what the leading countries like Switzerland did.

“The real business is a business of stockpiling. It is not a reactive market. It is something that is proactively being built with governments,” Mr. Monteyne said.

Other countries, including Canada, took notice of what the Swiss were doing. In the past 12 months, the number of countries using such stockpiling methods has grown to 60 from less than 10. When H1N1 broke out and temporary vaccine shortages occurred, Canadians learned that the federal government has become a big buyer of adjuvants.

As far as the vaccine makers are concerned, adjuvants are the future because they encourage countries to stockpile what they’ve bought from the drug companies. Asked by an analyst whether the company could keep generating the record vaccine profits it saw in 2009, Mr. Witty didn’t hesitate: Yes, it could.

“What’s been created this summer is essentially a stockpiling marketplace, which over a period of time will have to be refreshed,” Mr. Witty told analysts. “And that’s exactly where we see there being some kind of steady state” for the vaccine industry.

New fears over H1N1 were the catalyst to a completely new way of buying and selling vaccines that many countries are expected to follow. Flu shots are now a product for the masses. Non-seasonal flu shots such as H1N1 could become a yearly norm.

Soaring vaccine sales are also pushing companies to chase profit in other types of shots. The race is now on to develop blockbuster vaccines, defined as those that bring in more than $1-billion annually. Two recently developed vaccines – Prevnar for pneumonia and Garasil for cervical cancer – have become blockbusters, selling close to $2-billion a year.

In adult medicine, a common problem is poly-pharmacy. Each individual drug may be reasonably safe and effective for its intended disease. But given together, with 5 or 6 or more other chemicals, there are likely to be important interactions. The NY Times covered a study that persuasively suggested muscle side effects from statin drugs might be related to drug interactions.

Is it possible?  Absolutely!

Cellular sensitivity, also known as delayed or cellular hypersensitivity, depends on the development of immunologically reactive or “sensitive” lymphocytes and possibly other cells which react with the corresponding antigen to give a typical delayed-type reaction after a period of several hours, days or even weeks.

Cellular hypersensitivity depends on the original antigenic stimulation and a latent period, and is specific in its response. Delayed-type hypersensitivity is characteristic of the body’s response to various infectious agents such as viruses, bacteria, fungi, spirochetes and parasites. It is also characteristic of the body’s response to various chemicals, such as mercury, endotoxins, antibiotics, various drugs and many other substances foreign to the body.

The induction of a hypersensitivity reaction requires the presence in the tissues of the whole organism or certain derivatives of it, in addition to the specific antigen such as a lipid in addition to tubercle bacillus protein. Sensitization to a non-infectious substance must be mediated through the skin or mucous membranes, which probably provide further necessary co-factors.

A delayed hypersensitivity reaction may be enhanced experimentally by the employment of the antigen in a mineral oil adjuvant with added Mycobacterium tuberculosis or by injection of the antigen directly into the lymphatics. The delayed hypersensitivity response is accompanied by mild to severe inflammation, which may cause cell injury and necrosis. The inflammatory response, which occurs in delayed-type hypersensitivity, may not be protective, and in many instances may even be harmful (e.g., rejection of grafts is directly linked to delayed hypersensitivity).

To make a point.  Since the end of the Gulf War, tens of thousands of American, Canadian and British soldiers who participated in that war have claimed to be suffering from a variety of incapacitating symptoms which are generally termed as Gulf War Syndrome (GWS). The symptoms are multiple but mainly consist of excessive tiredness, muscle and joint pain, loss of balance, sensory symptoms, neurobehavioural manifestations, diarrhoea, bladder dysfunction, sweating disturbances, and respiratory, gastrointestinal, musculoskeletal and skin manifestations.

These veterans have been exposed to a variety of damaging or potentially damaging risk factors including environmental adversities, pesticides such as organophosphate chemicals, skin insect repellents, medical agents such as pyridostigmine bromide (NAPS), possible low-levels of chemical warfare agents, multiple vaccinations in combinations, depleted uranium, and other factors.

A large number of basic research findings, clinical epidemiological studies, and case control studies are reviewed to try and link them together to produce a coherent picture and to demonstrate the complexity of the interaction of biological systems, environmental and genetic factors, combinations of drugs and toxins with human health.

The findings of these studies so far have demonstrated that many of the previous assumptions made about the ‘safety’ of certain drugs and toxic substances or vaccines must be radically reviewed.

Many of the findings have far reaching implications not only in terms of explanation of what might have gone wrong during the Gulf War, but also have wider implications for many occupational groups who are exposed daily to some of these risk factors. More open-mindedness and much less prejudice are required concerning the basic biology of interactions of the above factors and their effects on cell functions and wider intelligent research is urgently required with high priority.

So, Hep B vaccine in babies? I have yet to hear a convincing reason to mandate vaccinating a newborn for Hepatitis B–a blood/body fluid transmissible disease. (I looked through 6 pages of a Google search. It yielded recommendations, associations and speculations.)

It’s not really because we think 5-year-olds will be exchanging body fluids on a bloody sports field, is it? It’s not for convenience or adherence. Because surely we aren’t saying that we think parents can’t be relied on to bring their older children in for a beneficial treatment. No misunderstandings please.

I’m not suggesting Hep B vaccine is dangerous or that it is a bad idea–I am glad I am protected–but is it wrong to question the net clinical benefit of giving Hep B vaccine to a newborn who lives in non-endemic suburbia and was born to an HBV-negative mom? I’m just asking.

Maybe someone has a convincing scientific explanation; it’s just not on the first 6 pages of Google.

Be Well.

Live and Learn. We All Do.

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We Have Begun To Accept High Rates Of Cancer As Normal

I like to think that if some other mother’s child was in need I would respond, just as it comforts me to think that if my child was in need I could rely on another adult to step in. If we all lived in a world where we acted as if we were responsible for each other’s children, the lives of children would be immeasurably better.

One of the greatest challenges facing humanity in the coming decades is to heal the relationship between industrial civilization and the environment that sustains us. In the context of this larger healing, the role of healthcare needs to be transformed and enlarged.


Not only do we need to heal individual patients, but also the surrounding environment and the communities that are served by health care delivery systems. Moreover, health care itself is a major industrial enterprise and suffers from all the same contradictions of a system powered by fossil fuels and toxic chemicals. It is a significant source of pollution and related public-health impacts.

We need to transform this disequilibrium at a scale that matches the social and ecological crises that we face. First, we need to educate health care professionals around the world to understand the importance environmental conditions in disease onset; second, we need to help the health care sector clean up its own house by reducing its environmental and public-health footprint; third, we need to utilize the enormous purchasing power of health care to drive markets and create stimulus for greener energy, greener chemicals, and safer products and technologies. And finally, we need to activate health care leaders to advocate for broader societal policies that are more protective of everyone on the planet and the ecosystems that sustain us.

This transformation will require more than just money (although it will require plenty of that).

The United States spends more on health care than any nation on earth, yet its health statistics are worse than most industrialized countries and many developing countries. Its hospitals have the most advanced medical technologies, yet its citizens have the highest cancer rates.

According to the American Cancer Society, one in three women will get cancer in her lifetime and almost one in two men. Among children under fourteen, cancer is the leading cause of death by illness. As a society, we have begun to accept high rates of cancer as a normal consequence of living in our industrialized economy.

There are other troubling signs as well: obesity now affects almost 90 million Americans, contributing $147 billion a year to the nation’s bulging health care budget. Learning disabilities impact one in six children and infertility impacts one in six couples. How can we explain this epidemic of diseases and health conditions in the richest country on earth?

Over the last 15 years, the science implicating environmental threats to health has become impossible to ignore. The evidence linking toxic chemical exposures to learning disabilities, cancer, asthma, Parkinson’s disease, endometriosis, infertility, and a host of other conditions gets stronger every day.

The mounting drama of obesity-related diseases is increasingly understood as a consequence of a failed industrial food system and not just the result of poor individual food choices. And as the slow-motion crisis of climate change continues to unfold, we are learning that global warming will usher in an era of pandemics, infectious-disease migration, respiratory disease, heat-related deaths, and a tide of environmental refugees of biblical proportions. As Yogi Berra once said, “suddenly the environment is all around us.”

As long as we continue to ignore the environmental determinants of health, we will continue to medically intervene only after the onset of chronic disease. It’s as if we have designed an entire healthcare system to pull drowning people out of a river, rather than moving upstream to see why they are being thrown into the river in the first place.

Seventy percent of all health expenditures in the United States are devoted to treating chronic disease; only 4% of the healthcare budget is focused on primary prevention. Meanwhile, children are being born with up to 100 toxic chemicals in their bodies, already poisoned before birth. Climate change continues unabated, amid scientific consensus that it will lead to millions of new asthma cases and a plague of other conditions.

In the early years of the 21st century, we are learning that it is becoming increasingly difficult to support healthy people on a sick planet.

Is there evidence that a transformative program to detox our economy is even possible?

There is a growing consensus that we need to defend the rights of children to be born toxic-free and the rights of women to protect the purity of their breast milk. These are fundamental human rights that we need to fight for if we are to have any chance of protecting future generations.

Over the last decade, Health Care Without Harm (HCWH) has shown that the health care sector can be a catalytic force linking health issues with the greening of the economy.

No other sector has the same standing to accomplish this linkage. With minimal resources, we have demonstrated that large-scale change is not only possible, but also cost effective and in alignment with health care’s core mission to do no harm.

We are entering an era of global triage, where we will struggle to provide basic health care to everyone on a planet in crisis. In this critical mission, we need to make environmentally responsible health care the global standard and create markets for safe and affordable medical technologies and products that address the basic needs of billions of people.

We have shown that environmental protection, preventative health care and the greening of the economy can be powerfully linked to achieve all three objectives. It is now time to get to work and bring these solutions to scale.

Gary Cohen

Live and Learn. We All Do.

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Everyone Is A Food Activist When They Are Hungry

Put our love of soil before our addiction to oil.

Live and Learn. We All Do.

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And The Best Diet In The World Is….

By James Hamblinmar 

Researchers asked if one diet could be crowned best in terms of health outcomes. If diet is a set of rigid principles, the answer is a decisive no. In terms of broader guidelines, it’s a decisive yes.


Flailing in the swell of bestselling diet books, infomercials for cleanses, and secret tips in glossy magazines, is the credibility of nutrition science. Watching thoroughly-credentialed medical experts tout the addition or subtraction of one nutrient as deliverance—only to change the channel and hear someone equally-thoroughly-credentialed touting the opposite—it can be tempting to write off nutrition advice altogether. This month we hear something is good, and next we almost expect to hear it’s bad. Why not assume the latest research will all eventually be nullified, and just close our eyes and eat whatever tastes best?

That notion is at once relatable and tragic, in that diet is inextricable from the amount of healthy time we spend on Earth. Improvements in diet are clearly associated with significant lengthening of lifespan and dramatic decreases in risk of most chronic diseases. Combining disease and longevity into the concept of healthspan, the number of healthy years of life—fundamentally more important but less readily quantifiable than lifespan—the data in favor of optimizing our diets are even more compelling. No one is arguing that diet is less than extremely important to health and well-being, but seemingly everyone is arguing as to what constitutes the best diet.

“A diet of minimally processed foods close to nature, predominantly plants, is decisively associated with health promotion and disease prevention.”

The voices that carry the farthest over the sea of diet recommendations are those of iconoclasts—those who promise the most for the least, and do so with certainty. Amid the clamor, Dr. David Katz is emerging as an iconoclast on the side of reason. At least, that’s how he describes himself. From his throne at Yale University’s Prevention Research Center, where he is a practicing physician and researcher, said sea of popular diet media is the institution against which he rebels. It’s not that nutrition science is corrupt, just that the empty promises of memetic, of-the-moment diet crazes are themselves junk food. To Katz they are more than annoying and confusing; they are dangerous injustice.

Scientific publisher Annual Reviews asked Katz to compare the medical evidence for and against every mainstream diet. He says they came to him because of his penchant for dispassionate appraisals. “I don’t have a dog in the fight,” he told me. “I don’t care which diet is best. I care about the truth.”

Katz and Yale colleague Stephanie Meller published their findings in the current issue of the journal in a paper titled, “Can We Say What Diet Is Best for Health?” In it, they compare the major diets of the day: Low carb, low fat, low glycemic, Mediterranean, mixed/balanced (DASH), Paleolithic, vegan, and elements of other diets.

Despite the pervasiveness of these diets in culture and media, Katz and Meller write, “There have been no rigorous, long-term studies comparing contenders for best diet laurels using methodology that precludes bias and confounding. For many reasons, such studies are unlikely.” They conclude that no diet is clearly best, but there are common elements across eating patterns that are proven to be beneficial to health. “A diet of minimally processed foods close to nature, predominantly plants, is decisively associated with health promotion and disease prevention.”

Among the salient points of proven health benefits the researchers note, nutritionally-replete plant-based diets are supported by a wide array of favorable health outcomes, including fewer cancers and less heart disease. These diets ideally included not just fruits and vegetables, but whole grains, nuts, and seeds. Katz and Meller found “no decisive evidence” that low-fat diets are better than diets high in healthful fats, like the Mediterranean. Those fats include a lower ratio of omega-6 to omega-3 fatty acids than the typical American diet.

The Mediterranean diet, which is additionally defined by high intake of fiber, moderate alcohol and meat intake, antioxidants, and polyphenols, does have favorable effects on heart disease, cancer risk, obesity, metabolic syndrome, and “is potentially associated with defense against neurodegenerative disease and preservation of cognitive function, reduced inflammation, and defense against asthma.”

They also found carbohydrate-selective diets to be better than categorically low-carbohydrate diets, in that incorporating whole grains is associated with lower risks for cancers and better control of body weight. Attention to glycemic load and index is “sensible at the least.” Eating foods that have high glycemic loads (which Katz says is much more relevant to health outcomes than glycemic index—in that some quality foods like carrots have very high indices, which could be misleading) is associated with greater risk of heart disease.

Finally, in a notable blow to some interpretations of the Paleo diet, Katz and Meller wrote, “if Paleolithic eating is loosely interpreted to mean a diet based mostly on meat, no meaningful interpretation of health effects is possible.” They note that the composition of most meat in today’s food supply is not similar to that of mammoth meat, and that most plants available during the Stone Age are today extinct. (Though it wouldn’t surprise me to learn that Paleo extremists are crowd-funding a Jurassic Park style experiment to bring them back.)

Just because Katz is not one to abandon his scientific compass under duress of passion does not mean he is without passion, or unmoved by it in his own ways. The subjects of media headlines and popular diet books are dark places for Katz. “It’s not just linguistic, I really at times feel like crying, when I think about that we’re paying for ignorance with human lives,” he told me. “At times, I hate the people with alphabet soup after their names who are promising the moon and the stars with certainty. I hate knowing that the next person is already rubbing his or her hands together with the next fad to make it on the bestseller list.”

“That’s an excellent idea, and yet somehow it turns out to be extremely radical.”

“The evidence that with knowledge already at our disposal, we could eliminate 80 percent of chronic disease is the basis for everything I do,” Katz said. Just as he was finishing his residency in internal medicine in 1993, influential research in the Journal of the American Medical Association (“Actual Causes of Death in the United States”) put diet on a short list of the lifestyle factors blamed for half of deaths in 1990. “Here we are more than 20 years later and we’ve made just about no progress.”

A nod to the fact that popular media is not totally lost, Katz borrows from the writer Michael Pollan, citing a seminal 2007 New York Times Magazine article on “nutritionism” in concluding that the mantra, “Eat food, not too much, mostly plants” is sound. “That’s an excellent idea, and yet somehow it turns out to be extremely radical.”

Though Katz also says it isn’t nearly enough. “That doesn’t help you pick the most nutritious bread, or the best pasta sauce. A member of the foodie elite might say you shouldn’t eat anything from a bag, box, bottle, jar, or can.” That’s admittedly impractical. “We do need to look at all the details that populate the space between where we are and where we want to be.”

The current review is in pursuit of that, as is a system for determining the nutritional value of foods that Katz recently spent two years developing. It’s called NuVal, and it offers consumers a single numeric value to determine foods’ worth, as opposed to a complex nutritional panel. The number does things like differentiate intrinsic from added nutrients. “If you don’t do that, the best thing in the whole damn food supply is Total cereal. Total is basically a completely vapid flake delivery system for multivitamins. You could skip the cereal and take the multivitamin.”

“If you eat food direct from nature,” Katz added, “you don’t even need to think about this. You don’t have to worry about trans fat or saturated fat or salt—most of our salt comes from processed food, not the salt shaker. If you focus on real food, nutrients tend to take care of themselves.”

The ultimate point of this diet review, which is framed like a tournament, is that there is no winner. More than that, antagonistic talk in pursuit of marketing a certain diet, emphasizing mutual exclusivity—similar to arguments against bipartisan political rhetoric—is damaging to the entire system and conversation. Exaggerated emphasis on a single nutrient or food is inadvisable. The result, Katz and Meller write, is a mire of perpetual confusion and doubt. Public health could benefit on a grand scale from a unified front in health media: Endorsement of the basic theme of what we do know to be healthful eating and candid acknowledgement of the many details we do not know.

“I think Bertrand Russell nailed it,” Katz told me, “when he said that the whole problem with the world is that fools and fanatics are so sure, and wise people always have doubts. Something like that.”

Live and Learn. We All Do.

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Which Place Is More Sexist: The Middle East Or Latin America?

By Lourdes Garcia-Navarro

A semi-naked woman in a sequined Carnival costume. A veiled woman with only her eyes showing in a niqab. Two stereotypes of two vastly different regions — Latin America and the Middle East.

On the surface, these two images couldn’t be more diametrically opposed. What could the two have in common, right? What a woman wears — or what she doesn’t wear, in Brazil’s case — is often interpreted as a sign of her emancipation. The veil, for many, is a symbol of female oppression; the right to wear a bikini, one of liberation.

On the left: Women wearing burqas walk by the Gulf of Aqaba in Jordan in 2006. Right: Women in bikinis visit a beach in Rio de Janeiro in 2013.

Marco Di Fabio and Nelson Almeida/Getty Images

But underneath the sartorial differences, the Middle East and Latin America’s most famously immodest country both impose their own burdens on women in the way they are treated and perceived.

On a recent balmy afternoon, I was sitting at a seafront kiosk watching Brazil’s carnival coverage on the biggest broadcaster here, GLOBO. Suddenly, a naked woman popped onto the screen during a commercial break. She was wearing nothing. Literally nothing except a smile and some body glitter. Called the “globelleza,” she is the symbol of GLOBO’s festival coverage, and she appears at every commercial break.

Later programming showed a contest where women from various Samba schools — all of them black — were judged on their dancing and appearance by a panel that was all white. They all had their measurements read out for the crowd. But when one woman said she was studying at one of Brazil’s premier petrochemical departments to eventually work in the oil and gas industry, the male judge smirked in surprise.

The Role Of Women In Brazil

And that’s the thing about Brazil: It has a female president, and women are well-represented in the work force. This isn’t Saudi Arabia, where women cannot drive, or Afghanistan under the Taliban, where women could not study.

And yet it is one of the most dangerous countries to be female in.

Statistics show that about every two hours a woman is murdered in Brazil, a country with the seventh highest rate of violence against women in the world.

This juxtaposition of sex and violence isn’t new, according to Rosana Schwartz, a historian and sociologist at Mackenzie Presbyterian University in Sao Paulo. Brazil imported more slaves than any other country in the Americas, and slavery was only abolished in 1888.

“The female slaves were used as sexual objects to initiate the master’s son’s sexuality or to satisfy him. And the result has been that until today, Brazilian women are seen in a sexist way, in a more sexualized way, because she was used as a sexual object for so long,” Schwartz says.

The legacy still affects women of every class and race here.

In many parts of the the Middle East, however, women are mostly hidden away at home and, in the most traditional countries, are not allowed to have unsupervised contact with men outside their families. Female genital mutilation, where a woman has her clitoris removed, is still practiced in many parts of the Middle East.

Pressure To Conform

Brazilian women don’t face the same kinds of restrictions.

In Brazil, women are second only to the U.S. in the amount of plastic surgeries they have and in the number of beauty products they consume.

In a recent article talking about vaginal reconstruction — yes, Brazil is a world leader in that cosmetic surgery, too — psychoanalyst Regina Navarro noted that there is a huge amount of pressure in Brazil to conform to an ideal.

“Women want to adapt to what they think men want,” she told Brazil’s Glamourmagazine.

I recently spent some time at a leading international modeling agency in Sao Paulo. During the afternoon, waif-thin models came in with their amateur portfolios and big dreams. The girls were all in their early to mid-teens.

The main headhunter told me confidently that all young boys in Brazil wanted to be soccer stars, and all young women aspired to be models.

You can go to schools here and quickly learn that little girls are not encouraged to become the next Ronaldo. While Brazil is a global force in men’s soccer, women’s soccer in Brazil is almost nonexistent. But girls as young as 6 or 7 know which models are on the cover of magazines.

Which brings us to the recent controversy over Adidas. Clever marketers (presumably male) came up with two shirts that the World Cup sponsor was selling in advance of the games later this year.

One shows a woman in a bikini beside the slogan “Looking to Score in Brazil.” The other says “I (Heart) Brazil,” with the heart in the shape of a woman’s backside in a thong bikini. After Brazil complained that the T-shirts were sexist, they were pulled.

But the objection smacked of selectivity, if not hypocrisy.

A column in Brazil’s biggest daily, Folha de Sao Paulo, said: “Compared to the naked woman dancing on GLOBO TV every day during carnival, this is nothing. My 5-year-old daughter asked, ‘Why is that woman dancing naked on TV, Dad?’ And I had to explain that she was very warm. Our carnival coverage focuses exclusively on the female body, so by that standard these T-shirts are pretty tame.”

The 2022 World Cup will be played in Qatar, a country that is not known for its sex appeal. Women’s activists often target the Middle East for its policies toward women. But as living in Brazil has taught me, for women, even having all the freedom in the world can be its own cage.

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The Light To Fight The Shadows

Live and Learn. We All Do.

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Sit Up, Stand Tall, Walk Straight and Spartan Up!

Book Promo:

What’s so bad about the human body?  Why repress our instincts and distance ourselves from the human body?  Why repress our instincts and distance ourselves from the physical world?  There are several possible answers.  But one stands out as the most likely candidate.

The fear of the body comes from the refusal to recognize our animal nature.  And the obsessive desire to view ourselves as something other than animals stems from the biggest fear of all: the fear of death.


It is no mystery that any physical body that breaths and lives is destined to die and decompose.  Clearly, the annihilation of our bodies doesn’t sit well with most people.  So what to do…

Spartan Up!

There is fire, mud, water, barbed wire, and occasionally Hell on Earth.

There WILL be obstacles to catch you off guard. Curve balls, so to speak.

Get over it.

We’re here to rip you from your comfort zone. If you need a road map for each step of the way, then maybe this race isn’t for you.” The Spartan Race

Our physical energies beg us to get us, stretch, and move but one of the primary requirements of classroom learning is to become skilled at repressing these impulses.  Many of us grow up this way unable to kick the habit.

Personally, I was never able to buy into this idea, either was Joe Desena author of Spartan Up and founder of the Spartan Race.

“This conventional lifestyle of comfort and leisure is out of sync with our DNA”, says Joe Desena. By fighting our natural disposition for action, we’re short-circuiting our genetics.”

The material conditions of postindustrial society have radically changed our relationship with our own bodies.  In the not so distant past, the vast majority of human beings had to rely of physical labor to make a living.  Today, for the first time in history, this is no longer the case.  We are now free to do something more than be beasts of burden, we have extra energy now to pursue leisure, a fairly new concept.  At the same time though this evolution has furthered the divide between mind and body.  It is not uncommon for people to hardly ever more their bodies.

No longer being forced to engage in physical labor many people only remember they have a body when it’s time to feed it.  Many citizens in industrialized nations drive from home to work, sit at a desk somewhere all day, then get back into the car and drive home.

There, physical inactivity continues as people unwind from a long day at the office.  We melt into our couches and watch TV, surf the Internet, and stuff our faces with food.  The walk from the couch to the fridge in the longest many people take on a given day.  No longer having to chase one’s meal through the forest, or dig it out of the earth, comes at a heavy price.

The combination of lack of movement with easy access to enormous amounts of food is paradoxically turning into liability.  Too much comfort can be as bad as too little.

According to Joe Desena, instant gratification guides so much of modern-day life. The individual lacking self-control wants things from others now, but they themselves couldn’t be bothered to put in the work and get shit done. So they shortchange themselves and our society time and time again with disastrous long-term results.

Our self-control pales next to the Spartans. I’m convinced they would have looked at us with disgust and disbelief.

Spartan Up! is based on a series of concepts, but three of them trump everything: Question your Assumptions, Less is More, Discipline is Everything. In the races, we offer you no map. What you think is the finish line may just be the beginning.

These aren’t the musings of some detached self-help guru as I relate my own adventures, extreme enough to make me a legend in adventure racing circles I willingly put myself through hell, forcing myself into situations where water, shelter and food became my only concerns. At those moments, everything else that I thought was important in life, all the things I had stressed over, vanished. I became at home with danger and deprivation.

But I will relate my tales in service to a higher cause—helping others.

Total mind-body-spirit fitness is the Spartan ideal. History’s elite warriors have known that to win on the real battlefield, you must first win on the battlefield of your mind. This requires mastering your emotions and letting your intellect decide what’s important in unbiased fashion.

Contrast this with a 10K or marathon. I’m not knocking them—those are great accomplishments, I’ve run them myself, and there’s a lot of crossover between those races and our events. But no matter the distance, the runners are all focused on moving in linear fashion toward a finish line. I’d say the same of triathlons, despite the added elements. Those races punish you, but they don’t help you solve problems, don’t change the way you think. You don’t parent differently or rethink your work process because you ran a 10K or completed an Ironman last weekend.

The obstacles teach resourcefulness and develop true mental grit. It’s hard for anyone to complete a Spartan Race, given their difficulty, but seeing someone cross the finish line five hours after everyone else gets me every time.


The Spartan races demonstrate what people can accomplish after making self-discipline a daily habit, rather than an isolated act or a New Year’s Resolution. Participants don’t need to finish in first place or beat a particular time in order to triumph. Simply finishing is a great accomplishment. Having run a Spartan race, you’ll go back to your job or family and solve problems differently because you’ll see the path ahead differently. This new way of living is the difference between struggling and then dying unfulfilled, and leading an epic life.

Get rid of all the bullshit and live with what you need, not what you have been spoonfed by advertising to think you need.  That’s how you live like a Spartan.

Live and Learn. We All Do.

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