For my reader [emphasis on the singular] out there, I have a new article recently published.
- “What Is Mormon Transhumanism? And Is It Mormon?” (Interpreter: A Journal of Mormon Scripture Volume 29 (2018) pp. 161-190)
For my reader [emphasis on the singular] out there, I have a new article recently published.
The new update from the regional health people on the measles outbreak has a few interesting tidbits in it:
Several families are under quarantine, but some are not observing the quarantine recommendations.
So, stupid is as stupid does, I suppose.
Here’s a graphic from Alberta Health on vaccination rates in southern Alberta for measles by town and region.
Note that anything <80% creates conditions for a sustained epidemic. The AHS goal is 98% coverage, which is about what is needed for herd immunity to keep any cases from developing.
Note too that metro Lethbridge (due north of Spring Coulee, in the approx centre of the map) is in the 80-90% range, and yet that is where the outbreak began and is persisting for the moment. So 80-90% doesn’t cut it.
And, a second slide gives some of the complications that attend the illness.
They don’t mention SSPE, which can afflict the brains of measles patients even decades later.
(or, Why blaming nutrition is not your anti-vax get-out-of-jail-free card)
In Southern Alberta, we are currently in the midst of a measles outbreak.
Some have asked me recently about the claim that better nutrition would lead to better vaccine response.
The purpose of this claim seems to be an attempt to disprove concerns about herd immunity.
No vaccine is 100% effective. Those who do not respond to the vaccine, and patients that are too young to be vaccinated, depend upon herd immunity for protection—measles (or other infectious diseases) can’t get established in a population unless there is a certain percentage of vulnerable people.
So, when those who through bad science or their own philosophy reject vaccination, they increase the risks to everyone. If you don’t want to get a tetanus vaccine, fine—the only person you’ll kill or cripple is yourself.
One dose of measles vaccine is typically 95% effective. A second booster can get that to 98-99%. But, it ain’t 100%. Bluntly, if you forgo things like measles vaccines, you put me and my kids at risk. You also put kids with leukemia, and patients with HIV, and newborns too young to be vaccinated, and a variety of others at risk too.
(89% of patients in the USA in 2011 who got measles had not been vaccinated. But, 11% who got it had been. Thanks a lot.)
Blame the victims
Now, this seems like a pretty crumby thing to do—and it is. So, some are now claiming that they aren’t really putting your kids at risk, because vaccines work better if you have better nutrition. The subtext is clear—if you get the measles vaccine and you don’t respond to it, it’s your own darn fault for eating such a lousy diet, or not taking some vitamin supplement, or whatever. (If they go a step further and try to sell you the supplement, run away.)
We are supposed, then, to blame the lousy diet of people who do get vaccinated, and not the irrational and scientifically unsupportable decision of the vast majority of those who choose not to vaccinate.
This might be a compelling argument—if it were true. But it isn’t.
The First World and the Third World
It’s always a bit dubious when people start bemoaning poor nutritional status in North America. If anything, we eat too many calories and the like; we do not typically have a problem with macro- or micro-nutrient status (with some subgroups being exceptions, which I shan’t go into here).
But, for the sake of argument, let’s follow the claim, and see where it leads.
If poor nutrition was a significant factor in vaccine non-responders, that would be an important thing to know. Why? Well, for starters, when we give vaccines in the Third World, those people are at much higher risk of malnutrition, poor vitamin status, and all the rest than anyone in the First World would ever be in their worst nightmares. So, if nutrition is a factor in measles vaccine response, we ought to be able to detect that in the Third World especially. We’d like to know, because maybe it would be better to give them some vitamins or better nutrition, and then vaccinate them later. (A similar analysis could be and has been conducted for a variety of vaccines; I will focus on measles because it is the one in the news right now.)
If you go way back to 1980, this question was looked at for smallpox and measles. The conclusion:
Malnutrition did not affect the children’s ability to develop adequate immune response to measles o[r] smallpox vaccine, and there were no major complications during the 8-week period of follow-up. Since measles is a very severe disease, which in malnourished children can carry a case fatality rate as high as 50%, malnutrition should be a prime indication for measles immunization, and certainly not a contraindication.
No effect—and many of these kids were severely malnourished.
Is 1980 too long ago? Well, here’s one from August of 2013.
It looks at kids who are both malnourished and have potentially disastrous risk factor: kids with HIV+ mothers. This is a randomized, placebo-controlled trial that gave some kids vitamin supplementation prior to measles vaccination.
The stage of the mother’s HIV affected how well the kids’ immune system responded—more advanced HIV made it more likely for the children to respond. But, what about the “nutrition” that we’re assured is so important?
There were no effects of infant multivitamin supplementation on measles seroconversion proportions, IgG concentrations, or IgG avidity. 
Translation: Seroconversion means developing protective antibodies; IgG concentration is how much antibody; IgG avidity is how well the antibody binds to measles.
Long story short—giving the kids vitamins made no difference at all to the vaccine responses, and they’re from Tanzania.
Are we really expected to believe that a kid in North America—no matter how lousy his or her diet—is in worse nutritional shape than a child born to an HIV+ mother in Tanzania? Well, anti-vaccination activists have asked us to accept bigger whoppers than that, so I guess we shouldn’t be surprised.
An ironic risk—would supplements be risky?
Ironically, the public health worry about malnutrition and supplementation has been whether supplementation might worsen the measles vaccine response rate. It would be great to give all the kids you saw in your third world vaccination clinic Vitamin A—this has been shown to be cost effective, and they need it. It’s hard to get them into the clinics; they have to travel a long ways sometimes, and wait a long time. How great would it be to do both at once, if you can? But, what if doing one makes the other less effective? This actually might have happened when some six month old kids were vaccinated. (They were vaccinated early—but, this is a scary prospect, if true.)
Well, this has been looked at—happily, there is no concern so far.
Overall, the seroconversion rates did not differ between vitamin A (89.5%) and placebo (87.6%) groups. There were no significant differences in the geometric mean titers in the two groups (ratio of geometric means, 1.19; 95% confidence interval, 0.97–1.46). Among malnourished infants, the geometric mean titer was significantly greater in the vitamin A group compared to the placebo group (ratio of geometric means, 1.57; 95% confidence interval, 1.18–2.0), but seroconversion rates did not differ. There were no differences in seroconversion rates and geometric mean titers in the two study groups among the well-nourished children. These results indicate that 30 mg vitamin A does not reduce the immune response to the coadministered vaccine and, therefore, can be continued to be given safely in public health programs (emphasis added).
Note that antibody levels were slightly lower in malnourished kids—but, there was no statistical difference between malnourished or well-nourished children in whether they’d have measles immunity or not.
But, it’s ironic that the thing that worried real vaccine scientists is the exact opposite of what the North American anti-vax nutrition pushers claim—the worry was that supplementation in people who were truly malnourished might actually decrease the vaccine’s effectiveness. It certainly didn’t increase it.
Am I, perhaps, merely cherry-picking studies? Am I just finding a few that support my position, while ignoring the others?
A fair question. Fortunately, someone recently did an extensive analysis of all vaccines and all the data on nutrition status and response to those vaccines. (This was done for the Bill and Melinda Gates Foundation, which was founded by the Microsoft billionaire and his wife. They do really good work, and it is intensely data-driven.)
This review was published in 2009, and full text is available. Here’s some measles-related highlights (emphasis added in all cases):
Summing up the data
The authors frequently return to the fact that there isn’t a ton of data on this topic—which should tell us that if they don’t know, then the confident assertions of those in North America who claim that “studies show” that nutrition is a big factor in First World vaccine failures are talking out of their hat. Thus, far, we can barely find any evidence in the Third World in horrendous circumstances:
Surprisingly, we found little convincing evidence to indicate that current nutritional status or coadministration of nutrient supplements has clinically important effects on vaccine efficacy.
To claim that the non-responders have only their poor diet to blame if they get measles—instead of what is essentially a superstitious or pseudoscientific decision of non-vaccinators to forgo vaccination—just isn’t supported by the facts.
So, why do some people not respond to vaccines?
This is an active area of research. There’s a very interesting bit of data out of Israel that compared desert Bedouin Arab responses to measles vaccine versus Israeli Jewish children.
This is interesting for two reasons:
Intriguingly, the Bedouin had a 99% conversion rate, while the Jewish group had only a 79% response—astonishingly low. This was not a one-time fluke either—a previous study of Jewish children had likewise 24% not respond to the vaccine, despite having evidence they were vaccinated.
This sort of thing isn’t confined to the Middle East. Studies have observed:
You see where this is headed—vaccine response depends, at least in part, upon genetic factors. The mechanisms for this are just beginning to be explored, but they have to do with mutations to the receptors. Some mutations improve your response, and others decrease it.
So, a large part of whether you respond is simply a genetic luck of the draw. We can’t eat our way out of it.
So, if you’re not going to vaccinate yourself or your kids, please—at least be honest about the facts. You’re putting them at risk. But, you’re also putting the rest of us at risk too.
It isn’t because we wouldn’t eat our spinach.
For information about measles , go here.
If you think you or someone may have measles, do not go to the ER. Do not go to the doctor’s clinic. Do not go out in public.
If you live in Alberta, call this number, and do what they tell you: 1-866-408-5465.
 AE Ifekwunigwe, N Grasset, R Glass, S Foster, “Immune responses to measles and smallpox vaccinations in malnourished children,” Am J Clin Nutr 33/3 (March 1980) :621–4.
 Christopher R. Sudfeld, “Effect of Multivitamin Supplementation on Measles Vaccine Response among HIV-Exposed Uninfected Tanzanian Infants,” Clin Vaccine Immunol 20/8 (August 2013): 1123-1132.
 Recall that having HIV+ mother doesn’t just expose the child to risk of infection—such women are less likely to be well, are less able to work, will probably make less money in a country not known for high-riding lifestyles, and are less able to provide food for the baby, etc. You’re at risk in this situation.
 Rajiv Bahl et al., “Vitamin A Administered with Measles Vaccine to Nine-Month-Old Infants Does Not Reduce Vaccine Immunogenicity,” The Journal of Nutrition 129/8 (August 1999): 1569–1573.
 Mathilde Savy et al., “Landscape Analysis of Interactions between Nutrition and Vaccine Responses in Children,” The Journal of Nutrition 139/11 (November 2009): 21545–22185.
 Bracha Rager-Zisman, et al.¸ “Differential Immune Responses to Primary Measles-Mumps-Rubella Vaccination in Israeli Children,” Clin Diagn Lab Immunol 11/5 (September 2004): 913–918.
There is another strange medical thing making the Internet rounds again.
People are asking me what I think, so I will tell them, and anyone else who cares.
These are useful things to review not because they are particularly sophisticated bits of media (they aren’t) but because we can learn things about how to assess such material for ourselves.
The first is called “Heart surgeon speaks out on what really causes heart disease.” I’m going to address this according to the various rhetorical tricks or tactics that the article uses, which is authored by a Dr. Luddell.
Right off the top, consider the source. The same webpage tells us that “Strong evidence links vaccines to autism.” As readers of this on-line rag have learned before, this is fear-mongering nonsense. Such evidence simply does not exist. Anyone who claims it does is either misinformed, lying, or incapable of assessing scientific evidence.
But, leaving that aside, let’s consider the arguments and tactics.
Disclaimer: I’m a family physician, and I prescribe birth control pills. Yaz® and Yasmin® are not my first pills of choice, but I have prescribed them on occasion. I have never been paid by the company or provided any monetary compensation or other considerations for what I present here, or in the past. All I have received from them is free sample packets of pills to give patients, which I do at no charge. I have not been paid speakers’ fees or research money from whoever makes these drugs.
Ok, I just saw a really irresponsible bit of medical fear-mongering. You can watch it on the Canadian CTV station.
The title is “More risks being discovered with birth control pills.”
In the first place, the title is misleading, if not outright dishonest. At best, the title ought to be, “Health Canada has received a very small number of reports that might have something to do with the birth control pill, but also might be utter coincidence.”
The claim is about Yaz and Yasmin, two relatively new birth control pills on the Canadian market. The piece opens by “reminding” listeners that these pills have “possible links to deadly blood clots” [0:15].
Now, this is stupid for at least three reasons:
1) The links are not “possible,” they are known. All birth control pills have a risk of blood clots. That is known, and Yaz and Yasmin are no exception.
2) The error is worsened, however, by the implication that Yaz and Yasmin are more risky. They aren’t. What CTV doesn’t tell you is that women are most at risk of blood clots during the first year in which they start the pill. This can make Yaz and Yasmin look worse, because they are newer pills. Therefore, for a while, all the women starting Yaz and Yasmin are new users, because they haven’t been on the market long enough to have people who have used them for ages! So, older birth control pills look “better” when compared to newer pills, because older pills have a higher percentage of long-term users than newer pills. And, long-term users have already (presumably) successfully passed the highest risk period for developing clots, and so are less likely to do so than Yaz or Yasmin’s new users.
3) The piece also fails to properly contextualize these risks. Adults of reproductive age who do not use the pill have a risk of clots of 0.3 to 0.6 per 10,000. Birth control pills increase the risk of clots, but by how much? To about 1-1.5 per 10,000 (this is an increase in risk of 3-4x). To understand this kind of risk, consider that being pregnant increases your risk of a clot to about 13 per 10,000. So, you are at least eight times safer from blood clots by being on the pill than you are being pregnant.
But, since this misleading intro takes less than 5 seconds to say, the audience comes away already worried and primed to believe the worst. This just isn’t fair, or accurate.
Note what I am not saying. I am not saying that Yaz and Yasmin must be better, or are no different. I am saying that there is, at present, no evidence that they are worse than any other combined hormone pill (or, if there is, CTV has not presented it).
Correlation and causation
We are then told that now “Health Canada is also receiving reports of adverse reactions related to the kidneys” [0:53]. What does this mean? Well, anyone can send in an adverse drug reaction to Health Canada. I’ve done it as a physician. Anyone reading this can do it too. This isn’t “risks being discovered” about pills (as the piece’s title claims) but instead people who are taking the pill who report kidney problems.
Think of it this way—how many women take the pill? Lots. How many of those women might develop kidney problems? Some small amount. The question is, did the pill cause it, or is it just coincidence? At this point, no one knows—least of all CTV.
They then quote a pharmacist Lidia Molinara: “We don’t always know if it’s correlated, but it’s very coincidental”[0:57].
This is likewise idiotic. (I’m going to assume she misspoke.) Why?
1) We do know it is correlated. Correlated means something like “one thing happens and another thing happens too, with at least the appearance of a relationship.” So, the people took the Pill and have kidney disease. That’s correlation. They took the pill, had the problem, and so it appears (on the surface, at least) that the two events may be linked. This is what CTV is claiming.
2) The second rather silly thing is to claim it is “very coincidental”—what does this mean? Coincidence means things that just happen to occur together, but don’t have any causative link. So, what she’s saying is that we don’t know if they’re correlated (if they go together) but we do know that they are coincidentally together (i.e., they go together). This is utterly confused—the two statements almost contradict each other.
What I suspect she meant to say is, “We don’t know if it’s causative. It could be a coincidental correlation, but we don’t know if there’s causation.”
There is an old saying in science and medicine: Correlation does not equal causation—just because two things go together, doesn’t mean one causes the other. The sun rising is correlated with roosters crowing. But, roosters crowing does not cause the sun to rise (if anything, it’s the reverse).
This graph shows that the global temperature is correlated with the number of pirates in the world—as pirate numbers go down, global temperature goes up. But, that doesn’t mean pirates have anything to do with global warming, or vice versa:
Bad to worse
Having completely confused us about both previous risks and whether there’s any actual evidence of harm, things get worse.
The piece uses the efforts of US legal firms to launch class action lawsuits about components of the pill causing kidney problems due to potassium issues.
What they don’t tell you is that such lawsuits have not always been bastions of scientific reasoning. For example, consider that class action lawsuits against Dow Corning lead to bankruptcy protection over the issue of silicon breast implants.
Yet, there was never—and there still is not– any scientific evidence that the implants caused problems and they are now (surprise!) back on the market because plastic surgeons and their customers prefer them. This wouldn’t be possible if there was evidence of the harm claimed in the class action suit. So, Dow Corning employees, owners, and stockholders were taken to the cleaners over bogus claims of harm.
The complete non sequetur
Then, they go from bad to worse. Having claimed that the kidney problems are supposedly due to potassium issues, they then tell us that two women in Edmonton have reported problems but don’t want to be on camera. Those women are smart—I wish the CTV reporter had been as wise, because then she wouldn’t look completely clueless.
These two women have reportedly “suffered kidney infections while on the Yaz birth control pill” [1:34].
Kidney infections have nothing, repeat nothing, to do with potassium problems. I can assure CTV that many young women (the sorts who are on the Pill) tend to get bladder and kidney infections. This is certainly a correlation—but, I doubt very much that the Pill can be blamed for causing those infections. What’s the mechanism of action for the Pill causing it? It certainly has nothing to do with the supposed link to potassium that US class action attorneys are giving us.
“However,” CTV says, “neither of them [the two women] are sure if there’s a link.” Exactly. Nor should they be sure, nor should anyone claim that there is a link. Two women, of the likely tens of thousands in Edmonton taking the Pill, got a kidney infection. I would bet my house that at least two women in Edmonton who were not taking the Pill also got kidney infections.
So, let’s summarize. We have:
In short, disgraceful. They only useful information was the doctor telling people not to panic. But, after all you’d heard, would that be your conclusion?
Again, I’m not claiming there could not be matters worth looking at, or that all pills are the same. Drugs should be monitored for safety and unexpected complications.
But, this kind of reporting misses everything that matters in understanding these issues, is confused and muddled, and contributes not one jot to a rational discussion of the evidence.
All we can hope is that women discuss it with their doctor, and not someone from CTV.
Aluminum safety and vaccines
Some asked me about the risk of aluminum in vaccines, so I thought that would be a worthwhile question to address.
In addition to the substance against which a patient is being immunized, some vaccines contain adjuvants. An adjuvant is an additional substance that is used to boost the effectiveness of the vaccine. This has several benefits:
One adjuvant that used to be used was thimerosol, which is now only found in the annual influenza vaccine. It was removed as a precautionary measure, even though there is no evidence it causes harm, and a number of studies which failed to find any evidence of harm.
The vast majority of North American vaccines use aluminum salts (and aside from influenza, these are the only adjuvants used in Canada).
The three salts used are:
These have been used for seventy years in vaccines (since 1926), so they have a long track record of safety.
The World Health Organization and European standards bodies recommend (and Health Canada agrees) that no dose of vaccine contain more that 1.25 mg per dose of human vaccine).
Let’s put that dose in context. Aluminum is a very common substance in our environment. Even human breast milk, for example, contain 0.040 mg/L; commercial formulas have 0.225 mg/L. So, in about 31 litres (8 gallons of breast milk) you get as much aluminum as one vaccine dose (or 5.5 L of formula).
Doing the math
Let’s be conservative, and assume a breast-fed baby eats 6 times a day (every 4 hours, which as any new mom will tell you, is a relatively reasonable assumption). That means they’ll drink an average of 125 mL (5 oz) of breast milk every feeding, or 6 x 125 mL = 750 mL per 24 hours. Thus, with even fairly conservative assumptions, every 40 days or so, an exclusively breast-fed baby will eat as much aluminum as in one vaccine dose.
If, on the other hand, the baby is formula fed, at the same volume and rate, then the child ingests that much aluminum every 8 days or so.
Put another way, under US guidelines (and I expect Canadian ones are almost the same) within the first 6 months of life, a child would get a total of 4 mg of aluminum from vaccines. They would have absorbed 10 mg from breast milk, 40 mg from formula, or 120 mg from soy formula.
What happens to the aluminum?
Now, maybe there’s a difference between injecting aluminum and eating it? As it turns out, not that much.
Less than 1% of the aluminum consumed by mouth enters the bloodstream—it is quickly bound to a protein called transferrin (also involved in iron metabolism) and excreted through the kidneys.
Almost all the aluminum injected by vaccines will enter the bloodstream. But, there again it binds to transferrin, and is removed by the kidneys. How fast? Regardless of oral or injection route:
By adulthood, we have accumulated 50-100 mg of aluminum in the body. That gives you some idea of how rapidly you’re excreting it—40 mg of infant formula in the first 6 months is almost equivalent to the total aluminum that remains in the body by adulthood. Clearly, the vast majority is not sticking around.
We don’t have to rely on theory to prove this. All unvaccinated babies have 5 nanograms of aluminum per mL of blood all the time. If you vaccinate a baby, the concentration of blood aluminum doesn’t change enough for us to detect it. We’re talking about such tiny, undetectable increases that it would be incredible for it to cause a problem.
Are you saying aluminum can never be harmful?
No, of course not. With everything, “the dose makes the poison.” Even water is poisonous and potentially fatal at high enough doses.
Premature babies in NICUs can have aluminum troubles if their kidneys don’t work (remember, aluminum is excreted by the kidneys—no kidneys, and all that aluminum sticks around).
The second group is (you guessed it) adults with renal failure. If they take antacids, these can cause problems, since a daily dose of antacids contains about 1,000x the dose of aluminum in a vaccine. And even here it takes months or years of high-dose aluminum administration to cause problems.
Premature infants or patients with kidney failure have blood levels of aluminum at least 100x greater than healthy babies. And, remember, healthy babies’ blood level of aluminum doesn’t even budge when we vaccinate.
And, like anything, the immune reaction we’re trying to generation with aluminum can cause local soreness or redness, or rarely an allergic-type reaction. But, those are usually minor issues.
So, harm from this miniscule amount of aluminum (which is in our food and drinking water anyway, at higher levels) is extraordinarily unlikely.
Furthermore, we’ve used the stuff for seven decades, without a huge outbreak of problems from aluminum toxicity, which effects are well known from patients with renal failure.
But, we have even more cause for confidence. In 2004, an aluminum containing vaccine and adverse reactions was reviewed. This included 3 randomized trials, 4 semi-randomized studies, a cohort (retrospective) study, and 27 other studies.
[Note that this study was done in the UK, where the American/Canadian element aluminum is called aluminium, but it’s the exact same thing, just in the Queen’s English.]
Two main groups were compared:
Aluminum adjuvants caused more local pain or swelling—but, this is to be expected, because the whole reason we include adjuvants is to create a more robust immune response from the body. There was no difference in the rate of more serious adverse reactions:
The frequencies of local reactions of all types, collapse or convulsions, and persistent crying or screaming did not differ between the two cohorts of the trials. In older children, there was no association between exposure to aluminium-containing vaccines and onset of (local) induration, swelling, or a raised temperature, but there was an association with local pain lasting up to 14 days (2·05 [1·25–3·38]).
And, most importantly,
We found no evidence that aluminium salts in vaccines cause any serious or long-lasting adverse events.
Critics of vaccines will sometimes appeal to studies on mice or local reactions about the problems associated with aluminum injection. However, why rely on mice studies when we have decades of human evidence and experience that strongly suggest safety in the real human world?
(There’s an old joke in medical research that we can cure every cancer in mice—it’s shifting the treatment to humans that’s the trick.)
And, it should be remembered too—everyone in public health, in vaccine research, and government health groups puts their money where their mouth is. They get vaccinated. Their children get vaccinated. It seems a real stretch to claim that these people—who often dedicate their whole lives to children’s health—are part of a conspiracy to ignore data about the safety of children. Especially when those at risk includes them and their children.
Conclusion: What choices do we have?
Let’s imagine for a moment that the critics get their way—we stop using aluminum in vaccines.
Fine. What do we do then? We have, it seems to me, three options:
So, which do we pick? One of the three options above?
Options #1 and #2 seem to me to put us exactly where we are now, but with less evidence, more cost, and potentially less effectiveness of our vaccine programs. Not much of a deal.
Option #3 is madness. Even vaccine critics would realize that if the majority of the population wasn’t smart enough to ignore them. It only takes a couple of polio outbreaks to see the light. (With effort, polio may soon become the second disease after smallpox to be utterly eradicated by vaccination.)
(Iron lungs on a polio ward, New York, 1916).
Or, do we rely for now on seven decades of experience and studies—and pretty convincing evidence from the dose data—that nothing ominous is going on?
I—and every public health group on the planet—would recommend the latter.
A Latter-day Saint Blog
Critiques and analysis of John Dehlin's activities mostly focusing on his written contributions, but occasionally straying into other media and activities.
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Seeking the virtuous things in the world.
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