Does acetaminophen use in pregnancy lower testosterone in the male fetus?

Ultrasound of fetus larger sizeRecent research has suggested that taking Paracetamol (acetaminophen) during pregnancy for long periods of time may lower testosterone production in the male fetus – potentially increasing the risk for undescended testes and adverse reproductive health effects later in life.

The animal study published in the journal Science Translational Medicine (STM) investigated the effects of Paracetamol exposure on fetal testosterone levels. The researchers, from the University of Edinburgh, used host mice grafted with human fetal testicular tissue to study the effects of Paracetamol on testosterone production. The grafted testicular tissue simulated the developing testes during pregnancy.
The researchers found a 45% decline in plasma testosterone levels after 7 days of exposure to a typical dose of acetaminophen. However, after one day of exposure to a typical dose there was no change in testosterone levels.
A 2010 study published in the journal Epidemiology linked protracted use of Paracetamol during pregnancy to undescended testes (cryptorchidism) in males; however, the University of Edinburgh study was the first to demonstrate the effects of the drug on testosterone levels.
“These results are of clinical importance as there is growing evidence that most common male reproductive disorders, which can affect 1 in 6 men, may be attributed to sub-optimal testosterone exposure during fetal life,” the authors wrote.
What is testosterone?
Testosterone, a sex hormone, is produced by the testes in approximately the 7th or 8th week of pregnancy. Testosterone has key effects on sex drive, bone mass, the growth of body hair, fat distribution, muscle strength, brain function, metabolism, the vasculature and the production of sperm.
Testosterone is important to the developing fetus because it determines the sex of the newborn as well as future reproductive health.
Health implications of lowered testosterone in the womb
Researchers have suggested that reduced levels of testosterone in the womb may have implications later in life.
According to the authors of a reproductive health study published in the journal Proceeding of the National Academy of Science, during the period of fetal masculinization, testosterone exposure can (re) program fetal stem cells which later develop into testosterone producing adult Leydig cells. A lower testosterone exposure in the fetus can lead to lower
testosterone levels in the adult male which can ultimately impact fertility, erectile function, and sex drive.
Past research has previously linked low testosterone in adult males to an increased risk of other health issues such as obesity, depression and type 2 diabetes.
Paracetamol (acetaminophen) safety during pregnancy
According to the authors of an American Family Physician journal article, acetaminophen has a good safety record and is widely used during pregnancy with a paucity of adverse effects documented; hence, why acetaminophen has been validated as the pain reliever of choice during pregnancy.
An article published in the journal JAMA Pediatrics, suggests the safety record is less clear. The authors associated the use of acetaminophen during pregnancy to a higher risk of ADHD and other hyperactivity behavior disorders in children, with the risk stronger for maternal acetaminophen use in more than 1 trimester.
As both an over the counter and prescribed medication, Paracetamol is one of the most commonly used analgesic (pain) and fever medications used during pregnancy
A 2005 study published in the American Journal of Obstetrics and Gynecology reported at least 65% of women had used acetaminophen at one point or another during their pregnancy.
Planning a pregnancy?
This recent study also highlights the public health relevance of medication effects during pregnancy. Women who are planning a pregnancy or have just learned they are pregnant should consult with their physicians prior to taking any prescribed or over-the-counter medications.

Is The Era of Coffee as a Guilty Pleasure Over?

Coffee

Drinking that warm cup of coffee to get a jump on your day may not be all that bad for you-in fact, it may actually be the drink to impact your overall health.

But just as with many of life’s guilty pleasures, the landscape keeps shifting on whether we should or should not drink our favorite cup of morning “Joe”.  Now with the 2015 release of the Scientific Report of the Dietary Guidelines Advisory Committee, the era of coffee as a guilty pleasure may be over. As a matter of fact, the report implies that if you only drink one cup of coffee per day, you may want to consider drinking even more.

The report weighed in on the health effects of coffee and caffeine: “Consistent evidence indicates that coffee consumption is associated with reduced risk of type 2 diabetes and cardiovascular disease in healthy adults… moreover, moderate evidence shows a protective association between coffee/caffeine intake and risk of Parkinson’s disease.”

Although past reports have blamed coffee for everything from heart disease, cancer and even risk of death, the Advisory Committee report concluded that in healthy individuals there were no health risks with moderate consumption of 3-5 cups daily or equal to 400mg of caffeine per day.  Pregnant women, children and adolescents were advised to limit their caffeine.

The conclusion that coffee provides health benefits has been supported in past research. Coffee has been associated with providing antioxidants, increasing your concentration, improving your reaction time and jump-starting short term memory.  It’s also been shown to speed up metabolism and could be beneficial in training and exercise endurance.

That may be great news for coffee drinkers, but before you change your coffee sipping ways, keep in mind that coffee consumption may not be for everyone especially if you are sensitive to caffeine. And before anyone firmly establishes how many cups you should be drinking, you should be aware that it may also depend on just how well you metabolize caffeine.

Two new genes have been identified that can affect your metabolism of caffeine. Meaning some people may only need just one cup of coffee to feel energized in the morning, while another person may need up to 4 cups to feel the same effects, depending on your genes.

It may also mean that you may not be able to tolerate more than 1 cup of coffee per day, either. If you inherited a slow caffeine metabolizer gene, just one cup of coffee is all it could take to get your day going in the morning;  however, it may also take you much longer to off-load caffeine’s jittery side effects and prevent you from sleeping well at night, too.

But if you can tolerate coffee and you know your limits- go ahead and brew it! Turns out one of life’s guilty pleasures may not be so guilty after all.  And remember, despite all the good news, even guilt-free pleasures should be enjoyed in moderation.

For the best health benefits, here are a few tips:

  1. Know your limit. Besides keeping your coffee consumption at or below the 3 cup range, be aware if coffee affects your nerves, stomach or the quality of your sleep. Adjust your cups accordingly.
  2. As a rule of thumb, no caffeine after 2-3pm. That includes soft drinks and energy drinks and caffeinated teas. Studies have shown that caffeine consumed within 6 hours of sleep can have important disruptive effects on sleep. Do switch to decaf or an herbal no-caffeine tea.
  3. Don’t combine coffee drinks with alcoholic beverages. Not even rum and Coke. It could be deadly. Caffeine is a stimulant and alcohol is a depressant, but mixed the two do not cancel one another out. And by the way? Caffeine does nothing to decrease your blood alcohol content.
  4. Skip the sugar and cream. For all the obvious reasons. Substitute with Stevia or agave, and unsweetened Soy or Almond milk, instead.
  5. Add healthy spices such as cinnamon, nutmeg, or cardamom to your coffee. Cinnamon has been shown to help with blood sugar, weight loss, candida yeast infections, bacterial infections, IBS and much more.  Nutmeg is a good source of manganese. Cardamom is a good source of vitamin C, calcium, magnesium, potassium and zinc and research has shown it has antioxidant properties as well as promotes a healthy immune system
  6. Go ahead and add a little dark chocolate, too. The benefits of dark chocolate can outweigh the added calories or sugar if you keep it to a small amount. High quality dark chocolate can relax blood vessels, lower blood pressure, and improve insulin sensitivity. Dark chocolate is also a powerful antioxidant.

Loving Carbs and Exercise. What Do The Experts Say?

cupcakes

Q: Cynthia, I’m admittedly a carb lover which has put me around 30 pounds overweight. My goal is to lose weight and get muscle definition  instead of the fat I am carrying, especially around my waist. Do you think I should join a “boot camp” exercise program?

A: Work out for your health, but forget about working out just for your weight, say the experts. Granted exercise can help lower your lipids, improve your sugar levels, and reduce the risk of stroke, depression, arthritis and certain types of cancer, but according to an editorial in the British Medical Journal of Sports Medicine, “You can’t outrun a bad diet”. “We’ve been falsely lulled, by the food industries public relations machinery into thinking that we can just eat whatever type of junk food we want and drink sugary drinks and all we have to do is just exercise,” they complain. “The health halo legitimization of nutrient deficient products, must end…it’s misleading and unscientific,” they state.

Besides, after much debate on the weight loss benefits of exercise, studies have concluded that the emphasis from exercise should be on the health benefits and not on weight loss- as disappointing as this may sound, exercise alone will provide lower than expected results.

But that is not what we have been told, is it? We’ve been taught calories in equal calories out. We can eat that cupcake, blueberry muffin, or bagel with cream cheese, and just go to the gym for a couple of hours, right?

Wrong! We need to stop blaming obesity on eating too many calories and not exercising enough. That’s way too simplified. A calorie is not just a calorie. Calories from simple carbohydrates such as white bread, white rice, pasta, potato (technically a complex carb but acts like a simple carb) or sugary foods such as pastries or sodas affect your body much differently than fruits or vegetables and whole wheat or higher in fiber foods or complex carbohydrates.

Simple carbohydrates have shorter chains of sugar molecules, are less nutrient dense, more readily turned into fats and they encourage us to eat more of the same type of carbohydrates simply because they break down more quickly into energy and leave us not very full or satisfied. Compare that to a complex carbohydrate-higher in fiber, vitamins and minerals, and lower in sugar content, taking longer to digest and leave us more satisfied.

If you want to lose weight, cut out those simple carbs “you love.” You’re not ‘doing a body good’ by them. Incorporate more fruits and vegetables and substitute foods such as white bread for whole grain (but keep bread to a minimum) and get rid of sugary foods such as soda, cookies, cakes and processed foods that come in a bag or box- loaded with high fructose corn syrup. If you need guidance, work with a nutritionist who can personalize a diet plan for you.

Let’s now talk exercise. Go ahead and bulk up for beauty. You’re more likely to now lose that weight.

Cynthia Jaffe, D.C., NP Joins NurseGail.com’s Health Writer Team

Cynthia Jaffe, D.C., NP has joined the health writing team for NurseGail.com

NurseGail.com is the first health and wellness website authored solely by nurses.

Learn why waking up and going to bed at the same time each day is important to your health here– it’s one of Cynthia’s posts!

 Read the rest of Cynthia’s article’s on NurseGail.com

nursegail_com-profile-picTo connect with NurseGail:

The Germanwings crash opens a discussion of privacy, safety and self-disclosure in mental health

airplane

The above the fold news of the tragic deaths of 150 people by the crash of a Germanwings pilot has become more disturbing as more information has come on the scene. There was evidence that the pilot had a mental disorder history that he concealed from both his employer and colleagues.

Aviation regulatory agencies do have health screening processes that determine the fitness of a pilot to fly a plane. But critics are now debating if the yearly exams pilots undergo to prove fitness to fly are less than ideal.

In the U.S. a physical exam is performed yearly if you are under 40 and every 6 months if you are over 40 but they have mainly focused on the physical exam; although, safety procedures performed by an FAA medical examiner do look for clues of erratic behavior, medications and family history during the exam.  Disclosure of a mental health issue has largely relied on the pilot writing the answers to typical questions for example, if they ever had a suicide attempt, mental disorder or substance abuse.  But we have to hope that the pilot is not afraid to answer it honestly.

Let’s exclude the heavy hitters such as substance abuse and suicidal tendencies. Depression alone has not excluded pilots or other people whose professions involve the safety of other people from performing their jobs, so why then would an individual not answer honestly? What makes them so afraid? Could it be the fear of stigma and discrimination or the concern for privacy?

Here in the U.S. we have a privacy policy known as HIPPA, or the Health Insurance Portability and Information Act. HIPPA is a Federal law passed by Congress in 1996 and put into place in order to protect the privacy of your health information as well as determine just how your medical records are used and disclosed. Although, your doctor can’t give your private health information to an employer or anyone else without your consent, there are circumstances when HIPPA laws allow sharing your health information to ensure that you receive the best treatments or for your health and safety.

For instance, your treatment records may be shared with another physician so that results can be seen and tests are not repeated.

An exception to HIPPA that allows your information to be shared are psychotherapy notes. They are given additional privacy protection unless overridden by stringent laws that can vary from state to state. Because psychotherapy notes do not contain information regarding medications, diagnosis or treatment, they are not maintained in any medical or electronic records;     affording not only privacy but insuring client-therapist confidentiality.

However, if there is something that happens that the therapist has to report, they will be required to break this rule.

In the U.S in many states mental health professionals are mandated by the “Tarisoff” rule. The rule states a mental health professional has a duty to warn as well as protect if they have a reasonable suspicion that their client intends to actually harm somebody.

In general, this ruling has created conflict and debate among clinicians with the choice between protecting themselves from a breach of confidentiality and doing what is moral and ethical by reporting. The knee jerk reaction is that the system is flawed. For when exactly does HIPPA begin and Tarisoff leave off?

This perhaps explains why self-disclosure may be difficult for those with mental illness to do. We can well imagine that the social climate at the time of disclosure and prior discrimination by others might all play a role.

But hopefully, these open dialogues on mental illness will encourage professionals in the field to develop strategies to reduce stigma and discrimination while encouraging the teaching of how and when to disclose.

Can a Professional Basketball Player Like Derrick Rose Recover Fully After a Meniscus Injury?

basketball[1] Q: Cynthia, I am beginning to think Derrick Rose, with the Chicago Bulls, just can’t catch a break (yes, pun intended). His most recent injury was his second tear to his right knee meniscus. How did he did he do this again, and will he be able to return to his pre-injury MVP form by next season?

A: Derrick seems to have this intolerably stacked deck. This is Derrick’s third knee injury in the last 3 years among an “assortment” of other lower extremity injuries. His most recent injury to the right meniscus in February was a big setback for him. He had just regained his confidence and rhythm after tearing the same knee meniscus, in late 2013. The good news is that this meniscus tear is a minor tear compared to the one last year. We need to remember that Derrick has been down this path before and knows exactly what he needs to do to put his rehab into gear.

Look, Its no secret that basketball is hard on the knees. All it takes is a hard foot plant and pivot, or a fast stop and start to easily cause the meniscus to tear. Typically the meniscus, especially the medial meniscus, is particularly stressed from a forced rotation in an improper direction during bending or extending the knee. Although no one seems to know exactly how Rose injured his knee, the mechanism of injury looks like this: As the knee initially begins to flex or bend, the tibia is supposed to rotate internally, or in an inside direction. If the tibia gets forced externally or in an outside direction, the meniscus gets torn from trying to move between flexion with the tibia and into rotation (in the wrong direction) with the femur.

With Derrick’s November 2013 meniscus injury, known as a “Bucket Handle” tear, he opted to re-attach vs remove the meniscus, which he well knew going in would be a longer rehab and possibly open the door for another meniscus injury.

According to my interview with Dr. Eric Chehab, orthopedic knee surgeon with Illinois Bone and Joint in the Chicagoland area, “repairing a meniscus provides a 70% success rate, with about a 1 in 3 chance of the meniscus failing again,”  he said.  “The reason a player would opt for this route is for a reduced risk of arthritis in the future,” he stated.  In a meniscus injury with a player that required surgery, would a sports surgeon recommend repairing or removing the meniscus?  Dr. Chehab opinioned, “Most sports surgeons would recommend salvaging and repairing the meniscus if possible as it’s in the player’s best long term interest.”

With this second more recent injury, Rose reinjured the same meniscus that was torn in 2013. He and his doctors opted to remove the torn fragment versus undergoing another repair. The part that was removed was the soft cartilage of the meniscus leaving just the hard cartilage to coat the bone. Dr. Chehab explained, “people often have a misconception that removing a meniscus leaves the knee bone on bone, but the hard cartilage actually remains.”  He also said,”removing the damaged fragment of a meniscus tear would improve the pain right away; however, it subjects the hard cartilage to more stress and damage over time.”

The recovery time for a removal is much shorter than a repair, with 6-8weeks for removing the fragment vs 6-8 months with a repair, which really looks hopeful for Rose doing well the rest of the season and definitely promising going forward into the next. When I asked Dr. Chehab how well a professional basketball player would be able to play at a pre-injury level after rehabbing this type of injury, he felt that a player should actually do quite well. “After all, it’s not until decades later that arthritis would be a problem,” he said. Meaning a player should not have it effect the rest of his career.

The last time I checked any recent news on Derrick Rose, apparently his rehab was really doing great. K.J Johnson, Chicago Bulls reporter for the Chicago Tribune, reported that Roses surgery got a test ride when his knee took full contact in practice already and so far, no ill effects have been reported.

The future for Rose? It’s looking pretty rosy.

Do You Know Where You Are Going to Die?

Senior on bench at beach A

The fear of dying soon and burdening others was the usual catalyst for calling my Uncle  Henry.  He sold cremation plans for one of the larger well known cremation services.  Henry’s job entailed visiting seniors who had filled out a mailer inquiring about cremations, although he once followed up on a mailer from a young woman who traveled all over America riding on rollercoasters with 300-foot drops and names like “Exterminator,” “ Apocalypse,” and “Poltergeist.” She was convinced that she was going to one day die in her quest for that instant adrenaline rush while ‘serial’ riding on rollercoasters.

Henry’s main goal was to help folks make that final decision as economically and simply as possible while at the same time having a say so as to what happened once they were deceased. Just as the young woman had decided, the purpose was to avoid burdening their children and loved ones with any financial and emotional decisions that would occur in the event of their death.

The topic of dying was always a difficult one for my Uncle to talk about over the phone with people, so Henry often had to travel up to 50 miles dressed in his “Sunday best” to discuss one’s final arrangements.  He was always sensitive yet at the same time up front and realistic regarding all of the contingencies that could occur surrounding a death. The topics he had to carefully finesse during his visits were questions such as, “What if your children could not afford to make your final arrangements”, or “What if nobody knew that you had made any arrangements?”

One of the services that was available was to insure the transportation of the remains. After all, the client’s death could occur away from home such as dying on an Island, which actually happened to one of his  clients. With this particular client there was no crematory on the Island and only by the stroke of luck had the transportation policy been purchased. A helicopter had to be flown in to pick up the remains. Without that policy the family would have been stuck paying a funeral home to ship the remains back; a costly situation, indeed.

A lot of folks tried to forgo the transportation policy. They never considered that they could die anywhere but in their home. Did they think the family could just drive them in the back of the Chevy with the air conditioning on full blast to the crematory?  Does not sound pleasant, by all means.

In order to lead up to that subject so as not to appear to be “upselling” transportation services, Uncle Henry once asked a very spry 85 year old woman, “Do you know when you are going to die?” She said, “No one knows that.” He then asked, “Do you know where you are going to die?” She quickly responded, “If I knew that, I wouldn’t go there.” “Well, that makes sense,” he replied.   Henry laughed all the way on his ride back home but never forgot what she said.

Hearing about Henry’s “stories” about death and dying made me a bit afraid of him growing up, I must admit. I certainly did not want to think of my grandmother or parents  being called on by someone from a cremation service and was always afraid that day might one day come. I’m not sure if Uncle Henry’s stories were ultimately meant to help me prepare for my job as a nurse practitioner working at one point for a long term care facility. You always faced doctors and nurses aggressively caring for the critically ill while full knowing that the patient may not benefit or at the end of the day the patient ultimately may not want the care.

End of life decision making is one of the most challenging ethical issues that physicians and critical care nurses face, often bringing the highest level of moral distress not only to the physician but also to the critical care nursing staff. Especially, when the provider faces the challenges of communicating to families in conflict or indecisiveness information related to life support, while at the same time having these families face very poor prognoses.

Physician to family communication actually was toughest for families that wanted to be more involved in the decision making process. It was very hard on them to accept and at times respect the autonomy of the patient in the decision making process to decline unwanted treatments.

At the end of the day, I often thought of my Uncle Henry and his, “If I knew where I was going to die, I wouldn’t go there” story. If only it was that easy! I could appreciate the simplicity of what his service provided, yet the complexity and precariousness of the autonomy that at the moment in time his clients ultimately controlled.

Cynthia Jaffe, D.C., NP-C, F.I.A.M.A

This post was written as part of the Nurse Blog Carnival. More posts on this topic can be found at This Nurse Wonders. Find out how to participate.

Nurse Blog Carnival - The Nerdy Nurse - 300x300

Til Genetics Do Us Part

Newly married couple march newsletter

It’s complicated….. Whether or not a couple can weather through the storms of conflict or not depends not only upon our emotions but also according to research, what’s hard-wired in our genes.

Emotions play an extremely important role in the stability and longevity of a marriage. Let’s face it, all couples experience some conflict in their marriage. Some may only disagree once in a blue moon. Others experience full blown power struggles, disagreements, anger, and perhaps frustration. Once the honey-moon stage is over the rose-colored glasses may slip off for some or perhaps not at all for others.

A psychologist from UC Berkeley, Dr. Robert Levenson along with 9 other researchers, published a 13 year longitudinal study of how genetics and emotions can help shape the stability of the marriage relationship.

The researchers found that certain genes allow some of us to be affected by a negative emotional climate in a marriage while other genes tell us to instead overlook the negativity. The researchers also found that some couples may become hugely satisfied in their relationship when exposed to positive emotions, while another couple may remain largely unaffected. Interestingly, Levenson also found that genetic influence on emotions actually strengthened increasingly as people got older and could eventually affect relationship outcomes.

The results centered around 5-HTTLPR, a serotonin- transporter gene that keeps our moods in check and plays an important role in whether or not over time, positive or negative emotions will affect marriage satisfaction.

The genes came in either short of long lengths. Those people who had long lengths of 5-HTTLPR were less likely to be affected by either negative or positive emotions in the marriage. Those with short lengths of the gene showed much less tolerance of negative emotions and also expressed a much stronger response of elation when things were going very well in the marriage.

So what should we do with this information? What if a simple blood test was available to check for the long or short lengths of the serotonin-transporter?

Would it be wise to screen a potential significant other? Like I said, “Til Genetics Do Us Part.”

http://www.bionews.org.uk/page_352782.asp

http://ucresearch.tumblr.com/

http://www.zmescience.com/

http://www.nber.org/papers/w12944

The ‘Dark Side’ of the Sun

hammock picture march newsletter

Planning a vacation in the sun? You may want sunscreen long after the sun has gone down

Rolling off the press study ups the ante of the dangers of the sun. Researchers from Yale University School of Medicine published a February 2015 study in the Journal Science of UV lights’ damaging effect on our skin that occurs hours after we have been exposed- even in the dark.

Here is what we already have known about the sun’s rays: The sun emits UVA, UVB and UVC light in wavelengths that are not visible to the naked eye. UVA light, at 320-400 nanometers, is the longest in length and reaches the earth easily. It makes up 95% of the sun’s rays that we absorb. It can penetrate glass and clouds as well as our skin and is classified as a ‘human carcinogen’. With enough exposure, it can damage the skin’s DNA at a cellular level causing photo-aging, wrinkling of the skin and the initiation of skin cancers. UVB rays, range from 290-320nm, cause the redness in the skin or the ‘sunburn’ we feel and see and damages the superficial layers of the skin. UVC does not reach the earth and is instead absorbed by the ozone layer.

Melanin, our skin pigment made by cells known as melanocytes, has been thought of in the past as the most important photo protective factor of the sun’s UV rays, with the darker the pigment the better. However, after sun exposure or UVA light from tanning beds, the DNA in the Melanocytes that produce the melanin can be damaged.

A team of dermatology and radiology Researchers from Yale School of Medicine exposed mouse and human Melanocyte cells to harmful UV rays. The UV light caused a type of DNA damage in the cells known as a cyclobutane dimer (CPD) by causing 2 letters of DNA to bend so that it was unable to be correctly read and therefore, damaging the DNA. The researchers found that the Melanocytes not only generated CPD’s as soon as they were exposed to UV light, but surprisingly continued to generate CPD’s for hours after exposure in the dark. Why in the dark? In the dark the Yale team found two enzymes that stimulated electrons in the Melanin in a slow process known as chemiexcitation. This caused the transfer of energy to the DNA creating DNA damage in the dark that was the same as in the daylight.

The researchers concluded, with melanocytes much of the damage to the skin by ultraviolet rays occurs in the dark long after you have gotten out of the sun.

“I know, I know,” you’re thinking, “I’m going to say the moral of the story is to never lay in the sun.”

Well, yes, of course I’m going to tell you that. But I’m also going to tell you to get ahead of the curve on this; it looks like the market has just opened up for an ‘Apres-Sun’ sunscreen to be applied in the dark. Any takers out there?

http://www.sciencedaily.com/releases/2015/02/150219144641.htm

http://www.zmescience.com/medicine/skin-gets-damaged-by-uv-dark-042423/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2671032/

http://www.cbsnews.com/news/sun-damage-to-skin-continues-after-dark/

http://news.yale.edu/2015/02/19/sunlight-continues-damage-skin-dark

http://www.sciencemag.org/content/347/6224/842.abstract

http://www.skincancer.org/prevention/uva-and-uvb/understanding-uva-and-uvb

Measles: Outbreak Reignites the Vaccine-Autism Debate

vaccine autism debateAn explanation of the anti-vaccine movement. Its origin and its claim

The measles outbreak at Disneyland, December 2014, prompted a frenzy of public and media attention to the hyperbole of the vaccine-autism debate. Politicians, both democratic and republican, waded into the debate to give their opinion- much to the alarm of scientists and physicians.

Irresponsible reporting

Most concerning to health officials, was that the pundits, by irresponsibly reporting fraudulent studies and the “opinions” of politicians and celebrity activists, gave the thoroughly debunked “Vaccine-Autism theory” a relevance that it doesn’t deserve. Unfortunately, the consequence has been that significant numbers of parents have delayed or refused the vaccine.

Vaccine-Autism theory

The origin of the Vaccine-Autism theory started with a 1998 article in the Lancet, a peer- reviewed medical journal that linked autism and vaccines written by a British physician, Andrew Wakefield, along with a dozen other co-authors. The title of the paper:”Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children”, was not the larger than life title that would have grabbed the attention of the mainstream media. It also would not have clued in parents who may have been confused, concerned or on the fence with vaccinating their children.

The study was based on a dozen kids who developed intestinal and behavioral problems. Eight of the 12 had been vaccinated with the Measles, Mumps, and Rubella vaccine. Soon afterward, the parents reported that behavior changes took place in their children after they received the vaccine. Wakefield and his co-authors then took biopsies of the colon and reported that several of the children had non-specific colitis and hyperplasia of the Ileum of the colon. Wakefield and his co-authors concluded, therefore, that there may be a possible link with the intestinal disorders leading to neuropsychiatric disorders after administration of the MMR vaccine.

Anti-vaccine crusade

A press conference and video news release of the study was all it took to spark a backlash against the MMR vaccine. Soon celebrities, such as Jenny McCarthy, and other high profile anti-vaccine advocates jumped on the bandwagon to launch an anti-vaccine crusade, furthering a world-wide scare of vaccines.

The events triggered a decline in immunizations, an increase in MMR outbreaks, and the anti-vaccine movement pushing full speed ahead.

Between 2003 and 2011, a British investigative reporter, Brian Deer, best known for his investigations into science, medicine, and social issues for the Sunday Times of London, investigated the vaccine-autism connection study in the Lancet.

Lancet retracts study

Deer published his findings of the study in the BMJ medical journal. According to a BMJ 2011 editorial, Deer discredited the study alleging a conflict of interest through Wakefield’s involvement with a lawsuit against the vaccine manufacturers and manipulation of the data.

Multiple large epidemiological studies were later performed and were unable to reproduce the study or to find any link between autism and the MMR vaccine. Eventually, after 12 years of investigations, the Lancet retracted the study

Unfortunately, there was not a direct correlation with the retraction of the study and public confidence in vaccines.  According to a CNN report on the retracted study, a sharp drop off in the vaccine rate in Britain, as high as 80% by 2004, occurred after the Lancet published the study as parents panicked.

The vaccine rate never seemed to recover fully even after the story was discredited as parents continue to blame vaccines for their child’s condition.

Why is there continued mistrust?

Today, the number of measles cases has dramatically increased, especially for a condition that was once largely eradicated. Recently, the organization Autism Speaks, discussed on their website that a large scale 2015 study, reported in the Journal of the American Medical Association (JAMA), of over 95,000 vaccinated children including 15,000 unvaccinated children and children already at high risk for autism, that there was no link with the MMR vaccine and autism. The study found that autism rates were actually lower in the vaccinated group.

So why do parents still mistrust vaccines? The most logical explanation is that infants start vaccinations during a period in their life when rapid developmental changes are happening.

Once a child misses an important developmental milestone, which naturally would be after initiation of multiple vaccines, parents assume causation.

What is interesting is that the Vaccine-Autism theory has changed multiple times over the years. First, Autism was linked as a direct cause and effect from vaccines originating from an intestinal reaction after the Wakefield study. Next, it was due to the preservative, Thimerosal. After Thimerosal had been removed from childhood vaccines, it switched to the vaccine schedule itself.

Disneyland measles

Fast forward to December 2014 at Disneyland. An infected person creates a measles outbreak at Disneyland which then spread to several states and left over 100 people infected.

The outbreak illustrated just how rapidly these once common childhood diseases can spread. As of April 24, 2015, 166 people were already infected in 19 states.

According to the CDC, “Measles can cause serious health complications, leading to pneumonia, encephalitis (swelling of the brain), and death”. The symptoms of measles start with a cough, sore throat, runny nose, red eyes, followed then by a rash that spreads all over the body. Measles is so highly contagious that over 90% of the people who are not immune and come in close contact with an infected person will come down with the disease.

No Vaccination? No Herd Immunity

According to a 2014 CDC report, with the low vaccine rates, large numbers of children were at risk of losing what is known as herd immunity. Herd immunity occurs when enough people are vaccinated to protect those who have not developed immunity- those too young or too sick to be vaccinated, or those who have refused the vaccine. To achieve herd immunity 90-95% of the population needs to be vaccinated to afford protection in the population.

Unfortunately, Herd immunity can be fractured. Herd immunity won’t protect people who are not vaccinated if the number of vaccinated falls low enough. With conditions that are highly contagious, such as measles, it wouldn’t take much to tip the scales toward an epidemic.

Matter of fact approach

The solution? As practitioners, we need to be careful how we communicate with people who are siding with the anti-vaccine movement. It’s counterproductive to shame them in social media and on national T.V. by calling them selfish, stupid or uninformed. Not to mention politicizing the debate is only making things worse. It stirs the pot and causes others to view the anti-vaccine message as mainstream. It’s kind of like bad publicity eventually is good publicity for all the wrong reasons. It fails to deliver constructive information and only leads to confusion.  The result is people dig in further.

How should a physician address concern? Personally, I would think that a shared decision- making approach or taking the time to dispel myths would be the way to best deal with vaccine-wary parents.

Surprisingly, research shows that when physicians used a more matter of fact approach to vaccinations, they got much better results. The physicians who told parents exactly what vaccines their child would be getting that day without inviting any discussion saw more than 70% of the parents vaccinating their children.

Instead, the physicians who were flexible and invited parents to discuss their thoughts on vaccines resulted in a whopping 83% declining vaccines.

It speaks to the conclusion that parents are not sure themselves and want reassurance that a public health policy is supported by the scientific community. Additionally, when physicians communicate the goal of 100% vaccination rates, it sends the right message.

 

 

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