Sunday, May 12, 2019

Measles Update

I'm interrupting my series on herbal and nutritional medicine to update my audience on the measles outbreak. Now the Centers for Disease Control reports 764 cases in 22 states.
How this compares to recent years...
And, writing this on a Sunday morning, I just heard that NPR's Hidden Brain will be running an episode on how we know what's "true", one story featuring a woman who was an "anti-vaxxer" and now has come around to the view that vaccines are important and that they work. In Washington State, New York City, and elsewhere health authorities and legislatures are tightening restrictions on both public-space access for the unvaccinated and exemptions to vaccination.

Interestingly--and despite the warning that measles is "deadly" and causes "severe complications"--the CDC reports that no deaths or encephalitis cases have been filed from any location in the U.S. There were 66 hospitalizations, and these include 3 cases of pneumonia. 71% of cases through April 2019 were in unvaccinated persons. 25% were in infants too young to be immunized with the MMR vaccine. And another 24% were too young to have been fully immunized (2 doses) at age 4. The remaining 51% were distributed among adolescents and adults.

One way to look at this is that 628 people who were unvaccinated or whose immunity status was unknown are now immunized against measles. Another interesting conclusion is that 11 cases of measles were in people who were fully immunized, much smaller than the number suggested by published reports of 98-99% long term protection in those who are immunized (that's good, right?). CDC data also suggest that the peak of this outbreak was in the 3rd week of March; by the end of April, measles had dropped to about 11 new cases nationwide. This is consistent with how most infectious disease outbreaks trend. Eventually, the epidemic fades.

I've written before (1, 2, 3, others) about what I believe are the real issues in the "vaccine controversy" or "vaccine debate" or whatever you want to call it, so I won't repeat all that here. But I thought that under the circumstances it might be a useful time to share snapshot of the reality of the current episode.

This outbreak is being sold as a failure. It's a failure of parents who don't "believe" in the science. It's a failure of doctors and nurses to sufficiently coerce parents into getting their kids immunized. It's a failure of state governments to restrict vaccine exemptions to only the most extreme circumstances (like an actual medical allergy). It's a failure of our society to "get on board" with this public health measure.

I think it is a failure too. For me it's a failure of our society to have a more effective conversation about health, disease, and health care. For anti-vaxxers whose kids just got over the measles without anything catastrophic happening, it just confirms what they already believed: measles isn't a very bad disease, and their kids turned out okay without the use of measles immunization. This news will spread throughout social media and further serve to undermine the messages of public health authorities, nurses, and doctors who promote immunization.


What won't be discussed is that the reason this outbreak--so far--hasn't caused a wave of medical calamity (deaths, brain damage), is that this isn't a very serious disease. Older doctors who report how "devastating" measles was in the past, causing deafness, mental retardation, and of course death, don't address how much different public health and medical care were 40 or 50 years ago. That measles tends to cause complications in the poor, the undernourished, is not discussed. I have stated before that poverty, nutrition, safety, and hygiene are known to be key reasons for health problems and deaths that can occur from even simple illnesses like the flu, measles, or infant diarrhea.

This allows us to ignore the disparities in society. We can turn our sights away from systemic, societal problems--like racism, poverty, and hunger--and attribute disease outbreaks to stubborn parents who refuse to follow along in the hymnal like the rest of us righteous folk.

From NPR and ABC
Recently, I saw this report on how actress Maureen McCormick and other former cast members of The Brady Bunch are upset that the episode "Is There a Doctor in the House?" is being viewed by people who avoid vaccinating their kids as confirmation of the non-seriousness of measles. In that episode, the kids get the measles, and home-bound hijinks ensue (cue laugh track).

Interesting too is the story's report on how Merck Co. helped to shift the public's perception of the mildness of measles through educational campaigns like "Mission: Measles--The Story of a Vaccine." Of course, this was good for Merck. More immunizations = more dollars; witness this story from the New York Times about ever-higher vaccine costs.

I remember this episode of The Brady Bunch (we were a family of eight too, so we saw ourselves in that show), and although it can be argued that in the 1960s, there were worse diseases that did make measles seem less serious (smallpox, polio), maybe the impulse to make all diseases seem serious--no matter how little their real risk--does society a disservice. Maybe it distracts us from what we ought to be paying attention to, from what social and political policies really need to be changed.

And with that, I wish you all good health!

Monday, May 6, 2019

Herbs and Nutritionals Series: Allergies

The University's local Commencement was Saturday. As the graduates commence their journey forward, I commence with summer break. I'll start with some writing. Recently I promised a series on herbal medicines, so I'll start there.

Spring brings with it high pollen counts and if you are sensitive to it, it can be pretty miserable. I suffered from allergies (in the fall) for years, but no longer. I find the best treatment for allergies is a carefully-selected homeopathic remedy. If you're not quite there though, or still in the need-for-support stage, here are some things that can help. Caveat: This piece is educational and is no substitute for personalized medical advice.

Vitamin C
In high doses this vitamin is anti-inflammatory. "High" means several thousand milligrams a day. I learned that naturopaths prescribe this "to bowel tolerance" meaning you keep upping the dose until the bowels become a bit loose. However I find that 3,000-6,000 mg per day is often helpful. I tell patients to take it in "divided doses"--meaning one spreads that out over the course of the day, for example 1,000 mg three times a day. 

This is a naturally-occurring nutrient found in grapes, cherries, berries, kale, tomatoes, and broccoli, among others. Quercetin is a component of cell-walls, and having a diet with enough of this nutrient ensures that cell walls have all they need. The thinking is that strong cell walls means that they're less likely to break. "Mast cells" are in the body to protect against certain kinds of infections. When organisms try to get into the body, mast cells break open to release histamine which brings white blood cells to the area. Some studies have found that taking quercetin reduces the "breakability" of mast cells just enough to reduce histamine release. You can get this from foods or from supplements. The latter will often be compounded with plant-based digestive enzymes like bromelain or papain to help the quercetin be absorbed.

Image result for neti potNasal Lavage ("neti pot")
This is a nice, "nursey" hygiene measure. The neti pot is a specially-designed pot so the user can washout the nasal passages.
 It's been in use for thousands of years, and can wash away the inhaled pollen and collected mucus that leads to symptoms. There's lots of stuff on the internet one can look up for the details, but I always emphasize with my patients that the pot should be cleaned with hot water with each use, to reduce the risk of sinus infection. The washing solution is salt water, and there are premixed solutions available, or a person can make their own. I also emphasize lukewarm water! Very hot or cold water can cause problems. Saline nasal sprays are a less messy means to achieve the same "wash out", but may not be as effective.

Image result for stinging nettlesStinging Nettles (Urtica dioica)
This is a plant that actually suppresses T-cell function, which is one of the main causes of allergies. Without getting into too many details, T-cells are a type of cell that "memorizes" allergy and initiates the reaction that pops mast cells. 

One has to be a little careful with this one for two reasons. First, the plant must be picked and processed at a certain part of its life cycle to avoid the "cystoliths"--tiny hard bits of calcium carbonate--that are said to cause kidney and liver damage. Some sources dispute this, but it isn't hard to stick to young plants that are pretty much cystolith-free, so why take the chance? For my patients, I always recommend verified professional-quality nettles.

Second--and this is not in dispute--is that this stuff actually works to get at the source of allergy symptoms. T-cell suppression isn't as strong as some of the drugs that also do this (as in drugs for autoimmune diseases), but I have observed that when used for too long, sometimes the user will actually catch a cold! So for my patients, I tell them to limit daily use to only a couple of weeks at a time.

That's it for now. Look for a few more highlights of various herbs and nutritionals in this series.