Vaccination, an Overview, Part 3 The New Epidemic

In America today, what infectious diseases remain, such as the flu, are not as life-threatening, and infant mortality has drastically decreased from just a century ago. Children of today are highly likely to make it to adulthood. Coinciding with the reduction of infectious disease, however, has been a corresponding emergence of an entirely new kind of health problem in children: chronic disease. Children in ever greater numbers are suffering from immune system disorders and developmental delays which have no known cause or cure. Eczema, hives, hay fever and food sensitivities have been increasing since the 1920s, with rapid surges occurring in the 1960s and the 1980s, and these allergies now occur in the tens of millions. Asthma has been increasing since the 1960s, particularly in developed countries, and it now affects 6 million children in the U.S. Attention-Deficit Hyperactivity Disorder has tripled in incidence since the 1970s. Autism spectrum disorders have grown from 1 in 2,000 in the 1960s and 1970s to 1 in 150 today, with the greatest spike occurring from 1996 to 2007.   All of these increases in incidence are too great to be explained solely by genetic mutations (although genetic susceptibility does seem to be a factor) or by evolving diagnostic methods and definitions.  Consequently, an external, environmental agent (or agents) must be triggering them. Since these diseases are chronic but seem to be unassociated with any pathogen and not infectious, they cannot be explained by the germ theory of disease, and scientists possess no alternative theory that would explain what in our environment could be triggering these types of health problems.

It is worth noting that our environment has changed drastically over the last half-century. Our food, water and air are less likely to be contaminated by bacteria like tuberculosis or cholera but are more likely to contain pesticides and other potentially toxic chemicals. Children who used to run and play outdoors, using up their excess energy and exposing their immune systems to many different natural substances, from pollen to poison ivy, now spend most of their time indoors in school or sitting still in front of a screen at home. At the same time they have adopted diets high in excess calories and low in nutrients. Antibiotics and pasteurization have reduced the presence of both bad and good bacteria in their lives. This new lifestyle could be the culprit for children’s hypersensitive immune systems and hyperactive behavior, or it could at least be a contributor. When it comes to autism spectrum disorders, however, many parents believe that vaccines play a major role.

Vaccines have never been completely without side effects, and even the safest vaccines will cause temporary side effects (such as pain and swelling, fever, vomiting, diarrhea, rashes, headaches and crying) between 5% and 40% of the time.  Serious side effects are usually some form of inflammation: Guillain-Barre syndrome  (an autoimmune disorder causing paralysis) and encephalitis (inflammation of the brain).  However, these are said to be extremely rare. A vaccine for which the serious side effects were found to be relatively more common was the first combination vaccine, DTP (diphtheria, tetanus and pertussis), which was released on the market in 1946. In the 1970s and 1980s there was a growing awareness that the pertussis portion of the vaccine, which used a whole-cell B. pertussis bacteria, was responsible for a higher-than-expected rate of reactions such as convulsions, shock, cardiac distress and brain damage. In 1981 Japanese scientists developed a new vaccine that used a safer acellular pertussis component, and caused far fewer reactions, but this form of the vaccine was only adopted in the United States in 1996, after many years of lobbying by parents who had observed their children react adversely to the DTP vaccine.

As was the case with the DTP vaccine, suspicions of a link between autism and vaccines have their initial basis in the case reports of parents who see their children lose previously acquired mental and social skills following doses of vaccines, the majority of which are administered in the first two years of life, the same timespan in which autism usually appears. This correlation could be explained as a coincidence, but the issue is complicated by the fact the rates of autism have increased in conjunction with rising number of shots given to children. In 1983, for example, children received vaccines for diphtheria, tetanus, pertussis (given together as DTP), polio, and mumps, measles and rubella (given together as MMR). This schedule represented vaccines for 7 diseases in the first 4 years. There were 6 shots containing 18 doses of vaccines plus an additional 4 doses of the oral polio vaccine, totaling 22 doses of vaccines. In the year 1995 the schedule was largely the same, except for the addition of the vaccine against Haemophilus Influenzae Type B (HIB) a bacteria that causes meningitis. After that, however, the number of vaccines began to increase.  By 2007, children following the standard schedule were receiving 40 total doses of vaccines against 14 diseases, double what had been given a decade previously. At the same time the number of shots did not greatly increase, because new combination vaccines became available that combine four or five vaccines into one shot. The result has been a significant increase in the amount of foreign material injected into a child’s body at one time.

As discussed in last week’s newsletter, the ingredients of a vaccine must be carefully balanced and formulated in order for the vaccine to be both safe and effective. The typical vaccine components mentioned in the first section – the pathogen, the tissues in which it is cultured, an adjuvant to help stimulate immunity, and a preservative to protect the vaccine from additional pathogens – are each capable of causing unwanted side effects.Live viruses and bacteria, found in the DPT and MMR vaccines among others, are better able to stimulate immunity, but are more likely than weak or killed pathogens to cause a persistent infection and excessive inflammation, including inflammation of the brain (encephalitis) and subsequent brain damage.  Animal or human tissues in which pathogens are cultured contain proteins similar to those contained in our own tissues.  In reacting to the pathogen in a vaccine, some immune systems may see these proteins as part of the threat, and produce autoantibodies against them. These autoantibodies can’t tell the difference between the injected proteins and body’s proteins, resulting in chronic inflammatory autoimmune disease such as Guillain-Barre syndrome, arthritis or multiple sclerosis. The most typical adjuvant in vaccines, aluminum, is a metal that has been linked to Alzheimer’s disease, dementia and brain damage, and it may be difficult for some children to detoxify. As for preservatives, some vaccines contain formaldehyde, a carcinogen, and most vaccines previously contained thiomersal, a form of mercury, before vaccine manufacturers agreed to provide mercury-free vaccines upon request several years ago. Could these ingredients, as they are injected into children with greater frequency and in greater quantities, be responsible for the increasing incidence of chronic immune hypersensivity and developmental disorders in children?  Clearly, not all children have negative long-term reactions to vaccines; in fact, it seems that most of them don’t.  But might some children have a genetic susceptibility to having adverse reactions to vaccines, particularly when administered according to the current schedule?

What are the facts of the situation? First, vaccines carry the potential for adverse effects, including brain damage.  Second, there is a parallel between increasing autism rates and the increased number of vaccines given.  Last, autism typically emerges in children during the period of time when vaccines are administered.  What have we proved?  Nothing.  These facts are not proof of a causal relationship between vaccines and autism–they only show a correlation.  However, this correlation makes a causal relationship a possibility worth investigating, especially since no other cause of autism has been identified. Accordingly, many scientific studies have been done on whether a link between vaccines and autism exists. The initial safety studies done on each new vaccine by Merck, Sanofi Pasteur, Wyeth, and GlaxoSmithKline (the four large pharmaceutical companies that manufacture almost all vaccines), the results of which are reviewed by the FDA and the CDC’s Vaccine Adverse Events Reporting System (VAERS), have not found a link for any individual vaccine. Doctors and research scientists, most notably the independent, non-profit Institute of Medicine, have conducted many additional studies over the past two decades, as well as comprehensive reviews of earlier research, and the vast majority of them have also concluded that no link can be proven, thus confirming the scientific consensus that the serious side effects of vaccines are extremely rare and do not include autism.

The most famous study that did hint at a possible connection between vaccines and autism was published in 1998 in The Lancet, a British medical journal that is perhaps the most respected in the world. The lead author, Dr. Andrew Wakefield, and twelve of his colleagues, argued, based on observations of twelve children with both inflammatory bowel disease and autism, that the children might have a new syndrome caused by the vaccine-strain measles virus, which was found in their intestines. Because the children were previously normal, Dr. Wakefield suggested an environmental trigger might be the cause of the syndrome, and called for the MMR vaccine (measles-mumps-rubella combination) to be discontinued in favor of separate vaccines administered at separate times, until more research could be done. However, the British government felt that to do so would increase the exposure of children to the three diseases. The results of the study were widely reported in the news media, and with MMR remaining the only vaccine available, many parents did not vaccinate their children against the diseases at all.

In the years that followed, both Wakefield and the study received increasing criticism. Other scientists did similar studies and reported that they had failed to duplicate the results. A journalist investigating Wakefield found that he had ties to a lawyer preparing a lawsuit against the MMR manufacturers, and that he had a patent on a new measles vaccine, both indicative of serious conflicts of interest. Ten of the twelve co-authors eventually disowned the paper. Earlier this year, The Lancet itself finally retracted the paper, and Dr. Wakefield lost his license to practice medicine in the UK.

In light of this evidence, it would seem that the possibility of any link between vaccines and autism has been thoroughly eliminated. But for a variety of reasons, we must question the credibility of those who signed off on vaccine safety, who authored and reviewed pro-vaccine studies, and who have promoted vaccines in the media. To begin with, the general public has long had good reason to distrust the ethics and integrity of the pharmaceutical industry, which has been known to disguise or minimize knowledge of adverse reactions to its products (such as Avandia, Vioxx and Fen-Phen). It has also been known to aggressively market its products to as wide a customer base as possible — even urging in recent months, with governmental approval, cholesterol-lowering drugs on people who do not even have high cholesterol. Vaccines are a guaranteed lucrative investment, given that they are prescribed equally to almost every individual in the country.

An additional strike against the pharmaceutical companies’ assurances of safety is that they are not responsible for adverse side effects of the vaccines they manufacture. In the 1980s, as more parents whose children had been injured by the DPT vaccine began to bring lawsuits against vaccine manufacturers, those manufacturers threatened to stop making vaccines entirely, reasoning that it would be unprofitable to continue if they had to pay expensive personal injury claims. In order to ensure that vaccines remained available to the public, the U.S. government stepped in and passed the National Childhood Vaccine Injury Act, which set up a special government court for hearing vaccine injury claims, and awarding damages up to $250,000.  The damages are funded by proceeds from a tax on vaccines, thus shielding vaccine manufacturers from any financial liability. Claims are argued before a government-appointed judge rather than a jury, and while most claims are rejected, the court has had to award almost $2 billion in damages since its inception.

Clearly, pharmaceutical companies manufacture vaccines for profit, not out of an overriding concern for the safety of children. It is not likely that they would abandon profitable products such as vaccines even if they knew that such products caused relatively frequent and severe side effects–just as they knew, but kept secret, the fact that Avandia increased the risk of heart attacks, for example. It is therefore prudent not to accept at face value claims (and by claims, I mean advertising) by the vaccine manufacturers, and by the scientists whom they employ, that vaccines are extremely safe.

What about the government’s independent oversight and regulatory authority? Unfortunately, as in so many industries (including banking, energy, and health care) a revolving door of employment exists between the pharmaceutical companies and the federal authorities that regulate them. An example is Dr. Julie Gerberding, who directed the CDC from 1998 to 2009. This was the period during which the number of vaccines administered and the number of autism cases greatly increased. Dr. Gerberding waited exactly one year and one day after leaving the CDC – the legal minimum – before taking on the job of President of the Vaccine Division of Merck Pharmaceuticals. Gerberding, during her CDC tenure, heavily promoted Merck’s new-to-the-market HPV vaccine, Gardasil, as well as the safety and effectiveness of vaccines in general.

As for scientists and medical doctors who conduct research on the safety of vaccines, many rely on the financial support of the pharmaceutical companies to carry out their research.  Without that support, they would be unable to carry out wide-ranging, long-lasting epidemiological studies of vaccine reactions. The most vocal and media-friendly proponent of vaccine safety, Dr. Paul Offit of the Children’s Hospital in Philadelphia, happens to be the co-inventor of the Rotavirus vaccine RotaTeq (also manufactured by Merck).   Offit has received royalties totaling $182 million from RotaTeq alone.

The conflicts of interest described so far have their origin in greed, but some conflicts can arise from humanitarian motivations. Most public health officials have concerns that if doubts about vaccine safety are given a more thorough hearing, a majority of parents might choose to vaccinate their children less, or not at all (as we saw happen in the aftermath of the Wakefield study publication) and consequently return us to an era of epidemic disease rivaling that of the 19th and early 20th centuries. The authorities may be unwilling to give a fair hearing to the possibility of a vaccine-autism link to serve the greater good. It’s possible that, even if Dr. Wakefield was partly right in his conclusions, the government and scientific community may have been driven by these types of fears to dissect his work for errors and conflicts and to magnify those flaws.

With so many powerful institutions – pharmaceutical companies, government, and scientific bodies – motivated for a variety of reasons to disprove a link between vaccines and autism, it is unlikely that any individual scientist or pediatrician is willing to stake their reputation, potentially even their license to practice medicine, by publishing (or even conducting) a study indicating greater-than-reported side effects of vaccines.  Not only would funding for such a study be difficult to obtain, any flaws in its methodology will be far more heavily scrutinized than if it were to confirm what has already been promoted as scientific truth.

If so many conflicts of interest are at work, shouldn’t we expect to see weaknesses in the pro-vaccine studies?  In fact, on closer examination, many of the studies showing that vaccines are unrelated to autism have significant methodological flaws or are reported to have broader conclusions than they really do. To take a recent example, an epidemiological study by researchers from the University of Louisville School of Medicine was published in Pediatrics magazine on May 24th of this year, stating that giving children vaccines on schedule had no negative effect on long-term neurodevelopment. Most news outlets reported that the study had shattered the “myth” that a delayed or alternative vaccine schedule was safer than the standard, CDC-recommended schedule. However, the study was based on data from a 2007 study published in the New England Journal of Medicine intended to determine whether increased amounts of thiomersal in vaccines caused greater numbers of neuropsychological disorders. That study contained a disclaimer noting that children with autism spectrum disorders were specifically excluded from the data set. Consequently, such children were not examined in the recent study either, and the authors acknowledged that they were restricted in their ability to assess outcomes such as neuro-developmental delay, autism, and autoimmune disorders. The differences between the two groups that were compared were also not significant. Those who were placed in the “timely” group received the recommended 10 vaccines in their first seven months while the “untimely” group received an average of 8. The untimely group, though their shots were delayed, did not actually receive fewer vaccines at each doctor visit, and the study indicates that they may have missed vaccines for socioeconomic reasons rather than intentionally abiding by a different schedule. Finally, the study was only of children receiving shots from 1993 to 1997, the period just prior to that in which the number of vaccine shots increased dramatically.

While, as stated above, these types of omissions and flaws are characteristic of most of the pro-vaccine studies, the fact that Dr. Wakefield’s study has been discredited as well is not necessarily comforting for those wanting to be reassured about the safety of vaccines, as it indicates that his conflicts of interest, as well as an error-filled study, somehow escaped the notice both of the editors of the Lancet and of the dozen co-authors who participated in the research. It must be concluded that we cannot simply take for granted the results of scientific studies from even the best medical journals, having seen what happens when they are subjected to intense scrutiny.  And, above all, we must keep in mind that such scrutiny is not likely to be applied to studies that confirm the scientific consensus on vaccines.

To better determine whether a connection might exist between vaccines and autism, we would need a long-term study comparing the health problems of a control group of completely unvaccinated infants against another group that has the standard vaccine schedule, and possibly additional groups that follow selective or alternative vaccine schedules. No study of this type has yet been done.  Pro-vaccine groups argue that such a study would be unethical, assuming ahead of time that vaccines are safer than the alternative, though this is what the study would be meant to determine.  Though such a study would be expensive, anti-vaccine groups might be able to fund it, were it not for the fact that, having staked their reputations on a link between vaccines and autism, they could not be considered an objective sponsor. Perhaps the main obstacle, however, is that a study of this type would require a large number of children to go unvaccinated and potentially susceptible to disease, and no public or private institution would want to take responsibility and liability for these potential adverse effects. Of course, autism is itself an epidemic that must be addressed, but as long as its cause remains unknown, no institution is officially liable for it.  Only the families of autistic children bear the burden for it.

As the controversy rages on, fewer parents are taking the medical establishment (including the CDC) at its word.  On May 5th, 2010, the CDC announced the results of a study they had conducted on parental compliance with the current recommended vaccine schedule. The percentage of parents who refused or delayed at least one vaccine for their children had increased from 22% in 2003 to 39% in 2008. Why? The parents cited concerns about the safety of vaccines, particularly the risk of autism. If the risks of vaccines are in fact much greater than reported, these parents seem to be making the right choice. However, one must not forget the reason why we vaccinate in the first place: to protect our children from infectious diseases. Eliminating one of the possible causes of autism from your child’s life won’t do them any good if they suffer permanent damage or death from polio, measles, diphtheria, tetanus or meningitis. Therefore, suspecting that the side effects of vaccines may be greater than reported leaves us with no easy decision to make. The overarching question that remains is the same that has pursued us throughout human history: how do we safely protect our children from disease?

 

We’ll take a stab at answering that question in next week’s newsletter, “Building Immunity.”

 

Vaccination: An Overview (Parts 1 and 2)

1. How Vaccines Work

 

We live in a world permeated by microorganisms of all kinds – bacteria, fungi, even microscopic animals and plants. Microorganisms interact with human beings in a number of different ways, in many cases seeking us out as their hosts for mutual benefit. Probiotics, for example, are various species of bacteria that live in our intestines, helping us digest our food and absorb nutrients. But some viral and bacterial microorganisms, known as pathogens or germs, cause disease and death in their human hosts rather than coexisting in a mutually beneficial relationship. Vaccination is meant to be a way of protecting us from these pathogens.

Generally speaking, a vaccine is a biological solution, prepared in a laboratory, that contains a weakened or killed virus or bacteria. A person who receives a dose of a vaccine containing a microorganism becomes immune to the disease caused by that microorganism. For example, the measles vaccine grants immunity to the measles virus and thereby to the disease the virus causes. The vaccine accomplishes this by taking advantage of the amazing immune system that exists in the human body.

The immune system is a network of biological processes that combine to protect us from infectious agents such as the pathogens mentioned above. Components of the immune system include physical barriers like skin and mucus but also interior protective agents such as white blood cells and interferons (proteins that protect us from viruses). Our most complex and advanced form of immunity, known as adaptive immunity, involves antibodies (aka immunoglobulins). Antibodies are specific proteins that the immune system produces upon encountering a foreign substance such as a microbe (aka an antigen). An antibody enables the body to more quickly recognize and neutralize the antigen to which it corresponds. As a result, after just one encounter with a pathogen, we can become permanently immune to it upon any future encounters. In other words, due to our ability to produce antibodies, we are able to adapt to an attack such that the same attack won’t work on us twice.

When we are injected with a dose of a vaccine containing a weakened or killed virus or bacteria, the immune system kicks into gear and fights off the pathogen, at the same time producing antibodies against it. Ideally, the pathogen will be weak enough to pose no danger to the body, but strong enough to still stimulate antibody formation. That way, if we encounter the pathogen in the future, we’ll have the antibodies ready to fight it off regardless of its strength. In other words, we’ll be immune to it.

Most vaccines contain, in addition to the pathogen, the following ingredients: animal or human tissues, which serve as a medium in which the pathogen can be cultured; a preservative (such as thiomersal, a mercury-containing compound, or formaldehyde) to keep other pathogens from contaminating the vaccine; a stabilizer such as MSG, to prevent the vaccine from being damaged by heat, light, acidity or humidity; and an “adjuvant,” usually aluminum, which is a substance that increases the response of the immune system. These ingredients, which differ depending on the vaccines, are the result of many decades of research on how to make vaccines safe, effective, and cost-effective.

The most crucial balance to strike in making a vaccine is between a too-strong pathogen and a too-weak one. In the former case, the pathogen may overwhelm the recipient’s immune system, resulting in disease; in the latter case, the pathogen may not stimulate lasting immunity. For example, the oral polio vaccine, which used a live polio virus administered in a similar manner to the way the actual polio virus is contracted, actually caused polio and subsequent paralysis in a small number of children each year before it was discontinued in the early 2000s. For this reason many vaccines are injected, entering the body via the bloodstream, and feature weakened or killed pathogens, relying partially on the afore-mentioned adjuvants for additional stimulation of the immune system. However, this method, presumably because it bypasses certain aspects of the immune system, sometimes does not result in lasting antibody production, in which case it does not confer permanent, lifelong immunity in the subject (hence the need for recurrent “booster shots” of certain vaccines ). In contrast, immunity from a naturally contracted infection is more likely to be permanent, but the risk of serious disease is much greater when acquiring immunity in this way. This dilemma of safety versus effectiveness, of stimulating immunity without harming the patient, has been present since the earliest and most rudimentary attempts at vaccination.

 

2. The History of Vaccination

 

Observing the progress of the Plague of Athens in 430 BC, the Greek historian Thucydides wrote that the plague (now thought to be typhus) “never took any man the second time so as to be mortal.” Those who got sick but survived did not have to fear dying from the disease later on. Similar observations of adaptive immunity may have been what led seventh century Buddhist monks to adopt the practice of drinking a small amount of snake venom to make them immune to the poison from an actual bite. In ancient China, the most threatening disease was smallpox, and by the 10th century one Buddhist nun had found a method for treating smallpox with inoculation. Inoculation, a more general term than vaccination, is the placement of something into a medium in which it can grow and reproduce, such as a plant part grafted on to another plant, or an antigen into a human body. Inoculation with smallpox for immunization purposes is known as variolation.  Over the next few centuries, variolation became common practice in China as a means of providing some protection against smallpox.

Ancient Chinese methods of variolation generally consisted in drying and pulverizing smallpox scabs from people with mild cases of smallpox and blowing the scab powder into the nostrils of healthy people. The mild cases were chosen for the same reason that vaccine makers now often use weakened or killed pathogens: to reduce the risk of inducing a serious infection. Another form of variolation was to have healthy children wear the undergarments of infected children for several days – a tactic similar to the chickenpox playdates of the 20thcentury, prior to the invention of the chickenpox vaccine.

Similar forms of variolation were eventually practiced in India, Byzantium and the Middle East. Due to various causes including the Crusades, the slave trade, and other forms of trade, smallpox spread to Europe and the Americas, and variolation followed.  Variolation techniques now included applying smallpox scab powder to cuts or scratches on the skin, and the process was slowly accepted in the West as a preventative against the disease, though many distrusted it based on its Oriental origin. The major drawback of variolation, however, was that people occasionally developed serious cases of smallpox from the procedure, and either died or suffered scarring and blindness. People sometimes feared the preventative almost as much as the disease itself.

In the eighteenth century, smallpox was widespread throughout England, but one group of people were curiously unaffected by the disease: dairy workers. Through their contact with cows, dairy workers typically became infected with cowpox, a disease similar to smallpox but much less dangerous, which was spread by touch from the infected udders of cows to humans. Cowpox was similar enough to smallpox that the antibodies produced by the infected workers could fight off smallpox microbes as well as cowpox microbes. One of the first people who took advantage of this phenomenon to deliberately induce immunity was an English dairy farmer, Benjamin Jesty.  In the year 1774, during a local smallpox epidemic, Jesty infected his family with the cowpox virus that had already infected his servants and workers. The family easily recovered from the cowpox virus and were untouched by smallpox.

Other farmers carried out similar experiments with success. Eventually, word of this immunization method reached the surgeon and scientist Edward Jenner, who in 1796 decided to test it out by inoculating his gardener’s eight-year-old son with pus from a milkmaid’s cowpox blisters, and then deliberately injecting him with smallpox (scientists had a little more leeway to experiment freely back then).  Since the smallpox virus did not appear to affect the boy, Jenner announced that he had been successfully “vaccinated,” deriving the term fromvacca, Latin for “cow.” Jenner continued to test vaccination on dozens of additional subjects with immediate success, and thanks to his connections in scientific and government circles, was able to widely publicize his findings. He also founded an institution to promote his method, and the British government soon banned variolation in favor of vaccination.

Over the course of the 19th century, vaccination against smallpox became standard practice in most European countries, and was in some cases mandatory. However, smallpox epidemics continued, particularly during times of stress and upheaval.  During the Franco-Prussian war of 1870-72, a smallpox epidemic struck France and Germany and killed over 100,000 people. Jenner himself became aware that both the safety and the effectiveness of the smallpox vaccine were less than ideal. He had discovered that a significant number of people still developed smallpox even after vaccination. They also sometimes became infected with other diseases that had contaminated the vaccine. As for the immunity from vaccination, it generally only lasted 3-5 years and then began to decline.

What Jenner did not know was the nature of smallpox and how it was transmitted. Only by the end of the 19th century did scientists investigating both smallpox and the many other infectious diseases that were prevalent at the time (tuberculosis, diphtheria, cholera and typhus, among others) come up with the famous germ theory of disease. The germ theory stated that each individual infectious disease was caused by an individual, microscopic, living organism. The noted French chemist Louis Pasteur was a major contributor to the theory, having proven that microscopic organisms, good and bad, do not generate spontaneously but reproduce by subsisting on nutrients, and can be airborne or anaerobic. Pasteur subsequently put his discoveries to use in developing pasteurization, the method of heating liquids to kill most microorganisms present within them.

 

The germ theory of disease enabled scientists to more easily develop vaccines against infectious diseases besides smallpox. Pasteur himself worked on vaccines against rabies and anthrax. Aided by his expertise in microbiology, he discovered methods for attenuating (weakening) bacteria in vaccines so that the vaccines could confer immunity with less risk of actually causing disease.  In the following decades, scientists further refined and improved the techniques of vaccine development, introducing vaccines for diphtheria, tetanus, and whooping cough prior to World War II. A polio vaccine was developed during the early 1950s. Since then, vaccines have been developed for many other infectious diseases: measles, mumps, rubella, hepatitis A and B, meningitis, chickenpox, flu and most recently HPV and rotavirus. Today, each disease against which we routinely vaccinate has a small or nonexistent incidence in the developed world. If the 19th century was the Age of Infectious Disease, the 20th century was the Age of the Vaccine.

 

Health Food Store Shopping List

In the old days, health food stores were small, grungy, lovable, hole–in–the–wall establishments that carried a few basics for health food nuts: organic carrots, tofu, brown rice, sea vegetables, carob chips, etc. As healthy eating became more popular, these stores multiplied to the point where almost every major town in America had a local health food store. With that multiplication came expansion: in addition to rice, beans and greens, you could also acquire healthier versions of the chips, crackers and cookies carried by conventional supermarkets.

In recent years, the health food store market has been cornered by Whole Foods, a mega–chain that drove many smaller stores out of business. While Whole Foods has made health food more accessible for many people, it may have missed the point of the original health food store. At many Whole Foods stores, it has become almost impossible to find bulk brown rice, or macrobiotic foods, within the countless aisles of organic soda or breakfast cereal made with cane sugar instead of corn syrup. While those processed foods are better than the counterparts you’d find at the local Walmart, they signify that just because a food is sold in a health food store doesn’t mean it’s healthy. What follows is my slimmed–down guide to the essential foods you need from your local health food store:

Fruit. The best tasting and most nutritious fruit is fresh, local and organic, qualities which you can usually only find in a health food store or at a farmer’s market. Make local and in season your priority, followed by organic. Fruit can be expensive, but it’s worth the cost. If you need to, shop at a conventional supermarket for fresh fruit rather than go without entirely.

Vegetables. Health food stores carry a wide variety of fresh, local and organic vegetables. When purchasing vegetables, you should try to incorporate a variety of different vegetable groups, which include greens (such as kale or collards), roots (like carrots and beets), bulbs (ex. onions or celery), gourds (squashes), and nightshades (tomatoes, potatoes, eggplant, etc). Vegetables should generally be stored in the crisper at the bottom of your refrigerator. Greens need to be kept in a plastic bag with the air pressed out, and they should be wrapped in a paper towel or two first so that the water on them is soaked up. Greens can be kept until they turn yellow (which takes about a week or two). Other vegetables will stay good for several weeks but generally it’s best to use them quickly, as they lose nutrition over time.

Grains and Beans. Whole grains and beans are kept in bulk bins, and are very inexpensive when purchased this way. You can get much of your calories and protein from these foods, which take some time to cook (especially beans, which need to be soaked and then boiled), but they last a long time and once cooked, can keep in the fridge for several days. Uncooked dry beans and grains keep for a year or more.

Nuts and Dried Fruit. These are good choices for snack foods, but they are not meal replacements. Only snack between meals if you’re still hungry despite having had a solid breakfast, lunch and dinner. These foods can also be expensive. Don’t try to cut back on fresh fruit, vegetables, or all–natural animal products so that you can buy snack foods.

Dairy Products. Raw dairy products from healthy cows are best, but in most states these cannot be sold in stores. Cheese is an exception—choose unpasteurized cheese when it is available. If you don’t have a source of raw milk, grass–fed organic pasteurized milk is the next best thing (non–homogenized is good too). Butter is best when cultured and unsalted. Yogurt should have no added sugar; add your own natural sweetener (such as raw honey) instead.

Fish. Fish is very good for you if it is wild caught, rather than farm raised. Wild caught fish is more expensive, so you may have to have it only occasionally, which is okay, especially since mercury in many species of fish is a concern. Sardines are a low–mercury, less expensive option.

Poultry, Pork, Beef, Eggs. Meat and eggs can be an important part of your diet and a good source of protein and fat; the meat must come from a healthy animal. For poultry, choose organic and free–range (or at least free–range), and hormone and antibiotic free. Pork should be organic if possible. Beef should be organic, but more importantly, grass–fed. Eggs should be from organic and free–range chickens. Be sure to check out local options.

Herbs and Spices, Salt, Natural Sweeteners. All of these condiments should be staples in your kitchen. Start building up a collection of herbs and spices and natural sweeteners (esp. raw honey), and use sea salt instead of regular salt. Buying herbs and spices in bulk is more cost–effective and you can buy less of the ones you won’t use as much. Most health food stores have a bulk spice section separate from bulk grains and beans.

Macriobiotic Foods. The original standbys of the health food store, these foods can now be difficult to find. However, they are usually grouped together, and include tamari (a natural form of soy sauce), brown rice vinegar, umeboshi plum paste, tekka, gomashio, and sea vegetables (nori, kombu, wakame, arame, hijiki). In the cold section you can also usually find the macrobiotic foods miso, tofu, tempeh, seitan, and mochi. These foods originate in the traditional Japanese diet and are all very nutritious and beneficial to health.

Oils, vinegars, sauces, nut butters, pastas, pickles, etc. Not all foods you buy need to be whole foods. It’s not convenient to buy your own olives to make olive oil, or grind your own peanuts for nut butter, for example, and you wouldn’t necessarily come up with a better quality product. In this sense some pre–made foods are perfectly fine, as long the ingredients themselves are whole foods. Peanut butter that contains peanuts and salt—fine. Peanut butter containing peanuts, salt, and hydrogenated vegetable oil—not so good. Pasta that is made from whole wheat is much better than pasta made from white flour. Olive oil should be unrefined and unfiltered rather than filtered and refined. Generally, the fewer ingredients—and the more whole–food the ingredients—the better.

Bread. People are always confused about what bread to buy, but the answer is fairly simple. Choose bread that is made from 100% whole grain flour (i.e. whole wheat, whole rye, etc.). If it says simply “wheat flour” or “whole wheat flour and white flour,” skip it. 100% whole grain flour molds quickly, since it is so nutritious, so keep it in the refrigerator or freezer. In fact, many whole grain breads are kept in the freezer section of the health food store. Don’t be afraid to try something new!

Supplements. If you eat the foods listed above, you really don’t need supplements. You may occasionally benefit from certain herbs, if you happen to be sick. But the most important thing is to be eating a good diet so you don’t get sick in the first place. When it comes to injuries such as bruises, cuts, stings/bug bites, and burns, the supplement section has some effective remedies such as arnica, calendula, stingstop, and aloe vera.

If any of the foods listed above catch your attention, in that you’ve never heard of them or at least have no idea how to incorporate them into your diet, then be sure to contact me with your questions!