Anti-vaccination propagandists help create the worst whooping cough epidemic in 70 years

The great northwest of the U.S. is known for its natural beauty.  It's also a high-tech region with a highly educated public - not exactly the kind of place one would expect to fall for the anti-science rhetoric of the anti-vaccine movement.

But it has.  The anti-vaxxers have convinced a frighteningly high number of parents in Washington State to withhold vaccines from their children.  A story in The Seattle Times last year reported that 

"Washington [state] parents are choosing not to vaccinate their kindergartners at a rate higher than anywhere else in the country."  

This despite the fact that the Bill & Melinda Gates Foundation (formed by the founder of Microsoft, which is headquartered in Seattle) is one of the world's leading sponsors of vaccine research.  

When the vaccination rates drop, everyone becomes more vulnerable to infectious diseases.  When more than 90% of the population is vaccinated, we have "herd immunity" - this means the disease can't spread because there aren't enough susceptible people in the community.  So the high rate of vaccine refusal in Washington makes it easier for whooping cough (and other diseases) to spread.

The media has been complicit in spreading some of the anti-vaccine misinformation.  Sometimes it comes straight from the media itself, such as the credulous, anti-science, anti-vax CBS reporter Sharyl Attkisson. Other times it comes from talk shows, magazines, or even airline advertisements that provide a platform for anti-vax celebrity doctors such as Jay Gordon (who gained fame as Jenny McCarthy's son's doctor) and "Dr. Bob" Sears, who has published his own "alternative" vaccine schedule in a book filled with anti-vaccine nonsense.  These characters continue to claim, at every chance they get, that vaccines cause autism (as Gordon has said, repeatedly), or that they cause other harms, despite overwhelming evidence to the contrary.  They use their medical degrees and their faux concern "for the children" to frighten parents into keeping their kids unvaccinated.

And now we learn that the U.S. is in the midst of the worst whooping cough epidemic in 70 years.  One of the most hard-hit states is Washington, which the CDC just announced (on 20 July) has suffered 2,520 cases so far this year, a 1300% increase over last year.  This is the highest number of cases reported in Washington since 1942.  This plot of the number of cases this year compared to last year shows the dramatic rise in infections:

The figure above shows the number of confirmed and probable pertussis cases reported, by week of onset in Washington, during January 1, 2011-June 16, 2012.  Source: Morbidity and Mortality Weekly Report, U.S. Centers for Disease Control and Prevention.

Making things worse, it seems, is an increase in cases among children aged 13-14.  Children get a booster shot at age 11-12, but the new outbreak indicates that the effectiveness of the booster may not last very long.  The dramatic increase in whooping cough this year also suggests that the bacterium that causes it, Bordetella pertussis, is mutating to make the vaccine less effective.  Nevertheless, the CDC emphasizes: 

"Vaccination continues to be the single most effective strategy to reduce morbidity and mortality caused by pertussis. Vaccination of pregnant women and contacts of infants is recommended to protect infants too young to be vaccinated."

This good advice is seriously undermined when misinformed doctors such as "Dr. Bob" Sears directly advise pregnant women not to get the whooping cough vaccine, as he did in the Huffington Post. (Hint: it's a good rule to be very skeptical of celebrity doctors who go by their first name.)

I should also point out that whooping cough is a national problem, not just Washington State's.  The U.S. has had over 17,000 cases this year, putting it on track for the worst year since 1959.  The highest rate of infection in the nation is in Wisconsin (which has also been hit hard by anti-vaccine effects), followed by Washington and Montana. 10 deaths have been reported, mostly in infants who were too young to be vaccinated.  For all this, we can thank the anti-vaccination movement.

Zinc for the common cold: the industry responds

In my recent articles about zinc treatments for the common cold (in March and May), I expressed skepticism that zinc has any effect on the duration of colds.

The maker of Cold-EEZE, ProPhase Labs (PRPH), sent me a detailed response from their Chairman and CEO, which I'm posting here for my readers. Because the document is rather long, I've only included a portion of it below, with my commentary interspersed.  The full text, with references, can be found here.  Now on to the response.

Response from the makers of Cold-EEZE
The objective of this document is to respond to your original article in Forbes titled “Zinc Versus Chicken Soup, Round Two.”

The following information will provide a clearer picture as to what the Common cold is and how it progresses in your body.  Also discussed is how certain zinc formulations are clinically proven to reduce the severity of cold symptoms and the duration of the common cold by nearly half. Finally, we provide some clarity as to why some zinc formulations are more effective than others, and thus, some studies on zinc formulations demonstrate significant efficacy while other studies fail to do so.

We would like to start by correcting some misinformation in your article. Contrary to your claim, ProPhase Labs, Inc. (former The Quigley Corp.) did not sponsor the two clinical studies supporting the effectiveness of Cold-EEZE zinc lozenges.  ProPhase Labs, Inc. only provided the zinc gluconate lozenges for these studies.

The first study at The Dartmouth College was sponsored by Godfrey Science & Design, Inc., Huntingdon Valley, PA and by a grant from the Rorer Pharmaceutical Corp., Fort Washington, PA. The second study conducted by Cleveland Institute was granted by the General Pediatrics Research Fund and the Departments of Infectious Diseases and General Pediatrics of the Cleveland Clinic Foundation.

[COMMENT: I didn't claim that at all.  I stated, correctly, that all 17 studies in a recent review article were funded by industry.  The review article lists the funding sources in Table 1.]

Another criticism in your article related to the fact that some of the clinical studies had been conducted 10 to 20 years ago and that the results from these studies were therefore no longer valid. This is simply not a valid conclusion. The science to conduct such studies, the metrics to measure the response, and the statistical tools utilized for analyzing the results has not been modified or changed significantly during this time.  One should bear in mind that there are plenty of drug products on the market today which are approved by FDA based on clinical studies conducted more than 20-30 years ago.

[COMMENT: I did not state that these studies were "no longer valid."  Here's what I wrote 

"… their website points to three studies from 10-20 years ago.  They conveniently ignore the more recent studies that showed far less (possibly no) benefit."  

As any good scientist knows, scientific conclusions that don't hold up under further examination must be revised or thrown out entirely.  The follow-up studies of zinc didn't support these early results.  This happens all the time in science, and what we usually do is conclude that the early results were incorrect.] 

The Common Cold and Zinc
For the past decenniums, scientists have studied the effect of Zinc on the common cold caused by the Rhinovirus and have tried to understand the science behind it. The exact mechanism of action of Zinc in the common cold has not been fully identified yet; however, there is strong scientific evidence, based on several ex-vivo and in-vitro studies, supporting the two main mechanism hypotheses:

1. The zinc ion, based on its specific property and electrical charge, has an affinity for a specific intracellular adhesion molecule called ICAM-1 receptor present in the nasal epithelium cells. The Zinc ion has an ability to form a complex with the receptor and thereby prevent the binding of the Rhinovirus to nasal epithelial cells.  
2. The Zinc ion has an ability to prevent the formation of viral capsid proteins and thereby inhibits the replication of several viruses, including Rhinovirus.  

There are several peer reviewed scientific publications which provide a better understanding regarding the effect of Zinc on the common cold caused by Rhinovirus and the possible mechanism of actions to inhibit the progress of Rhinovirus infection. 

[COMMENT: the makers of Cold-Eeze point to a list of 9 "peer reviewed" papers that they say support their point. Few of us (certainly not me) have time to read all these papers, but I did look at them briefly.  Two papers are in the journal Medical Hypotheses, which is not only not peer reviewed, but is well known as a trash bin full of crank theories without any scientific support or plausibility.  See the excellent discussion by Photon in the Darkness about why Medical Hypotheses is a bogus source.
Citing bogus sources is never a good idea.  However, some of the other cited articles are legitimate, and the most recent one, from 2009, does show that zinc is a plausible agent for inhibiting the cold virus.]

The different outcomes from different Zinc studies
The inconsistency in the clinical results between different studies may be explained by the fact that: (i) the type of virus causing the common cold may have varied in each study and; (ii) the type of zinc formulation that was studied also varied. Different formulations use different types of additives such as flavoring agents and sugars which are commonly used to help improve the palatability of the zinc ions.  In some formulations, these additives form highly bound complexes with the zinc ions.  This results in poor ionic zinc availability.  Given the link between ionic zinc availability and prevention of cold virus replication, it is only logical that decreased ionic Zinc availability may lead to decreased efficacy observed in some particular clinical studies. Effective delivery of the Zinc ions in the oral cavity is critical to the success of zinc formulations reducing the duration of the common cold caused by rhinovirus. There are many forms of Zinc supplements which do not release the Zinc ions in the oral cavity. This is likely to be a major reason for the inconsistent results in some zinc studies.

[COMMENT: This is what is known as "special pleading", a common logical fallacy.  The many studies showing no effect are a big problem for zinc.  It just doesn't seem to work, and no amount of special pleading will change that.]

Based on the strong, statistically significant results obtained from the two double blinded, randomized, placebo controlled studies conducted by Cleveland Institute and The Dartmouth College, we are convinced that our Cold-EEZE product releases and effectively delivers the right amount of Zinc ions in the oral cavity to fight the Common Cold caused by rhinoviruses.  Furthermore, two other studies were conducted by the Heritage School in which teenage students were provided with one Cold-EEZE lozenge daily.  The reduction in the number of instances of upper respiratory infections was dramatic.  Moreover, for those students who did catch a cold, the duration was reduced significantly relative to the prior year.  Unfortunately, these were not placebo controlled studies so our technical conclusions are a bit more limited but the results are highly convincing and supportive of the other two statistically significant studies that we refer to.

[COMMENT: These are the older studies that have not held up upon further study.  The conclusions might be "highly convincing" to the makers of Cold-Eeze, but not to me.]

Finally, we include an insert in every package of Cold-EEZE, asking consumers for feedback.  Well over 90% of consumer feedback is directly positive toward efficacy and incredibly, only approximately 1% is negative regarding efficacy.  (The rest of the consumer feedback primarily relates to packaging and flavor comments and suggestions.)  These real life results in the field powerfully confirm the supportive clinical studies.

[COMMENT: Do you really believe that feedback from your own biased sample of consumers, who already bought your product on the assumption that it would work, is confirmatory evidence?  Sorry, but this claim gets a failing grade.]

Conclusions
An understanding of the different zinc formulations including their zinc ion availability and delivery is critical to drawing the appropriate conclusions with regard to zinc efficacy. Our intention in this response has not been to undermine the nutritional value of chicken soup which most probably has a complimentary function in shortening the duration of the common cold.

[COMMENT: We agree on chicken soup!]

The U.S. enters the 20th century (or: why our electrical grid is a failure)

No, the title of this article is not a typo.  We did enter the 20th century - the early 20th century - last week.  All it took was a thunderstorm.


Sometimes I am struck by how phenomenally shortsighted our national leaders are.  In just 45 minutes last week, a single storm brought the capital of the U.S. to its knees for nearly a week.  Millions of people were left in the dark, with no power, no telephones, no internet, and no air-conditioning during the worst heat wave in years.  The damaged stretched from Ohio east into Maryland and Virginia.  A national emergency?  Yes.  The response from the federal government?  Nothing.  Nada.  Zip.  The local governments and the privately-owned power companies were left scrambling, as usual, without the resources to fix things.

How is this possible?  Simple: unusually strong winds during the storm, up to 70 mph (112 kph), knocked down huge trees everywhere.   In this part of the U.S., like most of the country, all the power lines are above ground, strung between flimsy wooden poles, exactly as they were over 100 years ago.  So just like that, in the blink of an eye, the high-tech region around the nation's capital was tossed back into the early 20th century, when horse-drawn carriages ruled the day and when the only form of air-conditioning was shade.

This is pathetic.  How can it be that we haven't put our valuable infrastructure - the power and communications network - underground, where a common thunderstorm can't touch it?  This debate comes up after every storm, as it has this week (especially in the Washington and Baltimore region), and the answer is always the same: it's too expensive.  The power company immediately responded to a few tentative suggestions that the lines should be underground, lashing out that those who were making the suggestions were naive, or didn't realize how costly it was.  The power company then blamed the victims, saying that local governments and residents make it difficult for them to trim the trees properly.

Tree trimming?  Are you kidding me?  How exactly were you planning to trim the 60-foot oak that fell in my back yard, snapping the power lines feeding our neighborhood?  Or the countless other huge trees that crashed through power lines?

The problem we face will never be solved by the power company.  It costs money to put lines underground, lots of it.  Sure, the costs of these disasters are far, far greater than the cost of "undergrounding", but those costs aren't paid by the power company, so why should they care?  They don't.

So yes, it is too expensive for the power company to put lines underground, so they will never, ever do it.  Not on their own dime, that is. Local governments won't solve it either: they are just too small and too poor.  We need a national effort to put our valuable, all-too-vulnerable power and communications lines underground - everywhere.  

What, the U.S. can't afford it?  It's true, we have a massive debt that is getting worse each year.  But somehow we can afford to build roads and other infrastructure in Iraq and Afghanistan.  Our national leaders seem to think the infrastructure in those countries is more important than in our own backyard.  This is just nuts.

Here's an argument that might just reach our political leaders.  Losing power and communications is a national security issue.  The storm last week caused far greater disruption than any terrorist could ever hope to achieve with man-made devices.  Our enemies don't need to attack us: they can simply let us continue to spend our money bombing other countries and then rebuilding the infrastructure in those countries.  Ironically, this was Reagan's strategy with the Soviet Union: force them to spend themselves out of existence.  It worked.

We need a discussion on this at the national level, where priorities need to be re-set to recognize the antequated state of our own infrastructure.  Over the past decade, we've spent hundreds of billions of dollars destroying much of the infrastructure in Iraq and Afghanistan, and many more billions re-building some of that infrastructure.  Then when a storm hits our own capital, government and industry representatives, and multiple columnists in the media, say it's "too expensive" to put the lines underground.

And by the way, the investment to fix our power infrastructure might be large, but overall it will save money, but only if you account for the costs to everyone (not just the power company).  The American Society of Civil Engineers estimates that 

"service interruptions and capacity bottlenecks that … will cost households $6 billion in 2012, $71 billion in total by 2020 and $354 billion in total by 2040. Businesses will pay $10 billion in 2012, $126 billion in 2020 and $641 billion by 2040 in avoidable costs."

To avoid these losses, the ASCE estimates we need $11 billion in additional investment per year through 2020.

The Department of Homeland Security, created in the panic following the 9/11 attacks, hasn't taken any responsibility for putting our national power and communications infrastructure underground.  On the contrary: power crews from Canada who were coming to aid us down here in Maryland and Virginia after last week's storm got held up at the border by our own DHS personnel, delaying some of the crews by many hours while people sweated, food spoiled, and tempers boiled.  Let's stop all this phony security theater and start rebuilding our country.  Shut down the entire DHS if they can't even keep the lights on.

And let's bring our troops home now, today, and put them to work fixing our crumbling infrastructure.  Countless news stories over the past few years have lamented the difficulties that our veterans have finding jobs when they return home: well, there's plenty for them to do.   And fixing our infrastructure - undergrounding power lines, building new roads and bridges - is a far better use of our money than blowing things up.