Measles is back. Blame the anti-vaxxers.

In the year 2000, the CDC announced that measles had been eliminated from the U.S. This was a fantastic public health achievement, made possible by the measles vaccine, which is 99% effective and which has virtually no side effects.

Unfortunately, measles is back. Just last week, the CDC announced that we've had at least 695 cases this year, the most since 2000, primarily from 3 large outbreaks, one in the state of Washington and two in New York. Because the CDC's surveillance is far from perfect, the true number of measles cases is likely much higher. And we're only four months into the year.

Also this week, UCLA and CalState-LA had to quarantine over 700 students and staff members who were exposed to measles from an outbreak in the Los Angeles area. At UCLA, one student who had measles attended multiple classes while still contagious, exposing hundreds of others to the highly contagious virus, according to a message from the university's chancellor.

No one has died as of yet, but if we don't quash these outbreaks, it's only a matter of time before someone will die. Measles has a fatality rate of 0.2%, or 2 deaths per thousand cases. That may sound small, but it's truly frightening when you consider that the U.S. had an estimated 500,000 cases per year before the vaccine was introduced in 1963.

Given the risks of measles, and given the remarkable effectiveness and safety of the vaccine, why don't people vaccinate their children? The primary reason is simple: it's the highly vocal, supremely confident, and utterly misinformed anti-vaccine movement. Anti-vaxxers spread their message daily on Facebook, Twitter, websites, and other media outlets. (I will not link to any of them here because I don't want to increase their influence.) They have launched systematic efforts throughout the U.S. and in other countries to convince parents not to vaccinate their children, claiming that vaccines cause a variety of harms, none of which are correct. (I won't list those here either, because even mentioning them gives the claims credibility.)

In one of the two outbreaks in New York, anti-vaxxers distributed highly misleading pamphlets in an effort to convince parents in an ultra-religious Jewish community not to vaccinate their kids. The anonymously-published pamphlet was "filled with wild conspiracy theories and inaccurate data," but it seems to have worked, as least among some of the parents.

The anti-vax movement is also behind the state-by-state effort to allow parents to opt out of vaccinations for their children in public schools. We're finally seeing some states roll this back, but it is still far too easy for parents to claim an "ethical" or "religious" exemption, allowing them to put their unvaccinated kids in school and thereby expose countless other children to measles and other preventable diseases. (I put those words in quotes because there is no valid ethical or religious objection to vaccines. All major religions strongly support vaccination.) Anti-vax websites provide how-to instructions telling parents how to get exemptions for their kids, and a small number of anti-vax doctors (I'm looking at you, Bob Sears) readily dispense large numbers of anti-vax exemptions. This needs to end.

The modern anti-vaccine movement started in 1998, with a fraudulent paper about the measles, mumps, and rubella vaccine, published by a former doctor who lost his medical license after the fraud was revealed. The lead author was eventually revealed to have taken large sums of money (unbeknownst to his co-authors) from lawyers who were trying to build a case to sue vaccine makers. That same ex-doctor, who I also won't name here (his initials are AW), is now a hero to the anti-vax movement, and he travels the world spreading his toxic message. He's even made an anti-vax movie.

I sincerely hope we won't see any children die before the anti-vaccine movement finally goes away. For any parents who are thinking that they won't vaccinate their kids, I urge them to read the heartbreaking words of Roald Dahl (author of Charlie and the Chocolate Factory, The BFG, and many other wonderful books), whose oldest daughter Olivia died of measles in 1962, at the age of seven:

"...one morning, when [Olivia] was well on the road to recovery, I was sitting on her bed showing her how to fashion little animals out of coloured pipe-cleaners, and when it came to her turn to make one herself, I noticed that her fingers and her mind were not working together and she couldn't do anything.

'Are you feeling all right?' I asked her.

'I feel all sleepy,' she said.In an hour, she was unconscious. In twelve hours she was dead.The measles had turned into a terrible thing called measles encephalitis and there was nothing the doctors could do to save her." 

The measles vaccine was a miracle of modern medicine, and it's been administered safely to hundreds of millions of people. Measles is a dangerous illness, but we can prevent it. No parent should have to go through what Roald Dahl went through.

Climate change is making us sneeze

Allergy sufferers are having a rough time of it this spring. If you're among them, and if you think it's getting worse, you're right–and climate change is at least partly to blame.

Admittedly, warming climate has far more severe consequences, such as the eventual flooding of entire coastal cities. On a personal level, though, pollen allergies make people pretty miserable. (I write this as a lifelong sufferer myself.) When springtime comes and trees burst into buds, some of us shut all the windows and huddle inside.

I hadn't thought that climate change would affect the pollen season until I read a newly published study in a journal called The Lancet Planetary Health. (Aside: yes, there really is a journal with that name, a specialty journal created two years ago by the venerable publishers of The Lancet.)

The new study, by USDA scientist Lewis Ziska and colleagues from 15 other countries, looked at airborne pollen data from 17 locations, spanning the entire globe, and stretching back an average of 26 years. The news isn't good for allergy sufferers:

"Overall, the long-term data indicate significant increases in both pollen loads and pollen season duration over time."

In other words, it's a double whammy: we getting more pollen than ever before, and the allergy season last longer. Okay, not that much longer, only an average of one day. But if you have hay fever, every day is one too many.

To be fair, not every location experienced a significant increase in pollen. Here are the 12 (of 17) that did:

• Amiens, France
• Brussels, Belgium
• Geneva, Switzerland
• Kevo, Finland
• Krakow, Poland
• Minneapolis, USA
• Moscow, Russia
• Papillion, USA
• Reykjavik, Iceland
• Thessaloniki, Greece
• Turku, Finland
• Winnipeg, Canada

Perhaps not coincidentally, the pollen season this spring is making headlines in the U.S. As the NY Times reported this week, "extreme" pollen has blanketed the middle of North Carolina this week. It's so bad that the air has taken on a yellowish tinge, as shown in this unaltered photo, one of several taken by photographer Jeremy Gilchrist and shared last week on social media.

A yellow haze caused by pollen over Durham, North Carolina
in April 2019. Photo credit: Jeremy Gilchrist via Facebook.

According to Ziska et al.'s study, more pollen-filled springs are the new normal. Their projections indicate that pollen seasons will continue to get longer in the future, and that the amount of pollen in the air will also increase during the spring and again in the fall, when ragweed pollen is at its peak.

What can you do about spring allergies? I wrote about this last year: for some people, over-the-counter antihistamines help, although they only treat the symptoms. Allergy shots can provide long-term relief, if you have the time to go through the months-long regimen. Other than these options, the best you can do is stay inside and wait for pollen season to end. You can always catch up on your reading of The Lancet Planetary Health.

NEJM says open access is unnecessary. Right.

Surprise: the New England Journal of Medicine thinks open access is a bad idea. Open access is the model of scientific publishing in which all results are freely available for anyone, anywhere, to read.

This week NEJM published an editorial by one of their correspondents,  Charlotte Haug, that purports to present an objective look at open access publishing, and finds that the "experiment" has failed, and that free access to scientific publications hasn't delivered on its promises.

What is NEJM worried about? Their expensive, exclusive model of publishing–where everyone has to pay high subscription fees, or else pay exhorbitant fees for each article they read–is threatened by scientists who want all science to be free. Pesky scientists!

NEJM is especially worried about "Plan S", a proposal in Europe to require that all scientists whose work is funded by the public be required to publish their results in open-access venues. Plan S is due to take effect very soon, in 2020 for 11 research funders in Europe.

The NEJM article is a clever but deeply flawed effort to prove that open access isn't working. It's full of fallacies and straw men, so much so that it's hard to know where to begin. Since they're not playing fair, though, I won't either: I'll cherry-pick three of Haug's arguments and explain why she's wrong about each one.

But first, to set the stage, let's remind everyone of what we're talking about. Scientific papers are written by scientists (like me), who are largely funded to do their work by governments, non-profit organizations, and occasionally by commercial companies. The writing is done by the scientists themselves, who submit papers to journals for peer review. The peer reviewing is also done by scientists (again, like me) who do this work for free. The journals pay nothing for all this work.

In other words, we do all the work for free, using funding provided by the public, and the journals then take that work and sell it for a very tidy profit. (Richard Smith estimates that NEJM itself has an income of $100 million with a 30% profit.) The vast majority of scientific and medical journals are owned by five for-profit corporations, as the NEJM points out:

"The five largest publishing houses (SAGE, Elsevier, Springer Nature, Wiley-Blackwell, and Taylor & Francis) continue to grow, with high profit margins."

For the past two decades, scientists have spoken out more and more over the outrageous practices of for-profit publishers, whose subscription fees and profits have grown while the costs of distribution have plummeted. Virtually everyone gets scientific papers online now. Why sign over copyright when we can distribute our work so cheaply now? The open access movement was founded to provide an alternative: open access journals allow everyone to read all the content for free, and the authors retain their copyrights.

Now let's look at the NEJM article. Haug starts by pretending to agree that open access is a good thing, writing:

"The idea — that the results of research should be available to be read, discuss, and examine... — has few, if any, opponents in either the scientific community or the public."

Reading this, you might think that Haug (and NEJM, by extension) are fans of open access. They are not.

Haug then proceeds (she thinks) to dismantle the arguments in favor of open access. First, she states that publishing costs have not dropped, but have increased. As evidence, she asserts that "Electronic production and maintenance of high-quality content are at least as expensive as print production and maintenance." This claim is, frankly, nonsense, but since Haug doesn't cite any evidence to back it up, there's nothing really to refute. It's obviously much cheaper to post a PDF on a website than to print thousands of hardcopies and physically ship them to libraries around the world. If costs are going up (and again, Haug cites no evidence), that could be simply because publishers are paying themselves higher salaries (NEJM reported compensation of  $703,324 for its chief editor in 2017), or hiring large staffs, or renting luxurious offices–who knows? Haug doesn't explain.

In any case, the costs of publishing at NEJM, a closed-access, subscription-based journal, have little to do with whether or not scientific and medical research should be freely available.

Her next argument against open access is that the most highly-cited journals are subscription-based, like (ahem) NEJM. My response: so what? Everyone within academia knows that it takes a very long time to establish a reputation as a "top" journal, and young scientists will always want to publish in those journals, regardless of how expensive they are. This has given closed-access journals like NEJM (and Nature, Science, JAMA, and Cell, to name a few more) tremendous power, which they have wielded to fight against open access at every opportunity. This editorial represents another example of that fight. The fact that many scientists still want to publish in these journals doesn't mean they should keep the results locked behind a paywall.

Setting aside this tiny number of "prestige" journals, open access papers do get cited more, as was demonstrated by this study from 2016. The evidence shows that open access does lead to higher impact: papers that are freely available are read more and cited more.

Finally, let's turn to Haug's coup de grace, which she wields near the end of her piece, as a sort of "proof" that open access is really unnecessary. Here she argues that NEJM is already open, mostly:

"About 98% of the research published in the Journal since 2000 is free and open to the public. Research of immediate importance to global health is made freely accessible upon publication; other research articles become freely accessible after 6 months."

First, let's acknowledge that merely by pointing this out, Haug is admitting that the main arguments for open access are legitimate; i.e., that it's a huge benefit to society to make research freely available. I'm going to agree with her here.

What Haug doesn't mention here is that there is one reason (and only one, I would argue) that NEJM makes all of its articles freely available after some time has passed: the NIH requires it. This dates back to 2009, when Congress passed a law, after intense pressure from citizens who were demanding access to the research results that they'd paid for, requiring all NIH-funded results to be deposited in a free, public repository (now called PubMed Central) within 12 months of publication.

Scientific publishers fought furiously against this policy. I know, because I was there, and I talked to many people involved in the fight at the time. The open-access advocates (mostly patient groups) wanted articles to be made freely available immediately, and they worked out a compromise where the journals could have 6 months of exclusivity. At the last minute, the NIH Director at the time, Elias Zerhouni, extended this to 12 months, for reasons that remain shrouded in secrecy, but thankfully, the public (and science) won the main battle. For NEJM to turn around now and boast that they are releasing articles after an embargo period, without mentioning this requirement, is hypocritical, to say the least. Believe me, if the NIH requirement disappeared (and publishers are still lobbying to get rid of it!), NEJM would happily go back to keeping all access restricted to subscribers.

The battle is far from over. Open access advocates still want to see research released immediately, not after a 6-month or 12-month embargo, and that's precisely what the European Plan S will do.

With Plan S looming, I've no doubt we'll see more arguments against open access in the coming months, but scientists have at least one ace up our sleeves: we're the ones who do all the work. We do the experiments, we write the papers, and we review the papers. Without us, the journals would cease to exist. The journals will have no choice but to go along with plan S, because without the scientists, they'll have nothing to publish. Let's hope the U.S. will follow suit in the very near future. It's long past time to change the archaic, closed-access policies that have kept medical and scientific results–results that were funded by the public–locked behind the paywalls of for-profit publishers.