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Aug
21

Everything I needed to learn about life I learned from Robin Williams

written by Tara Haelle

They say everyone grieves differently. I have never – never – cried for a celebrity’s death. I feel shock, sorrow and sadness. I feel sympathy for the family. But I did not know that person. I only knew a tiny slice of them, of who they were, of what they let us see. They were only a persona to me.

And then Robin Williams died. But I didn’t cry. I was shocked. I was sorry. I was sad. I felt more deeply touched than any other famous-person-I-didn’t-know’s death. I kept trying to come to terms with it. I never met the man, for goodness sakes. I cannot possibly lay claim to 1% of the grief his family feels. And yet, he kept haunting me. A week went by. I thought of him every day. Several times a day. Randomly. I thought of him in the way you think of your ex-boyfriend every day for weeks after you break up. He invades your thoughts when you least expect it. You see things he would have loved and wonder if he’s seen whatever it was. You see a bird and realize he won’t see another bird. And then you imagine how he would impersonate a bird and you laugh.

Photo courtesy Wikimedia Commons.

Photo courtesy Wikimedia Commons.

Robin Williams was different. We did know more of him than that tiny slice because he let us. He gave himself to us in so many ways. He gave of himself in the way a mother gives of herself for her child: because she cannot do anything else and it’s what she’s compelled to do. No, we did not know his inner, private life, but we knew so much more of him than we know of most celebrities because that was how he survived himself – to keep giving and giving.

And then I had an idea. I wanted to write a sort of tribute after the famous poem, “All I Really Needed to Know, I Learned in Kindergarten,” because I realized, all the years I was growing up, I had learned so much from the roles Williams played.

When I taught English, I cannot deny I emulated his character in Dead Poets Society. I learned my first Latin words – Carpe diem – from him. The Fisher King, which I have not seen in more than a decade, has randomly visited me over that decade. Few films have meant as much to me personally as that one. And I remember watching Hook – I cried eight times. Eight. I counted. I don’t know why, maybe because I realized how foolish it felt to be crying in a friggin’ movie about Peter Pan. “There you are, Peter.” That line killed me. I had to pause the tape because I was bawling so hard. And that’s what I’m doing now. I gathered all the things I wanted to say for the tribute. I looked through his quotes. I read through his filmography, scrolling up and down the Wikipedia entry. I thought about his films. I watched some clips on YouTube. I thought about how deeply so many of them touched me. I thought about how I had grown up with him, how my childhood and adolescence and young adulthood would have all been just a little different, and a little less bright, without him. And then I finally pulled the piece together.

And then I lost it. I woke up my son a little bit ago with my heaves and sobs. I am a weird griever. It takes a long time for things to hit me, and they come unexpectedly. I repress a lot. I intellectualize. I rationalize. I push aside. I bury. I don’t do any of this on purpose. And then, at some point, it just forces its way out, and I realize how much pain and sorrow I’ve been feeling. And I can’t stop sobbing.

I refuse to speculate on why Robin Williams died the way he did. But as everyone knows, he suffered from addiction and depression. I, too, have a diagnosed mental illness that I’m getting better about gradually talking about, despite my fear that it will scare off editors and other potential clients and employers, regardless of my track record as a journalist. I know what that pain can be. And so I think my grieving is mostly about me and what I lost, and what I have gained, and all the things I could never put into words as eloquently as his brilliant mind could.

And so here, I’ve tried to distill into the simplest statements possible what I learned from Robin Williams in my 36 years.

 

Everything I needed to learn about life I learned from Robin Williams

All I really need to know about how to live and what to do and how to be I learned from Robin Williams. Wisdom was found within his comedy and compassion and within the roles he chose. Not all the words he spoke in his roles were his at first, but they became his when they left his mouth, when they became part of his legacy.

These are the things I learned:

Life is better when shared.  [Good Will Hunting]

Life isn’t fair.  [Good Morning, Vietnam]

Believe in miracles.  [Awakenings]

Family is important.  [Mrs. Doubtfire, The Birdcage]

Confront your demons. [The Fisher King]

Be brave.  [The Fisher King, Hook, Good Will Hunting]

Be true to yourself.  [The Birdcage, Happy Feet]

War is hell.  [Good Morning Vietnam]

Never grow up, no matter what.  [Hook, Jack]

Believe in wonder, in imagination.  [Hook]

Always hold on to hope.  [Jakob the Liar]

Laughter is essential medicine.  [Patch Adams]

Take risks.  [Awakenings, The Fisher King]

Never give up.  [Flubber, What Dreams May Come]

Follow your dreams.   [Dead Poets Society]

Pay attention, don’t move too fast.  [Being Human]

You do not deserve to be hurt.  [Good Will Hunting]

Believe in love.  [What Dreams May Come, Good Will Hunting]

Love means loving something more than yourself.  [Good Will Hunting]

Read poetry.  [Dead Poets Society]

Everyone is a little mad. Treasure it.  [Good Will Hunting, The Fisher King]

There is a place for you on this earth.  [The World According to Garp]

Having the world at your fingertips means nothing if you are not free.  [Aladdin]

Carpe diem. Seize the day.  [Dead Poets Society]

When in doubt, laugh… and laugh and laugh and laugh.

Life only has meaning because we die.  [Bicentennial Man]

Really, Robin Williams taught me so much more than all these things, and probably things I don’t know about yet as I watch the films I had not yet seen, or as I rewatch his films and discover what I missed. At the least, however, perhaps his most important lesson is contained within one of his most-cited quotes: “You’re only given a little spark of madness. You mustn’t lose it.” I don’t have a choice with this one. I have more than a spark, and it’s not going anywhere. And so I will use it.

Aug
18

What to expect when you’re expecting a book…

written by Tara Haelle

The past several weeks have been a bit of a whirlwind for me. I’ve taken on a new semi-regular client, and I’ve written a number of exciting stories that pulled my time away from the blog (and which I’ll share below). But the next few months will be even more of a whirlwind as I try to wrap up the evidence-based parenting book I’ve been working on the past year with Emily Willingham.

You may have noticed that I’ve published a few more frequent guest posts, and there may be a few more coming. My goal is to keep the content on this blog fresh and helpful – and, of course, based always on the evidence – while taking care of my many other responsibilities, which are nearly always either a paid gig (unlike this blog) or my family. I will still try to post at least one post a week myself, though they may not be as thorough as the ones I prefer to write. Hopefully you’ll bear with me (and be rewarded with the extensive research in the book when it comes out next year!).

In addition to researching and writing the book and writing new articles, this little guy has been keeping me busy too!

In addition to researching and writing the book and writing new articles, this little guy has been keeping me busy too!

I have more than a dozen posts, perhaps two dozen, in my list to blog about, and I’ll do my best to work my way through them if you can forgive the fact that they will sometimes be based on studies a few weeks or months old. I also have a number of books I’m anxious to write about. I have been reading Emily Oster’s excellent evidence-based book on pregnancy, Expecting Better (now available in paperback), and I’ve been impressed with the depth and breadth of her research. Although I have not finished it – despite her sending me a review copy long ago – I can already say that I recommend it for those wanting to know more about what the evidence actually says for various pregnancy issues.

Another book I will be reading and blogging about (hopefully sooner rather than later) is Positively Negative: Love, Pregnancy, and Science’s Surprising Victory Over HIV. Journalist Heather Boerner has provided me a review copy of her book (though you can already buy the ebook on Amazon), and I’m looking forward to reading about a couple who conceived a baby naturally despite the father having HIV.

And what have I been doing lately? I’ve also written several pieces about marine science, starting with a run-down of everything that went wrong in the reporting of a 12-year-old girl’s science project on lionfish. I followed that with a fun piece at Slate on the ocean’s most amazing supermom, a deep-sea octopus who protected her eggs for four years.

And then, in the midst of Discovery Channel’s Shark Week, I wrote for Science about a new way to reduce shark bites, and for Pacific Standard, I profiled David Shiffman, a shark scientist who blogs at Southern Fried Science and has made it his mission to correct all the myths and misinformation spewed by Discovery during its signature TV event. If you’re as much a shark lover as I am, you’ll want to check out the piece on him (as well as his many pieces).

After hearing about Iranian mathematician Maryam Mirzakhani’s Fields Medal win, I was also inspired to write about my own problematic past with math, a subject I loved until an unfortunate experience in junior high. And I’m writing a cool piece about the flu vaccine’s ingredients that will be in Wired Magazine in a few months.

I’m also writing for HealthDay now, and some of my recent stories there have looked at the link between fitness and depression in girls and how unhealthy packed lunches are for many elementary students – less healthy, in fact, than the hot school lunches. One of my most recent pieces was sad to write, however, because it dealt with the link between poor sleep and suicide risk and I was finishing it up at the same time that I was grieving for the loss of Robin Williams.

And of course, in the midst of all this, I’ve been taking care of my new baby, who is growing faster than I can keep up. He’s the happiest, most smiley baby I’ve ever seen, and lately he’s the fattest as well. One of my future posts actually discusses what I’ve learned in feeding him, but that’s just one of many I want to write, and there are only so many (so few!) hours in a day.

So, I hope you’ll bear with me over the next few months as my posts are fewer or perhaps more erratic while I race to finish the book. Rest assured I’ll return to the long, analytical pieces or the mythbusters before too long!

Aug
8

Yay for breastfeeding and immunizations!

written by Tara Haelle

It can be exhausting to keep up with all the different world and national awareness weeks and months, but it isn’t hard for me to choose my favorite “awareness” time of the year – it’s August! The whole month of August is National Immunization Awareness Month, and the first week is World Breastfeeding Week. Boobs and shots! Does it get better than that, folks?

My 4-month-old loves his breastmilk!

My 4-month-old loves his breastmilk!

Seriously, though, I am excited that a time of the year is set aside to raise awareness about the value of both these practices, and there is something poetic about the fact that they overlap. After all, breastfeeding is the most ancient effective method of reducing the risk of disease that we have, and vaccines are the most successful modern method of reducing disease. The two are a perfect pair.

But featuring both breastfeeding and immunizations together is an excellent opportunity to point out that breastfeeding cannot replace vaccination as a method of disease risk reduction. The antibodies, proteins and other goodies mothers pass along in breastmilk most certainly help protect infants from infections and various chronic conditions, including asthma, childhood leukemia, childhood obesity, ear infections, eczema, lower respiratory infections, necrotizing enterocolitis, type 2 diabetes and even SIDS. These are also all conditions for which vaccines do not exist.

However, the antibodies conferred by breastmilk have limits as to what they can protect against, and they cannot protect against the infectious diseases that vaccines help prevent. Infants will often have antibodies against measles, rubella, pertussis and other diseases that the mother has either had during her lifetime or else has been vaccinated against, but these antibodies are transferred via the placenta while the baby is still in the womb. And those fade. The only way to maintain partial or complete immunity for those diseases is for your child to be vaccinated on time, preferably according to the CDC schedule.

I’ve often heard parents ask what seems, on its face, to be a reasonable question: “Why are there so many vaccines these days? There are so many more than when I was a child.” It’s true – the number of shots has doubled (or more, depending on your age) from our childhood, but stop and think about what that actually means. It’s not simply that the number of vaccines themselves have increased. Rather, the number of diseases we are now able to prevent has increased. By any measure, that is scientific progress.

The next question parent may ask is whether it’s actually necessary to protect against all those diseases. However, imagine for a moment a parent asking 50 years ago, “Is it really necessary to protect against polio and measles? I didn’t have those vaccines and I did fine.” Such a question – back when polio and measles killed or disabled so hundreds of thousands of children every year – would have seemed ludicrous. The only reason a similar question does not seem so ludicrous today is that many parents have not seen these diseases around them to realize how destructive they can be. Indeed, the number of lives saved by vaccines is extraordinary – especially when the risks of that prevention are so low.

LaughingBaby2Another important thing to keep in mind regarding breastfeeding: your child gains the benefits even if your child also receives formula. In a recent heartbreaking essay in the Washington Post, a mother described how she felt guilty about feeding her twin preemies formula – even though they had also received breastmilk. I know how this feels. Although I exclusively breastfed my first son, I had to supplement with my second son, something I still have not fully come to terms with.

But that difficulty in accepting that my second son has been fed with formula is based on emotion, not on science. I am still breastfeeding him, and the author of the WaPo essay still gave her children breastmilk. A friend of mine has a baby who was unable to breastfeed for five months, yet she pumped and ensured he received breastmilk. And all of those babies receive the same protective benefits as infants who were exclusively breastfed.

Exclusively breastfeeding offers wonderful health benefits and should be encouraged as the default norm. Yet World Breastfeeding Week is actually a good time to also remind folks that as long as a baby is well fed, a mother’s choice should be respected in how she feeds her child, and no mother should be made to feel guilty or ashamed if she is feeding her child some or all formula.

That said, women also deserve much more support for breastfeeding than they currently receive in the U.S. If you are struggling to breastfeed, seek out your local La Leche League chapter or find a lactation consultant near you. In addition, two of the best breastfeeding resource sites are Kelly Mom and those of Dr. Jack Newman.

And of course, awareness weeks and awareness months are just that – opportunities to raise awareness. So, share articles on social media, talk up the benefits of vaccines, promote the normalization of breastfeeding in public and take whatever other steps you feel comfortable doing to support the health of mothers and their children this month!

Aug
3

Your Ebola reading list: Should you worry?

written by Tara Haelle

The news is abuzz with the Ebola outbreak in three African countries – Liberia, Guinea and Sierra Leone – and much of the media had a conniption when it was announced that Dr. Kent Brantly – the doctor who contracted the virus while doing humanitarian work treating Ebola patients – would be transferred to Emory Hospital in Atlanta, also home to the CDC. He has now arrived, of course, and in fact, he walked into the hospital himself (amid a completely shameful and unnecessary media circus).

Original image created by CDC microbiologist Frederick A. Murphy.

Original image created by CDC microbiologist Frederick A. Murphy.

In the past several days, I’ve seen very smart and educated friends of mine on Facebook sharing status messages of fear and concern about the virus, asking whether it’s such a good idea to “bring Ebola to the US” (when, in fact, it’s been here for many years) and whether it is appropriate to treat the infected doctor stateside. We fear that which we do not understand, so I’m writing this post to clear up some of that misunderstanding and hopefully alleviate some of those fears.

Ebola is not among my specialty areas of knowledge, but the advantage of being a science journalist is that I get to talk to a lot of epidemiologists and other infectious disease specialists, and one of my strongest skills is sniffing out the facts and separating the wheat from the chaff when it comes to picking out accurate, non-sensationalized articles that put news into perspective. Therefore, I’m providing a reading list of what you *should* be reading instead of the fearmongering at CNN and other outlets. (I pick on CNN because I keep thinking they should know better.)

First, however, the most important thing to know about Ebola virus is that your own likelihood of contracting the disease is *tiny* – it’s less likely than being attacked by a shark, which is less likely than being struck by lightning, which is less likely than SIDS, which is FAR less likely than fatal car accidents. (Or, as a friend and bioterrorism expert at the University of Pennsylvania put it on Facebook, “there are so, so many other things to worry about. Like antivaxxers. Food poisoning. Kangaroo attacks. Hippos. The morning commute. And so on.”)

But wait, you say, it’s a contagious disease! And it has a 90% mortality rate! However, both of those statements need heavy qualifiers. It is a contagious disease that is neither food-borne nor airborne and which requires contact with bodily fluids. The mortality rate ranges from 25% to 90%, but that rate has MUCH more to do with the health care quality and resources than it does the disease itself. A 60-90% mortality rate in Africa does not translate to a 60-90% mortality rate in the US.

Image creator wished to remain anonymous.

Image creator wished to remain anonymous.

And so, moving on, here is your (relatively short) curated reading list on the Ebola outbreak and the virus itself:

First up is a great FAQ at the Daily Kos. Yes, the Daily Kos is a partisan site, but this piece was pulled together by a contributing editor who is also a medical doctor, Greg Dworkin, and I contributed (on Twitter) some of the links he includes. It basically brings together the best gems from a wide range of linked sites.

Another nice overview and FAQ is at Nature: “Largest ever Ebola outbreak is not a global threat

Next, infectious disease specialist Tara C. Smith provides some perspective at her blog Aetiology: “Ebola is already in the United States” and “Are we *sure* Ebola isn’t airborne?

Next, epidemiologist Rene Najera at John Hopkins Bloomberg School of Public Health offers some great commentary on these two posts: “If Ebola does get to the United States, we’re doomed, but not for the reasons you think” and “Ebola is in the United States, now what?

UPDATE: Please be sure to check out Maryn McKenna’s commentary and curation at Wired: “Ebola in Africa and the U.S.: A Curation.” McKenna is pretty much *the* infectious disease reporter you want to follow for anything about “scary diseases.” She is based in Atlanta only a few miles from the CDC and has been covering infectious disease and food for well over a decade (or two).

UPDATE: A fun Q&A between Erin Gloria Ryan and two doctors, in classic Jezebel style, answers a lot of those pesky questions you keep thinking of at 3 am: “The Paranoid Hypochondriac’s Guide to the Ebola Outbreak.” h/t Andrea Luttrell

Over at Atlanta Magazine is this excellent short read by Rebecca Burns, “Yes, Ebola patients are coming to Atlanta for treatment. No, you do not need to panic.

Also, some good commentary on the arrival of Dr. Brantly is here at Forbes by David Kroll: “Should We Be Concerned About American Ebola Patients Coming To Emory Hospital?

UPDATE: If you’re wondering why treatment is so tricky for Ebola, check out Helen Branswell’s thorough piece at National Geographic: “Promising Ebola Drugs Stuck in Lab Limbo as Outbreak Rages in Africa.

Finally, though less about Ebola and more about risk perception, I highly recommend this brief thought piece on how we think and feel about risk: “How Ebola Can Help Us Vaccinate Against the Danger of Fear.

This list is not exhaustive, of course, but I wanted to highlight some of the better pieces I had come across, most of which are short, easy reads since we parents don’t have tons of time to be reading everything we come across. If you’ve found another good article, please leave it in the comments. I may update this post with other ones I come across.

Oh, and one last thing: No, for goodness sake, homeopathy cannot treat Ebola, and neither can cinnamon and oregano essential oils.

 

Jul
29

Florida law preventing doctors’ questions about firearms upheld

written by Tara Haelle

I don’t typically write about court cases or policy, but after writing the post a few weeks ago about the Ask Campaign, it’s hard to ignore one particular recent court decision that directs relates to children’s safety. In that post, I advocated that parents ask the parents of their children’s playmates whether there is a gun in the home. Today, I write about the law that prevents doctors from asking the exact same question.

More than 7,000 children and teens are injured or killed by firearms every year. Given the steady stream of tragic news stories about children finding unlocked guns, you would think it makes sense for pediatricians to ask parents whether they keep their guns locked up. But doing that requires pediatricians to ask whether the parents have any guns in the first place.

Should pediatricians have the right to ask whether you own one of these? Photo by Svend Damsgaard

Should pediatricians have the right to ask whether you own one of these? Photo by Svend Damsgaard

In Florida, that’s against the law. At least since June 2011, when Rick Scott signed into law the Florida Privacy of Firearm Owners Act.

You might think such a law would violate the First Amendment by restricting physicians’ right to free speech. Or, at least that’s what a bunch of physicians thought. Along with several Florida doctors, the state chapters of the American Academy of Pediatrics, the American Academy of Family Physicians and the American College of Physicians sued the state of Florida for a law they claimed violated their right to free speech (potentially including their right to pass along data in professional policy statements such as this one on firearms).

However, in a 2-1 ruling (pdf) today, a federal appeals court upheld the Florida law, arguing that a doctor’s questions about firearms violated a patient’s right to privacy. “The act simply codifies that good medical care does not require inquiry or record-keeping regarding firearms when unnecessary to a patient’s care,” the majority opinion stated in the case Wollschlaeger v. Governor of the State of Florida.

The problem is, good medical care always requires taking into consideration ways to reduce the risk of injury or death. When we choose our doctors, we let them ask us questions about private family issues in exchange for their help managing our family’s health. There is no reason firearms should be any different than asking parents whether they keep their household chemicals and medications out of children’s reach.

Professional medical associations in the U.S. agree that firearm violence represents a major public health problem in the U.S. Given that the U.S. has the highest rate of gun ownership and of firearm deaths and injuries in the developed world, it’s pretty hard to argue that point. Physicians are the stewards who help address public health issues. Arguing that a doctor’s questions about a family’s ownership of firearms violates the family’s right to privacy is akin to arguing that asking about the presence of lead paint – a standard well-child screening question – is a violation of their privacy. Why is it the doctor’s business whether a family has lead paint in their home? Because it presents a risk to children. So do firearms, so why are they any different?

The AAP thinks firearms in the home should be treated at least as seriously as lead paint. In a statement released today following the decision, James M. Perrin, MD, FAAP, the president of the AAP, said the following: “State legislatures should not stop physicians from practicing good medicine. This law has a chilling effect on life-saving conversations that take place in the physician’s office. More than 4,000 children are killed by guns every year. Parents who own firearms must keep them locked, with the ammunition locked away separately. In this case, a simple conversation can prevent a tragedy. The evidence is overwhelming – young children simply cannot be taught to overcome their curiosity about guns, and to suggest otherwise is, frankly, the height of irresponsibility.”

The president of the Florida chapter of the AAP, Mobeen Rathore, MD, FAAP, issued a similar statement: “We strongly disagree with the 11th Circuit’s decision. It is an egregious violation of the First Amendment rights of pediatricians and threatens our ability to provide our patients and their families with scientific, unbiased information. This dangerous decision gives state legislatures free license to restrict physicians from asking important questions about health and safety that are vital to providing the best medical care to patients.”

Ten other states have laws similar to Florida’s introduced in their legislatures. The plaintiffs have said they will appeal the case to the 11th circuit court to be heard by the full 11th circuit court rather than the three-judge panel. Perhaps that court considers the argument made by dissenting judge Charles Wilson: “This law is … designed to stop a perceived political agenda, and it is difficult to conceive of any law designed for that purpose that could withstand First Amendment scrutiny. Regardless of whether we agree with the message conveyed by doctors to patients about firearms, I think it is perfectly clear that doctors have a First Amendment right to convey that message.”

Screen shot 2014-07-29 at 12.29.54 AM

Jul
27

Guest Post: Water remains No. 1 among fortified drinks

written by Guest Author

Today’s guest post by Donald Bucklin (bio below) points out that the most important drink you can consume is good old fashioned water. This post is one of the few unsolicited blog posts I have decided to publish that came to me from a company, though I have no relationship with U.S. HealthWorks and do not necessarily endorse or oppose their business. I hosted this guest post because the message is simple, but the information is important and evidence-based.

It’s summer at last, which means it’s the perfect time to discuss hydration. Given the proliferation of the so-called science of hydration, one would expect only a Ph.D. could make an intelligent buying decision in the beverage isle at the local grocery store.

Despite all the marketing hype, water is still the best drink to consume for your body. Photo by Vjeran Lisjak

Despite all the marketing hype, water is still the best drink to consume for your body. Photo by Vjeran Lisjak

Au contraire! Do not underestimate the genius of the human body. The fluids in your body are very closely monitored, and the kidneys have a rather broad operating range to make the most out of almost any drink, because they are mostly water. Since it is hard to sell mostly plain water, other alternatives come in a lot of colors with a variety of micronutrients, vitamins, minerals and salts. And the appeal of these drinks are enhanced by some clever bottle shapes and contraptions.

Gatorade was the original mostly water-based sports drink. It initially came in powder, one flavor (lemon lime), and you had to add the water. It was a simple mixture of sugar, salt, artificial color and flavor. It was the brainchild of several scientists at the University of Florida (the Gators) College of Medicine, who were asked by the football coach to make a rehydration beverage. It was originally going to be called Gator-Aid, but the inventors thought the “Aid” would trigger FDA scrutiny and require scientifically validated testing.

Gatorade was intended for a different commercial direction where outlandish beverage claims were tolerated. Gatorade is a PepsiCo product and has 70 percent of the sports drink market in the U.S.  If you are not doing heavy exercise in the Florida heat, you can plan on an extra 3.5 pounds per year from drinking Gatorade daily.

Following Gatorade, vitamin-charged drinks were the next wave of performance water. And while in 25 years of medicine I have never diagnosed a single case of scurvy, pellagra, beriberi or rickets, the country is no doubt fractionally safer from these scourges. Excess vitamins, with very few exceptions, have no proven benefit to your health. And now there are cleverly designed bottles with the dry vitamin powder in a container at the top. Give it a twist, shake, and the result is a freshly-made vitamin fortified super drink. For pure placebo effect, this is hard to beat.

Is there good science behind these drinks actually increasing performance? No.

But if slightly modified, these mostly water beverages can sell as sports drinks – and they have! The list includes morning drinks, calming drinks, energizing drinks, drinks that make you smarter, stronger, braver and just a better human being. And if it were that easy, I would say “sign me up.” I could sleep in, buy a selection of hi-tech beverages and live a long and healthy life. Unfortunately, you actually have to do the work, which means you need to sweat.

My favorite rehydration drink is an inch of OJ in a big glass of ice water. It’s low in calories, thirst quenching, tastes pretty good, is almost free, and most importantly – it’s mostly water.

Donald Bucklin, MD (Dr. B) is a Regional Medical Director for U.S. HealthWorks and has been practicing clinical occupational medicine for more than 25 years. Dr. B. works in the Scottsdale, Arizona clinic of U.S. HealthWorks.

Jul
17

Guest post: Vaccines and “Unavoidably Unsafe Products”

written by Tara Haelle
Have you ever heard the term “unavoidably unsafe,” especially as it relates to vaccines or other pharmaceuticals? In this guest post by Dorit Reiss, this technical legal term is explained. This post is a bit different than the usual fare here, delving into meanings of a law, but it’s very important by those who misunderstand the term. A version of this post first appeared on the Moms Who Vax blog. Dorit is a professor of law and vaccine advocate, and a member of Voices for Vaccines’ Parent Advisory Board.

 

Those of us engaged in vaccine-related discussions online often hear vaccine critics claim the Supreme Court has declared vaccines “unavoidably unsafe” and thus incredibly dangerous. The critics are doubly wrong. First, the Supreme Court has said no such thing. Second, in the law’s eyes, an unavoidably unsafe product is not a “super-dangerous” product.  Quite the opposite, an unavoidably unsafe product is a product whose tremendous benefits justify the reasonable risks it poses.

What is an “unavoidably unsafe” product?

Normally, in the United States, a person only has to pay damages if they caused harm to someone else with fault—in other words, if they acted negligently or intentionally. In the area of products liability, however, the United States adopted a different approach.

In 1965 the American Law Institute published the Restatement (Second) of the Law of Torts, §402A. A “restatement” is an essay of sorts written on specific legal subjects by experts. They usually summarize and explain existing law, but they can also suggest reforms or rethinking of it.

Understanding how the law uses precise technical terms can prevent misunderstandings about those terms. Photo by Marcelo Gerpe

Understanding how the law uses precise technical terms can prevent misunderstandings about those terms. Photo by Marcelo Gerpe

In this case, Section 402A, was an attempt by the ALI – a nonprofit organization of lawyers, judges and academics – to rationalize a growing number of court decisions that held manufacturers and sellers of defective products liable to the consumers that their defective products injured.  Section 402A adopted a standard of liability without fault when a business sells a product “in a defective condition unreasonably dangerous to the user or consumer or to his property.”

The qualification was important: not every product that causes harm is defective.  Well-made knives can cut fingers, and even the best whiskey can get you drunk!   To be defective, a product had to be unreasonably dangerous, either because it was poorly made, or because consumers weren’t aware of its dangers, or because a different design could have made the product safer.

Restatements are very influential (though not binding), and section 402A was quickly adopted by pretty much every state.

The Restatement’s drafters wanted to provide certain products with additional protection against liability because, although those products carried risks, they provided especially high benefits as well.  The Restatement’s drafters expressed this idea in a comment to section 402A, namely, in comment k:

“Unavoidably unsafe products: There are some products which, in the present state of human knowledge, are quite incapable of being made safe for their intended and ordinary use. These are especially common in the field of drugs. An outstanding example is the vaccine for the Pasteur treatment of rabies, which not uncommonly leads to very serious and damaging consequences when it is injected. Since the disease itself invariably leads to a dreadful death, both the marketing and the use of the vaccine are fully justified, notwithstanding the unavoidable high degree of risk which they involve. Such a product, properly prepared, and accompanied by proper directions and warning, is not defective, nor is it unreasonably dangerous.”

The last sentence is the important one: A vaccine whose benefits outweigh its risks is not unreasonably dangerous or defective – even if the risks are as frightening as those attributed to the Pasteur vaccine, let alone modern vaccines, with their much lower risks.

In retrospect, the Restatement’s drafters could have chosen better language to capture the idea that a product or a drug can be valuable even it if poses some risk to its users (and indeed, the drafters of the Restatement (Third) of Torts: Product Liability did away with the “unavoidably unsafe” language while preserving the same idea).

Saying a product is “unavoidably unsafe” makes it sound like the product is a bad one, when what the drafters meant was precisely the opposite: the comment was meant to apply only to ethical drugs or vaccines. That is, products where the benefits outweigh the risks.  But courts understood.  Some courts (California, New York, Alabama) adopted comment k wholeheartedly, exempting all properly manufactured prescription drugs and vaccines from strict liability.  Others (Idaho, Colorado, Hawaii) applied comment k selectively, requiring a case-by-case determination that there is no safer alternative design for a drug or vaccine before finding the risk unavoidable.  Some courts, inevitably, are unclear or take an intermediate position (Florida, Georgia, Indiana).

The message comes through clearly: these products are beneficial enough that society wants to encourage their manufacturing. Therefore, while strict liability would be applied to most products, a manufacturer that prepared a drug or vaccine carefully and warned consumers of its risks should not have to pay for the side effects of a drug or vaccine whose benefits outweigh the risks unless that manufacturer can be shown to have been negligent.

In other words,  “unavoidably unsafe” is the opposite of “unreasonably dangerous” in the Restatement’s categorization. It justifies a more favorable treatment because of those products’ extraordinary benefits.

What Did the Supreme Court Actually Say? Read the rest of this entry »

Jul
16

What the newest bedsharing study can and cannot tell us

written by Tara Haelle

I have written before about how the infant sleep recommendations of the AAP and the US public health community in general are unrealistic and even potentially dangerous in their effects, regardless of their intentions. A new study in Pediatrics explores the contribution of different risk factors to sleep-related infant deaths, offering findings which are certainly valuable in understanding how risk varies as a child ages. However, I see many of the same flaws, primarily missing data, that prevent the possibility of truly evidence-based recommendations.

So once again, I feel it’s necessary to review – in addition to what the study found – all the things the study neglected to consider. Again, the flaws are not so much a result of the analysis but of the data not available to the investigators. In analyzing this study, I had a number of questions that the lead author, Jeffrey Colvin, MD, JD, of the Department of Pediatrics at Children’s Mercy Hospital in Kansas City, MO, answered via email. One of the questions he generously calculated for me was particularly enlightening – the association of bedsharing as a risk factor across causes of death. (Spoiler alert: bedsharing was much less likely among SIDS cases than among suffocation/asphyxiation and undetermined causes.)

But before I launch into all of that, it’s important to explain WHY this issue, and why pointing out flaws in these studies, is so important.

Is there really only one "safe sleep environment" for babies? Photo by Sam Hatch.

Is there really only one “safe sleep environment” for babies? Photo by Sam Hatch.

New parents receive a barrage of advice from every direction, solicited and unsolicited: their parents, other relatives, friends, virtual friends in online social networks, random strangers online and in real life – and of course all the experts: pediatricians and other professionals both in person and through media reports. Inevitably, this advice is conflicting, but hopefully most parents give a bit more weight to what their doctors say. After all, a doctor’s advice is supposed to be based on the evidence.

But what if the evidence base is horribly incomplete on an issue, a life or death issue, in fact? Vaccines are a life or death issue, but the research consensus is overwhelming, and studies have explored every possible avenue to examine the safety and effectiveness of official recommendations. The evidence base on bedsharing/cosleeping, SIDS and other infant sleep deaths, however, includes a large body of evidence yet remains woefully inadequate.

In addition, the research findings that have been published lack context. Just as there are risks – albeit tiny – to vaccination, there are risks to NOT bedsharing for many parents. Yet, I have yet to see a single study discuss this, or even consider the possibility that, at the population level, not bedsharing could carry any risk. Every single action and inaction carries risk, as do the opposite actions/inactions. It’s all a matter of balancing those risks, and parents need all the information they can get about risk to make informed decisions.

This most recent study does offer some information on risk factors for infant sleep deaths and these are no doubt valuable to other researchers and those shaping public policy, but because of significant gaps in the data, a lack of a control group and a lack of overall context, the findings cannot help parents or pediatricians much. (I will use “bedsharing” from here on because it’s the term used in the study and it eliminates confusion since “cosleeping” can mean sharing a room but not a bed.)

The study’s goal was to assess the extent to which established risk factors for sleep-related infant deaths vary by a baby’s age. The researchers analyzed data on 8,207 deaths in children less than a year old, all occurring during sleep but not resulting from a medical condition or firearm. The data came from cases voluntarily reported  between 2004 and 2012 in 24 states to the National Center for the Review and Prevention of Child Deaths Case Reporting System.

They divided the children into 5,677 younger (0-3 months old) and 2,530 older (4 months to 364 days old) infants. Although an autopsy was performed in 98% of the cases, the largest category of cause of death was “unknown/undetermined,” with 38% of the children. SIDS was listed for 35% and accidental suffocation/strangulation was listed for 27%.

On the one hand, it’s helpful to have these causes separated since these categories used to be collapsed into one. As the authors note, SIDS has declined since 2000 while accidental suffocation/asphyxiation has increased, but it’s likely this shift is due to the fact that suffocation/asphyxiation cases are often no longer categorized as SIDS. That said, this data is self-reported from across the country, and different regions have different criteria for classifying SIDS vs. suffocation vs. strangulation vs. unknown/undetermined, a limitation noted by the authors in their discussion.

The Findings

I’ll provide an abbreviated list of the findings to refer back to as I discuss the flaws in the study (including the definitions used for these categories): Read the rest of this entry »

Jul
15

How to explain to kids the passing of a pet

written by Guest Author

Today’s post is a guest post is from Hank McKinsey, a stay-at-home-dad blogger at Home By Hank. While the research literature does not contain much on helping children process the death of a pet, Hank has pulled together what is known from research about grief and child development in general to offer some tips.

Talking to your children about death is a scary topic. For many families the topic will first come up when a beloved family pet passes away. While this is certainly heartbreaking for many families, it is a great opportunity to take the time to talk to your children and teach them healthy ways to cope with their loss. Here are a few tips to help make the conversation a little easier:

Creating a memorial box can be one way to help children cope with the loss of a pet. Photo provided by Hank McKinsey.

Creating a memorial box can be one way to help children cope with the loss of a pet. Photo provided by Hank McKinsey.

Talk to your child beforehand, if possible: If your family pet is very old or very sick, you can help your child prepare for the loss of their pet by talking about what will happen before your family pet passes away. While this may seem morbid, by being honest and not hiding the truth, you are helping your children understand that all living things will eventually die. By helping them accept the passing as early as possible can make the grieving process a little easier. There are many resources available that can help guide this conversation.  Encourage your child to say goodbye and get their cuddles in while they are still able to.

Encourage your child to grieve: When an adored family pet passes away, young children may not understand why they can’t play with their favorite pal anymore. If your child cries, has nightmares, or seems very sad for a little while, recognize that this is pretty normal behavior. They may even want to sleep with one of their pet’s favorite toys. While these are all very normal parts of grieving, do make sure you encourage your child to get out and play. You may want to talk to a doctor if you are concerned that their grief seems more severe than typical.

Expect questions:  The hardest part for many parents is fielding questions about the death of the pet. “Did she feel pain?” “When is he going to wake up so we can play together again?” “Where do our pets go after they die?” And even “Are you (or am I) going to die too?” These questions are not only totally normal, they are a great segment into discussing the loss of a pet. Your answers should be truthful and succinct, as your child will take time to process your answers and come back later if they need any more information.

Remember to use simple language and help your child understand that just because their favorite pet cannot be with them anymore, they can always remember them and talk about them. Encourage your child to come to you with questions or concerns. Many times the security of knowing you will be there to answer their questions is helpful in helping them move on.

Create a memorial: Consider hosting a funeral or memorial service for the beloved family pet. You could include photos, video and handmade crafts. Encourage your children to tell about their favorite memories and say goodbye to their pet. You may consider burying your pet in your backyard.

Another simple idea that can help children grieve is to use a pet memorial box, like the one found here. Encourage your children to include their pet’s favorite toy, photos and other items that remind them of their lost pet. When your child feels sad they can sit down and look at all the items in the box to help them have happy memories about their pet.

Don’t get a new pet right away:  You may think that purchasing another pet for your child right away would be helpful. But, this is rarely the case. Allow your child the chance to be sad about the loss of their friend and broach the subject of a new pet when you feel they are ready to consider it.

The loss of a pet is a sad event. For young children it can be confusing and scary as well. By taking the time to help your little one say goodbye to their friend and teaching them that it’s okay to be sad will make the grieving process easier.

 

Hank McKinsey is a lifestyle and DIY blogger based out of central California.  When he’s not crafting or blogging, he can be found playing tennis or lounging with his dogs.  Follow Hank on Google + here.

Jul
8

Nope, the HPV vaccine doesn’t cause blood clots

written by Tara Haelle

As one of the newest vaccines, the HPV (human papillomavirus) vaccine is one of those plagued with some of the worst misinformation out there. Horrible anecdotes tell of strange illnesses and death that have struck down girls after they received their first HPV shot, and I’ve even written about Katie Couric’s irresponsible spotlight on these stories when there is no evidence that such tragic incidents are actually related to the vaccine.

This is a shame since this vaccine is one of the very few which can actually prevent cancer, of the cervix for women but also of the throat, mouth, neck, penis and anus. Yet the anecdotes are frightening and powerful, and researchers continue to study safety concerns to make sure nothing has been missed. A large, very well-designed study in JAMA today continues that research by looking at the risk of blood clots with the quadrivalent HPV shot, Gardasil.

The HPV vaccine is recommended for both girls and boys to prevent the virus, which can cause cancer. Photo by Milissa Thompson

Yay! No blood clot risk! The HPV vaccine is recommended for both girls and boys to prevent the virus, which can cause cancer. Photo by Milissa Thompson

Although many concerns associated with HPV vaccine have been addressed by the CDC, those who prefer to see the primary research can review the existing excellent studies showing no link between the vaccine and autoimmune, neurological or blood clot problems. But good science requires an accumulation of evidence, including evidence of no harm.

And that’s exactly what this new study shows: no risk of blood clots from the vaccine.

The researchers started with a population data set: all the women in Denmark who were aged 10 to 44 between October 1, 2006, and July 31, 2013, which included more than 1.6 million females. (Scandinavian countries’ nationalized health care systems make it conveniently possible to use data from an entire population’s medical records.)

Among these 1.6 million girls and women, about a half million (31%) had received Gardasil. Also out of this 1.6 million, a total of 5,396 individuals had experienced a venous thromboembolism during that study period. (A venous thromboembolism is blood clot that breaks free in the veins and starts traveling up toward the lung, where it could become a pulmonary embolism).

Then the researchers excluded all the women who had been pregnant with the blood clot or who had had surgery in the past month or been diagnosed with cancer in the past year – pregnancy, cancer and surgery all increase the likelihood of a blood clot. These exclusions left 4,375 women, about one in five of whom had been vaccinated against HPV.

Those 889 women are the ones the researchers focused on. Read the rest of this entry »



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