One In Five Children Who Contract Diphtheria Die – Are Anti-Vaccination Activists Dangerous, Or Simply Misinformed?

vaccine1I had the pleasure of speaking in the plenary session at the 2014 AAVLD/USAHA Annual Meeting this week, where, among other topics, we discussed risk. One of the other panelists made the best point that I’ve heard in a long time – activists hate denominators.

Think about the last few scare stories you’ve seen – there’s no doubt that it is frightening to read that 3,000 people die from food poisoning each year, or that, to date, 4,546 people have died from Ebola (one in the USA). Yet if we put this into context, one person out of 315 million in the USA dying from Ebola is a tiny tiny fraction, and a correspondingly tiny risk.

Activists hate denominators because they provide us with context, a way to assess whether we’re really in danger. Statistically speaking, you’re  more likely to die from a traffic accident (one in 71 deaths), flu (one in 1,642 deaths), or syphilis (one in 55,866 deaths) than Ebola (one in 2,515,458 deaths). Which brings me to my current favorite activist, anti-vaccine zealot and proponent of “well-researched” bad science, Modern Alternative Mama (MAM). Thus week, she’s been promoting what she optimistically calls a “risk:benefit analysis” of the DTaP (diphtheria, tetanus and pertussis) vaccine.

Interestingly, she appears to consider all vaccine risks equal: death is no more of a minor inconvenience than redness at an injection site, and she earnestly notes that there is “no known benefit to getting diphtheria“. That sentence alone causes the mind to boggle. On a positive note, she does use valid CDC data, reporting that there were 3,169 adverse effects attributed to DTaP in 2011, which she claims is an underestimate of up to 9-fold.

So let’s run the numbers. Each year, approximately 3.95 million babies are born, of which 82.5% are given the DTaP vaccine. Between birth and 6 years of age, 5 doses of DTaP are recommended, so each year, 5 x 3.95 million x 82.5% = 16,293,750 doses are given (note that babies will have three each in that year, but older children (18 months and 4-6 years) will also receive a dose). Let’s give MAM the benefit of the doubt and assume adverse vaccine events are actually 5x the cited CDC number, at 15,845 events. The CDC classifies 10% of these events as “serious”, which equals 1,585 serious events per year.

So what is your child’s chance of having a serious reaction to the DTaP vaccine? 1,585/16,293,750 = 0.0000973, or one in 10,277 children will have a serious reaction to DTaP.

By contrast, we could take our chances in not vaccinating and hope that our child doesn’t contract diphtheria, which carries a risk of death of up to 20% in children under five years old. That means one in five children who contract diphtheria will die.

Given MAM’s antagonism towards vaccines, it’s not altogether surprising that she concludes “Although diphtheria is serious, it appears that the risk from the vaccine is much greater.” Yet let’s be realistic about this. One in 10,277 children will have a serious reaction to DTaP (serious reactions does not mean death, although that is one possible outcome) versus one in five children who will die after contracting diphtheria.

Admittedly that’s assuming that all unvaccinated children will get diphtheria. They won’t, but even if only 5% do, the risk is still overwhelmingly lower in the vaccine category (one in 10,277 suffering a serious reaction to the vaccine vs. one in 100 dying from diphtheria).

The site carries a disclaimer that writers are neither education professionals nor providing medical advice, yet the suggestion (by the author herself) that this is a well-researched, scientific post will no doubt cause some parents to congratulate themselves on their choice to not vaccinate.

This pseudoscientific scaremongering is dangerous, potentially lethal. All parents are concerned for their children’s health and welfare, but propounding nonsensical “risk:benefit analyses” that do not consider the denominator but simply the total adverse effects does not allow any parent to make a rational and well-considered decision. If my child is the one in 10,277 who suffers a serious DTaP vaccine reaction, I’m unlikely to care whether she is one of few or many, but at least I can make the decision whether or not to vaccinate (my answer is an overwhelming “yes”) based on risk. We all want our babies to grow up healthy and happy – in this case, it’s time to be a mainstream vaccinating Mama, rather than a “modern alternative” one.

Hyperbole, Hysteria, and a Sample Size of One – Where’s the Science?

IMG_9219I often describe this blog as a place where I write about things that irritate me. Today, is a case in point. There’s a new princess of technology paranoia on the block: move over Jenny McCarthy, because Modern Alternative Mama (MAM) is out to smother your crown with homemade liver pills and tweak it off your head. Billed as “a community of supportive people and well-researched information” the site is full of useful hints and tips on how to keep your children healthy – which in this case means unvaccinated, with unbrushed teeth and breast milk squirted up their noses to cure congestion. I wish this were my hyperbole – it’s not.

One of the common themes in the litany of anti-vaccination posts is the fact that vaccine scientists need funding to do experiments  (gasp!) and that such funding comes from companies that manufacture vaccines (gasp!). Obviously these scientists are the epitome of corporate shilldom and would sell their first-born child for a microscope and box of latex gloves. Best not to trust their pesky peer-reviewed science.

Don’t worry though, MAM is here to do the research for you and write about in a balanced and fair way. This translates roughly as: “Science (pesky corporate shills) shows there is no harmful effect of X, but if you allow the dastardly medical profession to force it on your defenseless bundle of joy they have a 756% increased risk of <insert scary disease here>, will be in therapy (blaming YOU) till they’re 45, and will never pass third-grade algebra. Oh, and did we mention that X has been linked to leukemia/childhood obesity/autism/type II diabetes/ADD/teenage pregnancy/atheism/voting Republican (delete as appropriate)“. They helpfully highlight the scary messages on the website in bold, so that you don’t miss them.

As with so many anti-technology sites, science is the enemy…unless it’s happy touchy feely science that backs up whatever theory is being propounded this week. Which is why it’s so funny to see them reporting that Baltic amber necklaces “really work” for preventing teething issues in babies.

One of the bloggers was sent a necklace by an amber company. She put it on her baby at 3 months of age (too early to teethe). 5 months and 5 teeth later  – no loss of sleep, no cranky baby, no teething problems whatsoever. Hooray! It’s a miracle! In her words: “Baltic amber is a win!” For the moment, let’s gloss over the fact that the necklace was provided free of charge and that the blogger was compensated for her post (ahem, Baltic amber shill).

So let me compare this to my experience. My baby is now 8.5 months old and also has 5 teeth. We’ve had no loss of sleep, no crankiness, no problems whatsoever with teething….and no amber necklace! Hooray! It’s a miracle! Wearing stripy Rainbow Brite-style leggings and pointing excitedly at next door’s dog (my daughter’s current favorite activity) are a win! Or maybe it’s the cucumber that she often eats for dinner! Or the fact that she can see the mountains from her crib! Or… some babies just teethe better than others.

Billions of children have been given vaccines that prevent disease with no ill-effects whatsoever, which the anti-vaccination activists appear to consider irrelevant. Yet one child given an amber necklace, with no control group or latin-square experimental design to test it’s efficacy – it’s a win! Baltic amber works! For goodness sake, try and be consistent MAM – you wouldn’t consider a sample size of one (my daughter for example, who has experienced no adverse effects from vaccines to date) to be proof that vaccines are ok – why do it with other issues that affect children’s health and wellbeing?

I’m not suggesting that teething pain is on the same scale of importance as the provision of vaccines, but let’s be realistic. If you’re going to this site (or others like it) for unbiased, sound information about vaccines or child health, just take a look at the other posts and products that are being promoted. Would I take cardiac advice from a surgeon who offered me three leeches and a tincture of wormwood to cure cancer*? No – and neither should you.

*Or eating tumeric and avoiding wearing a bra to avoid getting breast cancer, as MAM suggests

Breast is Best…But My Baby and I Are Eternally Grateful for “Udder” Alternatives

BreastisbestJust over 11 months ago my life changed forever. As a breast cancer survivor who underwent 6 years of surgery, chemotherapy, radiation, monoclonal antibodies and hormone treatment, I’d resigned myself to that fact that my chance of having children was less than 4%. As a fiercely independent traveler, I was ok with that (sort of…), diverting my attention to work and celebrating the fact that with no ties, I could go to bed at 3am, attend any social event or fly overseas at a moments notice.

Then I found I was pregnant. The most unexpected, amazing, literally mind-blowing event of my entire life. I become “that” pregnant woman, giving up soft cheeses, beef jerky, champagne, ibuprofen and horse-riding overnight and doing absolutely everything I could to nourish the baby growing inside me. In January my baby girl was born, and (to quote my sister-in-law) every single day since then has been like waking up on Christmas morning. I could never have wished for such a beautiful and perfect gift.

When I saw this PETA video starring Emily Deschanel I absolutely sympathized with her opening statement – nothing compares to the joy of raising my child. Yet, as the video progressed and Ms Deschanel described the atrocities that allegedly occur on dairy farms, accompanied by emotive video footage, I became more and more concerned. At the end of the clip Ms Deschanel suggested that the only way forwards was to end the cruelty on factory farms and go vegan. That’s when I almost lost it.

I’ve always supported the dairy industry – I think I may actually be clinically addicted to cheese and my yogurt consumption could be considered an extreme sport; but now I have an even better reason to celebrate dairy farmers – they ensure that I have a happy, healthy baby girl.

There’s no doubt that the “breast is best” slogan is right – babies are mammals, they thrive on mammalian milk – indeed milk is the most highly digestible food available for their little stomachs. However, because of my cancer treatment, I can’t produce enough milk to nourish my baby; so she’s fed both breast-milk and formula.  Until now, I’d never thought about where formula comes from – I’d rather assumed it was a synthetic mix of amino acids produced in a test-tube. In reality, it’s a combination of nonfat cows’ milk*, lactose, and whey protein concentrate (both of the latter ingredients also from cows’ milk); combined with other ingredients to provide the energy, vitamins, minerals and essential fatty acids that my little girl needs to grow and be healthy.

I would do anything for my little girl – I can’t even imagine what it would be like to try and care for her if formula didn’t exist and I could only provide her with half the nutrients she needed through breast-feeding. Alarmingly, the third result on Google for “vegan baby formula” is a recipe for home-made formula based on coconut water and raw almonds. The mind would boggle if I weren’t just terribly worried that somewhere, a mother thinks that this is the right choice for her child. To raise a baby as vegan because of parental ideology would seem irresponsible, if not dangerous – after all, surely breast-feeding is non-vegan?

Got milkSo THANK YOU dairy farmers, for the nutrients that I get from my diet and can pass on to my baby, and for the milk that goes into formula to help her grow and thrive. You guys are the best!

 *Soy-based formulas are also available for babies who are allergic to cow’s milk, I’m lucky that my little girl thrives on dairy products! 

Thanks to @DairyCarrie and @AgProudRyan for showing me the PETA video, and to @JodiOleen for reminding me that I’d intended to blog about it.

Is Our Modern, Chemical-Laden, Twinkie-Guzzling Lifestyle Killing Us?

Burger4How often do we hear that we’re so much more unhealthy than our ancestors? That our modern chemical-laden diet is responsible for the fact that in 2010, the top three causes of death were heart disease, cancer and chronic airways disease? That if we only ate like our ancestors did (if you can’t pronounce it, it shouldn’t be in your food…) we’d have the secret to eternal life?

Let’s take a trip back to 1900 – the US contained 70 million US inhabitants, McKinley was president, and the first Hershey bar was introduced. Life was so much simpler without those pesky whipper-snapper millenials on social media and everybody lived till they were 95, passing with a smile on their face surrounded by their 17 children…or did they?

It’s a beautiful image – and an absolute fallacy. Life expectancy at birth in 1900 was 47.3 years. To put that into context, Michelle Obama, Keanu Reeves and Elle McPherson would already be dead, and Julia Roberts, Matt LeBlanc and Will Ferrell would be enjoying their final days of celebrity life. The low life expectancy was skewed by the high rates of infant mortality in 1900 – premature birth was the #11 most-common cause of death and up to 10% of infants died before their first birthday. Any child that made it past 5 years old had a pretty good chance of surviving – as long as disease didn’t set in – the top three killers in 1900 were pneumonia/flu, tuberculosis and heart disease.

Hold on… heart disease? Surely that’s a consequence of our modern, slothful, twinkie-guzzling lifestyle? Let’s move on to 1950, when most food was still organic, high-fructose corn syrup hadn’t yet been invented and the majority of beef and dairy cattle were grazed on pasture. Top three killers: heart disease, cancer, stroke.

There’s a reason why Mark Twain’s saying “lies, damned lies and statistics” gets quoted so often. In this case, the data is true. However, when we look at the statistics, i.e. the % of people killed by heart disease or cancer, those have indeed gone up. Why? Because very few people die of pneumonia, flu or TB. If we express something on a percentage basis, a decline in one factor means an increase in another. Simple 3rd-grade math. I hate to point out the obvious, but we’re all going to die – and there will always be a cause.

Many enthusiasts for the “Paleo” diet like to suggest that it must be a healthy lifestyle, because the average lifespan for our ancestors was the same as it is now – providing that they didn’t die in accidents, war or from infection. Way to go for those few ancestors who stayed in their cave and didn’t get attacked by a wildebeest! All that actually suggests is that a human body has a genetic potential for life of 75-80 years. Europeans who died from the Black Death in 1348-1350 weren’t genetically programmed to live shorter lives, they were just unlucky enough to run up against the microorganism Yersinia pestis. We can’t eliminate specific causes of death that don’t suit our theory to “show” that one lifestyle is more healthy than other – everything that we do, every single day will have some positive or negative effect on our eventual lifespan.

We’re lucky enough to live in a society where we have effective sanitation, a wide variety of nutritional choices, antibiotics, vaccines, x-rays and prenatal vitamins. In the US, nowadays only 6 babies die per 1,000 births compared to ~100 per 1,000 births in 1900. Average life expectancy is 78.1 years. If I were to follow the activist “correlation = causation” logic I could point out that in the past 114 years we’ve seen the introduction of cell phones; nuclear bombs; GMO-crops; rbST for dairy cattle; implants and antibiotics for beef cattle; and corn-fed beef… so these technologies must make us live longer!! Hooray!! Instead, I’ll just be thankful that I will be giving birth within the next week in a world where we have a safe, effective food supply and that my baby will have a far better chance of surviving than her great-grandparents did. Thank goodness for technology.

Do Moms Have Instant Beef Credibility?

TrustI spoke at the International Livestock Congress back in January 2012, and at the end of the day, had the pleasure of listening to a couple of distinguished industry colleagues wrapping up the day’s talks in Q&A format. The conversation went thus (with names changed to spare the blushes of the individuals concerned):

Dr. R: “Jude Capper talked about the importance of having credible industry spokespeople to communicate with consumers – how do you suggest that we improve the image of beef sustainability?”

Dr. S: (hitches up his pants, stands up straight): “Well, Jude Capper is credible because she is female…” (pause while the shoulders and eyebrows of 50 or so female graduate students in the audience almost hit the ceiling) “…and she’ll be even more credible when she has children.”

If any one of those graduate students had a gun, a knife or even a sharpened pencil, I think it’s a safe bet that Dr. S would not still be on this earth – the air was so thick with “How dare that chauvinistic old man SAY that?!” it was like spending a weekend in a cigar bar. Yet Dr. S was absolutely right (although he’d probably have fewer voodoo dolls created in his image if he’d explained his statement) – female scientists, especially those who have children, are trusted by female consumers more than the traditional scientific image of an older man in a white lab coat. Why? Well it’s all about how we relate to others. We’re more likely to trust people who seem more like ourselves (age, ethnic group, profession, socioeconomic class) than those with whom we perceive we have little in common. It’s therefore not surprising that recent research (graphs below) shows that we trust our friends and families more than we trust the media, TV shows (take that, Oprah!) or politicians.

Early baby bumpI’m excited to announce that I’m gaining credibility by the day…pound by pound…literally. At almost 7 months pregnant, the most popular question I have at conferences is still “How do I communicate this information to the consumer?”, but it’s swiftly followed by “When is your baby due?”. My baby bump has given me more opportunities for conversations about the importance of beef in pregnancy nutrition with people in airports, on planes and in the grocery store in the past few months than in the rest of my life to date – and I haven’t been the person starting the conversation.

Who do consumers trust 1

Who do consumers trust 2

So what does this mean for communicating with the consumer? Even in these enlightened times, women still make the bulk of food-buying decisions, so we need to specifically target the female consumer . In almost every talk I do, I urge farmers and ranchers to put photos, videos and status updates on Facebook and Twitter so that they can reach their crazy cousin, unsure uncle or doubting daughter, living in a far-off city, with positive messages about agriculture. This time, I’m widening the net – if you happen to be male*, please also ask  your wife, girlfriend, daughter, mother, granddaughter or niece to post and let the female consumer know why we do what we do every day, why beef is a great choice for our families, and why we spend time for caring for baby calves almost as if they are our own children. If you’re female… well, have at it! There are already some excellent blogs out there from women in the livestock industry (e.g. DairyCarrie, The South Dakota CowgirlFeedyard Foodie, Mom at the Meat CounterThe Real Farm Wives of America and The Pinke Post) – let’s push back against all the tide of anti-meat or anti-conventional agriculture misinformation with more real-life experiences from the parents of the next generation of farmers, ranchers and consumers.

*Note that I am NOT suggesting that only women should blog or post on social media! This is simply about making that female-female connection that, whether we like it or not, does promote an instant degree of trust

Scare Tactics – Why Do So Many “Public Health Experts” Promote Fear vs. Food?

pork chop 1How many of us are motivated by fear every single day? We’d like to think that we’re lucky enough to live in a society where we don’t feel afraid. In contrast to inhabitants of many war-torn regions we are unlikely to be shot as we drive to work; when we’re sick we have the luxury of modern medical attention (Obamacare not withstanding); and we can buy almost any food we fancy, at any time of year and feel safe in our food choices… or can we?

Food safety is an underlying assumption of dietary choice within the USA. We buy food based on three major factors: taste, price and nutrition. Safety isn’t a defining factor in choosing between the cheese quesadilla, the chef’s salad or the T-bone steak because most of us have rarely experienced significant negative health effects as a consequence of food choice (aside from the annual Thanksgiving food coma).

Yet so many food commentators, self-proclaimed experts (I read Michael Pollan therefore I am…) or bloggers appear to exist for the sole purpose of instilling consumer fear. Take this recent article in Salon – 9 reasons why we should fear eating steak – apparently it’s riddled with antibiotics, full of heavy metals and likely to give us all mad cow disease. I’m not going to turn this blog post into a thesis, so today will simply address one of the issues raised in the article, and examine the others in future posts.

I’m a scientist by training. In my career to date, I’ve learned that the more controversial the topic, the more important it is to base claims on sound data that is peer-reviewed and published in order to gain trust. If I present data that challenges perceptions, the first questions are always “Is this published in a peer-reviewed journal? Who funded it? How do I know it’s correct?” That is not to say that science is the only way to communicate – it’s not. Yet when making claims, it’s important to have science, or at least logical and biologically-feasible arguments, to back them up.

Yet, if we’re asking a question, even if it’s a loaded question that may instill fear or doubt into the reader, apparently scientific foundation is redundant. Could combining coffee and bagels in the same meal cause impotence? Is breast cancer caused by the rise in popularity of household pets sleeping on their owners’ beds? Is your tiredness really the result of too little sleep, or could it be all the chemicals that “big food” uses every single day? Hey, I’m just asking! Not making a claim, not saying that X + Y = Z, just throwing the thoughts out there. But having read them, how many of us now are thinking about our sexual performance, the potential ill-effects of Fluffy the cat, or how we really do seem to be more tired nowadays? (note that these really are examples that I have invented, I know of no scientific foundation for any of them).

Possibly the most damaging line in the Salon article contained no data. No scientific foundation. Just a question:

Could Ractopamine, added to the food supply in 1997 with little public awareness1, be contributing to skyrocketing rates of obesity and hyperactivity in children?

The FDA approved the use of Ractopamine in swine in 1999. It’s added to the diet of finishing pigs, improving feed efficiency and partitioning more feed nutrients into lean meat rather than fat (as demanded by today’s consumer). Effectively it allows us to produce more pork using fewer resources, but it has been linked to behavioral changes in pigs.

Most of us are aware that childhood obesity is a huge issue (pardon the pun). Many of us know children that have been diagnosed as having attention deficit hyperactivity disorder (ADHD). So does Ractopamine cause these? It’s as likely as suggesting that eating alfalfa hay is going to make us lactate like dairy cows.

Maximum residue limits (MRLs) exist to make sure that there are no human physiological effects of veterinary drugs in meat, milk or eggs from treated animals. Regulatory bodies including CODEX assess potential human effects of a drug residue in animal products by multiplying the average residue level in food by the average intake. For example, if the residue level is 2 micrograms per 100 grams and the average person eats 300 grams of that food each day, the intake would be 6 micrograms. This intake is then compared to the acceptable daily intake (ADI) – the quantity that could be eaten every day for a lifetime without human health risk. This is usually the intake that would have a physiological effect, divided by a safety factor of one hundred. The MRL for Ractopamine in meat is 0.25 parts per million (0.00000025 grams per gram) with an ADI of 1.25 micrograms per kg of bodyweight per day.

If we examine the average pork intake for a 10 year old child in the USA (detailed calculation below) we see that they’d have to eat 13.3x more pork than the daily average to even equal the ADI – remember that’s the intake at which we would expect no physiological effect. For Ractopamine to have a physiological effect, the ADI would have to be increased one-hundred-fold. So the average 10-year old child would have to eat 1,330x more than the average child’s intake of pork, equivalent to 35 lbs of pork per day, every single day (the average adult only eats 48 lbs of pork in a year), for Ractopamine to have a health effect. My little nieces adore pork sausages, but they are pushed to eat two (approx 2 oz) in a day, let alone 35 lbs worth!

Still think that we can link Ractopamine use to obesity and ADHD? We can’t prove a negative, but it’s as tenuous a link as suggesting that we could drown in a single drop of water. So why are public health “experts” like Martha Rosenberg using fear tactics to scare us rather than extolling the positive contributions that high-quality animal proteins make to the human diet? Surely there’s no agenda there….is there?

1Note that all the data relating to this is freely-available on the internet – the “little public awareness” line is simply more fear-mongering.

Details of Ractopamine calculation

Let’s examine an average child’s intake. The average 10-year-old boy in the USA weighs 32 kg (71 lbs) and needs 34 grams of protein each day. In the USA, meat contributes about 40% of protein intake and about 21% of that comes from pork. That means, on average, a 10-year-old boy would eat about 12 g of pork per day (2.9 g protein).

If Taylor eats 12 g of pork each day at the maximum residue limit of Ractopamine (note that this would be unusually high), he’s consuming 12 g x 0.25/1,000,000 = 0.000003 g Ractopamine. His ADI = 1.25 micrograms x 32 kg bodyweight = 40 micrograms, or 0.00004 grams. That’s 13.3x higher than his intake. So a child could eat 13.3x more pork than average, every single day, and not be expected to have any physiological effects. For ingested Ractopamine to have a physiological effect he would have to eat 100 times that amount – 16 kg, or 35 lbs of pork per day. To put that into context, the average adult eats 48 lbs of pork in a year.