Polio Not-So-Trivial Pursuits

DON'T PEEK!!!!

What year were the Americas certified as being free of polio?

What year was Europe certified as being free of polio?

Please consider posting your guess in the "comments" section before scrolling down to check your answer...

Answers:

The Americas were certified as being polio-free on September 29, 1994.

Europe was certified as being polio-free on June 21, 2002.

Surprised?  How close were your guesses?

For more information on polio, check out these two pages:

http://www.unicef.org/newsline/poliopkglmilestones.htm
http://www.unicef.org/newsline/poliopkeuromilestones.htm

A Community Conversation - Part 4

A Community Conversation About Health and Responsibility: Vaccines and Beyond

Part 4: Blogs, Beatrix Potter, Biospheres & Human Microbiomes...oh my!

Question: What do you do when you have a thousand words to cover a subject on which dozens of books have already been written?

Our answer: You lean more heavily on a blog, where you can offer additional information and references to some great resources!

If these articles intrigue you or leave you wanting more, that's good!  Visit our blog!  Find out more details, discover some terrific resources, read some breaking news, and learn about upcoming events.  Our blog also makes it easier to share information with the larger community. E-mail copies of articles to family and friends or link to us on Facebook.  Tell us what you think, share your favorite resources, and bring your voice to the conversation.   Vaccinesandbeyond.blogspot.com.

Speaking of upcoming events, there's a fascinating documentary on this subject that will be coming to Vashon Island soon!  Stanford graduate student, Laura Green spent several months interviewing Vashon residents about how we manage pertussis.  The film, Everybody's Business, will be shown at the Vashon Theater @ 1:30pm on Sunday, June 2nd.  

Let's travel back in time.  Do you remember Peter Rabbit?  Or Jemima Puddleduck?  These lovely, affable characters - which have entertained and instructed generations of children - were born from the imagination of a very astute naturalist and scientist, Beatrix Potter.  She was also one of the first to observe and prove the existence of mutual symbiosis through detailed and painstaking observations of lichen.  Unfortunately, most European scientists of the 1890‘s categorically rejected the idea of mutual symbiosis which they saw to be in direct violation of the natural law of competition.  Much to the dismay of our observant and shy Miss Potter, she was publicly scoffed at, privately snubbed, and utterly dismissed as a foolish woman who hadn’t the faintest concept of how the natural world worked.  She was also right.  Her detractors did eventually get over their arrogance and held a meeting in her honor....100 years later.  Miss Potter's experience (and many similar historical stories) raise the question “What do we today accept as obvious truth, which our grandchildren will know to be patently false?”  Please visit our blog for more about Beatrix Potter’s story!

But what is mutual symbiosis anyway?  The dictionary defines it as “A close, prolonged association between two or more different organisms of different species that may, but does not necessarily, benefit each member.”  Parasites have been widely acknowledged for ages.  However, the idea of mutually beneficial relationships (also called mutual symbiosis or mutualism) between different organisms is relatively new.  In the early twentieth century, the idea of mutualism was considered impossible.  As the evidence mounted, it was acknowledged that mutualism did occur, but it was still considered very rare.  However, current research indicates that nearly all species exist in some form of mutual symbiosis.  Including us!

Did you know that you are only about 10% human?  Admittedly, the microbe cells are a lot smaller than the human cells so they only add up to 1-3% of our total mass.  But if you're counting cells, microbes that live in and on the body of a healthy adult human being are estimated to outnumber the human cells by about ten to one.  It's an odd thought isn't it?  Makes you feel a bit like a coral reef or a rainforest.  This population of microbes is called the human microbiome.  Until recently, the study of our human microbiome was limited to what would grow in a petri dish....and most microbes just won't grow outside their home habitat.  Due to recent technological advances in genetic sequencing, we are finally beginning to get a glimpse of the amazing ecosystems that are...us.  If you are interested in the details of this project, please visit our blog for more information and links to the Human Microbiome Project website.

There are two ways in which knowing the past can help us understand our present.  First, our present has been created by the combined events of the past.  Second, human nature is fairly constant and people respond in consistent ways to similar stressors regardless of what century they are living in.  Miss Potter’s case gives us an excellent example of how the human tendency toward over-confidence can lead to closed minds.

When it comes to the Human Microbiome Project, we can again learn from history.  Hundreds of years ago, people were completely unconcerned about altering ecosystems and transporting living things all over the planet.  Only after the damage was done did we come to understand the fragility of these “macro” ecosystems.  As we face the unintended consequences of our actions, questions arise about the impact we have on our microbiomes every day.  

Hopefully, as the Human Microbiome Project proceeds we will not repeat the errors of the scientific elites of Miss Potter’s day.  Instead, let us stand ready with open minds and an eagerness to expand our understanding of our body’s microbiome.  Let us focus on humility, so that we can inculcate new and unexpected discoveries into our existing world view.  

This we must do, if we hope to evolve, grow, and improve our approach to health.  This we must especially do, if new discoveries contradict any currently held (and deeply trusted) health strategies such as the War on Germs.

Closed minds did not make Miss Potter’s research any less true.  We cannot deny something into being wrong.  Due diligence and skepticism is necessary yet we need to guard against being overly attached to current paradigms.  Such attachment can interfere with our ability to accept new, vitally important, information and slow the advancement of science.  

“Talking About Public & Private Health - Vaccines and Beyond” is an ongoing series written by two close friends with a passion for improving community cohesion and building respectful relationships in a diverse world.  This article was co-created by Karen Crisalli Winter and March Twisdale.  BLOG: KarenandMarch.blogspot.com  Email: KarenandMarch@rocketmail.com

You Are A Rainforest

Did you know that you are only about 10% human?  Admittedly, the microbe cells are a lot smaller than the human cells so they only add up to 1-3% of our total mass.  But if you're counting cells, microbes that live in and on the body of a healthy adult human being are estimated to outnumber the human cells by about ten to one.  It's an odd thought isn't it?  Makes you feel a bit like a coral reef or a rainforest.  This population of microbes is called the human microbiome.

What are all these microbes?  Well, we actually don't know much about them.  Until recently, the study of our human biome was limited to what would grow in a petri dish....and most microbes just won't grow outside their home habitat.  Due to recent technological advances in genetic sequencing, we are finally beginning to get an accurate look at the billions of diverse ecosystems walking around every morning getting coffee.  If you are interested in the details of this project, do an internet search for the Human Microbiome Project (HMP), funded by the National Institutes of Health (NIH).

What we have already learned is fascinating.  We are born nearly sterile.  During and after birth, we “catch” the mix of microbes that colonize our bodies over our first few months.  The HMP estimates there are approximately 10,000 different species of microbes that commonly inhabit human beings.

Moreover, the microbes that live in my nose are a completely different mix of species from the microbes that live in your nose.  In a way, this is not surprising.  We notice the same thing in rainforests and coral reefs: the exact mix of species can vary dramatically from spot to spot, even when there are no obvious differences in environmental conditions.  But it does raise some interesting questions.  We know that the human microbiome is essential for our health.  But we don't know how to identify a healthy human microbiome!  What does a healthy forest look like?  At what point is intervention required?  At what point does intervention do more harm than good? These same questions must be asked at the microbial level.

All of this new research brings up some serious questions about our “war on germs.”  We used to believe that microbes could be neatly split into categories of beneficial (good) or pathogenic (bad).  But now we're discovering the existence of conditionally pathogenic bacteria.  These bacteria are part of our normal human microbiome.  They are usually harmless or even beneficial.  However, in certain circumstances they can cause disease.

At one time in human history, it was considered desirable to drive a species extinct.  Animals that threatened human beings or their livestock were subject to extermination campaigns around the world.  This made sense at the time.  Who wants to risk the possibility of getting eaten on the way home from work?  Who wants to starve this winter because a predator ran off with most of your livestock?  Trying to exterminate the wolf, the tiger, and other large predators was “common sense” that led to some serious unexpected consequences.  These days, we generally look at that “common sense” as tragic.

Ecosystems are complex things.  Adding or removing a species from an ecosystem can have unforeseen consequences both positive and negative, even if you're looking at a very localized ecosystem.  Does that mean we should never act on an ecosystem?  Well, no.  All living things adjust their local environment, even plants and fungi.  Weeding your garden or setting a mousetrap are attempts to remove certain species from your localized ecosystem.  I certainly have no qualms about keeping mice out of my pantry and morning glory out of my veggie garden!  Nor do I object to planting tomatoes every year, despite the fact that they are not native species.  

But we must also act with caution and intention.  Kudzu was imported to the southeastern area of the US as an attractive, fast-growing plant to control erosion and provide forage for domestic animals.  Now it's called "the vine that ate the south" and is wreaking havoc on the economy, infrastructure, and ecosystem.  During the Great Leap Forward in China, sparrows were nearly exterminated to prevent them from eating grain.  It was subsequently discovered that sparrows prefer to eat locusts and other grain-eating insects.  The net result was a locust swarm that contributed to massive famine.  Approximately 30 million people starved to death.

So it is important to exercise caution when intervening in an ecosystem!  This brings us back to microbes and our current “war on germs.”  Obviously, there are some microbes that are scary, nasty pathogens and which have the potential to make many people very sick.  Living in a world without smallpox is a goal we sought...and achieved.  Similarly, we may be only a few years from eradicating polio!  

But it may be time to question certain aspects of the “war on germs.”  Are antimicrobial washes a good idea?  If so, under what circumstances should they be used?  Antibiotics have saved lives.  However, using an antibiotic is very much like clear-cutting part of our microbiome.  After clear-cutting a forest, what comes back is not what was there originally.  In our part of the world, scotchbroom is quick to colonize newly exposed land...preventing slower growing, native plants from recovering.  How does this look inside of our gut?  Our colon? Our nose?  And, what is the health impact of this change?  Currently, we have very few answers.

And then there are vaccines.  The first vaccine wiped smallpox off the planet, an achievement which we all celebrate.  Polio vaccination - and cleaner water supplies - have nearly eliminated polio, another tremendous achievement.  And now...we have vaccines against 28 different diseases with nearly 300 new vaccines in various stages of development.

What does this all mean for our human microbiome?  Perhaps nothing.  Perhaps everything.  Smallpox and polio vaccines have done wonderful things for humanity.  On the other hand, these successes do not mean that all further vaccines will be such a success.  Decades ago, we had a simple goal: eliminate infectious disease by controlling germs.  That theory is starting to look as woefully simplistic as trying to protect our gardens by killing deer.  Most would agree that building a strong and safe enclosure for a garden works much better...and most health practitioners agree that an ounce of prevention (through a strong and healthy lifestyle) is better than a pound of cure.  

Given that we now recognize the existance of conditionally pathogenic bacteria...what about viruses?  Fungi?  Parasites?  Yup, even parasites might have their benefits.  Active research is currently being done on “helminthic therapy” otherwise known as intentionally giving someone parasitic worms to treat or prevent autoimmune diseases.  It boggles the mind!

You are as delicately balanced as a coral reef or a rainforest.  You are a walking, talking, breathing ecosystem with up to 10,000 different species interacting in a delicate balance.  Amazing, isn't it?

Beatrix Potter, the scientist...

If you just read our Part 4 article in The Loop, you're probably here to learn more about Beatrix Potter's lifelong passion for the natural world.  Here are some links that we think you will like a lot...  

Article about Beatrix Potter's passion for fungus, her use of painting and drawing to study them, and more!

http://www.the-scientist.com/?articles.view/articleNo/24954/title/Beatrix-Potter--scientist/

By Manasee Wagh | April 6, 2007

See Beatrix' amazing artwork as displayed @ Victoria and Albert Museum

http://www.vam.ac.uk/content/articles/b/beatrix-potter-natures-lessons/

Even Australia has taken an interest in Beatrix Potter, and this article covers details not found in the two previous resources:

http://www.anbg.gov.au/fungi/case-studies/beatrix-potter.html

We hope you have enjoyed learning more about, Beatrix Potter, the creator of Peter Rabbit and many other amazing animal characters!  Please keep in mind that the errors made in her day, by a generally over-confident and elitist scientific community, can teach us a great deal about the value of holding onto humility today, when evaluating new research.

Enjoy!

March & Karen

Link to Human Microbiome Project...

The Human Microbiome Project is funded by the National Institutes of Health.  Their mission is to “characterize the microbial communities found at several different sites on the human body, including nasal passages, oral cavities, skin, gastrointestinal tract, and urogenital tract, and to analyze the role of these microbes in human health and disease.”

If you want to learn about the latest research and findings of the Human Microbiome project, check out their website: http://commonfund.nih.gov/hmp/

Have fun!

Karen & March

A Community Conversation - Part 3

A Community Conversation About Health and Responsibility: Vaccines and Beyond

Part 3:  Individual Power in Community Health Dynamics

Nothing in healthcare is simple.  We have a limited understanding of the human immune system.  The study of the human biome is in its infancy.  Vaccine science is imperfect.  Microbes keep evolving and antibiotic effectiveness is plummeting.  Feel powerless yet?   

Actually, we have a lot of power.  Small decisions matter.  We have the power to protect the community.  When it comes to contagious diseases the moment of power can come when we wake up with cold symptoms and face the hard decision of whether to go to work...or stay home and take care of ourselves.

We live in a society that values tenacity and often regards self-care as weakness.  Stepping back from obligations can be viewed as inconsiderate.  Perhaps it is time to challenge these values?

Challenging an entrenched social value is always easier with good tools.  These 6 steps illustrate a new way of approaching our role in community health care.

Step 1:  Take care of yourself
Many pathogens are opportunistic. If your immune system is in poor shape, you are more likely to catch something nasty and more likely to spread it through the community. Start with the basics. Get enough sleep, get enough exercise, eat good food, drink enough water, get medical care as appropriate.

Step 2:  Body awareness

Early signs of illness can be very subtle. Unfortunately, this is often the time when you are most contagious. Learn to notice that you are ill before you are flat in bed with a fever of 103. Aside from the community benefits, caring for yourself early may shorten the duration of the illness and return you to full health more quickly.

Step 3: Observation
When a lot of people are sick with similar symptoms, it's probably the same pathogen. If you've been hanging out with these folks, you have probably been exposed. Now is a great time to take extra good care of your health. A strong immune system can't prevent all illness, but it usually helps. Remember that in certain cases you can be a disease carrier even if you don't have any symptoms. 

Step 4:  Research!  

When researching, look for the incubation period, contagious period, normal progression of the disease, possible complications, treatment, testing, and high-risk populations.

Step 5:  Minimize contact 

If you have symptoms, assume you are contagious unless you have medical evidence to the contrary. If you've been heavily exposed to an illness, consider the possibility that you might be an asymptomatic carrier. This means you can be contagious even if you have no noticeable symptoms. Take reasonable precautions based upon the illness to which you've been exposed. This might be anything from washing your hands a lot to putting yourself in full quarantine. Be especially aware of vulnerable populations like tiny babies, pregnant women, immunocompromised individuals, and frail elders.

Step 6: Support others

There are many forces in society that pressure people to “keep going” despite being sick. Try not to be one of these forces. Encourage employees, volunteers, students, and clients to stay home and rest when ill. Offer to pick up groceries for a sick friend. Take whatever actions you can, large or small, to support people in making responsible choices.

Of course...sometimes we get lucky and get specific information about the disease that is circulating. Suppose you get a memo from your school or workplace that several people have been diagnosed with pertussis. How would you apply the above process?

Step 1:  Research

You are lucky!  You know what you’re dealing with...so you can start with research.  You will discover that pertussis is annoying for most healthy adults, terrifying for people with health challenges, and potentially fatal for infants.  It would also be useful to gain a realistic understanding of the potential benefits and failures of the vaccine, the accuracy of available tests, the likelihood of an inaccurate diagnosis, and the fact that over 50% of adult pertussis cases never have the characteristic "whooping" cough.  In fact, some people can be entirely asymptomatic carriers.  It would be useful to know that antibiotics can be helpful, but only if given early.  You also might like to know that up to 30% of pertussis cases are actually caused by parapertussis, for which we have no vaccine.  All of these details are important if you are to take effective steps to protect yourself and the community.

Step 2: Take Care of Yourself

Evaluate your own risk factors.  Apply what you learned in Step 1 to your unique situation.  Respect the disease and respond accordingly.

Step 3: Body Awareness

The first signs of pertussis are trivial and look just like a cold or even allergies. A runny nose, nasal congestion, sneezing, red and watery eyes, a mild fever, and a dry cough are the classic symptoms of early pertussis.  Notice them.  If you have a known exposure to a specific case of pertussis, assume you have pertussis.  Otherwise, track your symptoms on your calendar to see if they match the patterns of pertussis. Keep your health provider informed, and err on the side of caution.  Your mild case can give a deadly case to another person.  Respect the disease.

Step 4:  Observation

In this scenario, someone told you that pertussis is circulating in your community. But you won't always get a memo. If you notice a steadily growing population of people who have an odd cold that lingers for months, pay attention. It could be pertussis.

Step 5: Minimize Contact

When you have a known exposure to pertussis, stay away from newborn babies and pregnant women in their third trimester.  This is true whether or not you have developed symptoms.  People who have been vaccinated against pertussis must be especially alert, since the protective effect of the vaccine increases the likelihood of them becoming an asymptomatic carrier.

Step 6: Support Others

Encourage others to openly discuss the complexities of this disease. Support the use of masks, working from home, taking time off, visiting the doctor, and other forms of self-care. Most importantly, remind everyone to keep all coughs away from newborns and anyone in close contact with newborns.

There are many powerful tools available to us in our quest for personal and community health. These six steps are a good start. By using them, we can help limit the spread of communicable disease and protect the most vulnerable. In the case of pertussis, we can even save a life.

“A Community Conversation About Health and Responsibility: Vaccines and Beyond” is an ongoing series written by two close friends with a passion for improving community cohesion and building respectful relationships in a diverse world.  This article was co-created by Karen Crisalli Winter and March Twisdale.  BLOG:  Vaccinesandbeyond.blogspot.com   Email:  KarenandMarch@rocketmail.com  

A Community Conversation - Part 2

A Community Conversation About Health and Responsibility: Vaccines and Beyond

Part 2:  How do you decide?

Over the years, people have blamed diseases upon God, Satan, witches, ghosts, evil spirits, stale air, cats (instead of rats), rats (instead of fleas), swamp air (instead of mosquitos), the four humors, sinfulness, and who knows what else!  Today, however, most look to different causes for health problems: genetics, air pollution, contaminated food or water, lack of exercise, heavy metals, bacterias, viruses, weakened bodies, black mold, prions - and rarely - the ingredients of vaccines.

Emblematic of the enormity of this discussion is the 11.3 BILLION dollar annual budget of the CDC!  Humans do not allocate such sums for simple questions!   Still, with all these committed resources, the CDC cannot offer us a flawless answer.  And yet, we all have to make decisions about this complex subject.  So, how do we decide?

In the arena of human immunity, public health, and vaccines, we can observe three basic decision-making styles which we are defining as:  Simplifiers, Delegators, and Questioners.  ALL three decision-making styles are valid, offer value to the community, and deserve our respect.  

First, it is vitally important to acknowledge that Simplifiers are not simple.  However, their preferred approach is to simplify a complex subject into a few basic rules.  They are the people who tend to say, “All vaccines are safe!” or “All vaccines are dangerous!"  This greatly simplifies decision-making!  As in religion, the greatest zealots are often the converts.  Simplifiers who feel their previous choices were wrong are often very diligent about trying to rescue everyone else from repeating their mistakes. When Simplifiers ask questions, they are attempting to either establish some simple rules or reinforce existing rules.

Next, we have Delegators.  Delegators select an expert they find trustworthy and follow their instructions.  This makes sense,  given that life - and especially parenting -  can be quite challenging, and no one can become an expert in every subject.    Delegators may do a great deal of research on selecting that expert, or none at all.   When Delegators ask questions, they are attempting to evaluate the qualifications of an expert.

The third group is Questioners.  Questioners are fascinated by the subject, comfortable with ambiguity, and driven to continually ask questions.  Questioners often seek out experts as a source of information, but will always reserve the rights and responsibilities of making choices for themselves.  Questioners seek their own “best possible” solution to these complex questions while keeping their unique situation in mind. Even after Questioners have found adequate solutions for themselves, they often continue asking questions simply for the joy of discovery.

Each group tends to have a strong bias that their way of deciding is best for society. And each one is incorrect. All three decision-making styles offer tremendous benefits for society. While we may annoy each other at times, we need each other.

Simplifiers often have a great deal of passion about the subject.  They keep the conversation publicly alive, and their actions can prevent society from becoming complacent about the issue.

Delegators are often the least opinionated and can help calm down overheated conversations.  Also, when seeking out relatively rare or subtle effects of vaccines & diseases, researchers can utilize the medical records of thousands or even millions of Delegators to advance medical knowledge for all of society.  

Questioners can be annoying.  However, by highlighting existing problems and demanding better solutions, Questions are an integral part of the ongoing effort to improve public health.  Questioners remind us to use all of our medical tools to best advantage instead of relying completely on one solution. 

A society that accepts all three categories of “decision-making strategies” ends up with healthier people, better science and better public health policy. So how to apply this in the real world of talking to your neighbors about diseases, public health, immunity, and vaccinations? 

The first steps happen within yourself. Identify your own style. Understand that your own decision-making style is not the only style.  Then accept that the other styles are reasonable choices.

Next, figure out the style of the person you're talking with. Does your conversation partner frequently make statements without caveats or exceptions? No matter how well researched their opinion, they're probably a Simplifier. Does your conversation partner frequently reference how much they trust the advice of a certain individual or group? No matter how empowered they are, this person is probably a Delegator. Does your conversation partner pause and reflect upon the complexity of the issue before sharing information?  No matter how opinionated they are, they're probably a Questioner.

So you know your own style and you know your conversational partner's style. Now what?

If you are a Simplifier, please understand that not everyone shares your beliefs.  Overt judgmentalism will cause more damage then you think. Whether you are ready to hear this or not, you do not have the best answer for every person, family, or community. You have a potentially good set of ideas. Share them with a loving heart, sensitivity and tact.

If you are a Delegator, you have found an expert which you trust. If you wish to encourage others to follow your chosen path, please remember that each family’s unique constellation of circumstances matters. Your expert may not be a good fit for another family. Also, some Questioners find the idea of delegation to be personally offensive, even if the expert is top-notch. Be sensitive to this value, even though you don't share it.

If you are a Questioner, please remember that continually asking questions is deeply uncomfortable for some people.  Many prefer to believe there is an attainable “best answer” and that they have found it. Alternately, many prefer to trust another person to sort through the overwhelming information on their behalf. Please respect both these choices. Not everyone has the time, energy, or interest to be a Questioner.  

Whether you are a Simplifier, Delegator, or Questioner, remember to stop talking sometimes and listen. There is a different story behind every person's decisions. Ask about them. You might be surprised by the answers.

“A Community Conversation About Health and Responsibility: Vaccines and Beyond” is an ongoing series written by two close friends with a passion for improving community cohesion and building respectful relationships in a diverse world.  This article was co-created by Karen Crisalli Winter and March Twisdale.  BLOG:  Vaccinesandbeyond.blogspot.com   Email:  KarenandMarch@rocketmail.com