Is the H1N1 Vaccine Safe?

Is the H1N1 vaccine safe? I've heard this question a lot since I began promoting the book I co-authored, The Complete Idiot's Guide to Vaccinations. Young adults and mothers of young children tend to ask me about the H1N1 vaccine, because they are weighing the risks and benefits of getting vaccinated.

Modern vaccines are extremely safe. Problems such as bacterial contamination of vaccines, a serious threat several generations ago, has been largely eliminated through the use of preservatives and improved packaging. Many older vaccines have also been reformulated to reduce the risk of side effects (such as the old DTP vaccine, and the earlier rotavirus vaccine for children).

The H1N1 vaccine is made in the same way as the seasonal flu vaccine. The viruses that cause the flu are grown and biologically weakened in chicken cells, until they are still strong enough to create an immune system response in people, but too weak to cause the disease in a healthy person. Then the weakened viruses are either:

• killed and used in the seasonal or H1N1 flu shot (the best choice for people with weakened immune systems or other risks), or 
• kept alive and used in the seasonal or H1N1 flu nasal spray vaccine (the best choice for certain people with healthy immune systems).

The seasonal flu shot has been available since the middle of the last century; the nasal spray flu vaccine was licensed in the United States in 2003.

The CDC tracks health problems that might be linked to vaccines with the Vaccine Adverse Event Reporting System (VAERS). Both health care providers and the general public can report health problems that occurred after a vaccination to VAERS. Researchers monitor VAERS, looking for patterns of problems with a vaccine. If a pattern does occur, then they do further research within the Vaccine Safety Datalink (VSD), a database containing the health records from eight managed-care organizations across the country.

What have they found since they have been tracking the H1N1 flu vaccine? The CDC's Dec 11 Morbidity and Mortality Weekly Report (MMWR) found that the risk of serious side effects (adverse events) from the H1N1 vaccine is about the same as the risk for the seasonal vaccine. In a word: low. From October through November 2009, VAERS data showed 82 adverse events per million doses of H1N1, and 47 adverse events per million doses of seasonal flu vaccine.

Still, the rumors are flying about the H1N1 vaccine: that it can cause Gulf War Syndrome or Guillain-Barre syndrome, that it contains Agent Orange, and so on. The website FactCheck.org's "Inoculation Misinformation" article provides a good overview and rebuttal of some of the questions that have cropped up in emails and online about the H1N1 vaccine.

Take Your Eyes Outside

Since I am nearsighted myself, I was intrigued by a recent article in New Scientist that looked at the causes of myopia (nearsightedness). Myopia rates have skyrocketed around the world, explained author Nora Schultz in "Generation specs: Stopping the short-sight epidemic," affecting 80% of the population in some Asian countries and 30% to 50% of the population in Western countries.

Researchers once thought that reading and other "near work" might cause myopia, but they have been unable to prove this definitively. Schultz writes that they have found that myopia is less common in children who spend more time outdoors, though.

Why is this? It doesn't seem to matter whether or not the children are getting any exercise outdoors, she explains. Instead, researchers believe that exposure to bright natural light might slow eyeball growth, preventing a child's eyes from growing into a shape that can cause myopia.

Focusing on far-away objects outdoors also might help prevent eye problems. Children who live in urban areas have fewer opportunities to look out over long distances than those who live in the country. This might contribute to high rates of myopia in urban areas.

So there is it, yet another argument to get outside and play in nature: it's good exercise for your eyes. A recent family trip we took to Marin County's Point Bonita Lighthouse was certainly a good example. To get there, we had to hike down a long trail that dropped off to crashing surf far, far below. We stopped at the edge of the trail a few times to peer down at the tiny fishing boats making their way toward the Golden Gate Bridge. The trail ended at a long, dark tunnel blasted into the cliffside.

We came out of the tunnel, squinting at the light, into a small gathering area with a group of other people. From there it was a short trip over a weather-beaten footbridge that the park rangers warned could only hold two people at a time, below which the surf crashed and spit into the rocks. I held my daughter's hand and walked carefully across (trying not to think about how much or how little money the National Park Serivce spends on repairs and maintenance each year), only looking forward at the cottage-sized lighthouse glued to a hunk of rock ahead of me because I really didn't want to look down.

Sure, there was a lot of bright natural light, and plenty of long scenic views from the lighthouse. But with the heights, the damp tunnel, the waves clawing at the cliff, and the rusty footbridge, I don't think I'll be back. I think our next trip will be to a nice peaceful meadow - inland.

YouTubilicious: Science and Entertainment

This week, I attended a press preview of the new digital show, Journey to the Stars, at the California Academy of Sciences' Morrison Planetarium (billed as "the largest all-digital planetarium in the world") - the show officially opens on September 26. The stunning images, of the Orion Nebula (see picture), the Milky Way, and the spiderweb paths of satellites that criss-cross the earth, were created based on the latest astronomical data.

As the show zoomed through images of the solar system, showing how it might have looked 13 billion years ago and ending with a projection of the sun's demise 5 billion years from now, portentous music swelled in the background. The narrator on this galactic tour? Whoopi Goldberg.

I like Whoopi Goldberg; she's smart, funny, and sassy, as was her planetarium narration. But it's hard for me to imagine the stand-up comedien, The View co-host, and star of Sister Act seriously pondering the origin of the universe or the magnetic fields of Saturn.

On the other hand, a low-tech, soporific, Carl Sagan-esque explanation of how stars are formed might not be the right approach to teaching science to the public. I remember visiting Chicago's Adler Planetarium in Chicago with friends in high school many years ago - bright future alumni of MIT, Brown University, and the United States Naval Academy, among other schools - and watching them doze off one by one in the darkened room as the image of Orion the Hunter was superimposed over the constellation of Orion's Belt on the ceiling.

Science doesn't have to be boring, especially with the new technologies available today. If Pixar studios can give a desk lamp a sparkling personality with computer animation, why can't science be presented in a more engaging way? Maybe a little more entertainment is just what the doctor ordered. With that in mind, here are my favorite, toe-tapping music videos about my two most recent obsessions: swine flu (novel H1N1) and health care reform.

Dr. John D. Clarke, FAAFP, won a recent public service announcement contest sponsored by the department of Health and Human Services with his "H1N1 Rap". Who knew that HHS could be so hip?




In response to data that ranked the United States 37th in the world for the quality of its health care, Paul Hipp wrote the rock-and-roll song "We're Number 37", proving that you really can write a song about anything.

Making Politics Palatable to Moms

A while ago, I signed up to receive emails from the political group MomsRising. The organization advocates for progressive, family-friendly policies such as paid family leave, expanded health care coverage for children, and better-quality child care options. I support these causes, but I was hesitant to join MomsRising because they are linked to MoveOn.org.

I remember well when MoveOn ran a notorious full-page ad in the New York Times in 2007 that criticized the war in Iraq by making fun of General Petraeus' name. I am constantly telling my children not to tease other people (or each other), but MoveOn had no problem with name-calling. Should an organization that uses ridicule to advance its objectives provide political leadership to mothers?

And what does it mean, exactly, to organize mothers into a political entity advocating for improvements in child health and other family-friendly causes? Are American mothers that cohesive ideologically - or that easily lead? If they are, I'm not sure I want them to be.

When MomsRising - or other political or social organizations - send emails summarizing an issue and include a simple "click here to send a letter to your senator" button, I get a bit suspicious. If I take the time to do some research, the topic is inevitably more complex than it first appears. Furthermore, MomsRising tries to make political involvement fun, such as decorating a onesie to send to local politicians, or dressing in a superhero cape to advocate for health care reform - an approach akin to making smiley-faces out of your child's vegetables in order to persuade her to eat them. They forget that mothers are adults, not children.

I'd like to see less drama and more thoughtfulness from an organization that advocates for mothers and families, particularly if they're going to talk about such a fraught issue as health care reform. Moms (and Dads) need to flex their critical thinking skills. It's following without thinking, believing rumors and hearsay about health and health care instead of facts and reports, that gets everyone in trouble in the first place.

Obesity: Less Talk, More Action

The CDC is wrapping up its first Weight of the Nation Conference in Washington, D.C. today, a meeting designed to discuss the prevalence and prevention of obesity in the United States. In a speech at the conference, Health and Human Services Secretary Kathleen Sebelius pointed out that more than two thirds of Americans are obese or overweight, and that obesity-related health problems now cost the nation $147 billion per year, far more than the $93 billion annual cost of treating all cancers. In her comments, Sebelius cited a Time Magazine poll that found that while most Americans say that they want to lose weight, far fewer Americans have any plan for losing that weight. These Americans know there is a problem, but the solution - and the motivation to make a change - has eluded them.

Obesity has complex sources and it requires a multi-faceted solution: first of all, better education about and access to healthy food and exercise, especially among the ethnic populations that have the highest rates of obesity. Sebelius hinted about an obesity prevention initiative currently in the works that will be funded by the stimulus package. This initiative would probably work on community-wide solutions (such as supporting local exercise programs and improving access to grocery stores and farmer's markets) and nation-wide solutions (such as pressuring the food industry to remove more fats and sweeteners from its products). But I think that these solutions should be combined with direct financial incentives for individuals. Maybe there could be an income tax credit for people who maintain a healthy body mass index (B.M.I.). What if health insurance under whatever new plan arises from the Obama administration were free for people who maintained a healthy B.M.I., and reasonably prorated for all other Americans? If the possibility of weight-related disease and disability won't make people lose weight - as it clearly hasn't - then financial incentives might.

Teen Safety Online and On the Road

How much freedom should teenagers have? They're certainly not children, but they're not yet adults either. Teens have less life experience and exercise poorer judgment than adults, even as they crave access to the adult world.

Experience and good judgement are especially critical in two areas that virtually define modern American adolescence: internet use and driving. The American Academy of Pediatrics' microsite on internet use for Internet Safety Month in June points out a range of problem behaviors that teens might encounter or engage in online, such as cyberbullying, online solicitation, and "sexting" (exchanging inappropriate or sexually explicit pictures of children and teens). The solution? Talking with your teenager about cyber safety and privacy, and monitoring and limiting the use of computers and cell phones.

Driving is also hazardous to teens' health, with car crashes the top cause of death in teens ages 15-19, according to Mothers Against Drunk Driving. Inexperience, distraction from other passengers in the car, cell phone use or texting while driving, and underage drinking all contribute to this problem. Graduated driver licensing (GDL) programs, now commonplace in most states, can make a difference in protecting teen drivers and others around them. For teenagers under age 18, these programs create curfews for night-time driving (when the risk for crashes increases in this group), limit the number of teenaged passengers in the car, and delay access to drivers' licenses if teens are cited for moving violations while they have their learner's permits. These rules force teens to build their driving skills up slowly until are mature enough for unrestricted driving. In some states, parents can also request a copy of their teen's driving record to see how they are doing.

Teenagers (and perhaps their parents) might chafe against restrictions and oversight, but these are the most effective ways to keep teens safe until adulthood. In one study in upstate New York, for example, a GDL program decreased injuries among 16-year-old drivers by 31%. These are also public health measures, protecting others from mistakes that teens might make. It's good to see American society figuring out practical ways to give adolescents both freedom and protection as they wend their way toward adulthood, a path that seems to become rockier with each new generation.

Understanding Swine Flu

Is swine flu the next influenza pandemic? Swine flu does share genetic material with the flu strain that caused the influenza outbreak of 1918-1919, a strain that has been circulating on and off since then. Older adults are more likely to have encountered a version of this flu strain when they were younger, giving them better protection against it now. This topic is familiar to me because I was researching swine flu earlier this year as part of a book about vaccinations that I'm working on with a pediatric epidemiologist.

The 1918-1919 pandemic, the most famous influenza pandemic, infected about 30% of Americans. About 2% of the cases were fatal in an age without antiviral drugs and other medical interventions. Even then-president Woodrow Wilson caught the flu during the pandemic (and survived). Ultimately, influenza killed about 675,000 Americans between 1918 and 1919, an unlikely scenario in the U.S. today with improved medical care and a much better understanding of how infectious diseases spread.

The 1918-1919 flu pandemic was different from the seasonal flu because it spread extremely rapidly, and young adults, rather than the elderly, were most likely to die from the virus. The first U.S. cases in the pandemic were reported among soldiers on a military base in Kansas in 1918, arguably the healthiest members of society, although living in close quarters makes them more susceptible to infectious diseases.

The swine flu that began this month in Mexico is also most deadly among young adults, with numerous sad stories circulating about flu-related deaths in young adults in Mexico and the death of a child in the United States. Swine flu, an illness that pigs get, is sometimes transmitted from pigs to humans (i.e. only those who have been physically near pigs catch the virus). Rarely, swine flu has been transmitted from humans to humans. It has cropped up a few times in the past, most notably in 1976, when about 200 soldiers in Fort Dix, New Jersey were infected, four developed pneumonia, and one died. At Fort Dix, there was no evidence that the soldiers had had contact with pigs. The virus had mutated and was now transmitted from person to person.

Periodically, influenza viruses mutate into something new and more serious, with a potential to spread worldwide (causing a pandemic). For this reason, the 1976 swine flu cases spurred a strong response. A vaccine was developed and a mass swine flu vaccination campaign began that year. About 45 million people were vaccinated against the disease in 1976. The swine flu vaccine used then, however, was later recalled because it appeared to slightly increase the risk of developing a rare neurological problem called Guillain-Barre Syndrome (GBS) which can cause temporary paralysis. Swine flu did not spread and become a pandemic as feared.

For a long time, epidemiologists have been concerned about the source of the next influenza pandemic, often targeting avian influenza ("bird flu"). The swine flu virus circulating today, a mixture of pig, bird, and human viruses, is not a pandemic but it has the potential to become a problem. If you take precautions such as washing your hands adequately and often, however, you can help protect yourself and others.

The seasonal flu (influenza) itself causes plenty of problems every year. The CDC recommends a yearly flu vaccination for children up to age 18 (in part because they often pass on flu to the adults around them), adults 50 and over, and certain other groups of people such as health care providers. (This season's flu vaccination does not protect against swine flu.) Although most people recover easily from the seasonal flu, very young children and the elderly are far more likely to suffer from complications such as pneumonia if they catch it. Many people do not get their recommended flu shot each year. As a result, seasonal influenza is the top cause of vaccine-preventable deaths in United States, killing 36,000 and hospitalizing 226,000 each year, according to the CDC.

You can learn more about swine flu and how to avoid it at the CDC's Swine Influenza and You web page.

You can get updates on what's happening with the swine flu at the CDC Emergency Twitter site.

The Extra-Wide Chair

Yesterday, when I walked into my primary care doctor's waiting room with my children, my younger daughter asked me to share a seat with her. She plopped down on an extra-wide chair in the office, the sole standout in a sea of regular-width chairs there. She thought it was a small couch meant for two, when in reality is it there to accommodate obese patients. I see more and more of these chairs in doctors' offices, evidence of the high obesity rate in America.

At first glance, the extra-wide chairs would seem out of place here, because I live in a very health-conscious city. Many people here ride public transportation, a choice that guarantees some exercise as you walk to and from your bus stop. The Central Valley and local farmers' markets provide a steady stream of fresh produce, and outdoor activities ranging from mountain hikes to tidepooling are just a short drive away.

But it's not always easy to make healthy choices. The public schools promote a Walk to School Week every fall, for example, but this is a somewhat pointless program here. The public schools in San Francisco have been decoupled from their neighborhoods in response to a series of lawsuits about the uneven quality of the education they provide. As a result, many children from kindergarten on up have to commute to school by car (driven by a parent) or school bus across town every day. Even if they want to walk to school, it isn't a possibility for them. With funding cuts reducing gym to an occasional rather than a daily class at many schools as well, schoolchildren are getting less and less exercise.

When my own children were born several years ago, I began to notice what I called the "thin grandmother" syndrome. At follow-up doctor's visits after their children were born, many new mothers brought their own mothers along to help watch the baby. Most of the grandmothers were thin, but, increasingly, many of the mothers were not. No doubt they still carried some weight from their pregnancies, but I suspect lifestyle was also a factor - lots of driving, unhealthy eating habits, stress, and very little exercise. All of this happened in just one generation. The CDC's survey of obesity trends from 1985 to 2007, based on data collected from state health departments, shows a sharp increase in obesity rates during that time. In 1990, obesity rates topped out at 15% in a the states participating in the survey. By 2007, obesity rates had increased to 30% or higher in three Southern states, and over 25% in thirty states altogether. The CDC's data shows obesity rates creeping upward and westward state by state since the mid-1990s.

I understand how we got here as a society - the lure of convenience foods, the busy work schedules that allow little free time for exercise, the stress of getting everyone where they need to go each day, the time it takes to cook a healthy dinner at home or pack a healthy lunch. When I see the extra-wide chairs in the waiting rooms, though, I start to question to idea of a national health care plan, because access to health care won't solve the problem of obesity. Increasing obesity rates and the many expensive health problems linked to obesity, in fact, could bankrupt such a plan.

It's important to provide coverage for the uninsured, with states such as North Carolina recently making news headlines because a record 25% of the state's residents don't have medical insurance. But health care needs to be just one of the tools used to fight obesity. The country also needs better public policies relating to public transportation, employment rights, housing and urban planning, public education, and other issues that directly or indirectly affect people's health. Americans also need to take more personal responsibility for their health, mindful that their children are watching and learning from them. Last but not least, their choices have consequences not just for themselves and their families but for the country and its welfare as well.

Cell Phone Induced Adolescence

Last spring, when I was covering a medical conference, I used my cell phone incessantly for several days as I tracked down various doctors to interview for a set of news articles about their presentations. I kept my phone on as I walked from Moscone Center to the train to go home at the end of each long day downtown, and worried about what calls I might miss when the train went underground.

One night, when I got off the train in my neighborhood, I realized that the weather that day was, in fact, absolutely stunning. Who knew? I had been inside all day, running from session to session and downing coffee and sandwiches in the press room. That night, the sky was pink from the setting sun, the air soft and warm, and the tree leaves the pale green of spring. Just as I started to relax and enjoy the evening, my phone rang. I jumped and rummaged in my bag for the phone, but it was silent. That noise wasn't my phone's ring tone. I stopped on the sidewalk and listened. No, it wasn't my phone - it was a songbird. Perhaps the bird was trying to tell me to turn off my phone.

And so, when my husband and I decided to upgrade our old cell phones a few days ago, a growing necessity for our respective work, I had mixed feelings about it. On the one hand, I craved a hip new Blackberry to replace my boring, 4-year-old flip-open phone and (wouldn't it?) enhance my un-hip life. On the other hand, I wondered what owning a Blackberry, commonly referred to as "Crackberries" out here because they are so addictive, would do to me.

When he brought home a Blackberry-esque cell phone for each of us (Blackberries, we decided, were too expensive), within minutes I had it turned on and was playing with it. To keep the kids busy so I could tinker with my phone, I gave them our old cell phones. My four-year-old was not interested in them, but my six-year-old, the High School Musical fan, was. Soon she had curled up on a chair in the living room, poking at buttons to change the the screen image and theme colors of the phone. Before long, she was playing all the different tinny-sounding ring tones on the phone, over and over and over again. When I told her to put the phone away, she rolled her eyes at me. When we took it away, she pouted.

The next morning over breakfast, my husband and I excitedly pulled out our new phones and tried to figure out how the camera function worked. My older daughter ignored her cereal and poked more buttons on her "new" cell phone as well. When I looked up, though, my four-year-old was staring at me, hands on her hips, with an expression of wise exasperation. Um... did I forget to get you your cereal, honey?

"Okay, everyone, put the phones away," I said. I turned mine off and got back to more important business: breakfast.