Friday, March 1, 2013

Fear, Poor Communications and the Nebulas 'Community Benefit'



With the boys 5th birthday approaching, I have spent a substantial amount of time reflecting on the choices I made and taking the time to review my decisions and revise my positions particularly on vaccinations and other preventative health measures. I have been mulling over the whys and how I came to the decision to delay vaccinating my son.

 The main reason was fear. I was scared that I would allow something to be done to my child, it would cause him irreparable harm, and I would have no one to blame but myself. There was nothing in the 10 years of premedical and medical training that calmed these fears. I knew all the facts and statistics. I knew about incidence rates, relative risk, community immunity but none of these things meant shit if there was even a miniscule chance of it harming my precious baby. There were some things that I was able to justify with some credibility but for the rest I allowed my fear to run roughshod over my intellectual integrity.

The fear was compounded by the seeming inability for the public health community to effectively communicate with me. All public health publication I saw was written to communicate complicated ideas to people without much scientific literacy. Often these publications come off as condescending and seem to have the expectation that people will follow their paternalistic edicts without any discussion or inquiry. On the flip side, when you try to research these things you either go to scientific papers that, even with an advanced science degree, take many hours to read, parse and understand or you stumble upon pseudo or nonscientific sources that reflect and feed your fears.

Fear is a huge motivator. It is one of the things that allowed our species to survive. New channels, politicians, advertisers, religious leaders, parents, and swindlers all use it to their benefit. It is our job, however as ever evolving beings to recognize when our fear is overwhelming our reason and better judgment and do what we can to overcome it. We can only use the information we have to make the best decisions we can. If you try to base your decisions based on everything you don’t know you will forever be paralyzed with indecision.
 Below are my initial thoughts on some vaccines/preventative treatment and reasoned revisions of those opinions.

Vitamin K
·         The Facts
o   In the US, this is given shortly after birth (usually within 6 hours) to prevent Hemorrhagic Disease of the Newborn (HDN) which causes bleeding in the brain.
o   Without the injection the incidence is between 2.5 and 17 per 1000 newborns while when it is given the rate falls to near zero.
o   In the countries where it is not routine the incidence can be as high as 30 per 1000.
o   The risk is higher in newborns who are sick, premature or whose mothers take certain medication which inhibit Vitamin K absorption (anti-seizure meds and anticoagulants) or have certain mal-absorptive diseases.
·         Previous opinion
o   When the boy was born I felt that this was unnecessary because I did not have any of the risk factors and there were was some hints in the literature that it increased the risk of a certain type of leukemia.
·         Reasoned Revision/Current Opinion
o   HDN can be very severe if not caught and treated early. The symptoms can also be fairly insidious initially so it can be missed.
o   The link to childhood cancer has been studied extensively and no one has been able to replicate the findings of increased risk.
o   This single shot gives almost 100% protection and is the best measure to prevent HDN until researchers are able to pinpoint a more precise way to determine which newborns are likely develop this condition
Erythromycin Eye Ointment
·         The Facts
o   Used to prevent ophthalmia neonatorum (ON) which causes blindness in 3% of effected newborns.
o   Caused by chlamydia or gonorrhea infections that is passed to the newborn during vaginal delivery.
o   A woman can have chlamydia or gonorrhea without any symptoms.
o   Risk is increased if you have had multiple sexual partners, are under 25 or live in an area where infection rates are high.
·         Previous Opinion
o   I tested negative for Chlamydia and gonorrhea during pregnancy, was in a mutually monogamous relations and had no other so I declined this intervention.
·         Reasoned Revision/Current Opinion
o   I believed then and still do that there are many criteria that should indicate that you make sure that your child receives this intervention
§  If you have ever tested positive for chlamydia or gonorrhea.
§  If you have never been tested for chlamydia or gonorrhea.
§  If you are not in a mutually monogamous relationship with an uninfected partner.
§  If you live in an area with a high rate of infection with gonorrhea and chlamydia.
§  Or if there is any unknown/uncertainty about the above.
o   The recent emersion of antibiotic resistant gonorrhea may in the near future necessitate the use of the equally effective silver nitrate or povidone iodine drops, which are more effective for treating gonorrhea and equally effective in treating chlamydia (Darling and McDonald, 2010)  but do not have an approve formulation in the US.

Hepatitis B
·         The Facts
o   Since the introduction of the vaccine infection rates have decreased by 75-95%
o   Children who become infected usually have no acute symptoms but can be contagious
o   Children have an increased risk of developing chronic infection resulting in liver damage and cancer.
·         Previous Opinion
o   I decided to decline this vaccine when he was born.
o   I was fully vaccinated and was planning on exclusively breastfeeding and not sending him to daycare so I felt that he was not at risk and would still be protected if he got it at a later time.
o   I delayed this vaccine until he was 2.5 years old and was beginning to spend time with adult and children other than family
·         Reasoned Revision/Current Opinion
o   While my intentions were good it is possible that things may not have worked out as we planned and he may have been put at unnecessary risk.
o   I would have this vaccine given at the first office visit after hospital release and then on the recommended schedule (2nd – 1-2 months old and 3rd – 6-18 months)

Flu Shot
·         The Facts
o   Can present with mild upper respiratory symptoms to severe illness and death depending on the specific virus, when and who gets vaccinated and how well vaccine matches circulating virus
o   Complications (pneumonia, ear and sinus infections, dehydration and worsening of chronic conditions) from the flu are more common if you are older (over 65), young children (especially those who are too young to be vaccinated), pregnant women, and people with other conditions like asthma, diabetes or heart disease.
o   Since 1976 there have been between 3,000 to 49,000 deaths attributed to the flu each year.
o   Spread by doplets from coughs, sneezes or speaking in the air or on surfaces
o   It is possible to spread about 1 day prior to symptoms and for 5-7 days after symptoms appear. Young children and immune compromised people may be infectious for longer.
o   The only absolute contraindication is severe allergy to chicken eggs or had severe reaction to flu vaccine in the past
·         Previous Opinion
o   I was very ambivalent about this vaccine for a long time. I was young and healthy and thought the flu was just uncomfortable and not a big deal.
o   I got it some years when it was free and offered somewhere convenient but other skipped it.
o   I avoiding it for the boy until he was 2.5 years old
·         Reasoned Revision/Current Opinion
o   Getting a flu shot protects more than just me (though this is true for all vaccines), it helps keeps all those people who are too young or too sick to be vaccinated or mount a full immune response healthy.
o   Now I make sure that all members of my immediate family get the flu vaccine as soon and as long as they can.
o   This is doubly important if you have friends or family who cannot receive the vaccine (under 6 months, immune compromised or severely allergic to eggs)
Current Childhood Vaccination Schedule
·         The Facts
o   All vaccines are subject to large randomized controlled trials to determine efficacy and safety. These are powerful enough to detect common adverse events.
o   All vaccines are subject to post-marketing monitoring to detect any rare adverse events.
o   The US has an extensive monitoring of adverse events through the Vaccine Adverse Event Reporting System (VAERS), Vaccine Safety Datalink (VSD) and Clinical Immunization Safety Assessment Network sponsored by the CDC and the Post-licensure Rapid Immunization Safety Monitoring System (PRISM) funded by the FDA to capture even the most uncommon of adverse events caused by vaccines.
o   There is no evidence that the entire current vaccine schedule or any part of it responsible for any serious or long term adverse reactions.
o   Despite the greater number of diseases that are being vaccinated against there are fewer chemicals and antigens in the current
·         Previous Opinion
o   In my effort to assuage my fears I took to the internet to research. Rather than finding well reasoned, scientific information explained in easy to understand but non-condescending language I came across websites written in seemingly scientific language by people claiming expertise that fed my fears.
o   I thought that by exclusively breastfeeding and avoiding daycare and other intuitional settings he would be protected until he was fully vaccinated at some later time.
o   Despite the mountains of evidence to the contrary I was swayed by the emotional and fear laced claims of people like Dr. Mercola, Jenny McCarthy and other of that ilk.
o   I avoided all vaccines until the boy was nearly a year old and then I spaced them out, getting only a single vaccine at a time.
·         Reasoned Revision/Current Opinion
o   With any future children I have every intention of getting all vaccines on the prescribed schedule.
o   The benefits of vaccines go way beyond keeping an individual from contracting an illness.
o   Population wide prevention of vaccine preventable diseases (community immunity) is an important benefit of the current vaccine programs. When uptake of vaccinations diminishes the risk of outbreaks increases.
o   Since the vaccine campaigns have been so successful the current generation has no experience with the ravages of illnesses that they prevent and so tend to place more weight on the possibility of rare side effects than on the more common effects of the illnesses themselves.
o   The vaccines are placed in the vaccination schedule at particular points in time to ensure that children are protected from illnesses when they are most susceptible. Delaying them puts them at risk when they are most vulnerable.

TL:DR: I didn’t vaccinate my son out of fear of the unknown but now I do because of an understanding of what I (we) do know. (We can only do the best with what we know. When we know better we will do better)  

Monday, March 28, 2011

Bonus Weekly Recipe - Buttery Yellow Cake

This is a delicious all purpose yellow cake

Ingredients
12 3/8 oz Cake flour
2 1/2 tsp Baking powder
3/4 tsp Salt
16 tbsp unsalted butter
11 2/3 oz granulated sugar
4 large eggs (room temperature)
1 tbsp vanilla extract
1 1/2 cup whole mile (room temperature)

Equipment
2 8" or 9" round cake pans (or a 9"x13" cake pan)
Vegetable cooking spray
Parchment paper
Electric mixer
Rubber spatula

Directions
  1. Heat over to 350 degrees
  2. Coat pans with cooking spray and place parchment over the bottom
  3. Whisk flour, baking powder and salt into a large bowl and set aside
  4. Beat the butter and sugar together with an electric mixer on medium speed until light and fluffy (usually 3-6 minutes)
  5. Beat in the eggs, one at a time, until incorporated, scraping down the bowl and beaters as needed.
  6. Beat in the vanilla
  7. Reduce mixer speed to low and beat in 1/3 of flour mixture until combined
  8. Add 1/2 of the milk and beat until combines
  9. Add second 1/3 of flour mixture and beat until combined
  10. Add second 1/2 of the milk and beat until combined
  11. Add the final portion of the flour and beat until combined
  12. Give the batter a final stir with a rubber spatula to make sure that it is thoroughly combined
  13. Pour the batter into the prepared pans and shake to level and smooth the top
  14. Bake about 20-25 minutes until a wooden skewer inserted into the center comes out with only a few crumbs (rotate the pans half way through cooking)
  15. Let the cakes cool in the pans for ten minutes on wire racks
  16. Run a knife around the edge and then flip out onto the racks, remove parchment and flip the cakes upright
  17. Cool 1 to 2 hours before icing

Weekly Recipe - Easy Chocolate Chip Cookies

These cookies are so easy to make that a 3 year old can do most of the work.

Ingredients
14 tbsp     Butter
1/2 cup     Sugar
3/4 cup     Brown Sugar
2 tbsp       Vanilla Extract
8 3/4 oz    AP Flour
1 tsp         Salt
1              Eggs
1              Egg Yolk
1/2 tsp     Baking soda
8.5 oz      Ghirardelli bitter sweet chips


Equipment
Small light colored skillet
2 glass bowls
kitchen scale
whisk
#24 scoop
measuring cups and spoons
1/2 sheet pan
Cooling racks
Parchment paper




Directions

  1. Preheat oven to 375 degrees
  2. Melt 10 tbsp of butter is the light colored skillet and continue to cook for 1-3 minutes until lightly browned.
  3.  Place remaining 4 tbsp of butter into a heat resistant bowl, pour in hot melted butter and whisk until melted.
  4. Add sugars to butter mixture and whisk  
  5. Add salt, vanilla extract and eggs.  Whisk until combined.
  6. Allow mixture to sit for three minutes and whisk again (repeat three more times)
  7. In a separate bowl combine flour and baking soda
  8. Slowly add flour mixture to butter mixture and stir to combine. 
  9. Add chocolate chips and mix to distribute evenly through dough.
  10. Scoop eight 3 tbsp cookies (#24 scoop) onto half sheet pan lines with parchment paper
  11. Bake for roughly 11-14 minutes until the cookies are just brown on the edges.
  12. Allow to sit on sheet pan for 2 minutes and then transfer to cooling rack.

Monday, March 14, 2011

Weekly Recipe - Crème Brûlée

I thought I would start something new on my blog so I am going to try and post one of my favorite recipes along with some of the background on how it evolved to what it is. Many of the recipes that I use regularly started out pretty different from their current form. Often I start with something out of my library of cookbooks and I make little changes over time (either by necessity because I didn't have an ingredient on hand, or on a whim because I think it will make it better). Others I happened upon and loved so much that I kept making them.


I absolutely LOVE Crème Brûlée. It is hands down my favorite dessert. Too often I will order it at a restaurant only to be utterly disappointed. Usually it is because the chef doesn't actually know what a Crème Brûlée is and ends up serving a Creme Carmel/Flan or just did a really poor job making the custard.

The first time I made it I was so scared that I was going to mess it up but it turns out that it is really easy to make. So easy that I can make it with my 3 year old 'helping.'


Ingredients
4 cups heavy cream
2/3 cup granulated sugar
1 pinch salt
1 Vanilla bean*
10 Large egg yolks
1/4 cup turbinado sugar (i.e. sugar in the raw)

Equipment
Large roasting pan
Dish towel
8 six oz ramekins
Kettle of boiling water
Medium non-stick saucepan
Silicone whisk
Large measuring cup or pitcher
Tong with rubber bands wrapped around the tips
Cooling rack

Directions
  1. Adjust oven rack to the lower middle position and preheat oven to 350°F.
  2. Cover the bottom of a roasting pan with dish towel.
  3. Arrange eight 6oz ramekins in the pan making sure they don’t touch.
  4. Bring kettle of water to a boil.
  5. Combine 2 cups of cream, granulated sugar and salt in a medium saucepan
  6. Scrape the seeds from the vanilla bean and add it to the pan along with the pod.
  7. Bring the mixture to a boil over medium heat, stirring to dissolve the sugar.
  8. Remove from heat, cover and let steep for 15 minutes.
  9. Place egg yolks in a large bowl and whisk.
  10. Stir the remaining 2 cups of cream into the hot mixture.
  11. Slowly add in 1 cup of the cream mixture whisking constantly until smooth.
  12. Whisk in the remaining cream until thoroughly combined.
  13. Strain through a fine mesh strainer into a large measuring cup or pitcher.
  14. Pour the custard evenly into the ramekins
  15. Put pan in the oven and pour boiling water to 2/3 up the sides of the ramekins.
  16. Bake until the custards are barely set and are no longer sloshy (30-35 minutes or 25-30 for shallow or fluted dishes).
  17. Transfer the ramekins to a wire rack and allow to cool for 2 hours.
  18. Set on baking sheet, cover with plastic wrap & refrigerate for at least 4 hours.
  19. Just before serving uncover the ramekin and blot the top dry with a paper towel.
  20. Sprinkle the top with turbinado sugar and shake to distribute evenly.
  21. Ignite torch and caramelize the sugar. (Keep flame 2in above ramekin move in a sweeping motion from the perimeter to towards the middle until the sugar is bubbling and deep golden brown.

Helpful Hints #1: You have to use heavy cream. There is no way to make this dish low or lower fat.
Helpful Hint #2: You really need to use a vanilla bean. It is impossible to get the wonderful vanilla flavor with the extract. If you plan ahead there are great places to get vanilla beans online for way cheaper than $5 each that you pay at the grocery.
Helpful Hint #3: If you get the packets of turbinado a single one is the perfect amount for the top of one ramekin.
Helpful Hint #4: I am a big fan of Oxo tongs. The large rubber bands that come on fresh broccoli work great to help the tips grip the ramekins. All other methods I have tried of extracting the ramekins from the water bath have failed miserably.
Helpful Hint #5: Don't spend the extra money on one of the specialty kitchen torches. Just get a butane torch from your local hardware store or at a garage sale for a $1 like I did.

Tuesday, March 8, 2011

So Much More

It has been just over a week since my grandmother died and only I have spent a lot of time reflecting on how she impacted my life and how things will be different now that she is gone.

From her I learned the joys of being woken up by a song.


I learned the importance of telling, and more importantly showing, people that you love and care for them and that hugs and kisses are important even when you are angry.

I learned to love the awesomeness of nature. She made everything interesting, from the tiniest detail on a flower petal to the vastness of an old gnarly oak. She taught me to love the fierceness of torrential rain, the harshness of rolling thunder and the beauty of the jagged bolts of lightning all while snuggling together on a screened porch in a hammock.

She was the person who taught me to be adventurous and that is okay to take the long way or even the wrong way just to see something new.

She was a gateway into world of creation. Mostly through painting and photography but she also helped me to see how I could used my more orderly mind to be creative as well.

She transformed by hatred of writing and horrid penmanship by teaching me to draw my letter. I loved to watch her write using calligraphy pens and my love of fountain pens grew from that.

She was my cheerleader, my teacher, my sounding board, a comfort when the world was harsh and a dear friend.

She was my grandmother, but also so much more.

Saturday, September 11, 2010

Shopping Rant

About a year ago, we purchased a compact, portable booster seat to use at the grandparents house or when we travel other places. It was a generic kind of seat, it was made by a recognizable but smaller brand but it had all the features we were looking for. We paid about $15 for it.

Fast forward to yesterday. Brian and I decided that we wanted to put away the highchair and get a booster chair for the house. Since the other one worked so well and had really held up to the abuse I went back to ToysRUs to buy another one. I was browsing the selection and found the exact same seat, no changes or upgrades of any kind, but with a Fisher Price label slapped on it and the price tag was jacked up to $25.

It totally sucks that Fisher Price thinks that their name means so much that they can buy someone's product, make no changes except putting their tag on it, and price it for 66% more.

Friday, September 3, 2010

I took the time to read the recent New Yorker article on the head of the NIH, Dr. Francis Collins. It was very interesting to learn of his unusual upbringing and his progression from, as he puts it, a fundamentalist atheist to a devotee of the Christian faith. The path started with an encounter with an dying patient who asked what he believed in. He felt uncomfortable that he did not have an answer and decided to research to "affirm his atheism." Part of this quest involved a discussion over a golf game with the pastor of the church is wife attended which ended with Collins writing on the score card -

"When God knocks on my door, in a way that I—not my wife or pastor, but I—know that it’s God who’s knocking on my door, I will then accept Jesus Christ."


He then gave it to the pastor and who signed it and the contract was sealed.

After the passage of several months and a hike in the Cascades in which

"...he turned a corner and saw a frozen waterfall, perfectly formed into three separate parts. He took it as a revelation of Trinitarian truth, the sign that he’d contracted for on Sam McMillan’s golf card. The next morning, he vowed to devote his life to the Christian faith."


This seems rather coincidental that he spoke to a Protestant minister and saw what he perceived as sign of the Christian triumvirate. Would he have seen a crescent moon and star if the contract had been with an imam or a star of David if the contract had been with a Rabi? Those would certainly be more spectacular to see a waterfall frozen in the shape of but that probably would have been written off as being created by man and rightly so. Could the symbol of three be the Triple Goddess (Maiden, Mother and Crone) of the Wiccan religion or the Hindu triumvirate of Shiva, Brahma and Vishnu? It is only because of his upbringing and immersion in American society which follows, predominantly, the Abrahamic traditions that he can makes the assumption that the beautiful display of nature is a sign of the Christian God.

The paragraph above is really just an aside, I am more amazed frustrated concerned dismayed that an individual who is so well educated in the scientific method can jump to such a wild conclusion with regards to an easily observable, testable and repeatable natural phenomenon. He seems to think that an appropriate response to a spectacular and seemingly miraculous occurrence, such as water freezing, is to attribute it to a supernatural cause (a la 'God did it') rather than taking the time to research (or even think about for a few minutes) the possible natural ways it could have occurred.

I recognize and applaud all the positive steps he has made in improving the standing of science in the US most importantly his work towards repealing the ban on stem cell research. I continue to give him the benefit of the doubt because he has shown himself a staunch defender of the scientific method in all public domains within his control and of the research that has received funding from the NIH that has drawn criticism because of the oddity of the explanation of the research and the fact that lay people do not understanding its value. But I can help but have the smallest amount of apprehension that the unscientific conclusion jumping will rear it head again but in a way that will effects others and not just what Dr. Collins does with his Sunday mornings.

Read more about Francis Collins in the article in the New Yorker.

Friday, August 27, 2010

Todays disapointment

Since I was old enough I have given blood and/or platelets with the red cross or other blood services. Some time in my early 20s I had to stop donating whole blood because it totally wiped me out and I took ages to get all my red cells back. After that I started donating platelets as often as 2 times a month. I viewed it was a way to give of myself that would not only help others but could save someone life.

When I got pregnant with my son I had to stop donating platelets. It has been over three years since my last donation and I have been preparing myself to start again as my son has been slowly weaning himself. A new hurdle to jump, for anyone who has been pregnant, is an HLA antibody test. They instituted this test because the Red Cross found that there were more transfusion reactions with blood from donors who were HLA positive.

So on Monday I went into the donation center and had them draw a vial of blood for the test. Today I called for the results and, unfortunately, I am positive for the HLA antibody and can no longer donate platelets. I am unable to express how hugely disappointed I am.

Wednesday, August 4, 2010

Might Does Not Make Right

I was happy to hear that Chief U.S. District Judge Vaughn Walker ruled that voter approved Proposition 8 was unconstitutional and that it

"fails to advance any rational basis in singling out gay men and lesbians for denial of a marriage license. Indeed, the evidence shows Proposition 8 does nothing more than enshrine in the California Constitution the notion that opposite-sex couples are superior to same-sex couples"


Although nothing will actually change in California based on this ruling, the judge has also granted a stay until appeals can be completed, this is just another step in removing another form of institutionalized discrimination from our country.

The comments that I see repeatedly from the supporters of Prop 8 have to do with the judge (who stands as a symbol of the elite who are out of touch with the common man) ignoring the voice of the citizens. They seem to think that if they get enough votes then they can ignore the constitution. They want to pretend that "majority rules" is a covenant of our republic. They conveniently ignore the fact that convincing a majority of registered voters to cast a particular vote on a particular issue has nothing to do with the legality or constitutionality of that issue. The Constitution and its amendments are designed to protect the rights of the citizenry from the whims of the majority.

Throughout history of the United States, the voting majority of each time has sought to propagate discrimination on many fronts including denying women and blacks the right to vote and prohibiting the marriage of interracial couples. In turn, each of these were revealed to have no rational basis and that continued support of those ideas were based solely on animus. The same applies to the continued prohibition of same-sex marriages. At its most basic a marriage is a legal contract between two consenting adults. There is no rational or reasonable excuse that two men or two women should not be able to enter in to this contract and receive all the federal, state and local benefits afforded to a male and female entering into the exact same contract.

Wednesday, April 21, 2010

Shopping Frustration

This past weekend I spent some time looking at clothes and shoes for my 2 year old son. I encountered the same three problems at each store.

1. The toddler boys section is about a quarter the size of the toddler girl section.

2. The sales in the girls section were significantly better than in the boys section (Huge clearance section with 80-90% off in the girls section and the most off in the boys section was 50%).

3. There are very few shirts and shoes that don't have some kind of print or logo. Everything from the cutesy 'little slugger' type things to huge brand logos and TV characters to ridiculous plaids and strips.

I would like some nice quality solid color shirts, tennis shoes without mass marketed characters on them and some cute summer waterproof sandals but I guess that is just too much to ask for.