Dr Jennifer Gunter is a physician who is board-certified in obstetrics/gynecology and in pain medicine. She has dedicated her medical career to relieving her patients’ suffering. She has even risked her own life by performing abortions, in a country where some abortion providers have been assassinated by anti-abortion terrorists. One might think that this would have earned Dr Gunter considerable prestige among feminists, as both an expert on women’s health and a champion of women’s rights. Yet Dr Gunter has come under fire for complaining that a lot of people are using the Internet to spread dangerous false information about health and medicine. In particular, she pointed out that the organization Our Bodies, Ourselves (formerly known as the Boston Women’s Health Collective) has occasionally given some ridiculously bad health advice, such as encouraging women to put yogurt or garlic cloves in their vagina. In response, Jennifer Block (a former editor for Our Bodies, Ourselves and for Ms Magazine) viciously attacked Dr Gunter in an op-ed that appeared on Scientific American’s website. [The op-ed itself was eventually retracted by Scientific American.]

Some Bad Advice From Our Bodies, Ourselves

Block claims that Dr Gunter is targeting Our Bodies, Ourselves because the book Our Bodies, Ourselves “was originally written in the 1970s, and not by doctors” [emphasis in original]. In reality, Dr Gunter was concerned because Our Bodies, Ourselves was still urging women to put garlic cloves or yogurt in their vagina. The advice to put garlic cloves or yogurt in one’s vagina was still on the Our Bodies, Ourselves website as of November 29, 2019, in an article that was published in October 2011 and revised on September 10, 2019.

Food Goes in the Mouth, Not in the Vagina

Dr Gunter tells us that the vagina is self-cleaning, and that one should not put food in it. Her reasoning makes a great deal of sense. Garlic cloves are often contaminated with soil bacteria, including the bacteria responsible for botulism. Putting a garlic clove in your vagina would give those bacteria the perfect environment to multiply and produce botulinum toxin. Thus, putting a garlic clove in your vagina could put you at risk for paralysis or even death. Similarly, yogurt does contain lactobacilli, and some lactobacilli are supposed to live in the vagina. However, yogurt does not necessarily contain the right kinds of lactobacilli. Also, any yogurt that contains live lactobacilli could contain other live bacteria. So a woman who puts garlic cloves or yogurt in her vagina could be running serious risks, in exchange for extremely questionable benefits.

A Parody of Feminism?

Block’s op-ed seems almost to be a parody of the romanticism that was embraced by some feminists in the 1970s. For example, Block snipes that “Gunter was a child in the 1970s, but surely she has read some history.” Block then went on to describe how women “took off their pants and looked at their own and each other’s cervices” and swapped home remedies: “they compared all this gathered wisdom to what men in white coats had been telling them and doing to them.” Block then went on to extol the “ideals of informed consent and participatory medicine” and the movement that “sent droves of women to medical school.” Yet Gunter was among the droves of women who went to medical school; Block was not. Gunter has not only looked at other people’s cervices, she has performed surgery on them. Gunter has risked her own life to give other women the chance to make their own decisions about pregnancy. This fact should give Gunter a degree of credibility and prestige that Black sorely lacks.

Tea-Tree Oil Could Disrupt the Endocrine System

Block does not understand that a lot of Dr Gunter’s advice is based on the concept of “better safe than sorry.” That is why Dr Gunter urges women to abstain completely from some unnecessary products, including alcoholic beverages and tea-tree oil, during pregnancy. Block dismisses the study on tea-tree oil as “an unpublished case report presented at a meeting with industry sponsors.” That is a gross misrepresentation that reveals how little Block knows about how science is done. In reality, the study was not a “case report,” which would be a story about something that happened to a particular person, perhaps for unknown reasons. Instead, the study was a study of human cells that were being grown in a laboratory under tightly controlled conditions. The study is not “unpublished”: its presentation at ENDO (the annual meeting of the Endocrine Society) is actually a form of publication. A formal article about the study was published in August 2019 in the Endocrine Society’s journal, The Journal of Clinical Endocrinology and Metabolism.

It is preposterous for Block to dismiss ENDO as “a meeting with industry sponsors.” The Endocrine Society is not an industry trade group. Rather, it is a professional society whose 18,000 members are physicians and scientists who study the endocrine system (i.e., the hormones). The Endocrine Society has safeguards in place to prevent industry from choosing which abstracts are accepted for presentation at ENDO. Furthermore, the study on tea-tree oil wasn’t done by a pharmaceutical company or by anyone with a commercial agenda. It was done by scientists who work for the National Institute of Environmental Health Sciences.

Lavender and Tea-Tree Oils Make Boys Grow Boobs

Scientists from the NIEHS already had compelling evidence that soaps, shampoos, or lotions that contain lavender oil or tea-tree oil have estrogen-like effects. Use of those products can cause gynecomastia, which means abnormal growth of the breasts in boys. The NIEHS researchers used standard laboratory methods to show that some of the compounds found naturally in lavender oil and tea-tree oil really do act like female hormones or suppress the effects of male hormones on human cells that are being grown in a laboratory. This study is part of the National Toxicology Program’s efforts to identify substances that disrupt the endocrine system and to assess what kinds of effects these substances are having on human beings and on wildlife. This is a big story—the kind a journalist should cover—but Block missed it because she does not know how science works.

Don’t Put Stones in Your Vagina

Dr Gunter has also warned women not to put “jade eggs” or other stones in their vagina. If you want to strengthen the muscles of your pelvic floor, do Kegel exercises instead. The stone itself could carry bacteria, such as the kind that causes toxic shock syndrome, which can be fatal. Also, a woman could injure herself while trying to remove a slippery polished stone from her vagina. Dr Gunter has treated similar injuries that resulted from women using sex toys.

Don’t Worry About Glyphosate in Tampons

Given Dr Gunter’s cautions about alcohol, lavender oil, tea-tree oil, and vaginal stones, you may be surprised to hear that Dr Gunter tells women not to worry about the trace amounts of glyphosate that might be found in tampons. Block feels that this reassurance is hypocritical. Block sneered, “No need for precaution, because there’s not enough research.” This attitude merely shows that Block herself is unaware of the enormous body of research about the safety of glyphosate. Ms Block’s attitude also suggests that she has poor math skills. The reported amount of glyphosate in tampons is extremely small. As Dr Gunter explains, using tampons for every single day of every period for 40 years would expose a woman to a total of 1 thousandth of a gram of glyphosate from the tampons. This amount really is too small to matter. So the glyphosate in tampons should be the least of your worries.

Don’t Steam Your Private Parts

Ms Block is outraged because Dr Gunter tells women not to steam their vulva (the external female genitalia). Ms Block feels that “vaginal steaming” is “about bringing comfort and blood flow to areas that have suffered trauma, disconnect, and abuse” and that it is a way to help women “regain sensation.” Dr Gunter is concerned that women might burn themselves with the hot water. In fact, there have been reports of women who burned their private parts while trying to steam them. However, Ms Block scoffs at Dr Gunter’s warning—“as if women can’t handle boiling water.” Yet the Shriner’s Hospital burn team has been warning people for decades that scalding-hot water, even hot tap water, can cause serious or even deadly burns. In one famous case, Stella Liebeck was badly burned by a cup of hot coffee that spilled in her lap. As a result, she required 8 days of hospitalization for skin grafting, followed by two years of additional treatments. Her case is described in the documentary Hot Coffee:

We Have No Safeguards Against Bad Journalism

Ms Block complains about some things that Dr Gunter supposedly has not written about. “Instead of taking shots at what’s in your fridge or nightstand, she could be using her platform to talk about, say, obstetric violence, the rising maternal death rate, the pelvic mesh disaster or the overuse of hysterectomies, to name a few trends more threatening to women’s health and lives than yogurt.” Not only is this criticism unfair, given that Dr. Gunter actually has addressed some of these things, but it shows that Ms Block completely misunderstands the particular gap that Dr Gunter is trying to fill.

Americans already have systems in place to deal with dangerous products and bad doctoring. The Food and Drug Administration regulates the marketing of medicines and medical devices. The state governments regulate medical practice within their borders. State governments issue professional licenses, and state governments can take those licenses away from bad practitioners. State courts allow patients who have been injured by doctors to sue for damages. The state can even prosecute and imprison doctors for committing crimes like assault, rape, or fraud. In contrast, we have absolutely no protections against bad medical journalism. We have no system in place to ensure that the medical advice that people spread through books and magazines or over the Internet is actually reliable.  

Whom Should We Trust?

Both Dr Jennifer Gunter and Ms Jennifer Block have written books about the vagina. By writing her op-ed, Ms Block evidently wants to position herself as superior to Dr Gunter as a source of knowledge and wisdom about women’s health and as a champion of women’s rights. That’s a breathtaking display of narcissism, even in the age of Trump. It is astounding that Scientific American published Block’s op-ed, given that the piece shows Block’s obvious contempt for the scientific method and her fear and loathing of the scientific community. Block argues that “Doctors are not gods.” That’s certainly true, but the editors of women’s magazines are generally not even doctors. [Scientific American withdrew the op-ed with this note: “Editor’s note. The post that originally appeared here has been removed because we’ve determined that it doesn’t meet our editorial standards.” It was later amended to this note: “Editor’s Note: Because of lapses in Scientific American’s review and fact-checking process, the post that originally appeared here has been removed due to problems with sourcing and citations. We apologize to the author and our readers.” ]

Editors and Standards

Many thoughtful people share Dr Gunter’s concern that the Internet is being used to spread misinformation about health. This problem is mainly a lack of editorship. Ideally, a work about science or medicine would go through a scientific review before publication. The review process should prevent total nonsense from being published at all, and it should allow any defects in acceptable material to be corrected before publication. The review process that scientific publications use is not fool-proof. But much of the material that is published for the general public has not been reviewed by any scientist. As a result, the public is being given a lot of bad advice about matters of life and death.

We Need Honest Critiques of Medicine

Society really does need people to criticize persons and institutions, such as public figures and the medical profession. However, such critiques must be based on facts, not on rumors and guesses and biases and paranoia. One cannot really provide a useful critique unless one knows the facts and understands what those facts mean. To gain that understanding, you often have to take some of the hard, nerdy courses in college or even graduate or professional school. That’s why we need educated experts like physicians and scientists to educate the public. We also need editors and journalists who can simplify and clarify those experts’ messages. Healthcare reformers need to focus on real problems and work on finding real solutions. One of those real problems is the bad health advice that people are getting over the Internet. Dr Gunter has warned us about it. People from many walks of life will have to work together to solve it.

What Is a Personality Disorder?

Psychiatrists are not supposed to give people a diagnosis of mental illness just for holding false beliefs. It is normal for people to hold some false beliefs. Normal people tend to hold the same false beliefs as their friends and relatives. Nevertheless, the thought processes that lead someone to embrace and spread falsehoods are definitely faulty. If someone’s faulty thought patterns, groundless fear, and dysfunctional behavior are causing disability and suffering, they do constitute a mental illness. If those thoughts, feelings, and behavior are different from what one would expect for the person, given that person’s social background, they could even qualify for a diagnosis of a psychiatric disorder. If those dysfunctional ways of thinking and relating to the world, and to the other people in it, are long-standing and pervade many aspects of the person’s life, they may even qualify for a diagnosis of a kind of mental illness called a personality disorder.

How Mental Illnesses Are Classified

In my book Don’t Feed the Narcissists! The Mythology and Science of Mental Health, I explain that a mental illness can be any problem in the realm of cognition (which means perception and thoughts), emotion, and/or action. Each mental illness is likely to have some manifestations is all three areas. Psychiatrists classify mental illnesses according to the area in which the problem is most obvious. If the person’s most obvious problem in the realm of cognition (perceptions and thought patterns), the person is said to have a psychosis. If the most obvious problem is in the realm of emotions, the person is said to have a mood disorder. If the most obvious problem is a longstanding pattern of odd or bad behavior, the psychiatrist may consider the diagnosis of a personality disorder. People with personality disorders also have problems with thinking and mood. Those problems may be serious; however, they are less obvious than the person’s odd or bad behavior.

Cluster A, B, and C Personality Disorders

The American Psychiatric Association’s Diagnostic and Statistical Manual provides the diagnostic criteria for many different mental illnesses. It defines ten personality disorders, which are divided into three clusters: A, B, and C. The cluster A personality disorders involve problems in how the person relates to reality. The cluster B personality disorders involve problems in how the person relates to other people. The cluster C personality disorders involve problems in how the person deals with fear. The symptoms of the disorders within a particular cluster often overlap. Also, a person can have a diagnosis from more than one cluster. Also, the problems in one area can reinforce problems in the other area. Mood disorders and behavior disorders are often rooted in problems with logical reasoning.

How Personality Disorders Shape Beliefs and Actions

The personality disorders can provide a useful framework for understanding why someone would become an antivaccination zealot. Like people with a cluster A personality disorder, antivaccine zealots have difficulty in using evidence to evaluate the soundness of their ideas, and they may have a deep-seated irrational suspicion of other people’s motives. Like people with a cluster B personality disorder, many antivaccine zealots like to create drama and strife, to draw attention to themselves, to dominate others socially, or to exploit others personally and financially. Like people with a cluster C personality disorder, especially obsessive-compulsive personality disorder, many antivaccine zealots have deep-seated irrational fears of becoming contaminated, and they may have a strong inertia bias: they would rather accept serious risk by doing nothing, rather than assume a minor risk by taking some sort of positive action.

Disability and Suffering

A diagnosis of a personality disorder is based primarily on the person’s behavior. Their behavior must be not only unusual but dysfunctional—causing disability and/or suffering for themselves or suffering for other people. To qualify for a diagnosis of a personality disorder, the person must have a history of dysfunctional behavior that started early in life, that pervades many areas of the person’s life, and that seems to be resistant to correction. The fact that the pattern of dysfunctional behavior started early, is pervasive, and is resistant to correction suggest that the underlying problem in cases of personality disorder is a failure to grow up emotionally—especially since the behaviors in question would often be perfectly normal for a much younger person. Just as the storybook character Peter Pan still had his baby teeth, people with personality disorders are trying to get through adult life with coping skills that worked well when they were toddlers but are inappropriate for adults. By studying people with personality disorders, you can learn lessons about how to grow up yourself. Just get really good at the things that people with personality disorders do poorly.

Worries About Vaccines

Many people are worried about whether vaccines are necessary and safe. This worry is understandable, given the increasingly commercial nature of healthcare in contemporary capitalism. Yet for reasonable people, concerns about vaccination can be quickly and easily dispelled through consumer education. Yet for the die-hard antivax zealots, no attempt at persuasion will work. At best, they will tell you that they have decided to “agree to disagree.” At worst, they will become personally abusive to anyone who tries to reason with them.

How People Choose Their Talking Points

When you ask antivaccine zealots why they are against vaccines, they express concerns that fall neatly into the A, B, and C clusters and sometimes align with a particular personality disorder. Expressing one of these concerns does not mean that you have the corresponding personality disorder. But if you do have a personality disorder, you are likely to embrace the antivaccine talking points that align with your personality disorder.

Cluster A personality disorders (problems in the relationship with reality)

• A stated preference for some mystical or magical alternative, such as homeopathy or energy healing (schizotypal personality disorder).
• Concern that an evil conspiracy is putting poisons in the vaccines in order to sterilize children or cause genocide or depopulation (paranoid personality disorder).
• Belief that vaccines are part of an attempt to exert mind control on the population (paranoid personality disorder).

Cluster B personality disorders (problems in relationships with other people)

• The use of antivaccine advocacy to seek attention for its own sake (histrionic personality disorder).
• The desire to portray oneself as superior to medical doctors and the world’s top experts on biology and medicine and public health (narcissistic personality disorder).
• The belief that because of their close personal relationship with Jesus Christ, God would not allow any of their children to become sick (narcissistic personality disorder).
• Belief that vaccination would be unnecessary because of one’s exceptional parenting skills—breast-feeding, home cooking, etc. (narcissistic personality disorder).
• A desire to discredit real doctors and real medicine in order to sell some bogus “alternative” product or service, such as naturopathy, homeopathy, or herbal medicine (antisocial personality disorder).
• A need to create drama in interpersonal relationships by arguing about nonsense (borderline personality disorder).

Cluster C personality disorders (problems with fear)

• A desire to avoid doing anything that sounds even remotely risky (avoidant personality disorder).
• A desire to submit to and obey some charismatic leader, such as a pastor or alternative health practitioner (dependent personality disorder).
• Fear of contamination because of the scary-sounding ingredients or trace contaminants in vaccines (obsessive-compulsive personality disorder).

Psychosis or Personality Disorder?

People with personality disorders have problems with how they perceive the world and how they think, but those problems are not severe enough for them to qualify for a diagnosis of a psychosis. People with personality disorders tend to have unusually poor judgment. They are poor judges of the truth of ideas. They are poor judges of other people. They are poor judges of themselves. If you try to reason with someone with a personality disorder about their antivaccination ideology, you will run smack into their judgment problem. Nothing you can say will make a difference, precisely because their judgement is so poor that they do not realize that their judgment is poor. (In psychology, this is called the Dunning-Kruger effect.)

Diagnosing Personality Disorder

How do psychiatrists decide if a patient has a personality disorder? One of the biggest difficulties in psychiatry is drawing the line between normal and abnormal, and between healthy and ill. Those are actually two separate challenges. People who have abnormally good skills in some area are, by definition, abnormal—but this departure from normality does not mean that they are ill. Also, normality itself is not necessarily good. For example, in some social circles, it is perfectly normal to embrace certain irrational beliefs and to behave badly. To qualify for a diagnosis of a personality disorder from a psychiatrist, your coping skills and behavior have to be more than just bad. They have to be remarkably and consistently bad, so much so that you are not functioning normally within your society.

The Cause of Personality Disorder

What causes personality disorders? Nobody really knows. In the early 20^th century, German psychiatrist Emil Kraepelin believed that the severe forms of mental illnesses, including the psychoses and the personality disorders, were probably rooted in disease of the brain, which could sometimes be genetic. (Of course, as soon as the medical cause of a particular mental disorder is discovered, the disorder gets reclassified, often as a neurologic disorder as opposed to a psychiatric disorder.) At the same time, Sigmund Freud was popularizing psychoanalysis, which focused on the presumed psychological causes of mental illnesses. Psychological explanations are probably adequate for most of the mild, common problems that can be solved through talk therapy. Any given case of mental illness could have some combination of medical and psychological causes. The more severe the illness is, the more likely it is that there is a medical component. Yet even if there is a strong medical component, the person may still benefit from talk therapy, to help them learn to cope with or even compensate for their brain problem.

How to Outgrow a Personality Disorder

Each of the three clusters of personality disorders represents a failure to meet a particular kind of challenge that adults are expected to meet. People with cluster A personality disorders engage in magical thinking because they lack mature skills in reality testing. People with cluster B personality disorders don’t know how they fit into society. As a result, they behave like toddlers or teenagers instead of like adults. People with cluster C personality disorders do not know how to manage fear. As a result, they either become childishly dependent or go overboard in trying to control things. Ideally, our educational system would help people develop the skills they need for adult life. Psychotherapy could help them learn the lessons that they missed in school.

Cluster A Disorders and Reality Testing

Reality testing means “the objective evaluation of an emotion or thought against real life, as a faculty present in normal individuals but defective in psychotics.” Of course, it is natural and normal to have mediocre skills at reality testing. That’s why superstitions (false beliefs about cause and effect) are common, especially among the poorly educated. Ideally, the purpose of a science education would be to help people develop good skills in reality testing. Unfortunately, science classes are often focused exclusively on getting students to cram a set of disconnected facts into their short-term memory. As a result, the students do not develop the skills in reality testing that they will need in adult life. Nor do they even retain many of the facts that they were supposed to memorize. To improve your own skills in reality testing, read some books on logic and about the history of science. Learn about how and why the current scientific theories were developed, and why the obsolete ones were discarded.

Cluster B Disoders and Fitting Into Society

The Cluster B personality disorders are problems in how people relate to other people. People with histrionic personality disorder use attention-seeking as a way to solve problems. Like a newborn, they cry for attention, so that higher-ranking people will solve their problems for them. For histrionic people, antivaccine advocacy can be a way to seek attention. People with narcissistic personality disorder try to use dominance as a way to solve problems. They want to be regarded as the best and the brightest, so that other people will serve them. However, other people may not admire the narcissists as much as narcissists admire themselves, and narcissists are trying to occupy a higher social position than they can handle responsibly. Narcissists want to occupy the role of wise elder, but they do not have the knowledge or judgment to fulfill that role. For example, a narcissist may want to be regarded as an expert on all aspects of health, even if he or she has never taken even an introductory college-level course in biology or nursing. As a result, they often give foolish, dangerous advice. People with antisocial personality disorder view other people as objects to be used and exploited, not as fellow human beings whose joys and sorrows are to be shared. These sociopaths may get involved in antivaccine advocacy as a way to market useless goods and services. People with borderline personality disorder have problems with regulating their emotions. They desperately seek close relationships but then deliberately do things that drive people away. Arguing over things like vaccination would be a perfect way to create this kind of drama.

Cluster C disorders and Handling Fear

Fear is the primitive emotion that we feel when we think that our bodies or our feelings might get hurt. The natural reaction to fear is avoidance. This is a major reason why people refuse vaccination. They are afraid of needles, and they are afraid of the scary-sounding ingredients in the vaccine. Anything that increases the person’s sense of fear could make them even more avoidant. That’s why attempts to educate people about the dangers of the vaccine-preventable diseases can backfire. By intensifying the person’s fear, you make them even more avoidant. They become so terrified that they freeze in panic. Terrified people often refuse to take any action, even to run to safety. For this reason, any public relations campaign to promote vaccination should be carefully tested, to make sure that it does not accidentally increase resistance to vaccination.

To Solve Vaccine Disputes, Eradicate the Diseases

The antivaccine movement is creating problems on two time-scales. In the short run, it is leading to outbreaks of serious diseases, such as measles and pertussis, as well as sporadic cases of tetanus. In the long run, the antivaccine movement is undermining efforts to drive some of the vaccine-preventable diseases into extinction. A global vaccination campaign drove smallpox into extinction in the 1970s. A similar campaign has already wiped out two of the three strains of wild poliovirus. Many of the other vaccine-preventable diseases can also be eradicated because they occur only in human beings. And once a disease is extinct, we can safely stop vaccinating against it.

Why Do We Vaccinate?

Vaccines are used to prevent diseases that are serious because they are caused by germs that are good at getting past the body’s innate immune system but that can be controlled by the body’s adaptive immune system. The innate immune system is the general-purpose response to any infection. In contrast, the adaptive immune response is a custom-tailored response to a particular infection. We use vaccines to prevent the diseases can cause serious illness, permanent disability, or even death before the body’s adaptive immune system develops the ability to fight them. The purpose of vaccination is to give the adaptive immune system a head start, so that it can recognize and fight the infection before it takes hold. Many of the germs that are really good at getting past the innate immune system are so highly adapted to living in the human body that they are found nowhere else in nature. Once we stop those germs from circulating in the human population, they go extinct. At that point, we don’t need to vaccinate anyone against them anymore.

Let’s Focus on Disease Eradication

The measles vaccine was introduced in the 1960s, and the United States eliminated measles in 2000. This meant that the measles virus was no longer circulating within the U.S. population. Yet we would still have a few cases every year, brought in by travelers who caught measles in areas where measles is still circulating. So to wipe out measles, we need to wipe it out worldwide. By focusing on disease eradication, we can make it clear that the purpose of vaccination is to promote public health, not private profit. As soon as a disease is eradicated, sales of the vaccine to prevent it drop to zero and will remain zero forever. So disease eradication would be a bad investment for a “pharma bro.” Disease eradication has another important benefit. Once a disease is eradicated, we no longer have to frustrating conversations about that disease with ill-mannered people who think that they know more than the experts.

Measles Quarantine

A 1941 measles quarantine sign from Clifton Heights, Pennsylvania warned that no one but a doctor or nurse was permitted to enter or leave the house or take anything from the house without written permission from the Board of Health. Anyone who broke that rule or tampered with the sign could be fined up to $100 (which was a lot of money back then) or jailed for up to 30 days. For this reason, “measles parties” would have been rare, if they occurred at all.

My Mother’s Measles

My mother got measles as a kindergartener in Pennsylvania in the 1940s. She does not remember the measles quarantine sign on her apartment; but she was very sick by the time the measles was diagnosed, and she had not yet learned to read. She does remember the quarantine sign from chickenpox, which she got a few years later. While she was sick, none of her friends were allowed to visit. A cousin visited before it was clear that my mother had measles. This cousin then got the measles.  My mother also remembers being terribly sick from the measles. While she had the measles, her bedroom was kept very dark to protect her eyes. Her parents knew that measles could cause blindness.

Why Is Measles So Contagious?

Unfortunately, quarantine is not enough to prevent the spread of measles. That’s because at first, a case of measles looks and feels exactly like a common cold. It makes the person cough. Each cough produces a spray of droplets that can carry the virus to other people. You could catch the measles from simply being in a room where an infected person had coughed two hours earlier. Measles is contagious for about four days before the rash appears and the diagnosis of measles becomes obvious. So even though measles patients were quarantined, they were often quarantined too late to keep the disease from spreading. For this reason, nearly everyone who was born before 1957 eventually got the measles.

Measles Damages the Immune System

An ordinary cold runs its course in about a week, as the immune system learns how to make antibodies to that strain of cold virus. But instead of getting better at that point, someone with measles starts to get much sicker. That’s because the measles virus infects some of the cells of the immune system. Instead of killing the measles virus, many of those cells make many new copies of the virus and then die. In other words, the immune system is badly damaged while it is making the measles infection worse. The lingering effects of this damage can last for 2 years.

The Measles Vaccine

I was lucky. As a child in the early 1960s, I was among the first wave of children to be vaccinated against measles. One of our neighbors got measles just before the vaccine came out. I remember how relieved my mother was that we had not been at that girl’s house while she was contagious and how grateful my mother was for the vaccine. In 1971, the measles vaccine was combined into a triple vaccine that immunizes children against measles, mumps, and rubella (MMR). Thanks to the heavy use of this cheap, effective, and remarkably safe vaccine, the United States was declared free of measles in 2000. Unfortunately, measles has not yet been eradicated worldwide, so we still see outbreaks that result from imported cases.

Controlling Measles Outbreaks

Today, a measles outbreak is a public health emergency. Measles may spread like the common cold, but it suppresses the immune system like HIV. For this reason, most of the deaths due to measles are due to secondary infections, such as pneumonia. Even with the best of modern medical care, measles kills one or two out of every thousand patients. The death rate is much higher among people with suppressed immunity, including cancer patients. Up to a quarter of those people may die of measles.

Today, when a measles outbreak occurs, public health authorities race to find and help everyone who may have been exposed. If nonimmune people can be found within 72 hours of exposure to measles, they may be given a dose of the MMR vaccine. Vaccination during that time period may prevent the disease or at least weaken it. If an unvaccinated person cannot be found within 72 hours or is pregnant, is too young for vaccination, or has a suppressed immune system, they can be given a dose of immune globulin instead. Immune globulin is a dose of antibodies from human blood donors. It can be given up to 6 days after exposure. Exposed people who show signs of illness are quarantined, to keep them from spreading the disease to anyone else. During a measles outbreak, children who have not been or cannot be vaccinated may be banned from public school or day care facilities.

Wipe Out Measles, Don’t Spread It!

So “measles parties” are a myth. They would even be a crime. The MMR vaccine is cheap, and it is safe and effective when used as directed. However, it is a “live” vaccine and thus cannot be given to pregnant women, infants, or people with a damaged immune system. To protect them, we need to make sure that practically everyone else is immunized. If we vaccinate enough people worldwide, measles will go extinct. After a vaccine-preventable disease is eradicated, we will not need to vaccinate anyone else against it. Meanwhile, antivaxxers pose a serious threat to public health. They are keeping the vaccination rate low enough to allow diseases to spread, and they congregate in communities and networks that make it easier for diseases to spread.

Fortunately, a global vaccination campaign is about to drive polio into extinction. After the polio viruses are no longer circulating, we will no longer need to vaccinate anyone against this disease.

Rotary International has played an important role in supporting the polio eradication campaign. For more information, visit: https://my.rotary.org/en/take-action/end-polio.

What is an LLMD?

An MD degree, which stands for medical doctor, means that the person has been graduated from an accredited school of medicine. Often, medical doctors have other credentials. For example, FACP means that the doctor is a Fellow of the American College of Physicians. FACOG means that the doctor is a Fellow of the American College of Obstetricians and Gynecologists. Those fellowships are real, meaningful credentials. However, there is no official organization that grants LLMD credentials. In other words, LLMD is a phony credential. Let the buyer beware.

People seek out LLMDs for an understandable reason. When sick people go to a doctor, they mainly want the doctor to answer three questions: What is happening to me? Why is it happening to me? and How can you make it stop happening to me? In many cases, the doctor cannot answer any of those questions. As a result, desperate patients often go from doctor to doctor until they find someone who gives satisfying answers to at least one of those questions. Often, it is a struggle just to find a doctor who believes that they are really sick. Yet the answer that satisfies the patient is not always correct. As a result, people with mysterious chronic illnesses become easy prey for practitioners who provide false but satisfying answers. Many of these practitioners use one catch-all diagnosis, which is a single diagnosis that is given as an explanation for everything that is going wrong in practically every patient’s body. Since Lyme disease can cause many odd symptoms, it is useful as a catch-all diagnosis.

The doctors who call themselves “Lyme-literate” have been giving patients the answers that the patients are desperate to hear: Yes, you really are sick. I know what is happening to you, and I will try to make it stop. The LLMDs then start the patients on a long course of antibiotics, sometimes intravenously. This long-term treatment is profitable for the doctor because the patients must make many appointments. However, the long-term antibiotic treatment does little or no good and can cause serious harm, including death. In other words, the patients are given the wrong diagnosis. As a result, they get the wrong treatment, which probably does more harm than good. Since the treatment involves overuse of antibiotics, it poses a risk to everyone’s health. The long course of antibiotics allows the patient to develop antibiotic-resistant strains of bacteria, which can then spread to other people.

What is Lyme disease?

Lyme disease is useful as a catch-all diagnosis because it produces chronic inflammation. Thus, it produces the same signs and symptoms as many other chronic inflammatory diseases. The first known cases of Lyme disease were originally diagnosed as juvenile rheumatoid arthritis because the patients had hot, swollen, painful joints. Then, someone thought it was odd that so many children from Old Lyme, Connecticut, were coming down with the same rare, noncontagious disease. These children had been playing in the woods, and some of them remembered having tick bites and rashes.

Eventually, a medical entomologist named Willy Burgdorfer found the spiral bacterium (spirochete) that causes Lyme disease. It was named Borrelia burgdorferi in his honor.

Lyme disease is a chronic inflammatory disease. Unless you saw a tick or a rash, Lyme disease looks and feels just like many other chronic inflammatory diseases. The only way to tell these diseases apart is to do some laboratory tests. Unfortunately, the laboratory tests are not always accurate.

A laboratory test is like a burglar alarm. It is supposed to go off whenever there is a burglar in the house, but only when there is a burglar in the house. If it fails to go off when there really is a burglar, the result is a false negative. If the alarm goes off when there is no burglar, the result is a false positive. LLMDs often rely on Lyme disease tests that are nonspecific, which means that they produce a lot of false-positive results. In other words, many of the people who have been told that they have chronic Lyme disease may not have had Lyme disease to begin with. Currently, a two-step process is recommended for diagnosing Lyme disease.

In real cases of Lyme disease, a 2- to 4‑week course of antibiotics is effective in curing the infection. So far, we have no evidence that the bacteria can survive the recommended course of antibiotic therapy. Of course, the antibiotic cannot undo the damage that the infection has done to the body. Thus, some people may continue to suffer from symptoms, even after their Borrelia burgdorferi infection has been cured with antibiotics. However, this problem should not be called chronic Lyme disease. Instead, it could be called post Lyme disease syndrome (PLDS). But in many of these cases, the symptoms may be due to some other disease. A patient can have more than one disease at a time!

How can a registered dietitian help?

Many chronic inflammatory diseases are due to a rich, fatty diet. Often, these diseases can be cured by switching to a low-fat, purely plant based (vegan) diet. A few plant-source foods can create problems for some people. The most common offenders are wheat, soy, nuts, citrus fruits, and strawberries. A registered dietitian can help you plan an elimination diet to figure out which foods might be making you sick.

Your lung contains many tiny sacs that are supposed to fill with air when you inhale. But if you have a lung infection, those tiny sacs can fill up with pus or other fluid instead. Swelling of the tissue that surrounds the air sacs can also make it hard for the air sacs to inflate. This problem is called pneumonia. If a case of pneumonia gets bad enough, you could suffocate. That is why pneumonia has always been a major cause of death.

Fortunately, there are a few simple things you can do to protect yourself against pneumonia. One is to make sure that you get all of your recommended vaccinations, possibly including the pneumonia shot. The pneumonia shot protects against several strains of Streptococcus pneumoniae, which is also called the pneumococcus. Pneumococcal vaccines are given to babies and to elderly people, as well as to anyone else who is at risk for pneumococcal infection. The vaccine is particularly important for protecting people against the antibiotic-resistant strains of pneumococcus.

Streptococcus pneumoniae is a facultatively anaerobic organism. That means that it thrives in an oxygen-rich environment, such as the upper respiratory tract, but can also live in oxygen-poor environments. As a result, it thrives in the human upper respiratory tract, which is its natural habitat. However, it can also invade deeper tissues, such as the bloodstream, heart, joints, bones, and brain.

Since the pneumococcus naturally lives in the human upper respiratory tract, it is just waiting for an opportunity to cause problems. As a result, it often causes pneumonia and invasive infections in the wake of some other illness, such as a cold or a case of the flu. Thus, the influenza vaccine can also help to protect against pneumonia. Lung diseases such as emphysema, which is due to damage to the walls of the air sacs, can also increase the risk of lung infections and death from pneumonia.

To protect itself against the human immune system, the pneumococcus secretes a complex sugar called a polysaccharide. This polysaccharide forms a capsule around the bacterial cell. The capsule makes it hard for a white blood cell to grasp and swallow the pneumococcal cell. The capsule also hides the bacterial proteins. Thus, it makes it harder for the body to recognize the bacteria as a foreign invader. The human immune system can make antibodies against the polysaccharide. However, each strain of pneumococcus has a different polysaccharide. As a result, the antibodies against one strain of pneumococcus will not protect you against a strain with a different polysaccharide capsule.

Why Are There Two Types of Pneumococcal Vaccine?

Two types of pneumococcal vaccine are available. One type is the polysaccharide vaccine, which is made out of the polysaccharides from 23 different strains of pneumococcus. The other type is a conjugate vaccine. It is made by binding the polysaccharides from 13 different strains of pneumococcus to a bit of protein called a conjugate. The purpose of the conjugate is to help the body develop a stronger, longer-lasting immune response, even in children under 2 years of age.

Who Needs the Pneumonia Vaccine?

The pneumococcal conjugate vaccine is routinely given to babies at age 2, 4, 6, and 12 to 15 months of age, as well as to patients age 65 years or older. It may also be recommended for patients age 2 years to 65 years of age if they have certain health conditions. The pneumococcal polysaccharide vaccine is recommended for patients over 65. It may also be recommended for younger patients who are at high risk for pneumococcal infection.

Jill Stein, a medical doctor who is running for President on the Green Party ticket, has claimed that the pharmaceutical industry has a corrupting influence on the Food and Drug Administration (FDA). She has also claimed that she was part of a public health movement that led to the removal of mercury from childhood vaccines. In reality, we have no evidence that the mercury in childhood vaccines was causing any harm. Nor was any grassroots organization, other than the American Academy of Pediatrics, involved in the decision to stop using a mercury compound called thimerosal as a preservative in vaccines. (Stein is an internist, not a pediatrician.) The decision to make childhood vaccinations mercury-free was made by the FDA and the Centers for Disease Control and Prevention (CDC). Prominent antivaccination activists started speaking out about mercury in vaccines only after the vaccines became mercury-free.

It is disturbing that Republican and Green Party Presidential hopefuls, including some medical doctors, have been using the talking points of the antivaccination movement. What’s worse is that any medical doctor, and especially any medical doctor who wants to be chief executive of the federal government, does not seem to know how the federal government works to protect public health.

Many laymen were horrified to hear that a mercury compound was ever being used as an ingredient in childhood vaccines. Yet that mercury compound is a powerful preservative that was being used to solve a serious safety problem. This problem became obvious in 1928, in a disaster called the Bundaberg Tragedy. A bottle of diphtheria vaccine in a doctor’s office in Bundaberg, Queensland, Australia, became contaminated with a bacterium called golden staph (Staphylococcus aureus). The bacterium was probably carried into the bottle by the needle that was used to draw out one of the first doses from the bottle. Then, the bacteria grew inside the bottle as it sat on a shelf between doses. Twelve of the children who received vaccine from this contaminated bottle died. Five others became seriously ill but recovered. To prevent a similar tragedy from happening in the United States, the US Code of Federal Regulations (21CFR610.15) requires vaccine makers to put a preservative in multiple-dose containers of practically all vaccines. Single-dose containers can be preservative-free but are more expensive.

The regulation does not specify which preservatives must be used. However, it does say that the preservative must be “sufficiently nontoxic so that the amount present in the recommended dose of the product will not be toxic to the recipient.” Also, the preservative must not interfere with the potency of the vaccine. Thimerosal has been used since the 1930s as a preservative in vaccines because it was the most effective option, it did not interfere with the potency of the vaccine, and it was well tolerated. Thimerosal has also been used as a preservative in contact lens solutions. Even today, despite an extensive research effort, we have no evidence that the use of thimerosal in vaccines has caused any health problems.

The person who raised the question of the mercury content of medicines (not specifically vaccines) was Frank Pallone, a Democratic Congressman from New Jersey. In 1997, he introduced an amendment to the FDA’s reauthorization bill. This amendment gave FDA two years to compile a list of all medicinal products that contain mercury compounds as ingredients. The FDA had to analyze what kind of mercury compound was in each product, and how much of each mercury compound the product contains. In response to this Congressional mandate, the FDA revisited the question of how much exposure children were getting to thimerosal through their vaccinations.

Because of the introduction of some new vaccines, the amount of thimerosal that children were receiving had gone up. In 1999, scientists at the FDA calculated that the recommended vaccines would deliver a total of 187.5 micrograms of mercury. (A microgram is a millionth of a gram.) However, there was no reliable way to judge whether this amount of mercury exposure is a problem. In the human body, thimerosal is broken down into ethylmercury, but the federal guidelines on mercury toxicity were based on methylmercury. To be on the safe side, the scientists assumed that ethylmercury would be just as dangerous as methylmercury. (We now know that it is not, because it is quickly eliminated through the kidneys.) So they suggested that steps be taken to reduce thimerosal exposure. Back in 1999, we had no evidence that the thimerosal in vaccines was causing problems. By now, we have evidence that it was not causing any of the health problems that were investigated. However, it did become a serious public relations problem.

The FDA and the CDC take vaccine safety seriously. As a result, the recommended vaccines are amazingly safe. Yet there is one thing that we can do to improve safety still further, while restoring public trust in the public health authorities. We must focus on driving diseases like polio, measles, and rubella into extinction through vaccination. Once a disease is extinct, everyone is protected against it, forever. As a result, children do not need to be exposed to even the minimal risks, and the discomfort, of the vaccination. Instantly, the sales of the vaccine drop to zero. By working to eradicate a vaccine-preventable disease, we public health activists make it crystal clear that our goal is public health, not private profit.

Measles is not the only viral infection that is known to produce long-term suppression of the immune system. Another example is the human immunodeficiency virus (HIV), which is the cause of acquired immunodeficiency syndrome (AIDS). However, HIV and the measles virus attack different kinds of white blood cells, which are the workhorses of the immune system.

HIV attacks the T4 lymphocytes, which are often called T‑helper cells. T‑helper cells help the other cells of the immune system recognize infections and tumor cells. After an HIV-infected person’s T4 cell count drops to dangerously low levels, his or her immune system is less able to fight many infections and some cancers (such as Kaposi’s sarcoma). Thus, the weakening of the immune system gives germs and cancer cells an opportunity to survive and thrive. The resulting diseases are called opportunistic.

People who are infected by HIV will remain infected for the rest of their lives. In contrast, most people who catch the measles will eliminate the measles virus from their body after only a few weeks. Yet the measles infection can cause long-lasting effects on the immune system because it wipes out the immune system’s memory. Measles virus kills the B memory cells, which are the white blood cells that are supposed to remember the germs that the body has successfully fought in the past. After the B memory cells are killed off, the immune system must relearn much of what it had already learned about dangerous germs. In the meantime, the person remains at risk for opportunistic infections.

HIV is bad, and so is measles. Having HIV and measles at the same time is particularly bad. The death rate from measles is particularly high in people who have any other form of immune suppression. Unfortunately, people who have a suppressed immune system cannot be vaccinated against measles, because the measles vaccine is a “live” vaccine. To protect those vulnerable people, we must ensure that practically everyone else is vaccinated against measles.

Most of the deaths due to measles are due to opportunistic infections. Thus, it is hardly surprising that the death rate from measles started to fall after the introduction of antibiotics, even though antibiotics have no effect on the measles virus itself. Yet even with the best of modern medical care, people still die of measles. Even if they survive, they may be left with permanent disabilities, such as blindness, deafness, and brain damage. In some cases, the measles virus infection may persist in the brain. This persistent infection leads to a horrible disease called subacute sclerosing panencephalitis (SSPE), which slowly destroys the brain. Thus, it leads to a slow and horrible death. There is no cure or even any effective treatment. Fortunately, SSPE can be prevented by preventing measles.

The vaccine against measles provides powerful, long-lasting protection. If you have received two doses of the measles vaccine, your chances of catching measles go down by about 97%. Thanks to the widespread use of the measles vaccine, measles was eliminated from the United States by the year 2000. Unfortunately, we still have occasional outbreaks of measles in the United States. Most of these cases can be traced to someone who was exposed to measles in some other country. So the best way to protect ourselves against measles is to drive the measles virus into extinction worldwide.

Unfortunately, many parents are refusing to allow their children to be vaccinated against measles. Many of these parents have been told that it is better to allow their children to get sick, so that they develop immunity naturally. In reality, many of the vaccine-preventable diseases are dangerous because they suppress the immune system. This immune suppression is good for the germ that causes the disease, but it is bad for the person who has the disease. As a result, having a vaccine-preventable infection can increase your risk of dying of some other infection.

Many parents are refusing vaccination because they think that the vaccines are unnecessary and unsafe. Conspiracy theorists claim that vaccines are being promoted simply to make money for the pharmaceutical companies. Yet if some sociopathic “pharma bro” really wanted to make money on vaccines, he would make sure that the vaccine-preventable diseases remain in circulation. Once a disease has been driven into extinction through vaccination, there is no longer any need to vaccinate anyone against it.

Smallpox is extinct. Today, nobody vaccinates children against smallpox. After polio is extinct, the sales of the polio vaccine will drop to zero. Like smallpox and polio, measles is caused by a virus that can be found only in human beings. Once we have wiped measles, mumps, and rubella off the face of the earth, nobody will need the MMR vaccine. But it would be madness to stop vaccinating against those diseases before then.

For information about efforts to eradicate measles, visit the Measles & Rubella Initiative.

Dr. H.’s basic argument is this: She thinks that it would be better for your baby to catch whooping cough, which is a horrible and sometimes deadly disease, than to be vaccinated against whooping cough. This is what whooping cough is like:

Sometimes, pertussis is even worse than this. Some newborns are not strong enough to cough like this. Instead, they simply stop breathing and die, without warning.

Dr. H. claims that this study by Warfel and coworkers shows that having a natural Bordetella pertussis infection would be better than vaccination for promoting herd immunity. This idea is total nonsense. Whooping cough was once common. It is now rare, thanks to vaccination. Having more natural cases of Bordetella pertussis infection among the population would lead to more illness and more deaths. Better vaccination coverage leads to less illness and fewer deaths.

The first vaccine against Bordetella pertussis was introduced in 1940. At the time, roughly 6,000 Americans per year were dying of whooping cough. Roughly 95% of the dead were children. Thanks to the vaccination, the death rate dropped sharply. However, we are still seeing occasional cases of whooping cough, even in highly vaccinated populations. Even the immunity that results from a natural infection lasts for only 4 to 20 years. The protection from vaccination lasts for only about 4 to 12 years. That is why doctors urge people to get booster shots against pertussis. If you have partial immunity to pertussis, you might get only a mild case of the sniffles from a Bordetella pertussis infection. Yet you could pass the bacteria on to someone else, who could get severely ill.

Warfel and coworkers wanted to answer an important question: Is the modern acellular pertussis vaccine less effective than the old-fashioned whole-cell vaccine at preventing the spread of Bordetella pertussis from person to person? Since it would be unthinkable to expose human beings to live Bordetella pertussis, the researchers used baboons as experimental subjects. (Of course, many people have ethical objections to the use of animals, and especially primates, as research subjects.) Like human beings, baboons get a bad cough from a Bordetella pertussis infection.

Warfel and coworkers found that both the acellular vaccine and the whole-cell vaccine were effective for their primary purpose, which is to protect the vaccinated individual from getting sick after exposure to Bordetella pertussis. However, the whole-cell vaccine gave the baboons a little help in clearing the Bordetella pertussis from their upper respiratory tract. The acellular pertussis vaccine did not. It took 21 days for the baboons that received the whole-cell vaccine to clear the Bordetella pertussis from their upper respiratory tract. It took unvaccinated baboons and baboons that received the acellular vaccine about twice as long to clear the bacteria from their upper respiratory tract.

Dr. H. pointed out that the Bordetella pertussis bacteria could not colonize the baboons that were recovering from a recent Bordetella pertussis infection. From that, she concluded that natural infections were better for promoting herd immunity. Yet even the immunity produced by a natural infection declines after a few years. Also, the basic reproduction number of pertussis is 5.5, which means that in a susceptible population, a single natural case of pertussis would tend to lead to an average of 5.5 new cases of pertussis. So if we relied on natural immunity to solve our pertussis problem, we would have huge epidemics of pertussis, as opposed to occasional small outbreaks.

The study by Warfel and coworkers was not about whether to vaccinate against pertussis. It was about which vaccine to use. In the 1990s, Americans switched from the whole-cell vaccine to the acellular vaccine because the whole-cell vaccine sometimes caused children to spike a fever. This fever could sometimes cause a febrile seizure. These seizures were terrifying to the parents, but they do no lasting harm to the child. Some other countries consider this risk of fever to be acceptable because the whole-cell vaccine may be better for stopping the spread of Bordetella pertussis.

Bordetella pertussis is found only in human beings. Thus, we might be able to drive this germ into extinction through vaccination. Once it is extinct, nobody will need to get a pertussis vaccine. Yet to drive pertussis into extinction, we will need a better vaccine, one that provides longer-lasting protection against the carrier state, not just against clinical disease. In the meantime, we need for people to get their children vaccinated and to keep up to date with their pertussis boosters!

*I do not use her real name because I do not like to give people undeserved attention. I explain my reasoning in these two books:

Here are the basic facts that reporters should explain whenever mumps breaks out:

• Mumps is rarely fatal, but it can leave its victims deaf in one or both ears.
• Mumps can cause painful swelling of the testicles and can leave men sterile.
• Mumps is a respiratory virus, which is why it spreads easily from person to person.
• Vaccination is the only reliable way to prevent infections that spread easily from person to person.
• The vaccine against the mumps is part of the measles-mumps-rubella (MMR) combined vaccine.
• To prevent mumps, we need to vaccinate as many people as possible. If a large enough percentage of the population is immunized, then mumps stops spreading.
• By vaccinating everyone who can be vaccinated, we can protect the people who cannot be vaccinated (infants and people with immune system problems).
• A global vaccination campaign could drive measles, mumps, and rubella into extinction.

Here are some useful memes for fighting mumps: