Archive for February, 2008

Am. Acad. Ped. When Parents Refuse to Immunize Their Children

Wednesday, February 27th, 2008

This is an official document of the American Academy of Pediatrics discussing what to do about/with/to parents who refuse immunizatin for their children. Note that the document asserts that decision-making about the health care of the child should be shared between the parent and physician and that parents who do not agree with pediatricians to immunize their children are evaluating information less well than doctors. None the less, more than 4% of all pediatricians refuse to immunize their own young children.

CLINICAL REPORT

PEDIATRICS Vol. 115 No. 5 May 2005, pp. 1428-1431 (doi:10.1542/peds.2005-0316)
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CLINICAL REPORT
Responding to Parental Refusals of Immunization of Children
Douglas S. Diekema, MD, MPH and the Committee on Bioethics

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The American Academy of Pediatrics strongly endorses universal immunization. However, for childhood immunization programs to be successful, parents must comply with immunization recommendations. The problem of parental refusal of immunization for children is an important one for pediatricians. The goal of this report is to assist pediatricians in understanding the reasons parents may have for refusing to immunize their children, review the limited circumstances under which parental refusals should be referred to child protective services agencies or public health authorities, and provide practical guidance to assist the pediatrician faced with a parent who is reluctant to allow immunization of his or her child.

Key Words: immunization • parental refusals • medical neglect • vaccine refusal

Abbreviations: AAP, American Academy of Pediatrics

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The immunization of children against a multitude of infectious agents has been hailed as one of the most important health interventions of the 20th century.1–3 Immunizations have eliminated smallpox infection worldwide, driven polio from North America, and made formerly common infections like diphtheria, tetanus, measles, and invasive Haemophilus influenzae infections rare occurrences. By one account, pediatric immunizations are responsible for preventing 3 million deaths in children each year worldwide.3 Despite this success, some parents continue to refuse immunizations for their children. The number of pertussis cases has increased steadily in the United States over the past 20 years, and Web sites critical of immunization are prominent on the Internet, a source that many parents rely on for health information.4 It is ironic that the remarkable success of vaccine programs has resulted in a situation in which most parents have no memory of the devastating effects of illnesses such as poliomyelitis, measles, and other vaccine-preventable diseases, making it more difficult for them to appreciate the benefits of immunization.

According to a periodic survey of fellows of the American Academy of Pediatrics (AAP) on immunization-administration practices, 7 of 10 pediatricians reported that they had had a parent refuse an immunization on behalf of a child in the 12 months preceding the survey.5 Measles-mumps-rubella vaccine was refused most frequently, followed by varicella vaccine, pneumococcal conjugate vaccine, hepatitis B vaccine, and diphtheria and tetanus toxoids and pertussis vaccines. Four percent of pediatricians had refused permission for an immunization for their own children younger than 11 years. When faced with parents who refuse immunization, almost all pediatricians reported that they attempt to educate parents regarding the importance of immunization and document the refusal in the patient’s medical record. A small number of pediatricians reported that they always (4.8%) or sometimes (18.1%) tell parents that they will no longer serve as the child’s physician if, after educational efforts, the parents continue to refuse permission for an immunization.5

The AAP strongly endorses universal immunization. However, for universal childhood immunization programs to be successful, parents must comply with immunization recommendations. The problem of parental refusal of immunization for children is an important one for pediatricians. Parents may have many reasons for refusing immunization. Some parents may object to immunization on religious or philosophical grounds, some may object to what seems to be a painful assault on their child, and others may believe that the benefits of immunization do not justify the risks to their child. Many commonly held beliefs about the risks of immunization are not supported by available data, and they frequently originate from the unsupported claims of organizations that are critical of immunization. These antivaccine information sources not only propagate unproven claims regarding vaccines but also may undermine the physician-family relationship by challenging the parents’ trust of the medical profession.

What should the pediatrician do when faced with a parent who refuses to consent to immunizations for a child? The goal of this clinical report is to provide guidance to the pediatrician faced with this difficult situation. The physician faced with a parent who refuses to immunize a child faces 3 important and distinct issues that will be addressed in this report. First, are there situations in which parents who withhold immunizations from their children risk harming them sufficiently that their decision constitutes actionable medical neglect and should be reported to state child protective services agencies? Second, are there situations in which a parental decision to withhold immunization from a child puts other individuals at risk of harm sufficient to justify public health intervention? Finally, how should the pediatrician respond to a parent who refuses immunizations for his or her child?

PARENTAL REFUSALS AND THE BEST INTERESTS OF CHILDREN

Health care professionals and parents are bound by the duty to seek medical benefit for and minimize harm to children in their care. When faced with the decision to immunize a child, the welfare of the child should be the primary focus. However, parents and physicians may not always agree on what constitutes the best interest of an individual child. In those situations, physicians may need to tolerate decisions they disagree with if those decisions are not likely to be harmful to the child.6 Although decision-making involving the health care of children should be shared between physicians and parents, parental permission must be sought before children receive medical interventions, including immunizations.7 Parents are free to make choices regarding medical care unless those choices place their child at substantial risk of serious harm.

Whether parents place their children at substantial risk of serious harm by refusing immunization will depend on several factors, including the probability of contracting the disease if unimmunized and the morbidity and mortality associated with infection. The results of such an analysis will also vary depending on the prevalence of disease in the community in which the child resides or the areas in which the child is likely to travel. The balance between the risks and benefits to a given individual favors immunization most strongly when rates of immunization in the community are low and disease prevalence is high. In most cases, however, as immunization rates increase and disease prevalence decreases, the balance may tip the other way.8,9 Although the benefits of a measles-vaccine program, for example, clearly outweigh the risks at a population level,10 an unimmunized child living in a well-immunized community derives significant indirect protection from herd immunity.11 Even in a community with high immunization rates, the risk assumed by an unimmunized child is likely to be greater than the risks associated with immunization. However, the risk remains low, and in most cases the parent who refuses immunizations on behalf of his or her child living in a well-immunized community does not place the child at substantial risk of serious harm.

The role of the physician in these situations is to provide parents with the risk and benefit information necessary to make an informed decision and to attempt to correct any misinformation or misperceptions that may exist. For example, in a national survey of parents, 25% believed falsely that their child’s immune system could become weakened as a result of too many immunizations.12 Exploring and addressing parental concerns may be an effective strategy with reluctant parents. Only in rare cases in which the decision of a parent places a child at substantial risk of serious harm may the health care professional be obligated to involve state agencies in seeking to provide the necessary immunization over the parents’ objections. For example, for the situation in which a child has sustained a deep and contaminated puncture wound, it might be justifiable to challenge the decision of a child’s parents to refuse treatment with tetanus vaccine. In these situations, the health care professional would involve the appropriate state child protective services agency because of the concern about medical neglect. It would be up to the state agency to decide whether immunization would be required. Although this role of the state has been recognized as constitutionally valid in the United States, courts have closely examined such actions, showing reluctance to require medical treatment over the objection of parents “except where immediate action is necessary or where the potential for harm is rather serious.”13

COMMUNITY INTERESTS AND PUBLIC HEALTH
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The benefits provided by most vaccines extend beyond benefit to the individual who is immunized. There is also a significant public health benefit. Parents who choose not to immunize their own children increase the potential for harm to other persons in 4 important ways.14 First, should an unimmunized child contract disease, that child poses a potential threat to other unimmunized children. Second, even in a fully immunized population, a small percentage of immunized individuals will either remain or become susceptible to disease. These individuals have done everything they can to protect themselves through immunization, yet they remain at risk. Third, some children cannot be immunized because of underlying medical conditions. These individuals derive important benefit from herd immunity and may be harmed by contracting disease from those who remain unimmunized. Finally, immunized individuals are harmed by the cost of medical care for those who choose not to immunize their children and whose children then contract vaccine-preventable disease.

A parent’s refusal to immunize his or her child also raises an important question of justice that has been described as the problem of “free riders.”14–16 Parents who refuse immunization on behalf of their children are, in a sense, free riders who take advantage of the benefit created by the participation and assumption of immunization risk or burden by others while refusing to participate in the program themselves. The decision to refuse to immunize a child is made less risky because others have created an environment in which herd immunity will likely keep the unimmunized child safe. These individuals place family interest ahead of civic responsibility. Although such parents do reject what many would consider to be a moral duty, coercive measures to require immunization of a child over parental objections are justified only in cases in which others are placed at substantial risk of serious harm by the parental decision.

Compulsory immunization laws in the United States have been upheld repeatedly as a reasonable exercise of the state’s police power in the absence of an epidemic or even a single case.17,18 They also have been found to be constitutional even for cases in which the laws conflict with the religious beliefs of individuals.19

When others are placed at substantial risk of serious harm, the range of choices of the individual may be restricted. With regard to immunization, the key question becomes whether the harms associated with unimmunized individuals are great enough to make restrictions permissible. In times of epidemic disease, when an effective vaccine can end the epidemic and protect those individuals who have not yet contracted the disease, the answer clearly is yes.

In a highly immunized population in which disease prevalence is low, the risk of disease from the small number of children who remain unimmunized does not usually pose a significant-enough health risk to others to justify state action.20 Diseases with very high morbidity and mortality (such as smallpox), however, might create a situation in which even a single case of infection would justify mandatory immunization of the population. For most routine vaccines, less forcible alternatives can be used justifiably to encourage parents to immunize children because of the public health benefit. In the case of vaccines routinely recommended for children, the AAP supports the use of appropriate public health measures, education, and incentives for immunization.7 Because unimmunized children do pose a risk to other children who lack immunity to vaccine-preventable infections, the AAP also supports immunization requirements for school entry.

RESPONDING TO PARENTS WHO REFUSE IMMUNIZATION FOR THEIR CHILDREN
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What is the pediatrician to do when faced with a parent who refuses immunization for his or her child? First and most important, the pediatrician should listen carefully and respectfully to the parent’s concerns, recognizing that some parents may not use the same decision criteria as the physician and may weigh evidence very differently than the physician does.21 Vaccines are very safe, but they are not risk free; nor are they 100% effective.22 This poses a dilemma for many parents and should not be minimized. The pediatrician should share honestly what is and is not known about the risks and benefits of the vaccine in question, attempt to understand the parent’s concerns about immunization, and attempt to correct any misperceptions and misinformation.23–25 Pediatricians should also assist parents in understanding that the risks of any vaccine should not be considered in isolation but in comparison to the risks of remaining unimmunized. For example, although the risk of encephalopathy related to the measles vaccine is 1 in 1 million, the risk of encephalopathy from measles illness is 1000 times greater.22 Parents can also be referred to one of several reputable and data-based Web sites for additional information on specific immunizations and the diseases they prevent (see pages 52 and 53 of the Red Book25 for a list of Internet resources related to immunization).

Many parents have concerns related to 1 or 2 specific vaccines. A useful strategy in working with families who refuse immunization is to discuss each vaccine separately. The benefits and risks of vaccines differ, and a parent who is reluctant to accept the administration of 1 vaccine may be willing to allow others.

Parents also may have concerns about administering multiple vaccines to a child in a single visit. In some cases, taking steps to reduce the pain of injection, such as those suggested in the Red Book,26 may be sufficient. In other cases, a parent may be willing to permit a schedule of immunization that does not require multiple injections at a single visit.

Physicians should also explore the possibility that cost is a reason for refusing immunization. For a parent whose child does not have adequate preventive care insurance coverage, even the administrative costs and copayments associated with immunization can pose substantial barriers. In such cases, the physician should work with the family to help them obtain appropriate immunizations for the child.

For all cases in which parents refuse vaccine administration, pediatricians should take advantage of their ongoing relationship with the family and revisit the immunization discussion on each subsequent visit. As respect, communication, and information build over time in a professional relationship, parents may be willing to reconsider previous vaccine refusals.

Continued refusal after adequate discussion should be respected unless the child is put at significant risk of serious harm (as, for example, might be the case during an epidemic). Only then should state agencies be involved to override parental discretion on the basis of medical neglect. Physician concerns about liability should be addressed by good documentation of the discussion of the benefits of immunization and the risks associated with remaining unimmunized. Physicians also may wish to consider having the parents sign a refusal waiver (a sample refusal-to-immunize waiver can be found at www.cispimmunize.org/pro/pdf/RefusaltoVaccinate_2pageform.pdf). In general, pediatricians should avoid discharging patients from their practices solely because a parent refuses to immunize his or her child. However, when a substantial level of distrust develops, significant differences in the philosophy of care emerge, or poor quality of communication persists, the pediatrician may encourage the family to find another physician or practice. Although pediatricians have the option of terminating the physician-patient relationship, they cannot do so without giving sufficient advance notice to the patient or custodial parent or legal guardian to permit another health care professional to be secured.27 Such decisions should be unusual and generally made only after attempts have been made to work with the family. Families with doubts about immunization should still have access to good medical care, and maintaining the relationship in the face of disagreement conveys respect and at the same time allows the child access to medical care. Furthermore, a continuing relationship allows additional opportunity to discuss the issue of immunization over time.

Committee on Bioethics, 2003–2004
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Jeffrey R. Botkin, MD, MPH, Chairperson

Douglas S. Diekema, MD, MPH

G. Kevin Donovan, MD, MLA

Mary E. Fallat, MD

Eric D. Kodish, MD

Steven R. Leuthner, MD, MA

Marcia Levetown, MD

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Christine E. Harrison, MD

Canadian Paediatric Society

Marcia Levetown, MD

American Board of Pediatrics

Arlene Morales, MD

American College of Obstetricians and Gynecologists

Staff
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Alison Baker, MS

FOOTNOTES

The guidance in this report does not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.

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1. Centers for Disease Control and Prevention. Impact of vaccines universally recommended for children—United States, 1990–1998. MMWR Morb Mortal Wkly Rep. 1999;48 :243 –248[Medline]
2. Centers for Disease Control and Prevention. Ten great public health achievements—United States, 1990–1999. MMWR Morb Mortal Wkly Rep. 1999;48 :241 –243[Medline]
3. Bonanni P. Demographic impact of vaccination: a review. Vaccine. 1999;17(suppl 3) :S120 –S125
4. Davies P, Chapman S, Leask J. Antivaccination activists on the World Wide Web. Arch Dis Child. 2002;87 :22 –25[Abstract/Free Full Text]
5. American Academy of Pediatrics, Division of Health Policy Research. Periodic Survey of Fellows No. 48: Immunization Administration Practices. Elk Grove Village, IL: American Academy of Pediatrics; 2001
6. Buchanan AE, Brock DW. Deciding for Others: The Ethics of Surrogate Decision Making. New York, NY: Cambridge University Press; 1990
7. American Academy of Pediatrics, Committee on Bioethics. Informed consent, parental permission, and assent in pediatric practice. Pediatrics. 1995;95 :314 –317[Abstract/Free Full Text]
8. Pertussis vaccine. Br Med J (Clin Res Ed). 1981;282 :1563 –1564
9. Vaccination against whooping cough. Lancet. 1981;1(8230) :1138 –1139[CrossRef]
10. Hinman AR, Koplan JP. Pertussis and pertussis vaccine. Reanalysis of benefits, risks, and costs. JAMA. 1984;251 :3109 –3113[Abstract]
11. Fox JP, Elveback L, Scott W, Gatewood L, Ackerman E. Herd immunity: basic concept and relevance to public health immunization practices. Am J Epidemiol. 1971;94 :179 –189[Free Full Text]
12. Gellin BG, Maibach EW, Marcuse EK. Do parents understand immunizations? A national telephone survey. Pediatrics. 2000;106 :1097 –1102[Abstract/Free Full Text]
13. Wing KR. The Law and the Public’s Health. 3rd ed. Ann Arbor, MI: Health Administration Press; 1990
14. Veatch RM. The ethics of promoting herd immunity. Fam Community Health. 1987;10 :44 –53[Medline]
15. Menzel PT. The pros and cons of immunisation—paper four: non-compliance: fair or free-riding. Health Care Anal. 1995;3 :113 –115[CrossRef][ISI][Medline]
16. Ball LK, Evans G, Bostrom A. Risky business: challenges in vaccine risk communication. Pediatrics. 1998;101 :453 –458[Free Full Text]
17. McMenamin JP, Tiller WB. Children as patients. In: American College of Legal Medicine. Legal Medicine: Legal Dynamics of Medical Encounters. 2nd ed. St Louis, MO: Mosby Year Book; 1991:282–317
18. Dover TE. An evaluation of immunization regulations in light of religious objections and the developing right of privacy. Univ Dayton Law Rev. 1979;4 :401 –424[Medline]
19. Jacobson v Massachusetts, 197 US 11 (1905)
20. Ross LF, Aspinwall TJ. Religious exemptions to the immunization statutes: balancing public health and religious freedom. J Law Med Ethics. 1997;25 :202 –209, 83[ISI][Medline]
21. Meszaros JR, Asch DA, Baron J, Hershey JC, Kunreuther H, Schwartz-Buzaglo J. Cognitive processes and the decisions of some parents to forego pertussis vaccination for their children. J Clin Epidemiol. 1996;49 :697 –703[CrossRef][ISI][Medline]
22. Maldonado YA. Current controversies in vaccination: vaccine safety. JAMA. 2002;288 :3155 –3158[Free Full Text]
23. Wilson CB, Marcuse EK. Vaccine safety—vaccine benefits: science and the public’s perception. Nat Rev Immunol. 2001;1 :160 –165[CrossRef][Medline]
24. Pattison S. Ethical debate: vaccination against mumps, measles, and rubella: is there a case for deepening the debate? Dealing with uncertainty. BMJ. 2001;323 :840
25. American Academy of Pediatrics. Parental misconceptions about immunization. In: Pickering LK, ed. Red Book: 2003 Report of the Committee on Infectious Diseases. 26th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2003:50–53
26. American Academy of Pediatrics. Managing injection pain. In: Pickering LK, ed. Red Book: 2003 Report of the Committee on Infectious Diseases. 26th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2003:20–21
27. American Medical Association, Council on Ethical and Judicial Affairs. Termination of the physician-patient relationship. In: Code of Medical Ethics: Current Opinions. 2002–2003 ed. Chicago, IL: American Medical Association; 2002:110

http://aappolicy.aappublications.org/cgi/content/full/pediatrics;115/5/1428

Letter on Immunization from Am. Acad. Pediatrics President

Wednesday, February 27th, 2008

Dear Parents,

Most parents associate immunizations with school and day care requirements, filling out those dreaded forms every year and you ask yourself why. Well, the Web site you’re about to see tells you why.

Prior to the creation of many of the vaccines available today, thousands – and sometimes millions — of children became infected with diseases that often resulted in lifelong disabilities or, even worse, death. These diseases were contagious, meaning they were easily spread between children. Thankfully, we now have the ability to immunize children and adolescents against contagious, preventable and sometimes deadly diseases.

Immunization success stories, however, can lead parents to think that diseases like polio, whooping cough, and measles no longer exist…but they do. Because many parents today have never seen a child with whooping cough, for example, they mistakenly may think of it as simply a mild childhood disease. According to the National Foundation for Infectious Diseases, whooping cough causes coughing that lasts for weeks, even months. Coughing spells can lead to problems breathing, eating and sleeping. In serious cases, coughing may cause broken ribs or hospitalization. In 2005, 8 infants died in a whooping cough outbreak in Texas.

Whooping cough is on the rise in the United States, across all age groups. More than 20,000 cases were identified in the U.S. in 2005, but the vast majority go unreported. Experts estimate there may actually be up to one million cases every year. That’s why we have to be diligent about vaccinating our children and adolescents against illnesses. The fact that we don’t see certain diseases anymore doesn’t mean they no longer exist…it simply means the vaccines are working. They will continue to work, however, only as long as we continue to immunize our children.

Unfortunately, there’s a lot of misinformation on the Internet about vaccines, so I commend you for finding your way to this reliable Web site. We’re pleased to provide you with the information you’ll need to make an educated decision about immunization. And, of course, you’ll also want to discuss this issue with your partner in your child’s health…your pediatrician.

Sincerely,

Signature

Renée R. Jenkins, MD, FAAP
President
American Academy of Pediatrics

Vaccines: Hazardous for the Elderly

Wednesday, February 27th, 2008

Vaccines, Depression and Neurodegeneration After Age 50

By Russell L. Blaylock, M.D., CCN

It has been estimated that 14.8 million Americans suffer from major depressive disorder and of this number 6 million are elderly. If we include anxiety disorders, which commonly accompany depression, the number jumps to 40 million adults. At a cost of $44 billon dollars a year just for care of the seniors, this impacts the national budget as well.

Depression later in life tends to last longer and be more severe than at younger ages. It is also associated with a high rate of suicide.

Previously, it was thought that major depression was secondary to a deficiency in certain neurotransmitters in the brain, particularly the monoamines, which include serotonin, norepinephrine and dopamine. While alterations in these important mood-related neurotransmitters is found with major depression, growing evidence indicates that the primary culprit is low-grade, chronic brain inflammation.

In addition, we now know that inflammatory cytokines can lower serotonin significantly and for long periods by a number of different mechanisms.

MSG and Depression

Researchers have also discovered that most people with major depressive disease (MDD) have higher levels of the neurotransmitter glutamate in their spinal fluid (CSF) and blood plasma. This is the same glutamate found as a food additive-for example, MSG (monosodium glutamate), hydrolyzed proteins, calcium or sodium casienate, soy protein isolate, vegetable protein concentrate or isolate, etc.

Much of the free glutamate in the brain of depressed people comes from within, that is it escapes from special cells within the brain itself (microglia and astrocytes). Free glutamate, that is, existing outside the neurons, is very toxic to brain connections and brain cells themselves — mainly by a process called excitotoxicity.

This connection between high brain glutamate levels and major depression was discovered quite by accident, when researchers observed that the anesthetic drug ketamine could relieve depression for a prolonged period. Ketamine is a powerful blocking drug for a class of glutamate receptors (NMDA receptors).

For quite some time it was known that depression could cause a loss of neurons in the hippocampus of the brain-the area most important for recent memory (declarative memory or working memory), the form of memory most affected in Alzheimer’s disease.

This shrinkage of the brain usually occurred with long-term depression, yet it was shown, using sophisticated testing, that even without brain shrinkage, memory could be adversely affected. Some antidepressants could not only reverse the memory loss but could reverse the shrinkage as well.

The implication was that the elevated brain glutamate, via excitotoxicity, was destroying brain connections and later killing brain cells in the hippocampus and that the antidepressants were lowering brain glutamate levels. Subsequent studies have confirmed that drugs that block excitotoxicity also reduce depression and that some antidepressants reduce brain glutamate levels.

The Link Between Elevated Brain Glutamate and Inflammation

A tremendous amount of research has now demonstrated the link between chronic low-level brain inflammation, elevated brain glutamate levels and major depression. We know that as we age, the level of inflammatory immune cytokines increase (such as interleukin-1ß (IL-1), IL-6 and TNF-a). That is, the level of inflammation in our body increases, with high levels being seen at the extremes of life — the 80s and 90s.

This progressive elevation in the body’s inflammation increases our risk of a number of inflammation-linked diseases, such as cancer, arthritis, muscle weakness, fatigue, sleep disturbances, memory loss and confusion. People with Alzheimer’s and Parkinson’s disease have even higher levels of these inflammatory cytokines — much higher.

When inflammatory chemicals are elevated in the brain it makes brain cells more vulnerable to a number of toxins, many of which are in the environment. One study demonstrated, using a series of sophisticated techniques, that if brain cells were exposed to low levels of a pesticide there was little toxicity seen and that if you exposed these same brain cells to an immune stimulant alone, little damage occurred.

But if you first exposed the brain cells to the immune stimulant, the same low dose of pesticide could destroy a great number of brain cells.

The importance of this observation was that the vaccine made the brain cells hypersensitive to the toxin so that even in concentrations that normally would do not cause harm, could wiped out most of the neurons. One of the strongest connections between an environmental toxin (pesticides) and a neurological disorder is with Parkinson’s disease.

The reason it is more common in the elderly is that they have the highest levels of inflammatory cytokines. This also explains the high incidence of Alzheimer’s disease, which reaches incidences of 50% after age 80.

The link to depression was also serendipitous

Doctors using immune cytokines to treat patients with cancer or hepatitis found that one third of the patients developed major depressive illness within days of the treatment and that it resolved only when the treatment was terminated. Other studies, in which inflammatory cytokine levels were measured in people with major depressive illness, also found most had high levels of these inflammatory chemicals.

To their surprise, they found that many of the antidepressant medications commonly used lowered inflammatory cytokines levels and that patients who failed to respond had the highest level of the cytokines.

So, how is this linked to excitotoxicity?

Neuroscientists have known for some time that inflammatory cytokines cause the brain to release higher levels of glutamate — the more intense the inflammation, the higher the brain glutamate level. The highest levels are found in the prefrontal lobes and limbic system, the areas most related to mood control. MSG also increases brain inflammation.

Vaccination and Brain Inflammation

A great number of studies have shown that when you vaccinate an animal, the body’s inflammatory cytokines not only increase dramatically, but so do the brain’s inflammatory chemicals. The brain has its own immune system that is intimately connected to the body’s immune system. The main immune cell in the brain is called a microglia. Normally, these brain cells are lying throughout the brain in a resting state (called ramified).

Once activated, they can move around, traveling between brain cells like amoeba (called amoeboid microglia).

In the resting state, they release chemicals that support the growth and protection of brain cells and their connections (dendrites and synapses). But when activated, they secrete a number of very harmful chemicals, including inflammatory cytokines, chemokines, complement, free radicals, lipid peroxidation products, and two excitotoxins — glutamate and quinolinic acid.

In essence, these brain immune cells are out to kill invaders, since the body’s immune system sent an emergency message that an invasion had occurred. With most infections, this phase of activation last no more than a few days to two weeks, during which time the immune system successfully kills off the invaders.

Once that is accomplished, the immune system shuts down to allow things to cool off and the brain to repair what damage was done by its own immune system.

What researchers knew was that during this period of activation, people generally feel bad and that what they experience closely resembles depression — a condition called “sickness behavior”. Most of us have experience this when suffering from a viral illness — such things as restlessness, irritability, a need to get away from people, trouble sleeping, fatigue and difficulty thinking.

Studies have shown that there are two phases to this “sickness behavior”; one in which we have the flu-like symptoms and a later onset of depression-like symptoms that can last awhile. They have also shown that all of these symptoms are due to high levels of inflammatory cytokines in the brain, which come from activated microglia.

A number of studies have also shown that after age 50, people have exaggerated and prolonged “sickness behavior”, much more so than younger people. This is one of the reasons why many elderly hang onto flu symptoms for months after exposure.

There is also another immune phenomenon that plays a major role in vaccine-related brain injury. Researchers discovered that when you vaccinate an animal, the brain microglia immune cells turn on partially (called priming), that is, they are in a state of high readiness. If the immune system is activated again soon after (days, weeks to months), these microglia explode into action secreting levels of their destructive chemicals far higher than normal. This overreaction can be very destructive and make you feel very depressed.

Stimulating your immune system with a vaccine is far different than contracting an infectious illness naturally. Vaccines are made of two components — the agent you wish to vaccinate against — for example, the measles virus; and an immune system booster called an immune adjuvant.

These adjuvants are composed of such things as aluminum compounds, MSG, lipid compounds and even mercury. Their job is to make the immune system react as intensely as possible and for as long as possible.

Studies have shown that these adjuvants, from a single vaccine, can cause immune overactivation for as long as two years. This means that the brain microglia remain active as well, continuously pouring out destructive chemicals. In fact, one study found that a single injection of an immune activating substance could cause brain immune overactivation for over a year. This is very destructive.

Flu Vaccines and an Expanding Vaccine Schedule for the Elderly

Public health authorities and physician societies are in an all out campaign to have every elderly person vaccinated every year with the flu vaccine as well as a growing number of newer vaccines. When I was practicing neurosurgery, the hospitals had an automatic written order on all older patients’ charts mandating a flu vaccine, unless it was countermanded by the physician, which I always did.

Now, they are giving the shots in malls, tents and every available site they can muster. And worse still, using lies and scare tactics to frighten the elderly into getting the shots (such as the bold lie that 36,000 elderly die of the flu every year).

As you age, your immune system, including that special immune system in your brain, releases significantly more inflammatory immune cytokines than when you were younger. This serves to prime the microglia, as discussed. So, when you get your first flu shot your microglia overreact and does so for a very long period — perhaps years.

Many elderly report that the flu shot gave them the flu. Proponents of vaccines, retort with a condescending laugh; that it is impossible because the flu vaccine contains killed flu viruses. In truth, what these people are reporting is a prolonged, intense “sickness behavior” response to the vaccine. To the body, it is worse than getting the flu.

Remember, no one is recording the number of elderly who die after getting the flu shot, especially if they die months later, which can happen with sickness behavior, especially if they have a preexisting chronic illness or are infirm.

The Shocking Truth

With the elderly already having increased inflammatory cytokine levels both systemically and in their brain, stimulating these primed microglia so that a chronic overstimulation of the brain’s immune system is triggered, will not only increase their risk of developing one of the neurodegenerative diseases, but will also substantially increase their risk of developing major depression. Remember, this also increases their risk of suicide, and even homicide, dramatically.

Anxiety is a major problem with depression, and vaccinations will greatly worsen the condition. In fact, vaccination, especially multiple vaccinations, will maintain the brain in a state of inflammation that will be self-perpetuating, because the excess release of glutamate in the brain, as well as glutamate in the diet, will further enhance microglial activation and excitotoxicity.

Those who are prone to developing one of the neurodegenerative diseases, such as Alzheimer’s disease or Parkinson’s disease will be at a drastically increased risk as we have seen experimentally when even animals exposed to subtoxic concentrations of environmental toxins and vaccinated develop neurologic worsening.

Most people use pesticides in their home, and studies have shown that the concentrations in homes are sufficient to trigger Parkinson’s disease in susceptible people. Vaccinations, as these studies have shown, will greatly increase that risk. Most doctors are completely unaware of this important research.

You must keep in mind that “health authorities” urge the elderly to get the flu vaccine each and every year. This will keep the microglia in a primed and even activated state continuously. Recently, neurologists announced that the incidence of neurodegenerative disease had been grossly underestimated and that neurological diseases of aging were increasing at a frightening rate. They have no explanation.

Over the last three decades the number of elderly receiving yearly flu vaccines has risen from 20% before 1980 to over 60% today.

If this were not depressing enough, now the public health authorities and medical specialty societies are adding a whole new set of vaccines for those above 50 years of age, including the pneumococcal and meningiococcal vaccines. What is being completely ignored by the promoters of these vaccines is the effect of multiple doses of immune adjuvant that accompany each of these vaccines.

Let’s say you see your doctor and he talks you into getting the flu vaccine, the pneumococcal and meningiococcal vaccine all during the same office visit. That way, he can save you extra office visits. What your doctor ignores is that he is giving you three doses of powerful immune adjuvant all in one sitting, which means that your body and brain are assaulted by a massive dose of powerful immune activators, which have been proven to activate the brain’s immune system to dangerous levels, even when given as a single dose.

Proof of this mechanism exists not only in animal studies, but in humans as well.

Mercury and Aluminum

There are other ways that vaccines can cause havoc in the brain. Most vaccines contain aluminum compounds. A multitude of studies have shown that aluminum, especially if combined with fluoride, is a powerful brain toxin and that it accumulates in the brain. With each vaccine injection, a dose of aluminum is given. These yearly aluminum inoculations accumulate not only at the site of the injection, but travel to the brain, where it enters neurons and glial cells (astrocytes and microglia).

A number of studies have shown that aluminum can activate microglia and do so for long periods. This means that the aluminum in your vaccination is priming your microglia to overreact. The next vaccine acts to trigger the enhanced inflammatory reaction and release of the excitotoxins, glutamate and quinolinic acid.

You must also appreciate that any infection, stroke, head injury or other toxin exposure will also magnify this inflammatory brain reaction initially triggered by your vaccines. Studies have now indicated that the more one’s immune system is activated the more like he or she will suffer from one of the neurodegenerative diseases.

Mercury is also a powerful activator of brain microglia and can do so in extremely low concentrations — in nanomolar amounts. Because of its numerous reactions with sulfhydral compounds in the body (which are ubiquitous), mercury can poison a number of enzymes, both systemically and in the brain. Of special concern is the ability of mercury, especially ethylmercury (the kind found in vaccines called thimerosal) to inhibit the regulation of brain glutamate levels. (It does this by inhibiting the glutamate transfer proteins that control the removal of glutamate from outside the neuron, where it does its harm.)

In essence, mercury, in the concentrations being injected with vaccines, triggers excitotoxicity, increases brain free radicals and lipid peroxidation products, inhibits critical brain enzymes, inhibits antioxidant enzymes and impairs DNA repair ability. The flu vaccine contains enough mercury to do all of these things. You must keep in mind that each flu vaccine adds to the mercury supplied by your last vaccine — that is, it is progressively accumulating in your brain.

In addition, the aluminum in the vaccines also primes microglia, and when combined with mercury is infinitively more toxic to the brain. Now, if this is not enough, we also have to consider the contamination of vaccines with foreign viruses and viral components. Studies have shown that this is not a rare occurrence, with up to 60% of vaccines being contaminated in one study of several major manufactured vaccines.

When confronted with this fact, vaccine proponents just shrug their shoulders and say — “We don’t think these things are harmful.”

Yet, the studies say otherwise.

It has been found that insertion of viral fragments, not even the whole virus, is sufficient to trigger the brain’s microglial system and subsequent excitotoxicity, leading to progressive brain degeneration. This is accepted to be the mechanism by which the HIV virus causes dementia in a great number of AIDS victims. Fragments of the virus (gp140 and Tat) are engulfed by the microglia and this triggers chronic brain inflammation and excitotoxicity. The herpes virus and measles virus can do the same thing.

Danger of Live Virus Vaccines

A number of studies have shown that live viruses used in vaccines can enter the brain and reside there for a lifetime. One such study, in which autopsied elderly were examined for the presence of the measles virus, found that 20% of the brains had live measles viruses and 45% of other organs were infected. These viruses were highly mutated, meaning that they could be just as potent as other measles viruses, but could be even more virulent.

Worse, is that in most cases they cause a smoldering destruction of tissues without the obvious symptoms of infection, which has been shown in a number of studies.

Live virus vaccines are made using a process to attenuate the pathogenic or disease-causing virus by passing it through a series of cultures. The problem is that the reverse can also happen within the body. A number of studies have shown that when we produce free radicals in our body (and we produce tons of such radicals over a lifetime), it mutates the viruses residing in our tissues. This is what was found in the autopsy study I referred to above.

Likewise, these viruses can trigger brain inflammation and degeneration, which has been shown in a number of studies — that is, there exist a chronic degeneration of the brain over years or decades. Because it is so far separated from the time of the original vaccine, physicians just attribute it to old age or heredity. Anything but the vaccines.

Virologists are also concerned that such mutated live viruses can also infect other people, leading to outbreaks of disease totally unsuspected by health authorities.

Conclusion

Current recommendations by the CDC for adult vaccinations include a total of 14 separate inoculations with infectious agents and powerful immune adjuvants. To be fair, some of these are for special medical risks and conditions, such as high-risk behaviors, illegal drug use and HIV infected individuals.

If we eliminate these, women will be exposed to 10 inoculations and men 7, should they follow CDC guidelines, which doctors follow.

According to CDC recommendations, multiple vaccinations for a single disease are separated by no more than 4 weeks, which is close enough together to produce priming and subsequent hyperactivation of brain microglia. We have seen that this can trigger a smoldering process of brain inflammation and excitotoxicity that can not only result in depression, anxiety and high suicide rates, but can increase one’s risk of developing one of the neurodegenerative diseases as well.

We have also seen that in many cases a person will be injected with several vaccines during a single office visit and that this means their body is exposed to a very large dose of immune adjuvant. Compelling studies, using many animal species as well as humans, have shown that this overactivates brain inflammatory mechanism that can last for years.

In addition, several additives to vaccines, such as mercury and aluminum, are powerful brain toxins that are known to accumulate in the brain over years and can trigger brain inflammatory/excitotoxic mechanisms. Vaccine contaminants, such as bacteria, mycoplasma and viral fragments can also produce prolonged brain inflammation and neurodegeneration.

Because the elderly already have high levels of inflammatory cytokines, they are at a special risk. The very young (babies and small children) are at a high risk because their brains are undergoing the most rapid development at the very time they receive the greatest number of vaccinations — the first two years of life. In fact, they receive 22 vaccines during the first year of life, one of which contains a full pediatric dose of mercury.

Like adults, they receive many inoculations (up to 9 inoculations) in one office visit. This is insane and in my estimation, criminal.

Nasal flu vaccines are even worse, because they introduce a live virus into the nasal passages, which can then travel along the olfactory nerves, which leads to the very part of the brain first and most severely affected by Alzheimer’s disease. A number of studies have shown that viruses and bacteria can pass along this route to the brain.

In fact, in one study scientists sprayed a bacterium into the nose of mice and observed a rapid development of Alzheimer’s type plaques in the mouse’s brain.

So What Should Older People Do?

First, studies have shown that the primary cause of immune deficiency in the elderly is purely dietary. The carotenoids, such as beta-carotene, alpha-carotene, canthaxanthin, lutein and lycopene significantly enhance the immunity of the elderly. Zinc, magnesium and selenium are also essential. One should also avoid omega-6 oils (the vegetable oils: corn, safflower, sunflower, canola, soybean and peanut oils), since they greatly enhance inflammation and depress immunity. The EPA component of fish oils (omega-3 oils) is also a powerful immune suppressant. DHA is not.

A healthy immune system means that you can fight infections efficiently and rapidly.

Regular exercise, such as brisk walking or weight exercises three to five times a week also boost immunity, while extreme exercise suppresses immunity. Sugar and refined carbohydrates also suppress immunity and inflame the brain. Exercise protects the brain from aging effects and from degeneration.

Adequate sleep is also vital to both brain health and good immune function.

Pubic health officials and spokesmen for the major medical societies are lying to the public concerning vaccine safety. We now possess sufficient information from a great number of studies to halt this disastrous vaccine policy. We are facing a medial disaster in this country, which is already well on its way.

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French Judge Probes Hep B Manslaughter by Drug Companies

Wednesday, February 27th, 2008

French judges probe firms over vaccinations -source
Fri Feb 1, 2008 3:32am EST

PARIS, Jan 31 (Reuters) – French authorities have opened a formal investigation into two managers from drugs groups GlaxoSmithKline (GSK.L: Quote, Profile, Research) and Sanofi Pasteur over a vaccination campaign in the 1990s, a judicial source said late on Thursday.

Judge Marie-Odile Bertella-Geffroy also opened an investigation for manslaughter against Sanofi Pasteur MSD, a joint venture between Sanofi Aventis (SASY.PA: Quote, Profile, Research) and Merck (MRK.N: Quote, Profile, Research), the same source said.

The investigations follow allegations that the companies failed to fully disclose side effects from an anti-hepatitis B drug used in a vaccination campaign between 1994 and 1998.

There was no immediate comment from the companies or the two managers involved.

From 1994 to 1998, almost two thirds of the French population and almost all newborn babies were vaccinated against hepatitis B, but the campaign was suspended after concerns arose about possible secondary effects from the treatments.

Some 30 plaintiffs have launched a civil action in the case, including the families of five people who died after vaccination. (Reporting by Thierry Leveque; Writing by James Mackenzie; Editing by David Holmes)

GM Files: Fundamental Weaknesses of the GMO Concept

Wednesday, February 27th, 2008

What are the Dangers?

Fundamental Weaknesses of the Concept

* Imprecise Technology—A genetic engineer moves genes from one organism to another. A gene can be cut precisely from the DNA of an organism, but the insertion into the DNA of the target organism is basically random. As a consequence, there is a risk that it may disrupt the functioning of other genes essential to the life of that organism. (Bergelson 1998)

* Side Effects—Genetic engineering is like performing heart surgery with a shovel. Scientists do not yet understand living systems completely enough to perform DNA surgery without creating mutations which could be harmful to the environment and our health. They are experimenting with very delicate, yet powerful forces of nature, without full knowledge of the repercussions. (Washington Times 1997, The Village Voice 1998)

* Widespread Crop Failure—Genetic engineers intend to profit by patenting genetically engineered seeds. This means that, when a farmer plants genetically engineered seeds, all the seeds have identical genetic structure. As a result, if a fungus, a virus, or a pest develops which can attack this particular crop, there could be widespread crop failure. (Robinson 1996)

* Threatens Our Entire Food Supply—Insects, birds, and wind can carry genetically altered seeds into neighboring fields and beyond. Pollen from transgenic plants can cross-pollinate with genetically natural crops and wild relatives. All crops, organic and non-organic, are vulnerable to contamination from cross-pollination. (Emberlin et al 1999)

Health Hazards

* No Long-Term Safety Testing—Genetic engineering uses material from organisms that have never been part of the human food supply to change the fundamental nature of the food we eat. Without long-term testing no one knows if these foods are safe.

* Toxins—Genetic engineering can cause unexpected mutations in an organism, which can create new and higher levels of toxins in foods. (Inose 1995, Mayeno 1994)

* Allergic Reactions—Genetic engineering can also produce unforeseen and unknown allergens in foods. (Nordlee 1996)

* Decreased Nutritional Value—Transgenic foods may mislead consumers with counterfeit freshness. A luscious-looking, bright red genetically engineered tomato could be several weeks old and of little nutritional worth.

* Antibiotic Resistant Bacteria—Genetic engineers use antibiotic-resistance genes to mark genetically engineered cells. This means that genetically engineered crops contain genes which confer resistance to antibiotics. These genes may be picked up by bacteria which may infect us. (New Scientist 1999)

* Problems Cannot Be Traced—Without labels, our public health agencies are powerless to trace problems of any kind back to their source. The potential for tragedy is staggering.

* Side Effects can Kill—37 people died, 1500 were partially paralyzed, and 5000 more were temporarily disabled by a syndrome that was finally linked to tryptophan made by genetically-engineered bacteria. (Mayeno 1994)

Environmental Hazards

* Increased use of Herbicides—Scientists estimate that plants genetically engineered to be herbicide-resistant will greatly increase the amount of herbicide use. (Benbrook 1999) Farmers, knowing that their crops can tolerate the herbicides, will use them more liberally.

* More Pesticides—GE crops often manufacture their own pesticides and may be classified as pesticides by the EPA. This strategy will put more pesticides into our food and fields than ever before.

* Ecology may be damaged—The influence of a genetically engineered organism on the food chain may damage the local ecology. The new organism may compete successfully with wild relatives, causing unforeseen changes in the environment. (Metz 1997)

* Gene Pollution Cannot Be Cleaned Up—Once genetically engineered organisms, bacteria and viruses are released into the environment it is impossible to contain or recall them. Unlike chemical or nuclear contamination, negative effects are irreversible.

DNA is actually not well understood. 97% of human DNA is called ³junk² because scientists do not know its function. The workings of a single cell are so complex, no one knows the whole of it. (San Diego Union-Tribune 2000) Yet the biotech companies have already planted millions of acres with genetically engineered crops, and they intend to engineer every crop in the world.

The concerns above arise from an appreciation of the fundamental role DNA plays in life, the gaps in our understanding of it, and the vast scale of application of the little we do know. Even the scientists in the Food and Drug administration have expressed concerns. (Alliance for Biointegrity)