Group items tagged

audited existing maps for 174 infectious diseases of clinical importance. Following a huge systematic review, they scored the maps for each disease according to how much of the known global range is covered and the quality of the data—whether they were up-to-date and whether they relied on accurate measures like molecular diagnostics or GPS coordinates, rather than unverified expert opinion.

even the highest-scoring diseases have room for improvement.

. They argue that technology can help to plug the gaps in our maps in the future, and they point to several untapped sources of data. For example, both PubMed and GenBank, which collect biomedical literature and gene sequences respectively, contain geospatial information for the majority of diseases that the team reviewed. And social networks like Twitter can provide invaluable real-time clues about spreading symptoms and illnesses, often tagged with geographical information. During the 2009 outbreak of H1N1 swine flu, for example, Twitter predicted outbreaks 1 or 2 weeks ahead of traditional surveillance measures.

I struggled because governments or researchers wouldn’t share their information,” he said. “But there was all this incredible knowledge on the web being discussed through professional networks or news media.”

believes that the problem now is not a lack of data but a deluge of it. Sites like HealthMap and BioCaster are already using learning algorithms to filter online sources for information relevant to infections. They are also using crowdsourcing tools that ask online volunteers to check if flagged social media chatter actually relates to the disease of interest.

one of the leading modelers, Gabriela Gomes, suggested the entire area of research was being effectively blackballed out of fear it might encourage a relaxation of pandemic vigilance. “This is the very sad reason for the absence of more optimistic projections on the development of this pandemic in the scientific literature,” she wrote on Twitter. “Our analysis suggests that herd-immunity thresholds are being achieved despite strict social-distancing measures.”

Gomes suggested, herd immunity could happen with as little as one quarter of the population of a community exposed — or perhaps just 20 percent. “We just keep running the models, and it keeps coming back at less than 20 percent,” she told Hamblin. “It’s very striking.” Such findings, if they held up, would be very instructive, as Hamblin writes: “It would mean, for instance, that at 25 percent antibody prevalence, New York City could continue its careful reopening without fear of another major surge in cases.”

But for those hoping that 25 percent represents a true ceiling for pandemic spread in a given community, well, it almost certainly does not, considering that recent serological surveys have shown that perhaps 93 percent of the population of Iquitos, Peru, has contracted the disease; as have more than half of those living in Indian slums; and as many as 68 percent in particular neighborhoods of New York City

overshoot of that scale would seem unlikely if the “true” threshold were as low as 20 or 25 percent.

But, of course, that threshold may not be the same in all places, across all populations, and is surely affected, to some degree, by the social behavior taken to protect against the spread of the disease.

we probably err when we conceive of group immunity in simplistically binary terms. While herd immunity is a technical term referring to a particular threshold at which point the disease can no longer spread, some amount of community protection against that spread begins almost as soon as the first people are exposed, with each case reducing the number of unexposed and vulnerable potential cases in the community by one

you would not expect a disease to spread in a purely exponential way until the point of herd immunity, at which time the spread would suddenly stop. Instead, you would expect that growth to slow as more people in the community were exposed to the disease, with most of them emerging relatively quickly with some immune response. Add to that the effects of even modest, commonplace protections — intuitive social distancing, some amount of mask-wearing — and you could expect to get an infection curve that tapers off well shy of 60 percent exposure.

Looking at the data, we see that transmissions in many severely impacted states began to slow down in July, despite limited interventions. This is especially notable in states like Arizona, Florida, and Texas. While we believe that changes in human behavior and changes in policy (such as mask mandates and closing of bars/nightclubs) certainly contributed to the decrease in transmission, it seems unlikely that these were the primary drivers behind the decrease. We believe that many regions obtained a certain degree of temporary herd immunity after reaching 10-35 percent prevalence under the current conditions. We call this 10-35 percent threshold the effective herd immunity threshold.

Indeed, that is more or less what was recently found by Youyang Gu, to date the best modeler of pandemic spread in the U.S

he cautioned again that he did not mean to imply that the natural herd-immunity level was as low as 10 percent, or even 35 percent. Instead, he suggested it was a plateau determined in part by better collective understanding of the disease and what precautions to take

Gu estimates national prevalence as just below 20 percent (i.e., right in the middle of his range of effective herd immunity), it still counts, I think, as encouraging — even if people in hard-hit communities won’t truly breathe a sigh of relief until vaccines arrive.

If you can get real protection starting at 35 percent, it means that even a mediocre vaccine, administered much more haphazardly to a population with some meaningful share of vaccination skeptics, could still achieve community protection pretty quickly. And that is really significant — making both the total lack of national coordination on rollout and the likely “vaccine wars” much less consequential.

At least 20 percent of the public, and perhaps 50 percent, had some preexisting, cross-protective T-cell response to SARS-CoV-2, according to one much-discussed recent paper. An earlier paper had put the figure at between 40 and 60 percent. And a third had found an even higher prevalence: 81 percent.

The T-cell story is similarly encouraging in its big-picture implications without being necessarily paradigm-changing

These numbers suggest their own heterogeneity — that different populations, with different demographics, would likely exhibit different levels of cross-reactive T-cell immune response

The most optimistic interpretation of the data was given to me by Francois Balloux, a somewhat contrarian disease geneticist and the director of the University College of London’s Genetics Institute

According to him, a cross-reactive T-cell response wouldn’t prevent infection, but would probably mean a faster immune response, a shorter period of infection, and a “massively” reduced risk of severe illness — meaning, he guessed, that somewhere between a third and three-quarters of the population carried into the epidemic significant protection against its scariest outcomes

the distribution of this T-cell response could explain at least some, and perhaps quite a lot, of COVID-19’s age skew when it comes to disease severity and mortality, since the young are the most exposed to other coronaviruses, and the protection tapers as you get older and spend less time in environments, like schools, where these viruses spread so promiscuously.

Balloux told me he believed it was also possible that the heterogeneous distribution of T-cell protection also explains some amount of the apparent decline in disease severity over time within countries on different pandemic timelines — a phenomenon that is more conventionally attributed to infection spreading more among the young, better treatment, and more effective protection of the most vulnerable (especially the old).

Going back to Youyang Gu’s analysis, what he calls the “implied infection fatality rate” — essentially an estimated ratio based on his modeling of untested cases — has fallen for the country as a whole from about one percent in March to about 0.8 percent in mid-April, 0.6 percent in May, and down to about 0.25 percent today.

even as we have seemed to reach a second peak of coronavirus deaths, the rate of death from COVID-19 infection has continued to decline — total deaths have gone up, but much less than the number of cases

In other words, at the population level, the lethality of the disease in America has fallen by about three-quarters since its peak. This is, despite everything that is genuinely horrible about the pandemic and the American response to it, rather fantastic.

there may be some possible “mortality displacement,” whereby the most severe cases show up first, in the most susceptible people, leaving behind a relatively protected population whose experience overall would be more mild, and that T-cell response may play a significant role in determining that susceptibility.

That, again, is Balloux’s interpretation — the most expansive assessment of the T-cell data offered to me

The most conservative assessment came from Sarah Fortune, the chair of Harvard’s Department of Immunology

Fortune cautioned not to assume that cross-protection was playing a significant role in determining severity of illness in a given patient. Those with such a T-cell response, she told me, would likely see a faster onset of robust response, yes, but that may or may not yield a shorter period of infection and viral shedding

Most of the scientists, doctors, epidemiologists, and immunologists I spoke to fell between those two poles, suggesting the T-cell cross-immunity findings were significant without necessarily being determinative — that they may help explain some of the shape of pandemic spread through particular populations, but only some of the dynamics of that spread.

he told me he believed, in the absence of that data, that T-cell cross-immunity from exposure to previous coronaviruses “might explain different disease severity in different people,” and “could certainly be part of the explanation for the age skew, especially for why the very young fare so well.”

the headline finding was quite clear and explicitly stated: that preexisting T-cell response came primarily via the variety of T-cells called CD4 T-cells, and that this dynamic was consistent with the hypothesis that the mechanism was inherited from previous exposure to a few different “common cold” coronaviruses

“This potential preexisting cross-reactive T-cell immunity to SARS-CoV-2 has broad implications,” the authors wrote, “as it could explain aspects of differential COVID-19 clinical outcomes, influence epidemiological models of herd immunity, or affect the performance of COVID-19 candidate vaccines.”

“This is at present highly speculative,” they cautioned.

I see addiction as an attitude or self-concept that grows and crystallises with experience, often initiated by difficulties in childhood or adolescence. Indeed, addiction is in some ways like a disease, but that’s only half the story.

Many take comfort in the disease label, because it helps them make sense of how difficult it is to quit. But for others, the disease label isn’t just wrong, it’s repugnant – it’s a rationale for helplessness and an obstacle to healing.

“I am not diseased… I don’t have a disease. I had past traumas, environmental factors and learned behaviours… I feel I have learned new things… new skills opened up… new pathways that were underdeveloped.”

Several studies have shown that a belief in the disease concept of addiction increases the probability of relapse.

If we can acknowledge that addiction is like a disease in some ways and very much unlike a disease in other ways, maybe we can stop trying to label it and pay more attention to the best means for overcoming it.

But these latest shifts challenge key infection control assumptions that go back a century, putting a lot of what went wrong last year in context

They may also signal one of the most important advancements in public health during this pandemic.

If the importance of aerosol transmission had been accepted early, we would have been told from the beginning that it was much safer outdoors, where these small particles disperse more easily, as long as you avoid close, prolonged contact with others.

We would have tried to make sure indoor spaces were well ventilated, with air filtered as necessary.

Instead of blanket rules on gatherings, we would have targeted conditions that can produce superspreading events: people in poorly ventilated indoor spaces, especially if engaged over time in activities that increase aerosol production, like shouting and singing

We would have started using masks more quickly, and we would have paid more attention to their fit, too. And we would have been less obsessed with cleaning surfaces.

The implications of this were illustrated when I visited New York City in late April — my first trip there in more than a year.

A giant digital billboard greeted me at Times Square, with the message “Protecting yourself and others from Covid-19. Guidance from the World Health Organization.”

That billboard neglected the clearest epidemiological pattern of this pandemic: The vast majority of transmission has been indoors, sometimes beyond a range of three or even six feet. The superspreading events that play a major role in driving the pandemic occur overwhelmingly, if not exclusively, indoors.

The billboard had not a word about ventilation, nothing about opening windows or moving activities outdoors, where transmission has been rare and usually only during prolonged and close contact. (Ireland recently reported 0.1 percent of Covid-19 cases were traced to outdoor transmission.)

Mary-Louise McLaws, an epidemiologist at the University of New South Wales in Sydney, Australia, and a member of the W.H.O. committees that craft infection prevention and control guidance, wanted all this examined but knew the stakes made it harder to overcome the resistance. She told The Times last year, “If we started revisiting airflow, we would have to be prepared to change a lot of what we do.” She said it was a very good idea, but she added, “It will cause an enormous shudder through the infection control society.”

In contrast, if the aerosols had been considered a major form of transmission, in addition to distancing and masks, advice would have centered on ventilation and airflow, as well as time spent indoors. Small particles can accumulate in enclosed spaces, since they can remain suspended in the air and travel along air currents. This means that indoors, three or even six feet, while helpful, is not completely protective, especially over time.

To see this misunderstanding in action, look at what’s still happening throughout the world. In India, where hospitals have run out of supplemental oxygen and people are dying in the streets, money is being spent on fleets of drones to spray anti-coronavirus disinfectant in outdoor spaces. Parks, beaches and outdoor areas keep getting closed around the world. This year and last, organizers canceled outdoor events for the National Cherry Blossom Festival in Washington, D.C. Cambodian customs officials advised spraying disinfectant outside vehicles imported from India. The examples are many.

Meanwhile, many countries allowed their indoor workplaces to open but with inadequate aerosol protections. There was no attention to ventilation, installing air filters as necessary or even opening windows when possible, more to having people just distancing three or six feet, sometimes not requiring masks beyond that distance, or spending money on hard plastic barriers, which may be useless at best

clear evidence doesn’t easily overturn tradition or overcome entrenched feelings and egos. John Snow, often credited as the first scientific epidemiologist, showed that a contaminated well was responsible for a 1854 London cholera epidemic by removing the suspected pump’s handle and documenting how the cases plummeted afterward. Many other scientists and officials wouldn’t believe him for 12 years, when the link to a water source showed up again and became harder to deny.

Along the way to modern public health shaped largely by the fight over germs, a theory of transmission promoted by the influential public health figure Charles Chapin took hold

Dr. Chapin asserted in the early 1900s that respiratory diseases were most likely spread at close range by people touching bodily fluids or ejecting respiratory droplets, and did not allow for the possibility that such close-range infection could occur by inhaling small floating particles others emitted

He was also concerned that belief in airborne transmission, which he associated with miasma theories, would make people feel helpless and drop their guard against contact transmission. This was a mistake that would haunt infection control for the next century and more.

It was in this context in early 2020 that the W.H.O. and the C.D.C. asserted that SARS-CoV-2 was transmitted primarily via these heavier, short-range droplets, and provided guidance accordingly

Amid the growing evidence, in July, hundreds of scientists signed an open letter urging the public health agencies, especially the W.H.O., to address airborne transmission of the coronavirus.

Last October, the C.D.C. published updated guidance acknowledging airborne transmission, but as a secondary route under some circumstances, until it acknowledged airborne transmission as crucial on Friday. And the W.H.O. kept inching forward in its public statements, most recently a week ago.

Linsey Marr, a professor of engineering at Virginia Tech who made important contributions to our understanding of airborne virus transmission before the pandemic, pointed to two key scientific errors — rooted in a lot of history — that explain the resistance, and also opened a fascinating sociological window into how science can get it wrong and why.

Dr. Marr said that if you inhale a particle from the air, it’s an aerosol.

biomechanically, she said, nasal transmission faces obstacles, since nostrils point downward and the physics of particles that large makes it difficult for them to move up the nose. And in lab measurements, people emit far more of the easier-to-inhale aerosols than the droplets, she said, and even the smallest particles can be virus laden, sometimes more so than the larger ones, seemingly because of how and where they are produced in the respiratory tract.

Second, she said, proximity is conducive to transmission of aerosols as well because aerosols are more concentrated near the person emitting them. In a twist of history, modern scientists have been acting like those who equated stinky air with disease, by equating close contact, a measure of distance, only with the larger droplets, a mechanism of transmission, without examination.

Since aerosols also infect at close range, measures to prevent droplet transmission — masks and distancing — can help dampen transmission for airborne diseases as well. However, this oversight led medical people to circularly assume that if such measures worked at all, droplets must have played a big role in their transmission.

Another dynamic we’ve seen is something that is not unheard-of in the history of science: setting a higher standard of proof for theories that challenge conventional wisdom than for those that support it.

Another key problem is that, understandably, we find it harder to walk things back. It is easier to keep adding exceptions and justifications to a belief than to admit that a challenger has a better explanation.

The ancients believed that all celestial objects revolved around the earth in circular orbits. When it became clear that the observed behavior of the celestial objects did not fit this assumption, those astronomers produced ever-more-complex charts by adding epicycles — intersecting arcs and circles — to fit the heavens to their beliefs.

In a contemporary example of this attitude, the initial public health report on the Mount Vernon choir case said that it may have been caused by people “sitting close to one another, sharing snacks and stacking chairs at the end of the practice,” even though almost 90 percent of the people there developed symptoms of Covid-19

So much of what we have done throughout the pandemic — the excessive hygiene theater and the failure to integrate ventilation and filters into our basic advice — has greatly hampered our response.

Some of it, like the way we underused or even shut down outdoor space, isn’t that different from the 19th-century Londoners who flushed the source of their foul air into the Thames and made the cholera epidemic worse.

Righting this ship cannot be a quiet process — updating a web page here, saying the right thing there. The proclamations that we now know are wrong were so persistent and so loud for so long.

the progress we’ve made might lead to an overhaul in our understanding of many other transmissible respiratory diseases that take a terrible toll around the world each year and could easily cause other pandemics.

So big proclamations require probably even bigger proclamations to correct, or the information void, unnecessary fears and misinformation will persist, damaging the W.H.O. now and in the future.

I’ve seen our paper used in India to try to reason through aerosol transmission and the necessary mitigations. I’ve heard of people in India closing their windows after hearing that the virus is airborne, likely because they were not being told how to respond

The W.H.O. needs to address these fears and concerns, treating it as a matter of profound change, so other public health agencies and governments, as well as ordinary people, can better adjust.

It needs to begin a campaign proportional to the importance of all this, announcing, “We’ve learned more, and here’s what’s changed, and here’s how we can make sure everyone understands how important this is.” That’s what credible leadership looks like. Otherwise, if a web page is updated in the forest without the requisite fanfare, how will it matter?

The researchers note that only a few modifier genes of disease mutations such as Ankrd16 have been identified and a modifier-based mechanism for understanding the underlying pathology of neurodegenerative diseases may be a promising route to understand disease development.

they used very meaningful endpoints. They did not look at risk factors like cholesterol or hypertension or weight. They looked at heart attacks and strokes and death. At the end of the day, that is what really matters.”

it did so using the most rigorous methods. Scientists randomly assigned 7,447 people in Spain who were overweight, were smokers, or had diabetes or other risk factors for heart disease to follow the Mediterranean diet or a low-fat one.

“Now along comes this group and does a gigantic study in Spain that says you can eat a nicely balanced diet with fruits and vegetables and olive oil and lower heart disease by 30 percent,” he said. “And you can actually enjoy life.”

One group assigned to a Mediterranean diet was given extra-virgin olive oil each week and was instructed to use at least 4 four tablespoons a day. The other group got a combination of walnuts, almonds and hazelnuts and was instructed to eat about an ounce of the mix each day. An ounce of walnuts, for example, is about a quarter cup — a generous handful. The mainstays of the diet consisted of at least three servings a day of fruits and at least two servings of vegetables. Participants were to eat fish at least three times a week and legumes, which include beans, peas and lentils, at least three times a week. They were to eat white meat instead of red, and, for those accustomed to drinking, to have at least seven glasses of wine a week with meals.

They were encouraged to avoid commercially made cookies, cakes and pastries and to limit their consumption of dairy products and processed meats.

The participants stayed with the Mediterranean diet, the investigators reported. But those assigned to a low-fat diet did not lower their fat intake very much. So the study wound up comparing the usual modern diet, with its regular consumption of red meat, sodas and commercial baked goods, with a diet that shunned all that.

Often, preliminary studies fuel irrational exuberance about a promising dietary supplement, leading millions of people to buy in to the trend. Many never stop. They continue even though more rigorous studies — which can take many years to complete — almost never find that vitamins prevent disease, and in some cases cause harm

There’s no conclusive evidence that dietary supplements prevent chronic disease in the average American, Dr. Manson said. And while a handful of vitamin and mineral studies have had positive results, those findings haven’t been strong enough to recommend supplements to the general American public, she said.

The National Institutes of Health has spent more than $2.4 billion since 1999 studying vitamins and minerals. Yet for “all the research we’ve done, we don’t have much to show for it,” said Dr. Barnett Kramer, director of cancer prevention at the National Cancer Institute.

A big part of the problem, Dr. Kramer said, could be that much nutrition research has been based on faulty assumptions, including the notion that people need more vitamins and minerals than a typical diet provides; that megadoses are always safe; and that scientists can boil down the benefits of vegetables like broccoli into a daily pill.

when researchers tried to deliver the key ingredients of a healthy diet in a capsule, Dr. Kramer said, those efforts nearly always failed.

It’s possible that the chemicals in the fruits and vegetables on your plate work together in ways that scientists don’t fully understand — and which can’t be replicated in a table

More important, perhaps, is that most Americans get plenty of the essentials, anyway. Although the Western diet has a lot of problems — too much sodium, sugar, saturated fat and calories, in general — it’s not short on vitamins

Without even realizing it, someone who eats a typical lunch or breakfast “is essentially eating a multivitamin,”

The body naturally regulates the levels of many nutrients, such as vitamin C and many B vitamins, Dr. Kramer said, by excreting what it doesn’t need in urine. He added: “It’s hard to avoid getting the full range of vitamins.”

Not all experts agree. Dr. Walter Willett, a professor at the Harvard T.H. Chan School of Public Health, says it’s reasonable to take a daily multivitamin “for insurance.” Dr. Willett said that clinical trials underestimate supplements’ true benefits because they aren’t long enough, often lasting five to 10 years. It could take decades to notice a lower rate of cancer or heart disease in vitamin taker

For Charlsa Bentley, 67, keeping up with the latest nutrition research can be frustrating. She stopped taking calcium, for example, after studies found it doesn’t protect against bone fractures. Additional studies suggest that calcium supplements increase the risk of kidney stones and heart disease.

People who take vitamins tend to be healthier, wealthier and better educated than those who don’t, Dr. Kramer said. They are probably less likely to succumb to heart disease or cancer, whether they take supplements or not. That can skew research results, making vitamin pills seem more effective than they really are

Because folic acid can lower homocysteine levels, researchers once hoped that folic acid supplements would prevent heart attacks and strokes.In a series of clinical trials, folic acid pills lowered homocysteine levels but had no overall benefit for heart disease, Dr. Lichtenstein said

When studies of large populations showed that people who eat lots of seafood had fewer heart attacks, many assumed that the benefits came from the omega-3 fatty acids in fish oil, Dr. Lichtenstein said.Rigorous studies have failed to show that fish oil supplements prevent heart attacks

But it’s possible the benefits of sardines and salmon have nothing to do with fish oil, Dr. Lichtenstein said. People who have fish for dinner may be healthier as a result of what they don’t eat, such as meatloaf and cheeseburgers.

“Eating fish is probably a good thing, but we haven’t been able to show that taking fish oil [supplements] does anything for you,

In the tiny amounts provided by fruits and vegetables, beta carotene and similar substances appear to protect the body from a process called oxidation, which damages healthy cells, said Dr. Edgar Miller, a professor of medicine at Johns Hopkins School of Medicine.Experts were shocked when two large, well-designed studies in the 1990s found that beta carotene pills actually increased lung cancer rates.

Likewise, a clinical trial published in 2011 found that vitamin E, also an antioxidant, increased the risk of prostate cancer in men by 17 percent

“Vitamins are not inert,” said Dr. Eric Klein, a prostate cancer expert at the Cleveland Clinic who led the vitamin E study. “They are biologically active agents. We have to think of them in the same way as drugs. If you take too high a dose of them, they cause side effects.”

“We should be responsible physicians,” she said, “and wait for the data.”

(50.4 percent) of cases are mild

the pooled percentage was 45.2 percent for the combined group of mild AD dementia and MCI that later progressed to AD.

We found that approximately 45 percent of all those who are cognitively impaired or diagnosed with AD-dementia had early AD.

Diagnosis and severity were assessed by consensus dementia review.

According to the researchers the finding that half of the people living with AD have mild disease underscores the need for research and interventions to slow decline or prevent progression of this burdensome disease.

The researchers believe that most people who have AD are still at a stage when there is still some preserved quality of life.

Much of the old nomenclature has turned out to be not only stigmatizing but inaccurate. The Ebola virus, for instance, gets its name from a river that sits about forty miles from Yambuku, the Congolese village where researchers first investigated the disease, in 1976.

Still, it’s hard not to see a similarity between the recent reports of harassment against Asian-Americans and the stigmatization that gay people suffered in the wake of the AIDS outbreak.

Evolutionary psychologists refer to a “behavioral immune system” that attunes humans to physical differences or unfamiliar behavior, even when it poses no risk.

Last week, an Asian-American journalist reported that a member of the President’s staff called COVID-19 the “kung flu” to her face.

This may seem like a trivial issue to some, but disease names really do matter to the people who are directly affected

no disease better illustrates the perils of disease naming than AIDS, which, in its early days, was sometimes called “gay cancer.”

“Sometimes, I feel like we’re practicing in the 1950s,” said Dr. Eric Ball, a pediatrician in southern Orange County, where some schools report that 50 to 60 percent of their kindergartners are not fully vaccinated and that 20 to 40 percent of parents have sought a personal beliefs exemption to vaccination requirements. “It’s very frustrating. It’s hard to see a kid suffer for something that’s entirely preventable.”

Dr. Ball said he spent many days trying to persuade parents to vaccinate their children. He tries to alleviate their concerns. He shows parents his own children’s vaccine records. But it has not worked, and lately, as worries and anger over this outbreak have spread, some families who support vaccines have said they do not want to be in the same waiting room as unvaccinated families. The clinic where Dr. Ball works has treated unvaccinated children for years, but its staff is meeting next week to discuss a ban.“Our patients are really scared,” Dr. Ball said. “Our nightmare would be for someone to show up at our door with the measles.”

Norm Warren, the manager of the supermarket in Kearny, Gordon’s IGA, has changed his thinking toward those who do not vaccinate their children.“Before, I thought, ‘If you think your child will become autistic, fine.’ But now they’re pushing their beliefs on everybody, and I feel differently,“ he said. “How many lives have been saved by vaccination?“

Members of the anti-vaccine movement said the public backlash had terrified many parents. “People are now afraid they’re going to be jailed,” said Barbara Loe Fisher, the president of the National Vaccine Information Center, a clearinghouse for resisters. “I can’t believe what I’m seeing. It’s gotten so out of hand, and it’s gotten so vicious.”

In San Geronimo, Calif., a mostly rural community of rolling hills and oak trees about 30 miles north of San Francisco, 40 percent of the students walking into Lagunitas Elementary School have not been inoculated against measles, according to the school’s figures. Twenty-five percent have not been vaccinated for polio. In all, the state says that 58 percent of Lagunitas kindergartners do not have up-to-date vaccine records.

“A lot of people here have personal beliefs that are faith based,” said John Carroll, the school superintendent, who sent a letter home to parents last week encouraging them to vaccinate their children. The faith, Mr. Carroll said, is not so much religious as it is a belief that “they raise their children in a natural, organic environment” and are suspicious of pharmaceutical companies and big business.

Some parents forgo shots altogether. Others split vaccine doses or stretch out their timeline, worried about somehow overwhelming their children’s immune system. Kelly McMenimen, a Lagunitas parent, said she “meditated on it a lot” before deciding not to vaccinate her son Tobias, 8, against even “deadly or deforming diseases.” She said she did not want “so many toxins” entering the slender body of a bright-eyed boy who loves math and geography.

Tobias has endured chickenpox and whooping cough, though Ms. McMenimen said the latter seemed more like a common cold. She considered a tetanus shot after he cut himself on a wire fence but decided against it: “He has such a strong immune system.”

“It’s good to explore alternatives rather than go with the panic of everyone around you,” she said. “Vaccines don’t feel right for me and my family.”

Globally, the numbers can be even worse, and the stakes often higher. “Say a person comes into the hospital in Sierra Leone with a fever and flulike symptoms,” DeRisi says. “After a few days, or a week, they die. What caused that illness? Most of the time, we never find out. Because if the cause isn’t something that we can culture and test for” — like hepatitis, or strep throat — “it basically just stays a mystery.”

It would be better, DeRisi says, to watch for rare cases of mystery illnesses in people, which often exist well before a pathogen gains traction and is able to spread.

Based on a retrospective analysis of blood samples, scientists now know that H.I.V. emerged nearly a dozen times over a century, starting in the 1920s, before it went global.

Zika was a relatively harmless illness before a single mutation, in 2013, gave the virus the ability to enter and damage brain cells.

The beauty of this approach” — running blood samples from people hospitalized all over the world through his system, known as IDseq — “is that it works even for things that we’ve never seen before, or things that we might think we’ve seen but which are actually something new.”

In this scenario, an undiscovered or completely new virus won’t trigger a match but will instead be flagged. (Even in those cases, the mystery pathogen will usually belong to a known virus family: coronaviruses, for instance, or filoviruses that cause hemorrhagic fevers like Ebola and Marburg.)

And because different types of bacteria require specific conditions in order to grow, you also need some idea of what you’re looking for in order to find it.

The same is true of genomic sequencing, which relies on “primers” designed to match different combinations of nucleotides (the building blocks of DNA and RNA).

Even looking at a slide under a microscope requires staining, which makes organisms easier to see — but the stains used to identify bacteria and parasites, for instance, aren’t the same.

The practice that DeRisi helped pioneer to skirt this problem is known as metagenomic sequencing

Unlike ordinary genomic sequencing, which tries to spell out the purified DNA of a single, known organism, metagenomic sequencing can be applied to a messy sample of just about anything — blood, mud, seawater, snot — which will often contain dozens or hundreds of different organisms, all unknown, and each with its own DNA. In order to read all the fragmented genetic material, metagenomic sequencing uses sophisticated software to stitch the pieces together by matching overlapping segments.

The assembled genomes are then compared against a vast database of all known genomic sequences — maintained by the government-run National Center for Biotechnology Information — making it possible for researchers to identify everything in the mix

Traditionally, the way that scientists have identified organisms in a sample is to culture them: Isolate a particular bacterium (or virus or parasite or fungus); grow it in a petri dish; and then examine the result under a microscope, or use genomic sequencing, to understand just what it is. But because less than 2 percent of bacteria — and even fewer viruses — can be grown in a lab, the process often reveals only a tiny fraction of what’s actually there. It’s a bit like planting 100 different kinds of seeds that you found in an old jar. One or two of those will germinate and produce a plant, but there’s no way to know what the rest might have grown into.

Such studies have revealed just how vast the microbial world is, and how little we know about it

“The selling point for researchers is: ‘Look, this technology lets you investigate what’s happening in your clinic, whether it’s kids with meningitis or something else,’” DeRisi said. “We’re not telling you what to do with it. But it’s also true that if we have enough people using this, spread out all around the world, then it does become a global network for detecting emerging pandemics

Metagenomic sequencing is especially good at what scientists call “environmental sampling”: identifying, say, every type of bacteria present in the gut microbiome, or in a teaspoon of seawater.

After the Biohub opened in 2016, one of DeRisi’s goals was to turn metagenomics from a rarefied technology used by a handful of elite universities into something that researchers around the world could benefit from

metagenomics requires enormous amounts of computing power, putting it out of reach of all but the most well-funded research labs. The tool DeRisi created, IDseq, made it possible for researchers anywhere in the world to process samples through the use of a small, off-the-shelf sequencer, much like the one DeRisi had shown me in his lab, and then upload the results to the cloud for analysis.

he’s the first to make the process so accessible, even in countries where lab supplies and training are scarce. DeRisi and his team tested the chemicals used to prepare DNA for sequencing and determined that using as little as half the recommended amount often worked fine. They also 3-D print some of the labs’ tools and replacement parts, and offer ongoing training and tech support

The metagenomic analysis itself — normally the most expensive part of the process — is provided free.

But DeRisi’s main innovation has been in streamlining and simplifying the extraordinarily complex computational side of metagenomics

IDseq is also fast, capable of doing analyses in hours that would take other systems weeks.

“What IDseq really did was to marry wet-lab work — accumulating samples, processing them, running them through a sequencer — with the bioinformatic analysis,”

“Without that, what happens in a lot of places is that the researcher will be like, ‘OK, I collected the samples!’ But because they can’t analyze them, the samples end up in the freezer. The information just gets stuck there.”

Meningitis itself isn’t a disease, just a description meaning that the tissues around the brain and spinal cord have become inflamed. In the United States, bacterial infections can cause meningitis, as can enteroviruses, mumps and herpes simplex. But a high proportion of cases have, as doctors say, no known etiology: No one knows why the patient’s brain and spinal tissues are swelling.

When Saha and her team ran the mystery meningitis samples through IDseq, though, the result was surprising. Rather than revealing a bacterial cause, as expected, a third of the samples showed signs of the chikungunya virus — specifically, a neuroinvasive strain that was thought to be extremely rare. “At first we thought, It cannot be true!” Saha recalls. “But the moment Joe and I realized it was chikungunya, I went back and looked at the other 200 samples that we had collected around the same time. And we found the virus in some of those samples as well.”

Until recently, chikungunya was a comparatively rare disease, present mostly in parts of Central and East Africa. “Then it just exploded through the Caribbean and Africa and across Southeast Asia into India and Bangladesh,” DeRisi told me. In 2011, there were zero cases of chikungunya reported in Latin America. By 2014, there were a million.

Chikungunya is a mosquito-borne virus, but when DeRisi and Saha looked at the results from IDseq, they also saw something else: a primate tetraparvovirus. Primate tetraparvoviruses are almost unknown in humans, and have been found only in certain regions. Even now, DeRisi is careful to note, it’s not clear what effect the virus has on people. “Maybe it’s dangerous, maybe it isn’t,” DeRisi says. “But I’ll tell you what: It’s now on my radar.

it reveals a landscape of potentially dangerous viruses that we would otherwise never find out about. “What we’ve been missing is that there’s an entire universe of pathogens out there that are causing disease in humans,” Imam notes, “ones that we often don’t even know exist.”

“The plan was, Let’s let researchers around the world propose studies, and we’ll choose 10 of them to start,” DeRisi recalls. “We thought we’d get, like, a couple dozen proposals, and instead we got 350.”

One study found more than 1,000 different kinds of viruses in a tiny amount of human stool; another found a million in a couple of pounds of marine sediment. And most were organisms that nobody had seen before.

“When you draw blood from someone who has a fever in Ghana, you really don’t know very much about what would normally be in their blood without fever — let alone about other kinds of contaminants in the environment. So how do you interpret the relevance of all the things you’re seeing?”

Such criticisms have led some to say that metagenomics simply isn’t suited to the infrastructure of developing countries. Along with the problem of contamination, many labs struggle to get the chemical reagents needed for sequencing, either because of the cost or because of shipping and customs holdups

we’re less likely to be caught off-guard. “With Ebola, there’s always an issue: Where’s the virus hiding before it breaks out?” DeRisi explains. “But also, once we start sampling people who are hospitalized more widely — meaning not just people in Northern California or Boston, but in Uganda, and Sierra Leone, and Indonesia — the chance of disastrous surprises will go down. We’ll start seeing what’s hidden.”

the government is paying more than $200 for each course of treatment.

But when stockpiling a smallpox drug was first proposed in 2001 after the Sept. 11 and anthrax attacks, it was expected to cost only $5 to $10 per course, said Dr. Donald A. Henderson, who led a government advisory panel on biodefense in the wake of those attacks. Dr. Henderson was a leader in the eradication of smallpox in the 1960s and is now at the Center for Biosecurity at the University of Pittsburgh Medical Center.

Smallpox has such a long incubation period that the vaccine can prevent disease even if it is given as late as three days after infection. Arestvyr may also prevent infection if given early enough, but that has not been proven.

the price being charged for a patented drug was a bargain compared with AIDS antiretrovirals that cost $20,000 a year and cancer drugs that cost more than $100,000 a year.

“There are 80 million courses of Tamiflu in the strategic national stockpile,” he said. “Smallpox is just as contagious and has 30 times the mortality. By measures like that, I’d say 2 million is on the low end.”

The creators of the D.S.M. in the 1960s and ’70s “were real heroes at the time,” said Dr. Steven E. Hyman, a psychiatrist and neuroscientist at the Broad Institute and a former director at the National Institute of Mental Health. “They chose a model in which all psychiatric illnesses were represented as categories discontinuous with ‘normal.’ But this is totally wrong in a way they couldn’t have imagined. So in fact what they produced was an absolute scientific nightmare. Many people who get one diagnosis get five diagnoses, but they don’t have five diseases — they have one underlying condition.”

Decades of spending on neuroscience have taught scientists mostly what they do not know, undermining some of their most elemental assumptions. Genetic glitches that appear to increase the risk of schizophrenia in one person may predispose others to autism-like symptoms, or bipolar disorder. The mechanisms of the field’s most commonly used drugs — antidepressants like Prozac, and antipsychosis medications like Zyprexa — have revealed nothing about the causes of those disorders. And major drugmakers have scaled back psychiatric drug development, having virtually no new biological “targets” to shoot for.

Dr. Insel is one of a growing number of scientists who think that the field needs an entirely new paradigm for understanding mental disorders, though neither he nor anyone else knows exactly what it will look like.

Dr. Hyman, Dr. Insel and other experts said they hoped that the science of psychiatry would follow the direction of cancer research, which is moving from classifying tumors by where they occur in the body to characterizing them by their genetic and molecular signatures.

Dr. Insel said in the interview that his motivation was not to disparage the D.S.M. as a clinical tool, but to encourage researchers and especially outside reviewers who screen proposals for financing from his agency to disregard its categories and investigate the biological underpinnings of disorders instead.

This kind of modeling is already in use to study individual cellular processes like metabolism. But Dr. Covert said: “Where I think our work is different is that we explicitly include all of the genes and every known gene function. There’s no one else out there who has been able to include more than a handful of functions or more than, say, one-third of the genes.”

The simulation, which runs on a cluster of 128 computers, models the complete life span of the cell at the molecular level, charting the interactions of 28 categories of molecules — including DNA, RNA, proteins and small molecules known as metabolites, which are generated by cell processes.

They called the simulation an important advance in the new field of computational biology, which has recently yielded such achievements as the creation of a synthetic life form — an entire bacterial genome created by a team led by the genome pioneer J. Craig Venter. The scientists used it to take over an existing cell.

A decade ago, scientists developed simulations of metabolism that are now being used to study a wide array of cells, including bacteria, yeast and photosynthetic organisms. Other models exist for processes like protein synthesis.

“Right now, running a simulation for a single cell to divide only one time takes around 10 hours and generates half a gigabyte of data,” Dr. Covert wrote. “I find this fact completely fascinating, because I don’t know that anyone has ever asked how much data a living thing truly holds. We often think of the DNA as the storage medium, but clearly there is more to it than that.”

scientists chose an approach called object-oriented programming, which parallels the design of modern software systems. Software designers organize their programs in modules, which communicate with one another by passing data and instructions back and forth.

“The major modeling insight we had a few years ago was to break up the functionality of the cell into subgroups, which we could model individually, each with its own mathematics, and then to integrate these submodels together into a whole,”

The system may also play a role in symptoms of traumatic brain injur

Mice are a good model, she says, because their glymphatic systems are very similar to humans’. She and Iliff found that even months after being injured, the animals’ brains were still not clearing waste efficiently, leading to a buildup of toxic compounds, including amyloid beta. Nedergaard returns to the dishwasher analogy. “It’s like if you only use a third of the water when you turn on the machine,” she says. “You won’t get clean dishes.”

glymphatic flow is significantly decreased in the period just before a migraine. The intense pain in these headaches is caused largely by inflamed nerves in the tissue that surrounds the brain. Neuroscientists Rami Burstein and Aaron Schain, the lead authors, theorize that faulty clearance of molecular waste from the brain could trigger inflammation in these pain fibers.

Nedergaard has shown that at least in mice, the system processes twice as much fluid during sleep as it does during wakefulness. She and her colleagues focused on amyloid beta; they found that the lymphatic system removed much more of the protein when the animals were asleep than when they were awake. She suggests that over time, sleep dysfunction may contribute to Alzheimer’s and perhaps other brain illnesses. “You only clean your brain when you’re sleeping,” she says. “This is probably an important reason that we sleep. You need time off from consciousness to do the housekeeping.”

Sleeping on your stomach is also not very effective; sleeping on your back is somewhat better, while lying on your side appears to produce the best results.

in mice, omega-3 fatty acidsimproved glymphatic functioning.

other scientists have found that deep breathing significantly increases the glymphatic transport of cerebrospinal fluid into the brain.

An overwhelming majority of American adults (88%) say the benefits of the measles, mumps and rubella (MMR) vaccine outweigh the risks, according to a new Pew Research Center survey.And last year, 14 states proposed eliminating religious exemptions for vaccines -- a marked increase from years past, according to the American Academy of Pediatrics.

"When you choose not to vaccinate, you're putting your child at risk of disease, but you're also putting other people at risk," O'Leary said.

"We need to have the ability in our country, if we find a commercial pharmaceutical product is not as safe and effective as we're being told it is, we should have the right to make informed consent to use the product," she said.

"When vaccination rates fall, we see disease, and people suffer. Protecting children in schools is a worthy goal of government, regardless of political affiliation," he said. "There's really no good reason to exempt your child from vaccination -- only medical."

"Science is really on the side of vaccinations," said O'Leary, who is an associate professor of pediatrics at the University of Colorado School of Medicine. "They're one of the best public health interventions in history in terms of the numbers of lives saved. The benefits far outweigh the risk."

New York, California and Washington state took action after massive measles outbreaks in 2019, a year that saw the highest reported measles cases since the disease was declared eliminated nationwide in 2000.

Many of the religious exemption laws are not new. Several states first passed them in the 1960s and 1970s, thanks to an influx of lobbyists from the Christian Science Church, which doesn't ban members from using vaccines but encourages healing through prayer.

Supporters of vaccine exemptions see laws like those passed in New York and Washington as "fundamentally a threat to their ability to make informed consent about vaccinations," said Fisher, president of the National Vaccine Information Center.

Proponents on both sides of the debate have found allies across the political spectrum. Republican lawmakers have sponsored stricter bills, and Democratic governors have drawn the line at mandating vaccines.

"It's a tough balance, but you're using a public -- and private -- resource in conjunction with lots of other kids," Harris told CNN. "There are other venues where they can be educated, they can still have their freedom, but they're not going into a public school and spread their disease."

Functional Medicine isn't a protected title and a medical qualification isn't a prerequisite to practice. The result is an unregulated and disparate field, with medical doctors, nutritionists, naturopaths and homeopaths among the many practitioners.

Some other chronic illnesses the field claims to treat include heart disease, type 2 diabetes, irritable bowel syndrome, ulcerative colitis, depression, anxiety and arthritis

ll kinds of different reasons, some might have gluten issues, gut issues, others might have a deficiency causing neurological issues, MS is a symptom."

"There are components of Functional Medicine that absolutely lack an evidence base and there are practitioners of what they call Functional Medicine, they charge people for intravenous nutritional injections, they exaggerate claims, and that is professionally inappropriate, unethical and it lacks evidence.

On Dr Mark Hyman's view of MS he says, "there are a lot of terms put together there, all of which individually make a lot of sense, but put together in that way they do not.

"What does FM actually mean? It means nothing. It's a gift-gallop of words thrown together. It's criticised by advocates of evidence-based medicine because it's giving a veneer of scientific legitimacy to ideas that are considered pseudoscientific. For example, it'll take alternative medicine modalities like homeopathy and then call them 'bio-infusions' or something similar, rebranding it as something that works.

"It's a redundant name, real medicine is functional."

Next month the third annual Lifestyle and Functional Medical conference will take place in Salthill, Galway on November 3. Last year's event was attended by more than 500 people and featured a keynote address by honorary consultant cardiologist Dr Aseem Malhotra, author of bestselling The Pioppi Diet (which was named one of the top five worst celebrity diets to avoid in 2018 by the British Dietetic Foundation).

Dr David Robert Grimes is physicist and visiting fellow of Oxford and QUB. His research into cancer focuses on modelling tumour metabolism and radiation interactions. For Dr Grimes, the lack of definition, or "double-speak" as he puts it, in FM is troubling.

As well as the cost of appointments, FM practitioners commonly charge extra for tests. An omega finger prick test is around €100. A vitamin D test can cost upwards of €60, full thyroid panel more than €150 and a gut function test €400. Prices vary between practitioners.

"If I, as a GP, engaged in some of these behaviours I would be struck off." Specifically? "If I was recommending treatments that lacked an evidence base, or if I was promoting diagnostic tests which are expensive and lack an evidence base.

GPs engage every year in ongoing continuous professional development, I spend my evenings and my weekends outside of working hours attending educational events, small-group learning, large-group learning, engaging in research. This is an accusation that was levelled at the profession 30 years ago and then it was correct, but the profession has caught up…

"Obviously promoting wellness and healthy diet is very welcome but going beyond that and stating that certain aspects of 'functional medicine' can lead to reduced inflammation or prevent cancer, we have to be very careful about those claims.

Often the outcome of such tests are seemingly 'benign' prescriptions of vitamins or cleanses. However, dietitian Orla Walsh stresses that even these can have potentially harmful effects, especially on "vulnerable" patients, if not prescribed judiciously.

FM has five basic principles. 1. We are all genetically and biochemically unique so it treats the individual, not the disease. 2. It's science-based. 3. The body is intelligent and has the capacity for self-regulation. 4. The body has the ability to heal and prevent nearly all the diseases of ageing. 5. Health is not just the absence of disease, but a state of immense vitality.

She began her Functional Medicine career while training as a medical doctor and now travels the world working with high-profile clients. Dr McHale charges €425 for an initial consultation and €175 for follow-up appointments. Straightforward lab tests are €250 to €750, for complex cases testing fees can be up to €2,000.

"The term [Functional Medicine] tends to be bandied around quite a bit. Other things people say, such as 'functional nutritionist', can be misleading as a term. Many people are Functional Medicine practitioners but don't have any real medical background at all... I think regulation is always probably the best way forward."

"There's an awful lot to it in terms of biochemistry and physiology," she says. "You do need to have a very solid and well ingrained bio-chemistry background. A solely clinical background doesn't equip you with the knowledge to read a test.

"Evidence-base is the cornerstone of medicine and that has to be maintained. It becomes problematic in this area because you are looking at personalised medicine and that can be very difficult to evidence-base."

GP Christine Ritter travelled from England to attend the Galway conference last year with a view to integrating Functional Medicine into her practice.

"It was very motivating," she says. "Where it wasn't perhaps as strong was to find the evidence. The Functional Medicine people would say, 'we've done this study and this trial and we've used this supplement that was successful', but they can't show massive research data which might make it difficult to bring it into the mainstream.

"I also know the rigorous standard of trials we have in medicine they're not usually that great either, it's often driven by who's behind the trial and who's paying for it.

"Every approach that empowers patient to work on their destiny [is beneficial], but you'd have to be mindful that you're not missing any serious conditions."

Dr Hyman is working to grow the evidence-base for Functional Medicine worldwide. "The future is looking very bright," he says. "At the Cleveland Centre we're establishing a research base, building educational platforms, fellowships, residency programmes, rotations. We're advancing the field that's spreading across the world. We're seeing in China the development of a programme of Functional Medicine, South Africa, the UK, in London the Cleveland Clinic will hopefully have a Functional Medicine centre."

For Dr Mark Murphy regulation is a moot point as it can only apply once the field meets the standards of evidence-based medicine.

"Despite well intentioned calls for regulation, complementary and alternative medical therapies cannot be regulated," he says. "Only therapies that possess an evidence-base can enter our standard regulatory processes, including the Irish Medical Council, the Health Products Regulatory Authority and Irish advertising standards. In situations where complementary and alternative therapies develop an evidence base, they are no longer 'complementary and alternative', but in effect they become part of mainstream 'Medicine'.

l What are the principles?

"There's a huge variation between therapists, some are brilliant and some are okay, and some are ludicrous snake oil salesmen."

He is so concerned that patients' health and wealth are being put at risk by alternative therapies that earlier this year he joined Fine Gael TD Kate O'Connell and the Irish Cancer Society in introducing draft legislation earlier this year making it illegal to sell unproven treatments to cancer patients. Violators face jail and heavy fines.

Dr Grimes says criticism of variations in the standards of traditional medical research can be fair, however due to the weight of research it is ultimately self-correcting. He adds, "The reality is that good trials are transparent, independent and pre-registered.

"My involvement in shaping the Bill came from seeing first-hand the exploitation of patients and their families. Most patients undergoing treatment will take some alternative modalities in conjunction but a significant portion are talked out of their conventional medicine and seduced by false promises

Poor sleep may be contributing to the buildup of the brain plaques that drive the disease

“Sleep is a great early warning beacon, a distress call that we can latch onto, to potentially alert us to the beginnings of Alzheimer’s,” says Walker.

“Your results are not the least bit surprising,” he told me. “Anything short of sequencing is going to be short on accuracy — and even then, there’s almost no comprehensive data sets to compare to.”

“Even if they are accurately looking at 5 percent of the attributable risk, they’ve ignored the vast majority of the other risk factors — the dark matter for genetics — because we as a scientific community haven’t yet identified those risk factors,”

There are only 23 diseases that start in adulthood, can be treated, and for which highly predictive tests exist. All are rare, with hereditary breast cancer the most common. “A small percentage of people who get tested will get useful information,” Dr. Klitzman said. “But for most people, the results are not clinically useful, and they may be misleading or confusing.”

To be sure, my tests did provide some beneficial information. They all agreed that I lack markers associated with an increased risk of breast cancer and Alzheimer’s. That said, they were testing for only a small fraction of the genetic risks for these diseases, not for rare genetic variants that confer much of the risk. I could still develop those diseases, of course, but I don’t have reason to pursue aggressive screenings as I age.

He added: “If you want to spend money wisely to protect your health and you have a few hundred dollars, buy a scale, stand on it, and act accordingly.”

It summarized and condemned the scientific and medical fraud that the British researcher Andrew Wakefield perpetrated. Years earlier, he had falsely linked the measles, mumps, and rubella (MMR) vaccine to autism. The editorial lamented that “the damage to public health continues, fuelled by unbalanced media reporting and an ineffective response from government, researchers, journals, and the medical profession.”

Reporters also seek to ensure that viewers, listeners, or readers understand that measles can afflict a victim more powerfully than does a mere passing ailment.

Measles doesn’t spread in most U.S. communities because people are protected by “herd immunity,” meaning that 92% to 94% of the population is vaccinated or immune. That level of protection makes it hard for one case of measles to spread even from one unvaccinated person to another without direct contact.

a study that “found that only 51 percent of Americans were confident that vaccines are safe and effective, which is similar to the proportion who believe that houses can be haunted by ghosts.”

In some parts of California, resistance to vaccinations including the MMR shot is stronger than ever, despite cases of measles hitting five US states.

“Vaccines are a great idea, but they are poisoning us, adding things that kick in later in life so they can sell us more drugs.”

Health professionals say those claims are unfounded or vastly overstated.

“the anti-vaccination movement is fueled by an over-privileged group of rich people grouped together who swear they won’t put any chemicals in their kids (food or vaccines or whatever else), either because it’s trendy to be all-natural or they don’t understand or accept the science of vaccinations. Their science denying has been propelled further by celebrities

the outbreak “should worry and enrage the public.” It indicted the anti-vaxxers’ “ignorant and self-absorbed rejection of science” and declared, “Getting vaccinated is good for the health of the inoculated person and also part of one’s public responsibility to help protect the health of others.”

“It’s wrong,” the editors emphasized, “to allow public health to be threatened while everyone else waits for these science-denying parents to open their eyes.”

“It’s because these people are highly educated and they get on the Internet and read things and think they can figure things out better than their physician.”

linked vaccination opposition to the “political left, which has long been suspicious of the lobbying power of the pharmaceutical industry and its influence on government regulators, and also the fringe political right, which has at different times seen vaccination, fluoridisation and other public-health initiatives as attempts by big government to impose tyrannical limits on personal freedom.”

Attempts to increase concerns about communicable diseases or correct false claims about vaccines may be especially likely to be counterproductive.

“attempting balance by giving vaccine skeptics and pro-vaccine advocates equal weight in news stories leads people to believe the evidence for and against vaccination is equally strong.”

A recent edition of the Washington Post carried a letter defending anti-vaxxers as “people who generally are pro-science and highly educated, who have high incomes and who have studied this issue carefully before coming to the conclusion that the risk to their children is greater than the slim possibility of contracting a childhood disease that [in many cases leaves] little or no residual consequences.”

anecdotal evidence suggests that some journalists, rather than omitting anti-vaxxers’ views, prefer to expose them and then oppose them.

“unwarranted fear . . . an assault on one of the greatest public-health inventions in world history.”