Tag Archives: surgeon general

To Be or Not to Be (Vaccinated)?

For many years, Americans did not need to worry about contracting the once-widespread disease called the measles. In fact, the Centers for Disease Control and Prevention (CDC) officially declared measles eliminated in the U.S. in 2000. Unfortunately, that is no longer the case. In January 2015 alone, there were already more confirmed cases in the U.S. than are typically diagnosed in a full year. Public health officials are very concerned and have moved to aggressively contain this very contagious, but 100% preventable, disease. The current outbreak and surge in confirmed cases of measles, most notably in California, has been scientifically linked by researchers from MIT and Boston’s Children Hospital to the outbreak that began in Disneyland in December 2014. Medical researchers believe the spread of the current measles outbreak is solely because of low vaccination rates in certain communities based on a widespread but false link between childhood immunizations and autism. International health officials have called the link between the MMR (measles, mumps and rubella) vaccine and autism “the most damaging public health hoax in the past 100 years.”

Just last week on April 21, the Journal of the American Medical Association (JAMA) released the findings of a comprehensive study using the health insurance data base of 95,000 children and found no overall link between autism and the MMR vaccine. The study also found no link for children with an autistic sibling. The study did find a lower vaccination rate for the younger siblings of children with autism based on parents’ continued fears of a link. The JAMA study authors from the Lewin Group in Falls Church, Va., stated; “Consistent with studies in other populations, we observed no association between MMR vaccine and increased ASD (autism spectrum disorder) risk among privately insured children.”

Despite the overwhelming medical evidence that the MMR vaccine is both very safe and highly effective, anti-vaccination groups still dispute the facts and are warning parents not to be pressured into having their children vaccinated, which is the crux of this public health problem. On the same day that the JAMA study was released, CBS Evening News ran a segment on the current U.S. Surgeon General Vice Admiral Vivek Murthy, MD, MBA, or “America’s Doctor,” who appeared on Sesame Street to promote childhood vaccinations. CBS closed the segment with; “Vaccination critics don’t see anything cute about this video after the controversy over the recent measles outbreak.” Really? There is no controversy. It was all based on a documented hoax.

The original belief that vaccinations cause autism was based on a reported study in 1988 by Dr. Andrew Wakefield in the U.K., which has since been 100% completely discredited. His report unnecessarily panicked many parents around the world, causing a sharp decline in the number of children getting the MMR vaccine. The false claims and widespread panic began when a British medical journal, the Lancet, published Wakefield’s article. It was later determined that the author had multiple conflicts of interest, had manipulated evidence and had broken ethical research codes of conduct, including accepting funding by attorneys involved in lawsuits against vaccine manufacturers. The Lancet fully retracted the article, but not until 2010, when the editor-in-chief stated that the link was “totally false” and that the world-famous medical journal was “deceived.” The Canadian Medical Journal in 2010 went on to state that the original research included a “callous disregard” for the “carefully selected” study group of only 12 children and that “several elements of this research were incorrect and contrary to findings of an earlier investigation.” Dr. Wakefield subsequently lost his license to practice medicine in the U.K as a result of this fraudulent research.

These are the facts that parents need to know about the measles. Symptoms typically begin with a high fever, runny nose, sore throat and cough, which can easily be misdiagnosed as a simple cold or the flu. The incubation period is between seven and 18 days of exposure to the virus. It is very dangerous because people are contagious up to four days before the red rash appears and likely do not know they are infected. In addition, a room can still be contaminated as long as two hours after an infected person leaves. A single infected person can spread the disease to between 11 and 18 people. An unvaccinated person has a 90% chance of infection if exposed to the virus. The risk of serious complications and death is even greater for adults and infants than for children and teenagers. Rubella, known as the German measles, is also caused by the virus and is usually a mild form of the disease but is a very serious infection that causes miscarriages, still births or birth defects in unborn children when pregnant women get the disease.

Most people born prior to 1957 had the measles. The disease was once so prevalent that in New York City, in the first 10 weeks of 1933 alone, there were 10,000 cases and 434 deaths. The first vaccines developed began in 1958 and became widely available in 1963. Prior to 1963, there were three to four million cases of measles reported each year in the U.S., with 400 to 500 reported deaths annually.

Although many parents in the anti-vaccination movement believe the measles is not dangerous and the MMR vaccine is, the medical facts state otherwise. In fact, from 2001 to 2013, 28% of children in the U.S. with the measles had to be hospitalized. Public health officials fear that many more cases will develop from this outbreak of a very preventable disease, unless aggressive public health measures are undertaken. What is required is an extensive education campaign including widespread vaccination of the unvaccinated U.S. population, starting with infants at 12 months and a booster shot at age four to six, prior to pre-school or kindergarten. Unvaccinated adults also need to be vaccinated.

There are a number of myths associated with the measles vaccination that keep some parents from protecting their children. The controversy surrounding the anti-vaccination movement is based largely on parents’ philosophical beliefs against the vaccination. Dr. James Cherry, a pediatric infectious disease expert at UCLA, believes that the recent outbreak in California is “100% connected to the anti-immunization campaign.” He went on the say that there are “some pretty dumb people out there.”

Medical researchers from MIT and Boston Children’s Hospital documented that the rapid spread of measles from the Disneyland outbreak, beginning in mid-December 2014, indicated a significant percentage of the population exposed had low vaccination rates. These researchers determined that the exposed population rate might have been as low as 50% and likely no higher than 86%. These rates are well below the 96%-99% level known as “herd immunity,” which is required to prevent future outbreaks.

The anti-vaccination movement includes those parents who believe that there is no medical risk from not vaccinating their child, that the disease is extinct, that doctors and drug companies push vaccinations for their own profit, and that you can get the measles from the vaccination. Still others believe the false and discredited link to autism. For the parents who are against vaccination, they not only put their own children at risk, they dramatically increase the risk for the general population who are unable to get the vaccination, such as infants under the age of one, and children and adults with weak immune systems, including people with cancer and other diseases.

Measles is still widespread throughout the world. Travelers from overseas continue to bring the disease into the U.S on a daily basis. The anti-vaccination conspiracy movement belief that doctors and insurance companies promote the vaccination to increase profit is absurd and is negated by the fact that health insurance companies pay for the vaccinations at no cost to the patient. Similar to the flu shot that is a dead virus from which someone cannot get the flu, it is almost impossible to get the measles from the MMR vaccine.

The CDC states there is a 1 in 3,000 chance of a mild allergic reaction to the MMR vaccine but a 90% chance of infection if an unvaccinated child is exposed to the virus. Parents should do the math. In addition, a blood product containing an immune globulin is available for people who are medically unable to immunize with the MMR vaccine for any reason.

What parents need to know is that the scientific community has found no evidence whatsoever of a link between MMR vaccine and autism or any other childhood development disorder. In addition to the just-released JAMA study, large epidemiological studies conducted by the CDC, the American Academy of Pediatrics, the Institute of Medicine at the U.S. National Academy of Sciences and the U.K. National Health Services all found no link between MMR and autism. This original false research has done significant damage to the field of public health and has done serious harm to children of parents who were misled by this report, which resulted in unnecessary deaths, severe impairment and permanent injury in unvaccinated children. Because of wide dissemination of this discredited link, there were many lawsuits by parents with children with autism, but a special court convened by the National Vaccination Injury Compensation program denied all compensation claims in U.S. federal court against manufacturers of the vaccine in 2009.

The recent measles outbreak in California is what has spiked the “controversy” over vaccinations, which has made the national news in 2015 including; CNN, the New York Times and Time Magazine. There have been 178 documented new cases of the measles by late March by the CDC, including five unvaccinated Disneyland workers in Orange County, and the outbreak is now spreading across the U.S.

Although traditional public health issues are typically rooted in poor or rural areas of the country, this current measles outbreak is concentrated in wealthy neighborhoods in California and surrounding states. Although it is reported that only 3.1% of parents in California refuse to vaccinate their children, for health or religious reasons, this number is misleading. In fact, many areas within California have double-digit exemption rates from vaccinations, with some areas as high as 50%.

The MMR vaccination is the best way to prevent disease both for the individual and the general population. It works by making the body produce anti-bodies against the virus. The measles vaccination is recommended for all people 12 months of age or older, and especially people traveling overseas. MMR vaccinations are supported by the American Academy of Family Physicians, American Academy of Pediatrics, the Centers for Disease Control and Prevention and the Mayo Clinic, to name just a few.

An extensive education campaign is required to overcome false and unfounded fears among parents of unvaccinated children. Legislation is needed to strengthen immunization laws requiring all school-age children to receive the measles vaccination, except for those with a medical exemption certified by a licensed physician. Public health officials should also track and verify both statewide and local immunization rates and should mandate that schools maintain an up-to-date list of pupils with exemptions so they can be excluded quickly if an outbreak occurs, temporarily exclude unvaccinated students and teachers from attending school and offer measles vaccinations for unvaccinated students and teachers.

The MMR vaccine is 99% effective and provides immunity for a lifetime. It was once considered one of the major public health campaign success stories. Now, health officials fear the potential for a public health crisis based on blatantly false research and unfounded fears. The CDC points out that people who refuse to vaccinate usually live in the same community. “When measles find its way into these communities, outbreaks are more likely to occur.” Consumers and parents should confirm with their doctor that they or their children do not have any allergic reactions to other medications. They should also verify that they do not have an immune deficiency condition, which may cause side effects and decrease the vaccine’s usefulness.

The myth that childhood vaccinations lead to autism was based largely on a completely discredited medical research hoax. This myth is still being widely perpetuated today not only by the anti-vaccination conspiracy movement led by Hollywood celebrities but also by the mainstream media.

My heart breaks for the parents of children with autism, including a close family friend. But it breaks my heart even more knowing that thousands of children are unnecessarily exposed to unimaginable consequences of birth defects and death from something so preventable. Parents need to listen to the Surgeon General, the CDC, the Mayo Clinic and the American Academy of Pediatrics and not Hollywood celebrities with zero background in public health.

I would like to thank my research assistant and co-author Ms. Chandler Berke who is a public health/science undergraduate student at the College of Charleston in South Carolina.

Five Things Employers Need to Know About Mental Health

“The workplace is the last crucible of sustained human contact for many of the 30,000 people who kill themselves each year in the United States. A coworker’s suicide has a deep, disturbing impact on work mates. For managers, such tragedies pose challenges no one covered in management school.” (Shellenbarger, 2001)1

Five things employers need to know about workplace mental health and suicide include some bad news…

  1. Depression is a top driver of health care costs to employers.2 3 Depression represents employers' highest per capita medical spending. (The per-capita annual cost of depression is significantly more than that for hypertension or back problems, and comparable to that for diabetes or heart disease. People with depression also have more sick days than people suffering from other conditions.)4
  2. If we take a snapshot of any workplace at any given point in time, at least one in five people will have a diagnosable mental health condition.5 The most common are mood disorders like depression or substance abuse disorders like alcohol abuse.
  3. The majority of people who die by suicide are of working age. While other groups’ suicide rates are holding steady or decreasing, the rates for men and women in the middle years have increased significantly over the last decade.

And some good news…

  1. By engaging in simple preventative steps (e.g., stress management or depression screenings) anyone can help maintain their own mental health. By learning practical tactics (e.g., becoming suicide prevention gatekeepers or referring coworkers to employee assistance services) employees can help promote the mental health and safety of others.6 7
  2. A comprehensive and evidence-based approach to suicide prevention and mental health promotion exists,8 is cost-effective9 and gives employers a clear guide on what to do. By being “visible, vocal and visionary” leaders, employers can set the expectation that a culture of health and safety is a priority and that mental health promotion and suicide prevention are a critical part of that priority.

While managers often feel responsible for the well-being of the people they supervise, very few have been given any substantial training in how to identify people in a suicide crisis and how to link them to life-saving care. Employers can play a critical role in closing this gap through a comprehensive approach.

A five-year analysis of the nation’s death rates released by the Centers for Disease Control and Prevention found that the suicide rate among 45- to 54-year-olds increased 20% from 1999 to 2004, while rates for youth and elderly persons are decreasing. The Surgeon General’s National Strategy for Suicide Prevention targets employers as critical stakeholders in the prevention of suicide.10

While suicide prevention may seem to be too intensive for workplaces to take on, there are many upstream prevention strategies that do not take much effort but yield tremendous results. Here are low-cost, high impact strategies employers can take to promote mental health and prevent suicide:

  1. Promote the Suicide Prevention Lifeline. This free resource (1-800-273-8255 [TALK]) is available to employees 24/7 and used by both people in crisis and those who are trying to support them. The line connects to local crisis call centers and is answered by certified volunteers, most of whom have had more training and experience in de-escalating suicidal behavior than many of our mental health professionals.
  2. Participate in National Screening Days.  Whenever we can identify a health condition early in its course, we are in a much stronger position to prevent it from escalating. Employers can help coordinate screening days as a part of a larger national awareness effort. Mental Health Screening offers workplaces promotional and screening tools for National Depression Screening Day (October), National Eating Disorders Awareness Program (February), National Alcohol Screening Day (April), and National Anxiety Disorders Screening Day (May). In addition, their WorkplaceResponse program gives employees an anonymous opportunity to self-screen for depression, bipolar disorder, Post Traumatic Stress Disorder, generalized anxiety disorders, eating disorders, and alcohol use disorders.  These screenings offer immediate results and referrals to an organization’s employee assistance program and community-based resources.
  3. Reward Mental Wellness. For example, the Working Minds program offers a contest every year to workplaces that have developed mentally healthy policies and practices that demonstrate positive outcomes like retention, lower absenteeism, and higher employee satisfaction. These workplaces then become the model for others.
  4. Change the Conversation Through Social Marketing.  By showing models of people who have experienced significant psychological distress and who have recovered and are thriving, employers can show that struggles are normal and increase a sense of efficacy among the hopeless. For example, workplaces can develop a multimedia campaign that lets people know they are not alone if they are thinking about suicide and that many resources exist to help. If the company’s leaders are courageous enough to model this message, the culture of the organization usually shifts accordingly.
  5. Offer Educational Programs on Mental Illness. Employee assistance professionals can provide “lunch-and-learn” sessions that increase awareness about the signs and symptoms of depression, bipolar disorder, alcohol dependence, and other mental illnesses that can lead to suicide.  These presentations should share how treatments are effective while dissipating misperceptions people have that create barriers to care.
  6. Training Staff to Become Suicide Prevention Gatekeepers. In addition to offering general training, workplaces should train key people in suicide prevention gatekeeper methods. The concept is similar to CPR – train lay people to know the warning signs of a life-threatening situation and how to sustain a person’s life until they can be linked to professional care. Many models for this training exist, including Working Minds, QPR, and ASIST. For more information, review the gatekeeper matrix on the Suicide Prevention Resource Center website.

As our workplaces accelerate from the industrial age to the information age and beyond, we come to increasingly rely on our mental muscle to get us through our workday. Like any other muscle, our mental muscle can get injured or fatigued, and we can experience high levels of distress, sometimes leading to a suicide crisis. Workplaces can prepare for this in many ways and develop a comprehensive approach to reduce suicide risk and promote mental resiliency.

For more information, visit WorkingMinds.org. Working Minds is one of the first programs in the country to provide workplaces with a comprehensive approach to suicide prevention. Working Minds is a priority program of the Carson J Spencer Foundation based in Golden, Colorado. In a little more than a lunch hour, employees at all levels of a workplace can be taught how to identify warning signs and risk factors and help link distressed coworkers to appropriate care.

1 Schellenbarger, S. (2001, June 13). Impact of colleague’s suicide is strongly felt in workplace. The Wall Street Journal.

2 Mental Health America (n.d.) Depression in the Workplace.

3 Witters, D. (2013, July 24). Depression Costs U.S. Workplaces $23 Billion in Absenteeism.

4 Managed Care Magazine (2006, Spring) Depression in the Workplace Cost Employers Billions Each Year: Employers Take Lead in Fighting Depression.

5 Gray, T. (2004) ValueOptions Articles – Managers.

6 Paul, R. & Spencer-Thomas, S. (2012). Changing Workplace Culture to End the Suicide Standstill. National Council Magazine. (2), 126-127.

7 Spencer-Thomas, S. (2012). Developing a workplace suicide prevention program. Journal of Employee Assistance, 42(1), 12-15.

8 National Action Alliance for Suicide Prevention (2013) Comprehensive Blueprint for Workplace Suicide Prevention. Retrieved from http://actionallianceforsuicideprevention.org/task-force/workplace/cspp

9 National Institute of Mental Health (2007, September) Workplace Depression Screening, Outreach and Enhanced Treatment Improves Productivity, Lowers Employer Costs.

10 U.S. Department of Health and Human Services, Public Health Service. (2001). National strategy for suicide prevention: Goals and objectives for action, p. 67.