You’ve Come a Long Way, Baby

50th Anniversary of the Surgeon General's Report on Smoking and Health

Yesterday marked the 50th anniversary of the landmark Surgeon General’s report on smoking and health. It really wasn’t that long ago that smoking was a way of life. As the author points out in this piece on why people smoke, even doctors had cigarettes in their mouth while examining patients back then. The Surgeon General himself, Dr. Luther Terry, was a smoker until a few months before he made his speech in 1964. And for something so deeply ingrained into the culture, so addictive, and a major part of the economy – the report was given on a Saturday in fear of a negative stock market response – we really have seen a remarkable decline in smoking.

The antismoking campaign is a major public health success with few parallels in the history of public health. It is being accomplished despite the addictive nature of tobacco and the powerful economic forces promoting its use.

–          CDC

We now have a better understanding how diffusely tobacco affects the body. People who smoke are at higher risk of everything we worry about getting: cancer, heart attack, stroke, vascular problems leading to leg amputation, and looking older. I see many adult children of smokers who have never smoked, deterred by their parents’ habit. But many children and young adults continue to experiment with smoking, often thinking that they can quit anytime. Unfortunately, smoking continues to be glorified in other settings. Hollywood practically gives them away, somewhat reminiscent of cigarettes being provided to US soldiers in the past.

We’ve come a long way, but we’ve got more work to do.

Vaccines and Public Health in the U.S.: We Need a (Celebrity) Hero.

“I was also fearful as a new mom but as a student of public health, I understand the evidence-based research now.”

– (author to be disclosed later in this post)

The above statement was made in reference to vaccines a little over a month ago… preBachmann. Michele Bachmann, as the reader likely is aware, is the Republican presidential candidate who broadcasted second-hand, anecdotal, unresearched, fear-mongering on national television on September 12, 2011. She did this by relating the story of a woman who had told Bachmann that her daughter developed “mental retardation” after receiving the HPV vaccination. The American Academy of Pediatrics made a statement the very next morning refuting any link.  It was a wise and necesarry move which seemed swift, yet quite possibly neither fast nor impactful enough.

Bachmann’s words were disheartening to doctors and public health advocates who were just beginning to see some light at the end of the vaccine controversy tunnel – a path that had been leading to new outbreaks of measles, which had been rarely seen in the last few decades. The February 2010 retraction of a Lancet article written by Andrew Wakefield (which had linked vaccines to autism) gave doctors more confidence and something more tangible with which to bolster vaccination recommendations. This is not to say there wasn’t enough evidence prior to that. However, a mere 587 days after the retraction of Wakefield’s article, vaccine proponents were dealt another blow with Bachmann’s story.

One would suspect that the vast majority – if not all – of graduating medical students understand and would emphasize the importance of vaccination. But with primary care doctors squeezed from every angle imaginable in today’s healthcare environment, taking the time to discuss vaccines with each and every patient can seem nearly impossible. In a way, it would seem that doctors who do not have the discussion of the benefits and risks of vaccines have also somehow lost the vision that their role as physicians includes understanding and meeting the needs of the “greater good” of society, as well.**

So, in times of pro-vaccination despair, who will take up the torch?

We need a hero.

The most obvious answer would be a celebrity. Dr. Kevin Pho concurs, stating in a recent blog post,

“Doctors are playing from behind, both with their job of ‘unscaring’ people and combating the celebrity-laden anti-vaccine movement. We need to get more politicians and celebrities onto the side of evidence-based medicine in order to reframe the vaccine debate.”

There is a celebrity who has historically been against vaccination. There are those who promote clean water. As alluded to in a previous blog post, it seemed unlikely that any celebrity would educate the public about the importance of vaccination as fervently.  Salma Hayek, to her credit, has worked with UNICEF and a diaper brand to promote tetanus vaccination in Africa. While there are certainly a lot of commendable and valuable global efforts and not enough for the immense need, vaccination against preventable diseases should continue to be emphasized here in the US.

So, to return to the comment at the very beginning of this blog post, the author is a public figure whom I have been following on Twitter for a few months. She is a well-known advocate for global maternal health and an internationally–recognized supermodel. Last month, I was excited to see that she had posted a couple of valuable tweets regarding the benefits of vaccination, including links to a relatively tame Penn and Teller skit and to an article in the LA Times.

This individual is clearly using knowledge from her public health studies to help spread the word about the importance of vaccines.  I wouldn’t want to put her on the spot as a definite “spokesperson” for vaccination, but I do admire her recent use of Twitter to address this very important issue.

The fact remains, we need a public health hero. Christy Turlington is willing to contribute. Is anyone else?

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(**Choice and informed decision making are very important in Western medicine. But the “informed” part needs to be just that – truly informed. Physicians need to educate, listen, and address concerns. Educate more. Then decide together.)

For Safe Grilling, Use a Meat Thermometer

It’s the Fourth of July and you’re ready to have your friends and family over for a barbeque. You’re setting up your grill and going down your checklist. Meat? Check. Buns? Check. Beer? Check. Meat thermometer….?

What’s that? No thermometer?


Go over to your kitchen right now and pull out that meat thermometer that’s been hiding in the junk drawer since two Thanksgivings ago. If you don’t have one, run to the grocery store and get one before you forget because you will be almost certainly be distracted when your guests arrive and and will end up relying on the false security of your vision.

According to the USDA’s Federal Safety and Inspection Service website, 1 out of every 4 hamburgers turns brown before it reaches a safe internal temperature. So, use that thermometer. Here is info from the website, followed by other important reminders:

USDA Recommended Safe Minimum Internal

Cook all raw beef, pork, lamb and veal steaks, chops, and roasts to a minimum internal temperature of 145 °F as measured with a food thermometer before removing meat from the heat source. For safety and quality, allow meat to rest for at least three minutes before carving or consuming. For reasons of personal preference, consumers may choose to cook meat to higher temperatures.

Cook all raw ground beef, pork, lamb, and veal to an internal temperature of 160 °F as measured with a food thermometer.

Cook all poultry to a safe minimum internal temperature of 165 °F as measured with a food thermometer.

Note that allowing meat to “rest” (which means waiting at least 3 minutes after pulling the meat off of the heat source, usually covered with foil) allows the temperature and “doneness” to even out.

Avoid using wooden cutting boards when handling meat, particularly if it is raw or potentially undercooked. Instead, use at least two dishwasher-safe, plastic cutting boards (one for meat and one for

DO NOT cross-contaminate. I repeat DO NOT cross-contaminate. That applies to working surfaces and marinades, too. Do not brush meat that is cooking on the grill with the same liquid your raw meat was sitting in. Instead, prior to mixing the marinade with the meat, save a portion of it for use on the grill.

So have fun and enjoy your time with friends/family, but protect them by following the guidelines above.

Have a Happy (and Safe) Fourth of July!

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Zostavax now approved for people 50 years and older

Big news that just came out today:

Zostavax (the immunization that helps prevent shingles) was previously approved for people aged 60 and older. The FDA has broadened the eligible age range to include 50-59-year-olds. However, please note that many insurance companies have not even covered this immunization for 60+ year-olds, so patients would have to find out from their insurance plan whether this would be covered for them. It is not an inexpensive vaccination and not for everyone (depending on your underlying health condition). There have also been supply issues in the past, making it unavailable at times.

The Vaccine-Autism (Dis)connection

photo by Sura Nualpradid (

A recent briefing by the King County Public Health Department addressed the recent retraction of Andrew Wakefield’s pivotal, but extremely flawed – fraudulent – article in Lancet.  Recall that the initial 1998 publication implicated MMR vaccination in the development of autism and started a trend of significant hesitancy towards vaccination of children.  Unfortunately, this hesitancy has become prevalent among parents AND some medical professionals.

Jeffrey S. Duchin, MD, Chief of the Communicable Disease Epidemiology and Immunization Section sent out a memo after the Lancet RETRACTED the original article written by Wakefield. The briefing is directed at providers, but is available on the website:

Page one of this briefing is useful for both providers and patients who want to know more about why the medical community has come to find Wakefield’s research unethical and fraudulent and the impact Wakefield’s assertions have made over the past several years. Page two is useful for providers who want to educate patients who still feel dubious about vaccinating their children (which, by the way, is still quite likely, as much of the public is unaware of the momentous Lancet retraction).  

Is the medical community beating a dead horse? Probably not. As widely publicized and accepted as Wakefield’s Lancet article was, it will take an even more significant effort to undo the damage done.

“In 2008, there were more cases of measles reported in the US than in any other year since 1997, with >90% of cases occurring in unvaccinated individuals or in those whose vaccination status was unknown. The current pertussis epidemic in California is the largest since 1955.”

It was a public figure who fueled the controversial fire a few years ago. Is it likely that any celebrity would educate the public about the importance of vaccination as fervently? Perhaps social media and the blogosphere have the power to clean up the mess Wakefield left behind. (Imagine: A big “S” on this blogger’s white coat).

New guidelines on the “whooping cough” vaccine

I recently went to the American College of Physicians Chapter Meeting in Seattle and came away with a lot of great information, including a significant change in immunization of adults against pertussis (whooping cough).

When patients need a booster of tetanus immunization, we often give it in combination with a vaccine to protect against pertussis. As you may know, tetanus is a life-threatening infection by a bacteria that can cause severe muscle spasms and lockjaw. Immunization boosters for tetanus (Td) are given every 10 years to prevent the life-threating tetanus infection that can causes severe muscle spasms and lockjaw. The Tdap (tetanus-diphtheria-acellular pertussis) vaccine is a combination vaccine that helps prevent both tetanus and pertussis and has been typically given to patients aged 11-64 when they were due for their next tetanus immunization (if they had not received it yet).

Unfortunately, we are seeing a rise in whooping cough. In California, there have been more than 6200 cases and 10 deaths related to pertussis. It is also on the rise in other states. Often, it is grandparents and siblings that pass on pertussis to infants. For this reason, the recommended age group receiving the Tdap shot has broadened. Although the Tdap is not approved for adults 65 and older, research has shown that these vaccines are safe in this age group. Also, there is no longer a required interval between the Td and the Tdap vaccine (which used to be 5 years).


*People aged 11 to 64 who have not received the Tdap should get it, even if they are not sure when they last got it.

*Ask your pediatrician about immunizing children who are younger.

*I would strongly urge that adults 65 and older who are likely to have close contact with an infant also get the Tdap vaccine if they have not received it or even if they are not sure that they have.