Of The Clinical Research Program 2006 - Children'S Hospital Boston: Fill & Download for Free

Even though many will dis Hillary as corrupt and ineffective, if you take time to read about her, you’ll see that she is a truly great woman who accomplished more than dozens of her detractors. If you asked a true patriot like McCain, he’d say he’d much rather have Hillary in the White House than trump. The only way the Rs could defeat her was decades of misinformation and character assassination that has nothing to do with how immensely effective she was in doing her job. Unfortunately America got probably the worst President in 100 years and gave up the best in the process. We should have nothing but admiration for a woman who is truly amazing.Hillary Clinton’s AchievementsWith all the inflammatory rhetoric, it’s easy to lose perspective of what an impressive personal and political career Hillary Clinton has had. So let’s take a look at some of her accomplishments and examples of her working hard for the American people.Foreign Policy:Myanmar transitionIran nuclear deal frameworkIsrael/Hamas peace agreement/ceasefirePromoting LGBT rights in Africa as Secretary of StateHIV/AIDS testing and treatment through Clinton Foundation partnership with ANTIAIDS and the Victor Pinchuk Foundation in UkraineLaunched Global Hunger and Food Security programSaved the Turkish-Armenian accordCo-sponsored Afghan Women and Children Relief Act of 2001Co-sponsored Zimbabwe Democracy and Economic Recovery Act of 2001Co-sponsored Democratic Republic of the Congo Relief, Security, and Democracy Promotion Act of 2006Co-sponsored Iraq Reconstruction Accountability Act of 2006Co-sponsored Palestinian Anti-Terrorism Act of 2006Health:Expanded the Family Medical Leave Act to include national guard/reservistCo-sponsored Prevention First Act (family planning)Changed State Department policy to include same sex couples in Diplomat benefits packageLead group investigating 9/11-related illnesses in first responders (her Senate successor ended up passing her bill)Co-founded Arkansas Advocates for Children and FamiliesHelped increase research funding for prostate cancer and childhood asthma for NIHHelped investigate Gulf War SyndromeCo-sponsored Traumatic Brain Injury Act of 2008Co-sponsored ALS Registry ActCo-sponsored Poison Center Support, Enhancement, and Awareness Act of 2008Co-sponsored Veterans’ Mental Health and Other Care Improvements Act of 2008Education:Built Arkansas’ Home Instruction Program for Preschool YoungstersReformed Arkansas’ education system as chair of the Arkansas Educational Standards CommitteeCo-sponsored Carl D. Perkins Career and Technical Education Improvement Act of 20069/11:Instrumental in bringing $21 billion in funding for the World Trade Center site’s redevelopmentEstablished family compensation/small business loan programsCo-sponsored Procedural Fairness for September 11 Victims Act of 2007Children/Women:Helped create Office on Violence Against Women at the Department of JusticeHelped pass Adoption and Safe Families ActHelped pass Foster Care Independence ActSupported and promoted the passage and rollout of the State Children’s Health Insurance Program (SCHIP), which expanded health insurance for children in lower-income families.Co-sponsored Native American Breast and Cervical Cancer Treatment Technical Amendment Act of 2001Co-sponsored Pediatric Research Equity Act of 2003Co-sponsored PREEMIE ActCo-sponsored Newborn Screening Saves Lives Act of 2007This is considered by many to be one of the turning points of international women’s rightsIn 1995, during an unprecedented address in Beijing to the United Nations Fourth World Conference on Women, Hillary recounted worldwide abuses and declared “It is time for us to say here in Beijing, and for the world to hear, that it is no longer acceptable to discuss women’s rights as separate from human rights.”First Lady Hillary Rodham Clinton’s Remarks to the Fourth Women’s Conference in Beijing, ChinaCareer:Staff attorney for the Children’s Defense Fund in CambridgeBoard member of the Yale Review of Law and Social ActionLegal work at the Yale Child Study Center for child abuseVolunteer at New Haven Legal Assistance AssociationDirector of the Arkansas Legal Aid ClinicChair of the American Bar Association’s Commission on Women in the ProfessionPolitical Career:Researcher on migrant worker problems — Subcommittee on Migrant LaborJimmy Carter’s Indiana director of field operationsChaired Arkansas’ Rural Health Advisory Committee, working to expand medical facilities for the poorChair of the Arkansas Educational Standards CommitteeChair of Presidential Task Force on National Health Care ReformFirst Lady of ArkansasFirst Lady of the United StatesUnited States Senator from New YorkUnited States Secretary of StateVoting RightsWrote Count Every Vote Act of 2005Co-sponsored re-introducing the Equal Rights AmendmentMore legislation (that became law)Co-sponsored Lilly Ledbetter Fair Pay Act of 2009Co-sponsored Methamphetamine Production Prevention Act of 2008Co-sponsored PROTECT Our Children Act of 2008Co-sponsored KIDS Act of 2008Co-sponsored Broadband Data Improvement ActCo-sponsored Appalachian Regional Development Act Amendments of 2008Co-sponsored Healthy Start Reauthorization Act of 2007Co-sponsored Hematological Cancer Research Investment and Education Act of 2002Co-sponsored Persian Gulf War POW/MIA Accountability Act of 2002Co-sponsored FHA Downpayment Simplification Act of 2002Co-sponsored Strengthen AmeriCorps Program ActCo-sponsored 21st Century Nanotechnology Research and Development Act

In this technocracy dominated era, there's no dearth of technological approaches to improve clinical trial (CT) participation. Ranging from alert systems linked to electronic health records (1) to online registries (2, 3, 4), the usual technology-based suspects have made their appearance on the scene to no avail. For e.g., available free to anyone online, ResearchMatch allows any US resident to register as a potential CT participant (volunteer). Hosted at Vanderbilt University and funded by the NIH, this registry launched in December 2008. Yet >7 years on, its name recognition is limited and <100000 volunteers have signed up (2).Obviously, core of the problem requires a human, not technological, touch. Meantime, the general population gains the bulk of its knowledge about CTs from entertainment fare online or on TV and from news (5, 6, 7, 8). Obviously such sources are more likely to fuel and sustain misconceptions rather than anything remotely close to the truth about CTs. Essentially, the current CT ecosystem woefully under-utilizes two of its foundational pillars,1) Referring physicians and other healthcare providers who lead patients to CTs (9, 10).2) Current and previous CT participants, i.e., potential Patient Advocates.Even more inexplicably, pertinent questions relating to the CT process remain unansweredWhat's the difference between healthcare providers who either do or don't participate in CTs, and between those who either do or don't refer patients to CTs?What are the recruiting strategies used by successful CTs (11, 12, 13)?Why don't organizers of successful CTs routinely record and report their recruiting strategies? Clearly trial funders should mandate their doing so.What level of engagement remains with CT participants after a trial's over? Do trial organizers and their staff stay in touch with them? While volunteers are enrolled in a trial, which can be for several months to even years, do trial organizers develop a rapport with at least their most enthusiastic participants, and teach and encourage them to advocate and recruit newer volunteers on their behalf within their families and communities (14, 15)? Given the current state of affairs, clearly not and yet wouldn't doing so set up a virtuous positively reinforcing cycle leading to cumulatively increasing CT participants? Instead, why is the system set up to recruit and forget once the trial's over? Isn't this an egregious example of re-inventing the wheel every time?~70 years since the 1st double-blind, placebo-controlled randomized CT and with >210,000 ongoing registered CTs across the US and 193 other countries (see figure below from 16), it's scarcely believable but sadly true that such basic issues aren't well-studied nor their lessons freely available for others' benefit (17, 18).Upon reflection, it's only to be expected that an inherently top-down and paternalistic enterprise like human biomedical research would under-utilize Patient Advocates. After all so insular is it that its very basics such as research ethics and regulatory oversight have been developed without seeking and incorporating the input of research volunteers (19), who are more frequently described condescendingly as subjects. Even peer-reviewed literature about woefully lacking CT participation rates is dominated by the voices of biomedical research aficionados. Where are the voices of CT participants? Why don't medical and scientific journals report their perspective, about their experiences and suggestions in their own words? Imbalance couldn't get starker than this (20). When was the last time the US FDA or the NIH convened meetings or town halls specifically inviting volunteer input into the CT process? Never. The current CT world is strikingly insular (21, 22).'Findings concur with previous research suggesting that CT investigators rarely communicate about clinical research outside of specific, study-based recruitment messages, which are often only provided to current patients already familiar with the medical institution...Findings from the current study, however, show that CT teams rarely promote CT research outside of the medical setting or reach out to community organizations to serve as an important conduit between the medical institution ß and hard-to-reach populations...Although investigators rely heavily on local physicians to recruit patients into their studies, there may be limited communication between the investigators and local physicians [37] and between these local doctors and their patients [28].'(8).The funders and fund recipients, i.e., clinical researchers and their support staff working largely in academic medical centers, currently control the process. They hold endless rounds of meetings and write exhaustive white papers and reports filled with earnest recommendations. These current CT stakeholders haven't yet thought to expand their fold and bring into it the ones whose voices perhaps matter the most in CT participation and logistics, patients and volunteers who've participated in CTs, i.e., Patient Advocates. We all know new drugs and therapies can't get approved unless robustly tested on large pools of volunteers, and yet those same volunteers, the very heart of human biomedical research, have no say in how the process could be structured so their ranks stay filled, not depleted.What Factors Deter CT Participation And How They Could Be MitigatedObvious ones are fears about unapproved medications and procedures, i.e., that one could be used as a 'guinea pig', as well as fears of side-effects, and that one could get a placebo instead of Rx due to randomization. Given such fears are likely pervasive among the population at large (23, 24, 25, 26), who could be more persuasive in convincing others to participate in CTs than those who've done so themselves? If previous trial participants aren't doing so, maybe there's something inherently discouraging about the process that urgently needs to be overhauled? While the medical and scientific aspects of CTs are rightfully the purview of clinical researchers and scientists, and should remain so, these patient-centric aspects are areas where Patient Advocates could help reshape the process to encourage others.Studies also suggest local community-based sources of CT information are seen as more trustworthy. These include local doctors, TV and community health centers (7). As well, informal family and community networks, i.e., family and friends, and local church and faith-based organizations (26).Cancer Clinical Trial (CT) Participation Rates Are High In Children Regardless of Race/Ethnicity But Very Low Among Adults. What Accounts For Such A Difference?Poorly envisaged top-down policies often lack mechanisms to enforce their recommendations. In US biomedical research, one of the most prominent examples is the 1993 NIH Revitalization Act that mandates inclusion of racial and ethnic minorities in federally funded biomedical research (27). 23 years on, African Americans and Hispanics represent 12% and 16%, respectively, of the US population and yet constitute only 5% and 1% of CT participants (28) while whites are over-represented (29). Why is this so? Among US CT volunteers, blacks are supposed to mistrust medical research, and language and culture are supposed to be barriers to Hispanic participation while implicit bias among clinical researchers is supposed to disfavor minority participation in CTs. However, a crucial piece of data unerringly rebuts these oft-repeated myths because there's more than adequate participation among children regardless of race/ethnicity compared to dismal rates among adults.In the US, only 3 to 5% of ~10 million adults with cancer participate in CTs (30). However, CT enrollment among <15 years old is anything but dismal. In the US, 60% of cancer patients aged <15 years are enrolled in CTs (31). That's not all. Proportion of minority pediatric cancer patients enrolled in cancer CTs (~10% blacks, ~12% Hispanic) ~matches their proportion in the population (32). This means neither do pediatric minorities systematically lack access to health research nor face systemic bias against CT enrollment. How to explain this huge difference between children and adult CT enrollment rates? What's different about the pediatric CT recruitment process? Undoubtedly, applying what works in recruiting children to CTs would hugely improve adult enrollment rates.Crux Of The Problem: Huge Gap Between Eligible And Actual Adult Clinical Trial (CT) ParticipantsReal gap in adult CT enrollment is ~10X. For e.g., in the US, ~20% of cancer patients are typically eligible to participate (33, 34) but only 3 to 5% of them do so (30). This huge gap between eligible and actual participants is the critical problem needing to be solved. Weakest link in the chain? Extremely poor inclusion of referring physicians and Patient Advocates into the CT recruitment process, i.e., we're back to square one, the need to expand the fold of current CT stakeholders to include patients and volunteers, and their physicians, and seek their input in improving CT participation and logistics. One approach could be to have CT participants access trial-related procedures and services closer to their home rather than exclusively at academic CT sites, which are often far from their homes.Clinical Trial (CT) Location Matters Hugely To CT ParticipantsTravel distance to and lack of transportation to and from the trial site are major barriers in CT participation (35, 36, 37). Even in the US, arguably the wealthiest country in the world and unquestionable global CT leader, many if not most CT volunteers need to drive >1 hour each way to reach a CT site (see figure below from 38).Bibliography1. Embi, Peter J., et al. "Effect of a clinical trial alert system on physician participation in trial recruitment." Archives of Internal Medicine 165.19 (2005): 2272-2277. https://www.researchgate.net/profile/C_Harris/publication/7519692_Effect_of_a_Clinical_Trial_Alert_System_on_Physician_Participation_in_Trial_Recruitment/links/00b7d51e41b31eddbe000000.pdf2. Harris, Paul A., et al. "ResearchMatch: a national registry to recruit volunteers for clinical research." Academic medicine: journal of the Association of American Medical Colleges 87.1 (2012): 66. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3688834/pdf/nihms335956.pdf3. Denicoff, Andrea M., et al. "The National Cancer Institute–American Society of Clinical Oncology Cancer Trial Accrual Symposium: Summary and Recommendations." Journal of Oncology Practice 9.6 (2013): 267-276. Summary and Recommendations4. Tan, Meng H., Matthew Thomas, and Mark P. MacEachern. "Using registries to recruit subjects for clinical trials." Contemporary clinical trials 41 (2015): 31-38.5. Kelch, Robert P. "Maintaining the public trust in clinical research." The New England journal of medicine 346.4 (2002): 285.6. Len-Rios, Maria E., and Qi Qiu. "Negative articles predict clinical trial reluctance." Newspaper Research Journal 28.1 (2007): 24.7. Tanner, Andrea, et al. "Communicating Effectively About Clinical Trials With African American Communities A Comparison of African American and White Information Sources and Needs." Health Promotion Practice (2015): 1524839915621545.8. Tanner, Andrea, et al. "Promoting clinical research to medically underserved communities: Current practices and perceptions about clinical trial recruiting strategies." Contemporary clinical trials 41 (2015): 39-44.9. Baer, Allison R., et al. "Engaging referring physicians in the clinical trial process." Journal of Oncology Practice 8.1 (2012): e8-e10. Engaging Referring Physicians in the Clinical Trial Process10. Robinson, M. Koa, JoAnn U. Tsark, and Kathryn L. Braun. "Increasing primary care physician support for and promotion of cancer clinical trials." Hawai'i Journal of Medicine & Public Health 73.3 (2014): 84. http://www.hjmph.org/HJMPH_Mar14.pdf#page=1211. Lai, Gabriel Y., et al. "Effectiveness of strategies to recruit underrepresented populations into cancer clinical trials." Clinical Trials 3.2 (2006): 133-141. Effectiveness of strategies to recruit underrepresented populations into cancer clinical trials12. Friedman, Daniela B., et al. "How are we communicating about clinical trials?: an assessment of the content and readability of recruitment resources." Contemporary clinical trials 38.2 (2014): 275-283.13. Friedman, Daniela B., et al. "A qualitative study of recruitment barriers, motivators, and community-based strategies for increasing clinical trials participation among rural and urban populations." American Journal of Health Promotion 29.5 (2015): 332-338. https://www.researchgate.net/profile/Caroline_Bergeron2/publication/261137533_A_Qualitative_Study_of_Recruitment_Barriers_Motivators_and_Community-Based_Strategies_for_Increasing_Clinical_Trials_Participation_Among_Rural_and_Urban_Populations/links/54c78b270cf238bb7d0ab8ab.pdf14. Friedman, Daniela B., et al. "Improving our messages about research participation: a community-engaged approach to increasing clinical trial literacy." Clinical Investigation 4.10 (2014): 869-872. http://www.future-science.com/doi/pdf/10.4155/cli.14.8715. Tanner, Andrea, et al. "Barriers to medical research participation as perceived by clinical trial investigators: communicating with rural and African American communities." Journal of health communication 20.1 (2015): 88-96.16. Trends, Charts, and Maps17. Michaels, Margo, et al. "Impact of Primary Care Provider Knowledge, Attitudes, and Beliefs about Cancer Clinical Trials: Implications for Referral, Education and Advocacy." Journal of Cancer Education 30.1 (2015): 152-157.18. Sriphanlop, Pathu, et al. "New York state health care provider participation in clinical trials: a brief report." (2016). http://www.vipoa.org/journals/pdf/9370870213.pdf19. Dresser, Rebecca. "What Subjects Teach: The Everyday Ethics of Human Research." Wake Forest Law Review 50 (2015): 301. What Subjects Teach: The Everyday Ethics of Human Research20. Holzer, Jessica K., Lauren Ellis, and Maria W. Merritt. "Why We Need Community Engagement in Medical Research." Journal of Investigative Medicine 62.6 (2014): 851-855.21. Comis, R. L., et al. "Baseline study of patient accrual onto publicly sponsored US Cancer Clinical Trials: an analysis conducted for the global access project of the National Patient Advocate Foundation." Philadelphia, PA, Coalition of Cancer Cooperative Groups (2006): 1-52.22. Friedman, Daniela B., et al. "What do people really know and think about clinical trials? A comparison of rural and urban communities in the South." Journal of community health 38.4 (2013): 642-651.23. Meropol, Neal J., et al. "Barriers to clinical trial participation as perceived by oncologists and patients." Journal of the National Comprehensive Cancer Network 5.8 (2007): 753-762. Barriers to Clinical Trial Participation as Perceived by Oncologists and Patients24. Weckstein, Douglas J., et al. "Assessment of perceived cost to the patient and other barriers to clinical trial participation." Journal of Oncology Practice 7.5 (2011): 330-333. http://nnecos.org/Resources/Documents/JOP-2011-Weckstein-330-3.pdf25. Fleisher, Linda, et al. "Application of best practice approaches for designing decision support tools: the preparatory education about clinical trials (PRE-ACT) study." Patient education and counseling 96.1 (2014): 63-71. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4171039/pdf/nihms621149.pdf26. Bell, Jennifer AH, and Lynda G. Balneaves. "Cancer patient decision making related to clinical trial participation: an integrative review with implications for patients’ relational autonomy." Supportive Care in Cancer 23.4 (2015): 1169-1196.27. Chen, Moon S., et al. "Twenty years post‐NIH Revitalization Act: Enhancing minority participation in clinical trials (EMPaCT): Laying the groundwork for improving minority clinical trial accrual." Cancer 120.S7 (2014): 1091-1096. Twenty years post-NIH Revitalization Act: Enhancing minority participation in clinical trials (EMPaCT): Laying the groundwork for improving minority clinical trial accrual - Chen - 2014 - Cancer - Wiley Online Library28. Clinical Trials Shed Light on Minority Health. FDA, April 2013. http://www.fda.gov/downloads/ForConsumers/ConsumerUpdates/UCM349488.pdf29. ThinkProgress, Tara Culp-Ressler, April 4, 2014. There Are Too Many White People In Clinical Trials, And It’s A Bigger Problem Than You Think30. Murthy, Vivek H., Harlan M. Krumholz, and Cary P. Gross. "Participation in cancer clinical trials: race-, sex-, and age-based disparities." Jama 291.22 (2004): 2720-2726. https://www.researchgate.net/profile/Cary_Gross2/publication/8520126_Participation_in_Cancer_Clinical_Trials_Race-_Sex-_and_Age-Based_Disparities/links/5471f6ea0cf24af340c3e241.pdf31. Fern, Lorna A., and Jeremy S. Whelan. "Recruitment of adolescents and young adults to cancer clinical trials—international comparisons, barriers, and implications." Seminars in oncology. Vol. 37. No. 2. WB Saunders, 2010.32. Bleyer, W. Archie, et al. "Equal participation of minority patients in US national pediatric cancer clinical trials." Journal of pediatric hematology/oncology 19.5 (1997): 423-427.33. Sateren, Warren B., et al. "How sociodemographics, presence of oncology specialists, and hospital cancer programs affect accrual to cancer treatment trials." Journal of Clinical Oncology 20.8 (2002): 2109-2117.34. Brawley, Otis W. "The study of accrual to clinical trials: Can we learn from studying who enters our studies?." Journal of Clinical Oncology 22.11 (2004): 2039-2040. Can We Learn From Studying Who Enters Our Studies?35. Kanarek, Norma F., et al. "Geographic proximity and racial disparities in cancer clinical trial participation." Journal of the National Comprehensive Cancer Network 8.12 (2010): 1343-1351. Geographic Proximity and Racial Disparities in Cancer Clinical Trial Participation36. Coakley, Meghan, et al. "Dialogues on diversifying clinical trials: successful strategies for engaging women and minorities in clinical trials." Journal of women's health 21.7 (2012): 713-716. http://online.liebertpub.com/doi/pdf/10.1089/jwh.2012.373337. Itty, Tracy Line, Felicia Schanche Hodge, and Fernando Martinez. "Shared and unshared barriers to cancer symptom management among urban and rural American Indians." The Journal of Rural Health 30.2 (2014): 206-213. https://www.researchgate.net/profile/Felicia_Hodge/publication/261289550_Shared_and_Unshared_Barriers_to_Cancer_Symptom_Management_Among_Urban_and_Rural_American_Indians/links/543556e30cf2dc341db0a397.pdf38. Galsky, Matthew D., et al. "Geographic Accessibility to Clinical Trials for Advanced Cancer in the United States." JAMA internal medicine 175.2 (2015): 293-295. Accessibility to US Clinical Trials for CancerThanks for the A2A, Joseph Philleo.

Guide to the Answer:A. History of VaccinationB. Major Arguments Against VaccinationThe history of vaccination is long - very long. I think in order to understand our current resistance to vaccination you need to understand the history a little. Throughout the story you will see a pattern -“We don’t like what we don’t understand, in fact it scares us, and this monster is mysterious at least!”Historians noted that people began observing the protective effect of acquiring some diseases, such as smallpox as early as 430 BC.[1] Records from the 10th century indicate Chinese physicians were inoculating through a process called “variolation” - deliberate infection with disease by blowing scabs up a healthy person’s nose. Variolation worked, too - cutting mortality from around 30% down to 1–2%.[2]Why would it take so many centuries? There were several problems. First, the early inoculation attempts worked — sort of. Often the person would get a lesser form of the disease. Sometimes they wouldn't. Sometimes they’d contract another disease. Because the physicians had no clue about other blood-borne diseases, sterile technique, secondary infections and the like, they often caused unexpected problems that were rather difficult to understand.Above everything else — no one really understood why people got sick in the first place, much less why this method of making a person sick — just less sick — worked. Germ theory of disease was proposed in 1546, and improved in 1762 — but largely ignored in favor the more plausible miasma (bad air) theory, which went back to antiquity (note to scientists — beware of “settled science”!) So the physicians by and large believed that smallpox was caused by “bad air”, and for whatever reason, exposing people to the lesions and giving them the disease this way protected them against the disease contracted through the “bad air” — particularly if a worse case of “bad air” came along.The physicians were pragmatic — they observed it worked, so they wanted to do it, but let’s be real here, the treatment is a bit gross. A lot gross. The physicians were cutting open scabs from the following types of lesions:People were terrified of this disease, and rightfully so. It killed between 30% to 100% of the people who got it, depending on the strain. Many people who survived were scarred for life. They might go blind, or become completely crippled from the disease attacking their bones and joints.Physicians were asking people to let them take fluid or powder from those pustules, and blow it up their nose or inject it right into them. Think about how frightening that must have been! They didn't even want to be near someone with the disease, or near someone who had been near a person with it because they all knew it was contagious. This was a terrible invasion of privacy.So people did what people always do — they invented a million reasons the physician should NOT do this terrifying thing to them.In 1721 a tremendous smallpox epidemic broke out in Boston. The Rev. Cotton Mather initiated a highly controversial inoculation program. Yes, that Cotton Mather, of the Salem Witch Trials — he wasn’t all bad.mezzotint portrait of Cotton Mather (Feb. 12, 1663 - Feb. 13, 1728), American Puritan clergyman.Peter Pelham, artist - http://www.columbia.edu/itc/law/witt/images/lect3/Cotton Mather was inspired by a slave named Onesimus, who told him about his inoculation in Africa, and by a letter published to the Royal Society of London in 1721 by Emanuale Timoni describing the procedure and its efficacy. He was backed by exactly one physician — Zabdiel Boylston. He faced opposition that was religious and scientific.Why do you fight God’s will? (doesn’t this sound familiar)There’s not enough evidence to use that method (not a bad science argument).Cotton Mather and Zabdiel Boylston decided to argue against the religious people with a fairly succinct message — this is no different than any other invasive medical procedure.And the scientific argument? Well — that meant collecting data. So they began inoculating people — not as many as they could have if they had had the support of the town’s physicians as a whole, but they managed to inoculate 287, and only 2% died, compared to nearly 15% of those in the city at large.[3] That largely put the matter to rest in the mind of the scientific community, and the practice was adopted to the great health benefit of the Boston community. (See graph below)The Fight Over Inoculation During the 1721 Boston Smallpox Epidemic - Science in the NewsNow, keep in mind, people still had no idea why this worked. Only that it did.Twenty years later, in 1774, a farmer in England named Benjamin Jetsay contracted cowpox. All the dairy farmers and milkmaids knew if you got cowpox, you could safely nurse people with smallpox and you wouldn't get the disease. Cowpox was much milder than any form of smallpox, so this was very good. Jetsay had heard about inoculating people with smallpox, and even though he wasn't a doctor, he decided to deliberately inoculate his wife and sons with cowpox.[4]It worked.It was another twenty years before Edward Jenner caught wind of this wonderful phenomenon, and decided to stake his career as a physician on it. In 1796, Jenner gave his first trial, inoculating a child with material he gathered from a milkmaid’s pustule. He continued his inoculations, and two years later published “An Inquiry into the Causes and Effects of the Variolae Vacciniae.”[5] The book was pretty much a hit — people read it — and debated it widely — but it wasn't really accepted by the scientific community immediately. Jenner had to do a lot of work to get this idea accepted. However, he was tireless, and vaccination spread through England, and ultimately to America as well.That’s not to say it didn't have people up in arms!James Gillray's The Cow-Pock—or—the Wonderful Effects of the New Inoculation!, Library of Congress, Prints & Photographs Division, LC-USZC4-3147As you can see from the image abov,e there were those who thought that cowpox inoculation might turn you into a cow. Does this really seem much different than modern-day fears?All this — and people still thought disease was transmitted by “bad air”. Although several physicians working with microscopes had described microorganisms and implicated them in the bubonic plague (black death), smallpox, measles, rabies, and others, their work by and large just wasn’t accepted by physicians or the public.This work was probably set back in no small part due to the understandable fear of Antonie van Leeuwenhoek[6], “the father of Microbiology”, who developed a unique method of grinding lenses in the 1650s that enabled him to create microscopes of spectacular resolution. Due to a lack of patent law protection, he guarded his secrets and took them to his grave, and similar caliber instruments weren't developed for almost 200 years. This set back microbiology by about the same amount.The Geographer - by Johannes Vermeer - historians believe painting is of Antonie van Leeuwenhoek[7]It wasn’t until 1854 when a physician named John Snow, working to stem a cholera outbreak, realized that the disease must be transmitted by an agent present in water [8]— and that it was coming from feces of infected individuals. He meticulously detailed the contamination of water used for drinking and cooking with waste from infected individuals in a number of cases. Only after removing a single pump he believed infected with cholera did the epidemic in London subside.After another outbreak, he argued strenuously for filtration of water. He was convinced that people’s poop was contaminating water, and in drinking water with poop from sick individuals, everyone was getting sick and dying. Unfortunately for the citizens of London, and the world elsewhere, his ideas were slow to catch on. Why?It was too disgusting to accept.[9]How slow? Well, in 1854 the Italian scientist Filippo Pacini published a full description of the virus[10] that caused cholera, and in subsequent years further described how to properly treat the disease as well as how the disease became so deadly[11]. Somewhat later, and independently of him, scientific literature not being quite so easy to share in the 19th century, Robert Koch published his work describing the same bacterium[12] (1884).Now you would think the matter of cholera settled, right? It is, after all, 2019. We've understood how to combat this disease now for over 150 years.WHO Cholera Kit inforgaphic. [13]From the infographic: “Researchers estimate there are as many as 4 million cases each year and up to 143,000 deaths annually (2017).”OK, but what does this have to do with worldwide anti-vaccination sentiment?A lot, I’m afraid. You see, the persistence of cholera is only one symptom of the anti-vaccination sentiment that’s been around since the beginning of vaccination. The first cholera vaccination was available in the 1880s.[14] People are still afraid to get vaccinated even when they know they run a high risk of contracting and dying from cholera, a disease that has mortality between 10–90%, and can kill within 2 hours[15].2 hours.Did I mention there are vaccines for this? Now you’d think people would be MORE afraid of cholera than of vaccines, but — no. In fact, they’re not even afraid enough of cholera to wash their hands or drink bottled water consistently.[16] People are weird like that.Throughout history, and worldwide, people invoke the same reasons over and over and over for why vaccination is bad, or at least just isn't right for them.[17][18][19] [20][21] [22] [23] [24]Moral/Religious FoundationInvulnerabilityCost/Benefit Ratio isn't worthwhile* (this is complex)Fear of Bad EffectsNone of these are irrational — per se — not even the moral/religious foundation argument.Moral/Religious FoundationThis argument hasn't changed much. There aren’t that many groups [25]that claim a religious exemption to vaccination, and those that do aren’t under significant expansion in numbers. You’ve got the Christian Scientists, and some members of the Dutch Reformed church. For major religions, that’s it.InvulnerabilityCalvin of Calvin and Hobbes - being selective about accepting realityPeople are very good at this — feeling invincible. Invulnerable. That’s why 15% of Americans don’t use seat belts[26] and 43% of drivers admit to texting and driving[27] (seriously, people STOP IT!). When it comes to vaccines, a fair number of people don’t believe they or their child will actually become ill, so they forgo vaccines. This is a major factor in why people routinely travel without proper vaccinations.Cost/Benefit Ratio isn’t worthwhile* (this is complex)Costs of vaccination vary widely. Many people receive free or low-cost vaccination for children — but the money cost isn't the only cost involved. There’s time spent traveling to and from the provider. This may be fairly trivial in much of the Western world, where vaccinations can be received at any grocery store pharmacy as well as community clinic or hospital, but in developing nations it can present a huge roadblock. A parent may not want to deal with a child being feverish or cranky after vaccination after a tough night on a previous course. They may perceive vaccines as not being effective enough to justify the cost or inconvenience (this is especially true with influenza vaccines). A lot goes into the decision to actually get up and go get a vaccination — and people acting in rational self-interest don’t always weigh the factors the way those invested in public health would hope they should.Fear of Bad EffectsBy far and away, the current anti-vaccine sentiment roared to a new momentum with the 1998 study led by Andrew Wakefield that seemed to link autism to the combined measles mumps & rubella (MMR) vaccine.[28]Andrew Wakefield, Certified FraudThat study was a disaster from the moment of publication — and honestly, it wreaked havoc in far more than just vaccine science. In that same paper, now retracted, which cost Wakefield his medical license, [29]Wakefield et al. proposed the now terribly popular “leaky gut” theory that you can find all over the place — that GI disturbances from food cause a “leaky gut” which in turn leads to “bad blood” and every ailment known to mankind. All of it is modern quackery nonsense, and all of it widely embraced by far more than just those afraid of vaccines.The study was a disaster — with a selected sample size of 12, no control, and terrible statistics, The Lancet never should have published it. Publish it they did, and the damage was done. His co-authors ultimately retracted the paper, but Wakefield went on a martyr tour, selling his “leaky gut” hypothesis. After that, as they say, the horse was out of the barn, and hysterics piled on.“Thiomersal!” became the new rallying cry. As with the MMR issue, there was little scientific evidence for that hypothesis, and a lot against it.[30][31]In fact, there is only one serious research group pursuing this theory at this time, and they self-refer to their own studies most of the time, a hallmark of quack science. Moreover, even though the use of the preservative was phased out[32] in most of Europe and the U.S. after 1999, autism rates continue to rise — making the correlation hypothesis very difficult to support.This is the oldest, and most intractable of the problems — yet seemingly the most simple. Unfortunately, it goes hand-in-hand with distrust of authority, so reinforcement by peer networks is playing a large role in the spread of anti-vaccination sentiment.Combating this movement will require a good deal of public health work[33] — but it also is a responsibility of every parent and citizen. Talk to your friends and neighbors. Encourage vaccination with positive, fact-based information. When you see them spreading misinformation, don’t be afraid to point it out — tactfully. (OK, I admit — this can be hard!). Ultimately vaccination protects both individuals and the population.It’s a wonderful time we live in, when so many awful diseases can be prevented. Now, if only we can get everyone to fully appreciate how lucky we are!Now go check to make sure your vaccines are up-to-date.And get your flu shot!Don’t forget — immunizations are for adults, too!Relaxed. Researched. Respectful. - War ElephantFootnotes[1] http://Gross, C. P., & Sepkowitz, K. A. (1998). The myth of the medical breakthrough: smallpox, vaccination, and Jenner reconsidered. International journal of infectious diseases, 3(1), 54-60.[2] Smallpox: Variolation[3] The Fight Over Inoculation During the 1721 Boston Smallpox Epidemic - Science in the News[4] http:// Nicolau Barquet and Pere Domingo. "Smallpox: The Triumph over the Most Terrible of the Ministers of Death". Annals of Internal Medicine. Retrieved 2006-10-26.[5] http://Jenner, E. (1800). An inquiry into the causes and effects of the variolae vaccinae, a disease discovered in some of the western counties of England, particularly Gloucestershire, and known by the name of the cow pox. author.[6] Antonie van Leeuwenhoek | Biography, Discoveries, & Facts[7] The Geographer by Johannes Vermeer: Geography in Fine Art[8] http://Snow, J. (1855). On the mode of communication of cholera. John Churchill.[9] http://Chapelle, Frank (2005) Wellsprings. New Brunswick, New Jersey: Rutgers University Press. ISBN 0-8135-3614-6. p. 82[10] http://Pacini, F. (1854). Osservazioni microscopiche e deduzioni patologiche sul cholera asiatico. tip. di F. Bencini.[11] Who first discovered cholera?[12] http://Koch, R. (1884). An address on cholera and its bacillus. British medical journal, 2(1236), 453.[13] World Health Organization[14] http://Barrett, A. D., & Stanberry, L. R. (2009). Vaccines for biodefense and emerging and neglected diseases. Academic Press.[15] Cholera - Symptoms and causes[16] http://KOZICKI, MARKUS, ROBERT STEFFEN, and MEINRAD SCHÄR. "‘Boil it Cook it, Peel it or Forget it’: Does this Rule Prevent Travellers ‘Diarrhoea?." International journal of epidemiology 14.1 (1985): 169-172.[17] The Four Main Reasons People Don't Vaccinate[18] http://Gordon, D., Waller, J., & Marlow, L. A. (2011). Attitudes to HPV vaccination among mothers in the British Jewish community: reasons for accepting or declining the vaccine. Vaccine, 29(43), 7350-7356.[19] http://Canning, H. S., Phillips, J., & Stephen Allsup, M. D. (2005). Health care worker beliefs about influenza vaccine and reasons for non‐vaccination–a cross‐sectional survey. Journal of clinical nursing, 14(8), 922-925.[20] http://Kee, S. Y., Lee, J. S., Cheong, H. J., Chun, B. C., Song, J. Y., Choi, W. S., ... & Kim, W. J. (2007). Influenza vaccine coverage rates and perceptions on vaccination in South Korea. Journal of Infection, 55(3), 273-281.[21] http://Singleton, J. A., Santibanez, T. A., & Wortley, P. M. (2005). Influenza and pneumococcal vaccination of adults aged≥ 65: racial/ethnic differences. American journal of preventive medicine, 29(5), 412-420.[22] http://Constantine, N. A., & Jerman, P. (2007). Acceptance of human papillomavirus vaccination among Californian parents of daughters: a representative statewide analysis. Journal of Adolescent Health, 40(2), 108-115.[23] http://Darden, P. M., Thompson, D. M., Roberts, J. R., Hale, J. J., Pope, C., Naifeh, M., & Jacobson, R. M. (2013). Reasons for not vaccinating adolescents: National Immunization Survey of Teens, 2008–2010. Pediatrics, peds-2012.[24] http://Francis, M. R., Nohynek, H., Larson, H., Balraj, V., Mohan, V. R., Kang, G., & Nuorti, J. P. (2018). Factors associated with routine childhood vaccine uptake and reasons for non-vaccination in India: 1998–2008. Vaccine, 36(44), 6559-6566.[25] http://Grabenstein, J. D. (2013). What the world's religions teach, applied to vaccines and immune globulins. Vaccine, 31(16), 2011-2023.[26] Policy Impact: Seat Belts[27] Facts & Statistics About Texting & Driving (Updated for 2018)[28] http://Wakefield, A. J., Murch, S. H., Anthony, A., Linnell, J., Casson, D. M., Malik, M., ... & Valentine, A. (1998). RETRACTED: Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children.[29] Doctor behind vaccine-autism link loses license | TIME.com[30] http://Gadad, B. S., Li, W., Yazdani, U., Grady, S., Johnson, T., Hammond, J., ... & Ferrier, C. (2015). Administration of thimerosal-containing vaccines to infant rhesus macaques does not result in autism-like behavior or neuropathology. Proceedings of the National Academy of Sciences, 112(40), 12498-12503.[31] http://Uno, Y., Uchiyama, T., Kurosawa, M., Aleksic, B., & Ozaki, N. (2015). Early exposure to the combined measles–mumps–rubella vaccine and thimerosal-containing vaccines and risk of autism spectrum disorder. Vaccine, 33(21), 2511-2516.[32] Thiomersal - Wikipedia[33] The International Roadblocks To Achieving Global Vaccination