Antivaxxers are people who deny the need for or the efficacy of vaccines and their role in controlling some of the most dreadful diseases in the history of humanity. Not only this, but antivaxxers also claim that vaccines have huge side effects that actually harm more people than they benefit, and they have been particularly vocal about the COVID-19 vaccines. All this is, of course, not true. The COVID-19 vaccines have saved millions of lives by decreasing the proportion of hospitalizations and deaths among the vaccinated to a much greater extent compared to the unvaccinated. Antivaxxers have also spread misinformation and lies about the COVID-19 vaccines that have been repeatedly debunked over and over and over. Nevertheless, they ignore this while expressing outrage at pro-vaccine people, at best calling them “sheep” (sheeple), or at worst claiming that they are being manipulated by or are part of an immoral and unethical alliance of the government, pharmaceutical companies, and other organizations bent on profit and societal control.
So what should be my approach to dealing with antivaxxers? I see two alternatives: the inflammatory approach and the conciliatory approach.
Considering the high effectiveness of the COVID vaccines at decreasing the hospitalizations and deaths from COVID-19, considering that antivaxxers have been waging an aggressive campaign of spreading misinformation about the COVID-19 vaccines on social media, and considering that online misinformation is linked to COVID vaccination hesitancy and refusal, it is not surprising that many people were harmed or killed by the misinformation spread by antivaxxers. During the peak of the Delta variant the daily consequences of spreading misinformation have been estimated at 300 deaths, 1,200 hospitalizations, and 20,000 COVID-19 cases with a cost of 50 to 300 million dollars. I am appalled and outraged at how many lives antivaxxers have damaged.
So my question is: should antivaxxers pay for their crimes?
This is not a far-fetched concept. Alex Jones, the talking head from Infowars, spread misinformation and disinformation about the shooting at Sandy Hook Elementary School where 20 children and 6 adults were killed. He said that the shooting was a false flag operation carried out by anti-gun groups, that no one died, and that the children were actors. As a result of this, the families of the murdered children experienced years of harassment by the followers of Alex Jones. Thankfully, he was brought to court and tried and found guilty, and now he has to pay the Sandy Hook families millions of dollars. Alex Jones tried several defenses including his right to free speech, but the judges didn’t buy it. He spread falsehoods and this hurt people. That was the bottom line. So, if anything, the case against antivaxxers should be even more clear cut, because many people who followed their ideas were harmed or died.
Although in the case of Alex Jones the Sandy Hook families sued him for slander, a person or the family of a person harmed by antivaxxers could sue them for fraud. They would have to prove that the antivaxxer spread the misinformation while knowing that it was false. They would have to prove that the person who was harmed relied on the antivaxxer in their decision to forgo vaccination. And they would have to prove that there was economic loss (hospital bills, lost wages, funeral expenses, etc.). There are, of course, additional subtleties that have to be taken into account depending on the specific antivaxxer entity or person being sued, but this is a possible approach.
Following this rationale, I think that at the very least, any antivaxxer that fulfils the conditions outlined above should be sued for the medical and funeral expenses incurred by the people (or their relatives) who followed their advice in good faith and were harmed or died.
The above is the inflammatory approach. It’s the sort of thing you say/write to scandalize and infuriate people and increase their engagement, drive traffic to your blog, website, or podcast, and grow your brand. This approach makes tempers flare and generates a lot of heat and ill will as invectives fly back and forth and hatred is spewed everywhere.
But there is another way to do this. It’s probably not as successful for getting engagement, but it may be more useful to society, civil discourse, and the psychological well-being of the public.
Every time two groups of people have strong disagreements on some things, the recommended course of action is to find areas of agreement. Antivaxxers are concerned about the side effects of COVID-19 vaccines. The evidence we have indicates that the frequency of serious side effects as a result of these vaccines is very low, which makes the vaccines much safer than having the disease. However, even if rare, when hundreds of millions are vaccinated, the number of net cases start to accumulate. And some of these cases are severe enough that exceptionally susceptible people may end up impaired and saddled with huge debts due to their medical bills. Shouldn’t these people be compensated?
I would venture that most people, whether pro or anti-vaccine, would agree with this. Unfortunately, this is not what is happening. There is a federal program known as the Vaccine Injury Compensation Program (VICP) that is available to people who have been injured by the routine vaccines that are administered in the United States. This program in its lifetime has awarded $4.7 billion in compensation for vaccine injuries to cover 36% of the claims it has received. But this program does not cover the COVID-19 vaccines. Compensation for harm from the COVID-19 vaccines is handled by a program called the Countermeasures Injury Compensation Program (CICP). The CICP program was designed to handle compensation for people injured by treatment for rare events such as an Anthrax attack, but this program is now handling compensation claims for a treatment dispensed to hundreds of millions of Americans. The CICP program is underfunded, understaffed, and overwhelmed with claims, which it is resolving at a glacial pace, and so far congress has not done anything about this.
So here is the chance for antivaxxers to make a difference and actually achieve something positive. If they stop their attacks on vaccines and pro-vaccine people and focus on lobbying congress to, for example, expand and fund the CICP program or move the COVID-19 claimants to the VICP program, that would be a major achievement that would help people affected by the side effects of vaccines. At the same time many pro-vaccine individuals and organizations that advocate for the rights of patients could join ranks with them to work together towards a common goal and actually benefit people.
The alternative, of course, is to keep engaging in the usual cycle of claims, counterclaims, insults, counterinsults, and endless vitriol, which may help increase engagement but which does not accomplish anything meaningful to benefit society.
So my question to antivaxxers is, what is it going to be: inflammatory or conciliatory?
Image from pixabay by Gerd Altmann is free for commercial use and was modified from the original.
I got my first shot of the COVID-19 (Moderna) vaccine, and to celebrate this event I thought I would write about the vaccine and how societies in general reacted to vaccines in the past.
Before COVID-19 we were spoiled. The massive success of vaccination in eradicating or diminishing disease had made it possible for people to enjoy the luxury of dabbling in antivaxxer pseudoscience and indulging in vaccine hesitancy. Until COVID-19 hit us, many people had not experienced the fear for their loved ones that people had experienced in the times before vaccines were available during epidemics of diseases such as polio.
Nowadays few people remember the peace of mind and hope that vaccines brought to humanity. The bliss experienced by people finally rid of the scourge of certain diseases such as smallpox, which periodically decimated entire communities, is difficult to describe today. To give you an idea, let me just present below a translation of a stanza of the poem Oda a La Vacuna (Ode to the Vaccine) by the Venezuelan poet Andres Bello written in 1804 (he mentions Jenner, the discoverer of the smallpox vaccine, and Carlos, the King of Spain who promoted the distribution of the vaccine).
“Supreme Providence, the tearful echoes of the disheartened man at last arrived to your abode, and you raised your righteous arm from his neck; admirable and amazing in your resources, you gave the man medicine, wounding the herds with contagious plague; you opened for us new springs of health in the sores, and you stamped upon our flesh a miraculous seal that the black pox respected. Jenner is the one who discovered under the roof of the shepherds such a precious find. He joyfully published to the universe the happy news, and Carlos distributes to earth the gift of heaven.”
Although many individuals today are too far gone down the rabbit hole of antivaxxer irrationality to be redeemed, now that science has delivered for humanity an effective vaccine against COVID-19 in record time, I hope that many people will regain a measure of gratefulness and respect for vaccines and for scientists.
The COVID-19 vaccine has an amazing history involving failure, tragedy, perseverance, and triumph that is worth reading about. This vaccine was made possible by a remarkable confluence of several technologies produced by numerous discoveries in basic and applied science. Others have already reported in depth on these stories, so here I will provide a summary of the most salient points with references.
A couple of decades ago, the scientific establishment was skeptical of the concept on which the Moderna and Pfizer vaccines are based: using mRNA to direct the production of a viral protein and generate an immune response. This was mostly due to the fact that the mRNA triggered an immune response against itself that interfered with its effectiveness. A Hungarian born scientist in the United States, Dr. Katalin Karikó, spent many years fighting against this skepticism and paying dearly for it in terms of stress, remuneration, and career advancement. Finally in 2005, Dr. Karikó and a collaborator, Dr. Drew Weissman, succeeded in modifying the molecule to make it more stable. Two emerging biotech companies, Moderna (founded in 2010) and BioNTech (founded in 2008) licensed the technology from Karikó and Weissman and began working on a series of applications for the modified mRNA. When the COVID-19 pandemic broke out, they were ready to hit the ground running with the technology.
In 1966, a trial of a vaccine against a virus called respiratory syncytial virus (RSV) went horribly wrong. The vaccine not only was unsuccessful in protecting immunized children, but it actually worsened their response to the virus with 21 children being hospitalized and 2 dying. Dr. Barney Graham, an American virologist, devoted his career to finding out what had happened. Finally, he and his colleagues figured out that the protein the viruses use to fuse with human cells changes shape in the process. Antibodies against the pre-fusion protein were effective against the virus, whereas antibodies against the post-fusion form were not and actually made things worse. Dr. Graham and his colleagues applied this knowledge to develop a vaccine against a type of coronavirus that appeared back in 2012 called Middle East Respiratory Syndrome (MERS) which could not be tested because the disease did not reach epidemic levels. However, by 2017 they had figured out how to develop a vaccine against coronaviruses in general. Graham teamed up with Moderna to incorporate his research into the design of mRNA vaccines. When the COVID-19 pandemic began, Graham’s research and experience with coronaviruses allowed Moderna and other companies to design a vaccine for the right form of the protein.
A seldom mentioned issue is that the mRNA in the vaccines is a large and fragile molecule that is easily degraded once inside the body and which does not cross cell membranes. The reason the vaccine mRNA is effective, is that the molecule is packed into vesicles called lipid nanoparticles (LNPs) which protect the molecule and allow its efficient delivery into cells. When Moderna and BioNTech began their work to find the right LNPs to deliver their vaccine mRNA, they benefited from the experience of decades of hit and miss research conducted by multiple labs that painstakingly combined different lipid components, tweaked their proportions, and tested them in cell, animal, and humans studies for effectiveness and toxicity. When the pandemic started, both companies had already produced working LNPs to deliver mRNA.
And finally, there are multiple discoveries that resulted in technologies that made possible the day to day practical and theoretical work of scientists. Among these are the advances in genetic sequencing technology, which allowed the quick elucidation of the genome of the virus, and the advances in computing and bioinformatics, which allowed the visualization and analysis of sequences and molecular structures, and the quick sharing of information among scientists worldwide.
A lot of things have improved in our societies since Andres Bello published his poem back in 1804. Science has spearheaded a revolution that has increased human lifespan and quality of life, and vaccines such as the COVID-19 vaccine have been an essential part of this process. Sadly, one of the things that has changed for the worst is that today poetry is no longer an art cultivated by the younger generations which consider it something old fashioned. But I am grateful for this gift that science has given to us, and I hope somebody considers composing an ode to the COVID-19 vaccine!
The photograph is property of the author and can only be sued with permission.
We have begun to detect early signs that COVID-19 vaccination is having a dramatic effect in reducing the number of new cases and deaths. This data comes from studies performed in nursing homes where the vaccine was made available first. Despite this good news, there is a substantial amount of misinformation about the COVID-19 vaccine that is stoking doubt among people that would otherwise elect to be vaccinated. In this post I will address some of these claims.
Vaccine development is a process that takes a decade or more. The COVID-19 vaccines were developed in a year (Operation Warp Speed), so they were rushed, therefore there is no way they can be safe.
This claim reveals a misunderstanding of what Operation Warp Speed did. This vaccine development operation was not fast because they cut corners. There are several reasons vaccine development was fast, but one of the most important ones was that the government funded multiple stages of the vaccine development process at once. For example, the vaccine was produced at the same time the clinical trials were ongoing. A pharmaceutical company normally waits for the results of the trials before producing the vaccine, because if the trial fails, then it would lose all the investment in producing a vaccine that wouldn’t be approved. In Operation Warp Speed it was the government that assumed this economic risk, and this accelerated the pace of vaccine production. No corners were cut in the development process. The vaccines were tested in regular clinical trials and they were found to be effective and safe.
The coronavirus is a new virus and the Moderna and Pfizer messenger RNA (mRNA) vaccines are a new technology. There is no way that a new technology can be applied to a new virus and result in a safe vaccine in such a short time.
This claim ignores the history of both the involvement of scientists with coronaviruses and the history of the development of the mRNA technology. Scientists had been researching coronaviruses such as SARS (2003) and MERS (2012) for many years. By studying these and other viruses they discovered how the proteins in the surface of the virus change when attacking a cell, and they figured out how to make antibodies to the right proteins to avoid problems that can compromise a vaccine. The mRNA technology they used had also been researched for decades and had reached its full potential by the time COVID-19 came around. Finally the Johnson and Johnson vaccine is also as effective and safe as the others and is not based on mRNA technology.
The mRNA vaccines will change your DNA, and can give you COVID-19.
This is not how mRNA works. DNA produces mRNA, and mRNA carries the instructions for the production of proteins. However, mRNA cannot go back to DNA and alter it. If I asked you whether you are concerned that while you are walking on the sidewalk the concrete under your feet will turn into quicksand and swallow you up, you would probably reply that is silly because it’s not in the nature of concrete to do that. Similarly, it is not in the nature of mRNA to alter DNA. The SARS-Cov-2 virus that produces COVID-19 has a total of 29 proteins. The vaccines contain an mRNA molecule that carries the information to produce ONLY ONE viral protein (the spike protein that the virus uses to enter the cells). The body then produces antibodies against this protein, and the mRNA is degraded after a few hours. The mRNA does not carry the information to produce the rest of the proteins of the virus, thus it is impossible for the mRNA vaccine to give you COVID-19.
They tell us that after we get vaccinated, we still need to wear a mask and social distance, so why get vaccinated at all?
It is not known if the vaccine can prevent you from being infected with the virus. What we know is that the vaccine will help you fight the virus and protect you against moderate and severe COVID-19 disease. However, scientists don’t know if vaccinated people are still capable of carrying the virus and transmitting it to other people. Thus, scientists are just being careful and recommending that vaccinated people still use masks and social distance while in the presence of others that may not yet be vaccinated until they can answer this question.
The COVID-19 vaccines have side effects and have caused severe allergic reactions.
The side effects of the COVID-19 vaccines are an indication that the immune system is working. These side effects, such as pain at the site of injection, fatigue, headache, and muscle pain, normally last 24 hours and are an acceptable tradeoff for gaining immunity against a disease that can potentially be lethal or debilitating to you and others you may transmit it to. In rare cases an allergic reaction to the vaccine has been documented which mostly occurs within 30 minutes of vaccination and can be treated by the medical personnel administering the vaccine. This is why it is recommended that people who have a history of allergic reactions should consult with their doctors before getting the vaccine.
The COVID-19 vaccines have caused several deaths.
This piece of misinformation is straight out of the antivaxxer playbook, and it is based on claims that people who died or had a problem after receiving a vaccine died or had the problem because of the vaccine. In a population of millions of individuals, thousands of people naturally die or have health issues every day. If millions of people get a vaccine, some of them will naturally die or have health issues around the time they received the vaccine, but in a manner unrelated to the vaccine. In other words: correlation does not imply causation. So far the alleged vaccine deaths that have been investigated have not been linked to the vaccine.
More than 500,000 American have died as a result of COVID-19 and tens of thousands have been left with long-lasting side effects. All this could have been avoided if we had had a vaccine for the disease at the begining. Well, now we have 3 vaccines against the disease (not counting the Russian, Indian, and Chinese vaccines). There are still tens of millions of people in the US who have not yet had COVID-19, and therefore there is potential for additional morbidity and mortality from the disease. It is important for everyone to get vaccinated to protect both themselves and those around them, so please don’t fall for the vaccine misinformation. Get vaccinated.
The photo of the COVID-19 vaccine by Lisa Ferdinando (DOD) was taken from the Flickr photostream of the US Secretary of Defense and is used here under an Attribution 2.0 Generic (CC BY 2.0) license.
For years those opposed to vaccination (antivaxxers) have peen plastering social media with their claims that vaccines are harmful, unnecessary, and ineffective. I had addressed the antivaxxer’s claims before, but I recently had a harsh exchange with some of these people on Twitter. These individuals bombarded me with links to articles and other evidence that “proved” their position was true. After I spent several days going over all this evidence, I found that the vast majority of it was nothing more than a mishmash of mediocre science, innuendo, exaggeration, distortion, and lies. So I organized all the evidence to address their claims. I started writing what I expected to be a two or three part blog post exposing the inaccuracy of the antivaxxer’s claims. However, besides getting me into another fight, I realized my effort wouldn’t really convince anyone that antivaxxers where wrong. I sensed the vaccine issue for most people hinged on more emotional rather than rational variables, and antivaxxers had proven particularly adept at stoking the fears of people and manipulating their emotions.
For years antivaxxers had thrived due to the fact that our society had become complacent. Today’ parents have never had to live with the horrors of smallpox, polio, diphtheria, whooping cough, tetanus, and other diseases. Even though antivaxxers are a minority, they were vocal and organized. They generated enough doubt in our society to give rise to vaccine hesitancy where parents delay or even refuse to administer some vaccines to their children. Predictably, some of the most contagious diseases like measles started coming back. A few antivaxxers thought that the possibility of a world without vaccines was within their reach, and they sought to articulate for others how that world would look. As it turns out, that was unnecessary. If anybody ever wondered how the world would look without vaccines, the COVID19 pandemic has made it abundantly clear how the world looks without ONE vaccine.
As I write this, the worldwide confirmed cases of COVID19 exceed two million with more than 169,000 deaths, and more than 700,000 of those cases and 41,000 of those deaths are in the United States alone. Cities, states, and entire countries on lockdown, health care systems overwhelmed, and economies devastated. If anyone harbored any type of misgiving about the need for vaccines, that doubt has been vanquished. And COVID19 is not going to go away anytime soon. There are likely to be waves of the virus as a result of reintroduction when social distancing measures are eased. If sufficiently high numbers of people become infected and recover, a degree of what is called herd immunity may be able to protect those who have not been infected. However, only a vaccine will confer total immunity against the virus. There are currently around 41 research groups and companies in the race for a vaccine, and the hope is that one of these will prove sufficiently safe and effective to neutralize the COVID19 threat for the long-term.
Now that everyone has had a first-hand emotional experience of what a disease can do without a vaccine, I fully expect the antivaxxer influence to wane in our society. I am also planning not to write those blog posts rebutting the antivaxxer’s arguments, as they have become moot and are now a waste of my time. But there is one thing that I do have to point out, and that is the damage that antivaxxers have caused, but not just the one related to vaccine hesitancy or the wasting of resources investigating nonexistent connections between things like vaccination and autism.
Vaccines are safe, but they are not risk-free. While being vaccinated is safer than risking having the disease, there are a very small percentage of individuals that will exhibit serious adverse side effects as a result of a vaccine. As vaccines are applied to hundreds of thousands, there will always be a chance that someone with an unknown susceptibility or condition will experience a serious reaction to a vaccine. Here is where antivaxxers could have made a difference for the greater good of society. They could have accepted the effectiveness and safety of vaccines and the need for them, while at the same time advocating for researching vaccine side effects and defining the characteristics of the susceptibility of individuals to developing adverse effects to vaccination. But instead of becoming advocates, they chose to become opponents. Antivaxxers sought out every possible side effect of a vaccine to paint it in the worst possible light. The interest that should exist in the side effects of vaccines has become linked to the antivaxxer position giving it a social stigma. Many people who accept the need for vaccines, but who are genuinely interested in studying and defining the side effects of vaccines, have found out to their chagrin that what they do is often associated with opposition to vaccination. How many people have antivaxxers impacted negatively by creating this stigma may never be known.
It is unlikely however, that the antivaxxers will let up anytime soon. As the world anxiously awaits a COVID19 vaccine, antivaxxers may not have the influence that they once had. But if there is anything I have learned from arguing with climate change deniers, creationists, and proponents of 911 conspiracies, chemtrails, the flat Earth and other irrational skeptics is that they will move the goalposts. They will rationalize their failure, rework their arguments around any new evidence or situation, and fan new conspiracies. However, now that the sheer lunacy of the antivaxxer’s dream of a world without vaccines has been exposed, I am hopeful that society will not be as receptive to their arguments.
The image by TheDigitalArtist from pixabay is free for public use.
Anti-vaccination groups have put out many arguments against vaccines which have been rebutted by scientific and health organizations in many publications. I don’t want to cover all these arguments because I want to address the most important and irrefutable argument against vaccines, but before I do that, I want to mention some of the most salient of the lesser arguments.
Scientists and Clinicians have sold out to pharmaceutical companies which make a lot of money from unnecessary and dangerous vaccinations.
The vast majority of scientists and clinicians vaccinate their children. If these scientists and clinicians are dishonest people who sell out to pharmaceutical companies to peddle and support harmful vaccinations, why would they do that to their kids? Do you think all these people with doctorate degrees are evil, ignorant, or stupid? Also, pharmaceutical companies would make a lot more money from selling the medicines required to treat the onslaught of diseases that would roar back into our societies if we stopped vaccination than they make from vaccination itself.
Vaccines cause autism and sudden infant death syndrome (SIDS).
No they don’t. Well-designed studies with large numbers of children have found that vaccines are not linked to autism or SIDS.
If a child is all right and develops autism after he gets his vaccines doesn’t that mean vaccines cause autism?
The age at which most children are diagnosed with autism coincides with the age at which many vaccines are administered. Considering that millions of children are vaccinated, it is very likely a vaccination and an autism diagnosis will take place sufficiently close together that a parent may be tempted to infer a causal relationship between them. But there is no such relationship.
Vaccines contain chemicals that cause health problems.
Vaccines contain small amounts of chemicals that fulfill different functions during the production of a vaccine or in the final product. Many of these chemicals are already present in other medicines, in the food we eat, and even around our houses. At the doses used in vaccines, none of these chemicals has been found to be harmful.
All the vaccines children receive can overwhelm their immune system.
From the moment a child is born they are exposed to the myriad of bacteria, viruses, fungi, and other microorganisms present in the environment. The challenge to a child’s immune system posed by vaccines is a small fraction of what the immune system normally handles and no studies have found that too many vaccines can overwhelm the immune system.
Vaccination is unnatural. It is better for children to get diseases and develop a natural immunity.
The process by which a child’s immune system responds to a vaccine or to an infection is the same. The difference is that with vaccines the child doesn’t have to get sick, or face the risk of dying or developing complications from the disease.
There are risks involved in getting vaccinated.
Yes, and there are also risks involved in driving a car. Everything has a risk associated with it, and vaccines are no exception. However, the risks of getting vaccinated are extremely small compared to the risks of not being vaccinated. The safety of vaccines and adverse effects due to vaccines are continuously monitored and compiled by government agencies, and they are the object of scientific research. There are individuals who should not get vaccinated if they, for example, are prone to strong allergic reactions or have weak immune systems.
So now that we have disposed of some of the lesser arguments against vaccination, let’s get down to the real argument against vaccines. This is in fact the most important argument of them all, and it permeates the whole of the anti-vaccine movement and the anti-vaccine literature, although it is seldom expressed in verbal or written form. This argument is the following:
Vaccines HAVE to cause disease. Vaccines HAVE to be dangerous. Vaccines ARE unnecessary. Doctors and scientists ARE lying to us. ACCEPTING ANYTHING DIFFERENT IS UNACCEPTABLE, period, end of the discussion.
In the majority of cases, this is the real argument against vaccines, and it is, of course, irrefutable. The truth is that by and large most of those vehemently opposed to vaccination are too emotionally invested in their cause to consider the evidence. The reasons for this are complex and may differ from one person to another, but they are probably related to the general reasons why human beings uncritically believe in conspiracy theories.
In any case, this argument creates a challenge for scientists and health professionals. But the challenge is not to convince those that are against vaccination, which are a minority. The real challenge is vaccine hesitancy. This involves many parents who are open to vaccinating their kids but have concerns because of things they have read or heard. These are the individuals that pose the real risk to society because of the possibility that they will delay the vaccination of their children or choose only to vaccinate them against some diseases, or not to vaccinate at all.
Health professionals must get to these parents before the anti-vaccination activists win their hearts and minds, and this cannot be achieved by coldly reciting the results of studies, or by pressuring or shaming them. In this modern era, not only have parents been exposed to a lot of alarmist misinformation regarding vaccines, but they also do not have the experience of earlier generations that lived at a time when many diseases such as polio ran rampant. When explaining to parents the need for vaccination, health professional must avoid judging and contradicting the parents. The parents’ concerns must be addressed sympathetically within the framework of a dialog that helps them examine their own uncertainties, and this must be done beginning at the time of a baby’s birth. Only in this way we will meet the challenge.
The vaccine photograph by the US army is in the public domain.
In the United States, there is now a growing movement to ban the dangerous chemical “dihydrogen monoxide”. What is this chemical?
Dihydrogen monoxide is widely used in industry for processing, washing, diluting, cooling, or transporting a variety of products. Specifically, it is used by smelting facilities, petroleum refineries, and industries producing metal, chemical, and paper products, but most alarmingly, it is also widely used by the food industry.
So what is the problem with this chemical? The problem is that it can kill people!
Accidental inhalation of dihydrogen monoxide kills several thousand Americans every year and over 2 million people worldwide. Oral ingestion of dihydrogen monoxide can result in dihydrogen monoxide intoxication which is characterized by headaches, confusion and disorientation, and nausea and vomiting. If left untreated, dihydrogen monoxide intoxication may lead to muscle weakness, spasms or cramps, and can cause seizures and loss of consciousness. Exposure to the solid form of dihydrogen monoxide can cause serious tissue damage. Pure dihydrogen monoxide injected intravenously to laboratory rats or mice will kill them.
Despite the above, get ready for this, there is no urgency whatsoever in the government to ban this chemical. It is dumped legally (!) as a waste product by multiple industries into our rivers and lakes, and even into the ocean. Dihydrogen monoxide in the environment contributes to global warming, and to the erosion of the landscape. It causes corrosion of metals, electrical failures, and millions of dollars in property damage each year. The acid form of dihydrogen monoxide (hydroxyl acid) is a component of acid rain which destroys our forests. The presence of dihydrogen monoxide can be detected in wildlife and in our own bodies!
Enough is enough! The time has come to ban the use of dihydrogen monoxide for good. Will you join our group of concerned citizens, donate to our cause, and help us pressure our government to vanish the use this dangerous chemical?
Let me answer that question for you. The answer is: NO. Why? Because dihydrogen monoxide is one of the chemical names of “water”.
What I wrote in this post about dihydrogen monoxide is just my version of a recurrent hoax /joke that has been going around for decades, and is meant to illustrate how the lack of scientific literacy, and the phrasing of alarmist claims, can affect public opinion. In the most extreme forms of this hoax, people are requested to sign a petition to ban dihydrogen monoxide, which often leads to the collection of many of signatures.
Choosing the right words, and saying things about any chemical in the right way, can make it look scary, and in this case, I didn’t even have to lie. Everything I wrote is true. For example, accidental inhalation of water can kill people (it’s called drowning), excessive ingestion of water can be hazardous (it’s called over hydration; there is a method of torture based on this), formation of water crystals (ice: solid form of water) inside the cells of your tissues can damage them (frostbite), and injection of the right amount of pure water into animals can wreak havoc on the body’s electrolyte balance and kill them.
In today’s vast scientific literature, where virtually every chemical has been tested in one way or another, it is very difficult not to find examples of a chemical having a deleterious effect on some parameter of some biological model. And with today’s unparalleled access to information, people who believe they know more than the experts can set out on a crusade against any chemical. All they have to do is pick and choose studies from the scientific literature, without any regard for their quality or relevance, and weave them into a narrative using innuendo and questionable association to other compounds, which will cast the chemical in the worst possible light. This approach combined with the right mix of emotions, exploitation of human suffering, and politics can prove very effective, and is not unlike selling snake oil.
A famous case of the above strategy is when those opposed to vaccination waged a campaign against the chemical thimerosal which was alleged to cause autism. Thimerosal is a chemical that was used in many vaccines to prevent the growth of germs. Once inside the body, thimerosal is degraded to a derivative of mercury called ethylmercury. Mercury by itself or in the form of methylmercury is toxic, but ethylmercury is not toxic at the levels delivered by vaccines and is cleared from the body faster than methylmercury. In many cases, the anti-vaccine popular literature engaged in the innuendo that because mercury is toxic and thimerosal contains mercury, then thimerosal must be toxic. However, the toxicity of an element like mercury is heavily dependent on the way it is combined with other elements in chemical compounds. For example, the explosive elemental sodium (Na) and the extremely toxic chlorine (Cl), when combined with each other form the innocuous NaCl which is table salt.
The pressure to ban thimerosal kept mounting, and the US Public Health Service decided to request that vaccine companies remove thimerosal from most childhood vaccines in 1999 as a precautionary measure to decrease overall exposure in infants to mercury derivatives. However, the best designed studies did not find any conclusive association between thimerosal (or vaccines for that matter) and autism. After thimerosal was removed from most childhood vaccines, the number of cases of autism has kept on increasing, indicating that thimerosal in vaccines was not responsible for this trend. However, none of this has been accepted by the anti-vaccine community, which is busy at work convincing more and more parents not to vaccinate their children and peddling conspiracy theories. Not unexpectedly, the number of measles cases in the United States has reached an all-time high since it was seemingly eliminated in 2000.
This is not to say that there aren’t legitimate cases where the public should be concerned about the use of certain chemicals in medicine and industry, or instances where politics or other influences have vitiated the established procedures to determine safety. But the answer is not to stoke people’s fears, enshrine faulty science as truth, and disavow the assessment of experts on complex scientific issues claiming they have “sold out” if they do not support alarmist theories. The dihydrogen monoxide hoax is a joke, but what happened to thimerosal isn’t. Our life is better today thanks to thousands of medicines and chemicals produced by our pharmaceutical companies and industries. If we are concerned about the safety of these products, we should work with our scientific and medical organizations, not against them. Human nature is flawed. There will always be individuals who will engage in deceit, but the vast majority of scientists are principled people who will accept the evidence when it is clear and reproducible.
The image from Pixabay is licensed for public use. The image of thimerosal by vaccinationist was taken from PubChem and is in the public domain.
I have written that science can replace magical thinking, superstition, or erroneous ideas or beliefs by ever more refined and focused views of reality though observation and experiment. And this is essentially true. Science has done away with many beliefs and ideas that were not backed by facts. However, these changes rarely happen overnight, and in fact they are often met with stiff opposition. A significant number of people won’t modify their thinking based merely on piles of scientific evidence. If one of the purposes of performing science is to generate knowledge that will help people, then scientists have to take the beliefs and cultural norms of societies into account when pursuing the application of scientific knowledge. To illustrate this, let me tell you a story.
A long time ago a physician friend of mine was working in the Amazon jungle. He was tasked with helping the local natives with their medical needs. At the time, an outbreak of malaria was decimating some of the local tribes. My friend told me the story of how he had traveled by boat up a river for several days and then hiked through the jungle to reach a particularly remote tribe. He contacted the tribe’s healer and explained to him that he had some medicine that could help protect the tribe against malaria, but that it was not strong enough by itself, so he needed the help of the healer. He explained that if they combined his medicine with the healer’s powers, they would be able to beat the malaria scourge that was affecting the tribe. So my friend proceeded to treat all the members of the tribe and the healer proceeded to make his potions and perform his dances and rituals, and all the individuals in the tribe affected with malaria were cured.
On hearing this, I was astonished. Did my friend really think that the superstitious rituals and brews concocted by the tribe’s healer contributed or were needed at all to cure the malaria?
Now, let me be clear on two things. First, I agree that indigenous peoples throughout the world have developed a rich and effective arsenal of products derived from plants and animals in their environment to treat different ailments and conditions. Second, I also agree that in diseases that are self-terminating (i.e. those from which most people recover) the right psychological frame of mind can go a long way towards making individuals recover faster from their ailment. Even if a treatment is not really effective in curing a person, merely believing it is can make a difference in terms of how fast a person recovers their health. However, when it comes to certain extreme diseases, both indigenous medicine and psychology have limitations, and they cannot compete with medicines designed through evidence-based science.
When I questioned my friend about these matters, he agreed with me that the healer’s traditional methods were not effective against malaria, but then he stated that that was not the issue. He explained that in tribes like the one he visited, the healer is a central figure in the hierarchy of the tribe. In the eyes of his fellow tribe members, the healer is so important in the role of protecting the tribe from dangers both real and imagined, that a healer who is perceived as ineffectual can deeply affect the psychology of the tribe and impair the way the tribe faces difficult challenges. My friend said that if he had barged right in and cured everyone, he would have delegitimized the healer in the eyes of the tribe and done a greater damage to the tribe than malaria. This is why he concocted the story about the need to combine both treatments.
I was a bit shook up by this. I understood that from a practical point of view this approach made sense, but I remained ambivalent. I asked him, what about truth, facts, evidence, and reality? My friend replied that if enough people believe something no matter how preposterous, that belief for all practical purposes becomes a reality that you have to deal with if you are interested in helping out. If you go head on against these beliefs and disavow or belittle them, you will do more harm than good.
I have thought about what my friend said over the years, and I believe it has some truth. People have deeply held beliefs that are often very important to them. From a scientific point of view, I may understand that some of these beliefs can be demonstrated to be false such as, for example, the belief in creationism, but I have to understand that the mere generation of more data and its repetition will not sway minds. And I think that this is a concept that should be applied (and is actually being applied) to the opposition against many of the initiatives that we need to implement today such as dealing with global warming or dealing with an increasing number of unvaccinated children. This is especially true in our current polarized environment, where scientists are portrayed by many with vested interests either as atheistic, liberal, socialist individuals who want the government to take over the lives of regular folk, or as individuals beholden to corporate interests who deliberately hide, falsify, or mischaracterize data.
The success of the strategy I outlined above will depend on the approach. Very conservative and religious people will be suspicious of scientists warning them of how, unless we change our behavior, we will harm the planet. However, they may be more receptive if the focus is on the concept that humanity is the steward of creation; that we should take care of what God has created. This approach will be even more effective if it is implemented by individuals who share their own beliefs.
A similar approach is also needed with people who are hesitant to vaccinate their children because they believe that vaccines cause autism. Many of these people have been swayed by stories of human suffering interpreted within the context of false or simplistic alarmist explanations. Data and facts are important in combating these false or misleading narratives, but the human side of the issue has to be addressed if scientists wish to change some minds. Scientists should acknowledge the parent’s fears and stress that the common goal of everyone is to protect children, and explain that’s why scientists vaccinate their own children. They should talk about the millions of people alive today because of vaccines, about how the world was when smallpox, diphtheria, pertussis, tetanus, polio, measles, mumps, rubella, and other diseases were prevalent in our societies. Again, these arguments will be more convincing if delivered by former vaccine opponents.
The human mind is very complex. Different people perceive the same reality in different ways determined by genes, experience, and culture. Some of these perceptions will not conform to the actual veridical reality that’s out there, but as explained above, this in itself constitutes a reality that must be taken into account if we truly want science to help humanity. Whether it is helping a tribe in the Amazon or getting people to go green or to vaccinate their children, science cannot operate in a vacuum.
Photo by Agência de Notícias do Acre used here under a Creative Commons Attribution 2.0 Generic license.
There are a lot of conspiracies out there nowadays, and many of them include scientists as the “evil guys”. Some conspiracy theorists argue that climate change isn’t real, and it’s all doctored or exaggerated data generated by scientists promoted by research funding agencies and green companies. Others argue that vaccination produces autism, and that scientists and pharmaceutical companies are trying to hide this fact. Still others argue that scientists are hiding evidence for a young Earth and the discovery of Noah’s Ark because this would confirm creationism. There are also those conspiracy theorists that state that the scientists that carried out the analyses of the destruction of the Word Trade Center by terrorist during 911 engaged in faking data and misdirection to hide the fact that the attacks were a false flag operation staged by the US government to justify the invasion of Afghanistan and Iraq. And there are even some who argue that the Earth is really flat, that the moon landing never happened, and that pictures of a round Earth are fake.
It is tempting to roll our eyes and dismiss these conspiracy theorists as ignorant, but when you check the social media accounts of these characters and read the debates in which they become involved in public forums, you find that many of them are quite knowledgeable individuals. In fact some believers in conspiracy theories are, or have been, eminent scientists!
Conspiracy theorists and scientists share the fact that they are both skeptics, and skepticism is a healthy attitude in science. There is nothing wrong in being a skeptic, and truth be told, conspiracies should not be dismissed outright either as there have been a number of documented conspiracies. But many would argue that when it comes to some of the conspiracy theories outlined at the beginning of this post, conspiracy theorists are going too far in their skepticism and are not behaving like true scientists. So how do we differentiate between the reasonable skeptics and the irrational skeptics? How do we determine when conspiracy theorists are not behaving like true scientists?
I have stated before that, unlike other disciplines, the reason that science can be right is that it can be wrong. In other words, scientific claims can be tested and proven wrong, if indeed they are. On the contrary, non-scientific claims can never be proven wrong. The proponents of non-scientific claims constantly move the goalposts and engage in fancy rationalizations to explain away the data that disprove their ideas. This is one of the characteristics of many conspiracy theorists. It is impossible to prove they are wrong, and in fact many of them when backed into a corner will argue that the mere act of trying to discredit their ideas is further proof that there is a conspiracy!
It is important to identify these individuals in order to avoid getting sucked into pointless debates that will consume a lot of your valuable time. So here is the question you should ask conspiracy theorists:
What evidence will convince you that you are wrong, and, if such evidence is produced, will you commit to changing your mind?
If a conspiracy theorist cannot answer this question with examples of such evidence, and make the commitment to change their minds if said evidence is produced, then you can infer they are not behaving scientifically. This is one of the differences between a reasonable skeptic and an irrational skeptic.
There is another big difference between reasonable skeptics and irrational skeptics. Most conspiracy theorists are individuals who are perfectly comfortable with sitting smugly in their corner of the internet engaged in ranting out against their favorite targets to their captive audiences, but do nothing to settle the issue. Reasonable skeptics, on the other hand, do something about it. I have already mentioned in my blog the case of Dr. Richard Muller, a global warning skeptic who decided to check the data for himself. He got funding, assembled a star team of scientists (one of them would go on to win a Nobel Prize), and reexamined the global warming data in their own terms with their own methods. He concluded that indeed the planet was warming and that human activity was very likely to be the cause.
This is the way rational skeptics behave. Why don’t proponents of the flat Earth theory band together, raise money, and send a weather balloon with a camera up into the atmosphere, or finance an expedition to cross the poles? Why doesn’t the anti-vaccine crowd fund a competent study to assess the safety of vaccines? Why don’t those that argue that scientists are hiding evidence of a young Earth finance an investigation employing valid methods to figure out the age of rocks? Why don’t 911 conspiracy theorists finance a believable attempt to try to model the pattern of collapse of the Word Trade Center buildings according to evidence?
The answer is very simple, and it is the reason why fellow global warming skeptics repudiated the results of Dr. Richard Muller when he confirmed global warming is real. It’s because for the irrational skeptic, truth is a secondary consideration. Irrational skeptics are so vested in their beliefs and/or ideas that their main priority is to uphold their point of view by whatever means necessary. No fact or argument will sway them, no research or investigation is necessary. Because of this, when it comes to these characters, the best course of action is to apply Aldler’s Razor (also called Newton’s Flaming Laser Sword) which states that what cannot be settled by experiment or observation is not worth debating.
The World Trade Center photograph by Michael Foran is used here under a Creative Commons Attribution 2.0 Generic (CC BY 2.0) license. Photo of Buzz Aldrin by Neil by Armstrong, both from the NASA Apollo 11 mission to the moon, is in the public domain. The image of a 5-year average (2005-2009) global temperature change relative to the 1951-1980 mean temperature was produced by scientists at NASA's Goddard Institute for Space Studies and is in the public domain.
Many snippets of wisdom that have permeated our culture are routinely quoted in social media such as the one from the Irish playwright George Bernard Shaw featured in the image above that states that all progress depends on the unreasonable man.
Everyone seems to have an affinity with this particular trope. After all, who doesn’t love the story of the little guy fighting against the establishment? It seems that most of us, within reason, are programed to root for the underdog. The mavericks, the misfits, the fringe-thinkers, the outcasts: why do these characters have a place in our hearts? Is it perhaps because in the daily tedium of our lives, as we persevere overburdened by challenges at work, in our homes, and in society, we sometimes wish we could upturn the established order and restart anew? Perhaps we have considered going against the current, challenging the system, rocking the boat, but then deemed the risks of doing so too dire and just bowed our heads and kept on going. So maybe when one of these colorful characters that actually dares to challenge the powers that be comes along, we live vicariously through their plight a fantasy that we ourselves are too cowardly to bring to reality.
Be that as it may, in the field of science many of these characters have captivated the public’s imagination. Take the case of Dr. Barry Marshall who proposed the hypothesis that stomach ulcers are not caused by excessive acid secretion due to stress, as was thought by most experts, but by infections with a type of bacteria called Helicobacter pylori. Dr. Marshall failed to convince the scientific establishment. He was not able to develop an animal model of the disease, and could not obtain funds to perform a human experiment. So what did he do? He experimented on himself! He drank a broth infected with the H. pylori isolated from a patient who had developed severe gastritis. Within days he developed the same symptoms the patient had, and he was able to cure himself using antibiotics. It took another decade of struggles, but gastroenterologists were eventually convinced of the truth of his claim, and Dr. Marshall won a Nobel Prize in 2005.
Isn’t that a great story? And like this story, there are many other such stories of the unreasonable man battling the system and prevailing in the end. However, the popularization of these stories has generated several notions in the public consciousness that are not accurate.
The first is the notion that the only way science makes progress is when one of these characters upends conventional wisdom and triggers a revolution. This is not true. Most of the time progress in science occurs incrementally as thousands of scientists perform vital work within the system developing new knowledge, methodologies, procedures, and applications. The backgrounds and expertise of these scientists are fundamental to driving any new or old area of science forward. Without these individuals working within the system there would be no science. The notion that ALL progress, at least in science, depends on the unreasonable individual is simply false.
The second notion is that just because you are one of the unreasonable individuals you must be right, and the scientific establishment must be wrong. It must be understood that for every individual who has challenged the established order successfully, there have been dozens to hundreds of other individuals who have challenged the established order and were proven to be wrong. The stories of these individuals are normally not of interest except, if at all, to those whose write historical descriptions of the development of a given scientific field, and they are barely mentioned in the popular press.
Finally, the last (and probably most troublesome) notion is that when the scientific establishment lashes out at one of these unreasonable individuals, this is taken as proof that there is a bias within the scientific community motivated at best by intellectual conformity and closed-mindedness, or at worse by corrupt influences tied to granting agencies or corporate interests. However, what the public may interpret as an unfair treatment of a scientist by the scientific community is more often than not due to the fact that science is a very conservative enterprise, and the bar to overturn or reinterpret established science is set pretty high. Science is biased towards established knowledge; as it should be! When you go against established science, you’d better have some exceptional evidence and arguments or else you are going to be given a very hard time! Even scientists with Ph.Ds. can propose things that are wrong, misguided, or just plain stupid. Not all ideas deserve to be treated equally, not all evidence is sound, and not all interpretations of the data are correct.
What most individuals seeking to change the prevailing scientific paradigm do is address the criticism made by their peers, generate more evidence, and reformulate their ideas or their presentation. Convincing other scientists that you are right is the warp and woof of science. However, a disturbing phenomenon has emerged. Today those individuals who have been rebuffed by the scientific community can take their case to “the people” arguing that they are victims of a corrupt scientific establishment that is hell bent on silencing them and discrediting their ideas. Such is the case of Dr. Andrew Wakefield who, when his views that vaccination was linked to autism were rejected by the medical community, took his case directly to the public. He actually succeeded in convincing many parents to avoid vaccinating their children leading to a spike in infant deaths from some diseases that are preventable nowadays.
Established science is called that for a reason. Scientific theories are constructs that have grasped important aspects of the realties they seek to explain, and they cannot be overturned on a whim. The quixotic quest of the unreasonable man must not be romanticized. These individuals are wrong most of the time, and established science must be protected from them. If you want to upend established science, the burden of proof is on you!
The image of George Bernard Shaw was modified from a photograph in the George Grantham Bain collection at the Library of Congress and has no known copyright restrictions.
The near eradication of many diseases by vaccination is one of the greatest scientific and public health achievements of the twentieth century. And this was not merely a result of better hygiene and sanitation as claimed by some. One by one, smallpox, diphtheria, pertussis, tetanus, polio, measles, mumps, rubella and other scourges of mankind were beaten back as scientists discovered how to coax our immune systems to make antibodies against the pathogens that cause these diseases. Among the chief beneficiaries of this improvement in the health of our population were children. If you go to old cemeteries and check the graves, you will find a much larger number of children’s graves compared to modern cemeteries. Therefore it seems somewhat paradoxical that nowadays in our society and others a significant group of parents have refused to vaccinate their children claiming among other things that vaccines cause autism. This in turn has led to a resurgence of some of these diseases such as the measles outbreaks in California in 2014, Arizona in 2016, and the recent outbreak in Minnesota. What is happening here?
First of all, what is autism? Autism, or more accurately autism spectrum disorder (ASD), is a neurodevelopmental disorder where the afflicted children exhibit a lack of social interaction. Autistic children are withdrawn as if living in their own world, and many exhibit mental retardation, hyperactivity, irritability and repetitive behaviors. The specific cause of ASD is not known but it seems to encompass both genetic and environmental factors.
Now, how did autism ever become associated with vaccines?
The strongest catalyst for this association was an article published in 1998 by Dr. Andrew Wakefield and 12 other researchers in the medical journal the Lancet which suggested a link between the measles, mumps, and rubella (MMR) vaccine and autism through a mechanism that involved a type of gastrointestinal disease. The study was small (only 12 children), did not include a control group, and the nature of the evidence was correlational without any evidence of causation. However, the study was picked up by the media and widely publicized. As a result of this vaccination rates against measles, mumps, and rubella began to drop due to parents being concerned about vaccines and autism. This led to an increase in cases of these diseases in children resulting in several deaths.
In 2004, investigations by a journalist revealed that Dr. Wakefield had perpetrated fraud by altering the facts of the patients’ medical histories for what appeared to be financial gain. Ten of the original authors of the paper retracted the interpretation of the findings making it clear that they had not found any causal association with the MMR vaccines and autism. Also in 2004, the journal carried out an investigation that absolved the researchers of the paper of charges of ethical misconduct that had been levied against them only to retract the paper 6 years later when additional investigations by the British General Medical Council found evidence of scientific misconduct. As a result of these investigations, Dr. Wakefield was removed from the United Kingdom’s Medical Registry and he now cannot practice medicine.
In response, Dr. Wakefield has claimed that he is being targeted by the medical establishment in collusion with vaccine manufacturing companies, and that he has never committed fraud. Wakefield has moved to the US where he has developed a following among anti-vaccination groups who consider him a hero. The whole autism/vaccine topic has become mired in endless controversy with one side accusing the other of ignoring scientific findings and the other side retorting that the truth is being manipulated by “the system”.
What is a concerned person to do about this issue? How do we determine who is right and who is wrong without getting bogged down in technical details?
The answer is: studies. Studies are the warp and woof of science. It is through studies that we determine the truth. But here is the thing; you need several of them. You can’t rely on just a couple, and you can’t quote selectively those studies that favor your pet theory. You also need the studies to have a large enough sample size. Small studies are notorious for producing erroneous results. Finally, some studies may be of greater quality than others. Therefore you need enough studies to accumulate so reviews of the studies can be performed (a study of studies if you will). This is normally a process that can take many years, but fortunately the issue of the MMR vaccine and autism has generated enough interest that many researchers have investigated it.
So what are the results?
An 2012 review as well as a more recent update of some of the best studies evaluating, among other things, any possible link between the MMR vaccine and autism reached the conclusion that there was no significant association between the two. These studies were conducted in many countries and, unlike Wakefield’s original study with 12 children, these studies all in all included hundreds to hundreds of thousands of children.
Are these negative results part of a vast international conspiracy of scientist who have sold out to some sort of evil conglomerate of pharmaceutical companies spanning the whole world?
Do you know about the “war” that scientists waged against the claims of the cigarette companies that smoking was not hazardous or that whether it was or not was not settled science when study after study demonstrated otherwise? Are you aware of the current struggle of scientists worldwide to counter the claims that there is no global warming when all evidence points in that direction? Why do we presume bad faith is involved on the part of all scientists that come to the conclusion that the MMR vaccine is not linked to autism? Do you think these scientists don’t vaccinate their children?
Let me explain something. The history of science is full of individuals that, like Wakefield, discovered something and had to fight to get their voice heard. But, unlike Wakefield, these individuals discovered something real that other scientists were able to duplicate in their studies and became convinced. Paradigms and ideas switch all the time in science. Just consider the proposals or discoveries of evolution, deep time, deep space, plate tectonics, the germ theory of disease, the deficiency theory of disease, relativity, DNA, prions and many others. Very few scientists would walk away from being associated with discovering a solid causative factor for autism. The truth is that the available data has convinced scientists that the link between the MMR vaccine and autism is nonexistent. Scientists have lost interest in this theory and they have moved on to explore what other factors can be responsible for autism, and this is an important and active area of research nowadays.
I understand that the autism issue can be a very emotional one, and it is really frustrating for parents to hear scientists say they don’t know what causes it. I also understand how in the midst of their despair many parents can be swayed by those who claim to have a simplistic answer along with an evil to fight against. If anything, the current political climate in the U.S. has demonstrated that this strategy works admirably well! However the best way to move forward is not to demonize scientists, but to join ranks with them and cooperate in finding the truth. This happens with many other diseases where families, clinicians, and scientists are actively involved in finding a cure and developing treatments.
The photograph by the US army is in the public domain.