Original photo by: astique I have been thinking a lot about science and religion, in part because of the debate over health care, with people of different religious convictions coming out on both sides of the issue. Do we support individual rights by keeping government out of health care? Or do we ensure some measure of equality and community by moving health care out of the for-profit business model through more government involvement? In a religious sense, the first group may value a personal, transforming relationship with God, while the second may base their opinions on a sense of the religious call to work for the common good, with a special concern for the poor and the powerless. I won’t venture my position here, though if you have read my previous posts you may make a good guess.

What seems missing from the debate, in my opinion, is science. I hear a lot of ideology coming out of Washington and being espoused at town hall meetings and by protesters on both sides of the issue. I don’t hear much from people who have studied various health care systems and have gathered good information about what systems work and why they work and how to practically adapt such systems in the United States.

I think that science is fundamentally about information and religion is fundamentally about relationship. The word religion comes from the Latin "to reconnect." Immanuel Kant wrote in The Critique of Pure Reason that human reason has gone from the position towards nature as that of a pupil before the teacher, to that of a judge before a witness. In other words, science has become more about information and less about a basic curiosity and respect and even love for nature. On the other hand, religion has become more and more self-centered. When Catholic Bishops care more about the reputation of the Church and less about the welfare of the poorest and most vulnerable in their communities, we have a problem. When popular preachers use their influence to push a particular political agenda, while enriching themselves in the process, we have a problem.

I don’t know how the debate about health care will turn out, but I do have an example of how it can work. I take medication for a chronic condition, and see a doctor two or three times a year to discuss my medication, make adjustments, and so on. With her help I have been able to live a pretty healthy and fulfilled life. She spent years in medical school working very hard to gather information about the human body, its deceases, and its cures. She has spent many years gaining experience in applying that information in particular cases. But when I see her there is more going on then the passing of information. I believe she cares how I am doing. I think, within the boundaries of her profession, that she loves me, as she does her other patients with whom she has been able to build a relationship over time. However the health care debate turns out, I hope it allows more people to have the kind of relationship I have with my doctor. And I hope that it encourages more doctors to be healers, and not just dispensers of information and pills.

This week's local science event pick focuses on health care reform.A recent PBS News Hour with Jim Lehrer opened with this quote from President Barack Obama: "There are examples of how we can make the entire health care system more efficient. …What works? The Mayo Clinic. The Cleveland Clinic. Geisinger. Kaiser Permanente. There are health systems around the country that actually have costs that are as much as 20 percent or 30 percent lower than the national average and have higher quality. What is it that they are doing differently from other systems?"

The idea for Kaiser was developed by Dr. Sidney Garfield way back in 1933. He established a prepayment health plan for 5000 workers building the Los Angeles Aqueduct in the Mojave Desert. Workers paid about a nickel a day to receive full medical care from Dr. Garfield. He emphasized prevention and early treatment to prevent more serious problems later.

Fast forward to today, the same issues of prevention to keep down costs are still being discussed today. Certainly, HMOs are not without criticism, but it is certainly a compelling story to trace the development of the modern system from a place of preventative care. Plus, it will be a relief to have a healthcare discussion without all the yelling.

Tom Debley is the author of The Story of Dr. Sidney R. Garfield: The Visionary Who Turned Sick Care into Health Care, the theme of his talk will be "The Long Quest for Health Care Reform: A Bay Area Doctor's Belief in Health Care as a Right." He will trace the story of Dr. Garfield's life because so much less is known about him than his co-founder, Henry J. Kaiser.

The Long Quest for Health Care Reform: A Bay Area Doctor's Belief in Health Care as a Right

When: Tuesday, August 25^th 2009

Where: Commonwealth Club, 595 Market Street 2nd Floor

Cost: $8 members, $15 non-members, Tickets

The rate of asthma in children younger than five increased 160
percent between 1980 and 1994.
When I set out to produce a QUEST story on the latest research on the causes of childhood asthma, I didn't expect to discover how little researchers know about this question. They do understand the lung disease's mechanisms: a chronic inflammation of the airways causes an overreaction to allergens like pollen and dust mites, which in turn brings on symptoms like wheezing, coughing and a dangerous tightening of the chest and shortness of breath.

But asthma researchers are still very much working to figure out what, besides changes in the way asthma is diagnosed, might account for the 160 percent rise in the rate of asthma in children younger than 5 that took place between 1980 and 1994. Our QUEST TV story looks at one interesting hypothesis, called the "hygiene hypothesis." The hypothesis proposes that as certain types of bacteria have become less and less present in our lives, we have developed allergic diseases in response.

I also asked researchers if their findings allowed them to make recommendations to parents on what they might be able to do to help reduce the risk of their children developing asthma. Although our two interviewees were careful to caution how little scientists know with certainty at this point, they were willing to venture some advice, which you'll see in our Web-only video.

Watch the Asthma television story online.

(Editor's note: Today we've got a guest post from Nick Vidinsky, Producer of KQED's Health Dialogues)

Hi everybody. I want to let the QUEST community know that over at KQED’s Health Dialogues, we just launched a new project, called Healthy Ideas: Californians Weigh In on Health Care Reform.

In his 100th day press briefing a few days ago, President Obama reiterated his desire to enact health care reform by the end of 2009. The President has also put out a call to all Americans to submit our ideas on just how to do that. So, Health Dialogues decided that we’d let Washington know what Californians think.

Is the cost of new medical technologies worth the potential health benefits? What can we do to eliminate health disparities across socioeconomic backgrounds? Should everyone be required to purchase health insurance?

Healthy Ideas is a conversation among academics, health care professionals, policy think tanks and the general public about what kind of health care reform California wants and needs. During the next two months, you can join the dialogue by reading our authors’ weekly posts, rating them and contributing your own thoughts and questions. At the end of the project, on July 1, we’ll summarize your ideas and deliver them to California’s representatives in Washington, as well as the Obama Administration, Senate Finance Committee Chairman Max Baucus and Senate Committee on Health, Education, Labor and Pensions Chairman Edward Kennedy.

To contribute your thoughts and let Washington know what kind of health care reform you want, join the dialogue at Healthy Ideas: Californians Weigh In on Health Care Reform.

Thanks!
Nick Vidinsky
Producer, Health Dialogues

Some 30 researchers from the University of California-San Francisco and the Gladstone Institute of Virology and Immunology have come together to investigate why HIV-positive patients, who are now living longer lives thanks to anti-retroviral drugs, seem to be aging faster than their uninfected peers.

"There's a long list of concerns that people have raised about the effects of chronic HIV infection on different health outcomes," says Dr. Paul Volberding, who as a co-chair of San Francisco's Center for AIDS Research is bringing together this group of scientists. UCSF/San Francisco General Hospital cardiologist Priscilla Hsue, for example, has found that HIV-positive patients (the patients she sees in San Francisco are mostly men) have heart attacks when they're around 50 years old. That's 10 years earlier than when your average, uninfected, man has a heart attack.

Other researchers have found that HIV-infected patients develop dementia younger and kidney failure at a faster rate than their uninfected peers. Volberding says that these patients are also showing accelerated bone loss and accelerated loss of their kidney function. These are all ways in which our bodies normally decline as we age. But in patients with HIV, the decline seems to be faster.

At the beginning, researchers believed that anti-retroviral drugs were causing the aging, but as research has progressed, the thinking has shifted. "The more nuanced recognition now is that maybe some of that was from the drugs," says Volberding, "but maybe some of it was because the drugs were working and patients were living longer and allowing us to see these other effects of chronic viral infection." Even though anti-retroviral drugs can bring the amount of virus in the body down to almost undetectable levels, there is always a tiny amount of HIV replicating inside a patient's body. And Volberding and others believe that this virus could be responsible for the sped-up aging.

UCSF molecular biologist Elizabeth Blackburn, another member of this new group, has spent her life studying the tips of our chromosomes, called our telomeres (pronounced TEAL-oh-meres), and the role they play in aging. Blackburn has found that as we age, our telomeres wear away and shorten. She has studied the telomeres in patients with heart disease and cancer, and now she wants to look at HIV patients' telomeres.

Listen to the Graying of HIV radio report online.

You're as likely to be struck by lightning
as to have a severe reaction to a vaccine.

I was reading an article in Time last week about parents not vaccinating their children. The story was about how this phenomenon is becoming more widespread.

These kinds of stories are weird to me because vaccines are pretty safe. The risk of an adverse side effect is incredibly small. For example, the risk for anaphylaxis from the Hepatitis B Virus vaccination is around 1 in 600,000. This is about the same risk as being struck by lightning (1 in 700,000).

Of course, the article wasn't talking about known risks. Instead, it was referring to a hypothesized link between vaccines and autism.

People proposed this link when they noticed that cases of autism and the number of vaccinations were rising at the same time. Of course, just because two things happen to occur at the same time, this does not mean they are causally linked. For example, the increase in global temperature is not related to the decrease in the world's populations of pirates (despite what the Pastafarians say).

So how could an increased number of vaccinations cause an increase in the number of cases of autism? I have seen two ideas put forth. The first is that thimerosal is to blame. The second is that there are so many vaccinations now that we are stressing out the body's immune system. Most likely neither idea is valid.

Thimerosal is a mercury-based preservative that used to be used in vaccines. Even though there haven't been any good studies on the effects of thimerosal on brain development, everyone knows mercury is bad for the brain. So the idea behind thimerosal makes some sense.

Back in 2001, vaccine manufacturers decided to eliminate thimerosal from their vaccines. We would predict, then, that cases of autism should go down significantly if thimerosal was linked to autism. They haven't. In fact, in one California study, cases have continued to climb. So thimerosal is most likely not to blame.

Another point that has been made is that there are so many vaccines now that we are stressing out our bodies' immune systems. Again, this concern is unfounded.

Vaccines are injections of viral proteins. Our bodies see the proteins and raise antibodies to them. Then when a virus invades, we have antibodies that recognize the virus and target it for destruction.

It is the number of viral proteins that matter in terms of taxing the body's immune system and not the number of vaccinations. All of the current vaccines put together do not have as many viral proteins as the old smallpox vaccine (150 vs. 200). So the number of vaccines is unlikely to be the issue.

What all of this means is that vaccines are probably not responsible for the significant increase in the number of cases of autism. What is responsible? No one knows for sure.

It may be that the rise just comes from all of us recognizing the symptoms more. Or it could be due to some cause we don't know about or understand.

What we do know is that vaccines save many lives. I assume no one wants to go back to the early 20th century when polio epidemics swept the country. For example, 2,500 cases of polio ended up at one Los Angeles hospital between May and November of 1934. And in 1952, the U.S. had 21,000 cases of paralytic polio.

We can prevent this sort of thing from happening by making sure everyone is vaccinated. And yet there are people who choose to hide behind the people who take the miniscule risk of getting vaccinated.

Is this a matter of free choice? Should parents be allowed to opt out of vaccinating their children even if it risks society at large?

One idea, I suppose, is to have people who choose not to be vaccinated to sign a waiver saying they accept full responsibility for their actions. In practice this would mean that health insurance and the government would not be responsible for their children's health care bills if they become ill with one of the diseases they refused to be vaccinated against.

And if your infant, grandma, or immuno-suppressed cousin came down with a disease these folks refused to be vaccinated against, then you could sue the un-vaccinated for damages. The common good isn't enough to encourage these folks. Perhaps threats to their pocketbook will be.