Is Buying Organic Worth the Cost?

In the fall of 2012, it was all over the media: organic food is no healthier than conventional. A study from the prestigious Stanford University said so, so it must be true, right? Not so fast. The Stanford study only compared a few aspects of organic versus conventional which allowed them to make some limited conclusions. As it frequently happens, what the study said and what was widely reported were quite different. Let’s tease out what it really found and what it did not address.

Before you get mad at the authors or the study itself, consider the study’s actual conclusion: “The published literature lacks strong evidence that organic foods are significantly more nutritious than conventional foods. Consumption of organic foods may reduce exposure to pesticide residues and antibiotic-resistant bacteria.”

As a naturopathic physician in clinical practice, I don’t recommend my patients choose organic foods for their nutrient density. No, for that, I counsel them on how to eat a whole foods diet. I recommend organic foods for precisely the reason the authors suggested: lower exposure to pesticides and antibiotic-resistant bacteria. This is significant, especially in pregnant women, infants and children. And they did find that eating organic reduced the measurable pesticides in children. There were no studies looking at this in adults. In fact, according to the authors, “these are some of the most important findings of our study.” Somehow, though, these findings did not make the headlines.

The Stanford study was a meta-analysis, which means it did not do any original research, but compiled and compared results from a of number previous studies – 237 to be exact. Most looked at differences between conventional and organic foods. Seventeen were studies in humans, and of these, only three studies looked at clinical outcomes – that is, actual effects on health rather than markers like cholesterol levels. These did not find a difference between eating primarily organic rather than conventional foods in terms of risk for eczema and allergies. However, I’m not sure anyone thought organic foods decreased the risk for eczema or allergies to begin with.

Also, these three were short-term studies, which makes them much less meaningful. In a sense, being exposed to background levels of toxic chemicals is like smoking tobacco, eating a poor diet, or regularly drinking too much alcohol. We don’t expect most people to fall ill from eating conventional apples for 2 days, 2 weeks or 2 months. In order to accurately assess the long-term health impact, we need long-term studies. Unfortunately, we don’t have them, so we just don’t have a clear answer to this question. However, we do know that cleaner living supports better health. We have lots of information that shows the opposite – toxic exposure leads to illness. In fact, in 2010 the President’s Cancer Panel recommended reducing exposure to environmental toxins by choosing “food grown without pesticides or conventional fertilizer,” in order to reduce risk of cancer.

Previous work has found organic food is indeed more nutritious. But even if that turns out not to be the case, there are still plenty of reasons to pay extra for organic. The authors themselves recognized that “there are numerous valid reasons why consumers might choose organic over conventional foods, including concerns about the environment, animal welfare, farm worker health, taste and cost.” I would add avoiding toxic exposures to this list. (And perhaps remove cost, since organic tends to cost more).

If eating organic is just too expensive, have a look at the Environmental Working Group’s Annual Shopper’s Guide. Here you can look at their ratings of which produce have the highest and lowest levels of pesticide residues, so you can choose to buy organic where it matters most – the foods with the highest pesticide residues.

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The Whole Life Nutrition Cookbook: Review

I was sent a prepublication copy of this cookbook back in May and I intended to review it right away. Clearly, I am a bit behind on my writing, but I am happy to finally be sharing this great resource.

Whole_Life_Nutrition_Cookbook The Whole Life Nutrition Cookbook by husband and wife dynamo Alissa Segersten and Tom Malterre, MS, CN offers over 300 recipes, including dishes that are free of gluten, dairy, soy, and egg. This book is my go-to recommendation when I put a patient on an elimination diet—a brief trial of a very limited diet that eliminates the above foods (and sometimes others as well!) There are a number of beautiful color plates showing just how gorgeous whole-foods cooking can be.

The introductory chapters are chock-full of information including an overview of a number of popular diets, including raw vegan, paleo and Weston Price and describe who and what they are appropriate for. I love this take. These diets are often presented as the one true answer to being healthy. But there is no “one healthiest diet” that is right for everyone. Each person has their own unique genetic blueprint, physiology, and emotional history that make them different from everyone else, even a twin. Eat accordingly.

I tried a number of the recipes and was overall very pleased:

When Ali Segersten claimed that her children loved the pickled radishes, I was skeptical but I went ahead and tried it anyway. The recipe was simple and quick and she was right. My 5 year old chomped them down like they were potato chips.  They come out a beautiful bright pink and would make a lovely garnish or addition to a salad.

I had never heard of Curtido, but it looked intriguing so I tried it. Curtido is a South American dish traditionally made with vinegar, but here Ali altered it to use lacto-fermentation instead–think a fresher sauerkraut with carrots, spiced with oregano and chili flakes. I am a big fan of people eating something fermented everyday, so I thought I’d see how it went over with my family. It was a hit, both with my kids and my husband who doesn’t lie to make me feel better. The downside about this recipe was that it failed to mention early on to save a cabbage leaf for the fermentation process. For someone who is not very familiar with fermenting cabbage (ahem, that includes me), I only realized I need to do that after shredding the whole head. Luckily, I had some kale in the fridge to use instead.

My favorite dish was probably the beet, kale and walnut salad with feta and basil.. I made this for the whole family while we were visiting my parents. It went quickly; everyone loved it. Toasting the walnuts was key. I’m not usually a walnut fan, but the freshly toasted ones were absolutely delicious. We made a quinoa salad that evening as well, and it was tasty too.

There is a wealth of information in the first pages regarding food sensitivities, blood sugar regulation, organic foods and more. And the cookbook follows with your practical guide on how to follow through. I’ll vouch for this source. I know Tom personally and he is no schlump. I’ve heard him speak publically and seen the hundreds of research articles he uses when writing or presenting. The guy is brilliant and knows his stuff. So if you are interested in getting healthier and looking for a place to start learning about how to do it, you won’t go wrong starting here.

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What’s the deal with gluten sensitivity?

Gluten has been getting a lot of attention lately—both from people who avoid it and from others who scoff at them. In fact, when my husband brought a review of recent research to my attention on certain social media site (follow me here!), it sparked a passionate debate between folks with self-diagnosed non-celiac gluten sensitivity (NCGS), as it has recently been named, and others opposing the idea.   I promised an in-depth assessment of the study.  So I’ve read about 15 papers and now have some perspective to share.

It turns out that in the last 3-4 years, NCGS has gotten its name, its own acronym, and a whole lot of scrutiny.  This attention is good.  Because despite heavy-handed articles like this one that claim one study can close the book on a subject, it is actually by looking at the weight of evidence that we can begin to understand a subject.  Right now, NCGS research is in its infancy.  Researchers are only just now starting to believe in this new entity, so please don’t expect me to give you a definitive answer. I will say though: it is looking like wheat sensitivity is a real thing, although the details need to be sorted out.  I’ve seen this clinically for years, but now the research is starting to support my experience.

In 2011, Jessica Biesiekierski et al published one of the first studies since the early 1980s to examine possible negative effects of gluten.  It was decisively titled Gluten Causes Gastrointestinal Symptoms in Subjects Without Celiac Disease: A Double-Blind Randomized Placebo-Controlled Trial.  After ruling out celiac disease, this group followed the gold standard for identifying food sensitivities: double blind, placebo-controlled challenge. The subjects were a small group of 34 irritable bowel syndrome (IBS) sufferers whose symptoms were controlled by avoiding gluten. They were split into two groups: one given gluten in the form of 2 bread slices and a muffin per day, the other given placebo as gluten-free forms of bread and muffins.  After 6 weeks, the gluten-free group was doing significantly better than the gluten group.  The results of this study showed that the subjects who ate gluten had more pain, more fatigue and worse stool consistency “over the entire study period.”

If you’ve ever tasted gluten-free—well, gluten-free anything, it is hard to miss. The team accounted for that. All the bread and muffins were made with the same flour base, but commercially prepared pure gluten was added back in to the test breads.  And in a mini-pre-test test, 10 subjects could not tell the difference.

Surprised by their results, the group followed up with two more specific—but still small—studies to investigate where these effects were coming from.  They used many of the same people with IBS who did not have celiac disease. (By the way, folks, it is not celiacs.  No “s.”)  In both, they rigidly controlled the subjects’ diets to eliminate the “background noise” of their regular diets, as much as possible.   After two weeks on a diet low in Fermentable Oligo-Di-Monosaccharides and Polyols (FODMAPs), all the subjects felt better: this was the baseline where they started giving the gluten and placebo baked goods.  In contrast to the previous study, the results of this first follow-up study did not show an association between gluten and symptoms of pain, fatigue, bloating, or wind, as they say in Australia.  In other words, gluten wasn’t the problem.   Curious why the subjects decided to stay gluten-free despite these results, they investigated again and found that gluten did significantly increase symptoms of depression (not by a lot, but it was statistically significant).

There are some issues with their approach, including the use of whey protein as a placebo.  Whey protein is problematic because dairy is often a trigger in people with IBS.  However, they looked at this, by following up with a trial that included a GFDF placebo arm in both of these follow-ups and their results did not change.

Another problem with this study was with their selection of participants.  They carefully ruled out celiac disease, as they should, and had specific criteria for subjects who were on a GF diet and whose symptoms were adequately controlled. However, a number of these people who met the criteria reported that while they felt better on a GF diet, they still had symptoms.  This suggests they these people may have had other sensitivities. There may have been an unintentional selection bias for people who were indeed sensitive to gluten, but perhaps also to the FODMAPs—most likely to the fructans contained in wheat.  The mood issues may be due to exorphins–mood-changing opioid-like peptides derived from gluten and other proteins.  Also, they may have also excluded people with allergy/sensitivity to gluten and ended up with a very specific population.  This is part of the trouble with small studies of tens rather than thousands of people: it is very difficult to extrapolate results to the general population.  Read more about this issue here if you like.

Despite these problems, this is a very interesting paper that really does help us to understand what may be going on for a lot of people.  Many folks who believe they are sensitive to gluten may indeed do better on a gluten-free diet, but they may actually be sensitive to the fructans or other FODMAPs in wheat, rye, and barley.  Biesiekierski et al suggested another interesting point: perhaps FODMAPs and gluten work hand in hand to create symptoms.  Perhaps in some people the FODMAPs are the main irritant but when take with gluten, things get worse.  Interestingly, in a 2013 review, the same group points out, “Cereal products with the lowest FODMAP contents are mostly gluten-free, based on rice, oat, quinoa and corn ingredients,” so that people on a GF diet may end up feeling better whether its the gluten or the FODMAPs that were the original problem.

In the research that I have reviewed, it is pretty well accepted that some kind of reaction that is currently being called NCGS does exist, at least in some populations.   Antonio Carrocio and his buddies suggested that non-celiac wheat sensitivity would be a better name. I agree.  Even this name is not perfect, but no one is going to say Non-Celiac Wheat-Rye-Barley-Triticale sensitivity.  As it stands right now, we do not know for sure what it is in these grains that people are reacting to.  In addition to the aforementioned gluten, FODMAPs, and exorphins, there are other potential problems.  Non-gluten wheat proteins including α-amylase/trypsin inhibitors have recently been shown to cause inflammation in the gut.  And then there is the little-recognized, but well established wheat allergy (most common in bakers).  We also do not yet understand the underlying mechanism, although this has also been the subject of recent research.  Remember that part about me not being able to give you a definitive answer?  Yeah, here it is.

Before I wrap up, I have to offer a brief word on avoidance diets in general. It is not all about gluten. Many people do not tolerate gluten, but gluten is not the only food people do not tolerate.  If you have persistent digestive issues, a gluten-free trial is a reasonable approach, but if that does not resolve your issues, do not give up. There are many foods that I have found irritate people and cause symptoms. Discovering what these are is best done under supervision, as questions usually arise during the process, and it can be tricky to get adequate calories and sound nutrition.   I do find value in books like David Perlmutter’s Grain Brain.  But I am frustrated by the current laser focus on gluten and grains. The link between inflammation, chronic disease, and overconsumption of refined carbohydrates is important.  But in addition, in my practice, I find many people are sensitive to other foods, commonly dairy, soy, and corn, among others.  Food is a major culprit in the epidemic of chronic disease in the USA, beyond obesity, diabetes and cardiovascular disease.


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Measles, Part 4: Wrapping it up

(This is the final episode of a four-part series. If you are just joining us, you might want to start with the introduction.)

Let’s start with what we know about delaying or refusing vaccines:

The bottom line and perhaps the most obvious consequence to alternative schedules is that they increase the amount of time an infant or young child is susceptible to a vaccine-preventable disease. This often (although not always) ends up being the time when a child is most at risk for severe infection.  I’ve heard many parents say that because they raise healthy-eating and healthy-living children, they are safe. This is a falsehood.

Look, I’m a naturopath. Therapeutic lifestyle change (TLC!) is the foundation of my practice. Diet and lifestyle alone can create vibrant health (in some people). Certainly being healthy, without underlying chronic disease, makes it less likely you’ll fall ill and/or have terrible outcomes when you do. But measles is extremely contagious. A healthy lifestyle is no guarantee that you won’t catch it. Of course, immunization is not either, but the 95-99% reported by various reliable bodies is pretty darn good.

Are you ready to refuse?

From a civil liberties perspective, I believe that Americans should have the right to choose what happens to their bodies.   But refusing vaccines is not a decision to be made lightly. It impacts you, your children, and your community. Please don’t unintentionally delay vaccination out of indecision or a lack of information.   One additional question I encourage questioning parents to ask is whether their work and lifestyle would allow them to stay home with their sick children the entire time they are contagious (usually up to eight days).

Also keep in mind it is next to impossible to avoid exposing others in the event you or your child is infected with measles. The rash doesn’t appear for 2-4 days, and at the onset of symptoms, there are only general signs of illness like fever and runny nose. You are not likely to be thinking measles at this time but will be very contagious.

In addition to the immunization class I had offered, I teach workshops on practical ways to avoid toxic exposures in everyday life. I think this is probably the most important topic I speak about publically. But my vaccine class was the most popular. And here is the thing: while it is true that vaccines have toxic ingredients—mostly in miniscule amounts—they have very real public and personal health benefits. The arsenic in your water and the bisphenol A in your soup do not. If you are concerned with toxic exposure, why not start with the toxins you are exposed to in large quantities and afford you no benefit?


Before signing off, I want to take a moment to discuss this drug. I have many problems with acetaminophen (the active ingredient in Tylenol), including its narrow therapeutic window. It is an analgesic and also used to lower a fever, a common side effect of MMR immunization. But when prophylactic, or preventative, acetaminophen (known as paracetamol in other parts of the world) was tested with a number of vaccines (although not MMR in this study) it seemed to interfere with the antibody response to immunization, meaning the vaccine doesn’t work as well. Additionally, there are preliminary suggestions that fever suppression (post vaccine or otherwise) or pre- and perinatal use of analgesics like acetaminophen may play a role in autism or other neurodevelopmental issues. (I’m NOT suggesting vaccines cause autism. If that is unclear, please read my previous posts. This evidence is very preliminary. It is too soon to tell whether fever suppression will be one of many contributing factors to the complex condition that is autism.)  Fevers are not as dangerous as most people believe. In fact, a fever suggests that the immune system has been stimulated, and is mounting an antibody response to the measles antigen in the vaccine. As a naturopathic doctor, I prefer to let the body respond without suppression, as long as the fever stays within a safe range.   This is not as ‘woo-woo” or out there as you might think. Seattle Children’s Hospital suggests that “fevers only need to be treated with medicine if they cause discomfort. That usually means fevers above 102°F (39°C).”

In Conclusion

I must admit, when I first started considering these issues, I was much more skeptical of vaccine safety.   I hadn’t done much research; I hadn’t taken my pediatrics courses yet, but like many parents out there, I had gotten the message that there was something to be scared of.   When I started intensively researching the issue for my local lectures, I suspected my audience would be of a similar persuasion. I did my best to look at the evidence beyond the arguments on both sides.  It wasn’t easy to find legitimate evidence of major harm from vaccines beyond known adverse events. And what was out there kept being debunked. After years of reading, writing, and teaching on the topic, I have gotten progressively more and more convinced that the risk-benefit analysis favors immunization with MMR. Does safe equal risk-free? Of course not. But it’s the best protection we have from a virus that is on the rise, and even better in conjunction with healthy habits that support the foundation for health.

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Measles, Part 3: Vaccine Safety

(This is the third in a four-part series. If you are just joining us, you might want to start with the introduction.)

Because vaccines are so widely used—and because state laws require that children be vaccinated to enter daycare and school, in part to protect others—immunization safety concerns should be vigorously pursued in order to restore this trust.” IOM, 2002

As I mentioned earlier, all medical interventions have risks. MMR does have some of the more worrisome adverse effects of the vaccines we have. Some of the common ones associated with MMR include fever, rash, swelling of the lymph nodes, and inflammation of the parotid salivary gland. But these are also associated with catching the three viruses found in MMRII naturally and occur less frequently with vaccination than infection. (Remember, MMR is a live virus vaccine and so induces a very mild, non-communicable infection.) Adult women, however, are at an increased risk for adverse effects of vaccination. Up to 25% may develop joint pain that can be either transient or longer lasting.

There are people who should not get a live virus vaccine like MMR, including those with severe immune suppression. It is important to know that women who are pregnant should not receive this vaccine and all women should avoid becoming pregnant for 3 months after receiving it.  Additionally, the ProQuad vaccine, that includes varicella (chickenpox) along with measles, mumps and rubella, is not recommended for breastfeeding mothers, as the varicella virus may be transmitted through breast milk. ProQuad (which includes the chickenpox vaccine) is also associated with a higher rate of fever and febrile seizures than is MMRII.   I will also add that I prefer a child to be healthy, without a fever, and, if possible, not at all under the weather when receiving an immunization.

It was Andrew Wakefield’s 1998 Lancet study that started the big commotion over MMR, linking it with autism. The paper was fraudulent and has since been retracted. There are people who do not believe that Wakefield’s trial was fair and perhaps Brian Deer and the BMJ had gone after him with too much hype and vengeance. But to be honest, it doesn’t matter.   I’ve read this short paper a number of times. Even if it was strictly factual and their methods were transparent (which they were not), the evidence he presented was too weak to draw any conclusions. His data does not link MMR vaccination with autism, but the media—very much encouraged by Wakefield—did. Really, it is a bad study. I don’t want to spend more time talking about autism and MMR, but if you want to learn more, check out the Yokohama study or this synopsis. I’m not an epidemiologist, but if you are, and are reading this, I’d love to hear your take on Wakefield’s response.

Autism aside, we do need more research into the safety of the measles vaccine. This was the conclusion of the highly respected Cochrane Collaboration in 2011. While they asserted that MMR is probably safe, they also admitted “the design and reporting of safety outcomes in MMR vaccine studies, both pre- and post-marketing, are largely inadequate.” Before you decide that is enough to stop vaccinating, know that the Cochrane investigators went on to say that the “existing evidence on the safety and effectiveness of MMR vaccine supports current policies of mass immunization aimed at global measles eradication.” So, this does not mean the vaccine is not safe. It does mean that we don’t know for sure what all the risks are.   I would really like to see long-term studies on the impact of our childhood vaccination program on chronic disease.   What might 30+ immunizations before the age of 6 contribute? We don’t currently know. Does this make me nervous? To be honest: a little bit, yes. But not enough to decline to vaccinate my children.  Weighing the existing evidence on risks and benefits, vaccination emerges the better option.

Stay tuned, the next and final installment will get into vaccine choices and related considerations.

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Measles, Part 2: The Basics

(This is the second in a four-part series. If you are just joining us, you might want to start with the introduction.)

Measles Virus

Measles is a highly contagious virus transmitted like the common cold i.e. via respiratory droplets. It is so contagious that you can catch measles by entering a room that a contagious person had left two hours before.  Most of the time, the illness is fairly mild. But rare infections can be severe and even fatal—and it is not simple to predict who will have it easy and who will really suffer. Since 1995, there has been an average of one measles-related death per year in the U.S. Young children and adults are at the highest risk for serious complications. This is part of why vaccination is scheduled to start early: to protect the most vulnerable. However, measles is not one of the earliest vaccines recommended by the CDC schedule, because it is not as effective when given before 12 months of age.

Some anti-vaccine activists say that improved sanitation and nutrition took care of infectious disease before the vaccines came around. Clean water and sewers certainly did impact the incidence of infectious disease. Regarding measles specifically, improved nutrition was a major factor in dropping the death rate (more so than the incidence of disease). This link shows rates of both disease and death in Britain; notice the big drop in deaths from measles well before the introduction of the vaccine in the 1960s. However, by mid-century, the rates had basically plateaued. Then the vaccine was introduced and drastically dropped the incidence of disease, and consequently deaths as well. From the CDC’s Pink Book:

“Before 1963 approximately 500,000 cases and 500 deaths were reported annually, with epidemic cycles every 2–3 years. However, the actual number of cases was estimated at 3–4 million annually. Following licensure of vaccine in 1963, the incidence of measles decreased by more than 98%, and 2–3-year epidemic cycles no longer occurred.”

Keep in mind, there are other complications from measles infection besides death. For more detail the history of measles and the measles vaccine, you might read Dr. Ian York’s interesting “Measles week” series.

While we are on the topic of sanitation, I’d like to mention that every intervention carries some risk. Do you remember when walking down a city street meant risking a pot of raw sewage being dumped on your head? Neither do I. While I have no interest in going back, I want to point out that even sanitation is a double-edged sword. Before clean water and sewers were commonplace, polio was endemic, meaning always present in some part of the population. However, infection in infants less than 6 months was rare and/or they were asymptomatic. After sanitation measures were rolled out, kids were not exposed to polio at such a young age, leading to decreased immunity and subsequently the polio epidemics of the 1940s and 1950s.

Measles Vaccine

All right, so that is some background on measles itself. Let’s talk about the vaccine. MMRII is an effective vaccine. One dose works in 95-98% of kids, increasing to more than 99% after the booster dose. It is a live-virus vaccine that produces a mild, usually asymptomatic, non-com­municable infection. Vaccine-induced immunity appears to be long-term and probably lifelong.

Vaccination may have had an impact on measles immunity and susceptibility in infants as well, even though children do not receive the vaccine until they are 12-15 months of age. Here is how that works: mothers, who develop a measles infection, develop a robust immune response. These antibodies are passed on to their infants and protect the babies in their first months of life. In moms who were vaccinated, fewer antibodies against measles cross the placenta to baby. This results in infants who are susceptible at a younger age than in the past. This is certainly a downside of immunization. The up side is that more of these babies survive to become parents than in days when wild-type measles was common.

I’ll get into the safety of the measles vaccine in the next installment. In the meantime, feel free to post questions you may have on my facebook page.

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Measles, Part 1

Measles has arrived in western Massachuestts. I live and work in this educated, liberal community with high rates of vaccine refusal. I used to teach a class on childhood immunizations for new and expecting parents, so I’ve been asked to write out my thoughts on this recent outbreak and on the MMR vaccine specifically.

Vaccines have become a highly sensitive and controversial topic—at least in public discourse. The scientific and medical communities are pretty much on the same page. Nevertheless, both the pro- and anti-vax camps continue angry finger pointing and character assassination.  Both sides are so dug in that no one is listening; it is frustrating and counterproductive.

Yes, I said both sides. This is a potentially controversial statement. The media tends to represent two sides of scientific arguments, even when the scientific community is generally in agreement. This representation creates a false sense of ongoing debate where there really isn’t one (at least not much).  The scientific evidence that we have supports the safety and efficacy of the vaccine program. The decline of the national vaccine program would be a terrible thing for all of us. Herd immunity really does protect us.

However, there is a growing population of parents who are skeptical about vaccinating their children.   These are well-intentioned people who are trying to make the best decisions for their children. Belittling them and calling them names does nothing to increase the rates of vaccination. And while the most radical vaccine opponents fueling this fire often misrepresent the evidence, it would be disingenuous to assert that the safety data on vaccines is complete.  The evidence is not as complete as it should be.  I have wondered whether self-censorship among researchers regarding adverse reactions is hindering vaccine safety research. The few who report findings of unexpected adverse reactions are maligned from all sides.   Of course, it could be that the vast majority of scientists think this question has been answered.  But still, there is a vehemence in these attacks that I have not come across in other fields.

In the periodic workshops I’ve offered on this topic, I’ve found the most effective way to reach parents who are concerned about vaccine safety is to acknowledge that, like any medical intervention, vaccines have risks. I believe that authentic inquiry and honest discussion do more for the public’s trust than across-the-board denial. And that is what I hope to support with this series of four posts. In the next three, I will give some background on the measles virus, discuss the safety profile of the measles vaccine, and offer some other useful information for parents on the fence.

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