Carvings       September 15, 2021

In the news

To boost or not to boost. Hamlet had an easier choice.

            As if the coronavirus hadn’t already scrambled our brains – literally or figuratively – the need for a third dose of the COVID-19 vaccine (or a second if you had the J&J vaccine) is the argument du jour and probably will be until sometime early in 2022.

            No matter what the stimulus might be, a natural infection or an artificial one like a vaccine, immunity always declines. The protection provided by a vaccine tends to be less long-lasting than that produced by natural infection but that’s not always the case. Natural tetanus can occur more than once yet developing tetanus after having received the vaccine is extremely rare. On the other hand, persons who have had natural mumps will never have a recurrence; some persons who have received two doses of the mumps vaccine might experience it again by the time they reach twenty. I mention these two very different responses to highlight the fact that the science of immunology is so complex that we should not be surprised if the experts are not sure of how to evaluate the need for boosters of the COVID vaccine.

            Expect even more confusion, considering these factors: there are many strains of coronavirus circulating around the world; there are already five different vaccines being given in various countries and scores more are under development; not everyone has the same quality of the immune system and not everyone responds the same way to an infection or to a vaccine; many among us have weakened or disordered immune systems because of an illness such as leukemia, chemotherapy, or even conditions such as obesity or diabetes. Whew!

            Be patient! Expect disagreement among the experts.

            At the moment it appears that not everyone needs to consider a booster dose of the vaccine but in my opinion, anyone over the age of 65 (just a convenient number that I picked because that’s when Medicare begins) and especially if they have a comorbidity such as obesity, diabetes, hypertension or disease of the heart, lungs or kidneys should consider a booster dose.

            Should you “mix and match”, i.e., should you get a different type of booster vaccine than your primary series? Studies are underway now to determine that.

            How long after your primary series should you get a booster? Probably at least 6 months.

            Can you expect even more side effects and/or discomfort after the booster than you had after the second dose? It probably depends on what your previous discomfort, if any, was like and what type of vaccine you get as a booster. Remember that if the artificial infection (the vaccine) ruined your day, the natural virus might have killed you or made you really sick.

            But in all of this, the most important thing is to get the vaccine!! I have recently read that MOST of the vaccine-refusers are opposed because fetal tissue was used in the vaccine development. My take: if it doesn’t bother the Pope it shouldn’t bother the rest of us. Those cells were harvested more than two generations ago and there is not a molecule of the original tissue in today’s cell cultures. Does it bother me that human fetuses were used to develop vaccines? Of course, but we can’t undo that.

            Finally, should children under age 19 get the vaccine? My opinion: only if they have a comorbidity, and that includes even being overweight.


            Aaaarghhh! The issue of eggs and cholesterol is back in the news and today’s argument, that we should have no more than a couple of eggs per week and even fewer if we have cholesterol problems is as inane as it was 40 years ago.

            Here’s the straight skinny: unless you are eating several eggs every day, the cholesterol in an egg (less than 200 milligrams) will not raise your cholesterol for one simple reason. The more cholesterol in your diet the less your liver will manufacture. However, if you are unlucky enough to have a genetic tendency to have a high LDL cholesterol, consider having them only occasionally. Eggs have too many healthy nutrients to give them up forever.

            BUT: it’s those “egg helpers” that raise cholesterol, the bacon, sausage, butter, hash browns, ham and Canadian bacon. Even then, an occasional (once a week) serving is not going to push you into an early grave. If you substitute those delicious but saturated fat-laden evil foods with a scoop of frozen mixed vegetables to make a great omelet, you’ll be getting all the benefits of eggs with no downside. Enjoy!

Carvings September 2, 2021

Upcoming presentations at Osher and OASIS plus a freebie

Osher Lifelong Learning at Cal State San Marcos campus. Register at or 760-750-4020

A day in the life of a Renaissance physician     Wednesday      September 15 1:00  $45 for the series

A day in the life of a California Gold rush physician                 September 22

A day in the life of an ancient Egypt physician                         September 29  

Temecula campus Immunizations: the good, the bad and the future   Friday, September 10, 9:30 $15

OASIS Adult Learning Center, Grossmont in La Mesa. Google San Diego OASIS or call 619-881-6262

Baby Boomer blindness                         Thursday          September 16   2:30      (Online only – no cost)

Probiotics, the germs that keep us alive Monday           September 20   1:00      in-person or online  $12

Wine in the time of Jesus    A brief presentation at St. Thomas More church, Parish Center. Lower level   

                                          1450 S. Melrose, Oceanside     Tuesday, September 6   7:30 p.m.  No charge 

In the news

Is it the end of the beginning?

            The pandemic that began about 21 months ago has been more deadly than any in this century and most of the previous one. Medical science has been rocked by the unpredictability of this virus and humbled by recurring waves of infection and deaths. But there have emerged some hopeful signs that we are, indeed, at the end of the beginning.

            Effective vaccines were developed in a nearly miraculous brief span of time, building on discoveries of more than 30 years ago (the mRNA vaccines), with even more new technological advances on the way that promise longer-lasting immunity, simpler storage requirements and elimination of the need for booster doses.

            Vaccine side effects can be serious, even fatal, but after more than five billion doses of vaccines administered around the world, the medical community is both surprised and gratified that the rate of such adverse effects is lower than what most had expected. From the birth of vaccines at the end of the 18th Century there has never been one with zero side effects. But let’s pause for a moment to recognize what is really happening. It’s quite possible, though impossible to prove, that serious symptoms from the mild artificial infection (the vaccine) are signs that the natural infection would have resulted in grave illness or death.

            Persons with allergic conditions are justifiably anxious about what might happen if they receive a vaccine but a study in Israel should provide significant comfort. Among 429 persons deemed to be at high risk because of multiple drug allergies, previous anaphylactic reaction to any drug or vaccine or a condition called mast dell disorder only two percent had an allergic response. Six had only minor symptoms (skin rash, cough, swollen tongue) and only three had an anaphylactic response that was controlled by treatment. To repeat – all were at high risk to begin with.

 “Breakthrough” infections are also not as deadly as had been feared. As I noted in the post on July 15th, there are several reasons why vaccines fail. Further, among those who suffered an infection after full vaccination, few have died, and those who did are overwhelmingly in high-risk groups that are older and afflicted with three or more comorbidities such as heart disease or diabetes. CDC data show that nearly a third had immunosuppressive conditions.

Another positive finding: in a study from Israel, persons who become infected after vaccination are found to have “significantly higher levels of antibodies afterward” than vaccinees who were not later infected.

Will this SARS-CoV-2 virus ever go away? Not likely. And it will continue to mutate. The biggest fear is that some future mutation (we’ll probably have to come up with more than the Greek alphabet, which has only 24 characters) will evade vaccine-induced immunity and be even more destructive. Call me a Pollyanna, but I don’t expect either of those things will happen. And if they do I believe that we’ll be able to handle them.

Carvings                 August 1, 2021

In the news

Your favorite drinks – coffee and cocoa — are looking better!

            Today’s Carvings format is a little different. Two items appeared in the news this week concerning lifestyle and I’m combining both sections. Most of us drink more coffee than cocoa so I’ll start with that one.

            Over several decades it’s been a bumpy road for coffee – sometimes a villain, sometimes a hero. Actually it’s a bit of both but not if you watch how much you drink. (Hmmm – doesn’t that sound like it might apply to red wine?)

            One benefit of coffee that I have mentioned in previous posts is that coffee is the single most common source of antioxidants in the U.S. That’s because most Americans have such a meager intake of fruits and vegetables, which for many millennia were the most abundant source of these inflammation-fighting nutrients.

            Overall, drinking one or two cups of coffee does have health benefits but the trouble begins with larger amounts. In a UK study of more than half a million (!) participants, it was found that drinking SIX or more cups of coffee a day is associated with smaller brain volume and a 53% increased risk of dementia. Other studies have shown an association between high intakes of coffee and Alzheimer’s disease – something to consider if you have a family history of that malady.

            A cup or two of coffee at breakfast and one or two cups with dinner won’t shrink your brain but most studies show that you’ll avoid some diseases and you’ll certainly be in a better mood most of the day.


            There’s nothing like a cup of hot chocolate after a day on the ski slopes (or after shoveling out your sidewalk and driveway of snow) but we’re in the middle of summer, many of us have forsworn cold norther climates and now enjoy life in sunny Southern California, Arizona or Texas. But here’s some good news.

            Peripheral Artery Disease (PAD) limits one’s ability to walk and with the dramatic rise in the incidence of type 2 diabetes it is increasing steadily in our population. There is some good news from Northwestern University in Chicago. The study was small, only 44 patients, but the researchers found that those who drank a flavanol-rich chocolate drink three times a day for six months improved their ability to walk over six minutes by about 50 feet. That doesn’t sound like much unless your lifestyle has been severely limited by PAD – so that now you can walk to the mailbox without pain.

            So can a dark chocolate bar have the same effect? The only study that I found said that it does not 😦 but they only gave the participants one and a half ounces of chocolate and only took measurements on two consecutive days. Maybe the results would have been different if the patients ate 1 ½ ounces of dark chocolate every day for six months, as in the cocoa trial. That hardly sounds like a great burden. And I’d bet that some research group could find lots of volunteers for that study!

Carvings July 16, 2021

In the news

Uh-Oh! Another variant. And what about those “breakthroughs”?

            We were told very early in the COVID-19 pandemic that we could expect mutations to arise and that some of these might carry severe consequences and might be able to evade any vaccine. The good news is that although some changes have occurred – a recent variant dubbed Delta does have the capacity to spread more easily – the three vaccines currently in use in the United States maintain their effectiveness.

            One of the most frustrating things about this virus is that it doesn’t seem to play by the rules. It causes symptoms and complications that no one anticipated. Even the vaccines – although they work much better than the most optimistic of us expected – cause serious, sometimes deadly side effects.

            As I noted in an earlier blog there are some individuals in whom the vaccine does not seem to have a protective effect – a vaccine failure. These failures are well known to immunologists and include improper storage or handling of the vaccines, patients who cannot mount an immune response because of obesity, diabetes, steroid therapy or chemotherapy, or even a genetic defect that affects the immune system. As of midsummer fewer than 200 vaccinated persons have died among the nearly three and a half billion persons who have received the vaccine. Every one of these is a tragedy to be sure, but these deaths pale in comparison to the four million persons who have died from the natural infection.

            As always, perspective matters.


          Don’t pass the salt, please!

                Taking in less sodium isn’t going to do much for weight loss but it will certainly improve your overall health.  Americans take in about 5 times (!) as much sodium as they need, contributing to the current epidemics of high blood pressure, heart disease and osteoporosis.

            Most of our daily sodium intake comes from packaged, processed food. That’s why it’s so important to read the Nutrition Facts label on every package. If the sodium content is over 500 mg. (milligrams) per serving, take a pass.

            There are plenty of tasty substitutes for salt but potassium chloride isn’t one of them. Most users complain about the taste. However, there are plenty of spices that you can use to pep up your menu. Just start experimenting.

            Speaking of substitutes, the best ones consist of unprocessed vegetables and fruits. They are naturally low in sodium and their potassium, fiber and generous supply of vitamins and antioxidants are what our bodies are designed for – not all that salt.

Carvings July 1, 2021

In the news

            A distressing report appeared a few days ago at the Medscape site: “ ‘Staggering’ doubling of type 2 diabetes in kids during the pandemic ”.

            Type 2 diabetes has become an epidemic throughout the world, especially First World countries. In the U.S. it now affects more than 12 percent of adults and an astonishing 60 percent in persons over the age of 65.

            In my 35 years of pediatric practice I managed several patients with type 1 diabetes but none with type 2 – the co-called “adult onset” version. Nearly half of new childhood diabetics are now type 2, and the number is even higher in metropolitan clinics.

            The recent news is extremely troubling. During 2020 the number of children hospitalized for type 2 diabetes doubled compared to 2019. Those with the severest form, ketoacidosis, a life-threatening condition, was nearly 6-fold higher!

            The majority of these children were African-American: 7 out of 8 in one study and 16 of 17 in another. The apparent reasons are numerous and I’ll address these in a future post.

            This is a global problem and it is especially serious in Asia. By coincidence I was reviewing a paper published in 2004, a harbinger of the current disaster: The global spread of type 2 diabetes mellitus in children and adolescents, in the Journal of Pediatrics.

            Can we do something about this? Perhaps, but it will be a long process. It begins with teaching our children and grandchildren about the importance of avoiding obesity and the need to be physically active. For example, in one study, 80 percent of kids with diabetes were obese.

            Our country – and the world – cannot afford to have half its people affected by a devastating life-long disease.


            Major controversies in the organic/conventional food battle: nutrition and the environment.

            It’s not easy to find wholly impartial observations in this area and the question of whether or not organic foods provide better quality nutrition is an example.

            A study published in the journal Environmental Health in 2017 noted that there was only a marginal increase in nutritional quality but persons who prefer organic produce tend to have healthier lifestyles as well, making a direct comparison of health effects difficult. In 2012 the Nutrition Action Healthletter observed that in about 60 percent of the studies, organic food is higher in some nutrients, in 30 to 35 percent there is no difference and in 5 to 10 percent of studies conventionally-grown foods have higher amounts of nutrients. That is not a ringing endorsement.

            Given that nutrient content varies by climate, soil type, plant variety, degree of ripeness, length of storage and other factors you can see why after decades of study there is no clear consensus. Theoretically since organically-grown plants have to provide their own, i.e., not helped by chemicals, defense mechanisms in the form of polyphenols and other phytonutrients, that should be a plus. It is, but not by much.

            In regard to the environment it’s obvious that runoff carrying nitrogen, antibiotics and other damaging chemicals into our waterways is a major problem to which organic farming contributes almost nothing. However, it takes many more people to control weeds and insects without the help of chemicals, and more people means more human waste, energy requirements, gasoline for transportation, etc. Organic foods also cost more, sometimes a great deal more.

            Buying from local farmers is not a solution unless you know that they use certified organic methods and they don’t simply stock their stands with produce trucked in from distant farms whose practices may or not be organic.

            In my opinion, organic foods are better for you and the environment and often taste better. Their health benefits, however, are less significant than those that we can obtain by eating more fruits and vegetables, eliminating sugar-containing foods, limiting calories in general and being more physically active.

Carvings June 15, 2021

In the news

                On June 11th Dr. Mark Sawyer, a pediatric infectious diseases specialist at Rady Children’s Hospital and the UCSD School of Medicine gave an excellent review of COVID vaccines, including observations on a newly-recognized complication associated with vaccination, myocarditis.

                Myocarditis is an inflammation of the heart muscle that occurs in about 10,000 persons a year, many of them young male adults. There has been a greater than expected incidence of this problem among recipients of the coronavirus vaccines, nearly 800 cases as of this writing. More are likely to be reported because the vaccines are now being given to persons over the age of 12, and there is greater awareness of the condition.

                Dozens of common viruses can cause myocarditis. Although there is no live virus in any of the ten currently available vaccines the association is significant. It’s important to note that so far there have been no reported deaths due to vaccine-associated myocarditis and that full recovery is the rule.

                More than 2 billion doses of COVID vaccines have been given to date and that number will probably reach 3 billion before the end of the year. The level of protection is more than 90 percent and the various mutations do not seem to have been a problem so far.


Organic – part two

                The organic-vs.-conventional food issue is extremely complex and decades of research have failed to give us definitive answers. Major issues concern the effect of pesticides, the nutritional value of organic vs. conventionally-raised foods and environmental and economic issues.

                 Pesticide residues are found in organic foods, ranging in some studies from 7 percent to more than 20 percent, but none in amounts exceeding allowable limits. Those that did have higher amounts were found only in countries of the European Union.

                The American Cancer Society has stated that the small amounts of pesticides in conventional foods have not been associated with the development of cancer and that there is no research that shows organic foods to reduce the risk of cancer when compared to conventional foods.

                Although there may be several days’ delay between harvesting and marketing plant products this allows time for the natural breakdown of pesticide residues. The cook who washes or at least rinses vegetables prior to serving also removes some pesticide residues. Peeling prior to cooking or serving removes even more.

                The conclusion is that pesticides that are applied to plants in the field do not cause disease in persons who consume them. Although chemicals that are used in agriculture can cause serious disease in those who face heavy exposure, including farm workers and their families, that is an entirely different matter.

                We’ll address nutritional and environmental matters in future posts.

Carvings May 15, 2021

What will your life be like in 2022?

            We are finally beginning to enter a post-COVID era.  What will life be like a year from now?

            It will take a long time for us to be less wary of crowds, concerts and even church services. Not only because of COVID but because we have become aware that nasty germs lurk everywhere and the next pandemic might be just around the corner. There will be a certain amount of complacency, of course as the threat of becoming infected becomes a memory. Most Americans will have been vaccinated against this quirky coronavirus by year’s end but there will be a smoldering fear that will linger for many months. Even the scientists who developed these vaccines don’t know how long true protection will last.

            Will you wear a mask when away from home, or at least have one available in pocket, purse or your car’s console? Will you unconsciously maintain social distancing, as if by habit? Will you frequent your favorite venues – restaurants, theaters, and clubs – less frequently?

            Here are some positive things to consider. First, we know that the coronavirus vaccines prevent serious disease and the need for hospitalization, even though some are rookies in the sense that they have no long track record.

            A second “positive” is that the enormous effort to come up with a vaccine has spawned a treasure trove of vaccine-related knowledge that will certainly lead to a long-lasting influenza vaccine, vaccines that we will take in our favorite drink or snack, childhood vaccines so effective that first-graders will be spared a plethora of booster shots, vaccines against cancer, heart disease, even obesity.

            When the next pandemic arrives – and there certainly will be more in the coming decades – health authorities ought to have their act together so that there will be no need to bring nations’ economies to their knees with draconian shutdowns.

            Let’s hope that the new normal will be a blessing, not a burden.


            What’s the skinny on organic? There’s no good answer. In its wisdom, the government has established five different kinds of organic food, and trying to remember which is which is a real challenge.

            The argument continues to rage over whether organic food is nutritionally superior or tastes better – or both. This is never going to be settled! There are too many zealots/moneyed interests/dumb regulations (take your pick). Judging from the paucity of publications on this topic in the past few years the scientific community doesn’t seem to consider the organic issue worth pursuing.

            A few studies have shown that there isn’t much difference between the amount of leftover pesticides on organic and “regular” produce, partly because of government regulation and partly because lots of that stuff is removed or evaporates by the time it gets to you. Some pesticides drift over onto organic fields from the “regular” farms.

            There is some increased risk of cancer to farm workers who handle pesticides and fertilizers but the amount that the average buyer ingests is not really a great threat. There is lots more risk from tobacco smoke, even for non-smokers.

            If taste is what really matters to you, grow your own fruits and vegetables or shop at your nearest farmer’s market, where the produce isn’t picked long before it’s ripe and doesn’t have to be shipped hundreds of miles, stored in warehouses and gassed to keep it looking fresh.

Carvings                    May 1, 2021

In the news

Flu who?

            Have you noticed that no one you know has seemed to have gotten the flu this year? There have been remarkably few cases of influenza this season, the CDC noting that the number of hospitalizations has been the lowest since 2005. One of the blessings of this lull is that only one child has died of influenza this year, a tragedy to be sure for that family but thankfully less than the hundred or more kids who die in most flu seasons.

            It seems that hunkering down at home, social distancing and mask wearing keep us from infecting each other with various germs. The CDC doesn’t keep up with simple colds but they do watch the incidence of Respiratory Syncytial Virus (RSV) infections, a serious lung disease among infants, and they are down too.

            Some pundits propose that we simply aren’t testing as much for influenza because of our focus on COVID-19 or that the flu virus, with fewer victims, has mutated so little this year that the current vaccine is still working.

            Does all this portend a worse than usual flu season next winter? Based on what happened following a similar drop in the 2011-2012 flu season, that’s not likely – but it’s no reason to skip your flu vaccine next October or November!

            Advances in vaccine development have been so dramatic that we may have a combined influenza/coronavirus vaccine before the end of the year. Wouldn’t that be a great outcome of this crummy epidemic?


Sensible snacking

Snacks can make or break a diet. The kind that you find while you’re standing in line at the checkout counter is probably the worst, even the trail mix or beef jerky. Some trail mixes have well over 100 calories per ounce and a piece of beef jerky that weighs a little more than a half-ounce can contain as much as 440 milligrams of sodium – about 20 percent of what you should allow yourself in a whole day.

            The ideal snack should contain enough fiber or protein to satisfy your appetite. A piece of fruit averages only 50 to 75 calories but the fiber leaves you feeling full. A single handful of nuts, especially almonds or walnuts (for the engineers and accountants in the audience that’s about 12 pieces or about ½ ounce) will provide about 80 or 90 calories. That will also give you some protein and some omega-3 fats, both of which will give you a feeling of fullness – especially if you eat them slowly!

            Diet gurus sometimes recommend a tablespoon of peanut butter on a stalk of celery. Nice theory but who has the time to make it – and not find something else in the refrigerator to nibble on while searching for the celery?

            Dried fruit? Not such a good choice because it’s high in sugar. After all, 6 apricot halves are the equivalent of 3 whole apricots, and four prunes are the equivalent of four plums. Do you usually eat that many pieces of fresh fruit at one time?

Carvings             April 15, 2021

In the News

Another COVID surprise!

* Caveat: any numbers in this post should be considered temporary estimates. The input from government and academic institutions changes by the hour.

          The good news: we have two effective vaccines against the virus that has taken the lives of millions of people and disrupted the lives of almost everyone else.

            The bad news: two other vaccines by Johnson and Johnson and Astra-Zeneca that have the advantage of requiring only one dose have been associated with about a dozen deaths from a rare blood clotting disorder. Those deaths have mostly occurred in women of early middle age who should have had decades more of life with their families.

            It’s called Vaccine-Induced Thrombotic Thrombocytopenia (VITT). Thrombocytes, known as “platelets” because they resemble small dinner plates, are sharply reduced, partly because they are taken up in the formation of blood clots in various organs. This results in thrombocytopenia, meaning scarcity of platelets and some patients have simultaneous hemorrhages when there aren’t enough platelets remaining to control bleeding.

            The condition typically arises during the second week after vaccination. Clots in the brain cause headaches; those in the blood vessels that supply the intestines produce abdominal pain; clots in the legs result in leg pain and those in the lungs cause shortness of breath. Anyone with these symptoms following receipt of the Johnson and Johnson or Astra- Zeneca vaccine should seek medical attention without delay in order to present stroke or even death.

            We have a long way to go before we can unravel the cause, provide lifesaving treatment and perhaps modify the vaccines. Fatalities have so far occurred only in about once for every million doses of vaccine in the U.S. To put this in perspective, the loss of life among a million persons with COVID-19 would be about twenty thousand! A report from the University of Oxford states that this clotting disorder is about forty times as likely from COVID-19 infection as it is from the vaccine.

            A further perspective: the CDC estimates that deep vein thrombosis (DVT), sometimes associated with air travel, causes death in from 60,000 to 100,000 persons every year.      

            Why have most of the deaths occurred in women? One reason might be that they have higher levels of estrogen, somehow making them more susceptible to the condition. Another reason is that women are more often affected by autoimmune diseases such as lupus, rheumatoid arthritis and multiple sclerosis, all of which are autoimmune diseases, which VITT appears to be.

            Some reassuring thoughts: the disease is rare, especially in males. More than 600 million doses of the current vaccines have been administered so far and this clotting disorder has been reported in fewer than 300 persons with about a dozen deaths. We have two vaccines that are known to be safe – to my knowledge there have been no deaths attributed to either the Pfizer or the Moderna vaccines — and effective, more than 90 percent at the six-month mark.

            It would seem prudent that women of childbearing age should not receive either of the one-dose vaccines. They should opt for either the Pfizer or the Moderna vaccine, neither of which has been linked to deaths from VITT. The risk to men appears to be vanishingly small.

            There are several more vaccines in the pipeline and some of these employ new technology. You can be sure that there are more surprises among them.


Some Stone Age humans were probably aware of plant products that gave them a caffeine-like jolt but they never started the day with a good old cup of coffee. It was just a few years ago though, that America’s favorite beverage caught the blame for causing a variety of ills, including cancer of the pancreas. Fortunately for Starbucks devotees, coffee now has a clean rap sheet and is taking credit for some genuine health benefits.

The pancreatic cancer issue has been put completely to rest and there is convincing research showing that coffee lowers the risk of several types of cancer, including liver, brain, prostate, uterus, mouth and throat. Except for a link to bladder cancer in men who drink several cups a day, there is no evidence that it causes cancer.

Coffee is a plant product and like red wine and dark chocolate it contains thousands of chemicals that have beneficial health effects. These include antioxidants that protect blood vessels from damage by harmful free radicals and substances known as antimutagens that keep cells from becoming malignant. There are chemicals in coffee that rein in inflammation, a contributor to heart disease, stroke and rheumatoid arthritis.

In spite of coffee’s growing list of advantages, drinking more than three eight-ounce cups a day can cause nausea, irritability and insomnia. Even decaffeinated versions are not entirely free of caffeine and may lead to poor sleep in caffeine-sensitive individuals. Excess caffeine can increase heart rate and raise blood pressure.

Adding milk to coffee appears to diminish at least some of its benefits in the same way that converting dark chocolate to milk chocolate does. Of course, when the addition of lots of cream and sugar transforms a large cup of black coffee into a 500-calorie “specialty of the house” you can kiss the heart-health benefits goodbye. Moderation, as usual, is a good thing.

Pandemic Perspective #41  April 3, 2021

Why vaccines don’t always work

            Vaccines have never been without controversy since the first one appeared at the end of the 18th century. The permutations of that first smallpox vaccine led to the total eradication in the 1970s of one of the most terrifying of human afflictions, one that sometimes killed half of its victims and left many of the rest with characteristic pitted facial scars.

            The COVID-19 vaccines that have now been given to more than half a billion (!) people appear to have a protective effect in as many as 95 percent of vaccinees. Why not 100 percent? There are multiple reasons and they apply to all vaccines in one way or another.

            Reason #1. After more than half a century we still don’t have an influenza vaccine that is completely effective or whose protection lasts more than a few months. That virus undergoes mutations in those structures that are the targets of the vaccine so that a new preparation needs to be produced nearly every flu season. The SARS-CoV-2 virus that has upended the global economy mutates too but those changes – at least for the moment – are not of the type that negate the effectiveness of the vaccine.

            [Note: as of this writing there have been no deaths attributed to the current vaccines and no COVID-19 deaths among persons who are at least one month post-vaccination. That too might change by the time you read this but the numbers showing its safety remain overwhelming.]

            Reason #2. The human immune system is enormously complex and some persons are genetically missing a key component. An example is that some persons are incapable of forming antibodies against the diphtheria vaccine. However the redundancy of the immune system probably covers for that defect.

            Reason #3. Obesity and diabetes (type 1 and type 2) reduce the effectiveness of the immune system. The high incidence of obesity (nearly 40 percent) and type 2 diabetes (more than 12 percent) undoubtedly limit the protection afforded by the vaccine in these groups.

            Reason #4. Using a standard needle in an obese person can put the vaccine into fat, not muscle. This not only can make the vaccine ineffective it can lead to complications such as abscess formation. Some health facilities now use needles in obese persons that are twice as long as those used for those who appear to be of normal weight.

            Reason #5. Improper storage. Some COVID-19 vaccines require ultra-cold freezers to maintain potency.

            After the measles vaccine became available in the 1960s some children developed the disease in spite of having been vaccinated. Some medical offices had stored the vaccine in the door shelves of the refrigerator, where the temperature was too high, severely reducing the potency of the vaccine.

            Reason #6. Aging reduces the strength of the immune system. That’s why there exists a high-potency influenza vaccine for seniors. We don’t yet know if this will be a problem among our oldest old in this pandemic but it will require monitoring.

            Reason #7. Timing. The measles vaccine is not given to children until the age of  12 to 15 months. Prior to about 1985 most women had had natural measles infection and they transferred protective antibody to their infant that persisted for several months. A measles vaccine given too early might be ineffective, hence the delay. None of today’s mothers born in the U.S. have experienced natural measles and vaccine antibodies do not last as long as those induced by wild measles virus. For that reason, infants above the age of six months that are exposed during an outbreak should receive the vaccine.

            Coronavirus infections are common during the preschool years, less so afterwards. Existing natural antibody may help to explain why children rarely become seriously ill from the COVID-19 virus but it could reduce the effectiveness of the vaccine. Vaccine trials in children are only now being done and the vaccination of children will probably begin this summer. How they will respond won’t be known for at least another year.

            Vaccine failure is common, it is not unexpected and it should not be a reason for not accepting the vaccine. If you are willing to take a chance on being killed while driving your car you should be willing to take a chance on the vaccine. I’ll bet on the vaccine every time.