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Sanjeev K. Sriram
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On the We Act Radio network, Dr. Sriram is the host of "Dr. America," a show about health justice, where current events and politics are examined from the vantage point of public health and equity. Dr. Sriram completed his medical degree and his pediatrics residency at UCLA, where he also served as chief resident at the Department of Pediatrics. He completed the Commonwealth Fund / Harvard University Fellowship (CFHUF) in minority health policy and earned his masters in public health. He currently cares for children in southeast Washington, D.C.. Dr. Sriram is a member of the National Physicians Alliance, and of the American Academy of Pediatrics. Any opinions expressed here reflect those of the author, and not necessarily those of his employer, associations, or organizations.

Entries by Sanjeev K. Sriram

2015: Best & Worst in Health Justice

(2) Comments | Posted December 30, 2015 | 10:03 AM

As we close 2015, let's reflect on how we harmed and helped each other's health and wellness with two Top 5 lists for the year: the first for our shortcomings, and the second for our successes.

2015's Worst in Health Justice:

5. Lead in the Water? Seriously?!?!: For...

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To Congress: CDC Research on Guns Will Save Lives

(111) Comments | Posted December 14, 2015 | 11:31 AM

A little over 20 years ago, health researchers showed that the risk of homicide was significantly high for gun owners. Rather than having meaningful dialogue about what risk factors were discovered and how new knowledge could save lives, panicked members of Congress passed the Dickey Amendment...

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For National Domestic Violence Awareness Month, Let's Close the Boyfriend Loophole

(64) Comments | Posted October 22, 2015 | 6:28 PM

"Never let the hand you hold, hold you down." These are words of empowerment for millions of survivors of domestic violence in America. The words could also apply to many members of Congress, who must let go of the hands of gun industry lobbyists. Their hands hold campaign contributions but...

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Dr. Carson and Dr. Paul: Pandering to Anti-Vaxxers?!? Really?!?

(57) Comments | Posted September 18, 2015 | 6:01 PM

Being a pediatrician and a public health advocate, there were several things that bothered me about Wednesday night's "debate" about vaccines. Let's start with the first part of Jake Tapper's question: "Dr. Carson, Donald Trump has publicly and repeatedly linked vaccines, childhood vaccines, to autism, which, as you...

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Now that Kim Davis is in Jail, Let's Re-Think Hobby Lobby

(585) Comments | Posted September 4, 2015 | 6:53 PM

In a homophobic political stunt poorly veiled in "religious beliefs," Rowan County, Kentucky clerk Kim Davis denied marriage licenses to LGBT couples despite a federal court order instructing her that the US Supreme Court legalized same-sex marriage nationwide, and she must comply. She claimed that issuing the licenses...

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Hey Congress, Defunding Planned Parenthood Is Bad For Your Health

(262) Comments | Posted August 4, 2015 | 4:15 PM


Using heavily edited videos made by frauds as an excuse, long-time misogynists in the Senate scheduled a knee-jerk vote to defund Planned Parenthood.

The stupidity of this exercise would be laughable if it weren't so ignorant and cruel....

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Hey America, Great Job on Gay Marriage, Now How About Gay Adoption?

(2) Comments | Posted June 26, 2015 | 1:48 PM

Like many, many Americans, I was thrilled when the Supreme Court declared same-sex marriages must be recognized nationwide. As a heterosexual, Hindu, Indian-American, I do not take my rights for granted, and I am glad to see the growth of justice for ALL. As a pediatrician, I was particularly glad...

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Charleston Shooting: Pray for Courage, Not Serenity, to Deal with Guns

(7) Comments | Posted June 19, 2015 | 3:08 PM

On June 17 at the Emanuel African Methodist Episcopal Church, 21-year-old Dylann Storm Roof allegedly shot and killed 9 people, including South Carolina State Senator Rev. Clementa C. Pinckney. As I am writing these words, Roof has been caught by law enforcement in North Carolina. There is ongoing scrutiny over his social media and comments from his family and acquaintances. We do not know many details about his mental health and I find it abhorrent to dismiss him as a "lone crazed gunman." Mythologizing Dylann Storm Roof into a mysterious villain distracts us from confronting tough truths about guns. Even if we discover he does have a mental illness (whether previously diagnosed or not), what we really need to talk about is why Dylann Storm Roof has "gun rights" but not health rights.

Rather than succumbing to another mean-spirited non-conversation about mental illness, fraught with misinformation and stigmatization, let's have some real talk about America's addiction to guns. This obsession with firearms has taken many states like South Carolina on a misguided journey of making it easier for people to access guns and harder for them to seek health care. Our addiction to weapons has deluded us into instilling guns with rights while still treating healthcare as a privilege.

As we continue praying for grieving families in Charleston, now is the time to reflect on the prayer used by some addicts and by others overcoming adversity:

"I pray for the courage to change the things I can, the serenity to accept the things I can not, and the wisdom to know the difference."

America must pray for the courage to change the things we can. We need the courage to admit that owning 300 million guns means there are too many guns. We need the courage to get real about the 2nd Amendment's place in the 21st century, and then completely rethink and rebuild how guns are owned in this country. We need the courage to admit that "gun rights" are not real. Legal gun ownership is a privilege, not a right. Sadly, we don't like any of that because it involves hard work, taking responsibility, and awkward confrontations with ourselves. So America might pray for courage but we don't really want to use it.

Instead, America will probably pray for the serenity to accept the things we can not change. Unfortunately, that sounds an awful lot like complacency, which is the real request within calls for calm. When you're calm, you start losing the urgency to do all the hard work to stop gun violence. Rather than ask tough questions about why we have "gun rights" but not health rights, we drift into accepting gun violence as the norm that we can not change. We calmly forget the lives lost, accepting mass shootings as an aw-shucks inevitability rather than a preventable shame. Apathy, that serene complacency, may be comfortable and convenient, but it's cowardly.

Apathy is tough to prevent because it is so subtIe and insidious, and it is convenient when faced with repeated stories of gun violence. From time to time I'm probably as guilty of apathy as the next person. If you think you're immune to numbness towards mass shootings, then consider this. Prior to reading this sentence, did you remember that the last domestic terrorist attack on a place of worship was on August 5, 2012 at the Sikh Temple in Oak Creek, Wisconsin, where a "lone crazed gunman" killed 6 people? Or was that tragedy just lost in "all the others"? Perhaps we forget because remembering every life lost would be overwhelming, but it feels like we have been on a dangerous path of accepting gun violence as a some kind of sick new normal.

America should pray for the wisdom to know the difference between changing what we can and accepting what we can not. We should act upon the wisdom of Dr. Martin Luther King Jr, who in 1963 eulogized the girls killed in the bombing of the 16th Street Baptist Church in Birmingham, AL:

"They say to each of us, black and white alike, that we must substitute courage for caution. They say to us that we must be concerned not merely about who murdered them, but about the system, the way of life, the philosophy which produced the murderers. Their death says to us that we must work passionately and unrelentingly for the realization of the American dream."

Dr. King's wisdom is exactly the blessing we need now. We must find the courage to make America a place where our health rights are championed long before any "gun rights." We must pray for the tenacity and stamina to transform America into a country free from gun violence. We must pray for justice born out of courage, wisdom, and action, because without justice, there is no peace, no serenity, for any of us.

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Doctors Want a Second Opinion on TPP

(1) Comments | Posted June 7, 2015 | 8:08 PM

Many health care providers are deeply concerned about the Trans Pacific Partnership (TPP), a free trade deal that the U.S. Senate agreed to "fast-track" last month. This means our Senators will neither debate nor amend the eventual final draft of the TPP. Instead, they will take a simple yes or no vote on a humongous set of policies that will impact the health of millions. There are still several important civics hurdles before this free trade deal is finalized, and our policymakers must consider how TPP is detrimental to medicine and public health for all of us.

1. Those already high costs for prescription drugs could skyrocket.

Millions of us, regardless of whether we have asthma, AIDS, cancer, tuberculosis, or diabetes depend on generic medications to keep us alive and healthy. These lower priced medications make it possible for public health agencies and health care providers to care for millions of patients. On "Dr. America," in my conversation with Eva Dominguez from the Alliance for Retired Americans, she pointed out that patients already face huge prices for biologics: a patient with rheumatoid arthritis can pay $2,632 to $5,264 per month for a 40 milligram injectable kit of Humera. On the one hand, President Obama and other political leaders have agreed that these costs need to be reduced, and lowering patent protections can facilitate the use of cheaper biosimilars and generic medications.

On the other hand, these same politicians support the Trans Pacific Partnership, which threatens the affordability of biologics and thousands of prescription drugs by greatly expanding intellectual property protections. Extending these protections is a gift to the pharmaceutical companies owning patents on expensive brand-name medications, and a disaster for makers of generic medications who will have to wait as long as 20 years to produce life-saving treatments. For groups like the Foundation for AIDS Research (amFAR), patent protections of antiviral drugs have already been obstructive to saving entire communities, and TPP worsens these circumstances and puts lives at risk unnecessarily. Regardless of your diagnosis, you should never have to sacrifice your wealth or decades of your time for your health.

2. Could candy companies sue Michelle Obama for encouraging healthy eating?
The TPP includes a legal mechanism called Investor State Dispute Settlement (ISDS), which allows a corporation to sue local, state, and/or federal governments whenever that corporation worries its products are threatened by new government policies. For instance, if the government of a country participating in TPP passes legislation to enhance warning labels on cigarette packs, a Big Tobacco company could sue that government, as happened in Australia and Uruguay, because profits from cigarettes are threatened by common-sense public health education. Here in America, Maryland recently passed a ban on fracking for two and a half years, after which fracking will be strictly regulated. As Marylanders learn more about the health consequences of fracking, the state's new regulations may be "troublesome" for Big Oil companies, who could theoretically use ISDS to sue the state.

To be clear, under ISDS, international trade lawyers would convene a special legal forum to resolve the dispute. Our courts and judges, the parts of our democracy in charge of determining what is just, would be left out. Furthermore, governments and public health agencies acting in the interests of health and wellness would not have any means of appealing the decision made by an ISDS.

When doctors, public health groups, and concerned citizens advocate to Congress and legislatures for anti-tobacco programs, regulations on chemicals, and food safety policies, we are not attacking capitalism or free trade. These efforts to build healthier and safer communities should not be undermined to protect the profits of mega-corporations. If a government is afraid of expensive super-secret lawsuits from multi-billion dollar companies, then political leaders may avoid applying public health research in new policies that could benefit the well-being of millions.

By voting against the Trans Pacific Partnership, Congress has an opportunity to stand with thousands of doctors and public health experts, and remind America and the world that we should not be forced into false choices between staying healthy and facilitating commerce. We need to continue our efforts to provide medications for patients, reduce smoking, make our food safe, and protect our air and water. This work should not be undermined by TPP's protections for wealthy mega-corporations or by TPP's legal tricks to intimidate democratically elected leaders. Time is running out for everyday Americans to take action against the Trans Pacific Partnership. Contact your members of Congress immediately and tell them free trade should not cost our...

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4 Lessons from Luis Lang's Lost Eyesight

(0) Comments | Posted May 22, 2015 | 5:24 PM

Recently, on the "Dr. America" show, I reported on the now-viral story of Luis Lang, a 49-year-old man from South Carolina who initially opposed Obamacare, and is now facing financial ruin as he suffers some dire health problems, including possible blindness. I made a small donation on his GoFundMe online fundraiser, as did many progressives who have long supported the Affordable Care Act. After sharing that I made a donation to help Mr. Lang, I received mixed responses from fellow progressives, and I want to clarify my position and offer some advice.

1. Health Justice for All means ALL.
When many of us advocate for health justice, we intend for it to be available, accessible, and used by everyone -- not just those who please us. If we have to pass perfection tests on our principles before we can have basic human rights like health care, then we are doomed. As a physician, I know just how flawed and vulnerable we are as human beings. No one deserves to be shamed or ridiculed for their personal politics when they are facing health problems even when those problems, when looked at very broadly, have connections to misguided political ideologies. For example, Mr. Lang is a smoker, and perhaps his conservative politics may run anathema to public health campaigns like anti-tobacco regulations. However, his personal politics are not an excuse to deny him care or let him go blind.

2. The Tortoise Did Not Win Bragging Rights Over The Hare.
One rebuttal I heard to my decision to donate to Mr. Lang's fundraiser was that we should make him live with the consequences of his choices. To me, this is petty and more importantly, unnecessary. The moral of Mr. Lang's story has been made: he opposed Obamacare on flawed political reasoning and then finds himself in a dire situation where universal healthcare could have saved his health without costing his personal wealth. The irony is illustrative enough, and for Mr. Lang to suffer further in the richest country on earth when treatment is possible is cruel and unusual. When Aesop wrote "The Tortoise and the Hare," the moral was simply "Slow and steady wins the race." There is no sequel that says the winner gets to be a jerk about it.

3. Talk the Talk, but Do It While Walking the Walk.
Another rebuttal I heard regarding my donation to Mr. Lang is that it was unsustainable. What about everyone else who needs care but lives in places like South Carolina that refuse to expand Medicaid and create obstacles to Obamacare implementation? Is it sustainable to set up fundraising websites for the 4 million Americans in the coverage gap (194,000 of whom live in South Carolina)? These are perfectly valid questions, and merit discussions about implementing and improving upon the Affordable Care Act. However, as those discussions continue, let us not lose focus on the urgency of now. We must provide care right now for those who need help right now. As much as I enjoy debates about health policy that get deep into the weeds, I am glad my clinical experiences remind me that patients often can not wait for perfect policies, and we are obligated as children of God to care for one another -- by any means necessary in the present, while building more sustainable systems.

4. Where to Stick That Wagging Finger.
Ultimately, if we are so compelled to blame or shame someone, then let's redirect frustration away from Mr. Lang and towards those with the power to change his (and our) circumstances. Living in South Carolina should not be a danger to anyone's health, but by refusing to expand Medicaid and criminalizing the implementation of Obamacare, Governor Nikki Haley and the South Carolina legislature are making health care a privilege, not a right in their state. Political leaders who continue to oppose Obamacare should take a good hard look at the substantial track record of Republican-majority states that have expanded Medicaid and facilitated other provisions of the Affordable Care Act. There are 25 million insured Americans, better functioning hospitals, and improving state budgets, all of which justify implementing the Affordable Care Act.

Mr. Lang's story has gone viral in the world of health news because it takes place in a state where politicians punish people for being flawed and vulnerable -- in other words, for being people. None of us should be expected to have perfect personal choices in politics or healthy behaviors before we are deemed worthy of health care. Mr. Lang's story is not about his personal responsibility as much as it is about our collective responsibilities to each other. No one should go blind and broke in the richest country on earth. Let's realize a vision of health care working hand-in-hand with social...

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Top 5 Reasons to Celebrate Obamacare's 5th Anniversary

(22) Comments | Posted March 23, 2015 | 12:00 PM

Doctors in white coats marched in the rain from Freedom Plaza near the White House to Capitol Hill in Washington, D.C. on March 22, 2010 to show support for health reform and to ask the Senate to do likewise. I was one of those doctors, drenched but undeterred. We represented thousands of health care providers in organizations like the National Physicians Alliance, Doctors for America, and the American Medical Student Association, just to name a few. But more than anything, we represented millions of our patients nationwide. Our march in the rain was nothing compared to the arduous journeys that patients and families suffered in the broken American health care "system" (or lack thereof), losing their lives, their fortunes, and their dignity. The next day, March 23, 2010, the Patient Protection and Affordable Care Act was signed into law.

There are plenty of reasons to celebrate what Obamacare has accomplished over the past five years. My Top 5 lists those reasons that might be overlooked but are paramount to building health justice in America:

5. Caring for your health won't cost you your wealth.

For the first time in 50 years, people are not double-checking their pocketbook before they decide to go to the doctor. According to the Commonwealth Fund, back in 2012, there were 80 million working age adults who reported at least one cost-related problem accessing needed health care. Last year, there were 66 million. Thanks to a lot of the provisions in the Affordable Care Act, 14 million people did not delay health care because they were worried about the cost of care. Similarly, millions of people are having less problems paying medical bills. Clearly there are still too many Americans facing the false choice between preserving their health and preserving their wealth, but Obamacare is reversing this tragic trend.

4. Women are people, not "moral hazards" for health insurance companies.

Insurance companies are no longer allowed to use gender when they determine rates for plans, meaning women no longer pay more for their health insurance just because they are women. A full range of preventive services are covered, saving lives and strengthening the health of millions: prenatal care; breast cancer and cervical cancer screening; contraceptive counseling and prescriptions; breastfeeding counseling and support services; and intimate partner violence screening and counseling. Just as importantly, these services are covered at no extra cost to women, thus eliminating the financial barrier to better health outcomes for individuals and communities. To the misogynists who whine about having to pay for these services they will not use, I want to remind them of the simple principle of risk pooling. For example, there are hundreds of thousands of lesbians paying insurance premiums so hundreds of thousands of men can be treated for erectile dysfunction or prostate cancer. The point is that we all pay a little so none of us go broke from illness. "United We Stand" is real, not just rhetoric.

3. Obamacare helps you if you're red or blue (but especially if you're red?).

People living in Republican counties are benefiting from Obamacare, and sometimes they benefit more than people living in Democrat counties. Before the health reform law was passed, 18.5 percent of people living in Republican counties were uninsured. As of October 2014, that number decreased to 13.1 percent. The ongoing progress of the Affordable Care Act in parts of the country that oppose President Obama demonstrates the foolishness of playing politics with this law. Kentucky proves it: in one year, the uninsured rate dropped from 20.4 percent to 9.8 percent.

2. Medicaid deserves a medal.

A critical part of the successful enrollment of the uninsured in Kentucky and many other states is the expansion of Medicaid. Depending on where they live, families struggling at or below 138% of the federal poverty level ($33,465 for a family of four) may or may not have access to health care under Medicaid. The District of Columbia and 28 states opted to extend this lifeline, and now over 7 million Americans have the basic human right to see a healthcare provider when they need one. Sadly, many states are still putting politics before patients, and there are 4 million Americans stuck in the "coverage gap." Earning $10,000 per year as a parent is not enough to buy insurance on the federal exchange, but it may be "too high" of an income to be eligible for Medicaid in states refusing to expand the program. This injustice must end because it perpetuates the notion of healthcare as a privilege, not a right.

1. Implementation of the ACA advances civil rights.

First, remember that of the total US population, 17.1 percent are Latino-Americans and 13.2 percent are African-Americans. Prior to the enactment of the Affordable Care Act, minorities made up a disproportionate number of the uninsured, working at low-income jobs, where employers do not offer health insurance. However, thanks to Obamacare and Medicaid expansion in DC and 28 states, we are seeing significant improvement in the rate of uninsurance for minority communities: for Latino Americans, the uninsured rate fell from 41.8 percent to 29.5 percent. For African Americans, it fell from 22.4 percent to 13.2 percent. The job is not over. In the coverage gap mentioned earlier, the danger and injustice of lacking health insurance falls disproportionately on minority communities. 24 percent of the 4 million people in the coverage gap are Latino-American and 26 percent are African-American. As long as governors and state legislatures continue to resist the Affordable Care Act and Medicaid expansion, these injustices will persist.

My hope in sharing this Top 5 list is that we see the Affordable Care Act as a cause for celebration and a call to action. Health care is a human right and fundamental for a moral society. The ACA and its many provisions are important steps on our journey to health justice, a path that requires all of us (healthcare providers, elected officials, public health experts, and "ordinary" people) to do our part for our fellow...

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Gay Marriage Is Good For Your Health -- Even If You're Not Gay

(0) Comments | Posted February 18, 2015 | 5:06 PM

Last week, Alabama's Supreme Court Justice Roy Moore joined a long, pathetic line-up on the wrong side of history when he tried to defy the US Supreme Court by ordering Alabama court officials to continue denying marriage licenses to gay and lesbian couples. Some writers correctly compared the stand-off to a previous shameful chapter of Alabama history, when Governor George Wallace tried to defy US Supreme Court rulings about segregation. What I would like to add to all of this dialogue are the benefits to health justice when we recognize same-sex marriages. Given the network of mutuality in which we live, the health of our whole society improves when we uphold the rights for our LGBT brothers and sisters.

For many of us, access to health care depends on the legal recognition and standing of our relationships. When a person is covered by her or his spouse's employer-based health insurance, that coverage depends on the marriage being legally recognized in their state. Similarly, when a person wants to make medical decisions on behalf of an incapacitated spouse, having a legally recognized marriage supports the authority of patients and families. These are basic components of health care access and delivery for all of us, regardless of our sexual orientation. As a physician, I believe patients and their families have enough to deal with from illness and injury. It is an unjust and unnecessary burden to require couples and families to defend the validity of their relationships when seeking health care. I am not alone in this line of thinking. The American Academy of Pediatrics, the American Medical Association, the American Congress of Obstetricians and Gynecologists, and the American Psychiatric Association have all issued unequivocal statements of support for marriage equality for same-sex couples.

Regardless of our fields of expertise, health care providers should be glad to see the progress made at the federal level to build equality for same-sex married couples. For federally-funded health care programs (including all of the health insurance exchanges set up by the federal government in 30 states), the Affordable Care Act prohibits basing coverage eligibility, benefits, and insurance premiums on gender identity, sexual orientation, or sex stereotyping. The health insurance exchanges set up by state governments are similarly prohibited from discriminating based on sexual orientation. When the Supreme Court struck down the Defense of Marriage Act (DOMA) in 2013, there were a variety of positive outcomes for access to and delivery of health care. Since that ruling, same-sex spouses have been able to use benefits under Medicare Advantage and the Veterans Administration.

However, as Americans we are governed by an interplay of federal and state laws. Defeating DOMA was a major step in the right direction, but the journey is hardly over. The US Department of Health and Human Services must defer to state governments to recognize same-sex marriages when determining Medicaid eligibility. One can imagine how much harder it is for low-income LGBT Americans (almost 40 percent earn less than $30,000 per year) to get health insurance coverage when they live in a state that neither expands Medicaid nor legalizes their marriages. Additionally, for same-sex couples living in states that do not recognize their marriage, they can not readily use provisions of the Family Medical Leave Act (FMLA) to bond with a newborn, to welcome a newly adopted child to their home, or to care for a sick family member. This system of double standards contributes to disparities in health care for our LGBT brothers and sisters, especially when we look at HIV and mental health burdens.

When any of us live as second-class citizens, none of us can truly thrive. By taking such contrasting policy paths for marriage and health, our state governments are turning America into a place where access to basic equality and health rights depends on what we earn, who we love, and where we live. Crossing state lines can transform whether we are insured, whether we can participate in medical decisions for our families, whether we can take time away from our jobs to prioritize health needs, and so on. As a physician, these conditions are not part of the Hippocratic Oath I took, and as an American, this patchwork of discrimination undermines "liberty and justice for all." I do not have to be gay to realize that we are all vulnerable as individuals, but we can draw strength from communities united under common values of health justice. We can do better. We must do better. Let's start acting like Americans and manifest equality for all of us, regardless of who we...

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Dr. America Calls Out Vaccine Villains

(0) Comments | Posted February 9, 2015 | 4:26 PM

The current measles outbreak has now spread to 14 states. Almost as concerning as the virus are the comments being made by politicians and media figures. Our elected officials and major media producers need to put aside their political aspirations and their cravings for ratings, and follow the motto of Spider-Man: "With great power comes great responsibility." The public deserves to hear clear truths about protecting their families from measles and other preventable diseases. Instead, we hear pandering and paranoia, sometimes muddled with a random fragment of pragmatism. This noise leaves most reasonable people thinking... "huh?"

Just as Spider-Man periodically squares off with the Sinister Six (a changing team-up of supervillains including Hobgoblin, Doctor Octopus, Electro, Sandman, and others), we are seeing the rise of Vaccine Villains. Each of them must be called out for their inaccuracies and irresponsibility in the ongoing conversations about measles.

Vaccine Villain: Governor Chris Christie. While touring a vaccine facility in England, Governor Christie was asked whether he thought Americans should vaccinate their children. To his credit, the first words from his mouth were responsible. He said his children are vaccinated, and that was "the best expression I can give you of my opinion." But he added unnecessary confusion by saying "parents need to have some measure of choice in things as well... that's the balance that the government has to decide..." He later clarified statements, but my frustration with the Governor's comments is his poor assessment of public health threats and his disregard for medical science when political points might be scored.

Back in October, when Nurse Kaci Hickox arrived at a New Jersey airport after a volunteer mission in Sierra Leone to care for people struggling with Ebola, Governor Christie treated her like a criminal. Police cars with lights flashing and sirens blaring took her from the airport to a nearby hospital, and she was forced to endure four days in a quarantine tent despite her being Ebola negative and non-symptomatic. This misuse of government resources was against the expert advice of public health researchers and healthcare providers.

Now, during this measles outbreak, public health researchers and healthcare providers are finding that our herd immunity against measles is undermined when families opt out of vaccination. Though Governor Christie's office later issued a statement in support of vaccines, it would help if he showed real leadership to a concerned public by facilitating their understanding of the scientific consensus, rather than play political games. Let's not leave the door open to measles by pandering to the misinformed fears of anti-vaxxers.

Vaccine Villain: Senator Rand Paul. Like Governor Christie, Senator Rand Paul is trying to have it both ways by supporting unfounded fears of vaccines while also supporting their public health value. In a meandering interview, Senator Paul, who is also a doctor, said:

"I've heard of many tragic cases of walking, talking normal children who wound up with profound mental disorders after vaccines. I'm not arguing vaccines are a bad idea, I think they're a good thing. But I think the parent should have some input. The state doesn't own your children. Parents own the children and it is an issue of freedom."

Let's deconstruct the irresponsibility of this statement. Senator, you and I are physicians who are supposed to be guided by science, not just hearsay. The whole point of peer-reviewed, evidence-based scientific research is to evaluate situations and test hypotheses. Time and again, when it comes to vaccines the research has come to the same conclusion: they do not cause mental disorders. Giving validity to false accusations only perpetuates misinformation about vaccines, even if you backtrack to say "they're a good thing."

Furthermore, Senator Paul, you are completely misunderstanding how vaccines are an "issue of freedom." For a disease like measles, which is 90 percent contagious and can linger in the air we breathe for hours after a sick patient coughs, the vaccine is the freedom from illness and from the consequences of deafness, blindness, brain damage, etc. Of course parents own their children, but they do not have the right to put other children at risk of preventable diseases like the measles. What are we supposed to tell the 6 babies who caught the measles at Disneyland, or the 5 babies now diagnosed with measles in Chicago? Regardless of whether all these cases are from the same outbreak or not, America was measles-free 15 years ago. Are we supposed to tell these children, all too young to be immunized for measles, that they caught a preventable disease because of your skewed view of "freedom"? As an elected official and a physician, I expect you to recognize that herd immunity is intended to give these young Americans the liberty of a healthy, measles-free life, but we are failing them as we pander to anti-vaxxer fears.

Vaccine Villain: Dr. Jack Wolfson. In Phoenix, AZ, Dr. Tim Jacks wrote a moving appeal to his fellow Americans to get vaccinated against measles because for him the threat is all too real: he is the father of a daughter with leukemia and a 10-month-old son too young to be vaccinated. These are exactly the kinds of people our herd immunity is meant to protect. Ignoring all of basic science and basic human decency, Dr. Jack Wolfson told CNN the following:

"It's not my responsibility to inject my child with chemicals in order for [a child like Maggie] to be supposedly healthy. As far as I'm concerned, it's very likely that her leukemia is from vaccinations in the first place. I'm not going to sacrifice the well-being of my child. My child is pure. It's not my responsibility to be protecting their child." When CNN asked Wolfson if he could live with himself if his unvaccinated child got another child gravely ill, he said, "I could live with myself easily. It's an unfortunate thing that people die, but people die. I'm not going to put my child at risk to save another child."

Wolfson is a "paleo-cardiologist," which must mean his heart is unevolved. To show such cruelty and callous disregard for another life is a violation of the Hippocratic Oath's most basic tenet: "Do no harm." I am calling on Wolfson to relinquish your medical license and seek forgiveness from the Jacks family. Rather than spend more time condemning your remarks and countering your misinformation, I will simply say you are no longer worthy of the title of Doctor. Do us all a favor and leave the profession.

Vaccine Villain: Anti-government, Anti-corporate Guy. This is not a specific person in the news cycle right now, but it is a persona that I have encountered since writing "Anti-Vaxxers, Like Drunk Drivers, Are a Danger to Us All." This is a person who rejects recommendations about vaccines because those recommendations come from government agencies like the CDC and other health departments, and because the vaccines are manufactured by pharmaceutical companies. I actually have some empathy for Anti-government, Anti-corporate Guy because government bodies and corporations do have long, exhaustive records of making mistakes and causing harm.

However, consider the following example. Our major car manufacturers have a profit-motive behind making the safest car possible. To that end, they research seatbelts, airbags, and infant car seats. The US Department of Transportation and numerous state highway patrols have an interest in keeping people safe when they're on the road. To that end, they also research seatbelts, airbags, and infant car seats. Based on all of this data, and based on our collective experiences and knowledge from millions of car accidents, we have policies mandating people to wear their seatbelts and to use age-appropriate car seats for children. And these policies work: there has been a steady decline in traffic fatalities. This proven safety record does not absolve car manufacturers from their problems with recalling malfunctioning vehicles, nor does it absolve highway patrol officers from their misconduct and injustices. However, regardless of the problems we encounter with car manufacturers and law enforcement, those difficulties are not excuses to reject using seatbelts and child car seats.

Similarly, vaccines have a well-proven safety and efficacy record. They should not be rejected because of legitimate grievances against pharmaceutical companies and different government agencies. As I have written before, I am all for genuine skepticism and tough scrutiny for these entities. There is so much that the drug companies and regulatory agencies need to answer for, but to cover all of government and all of business with an overly broad blanket of cynicism is deeply misguided.

Despite the media attention given to the Vaccine Villains, I am glad we have some political leaders who seem to be following Spider-Man's motto: "With great power comes great responsibility." In California, the state legislature will debate a bill by state Senator Richard Pan (who also happens to be a pediatrician) and state Senator Ben Allen (a former president of the Santa Monica school board) which will remove a parent's ability to opt out of mandatory immunizations for their children due to personal beliefs (exemptions will remain for children with health problems where vaccines are contraindicated). Political leaders like these are applying the power of vaccines and public health research to responsibly protect our communities. We need to encourage this approach to policy-making nationwide. Pandering to misinformation and fear from anti-vaxxers for the sake of a few fleeting political points is dangerous and...

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Los antivacunas son como los conductores ebrios: un peligro

(84) Comments | Posted February 5, 2015 | 11:47 AM

Me enfado cuando la gente toma decisiones malas que amenazan la salud y la seguridad de otras personas. Tanto si conduces borracho como si desfilas con armas cargadas en público o decides no vacunar a tus hijos (a menos que tus hijos tengan algún problema de salud por el que...

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Anti-Vaxxers, Like Drunk Drivers, Are a Danger to Us All

(485) Comments | Posted February 2, 2015 | 11:54 AM

It angers me when people make bad decisions that threaten the health and safety of other people. Whether you're driving drunk, parading loaded firearms in public, or choosing to not vaccinate your child (exceptions for children with health conditions that contraindicate vaccinations), you are a danger to your own health and to the health of others -- and I am fed up with the ignorance and arrogance behind these decisions.

To be fair, I have to briefly clarify my frustration with drunk driving. Knowing what we now know about the interactions between genetics, neurobiology and the social variables of alcoholism and substance abuse, I can wrap a little compassion around those drunk drivers who are struggling with addiction. By no means will I condone or pardon drunk driving, but there is some tiny fragment of that phenomenon that eventually warrants patience and understanding.

Anti-vaxxers, on the other hand, are no longer deserving of my patience and compassion. People who purposely choose not to vaccinate themselves or their children against diseases like measles, whooping cough, rubella, and so on are endangering the lives of others. In the current measles outbreak that started in Disneyland, six babies have contracted measles. All of these babies are younger than 1 year old, which is the age at which the first MMR (measles-mumps-rubella) vaccine is done. These infants were counting on us, their herd, to provide them with community immunity until they were old enough to get vaccinated. It is not science's fault that these children, our fellow Americans, caught the measles. It is not their parents' fault. It is the fault of the anti-vaxxers, the vaccine cynics.

Let's all stop calling anti-vaxxers "vaccine skeptics" because it is unfair to genuine skepticism. As a pediatrician, I have seen the difference between skeptical parents and cynical parents. Skeptics are driven by curiosity, and they make it clear that health care providers have to earn their trust -- but it can be earned. As a health care provider, I do not assume anyone's trust and appreciate the opportunity to earn and maintain the trust of my patients and their families. Whether we are talking about vaccinations, medications, imaging studies, or surgical procedures, the skeptical parents of my patients want to have their concerns acknowledged and their questions answered. I am happy to oblige. My conversations with them are informative and even enjoyable because these are transparent exchanges about what priorities shape our perspectives, where we get our information, and how to contend with risk. Genuine skepticism can transform the doctor-patient relationship from patriarchy to partnership, and we need this now more than ever in modern medicine.

Anti-vaxxers are mostly cynics, and they are a whole other phenomenon. I am fortunate to have only experienced cynical parents outside of my direct clinical work. Cynics are not driven by curiosity but by an ugly mix of ignorance and arrogance. After dumpster diving on the Internet for pseudo-science, anti-vaxxers have decided that their contempt for public health guidelines and their distrust of modern medicine somehow makes them more "informed."

As a pediatrician and public health policy wonk, the cynical anti-vaxxers frustrate me on several levels. First, there is no amount of expensive scientific research that will assure anti-vaxxers about the safety, efficacy and necessity of vaccines. Where genuine skeptics ask questions in order to learn, cynics ask questions in order to scorn. Presenting legitimate peer-reviewed scientific data to anti-vaxxers does not persuade them because they already reached a verdict based on their fears and contempt. The scientific community has diverted so much funding and resources towards disproving any causal relationship between vaccines and autism, but to what end? Those who get vaccinated don't really need the additional proof, and anti-vaxxers don't really care about the real work of the scientific method. As a result, millions of dollars that could have been used to research the real causes of autism or to study the real toxins in our environment are wasted proving what has already been proven repeatedly: Vaccines are safe, effective, and necessary for public health.

It frustrates me that anti-vaxxers benefit from herd immunity but refuse to contribute to it. Those of us who get vaccines are improving our own individual lives as well as those around us because vaccinated bodies do not give dangerous viruses and bacteria opportunities to start an infection, reproduce, and pass on to others. This is exactly how the United States declared itself free of measles 15 years ago. Regardless of whether the anti-vaxxers admit it or not, they benefit from herd immunity. But anti-vaxxers are not the ones for whom herd immunity is intended. As a pediatrician, I see infants who are too young to receive certain vaccines. I see patients whose immune systems are impaired because they have organ transplants or they are undergoing treatments for cancer. All of these children are part of our herd, our community, and they are depending on the rest of us who are healthy enough to get vaccines to do our part in maintaining our collective immunity.

Getting vaccinated involves an element of social responsibility. The strength of our public health is reliant on a web of mutuality. When we drive sober and at the speed limit, or when we ban smoking in public places, we are doing the basic but important work of keeping each other safe and healthy. Vaccinations are an integral part of that process, and no one should have to suffer from preventable diseases. As much as anti-vaxxers may think they are exercising their right to choose, they do not have the right to put others at risk. It took tough laws against drunk driving to keep people safe, and there has been a slow but welcome cultural shift against driving under the influence. Similarly, we must urge anti-vaxxers to look beyond their egos and show some responsibility toward public...

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Happy Birthday, Dr. Martin Luther King, Jr., Birth Control Hero

(0) Comments | Posted January 19, 2015 | 11:19 AM

Among many of Dr. Martin Luther King, Jr.'s accomplishments that we should celebrate is his Margaret Sanger Award, bestowed upon him by the Planned Parenthood Federation of America in 1966, along with 3 other men (one of whom was President Lyndon Johnson). The award was presented in Washington, D.C., and...

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Dr. America's Top 10 Health Justice Accomplishments of 2014

(12) Comments | Posted December 27, 2014 | 1:10 PM

As we close 2014, I want to take a moment to look back at what We the People accomplished in health policy and health justice this year. By celebrating these accomplishments, large and small, I hope our community of advocates and activists can find inspiration to keep up the hard...

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Beyond Three-Fifths of Health With Dr. America

(0) Comments | Posted December 11, 2014 | 11:54 AM

I'm proud to be an American. I was born in this country, and my pride in America is based in this country's potential for acknowledging problems, improving ourselves, and the possibility of turning the ideal into the real. Indeed, it is that promise that drives me as a doctor and health justice advocate. However, in the midst of all that language of potential and possibility, there is undeniable struggle with no guarantee of outcomes. That is true for all of us as individuals, as communities, and as a country, right from the beginning of America. It is also true that too many of our struggles are due to man-made apathy and inaction.

One of our first sins as a country was abandoning an ideal of the Declaration of Independence: "all men are created equal." When it came time to write our Constitution, we included a three-fifths clause that said if you fit the slave profile, then you only count as three-fifths of a person. If you fit the white profile, you will be counted, but even within that category, if you have lady parts then you can not vote.

Some amateur and professional historians look at the three-fifths clause as an unfortunate but necessary evil: a desperate compromise between the different colonies to build a united country. But no matter how you reason it, we wrote into law that all men are not created equal.
Ever since then, we have struggled to see "all the fifths" of a person. We have struggled to see the humanity of families different from our own. The ideal of equality is still a work in progress. Despite all the sacrifices made by abolitionists, women suffragists, labor activists, LGBT activists, and various civil rights movements, it feels like we still fail to see a human being as a whole person in 21st century America. We are still only seeing three-fifths of our fellow Americans, either individually or as communities.

This is particularly evident in health. We have been locked into the biomedical paradigm of seeing a person's health as their organs and cells; what happens when these things go wrong; and what kinds of drugs and devices can be put in there to fix it. This is not to dismiss the work of biomedicine, but it is still only three-fifths of health.

It has been my privilege to serve as a pediatrician in southeast Washington, D.C., one of the poorest neighborhoods in the country. I want to share the experiences of my patients and their families so their fellow Americans can get to know "all their fifths" and see them as more complete people.

This fall, I joined We Act Radio to start "Dr. America," a radio show about health and its politics. Our journey tells truths to power and gives power to the truths of underserved, unheard, and unseen communities. "Dr. America" is about exploring "all the fifths" of health.

This show seeks to expand our notions of health beyond biomedicine. After all, what is the point of all the research endeavors if the fruits of those labors are not available to everyone through equitable access to healthcare?

Our show will put a health spotlight on events and issues that impact the health of millions, but are sometimes overlooked because there is no flashy drug or device to market. As we make our way through the current flu season, there are millions of Americans who go to work sick, or they send their sick child to school -- not because they are cruel or negligent of their health, but because millions of low-income workers in America do not have paid sick days. Again, our failure to recognize "all the fifths" of our fellow Americans leads to imposing a false choice upon them: you can have your little bit of health or your little bit of wealth, but not both.

"Dr. America" will discuss how health fits into places beyond our clinics, hospitals, laboratories, and doctors' offices. From the courthouse to the schoolhouse to the warehouse and to the statehouse, there are "fifths" of health to be explored. Wellness depends on our zip codes as much as if not more than our DNA codes, so we must have conversations with our fellow Americans living in poverty, struggling to put food on the table, trying to get by with low employment and high pollution, and so on.

My ardent hope is that through the dialogue on "Dr. America," we will gradually see beyond the broken "three-fifths of health" model to a new framework: SALUD. In Spanish, it means health, it means bless you, and it means cheers. On "Dr. America," we will distinguish the scientific facts from the fiction about health issues. We will discuss the health benefits of strengthening the socioeconomic and cultural bonds between us. Our society's broader spiritual health depends on that connectivity. Finally, we will celebrate health or health policy accomplishments and learn from our heroes.

Our concept of health should be multidimensional, and through "Dr. America" I am excited to take that journey with...

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Back to the Future of My MD (Pt. II)

(0) Comments | Posted June 18, 2014 | 10:00 AM

Ten years ago, I earned my MD at the UCLA David Geffen School of Medicine, and was honored to be chosen as the student speaker at our graduation ceremony. Having endured residency, enjoyed a policy fellowship, and practiced as a general pediatrician in an inner-city community, I was wondering what...

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Back to the Future of My MD (Pt. I)

(0) Comments | Posted June 17, 2014 | 7:41 AM

My medical doctorate turned 10 years old this month. Here is the speech I gave at my graduation ceremony back in 2004, at the UCLA David Geffen School of Medicine.

Before I begin, I wish to thank the families, the friends, and the faculty for their unconditional love, support,...

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