PSYCHOLOGY

Week 2 Assignment 2: Article Analysis

In this assignment, you will critically evaluate articles in the field of adult development. Each week, you will read two articles from the Annual Editions: Human Development textbook (see the weekly readings for the chosen articles). For each article, do the following:

• Write a summary.

• Describe the main points of the article and how it relates to the week’s course and text readings.

• Evaluate the article on the basis of your own thoughts and perspectives on the topic covered.

Write your responses in a Word document, and name it PSY2022_W2_A2_lastname_firstname . By Tuesday, November 5, 2013, submit your work to the W2: Assignment 2 Dropbox.

Use the lessons and vocabulary found in the readings. Your responses should clarify your understanding of the topic and should be original and free from plagiarism. Follow APA guidelines for the writing style, spelling and grammar, and citation of sources.

• Article 6 Keys to Quality Infant Care: Nurturing Every Baby’s Life Journey
• Article 7 Vaccination Nation

Article 10 Little by Little

Article 6 Keys to Quality Infant Care: Nurturing Every Baby’s Life Journey

ALICE STERLING HONIG

Teachers of infants need a large bunch of key ideas and activities of all kinds to unlock in each child the treasures of loving kindness, thoughtful and eloquent use of language, intense active curiosity to learn, willingness to cooperate, and the deep desire to work hard to master new tasks. Here are some ideas that teachers can use during interactions with infants to optimize each child’s development.

Get to Know Each Baby’s Unique Personality

At 4 months, Luci holds her hands in front of her face and turns them back and forth so she can see the curious visual difference between the palms and backs. Jackson, an 8-month-old, bounces happily in accurate rhythm as his teacher bangs on a drum and chants, “Mary had a little lamb whose fleece was white as snow!” Outdoors, 1-year-old Jamie sits in an infant swing peering down at his feet sticking out of the leg holes. How interesting! Those are the same feet he has watched waving in the air while being diapered and has triumphantly brought to his mouth to chew on.

Teachers can tune in to each child’s special personality—especially the child’s temperament. There are three primary, mostly inborn, styles of temperament (Honig 

1997

). Some babies are more low-key; they tend to be slow to warm up to new caregivers, new foods, and new surroundings. They need reassuring hand-holding and more physical supports to try a new activity. Others are more feisty and sometimes irritable. They tend to be impetuous, intense in their emotional reactions, whether of anger or of joy. Easygoing babies are typically friendly, happy, accept new foods and caregivers without much fuss, and adapt fairly quickly and more flexibly after experiencing distress or sudden change. Try to find out whether each baby in your care tends to be shy and slow to warm up or mostly feisty and intense or easygoing. A caring adult’s perceptive responses in tune with individual temperament will ease a child’s ability to adapt and flourish in the group setting.

Physical Loving

Your body is a safe haven for an infant. Indeed, some babies will stay happy as a clam when draped over a shoulder, across your belly as you rock in a rocking chair, or, especially for a very young baby, snuggled in a sling or carrier for hours. As Montagu (

1971

) taught decades ago, babies need body loving: “To be tender, loving, and caring, human beings must be tenderly loved and cared for in their earliest years. … caressed, cuddled, and comforted” (p. 138).

As you carry them, some babies might pinch your neck, lick your salty arm, pull at your hair, tug at eyeglasses, or show you in other ways how powerfully important your body is as a sacred and special playground. Teach gentleness by calmly telling a baby you need your glasses on to read a story. Use the word gently over and over and over. Dance cheek-to-cheek with a young child in arms to slow waltz music—good for dreary days! Also carry the baby while you do a routine task such as walking to another room to get something.

Provide lap and touch times generously to nourish a child’s sense of well-being. Slowly caress a baby’s hair. Rub a tense shoulder soothingly. Kiss one finger and watch as a baby offers every other finger to kiss. Rock a child with your arms wrapped around him for secure comfort. Babies learn to become independent as we confirm and meet their dependency needs in infancy. A sense of well-being and somatic certainty flows from cherishing adults who generously hold, caress, and drape babies on shoulders and tummies.

Create Intimate Emotional Connections

Scan the environment so you can be close to every baby. Notice the quiet baby sitting alone, mouthing a toy piece and rocking back and forth with vacant eyes. Notice shy bids for attention, such as a brief smile with lowered lids. The child with an easy or cautious temperament needs your loving attention as much as the one who impulsively climbs all over you for attention.

A caring adult’s perceptive responses in tune with individual temperament will ease a child’s ability to adapt and flourish in the group setting.

Shine admiring eyes at the children, whether a baby is cooing as she lies in her crib, creeping purposefully toward a toy she desires, or feeding herself happily with messy fingers. Speak each child’s name lovingly and frequently. Even if they are fussing, most babies will quiet when you chant and croon their names.

Although babies do not understand the meanings of the words, they do understand tonal nuances and love when your voice sounds admiring, enchanted with them, and happy to be talking with them. While diapering, tell the baby he is so delicious and you love his plump tummy and the few wispy hairs on that little head. Watch him thrust out his legs in delight on the diapering table. Your tone of voice entrances him into a deep sense of pleasure with his own body (Honig 

2002

).

Harmonizing Tempos

Tempo is important in human activities and is reflected in how abruptly or smoothly adults carry out daily routines. Because adults have so many tasks to do, sometimes we use impatient, too-quick motions, for example, while dressing a baby to play outdoors. When dressing or feeding, more leisurely actions are calming. They signal to children that we have time for them. Rub backs slowly and croon babies into soothing sleep.

A baby busily crawling across the rug sees a toy, grasps it, then plops himself into a sitting position to examine and try to pull it apart. He slowly looks back and forth at the toy as he leisurely passes it from hand to hand. He has no awareness that a teacher is about to interrupt because she is in a hurry to get him dressed because his daddy is coming to pick him up. Young children need time and cheerful supports to finish up an activity in which they are absorbed. If they are hurried, they may get frustrated and even have a tantrum.

Enhance Courage and Cooperation

Your presence can reassure a worried baby. Stay near and talk gently to help a child overcome his fear of the small infant slide. Pascal sits at the top, looking uncertain. Then he checks your face for a go-ahead signal, for reassurance that he can bravely try to slide down this slide that looks so long to him. Kneeling at the bottom of the slide, smile and tell him that you will be there to catch him when he is ready to slide down.

Be available as a “refueling station”—Margaret Mahler’s felicitous term (Kaplan 

1978

). Sometimes a baby’s independent learning adventure comes crashing down—literally. Your body and your lap provide the emotional support from which a baby regains courage to tackle the learning adventure again.

Create loving rituals during daily routines of dressing, bath times, nap times, feeding times. Babies like to know what will happen and when and where and how. Babies have been known to refuse lunch when their familiar, comfortable routines were changed. At cleanup times, older babies can be more flexible and helpful if you change some chores into games. Through the use of sing-song chants, putting toys away becomes an adventure in finding the big fat blocks that need to be placed together on a shelf and then the skinny blocks that go together in a different place.

Young children need time and cheerful supports to finish up an activity in which they are absorbed. If they are hurried, they may get frustrated and even have a tantrum.

Address Stress

Attachment research shows that babies who develop secure emotional relationships with a teacher have had their distress signals noticed, interpreted correctly, and responded to promptly and appropriately (Honig 
2002
). At morning arrival times, watch for separation anxiety. Sometimes holding and wordlessly commiserating with a baby’s sad feelings can help more than a frenzied attempt to distract her (Klein, Kraft, & Shohet 

2010

). As you become more expert at interpreting a baby’s body signals of distress and discomfort, you will become more sensitively attuned in your responses (Honig 
2010
).

Learn Developmental Milestones

Learning developmental norms helps teachers figure out when to wonder, when to worry, and when to relish and feel overjoyed about a child’s milestone accomplishments. Day and night toilet learning can be completed anywhere from 18 months to 5 years. This is a wide time window for development. In contrast, learning to pick up a piece of cereal from a high chair tray with just thumb and forefinger in a fine pincer grasp is usually completed during anarrow time window well before 13 months. By 11 months, most babies become expert at using just the first two fingers.

Hone Your Detective Skills

If a baby is screaming and jerking knees up to his belly, you might suspect a painful gas bubble. Pick up the baby and jiggle and thump his back until you get that burp up. What a relief, for you as well as baby. Maybe an irritable, yowling baby just needs to be tucked in quietly and smoothly for a nap after an expert diaper change. Suppose baby is crying and thrashing about, and yet he has been burped and diapered. Use all your detective skills to determine the cause. Is it a hot day? He might be thirsty. A drink of water can help him calm down.

Notice Stress Signs

Scan a child’s body for stress signs. Dull eyes can signal the need for more intimate loving interactions. Tense shoulders and a grave look often mean that a child is afraid or worried (Honig 
2010
). Compulsive rocking can mean a baby feels forlorn. Watch for lonesomeness and wilting.

Some babies melt down toward day’s end. They need to be held and snuggled. Murmur sweet reassurances and provide a small snack of strained applesauce to soothe baby’s taste buds and worries. Check his body from top to bottom for signs of stresses or tensions, such as eyes avoiding contact, teeth grinding, fingernail chewing, frequently clenched fists, so that you can develop an effective plan for soothing. Be alert, and tend to children’s worrisome bodily signs; these will tell you what you need to know long before children have enough language to share what was stressful (Honig 

2009

).

Play Learning Games

Parents and teachers are a baby’s preferred playmates. While playing learning games with infants, pay attention to their actions. Ask yourself if the game has become so familiar and easy that it is time to “dance up the developmental ladder” (Honig 

1982

) and increase the game’s challenge. Or perhaps the game is still too baffling and you need to “dance down” and simplify the activity so that the child can succeed.

Provide safe mirrors at floor level and behind the diapering table so children can watch and learn about their own bodies. Hold babies in arms up to a mirror to reach out and pat the face in the mirror. Lying on the floor in front of a securely attached safety mirror, a young child twists and squirms to get an idea of where his body begins and ends.

Your body can serve as a comforting support for some early learning activities. Sit an infant on your lap and watch as he coordinates vision and grasp to reach and hold a toy you are dangling. Babies love “Peek-a-boo! I see you!” These games nurture the development of object permanence—the understanding that objects still exist even when they are out of sight. Peek-a-boo games also symbolically teach that even when a special adult is not seen, that dear person will reappear.

Provide Physical Play Experiences

Play pat-a-cake with babies starting even before 6 months. As you gently hold a baby’s hands and bring them out and then back together, chant slowly and joyously, “Pat-a-cake, pat-a-cake, baker’s man; bake me a cake just as fast as you can. Pat it, and roll it, and mark it with a B, and put it in the oven for [baby’s name] and me.” Smile with joy as you guide the baby’s hands rhythmically and slowly through the game, and use a high-pitched voice as you emphasize her name in the sing-song chant. Over the next months, as soon as you begin chanting the words, the baby will begin to bring hands to the midline and do the hand motions that belong with this game. Babies who are 9 to 11 months old will even start copying the hand-rolling motions that belong with this game.

To encourage learning, try to arrange games with more physical actions. Sit on the floor with your toes touching the baby’s toes, then model how to roll a ball back and forth.

Introduce Sensory Experiences

Safe sensory and tactile experiences are ideal for this age group. As he shifts a toy from hand to hand, turns it over, pokes, tastes, bangs, and even chews on it, a baby uses his senses to learn about the toy’s physical properties. Teachers can blow bubbles so babies can reach for and crawl after them. Provide play-dough made with plenty of salt to discourage children from putting it in their mouths. Older babies enjoy exploring finger paints or nontoxic tempera paint and fat brushes.

Play Sociable Games

Give something appealing to a seated baby. Put out your hand, smile, and say “Give it to me, please.” The baby may chew on the “gift,” such as a safe wooden block or chunky plastic cylinder peg. After the baby passes it to you, say thank you, then give the object back with a smile. Give-and-take games with you are a sociable pleasure for babies and teach them turn-taking skills that are crucial for friendly social interchanges years later.

Seated on a chair, play a bouncing game, with the baby’s back resting snuggly against your tummy. After you stop bouncing and chanting “Giddyup, horsie,” a baby often bounces on his or her tush as if to remind you to start this game over and over. An older baby vigorously demands “More horsie!” to get you to restart this game. Babies enjoy kinesthetic stimulation too, such as when you swing them gently in a baby swing. A baby will grin with glee as you pull or push him in a wagon around the room or playground.

Observe Babies’ Ways of Exploring and Learning

Observe a baby to learn what and how she is learning, then adapt the activity to offer greater challenge. Observation provides information that lets teachers determine when and how to arrange for the next step in a child’s learning experience. Watch quietly as a baby tries with determination to put the round wood top piece for a ring stack set on the pole. His eyes widen in startled amazement as he gradually realizes that when the hole does not go through the middle, then that piece will not go down over the pole—a frustrating but important lesson. Calmly, a teacher can demonstrate how to place the piece on top of the pole while using simple words to describe how this piece is different. She can also gently guide the baby’s hands so he feels successful at placing the piece on top.

Enhance Language and Literacy in Everyday Routines

Talk back and forth with babies; respond to their coos and babbles with positive talk. When the baby vocalizes, tell her, “What a terrific talker you are. Tell me some more.”

The diapering table is a fine site for language games. With young babies, practice “parentese”—a high-pitched voice, drawn-out vowels, and slow and simple talk. This kind of talk fires up the brain neurons that carry messages to help a baby learn (Doidge 

2007

). Cascades of chemicals and electrical signals course down the baby’s neural pathways. A baby responds when you are an attentive and delighted talking partner. Pause so the baby gets a turn to talk too, and bring the game to a graceful close when baby fatigue sets in.

Talk about body parts on dolls, stuffed animals, yourself, and the babies in the room. Talk about what the baby sees as you lift her onto your lap and then onto your shoulders. Talk at mealtimes. Use every daily routine as an opportunity to enhance oral language (Honig 
2007
).

Daily reading is an intimate one-on-one activity that young babies deeply enjoy in varied spaces and at varied times of the day (Honig 

2004

). Hook your babies on books as early as possible. Frequent shared picture-book experiences are priceless gifts. Early pleasurable reading experiences empower success in learning to read years later in grade school (Jalongo 
2007
).

Cuddle with one or several children as you read and share books together every day. Use dramatic tones along with loving and polite words. You are the master of the story as you read aloud. Feel free to add to or to shorten picture-book text according to a particular child’s needs. Group reading times can be pleasurable when infants lean against you as you sit on the rug and share a picture book. Teachers often prefer the intimacy of individual reading times with babies (Honig & Shin 

2001

). Individual reading can help a tense or fussy baby relax in your lap as he becomes deeply absorbed in sharing the picture-book experience.

Encourage Mastery Experiences

Children master many linguistic, physical, and social skills in the first years of life. Watch the joy of mastery and self-appreciation as a baby succeeds at a task, such as successfully placing Montessori cylinders into their respective sockets. Babies enjoy clapping for their own efforts. Mastery experiences arranged in thoughtful doses bring much pleasure, such an eagerness to keep on exploring, trying, and learning. Watch the baby’s joy as he proudly takes a long link chain out of a coffee can and then stuffs it slowly back in the can. He straightens his shoulders with such pride as he succeeds at this game of finding a way to put a long skinny chain into a round container with a small diameter opening.

Mastery experiences arranged in thoughtful doses bring much pleasure, such an eagerness to keep on exploring, trying, and learning.

Vygotsky taught that the zone of proximal development is crucial for adult-child coordination in learning activities. You the teacher are so important in helping a child to succeed when a task may be slightly too difficult for the child to solve alone. Hold the baby’s elbow steady when she feels frustrated while trying to stack one block on top of another. For a difficult puppy puzzle, a teacher taped down a few of the pieces so a baby could succeed in getting the puppy’s tail and head pieces in the right spaces. If a baby has been struggling with a slippery nesting cup for a while, just steady the stack of cups so he can successfully insert a smaller cup into the next largest one.

Promote Socioemotional Skills

Babies learn empathy and friendliness from those who nurture them. Empathy involves recognizing and feeling the distress of another and trying to help in some way. A young baby who sees another baby crying may look worried and suck his thumb to comfort himself. Fifteen-month-old Michael tussles over a toy with Paul, who starts to cry. Michael looks worried and lets go of the toy so Paul has it. As Paul keeps crying, Michael gives him his own teddy bear. But Paul continues crying. Michael pauses, then runs to the next room and gets Paul’s security blanket for him. And Paul stops crying (Blum 

1987

).

When teachers showed deeply respectful caregiving, then they observed that babies did develop early empathy and internalize the friendly interactions they had experienced.

Friendliness includes making accommodations so children can play together. For example, move a child over to make room for a peer, or make overtures to invite other babies to engage in peer play. Perhaps they could take turns toddling in and out of a cardboard house. Babies act friendly when they sit near each other and companionably play with toys, happy to be close together. McMullen and colleagues (
2009
) observed that positive social-emotional interactions were rare in some infant rooms. But when teachers showed deeply respectful caregiving, then they observed that babies did develop early empathy and internalize the friendly interactions they had experienced. One teacher is described below:

Her wonderful gentle manner, the way she speaks to the babies, how they are all her friends … only someone who utterly respects and values babies could put that kind of effort into this the way she does, almost like she is setting a beautiful table for honored guests each and every morning. (McMullen et al.2009, p. 27)

Conclusion

Later in life, a baby will not remember your specific innumerable kindly caring actions in the earliest years. However, a child’s feelings of being lovable and cherished will remain a body-memory for life. These feelings of having been loved will permeate positive emotional and social relationships decades later.

Keep your own joy pipes open. How brief are the years of babyhood. All too soon young children grow into the mysterious world of teenagers who prefer hanging out with peers to snuggling on an adult lap. Reflect with deep personal satisfaction on your confidence and delight in caring for tiny ones—hearing the first words, seeing the joy at a new accomplishment, watching the entranced look of an upturned face as you tell a story, feeling the trust as a baby sleepily settles onto your lap for refreshment of spirit, for a breath of the loving comfort that emanates from your body.

Life has grown more complicated in our technological, economically difficult, and more and more urbanized world. But you, the teacher, remain each baby’s priceless tour guide into the world of “growing up!” You gently take each little person by the hand—literally and figuratively—and lure each and every baby into feeling the wonder and the somatic certainty of being loved, lovable, and cherished so that each baby can fully participate in the adventure of growing, loving, and learning.

Your nurturing strengthens a baby’s determination to keep on learning, keep on cooperating, keep on being friendly, and keep on growing into a loving person—first in the world of the nursery and later in the wider world. You can give no greater gift to a child than to be the best guide possible as each child begins his or her unique life journey.

References

Blum, L. 1987. Particularity and responsiveness. In The emergence of morality in young children, eds. J. Kagan & S. Lamb, 306–37. Chicago: University of Chicago Press.

Doidge, N. 2007. The brain that changes itself. New York: Penguin.

Honig, A.S. 1982. Playtime learning games for young children. Syracuse, NY: Syracuse University Press.

Honig, A.S. 1997. Infant temperament and personality: What do we need to know? Montessori Life 9 (3): 18–21.

Honig, A.S. 2002. Secure environments: Nurturing infant/toddler attachment in child care settings. Washington, DC: NAEYC.

Honig, A.S. 2004. Twenty ways to boost your baby’s brain power. Scholastic Parent and Child 11 (4): 55–56.

Honig, A.S. 2007. Oral language development. Early Child Development and Care 177 (6): 581–613.

Honig, A.S. 2009. Stress and young children. In Informing our practice: Useful research on young children’s development, eds. E. Essa & M.M. Burnham, 71–88. Washington, DC: NAEYC.

Honig, A.S. 2010. Little kids, big worries: Stress-busting tips for early childhood classrooms. Baltimore: Brookes.

Honig, A.S., & M. Shin. 2001. Reading aloud to infants and toddlers in childcare settings: An observational study. Early Childhood Education Journal28 (3): 193–97.

Jalongo, M.R. 2007. Early childhood language arts. 4th ed. New York: Pearson.

Kaplan, L. 1978. Oneness and separateness: From infant to individual. New York: Simon & Schuster.

Klein, P.S., R.R. Kraft, & C. Shohet. 2010. Behavior patterns in daily mother-child separations: Possible opportunites for stress reduction. Early Child Development and Care 180: 387–96.

McMullen, M.B., J.M. Addleman, A.M. Fulford, S. Moore, S.J. Mooney, S.S. Sisk, & J. Zachariah. 2009. Learning to be me while coming to understandwe. Encouraging prosocial babies in group settings. Young Children 64 (4): 20-28. 

www.naeyc.org/files/yc/file/200907/McMullenWeb709

Montagu, A. 1971. Touching: The human significance of the skin. New York: Harper & Row.

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Article 7 Vaccination Nation

CHRIS MOONEY

The decadelong controversy surrounding the safety of vaccines is over—or is it? A fierce debate continues over what really puts our children at risk.

Vaccines do not cause autism. That was the ruling in each of three critical test cases handed down on February 12 by the U.S. Court of Federal Claims in Washington, D.C. After a decade of speculation, argument, and analysis—often filled with vitriol on both sides—the court specifically denied any link between the combination of the MMR vaccine and vaccines with thimerosal (a mercury-based preservative) and the spectrum of disorders associated with autism. But these rulings, though seemingly definitive, have done little to quell the angry debate, which has severe implications for American public health.

The idea that there is something wrong with our vaccines—that they have poisoned a generation of kids, driving an “epidemic” of autism—continues to be everywhere: on cable news, in celebrity magazines, on blogs, and in health news stories. It has had a particularly strong life on the Internet, including the heavily trafficked Huffington Post, and in pop culture, where it is supported by actors including Charlie Sheen and Jim Carrey, former Playboy playmate Jenny McCarthy, and numerous others. Despite repeated rejection by the scientific community, it has spawned a movement, led to thousands of legal claims, and even triggered occasional harassment and threats against scientists whose research appears to discredit it.

You can see where the emotion and sentiment come from. Autism can be a terrible condition, devastating to families. It can leave parents not only aggrieved but desperate to find any cure, any salvation. Medical services and behavioral therapy for severely autistic children can cost more than $100,000 a year, and these children often exhibit extremely difficult behavior. Moreover, the incidence of autism is apparently rising rapidly. Today one in every 150 children has been diagnosed on the autism spectrum; 20 years ago that statistic was one in 10,000. “Put yourself in the shoes of these parents,” says journalist David Kirby, whose best-selling 2005 book, Evidence of Harm, dramatized the vaccine-autism movement. “They have perfectly normal kids who are walking and happy and everything—and then they regress.” The irony is that vaccine skepticism—not the vaccines themselves—is now looking like the true public-health threat.

The decadelong vaccine-autism saga began in 1998, when British gastroenterologist Andrew Wakefield and his colleagues published evidence in The Lancet suggesting they had tracked down a shocking cause of autism. Examining the digestive tracts of 12 children with behavioral disorders, nine of them autistic, the researchers found intestinal inflammation, which they pinned on the MMR (measles, mumps, and rubella) vaccine. Wakefield had a specific theory of how the MMR shot could trigger autism: The upset intestines, he conjectured, let toxins loose in the bloodstream, which then traveled to the brain. The vaccine was, in this view, effectively a poison. In a dramatic press conference, Wakefield announced the findings and sparked an instant media frenzy. For the British public, a retreat from the use of the MMR vaccine—and a rise in the incidence of measles—began.

In the United States, meanwhile, fears would soon arise concerning another means by which vaccines might induce autism. Many vaccines at the time contained thimerosal, a preservative introduced in the 1930s to make vaccines safer by preventing bacterial contamination. But thimerosal is 50 percent mercury by weight, and mercury is known to be a potent neurotoxin, at least in large doses. In 1999 new federal safety guidelines for mercury in fish stirred concerns about vaccines as well.

The U.S. government responded by ordering that thimerosal be removed from all vaccines administered to children under age 6, or reduced to trace amounts. (Some inactivated influenza vaccines were exempted.) The step was described as a “precautionary” measure. There was no proof of harm, government researchers said, just reason to worry that there might be. Meanwhile, scientists launched numerous studies to determine whether thimerosal had actually caused an autism epidemic, while some parents and their lawyers started pointing fingers and developing legal cases.

Within weeks of this year’s federal court decisions—which examined and vindicated both the MMR vaccine and thimerosal environmental lawyer Robert F. Kennedy Jr. wrote a column in The Huffington Post in which he continued to press his case that the government has peddled unsafe vaccines to an unsuspecting public. It is a cause he has championed since 2005, when he published “Deadly Immunity” in Rolling Stone and Salon magazines. The article was a no-holds-barred denunciation of the U.S. public-health establishment, purporting to tell the story of how “government health agencies colluded with Big Pharma to hide the risks of thimerosal from the public … a chilling case study of institutional arrogance, power, and greed.” Half a decade after the original thimerosal concerns were first raised, Kennedy claimed to have found the smoking gun: the transcript of a “secret” 2000 meeting of government, pharmaceutical, and independent researchers with expertise in vaccines. Kennedy’s conclusion: The generational catastrophe was real; our kids had been poisoned. If true, it would be perhaps the greatest biomedical catastrophe in modern history.

But for Kennedy to be right, a growing consensus in the medical establishment had to be wrong. Indeed, Kennedy blasted a leading organ of science that had just vindicated both the MMR vaccine and thimerosal, the Institute of Medicine (IOM). “The CDC [Centers for Disease Control and Prevention] paid the Institute of Medicine to conduct a new study to whitewash the risks of thimerosal,” Kennedy wrote, “ordering researchers to ‘rule out’ the chemical’s link to autism.” In reality, the IOM—a branch of the National Academy of Sciences (NAS), the government’s top independent scientific adviser—carefully creates firewalls between the funding it receives to conduct scientific assessments and the results it ultimately produces. “Funders don’t control the composition of the committee, and they don’t meet with the committee,” says Harvard public-health researcher Marie McCormick, who chaired the IOM vaccine-safety committee in question. “And on no NAS or IOM committee are the members paid; they all work pro bono. There’s no reason for them not to look at the data.”

The same year Kennedy’s article came out, journalist David Kirby published Evidence of Harm—Mercury in Vaccines and the Autism Epidemic: A Medical Controversy. He followed a group of parents from the Coalition for SafeMinds, an autism activist organization. They had grown convinced that vaccines and other environmental factors had caused their children’s conditions. Kirby’s chronicle of the parents’ efforts to publicize the dangers of vaccines became a best seller and greatly advanced SafeMinds’ cause.

“It’s not hard to scare people,” says pediatrician and leading vaccine advocate Paul Offit. “But it’s extremely difficult to unscare them.”

Yet even as vaccine hysteria reached a fever pitch in the wake of Kennedy’s and Kirby’s writings, the scientific evidence was leaning strongly in the other direction. In discounting the dangers of both the MMR vaccine and thimerosal, the IOM had multiple large epidemiological studies to rely on. For MMR, the IOM examined 16 studies. All but two, which were dismissed because of “serious methodological flaws,” showed no evidence of a link. For thimerosal, the IOM looked at five studies, examining populations in Sweden, Denmark, the United Kingdom, and the United States (studies that vaccine critics contend were flawed). Since then, further research has strengthened and vindicated the committee’s original conclusion. It is a conclusion that has been “independently reached by scientific and professional committees around the world,” as a recent science journal commentary noted. Either the scientific community has found a clear, reassuring answer to the questions raised about thimerosal in vaccines, or there is a global scientific conspiracy to bury the truth.

Whether the public is hearing the scientific community’s answer is another matter. “It’s not hard to scare people,” says pediatrician and leading vaccine advocate Paul Offit, who himself coinvented a vaccine. “But it’s extremely difficult to unscare them.”

A backlash against vaccine skeptics is beginning to mount. Standing up to fellow celebrities, actress Amanda Peet, who recently vaccinated her baby daughter, has become a spokeswoman for the provaccine group Every Child by Two. Offit’s book Autism’s False Prophets has further galvanized vaccine defenders—not only by debunking the science of those who claim vaccines are dangerous but also by contending that the parents of autistic children and the children themselves are indeed victims, not of vaccines but of medical misinformation.

The provaccine case starts with some undeniable facts: Vaccines are, as the IOM puts it, “one of the greatest achievements of public health.” The CDC estimates that thanks to vaccines, we have reduced morbidity by 99 percent or more for smallpox, diphtheria, measles, polio, and rubella. Averaged over the course of the 20th century, these five diseases killed nearly 650,000 people annually. They now kill fewer than 100. That is not to say vaccines are perfectly safe; in rare cases they can cause serious, well-known adverse side effects. But what researchers consider unequivocally unsafe is to avoid them. As scientists at the Johns Hopkins Bloomberg School of Public Health recently found while investigating whooping cough outbreaks in and around Michigan, “geographic pockets of vaccine exemptors pose a risk to the whole community.”

When it comes to autism, vaccine defenders make two central claims. First, the condition is likely to be mostly genetic rather than environmentally caused; and second, there are reasons to doubt whether there is really a rising autism epidemic at all.

It is misleading to think of autism as a single disorder. Rather, it is a spectrum of disorders showing great variability in symptoms and expression but fundamentally characterized by failed social development, inability to communicate, and obsessive repetitive behavior. Autism generally appears in children at early ages, sometimes suddenly, and its genetic component has long been recognized. Studies have shown that if one identical twin has autism, there is at least a 60 percent chance that the other also does. “From my point of view, it’s a condition associated with genetic defects and developmental biology problems,” says Peter Hotez, a George Washington University microbiologist and father of an autistic child. Hotez, who is also president of the Sabin Vaccine Institute, says, “I don’t think it’s possible to explain on the basis of any vaccine toxin that is acquired after the baby is born.” Still, scientists cannot fully rule out environmental triggers—including various types of toxicity—that might interact with a given individual’s preexisting genetic inclination. Autism is a complex disorder with multiple forms of expression and potentially multiple types of causation that are incompletely understood.

As for whether autism is rising, a number of experts say it is hard to know. Is the increase real, or is it largely the result of more attention to the condition, an expansion of the autism spectrum to embrace many different heterogeneous disorders, a new focus on children classified as autistic in federal special education programs during the 1990s, and other factors? It could be some combination of all these things.

But if environmental triggers of autism cannot be ruled out, the idea that those triggers can be found in the MMR vaccine or in thimerosal has crumbled under the weight of scientific refutation. Epidemiological studies have cast grave doubt on Andrew Wakefield’s MMR hypothesis—and so have subsequent scandals. Nearly all of Wakefield’s coauthors have since retracted the autism implications of their work; The Lancet has also backed away from the study. A series of investigative stories published in The Times of London unearthed Wakefield’s undisclosed ties to vaccine litigation in the U.K. and, more recently, suggested he fabricated his data (which Wakefield denies).

As for thimerosal, government precautions notwithstanding, it was never clear how threatening it might be. The federal mercury standards that first heightened concern were developed for methylmercury, not ethylmercury, the form contained in thimerosal. Ethylmercury has less risk of accumulating to a toxic dose because it does not last as long in the body. And, according to the IOM’s 2004 report, there had never been any evidence of a major incident of mercury poisoning leading to autism.

The strongest argument against the idea that thimerosal poisoned a generation of children does not emerge from the body of published studies alone. There is the added detail that although thimerosal is no longer present in any recommended childhood vaccines save the inactivated influenza vaccine—and hasn’t been, beyond trace amounts, since 2001—no one is hailing the end of autism. “If you thought thimerosal was related to autism, then the incidence of autism should have gone down,” Harvard’s McCormick explains. “And it hasn’t.”

Children who would have been classified as mentally retarded or learning disabled were now being classified on the autism spectrum.

In 2005 David Kirby stated that if autism rates didn’t begin to decline by 2007, “that would deal a severe blow to the autismthimerosal hypothesis.” But as McCormick notes, despite the absence of thimerosal in vaccines, reports of autism cases have not fallen. In a 2008 study published in Archives of General Psychiatry, two researchers studying a California Department of Developmental Services database found that the prevalence of autism had actually continued increasing among the young. Kirby concedes that these findings about the California database represent a “pretty serious blow to the thimerosal-causes-autism hypothesis,” though he does not think they thoroughly bury it. In an interview, he outlined many problems with relying on the California database, suggesting potential confounding factors such as the state’s high level of immigration. “Look, I understand the desire to try to end this and not scare parents away from vaccination,” Kirby says. “But I also feel that sometimes that desire to prove or disprove blinds people on both sides.”

Kirby says—and even some vaccine defenders agree—that some small subgroup of children might have a particular vulnerability to vaccines and yet be missed by epidemiological studies. But the two sides disagree as to the possible size of that group. “If one or two or three children every year are getting autism from vaccines, you would never pick that up,” Offit says. Kirby, in contrast, feels that while the idea of thimerosal as the “one and only cause of autism has gone out the window,” he still believes there is an “epidemic” with many environmental triggers and with thimerosal as a possible contributing factor.

Meanwhile, in the face of powerful evidence against two of its strongest initial hypotheses—concerning MMR and thimerosal—the vaccine skeptic movement is morphing before our eyes. Advocates have begun moving the goalposts, now claiming, for instance, that the childhood vaccination schedule hits kids with too many vaccines at once, overwhelming their immune systems. Jenny McCarthy wants to “green our vaccines,” pointing to many other alleged toxins that they contain. “I think it’s definitely a response to the science, which has consistently shown no correlation,” says David Gorski, a cancer surgeon funded by the National Institutes of Health who in his spare time blogs at Respectful Insolence, a top medical blog known for its provaccine stance. A hardening of antivaccine attitudes, mixed with the despair experienced by families living under the strain of autism, has heightened the debate—sometimes leading to blowback against scientific researchers.

Paul Shattuck did not set out to enrage vaccine skeptics and the parents of autistic children. Currently an assistant professor at the George Warren Brown School of Social Work at Washington University in St. Louis, he has dedicated the last decade of his professional life to helping people with autism in their families. “Some of my dearest friends have kids with autism,” he says.

But in 2006 Shattuck came under fire after he published an article in the journal Pediatrics questioning the existence of an autism epidemic. No one doubts that since the early 1990s the number of children diagnosed with autism has dramatically increased, a trend reflected in U.S. special education programs, where children enrolled as autistic grew from 22,445 in 1994–1995 to 140,254 in 2003–2004. Yet Shattuck’s study found reasons to doubt that these numbers were proof of an epidemic. Instead, he suggested that “diagnostic substitution”—in which children who previously would have been classified as mentally retarded or learning disabled were now being classified on the autism spectrum—played a significant role in the apparent increase.

Shattuck did not reject the idea that rising autism levels might be in part due to environmental causes; he merely showed the increase was largely an artifact of changing diagnostic practices, which themselves had been enabled by rising levels of attention to autism and its listing as a diagnostic category in special education. Yet simply by questioning autism epidemic claims in a prominent journal, he became a target. “People were obviously Googling me and tracking me down,” he recalls. Shattuck emphasizes that most e-mails and calls merely delivered “heartfelt pleas from people with very sick kids who’ve been led to believe a particular theory of etiology.” The bulk weren’t menacing, but a few certainly were.

Others attacked Shattuck’s research on the Web and insinuated that he had fabricated his data or committed scientific misconduct. “It was dismaying to feel like people were calling me a traitor to autistic kids and families,” he says.

“If there has been a more harmful urban legend circulating in our society than the vaccine-autism link,” University of Pennsylvania bioethicist Arthur Caplan wrote in The Philadelphia Inquirer, “it’s hard to know what it might be.” One type of harm, as Shattuck’s story shows, is to individual scientists and the scientific process. There is a real risk that necessary research is being held back as scientists fear working in such a contested field. Shattuck’s experience is not unique. Offit cannot go on a book tour to promote Autism’s False Prophets because of the risk involved in making public appearances. He has received too many threats.

Yet another cost comes in the rush toward unproven, and potentially dangerous, alternative therapies to treat autism. It is easy to sympathize with parents of autistic children who desperately want to find a cure, but this has led to various pseudoremedies whose efficacy and safety have been challenged by science. These include facilitated communication, secretin infusion, chelation therapy (which involves pumping chemicals into the blood to bind with heavy metals such as mercury), and hormonal suppression. It is estimated that more than half of all children with autism are now using “complementary and alternative” treatments.

Disease, however, is the greatest danger associated with holding back vaccines amid the ongoing investigation of dubious claims. Both the vaccinated and the unvaccinated populations are placed at greater risk. Given enough vaccine exemptions and localized outbreaks, it is possible that largely vanquished diseases could become endemic again. (That is precisely what happened with measles in 2008 in the U.K., following the retreat from the MMR vaccine in the wake of the 1998 scare.) The public-health costs of such a development would be enormous—and they would not impact everyone equally. “If vaccine rates start to drop, who’s going to get affected?” Peter Hotez asks. “It’s going to be people who live in poor, crowded conditions. So it’s going to affect the poorest people in our country.”

Paradoxically, the great success of vaccines is a crucial reason why antivaccination sentiment has thrived, some scientists say. Most of the diseases that vaccines protect against have largely been licked. As a consequence, few people personally remember the devastation they can cause. So with less apparently on the line, it is easier to indulge in the seeming luxury of vaccine skepticism and avoidance. Even before the recent spike in attention to thimerosal, members of the public were alarmingly skeptical of vaccines. In a 1999 survey, 25 percent felt their children’s immune systems could be harmed by too many vaccinations, and 23 percent shared the sentiment that children receive more vaccinations than are healthy. There is every reason to think that those numbers—gathered before the vaccine-autism controversy reached anything like its current intensity—have risen since.

In the United States, population pockets with low vaccination rates (such as in Boulder, Colorado, and Ashland, Oregon) have existed for some time, and the great fear among many governmental medical authorities is that high-profile claims about vaccine dangers will widen the phenomenon, with potentially disastrous consequences. Already, medical and religious vaccination exemptions are climbing: In New York State they totaled 4,037 in 2006, nearly twice as many as in 1999. In New Jersey they came to 1,923 in 2006 versus only 727 in 1990. It is not just exemptors: The far larger concern, according to McCormick and others, is those parents referred to as “vaccine hesitaters.” They have heard all the noise about vaccines and will probably get their children shots because they feel they have to, but their skepticism is growing.

Offit points to still another threat: litigation. The wave of autism-related claims filed with the U.S. government’s Vaccine Injury Compensation Program is unprecedented. Since 2001 autism claims have outnumbered nonautism cases almost four to one. Following the science, the court has now dismissed many of them, but there is the possibility that civil litigation will follow. “I still think it’s going to be another 10 years before this really washes out in litigation,” Offit says. If the legal atmosphere becomes too difficult for vaccine manufacturers, they could stop producing them or be forced out of business.

Ultimately, that is why the vaccineautism saga is so troubling—and why it is so important to explore how science and so many citizens fell out of touch.

“It wouldn’t have been possible without the Internet,” says journalist Arthur Allen, who has covered the vaccine-autism story since 2002, when he wrote a high-profile New York Times Magazine article that took the thimerosal risk seriously. Over time Allen changed his mind, coming to reject the idea that vaccines are to blame. Still, he recognizes why it persists. “If people believe something happened to them, there are so many people on the Web you can find who believe the same thing.” The Internet has become a haven for a number of autism support groups that continually reinforce the vaccine-autism argument. This has led to the radicalization of some elements who have denounced scientists as “vaccine barbarians,” “pharmaceutical and medical killers,” and so on. And after all we have heard about environmental and chemical risks—some accurate, some not—people are now easily persuaded about all manner of toxin dangers.

But if the Internet has made it easier for pockets of antiscience feeling to grow and flourish, scientific authorities also deserve some of the blame. “I don’t think they woke up that this was a serious problem until maybe 2008,” David Gorski says about the growing antivaccine sentiment. George Washington University’s Hotez notes that “the office of the surgeon general, the secretary of Health and Human Services, and the head of the CDC have not been very vocal on this issue.” True, the CDC, the Food and Drug Administration, and other governmental organizations feature accurate and up-to-date information about vaccine risks on their websites. But that is very different from launching a concerted communications campaign to ensure that the public retains faith in vaccination.

Some outspoken scientists may have actually increased the polarization on this issue. For example, calling those against vaccines “scientifically illiterate”—or, as CDC vaccine expert Stephen Cochi reportedly put it to one journalist, “junk scientists and charlatans”—may just lead to a further circling of the wagons.

The most promising approach to the vaccine-autism issue comes from the government itself. Consider the work of Roger Bernier, a CDC scientist who turned to emphasizing the public-engagement aspects of the vaccine problem after hearing one parent declare any new government research on the topic “dead on arrival.” The central problem Bernier has confronted: how to deal with a situation in which so many parents are unswervingly convinced that their children have been harmed, in which they could be harming their children even more by using untested therapies, and in which dangerous misinformation abounds.

“There’s no end to the kind of noise people can make about vaccines,” he observes. “And so if you’re in the vaccine community, what’s the best approach to this? I don’t think it is ignoring people.” Instead, Bernier has headed up a series of award-winning projects that bring together average citizens with scientists and policymakers to reach joint recommendations on vaccines, holding public dialogues across the country to break down boundaries between the experts and everybody else, literally putting multiple perspectives around a table. His example suggests that while science’s first and greatest triumph in this area was to develop vaccinations to control or eradicate many diseases, the challenge now—not yet achieved, and in some ways even more difficult—is to preserve public support for vaccine programs long after these scourges have largely vanished from our everyday lives.

“The problem is not only research,” Bernier says. “The problem is trust.”

Article 10 Little by Little

LAURA BEIL

As food allergies proliferate, new strategies may help patients ingest their way to tolerance.

Considering that food is full of foreign proteins, it makes sense that the intestine is the immune system’s version of Grand Central station. It’s the largest organ to regularly sweep up and annihilate molecules that don’t belong. And because food comes from outside, it’s no surprise that some people have allergies to it. The bigger mystery is why most don’t. Somehow during evolution, the immune system and food components developed a secret handshake that allows munchables to pass without a fuss.

Most of the time, that is. Once relatively rare, serious allergies to peanuts, milk, shellfish and other foods appear to be afflicting a growing number of children. The U.S. Centers for Disease Control and Prevention reports that food allergies now affect about 4 percent of American children, almost 20 percent more than a decade ago. Scientists have ideas to explain the increase—from children raised with too few germs exercising their immune cells to modern food processing that alters natural proteins and adds nonfood substances never before consumed in large amounts. Some studies implicate the use of certain vitamins and even childhood obesity.

Despite the growing problem, doctors have had little to offer beyond advising patients to avoid allergic triggers. Recently, though, studies have raised hope that new approaches might one day treat food allergies and perhaps even prevent the next generation from developing them. “I think we’re all encouraged that progress has happened relatively quickly,” says Robert Wood of Johns Hopkins Children’s Center in Baltimore. Nonetheless, he cautions, a true, effective therapy is still years away.

If nothing else, the experiments have shown for the first time that curing food allergies is at least possible, even if the long-term prospects aren’t clear. Some children who began studies with immune reactions to even the smallest trace of peanut can now eat up to 13 nuts in one sitting. Similar dramatic gains have been seen for milk and egg allergies. Only a few children have been involved in each study so far, but researchers are cautiously increasing the number of enrollees and are emboldened to try other, more innovative methods.

“It’s the beginning,” says Andrew Saxon of UCLA’s David Geffen School of Medicine. In a field with a history of false starts and disappointment, he says, “it’s the real beginning this time.”

New Strategies

Oral Tolerance

Eating tiny amounts of peanut protein can gradually retrain the immune system to tolerate allergens by avoiding the IgE antibody-mediated response.

Vaccines

Hiding a peanut protein in a bacterial cell or injecting a gene-based vaccine may help patients tolerate peanuts by avoiding IgE-activated response.

Tapping Parasites

Scientists are harnessing proteins from helminth parasites that block the activity of mast cells and other immune players to quell allergies.

Curing food allergies has been challenging, in part, because there are many ways to go wrong. No body process is simple, but the immune system is so terrifically complex that Nobel laureate Niels Jerne once likened it to a foreign language operating independently of the brain. Immunity (or allergy, which is essentially immunity run amok) involves legions of cells that not only chatter back and forth at lightning speed each time they encounter something new, but also remember their conversations for a lifetime.

Simply speaking, when an antigen such as peanut protein passes through the digestive tract, it is first greeted by an “antigen-presenting” cell. This cell functions like a maître d’, escorting guests to their table and alerting the waiter. The waiters—it’s a fancy establishment, so there are more than one—are the T cells, which help the body recognize friend from foe. When food allergy develops, the T cells, instead of welcoming the peanut as the valued customer it is, initiate a process that alerts another type of immune cell, called a B cell. B cells make antibodies—the body’s bouncers. In the case of food allergies, B cells start to make IgE antibodies, which when bound to a peanut protein summon mast cells. Mast cells come armed with chemical weapons. Substances released from mast cells, including histamines and cytokines, lead to the most frightening symptoms of food allergies: hives, vomiting and anaphylaxis, which can be deadly. Once the IgE antibodies are on patrol, the peanut protein finds itself on the blacklist, and will be violently ejected by security should it try to return.

Second Chance for a First Impression

Treatments for pollen, cat dander and other nonfood allergies can slowly refocus the immune system, starting with injections of antigen in amounts too minuscule to provoke IgE antibodies and gradually increasing the dose. In the presence of minute amounts of the antigen, immune responsibility gradually shifts back to the more friendly reception of T cells and antigen-presenting cells. The problem is, attempts in the 1980s to treat food allergies with shots produced severe, even life-threatening side effects. The risks from treatment exceeded the risks from the allergy itself. “With that, we quit trying for a while,” says Wesley Burks of Duke University Medical Center in Durham, N.C.

But as the number of children with food allergies began to rise, so did renewed interest in research. (The U.S. National Institute of Allergy and Infectious Diseases alone increased funding for food allergy studies from $1.2 million in 2003 to more than $13 million in 2008.) Allergy experts spooked by the results of early experiments began to consider new approaches, among them giving allergy treatment orally rather than by injection.

Food Allergy Facts: Serving Size: U.S. Population

Children affected ≤ 4 years	6–8%
People affected ≥ 10 years	4%
Food-induced anaphylactic reactions per year	30,000
Percentage of ER visits for anaphylaxis food-allergy related	34–52%
Hospital admissions per year, food-allergy related	2,000
Deaths per year, food-allergy related	200
U.S. children affected ≤ 5 years by peanut allergy	1%
Total U.S. population affected by allergy to peanuts, tree nuts or both	3 million
COMMON FOOD ALLERGENS: FISH AND SHELLFISH SUCH AS SHRIMP, CRAYFISH, LOBSTER AND CRAB; EGGS; MILK; SOY; PEANUTS AND TREE NUTS SUCH AS WALNUTS. RECOMMENDED TREATMENT: AVOIDANCE HALF OF PEOPLE WITH FOOD ALLERGIES DEVELOP A REACTION AFTER ACCIDENTAL EXPOSURE OVER A 2-YEAR PERIOD

Burks and others had long thought that the problem with previous treatment attempts was the shots themselves. Research suggested that the immune response to food particles introduced by mouth was safer and more likely to lead to tolerance. In 2003, for example, researchers writing in the New England Journal of Medicine noted that British infants were more likely to have peanut allergies if their skin had been exposed to creams containing peanut oil, instead of a first exposure through food. Experts believe that the human body is more inclined to tolerate substances introduced through the mouth, precisely because the digestive system must deal with the large amount of outside proteins in food and with the colonies of bacteria that live peacefully in the gut. “Understanding oral tolerance has been recognized as a key component in developing strategies for preventing and treating food allergies,” Burks writes in the August issue of Current Opinion in Allergy and Clinical Immunology.

So guardedly, and under intense medical supervision, he and his colleagues began giving children infinitesimally small amounts of peanut powder to swallow (mixed with food), and increasing the dose in halting increments. In the August Journal of Allergy and Clinical Immunology, the researchers report that after months of treatment, 27 of 29 severely allergic children were able to eat about 13 peanuts. The most common reactions during the treatment were sneezing, itching and hives. Molecular analysis also revealed clues to explain how oral tolerance therapy might dampen the allergic response. Tests of the immune cells in the treated children found that after the experimental therapy, T cells were more likely to contain genes active in cellular suicide, or apoptosis, a finding that “is novel and may provide insight into the mechanism of oral immunotherapy,” the scientists write.

Tolerance to a T

Under the oral tolerance scenario, almost any food antigen could be a candidate for therapy. For example, in October 2008, Wood from Johns Hopkins and his colleagues released results of the first randomized trial using oral tolerance to treat milk allergy—a study of 20 children that 19 completed. At the beginning, no child could drink more than about one-fourth of a teaspoon of cow’s milk without a severe immune reaction. Writing in the Journal of Allergy and Clinical Immunology, the scientists reported that four months after starting treatment, children were able to tolerate from 2.5 to 8 ounces of milk. A follow-up published online in the journal this August described the experiences of more than a dozen children who were able to continue to gradually increase their intake of milk. While the results are encouraging, the team also noted that many of the children experienced side effects such as itching and hives that should be better understood before such a treatment becomes widespread.

Oral therapy isn’t the only way scientists want to try to reeducate the immune systems of allergic children. For example, studies will soon be underway with a vaccine that encapsulates modified peanut proteins in E. coli bacteria. With the protein tucked inside a bacterium, researchers hope to sneak in under the IgE antibody radar, but still alert the nonallergic components of the immune system. “By altering the peanut proteins just a bit, but in very specific ways, it is hoped that the IgE will not as readily see the vaccine,” says Scott Sicherer of Mount Sinai School of Medicine’s Jaffe Food Allergy Institute in New York City. Other modifications should improve safety and effectiveness, he says.

Meanwhile, the idea of giving food-allergy shots has even been revived. UCLA’s Saxon is trying to develop a genetic food-allergy vaccine—injecting not the peanut protein this time, but the gene that codes for it. The idea is to slip the gene into the maître d’/antigen-presenting cells and coax those cells to make the peanut protein. If the antigen-presenting cells produce the peanut protein robustly enough, the responsibility for the immune response might shift away from the IgE antibodies and mast cells.

“The idea of gene vaccines has been around a long time,” Saxon says. “The biggest bugaboo is getting it where you want.” If the introduced gene doesn’t find the correct cell, the protein won’t get made, or it won’t get made in the right place. However, in July, he and his colleagues described a molecule they believe can deliver the gene straight to the antigen-presenting cells. The idea is still being tested in mice.

Promise from Parasites

Other future strategies take lessons from the past, by considering the origin of food allergies. Studies have long suggested that such allergies are a wayward version of the immune reaction to infection with human parasites such as helminths, the worms that cause river blindness, elephantiasis and other diseases. “If you study people in those countries where there are normally multiple parasites, the incidence of allergy is very low,” says Marie-Hélène Jouvin of Beth Israel Deaconess Medical Center in Boston. Yet when children are treated for parasites, she says, the tendency for allergy rises.

Parasites survive by manipulating the immune system to grudgingly allow their presence. Since a helminth attaches itself to the inside of the intestine, the parasite’s survival depends on creating a tolerant environment inside the body. One tactic was revealed in 2007: A research team led by scientists from the University of Strathclyde in Glasgow reported in Nature Medicine that a substance isolated from a helminth was able to disarm mast cells.

Jouvin and her colleagues hope to soon receive approval to study a kind of oral therapy that might mimic the natural protection from food allergies that follows a parasitic infection. Using helminth eggs, researchers hope to test a treatment designed to trick the immune system into reacting as if it were accommodating a parasite (minus the actual worm), and tempering the mast cell response.

The helminth experiments would also be consistent with the “hygiene hypothesis,” one of the leading theories to explain the rise in the prevalence of allergies—that children raised in the indoor, antibacterial age lack the exposures to antigens of their ancestors, and so the children’s immune systems don’t always develop as nature intended. “Children are born with an immune system that is immature,” Jouvin says.

Other clues, too, point to food allergies as a consequence of an immune system too bored in early life. Parents are often advised to avoid giving children foods that are particularly prone to causing allergies for about the first year of a child’s life. But many studies are questioning that conventional wisdom, including one described late last year in the Journal of Allergy and Clinical Immunology. Researchers examined the prevalence of allergies among Jewish children in Israel and Great Britain, finding that the British elementary school children had almost 10 times the risk of peanut allergies (SN: 12/6/08, p. 8).The biggest difference in diets? Israeli children are fed peanuts earlier and more frequently than British children. The researchers also note that in the Middle East, Asia and Africa, peanuts are generally consumed in infancy and peanut allergies are uncommon.

“Our findings raise the question of whether early and frequent ingestion of high-dose peanut protein during infancy might prevent the development of peanut allergy,” wrote an international research team funded in part by the National Peanut Board. “Paradoxically, past recommendations in the United States and current recommendations in the U.K. and Australia might be promoting the development of peanut allergy.” Some countries, such as Sweden, have now abandoned the advice to avoid the introduction of certain foods early in life.

American doctors remain wary about early exposure to allergy-prone foods, believing the information still isn’t conclusive enough to change official recommendations. “We will do the same things we’ve been doing until the ongoing studies have given us better guidance,” Burks says. In particular, doctors are awaiting the results of a large study underway in Great Britain, in which children are being randomly assigned to eat peanuts in infancy or avoid them until later (for more information, see 

www.leapstudy.co.uk

). Only when these and other studies conclude will experts know whether the secret weapon against food allergies ultimately lies in the culprit itself.

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