Health Wanted: Worker Maladies

The Episode

If you’ve ever found yourself muttering the phrase “this job is killing me,” take a moment to be grateful you mean it metaphorically and not literally. In this episode of Health Wanted, host Laurel Bristow dives into forgotten occupational diseases—from jobs that turn you yellow to jobs that melt your face off.

She’s joined by guest Linda Forst, MD, to explore workplace safety today, in the United States and around the world.

Listen to the episode now

The Listener Questions

How do I respond when hear someone say that we shouldn’t care if others get vaccinated, because vaccines will protect the individual?

First and foremost, we want others to get vaccinated so that they are protected, too. Vaccines work very well to prevent the worst outcomes of disease, and some work well enough to prevent disease entirely.

They work so well that a lot of people seem to forget that the reason we don’t face a high morbidity and mortality from certain infectious diseases anymore is because of vaccines.

But we still people to get vaccinated because, while it’s true a lot of vaccines have very high efficacy on the individual level against disease, none of them offer 100% protection and not everyone can get them (like infants or the immunocompromised). To cover those who cannot be vaccinated, we rely on herd immunity.

To understand herd immunity, you first have to understand what’s known as the basic reproduction number, or R0. This is the average number of people that an infected person will infect. For flu it’s a little over one, and for measles it’s between 12 and 18.

The herd immunity threshold is the percentage of a population that needs to have immunity to a pathogen to bring the R0 below one. That means that cases decline until the R0 is zero, meaning someone who is infectious is unable to encounter a susceptible person and transmission ends.

There is a very basic calculation for the herd immunity threshold that uses the R0 but the gist of it is: The more contagious a pathogen is, the more people need to have immunity to reach that threshold.

The best time for people to get vaccinated is in childhood before they are ever exposed to the pathogen and before they enter an environment that has a high risk of rapidly spreading disease, like school. So, if you do something like remove requirements that kids get their vaccines before they can enroll, you’re not only going to have the unvaccinated children of people with vaccine hesitancies in school. You’re also going to have unvaccinated children of people who just didn’t get around to it, because it wasn’t necessary anymore. And you’re going to have children who cannot get vaccinated because they are immunocompromised and are no longer protected by herd immunity.

But school mandates ending are not the only threat to herd immunity. If we take seriously the rumors that the Food and Drug Administration wants to break up multi-pathogen childhood vaccines into individual doses (for no scientific or safety reason), which would require even more doctors’ visits, you’d expect that vaccination coverage would drop even further simply due to inconvenience or cost.

Additionally, over half of kids in the U.S. get their vaccines through the federally funded Vaccines for Children program. Which vaccines are included in the program is determined by the Center for Disease Control and Prevention’s advisory committee. If they choose to remove certain recommendations for childhood vaccines, a lot of kids will be left without an option to get vaccinated, opening that gap even further.

These conversations can be hard, because people will often talk about how other countries, like Sweden, don’t have school vaccine mandates. And that’s true, but the Swedish just voluntarily get their kids vaccinated. Vaccination coverage in the country for things like diphtheria, tetanus, pertussis, measles, mumps, rubella, polio, pneumococcus, and haemophilus influenzae b is over 97%.

Do coffee enemas actually cure cancer or have any other good or bad effects?

The idea that coffee enemas can cure cancer comes from something called Gerson therapy, which was started by Max Gerson in the 1930s. It involves a strict diet and lifestyle that includes coffee enemas.

The thought is that putting coffee up the rear causes the caffeine to stimulate the liver to open the bile ducts and purge the body of unnamed “toxins.”

People make many claims about coffee enemas: that they’re a “detox,” that they stimulate the liver and gallbladder to purge your system, that they stimulate glutathione production, and that they can detox your large intestine. Of course, there is no evidence that coffee enemas do anything they claim to do.

They are also potentially dangerous, causing burns when people don’t realize how hot the coffee still is. They can also cause irritation or damage to the colon, and they can cause dehydration. You also will get more caffeine from just drinking coffee.

Should we all be getting MRIs instead of or as a supplement to mammograms? 

We shouldn’t necessarily be getting MRIs in addition to, or instead of, mammograms, but we should be using risk assessments as part of the decision-making process for what tests to get.

These risk assessments take into account certain factors that put someone at higher risk for breast cancer—like age of your first period, family history, genetic risks, and if you've ever breastfed or had a baby—or identify people for whom mammograms might not detect cancer as well as an MRI.

For example, people with particularly dense breasts have less accurate mammograms, because it’s harder to see what’s going on. So, that’s a question in these assessments that can let someone know if they should get additional screening.

MRIs have their benefits, but they’re not perfect. They have a risk of false positives when they identify abnormalities that aren’t cancerous. They also require you to be in an MRI tube for 30 to 60 minutes and are much more expensive.

But they are still better at detecting cancer early in high-risk women. The fastest way to know if you are high risk is through these screening tests, which you can take yourself online.

Catch all the listener questions and Laurel’s answers on the full episode of Health Wanted by:

• Streaming at wabe.org or the WABE app
• Subscribing on Apple or Spotify
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