As more and more Americans receive their COVID-19 vaccinations, the highly publicized debate about the innovative drug’s efficacy continues. While the vaccine was rolled out to the public in record time, its development is based on decades of previous research on similar viral infections and messenger RNA (mRNA). As Krisberg highlights in her article for The Nation’s Health, the challenge of developing an effective vaccine is only the first step in the process of winning the battle against COVID-19. The next – and as some would argue, most important – step in the process is actually getting people vaccinated (6). This may be the biggest challenge yet. 

​Educating the public, and particularly those who are at increased risk of contracting COVID-19, on the benefits and risks of receiving the vaccine is the current priority of health communication professionals. An understanding of the political climate in the United States and other social factors certainly influence the strategies that are used to persuade individuals to roll up their sleeves. But a deeper analysis of the historical underpinnings that surround vaccines in general, and the social implications involved, is necessary to fully grasp the public’s response to the current crisis. By viewing the vaccination dilemma through a health communication lens and using the development of the canine distemper vaccine and the human papillomavirus (HPV) vaccine as examples, I hope to shed light on this pressing public health issue.

The growing popularity of hunting and pet ownership in late nineteenth and early twentieth century Britain led researchers to begin their investigation into the cause of canine distemper. Early studies sought to isolate and identify the agent responsible for the disease, eventually leading to the development of several experimental vaccines with varying levels of effectiveness. This complex process spurred advances in both animal and human medicine, including the use of ferrets in research (which would prove integral to research on human influenza), new protocols for vaccination and the two-stage vaccine method of immunization (2). 

​Along with new scientific knowledge, distemper research contributed to the development of creative advocacy and funding campaigns that would continue to influence health communication in the coming century. In 1923, the editor of England’s popular magazine The Field established the Field Distemper Fund, allowing the public to participate in an initiative that brought together veterinarians, medical researchers, breeders and various professional associations in the pursuit of a common goal. Advertisements appearing in the magazine encouraged individuals and organizations to contribute to the fund. As a result, over 3,500 donors from around the world became stakeholders in the project. As Bresalier and Worboys point out, “not only did individuals send in donations, but they also followed the progress of the research in popular publications, corresponded with NIMR and WPRL researchers, volunteered pets for trials, and, after 1931, were willing to pay to have their dogs immunized by one of the two methods available” (2). The development of the distemper vaccine highlights a significant shift in public engagement with medical research and the role of communication and health promotion in science and medicine. 

​Misinformation about the prevalence of HPV and the fear that the vaccine will promote adolescent promiscuity have made some parents hesitant to have their children vaccinated. While the vaccine has been approved for both males and females, the benefits of vaccination are certainly greater for females. This fact, along with the knowledge that HPV can also be prevented through abstinence, has led to a wide range of responses from both adolescents and parents. Engels emphasizes this disparity, citing “a significant gap between parents who are in favor of mandatory TDAP (tetanus, diphtheria, and pertussis) vaccine and those in favor of mandatory HPV vaccine… suggesting that many hold the view that HPV can be avoided through methods other than vaccination” (3). She describes making the vaccine mandatory as a new form of biopower and a strategy of normalization, resulting in a shift in attitudes, behaviors and norms. As health communication professionals work to dispel the myths surrounding the HPV vaccine, they’ve begun to incorporate creative methods of engaging parents and adolescents. For example, researchers at The Ohio State University developed and tested a comic book designed to entertain young people while educating them about the dangers of HPV and the benefits of vaccination (5). 

​While the COVID-19 vaccine and the regulations surrounding it continue to spark controversy in the United States, health communication professionals are tasked with the difficult challenge of not only finding effective ways to share important information, but also influencing individual health behavior on a large scale. In addition to traditional print publications like those used in the fight against canine distemper and even the more recent campaign for HPV vaccination, new tools and technology like social media present new challenges and opportunities to reach the public. The strategic use of these tools could determine the outcome of the current pandemic and pave the way for future advocates in the realm of health literacy. 

The following essay is a recent assignment for a class I'm currently taking, the Interface of Art and Disease, at the University of Findlay.

Throughout history, religion and spirituality have played vital roles in the understanding of disease and the practice of medicine. Connections between religious beliefs and disease can be found in almost every culture, and the interplay of science and religion has often led to controversy that has both hindered and spurred medical advancement. Many people turn to faith for a better understanding of the afflictions they experience and an explanation for their pain. This is especially apparent in the case of the infamous Salem witch trials. 

​Founded by the Puritans in 1629, the Massachusetts Bay Colony was established to be a model society, a Christian utopia that would provide the rest of the world with a beacon of Biblical goodness. So when several girls in Salem Village were afflicted with unexplainable symptoms in 1692, the idea that their fits were caused by some form of sin (witchcraft) seemed the obvious conclusion. In the centuries since the Salem witch trials, many theories have emerged in an attempt to explain the unusual events that led to dozens of deaths, ranging from political conflict and economic hardship to Indian raids. More recently, some historians have theorized that an underlying medical cause may be at the root of the afflicted girls’ strange behavior (3).  

In the 1970s, one researcher proposed ergotism as a possible cause of the Salem girls’ symptoms. Ergot, a fungal disease that affects rye and other crops, is dangerous for humans who consume plants that contain the chemicals produced by the fungus. Ergotism can cause symptoms including tremors, hallucinations, prickling sensations, seizures and muscle spasms. Cool, wet weather and an overreliance on rye as a staple crop have led some historians to believe that many reported episodes of “witchcraft” in Europe may have been triggered by ergot (2). While the symptoms of ergotism certainly parallel the experiences of the afflicted Salem girls, this theory and other medical conditions like meningitis don’t explain some accounts of the girls’ behavior. For example, the victims only exhibited symptoms in the courtroom when they were cued to do so by those in authority (3). 

Of course, this evidence doesn’t automatically negate a medical cause. Other researchers have argued that the symptoms exhibited in the courtroom could have been the result of trauma or coercion. The societal expectations of girls and women in seventeenth-century New England would have put the young girls, who ranged in age from eleven to twenty, in a position of powerlessness, potentially allowing them to be manipulated or even forced against their will to play the assigned roles as victims of witchcraft (3). Regardless of the root causes that led to the events in Salem, religion played a pivotal role in the way the trials played out. 

The Salem witch trials are a perfect example of the way religion has been recruited to fill in gaps in science throughout history. Without the knowledge of ergotism and other infectious diseases, the technology needed to properly diagnose physical symptoms or an understanding of the manifestations of psychological trauma, the people of Salem were left with one explanation: witchcraft. Their devout Puritan society naturally concluded that the events they were experiencing stemmed from the sin committed by the “witches” living among them. 

The notorious episode in Salem is one of many historical examples of the interplay between fanatical religion and society. But what happens when science and religion work together to address disease and public health? The popular BBC drama Call the Midwife, based on the memoirs of midwife Jennifer Worth, depicts the many successes of the partnership between the National Health Service and religious institutions in the East End of London in the 1950s and 1960s. In her commentary on the show, sociology professor Ellen Idler discusses the complexity of the relationship between religion and public health, pointing out that “there is a considerable amount of research showing that higher levels of religious participation in Western countries are associated with lower rates of mortality.” She emphasizes the World Health Organization’s focus on the social determinants of health, arguing that the social capital that a religious institution like Call the Midwife’s Nonnatus House holds in its community plays a vital role in the healthcare and wellbeing of some of London’s most economically-disadvantaged residents (1). 

​In later seasons of Call the Midwife, the still-timely issue of abortion and the ethics surrounding birth control are addressed. The main characters, including the young midwives, the sisters of Nonnatus House, doctors and low-income residents of Poplar, demonstrate the diversity of perspectives on a topic that still causes heated debate today. There is a clear struggle between the religious beliefs of some devout characters and the immediate healthcare needs of others, and this tension serves to highlight the larger existential conflict that characterizes the relationship between religion, science and society. More than half a century later, women’s healthcare and abortion continue to dominate the conversation and raise questions about religion’s role in the public health of a democratic nation. 

The Salem witch trials and the historical events depicted in Call the Midwife bring attention to the disparate roles that religion has played in health and medicine throughout human history. Arguments can be made that science and religion are two sides of the same coin, yet this view has led to countless deaths and disasters. It has also led to reforms in healthcare that removed barriers, allowing entire populations of disadvantaged people to access care and a better quality of life for the first time. The question of whether religion has been more of a help or a hindrance in the advancement of medicine and the health of populations has no straightforward answer. At every point in history, it has been both. Because the religion of any culture tends to weave its way into the fabric of everyday life, it can’t easily be disentangled from the threads of science, medicine and nature that also sustain us. The interaction of these sometimes contradictory elements can only be acknowledged and commented upon, often with the advantage of hindsight. Of course, the recognition of such relationships doesn’t always lead to answers either, as many survivors of the Salem witch trials realized when they were forced to grapple with difficult questions, like the one Ray addresses in his book: “How could a deeply religious society shed its feelings of guilt after realizing that it was responsible for killing innocent people in the name of God?” (3). While we’re not executing people accused of witchcraft in the US today, I would argue that we’re still wrestling with some of the same questions that plagued villagers in 1692. 

Sources
1. Idler, E. (2016, April 13). To see how RELIGION boosts public health, WATCH 'call the Midwife' (commentary). Retrieved March 02, 2021, from https://religionnews.com/2016/04/13/call-the-midwife-religion-health-care/
2. M. Harveson, R. (2017, July 27). Did a Plant Disease Play a Role in the Salem Witch Trials?. Julesburg Advocate (CO). Available from NewsBank: Access World News: https://infoweb-newsbank-com.ezproxy.findlay.edu/apps/news/document-view?p=AWNB&docref=news/165EBA002AD17CA0.
3. Ray, B. C. (2017). Satan & Salem: The witch-hunt crisis of 1692. Charlottesville, VA: University
of Virginia Press.

​While I’m not a sea swimmer, I can relate to the therapeutic experience Katherine describes in the article she wrote for The Outdoor Swimming Society. The story of her relationship with water and her adult diagnosis of autism are inseparable. She even gives us a glimpse into her winter of hospital visits and diagnostic tests as she awaits an explanation for her persistent abdominal pain.

Of course illness is only one manifestation of winter, but it certainly demands its share of rest and retreat. As Katherine puts it, “winter is asking me to be more careful with my energies and to rest a while until spring.” Some would say the world is enduring a collective winter of sorts at the moment. And while we anxiously await the spring, the best prescription for our wintering souls may be this book, a hot cup of tea and a warm blanket. 

If you enjoyed the book, check out Katherine’s podcast The Wintering Sessions.

​Christmas is almost here, and if you’re anything like the rest of us, you probably have a few gifts left to wrap. Fortunately, I’ve discovered a few handy hacks that make wrapping quick, easy and painless. Plus, they’ll have everyone on your list admiring your crafty, eco-friendly handiwork!

​Researchers have studied the strong connection between addiction and distance running, proving that many recovering addicts have a unique disposition for the sport. For many, one obsession is replaced by another (usually less destructive) one. The traits that can predispose a person to addiction can also produce fierce athletes. 

We hear less about runners who struggle with chronic pain. Of course, the cause of pain determines whether or not a chronic pain warrior is physically able to run without causing further damage. But those who continue to run through the pain, like those who have turned to running as an anti-drug, have a unique mindset and stamina that can lead to success in running and in life. 

But what about endurance athletes who already live in a chronic pain state? The jury is still out on this one. We know that activities like running increase feel-good hormones that can help reduce pain, but further research is needed to explore the relationship between chronic pain, endurance and performance.

As a runner who lives with chronic pain, I have my own theories. I think running appeals to me because it puts the ball back in my court. I didn’t choose chronic pain, but I can choose to run. And the pain associated with running is one that I can practice some control over with proper training, recovery and determination. That feeling of control, coupled with the mental fortitude required to run long distances with chronic pain, gives me a sense of power over my pain. 

Running isn’t an easy sport, and it certainly isn’t for everyone. But if you’re interested in giving it a try, keep in mind a few tips to start running as a chronic pain warrior:

​Your doctor can help you decide if running is safe for you and may be able to give you some recommendations based on your diagnosis and current fitness level.

​A general rule of thumb for beginner runners is to increase your weekly mileage no more than 10% each week. Runners with chronic pain should be especially mindful of this rule and give their bodies extra time to adapt. 

​Any running routine, from the low-mileage beginner plan to an elite training regimen, requires adequate rest and recovery. Take time to listen to your body and don’t ignore any unusual aches or pains. There’s nothing wrong with taking a day off!

Are you a runner with chronic pain? Share your tips in the comments!

Resources:
Effective Options for Runners with Chronic Pain
How Training Helps You Handle Pain
​Tips on Confronting & Managing Chronic Pain
Is It Safe to Run If You Have Chronic Pain?