Sunday, August 31, 2008

How Much Is Your Health Worth?

How much is your health (specifically, improving and then maintaining it) worth to you?

How much time are you willing to spend to do what it takes? How much of an effort are you willing to make? How much of your money would you invest to improve your health and live a healthy life?

Sadly, while the vast majority of people claim their health is of paramount importance to them, they are unwilling to invest the time and effort required to improve their own health. They particularly bristle and stall at the notion of having to invest their own money to do the necessary things to improve, and then maintain, their health; foolishly believing, 'my health insurance should do that."

How much is your health worth to you when you lose it to some major illness or disease?

Well now, for everyone, the answer is crystal clear. "Spare no expense! Gimme the works. I want all the latest and the great technologies: MRI, CT's, surgeries, drugs, tests, more tests and procedures and more drugs. Whatever it takes man; money is not an option! I don't want to die! And, besides, my insurance will cover that!"

Which takes more time and effort? Doing the simple things it takes to be healthy like exercising regularly, buying, cooking and eating healthy foods, spending quality time with your family and doing things you enjoy to to control stress? Or, being sick and going for repeated doctor's visits or out of town trips to specialists, trips to the pharmacy, hospital stays or tests, recovering from surgeries or procedures, fighting for insurance benefits, deciphering and arguing about medical bill, etc.?

Which costs more? Investing in things that promote health, like having a health coach and going for wellness care, having a gym membership, buying quality foods, buying a good bed, going for a weekend get-away with your family, etc.? Or, paying insurance deductibles, repeated co-pays for doctor's visits, expensive tests-procedures and surgeries, the costs of multiple drugs and medical devices, visiting nurses, traveling expenses, lost time from work or perhaps even losing your job?

(Hint: medical bills are the number one cause of personal bankruptcy and a major reason for industry outsourcing.)

Which, (being healthy or being sick) will be the major determining factor in your quality of life, your life span, your happiness, your self-esteem, your energy level, your outlook on life and your relationships with your spouse and family?

Can you think of anything more important to you than your health and the health of your loved ones?

Everything in life can be seen as a continuum: either it is getting better, or it is getting worse. How is your health now as compared to five years ago? What will your health be like five years from now?

What are you doing, each and every day, to improve your health? Nothing? Almost nothing? Then how can you expect to BE healthy? Are you living with the delusion, as so many are, thinking that by taking daily medications to control your blood pressure, to lower your cholesterol, to manage your blood sugar, etc that you are healthy? If you were healthy, you wouldn't need the medications!

Do you really believe your health insurance will keep you healthy? It only pays for disease care. Isn't that, by definition, too late?

Can you think of three things that you know that you can do that would make you healthier? Did you think of taking more drugs, having more tests or going for surgery? Or, did you think you could eat better, exercise more and control your stress better? What drugs can do that for you?

Achieving and having health throughout your life is possible and easier than you think.

First and foremost, you need to understand exactly what health is, and is not.

Then, you must take personal responsibility for your health, making daily lifestyle decisions to promote health.

Next, you need to make your health a high priority goal and make a commitment to yourself to achieve it.

And, finally, you must be open to making the requisite changes in your life and be willing to work on being healthy every day.

My suggestion: find a health coach to help keep you focused on your health.

Friday, August 22, 2008

Who Guards Against Gardasil?

Please see my post of the 08-20-2008, NYTimes article: "Drug Makers' Push Leads to Cancer Vaccine's Rise"

The following is an article that I wrote that was published in The North Adams Transcript, 03-05 2007: “Who Guards Against Gardasil?”


Who Guards Against Gardasil?

Peter D. May, DC

The North Adams Transcript: 03-05-2007

Recently the Governor of Texas issued an order making Texas the first state to require that schoolgirls get vaccinated against a sexually transmitted virus that is believed to cause cervical cancer. Eighteen other states are pursuing similar laws. Governor Patrick has proposed taxpayer funding for the same vaccine in our state. Their claim is that they want to save lives. And, of course, with that kind of claim, everyone jumps on board.

But what’s wrong with this picture? I don’t know about you, but I’m pretty wary of drug companies and their claims. This new vaccine, Gardasil, is being brought to you by Merck, the creators of Vioxx. Remember the claims they touted about that? The FDA attributes 27,785 deaths directly to Vioxx. And, I guarantee that is way under-reported.

In Texas, of all places, a jury found Merck negligent in the death of a 59-year-old triathlete who used Vioxx, awarding the man's widow a total of about $253 million. Oops! Sorry! Now they are mandating a Merck made vaccine that may save 3700 lives per year. How does this happen? Well, in Texas it is easy to understand. One of the Merck's three lobbyists in Texas is the Governor’s former chief of staff.

What is it with us and our blind faith in drugs, drug companies and their licensed drug pushers? Better health through better chemistry is a model that has failed! But, I digress.

So, let’s take a closer look at Gardasil.

According to their own TV commercial: 70% of all cervical cancers MAY BE caused by a virus and Gardasil MIGHT help. That’s a bunch of mights and maybes.

But more importantly: they want to give this vaccine to girls starting at age nine. Remember, drug companies do not test drugs on kids. There have been no Gardasil trials in girls, only women ages 16-26, and these trails have all been short term (less than five years) and seriously flawed. Need I say more?

According to Merck’s own web-site: GARDASIL has not been evaluated for the potential to cause carcinogenicity or genotoxicity (but it did show a rise in arthritic conditions in the young women who took it). It is not known whether GARDASIL can cause fetal harm when administered to a pregnant woman or if it can affect reproductive capacity. And, unbelievably, the duration of (possible) immunity following a complete schedule of immunization with GARDASIL has not been established.


American kids are already the most vaccinated children in the world, yet they are among the sickest in all categories studied in fifteen industrial countries. The U.S. ranks last or next to last in infant mortality rates per capita, as well as sudden infant death syndrome. We also rank last or next to last in the number of cases of pediatric allergies, asthma, cancer, diabetes and hyperactivity and autism. Is there a link to rising rates and vaccines? The debate continues as the numbers soar.

And now they are pushing another vaccine to give our children; a vaccine (created by a drug company which in one experiment killed 27,785 people) that may be helpful for virus that, in rare cases, might lead to cervical cancer and may save 3700 lives/year in the US.

Interestingly enough, according to statistics from the Centers for Disease Control: nearly 2 million US patients catch an infection from the hospital each year and about 90,000 die. This could be prevented if doctors and hospital staff would wash their hands between patients. But, no drug company would profit from that, unless of course they create a new vaccine.



1. Subsequent, but unrelated, to my article the Texas legislature over-rode the Governor and Texas did not mandate school girl vaccines with Gardasil. However, as of October, 2009 the state of Virgina has mandated Gardasil vaccines for all girls entering middle school.

2. In my article I cite 27,785 deaths attributed to Vioxx, another Merck drug. However, later in 2007, Merck reached an out-of-court settlement for $4.85 billion (about $125,000.00 per plaintiff) for the 140,000 heart attacks and more than 55,000 deaths directly attributed to Vioxx. See related article: "Vioxx Settlement Is Classic Wall Street Denial: Bury the Losses and Say It Never Happened" (


See related CNN video at:

Thursday, August 21, 2008

NYTimes article: Drug Makers’ Push Leads to Cancer Vaccines’ Fast Rise

This article is an important read for many reasons. While it only touches the surface, it does give a basic understanding of how (award winning marketing and highly financed political and medical lobbying by Big Pharma) and why (blockbuster profits) largely untested, unnecessary and thereby dangerous drugs, are not only sold, but in this case, mandated by state governments, for mass consumption, the final phase of drug testing.

To date, according to the NYTimes article, there have been 9,749 “adverse events,” including 20 deaths. Remember, as the article says, all reports of adverse events (including deaths) are voluntary. Therefore, the actual numbers are multiples of those reported.

Article Highlights

1. Cervical cancer is rare in the US and is almost always preventable with routine PAP smears.

2. Gardasil raced through FDA approval to universal, even state mandated, use in only 6 months. Tens of millions of young girls have been vaccinated. Gardasil’s long term effects are not known. Voluntary reporting by doctors has revealed 20 deaths so far. (See my post: Who Guards Against Gardasil)

3. The vaccine offers partial protection against infection from human papillomavirus, or HPV, a common and generally benign sexually transmitted virus that can in rare cases cause cancer after years of silent infection. HPV is nearly universal and generally benign. Eighty percent of people will contract it in their lifetime and most will clear it on their own.

4. Award winning marketing, opened a lucrative new market (young girls) for vaccines and established Gardasil as the “Brand of the Year,” with projected annual sales in the US alone at $ 1.6 billion.

NYTimes: (Excerpted Article: to see the full article)

(all highlighting and emphasis in the article are mine)

August 20, 2008

The Evidence Gap

Drug Makers’ Push Leads to Cancer Vaccines’ Rise ELISABETH ROSENTHAL

In two years, cervical cancer has gone from obscure killer confined mostly to poor nations to the West’s disease of the moment.

Tens of millions of girls and young women have been vaccinated against the disease in the United States and Europe in the two years since two vaccines were given government approval in many countries and, often, recommended for universal use among females ages 11 to 26.

One of the vaccines, Gardasil, from Merck, is made available to the poorest girls in the country, up to age 18, at a potential cost to the United States government of more than $1 billion; proposals to mandate the vaccine for girls in middle schools have been offered in 24 states, and one will take effect in Virginia this fall.

The lightning-fast transition from newly minted vaccine to must-have injection in the United States and Europe represents a triumph of what the manufacturers call education and their critics call marketing. The vaccines, which offer some protection against infection from sexually transmitted viruses, are far more expensive than earlier vaccines against other diseases — Gardasil’s list price is $360 for the three-dose series, and the total cost is typically $400 to nearly $1,000 with markup and office visits (and often only partially covered by health insurance).

…In the United States, hundreds of doctors have been recruited and trained to give talks about Gardasil — $4,500 for a lecture — and some have made hundreds of thousands of dollars. Politicians have been lobbied and invited to receptions urging them to legislate against a global killer. And former state officials have been recruited to lobby their former colleagues.

…Merck’s vaccine was studied in clinical trials for five years, and Glaxo’s for nearly six and a half, so it is not clear how long the protection will last. …Some experts are concerned about possible side effects that become apparent only after a vaccine has been more widely tested over longer periods.

And why the sudden alarm in developed countries about cervical cancer, some experts ask. …cervical cancer is classified as very rare in the West because it is almost always preventable through regular Pap smears. …Indeed, because the vaccines prevent only 70 percent of cervical cancers, Pap smear screening must continue anyway.

…“Merck lobbied every opinion leader, women’s group, medical society, politicians, and went directly to the people — it created a sense of panic that says you have to have this vaccine now,” said Dr. Diane Harper, a professor of medicine at Dartmouth Medical School.

In receiving expedited consideration from the Food and Drug Administration, Gardasil took six months from application to approval and was recommended by the C.D.C. weeks later for universal use among girls. Most vaccines take three years to get that sort of endorsement, Dr. Harper said, and then 5 to 10 more for universal acceptance. … “In that time, you learn a lot about safety and side effects and how to use it,” Dr. Harper said.

…Health economists estimate that depending on how they are used, the two cervical cancer vaccines will cost society $30,000 to $70,000, or higher, for each year of life they save in developed countries — a cost commonly seen in treating people already suffering from deadly cancers. That number will be far higher if a booster is needed.

Looked at another way, countries that pay for the vaccines will have less money available for other health needs. “This kind of money could be better used to solve so many other problems in women’s health,” said Dr. Lippman at McGill. “Some of our provinces are running out of money to provide primary care. I’m not against vaccines, but in Canada and the U.S., women are not dying in the streets of cervical cancer.”

The vaccines offer partial protection against infection from human papillomavirus, or HPV, a common and generally benign sexually transmitted virus that can in rare cases cause cancer after years of silent infection. The Merck vaccine also prevents some genital warts that are caused by other strains of the virus.

Merck last May swept the 2008 Pharmaceutical Advertising and Marketing Excellence awards, and Gardasil was named Brand of the Year by Pharma Executive Magazine….The marketing helped make Gardasil one of Merck’s best sellers, with a projected sales of $1.4 billion to $1.6 billion outside Europe this year, and more from sales in Europe…

Aggressive pharmaceutical advertising is nothing new, but the campaign was a revolution for a vaccine. Vaccines were traditionally the orphans of the pharmaceutical world because they were cheap and not particularly profitable. But the two for cervical cancer are the latest in a wave of high-priced vaccines that have come to market since 2001, opening a lucrative new field.

…In country after country, Merck and Glaxo also appealed to politicians. Vaccines, unlike antibiotics, tend to be recommended or mandated by governments. …In the United States, 41 states have passed or begun considering legislation on cervical cancer, according to the National Conference of State Legislatures, and 24 have considered proposals to mandate the vaccine for girls, generally in middle school. …The only state to pass a bill requiring the vaccine for school entry is Virginia; it takes effect in October, after school begins, so will first apply in 2009.

Merck has a growing economic interest in Virginia. In December 2006, Merck announced it would invest $57 million to expand its Elkton, Va., plant to make Gardasil, helped by a $700,000 grant from a state economic development agency that is part of the executive branch. Two months later, Gov. Tim Kaine, who has been mentioned as a possible Democratic vice presidential candidate, signed legislation requiring Gardasil for schoolgirls. Four months after that, Merck pledged to invest $193 million more in the plant to make drugs and vaccines, helped by a state grant of $1.5 million.

Delacey Skinner, a spokeswoman for the governor, said the state’s vaccination program included an unusually broad freedom to decline the shot. To exempt children from other vaccines, parents must provide a medical reason; for Gardasil, they do not. “It is a very easy step that we can take to prevent a sometimes deadly but certainly serious form of cancer,” Ms. Skinner said.

…But, as in many states where cervical cancer legislation has been considered, there have been ties between drug makers and members of government. …Early last year, Merck announced that it would no longer actively lobby for state mandates.

…Many questions about the vaccines remain unanswered, including how long immunity will last. Even commercials for Gardasil say — in small print — that “the duration of protection has not been established.”

Dr. Harper said that in the data from Merck’s clinical trials, which she helped conduct, the vaccine was no longer protective after just three years in some girls. …She said she believed that at least one booster shot, and probably more, would be needed over a lifetime.

…Other independent experts worry that eliminating the two cancer-causing HPV strains covered by Gardasil and Cervarix might allow the other cancer-causing strains of HPV to increase in frequency, reducing the vaccine’s effect

The question of side effects, however, has nagged the vaccine. …The Centers for Disease Control asks health care centers to report side effects through its Vaccine Adverse Events Reporting System; reporting is voluntary. There have been 9,749 reports, almost all from doctors and nurses, of patients experiencing adverse events after receiving the vaccine, the agency announced in a joint report with the Food and Drug Administration at the end of June. Ninety-four percent of them were not serious, ranging from arm pain to fainting, and 6 percent were classified as serious, including blood clots, paralysis and at least 20 deaths.

…Countries and consumers must decide whether it is worth preventing cervical cancer with a costly vaccine. …Where there are Pap smear programs, few women die of cervical cancer. In the United States, it is responsible for 12,000 new cases a year and 3,600 deaths, most in women who did not get Pap smears, said Laurie Markowitz, head of the HPV working group at the C.D.C. (Women with H.I.V. are predisposed to the cancer.)

Indeed, cervical cancer does not even make the American Cancer Society’s list of 10 deadliest cancers. Among American women, it causes well under a 10th of the number of deaths caused by lung cancer or breast cancer.

Though classified as a sexually transmitted disease, HPV is nearly universal and generally benign. Eighty percent of people will contract it in their lifetime and most will clear it on their own.

…Meanwhile, the vaccines’ proponents are moving to the next frontier: older women and boys. Merck recently applied for approval to market the vaccine to women 26 to 45 and is conducting studies on vaccinating boys, who can get genital warts from HPV.

One rationale for inoculating boys is that entire populations should be vaccinated to achieve what is called herd immunity. But critics ask whether it is worth conducting a campaign on the scale of the one used against polio to eliminate a generally harmless virus.

Said Dr. Raffle, the British cervical cancer specialist: “Oh, dear. If we give it to boys, then all pretense of scientific worth and cost analysis goes out the window.”

Sunday, August 17, 2008

DNA Is Not Destiny (Excerpted Article)

This is a fantastic article that documents that our DNA is not our destiny; that gene expression, for better or worse, occurs throughout our lives, in response to environmental stimuli and stressors, with profound effects on our health and the health of our offspring. Therefore, we can influence our health based on environmental exposures that are within our control, and our lifestyle choices.

(all emphasis/highlighting in the article is mine)

DNA Is Not Destiny Ethan Watters DISCOVER: published online November 22, 2006 Excerpt: for full article go to:

The new science of epigenetics rewrites the rules of disease, heredity, and identity.

Back in 2000, Randy Jirtle, a professor of radiation oncology at Duke University, and his postdoctoral student Robert Waterland designed a groundbreaking genetic experiment that was simplicity itself. They started with pairs of fat yellow mice known to scientists as agouti mice, so called because they carry a particular gene—the agouti genethat in addition to making the rodents ravenous and yellow renders them prone to cancer and diabetes. Jirtle and Waterland set about to see if they could change the unfortunate genetic legacy of these little creatures.

Typically, when agouti mice breed, most of the offspring are identical to the parents: just as yellow, fat as pincushions, and susceptible to life-shortening disease. The parent mice in Jirtle and Waterland's experiment, however, produced a majority of offspring that looked altogether different. These young mice were slender and mousy brown. Moreover, they did not display their parents' susceptibility to cancer and diabetes and lived to a spry old age. The effects of the agouti gene had been virtually erased.

Remarkably, the researchers effected this transformation without altering a single letter of the mouse's DNA. Their approach instead was radically straightforward—they changed the moms' diet. Starting just before conception, Jirtle and Waterland fed a test group of mother mice a diet rich in methyl donors, small chemical clusters that can attach to a gene and turn it off. These molecules are common in the environment and are found in many foods, including onions, garlic, beets, and in the food supplements often given to pregnant women. After being consumed by the mothers, the methyl donors worked their way into the developing embryos' chromosomes and onto the critical agouti gene. The mothers passed along the agouti gene to their children intact, but thanks to their methyl-rich pregnancy diet, they had added to the gene a chemical switch that dimmed the gene's deleterious effects.

With no more than a change in diet, laboratory agouti mice (left) were prompted to give birth to young (right) that differed markedly in appearance and disease susceptibility.

"It was a little eerie and a little scary to see how something as subtle as a nutritional change in the pregnant mother rat could have such a dramatic impact on the gene expression of the baby," Jirtle says. "The results showed how important epigenetic changes could be."

Our DNA—specifically the 25,000 genes identified by the Human Genome Project—is now widely regarded as the instruction book for the human body. But genes themselves need instructions for what to do, and where and when to do it. A human liver cell contains the same DNA as a brain cell, yet somehow it knows to code only those proteins needed for the functioning of the liver. Those instructions are found not in the letters of the DNA itself but on it, in an array of chemical markers and switches, known collectively as the epigenome, that lie along the length of the double helix. These epigenetic switches and markers in turn help switch on or off the expression of particular genes. Think of the epigenome as a complex software code, capable of inducing the DNA hardware to manufacture an impressive variety of proteins, cell types, and individuals.

In recent years, epigenetics researchers have made great strides in understanding the many molecular sequences and patterns that determine which genes can be turned on and off. Their work has made it increasingly clear that for all the popular attention devoted to genome-sequencing projects, the epigenome is just as critical as DNA to the healthy development of organisms, humans included. Jirtle and Waterland's experiment was a benchmark demonstration that the epigenome is sensitive to cues from the environment. More and more, researchers are finding that an extra bit of a vitamin, a brief exposure to a toxin, even an added dose of mothering can tweak the epigenome—and thereby alter the software of our genes—in ways that affect an individual's body and brain for life.

The even greater surprise is the recent discovery that epigenetic signals from the environment can be passed on from one generation to the next, sometimes for several generations, without changing a single gene sequence. It's well established, of course, that environmental effects like radiation, which alter the genetic sequences in a sex cell's DNA, can leave a mark on subsequent generations. Likewise, it's known that the environment in a mother's womb can alter the development of a fetus. What's eye-opening is a growing body of evidence suggesting that the epigenetic changes wrought by one's diet, behavior, or surroundings can work their way into the germ line and echo far into the future. Put simply, and as bizarre as it may sound, what you eat or smoke today could affect the health and behavior of your great-grandchildren.

All of these discoveries are shaking the modern biological and social certainties about genetics and identity. We commonly accept the notion that through our DNA we are destined to have particular body shapes, personalities, and diseases. Some scholars even contend that the genetic code predetermines intelligence and is the root cause of many social ills, including poverty, crime, and violence. "Gene as fate" has become conventional wisdom. Through the study of epigenetics, that notion at last may be proved outdated. Suddenly, for better or worse, we appear to have a measure of control over our genetic legacy.

"Epigenetics is proving we have some responsibility for the integrity of our genome," Jirtle says. "Before, genes predetermined outcomes. Now everything we do—everything we eat or smoke—can affect our gene expression and that of future generations. Epigenetics introduces the concept of free will into our idea of genetics."

Scientists are still coming to understand the many ways that epigenetic changes unfold at the biochemical level. One form of epigenetic change physically blocks access to the genes by altering what is called the histone code. The DNA in every cell is tightly wound around proteins known as histones and must be unwound to be transcribed. Alterations to this packaging cause certain genes to be more or less available to the cell's chemical machinery and so determine whether those genes are expressed or silenced. A second, well-understood form of epigenetic signaling, called DNA methylation, involves the addition of a methyl group—a carbon atom plus three hydrogen atoms—to particular bases in the DNA sequence. This interferes with the chemical signals that would put the gene into action and thus effectively silences the gene.

Until recently, the pattern of an individual's epigenome was thought to be firmly established during early fetal development. Although that is still seen as a critical period, scientists have lately discovered that the epigenome can change in response to the environment throughout an individual's lifetime.

........... In 1999 biologist Emma Whitelaw, now at the Queensland Institute of Medical Research in Australia, demonstrated that epigenetic marks could be passed from one generation of mammals to the next. (The phenomenon had already been demonstrated in plants and yeast.) Like Jirtle and Waterland in 2003, Whitelaw focused on the agouti gene in mice, but the implications of her experiment span the animal kingdoms.

"It changes the way we think about information transfer across generations," Whitelaw says. "The mind-set at the moment is that the information we inherit from our parents is in the form of DNA. Our experiment demonstrates that it's more than just DNA you inherit. In a sense that's obvious, because what we inherit from our parents are chromosomes, and chromosomes are only 50 percent DNA. The other 50 percent is made up of protein molecules, and these proteins carry the epigenetic marks and information."

....... Michael Meaney a biologist at McGill University and a frequent collaborator with Szyf, has pursued an equally provocative notion: that some epigenetic changes can be induced after birth, through a mother's physical behavior toward her newborn. For years, Meaney sought to explain some curious results he had observed involving the nurturing behavior of rats. Working with graduate student Ian Weaver, Meaney compared two types of mother rats: those that patiently licked their offspring after birth and those that neglected their newborns. The licked newborns grew up to be relatively brave and calm (for rats). The neglected newborns grew into the sort of rodents that nervously skitter into the darkest corner when placed in a new environment.

Traditionally, researchers might have offered an explanation on one side or the other of the nature-versus-nurture divide. Either the newborns inherited a genetic propensity to be skittish or brave (nature), or they were learning the behavior from their mothers (nurture). Meaney and Weaver's results didn't fall neatly into either camp. After analyzing the brain tissue of both licked and nonlicked rats, the researchers found distinct differences in the DNA methylation patterns in the hippocampus cells of each group. Remarkably, the mother's licking activity had the effect of removing dimmer switches on a gene that shapes stress receptors in the pup's growing brain. The well-licked rats had better-developed hippocampi and released less of the stress hormone cortisol, making them calmer when startled. In contrast, the neglected pups released much more cortisol, had less-developed hippocampi, and reacted nervously when startled or in new surroundings. Through a simple maternal behavior, these mother rats were literally shaping the brains of their offspring.

....Meaney says the link between nurturing and brain development is more than just a curious cause and effect. He suggests that making postnatal changes to an offspring's epigenome offers an adaptive advantage. Through such tweaking, mother rats have a last chance to mold their progeny to suit the environment they were born into. "These experiments emphasize the importance of context on the development of a creature," Meaney says. "They challenge the overriding theories of both biology and psychology. Rudimentary adaptive responses are not innate or passively emerging from the genome but are molded by the environment."

.....Through epigenetic alterations, our genomes retain something like a memory of the environmental signals received during the lifetimes of our parents, grandparents, great-grandparents, and perhaps even more distant ancestors. So far, the definitive studies have involved only rodents. But researchers are turning up evidence suggesting that epigenetic inheritance may be at work in humans as well.

....Michael Meaney, who studies the impact of nurturing, likewise wonders what the implications of epigenetics are for social policy. He notes that early child-parent bonding is made more difficult by the effects of poverty, dislocation, and social strife. Those factors can certainly affect the cognitive development of the children directly involved. Might they also affect the development of future generations through epigenetic signaling?

"These ideas are likely to have profound consequences when you start to talk about how the structure of society influences cognitive development," Meaney says. "We're beginning to draw cause-and-effect arrows between social and economic macrovariables down to the level of the child's brain. That connection is potentially quite powerful."