Kids & Public Health: Q&A with Dr Ellie Murray

Cutting through the chaos for answers to our public health parenting questions

The Pomegranate editors often have questions about their kids’ health that don’t fall into a cut-and-dry doctor’s appointment. Finding reliable, up-to-date public health information through the noise and chaos online can be tricky. Today, we invited actual public health expert Dr Ellie Murray, ScD to answer some of the questions that are weighing on our minds.

Dr Ellie Murray is an epidemiologist and science communicator. She has a doctorate of science in epidemiology from Harvard University T.H. Chan School of Public Health, and masters degrees in biostatistics (also from Harvard) and public health (from Columbia University). Formerly an epidemiology professor at Boston University, Ellie has written 100+ scientific articles and a textbook. You may know her from Twitter (x.com/epiellie), BlueSky, or Substack (E is for Epi). She is also the big sister of Pomegranate editor Sarah Radz.

Disclaimer: The following is for informational and educational purposes only, and should not be considered a replacement for individualized, professional medical advice.

Q: First things first, what is public health and how can listening to public health experts help us become better informed parents and caregivers?

Hi friends and readers of The Pom, great to speak with you.

This is an excellent first question because even though public health affects everyone’s daily lives, it’s not something most people learn anything about.

There are two ways to think about public health. One is the organized work of Public Health which includes all the things that governments, organizations, and people do to help protect our health. This work is typically centered in the Health Department, but it includes everything from garbage collectors to urban planners to vaccination clinic workers (although not all of these groups think of themselves as part of Public Health). When this system is working well, we generally don’t notice it and so it’s easy to forget that it exists or underestimate its importance. This means that it’s also fairly common for parts of the system to get defunded or shut down or deprioritized.

Public Health experts can help parents and caregivers recognize when the system is breaking down in these ways and help increase awareness of key system functions so that we can keep ourselves and our communities healthy. The important thing to remember is that the job of Public Health is not to control us. It’s to make our lives easier and to protect us from unscrupulous people who are willing to risk our health to make a quick buck. As such, the main job of the Health Department is to monitor our water, food, air, medications, parks, and streets for known hazards. So the information you can get from them will usually be focused on common dangers or tips to avoid them. Exactly the sort of information most people are probably looking for.

Separate from the job of Public Health is the concept of “public health.” This is not something that anyone has any special claim to. It’s a truly shared resource, but it can be hard to define because we don’t really talk enough about what “good public health” means. This is a topic parents and caregivers like you have so much to contribute to. You spend so much time in community settings and are much more likely to notice barriers or problems that others simply don’t see. For example, before Sarah’s kids were born, I would never have thought about fences with gates at public parks as part of a good public health infrastructure. But then she had a runner!

So, while it’s great and important to listen to public health experts, I think it’s also super important to talk to public health experts about what it would mean to you for your community to be healthy and to support you and those you care for in living their best and healthiest lives. Because public health isn’t just a job, it’s a resource that we all share. The science of Public Health can help us figure out how to reach our public health goals, the personnel at the Health Department can help us automate those processes, but the goals themselves have to be decided on by the public!

Image: Dr Ellie Murray and Pom editor Sarah Radz as children

Q: Everyone from Instagram influencers to the Oval Office has advice for what health and safety measures we should take for our kids. How can we evaluate who to trust and what guidance to follow?

The biggest one is financial conflicts of interest. Ask yourself: is the person giving this advice also recommending that you purchase a specific type of product or use a particular company? If so, this is probably not reliable advice because there is a good chance they are simply being paid for what they say. It is not actually advice. It is an advertisement.

The second red flag to look for is inconsistency. One very frequent type of inconsistency is people who complain about “big pharma” being insufficiently regulated and then turn around and recommend supplements without ever mentioning that the supplements industry is 100% unregulated. Supplement companies can, and often do, sell pills that contain almost none of the active ingredient on the label, and they can and do sell pills that contain all sorts of other (often harmful) ingredients not listed on the label. Because there is no regulation of these products at all. If someone is truly concerned about medication safety regulations, they should be more critical of supplements than pharmaceuticals.

The last piece of advice I have for evaluating who to trust is to look for people who admit when they get things wrong. Because science isn’t set in stone. It’s constantly evolving. For example, when the 1918 influenza pandemic happened we didn’t even know that viruses were a thing. One hundred years later, we had several different COVID vaccines all developed within a year of the first cases. We’re learning so much, so fast, that it’s pretty much guaranteed that anyone trying to share the best information will need to change their advice over time. Reputable sources will be clear about these changes and why they are making them because they understand that correcting ourselves is more important than never being wrong. As any parent has probably seen many many times, being wrong is a big part of how we learn. That’s true when we’re babies, and when we’re scientists.

Q: The Trump administration recently claimed that Tylenol use in pregnancy may cause autism. What is the current understanding on the causes of autism?

Based on what we know right now, the main cause of autism is genetics. The Trump administration has said recently that genetics can’t be the cause because genetics is incompatible with the relatively large increase in autism cases over the past two decades. First of all, it’s not actually clear that the number of people with autism has actually changed. It’s very possible that we have simply getting better at diagnosing people.

But second of all, just because something is caused by genetics doesn’t mean we can’t see rapid change. This is because there’s not actually a choice between genetic and non-genetic causes. Something can be 100% caused by genetics and also be 100% caused by environmental factors. A classic example of this is something called phenylketonuria. This disease is caused by a specific genetic factor. You either are born with it, or you are not. But having this disease simply means that you can’t process protein or aspartame the way other people can. And if you simply stick to a careful diet that avoids the problem protein (phenylalanine), you can live a long happy life with no symptoms. We test babies for phenylketonuria, but you could imagine that if this wasn’t something we tested for the rates of disease might have seemed to skyrocket after the introduction of diet sodas. But that wouldn’t change the fact that this is a genetic disease.

If there are environmental factors that trigger or worsen autism, we don’t yet know what those are. There are lots of hypotheses, and ideally the Trump administration would work with scientists to design good ways to test these. Unfortunately, that’s not what they’ve been doing.

Q: Donald Trump also recently claimed that babies do not need to be vaccinated against hepatitis B because it is sexually transmitted, and children should wait until age 12 until receiving this vaccine. What is the current best practice on vaccinations, and how do we know when to vaccinate our kids?

Hepatitis B can be sexually transmitted. But this isn’t the only way it can be transmitted. It can also transmit via the sort of every day contact with bodily fluids which is pretty common in families with young kids, including saliva. And young babies are particularly likely to end up with chronic liver disease if they get infected with Hepatitis B. Yes, moms are tested in hospital, and we could restrict the vaccine to babies whose moms test positive, but most babies have more caretakers than just their birth mother. Vaccinating at birth ensures that kids are protected during the stage of life when this disease is most harmful to them.

But even if Hepatitis B was only transmitted sexually (which again, it isn’t), waiting until 12 or later to get the vaccine isn’t necessarily a great plan. Yes, ideally we would all like our kids to stay kids as long as possible. But in the real world, some kids start exploring their sexuality early. And other kids don’t get a choice. By vaccinating before our kids have had any type of sexual contact at all, we do our best to protect them. That’s unpleasant to think about. But it’s true.

The last thing I always think about with the Hepatitis B vaccine is this: I was in middle school around time this vaccine was being introduced, and so I received it in middle school. And it sucked. I was so afraid of needles, that I would often cry or shake in anticipation of vaccines. If I could have gotten this as a little baby with no awareness of the world? I’m pretty sure I would have preferred that. Maybe your kids would too.

Q: If I am uncomfortable with vaccinating my child, why should I vaccinate them?

Around the time I learned to drive, passenger-side airbags were becoming standard in cars. I remember very clearly hearing a report on the radio one day warning that children under 5’3” shouldn’t sit in the front passenger seat if the car had an airbag because they could potentially be injured by the airbag itself during a crash. I was 16 years old and barely 5’2” and all cars had driver-side airbags. I was short enough that I used to literally sit on a phone book when I practiced driving. This report definitely freaked me out. What if I crashed and the airbag suffocated me?! I was uncomfortable driving for a long while. But the thing I realized is this: if I were driving a car that didn’t have an airbag and I crashed, I would be so much more likely to be injured. And almost certainly worse than if there had been an airbag.

What does this have to do with vaccinations? Everything! Because these vaccines were developed specifically because the diseases they prevent can seriously harm, disable, or kill people. And they were all tested in multiple randomized trials to ensure that they were absolutely definitely safer than getting infected. Yes, on rare occasions people do have bad reactions to vaccines. Just like on rare occasions, drivers get injured by airbags. But so many more people are saved by vaccines. Millions and millions of kids grew up to be adults because they were vaccinated. Millions more avoided becoming blind, or deaf, or paralyzed, or sterile because they got those same vaccines.

So, yes, maybe I could have found a car with no airbags and not risked being injured by the airbag in a crash. Or maybe I could have simply avoided ever learning to drive. But if I want to be free to live my life, accepting that an airbag is the safer option is the best way to do that. Same with vaccines.

Thank you Dr Ellie!

For more of Dr Ellie Murray’s work, please subscribe to her substack E is for Epi. You can also leave a question in the comments below, and we will invite her to join us here on The Pom again.

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