Science
A leading pediatrician was already worried about the future of vaccines. Then RFK Jr. came along
The best and the worst thing about vaccination, pediatrician Dr. Adam Ratner says, is that it “makes nothing happen.”
A child successfully inoculated against a vaccine-preventable disease — the measles, let’s say, to name the most infectious of them all — doesn’t fall sick with that condition, doesn’t miss school, doesn’t go to the hospital. They don’t suffer life-changing complications. They don’t die prematurely.
This absence of action can make it easy to forget the role vaccination played in keeping that child healthy. It can be easy to confuse a society that has responsibly controlled measles for a society that is no longer threatened by measles.
These moments of complacency are when vaccine rates dip and illnesses long kept at bay by effective public health programs begin creeping back, Ratner said.
And almost always, the first preventable illness to elbow its way back onto the scene is measles — a highly contagious virus that’s stunningly adept at exploiting our social and physical weaknesses.
Measles “is the thing we see first when public health starts to falter,” Ratner said recently from his office in New York City.
“It’s not that humans aren’t susceptible to these diseases, or that Americans are somehow magically protected against these things that used to kill lots of us,” he said. “They can come back. And they will.”
Ratner, who heads the pediatric infectious disease unit at NYU Langone’s Hassenfeld Children’s Hospital, tracks the history of the virus and its vaccination in his new book “Booster Shots: The Urgent Lessons of Measles and the Uncertain Future of Children’s Health.”
Ratner began drafting the book after the 2018-19 measles outbreak in New York City, in which he treated some of the roughly 650 people who fell ill.
He continued writing during the COVID-19 pandemic, as debates over trust in public health turned bitter and rancorous.
It publishes as the Senate seems poised to confirm President Trump’s nominee, Robert F. Kennedy Jr., a prominent vaccine critic, as the next health secretary.
“He’s written a book that, sadly, couldn’t be better timed,” said Dr. Paul Offit, a virologist and immunologist at the University of Pennsylvania.
“As people become less and less comfortable about vaccines, as they become more and more cynical about vaccines, immunization rates are starting to decline. That’s already happening,” said Offit, who runs the Vaccine Education Center at the Children’s Hospital of Philadelphia, where Ratner was a fellow. “Measles is the canary in the coal mine because it is the most contagious, far and away, of the vaccine-preventable diseases.”
In the book, which publishes Tuesday, Ratner describes a virus with an “unmatched ability to spread from person to person” that once regularly claimed the lives of at least 400 U.S. children per year.
Although a safe, cheap and effective vaccine to prevent most cases has been available “since well before the moon landing,” Ratner writes, measles has proved remarkably effective at undermining the collective effort required to keep populations healthy. The vaccine is to an extent a chronic victim of its own success.
“The better that we get at using the measles vaccine, the lower the case rates go. The lower the rates, the less people think about measles,” Ratner writes. Parents may wonder why it’s worth giving children an injection to prevent a disease that no one ever gets. Politicians may question whether vaccination drives are worth funding.
“When we forget,” Ratner writes, “measles thrives.”
Before the measles vaccine’s introduction in 1963, nearly all U.S. children contracted it before their 15th birthday, resulting in up to 4 million cases each year, according to the U.S. Centers for Disease Control. An estimated 48,000 people were hospitalized annually with serious complications such as encephalitis.
The measles vaccine, which in 1971 was combined with inoculations for mumps and rubella, is widely considered a triumph of public health. Since 2000, the MMR vaccine has saved an estimated 60.3 million lives.
There were 284 cases of measles in the U.S. last year, 40% of which required hospitalization. A full 96% of cases were in people who were unvaccinated, did not finish their MMR series or whose vaccine status was not known, according to the CDC.
Yet total eradication remains elusive, and control over the virus is precarious, Ratner warns.
A population achieves herd immunity from measles when more than 95% of people are fully vaccinated. Last year’s cohort of kindergartners failed to reach that target, with only 92.7% completing their measles, mumps and rubella vaccine series. Uptake rates among kindergartners for all vaccines declined from the year before.
Globally, armed conflict and social upheavals can upend vaccination goals. But it doesn’t require violence to derail public health goals, Ratner writes.
“Even in wealthy nations, when anti-vaccine charlatans and pseudoscience peddlers thrive, when funding to vaccination programs is cut, when well-meaning parents do not learn how to tell reliable information from its opposite and thus fail to vaccinate their children, measles is often the first sign,” Ratner writes. “It is also a sure indication that other problems are not far behind.”
Ratner finished the book well before the 2024 election and Kennedy’s subsequent elevation.
Kennedy was for several years chair of Children’s Health Defense, a nonprofit that falsely claims childhood vaccines cause autism, and has a well-documented history of publicly questioning the science behind the shots. He described the health effects of vaccines as a “holocaust” in 2015, for which he later apologized.
During confirmation hearings before two Senate committees last month, Kennedy said that his views on vaccines have been mischaracterized, and that he supported the childhood vaccination schedule.
The prospect of an outspoken vaccine critic heading the Department of Health and Human Services “is horrifying,” Ratner said in a recent interview. “I can’t imagine a worse situation for public health in the country.” (His views on Kennedy are solely his own, he noted, and don’t represent the position of his hospital.)
“People are trying to make political points, and people are angry about lots of things. But the problem is that the fallout is real children,” Ratner said. “When we can’t get new vaccines licensed, when we have to fight to keep the ones that are already licensed on a recommended schedule, it is children . . . that are going to suffer.”
There have been skeptics of inoculation for as long as humans have been experimenting with it. Ratner notes that when Puritan minister Cotton Mather advocated publicly in 1721 for variolation, an early form of smallpox vaccination, a grenade came crashing through his window bearing a note: “You Dog, Dam you: I’ll inoculate you with this, with a Pox to you.”
Hanging in his office is a framed vintage poster the CDC commissioned in the late 1970s, when the Vietnam War and Watergate had shaken the public’s faith in government authorities.
Above the “Star Wars” characters R2-D2 and C-3PO, the poster asks: “Parents of Earth, Are Your Children Fully Immunized?” It’s a reminder that vaccine hesitancy has been with us for decades, he says, and that accessible, trusted messengers can make a difference. The stakes could hardly be higher.
“Adam’s thesis is spot on: Public trust in science and public health is at an all-time low,” said Jay Vornhagen, a microbiologist and immunologist at Indiana University School of Medicine.
If we don’t find ways to rebuild that trust — if the medical and public health communities don’t reconnect with the public, and vice versa —more people, mostly children, will suffer,” Vornhagen said. “We need to come together as a community, to see the humanity in one another, and to make choices that extend beyond ourselves.”
Science
Can fire-resistant homes be sexy? ‘You be the judge,’ says this Palisades architect
At first glance, it looks like nothing more than a charming Spanish-revival, quintessentially Californian home — but this Pacific Palisades rebuild is constructed like a tank.
Every exterior wall of the steel-framed home is a foot-thick, fire-resistant barricade. The home is connected to a satellite fire monitoring service. Should a fire start in town, sturdy metal shutters descend to cover every window. An exterior sprinkler system can pump 40,000 gallons of water from giant tanks hidden behind the shrubs in the property’s yard. If the cameras and heat sensors around the house detect danger, the system can envelop the home in over 1,000 gallons of fire retardant and hundreds of gallons of fire-suppressing foam.
Palisades resident and architect Ardie Tavangarian is so confident in his design that he even asked the fire department if they could start a controlled fire on the property to test it all out. (They said no.)
Tavangarian built a career designing multimillion-dollar luxury homes in Los Angeles, but after the Palisades fire destroyed 13 of his works — including his family’s home — he found another calling: how to design a house that can handle what the Santa Monica Mountains throw at it. And how to do it quickly and affordably.
Water tanks form part of a backup water supply in a newly built fire-resistant home in Pacific Palisades.
“Nature is so powerful,” he said, sitting on a couch in the new house, which he built for his adult twin daughters. “We are guests living in that environment and expecting, ‘Oh, nature is going to be really kind to me.’ No, it’s not. It does what it’s supposed to do.”
Tavangarian watched the Jan. 1 Lachman fire from his property not far from here; a week later that fire rekindled, grew into the Palisades fire, and burned through his house. But the painful details of the fire — the missteps of the fire department, the empty reservoir — didn’t matter when it came to deciding how to rebuild, he said. The reality is, many fires have burned in these mountains. Many more will.
A sprinkler on the roof is part of a house-wide sprinkler system.
For the architect, who has spent much of his 45-year career designing for luxury, hardening a home against wildfire has brought a new kind of luxury to his homes: peace of mind.
It’s a sentiment that resonates with fire survivors: Tavangarian says he’s received considerable interest from other property owners in the Palisades looking to rebuild their houses.
The metal shutters and advanced outdoor sprinkler system are the flashiest parts of Tavangarian’s home hardening project, and the efficacy of these adaptations is still up for debate. Because the measures have not yet been widely adopted, there are few studies exploring how much or little they protect homes in real-world fires.
Architect Ardie Tavangarian inside the house he designed.
Anecdotal evidence has indicated the effectiveness of sprinklers can vary significantly based on the setup and the conditions during the fire. Extreme wind, for example, can make them less effective. Lab studies have generally found shutters can reduce the risk of windows shattering.
These measures aren’t cheap, either. Sprinkler systems can cost north of $100,000, for example. However, Tavangarian said when all was said and done, the home he built for his daughters cost around $700 per square foot — less than what Palisades residents said they expected to pay, but more than what Altadena residents expected for their rebuilds.
Tavangarian also hopes to see insurers increasingly consider the home-hardening measures property owners take when writing policies, which he said could potentially offset the extra cost in a decade or less. As he explored getting insurance for the new home, one insurer quoted him $80,000 a year. After he convinced the company to visit the property, it lowered the quote to just $13,000, he said.
The house includes metal heat shields that can drop down if a fire approaches.
The home also has essentially all of the other less flashy — but much cheaper and well-proven — home hardening measures recommended by fire professionals: The underside of the roof’s overhang is closed off — a common place embers enter a home. The roof, where burning embers can accumulate, is made of fire-resistant material. The windows, vulnerable to shattering in extreme heat, are made of a toughened glass. There is virtually no vegetation within the first five feet of the home.
When asked if he felt he had compromised on design, comfort or aesthetics for the extra protection — one of the many concerns Californians have with the state’s draft “Zone Zero” requirements that may significantly limit vegetation within five feet of a home — Tavangarian simply said, “You be the judge.”
Science
Commentary: My toothache led to a painful discovery: The dental care system is full of cavities as you age
I had a nagging toothache recently, and it led to an even more painful revelation.
If you X-rayed the state of oral health care in the United States, particularly for people 65 and older, the picture would be full of cavities.
“It’s probably worse than you can even imagine,” said Elizabeth Mertz, a UC San Francisco professor and Healthforce Center researcher who studies barriers to dental care for seniors.
Mertz once referred to the snaggletoothed, gap-filled oral health care system — which isn’t really a system at all — as “a mess.”
But let me get back to my toothache, while I reach for some painkiller. It had been bothering me for a couple of weeks, so I went to see my dentist, hoping for the best and preparing for the worst, having had two extractions in less than two years.
Let’s make it a trifecta.
My dentist said a molar needed to be yanked because of a cellular breakdown called resorption, and a periodontist in his office recommended a bone graft and probably an implant. The whole process would take several months and cost roughly the price of a swell vacation.
I’m lucky to have a great dentist and dental coverage through my employer, but as anyone with a private plan knows, dental insurance can barely be called insurance. It’s fine for cleanings and basic preventive routines. But for more complicated and expensive procedures — which multiply as you age — you can be on the hook for half the cost, if you’re covered at all, with annual payout caps in the $1,500 range.
“The No. 1 reason for delayed dental care,” said Mertz, “is out-of-pocket costs.”
So I wondered if cost-wise, it would be better to dump my medical and dental coverage and switch to a Medicare plan that costs extra — Medicare Advantage — but includes dental care options. Almost in unison, my two dentists advised against that because Medicare supplemental plans can be so limited.
Sorting it all out can be confusing and time-consuming, and nobody warns you in advance that aging itself is a job, the benefits are lousy, and the specialty care you’ll need most — dental, vision, hearing and long-term care — are not covered in the basic package. It’s as if Medicare was designed by pranksters, and we’re paying the price now as the percentage of the 65-and-up population explodes.
So what are people supposed to do as they get older and their teeth get looser?
A retired friend told me that she and her husband don’t have dental insurance because it costs too much and covers too little, and it turns out they’re not alone. By some estimates, half of U.S. residents 65 and older have no dental insurance.
That’s actually not a bad option, said Mertz, given the cost of insurance premiums and co-pays, along with the caps. And even if you’ve got insurance, a lot of dentists don’t accept it because the reimbursements have stagnated as their costs have spiked.
But without insurance, a lot of people simply don’t go to the dentist until they have to, and that can be dangerous.
“Dental problems are very clearly associated with diabetes,” as well as heart problems and other health issues, said Paul Glassman, associate dean of the California Northstate University dentistry school.
There is one other option, and Mertz referred to it as dental tourism, saying that Mexico and Costa Rica are popular destinations for U.S. residents.
“You can get a week’s vacation and dental work and still come out ahead of what you’d be paying in the U.S.,” she said.
Tijuana dentist Dr. Oscar Ceballos told me that roughly 80% of his patients are from north of the border, and come from as far away as Florida, Wisconsin and Alaska. He has patients in their 80s and 90s who have been returning for years because in the U.S. their insurance was expensive, the coverage was limited and out-of-pocket expenses were unaffordable.
“For example, a dental implant in California is around $3,000-$5,000,” Ceballos said. At his office, depending on the specifics, the same service “is like $1,500 to $2,500.” The cost is lower because personnel, office rent and other overhead costs are cheaper than in the U.S., Ceballos said.
As we spoke by phone, Ceballos peeked into his waiting room and said three patients were from the U.S. He handed his cellphone to one of them, San Diegan John Lane, who said he’s been going south of the border for nine years.
“The primary reason is the quality of the care,” said Lane, who told me he refers to himself as 39, “with almost 40 years of additional” time on the clock.
Ceballos is “conscientious and he has facilities that are as clean and sterile and as medically up to date as anything you’d find in the U.S.,” said Lane, who had driven his wife down from San Diego for a new crown.
“The cost is 50% less than what it would be in the U.S.,” said Lane, and sometimes the savings is even greater than that.
Come this summer, Lane may be seeing even more Californians in Ceballos’ waiting room.
“Proposed funding cuts to the Medi-Cal Dental program would have devastating impacts on our state’s most vulnerable residents,” said dentist Robert Hanlon, president of the California Dental Assn.
Dental student Somkene Okwuego smiles after completing her work on patient Jimmy Stewart, 83, who receives affordable dental work at the Ostrow School of Dentistry of USC on the USC campus in Los Angeles on February 26, 2026.
(Genaro Molina / Los Angeles Times)
Under Proposition 56’s tobacco tax in 2016, supplemental reimbursements to dentists have been in place, but those increases could be wiped out under a budget-cutting proposal. Only about 40% of the state’s dentists accept Medi-Cal payments as it is, and Hanlon told me a CDA survey indicates that half would stop accepting Medi-Cal patients and many others will accept fewer patients.
“It’s appalling that when the cost of providing healthcare is at an all-time high, the state is considering cutting program funding back to 1990s levels,” Hanlon said. “These cuts … will force patients to forgo or delay basic dental care, driving completely preventable emergencies into already overcrowded emergency departments.”
Somkene Okwuego, who as a child in South L.A. was occasionally a patient at USC’s Herman Ostrow School of Dentistry clinic, will graduate from the school in just a few months.
I first wrote about Okwuego three years ago, after she got an undergrad degree in gerontology, and she told me a few days ago that many of her dental patients are elderly and have Medi-Cal or no insurance at all. She has also worked at a Skid Row dental clinic, and plans after graduation to work at a clinic where dental care is free or discounted.
Okwuego said “fixing the smiles” of her patients is a privilege and boosts their self-image, which can help “when they’re trying to get jobs.” When I dropped by to see her Thursday, she was with 83-year-old patient Jimmy Stewart.
Stewart, an Army veteran, told me he had trouble getting dental care at the VA and had gone years without seeing a dentist before a friend recommended the Ostrow clinic. He said he’s had extractions and top-quality restorative care at USC, with the work covered by his Medi-Cal insurance.
I told Stewart there could be some Medi-Cal cuts in the works this summer.
“I’d be screwed,” he said.
Him and a lot of other people.
steve.lopez@latimes.com
Science
Diablo Canyon clears last California permit hurdle to keep running
Central Coast Water authorities approved waste discharge permits for Diablo Canyon nuclear plant Thursday, making it nearly certain it will remain running through 2030, and potentially through 2045.
The Pacific Gas & Electric-owned plant was originally supposed to shut down in 2025, but lawmakers extended that deadline by five years in 2022, fearing power shortages if a plant that provides about 9 percent the state’s electricity were to shut off.
In December, Diablo Canyon received a key permit from the California Coastal Commission through an agreement that involved PG&E giving up about 12,000 acres of nearby land for conservation in exchange for the loss of marine life caused by the plant’s operations.
Today’s 6-0 vote by the Central Coast Regional Water Board approved PG&E’s plans to limit discharges of pollutants into the water and continue to run its “once-through cooling system.” The cooling technology flushes ocean water through the plant to absorb heat and discharges it, killing what the Coastal Commission estimated to be two billion fish each year.
The board also granted the plant a certification under the Clean Water Act, the last state regulatory hurdle the facility needed to clear before the federal Nuclear Regulatory Commission (NRC) is allowed to renew its permit through 2045.
The new regional water board permit made several changes since the last one was issued in 1990. One was a first-time limit on the chemical tributyltin-10, a toxic, internationally-banned compound added to paint to prevent organisms from growing on ship hulls.
Additional changes stemmed from a 2025 Supreme Court ruling that said if pollutant permits like this one impose specific water quality requirements, they must also specify how to meet them.
The plant’s biggest water quality impact is the heated water it discharges into the ocean, and that part of the permit remains unchanged. Radioactive waste from the plant is regulated not by the state but by the NRC.
California state law only allows the plant to remain open to 2030, but some lawmakers and regulators have already expressed interest in another extension given growing electricity demand and the plant’s role in providing carbon-free power to the grid.
Some board members raised concerns about granting a certification that would allow the NRC to reauthorize the plant’s permits through 2045.
“There’s every reason to think the California entities responsible for making the decision about continuing operation, namely the California [Independent System Operator] and the Energy Commission, all of them are sort of leaning toward continuing to operate this facility,” said boardmember Dominic Roques. “I’d like us to be consistent with state law at least, and imply that we are consistent with ending operation at five years.”
Other board members noted that regulators could revisit the permits in five years or sooner if state and federal laws changes, and the board ultimately approved the permit.
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