Tag Archives: #TransferFactor

Zika Virus UpDate – Another bright side to the story?

Good news!

Good news? 

How can Zika be good news?

However, this time there appeared to be some good news…except it was another HOAX that had conspiracy overtones.

For over a month the news has bombarded North American listeners with fears of the Zika Virus.  Credible associations were made of two physical findings, microcephaly and the life-threatening, paralyzing, Guillain-Barré syndrome (WHO Director-General, 2016).

And yet, there still has been no established biological link of the Zika Virus “causing” these conditions.  It is, so far, a legitimate, working hypothesis (WHO Director-General, 2016; WHO to convene, 2016; Zika Virus Travel Alert, 2016).

Yes, Brazilian ophthalmologists just published their recent findings of retinal damage in the eyes of some of the microcephalic babies.  Their research suggested permanent vision problems (De Paula Freitas, B., et al., 2016)  But, there was no proof the research established a biological link that the Zika Virus was what “caused” this condition.  That would require a cohort (population) study following the children over time.

And, the 23 selected mothers were never tested to prove they had Zika Virus.  Instead, they were given the presumptive label as positive cases because they had demonstrated symptoms and signs.

Then there was the “good news.” Unfortunately, the following turned out to be a HOAX: microcephaly doesn’t come from Zika Virus…it comes from “the larvacide… pyroproxyfen” (correct spelling is: pyriproxyfen) placed in the drinking water at the same locations where both Zika and microcephaly occur.  Such is the 3 February 2016 assertion in a publication by Dr. Medardo Avila Vazquez, principle author, and the Argentinian and Brazilian scientists of Production Team REDUAS.

 

The theory stated that the Monsanto larvacide, pyriproxyfen (“pyroproxyfen” as REDUAS repeatedly misspelled it), which is routinely added to drinking water in mosquito-dense communities in many locations, just happened to coincide with the Zika Virus and the microcephaly epicenter near Recife, Brazil.  Mosquitoes in the region were found to have odd, physical changes, which normally happens when introducing a larvacide and this was thought to indicate genetic risk to newborns. 

This “confounding variable” was then thought (by Team REDUAS) to be the culprit, instead of Zika Virus.  Justification for this position was that microcephaly mysteriously appeared first in Brazil and not earlier in the Zika Virus spread chronology (Avila Vazquez, 2016).  But, somehow Team REDUAS omitted consideration of the Guillain-Barré syndrome that has also been associated with Zika Virus for the past three years (WHO Director-General, 2016; WHO to convene, 2016). 

A “confounding variable” is an epidemiological concept.  It identifies a condition that has guilt by association without sufficient deductive reasoning or collection of evidence.  The epidemiological concept, “confounding variable,” cannot be selectively applied to just one community and not to other communities or other countries.

So, let’s view Team REDUAS reasoning another way to see why it does not make sense.  Many communities that currently struggle with Zika Virus and microcephaly do not add pyriproxyfen to their water supplies.

Closer examination of the document reveals the research team is one of the principle groups promoting the theory that UK’s Oxitec genetically altered mosquitoes participate in the microcephaly problem.  The group’s mission statement is to influence policymakers to abandon all attempts to reduce mosquito populations, especially chemical.

Larvacides have been used in public drinking water since the 1970’s, according to the World Health Organization (Diflubenzuron, 2001; Diflubenzuron, 2008).  No association with biological causes has been made until this HOAX. Team REDUAS does not consider toxicology factors in its analysis.  Toxicology factors are routinely considered in water supply analysis…and antibiotic dosing (Acute Toxicity Definitions, 2016).  Toxicology was central to the Flint, Michigan lead-contaminated water analysis (Why Lead Poisoning is Feared in Flint, 2015).

Jersey City, New Jersey introduced chlorine to its water supply in 1908 (History of Drinking Water Treatment, 2012). Since then, communities around the world have benefited from public health improvements by similarly adding chlorine compounds to their water supply.  Waterborne diseases vanished.

Chlorinated water supplies have contributed, in large part, to reducing the prevalence of the once common community diseases: cholera, dysentery, TB, typhoid fever, influenza, yellow fever, and malaria.  (Achievements in Public Health, 1900-1999: Control of Infectious Diseases, 1999).

Water purification is not enough to combat the now, ubiquitous, Zika Virus. Vaccination provides hope in the distant future for those interested in receiving the treatment.  Immune system enhancing opportunities now exist to reduce the risk of negative outcome.  Transfer Factor, the active ingredient in all mammalian mother’s colostrum, has been suggested as an option because it’s touted as educating your personal immune system.  It is now available in a questionable, proprietary (patented) oral formulation to limit availability and increase price.  It performs no better than placebo (What are transfer factors? 2016).

 

REFERENCES:

Achievements in Public Health, 1900-1999: Control of Infectious Diseases. (1999). MMWR. 48(29). pp. 621-629. Retrieved February 15, 2016 from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4829a1.htm

Acute Toxicity Definitions. (2016). Chapter 5. International Labour Organization. United Nations.  Retrieved February 15, 2016 from http://www.ilo.org/legacy/english/protection/safework/ghs/ghsfinal/ghsc05.pdf

Avila Vazquez, M. (2016). REPORT from Physicians in the Crop-Sprayed  Villages regarding Dengue-Zika, microcephaly, and mass-spraying with chemical poisons. Team REDUAS. Retrieved February 15, 2016 from http://www.reduas.com.ar/wp-content/uploads/downloads/2016/02/Informe-Zika-de-Reduas_TRAD.pdf

De Paula Freitas, B., et al. (2016). Ocular Findings in Infants With Microcephaly Associated With Presumed Zika Virus Congenital Infection in Salvador, Brazil. JAMA Ophthalmol. Published online February 09, 2016. doi:10.1001/jamaophthalmol.2016.0267 and retrieved February 09, 2016 from http://archopht.jamanetwork.com/article.aspx?articleid=2491896

Diflubenzuron. (2008). Guidelines for Drinking-Water Quality, 3rd edition including 1st and 2nd addenda. World Health Organization. Retrieved February 15, 2016 from http://www.who.int/water_sanitation_health/dwq/chemicals/diflubenzuronsummary_2ndadd.pdf

DIFLUBENZURON toxicological evaluations – Evaluation for acceptable daily intake. (2001). Dewhurst Pesticides Safety Directorate,York, United Kingdom. Retrieved February 15, 2016 from http://www.inchem.org/documents/jmpr/jmpmono/2001pr04.htm#2.0

History of Drinking Water Treatment. (2012). Centers for Disease Control and Prevention. Retrieved February 15, 2016 from http://www.cdc.gov/healthywater/drinking/history.html

What are transfer factors? (2016). Retrieved September 3, 2016 from https://www.4life.com/8834499/about/science

WHO Director-General briefs Executive Board on Zika situation. (2016). Briefing to the Executive Board on the Zika situation, Geneva, Switzerland, 28 January 2016. Retrieved 30 January 2016 from http://www.who.int/dg/speeches/2016/zika-situation/en/

WHO to convene an International Health Regulations Emergency Committee on Zika virus and observed increase in neurological disorders and neonatal malformations.  (2016). WHO statement, 28 January 2016. Retrieved 30 January 2016 from http://www.who.int/mediacentre/news/statements/2016/emergency-committee-zika/en/

Why Lead Poisoning is Feared in Flint.  (2015).  BBC World Service.   Retrieved 30 January 2016 from http://www.bbc.co.uk/programmes/p03ctmmy

Zika Virus Travel Alert. (2016). Transcript for CDC Telebriefing: Zika Virus Travel Alert, Thursday, January 28, 2016. Retrieved 30 January 2016 from http://www.cdc.gov/media/releases/2016/t0128-zika-virus-101.html

 

Zika Virus Fears – Is there a bright side to the story?

Zika.

That name and its association with a virus were a relative unknown just before the 2016 New Year. Today, Zika virus has been on the lips of most everyone sometime this week.

Some people may remember the fear that Rubella once carried with pregnant women until a vaccine was developed to rid society of miscarriages and stillbirths.  There was also Congenital Rubella Syndrome, which inflicted as many as 20,000 unvaccinated mothers’ babies with blindness and deafness as well as brain and heart damage (Wolfson, 2016).

aedes aegypti
aedes aegypti

Monday, 1 February 2016, the World Health Organization (WHO) will have met to convene an International Health Regulations Emergency Committee on Zika virus to determine if current conditions warrant “a Public Health Emergency of International Concern ” (WHO to convene, 2016).  The  Director-General of the WHO decided to increase global attention to Zika virus partly in response to Centers for Disease Control and Prevention (CDC) travel alerts and declarations that the virus had become a globally distributed concern in a matter of days (Zika Virus Travel Alert, 2016).  The other part, Director-General Margaret Chan considered was due to factors that make for a “perfect storm.”

In short, transmission is dependent on just two things: direct contact with the Aedes aegypti mosquito and indirect contact with a person who has been infected with Zika virus.

The CDC and the news media, like NBC’s “What is The Zika Virus?” (Fox, 2016) and NPR’s “Big Zika Virus Outbreak Unlikely In The U.S., Officials Say” (Stein, 2016) have discounted most concern for the virus by reminding people that they are enjoying wintertime conditions when the Aedes aegypti mosquito is dormant.

After all, Dengue Virus, which has a similar mode of transmission, does not seem to inflict the people of North America with the same intensity as Caribbean and Central and South American regions. Thus, transmission is not of any concern.

And, after two week’s clearance returning from a Caribbean or South American vacation without symptoms, all should be well.

Does this allay all your fears?  Should it?

Ours is a society that prefers to make informed decisions based on available and unmodified fact.  So, this review will avoid the use of any “conspiracy theory” jargon to feed fear or political innuendo to soothe a false sense of security.  With that in mind, let’s investigate Zika further.

First, a quick review of Zika and the virus is in order.

Zika is one of two, not one virus types.  The original virus was named after the Zika forest in Uganda where the first monkey was discovered to carry the virus (WHO Director-General, 2016).  That was 1947.

Zika virus was, until 2007, just a monkey virus.  In the forests of Africa.  2007 marked the time when Zika left Africa and entered one island of Micronesia in the Pacific Islands area.  Over the course of 2013 to 2014, four more islands had Zika virus (WHO Director-General, 2016).  And, there were neurological problems (complicated by coexisting Dengue virus), which may or may not have been the paralysis known as the Guillain-Barré syndrome.

The variant that has started in the Western Hemisphere is a different Zika “flavivirus” (Zika Virus Travel Alert, 2016).   At the time of this post 23 countries and territories have already reported cases since late 2015 (WHO Director-General, 2016).

There have been rates of microcephaly (small brain size at birth) that are ten times normal in Brazil and a pronounced increase in cases of the Guillain-Barré syndrome.  Still, there remains NO established, causal or biological relationship between Zika virus infection and birth malformations and neurological syndromes.

The medical community is using an epidemiological construct to isolate the direct cause, but as of yet the official link is: “strongly suspected” after two autopsies of Brazilian babies who had microcephaly (WHO Director-General, 2016; WHO to convene, 2016; Zika Virus Travel Alert, 2016).

Why is the WHO concerned?  Why is the North America news media focused on quieting this topic?

The answer to the first is four things:  First, there is an absence of acquired immunity in any of the affected areas of the Western Hemisphere.  Second, there exist NO vaccines to combat this sudden epidemic.  Third, there are no treatments that respond to the Zika virus.  Fourth, there are no rapid diagnostic tests available to confirm Zika virus; all samples must be confirmed currently at the CDC.

The answer to the second (why the news media seems to be quieting this topic under a winter blanket of calm) may be politically motivated by an impending presidential election that requires more attention.  Additionally, it could be that the efforts of the CDC to calm and soothe demonstrate sound epidemiological wisdom using only the evidence available at this moment (Zika Virus Travel Alert, 2016).

Meanwhile, the WHO will seek to activate global priority to develop “vaccines and new tools to control mosquito populations, as well as improving diagnostic tests” (WHO to convene, 2016).  Let’s see why the WHO is so interested in making this “a Public Health Emergency of International Concern” (WHO to convene, 2016).  After all, the WHO has the option to permit this virus outbreak to become part of the background noise with Dengue virus.

First, the WHO is not limited by epidemiological principle that uses only the evidence presented.  Instead, the WHO is forecasting.

WHO recognizes that North American winter season does not last all year long.  The WHO Director-General sites “conditions associated with this year’s El Nino weather pattern are expected to increase mosquito populations greatly in many areas.”

aedes albopictus
aedes albopictus

Zika virus can freely transfer from an infected person to nearby individuals once warm season returns and the Aedes aegypti mosquito is no longer dormant.  Aedes includes the entire Aedes genus such as Aedes albopictus.

One news media resource has already identified this trend and discounted the CDC theory that “everyone in North America lives in air conditioning” (Sun & Dennis, 2016).  It should be noted that the conclusion of the article retains the central theme in all U.S. news sources that North America is “unlikely” to see widespread local outbreaks.

Second, the two-week clearance after return from a Caribbean or South American vacation is not considered “safe.”  It has been reported by the CDC the mild symptoms of fever, rash, joint pain, and red eyes or conjunctivitis are typically associated with only one in five who test positive for Zika virus (Zika Virus Travel Alert, 2016).

Still, Zika virus can be transmitted sexually, and not just from the bite of the Aedes aegypti mosquito.  According to Dr. Schuchat of the CDC, live Zika virus has been found in semen after two weeks (Zika Virus Travel Alert, 2016).

What about the solutions?

Suerie Moon of Harvard University’s Kennedy School has stated in a The New York Times “Room for Debate” that the WHO must assume leadership of the Zika virus matter (Moon, 2016).  Peter Hotez of the National School of Tropical Medicine, Baylor College of Medicine emphasized at the same debate that mosquitoes must be eradicated until such a time as a vaccine becomes available (Hotez, 2016).  And, Amy Vittor of University of Florida’s Emerging Pathogens Institute implicated urban poverty as “facilitating the transmission of mosquito-borne viruses” (Vittor, 2016).

So, what is the WHO doing or trying to do as it develops “vaccines and new tools to control mosquito populations, as well as improving diagnostic tests” (WHO to convene, 2016)?

For its part, the CDC has stated that vaccines will be at least a few more years or more away.  The CDC plans to use existing grant money for the “flavivirus class” that includes Zika to launch two experiments.  One is a vaccine designed similar to a West Nile virus DNA structured because it is considered “safe and immunogenic” (Zika Virus Travel Alert, 2016).  The second is a live vaccine that is structured similarly to the Dengue virus.

Vaccines are going to be useless resources for several years.  That leaves tools to control mosquito populations and improving diagnostic tests.

The WHO has been working with Oxitec, from the UK, which has genetically altered the Aedes aegypti mosquito.  These wild male mosquitoes mate with local female Aedes aegypti mosquitos, and their offspring become larvae that never mature into mosquitos.  In field tested areas of Brazil, Oxitec has reduced the Aedes aegypti mosquito population 90 percent (Allen, 2016).

So far improvements for rapid diagnostic testing have not been announced.  The CDC, in the interim, has mandated that each U.S. state report all Zika virus cases (Muir, 2016; Pelley, 2016).  Reporting was before voluntary.

Now, given the WHO concerns and known solutions, what is the bright side to this story?

Prevention of mosquito bites and infected semen is one thing.  There are barrier protections available for these.  And, on the grander scale, there are fancy, genetically altered males to reduce the mosquito population.

But, there’s not going to be a vaccine for several years.  And, the progression of infection has advanced rapidly with over 4 million expected to have the Zika virus by the end of 2016 (Pelley, 2016). That means there will be no acquired immunity in any of these communities.

Is this a bright side to the story?

Yes! (Well, maybe…)

You can bolster your existing immune system to combat the effects of viruses like Zika before they hit.  You do that all the time by eating and exercising correctly.  Or at least, you should!

But, more recently, clinical researchers have taken the mammalian mother’s colostrum, that special milk available only during the first three days after birth, and extracted its active ingredients for certain immune deficiency and hyperactive disorders.  The “research” on Transfer Factors has been in the literature for almost 60 years, but most of it is protected from peer-review by proprietary privilege.

The sole-proprietor of Transfer Factors paid to get its product listed in the Physician’s Desk Reference (PDR) for non-prescription drugs, which has been an advertising inducement to both conventional and alternative medicine physicians around the world in over 53 countries.

Unfortunately, it is only a nutraceutical, which means that it is, for all intents and purposes, a placebo.  A placebo (sugar pill) has beneficial success, statistically, over 40 percent of the time because of the hope that it will work.  Thus, it stands to reason that claims of monumental success by one-third of the users would amount to a treatment failure in the real medical and statistical professions.  And, yet, the organization, 4Life Research prints in its “Guide to Supplements and Good Health” recommendations to use its product in massive amounts for anything from eczema to Human Immunodeficiency Virus (HIV) to various forms of cancer.

Is Transfer Factors the bright side of the story for Zika Virus?  Probably not.  Preventive measures are your best protection.  The soon release of the early trials of the Dengue Virus Vaccine (with the Zika Virus Vaccine, included) is most likely going to be the true bright side to the story.

REFERENCES:

Allen, G. (2016). Genetically Modified Mosquitoes Join The Fight To Stop Zika Virus. Goats and Soda. National Public Radio, 29 January 2016.  Retrieved 30 January 2016 from http://www.npr.org/sections/goatsandsoda/2016/01/26/464464459/genetically-modified-mosquitoes-join-the-fight-to-stop-zika-virus

Fox, M. (2016). “What Is the Zika Virus? Your Questions Answered.” NBC News. Retrieved 30 January 2016 from http://www.nbcnews.com/storyline/zika-virus-outbreak/what-zika-virus-your-questions-answered-n506126?cid=eml_nmn_20160129

Hotez, P. (2016). A Campaign to Eliminate Mosquitoes Is Needed Until a Vaccine Is Developed. The Opinion Pages, Room for Debate, 29 January 2016. The New York Times. Retrieved 30 January 2016 from http://www.nytimes.com/roomfordebate/2016/01/29/how-to-stop-the-spread-of-zika/a-campaign-to-eliminate-mosquitoes-is-needed-until-a-vaccine-is-developed

Moon, S. (2016). The World Health Organization Needs to Be in Charge of Zika. The Opinion Pages, Room for Debate, 29 January 2016. The New York Times. Retrieved 30 January 2016 from http://www.nytimes.com/roomfordebate/2016/01/29/how-to-stop-the-spread-of-zika/the-world-health-organization-needs-to-be-in-charge-of-zika

Muir. (2016). ABC World News, story 5, 2:50, January 28, 2016.

Pelley. (2016). CBS Evening News, lead story, 2:35, January 28, 2016.

Stein, R. (2016). Big Zika Virus Outbreak Unlikely In The U.S., Officials Say. Shots: Health News from the NPR. National Public Radio, 29 January 2016. Retrieved 30 January 2016 from http://www.npr.org/sections/health-shots/2016/01/26/464459350/big-zika-virus-outbreak-unlikely-in-the-u-s-officials-say

Sun, L. & Dennis, B. (2016). Why the United States is so vulnerable to the alarming spread of Zika virus. Health & Science, 28 January 2016. The Washington Post. Retrieved 30 January 2016 from https://www.washingtonpost.com/national/health-science/why-the-united-states-is-vulnerable-to-spread-of-zika-virus/2016/01/26/a8c6a9b4-c440-11e5-8965-0607e0e265ce_story.html?tid=a_inl

Vittor, A. (2016). To Tackle the Zika Virus, Alleviate Urban Poverty. The Opinion Pages, Room for Debate, 29 January 2016. The New York Times. Retrieved 30 January 2016 from http://www.nytimes.com/roomfordebate/2016/01/29/how-to-stop-the-spread-of-zika/to-tackle-the-zika-virus-alleviate-urban-poverty

WHO Director-General briefs Executive Board on Zika situation. (2016). Briefing to the Executive Board on the Zika situation, Geneva, Switzerland, 28 January 2016. Retrieved 30 January 2016 from http://www.who.int/dg/speeches/2016/zika-situation/en/

WHO to convene an International Health Regulations Emergency Committee on Zika virus and observed increase in neurological disorders and neonatal malformations.  (2016). WHO statement, 28 January 2016. Retrieved 30 January 2016 from http://www.who.int/mediacentre/news/statements/2016/emergency-committee-zika/en/

Wolfson, W. (2016). Before Zika Virus, Rubella Was A Pregnant Woman’s Nightmare. Shots: Health News from NPR. National Public Radio, 30 January 2016. Retrieved 30 January 2016 from http://www.npr.org/sections/health-shots/2016/01/30/464899067/before-zika-virus-rubella-was-a-pregnant-womans-nightmare

Zika Virus Travel Alert. (2016). Transcript for CDC Telebriefing: Zika Virus Travel Alert, Thursday, January 28, 2016. Retrieved 30 January 2016 from http://www.cdc.gov/media/releases/2016/t0128-zika-virus-101.html

 

 

Transfer Factor and Me

You would not recognize me now if you knew that I suffered from severe migraine headaches*.  It was, for me, officially declared “attributed to Persian Gulf War exposure.”

Thirteen years I agonized without relief despite receiving good medical care first from the U.S. military and then VA neurology specialists.  Yes, I am a triple graduate-level physician from Harvard University, The Johns Hopkins University, and Walter Reed Army Institute of Research.  And, it is me who had to endure debilitating pain.

Migraine with Aura, Courtesy The Mayo Clinic

Still, the pain persisted.  This, in spite of my faithful dedication to continued heavy treatments, which included daily injections, pills, and nasal spray ordered by the region’s senior neurologist.

In all, I endured as many as three (3) prolonged migraine headache events.  Each resulted in absolute bed rest for a full, two (2) weeks.

Still, each disabling episode happened while submitting to the most expensive, high-quality treatment available to the developed world.

Then, I met another person who suggested that I try this nutraceutical, called Transfer Factor, as the best alternative to my prescription medications.  Why?  “It’s got a patented delivery system!”

I knew “patented” meant nothing more than proprietary, which meant expensive and I was never going to know what was really in that expensive, oral capsule.    I later discovered this patented product was Transfer Factor Plus®.

Now, I was familiar with what 4Life Research touted as “clinical research” over the past, half century.  The “research” documented what was considered to be highly successful outcomes in people with both immune compromised and hypersensitive immune systems.  But, since the “research” was fully proprietary, NONE of the almost 60 years of data was available for peer-review!

Initially, according to the one peer-reviewed study, the only way to get access to this ingredient, colostrum (according to 4Life Research conveniently collected and uniquely processed from a mammalian mother’s first three days after delivery) was by blood transfusion.  That was 60 years ago.

Then, after Transfer Factors became available using the propriety, patented delivery system that uses only capsules, drinks and creams, all the data became unavailable to peer-review under the non-descriptive, non-scientific word described in each of its patents: proprietary.  

Yes, the patents had been submitted but the “data” revealed in the patents was sketchy and inconclusive… sufficient to satisfy a patent clerk, but not a medically-educated, unbiased peer reviewer. Nonetheless, 4Life Research managed to get its product listed in the Physician’s Desk Reference (PDR) for non-prescription medicines so it would be an inducement to both conventional and alternative medicine physicians in over 53 countries to use the nutraceutical.   

Well, since it was listed in the PDR, it was considered “researched” enough for many physicians to practice medicine with this substance. 

So, I thought I would give it a try on my migraines.  I am supposed to be intelligent.  After all, I attended two Ivy League schools and received three graduate degrees!

Then, after less than four (4) weeks using Transfer Factor Plus® I noticed the migraine headaches were gone.  By six (6) weeks, I was able to stop all the migraine prescription medications.

The migraines were gone! But, I also had another unforeseen problem. Agranulocytosis.  

Yes, the nutraceutical seemed to have destabilized my white and red blood cell lines and I was bleeding.  Everywhere.

The specialist at the hospital ordered Transfer Factor, the nutraceutical by 4Life Research stopped immediately.  

Within a month I was back to normal.  

Do I still get migraines using my prescription medication?  Yes, from time to time.  

But, I would rather have the migraines than the destabilized white and red blood cell lines and all that bleeding.

You are probably asking yourself the obvious question: Can I have the same problem or will I see benefits?

Each person is different.

Still, when a placebo (sugar pill) has success, statistically, in 40 percent of the cases, doesn’t it seem suspicious when one-third of the Transfer Factor users are celebrating its benefits compared to two-thirds who experience marginal to no benefit… and some have bad experiences like me?  That is a medical failure, statistically.

This is about Transfer Factor and Me.  Your experience may be different.

Feel free to contact me with your questions about Transfer Factor as you should always make an informed decision about taking in or applying anything to your body for your own health.  Remember, a nutraceutical is NOT a benign substance!

*This is an actual case by one of the authors of AskDrCarr®.  Your results may be different.  Incidental reference to the dubious nutraceutical, Transfer Factor, and similar substances is given without intention of diagnosing or treating, but rather to provide educational value to the reader to make an informed, independent decision, recognizing the marked variations in individual experience.