Columbia Journalism Review Weighs in on Arthur

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http://www.cjr.org/issues/2007/1/Skloot.asp

Under the Skin

A History of the Vaccine Debate Goes Deep but Misses the Drama

Vaccine: The Controversial Story of Medicine's Greatest Lifesaver

by Arthur

By Skloot

At this point, it's safe to say, most people in the United States

have not been on the receiving end of midnight vaccination raids,

with doctors breaking into their homes and jabbing their families

with needles. It's been a long time since we saw entire cities

flattened by disease. So long, in fact, that lessons from those days

seem to have been lost on a few generations.

We're in the midst of a confused national debate over vaccines, with

some fearing immunization side effects more than the diseases they

fight, and others pushing for more vaccines, at younger ages, and

being baffled when parents object. Newspapers report that vaccines

may or may not cause autism, autoimmune diseases, and allergies; at

the same time, they warn of viral pandemics that can (and do) kill

millions, and call for new vaccines to save us (from, say, AIDS, or

avian flu). But when those new vaccines arrive and officials say we

must give them to our children, we balk. This is nothing new: The

vaccine debate has been raging for hundreds of years, because

immunizations have a long and complicated history of both saving our

lives and hurting us. We needed a book that laid out the history and

made sense of it.

There have been at least twenty books on smallpox and polio alone.

But until Vaccine: The Controversial Story of Medicine's Greatest

Lifesaver, by the science journalist Arthur , no book had so

carefully and clearly catalogued the history of immunization. And,

as writes, " the best way to gain an understanding of why our

children [are] vaccinated against particular diseases — and why some

people [are] challenging these choices — [is] to delve into the

history. "

We've seen viruses threaten to wipe out millions (and succeed).

Parents have refused immunization, then found themselves with sick

and dying children, while those doing the immunizing had to pay

large sums for damages caused by vaccines that were not properly

made or tested. And here's something ironic: when vaccines do their

job best, people doubt them most. They start thinking, Who gets

whooping cough anymore? Why should I expose my children to even the

slightest risk of vaccine side effects to protect them from a

disease no one gets? Anyone who's ever asked that question should

read this book. So should anyone who thinks vaccine doubters are

crazy. Because shows that those fears come from real stories

of vaccines causing everything from brain damage to tetanus to

polio. But more than that, he shows why we have vaccines in the

first place, and why it's a bad idea to shun them.

's book starts in the 1700s, with smallpox and the first

immunizations, and ends with the nearly 10,000 lawsuits filed in

2006 claiming vaccine damages. Along the way, he raises important

ethical issues (like the role vaccines played in eugenics), and

highlights the many ways children bore the burden of that history:

their bodies were used to develop and test vaccines (not always

ethically); they suffered the injection side effects, and got the

diseases when parents refused to immunize them. traces the

legal history of vaccine production, from the first lawsuit for

damaging side effects to a litigation free-for-all, with companies

paying large sums for problems their shots didn't cause. (Covering

their losses by raising vaccination costs was easier than fighting

in court.)

Much of the material devoted to smallpox and polio has been explored

elsewhere. 's truly original contributions come with more

recent issues that haven't been widely covered. Whooping cough, for

example, lingers in the United States in part because many parents

refuse to vaccinate against it. The story that feels largely missing

is the new vaccine for strains of the HPV virus, which can cause

cervical cancer. HPV is rapidly headed toward as much controversy as

any vaccine before it. More, perhaps, since this one — like the

vaccine for hepatitis B, which faced similar problems — is a

sexually transmitted disease. But makes up for that omission

with his detailed coverage of the autism controversy.

He is one of the first authors to really delve into the science

behind the do-immunizations-cause-autism debate. " No one could

deny, " he writes, " that autism diagnoses had gone up during a period

in which vaccine use was going up. " What caused that increase is

still unknown. In 1997, a study found that the hepatitis B vaccine

contained as much mercury as a can of tuna. That alone may not be

toxic, but because of multiple vaccinations, by the age of six

months, kids were getting " doses up to 87 times higher than FDA

guidelines for the maximum consumption of mercury from fish. "

Mercury is known to cause brain damage, so no one was wrong to ask

what it was (and still is) doing in vaccines. doesn't deny

that. But by documenting the science behind the debate, he makes a

convincing case against the vaccine-autism theory.

The way sees it, one reason the autism debate still exists,

despite evidence against it, is " pseudo-investigative,

sensationalist news reporting. " He says a " chunk of the news media "

continues to hype the story, and he criticizes them sharply for

this. (He might well criticize cjr. See " Drug Test, "

November/December 2005.) The vaccine-autism theory was,

says, " the Pamela of news stories — dumb, maybe, but oh, so

sexy. " Not that the media must always agree with science, but it's

irresponsible to ignore scientific evidence in favor of a sexy

headline, something clearly has not done.

When it comes to modern medicine, there are few topics more dramatic

than vaccination. It's a story full of politics, big-business,

desperate parents, sick and dying children, conflicts of interest,

national security — it even has abortion controversy, since many

vaccines are created using cells from aborted fetuses. The subject

should be a narrative goldmine.

But unfortunately, for the most part, that drama doesn't come

through in Vaccine. Its reporting is impressive; there are countless

wonderful and often surprising facts that drive the book forward

(like companies trying to cover up toxicity problems by spreading

out distribution of vaccines, to avoid noticeable clusters of side

effects). It's all interesting; it's just hard to wade through.

Vaccine is traditional historic nonfiction writing that lays out the

facts. But as I read it, I couldn't help asking myself, Why write a

nonfiction science book like this? Why wouldn't you incorporate

narrative into any story that's so potentially rich with it?

Narrative is one of the best tools science writers have for

conveying complicated and important information to the general

public.

It would be great if all readers loved science for science's sake,

but they don't. There's a limited audience for a string of facts

about vaccines. But there's no limit to the number of people who

want to read a good story. As long as there are characters to latch

onto, as long as there are scenes with action and dialogue, readers

will do the work required to understand the science.

How many readers come to McPhee's writing interested in geology

and ecology? Not a lot. But they read, say, his essay " Travels in

Georgia " because he follows two wonderful and complex characters who

talk funny and collect road kill and sleep next to poisonous snakes

and want nothing more than to save Georgia's wilderness from

bulldozers. People might pick up Oliver Sacks's An Anthropologist on

Mars to learn about neurology, but what gets them through the book

is an autistic scientist who communicates with animals, and a top

neurosurgeon with Tourette's who screams obscenities while ticking

his way through delicate brain surgeries without a single slip of

the scalpel. Such stories aren't just about keeping readers

entertained: they're about showing instead of telling — they

illustrate science at work.

People already interested in vaccination will get a lot out of

's book. It will educate parents seeking answers. Scientists

will enjoy it. But the general public — who may be the audience that

needs 's book the most — may have a hard time getting beyond

the early chapters, which tend toward a blur of information, like

this: " A survey of 9,000 American families conducted from 1928 to

1931 found that 26 percent of five-year-olds had been vaccinated.

The number jumped to 59 percent by age 7 . . . in cities, where

vaccination was a more heavily enforced annoyance, the percentages

were 37 and 75 percent, respectively. The last major epidemic, in

1921, brought 102,787 cases and 563 deaths. " The outbreaks and

deaths blur because they don't happen to characters. They're just

numbers.

Which didn't have to be the case. himself proves this late in

the book, when he takes a sharp narrative turn and appears as a

character. Suddenly, his voice becomes absorbing and personal as he

tells the story of driving through the hills of Colorado, visiting

towns filled with antivaccinators, trying to understand why they

resist even though they're some of the only Americans who actually

get whooping cough. This is, by far, the book's strongest section.

We meet people like Dawn Winkler, a full-fledged character who

believes only inoculated kids throw temper tantrums. We hear her

explain her neighbor's child by saying, " she must be vaccinated

because every time I see her she has a huge amount of snot on her

face. " We see her convince many parents not to vaccinate their

children though they live in an area with high whooping cough rates

(which are largely blamed on not vaccinating). We hear a mother

describing her children's infection as " a loud cough that goes down

to their toes . . . they cough and cough until they throw up, then

they sleep for an hour or two, then they wake up and start all

over. " But she's glad she didn't vaccinate them, she tells ,

because she believes shots weaken the immune system.

These stories speak volumes about the vaccination debate.

doesn't step in and tell readers, This is crazy. He doesn't have to.

Readers can decide what they think, because they've seen it for

themselves. (In the epilogue, comes across firmly pro-vaccine,

but with this caveat: " The history of vaccines has shown that

unexpected results are the rule rather than the exception. " ) The

Colorado episode is no less scientific or accurate than earlier

parts of the book — and it's clearer because the stories illustrate

the science. If had written the whole book with that same

voice, and with the same narrative touch guiding us through the

thickest of science lessons, it would have helped make his important

work accessible to a wider audience.

Skloot is a freelance writer. Her first book, The Immortal

Life of Henrietta Lacks, is forthcoming from Crown.