More on this book
Community
Kindle Notes & Highlights
We fear that vaccination will invite autism or any one of the diseases of immune dysfunction that now plague industrialized countries—diabetes, asthma, and allergies. We fear that the hepatitis B vaccine will cause multiple sclerosis, or that the diphtheria-tetanus-pertussis vaccine will cause sudden infant death. We fear that the combination of several vaccines at once will tax the immune system, and that the total number of vaccines will overwhelm it. We fear that the formaldehyde in some vaccines will cause cancer, or that the aluminum in others will poison our brains.
Jon Nakapalau liked this
He then goes on to evoke Mark Twain: “I heard once of an American who so defined faith: ‘that which enables us to believe things which we know to be untrue,’”
That’s why a person with Type O negative is known as a “universal donor.” My father would then reveal that his blood type was O negative, that he himself was a universal donor. He gave blood, my father explained, as often as he was allowed because blood of his type was always in demand for emergency transfusions. I suspect my father may have already known then what I would only discover later—that my blood, too, is Type O negative.
If we imagine the action of a vaccine not just in terms of how it affects a single body, but also in terms of how it affects the collective body of a community, it is fair to think of vaccination as a kind of banking of immunity. Contributions to this bank are donations to those who cannot or will not be protected by their own immunity. This is the principle of herd immunity, and it is through herd immunity that mass vaccination becomes far more effective than individual vaccination.
Those of us who draw on collective immunity owe our health to our neighbors.
Science, Surowiecki reminds us, is “a profoundly collective enterprise.” It is a product of the herd.
The belief that public health measures are not intended for people like us is widely held by many people like me. Public health, we assume, is for people with less—less education, less-healthy habits, less access to quality health care, less time and money. I have heard mothers of my class suggest, for instance, that the standard childhood immunization schedule groups together multiple shots because poor mothers will not visit the doctor frequently enough to get the twenty-six recommended shots separately. No matter that any mother, myself included, might find so many visits daunting. That, we
...more
Vaccination of humans has made one single virus extinct—the variola virus that causes smallpox. But novel viruses are constantly inventing themselves, as viruses have a special talent for genetic variation. Of all the varieties of germs, viruses may be the most vexing. They are mysterious creatures, parasitic and vampiric by nature. They are not exactly inanimate, but viruses are not, strictly speaking, alive. They do not eat, do not grow, and generally do not live in the manner that other living things live. Viruses must enter and inhabit a living cell in order to reproduce, or to do much of
...more
A rather surprising amount of the human genome is made up of debris from ancient viral infections. Some of that genetic material does nothing, so far as we know, some can trigger cancer under certain conditions, and some has become essential to our survival. The cells that form the outer layer of the placenta for a human fetus bind to each other using a gene that originated, long ago, from a virus. Though many viruses cannot reproduce without us, we ourselves could not reproduce without what we have taken from them. Our own adaptive immune system, the branch of our immune system that develops
...more
“Perceptions of risk—the intuitive judgments that people make about the hazards of their world,” the historian Michael Willrich observes, “can be stubbornly resistant to the evidence of experts.” We do not tend to be afraid of the things that are most likely to harm us. We drive around in cars, a lot. We drink alcohol, we ride bicycles, we sit too much. And we harbor anxiety about things that, statistically speaking, pose us little danger. We fear sharks, while mosquitoes are, in terms of sheer numbers of lives lost, probably the most dangerous creature on earth.
In a study that invited people to compare various causes of death, Slovic found that people tended to believe that accidents cause more deaths than disease and that homicide causes more deaths than suicide, when the opposite is true in both cases. In another study, people significantly overestimated the fatality rates of highly publicized or dramatic dangers like cancer or tornadoes.
When we encounter information that contradicts our beliefs, as Slovic found in one of his studies, we tend to doubt the information, not ourselves.
“Having children,” a friend with grown children reminds me, “is the greatest risk you can take.”
For toxicologists, “the dose makes the poison.” Any substance can be toxic in excess. Water, for instance, is lethal to humans in very high doses, and overhydration killed a runner in the 2002 Boston Marathon. But most people prefer to think of substances as either safe or dangerous, regardless of the dose.
Though toxicologists tend to disagree with this, many people regard natural chemicals as inherently less harmful than man-made chemicals. We seem to believe, against all evidence, that nature is entirely benevolent.
Vaccination is a kind of domestication of a wild thing, in that it involves our ability to harness a virus and break it like a horse, but its action depends on the natural response of the body to the effects of that once-wild thing.
The antibodies that generate immunity following vaccination are manufactured in the human body, not in factories.
Infectious disease is one of the primary mechanisms of natural immunity. Whether we are sick or healthy, disease is always passing through our bodies. “Probably we’re diseased all the time,” as one biologist puts it, “but we’re hardly ill.” It is only when disease manifests as illness that we see it as unnatural, in the “contrary to the ordinary course of nature” sense of the word.
The publication of Silent Spring in 1962 led to the creation of the Environmental Protection Agency and a ban on the production of DDT in the United States. The book popularized the idea that human health depends on the health of the ecosystem as a whole, but Carson did not use the word ecosystem. She preferred the metaphor of an “intricate web of life,” in which a disturbance anywhere on the web sends tremors across the entire web. “Silent Spring,” Carson’s biographer Linda Lear writes, “proved that our bodies are not boundaries.”
Vaccination is a precursor to modern medicine, not the product of it. Its roots are in folk medicine, and its first practitioners were farmers. Milkmaids in eighteenth-century England had faces unblemished by smallpox.
Twenty years later, the country doctor Edward Jenner extracted pus from a blister on the hand of a milkmaid and scraped it into the arm of an eight-year-old boy. The boy got a fever but did not become ill. Jenner then exposed the boy to smallpox, which did not infect him. Emboldened, Jenner continued his experiment on dozens of other people, including his own infant son. Before long, the procedure would be known by Jenner’s term for cowpox, variolae vaccinae, from the Latin vacca for cow, the beast that would forever leave its mark on vaccination.
The basic mechanism behind vaccination was not new even when an intrepid dairy farmer used a darning needle to vaccinate his children. At that point, variolation, the practice of purposefully infecting a person with a mild case of smallpox in order to prevent more serious illness, was still somewhat novel in England but had been practiced in China and India for hundreds of years.
The term immune system was used for the first time in 1967 by Niels Jerne, an immunologist who was trying to reconcile two factions of immunology—those who believed that immunity depended largely on antibodies and those who believed it depended more on specialized cells. Jerne used the word system to unite all the cells and antibodies and organs involved in immunity into one comprehensive whole. This idea that immunity is the product of a complex system of interdependent parts acting in concert is relatively new to science.
Infants have all the components of this system at birth. There are certain things the infant immune system does not do well—it has trouble penetrating the sticky coating of the Hib bacteria, for example. But the immune system of a full-term infant is not incomplete or undeveloped. It is what immunologists call “naive.” It has not yet had the opportunity to produce antibodies in response to infection. Infants are born with some antibodies from their mothers already circulating in their systems, and breast milk supplies them with more antibodies, but this “passive immunity” fades as an infant
...more
If a narrative of any kind emerged from those lectures, it was the drama of the interaction between our immune system and the pathogens with which it coevolved. This drama was sometimes characterized as an ongoing battle, but not the kind that involves Apache helicopters and unmanned drones—this was clearly a battle of the wits. “And then the viruses got even smarter,” my professor would say, “and did something ingenious—they used our own strategies against us.” In his telling, our bodies and the viruses were two competing intelligences locked in a mortal game of chess.
Believing that vaccination causes devastating diseases allows us to tell ourselves a story we already know: what heals may harm and the sum of science is not always progress.
Fears that formaldehyde from vaccines may cause cancer are similar to fears of mercury and aluminum, in that they coalesce around minuscule amounts of the substance in question, amounts considerably smaller than amounts from other common sources of exposure to the same substance. Formaldehyde is in automobile exhaust and cigarette smoke, as well as paper bags and paper towels, and it is released by gas stoves and open fireplaces. Many vaccines contain traces of the formaldehyde used to inactivate viruses, and this can be alarming to those of us who associate formaldehyde with dead frogs in
...more
Toxoid is the term for a toxin that has been rendered no longer toxic, but the existence of a class of vaccines called toxoids probably does not help quell widespread concerns that vaccination is a source of toxicity.
Power is what philosophers would call a positional good, meaning that its value is determined by how much of it one has in comparison to other people. Privilege, too, is a positional good, and some have argued that health is as well.
The smallpox virus now exists only in two laboratories, one in the United States and the other in Russia. Beginning shortly after the eradication of smallpox, the World Health Organization set a number of deadlines for the destruction of these stores, but neither country complied. In a 2011 discussion of the matter, the United States argued for more time with the virus so that a better vaccine could be developed, just to be safe. Smallpox has now ceased to be a disease and is only a potential weapon.
While we routinely call for more vaccine testing, and more human trials, the unspoken assumption is that we do not intend our children to be the subjects of those trials.
In 120 countries, vaccines containing thimerosal are currently used to save an estimated 1.4 million lives every year. Thimerosal is essential for multidose vaccines, which are less expensive to produce, store, and ship than single-dose vaccines. Some countries rely on multidose vaccines, not just because they are more cost effective and produce less waste than singledose vaccines, but also because they do not require refrigeration. There are places, mostly in poorer countries, where a ban on thimerosal would effectively be a ban on vaccination against diphtheria, pertussis, hep B, and
...more
“Most problems will get better if left alone. Those problems that do not get better if left alone are likely to kill the patient no matter what you do.” This is as much an argument for preventive medicine as it is a sigh of defeat.
My father was vaccinated against five diseases as a child. I was vaccinated against seven, and my son has been vaccinated against fourteen. The proliferation of childhood vaccines has become, for some of us, a kind of metaphor for American excess. Too many, too soon, one of the slogans common to vaccine activism, could easily be a critique of just about any aspect of our modern lives.
One of the mercies of immunity produced by vaccination is that a small number of people can forgo vaccination without putting themselves or others at greatly increased risk. But the exact number of people this might be—the threshold at which herd immunity is lost and the risk of disease rises dramatically for both the vaccinated and the unvaccinated—varies depending on the disease and the vaccine and the population in question. We know the threshold, in many cases, only after we’ve exceeded it. And so this puts the conscientious objector in the precarious position of potentially contributing
...more
When I was a child, I asked my father what causes cancer and he paused for a long moment before saying, “Life. Life causes cancer.” I took this as an artful dodge until I read Siddhartha Mukherjee’s history of cancer, in which he argues not only that life causes cancer but that cancer is us. “Down to their innate molecular core,” Mukherjee writes, “cancer cells are hyperactive, survival-endowed, scrappy, fecund, inventive copies of ourselves.” And this, he notes, “is not a metaphor.”
But none of these have enjoyed the kind of press devoted to one small, inconclusive study that suggested a link between vaccination and autism. “We live in a media culture,” the writer Maria Popova observes, “that warps seeds of scientific understanding into sensationalist, definitive headlines about the gene for obesity or language or homosexuality and maps where, precisely, love or fear or the appreciation of Jane Austen is located in the brain—even though we know that it isn’t the clinging to answers but the embracing of ignorance that drives science.”
Science is, as scientists like to say, “self-correcting,” meaning that errors in preliminary studies are, ideally, revealed by subsequent studies. One of the primary principles of the scientific method is that the results of a study must be reproducible. Until the results of a small study are duplicated by a larger study, they are little more than a suggestion for further research. Most studies are not incredibly meaningful on their own, but gain or lose meaning from the work that has been done around them.
And, as the medical researcher John Ioannidis has observed, “most published research findings are false.” The reasons for this are many, and include bias, study size, study design, and the very questions the researcher is asking. This does not mean that published research should be disregarded, but that, as Ioannidis concludes, “What matters is the totality of the evidence.”
“Any science may be likened to a river,” proposes the biologist Carl Swanson. “It has its obscure and unpretentious beginning; its quiet stretches as well as its rapids, its periods of drought as well as of fullness. It gathers momentum with the work of many investigators and as it is fed by other streams of thought; it is deepened and broadened by the concepts and generalizations that are gradually evolved.”
Knowledge is, by its nature, always incomplete. “A scientist is never certain,” the scientist Richard Feynman reminds us. And neither, the poet John Keats would argue, is a poet. “Negative capability” was his term for the ability to dwell in uncertainty. My mother, a poet, has been instilling this ability in me since I was a child. “You have to erase yourself,” she says, meaning abandon what I think I know. Or “live the questions,” as Rainer Maria Rilke writes in his Letters to a Young Poet. This, my mother reminds me, is as essential to mothering as it is to poetry—we must live the questions
...more
In 2004, the director of the WHO announced that another major pandemic is inevitable. “It’s not a matter of if, but when,” a bioethicist friend tells me.
“Apocalypse,” Sontag writes, “is now a long-running serial: not ‘Apocalypse Now’ but ‘Apocalypse From Now On.’ Apocalypse has become an event that is happening and not happening.” In this era of uncertain apocalypse, my father has taken to reading the Stoics, which is not an entirely surprising interest for an oncologist. What he is drawn to in their philosophy, he tells me, is the idea that you cannot control what happens to you, but you can control how you feel about it. Or, as Jean-Paul Sartre put it, “Freedom is what you do with what’s been done to you.”
“Life,” as Donna Haraway writes, “is a window of vulnerability.”
I have doubts that we can vaccinate away our prejudices, or wash our hands of them. There will always be diseases against which we cannot protect ourselves, and those diseases will always tempt us to project our fears onto other people. But I still believe there are reasons to vaccinate that transcend medicine.
Diversity is essential to the health of any ecosystem. But the language we use around racial diversity, particularly the word tolerance, tends to imply that other people are essentially a nuisance, and disguises the fact that we need and depend on each other. “They aren’t blind,” my son says of moles, “they just can’t see.” The same could be said of humans. We often manage not to see that we are, as Martin Luther King reminds us, “caught in an inescapable network of mutuality.”
