Honestly, I don’t even know how to review this book. I kept it past the two-week checkout window so I could re-read it and post on it. It is a beautiful, intelligent book, and I highly recommend it, especially in light of the measles outbreak and latest reports of mumps as well.
I am pro-vaccine. Daniel is fully vaccinated, and I believe that vaccines are a public health miracle. We are fortunate that we have never had to experience a polio outbreak or smallpox epidemic with little hope for a cure. Maybe it is because I’ve read way too many biographies of historical figures, but I cannot think of vaccines as anything but good.
But. I felt nervous when Daniel needed to receive the dreaded “MMR” vaccine. He received it on time, but I closely monitored him. I agree that these decisions are difficult, especially when it is your tiny, fresh new baby who is being poked. I get it. I get how easy and comforting it is to think if only you can feed you child the best, safest food; provide the safest, most enriching environment, you can somehow stave off disease of all types, ranging from the flu to cancer. What we forget or don’t want to think about is that we are all irrevocably tied to our environment and all the good and bad things in it. We have far less control than we think, including over our own bodies. As The Emperor of All Maladies (a book I had read already and one that Biss references) points out, cancer is us.
I don’t think I can do justice to this book in a review, so I’m going to post some quotes that stood out to me.
When I search now for a synonym for ‘protect,’ my thesaurus suggests, after ‘shield’ and ‘shelter’ and ‘secure,’ one final option: ‘inoculate.’ This was the question, when my son was born – would I inoculate him? As I understood it then, this was not a question of whether I would protect him so much as it was a question of whether inoculation was a risk worth taking. (p. 7)
The very expression ‘herd immunity’ suggests that we are cattle, waiting, perhaps to be sent to slaughter. And it invites an unfortunate association with the term ‘herd mentality,’ a stamped toward stupidity. The herd, we assume, is foolish. Those of us who eschew the herd mentality tend to prefer a frontier mentality in which we imagine our bodies as isolated homesteads that we tend ether well or badly. The health of the homestead next to ours does not affect us, this thinking suggests, so long as ours is well tended. (p. 20-21)
When I ask the pediatrician what the purpose of the hep B vaccine was, he answered, ‘that’s a very good question,’ in a tone that I understood to mean this was a question he relished answering. Hep B was a vaccine for the inner city, he told me, designed to protect the babies of drug addicts and prostitutes. It was not something, he assured me, that people like me needed to worry about. (p. 23-24)
The brief 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. (p. 24)
One of the mysteries of hep B immunization is that vaccinating only ‘high risk’ groups, which was the original public health strategy, did not bring down rates of infection…But rates of hep B infection remained unchanged until the vaccine was recommended for all newborns a decade later. Only mass vaccination brought down the rates of infection and it has now virtually eliminated the disease in children. (p. 25)
When the last nationwide smallpox epidemic began in 1898, some people believed that whites were not susceptible to the disease…And when smallpox arrived in Middlesboro, Kentucky, everyone in the black section of town who resisted vaccination was vaccinated at gunpoint. These campaigns did not limit the spread of the disease, but all the risk of vaccination…was absorbed by the most vulnerable groups. The poor were enlisted in the protection of the privileged. (p. 25-26)
If it was meaningful then for the poor to assert that they were not purely dangerous, I suspect it might be just as meaningful now for the rest of us to accept that we are not purely vulnerable. The middle class may be ‘threatened,’ but we are still, just by virtue of having bodies, dangerous. (p. 27)
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. (p. 37)
‘Intuitive toxicology’ is the term that Slovic uses for the way most people assess the risk of chemicals…For toxicologists, ‘the does makes the poison.’ Any substance can be toxic in excess. Water, for instance, is lethal to humans in very high doses…But most people prefer to think of substances as either safe or dangerous, regardless of the does. And we extend this thinking to exposure, in that we regard any exposure to chemicals, no matter how brief or limited, as harmful. (p. 38)
Allowing children to develop immunity to contagious diseases ‘naturally,’ without vaccination, is appealing to some of us. Much of that appeal depends on the belief that vaccines are inherently unnatural…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. (p. 41)
The idea that toxins, rather than filth or germs, are the root cause of most maladies is a popular theory of disease among people like me. (p. 73)
As for mercury, a child will almost certainly get more mercury exposure from her immediate environment than from vaccination. This is true, too, of the aluminum that is often used as an adjuvant in vaccines to intensify the immune response. Aluminum is in a lot of things, including fruits and cereals as well as, again, breast milk. Our breast milk, it turns out, is as polluted as our environment at large. Laboratory analysis of breast milk has detected paint thinners, dry-cleaning fluids, flame retardants, pesticides and rocket fuel. (p. 74)
Though toxin is now often used to refer to man-made chemicals, the most precise meaning of the term is still reserved for biologically produced poisons.(p. 74)
Immunity is a public space. And it can be occupied by those who choose not to carry immunity. For some of the mothers I know, a refusal to vaccinate falls under a broader resistance to capitalism. But refusing immunity as a form of civil disobedience bears an unsettling resemblance to the very structure the Occupy movement seeks to disrupt – a privileged 1 percent are sheltered from risk while they draw resources from the other 99 percent. (p. 95)
Paternalism has fallen out of favor in medicine, just as the approach to fathering that depends on absolute authority no longer dominates parenting. But how we should care for other people remains a questions. (p. 98).
Autonomy is usually imagined as the alternative to paternalism. But in what is sometimes called the “restaurant model” of medicine, the paternalism of doctors has been replaced by the consumerism of patients…And the doctor, who was a father in the paternalistic model, is now a waiter. (p. 99)
Once you are infected with chicken pox, the varicella virus never leaves your body. It lives in your nerve roots and must be kept at bay by your immune system for the rest of your life. (p. 115).
We used to live among wild things, mountain lions on the ridge and fires raging on the prairie. There were dangers….It is difficult to imagine any type of chicken pox, with its distinctive rash described as a ‘dew drop on a rose petal,’ as sinister. And it is hard not to suspect, when the two types of chicken pox virus are termed the wild type and the vaccine virus, that the wild type might be superior. (p.115-116)
The natural body meets the body politic in the act of vaccination, where a single needle penetrates both. The capacity of some vaccines to generate a collective immunity superior to the individual immunity produced by those same vaccines suggests that the politic has not only a body, but also an immune system capable of protecting it as a whole. (p. 126)
The anxieties generated by the AIDS epidemic have bled into our attitudes toward vaccination. Needles, as we learned from AIDS, can spread disease. The needle itself has become ‘dirty.’ AIDS reveals that our immune systems are vulnerable to sabotage and can be permanently disabled. (p. 136)
AIDS education taught us the importance of protecting our bodies from contact with other bodies, and this seems to have bred another kind of insularity, a preoccupation with the integrity of the individual immune system. Building, boosting and supplementing one’s personal immune system is a kind of cultural obsession of the moment. I know mothers who believe this is a viable substitute for vaccination, and who understand themselves as raising children with superior immune systems. (p. 137)