1. Young, Robert C. MD

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The measles outbreak that began in mid-December at Disneyland has thus far spread (at the time I am writing this in early February) to 14 states and Mexico. Ninety-one cases have been reported to date-27 in upscale Orange County, California. To date, no deaths have been reported.

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In 1963, before the measles vaccine, the United States had about 500,000 cases each year and over 400 fatalities yearly. Effective vaccination strategies country-wide eliminated measles as a naturally circulating disease in 2000 and in 2004 the U.S. reported 37 cases and no fatalities. Since then, the incidence has slowly increased in clustered outbreaks in unvaccinated or under vaccinated populations as the persistence of anti-vaccination myths and unproven vaccination doses and schedules grows. In one Santa Monica preschool, 68 percent of parents had filed "personal-belief" exemptions.


In the view of the vast majority of scientists, physicians, public health officials, and expert review panels, the benefits of vaccination are settled science. No credible science suggests otherwise. Arguably, the widespread systematic vaccination against many communicable diseases is one of the greatest of all health advances in modern times.


Unfortunately, a great swath of the public is not convinced. Eula Biss, the author of this book, points out that an Associated Press poll in 2014 found that only about half of Americans believe that vaccines are safe and effective. Why the disconnect? Why has the science utterly failed to convince the public?


A novel approach to that question is presented in On Immunity, which was selected as one of the New York Times Book Review's 10 Best Books of 2014. The author is a highly regarded and award-winning essayist and teacher at Northwestern University. Although she is clearly pro-vaccination, she comes from the demographic group most likely to be skeptical and suspicious of vaccines. She cites a 2004 report from the CDC that those refusing to vaccinate are more apt to be white, older, college-educated, married mothers who live in households with incomes above $75,000-precisely the group that should best understand the risk/benefits.


The strength of the book is that it presents both sides of the debate but comes down squarely on the side of vaccination. One suspects that the book's subtitle, "An Inoculation," is the author's signal that the work is an attempt to re-educate the public using emotional appeal rather than the more conventional scientific one. Since the many scientific articles, books, and expert panels have not won the day, her approach is worth our attention.


The book contains enough of the history and benefits of vaccination to provide the reader with the evidence of its dramatic impact on smallpox, hepatitis B, and the childhood illnesses. It also reminds us of the now-forgotten devastation that these diseases once caused. But Biss's focus is not on the details of the science-she covers much of that in the notes in the back of the book.


Personal Struggles Surrounding Decisions to Vaccinate

Her focus is rather on the personal struggles surrounding decisions to vaccinate. Here she calls on her own reactions as well as the opinions of "people like me." She builds the story of suspicion from conversations with her friends and colleagues and from voracious reading and research. Since these are the very people who most resist vaccination and live in the high-risk clusters, she believes we should listen to their concerns.


What she presents is a grand mix of fears including loss of control, government ineptness and over-reach, big-Pharma corruption, and general solutions that may not fit their perceived circumstances. Typical stated beliefs are that natural products are safer than "synthetic chemicals" and practicing what Biss calls "Intuitive Toxicology." Above all, those who choose not to vaccinate seem to believe that applying all their intelligence can result in a risk-free life.


Biss uses the metaphor of Achilles, whose mother dangled him in the river Styx, conferring immunity to all but his heel. This residual vulnerability is at the heart of her, and their, anxieties. She does not attack the vaccine skeptics directly but rather seeks to interpret them by sharing similar anxieties she experienced while raising her son. Her stories about panic over potential plastic products used in baby mattresses or anxiety about the function of her baby monitor while her son slept quietly 12 feet away would be amusing if they were not so heartfelt.


While the book is sympathetic to these fears, it draws on science, myth, literature, and metaphor to assure us that the risk/benefit favors vaccination. She carefully dispels the myths surrounding thimerosal, formaldehyde, squalene, MMR and autism, and DPT and sudden infant death syndrome.


She surgically dissects the theories of discredited physicians like Andrew Wakefield (the autism myth), Robert Spears (The Vaccine Book), and Joseph Mercola (, and other pseudo-scientists. Once again, one has to go to the end notes to get the full details. Those notes also contain revealing examples of how the Internet keeps unsubstantiated science alive long after the original research has been refuted and retracted.


In spite of Biss's explanations about how anxiety, voracious unfiltered reading, and erroneous information found on the Internet can sustain these suspicions, it is difficult to grasp how they persist in what Frank Bruni in the New York Times has called "a chilling disregard for science." In The Norm Chronicles, a book reviewed here previously (OT 1/25/15 issue), the authors stress that fear is the driver: "Children are not even sick when we inject them for diseases we no longer see."


Both books highlight several emotional truths: (1) Perception of risk can be stubbornly resistant to the evidence of experts; (2) People overestimate the fatality rates of highly publicized or dramatic dangers; and (3) We accept natural risks because we lack any control over them and perseverate over those we can influence.


On Immunity is a very thought-provoking book that explores the vaccination debate from both sides. Certainly this is a defensible approach, since the risk/benefits of vaccination presented from a scientific perspective have clearly failed to adequately convince the public. Nonetheless it is disquieting that the book takes the debate seriously when there is no credible science to support the anti-vaccine movement and so much potential harm can result.


As one reads about the author's anxieties and insecurities that seem to spill out on nearly every page, one wonders how she was able to come so clearly to the correct conclusion about the net benefits of vaccination. As she says "a privileged one percent are sheltered from risk while they draw resources from the other 99 percent."


Perhaps it's the insight of her father, a physician and oncologist. Amongst his sage advice she quotes: "You cannot control what happens to you, but you can control how you feel about it." "We can protect our children to some extent, but we cannot make them invulnerable."


And finally the one that says it all: "Vaccination works."


Three cheers for the oncologist!




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