April 19, 2011

BOOKS: Deadly Choices, Paul A. Offit (2011)

A few weeks, I very much enjoyed Ben Goldacre's Bad Science, a look at how our scientific illiteracy makes it easy for drug companies and the media to scare us with various non-existent medical crises; among Goldacre's targets was the incompetent and fraudulent science behind the anti-vaccine movement. Offit's book deals with that movement at greater length, and while he doesn't ignore the dismal "science" that's behind it, he focuses just as much on its history and politics.

It shouldn't be surprising that there have been anti-vaccine activists for just as long as there have been vaccines; the phrase "conscientious objector" actually derives from the anti-vaccine movement of late-19th-century England, and was only later used for those protesting military service.

(An interesting pop-culture artifact of the anti-vaccine movement: The Raggedy Ann doll, whose designer modeled it after his daughter, whose death he blamed on smallpox vaccine. The doll's floppy limbs mimic her symptoms.)

And the tactics of the anti-vaccine crowd have been remarkably similar from one era to another. Discredit the science; malign the motives of doctors; claim that vaccines are dangerous, unnatural, or a violation of God's will. The most dramatic change in the modern movement is the role of lawyers and money.

Offit also provides very good explanations of how we're all put at risk by unvaccinated children, and of what a difference mandatory vaccination makes. He offers as one dramatic example the case of Texarkana, a city that sits on the Texas-Arkansas border, which suffered a measles outbreak in 1970. At the time, Arkansas required children to be vaccinated before entering school and Texas did not. Of the 633 measles cases in Texarkana, 608 were on the Texas side of the city.

Is there any hope? Offit sees only three ways out, and acknowledges that one of them -- ending religious and philosophical exemptions to mandatory vaccination laws -- is unlikely to happen in the current political and legal climate. He clings to the hope that Americans will somehow come to their senses and begin to trust their doctors again.

I find it hard to be that optimistic; we've reached a point where parents are putting their faith in Jenny McCarthy over, say, the American Academy of Pediatrics, and I fear that Offit's third way out -- the most pessimistic -- is the most likely. And that way out begins with massive outbreaks of childhood diseases that once seemed nearly wiped out: mumps, measles, diphtheria, whooping cough. I'm afraid that a lot of parents will have to suffer, and a lot of children will have to die, to shock America back into its senses on this issue.

Offit explains the problem clearly, and lays out the science involved in a way that shouldn't be beyond most readers. This is an important, passionate book about a growing public health crisis; sadly, those who most need to hear its message will probably never read it.

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