Tuesday, April 14, 2015

Eula Biss's Book, On Immunity

Back when the California and Illinois measles outbreaks were happening, I read Eula Biss's short book On Immunity, and recommend it highly. It's amazing how the topic has faded with the churning news cycle, but this enduring problem never really goes away, unfortunately.

Biss raises many thought-provoking points, such as the implications of thinking some types of people are at higher risk than you and your child, or that resistance to vaccination is based in the innate human fear of contamination. And she frequently cites the work of the feminist medical anthropologist Emily Martin, whose earlier book The Woman in the Body influenced me as a child-bearing person back in the early 1990s. So big points from me for that.

My favorite part of the book, though, was her analysis of Dr. Bob Sears, who is known for encouraging his patients and readers to delay vaccines.  Sears -- son of the popular pediatrician William Sears, author of The Baby Book -- has used his family brand name to make a bunch of money with his own books and private practice.

In his Vaccine Book, the junior Sears recommends a selective vaccine schedule, which leaves kids unprotected for polio, measles,  mumps, rubella, and hepatitis B. If that's too out there for the reader/parent, he has an additional recommended schedule, which includes all of those but spreads them over eight years instead of the standard two years. He calls the latter the "best of both worlds."

But delaying vaccinations for six years doesn't protect kids during those six years, obviously, so I'm not sure how that's "best." On the hep B vaccine particularly, Sears has written, "This is an important vaccine from a public health standpoint, but it's not as critical from an individual point of view."

Which makes no sense at all, especially coming from a person who has a medical degree. As Biss puts it, "Public health, Dr. Bob suggests, is not our health" (page 109). It's the health of one of those others out there: probably someone who's poor, whom "we" (who can afford to pay Dr. Bob's bills) don't have to care about.

Sears even says as much in his book, which has a section called "Is it your social responsibility to vaccinate your kids?" His answer: "Can we fault parents for putting their own child's health ahead of that of the kids around him?" He goes on to encourage parents to keep their fears of the MMR vaccine to themselves, because if too many people avoid the vaccine, it will affect your own kid.

Wow, those are some bad ethics.

As for the "too many, too soon" school of thought among anti-vaxxers, including Sears, Biss says:
The small pox vaccine my father received contained far more immunizing proteins...than any of the vaccines we use today.... In that sense, a single dose of the smallpox vaccine our parents received presented a greater challenge to the immune system than the total challenge presented by all the twenty-six immunizations for fourteen diseases we now give our children over the course of two years (pages 110-111).
The idea that vaccines are a form of contamination relates closely to the idea that it's not germs that make us sick, but toxins. She writes,
In this context, fear of toxicity strikes me as an old anxiety with a new name. Where the word filth once suggested, with its moralist air, the evils of the flesh, the word toxic now condemns the chemical evils of our industrial world. This is not to say that concerns over environmental pollution are not justified -- like filth theory, toxicity theory is anchored in legitimate dangers -- but that the way we think about toxicity bears some resemblance to the way we once thought about filth. Both theories allow their subscribers to maintain a sense of control over their own health by pursuing personal purity. For the filth theorist, this meant a retreat into the home, where heavy curtains and shutters might seal out the smell of the poor and their problems. Our version of this shuttering is now achieved through the purchase of purified water, air purifiers, and food produced with the promise of purity (page 75).
But we are all, as Biss notes, already polluted. Our bodies are colonized by bacteria that we need to function -- in the gut, on the skin -- and we are full of chemicals, whether naturally occurring or from our environment at birth. There is no purity. We have to get over these aversions that arise from our monkey brains and use the best health practices found through the scientific method.

And we need to recognize that we each are part of a community of immunity, not free-riders taking advantage of the group.

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