Review of Elena Conis, "Vaccine Nation: America’s Changing Relationship with Vaccination"

His reputation will never recover from that unfortunate business in Salem, but Cotton Mather deserves some recognition for his place in American medical history. He was the anti-vaccination movement’s first target.

The scene was Boston in 1721. Beginning in April, a smallpox epidemic spread from a ship anchored in the harbor; over the course of a year, it killed more than 840 people. (Here I’m drawing on Kenneth Silverman’s excellent The Life and Times of Cotton Mather, winner of the Pulitzer Prize for biography in 1985.) In the course of his pastoral duties, Mather preached the necessary funeral sermons, but he was also a corresponding member of the Royal Society of London for Improving Natural Knowledge. The Puritan cleric had been keenly interested in medical issues for many years before the epidemic hit. He knew of a treatment, discussed in the Society’s journal, in which a little of the juice from an infected person’s pustule was scratched into the skin of someone healthy. It warded off the disease itself, somehow. The patient might fall ill for a short while, but would be spared the more virulent sort of infection.  

Two months into the epidemic, Mather prepared a memorandum on the technique to circulate among area doctors, one of whom decided to go ahead with a trial run on three human guinea pigs. All survived the experiment, and in a remarkable show of confidence Mather had his son Samuel inoculated. (Mather himself had contracted smallpox in 1678, so was already immune.)

News of the procedure and its success became public just as the epidemic was going from worrying to critical, but not many Bostonians found the developments encouraging. The whole idea seemed absurd and dangerous. One newspaper mocked the few supporters of inoculation for giving in to something “like the Infatuation Thirty Years ago, after several had fallen Victims to the mistaken notions of Dr. M____r and other clerics concerning Witchcraft.”

Still more unkind was the person or persons responsible for trying to bomb Mather’s house. It failed to go off, but the accompanying note made the motive clear: “You dog, damn you, I’ll inoculate you with this….”

The colonial era falls outside the purview of Vaccine Nation: America’s Changing Relationship with Vaccination (University of Chicago Press) by Elena Conis, an assistant professor of history at Emory University, who focuses mainly on the 20th century, especially its last four decades. The scene changed drastically since Mather's day. Knowledge lagged behind technique: pioneering though early vaccination advocates were, they had no sound basis for understanding how inoculation worked. And the “natural philosophy” of Mather’s era was nowhere near as institutionalized or authoritative as its successor, the sciences, grew in the 19th century.

By the point at which Vaccine Nation picks up the story -- with John F. Kennedy announcing what would become the Vaccination Assistance Act of 1962 – both the nation-state and the field of biomedical research were enormous and powerful, and linked up in ways that Conis charts in detail. “If the stories herein reveal just one thing,” she writes, “it is that we have never vaccinated for strictly medical reasons. Vaccination was, and is, thoroughly infused with our politics, our social values, and our cultural norms.”

Be that as it may, the strictly medical reasons were compelling enough. The Act of 1962 was a push to make the Salk vaccine -- which between 1955 and 1961 had reduced the number of new polio cases from 30,000 to under 900 – available to all children. This seems like progress of a straightforward and verifiable sort, with the legislation being simply the next step toward eradicating the disease entirely. (As, indeed, it effectively did.)

But in Conis’s account, the fact that JFK announced his support for a vaccination program on the anniversary of Franklin Delano Roosevelt’s death was more than a savvy bit of framing. The reference to FDR, “the nation’s most famous polio victim and survivor,” also “invoked the kind of bold, progressive Democrat [JFK] intended to be.” It positioned his administration as sharing something with “the nation’s impressive biomedical enterprise and its recent victory against a disease that had gripped Americans with fear in the 1940s and 1950s.”

It was technocratic liberalism at its most confident -- a peak moment for the belief that scientific expertise might be combined with far-sighted government to generate change for the common good. And it’s all pretty much downhill from there: Vaccine Nation is, in large part, the story of an unraveling idea of progress. True, scientists developed new vaccines against measles, diphtheria, rubella, and other diseases. But at the same time, the role of federal power in generating “public awareness and acknowledgement of a set of health threats worth avoiding” came into question. So did public trust in the authority of medical science and practice.

The erosion was, in either case, a drawn-out process. A couple of instances from Conis’s narrative will have to suffice as examples. One was the campaign against mumps. The military lost billions of man-hours to the highly contagious disease in the course of the two world wars. But a vaccine against mumps developed in the 1940s was left on the shelf when peace came. Mumps went back to being treated as a childhood ailment, rather than a disease with an associated cost.

But the postwar baby boom created a new market of parents susceptible to warnings about the possible (if very rare) long-term side-effects of getting mumps in childhood. Messages about the responsibility to immunize the kids were targeted at mothers in particular, stressing that the possible danger from contracting mumps made prevention more urgent than statistics could ever measure.

The logic of that appeal – “Why risk a danger that you can actively avoid?" – applied in principle to any disease for which a vaccine could be manufactured, and by the 1970s, early childhood meant having a cocktail of them shot into the arm on a regular basis. Then came the great swine flu scare of ’76. The government warned of an impending crisis, stockpiled a vaccine for it, and began immunizing people – especially the elderly, who faced the greatest risk.

The epidemic never hit, but the vaccine itself proved fatal to a number of people and may have been the cause of serious medical problems for many more. All of this occurred during the last months of Gerald Ford’s administration, though it has somehow become associated with the Carter years. There is no historical basis for the link, but it has the ring of truthiness. The whole debacle seemed to refute JFK’s vision of science and the state leading the march to a safer and healthier future.

The largely unquestioned confidence in vaccination was perhaps a victim of its own success. Insofar as nearly everyone was immunized against several diseases, any number of people suffering from a medical problem could well believe that the shots had somehow caused it or made them susceptible. And in some cases there were grounds for the suspicion. There were also cases of inoculation inducing the disease it was supposed to prevent, as well as allergic reactions to substances in the vaccine.

But Colis sees the rise of an anti-vaccination mood less as direct response to specific problems than as a byproduct of countercultural movements. Feminists challenged the medical profession’s unilateral claim of authority, and some women took the injunction to protect children by immunizing them and turned it on its head. If they were responsible for avoiding the risk, however slight, of preventable childhood illnesses, then they were equally responsible for avoiding the dangers, however unlikely, posed by vaccines.

Another strain of anti-vaccinationist thinking was an offshoot of environmental awareness. While industrial society polluted the air and water, heedless of the effects, medicine was pumping chemicals and biological agents into the smaller ecosystem of the human body.

Similar concerns had been expressed by opponents of vaccination in the late 19th and early 20th centuries -- though without much long-term effect, particularly given the effectiveness of immunization in preventing (even obliterating) once-terrifying diseases. Conis depicts anti-vaccinationists of more recent times as more effective and better-established.

Besides the feminist and ecological critiques, there is the confluence of anti-government politics and new media. Supporters of vaccination once downplayed the issue of side effects, but it’s an area that demands – and is receiving – serious medical investigation.

In places, Vaccine Nation suggests that the critics and opponents have made points worthy of debate, or at least raised serious concerns. And that may be true. It would almost have to be, the real question being one of degree.

But even with that conceded, many of the arguments the author cites are … well, to be nice about it, unpersuasive. “DISEASE IS NOT SOMETHING TO BE CURED,” says one vintage anti-vaccinationist tract revived in the 1980s. “IT IS A CURE.” The cause for illness? “Excess poisons, waste matters, and incompatible food” – but not, most emphatically, germs.

“Did you know,” asks another figure Conis quotes, “that when immunity to disease is acquired naturally, the possibility of reinfection is only 3.2 percent? If the immunity comes from a vaccination, the chance of reinfection is 80 percent.” In a footnote, Conis indicates that the source of these fascinating statistics “is unclear.” That much, I bet, is true.

Poor old Cotton Mather’s thinking combined superstition and enlightened reason. They can and do mix. But not in a statement such as “DISEASE IS NOT SOMETHING TO BE CURED. IT IS A CURE." The good reverend would dismiss that as little more than ignorance and magical thinking -- and rightly so.  


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Essay on "The Top Ten Retractions of 2014” and post-publication peer review

“The Top 10 Retractions of 2014appeared on the website of the life-sciences magazine The Scientist a couple of weeks back, garnering a little attention (mostly of the social-media, “Hey, look at this!” variety) but without making much of an impact. Comments were few and far between.

That seems unfortunate, given the stakes. Physicians, it has been said, bury their mistakes  -- a grim joke that very nearly applies to some of the researchers whose work made the Hall of Shame. But most of the inductees are charged with committing malfeasance rather than error. (A number of them were covered here at Inside Higher Ed over the past year.) 

The most egregious case? That would have to be the paper that the journal Retrovirology retracted, by a researcher who "spiked rabbit blood samples with human blood to make it look as though his HIV vaccine was working.” The runner-up is probably the situation that forced the Journal of Vibration and Control to retract 60 articles, which had been accepted for publication after receiving fraudulent “peer review” by scientists who manipulated the online submission system using up to 130 fake email accounts.

The good news is that the paper reporting on HIV vaccine work that had been tampered with seems not to have made much of an impression: it hadn’t been cited by other researchers. As for the phony peer-review gang, its leader was the identical twin brother of Taiwan’s minister of education, whose name appeared as a coauthor of some of the papers. Not long after the scandal broke, the minister resigned, while insisting that he had no idea of what his evil twin had been up to. (And you thought your family gatherings were awkward,)

The annual list (first compiled in 2013) is the work of the good people at Retraction Watch, who monitor and investigate the embarrassed announcements that publishers would rather not have to issue. Most of the stories they cover are from the sciences (chiefly natural, some social) although there is the occasional case from the humanities, where the main ground for retraction seems to be plagiarism. Or rather, problems of involving "mistaken punctuation" and "misreferencing," since euphemism prevails. (One author charged with plagiarism admitted to "misconduct in text," which is my new favorite expression.)

Besides fraudulent labwork and efforts to game the peer-review system, RW covers breaches of ethical norms in research -- the notorious "Facebook mood experiment" made the list for 2014 -- while also keeping an eye on predators lurking in the shadows around scholarly publishing. While unscrupulous academic publishers deserve all the bad press they get, they are often so brazen that it's hard to think of them as a menace. Consider the most widely noticed example in recent months: the story of a couple of computer scientists who wrote a "paper" consisting of an obscene seven-word sentence, repeated a few hundred times and incorporated into graphs and flowcharts. They submitted it to one of the sketchier journals in their field, where it appeared once the authors paid a fee. After all, the anonymous reviewer considered the paper "excellent.”

Which, in its own way, it was, though the paper is not on the top 10 list. Using the carelessness and greed of worthless journals to embarrass them may be an entertaining way to blow a few hundred bucks, but much less amusing is the thought that there must be academic libraries paying for subscriptions to said journals.

One of the year's top 10 items involved a French computer scientist who, the Retraction Watch says, “catalogued computer-generated papers that made it into more than 30 published conference proceedings between 2008 and 2013. Sixteen appeared in publications by Springer, and more than 100 were published by the Institute of Electrical and Electronic Engineers (IEEE).” The fact that the papers were computer-generated does not mean they were gibberish, since there are programs that can perform a database search and "write" a credible literature review. Still, that seems like streamlining the production of knowledge just a little too far.

The Retraction Watch site is littered with the wreckage of numerous careers, but it serves an important purpose apart from the dubious pleasures of Schadenfreude. In a recent column I wrote about Ben Goldacre's book I Think You'll Find It's a Bit More Complicated Than That (Fourth Estate), which includes a shrewd assessment of the strengths and weaknesses of the peer-review system that seems germane:

"[Peer-review] is often represented as some kind of policing system for truth, but in reality some dreadful nonsense gets published, and mercifully so: shaky material of some small value can be published into the buyer-beware professional literature of academic science; then the academic readers, who are trained to appraise critically a scientific case, can make their own judgments. And it is this second stage of review by your peers -- after publication -- that is so important in science. If there are flaws in your case, responses can be written, as letters to the academic journal, or even whole new papers. If there is merit in your work, then new ideas and research will be triggered. That is the real process of science."

Retraction Watch plays a role in what Greenacre calls "post-publication peer review." In mid-December it received a John D. and Catherine T. MacAurthur Foundation grant of $400,000 to expand its operations by hiring a reporter, an editor, and a database developer. Next year's list should be interesting.


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Review of Ben Goldacre, 'I Think You'll Find It's More Complicated Than That'

British libel law is so stringent and unforgiving -- so notorious for its tendency to find in favor of the aggrieved party -- that I am reluctant to say much more about it than that. Come to think of it, “stringent and unforgiving” seems a bit harsh. As does “notorious.” No aspersions on the British judicial system are intended; please don’t sue.

Between 2003 and 2011, the epidemiologist Ben Goldacre -- currently a research fellow at the London School of Hygiene and Tropical Medicine -- wrote a column called “Bad Science” for The Guardian as well as a book about shady practices in the reporting of clinical-trial results called Bad Pharma (2012). “Writing about other people’s misdeeds,” he says in the introduction to his new book, I Think You’ll Find It’s a Bit More Complicated Than That, “collecting ever greater numbers of increasingly powerful enemies – and all under British libel law – is like doing pop science with a gun to your head.”

Actually, reporting honest research can have the same menacing consequences. A few of the items in More Complicated Than That – a 400-page collection of Goldacre’s smart and mordant investigative reporting and commentary over the past dozen years – discuss cases of scientists and doctors sued just for going public with an informed opinion, or even lab results. Goldacre’s default mode is a lot more aggressive than that. Examining news and debates in both professional journals and the mass media, he’s constantly exposing unsupported claims, analyzing doctored statistics, and explaining the limitations, as well as the necessity, of the peer-review system. And with a suitably scathing tone, much of the time. No doubt Goldacre’s solicitor keeps very busy

Well before this point in a column, I would normally have provided a link to the press that brought out I Think You’ll Find It’s a Bit More Complicated Than That (here it is) but it may be a while yet the book reaches stores in the United States, where the large majority of Inside Higher Ed readers live. It hit the shelves in England only a few weeks ago. Consider the lag time of Big Pharma: Faber & Faber published the U.S. edition in April, a good two years after it drove the Association of the British Pharmaceutical Industry into damage-control mode. (In early January, the House of Commons Public Accounts Committee issued a report echoing Goldacre’s call for drug companies to increase disclosure in reporting of clinical-trial methods and findings.)

For now, American reader can order the print edition of More Complicated Than That from online bookstores. The ebook is available in England and with some pressure could probably be made available here sooner rather than later.  Frankly, Goldacre deserves a much bigger following than he has in the States, where the need for continuous, accessible public tutoring in statistical literacy and logical thinking (and in how they can be suborned by the unscrupulous) remains every bit keen as in the UK, to put it mildly.

One of Goldacre’s specialties is challenging “science by press release” – cases of the media “cover[ing] a story even though the scientific paper doesn’t exist, assuming it’s around the corner” or rewriting statements “from dodgy organizations as if they were health news.” The blame can hardly be borne by “quacks and hacks” alone, since the “dodgy organizations” sometimes include academic institutions. In 2004, one British university issued a press release on a study showing the wonderful health benefits of “nature’s superdrug,” cod liver oil. It did something or other to cartilage (the details went unelaborated) by means of an enzyme, presumably to be named later.

When more than a year went by without a report to the scientific community, Goldacre contacted the university asking what happened to the paper. He got an evasive though patronizing response (“Mr. Goldacre is quite right in asserting that scientists have to be very certain of their facts before making public statements or publishing data”) from the researchers involved, but no offprint. He would have to be patient, they said.

“In 2014, after being patient for a decade as requested,” he writes in an afternote, Goldacre tried again but received only “a skeletal description [of] a brief conference presentation,” running to four paragraphs. The original press release (which cannot have been written without the cooperation of the scientists, of course) had been 17 paragraphs long. “I’ll try them again in a decade,” Goldacre concludes.

It would be more amusing if not for another essay in which he explains the significance of a study (published in Annals of Internal Medicine in 2009) of 200 press releases selected at random from a pool of “one year’s worth of press releases from twenty medical research centers” at “a mixture of the most eminent universities and the most humble, as measured by their U.S. News & World Report ranking.”

Goldacre notes that half the studies were done on human subjects. But 23 percent of the press releases in that category “didn’t bother to mention the number of participants – it’s hard to imagine anything more basic – and 34 percent failed to quantify their results.”

Forty percent of the press releases on research involving human beings concerned studies “without a control group, small samples of fewer than thirty participants, studies looking at ‘surrogate primary outcomes’ (which might measure a blood-cholesterol level, for example, rather than something concrete like a heart attack) and so on.” While the results would not be as reliable as those of a study with a stronger design – involving randomization, control groups, and more subjects – Goldacre acknowledges that they might nonetheless be of value. But an astonishing 58 percent of the press releases analyzed “lacked the relevant cautions and caveats about the methods used and the results reported.”

O.K., that was quite a lot of numbers just now, and not nearly as entertaining as the pieces in which Goldacre scrutinizes claims about caffeine intake and hallucination (“Drink Coffee, See Dead People”) or explains how make-believe expertise informs public debate (“Politicians Can Define Which Policy Works Best By Using Their Special Magic Politician Beam”) or characterizes a paper in the non-peer-reviewed Elsevier journal Medical Hypotheses (“with a respectable ‘impact factor’… of 1.299”) as “almost surreally crass.”

At his best, Goldacre writes with a combination of Martin Gardner’s knack for science exposition (and pseudoscience demolition) with Christopher Hitchens’s dedication to eviscerating fools gladly (a reliable source of schadenfreude, at least if you agreed with him on who counted as a fool). As the holiday season approaches, anyone with a bright young relative showing an interest in science or medicine – or a leaning toward serious journalism – should consider I Think You’ll Find It’s a Bit More Complicated Than That as a possible gift. Consider it an investment in public intelligence.

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