Shots in the Dark
At the end of most of my kids' checkups, their pediatrician sends in a physician's assistant with a tray bearing whatever vaccines might be due and a miniature Looney Toons bandage. The purpose of the Band-Aid is obvious, but until recently I never gave much thought to the role of the creepily chipper aides. I just assumed that they allowed the doctor to see enough patients to pay both her malpractice insurance and her mortgage.
Lately, though, I've been wondering if the doctor lets someone else deliver the jabs in an effort to remain friendly and trustworthy to her tiny patients. It's a cynical thought, I know. And yet I feel like Pollyanna when I try to fathom the cynicism that allowed Congress to agree to outlaw lawsuits against Eli Lilly & Co. for injuries allegedly caused by thimerosal, a vaccine preservative. And I'm not mollified one bit by the public health establishment, which by and large has responded by asking people to pay no attention to the hypothesis behind the curtain.
Vaccines work because of something called herd immunity. If enough of us get them, we can vanquish a particular disease. Conversely, if enough of us refuse vaccines--that is, shirk our responsibility to the collective good because of the slight individual risk--we'll witness the return of some horrific diseases.
This is why it's so hard to decline a vaccine on behalf of one's child. Just try to register Junior in school or day care without proving he's had his shots. There is a process by which Minnesota parents can declare themselves conscientious vaccine objectors, but using it without turning into a homeschooler is about as hard as avoiding the draft.
As a child, I got a handful of vaccinations. Ten years ago, Minnesota recommended eight. But my kids are slated to endure some 28 separate injections designed to protect against more than a dozen illnesses. Meanwhile, at the same time that the number of needles has gone up, there's been an alarming rise in the number of children with autism and related disorders--more than 700 percent in Minnesota in the past decade, according to educators' statistics.
A number of parents have suspected there's a cause-and-effect relationship between these two trends; most often they blamed the combined measles, mumps, and rubella shot for their children's autism. But for the most part science has debunked their theories, and the public health establishment has dismissed them as the lunatic fringe.
Thimerosal, however, appears poised to change all of this. Eli Lilly is under siege by parents who are convinced that the preservative caused their children to develop autism and other developmental disabilities. And this time, the medical establishment has quickly conceded that research is needed.
Thimerosal contains mercury, a powerful neurotoxin long since proven to cause brain damage. It has been used in minute amounts to kill bacteria and fungi in multi-dose vials of vaccines since the '30s, but it wasn't until 1997 that scientists thought to add up the cumulative amount of mercury in childhood vaccines. Horrifyingly, the FDA found that the amount of mercury children received via vaccines had tripled in the '90s, and that perhaps 30 million American children had been exposed to dangerous levels of the toxin.
Two years ago, the federal government recommended removing thimerosal from as many vaccines as possible. Today, only a couple of children's vaccines still contain the preservative. But the issue has only just become visible, thanks in part to the crush of product liability attorneys trolling the Internet in search of thimerosal plaintiffs.
Over Veterans Day weekend last November, congressional Republicans tucked a rider barring lawsuits against Eli Lilly over thimerosal's alleged ill effects into the Homeland Security Act. It was hard to see the move as anything other than the kind of thinly veiled gift to Corporate America that, if not attached to such a headline-grabbing piece of legislation, would certainly provoke some embarrassing debate. Indeed, no one on Capitol Hill even attempted to advance a rationale, much less admit authoring the measure. And plenty of folks who spent the long weekend larding the anti-terrorism bill with pork had reason to: During the 2002 election cycle, Eli Lilly gave $1.6 million to political candidates. That's more than any other single pharmaceutical company offered up, and 79 percent of it went to Republicans.
Senate Majority Leader Bill Frist had previously authored a similar measure, which failed. Congressional aides told the New York Times that the thimerosal language appeared in a different typeface from the rest of the proposed legislation, making them suspect it had simply been transposed into Homeland Security. But Frist denied doing the cutting and pasting.
White House budget director Michael Daniels Jr. is a former Lilly exec, and last June, Bush appointed chairman and CEO Sidney Taurel to a presidential council on domestic security. Yet the White House denied pursuing the rider. (It's worth noting that Homeland Security also gave the feds the right to compel people to get the smallpox vaccine, while barring liability complaints against its makers.)
A week later Eli Lilly got another gift from the Bush administration: At the behest of Health and Human Services secretary Tommy Thompson, the Justice Department asked a federal claims court to seal its 1,000 thimerosal cases. The court in question administers claims against a government fund set up to compensate people injured by vaccines. Thompson's only ostensible rationale was that he was trying to preserve his right to control what information about the fund is made public. But critics asserted that the government was trying to keep them from gleaning any information that might later be used against Lilly.
In January, Congress did repeal the ban on thimerosal suits, but it's hard to imagine what it will take to restore the good faith necessary to sell the concept of herd immunity. A hearing held last month at the state capitol to consider expanding the number of vaccines required in Minnesota drew plenty of angry, active, and organized parents who appear to have won over several conservative legislators. Public health officials, meanwhile, just kept suggesting that a handful of conspiracy theorists were undermining public confidence in vaccines.
Steve Miles, a politically savvy physician who works for the University of Minnesota's Center for Bioethics, can wax eloquent on the pharmaceutical industry's stranglehold on Washington and on the government's abuse of the public's trust. But he still believes in the collective responsibility of the rest of us. "One of the questions people who don't get vaccinated have to ask themselves is what their responsibility is to the people who die from the breakdown in herd immunity," he says. "There's a sense that we don't belong in the public commons; in a sense, that we are all living in gated communities."
All things being equal, I believe in public responsibility, too. But it's precisely the perception of individual risk that created those gated communities in the first place. And when the needles are aimed at one of the chubby little thighs in my charge, it all boils down to one very simple reality: If Eli Lilly doesn't have to live with thimerosal's unforeseen consequences, if the company can retreat into a government-sponsored enclave, then we aren't all sharing the risk.
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