Books: Fatal

When I started listening to this book, my first impression was that it was going to be another screed against big business and toxic waste. (The last audiobook I listened to was Grisham’s The Appeal, regarding which I posted a moderately negative review six weeks ago.) Not counting the prologue (an apparently unrelated incident which is not explained until much later in the book), the novel starts with an accident at a coal mine, prompting concerns of safety violations and hints of possible toxic waste.

Then the book jumps to a separate storyline, regarding the pending approval of a new super-vaccine. Here the apparent villains are those responsible for pushing vaccines on the American public, touting their health benefits and minimizing or denying the risks. There are the drug companies, looking for big profits, doctors who benefit from a cozy relationship with the drug companies, and researchers dependent on grant money (much of it coming from drug companies).

Like David against Goliath, a small group of concerned parents (many of whom have watched their own children suffer terrible diseases – some have even died – after getting routine childhood immunizations) is fighting to make their concerns heard. They aren’t trying to get rid of vaccines, just to educate the public about possible risks, ensure that parents have a choice whether to have their children vaccinated, and push for more thorough research on the long-term effects of vaccinations.

Unlike Grisham’s book, this one was very enjoyable simply as a story. The plot is fast-moving, with a roller coaster of suspense as one new development after another reveals new dangers and new villains. The main characters find themselves in danger, escape in the nick of time, and are promptly back in harm’s way. The characters are well-developed and likable, heroic when needed but hardly without their own failings. There were hints which way the story was going but the end contained some surprises.

The controversy over vaccinations was also handled very well, I thought. Despite my initial concerns that the novel would simply feed widespread suspicion of the medical establishment, later on the perspective seems more nuanced. Vaccines do save a great many lives, the book acknowledges (via consumer advocate Ellen Kroft), and it is hard to argue for curtailing their use in order to prevent a muchsmaller number of children from developing disorders which can’t even be proven conclusively to have any causal connection to the vaccines.

What I was surprised to hear, and wondered if it was true, was that there are no double-blind studies into the long-term effects of vaccines (other than into their effectiveness in preventing contagious diseases, which they do in fact quite well). During the six weeks I was listening to the book, I knew nothing of the author, Michael Palmer, and thought he had just picked up this idea about vaccines as a compelling subject for a suspense novel. Today I discovered that he is a practicing physician, so he is writing this from the perspective of someone within the medical establishment. That gives me reason to take him quite a bit more seriously.

I don’t remember giving much thought to the matter when my older son got his immunizations. But in the fall of 1999, I happened to attend a concert at a community college, and – having arrived quite early because I wasn’t sure where I was going – I occupied myself reading whatever printed material I found handy. One of these was a brochure regarding the risks of childhood immunizations. With an infant (born in July 1999) home with the babysitter, the issue of potential health risks to him was naturally something I wanted to learn more about.

I did quite a bit more reading in the days and weeks following, and in the end was satisfied that the benefits of getting my son immunized were well worth the slight risks. At the medical clinic, I signed whatever paperwork I needed to, acknowledging that I had received information about the shots he would receive, and he got all his shots on schedule. A couple years later he showed signs of developmental disorder, eventually categorized as mild autism, but I do not blame any shots he received. I can’t say it’s not possible – since researchers don’t know what causes autism, nothing can be ruled out entirely, but I am satisfied with what I have read that current research does not show a reason to think it was his immunizations.

Palmer wrote this book in 2002, and since that time a good deal more study has been done on the whole matter of vaccine safety. In 2000, the Institute of Medicine, part of the National Academies of Sciences, set up a committee on Immunization Safety Review. Unlike the commission in Palmer’s novel, this committee was made up of experts with no financial ties to vaccine manufacturers or their parents companies, or who participated in the development or evaluation of a vaccine under study.

Their report examines, in particular, possible causal connections of immunizations to autism. At the time when they started their work, information on which to base such claims was inconclusive (no doubt one of the reasons for setting up this independent review). Since then, further studies have been done, and based on this additional information they were able to reject the the hypotheses that vaccines cause autism. That does not mean they have proved that vaccines cause autism – since we don’t know what causes it. But current research does not support the idea that the vaccines are the cause.

Vaccine safety has become a big issue. Many parents have been frightened, as I began to be in 1999, that they are endangering their children’s health, and possibly their lives, by getting them the immunizations their pediatricians urge them to get. There is a system for reporting adverse effects, but it is suspected that a small percentage of adverse effects are reported, and because they are relatively rare, the people submitting the reports are inexperienced with the process, resulting in inconsistency among the reports.

There is a great deal of sketchy information, and probably a fair amount of misinformation, out there on this topic. I found several websites warning parents of the dangers – though I also noted that numerous websites post the same articles. One had a publication date of 2002 (meaning it is based on outdated information), but that was noted only at the bottom of the article. People on both sides of the controversy claim that their opponents are lying.

Regarding the issue of double-blind studies, the anti-vaccination websites generally claim that there are none. (Palmer’s book explained the reasoning – to conduct them would require deliberately withholding protection against potentially fatal diseases from some children, who would not even know that they lacked this protection. And occasional outbreaks of these diseases shows that they remain a danger.) But sites explaining the process for licensing new vaccines show that double-blind studies are a standard part of the process. And I was able to find examples of such studies.

Then I looked further, and discovered that such studies often (always?) do not compare getting a vaccine with getting no vaccine, but rather getting one vaccine with getting another vaccine, or getting a vaccine in one form with getting it in a different form. Thus they are only comparing the relative benefits and risks between the two. If the danger is in a common ingredient or how the vaccine is administered, such studies will not detect it.

What I don’t think is reasonable is a knee-jerk reaction to the claims of the medical establishment. My mother distrusted all M.D.’s, convinced they were trying to protect their lucrative business by casting suspicion on any form of alternative medicine. Blind faith in science is not the answer, but neither is blind faith in anti-science. Some people are quick to blame increasing rates of autism and asthma on the increasing number of vaccines, but there are certainly plenty of other factors just as likely to be the cause.

In the past decades we also have had increasing use of automobiles, computers and other consumer electronics, air conditioning (with much more time spent indoors) and processed foods, just to name a few. And who knows whether the same children more susceptible to disorders such as asthma and autism might have been the ones to have contracted and died of communicable diseases prior to the development of vaccines (just as increasing cancer rates in older people could be a result of fewer of them dying of heart attacks at younger ages)?

Another claim I saw was that the mere existence of the National Vaccine Injury Compensation Program is a tacit admission that vaccines are not safe. But again, the time frame is significant. The NVICP was set up in 1988, following years of outcry by parents convinced their children had become disabled or had died as a result of required immunizations. In cases where the evidence was inconclusive, it may often have been thought best to make the payments. But as the Immunization Safety Review report (referenced above) shows, a great deal more has been learned since then.

On the other hand, just last year it was reported that an award would be given to a girl with autism. Was this an admission that there was a link after all? In this case, the reasoning given was that she also had mitochondrial disorder, and the vaccine had aggravated it.

Well, this is certainly one of the longest book reviews I have posted. This is the kind of book I really like – a really good story, with thought-provoking ideas that enhance but do not overshadow the story. I returned Fatalto the library this evening, hoping to find another audiobook by Palmer to listen to next. (This was his tenth book, and he has written more since then.) To my disappointment, they had only one other – and it was on cassette tapes rather than CDs. Oh well – I found a new Dean Koontz book.

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