Lösningar till fråga 38 ELF

Hösten 2016


Preventive Medicine

**A review of Vaccine by Arthur Allen** In 1796, an English country doctor named Edward Jenner successfully immunized a child against smallpox, the world’s deadliest infectious disease. News of Jenner’s stunning achievement led millions throughout Europe to roll up their sleeves. Yet, as Arthur Allen makes clear in Vaccine, a timely, fair-minded and crisply written account of “medicine’s greatest lifesaver,” not everyone welcomed Jenner’s feat. Criticism came quickly, often in apocalyptic terms. The economist Thomas Malthus wrote that vaccination might lead to dangerous population increases. Ministers warned against interfering against the Lord’s grand design. Others, meanwhile, objected to a process that injected foreign, perhaps poisonous, matter into the body. What possible good could come from polluting the bloodstream of a child? Antivaccine sentiment found fertile soil in the United States, where the ethos of individual responsibility often clashed with public health programs based on collective norms. What kept vaccine opponents on the defensive, however, were the rapid breakthroughs in medicine and public health. Jenner’s triumph was followed by a procession of other vaccines, for rabies, tetanus, yellow fever, diphtheria, and more. A healthier diet, advances in sanitation and surgery, the development of antibiotics and DDT – all combined to increase American life expectancy to 70 years from 47 between 1900 and 1955. World War II made vaccination fashionable. Polio turned it into a national crusade. No disease drew as much attention in postwar America, or created as much fear. Primarily striking children, polio killed some of its victims and paralyzed others, leaving behind vivid reminders for all to see: wheelchairs, leg braces, iron lungs, deformed limbs. The quest for a means of prevention led to the largest public health experiment in American history, involving nearly two million school-age volunteers. When Jonas Salk’s virus vaccine was declared “safe, effective and potent” in 1955, the nation celebrated as if a war had ended – and, indeed, one had. As late as the 1950s, parents had been encouraged to expose their children to diseases like measles and mumps in order to get them over with before adulthood, when the dangers increased. Vaccines for these illnesses have been around since the 1970s. More were on the way and some researchers spoke openly about a future without infectious disease. In our current age of AIDS, one marvels at the arrogance of such a belief. Nature remains a full step ahead. Allen is sympathetic to parental fears regarding the dangers of various vaccines, though he remains skeptical that scientific studies of these dangers will open many minds. At this point, he writes, much of the “antivaccinist” leadership is composed of countercultural types who view life through the prism of conspiracy theory: the government lies, the drug companies are evil, the medical profession is corrupt; trust the Internet instead. A fair number oppose traditional medicine in favor of homeopathy, believing that vaccines weaken the immune system and that sickness is a natural part of life. To a large extent, says Allen, this antivaccination impulse is fueled by an ignorance of the past. Vaccines have done their job so well that most parents today are blissfully unaware of the diseases their children are inoculated against. The end result is a culture that has become increasingly risk-averse regarding vaccination because people have greater trouble grasping the reward. The problem appears to be growing. As more children go unvaccinated in the United States, there has been a rise in vaccine-preventable diseases. Meanwhile, fewer pharmaceutical companies are now producing vaccines, citing the high cost of testing, diminishing markets and a fear of litigation. For Allen, a reversal of these trends will require something long overdue: a frank national discussion about the risks and benefits of vaccination. His splendid book is a smart place to begin.

**What are we told about the 1950s, from a medical point of view?**

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