Medical Risk and Faith : PATENTING THE SUN Polio, the Salk Vaccine, and the Children of the Baby Boom<i> by Jane S. Smith (William Morrow: $22.95; 413 pp., illustrated; 0-688-09494-5 </i>
For the better part of the 20th Century, the summer was a time of fear for American parents and children. As schools adjourned for the summer, anxiety about the return of paralytic polio would begin to rise. And, of course, there were powerful reasons for concern.
Early in the century, polio epidemics would sweep through a city or town; in 1916, about 27,000 people were paralyzed, 6,000 died. Despite remarkable improvements in health by mid-century and the introduction of “miracle” therapies for many childhood diseases, polio had only grown as a threat. The worst epidemic in U.S. history occurred in 1952, when 60,000 new cases were reported.
This pattern of anxious summers and long falls, counting the cases-some crippled, some dead, some remarkably spared in spite of infection--came to a dramatic end in the spring of 1955 when immunologist Tom Francis announced to the world that the polio vaccine developed by Jonas Salk and his colleagues at the University of Pittsburgh safely and effectively prevented polio. It is this dramatic story that Jane Smith tells so effectively in “Patenting the Sun.”
Smith shows how polio and the campaign to conquer it reflected the basic preoccupations and cultural values of a new generation of post-war Americans. The vaccine became a symbol of American scientific expertise, social voluntarism and the future of our children. Implicit in the victory over polio were heightened expectations that science and medicine would necessarily solve the most difficult persisting problems of disease and disability. The triumph of the Salk vaccine marks a moment of faith in the technological fix, in the magic bullets of modern medicine.
The vaccine that Salk discovered in 1952 marked the culmination of the efforts of the National Foundation for Infantile Paralysis, better known as the March of Dimes. Founded in 1937 by President Franklin D. Roosevelt, whose personal battle against polio had focused national attention on the disease, the foundation was led by F.D.R.’s former law partner, Basil O’Connor.
The foundation revolutionized American philanthropy by seeking funds from all Americans, not only the wealthy; everyone could do their bit to fight polio. From providing medical services to the afflicted--iron lungs, leg braces and rehabilitation--the foundation soon moved to provide resources to researchers to study the scientific aspects of polio. Although much of the research was technical and basic in nature, hopes soon were raised that a vaccine would be produced to end the threat of polio. O’Connor became the impresario of polio, dominating the philanthropic, public-relations and even scientific aspects of the campaign.
Jonas Salk--brilliant, dedicated and unwavering in his commitment to “solving” polio--remains Smith’s hero, although her portrait is nuanced. As she clearly shows, while the press and the public quickly came to consider Salk a demigod, to many in the scientific community he seemed a demagogue, far too eager to go public with his work, far too eager to appear on television or radio, to elite bioscientists hardly respectable forums to air scientific disagreements. The development of the Salk vaccine, highly publicized by the public-relations juggernaut of the March of Dimes, fractured the norms of the quiet, autonomous workings of science. Salk and his public pronouncements violated the norms of his caste.
Salk’s colleagues never forgave him his success. In his quest for the vaccine, he left the fold of academic research and never has returned. It was Enders, Weller and Robbins who won the Nobel Prize for their earlier discovery that the polio virus could be grown in culture--the basic science breakthrough that made all subsequent vaccine research possible. Salk never was elected to the National Academy of Science. Many considered his development of the vaccine “pedestrian.” But as Smith emphasizes, Salk was first, and in this instance, first meant that lives were saved by his vaccine.
Making scientific investigations and their vicissitudes accessible to a broad audience is no easy task, but Smith makes the science of polio research both clear and exciting. She effectively captures the genuine intensity that characterized the race to “conquer” polio. One breakthrough led to another, as it so rarely does: research from basic investigation into growing the virus in culture, and then into “typing” the various strains, quickly led to the possibility of a human vaccine.
Cooperation and collegiality soon succumbed to back-biting (and back-stabbing) as titanic egos clashed. The laboratory became more often a place of politics, ideologies and bitter personal competition. The vociferous controversy between Salk’s killed virus vaccine and Albert Sabin’s attenuated-virus oral vaccine remains something of an epic in the annals of 20th-Century biomedicine.
And indeed, three decades later the protagonists still will take up the debates concerning the relative safety and efficacy of these competing products. If “Patenting the Sun” has a failing, it is that Smith’s narrative fails to go adequately beyond these powerful personalities to evaluate the more fundamental questions implicit in the scientific and medical controversies raised by the development of these polio vaccines.
As the history of the Salk vaccine makes clear, the obstacles inherent in evaluating a new medical technology--especially a vaccine--are daunting. To demonstrate conclusively that a vaccine is both safe and effective is an enormously complex undertaking; ultimately a vaccine must be tested on humans, who risk succumbing to the very disease for which they are to be immunized. Almost 2 million American schoolchildren participated as test subjects in the Salk field trials, the largest medical experiment in history. These “Polio Pioneers” waited anxiously through the spring of 1955 to see if the vaccine was effective.
Throughout the research and field trials, the federal government was nowhere to be found. The failure of the government to maintain adequate oversight of vaccine production after the trial led to the distribution of small amounts of contaminated vaccine in which all the virus had not been inactivated. The notorious “Cutter incident,” which resulted in 204 cases of polio and 11 deaths among vaccinated children, nearly destroyed confidence in the Salk vaccine. The episode made clear the need for an active federal presence in evaluating and regulating research and production of vaccines and drugs.
Of course, even magic bullets need to be efficiently produced and delivered. The persistence of paralytic polio in the developing world signals all too tragically this conundrum: Why, given the effectiveness of vaccines for polio, do children go unimmunized?
And while celebrating the campaign against polio, it is impossible not to think of AIDS. Smith’s narrative makes clear that a set of complex relationships among science, government and philanthropy, as well as our popular understandings of the disease, will fundamentally affect the course of the epidemic.
A quarter-century ago, one of the Polio Pioneers who bravely volunteered (with the consent of her parents) was none other than Jane Smith. Now she has told the story of the Salk vaccine--her story--with spirit and intelligence.
BOOK MARK
For an excerpt from “Patenting the Sun,” see Opinion, Page 1.
