Prologue

fn1 A striking exception is the Tuskegee Syphilis Study, in which U.S. government researchers purposely left syphilis untreated in 399 poor, illiterate African Americans. That notorious study began in 1932.

Chapter Three

fn1 These cells, obtained without her knowledge in 1951 from the lethal cervical cancer of a thirty-one-year-old African American woman named Henrietta Lacks, have since been made famous by Rebecca Skloot’s 2010 book, The Immortal Life of Henrietta Lacks.

Chapter Four

fn1 Some of these dozens of cell lines were among those later shown by geneticist Stanley Gartler at the University of Washington to be contaminated with cancerous HeLa cells; others were also likely HeLa contaminated.

Chapter Five

fn1 Fifty years of study have since made it clear that the process through which a cell becomes cancerous is complicated and involves many steps; it isn’t like flipping an on/off switch. Nor are all cells clearly in one camp or the other. For instance, some cells have aberrant numbers of chromosomes and multiply indefinitely in the lab but have not tipped into the uncontrolled growth that is cancer.

Chapter Six

fn1 The vaccine against smallpox, then a routine childhood vaccination, was also crudely made, by harvesting virus from the scarred skin of calves, sheep, or buffalo that had been infected with a related virus called vaccinia. Vaccinia was one of the many viruses that could invade Hayflick’s human diploid cells. But interest in smallpox vaccination was on the wane: the last case of smallpox in the United States had been reported in 1949, and routine childhood vaccination against smallpox would be dropped in the United States in 1971. The last naturally occurring case of the disease anywhere was reported in 1977.

Chapter Seven

fn1 “Primary” means that the kidney cells were used once and then dispensed with, rather than multiplying through many generations in lab dishes, as Hayflick’s human fetal cells did.

fn2 For simplicity this book will refer to “polio vaccine virus.” However, Hayflick used a Koprowski polio vaccine virus called CHAT, which is a type I polio virus. Of the three polio virus types, type I causes the most disease. However, commercially marketed polio vaccines protect against all three types: I, II, and III. For an explanation of the distinctions and their discovery, see David M. Oshinsky, Polio: An American Story (New York: Oxford University Press, 2005), 117–21.

Chapter Eight

fn1 Today, under rules first put in place by the United States in 1978, extra protections pertain to prisoners in human experiments funded by the government. For instance, the ethics boards that approve human trials must include a prisoner or a prisoner representative if prisoners are to be subjects in a study. The prisoners’ participation in a trial, or their decision not to participate, may not be allowed to affect parole decisions. And the types of study allowed must pertain to prisoners particularly—for example, they may be studies of diseases that occur disproportionately in prisons or studies of the causes and effects of incarceration.

Chapter Nine

fn1 There are no records of how many cases occurred during the British epidemic, but one expert, Elizabeth Miller, notes that in nonepidemic years during this era, two hundred to three hundred children were born with congenital rubella syndrome in England and Wales. Miller estimates that there could have been ten times as many born on the heels of an epidemic. Interested readers should see Elizabeth Miller, “Rubella in the United Kingdom,” Epidemiology and Infection 107 (1991): 34.

fn2 The name of this government agency has since changed several times; today it is the Centers for Disease Control and Prevention. But the acronym, CDC, has remained unchanged.

fn3 One reason that critics were initially skeptical of the Australian Norman Gregg’s 1941 findings was because his study was “retrospective,” meaning that he asked the mothers about their history of rubella infection only after their babies had been born and diagnosed with congenital rubella. By contrast, the study that found ten of ten embryos affected, published in the Lancet in 1988, was prospective: scientists followed the pregnancies from the time of the diagnosis of rubella in the mother in early pregnancy and tracked the babies’ outcomes.

Chapter Ten

fn1 Plotkin and his colleagues reported on the number of black newborns because virtually all babies born at PGH were black. They actually measured the number of babies born with heart and eye defects—a proxy for congenital rubella syndrome. Because deafness, its most common manifestation, is hard to diagnose in newborns and wasn’t captured in their survey, they estimated that in actuality closer to 1.4 percent of newborns at the hospital were affected.

fn2 Despite rubella’s stunting effect on cell division, the kidney cells from fetus 27 did grow long enough in their lab bottles to be split four times. Plotkin surmised that they were capable of doing so because relatively few of the kidney cells were infected with rubella when he first planted the cells in bottles.

Chapter Fourteen

fn1 Five decades and several mergers and acquisitions later, Smith, Kline & French has morphed into what today is the giant Britain-based drug company GlaxoSmithKline.

Chapter Fifteen

fn1 This new adenovirus vaccine replaced the vaccine made using monkey cells that was fed to about 100,000 members of the U.S. military between 1955 and 1961 and was dropped when it was discovered to be widely contaminated with the silent monkey virus, SV40.

Chapter Sixteen

fn1 Regarding the risk of vaccination to pregnant women, over the next two decades, through 1989, the CDC would follow to term the pregnancies of 305 rubella-susceptible women who were inadvertently vaccinated within three months before or after conception. None of the women gave birth to rubella-affected infants. Today the CDC advises that women who inadvertently receive a rubella vaccine while pregnant should be counseled that there is a theoretical risk of up to 2.6 percent that the fetus will be affected. It adds that several additional studies have shown no cases of congenital rubella in about 1,000 infants of susceptible women who were vaccinated while they were pregnant, or just before conceiving.

Chapter Twenty-One

fn1 The Medical Research Council in London still had some of the original WI-38 ampules—ampules of cells that had divided just eight or nine times. Hayflick had given 100 of them to the MRC in the fall of 1962 and had sent more ampules to the London agency from time to time.

Chapter Twenty-Three

fn1 Unlike measles, it’s extremely rare for mumps to turn deadly, but it causes permanent deafness in some children and brain inflammation in others. In post-pubertal boys and men mumps can cause an excruciating inflammation of the testicles and, rarely, permanent sterility.

Chapter Twenty-Four

fn1 In 1983 President Ronald Reagan used an executive order to extend the Bayh-Dole Act to cover big businesses, too. Because any future president can reverse it, an executive order is not as ironclad as a bill passed by Congress and signed into law. In 1986 a new law (the Federal Technology Transfer Act) allowed big businesses with special contracts with government-operated labs to be awarded patents.

fn2 Normally, exclusive licenses were needed to lure commercial investors. However, the Cohen-Boyer patents were so broadly applicable and the technology they enabled so important and so much in demand that Neils Reimers, the Stanford patent guru who was managing the patents on behalf of both Stanford and UC, refused Genentech’s demand that they be licensed exclusively to the company.

Chapter Twenty-Five

fn1 Wright would go on to propose that the fundamental reason that normal cells stop dividing is to prevent cancer from forming. Cancer cells require many mutations to become malignant, and normal cells can’t accumulate these if they stop dividing.

Chapter Twenty-Seven

fn1 The World Health Organization says that WI-38 cells can be used for vaccine making until about ten generations before they stop dividing.

fn2 For the same reasons, the WHO and the FDA do not limit residual DNA in vaccines made in MRC-5 cells, derived from a British fetus in 1966.

fn3 There is one exception. Under a 1993 law fetal tissue from an abortion can’t be transplanted into a human being for therapeutic purposes—think, for instance, of Parkinson’s disease, for which fetal tissue transplants have been tried as a treatment—without the informed consent of the woman who had the abortion, even if the tissue has been stripped of identifiers.

fn4 Because of forceful protests a quarter century ago from intellectually disabled people and their advocates—a right-to-participate-in-research campaign, in effect—there are no special protections in the U.S. regulations for this group. The issue is not simple. The advocates were concerned, among other things, that if researchers had to jump through too many hoops to conduct studies, clinical research on mental illnesses would be neglected.