TAMPERING WITH NATURE
In 1985 the mother of a girl named Heather wrote to pediatrician and newspaper columnist Robert Mendelsohn for advice on which vaccines to give her daughter. She had vaccinated Heather against polio, planned to vaccinate her against tetanus, was dead set against the pertussis vaccine, but wasn’t sure what to do about diphtheria. She summed up her and her husband’s vaccine worries in a single sentence: “We have been afraid to give them to Heather because we are concerned that they contain dreadful toxic things, that they would not contribute to her health and might cause harm to her immune system.”1
Heather’s mother was one of a growing number of parents who, like the parents in the previous chapter, increasingly vocalized concerns about vaccines from the late seventies into the eighties, a period in which the environmental movement burgeoned, environmental politics grew ever more prominent, and environmentalist metaphors and worldviews became mainstream. In this context, environmentalist rhetoric (like health feminist rhetoric) seeped into lay vaccine critiques, giving parents who were even just a little bit squeamish about vaccines—like Heather’s mom—a new vocabulary with which to describe their hesitations. Those who began questioning vaccines in this period absorbed key theories and ideas from the environmental zeitgeist. Like the environmentalists who fought to ban the pesticide DDT a decade before, they became concerned about the possible relationship between the widespread use of new technologies and the rising prevalence of chronic and newly emergent diseases, and they began to see vaccines as modern technologies with unknown but potentially devastating long-term consequences for human health.
The anxiety expressed by Heather’s mom best classifies her as a vaccine skeptic. She wasn’t categorically opposed to vaccines; after all, she had vaccinated her daughter against polio and tetanus and was open to vaccinating her against diphtheria, too. But the environmental movement that informed her own vaccination hesitations also helped cultivate a distinctly modern form of anti-vaccinationism. In contrast with vaccine skeptics, anti-vaccinationists drew no distinctions between vaccines; they rejected them all out of an age-old belief in the wisdom and beneficence of nature. Vaccination, to them, was harmful because it represented an “artificial” way of developing immunity. This artifice, they feared, prompted otherwise benign nature to unleash even worse diseases in revenge. Like more circumspect vaccine skeptics, they saw vaccines as modern technologies with inadequately studied long-term effects. They also worried specifically about the chemical components of vaccines.
This last, distinctly modern, concern marked an important departure from the natural philosophical objections of earlier anti-vaccinationists, whose fears centered on the biological matter in vaccines. Anti-vaccinationists and vaccine skeptics alike in the late twentieth century saw vaccines as troublingly similar to pesticides, cigarettes, artificial sweeteners, and mercury. These chemical products and substances—and many more just like them—had been widely used, the public long assured of their safety, before the long-term dangers of their use came to light. Parents in particular wondered if the widespread use of vaccines represented a similar technological hubris that put the well-being of their children at risk. In the seventies and early eighties, trepidation about the unknown long-term consequences of vaccination was quite vague: parents like Heather’s mom worried that vaccines were “toxic” but weren’t quite sure what ill effects they might have. In the later eighties and nineties, however, these generalized anxieties evolved into well-defined fears of specific harms, such as autism and learning disabilities, and specific chemical vaccine components, such as thimerosal and aluminum.
Vaccination worries inspired and invited by the environmental movement originally found expression in obscure magazines and newsletters, self-published pamphlets and books, and volumes by small presses. In the 1980s, with the founding of the vaccine-safety group Dissatisfied Parents Together and the publication of DPT: A Shot in the Dark, this type of thinking became much more visible. In the 1990s and 2000s, it became more visible yet. Environmental organizations, it bears noting, were not directly responsible for this trend (by the late 1990s, some groups called for mercury to be removed from vaccines, but by then vaccine critics had been expressing anxiety about the “toxicity” of vaccination for close to two decades). Moreover, this trend had relatively little impact on vaccination uptake, which would climb to new heights in the late 1990s and 2000s. But this trend is worth examining nonetheless for the light it sheds on growing vaccination anxieties in the last decades of the twentieth century. The imprint of environmentalist thinking has been visible in the theories and complaints of a range of vaccine critics for the last several decades. For the environmental movement that took off in the 1970s had a lasting effect on the way some Americans came to think about the environment, risk, and disease, with profound implications for the way some came to view vaccines.
THE POISONED NEEDLE: THE ANTI-VACCINATIONIST LEGACY
Vaccine anxieties in the late twentieth century were not a new phenomenon. Nineteenth- and early twentieth-century anti-vaccinationists had decried the smallpox vaccine’s potential to “poison” the blood by transmitting either the disease itself, other diseases, or animal matter with unknown consequences for health. Anti-vaccinationists’ fears were not unfounded. At a time when vaccination might involve scratching lymph from previously vaccinated individuals into a laceration in the arm under less-than-sanitary conditions, syphilis or other infections were sometimes passed along as well.2 The practice of vaccinating with human or calf lymph also chafed against the ideals of many nineteenth- and early twentieth-century adherents of nature cures, who saw health as deriving from proper hygiene, diet, and environmental conditions; to some, disease was a necessary means of ridding the body of impurities acquired by eating meat, drinking alcohol, or engaging in other unscrupulous behaviors. In Victorian England, for instance, where anti-vaccination activity was particularly robust, anti-vaccinationism found firm devotees among medical botanists, hydropathists, hygienists, and other alternative medical practitioners and their followers.3
As in Victorian England, in Victorian and subsequently in the Progressive Era United States, many homeopaths, botanical physicians, and hydropaths threw their weight behind the anti-vaccinationist cause.4 In the United States, as in England, anti-vaccination agitation was as much a rejection of dominant medical ideology as it was a struggle over the limits of state power; prominent anti-vaccinationists often denounced compulsory immunization as a form of medical oppression akin to the religious and political oppression they believed their government was meant to protect them from.5 Organized anti-vaccinationist activity grounded in such leanings was particularly robust in the Progressive Era United States.6 But with changes in the nation’s public health priorities and in organized medicine, and with the deaths, in close succession, of anti-vaccination leaders Charles Higgins and Lora Little, anti-vaccination activity had faded considerably by the 1930s.7
It by no means disappeared, however, as a few devoted writers, including outspoken social critic and activist Annie Riley Hale, author of The Medical Voodoo, continued to attack vaccination through the 1930s and 1940s; to Hale, vaccination was a form of tyranny propped up by false science and capitalism.8 In the 1950s, California chiropractor and naturopath R. G. Wilborn founded Health Research, a small press that began reprinting nineteenth- and early twentieth-century works on teetotalism, fasting, natural hygiene, and other nature cures, several of which rejected vaccination as part and parcel of an overall rejection of orthodox medicine. Wilborn’s enterprise also sought out original works by contemporary alternative medicine adherents, and in 1957 the press published California naturopath Eleanor McBean’s The Poisoned Needle.9
McBean’s book, a harangue against both orthodox medicine and the practice of vaccination, synthesized more than a century of commentary on the moral transgressions and physical hazards posed by vaccination. While she cited the work of a few contemporaries, including American natural hygienist Herbert Shelton and British anti-vaccinationist Lily Loat, the bulk of her volume revisited the arguments of Victorian and Progressive Era philosophers, scientists, healers, and anti-vaccinationists, including British philosopher John Stuart Mill, British naturalist Alfred Russel Wallace, and American hydropath and health reformer Russell Trall. Quoting from this array of sources, McBean argued that vaccination poisoned the blood with animal proteins, was based on the “false premise” of germ theory, and served only to gild the coffers of profit-hungry doctors. She decried compulsory vaccination as an act of “medical oppression” and a form of “enslavement” practiced only by the most “backward” of states. She also denounced vaccination—compulsory or not—as a direct affront to the laws of nature.
This particular premise of McBean’s had long been held by anti-vaccinationists and so-called medical irregulars of all types. Wallace, best known for articulating the theory of natural selection, saw vaccination as “an attempt to cheat outraged nature” at its own necessary endeavors.10 Quoting Wallace, Trall, Shelton, anti-vaccinationist physician John W. Hodge, and others, McBean articulated a philosophy that saw nature and its human inhabitants, in their untouched states, as existing in perfect equilibrium. In humans, poor nutrition and the consumption of processed foods disrupted the body’s natural equipoise; it was these habits, not germs, that resulted in disease. Disease, wrote McBean, was the body’s way of cleansing itself of “excess poisons, waste matter, obstructions, and incompatible food.” “DISEASE IS NOT SOMETHING TO BE CURED; IT IS A CURE,” she emphatically wrote.11 McBean quoted extensively from nineteenth-century French biologist Antoine Béchamp, who had proposed that germs did not cause disease but were rather the result of disease, drawn to diseased tissue to consume it and return it to nature. Combining Béchamp’s premise with Wallace’s theory of evolution, McBean argued, as other post–germ theory anti-vaccinationists had before her, that germs were “useful wherever they are found in nature.”12 By fighting germs and not the true causes of disease, McBean wrote, “modern medical methods”—including first and foremost vaccination—“delay and frustrate the unexcelled healing efforts of nature.”13
Modern medical methods (understood as inherently “unnatural”) were not the only threat to health; McBean documented a litany of modern commodities and habits that destroyed the well-being of both humans and their environment. Like the century’s worth of natural healers who came before her, she emphasized the central importance of a diet of whole, unprocessed foods to good health. McBean’s list of modern “poisons” included not only canned, refined, and otherwise processed foods, but also food additives and preservatives, Coca-Cola, tobacco, and chemical fertilizers and insecticide sprays. Writing just before Rachel Carson would begin work on Silent Spring, McBean denounced the use of DDT and blamed it and other sprays for a host of modern ills, including cancer, heart disease, and polio. In her view, mass vaccination was a calculated distraction from “foodless foods” and “poison sprays,” the true causes of allegedly vaccine-preventable diseases, such as polio.
Like Carson, McBean (referencing a recently emergent literature on organic agriculture) drew an ecological view of health, in which insecticides caused harm not only to birds, butterflies, and bees, but also to humans, because of their dependence on the health of the ecosystem. Insecticide sprays poisoned food directly, McBean wrote, and were washed from crops into soil, where they killed earthworms and other organisms vital for healthy soil, which was vital for producing nutritious crops to fortify humans. The sprays caused even further damage by contaminating water supplies that both humans and animals relied upon. To McBean, widespread pesticide applications, which citizens were powerless to avoid, were, like vaccination, crimes committed by government acting in the interest of powerful corporations with no regard for human health. She wrote:
This staggering increase in a preventable disease is a grave reflection upon our present system of living with its popularized blood pollution practices by way of vaccination campaigns and mass poisoning as a result of government enforced spraying of fruits and vegetables with deadly lead arsenate and other poisons. The power politics of the drug and chemical companies have also influenced legislation to set aside vast sums of the taxpayer’s money with which to buy their poison chemicals. . . . The people are told that these practices are beneficial but facts disclaim these statements.14
Just as Carson would highlight the association between rising cancer rates and pesticide use, McBean made much of the parallel increases in cancer prevalence and the deployment of vaccines and insecticides. She also drew a parallel between these two categories of modern hazards and a third: atomic radiation. In McBean’s view, atomic radiation was the only modern poison that caused more harm to human health than vaccination did.
McBean’s book was a response to the nation’s massive polio vaccination efforts in the 1950s. It’s difficult to say how widely it was read, but when the first print run of 5,000 copies sold out, Health Research printed a second run of 5,000 in 1959. After that, the book went out of print for close to two decades, but the press brought back the title in 1974.15 By then, of course, polio and smallpox had all but disappeared from the United States, but vaccination efforts targeting other infections were on an upswing across the country. In McBean’s hometown of Los Angeles alone, there was a rush of official immunization activity in the early seventies. A countywide campaign began promoting rubella immunization in 1970. A new law requiring that all children be immunized against diphtheria, tetanus, pertussis, polio, and measles before starting school sent parents rushing to the doctor in 1972. And in 1973, the first polio case in a decade had health officials warning that the disease was poised to return in epidemic proportions unless vaccination rates improved.16 Health Research may simply have run out of first-edition copies of McBean’s book by 1974, but the press’s decision to reprint it may also have been a response to increased attention to the subject of immunization, coupled with increasing popular cynicism regarding authority. McBean’s anti-professional stance, her assertion of the value of American rights and freedoms, and her claim that justice had too long been the exclusive province of the rich and powerful must have resonated with readers who identified with the New Left movements that emerged in the sixties and swelled in the seventies. Her litany of environmental concerns undoubtedly did as well.
By 1974, the year The Poisoned Needle was reissued, Silent Spring had helped foster a new environmental movement, which had popularized concerns about radiation, heavy metals, pesticides, and other chemicals, and had prompted passage of a series of federal laws to protect the quality of air, water, and other natural resources.17 The values that McBean wove together in The Poisoned Needle—the preciousness of freedom and nature combined with a mistrust of government and industrialists—anticipated popular attitudes of many 1970s social activists by the better part of a generation. Indeed, as the 1970s progressed, McBean, then in her seventies, appeared to have found a new audience for her thoughts and renewed energy for her cause. She published three more anti-vaccine books between 1977 and 1980, and commentaries and articles by her inspired followers began to appear as well.18 McBean’s books may never have garnered a tremendous readership, but renewed interest in The Poisoned Needle in the 1970s was significant in that the book carried over a set of anti-vaccinationist ideas from the first half of the century (and earlier) to the latter half. The book thus served as a bridge between the anti-vaccinationism that faded in the 1930s and the renewed vaccine skepticism that began to gain momentum in the last decades of the century.
NEW VACCINE FEARS
The variety of vaccine skepticism that became increasingly prevalent at the end of the century inherited several key ideas from McBean, and, in turn, from the natural healers and anti-vaccinationists whose work had inspired her own. The predominant vaccine concerns expressed by parents, doctors, and others in self-published and small-press books and pamphlets were grounded in the ideas that nature, even in the form of disease, was purposeful if not benevolent; that health derived not from artificial immunity, but from balance and harmony with the natural order; and that vaccines were akin to environmental hazards inasmuch as they were products of industry with uncertain and potentially harmful long-term consequences. These vaccine beliefs mirrored some of the defining characteristics of the environmental movement of the 1960s and 1970s: the rise of popular ecology, concern about the health consequences of environmental choices, and the prevailing sense of a ubiquitously toxic environment.19
They also reflected environmentalist anxieties about everyday consumer product exposures, which became increasingly prevalent in the 1970s.20 From the 1960s through the 1970s, one episode after another had driven home the notion that unseen dangers were widespread in the consumer environment. Cigarettes, lead, asbestos blankets, red food dye, and more were all proven harmful one after the other, well after Americans had been long assured of their safety (if not their benefits). The accumulated revelations that such products could cause cancer, brain damage, and even death gave consumers legitimate cause to question the safety of consumer products generally—and the assurances that government and industry had taken sufficient measures to protect them from harm. The country’s experience with cigarettes in particular was a lesson not only in the power of industry obfuscation, but also the scientific challenges of proving a cause-and-effect relationship between a single chemical exposure (such as tobacco smoke) and a health outcome (such as lung cancer) that did not arise until very much later in life.21 Cigarettes, lead, asbestos, and radioactive materials couldn’t be proven unsafe until they were long and widely used, which in effect left an array of consumer products open to the critique that they, too, might someday be proven hazardous, but only well after much damage had been done.22 Indeed, it was this very argument—about the challenge of uncovering long-term health effects—that environmentalists famously used to win a ban on DDT in 1972.23
By the late seventies, environmentalists’ focus on the uncertain and unknowable long-term consequences of consumer-product interactions provided a framework for critics to question vaccines by highlighting the scientific uncertainties inherent in their use. Writing in 1978, Maine chiropractor Daniel Lander worried that “in reality, no one knows for sure how effective or safe immunization really is and it is unlikely that we will ever know.”24 Across the country in Oregon, childbirth educator Cynthia Cournoyer echoed this notion in a self-published pamphlet: When you vaccinate your child, “you cannot be sure you are not also administering a serious side effect,” she wrote, “much is left unknown. There is no conclusive evidence vaccines are completely safe.”25 Harvard- and New York University–trained physician-turned-homeopath Richard Moskowitz pointed out that not only were there uncertainties inherent in vaccine use; no attempt had been made to uncover the long-term implications of their use. “The fact is that we do not know and have never even attempted to discover what actually becomes of these foreign substances once they are inside the human body,” he wrote in 1984.26
These vaccine critics and others often adopted an environmentalist lexicon to explain why these uncertainties were worth worrying about. For many vaccine skeptics, for instance, the image of a dangerously polluted environment served as a powerful metaphor for the contemporary condition of the human body. These critiques held that the human body was a microcosm that faced the same onslaught of toxins that threatened the well-being of the natural macrocosm; this idea mirrored environmentalist laments about nature’s fragility and its loss of purity.27 McBean and her followers, in particular, embraced the idea that no environment, ambient or bodily, could be purified via the addition of ever more pollutants. “Certainly a city or other area cannot be immunized from pollution by introducing more contaminating substances into it,” wrote one of McBean’s admirers in the pages of Mothering magazine. “Could a thinking public be so brainwashed as to believe that the addition of more smog to their city would possibly have the effect of purifying it?”28
The pollution metaphor also evoked another hallmark of environmentalism: the hubris and shortsightedness of science and industry, often contrasted with the inherent wisdom of nature. Influential environmentalists such as Barry Commoner popularized in the 1960s and 1970s the idea that society had established a pattern of committing to new technologies—nuclear weapons, fertilizers, insecticides, detergents, and automobiles among them—before the consequences of mass deployment were completely understood.29 In the aftermath of several widely publicized drug scares (such as those involving thalidomide and DES), and following the revelation that the 1976 swine flu inoculation campaign had done more harm than good, lessons initially relevant to the environmental arena began to color perception of mass vaccination as well. Wrote a Boston Globe reporter in response to the swine flu fiasco: “It was as if Mother Nature were warning us against arrogance: there are many things in a world full of biological hazards that we don’t understand, don’t even have the tools to understand.”30 Moskowitz, among others, applied the lessons of environmental disasters to vaccination more broadly: “We have been taught to accept vaccination as a sacrament of our . . . participation in the unrestricted growth of scientific and industrial technology, utterly heedless of the long-term consequences to the health of our own species, let alone to the balance of nature as a whole.”31
In envisioning the potential for undesirable long-term consequences, many vaccine skeptics invoked the environmentalist metaphor of the chemical time bomb. In How to Raise a Healthy Child . . . in Spite of Your Doctor, Robert Mendelsohn suggested that vaccines might be a “medical time bomb” simply because “no one knows the long-term consequences of injecting foreign proteins into the body of your child.”32 To Marian Tompson, a co-founder of the breastfeeding advocacy group La Leche League, the consequences were clear. In her view, vaccination was creating a generation of weak, defenseless beings. “Instead of taking personal responsibility for our body’s immunological system, we try to handle everything with a vaccine, insulting our bodies and creating a sicker, more endangered species. We are, literally, walking time bombs!” she wrote in 1982.33 Tompson believed, as many other vaccine critics did, that the artificial nature of vaccination was compromising children’s natural defenses. But neither Mendelsohn nor Tompson pointed specifically to the explosive potential of any particular component of vaccines; to both, the vaccines in their entirety were the explosive materials encapsulated in human bodies.
Tompson’s worry—that vaccination was weakening the species—was related to a broader set of perceptions regarding the artificial nature of vaccines, the superiority of natural immunity, and the importance of balance to the pursuit of health. While a number of people began to question vaccines in the late 1970s and early 1980s, a much smaller subset rejected vaccines outright. Many of these staunch anti-vaccinationists rejected—as McBean had—the idea that germs caused disease. In this view, vaccines were unnecessary because sickness resulted not from microorganisms but from an imbalance between “a person’s inner environment and the external world,” as McBean follower Leonard Jacobs put it.34 Jacobs and like-minded vaccine skeptics argued that immunity was “the natural ability to maintain balance with the environment” and could be obtained through breastfeeding, a balanced diet, and exercise.35 (Others added such elements as “relaxation” and a “positive attitude” to the list.36) This ecological view of health was not the exclusive purview of germ-theory nihilists, however. Some, like New York pediatrician Victor LaCerva, shared the belief that health derived primarily from internal balance and balance with one’s environment, while asserting that viruses and bacteria did cause disease in bodies “out of balance.”37
But what, precisely, did “balance” signify for people with vaccine doubts? For many, including LaCerva, it signified an approach to health that emphasized lifestyle choices, including the decisions to breastfeed, exercise, avoid processed foods, and get adequate rest, an approach that gained increased traction in the 1970s.38 It also signified the acknowledgment that humans were part of an ecosystem, their own well-being dependent on the well-being of the larger environment in which they lived. It was this perception that prompted Albuquerque physician Sue Brown to write that while she worried about vaccine safety, she believed nuclear war and “an uninhabitable planet” were more important threats to children’s health.39 Balance also referred to a quasi-religious belief in the precise, perfectly calibrated interplay of natural systems, from the molecular to the macro, that was designed to promote health but was so intricate and complex that it was beyond the comprehension of humans. “There is a wisdom within the body,” wrote Maine chiropractor Lander, illustrating this point of view. “The human body has the most complex organic machinery in the world. It produces all the chemicals one will ever need to be healthy. . . . The wisdom that created our bodies is far superior to the finite mind of all scientists in the world.”40
Lander and other vaccine critics deliberately distinguished between what they saw as “artificial” immunization—that is, vaccination—and natural immunity, which derived not from a pharmaceutical product but from lifestyle choices.41 Indeed, it was the artificial nature of vaccines that most often came under attack from critics from the 1970s onward. This revived a complaint common among anti-vaccinationists of the nineteenth and early twentieth centuries; McBean herself also frequently decried the “artificial” nature of vaccines. Both old and new nature-based vaccine critiques held that vaccines were artificial because they represented a contrived way of encountering disease, an “unnatural way of handling foreign material.”42 But in the brand of vaccine skepticism that arose in the 1970s, critics looked for scientific evidence (as environmentalists often did) to prove their position. “Did you know,” wrote La Leche League’s Tompson, “that when immunity to a disease is acquired naturally, the possibility of reinfection is only 3.2 percent? If the immunity comes from a vaccination, the chance of reinfection is 80 percent.”43 Others argued that because vaccines conferred a lesser degree of protection from natural infection, they didn’t produce “true immunity,” and thus the term “immunization” was a misnomer.44
That vaccines were perceived as artificial—and that their artificial nature was something to be abhorred—was implied by the widespread adoption of the term “toxic” to describe them. McBean and other earlier anti-vaccinationists had routinely referred to vaccines as “poisons”; writing in the 1970s, McBean continued to employ the term. But in the 1970s and 1980s, the word had less traction than it once did, and vaccine critics broadly turned instead to “toxin” and “toxic,” both of which were becoming popularly adopted with the diffusion of contemporary environmentalist thinking.45 Concerns about the toxic environment were ubiquitous in the early phases of the environmental movement, and in the 1970s these morphed into concerns about how chemical substances wreaked toxic effects on human bodies.46 Pesticides, artificial sweeteners, food dyes, drugs, and other consumer products were all subject to popular attack and government regulation for their potential or demonstrated toxic effects on humans. Vaccines, to some, seemed a logical addition to this list. Some adapted this idea to age-old natural healing philosophies: “All vaccines, like drugs, are toxic. None render the body healthy, but rather more toxic,” wrote one natural hygienist in defense of her anti-vaccinationism.47 Others employed it to articulate their newfound vaccine worries, as did one Mothering reader who referred to vaccines as “standardly accepted injectable toxins.”48 In a new edition of her self-published pamphlet, Cournoyer told readers that “Manufacturers of vaccines admit they are highly toxic and by their very nature, cannot be made safe.” Cournoyer went on to enumerate the “toxic ingredients” in vaccines. In addition to “horse blood, dog kidney tissue . . . and other decomposing proteins,” she listed:
Phenol—(Carbolic acid) a deadly poison.
Formaldehyde—A known cancer causing agent which is commonly used to embalm corpses.
Mercury—A toxic heavy metal that is not easily eliminated from the body.
Alum—A preservative.
Aluminum phosphate—Used in deodorants. Toxic.
Acetone—A solvent used in fingernail polish remover. Very volatile.
Glycerin—A tri-atomic alcohol extracted from natural fats which are putrified and decomposed. Some toxic effects of glycerine are kidney, liver, lung damage, diuresis, pronounced local tissue damage, gastrointestinal damage and death.
Aluminum and Oil Adjuvants—Carcinogenic (cancer-producing) in laboratory mice.49
This focus on the chemical components of vaccines marked a distinct departure from the criticism of Victorian and Progressive Era anti-vaccinationists, who had also decried vaccination’s artificial nature and likened the process to pollution. From the 1970s on, however, these specific complaints encompassed a new meaning: they evoked not just biological contamination with “horse blood” and “cow pus,” a complaint that originated with earlier anti-vaccinationists, but the irreversible chemical pollution of bodies, a distinctly modern concern.50 Vaccine critics pointed out that “most parents who are trying to feed their children properly would not let them eat a food which contained any of the many ingredients in immunizations.”51 They employed the modifier “toxic” to describe the chemicals they found listed on vaccine package inserts, and by pointing out that some of the chemicals were carcinogenic, they implicated vaccines in the ever-growing epidemic of cancer. By pointing out that vaccines included heavy metals, they implicated immunization in other epidemics as well. To Cournoyer and other critics, the presence of such compounds in vaccines was proof that the products were under-regulated and thus unsafe. “When cancer causing elements are found in foods, they are either banned (remember cyclamates?) or an obvious warning label appears on the package (saccharin, cigarettes),” she wrote. Her conclusion: “There seems to be a double standard for vaccines!”52
In the eyes of vaccine critics, both aspects of the artificial nature of vaccines—their unique interface with the immune system and their contents—implicated vaccines in an ever-adjusting list of seemingly modern epidemics. The suspicion that vaccines might be responsible for the emergence or increasing prevalence of new (or perceived-as-new) diseases was long held by anti-vaccinationists. Lora Little linked vaccination to cancer in her 1905 anti-vaccine tract; Annie Riley Hale did the same in 1935.53 In 1957 and 1974 (her book was reprinted a third time, in 1993), McBean argued that the “900 percent increase” in cancer deaths in the first half of the century was brought on by vaccination.54 McBean (quoting Hale) maintained that modern medicine’s greatest achievement had been to “swap smallpox for cancer and typhoid fever for diabetes and insanity.”55 The suspicion that vaccination had resulted in an unfavorable trade-off was oft-repeated by vaccine critics from the 1970s on, who argued that Americans had “traded mumps and measles for cancer and leukemia”—or, put another way, for “the far less curable epidemic of chronic diseases of the present.”56
For much of the twentieth century, anti-vaccinationists and vaccine skeptics were unanimous in their suspicion of a link between vaccination and cancer. But around 1980, fears that vaccines were responsible for climbing cancer rates gave way to fears that vaccines were responsible for other epidemics, namely, epidemics of autoimmune diseases, learning disabilities, and childhood behavioral disorders. These anxieties were linked to the belief that vaccination constituted an unnatural bodily intrusion, and they shifted in response to other cultural anxieties. At the 1975 Asilomar Conference on Recombinant DNA, which followed an explosion of findings on genetic disorders and great advances in (and trepidations about) genetic engineering, some scientists speculated that vaccines might be introducing disease-inducing genetic material into the body. Vaccine skeptics quickly picked up on and circulated such hypotheses. In a 1976 issue of his newsletter The People’s Doctor, Mendelsohn described a theory proposed by a Rutgers University geneticist, which in Mendelsohn’s interpretation suggested that vaccines were seeding humans with genetic material that could form “pro-viruses” in the body; under the right conditions, he warned, the pro-viruses might lead to “rheumatoid arthritis, multiple sclerosis, lupus erythematosus, Parkinson’s disease and perhaps cancer.”57
Eight years later—following, not coincidentally, the discovery of HIV—Mendelsohn wrote of the “growing suspicion” among scientists that immunization “against relatively harmless childhood diseases” might be responsible for the recent rise in autoimmune diseases.58 With the emergence of AIDS, preoccupations with the potential link between vaccines and cancer were largely supplanted by concerns that vaccines were responsible for epidemic levels of immune dysfunction. Some feared that AIDS itself might have been caused by the vaccines against polio and hepatitis B.59 Others believed that AIDS and the “overall immunologic weakening of our children” were brought on by the generally artificial nature of vaccination.60 In 1985 Pennsylvania physician Harold Buttram (who long had unorthodox medical views and ties to anti-vaccinationists) articulated a theory linking vaccines to the recent epidemic of immune disease. Because injections permitted the material in vaccines to bypass mucous membranes and instead directly stimulate a set of antibodies that were not the body’s usual first line of defense, they constituted “immunologic shock treatment” and depleted the immune system’s resources. Buttram and a co-author proposed that this artificial route to immunity (coupled with exposure to environmental pollution and processed foods) was responsible for causing an “AIDS-like state” in children that was manifesting as an overwhelming rise in allergic disorders.61 One didn’t need to be a physician or a staunch anti-vaccinationist to draw a line between vaccines, their purportedly artificial nature, and the epidemic that came to define the 1980s. As one parent wrote to Mendelsohn in 1988, “The thought of injecting toxins (of fairly dubious origins) into my children, who have never known any illness more serious than an occasional cold, is absurd. . . . In this era of malfunctions of the immune system—cancer and AIDS specifically—our country would be better off spending its research money on learning about immune functions.”62
As times changed, Buttram’s theories evolved, and in the early 1990s he argued that the most worrisome trend in the health of American children was the rise of behavioral disorders, including hyperactivity and learning disorders. Those very same conditions stood out to Barbara Loe Fisher and Harris Coulter as they compiled DPT: A Shot in the Dark.63 After unearthing evidence from the medical literature linking pertussis vaccination to convulsions, seizures, encephalitis, and permanent brain damage, Coulter and Fisher proposed that the vaccine might also be responsible for a far greater number of cases of “minimal brain dysfunction, or learning disabilities,” including hyperactivity, dyslexia, and autism. Citing an idea popularized by the environmental movement, they argued that scientists had likely missed this connection because of the lag time between exposure and effect. To strengthen their case, they turned to the bellwether of the environmental movement, Rachel Carson’s Silent Spring.
In her 1962 book, Carson delineated the devastation that pesticides had wrought on wildlife and then argued that scientists had no way of knowing whether the very same exposures weren’t endangering in subtle ways the health of humankind as well. Coulter and Fisher seized on this latter point, quoting Carson at the start of a chapter they titled “Long Term Damage”: “We are accustomed to look for the gross and immediate effect and to ignore all else. Unless this appears promptly, we deny the existence of hazard. Even research men suffer from the handicap of inadequate methods of detecting the beginnings of injury.”64 A Shot in the Dark described the allergies, deafness, and behavioral disorders in children who had appeared to suffer acute reactions upon vaccination as infants. It documented the “phenomenal” increase in learning disabilities and hyperactivities over the previous three decades, the same period in which pertussis vaccination came into widespread use. To Coulter and Fisher, Carson’s words suggested that no matter the length of time that had elapsed between the shot and the onset of such conditions in a child, a connection between the two could not be ruled out.
Coulter and Fisher also noted that infantile autism was first documented by doctors just a few years after the pertussis vaccine was widely deployed in the United States. They quoted one mother who described the autistic-type behaviors in her son Richard, who suffered encephalitis following his third DPT shot and could assemble puzzles but not put on his own shoes. Richard’s mother was “convinced” of a connection between autism and her son’s pertussis vaccine, and Coulter and Fisher concluded that this was one of several possible vaccine-related harms that deserved greater scrutiny from the scientific community.65 Autism was also one of just a few harms that Coulter, an independent medical historian who had written extensively on alternative health, went on to investigate himself. For a subsequent book, he interviewed sixty parents of vaccine-damaged children in addition to the hundred that he and Fisher had interviewed for A Shot in the Dark. From these, he devised a theory that linked widespread vaccination to what he described as epidemic sociopathic behavior in American society.
Coulter’s 1990 book, Vaccination, Social Violence, and Criminality: The Medical Assault on the American Brain, proposed that vaccines had inflicted such widespread damage on the brains of children that they were responsible for the explosion of psychiatric disorders among American children since the 1950s, the social “turmoil” of the 1960s, increases in crime, alcohol and drug abuse, and even the pathological behavior of serial killer and rapist Ted Bundy. Coulter gave special attention to autism, attributing increasing prevalence of the condition to vaccine-induced encephalitis, a phenomenon well-documented in the medical literature (though Coulter proposed that it occurred far more commonly than documented). Coulter pointed out that the first medical descriptions of autism in the 1940s immediately followed the widespread use of pertussis vaccination. He also argued that the reason autism had been limited to offspring of upper-class parents prior to the 1970s was because they were the only ones who could afford to vaccinate their children. Only after the 1970s, when new policies made vaccination widely available to all socioeconomic classes, did autism spread more widely in his view.66
Coulter’s 1990 volume never achieved the readership or media attention that his book with Fisher enjoyed. But it’s worth noting because it joined a wave of books on immunization hazards that came out after DPT: A Shot in the Dark, a trend that signaled an expansion of vaccine skepticism. However, whereas DPT: A Shot in the Dark focused its attention on a single vaccine, and held out hope that science would provide a safer vaccine in time, many of the authors of the subsequently published vaccine critiques were far less sanguine about modern medicine and believed that safer routes to immunity existed. Books such as Walene James’s Immunization: The Reality Behind the Myth, Randall Neustaedter’s The Immunization Decision, Neil Miller’s Vaccines: Are They Really Safe and Effective?, Jamie Murphy’s What Every Parent Should Know about Childhood Immunization, and Viera Scheibner’s Vaccination decried the artificial nature of vaccines, the lack of research on long-term consequences, and vaccines’ potential role in fostering the spread of chronic diseases.67
On the whole, these books reflected the growing popularity of natural and alternative healing methods, which expanded in the late eighties and early nineties.68 Many of their authors subscribed to nature-based healing philosophies, and environmental metaphors and ideas filled their work. Murphy, a Massachusetts-based herbalist, equated vaccination to the pollution caused when oil drums were buried underground or industrial solvents dumped into open waters.69 Neustaedter, a San Francisco homeopath and acupuncturist, worried about “subtle and long-term damaging effects on the immune system and nervous system.”70 New Mexico journalist and father Miller argued against tampering with the “delicate structure of the human organism.”71 Scheibner, an Australian physician whose vaccine-skeptical book was published in the United States, argued that doctors and parents needed to “start respecting nature and recognize infectious diseases for the value they bring to children.”72 She was one of many who argued that even infectious diseases serve a purpose, and that nature gives all creatures everything they need to survive.
To these and other writers, recent history offered proof that their vaccination objections were justified. A recent resurgence of measles, which struck vaccinated as well as unvaccinated children in the late 1980s, was a troubling sign of nature’s obstinacy. The revelation that pertussis vaccine could cause brain damage was proof that vaccines could be proven harmful after many decades of use. And the cases of Guillain-Barré syndrome that occurred in people vaccinated against the swine flu back in 1976 offered a similar example of harm following assurances of safety on a compressed time scale.
DPT: A Shot in the Dark nudged vaccine skepticism into the national spotlight and proved that there was an audience for information on vaccination alternatives—or at least for more information on vaccines and side effects than was generally provided in doctors’ offices. But most authors of subsequent vaccine-critical books struggled to produce further evidence of harm. Several pointed to Coulter’s theory, repeating the observation that the climbing prevalence of both autism and hyperactivity correlated with increased vaccination. And more and more critics enumerated the chemicals in vaccines and hunted down details on their toxicity.
Murphy, in the 1994 book What Every Parent Should Know about Childhood Immunization, wrote that vaccines contained a “witch’s brew” of chemicals, including known carcinogens (such as formaldehyde), mercury (in the form of thimerosal), aluminum, and formalin. He described aluminum poisoning in factory workers and the Environmental Protection Agency’s decision to classify formaldehyde as “hazardous waste.”73 Thimerosal, he pointed out, was a mercury derivative, but no tests had been done to see how much of the metal remained in the body after vaccination. Bits of evidence from other studies, however, did provide cause for concern. Murphy described a report in the British Medical Journal that concluded there was a “theoretical risk” of harm to patients receiving immunoglobulin injections, which contained thimerosal. And he pointed out that the mercury in once widely used teething powders had been traced—after seven decades of use—to a condition called pink disease, a form of mercury poisoning, in children. Other vaccine critics noted that mercury was toxic to the kidneys and central and peripheral nervous systems and associated with tremors, dementia, and memory loss—symptoms that closely resembled those seen in children who had reportedly reacted to the DPT, pertussis, and the new Hib (Haemophilus influenza type b) vaccines, all of which contained thimerosal.74
The increasing suspicion that the chemical components of vaccines—especially thimerosal—might be toxic to children’s developing nervous systems took place against a backdrop of growing national concern about mercury exposure. Studies in the 1980s had revealed dangerously high levels of mercury in fish—including some of the highest levels ever recorded in the United States.75 The findings, reported the New York Times, bore out environmentalists’ warnings about pollutants in the food supply and were especially troubling in light of growing fish consumption among increasingly health-conscious Americans.76 As federal agencies examined the health and environmental effects of mercury emissions in the environment and debated the amount of mercury that individuals could safely consume, state governments and community groups went ahead with steps to reduce exposure to the metal.77
States issued warnings against consuming fish from local waters and passed regulations to monitor disposal of mercury-containing appliances; a few states even banned children’s flashing sneakers, which contained mercury switches.78 Advocacy groups began campaigns to phase out the use of mercury-containing thermometers and warned pregnant women and children to limit canned tuna consumption.79 News reports on mercury throughout the 1990s emphasized that even “tiny” amounts of the metal were toxic, especially to the fetus, and that exposure could cause subtle but permanent damage. Many articles also quoted officials who compared mercury to lead and cigarettes, the hazards of which were long ignored and then suppressed. In a July 1999 article that referred to “mercury madness,” Mothering notified readers about widespread warnings against fish consumption and the dangers of mercury thermometers, adding, “It only takes a drop of the toxin to contaminate a whole lake—or a child.”80
The article in Mothering made no reference to mercury in vaccines, but it likely would have had it gone to press just one month later. In July 1999, the Public Health Service and the American Academy of Pediatrics (PHS/AAP) issued a joint statement asking vaccine manufacturers to “eliminate or reduce as expeditiously as possible the mercury content of their vaccines.” The statement indicated that because of new vaccines and new vaccine recommendations (by now, the list of childhood immunizations had grown to include vaccines against hepatitis B, chicken pox, and Hib), children in their first six months were at risk of getting a cumulative level of mercury that exceeded a federal guideline on methyl mercury, a chemical relative of the mercury compound in thimerosal. The risk of harm from this exposure was unknown but certainly smaller than the risk of infectious disease, the statement went on, but it was nonetheless worth addressing “because any potential risk is of concern.”81
The determination that there was any risk from the mercury in vaccines came as a result of an amendment to the Food and Drug Administration Modernization Act of 1997 that required the FDA to evaluate the mercury contents of drugs and biologic products.82 It also followed the 1997 publication of the Mercury Study Report to Congress, the Environmental Protection Agency’s examination of the health and environmental effects of mercury emissions undertaken in response to the Clean Air Act Amendments of 1990.83 During—and after—the production of the Mercury Study Report, the safe exposure level was the subject of intense political debate. Industry cited results of a study finding no adverse effects among mercury-exposed children in fishing communities in the Seychelles, while public health and EPA officials cited a study of mercury-exposed children in a fishing community in the Faroe Islands, whose motor function, language, and memory were all diminished compared to non-exposed children.84
The 1999 PHS/AAP statement on vaccines set off its own debate over the health effects of mercury exposure, although this time the disagreement split the public health community. Pediatrician and outspoken vaccine proponent Paul Offit called the statement a “flawed” policy for elevating “a theoretical risk above an actual risk.”85 Veteran vaccine researcher Stanley Plotkin called it a “public health disaster” for delaying the vaccination of infants against hepatitis B.86 In an editorial defending the call to remove thimerosal from vaccines, Johns Hopkins University epidemiologist and federal vaccine adviser Neal Halsey equated the debate over mercury to that over lead, “where sequential studies over many years provided evidence for subtle effects with progressively lower exposures.”87 To Halsey, the theoretical risk of harm from thimerosal had to be balanced against the public’s tolerance of that risk, which in his estimation was growing ever more limited. Policies to limit risk also needed to appear consistent. As he later explained to a New York Times reporter, his own position on the presence of thimerosal in vaccines crystallized while he was canoeing on a lake in Maine, where he came across a sign reading “protect your children—release your catch.” It was a problem, he told the reporter, for the government to tell parents not to feed their children fish contaminated with mercury but to ask them to be injected with the same substance.88
Leslie Ball and Robert Ball, the FDA scientists who conducted the agency’s risk assessment on thimerosal, also defended the recommendation to remove the preservative from vaccines, both for its feasibility in the interest of limiting total human exposure to mercury and as a way of maintaining public confidence in vaccines.89 Indeed, at the end of the century, it was hard to ignore the fact that lay confidence in vaccines was flagging. CDC officials reported that the national immunization hotline had been receiving increasing numbers of calls about vaccine safety.90 The new vaccines added to the childhood vaccination schedule in the late 1980s and 1990s had evoked some consternation among parents and drew increased scrutiny from the press, which throughout the 1990s ran reports on potential vaccine harms, news of recalls, and investigations into the machinations of the “billion-dollar” vaccine industry. This pileup of negative, end-of-the-century vaccine news—discussed in chapter 9—often seemed to confirm skeptics’ long-held fears and convictions. When, for example, the Lancet published a well-publicized report on a potential link between measles vaccination and a form of autism in 1998, Barbara Loe Fisher received the news with equanimity. After all, she pointed out, the link between autism and vaccines was “first reported in DPT: A Shot in the Dark fifteen years ago” and had been “simmering” for over a decade.91 To skeptics, such “news” about vaccines was nothing new.
A CRISIS OF FAITH
According to historian Thomas Dunlap, environmentalism, like religion, “invokes the sacred,” “refuses to choose between intellect and emotion,” and “gives moral weight to the apparently trivial decisions of daily life.”92 Environmentalism and religious belief systems both grapple with questions of human existence and conceptualize life and the universe as a complex, quasi-mysterious whole whose intricate workings are beyond the comprehension of humanity. Over three decades of resistance, vaccine skeptics relied on a quasi-religious environmental belief system to make sense of vaccines and their encounter with human bodies and the environment. In doing so, they conceptualized not just the body but the immune system specifically as sacred and intricately complex beyond human comprehension.
As vaccine policies were strengthened in the 1970s, and as the vaccine schedule was expanded in the 1980s and 1990s, nature offered hesitant parents answers to the increasingly fraught questions of whether, and against which diseases, they should vaccinate their children. Nature also helped resolve the broader question of how to care for children in a complicated and incomprehensible modern world. The notion that everything in nature—viruses, bacteria, and diseases included—served an unknowable but crucial purpose was more comforting than the prospect of gambling with haphazard and ever-changing scientific knowledge. Not infrequently, vaccine skeptics attributed the sanctity of everything in nature to the workings of a higher power. As the mother of a vaccine-damaged son explained in DPT: A Shot in the Dark:
I thought I was being a good parent to give him that shot. If I had known about the risks, if I had been given an option, I might have taken my chances with the natural disease. . . . I was so happy when he was born. He was so beautiful, with ten toes and ten fingers. God gave me a perfect child, and man, with his own ways, damaged God’s perfect work.93
Many parents who eschewed vaccines expressed a desire, like the mother above, to leave (or to have left) their child’s fate in the hands of divine wisdom, be it nature’s or God’s. In the 2000s, this desire manifested in the revival of the chicken-pox party: “A little playing, some conversation and some passing of the pox to the next family,” as one Virginia mother put it.94 The development of a vaccine against chicken pox in the 1980s was followed in the 1990s by the adoption of state laws requiring proof of vaccination or immunity for children entering day care or school. But media reports shared the news that parents in Britain were opting for “disease parties” over the new vaccine.95 In the United States, Internet discussion boards soon buzzed with talk of the parties, and in 2004 Mothering published advice on establishing immunity the “natural” way. Varicella, the chicken pox virus, “is communicated easily through saliva,” the authors wrote, so they suggested having children at a “Pox Party” share whistles.96 Parents who chimed in online suggested passing around kazoos, popsicles, lollipops, or M&M’s while the gathered children did art projects or played games.
Over the next few years, popularity of the parties swelled, achieving a cult-like following and considerable press, particularly in upper-middle-class enclaves from coast to coast. When interviewed by the media, mothers who hosted or took their children to Pox Parties said they wished to give their children natural, lifelong immunity that they, in turn, could pass on to their own children someday. Often they described their thinking in religious terms. “I believe in the body’s ability to build immunity and heal itself,” said a Brooklyn mom and registered nurse who hosted a chicken pox party to spread her son’s infection.97 “I’m of the belief system that by putting a synthetic, or a dead virus, into a body as an inoculation creates an ongoing response to trying to build up immunity to that, and that ultimately it creates a situation where you have an overworked immune system,” said a California mom.98
Parents who saw ultimate doom in acceptance of the chicken pox vaccine saw not only a progressive, cumulative assault on natural immunity in the making but also (because the duration of the shot’s protection was unknown) a series of man-made disasters on the horizon: a generation of women with no maternal antibodies to pass on to their own children; an epidemic of shingles, the more serious manifestation of chicken pox virus infection in adolescents and adults; and a generation of daughters who could be susceptible to chicken pox during their own pregnancies, putting two generations removed at risk of birth defects. These fears echoed vaccine scientists’ own initial questions about the vaccine when it was first developed. But vaccine critics amplified these hypothetical scenarios until they became predictions of unavoidable disaster in which, like the devoutly religious, they firmly believed, and which guided their decisions and actions.99
Writing in the 1980s, historian Roderick Nash argued that American environmental ethics had come to be dominated by the ideas that nature has both “intrinsic value” and “the right to exist,” the latter an idea that placed environmentalism (an albeit “radical” movement) “squarely in the mainstream of American liberalism.”100 With the expansion of both the immunization schedule and immunization programs in the 1990s—a subject described in greater detail in chapters 7 and 8—vaccine-safety groups increasingly advocated for the freedom to make health care decisions for their children, arguing that this was a right of parents upon which the state should not intrude. This demand directly echoed the requests of anti-vaccinationists of a century before, and it fit neatly within the tradition of American emphasis on the importance of liberty and equality. At the same time, however, many vaccine critics, including those who resisted the new chicken pox vaccine, argued for the importance of letting childhood diseases run their course; they argued, that is, for the inherent value of these creations of nature. The belief that everything in nature has a purpose may not have been as common among vaccine skeptics as was the belief in a parent’s right to choose her or his child’s health care, but both beliefs have direct correlates in American environmentalism as well as American political ideology as a whole.
Even if every last germ was not of value, vaccine critics who derived their critiques from either environmentalist rhetoric or natural healing philosophies found nature intrinsically valuable in other ways. Many of the same critics who likened vaccinated human bodies to polluted lands or waters often referred to the body as “terrain” or “soil” and believed that only the most natural inputs could truly promote health. In this view, the body, like a pristine wilderness, stood its best chance of survival in an untouched state, sustained on pure water and whole, unprocessed foods—the life-sustaining fruits of nature, that is, not the products of humanity. Those who rejected vaccines because they followed natural healing practices generally ascribed to nature a wisdom and beneficence—and sometimes even a religious authority—perceived by centuries of nature-cure adherents before them.101 To cross nature would weaken the body and indeed the species, either by eroding “natural” immunity or prompting the transmutation of existing diseases into more horrific maladies (a possibility that McBean dubbed a “Frankenstein monster of immense proportions”). Fighting nature thus smacked of blasphemy and hubris, as Moskowitz indicated when he argued that vaccination was a misguided “attempt to beat nature at her own game, to eliminate a problem that cannot be eliminated, i.e., the susceptibility to disease itself.”102
AN EXHORTATION
Prompted in good part by the advent of the environmental movement, a prevailing philosophy of vaccine harm took shape and persisted in largely unchanged form across the final decades of the twentieth century. This philosophy was based on an ecological view of health; it regarded vaccines or their components as an artificial and therefore harmful intrusion upon the body, and it held that vaccines were responsible for chronic diseases that had reached epidemic proportions—even if science was as yet unable to prove a link between the two. In the 1970s, this philosophy was informed by generalized consumer worries about a toxic environment and the bodily effects of widespread pollution. In the 1980s, it sought to explain the spread of immune disorders, including AIDS, and growing rates of neurological and behavioral disorders in children. In the 1990s, the admission of an unknown risk of harm from the mercury compound in vaccines confirmed environmentalism-inspired charges that man-made technologies were all too often adopted before their harms were fully calculated or understood. And in the 2000s, vaccine rejection once again accompanied a wholesale rejection of technology in favor of the unfathomable wisdom of nature.
The environmentalism that emerged in the 1960s and evolved through the 2000s popularized this ecological view of health, fostered popular concern over toxic materials seen and unseen, highlighted the long-term consequences of hastily adopted technologies, and cultivated popular reverence for nature—in some cases in all of its forms, right down to the germ. Moreover, the environmental movement buttressed and popularized the idea that a lack of evidence of harm was no proof of safety, a notion that the country’s experiences with radiation, lead, cigarettes, DDT, and ultimately thimerosal appeared to prove. Finally, building on these very experiences, environmentalism (like health feminism) established an exhortation to question the assurances of those in authority that new technologies were fully vetted and safe. Coulter and Fisher illustrated this line of thinking when they quoted Rachel Carson at the very end of DPT: A Shot in the Dark:
Just as we have polluted our environment with man-made chemicals, we may well be polluting ourselves with a myriad of man-made vaccines in our quest to eradicate all disease and infection from the earth. In her exploration of the ways that Americans have polluted the air, water, and earth with synthetic chemicals, Rachel Carson concluded in Silent Spring that “The choice, after all, is ours to make. If, having endured much, we have at least asserted our ‘right to know,’ and if, knowing, we have concluded that we are being asked to take senseless and frightening risks, then we should no longer accept the counsel of those who tell us we must fill our world with poisonous chemicals; we should look about and see what other course is open to us.”103
Indeed, it was this “other course” that vaccine skeptics sought, whether they were hygienists or homeopaths or merely parents worried about the long-term consequences of their children’s toxic exposures. To all, environmental thinking justified the search for alternatives to immunity via vaccination. And to some, the search became more urgent as the number of vaccines required for children and federal involvement in vaccination continued to expand.