Eula Biss
– But it did escape my notice, as a child, that the parents in those (grimms) tales have a maddening habit of getting tricked into making bad gambles with their children’s lives
– A child cannot be kept from his fate, though this does not stop the gods themselves from trying.
– Immunity is a myth, these stories suggest, and no mortal can ever be made invulnerable.
– Every exchange about the new flu vaccine was an extension of the already existing discussion about immunization, in which all that is known of disease is weighed against all that is unknown about vaccines.
– Plumbing most any word will reveal what Emerson called “fossil poetry,” metaphors submerged below the surface of our current usage.
– Fathom, a means of measuring the depth of the ocean, now means understand because its literal origin, using outstretched arms to measure cloth from fingertip to fingertip, was once used as a metaphor for grasping an idea.
– “Our bodies prime our metaphors,” write James Geary in I Is an Other, his treatise on metaphor, “and our metaphors prime how we think and act.”
– The gist of the dracula stuff – starts on pg 14. Man there’s a lot here. Vampires fed on babies, corrupting blood, they were also wealthy in the lit, and doctoring was invented as a profession recently in society, only available to the rich, the poor were sus. Then there’s the stds being transited by doctors accidentally with arm-to-arm vaccination. Dracula land as a plague starts, rats, infections. A monster that creates more monsters. And there’s a narrative about if vampires are real, so there’s evidence/truth happening there too.
– the term herd mentality, a stampede toward stupidity. The herd, we assume, is foolish.
– If we were to exchange the metaphor of the herd for a hive, perhaps the concept of shared immunity might be more appealing. Honeybees are matriarchal, environmental do-gooders who also happen to be entirely interdependent.
– Groups of people, if they are sufficiently diverse and free to disagree, can provide us with thinking superior to any one’s expert’s.
– The concept of a “risk group,” Susan Sontag writes, “revives the archaic idea of a tainted community that illness has judged.”
– Debates on vaccination, then as now, are often cast as debates over the integrity of science, though they could just as easily be understood as a conversations about power.
– The last smallpox epidemic was in 1898, people said white folks couldnt be effected, it was an “other disease” and made up pejorative names for it for each racial group. Blacks were vaccinated at gun point in some places. But led to risks of tetnus that other groups didn’t face. Then there’s body autonomy issues for being forced to be vaccinated. Which, here lead to conversations about slavery. Those who refused didn’t want to spoil the purity of their bodies with the filth of science and disease. The wealthy always refused, disproportionately, compared to other.
– This is a radical inversion of the historical application of vaccination, which was once just another form of bodily servitude extracted from the poor for the benefit of the privileged. There is some truth, now, to the idea that public health is not strictly for people like me, but it is through us, literally through our bodies, that certain public health measures are enacted.
– A germ is an organism that causes disease, or it is a part of the body capable of building new tissue. We use the same word for something that brings illness and something that brings growth.
– There are, for instance, about a million different viruses in a teaspoon of seawater.
– The cells that form the outer layer of the placenta for a human fetus bind to each other using a gene that originated, long ago, from a virus. Though many viruses cannot reproduce without us, we ourselves could not reproduce without what we have taken from them.
– Some of our white blood cells combine and recombine their genetic material like random number generators, shuffling their sequences to create an immense variety of cells capable of recognizing an immense variety of pathogens. This technology was viral technology before it was ours.
– Not all germs should be put to death, he maintained. Killing germs, rather than washing them away, reminded hi of the Crusades, when an abbot who asked how to tell the faithful from the heretics replied, “Kill them all—God will know his own.”
The health risks triclosan (ingredient in hand sanitizer) poses for humans are probably low, but any degree of risk, he reminded me, should be unacceptable in a product that does not do any good.
– While a substantial amount of evidence is acceptable as proof that an event does and can happen, there is never enough evidence to prove that an event cannot happen.
– “Perceptions of risk—the intuitive judgments that people make about hazards of their world,” the historian Michael Willrich observers, “can be stubbornly resistant to evidence of experts.” We do not tend to be afraid of the things that are most likely to harm us. We drive around in cars, a lot. We drink alcohol, we ride bicycles, we sit too much. And we harbor anxiety about things that statistically speaking, pose us little danger. We fear sharks, while mosquitoes are, in terms of sheer number of lives lost, probably the most dangerous creature on earth.
– In another study, people significantly overestimated the fatality rates of highly publicized or dramatic dangers like cancer or tornadoes.
– One could interrupt this, as (Cass) Sunstein does, to mean that most people are just wrong about risk. But risk perception may not be about quantifiable risk so much as it is about immeasurable fear. Our fears are informed by history and economics, by social power and stigma, by myths and nightmares. And as with other strongly held beliefs, our fears are dear to us. When we encounter information that contradicts our beliefs, as Slovic found in one of his studies, we tend to doubt information, not ourselves.
– These are metaphors (cleaning) that address out base anxieties. And what the language of alternative medicine understands is that when we feel bad we want something unambiguously good.
– Most pharmaceuticals available to us are at least as bad as they are good…”There are very few perfect therapies in medicine.” (her dad)
– “Obviously the more artificial a human environment becomes, the more the word ‘natural’ becomes a term of value. We see the human and the natural economies as necessarily opposite or opposed, we subscribe to the very opposition that threatens to destroy them both. The wild and domestic now often seem isolated values, estranged from one another. And yet these are not exclusive polarities like good and evil. There can be continuity between them, and there must be.” Wendell Berry
– Vaccination is a kind of domestication of a wild thing, in that it involves our ability to harness a virus and break it like a horse, but its action depends on the natural response of the body to the effects of that once-wild thing.
– Our bodies are not boundaries
– us and them – the very opposition that threatens to destroy them both.
– Rather than imagine a war in which we are ultimately fighting against ourselves, perhaps we can accept a world in which we are all irrational rationalists.
– Our bodies have been programmed to respond to disease, and modified by technologically altered viruses. Idea from Chris Hables Gray, cyborg scholar who says if we’ve been vaccinated, we’re cyborgs.
– Vaccination is a precursor to modern medicine, not the product of it…Folk knowledge held that if a milkmaid milked a cow blistered with cowpox and developed some blisters on her hands, she would not contract smallpox even while nursing victims of an epidemic.
– Before long, the procedure would e known by Jenner’s term for cowpox, variolae vaccine, from the Latin vacca for cow, the beast that would forever leave its mark on vaccination
– Jenner had the evidence to suggest that vaccination worked, but he did not know why it worked. His innovation was based entirely on observation, not on theory.
– At that point, variolation, the practice of purposefully infecting a person with a mild case of smallpox in order to prevent more serious illness, was still somewhat novel in England but had been practiced in China and India for hundred of years.
– When Voltaire wrote, “On Inoculation,” the primary meaning of the English word inoculate was still to set a bud or scion, as apples are cultivated by grafting a stem from one tree onto the roots of another.
– When the word inoculate was first used to describe variolation, it was a metaphor for grafting a disease, which would bear its own fruit, too the rootstock of the body.
– I would note that the cells of the immune system lead lives in which they kiss, are naive, eat, purge, express, get turned on, are instructed, make presentations, mature, and have memories. “They sound like my students,” a friend of mine, a poetry professor would observe. If a narrative of any kind emerged from those lectures, it was the drama of the interaction between our immune system and the pathogens with which it coevolved.
– our bodies and the viruses were two competing intelligences locked in a mortal game of chess.
– Later, I would learn that one out of every ten children born in 1900 died before their first birthdays.
– But even when I do nothing, I am aware that I am irrevocably changing the future. Time marches forward in a course that is forever altered by the fact that I did nothing.
– But the art of healing, as doctors would discover, is rather difficult to commodify. The wise practice of waiting and watching is hard to sell, in part because it looks a lot like doing nothing.
– The pressures of the marketplace, Ehrenreich and English suggest, led to the practice of “heroic” medicine, which relied heavily on dangerous therapies like bleeding. The purpose of heroic medicine was not so much to heal the patient as it was to produce some measurable, and ideally dramatic, effect for which the patient could be billed.
– As childbirth moved into hospitals, the maternal death rate rose dramatically.
– “If it is not viral or bacterial, it must be maternal.” Janna Malamud Smith
– Even a modestly informed woman squinting at the rough outlines of a compressed history of medicine can discern that quite a bit of what has passed for science in the past two hundred years, particularly where women are concerned, has not been the product of scientific inquiry so much as it has been refuse of science repurposed to support already existing ideologies.
– Those who went on to use Wakefield’s inconclusive work to support the notion that vaccines cause autism are not guilty to ignorance or science denial so much as they are guilty of using weak science as it has always been used—to lend false credibility to an idea that we want to believe for other reasons.
– Believing that vaccination causes devastating diseases allows us to tell ourselves a story we already knows: what heals may harm and the sum of science is not always progress.
– In the nineteenth century, smallpox was widely considered a disease of filth, which meant that it was largely understood to be a disease of the poor. According to filth theory, any number of contagious diseases were caused by bad air that have been made foul by excrement or rot. The sanitary conditions of the urban poor threatened the middle class, who shuttered their windows against the air blowing off the slums.
– The idea that toxins, rather than filth or germs, are the root cause of most maladies is a popular theory of disease among people like me. The toxins that concern range from pesticide residue to high fructose corn syrup, and particularly suspect substances include the bisphenol A lining our tin cans, the phthalates in our shampoos, and the chlorinated Tris in our couches and the mattress.
– As long as a child takes only breast milk, I discovered, one can enjoy the illusion of a closed system, a body that is not yet dialogue with the impurities of farm and factory.
– Fears that formaldehyde from vaccines may cause cancer are similar to fears of mercury and aluminum, in that they coalesce around minuscule amounts of the substance in question, amounts considerably smaller than amounts from other common sources of exposure to the same substance. Formaldehyde is in automobile exhaust and cigarette smoke, as well as paper bags and paper towels, and it is released by gas stoves and open fireplaces.
– Large concentrations are indeed toxic, but formaldehyde is a product of our bodies, essential to our metabolism, and the amount of formaldehyde already circulating in our systems is considerably greater than the amount we received through vaccination.
– the journalist Florence Williams notes, “but if human milk were sold at the local Piggly Wiggly, some stock would exceed federal food-safety levels for DDT residues and PCBs”
– Though toxin is now often used to refer to man-made chemicals, the most precise meaning of the term still reserved for biologically produced poisons.
– In this context, fear of toxicity strikes me as an old anxiety with a new name. Where the word filth once suggested, with its moralist air, the evils of the flesh, the word toxic now condemns the chemical evils of our industrial world. This is not to say that concerns over environmental pollution are not justified—like filth theory, toxicity theory is anchored in legitimate dangers—but that the way we think about toxicity bears some resemblance to the way we once through about filth.
– Purity, especially bodily purity, is the seemingly innocent concept behind a number of the most sinister actions of the past century. A passion for bodily purity drove the eugenics movement that led to the sterilization of women who were blind, black, or poor. Concerns for bodily purity were behind miscegenation laws that persisted more than a century after the abolition of slavey, and behind sodomy laws that were only recently declared unconstitutional. Quite a bit of human solidarity has been sacrificed in pursuit of preserving some kind of imagined purity.
– we do at least know that we are no cleaner, even at birth, than our environment at large. We are all already polluted. We have more microorganisms in our guts than we have cells in our bodies—we are crawling with bacteria and we are full of chemicals.
– pg 77-82, more vampire stuff…vampires as a lens for the predicament of the times
– Wealthier countries have the luxury of entertaining fears the rest of the world cannot afford.
– thimerosal, ethyl and methyl mercury. Details of these and the differences between
– “Capital,” Karl Marx wrote, “is dead labor, that, vampire-like, only lives by sucking living labor, and lives the more, the more labor it sucks.”
– The extent to which it is hard to imagine an ethos powerful enough to compete with capitalism, even if that ethos is based on the inherent value of human lives, is suggestive of how successfully capitalism has limited our imaginations.
– We are justified in feeling threatened by the unlimited expansion of industry, and we are justified in fearing that our interests are secondary to corporate interests.
– Just because we have enemies, Sedgwick proposes, does not mean we have to be paranoid. Our cynicism may be justified, but it is also sad.
– That so many of us find it entirely plausible that a vast network of researchers and health officials and doctors worldwide would willfully harm children for money is evidence of what capitalism is really taking from us. Capitalism has already impoverished the working people who generate wealth for others. And capitalism has already impoverished us culturally, robbing unmarketable art of its value. But when we being to see the pressure of capitalism as innate laws of human motivation, when we being to believe that everyone is owned, then we are truly impoverished.
– the philosophy Michael Merry defines paternalism as “interference with the liberty of another for the purposes of promoting some good or preventing some harm.”
– The prevention of risk, Merry observers, is often used to justify coercive power.
– Medicine in America today, as a Dracula, sucking the blood and preying on the people.
– Indirect causation is typically considered causation.
– He (Dr. Bob) is banking against future knowledge, again—using the limitless promise of scientific discoveries to disguise a gamble as a prudent investment.
– immunizing proteins are the active, viral ingredient in vaccines.
– In that sense, a single dose of the smallpox vaccine our parents received presented a greater challenge to the immune system than the total challenge presented by all the twenty-six immunizations for fourteen diseases we now give our children over the course of two years.
– Any infant who does not live in a bubble is likely to find the everyday work of fighting off infection more taxing than processing weakened antigens from multiple immunizations.
– A popular alternative to vaccination in the nineteenth century was variolation, the practice of purposefully infecting a person with a mild case of smallpox.
– And the term conscientious objector, now associated primarily with war, originally referred to those who refused vaccination. Britain’s Compulsory Vaccination Act of 1853 required the vaccination of all infants.
– Before the term conscientious objector was written into law, it was used by vaccine resisters to distinguish themselves from negligent parents who had not bothered to vaccinate their children.
– George Washington, a survivor of smallpox, wrestled with the question of whether or not to require inoculation for revolutionary soldiers long before vaccination became a question of conscience. In 1775, roughly a third of the Continental Army fell ill to smallpox while laying siege to Quebec. They were eventually forced to retreat in the first battlefield defeat of this country’s history.
– If we owe the existence of this nation in some part to compulsory inoculation, we also owe some of its present character to the resistance against compulsory vaccination. Early vaccine refusers were among the first to make legal challenges to the growing reach of police power in the United States.
– Long before the term immunity was used in the context of disease, it was used in the context of law to describe an exemption from service or duty to the state. Immunity came to mean freedom from disease as well as freedom from service in the late nineteenth century, after states began requiring vaccination.
– Here we may suffer what economists call moral hazard, a tendency to take unwise risks when we are protected by insurance.
– “You don’t own your body—that’s not what we are, our bodies aren’t independent. The health of our bodies always depends on choices other people are making. The point is there’ an illusion of independence” (Eula’s Sister)
– The Greeks imagined the body politic as an organism, itself alive and part of a greater cosmic organism—both the citizen and the city were bodies within bodies. Our contemporary belief that we inhabit only one body contained entirely within the boundaries of our skin emerged from Enlightenment thinking, which celebrated the individual in both mind and body. But what defined an individual remained somewhat elusive. By the end of the Age of Enlightenment, the body of a slave was allowed to represent only three-fifths of a person. Some people remained parts of a whole while others enjoyed the novel illusion of being whole unto themselves.
– our bodies may belong to us, but we ourselves belong to a greater body composed of many bodies. We are, bodily, both independent and dependent.
– All sorts of risk-benefit analyses and models of herd immunity tend to produce the conclusion that vaccination benefits the individual as well as the public.
– We resist vaccination in part because we want to rule ourselves.
– pg 127 great paragraph about how the body is a great metaphor for the state, and this means attitudes toward one translate into attitudes toward another.
– Where two issues are metaphorically linked, the researchers concluded, manipulated a person attitude toward one can affect how she thinks about the other. Those most concerned or primed by reading about bacteria are scared of immigrants too…interesting context for pandemics…
– “If thought corrupts language,” George Orwell famously suggested, “language can also corrupt thought.”
– Stale metaphors reproduce stale thinking. Mixed metaphors confuse. And metaphors flow in two direction—thinking about one thing in terms of another can illuminate or obscure both.
– The inflammation that protects cells can, if allowed to persist unchecked, harm tissues.
– But the presence of regulation resembles the absence of regulation in that neither is highly visible.
– “Explosions on the sun make tiny particles, called neutrinos,” he tells our son. “These fly off the sun and travel through the atmosphere. They are so small that they pass right through our bodies without us ever feeling them. Think of that—we have little bits of the sun pouring right through our bodies all the time! We have sunshine in us!” I am grateful for this ode to the unseen because I have just read Silent Spring and my mind is full of malevolent invisibles.
– “What are some of the possible or likely consequences of thinking of the body as a complex system?” (Emily) Martin asks. “The first consequence might be described as the paradox of feeling responsible for everything and powerless at the same time, a kind of empowered powerlessness.” If one feels at least partly responsible for one’s own health, she explains, but understands one’s body as a complex system linked to other complex systems, including the community and the environment, the task of controlling all the factors that might affect one’s health becomes overwhelming.
– “Everyone who is born holds dual citizenship, in the kingdom of the well and in hte kingdom of the sick.” Susan Sontag, Illness as Metaphor
– Not all of us think of health as a transient state that we may be exiled from without warning.
– I am healthy, we tell each other, meaning that we eat certain foods and avoid others, that we exercise and do not smoke. Health, it is implied, is the reward for living the way we live, and lifestyle is its own variety of immunity.
– When health becomes an identity, sickness becomes not something that happens to you, but who you are.
– Your style of life, I gleaned from the way the word lifestyle was used in junior high school health class, is either clean or dirty, safe or unsafe, free of disease or prone to disease.
– My generation came of age in the shadow of the AIDS epidemic, and it seems to have left us believing not that we are all vulnerable to disease, but that it is possible to avoid disease by living a cautious life and limiting our contact with others.
– This fear of an immune system being “overwhelmed” can itself be traced back to AIDS—the HIV virus that overwhelms our system.
– AIDS education taught us the importance of protecting our bodies from contact with other bodies, and this seems to have bred another kind of insularity, a preoccupation with the integrity of the individual immune system.
– Those of us with impaired immunity depend on people with more functional immune system to carry to immunity and protects us from disease.
– Being lost in Wonderland is what it feels like to learn about an unfamiliar subject, and research is inevitably a rabbit hole.
– The problem, of course, is that believing highly improbable things is something we all do before breakfast. What makes science thrilling is the suggestion that improbable things are indeed possible.
– When we engage with science, we are in Wonderland. This seems as true for scientists as it is for lay people. But the difference for those of us who are not scientists is that, as with other news, what gets reported back to us most often from the land of science is that which supports our existing fears.
– For centuries before the word virus was first used to describe a specific type of microorganism, it was used more generally for anything that spread disease—pus, air, even paper. Now a bit of computer code of the content of a website can be viral. But, as with the kind of virus that infects humans, this content cannot reproduce without hosts.
– Misinformation that finds a host enjoys a kind of immortality on the Internet, where it becomes undead.
– Until the results of a small study are duplicated by a larger study, they are little more than a suggestion for further research.
– Most studies are not incredibly meaningful on their own, but gain or lose meaning from the work that has been done around them.
– And, as the medical researcher John Ioannidis has observed, “most published research findings are false.” The reasons for this are many, and include bias, study size, study design, and the very questions the researcher is asking. This does not mean that published research should be disregarded, but that, as Ioannidis concludes, “What matters is the totality of the evidence.” Thinking of our knowledge as a body suggests the harm that can be done when one part of that body is torn from it’s context.
– Dracula bit on page on 143
– Knowledge is, by its nature, always incomplete. “A scientist is never certain,” the scientists Richard Feynman reminds us. And neither, the poet John Keats would argue, is a poet. “Negative capability” was his term for the ability to dwell in uncertainty. My mother, a poet, has been instilling this ability in me since I was a child. “You have to erase yourself,” she says, meaning abandon what I think I know. Or “live the questions,” as Rainer Maria Rilke writes in his Letters to a Young Poet.
– The number of lives a disease claims, as Susan Sontag observes, is not what makes it a plague. In order to be promoted to plague, a disease must be particularly feared or dreaded.
– Perhaps the final qualification for what constitutes a plague is its proximity to your own life.
– But preemption in war has different effects than preemption in health care—rather than generating ongoing conflict, like our preemptive strike against Iraq, preventative health care can make further health care unnecessary.
– the idea that you cannot control what happens to you, but you can control how you feel about it. …”Freedom is what you do with what’s been done to you.” (Jean-Paul Sartre)
– “Life is a window of vulnerability.” (Donna Haraway)
– Dracula, after all, is not a person so much as he is the embodiment of disease. And the vampire hunters who pursue him are not people so much as they are metaphors for the best impulses of medicine. Vampires take blood, and vampire hunters give blood.
– My son, who has taken to wearing a cape, like to talk about bad guys and good guys, despite my insistence that most people are both. We are both vampires and vampire hunters, caped and uncaped.
– “If we demonize other people, she said,” and create monsters out of each other and act monstrous—and we will all have that capacity—then how do we not become monsters ourselves? (Naomi King, Stephen King’s daughter)
– Give a Little, Buy a Lot would also seem to be the theme of contemporary American life.
– Blood types may follow patterns of ancient ancestry, but they do not obey our racial distinctions, of course.
– the culture of self-interest, which is much of what is usually praised as ‘individualism.’ Self-interest now receives an added boost as simple medical prudence.”
– dracula pg 156 – on Judaism tie ins and false confessions
– Avoidance of outsiders, of immigrants, of people missing limbs, of people with marks on their faces is an ancient tactic for disease prevention. And this has fed, no doubt, the longstanding belie that disease is a product of those we define as others. Syphilis, Sontag writes, “was the ‘French Pox’ to the English, morbus Germanicus to the Parisians, the Naples sickness to the Flourentines, the Chinese disease to the Japanese.
– Evolutionary psychologists describe a “behavioral immune system” that causes us to be highly sensitive to physical differences or unusual behavior in others.
– Our tendency toward prejudice can increase whenever we feel particularly vulnerable or threatened by disease. One study has suggested, for instance, that pregnant women become more xenophobia in the early stages of pregnancy. The more vulnerable we feel, sadly, the more small-minded we become.
– In the fall of 2009, at the height of the H1N1 flu pandemic, a group of researchers began testing their hypothesis that people who feel protected from the disease might also be protected from feeling prejudice. The study looked at two groups of people, one vaccinated against the flu and the other not vaccinated. After both groups were asked to read an article exaggerating the threat posed by the flu, the vaccinated people expressed less prejudice against immigrants and unvaccinated people.
– After conducting one more study involving hand washing, the researchers reported a consistent patten in their findings across all three studies: “Treatments for physical diseases, such as the flu, can also be used to treat social maladies, such as prejudice.”
– The concept of self is fundamental to the science of immunity, and the dominant thinking in immunology is that the immune system must discriminate between self and nonself, and then eliminate or contain the nonself with protective barriers.
– Just as undead seems to mean something between living and dead, nonself seems to mean something between self and other. Nonself, I suppose, is an apt description of the human condition. In terms of sheer numbers of cells, our bodies contain more other than self. An alien looking down at us from outer space, an immunologist quips, might reasonably believe that we are just transportation for microbes. But we are using them as much as they are using us.
– The possibility that patterns or signals associated with dangers are what trigger immune response was proposed by the immunologist Polly Matzinger in 1994. The Danger Model, as Matzinger writes, is “based on the idea that the immune system is more concerned with entities that do damage than with those that are foreign.” The task of the immune system, following this thinking, is not to detect nonself, but to detect danger. Self can be dangerous, as immunologists have observed, and nonself can be harmless.
– The womb is sterile, and so birth is the original inoculation.
– “caught in an inescapable network of mutuality.” (MLK)
– Even the Danger Model, which does not imagine discrimination as the most essential function of our immune system
– “We must cultivate our garden” (Candide in Candid)
– The word optimism was new in 1759, and referred to the philosophy that this world, having been fashioned by God, is the best of all possible worlds.
– If we extend the metaphor of the garden to our social body, we might imagine ourselves as a garden within a garden. The outer garden is no Eden, and no rose garden either. It is as strange and various as the inner garden of our bodies