Eula Biss On Immunity Quotes

Wealthier countries have the luxury of entertaining fears the rest of the world cannot afford.

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 the information, not ourselves.

idea that you cannot control what happens to you, but you can control how you feel about it. Or, as Jean-Paul Sartre put it, “Freedom is what you do with what’s been done to you.

And when comfort is what we want, one of the most powerful tonics alternative medicine offers is the word 'natural.' This word implies a medicine untroubled by human limitations, contrived wholly by nature or God or perhaps intelligent design. What 'natural' has come to mean to us in the context of medicine is 'pure' and 'safe' and 'benign'. But the use of 'natural' as a synonym for 'good' is almost certainly a product of our profound alienation from the natural world.

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 begin to see the pressures of capitalism as innate laws of human motivation, when we begin to believe that everyone is owned, then we are truly impoverished.

But risk perception may not be about quantifiable risk so much as it is about immeasurable fear.

And I suspect that Coca-Cola, unpoisoned, is more harmful to our children than vaccination.

The problem has not been finding a place where I belong, which is how a children's book might tell it, but of finding ways of insisting on belonging nowhere.

However we choose to think of the social body, we are each other's environment. Immunity is a shared space--a garden we tend together.

If we imagine the action of a vaccine not just in terms of how it affects a single body, but also in terms of how it affects the collective body of a community, it is fair to think of vaccination as a kind of banking of immunity. Contributions to this bank are donations to those who cannot or will not be protected by their own immunity. This is the principle of herd immunity, and it is through herd immunity that mass vaccination becomes far more effective than individual vaccination.

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 numbers of lives lost, probably the most dangerous creature on earth.

Debates over vaccination, then as now, are often cast as debates over the integrity of science, though they could just as easily be understood as conversations about power.

Purity, especially bodily purity, is the seemingly innocent concept behind a number of the most sinister social actions of the past century.

While we routinely call for more vaccine testing, and more human trials, the unspoken assumption is that we do not intend our children to be the subjects of those trials.

A trust—in the sense of a valuable asset placed in the care of someone to whom it does not ultimately belong—captures, more or less, my understanding of what it is to have a child.

If vaccination can be conscripted into acts of war, it can still be instrumental in works of love.

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.

For toxicologists, “the dose makes the poison.” Any substance can be toxic in excess. Water, for instance, is lethal to humans in very high doses, and overhydration killed a runner in the 2002 Boston Marathon. But most people prefer to think of substances as either safe or dangerous, regardless of the dose. And we extend this thinking to exposure, in that we regard any exposure to chemicals, no matter how brief or limited, as harmful.

Immunity is a public space. And it can be occupied by those who choose not to carry immunity. For some of the mothers I know, a refusal to vaccinate falls under a broader resistance to capitalism. But refusing immunity as a form of civil disobedience bears an unsettling resemblance to the very structure the Occupy movement seems to disrupt--a privileged 1 percent are sheltered from risk while they draw resources from the other 99 percent.

I know you're on my side," an immunologist once remarked to me as we discussed the politics of vaccination. I did not agree with him, but only because I was uncomfortable with both sides, as I had seen them delineated. The debate over vaccination tends to be described with what the philosopher of science Donna Haraway would call "troubling dualisms." These dualisms pit science against nature, public against private, truth against imagination, self against other, thought against emotion, and man against woman.

This is why the chances of contracting measles can be higher for a vaccinated person living in a largely unvaccinated community than they are for an unvaccinated person living in a largely vaccinated community.

The belief that public health measures are not intended for people like us is widely held by many people like me. Public health, we assume, is for people with less—less education, less-healthy habits, less access to quality health care, less time and money. I have heard mothers of my class suggest, for instance, that the standard childhood immunization schedule groups together multiple shots because poor mothers will not visit the doctor frequently enough to get the twenty-six recommended shots separately. No matter that any mother, myself included, might find so many visits daunting. That, we seem to be saying of the standard schedule, is for people like them.

The tradition of the personal essay is full of self-appointed outcasts. In that tradition, I am not a poet or the press, but an essayist, a citizen thinker.

What he is drawn to in their philosophy, he tells me, is the idea that you cannot control what happens to you, but you can control how you feel about it. Or, as Jean-Paul Sartre put it, “Freedom is what you do with what’s been done to you.” What has been done to us seems to be, among other things, that we have been made fearful. What will we do with our fear? This strikes me as a central question of both citizenship and motherhood. As mothers, we must somehow square our power with our powerlessness. We can protect our children to some extent. But we cannot make them invulnerable any more than we can make ourselves invulnerable. “Life,” as Donna Haraway writes, “is a window of vulnerability.

We do not know alone. Dracula

Do people know which risks lead to many deaths and which risks lead to few?” the legal scholar Cass Sunstein asks. “They do not. In fact, they make huge blunders.” Sunstein draws this observation from the work of Paul Slovic, author of The Perception of Risk. In a study that invited people to compare various causes of death, Slovic found that people tended to believe that accidents cause more deaths than disease and that homicide causes more deaths than suicide, when the opposite is true in both cases. In another study, people significantly overestimated the fatality rates of highly publicized or dramatic dangers like cancer or tornadoes. One could interpret this, as 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 the information, not ourselves.

Do people know which risks lead to many deaths and which risks lead to few?” the legal scholar Cass Sunstein asks. “They do not. In fact, they make huge blunders.” Sunstein draws this observation from the work of Paul Slovic, author of The Perception of Risk.

In a section of The Vaccine Book titled “Is it your social responsibility to vaccinate your kids?” Dr. Bob asks, “Can we fault parents for putting their own child’s health ahead of that of the kids around him?” This is meant to be a rhetorical question, but Dr. Bob’s implied answer is not mine. In another section of the book, Dr. Bob writes of his advice to parents who fear the MMR vaccine, “I also warn them not to share their fears with their neighbors, because if too many people avoid the MMR, we’ll likely see the disease increase significantly.” I do not need to consult an ethicist to determine that there is something wrong there, but my sister clarifies my discomfort. “The problem is in making a special exemption just for yourself,” she says. This reminds her of a way of thinking proposed by the philosopher John Rawls: Imagine that you do not know what position you are going to hold in society—rich, poor, educated, insured, no access to health care, infant, adult, HIV positive, healthy immune system, etc.—but that you are aware of the full range of possibilities. What you would want in that situation is a policy that is going to be equally just no matter what position you end up in. “Consider relationships of dependence,” my sister suggests. “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.” She falters for a moment here, and is at a loss for words, which is rare for her. “I don’t even know how to talk about this,” she says. “The point is there’s an illusion of independence.

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 than the unvaccinated people.

Caretaking, she suggests, is not an inherent threat to liberty. “From a feminist, caring framework,” Peterson writes, “liberty is not defined as complete separation and independence from the parent.” If fathering still reminds us of oppressive control, mothering might help us imagine relationships based not just on power, but also care.

Consider relationships of dependence,' my sister suggests. '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.' She falters for a moment here, and is at a loss for words, which is rare for her. 'I don't even know how to talk about this,' she says. 'The point is there's an illusion of independence.

Immunity is a public space. And it can be occupied by those who choose not to carry immunity. For some of the mothers I know, a refusal to vaccinate falls under a broader resistance to capitalism. But refusing immunity as a form of civil disobedience bears an unsettling resemblance to the very structure the Occupy movement seeks to disrupt—a privileged 1 percent are sheltered from risk while they draw resources from the other 99 percent.

It is unfortunate that in some places, especially in the United States, people have resisted making choices that will keep them and their families safer. I don’t agree with these choices, but I also think it’s unhelpful to simply label them “anti-science,” as so many people do. In her book On Immunity, Eula Biss looks at vaccine hesitancy in a way that I think also helps explain the resentment we’re seeing toward other public health measures. The distrust of science is just one factor, she says, and it is compounded by other things that trigger fear and suspicion: pharmaceutical companies, big government, elites, the medical establishment, male authority. For some people, invisible benefits that might materialize in the future are not enough to get them past the worry that someone is trying to pull the wool over their eyes. The problem is even worse in periods of severe political polarization, such as the one we’re in now.

One of the mysteries of hep B immunization is that vaccinating only “high risk” groups, which was the original public health strategy, did not bring down rates of infection. When the vaccine was introduced in 1981, it was recommended for prisoners, health care workers, gay men, and IV drug users. But rates of hep B infection remained unchanged until the vaccine was recommended for all newborns a decade later. Only mass vaccination brought down the rates of infection, and it has now virtually eliminated the disease in children.

Vaccination works,” my father explains, “by enlisting a majority in the protection of a minority.” He means the minority of the population that is particularly vulnerable to a given disease. The elderly, in the case of influenza. Newborns, in the case of pertussis. Pregnant women, in the case of rubella. But when relatively wealthy white women vaccinate our children, we may also be participating in the protection of some poor black children whose single mothers have recently moved and have not, as a product of circumstance rather than choice, fully vaccinated them.

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. Building, boosting, and supplementing one’s personal immune system is a kind of cultural obsession of the moment. I know mothers who believe this is a viable substitute for vaccination, and who understand themselves as raising children with superior immune systems. But children with superior immune systems can still pass disease. Pertussis, like polio and Hib disease and HIV, can be carried without symptoms.

In 2012, a Taliban leader in northern Pakistan banned polio vaccination in his region until the United States ceased drone strikes there. Vaccination campaigns, he claimed, were a form of American espionage. While resembling the rumors of secret plots in Nigeria, this was, unfortunately, more easily verifiable. In pursuit of Osama bin Laden, the CIA had used a fake vaccination campaign—administering real hep B vaccine, but not the three doses necessary for immunity—to gather DNA evidence to help verify bin Laden’s location. This deception, like other acts of war, would cost the lives of women and children. The Lady Health Workers of Pakistan, a team of over 110,000 women trained to deliver health care door-to-door, had already endured years of brutal intimidation by the Taliban and hardly needed association with the CIA. Not long after the Taliban banned immunization, nine polio vaccinators, five of them women, were murdered in a coordinated series of attacks.

I gave my son a lavishly illustrated edition of Alice’s Adventures in Wonderland for his fourth birthday, and it did not take very long for me to realize that this was a gift for me, not for him. As Alice engaged in repartee with a dodo early in the book, my son became bored. Alice’s bewilderment and disorientation, which I had anticipated might speak to my son’s experience of being a child in an adult’s world, spoke instead to my own experience navigating the world of information. Being lost in Wonderland is what it feels like to learn about an unfamiliar subject, and research is inevitably a rabbit hole. I fell down it, in my investigation of immunization, and fell and fell, finding that it was much deeper than I anticipated. Like Alice, I fell past shelves full of books, more than I could ever read. Like Alice, I arrived at locked doors. “Drink me,” I was commanded by one source. “Eat me,” I was told by another. They had opposite effects - I grew and shrank, I believed and did not believe. I cried and then found myself swimming in my own own tears.

Perhaps what matters,” Sunstein muses, “is not whether people are right on the facts, but whether they are frightened.” And people do seem to be frightened. We are locking our doors and pulling our children out of public school and buying guns and ritually sanitizing our hands to allay a wide range of fears, most of which are essentially fears of other people. All the while we are also, in our way, reckless. We get intoxicated, from the Latin “to poison,” for fun. This contradiction leads Sunstein to worry that regulatory laws based on the priorities of the general public maybe prone to a pattern of “paranoia and neglect.” Too much attention may be spent on minimal risks, while too little is paid to pressing threats. Paranoia, the theorist Eve Sedgwick observes, tends to be contagious. She calls it a “strong theory,” meaning a wide-ranging, reductive theory that displaces other ways of thinking. And paranoia very frequently passes for intelligence. As Sedgwick observes, “to theorize out of anything but a paranoid critical stance has come to seem naïve, pious, or complaisant.” She does not believe that paranoid thinking is necessarily delusional or wrong, but only that there is value to approaches that are less rooted in suspicion. “Paranoia,” Sedgwick writes, “knows some things well and others poorly.

But when relatively wealthy white women vaccinate our children, we may also be participating in the protection of some poor black children whose single mothers have recently moved and have not, as a product of circumstance rather than choice, fully vaccinated them. 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.

The idea of preventive medicine is faintly un-American,” the Chicago Tribune noted in 1975. “It means, first, recognizing that the enemy is us.

When the last nationwide smallpox epidemic began in 1898, some people believed that whites were not susceptible to the disease. It was called “Nigger itch,” or, where it was associated with immigrants, “Italian itch” or “Mexican bump.” When

But if disease is a punishment for anything, it is only a punishment for being alive. When

as Jean-Paul Sartre put it, “Freedom is what you do with what’s been done to you.” What

Unvaccinated children, a 2004 analysis of CDC data reveals, are more likely to be white, to have an older married mother with a college education, and to live in a household with an income of $75,000 or more—like my child.

But refusing immunity as a form of civil disobedience bears an unsettling resemblance to the very structure the Occupy movement seeks to disrupt- a privileged 1 percent are sheltered from risk while they draw resources from the other 99 percent.

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 thought about filth. Both theories allow their subscribers to maintain a sense of control over their own health by pursuing personal purity. For the filth theorist, this meant a retreat into the home, where heavy curtains and shutters might seal out the smell of the poor and their problems. Our version of this shuttering is now achieved through the purchase of purified water, air purifiers, and food produced with the promise of purity.

The extra time and trouble required to follow Dr. Bob’s alternative schedule are hard to justify unless the dangers of contracting infectious diseases early in life are minimized and the dangers of vaccinating early in life are exaggerated. Much of The Vaccine Book is devoted to this minimization and exaggeration. Tetanus is not a disease that affects infants, according to Dr. Bob, Hib disease is rare, and measles is not that bad. He does not mention that tetanus kills hundreds of thousands of babies in the developing world every year, that most children will encounter the bacteria that causes Hib disease within the first two years of their lives, and that measles has killed more children than any other disease in history.

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. When Harvard researchers recently used game theory to build a mathematical model of vaccination behavior during an influenza epidemic, they found that even “a population of self-interested people can defeat an epidemic.” No altruism is required.

Why target two and a half million innocent newborns and children?” Barbara Loe Fisher asks of the hep B vaccine. The implication behind the word innocent is that only those who are not innocent need protection from disease. All of us who grew up during the AIDS epidemic were exposed to the idea that AIDS was a punishment for homosexuality, promiscuity, and addiction. But if disease is a punishment for anything, it is only a punishment for being alive. When I was a child, I asked my father what causes cancer and he paused for a long moment before saying, “Life. Life causes cancer.” I took this as an artful dodge until I read Siddhartha Mukherjee’s history of cancer, in which he argues not only that life causes cancer but that cancer is us. “Down to their innate molecular core,” Mukherjee writes, “cancer cells are hyperactive, survival-endowed, scrappy, fecund, inventive copies of ourselves.” And this, he notes, “is not a metaphor.

The pediatrician Paul Offit mentioned to me, during an interview about his work, that he had recently seen two children hospitalized with influenza. Both had been immunized against everything on the childhood schedule except the flu, and both ended up on heart and lung machines. One lived, and the other died. “And then the next day, when someone comes into your office and says, ‘I don’t want to get that vaccine,’ you’re supposed to respect that decision?” Offit asked me. “You can respect the fear. The fear of vaccines is understandable. But you can’t respect the decision—it’s an unnecessary risk.

Infectious disease is one of the primary mechanisms of natural immunity. Whether we are sick or healthy, disease is always passing through our bodies. “Probably we’re diseased all the time,” as one biologist puts it, “but we’re hardly ever ill.” It is only when disease manifests as illness that we see it as unnatural, in the “contrary to the ordinary course of nature” sense of the word. When a child’s fingers blacken on his hand from Hib disease, when tetanus locks a child’s jaw and stiffens her body, when a baby barks for breath from pertussis, when a child’s legs are twisted and shrunken with polio—then disease does not seem natural.

And allowing oneself to remain vulnerable to disease remains a legal privilege today. Dictionaries aside, what it means to have a conscience may be no more clear to us now than it was in 1898. We do recognize when it is lacking—she has no conscience, we say. But what exactly is missing? I put this question to my sister, who teaches ethics at a Jesuit college and is a member of the North American Kant Society. “It’s tricky,” she says. “In the eighteenth century, Kant wrote that we have a duty to ourselves to examine our conscience. This implies that it’s not transparent, that it must be scrutinized and deciphered. Kant thought of conscience as an inner judge and used the metaphor of a courtroom to explain its operation. In the courtroom of conscience, the self is both judge and judged.” I ask her if this means our conscience emerges from thought and is a product of our minds. “It’s an evolving concept,” she says. “It may have once been more closely associated with the emotions, but we still say we feel a pang of conscience—it involves a unity of thought and feeling.” Kant, she tells me, called the inner judge a “scrutinizer of hearts.” “The part that’s tricky,” my sister says, “is how you discern between a sense of discomfort and what your conscience is telling you.” This question remains with me, and I am disturbed by the possibility that I could mistake the call of my conscience for something else. I ask a former professor of mine, a novelist who teaches the Old Testament as literature, how one recognizes one’s own conscience. She looks at me sternly and says, “It’s a very distinct feeling. I don’t think one’s conscience is easily confused with any other feeling.

Intuitive toxicology is the term that Slovic uses for the way most people assess the risk of chemicals. His research reveals that this approach is distinct from the methods used by toxicologists, and that it tends to produce different results. For toxicologists, “the dose makes the poison.” Any substance can be toxic in excess. Water, for instance, is lethal to humans in very high doses, and overhydration killed a runner in the 2002 Boston Marathon. But most people prefer to think of substances as either safe or dangerous, regardless of the dose. And we extend this thinking to exposure, in that we regard any exposure to chemicals, no matter how brief or limited, as harmful. In exploring this thinking, Slovic suggests that people who are not toxicologists may apply a “law of contagion” to toxicity. Just as brief exposure to a microscopic virus can result in lifelong disease, we assume that exposure to any amount of a harmful chemical will permanently contaminate our bodies. “Being contaminated,” Slovic observes, “clearly has an all-or-none quality to it—like being alive or pregnant.” Fear of contamination rests on the belief, widespread in our culture as in others, that something can impart its essence to us on contact. We are forever polluted, as we see it, by contact with a pollutant. And the pollutants we have come to fear most are the products of our own hands. Though toxicologists tend to disagree with this, many people regard natural chemicals as inherently less harmful than man-made chemicals. We seem to believe, against all evidence, that nature is entirely benevolent.

range of chemicals in umbilical cord blood and breast milk might mean for the future of our children’s health, 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. We are, in other words, continuous with everything here on earth. Including, and especially, each other.

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. But refusal of vaccination undermines a system that is not actually typical of capitalism. It is a system in which both the burdens and the benefits are shared across the entire population. Vaccination allows us to use the products of capitalism for purposes that are counter to the pressures of capital.

Perceptions of risk—the intuitive judgments that people make about the hazards of their world,” the historian Michael Willrich observes, “can be stubbornly resistant to the 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 numbers of lives lost, probably the most dangerous creature on earth.

Observing that we have waged wars on poverty and drugs as well as cancer, Susan Sontag writes, “Abuse of the military metaphor may be inevitable in

We believe that modern-day Hitlers have deliberately adulterated the oral polio vaccines with anti-fertility drugs and contaminated it with certain viruses which are known to cause HIV and AIDS,” the chairman of the Supreme Council for Sharia in Nigeria maintained, urging parents to refuse vaccination.

If we do not yet know exactly what the presence of a vast range of chemicals in umbilical cord blood and breast milk might mean for the future of our children's health, we do at least know that we are no cleaner, even at birth, than our environment at large. We are 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. We are, in other words, continuous with everything here on earth. Including, and especially, each other.

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 the refuse of science repurposed to support already existing ideologies.

What are some of the possible or likely consequences of thinking of the body as a complex system?” 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.

Debates over vaccination, then as now, are often cast as debates over the integrity of science, though they could just as easily be understood as conversations about power. The working-class people who resisted Britain's 1853 provision for free, mandatory vaccination were concerned, in part, with their own freedom. Faced with fines, imprisonment, and the seizure of their property if they did not vaccinate their infants, they sometimes compared their predicament to slavery.  Vaccinations, like slavery, raises some pressing questions about one's rights to one's own body. But as the historian Nadja Durbach has noted, antivaccinators were often more interested in abolition as a metaphor for individual liberty than they were in the cause as a shared purpose. It was not in the recklessly selfless spirit of John Brown, who was hanged with his sons for their doomed effort to free slaves, that white workers resisted vaccination. "Anti-vaccinators were quick to draw on the political, emotive, or rhetorical value of the slave, or of the colonized African," Durbach writes of the movement in Britain. "They were quicker still to claim that the suffering of white English citizens took precedence over that of the oppressed elsewhere." Their primary concern, in other words, was with people like them. 

Having virtually invented a paid profession and being almost exclusively available to the rich, doctors were suspect to the working class.

In proposing that one truth may derail another, it invites an enduring question—do we believe vaccination to be more monstrous than disease?

Unvaccinated children, a 2004 analysis of CDC data reveals, are more likely to be white, to have an older married mother with a college education, and to live in a household with an income of $75,000 or more—like my child. Unvaccinated children also tend to be clustered in the same areas, raising the probability that they will contract a disease that can then be passed, once it is in circulation, to undervaccinated children. Undervaccinated children, meaning children who have received some but not all of their recommended immunizations, are more likely to be black, to have a younger unmarried mother, to have moved across state lines, and to live in poverty.

Attitudes toward the state easily translate into attitudes toward vaccination, in part because the body is such a ready metaphor for the nation.

many of us find it entirely plausible that a vast network of researchers and health officials and doctors worldwide would willfully harm children

In the nineteenth century, poor urban women could give birth in charity hospitals for free, though wealthier women still gave birth at home. As childbirth moved into hospitals, the maternal death rate rose dramatically. Childbed fever, as puerperal sepsis was called, was spread by doctors who did not wash their hands between exams. But doctors blamed it on tight petticoats, fretting, and bad morals.