The result has been a buffet-style, nonjudgmental approach to wellness where any combination of ingredients—a serving of Prozac, a side portion of self-help, and a dessert of yoga and meditation—can supposedly be transformed into a coherent meal. The appeal of such an approach is obvious: Who wouldn’t want to believe he could feel his way to the best course of treatment?
This type of faith-based metaphysics, indulged by doctors like Gordon and Sears and fetishized in the media, has no bigger cheerleader than Oprah Winfrey. The notion that physical health and personal fulfillment can result only from unifying the body with the mind, the physical with the psychological, the corporeal with the spiritual, is the thread that connects the assortment of New Age healers, “alternative” doctors, and past-their-prime celebrities Winfrey has promoted over the years. A recent example of the first category is Rhonda Byrne, the author of The Secret, who has been a guest on Winfrey’s show and was featured on Oprah.com and in the pages of O, Winfrey’s magazine. The Secret is based on something called the “law of attraction,” which holds that “everything that’s coming into your life you are attracting into your life.”
The second category is embodied by Winfrey’s “favorite ob-gyn,” Christiane Northrup, who believes that illness is an example of being “in labor with yourself because everything that no longer serves your highest purpose and your optimal health starts to go away.” (Northrup’s prototypical example of this phenomenon is thyroid problems in women, which she says are often the result of energy blockages that stem from “the result of a lifetime of ‘swallowing’ words one is aching to say.”) Finally there are those, like 1970s TV sitcom star Suzanne Somers, whose expertise seems to be based on nothing other than the fact that people recognize their names. In an appearance on Oprah to promote Ageless: The Naked Truth About Bioidentical Hormones, Somers detailed her health regimen, which, in addition to sixty daily supplements, includes injections of estrogen into her vagina that are meant to trick her body into thinking it’s still in its thirties as opposed to its mid-sixties. “She’s ready to take on anyone, including any doctor who questions her!” Winfrey told her audience after Somers bragged of her success. “We have the right to demand a better quality of life for ourselves—and that’s what doctors have got to learn to start respecting.”
While these empowering testimonials sound harmless enough, many of them are actually quite dangerous. On a psychological level, there’s the implication that sickness—or any other kind of difficulty—is symptomatic of a personal failing. (It’s probably easier for Winfrey, whose net worth is estimated at $2.7 billion, to meditate her way out of a funk than it is for a single parent who can’t afford health care.) In terms of physical health, the stakes can literally be life and death: After one of Winfrey’s viewers read about a breast cancer victim who claimed to have cured herself exclusively by using the law of attraction, the viewer decided to forgo surgery and chemotherapy and rely instead on the teachings of The Secret for a cure. In that instance, Winfrey, as Newsweek put it in a 2009 cover story on the talk show host, seemed “genuinely alarmed” when she discussed the incident on-air. “I don’t think that you should ignore all of the advantages of medical science and try to, through your own mind now because you saw a Secret tape, heal yourself,” she said.
Winfrey refused to talk to Newsweek, but she reiterated that point in a statement she gave to the magazine:
The guests we feature often share their first-person stories in an effort to inform the audience and put a human face on topics relevant to them. I’ve been saying for years that people are responsible for their actions and their own well-being. I believe my viewers understand the medical information presented on the show is just that—information—not an endorsement or prescription. Rather, my intention is for our viewers to take the information and engage in a dialogue with their medical practitioners about what may be right for them.
Winfrey’s suggestion that she is just a neutral disseminator of information is a dodge offered so frequently that it’s easy to overlook how absurd it is. The gibberish that Northrop or Somers—or, for that matter, Jenny McCarthy—is peddling does not qualify as “information,” and their appearances on Winfrey’s show are nothing if not endorsements. A more frank reckoning with the message Winfrey promotes would have acknowledged that in her world, being responsible for your actions has less to do with determining how your behavior affects those around you than it does with making sure you’re “living in harmony” with your true nature. This “I feel therefore it is” outlook may empower Winfrey’s viewers to take charge of their lives, but it ignores completely the perils that face a society where everyone runs around intuiting their own versions of the truth.
The notion that people should base medical decisions on what is “right for them” is particularly problematic in a public health context, where individual choices cannot be cordoned off from each other. Consider the case of Julieanna Metcalf, a fifteen-month-old fully vaccinated girl who was taken to the hospital on January 23, 2008, with what her mother thought was a particularly bad case of the flu. It was only after extensive tests that doctors discovered that Julieanna had a compromised immune system that rendered the vaccine for Hib ineffective. By the time she got out of the hospital almost a month later, Julieanna had suffered multiple seizures and had had a buildup of fluid in the brain so dangerous it required emergency surgery. She’d also lost all her motor skills—including the ability to swallow—and will require multiple immune globulin injections each week for the rest of her life.
Even with her weakened immune system, Julieanna might not have caught Hib if everyone around her had had their shots, but the Minnesota community in which she lived was a place where the same ethos emanating from Gordon’s and Sears’s waiting rooms and Winfrey’s couch had taken hold. The outbreak that ensnared Julieanna also resulted in the hospitalization of four other children. One was a baby who was too young to have been vaccinated. The parents of the three others had all chosen not to vaccinate their children; one of those, a seven-month-old girl, died of the disease.
Those realities are obviously hard to square with Bob Sears’s downplaying of the dangers of vaccine-preventable diseases—but Sears didn’t need to look to Minnesota for proof that those diseases actually can be “that bad.” Ten days before Julieanna ended up in the hospital, a seven-year-old boy who was later revealed to be one of Sears’s patients returned from a family vacation in Switzerland with the measles. While the boy’s parents had made a choice not to vaccinate their child—as his mother explained in a Time magazine article, “We analyze the diseases and we analyze the risk of disease, and that’s how my husband and I make our decision about what vaccines to give our children”—many of the people who paid the price for that decision had less say in the matter. Within days, the measles virus had spread to a swim school, a pediatrician’s office, a Whole Foods, a Trader Joe’s market, and a charter school; passengers on a plane headed to Honolulu were quarantined at a military base; and a ten-month-old child was hospitalized and required medical care for a full month. (According to Gordon, the hospitalization was an overly dramatic reaction: “My guess is that if this had happened in the 1960s, no one would have been hospitalized. They would have said, ‘Oh well, an . . . outbreak of measles.’ ”) An additional forty-eight children who were too young to be vaccinated had to be quarantined in their homes, at an average cost of $775 per family. In total, the outbreak cost more than $10 million to contain.
Eighteen months after one of Sears’s patients had caused what turned out to be the largest measles outbreak in California since 1991, I wrote to the “media inquiries” e-mail address listed on Sears’s Web site requesting “a time to speak with Dr. Sears for a book I’m working on for Simon & Schuster about vaccines.”57 A week later, I received a response with details about advertising on askdrsears.com, which, in addition to an online store selling the Sears Family Essentials line of “healthy snacks” and “supplements,” at the time fe
atured endorsements of products ranging from Vital Choice Wild Seafood (“My Favorite salmon!”) to Meyenberg Goat Milk Products. The e-mail read:
I’d like to put together a nice press kit for you. . . . We’d of course like to book as many [page view] impressions as you are willing to give us on a monthly basis, I believe you mentioned 8,000, would 10,000 be out of the question? We generally charge $15 cpm [cost per thousand page views] because of our specifically targeted audience, the vaccinebook.com is that in the price range you were expecting Please respond with any general ideas/questions. . . .
Also, what sort of tracking will be used and how would be [sic] bill according to tracking?
Thank you for your understanding and we look forward to the possibility of working with you.
Sears’s willingness to work with advertisers and self-indulgent parents alike has proven to be very profitable. (The Vaccine Book has already sold more than 100,000 copies.) The philosophy it espouses has also directly contributed to the rising number of affluent enclaves in which vaccination rates have fallen so low that diseases such as measles and whooping cough are once again becoming endemic. In March 2008, before he had admitted that it was his unvaccinated patient that had brought measles back from Switzerland, Sears wrote on his Web site, “The recent measles outbreak (if you can call it that) . . . raises awareness of a growing trend among families to decline certain vaccines.” According to Sears, this was a good thing: “I believe our nation can tolerate a certain percentage of unvaccinated children without risking the overall public health in any significant way. Since most children are vaccinated, our nation has enough ‘herd immunity’ to contain outbreaks like this one.”
57 That nationwide outbreak began in 1989 and lasted for two full years. In total, eleven thousand Americans were hospitalized and 123 died.
CHAPTER 23
BABY BRIE
Ralph Romaguera first met Danielle Broussard when they were children: He was ten and she was six, or maybe he was twelve and she was eight—the specifics don’t matter, Danielle says, because four years feels like an eternity when you’re that young. The two kept running into each other over the years—their fathers were friends—but by the time they’d graduated from high school they’d lost touch. Then, one night when they were in their early twenties, they bumped into each other at a school dance. (Ralph was there working as a photographer; Danielle had agreed to chaperone as a favor to her mother, who was, Danielle says, “the school’s disciplinarian.”) They started dating soon after, and in 1998, after two years of courtship, the couple got married. Five years later, on January 13, 2003, Danielle gave birth to the Romagueras’ first child. They named her Gabrielle, but from the day they brought her home from the hospital, they called her Brie.
Brie was not quite four weeks old when, at just after eleven a.m. on Saturday, February 8, her parents first noticed her cough. Initially, they didn’t think much of it. Brie, like all infants, produced a steady stream of new and mysterious sounds, and, Danielle says, this “sounded like a regular cough.” A couple of hours later, they’d grown more concerned. They called their pediatrician, who told the Romagueras that she suspected Brie had caught respiratory syncytial virus, or RSV, a common infection that’s relatively harmless in older children and adults but that can make it hard for infants to breathe. Just to be on the safe side, she recommended that Brie get checked out at the emergency room. Worst-case scenario, she said, Brie would be sent home with some antibiotics and her cough would clear up within a few days.
But on Sunday Brie sounded worse than she had in the ER the night before—her coughing fits had become more violent, the lag time between them shorter and shorter—and by Monday night, it broke her parents’ hearts just to hear her: Every fifteen minutes or so, Brie’s attempt at exhalation would result in a series of high-pitched barks followed by an equally alarming strained intake of breath. The next day, Danielle took Brie to see her pediatrician. This time, a tiny mask was placed over the infant’s face in order to administer medication via an aerosolized mist. That seemed to help, at least at first, but by Wednesday evening, Brie was once again gasping for air. By midnight, it seemed to Danielle and Ralph as if their daughter was on the verge of passing out each time she suffered through a new coughing attack. For the rest of the night, they took turns cradling Brie in one arm and gently pulling up on the back of her neck with the other. “We found,” Danielle says, “that if we could kind of extend her head, it was helping open her airways. I guess she was getting more air that way.” By the time the sun rose the following morning, Brie was turning blue around the lips. For the third time in less than a week, the Romagueras bundled their daughter into her car seat and took her to see a doctor. This time, there was no question that Brie needed immediate attention, and she was transported to River Parishes Hospital in LaPlace, Louisiana. By the time she arrived there, Brie was turning purple. Danielle was still filling out paperwork when she saw one of the emergency room’s pediatricians sprinting down the hall: Brie’s oxygen intake had fallen so precipitously that she needed to be airlifted to the Ochsner Foundation Hospital in downtown New Orleans.
After arriving at Ochsner, Brie began to vomit, which provided doctors with one clue as to a possible diagnosis: Because she’d been born three weeks early, they said, it was possible Brie had an underdeveloped epiglottis, which was causing food to become lodged in her windpipe. (The epiglottis, which is located at the back of the throat, is a thin, elastic piece of cartilage that covers the trachea during swallowing.) A little more than a week after Brie first started coughing, she underwent the corrective surgery her parents hoped would cure her.
“Here was this seven-pound baby girl,” Danielle says. “She had two tubes going into her mouth—one to suction out the phlegm and one to feed her. It seemed so horrible at the time.” Still, Danielle and Ralph felt lucky. For the eight or nine minutes in between Brie’s coughing spells, she seemed like a normal baby. That was not the case for many of the other infants at Ochsner. “These poor kids are having open-heart surgery,” Danielle thought to herself. “We’re going to be out of here in no time.”
Brie’s initial surgery went smoothly. “That afternoon, when she was coming out of the anesthesia, she looked like she was doing great,” Danielle says. But soon, the coughing started again. The Romagueras were back at square one. Over the next several hours, specialist after specialist came in for consultations. There was a pediatric cardiologist, a pediatric pathologist, a pediatric neurologist—the list seemed to stretch on forever. Finally, Dawn Sokol, a pediatric infectious disease specialist who’d treated everything from HIV/AIDS to osteomyelitis, came to see Brie. She immediately recognized what was wrong: “This baby has pertussis”—a disease that at the time was sufficiently rare that prior to Brie none of the other doctors had ever seen a case in an infant.
One of the reasons pertussis is so scary is that during its initial incubation period, its symptoms—low-grade fever, slight aches, mild cough—closely resemble those of other, relatively common illnesses, ranging from the common cold to the flu. The disease’s trademark “whoop,” which is the result of the body instinctively gasping for oxygen, doesn’t come until the next phase. The whoops bring with them paroxysms and cyanosis, which are the clinical terms for coughing fits so severe they cause the skin to turn blue. By this point, the body is under such constant attack that a patient’s white blood cell count can resemble that of someone with leukemia. Because children under six months of age oftentimes do not, as one research paper put it, “have the strength to have a whoop,” they frequently stop breathing during the attacks.58
Up until the 1940s, whooping cough was one of the world’s leading causes of infant mortality, but in the decades immediately following the widespread introduction of the pertussis vaccine, the total number of cases and the total number of deaths in the industrialized world declined by more than 90 percent. That trend reversed somewhat in the mid-1970s, when speculative or exaggerated reports about
the dangers of the whole cell pertussis vaccine led to a sharp drop in its use. In Japan, pertussis vaccine uptake fell from 80 percent in 1974 to 10 percent in 1976; three years later, an epidemic there resulted in thirteen thousand infections and forty-one deaths. In the U.K. during that same period, there were between ten thousand and twelve thousand new cases and around three dozen deaths each year. In Sweden, after vaccination rates fell from 90 percent in 1974 to 12 percent in 1979, the Swedish Medical Society abandoned the whole cell vaccine—and in the years to come, the country’s infection rates rivaled those in developing countries.
In the United States, the effects of media reports like “Vaccine Roulette” and various activist groups have been more diffuse; still, the combination of declining vaccination rates for children and waning immunity for adults led to a continuous rise in infections, from just over one thousand in 1976, to more than four thousand in 1986, eight thousand in 1996, and approximately ten thousand in 2002. Brie’s infection occurred at the start of a two-year period during which that steady increase became an explosion, with twelve thousand diagnoses in 2003 and 25,000 in 2004.
At the time, the Romagueras knew nothing about the growing number of vaccine skeptics or the reappearance of onetime childhood scourges. “The first thought that came into my head was, That’s something that happened when my grandmother was a kid, not today,” Danielle says. Still, the diagnosis left them feeling somewhat relieved: At least they knew what they were dealing with. “We didn’t know at the time how severe pertussis can be for a child that size,” Danielle says. “We were not thinking at all that we might lose our child.” That realization would occur gradually, over the next several days, as a series of increasingly invasive treatments, ranging from an oxygen hood to a ventilator, proved incapable of providing Brie with sufficient air to survive. Finally, her doctors decided the only hope Brie had of making it through yet another surgery was to be hooked up to an ECMO machine, a contraption used by only a handful of hospitals in the country.
The Panic Virus Page 29