CbC Reviews: The Cutter Incident
Continuing to drag my feet on putting up new content, I thought I would post my review of:
The Cutter Incident: How America’s First Polio Vaccing Led to the Growing Vaccine Crisis
By Dr. Paul Offit (2007 – Yale University Press)
Why bother? I’m interested in vaccines – their science, their politics and their history, and Dr. Offit has published some very prominent, very controversial books on the topic. I picked one I hadn’t heard of, and checked out its reviews on Amazon.com, hoping to find out if the book was good. What I learned was that Dr. Offit is either a courageous champion for Science and Not Dead Babies! or an Evil Pharma Shill. Very little about the actual book – literally 1 of 17 reviews was not either a 5 star or 1. So here’s my attempt to review it, from the perspective of a (fairly) well-educated, pro-vaccine, pro-well written books perspective:
The Too Long, Don’t Wanna Read Version: 3 Stars, Good but not Outstanding
The bulk of the book is in the form of classic science writing. We start with a statement of the problem (Polio kills people), and go through the early history of the development of vaccines, particularly those for polio, introducing characters along the way. Essentially, you have a book that looks like this:
[ERA 1 - (Person 1, Person 2, Person 3)] -> [ERA 2 - (Person 1, Person 2, remember person 3? Still alive)] -> etc.
Its very through, gives a very good picture of what’s going on, and somewhat, well, dull. Because individual scientists often have career paths tangental to the plot of the book, they will appear for a paragraph, never to be heard from again, or flicker in an out between eras as their importance waxes and wanes. A large bulk of beginning of the book is devoted to this, and its…long. I’m going to go ahead and call it a little grinding. I was maybe 2/3rds of the way through this part when I set down the book and went off to read the first 3 books in Glen Cook’s Black Company series to reengage with the idea of reading before bed.
Then we get to the good part. The meat of the book is the science, politics and hype surrounding the introduction of the Salk Vaccine, and on of America’s first public health disasters: the contamination of several million doses of vaccine made by a firm called Cutter Laboratories with live polio virus. Children die, more are injured, and the incident has serious consequences for the polio vaccine. Dr. Offit covers all of this with the characteristic detail of the first section, but now with a quickening pace and figures who last through multiple sections, the work is much more readable. Enough that it kept me awake on a plane flight, which is something of an achievement. His writing is even handed, covering the scope of the disaster, the confusion surrounding it, and how Cutter Labs, genuinely trying to follow Salk’s protocols and meeting what was at the time the established vaccine safety guidelines, and still got children killed.
The final part of the book is discussing the consequences of the disaster, and its impact on human health. Here, Dr. Offit’s own bias (he’s the developer of the Rotavirus vaccine) begins to show. The development of liability without negligence that emerges from the Cutter incident does have wide-spread ramifications on the development of vaccines – fear that negative outcomes, associated with the vaccine or not, will result in liability for the manufacturer. Doubtless, litigation has its impact, but coming out of the recent healthcare debate, I am wary of the ‘its all the trial lawyers fault’. Yes, there have been awards that compromise large shares of a company’s entire vaccine-related revenue. But that revenue wasn’t all that high in the first place. And drugs that don’t have that level of liability that are devoted to the treatment of increasingly more obscure infectious diseases suffer as well – just look at the rapidly evaporating development in next-generation antibiotics. And the success of several new vaccines – those for Rotavirus and HPV come to mind – suggests that vaccine development isn’t dead in the water due to liability. So, Dr. Offit gives a good summary, but overstates his case.
In short, The Cutter Incident is a decently written account of a fascinating period in the public health history of America, that suffers from the classic storytelling shortcomings of medical histories, and slightly too much zeal (admittedly, if I were in his position I’m not sure I would have done the same).
Filed under: Epidemiology, Reviews | Leave a Comment