National Foundation For Infantile Paralysis Research Articles

The Autumn Ghost. How the Battle Against a Polio Epidemic Revolutionized Modern Medical Care

The Autumn Ghost. How the Battle Against a Polio Epidemic Revolutionized Modern Medical Care

Between Simians and Cell Lines: Rhesus Monkeys, Polio Research, and the Geopolitics of Tissue Culture (1934-1954).

This essay argues that the racialized geopolitics of the rhesus monkey trade conditioned the trajectory of tissue culture in polio research. Rhesus monkeys from north India were important experimental organisms in the American “war against polio” between the 1930s and 1950s. During this period, the National Foundation for Infantile Paralysis (NFIP) expended considerable effort to secure the nonhuman primate for researchers’ changing experimental agendas. The NFIP drew on transnational networks to export hundreds of thousands of rhesus monkeys from colonial and later postcolonial India amid the geopolitical upheavals of World War II, the 1947 Partition, and the Cold War. In this essay, I trace how NFIP officials’ anxieties about the geopolitics of the monkey trade configured research imperatives in the war against polio. I show how their anxieties more specifically shaped investment in tissue culture techniques as a possible means of obviating dependence on the market in monkeys. I do so by offering a genealogy of the contingent convergence between the use of rhesus monkeys and HeLa cell cultures in the 1954 Salk vaccine trial evaluation. Through this genealogy, I emphasize the geopolitical dimensions of the search for the “right” experimental organisms, tissues, and cells for the “job” of scientific research. The technical transformation of polio research, I argue, relied on the convergence of disparate, racialized biomedical economies.

Borders and Blood Fractions: Gamma Globulin and Canada's Fight against Polio, 1950-55.

During the early 1950s, Canada's efforts to prevent polio became heavily influenced by developments in the United States. America's foremost polio charity, the National Foundation for Infantile Paralysis, sponsored University of Pittsburgh researcher Dr. William McD. Hammon to evaluate the efficacy of a human blood fraction, gamma globulin (GG), to prevent paralytic polio. When the resulting clinical trial data appeared to show that the blood fraction offered some protection against the disease, Canadians embraced the concept for reasons of historical trust, parental demand, and public health pragmatism. They established Canada's first national immunization program to fight polio before the vaccine, as well as developed a plan to produce, evaluate, and distribute GG to epidemic areas. Despite being an expensive enterprise for a geographically vast and sparsely populated nation, Canada's GG program was extended to citizens and it became an important response to polio before a safe and effective vaccine was licensed. Although the blood fraction was not as effective at preventing polio paralysis as researchers had anticipated, its systematic use reveals how Canadian health leaders drew on transnational relationships to reduce the incidence of disease.

Polio: The Odyssey of Eradication by Thomas Abraham

Reviewed by: Polio: The Odyssey of Eradication by Thomas Abraham Svea Closser Thomas Abraham. Polio: The Odyssey of Eradication. London: Hurst & Co., 2018. xxviii + 252 pp. £25.00 (978-1-84904-956-6). Polio: The Odyssey of Eradication is a comprehensive history of the effort to eradicate polio, spanning from Roosevelt's founding of the National Foundation for Infantile Paralysis to the modern program's struggles to eliminate polio from Pakistan. The book is quite simply the best comprehensive history of polio eradication I've [End Page 472] ever read. It is an accurate, illuminating narrative suitable not just for those interested in polio but for those considering the ethics and methods of eradication programs more generally. It would work well in the classroom and is highly recommended reading for anyone interested in the history of global health programs. The book opens in Karachi, Pakistan, where vaccinators struggle to deliver the oral polio vaccine in a community that doesn't trust them. The area is one of the world's last reservoirs of wild poliovirus, which has proven stubbornly resistant to eradication despite the Global Polio Eradication Initiative spending a billion dollars a year on the effort. This vignette introduces many of the themes that resonate throughout the book, including the tension between global goals (polio eradication) and community needs (basic sanitation and health services), and the ethical complexities that arise while attempting to eradicate a vaccine-preventable disease in places with poor routine immunization. Much of the story in Abraham's book has been told before, in excellent histories including David Oshinsky's Pulitzer Prize–winning Polio: An American Story and William Muraskin's Polio Eradication and Its Discontents.1 These earlier books cover specific time periods in depth. Abraham's achievement is in tying all of this material together into a comprehensive narrative, showing how midcentury fears of polio in the United States led to a global eradication program with deep tensions at its heart. Abraham's thoughtful, balanced discussion avoids the hubris of polio eradication's champions as well as the cynicism of the project's detractors. He gives polio eradicators credit for a heroic effort that has reached long-neglected populations, even while he explores complex ethical questions about the project's history and trajectory. Abraham conducted many interviews with key players in the eradication program and followed the program in settings from the Rotary Convention in Atlanta to door-to-door vaccination in Karachi. This original research, along with a vibrant writing style (Abraham has spent much of his career working in health communications), gives the book an engaging immediacy. Abraham makes beautiful use of South Asian examples to illuminate the ethical debates at the center of polio eradication efforts. In a few scattered places discussions of some areas in India and Pakistan can lean on stereotype. For example, health systems in Bihar are far from perfect, but it's not true, as Abraham states, that they have "changed little" since the smallpox eradication era (p. 157). Overall, however, the discussion is nuanced and sensitive. This is the rare book that would work well in the classroom at a variety of levels. Abraham does not assume preexisting knowledge on the part of his readers, and he gives comprehensive explanations of key issues including the biology and epidemiology of the poliovirus, the structure of global health institutions, the debate between those favoring vertical programs and those championing primary [End Page 473] health care, and political aspects of global health programs. All of this, coupled with the easy, accessible writing style, would make the book work beautifully in an undergraduate classroom, giving a vivid view of the complexity of programs that look good on the surface. At the same time this book would also have a great deal to offer a doctoral seminar. In particular, its detailed description of the complex politics of global health decision making is illuminating, providing surprising insights into a range of issues including the exact mechanisms by which dissenting voices are sometimes sidelined and how blame for problems is shifted from global decisions to local implementation. Pairing this volume with a book on smallpox eradication like William Foege's House on Fire...

Dr. Polio: Revisiting FDR's Medical Legacy.

The National Foundation for Infantile Paralysis (NFIP), the March of Dimes, and the Georgia Warm Springs Resort were reflections of Franklin D. Roosevelt's (FDR) complicated and personal relationship with polio. Between 1934 and 1957, significant advances were made in the care of polio survivors, and new and innovative medical fields gained both public attention and funding. The plight of disabled Americans and questions of accessibility also received widespread national attention. The NFIP helped establish a new prototype for grassroots philanthropy and personified FDR's vision for national health insurance. Drawing upon a variety of archival and primary sources, this article aims to revisit Roosevelt's contribution to the medical field. Rather than condone or defend FDR's public persona as a survivor of polio, this article argues that Roosevelt and his affiliated organizations played an important medical role during this period.

Stephen E. Mawdsley, Selling Science: Polio and the Promise of Gamma Globulin

The past few years have been good to those wishing to study the history of polio. The field has recently been enriched with many excellent works: Naomi Rogers’s latest book on Elizabeth Kenny has thrown light on the contested figure of polio treatment, her relationship with the American medical profession and her place in Cold War politics.1 Meanwhile, Charlotte DeCroes Jacobs’ exhaustive biography of Jonas Salk has taken us past the well-known story of hero scientist and his polio vaccine.2 Now, Stephen Mawdsley in his new book, Selling Science, guides us to a crucial, and as of yet entirely unexplored moment in the history of polio: the American trials and use of gamma globulin in polio prevention. Selling Science is set in the early 1950s, the years of severe polio outbreaks in the pre-vaccination era. With no vaccine at hand, Dr William McDowell Hammon, epidemiologist at the University of Pittsburgh began to build enthusiasm for the use of gamma globulin in preventing polio. A blood fraction, gamma globulin was known to be effective in measles and hepatitis control. Hammon pushed for ways to assess the efficacy of the serum in polio prevention and got the National Foundation for Infantile Paralysis (NFIP) on board to assist him in his goal. Utilising carefully planned communication strategies, playing on Cold War tropes and selectively revealing information to journalists, Hammon and his associates lay the groundwork for the first large scale and open clinical trial on a healthy population. The trials that expanded from a pilot study in Utah to field trials in Texas, South Dakota and Iowa into a national experiment, brought to the fore public trust in science and scientists; questions of experimenting with placebo in an epidemic outbreak; segregation in a study on populations; and expectations from scientists, officials and the public in public health practice. In his analysis, Mawdsley follows these issues and places the gamma globulin trials in the context of Cold War propaganda, racial politics and post-war medical ethics.

Selling Science: Polio and the Promise of Gamma Globulin by Stephen E. Mawdsley

Reviewed by: Selling Science: Polio and the Promise of Gamma Globulin by Stephen E. Mawdsley David Oshinsky Stephen E. Mawdsley. Selling Science: Polio and the Promise of Gamma Globulin. New Brunswick, N.J.: Rutgers University Press, 2016. xiii + 210 pp. Ill. $54.95 (978-0-8135-7439-4). Americans in the 1950s associated the polio vaccine with three individuals—Franklin Roosevelt, Jonas Salk, and Albert Sabin. It’s a perception that exists to this day. In truth, the two successful vaccines—Salk’s inactivated version, and Sabin’s live-virus competitor—were part of a team effort led by Basil O’Connor, president of the National Foundation for Infantile Paralysis, and its revolutionary marketing arm, the March of Dimes. At a time when the federal government and the pharmaceutical industry had yet to endorse serious funding for medical research, the March of Dimes filled an important void. Raising tens of millions of dollars to find both the prevention and cure for polio—the latter goal never fulfilled—it supported a host of researchers who provided the building blocks for Salk and Sabin. How many types of poliovirus existed? A thorough investigation determined there were three. How did poliovirus enter the central nervous system? Studies at the Yale and Johns Hopkins polio units figured it out. Was it possible to produce enough safe poliovirus to inject into the arms of millions of children? John Enders, Fred Robbins, and Thomas Weller at Boston Children’s Hospital found the solution—winning a Nobel Prize for their efforts. Stephen Mawdsley’s excellent new book, Selling Science, adds a fresh chapter to a now familiar polio story. By the early 1950s, he notes, Americans had become weary of waiting for the promised polio vaccines. Tens of thousands of children were being paralyzed each year, with no end in sight. Into this void stepped Dr. William McDowall Hammon, head of the Department of Epidemiology and Microbiology at the University of Pittsburgh, home to Salk’s well-financed and ever expanding virus laboratory. Hammon had little respect for Salk, and the feeling was mutual. Convinced that a vaccine could never produce a strong or lasting immune response, Hammon thought the risks outweighed the rewards. He proposed an alternative for battling polio: gamma globulin. It wasn’t an entirely new idea. Gamma globulin, the blood fraction containing antibodies against disease, had been separated in the laboratory of Harvard’s Edward Cohn in the 1940s and used with promising early results against hepatitis and measles. Unlike the still untested polio vaccine, it appeared to be perfectly safe. Even better, it was plentiful and ready to go. The only thing missing was a vocal champion—a respected scientist ready to lobby hard for gamma globulin as a potential polio fighter. Enter Dr. Hammon. With public confidence in the National Foundation eroding, Basil O’Connor and his medical advisors became more amenable to the possibility of gamma globulin as a stopgap measure until an effective vaccine could be developed. As Mawdsley notes, they agreed to conduct “a large controlled experiment on an open population of healthy children,” something that “had never been attempted before” (p. 55). Expecting some resistance from concerned parents, Hammon and the foundation sought out tight-knit, homogeneous communities like Sioux City, Iowa, where people knew each other, thought alike, and put great trust in their [End Page 821] family doctors, whom the foundation cultivated with great care. The experiment was double-blind, with neither the child nor the caregiver knowing who got the gamma globulin and who got the look-alike placebo. Intense preparation—the hallmark of the foundation’s well-oiled public relations machine—convinced these communities that the experiment was perfectly safe, and that its benefits extended not only to their offspring but to children everywhere. The national gamma globulin experiment of 1953 produced negligible results. Polio raged at a record pace that year, and gamma globulin provided no measurable protection to those who received it. The trials were soon forgotten, as was the man who stood behind them: William McDowall Hammon. But his shadow looms large in scientific exploration, as Mawdsley’s perceptive account makes clear. Hammon’s experiment became the playbook for the...

“Out of the Back Rooms”

Physician Virginia Apgar joined the National Foundation for Infantile Paralysis, the forerunner of today's March of Dimes, in 1959, a pivotal time in the non-profit's history. When the Salk polio vaccine proved to be effective in 1955, the organization created by Franklin Delano Roosevelt in 1938 to eradicate polio struggled to maintain the interest of donors and volunteers. In 1958, executives redirected the foundation's mission to focus on birth defects and arthritis. Apgar, already well known in medical circles for having created an effective method to assess a newborn's health, was hired to help manage a $6.1 million research agenda. However, the smart, charismatic physician soon became the organization's popular spokesperson. This article uses archival records, newspaper accounts, and primary interviews to show how a physician-turned-publicist popularized the cause of birth defects and, in so doing, helped a national organization successfully rebrand itself in the second half of the twentieth century.

‘Salk Hops’: Teen Health Activism and the Fight against Polio, 1955 – 1960

In the late 1950s, a health charity, known as the National Foundation for Infantile Paralysis (March of Dimes), organized American teens into volunteer divisions to fight polio, as well as tame adult anxieties surrounding juvenile delinquency. The alliance that developed permitted the NFIP to increase its influence and revenue, while granting teens an opportunity to assert their cultural power and challenge negative stereotypes. Although the NFIP nurtured and at times dominated the relationship, young volunteers joined for their own reasons and shaped the program to suit their own aspirations and interests.

Basil O'Connor, the National Foundation for Infantile Paralysis and the Reorganization of Polio Research in the United States, 1935–41

The costs associated with polio research in the late 1920s were high, while sources for research funding remained scarce. This began to change in the early 1930s with the creation of three private philanthropies that would form the basis of a system to fund polio research adequately: the International Committee for the Study of Infantile Paralysis (1928), The President's Birthday Ball Commission (1934), and the National Foundation for Infantile Paralysis (1938). This article explores how these three organizations shaped the process for directing funds to polio research. Beginning with the International Committee, all three philanthropies used medical advisory committees as vehicles for the review of proposals for research. The National Foundation adopted many of the policies and procedures of the earlier organizations, drawing on the experiences, misfortunes, and successes of its predecessors. The National Foundation also relied on some of the same personnel, although the microbiologist and writer Paul de Kruif, who was an influential figure in the early years, was gradually pushed out. This essay explores the establishment of the medical advisory committees of the National Foundation and reveals how by 1941 under leadership of Basil O'Connor and Dr. Thomas Rivers they developed a systematic and readily legitimated process for directing funding. By 1941, the NFIP had in place the fund-raising capacity to underwrite the scientific research that would ultimately produce two successful polio vaccines in the next twenty years.

The March of Dimes and Polio

The polio vaccine became available in 1955, due almost entirely to the efforts of the March of Dimes. In 1921, Franklin Roosevelt gave a public face to polio and mounted a campaign to prevent it, establishing the National Foundation for Infantile Paralysis in 1938. During the Depression, U.S. citizens were asked to contribute one dime. Entertainer Eddie Cantor suggested the name the March of Dimes, paraphrasing the popular newsreel “The March of Time”. Jonas Salk advocated a killed-virus vaccine while Albert Sabin proposed a live-virus vaccine. Both competed for both recognition and funding from the March of Dimes. In 1955 Salk's vaccine was adopted, nationwide vaccination programs were implemented, and polio rates dropped by 80 percent. In 1961, Sabin's vaccine, endorsed by the American Medical Association, became the vaccine of choice. The World Health Assembly advocated polio eradication by the year 2000. By 2004 eradication efforts were threatened by allegations linking vaccines to chronic diseases. Immunization dropped and polio resurfaced in the U.S., Australia, Africa and Russia. Research linking vaccines to chronic disease was discredited, but vaccine opponents remain active. Health educators are well positioned to mitigate damage caused by the anti-vaccine movement and address barriers to immunization efforts.

The 1954 Salk poliomyelitis vaccine field trial

On April 12, 1955, Thomas Francis, Jr., Professor of Epidemiology at the University of Michigan, held a press conference in Ann Arbor to announce the results of a ‘field trial’ of an experimental poliomyelitis vaccine. ‘Some of the best educated persons in American journalism’ elbowed each other aside to get their hands on a copy of the press release. The journalists’ ardor was not surprising: more Americans knew about the vaccine trial ‘than knew the full name of the President of the United States’ [1]. The ‘biggest public health experiment ever’ had enrolled 1,022,684 school children in 44 states. 300,000 school teachers, ‘classroom mothers’ and ‘clubwomen,’ nurses, physical therapists, doctors, and public health officials had volunteered to organize the immunizations and track polio cases [2,3]. Around the country, vaccine supplies were stockpiled, as families, physicians, and government officials waited to hear whether the new vaccine had worked. Francis’ announcement that the vaccine was ‘80 to 90 per cent effective against paralytic poliomyelitis’ did not satisfy Jonas Salk, the vaccine’s inventor, who promised future results of ‘100 per cent’ effectiveness [1,4]. No medical study, before or since, approaches the 1954 Salk vaccine field trial in size, complexity, or the extent of public involvement. The trial was initiated not by the federal government but by a private organization, the National Foundation for Infantile Paralysis (NFIP), which raised its money from millions of small donations. Ordinary citizens paid for the study, recruited the children who took the vaccine and the volunteers who helped administer it. It is a small wonder that trialists and vaccine researchers look back admiringly, even longingly, at the study [5–8]. Yet, the most remarkable fact about the 1954 field trial may not be the massive organizational effort involved, or the rigorous methodological design ultimately imposed. Given repeated controversies about the vaccine’s safety and the field trial’s design, it is remarkable that the trial was ever begun, much less successfully completed. The sciences of vaccine testing and of clinical trials are complex. Add parents, physicians, school, and health officials from 3100þ communities and the process grows even messier, little resembling the orderly procedure the textbooks prescribe. In Pittsburgh, Jonas Salk continued modifying the test vaccine until a few months before the study was launched. The field trial itself was shaped by decisions taken not only in New York at the NFIP’s headquarters, or in Francis’ Ann Arbor, but also in places like Montgomery, Alabama, where local health and school officials decided to go ahead with the trial, and Arlington, Virginia, where the community decided against participation. In this article I will try to capture the difficulties trial organizers faced, the contingencies they encountered along the way and the actions taken to overcome these obstacles.

“Dancing on Eggs”: Charles H. Bynum, Racial Politics, and the National Foundation for Infantile Paralysis, 1938–1954

In 1938, President Franklin D. Roosevelt and his law partner Basil O'Connor formed the National Foundation for Infantile Paralysis (NFIP) to battle the viral disease poliomyelitis. Although the NFIP program was purported to be available for all Americans irrespective of "race, creed, or color," officials encountered numerous difficulties upholding this pledge in a nation divided by race. In 1944, NFIP officials hired educator Charles H. Bynum to head a new department of "Negro Activities." Between 1944 and 1954, Bynum negotiated the NFIP bureaucracy to educate officials and influence their national health policy. As part of the NFIP team, he helped increase interracial fund-raising in the March of Dimes, improve polio treatment for black Americans, and further the civil rights movement.

Remembering the lost neuroscience of pharmaco‐EEG

To the electrophysiologist accustomed, in his animal experiments, to probing with his electrode into the nervous system and even into the nerve cell itself, it remains a matter of astonishment that so many of the brain's secrets escape across the wall of the skull to electrodes fixed to the scalp of man. That they indeed do so is testimony to the fact that the brain's electrical activity is a most sensitive indicator of its function. In this fact lies the attraction of electroencephalography for its devotees.

Polio chronicles: Warm Springs and disability politics in the 1930s

During the 1920s and 1930s, disabled polio survivors initiated a campaign which made them active, dissenting subjects in public discourse about disease and disability. Its source was a core of Warm Springs patients who wanted more than a healing refuge. They were well aware of the need to construct a new image of the disabled, and saw the resort's high public profile as a potent weapon in a cultural war to remake popular images of the disabled, whether as pathetic charitable objects or as horrific movie villains. Drawing on their own, disheartening experiences, this group of activists boldly critiqued the medical care offered most disabled patients as well as the training and attitudes of doctors, nurses and physical therapists. Protesting the narrow, medicalized definition of rehabilitation, they provocatively posed the need to "rehabilitate" prejudiced, able-bodied employers and health professionals. And most of all, they consciously designed the polio center at Warm Springs to function not as an inward-looking refuge but as an exemplar of the way polio survivors and other disabled people should be allowed to live, work and love. This story begins and ends in the 1930s. It traces a rise and fall: the rise of an activist community at the rehabilitative center at Warm Springs; and its decline with the creation of the National Foundation for Infantile Paralysis (known popularly as the March of Dimes) in 1937.

News and Events

News and Events Elin Wolfe and Dick Wolfe Call for Papers, 2009 Annual Meeting The American Association for the History of Medicine invites submissions in any area of medical history for its 82nd annual meeting, to be held in Cleveland, OH, 23–26 April 2009. The Association welcomes submissions on the history of health and healing; history of medical ideas, practices, and institutions; and histories of illness, disease, and public health. Submissions from all eras and regions of the world are welcome. Besides single-paper proposals, the Program Committee accepts abstracts for sessions and for luncheon workshops. Please alert the Program Committee Chair if you are planning a session proposal. Individual papers for these submissions will be judged on their own merits. Presentations are limited to 20 minutes. Individuals wishing to present a paper must attend the meeting. All papers must represent original work not already published or in press. Because the Bulletin of the History of Medicine is the official journal of the AAHM, the Association encourages speakers to make their manuscripts available for consideration by the Bulletin. The AAHM uses an online abstract submissions system. We encourage all applicants to use this convenient software. The Web site is: http:// histmed.org. If you are unable to submit proposals online, send eight copies of a one-page abstract (350 words maximum) to the Program Committee Chair, Howard Markel, M.D., Ph.D., University of Michigan, 100 Simpson Memorial Institute, 102 Observatory, Ann Arbor, MI 48109-0725 (tel.: 734 647-6914; e-mail: howard@umich.edu). When proposing a historical argument, state the major claim, summarize the evidence supporting the claim, and state the major conclusion(s). When proposing a narrative, summarize the story, identify the major agents, and specify the conflict. Please provide the following information on the same sheet as the abstract: name, preferred mailing address, work and home telephone numbers, e-mail address, present institutional affiliation, and academic degrees. Abstracts must be received by 15 September 2008. E-mail or faxed proposals cannot be accepted. [End Page 421] In Memoriam Saul Benison, 1920–2006 Saul Benison, a pioneer oral historian and long-time member of the AAHM, died of pneumonia on 5 October 2006 at the age of 85. For several years prior, he had been treated for dementia and other medical problems in various health care institutions in Baltimore under the watchful eye of his nephew, Dr. Ken Berger. A native New Yorker, Saul graduated from Queens College in 1941 and spent part of the war years as a historian for the War Production Board. He went on to earn a Ph.D. under Allan Nevins's direction at Columbia University in 1953, during which time and after, he taught at CCNY, Sarah Lawrence College, and Long Island and Brandeis Universities. He also was employed by Columbia's Oral History Research Office, the American Jewish Tercentenary Committee, and the National Foundation for Infantile Paralysis. While serving at the last named, he developed a lifelong interest in the history of polio and gradually made it his specialty. In 1969, Saul accepted an appointment as full professor in the history department of the University of Cincinnati (and later, a joint appointment in its School of Public Health). An incentive for him to leave the safety of his New York habitat was an opportunity to work on an oral history memoir with the renowned polio researcher, Albert Sabin. It was a happy choice, and he remained in Cincinnati until retirement in 1990. Although Saul's long-awaited work with Dr. Sabin was never published, his oral history interviews produced two other memoirs: one, by the Harvard social historian, Arthur M. Schlesinger, Sr., in the 1950s and his own highly praised Tom Rivers, Reflections on a Life in Medicine and Science (1967). While working at Rockefeller before it had its own archive, Saul interviewed several other researchers and virologists there and arranged for their correspondence and papers to be transferred to the American Philosophical Society, where they are preserved to this day. Yet another of his oral histories was later edited and published by J. Gordon Scannell in 1990: Wanderjahr, The Education of a Surgeon, Edward D. Churchill, with a...

David M Oshinsky, Polio: an American story, New York, Oxford University Press, 2005, pp. viii, 342, illus., £18.99, $30.00 (hardback 0-19-515294-8).

Born in 1934, my mother grew up afraid of rivers, lakes, and local swimming holes. Water was the conduit of polio, she was told by her own mother, and was to be avoided, especially in the hot summer months. Decades later, as a pre-schooler at my first swimming lesson, I still remember my mother reassuring me that I would not be a hydrophobe like herself, for we lived in a post-polio age. How such a drastic change in attitude occurred in only one generation is explained in David M Oshinsky's Polio: an American story. While the book is advertised as covering the entire twentieth century, Oshinsky focuses primarily on the middle decades, when the race to find a vaccine was fierce. He begins with a somewhat superficial overview of the history of polio from Galen to Warm Springs, Georgia. This is a large swath of time, the later portion of which has already been covered in great detail by Naomi Rogers in Dirt and disease: polio before FDR (1992). The author hits his stride, however, a third of the way through the book, when he unpacks the complicated interrelationship between private fundraising campaigns (spearheaded, in the case of polio, by the National Foundation for Infantile Paralysis, or NFIP), the new post-war media machine, bi-partisan politics, and the science of virology. We learn why Jonas Salk became a household name in the United States, while Albert Sabin—a leading international figure in polio research—did not. Oshinsky takes us from the optimism of April 1955, when newspapers ran headlines proclaiming that “Polio is Conquered”, to the sudden wave of scepticism that hit the country later that same year after dozens of children who received vaccines from Cutter Laboratories of Berkeley, California, contracted the disease and were left paralysed. By ending his book with a discussion of the first bouts of Post-Polio Syndrome in the 1980s, Oshinsky indicates that the history of polio is not a simple story of medical triumph but one marked by numerous setbacks and complications. There are many thematic threads to this book that will be of interest to medical historians. First, historians of medical ethics and human experimentation will find Oshinsky's discussion of the moral quandary of using children (institutionalized and not) as research subjects in the early live-virus vaccine trials compelling and rich. And those who study the history of media and medicine will find Oshinsky's story noteworthy, since he claims that the NFIP “created the concept of philanthropy as consumerism” (p. 5). For historians interested in women scientists, disability studies, or the patient perspective, Oshinsky has only a few brief sentences to offer. He leaves his reader wanting to know more about the women scientists who were essential to the development of the vaccine in the late 1940s and early 1950s, such as Dorothy Horstmann—a Yale investigator who was the first to discover the “viremic phase” of polio, the very brief period of time when vaccination is effective—and Isabel Morgan—a Johns Hopkins researcher who, Oshinsky speculates, could “have beaten Salk to the polio vaccine” if she had been willing to use children as experimental subjects and avoided marriage at the age of thirty-eight (p. 132). Oshinsky rarely discusses polio victims themselves, except for a brief mention of teenager Bill Kirkpatrick, Salk's “Subject No. 1”. In today's literature, polio is a topic of both disease and disability history—one wonders why Oshinsky did not draw upon the work of Daniel J Wilson better to address the view of those on the ground who personally experienced what it meant to have polio. Nevertheless, Oshinsky has written a highly readable history about the leaders behind America's mid-century campaign to eradicate polio. Albert Sabin, Jonas Salk, Basil O'Connor (director of the NFIP) and FDR “represent[ed] the public face of polio—the courageous victim, the devoted foundation leader, [and] the brilliant researchers with their lifesaving vaccines” (p. 112). It is a top-heavy story, but one of extreme importance to understanding how laboratory science operates in a consumer-conscious, media-saturated, risk-adverse society.

Triumph And Tragedy

This book contains a story and an essay, connected by a singular event. The story is an American one, complete with a happy ending, of how polio was defeated in the United States. The essay is on the incentives that shape vaccine research and manufacturing today. The essential message of the essay is that were a disease like polio to emerge today, it might prove harder for the United States to defeat the disease, despite decades of advancement in science and medicine. The story of triumph that opens the book becomes, in the end, a tragedy—and one of our own making. And what about the event that connects the story and essay? That, as you might have guessed, was a lawsuit. I told you this was an American story. The narrative begins in 1955, with a mother taking her daughter and son to the pediatrician. They were lucky, she believed. Her children were to be among the first to receive the Salk vaccine. They were to be protected from the scourge that had killed and crippled thousands of children. Sadly, days later, the daughter contracted polio from the vaccine itself. She, like her brother, had been given vaccine produced by Cutter Laboratories. Her brother was lucky, but she became a victim of what later became known as the “Cutter Incident.” At this point, the book draws back to describe the important events that led up to that dreadful incident, including the heightened concern, if not panic, that gripped the country during the polio epidemics, and the rivalry between the great polio researchers, Jonas Salk and Albert Sabin. These and other elements of this story are familiar, but they are told well, and the book contains many facts of which I was previously unaware. The author, Paul Offit, not only knows his subject but has researched it. Much of this research is original. If there is a single hero in this book, it is Salk, although Offit explains that Salk’s achievement depended on a great many people making a variety of contributions—some small, some large, and not all of them helpful. A few of these people proved to be as essential to the overall enterprise as Salk himself. But Salk’s discovery of “immunologic memory,” Offit believes, was reason enough to award him the Nobel Prize he was denied. It is a human tendency to celebrate the mythic hero—a person such as Salk. But in addition to the dozens of other scientists who contributed to the development of the polio vaccines, literally millions of people, mostly mothers, contributed their time and resources to raise the dimes needed to pay for the research. This, I believe, is another aspect of this story that is almost uniquely American. Alexis de Tocqueville, writing in the early nineteenth century, noted the peculiar tendency of Americans to volunteer, to associate, and to organize for a common cause, and that is just what the March of Dimes did in the mid-twentieth century—and to superb effect. The public’s involvement in financing the National Foundation for Infantile Paralysis helped raise expectations for a successful out-

Lesser Harms: The Morality of Risk in Medical Research (review)

Reviewed by: Lesser Harms: The Morality of Risk in Medical Research William G. Rothstein Sydney A. Halpern . Lesser Harms: The Morality of Risk in Medical Research. Morality and Society Series. Chicago: University of Chicago Press, 2004. xii + 232 pp. Tables. $37.50, £26.50 (0-226-31451-0). In Lesser Harms, Sydney Halpern analyzes the history of social control of human experimentation. Three eras are examined: when the scientific community alone exerted control; when organizational sponsors regulated the research; and when the federal government regulated human experiments. Halpern's evidence is drawn from vaccine tests for smallpox, rabies, influenza, measles, and polio, which have a long history that involved "especially stark discussions of hazards and benefits" (p. 10). Restrictions of human experimentation beginning in the eighteenth century were based on the "moral traditions" (p. 2) of the scientific community. Scientists agreed that interventions must produce "lesser harms" (p. 4)—that is, less than the risks of the naturally occurring disease; the experiments must be "technically sound" (p. 5); animal experimentation must precede human experimentation; and experiments must be suspended if early findings showed high levels of risk. Halpern concedes that there have been "marked variations in the application of [End Page 830] moral traditions" (p. 7), owing to disagreements about interpretation of the evidence and the appropriate risk-benefit ratio. In addition, "research networks are informal groups, poorly equipped to impose coercive constraints on their members. . . . Their principal means of social control are granting and withholding esteem and ostracizing those who violate collective norms" (pp. 64–65). The early twentieth century saw a transition to the "morality of method" (p. 36) by the scientific community. This new approach insisted on technical expertise in study design and procedures, and the use of controlled trials. Scientific leaders aborted the polio vaccine experiments in the 1930s because of dubious experimental techniques and interpretations of data. Organizational research sponsors then became the arbiters of human testing of vaccines, using three strategies: risk avoidance (refusing to support experiments); risk containment (imposing controls on the researchers); and risk delegation (delegating control to the researchers). Examining polio and influenza vaccine research in the 1930s, Halpern found that commercial sponsors used risk delegation more often than sponsors such as the National Foundation for Infantile Paralysis. By mid-century, organizations that sponsored research, now including the federal government, routinely adopted risk-containment strategies. This new policy was due to the rationalization typical of large organizations and to agreement on methods, including legal strategies, that would obtain social legitimacy and avoid legal sanctions. Organizations used written consent forms, oversight by scientific panels, and (least often) insurance for injured subjects. The written consent forms were "largely ceremonial" (p. 110). Advisory panels became widespread; they provided direction and intervened in hazardous situations. Halpern states that these controls were sometimes used to justify the undertaking of "extremely dangerous nontherapeutic experiments" (p. 110). The third period began in the 1960s when federal agencies undertook the regulation of human-subject research and later required the establishment of Institutional Review Boards to oversee the ethical conduct of research. The new rules greatly expanded the scope and importance of informed consent. Halpern contends, however, that these new institutional regulations have not superseded the need for the moral traditions of the scientific community: Official oversight has sometimes failed to utilize scientific expertise, with fatal consequences for subjects. Informed consent has been used to justify hazardous experiments. Corporate involvement in medical research has made researchers behave more like "isolated entrepreneurs than members of a scientific community" (p. 153). Halpern proposes a return to the free flow of scientific information that once characterized the scientific community. Lesser Harms is constructed on an impressive framework and describes an important subject. However, the federal regulation era is insufficiently described, and material on individual topics is often dispersed throughout the book. Nevertheless, this is a valuable history of basic changes in the regulation of human experimentation. William G. Rothstein University of Maryland, Baltimore County Copyright © 2005 The Johns Hopkins University Press

Polio: an American story

All who lived in the early 1950s remember the fear of polio and the elation felt when a successful vaccine was found. Now David Oshinsky tells the gripping story of the polio terror and of the intense effort to find a cure, from the March of Dimes to the discovery of the Salk and Sabin vaccines-and beyond. Here is a remarkable portrait of America in the early 1950s, using the widespread panic over polio to shed light on our national obsessions and fears. Drawing on newly available papers of Jonas Salk, Albert Sabin and other key players, Oshinsky paints a suspenseful portrait of the race for the cure, weaving a dramatic tale centered on the furious rivalry between Salk and Sabin. Indeed, the competition was marked by a deep-seated ill will among the researchers that remained with them until their deaths. The author also tells the story of Isabel Morgan, perhaps the most talented of all polio researchers, who might have beaten Salk to the prize if she had not retired to raise a family. As backdrop to this feverish research, Oshinsky offers an insightful look at the National Foundation for Infantile Paralysis, which was founded in the 1930s by FDR and Basil O'Connor. The National Foundation revolutionized fundraising and the perception of disease in America, using poster children and the famous March of Dimes to raise hundreds of millions of dollars from a vast army of contributors (instead of a few well-heeled benefactors), creating the largest research and rehabilitation network in the history of medicine. The polio experience also revolutionized the way in which the government licensed and tested new drugs before allowing them on the market, and the way in which the legal system dealt with manufacturers' liability for unsafe products. Finally, and perhaps most tellingly, Oshinsky reveals that polio was never the raging epidemic portrayed by the media, but in truth a relatively uncommon disease. But in baby-booming America-increasingly suburban, family-oriented, and hygiene-obsessed-the spectre of polio, like the spectre of the atomic bomb, soon became a cloud of terror over daily life.