On Immunity : An Inoculation (9781555973278) (15 page)

I
N THE SPRING following the H1N1 flu pandemic, when my son was a year old, the Deepwater Horizon oil rig exploded. Eleven workers were killed, and a wellhead on the sea floor began spilling oil into the Gulf of Mexico. It spilled 210 million gallons of oil over eighty-seven days. The mothers I knew were no longer talking about the flu, but we did talk about the oil spill. None of us said this explicitly, but the spill that kept spilling seemed emblematic of everything we could not control in our children’s lives.

One day that spring I called my husband in tears to tell him that we needed to get a new mattress for our son’s crib. “Okay,” he said carefully, understanding neither the need for the new mattress nor my tears. That morning my reading on vaccines had led me, through a meandering course, to an article about the chemicals used to plasticize plastics, which had led me to an article about the potential health hazards of plastic baby bottles, which had led me to an article about the gases released by the plastic often used to cover infant mattresses. Much of the research on this subject was preliminary, and many of the concerns were speculative. But I had read enough, by noon, to begin to wonder about my son’s mattress, where he slept an average of twelve hours a night. After examining the tag on the mattress and corresponding with the manufacturer, I talked to my father, who assured me that my son was fine, given all the air circulating around him while he slept, but acknowledged that, yes, he knew of a case in which people had been sickened by car interiors made of polyvinyl chloride, the type of plastic that covered my son’s mattress.

It wasn’t this that brought me to tears. It was that I had already, in that first year of my child’s life, discovered that some disposable diapers contained a chemical that gave him a red burning rash. And that the toothpaste I first used on his four tiny teeth, a “natural” brand, contained an additive that blistered the inside of his mouth. My son, like me, is unusually sensitive to certain chemicals, so I tried not to take this as an indication that we were swimming in danger. But after I learned, from another mother, that the FDA does not have the authority to regulate cosmetics, including shampoos and lotions for babies, in the way it regulates pharmaceuticals, I found myself paralyzed in the drugstore, staring at the ingredients of the lotion our pediatrician had recommended for my son’s skin, badly chapped by the wind whipping off Lake Michigan.

At that moment, unprecedented amounts of Corexit, a chemical dispersant, were being sprayed onto the Deepwater oil spill from airplanes. Corexit was one of 62,000 chemicals grandfathered under the Toxic Substances Control Act of 1976 without any health or safety review. Oil dispersants are, like the chemicals in my son’s mattress, plasticizers. But the plasticizers in the mattress become infinitesimal when compared to the 1.84 million gallons of dispersant spilled onto the spill. As the Environmental Protection Agency observed at the time, Corexit was neither the safest nor the most effective dispersant on the market—it was simply the most readily available to BP in the wake of the spill. That May, the EPA requested that a less toxic dispersant be used on the spill, but BP did not comply. While a full understanding of its toxicity is still emerging, Corexit’s primary virtue seems to have been that it made the oil spill appear to disappear.

I was not comforted that the oil, in some less visible form, was still roiling through the water, killing coral and sea turtles and dolphins, endangering everything from whale sharks to sea grass. In the wake of the collapse of a deregulated financial industry, I was panicked by the spillage of a poorly regulated oil industry and the leakage of an underregulated chemical industry. “If our government,” I cried to my husband, “can’t keep phthalates out of my baby’s bedroom and parabens out of his lotion, and 210 million gallons of crude oil and 1.84 million gallons of dispersant out of the Gulf of Mexico, for the love of God, then what is it good for?” There was a pause. “I hear you,” my husband said in a voice that I recognized as the first measure in a concerted effort to contain my runaway anxiety. “Let’s just get a new mattress for now,” he said. “Let’s start there.”

In immunology, the term
regulation
refers to the strategies the body employs to avoid doing damage to itself. We feel sick when we are sick in part because our immune system is not entirely benevolent to our body. The fever that slows the growth of bacteria can, if it becomes too high, damage the body’s enzymes. The inflammation that protects cells can, if allowed to persist unchecked, harm tissues. And the chemical signals essential to an immune response can, in excessive amounts, lead to organ failure. When protective impulses are unregulated, they can be as dangerous as they are necessary.

“In the fall of 1901, regulation was a controversial idea,” the historian Michael Willrich writes. “A few months later, it was federal law.” What happened in between was a smallpox outbreak in Camden, New Jersey, where nine children died after receiving a smallpox vaccine contaminated with tetanus. Over the next century, the production of vaccines would slowly become one of our better-regulated industries. Vaccine manufacture and testing is now overseen by the FDA and the CDC, and vaccine safety is evaluated by periodic independent reviews conducted by the Institute of Medicine. Vaccines are subject to ongoing surveillance through a national database that collects reports of side effects and a database that tracks medical records from large health care providers. But the presence of regulation resembles the absence of regulation in that neither is highly visible.

“What else is in the air that I can’t see?” my son asks after I explain radio waves to him. I tell him about X-rays and microwaves. When I pause, wondering whether to mention radon and pollution, my husband begins talking about sunlight. “Explosions on the sun make tiny particles, called neutrinos,” he tells our son. “These fly off the sun and travel through the atmosphere. They are so small that they pass right through our bodies without us ever feeling them. Think of that—we have little bits of the sun pouring right through our bodies all the time! We have sunshine in us!”

I am grateful for this ode to the unseen because I have just read
Silent Spring
and my mind is full of malevolent invisibles. “In this now universal contamination of the environment,” Carson writes, “chemicals are the sinister and little-recognized partners of radiation in changing the very nature of the world—the very nature of its life.” This may be true, but radiation also takes the form, as my husband reminds me, of sunshine.

It is both a luxury and a hazard to feel threatened by the invisible. In Chicago, where 677 children were shot the year after my son was born, I still somehow manage to find myself more captivated by less tangible threats. While two-year-olds take bullets in other parts of the city, I worry over the danger embedded in the paint that chips off my child’s toys and the walls around him. I fear that it is woven into the clothes he wears, that it is in the air he breathes, in the water he drinks, and in the compromised food I feed him.

If we understand ourselves as living in a world of unseen evils, the immune system, that largely conceptual entity devoted to protecting us from invisible threats, will inevitably take on an inflated importance and a distorted function. “The imperilled ‘immune system,’” the physician Michael Fitzpatrick observes, “is a metaphor for the prevailing sense of the vulnerability of the human individual in a hostile world.”

The term
immune system
, he notes, was probably a metaphor from its very introduction. In a medical context, the word
system
traditionally referred to a collection of organs or tissue, but the immunologists who first adopted it were using it in a broader sense. “Why was the term
immune system
accepted so widely and so rapidly?” asks the historian of immunology Anne-Marie Moulin. The answer, she suggests, resides in its “linguistic versatility,” the ability of the term to contain many concepts and multiple understandings. It entered the mainstream just a few years after its introduction to science, spilling into the popular usage of the 1970s. “Though the term was borrowed from the science of immunology,” Fitzpatrick writes, “its new meaning was filled out with ideas derived from influential contemporary trends, notably environmentalism, alternative health and New Age mysticism.”

The immune system also gathered significance from the emergence of systems theory in the natural and social sciences. Systems theory, the anthropologist Emily Martin observes, has become a pervasive model for how we think about both our environment and our bodies. Where the machine with its distinct components was once the most available metaphor for the body, we now tend to think of the body as a complex system—a sensitive, nonlinear field with elaborate regulatory mechanisms.

“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.

Feeling responsible for everything and powerless at the same time is also a good description, I think, of the emotional state induced by citizenship in this country. Our representative democracy endows us with empowered powerlessness. This is a problem of governance, but it is also, as Rachel Carson would suggest, something else. “For each of us, as for the robin in Michigan or the salmon in the Miramichi,” she writes, “this is a problem of ecology, of interrelationships, of interdependence.”

E
VERYONE WHO IS BORN holds dual citizenship, in the kingdom of the well and in the kingdom of the sick,” Susan Sontag wrote in her introduction to
Illness as Metaphor.
“Although we all prefer to use only the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place.”

Sontag wrote these words while being treated for cancer, not knowing how much time she had left to live. She wrote, she later explained, to “calm the imagination.” Those of us who have lived most of our lives in the kingdom of the well may find our imaginations already placid. Not all of us think of health as a transient state that we may be exiled from without warning. Some prefer to assume health as an identity.
I am healthy
, we tell each other, meaning that we eat certain foods and avoid others, that we exercise and do not smoke. Health, it is implied, is the reward for living the way we live, and lifestyle is its own variety of immunity.

When health becomes an identity, sickness becomes not something that happens to you, but who you are. Your style of life, I gleaned from the way the word
lifestyle
was used in junior high school health class, is either clean or dirty, safe or unsafe, free of disease or prone to disease. Health class in my school was devoted largely to AIDS education, and this was late enough in the epidemic that we were repeatedly reminded—while being informed on all the ways the disease could be transmitted—that AIDS was not spread through casual contact. To encourage our empathy for the infected, we were shown a documentary about a hemophiliac boy who contracted HIV through a blood transfusion. He had not engaged in any of the risky behavior we had been warned against in class, and the intended message was that innocent victims of this disease did in fact exist. The unspoken corollary was that other people with HIV were to blame for their infection.

My generation came of age in the shadow of the AIDS epidemic, and it seems to have left us believing not that we are all vulnerable to disease, but that it is possible to avoid disease by living a cautious life and limiting our contact with others. “Cancerphobia taught us the fear of a polluting environment,” Sontag writes, and “now we have the fear of polluting people that AIDS anxiety inevitably communicates. Fear of the Communion cup, fear of surgery: fear of contaminated blood, whether Christ’s blood or your neighbor’s. Life—blood, sexual fluids—is itself the bearer of contamination.”

The anxieties generated by the AIDS epidemic have bled into our attitudes toward vaccination. Needles, as we learned from AIDS, can spread disease. The needle itself has become “dirty.” AIDS reveals that our immune systems are vulnerable to sabotage and can be permanently disabled. Vaccines, which engage the immune system, are now suspect as potential saboteurs, capable, we fear, of producing autoimmune diseases or overwhelming a child’s immune system. This fear of an immune system being “overwhelmed” can itself be traced back to AIDS—the HIV virus, as I learned in health class, hides in our T cells, quietly proliferating until it releases an explosion of copies of itself that overwhelms our system. And then there is the unsettling presence, however remote or conceptual, of other people’s blood and bodies in vaccines themselves. Robbed of their context, some of the components involved in vaccine production—human albumin, protein fragments from human cells, residual DNA—suggest that debris from other bodies is being injected into us.

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. When I asked a friend how she would feel if her child contracted an infectious disease and did not suffer from it but passed it to someone more vulnerable who would suffer, she looked at me in surprise. She had not, she told me, considered that possibility.