Saturday, November 26, 2011

Smallpox, Then and Now

As one of the requirements for my eighteenth-century literature course, students have to give presentations on various historical and cultural topics. One such topic is Edward Jenner and smallpox.

If you don't know the story of smallpox and its eradication, it's both pretty amazing and downright horrifying. In The Demon in the Freezer (2002), Richard Preston describes the symptoms:
The pustules began to touch one another, and finally they merged into confluent sheets that covered his body, like a cobblestone street. The skin was torn away from its underlayers across much of his body, and the pustules on his face combined into a bubbled mass filled with fluid, until the layers of skin of his face essentially detached from its underlayers and became a bag surrounding the tissues of his head. His tongue, gums and hard palate were studded with pustules, yet his mouth was dry, and he could barely swallow. The virus had stripped the skin off his body, both inside and out, and the pain would have seemed almost beyond the capacity of human nature to endure. (35)
Eventually, the virus affects the messenger molecules of the victim's immune system by triggering unknown proteins that cause what's known as a "cytokine storm." Instead of attacking the invader, the person's immune system backfires on itself and cannot combat the massive viral infection.

This is what smallpox looks like, in its most common form.

I apologize if you find the picture upsetting, obviously, but you should know that this isn't actually the worst form of it, it's actually the "ordinary" form of variola.

It has a mortality rate of approximately 30% and, as you may imagine, it often leaves disfiguring scars on the victim's face. It can also cause blindness.

The more severe form, hemorrhagic smallpox, was often known as the "black pox." The victim's skin doesn't blister; instead, bleeding occurs under the skin, eventually causing the person to appear blackened.

One of the early signs of hemorrhagic smallpox is bleeding in the whites of the eyes: the victims' eyes often turn a deep red color and, if they survive long enough, they too turn black.

They bleed from the nose, mouth, rectum, urinary tract and vagina.

The mortality rate for hemorrhagic smallpox is nearly 100%. In all cases of smallpox, victims remain conscious and cognizant of what is happening to them throughout the duration of the illness, in "a peculiar state of apprehension and mental alertness that were said to be unlike the manifestations of any other disease." (Smallpox and Its Eradication)

There is no cure for smallpox, in any form. The only hope of prevention and eradication lies in vaccination.

In 1796, Edward Jenner developed the vaccine for smallpox, using methods that make Michael Jackson's personal physician look like a candy-striper. He noticed that women who worked on dairy farms often contracted what is known as "cowpox" (similar to smallpox, but it infects cows, obviously).

Jenner noticed that, when the women contracted cowpox, it was not as severe and they typically didn't die (unlike the cows). He also noticed that, having survived cowpox, the women usually didn't subsequently contract smallpox.

So one fine day, like any good eighteenth-century doctor, he scraped the pus from the pustules of his patient, Sarah Nelmes, who had contracted cowpox from her cow, Blossom, and he injected it into the arms of his gardener's eight-year-old son, James Phipps.

What are servants and their children for, after all, if not to conduct highly dangerous and unethical experiments on them? (And if you think it doesn't happen in our more civilized era, look into the practices of Jonas Salk in the 1940s.)

A few months later, Jenner injected James Phipps with a controlled amount of smallpox, a practice known as "variolation." In 1796, this was the only proven method of inducing immunity and, as you can imagine, it was highly risky.

But James Phipps, having been injected with cowpox, never contracted smallpox, even when he was subsequently injected with it (repeatedly).

And thus, vaccination was born.

Since simply mentioning the word "vaccination" will often trigger cries of "autism," I should point out that people who allege a connection between vaccines and autism are misunderstanding several things about the way the human body and its immune system works.

More importantly, they are overlooking the fact that the connection between the measles mumps and rubella (MMR) vaccine, inflammatory bowel disease, and autism was merely suggested by the British physician Andrew Wakefield and thirteen colleagues, in a study published in the Lancet in 1998.

Even Wakefield acknowledged that the connection was never actually, scientifically proven.

Moreover, subsequent studies were never able to replicate Wakefield's claims. In science, this is the acid test for fraudulent research.

In 2004, British journalist Brian Deer discovered that Wakefield and his colleagues had received undisclosed funds prior to the publication of the 1998 study. 10 of the 13 scientists involved in the study subsequently acknowledged the conflict of interest and retracted their claims.

Their research had in fact been funded by a lawyer representing the parents of the children with autism who had, in turn, been the subjects of the study: they were contemplating a lawsuit against the makers of the MMR vaccine, but they required evidence of a possible connection between the vaccine and autism, since none existed.

It was also revealed that Wakefield had previously applied for a patent for a single-jab measles vaccine that would also treat inflammatory bowel disease and autism.

Not only was this proposed vaccine in competition with the MMR combination vaccine, it alleges a connection between measles, inflammatory bowel disease and autism in June of 1997 and indicates that Wakefield had applied for a patent as early as March 1996, in which he also alleges a connection between the three.

Ultimately, it was also discovered that, in pursuing his study, Wakefield had performed unnecessary and invasive medical procedures on the children without proper authorization by an IRB (Institutional Review Board).

As a result of his actions, Wakefield is no longer licensed to practice medicine in the UK, and he has never held a license to practice in the US. But yes, he has a celebrity following in the US, including Jenny McCarthy.

The claims that vaccines containing thimerosal (a preservative used in cosmetics beginning in the 1930's) are linked to the rise in autism have been equally unsupported.

On the heels of public concern sparked in 1999, thimerosal was removed from vaccines in 2001. Nevertheless, the incidence of autism has not declined since 2001.

Wakefield claims it's all a huge conspiracy by Big Pharm (no surprise there). But although I'm not the "oh-just-stick-out-your-arm-and-trust-the-government" type, I can't say I'll ever put much faith in anything that guy has to say, given the findings.

And smallpox has been back in the news this week. According to a November 13th article in The Los Angeles Times, the Obama administration recently awarded a $443 million no-bid contract for a smallpox drug that is, by many accounts, untestable and potentially ineffective.

As reported in the LA Times this week, Senator Claire McCaskill (D-MO) is questioning the awarding of the contract to Siga Technologies, Inc..

As the article indicates, the controlling shareholder of Siga Technologies is Ronald O. Perelman, a major donor to the Democratic Party.

ST-246, as the drug is known, is not actually a vaccine for smallpox, per se. It is an antiviral medication designed to be administered along with the smallpox vaccine, for individuals who have compromised immune systems or who are at risk of developing "adverse reactions" as a result of receiving the smallpox vaccine. For individuals who may already have been exposed to smallpox, it may inhibit the growth of the virus, if it is administered within four days of exposure, and it may serve as a form of treatment for individuals who have become symptomatic.

If you're wondering why we can't simply cure smallpox, consider this fact: the AIDS virus has approximately 10 genes.

Smallpox has approximately 200.

Whatever they come up with, it had better damn well work or we'll all be wanting more than our money back.

No comments:

Post a Comment

Ralph Waldo Emerson once wrote, "Life is short, but there is always time for courtesy."