The Culture of Fear (29 page)

In short, breast implant settlements proved to be among the few genuine examples of what the Republicans’ “Contract With America” referred to as “outlandish damage awards [that] make a mockery of our civil justice system.” In the entire period between 1965 and 1990 juries had handed down awards of more than $10 million in only thirty-five product liability cases. The multimillion- and multibillion-dollar judgments in implant cases in the early 1990s provided some of the best evidence for the conservatives’ argument, and liberals and progressives could ill afford to concede the point. Instead they turned the tables. They claimed that journalists who criticized the implant settlements were out to “vindicate ‘victim’ corporations,” as Flanders put it. And they suggested that corporations such as Dow, with the help of unwitting reporters, were propagandizing about the implant issue in order to weaken laws that protect the public from unsafe products. The tort reform movement was just “another case of corporations using their political clout to escape potential liability,” according to the author of a
Ms.
article about implants.
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Following Bill Clinton’s reelection in 1996 the firestorm over tort reform died down, leaving behind little actual reform but lots of silly warning labels. Starbucks Coffee, hoping to avoid lawsuits like the one against McDonald’s, put on the side of its cups, “Careful, the beverage you are about to enjoy is extremely hot.” A Batman costume carried the following notice: “FOR PLAY ONLY: Mask and chest plate are not protective; cape does not enable user to fly.”
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Yet while shoppers were being told the obvious about consumer products, the most important question in the tort reform debate never did get answered:
Is
it possible to put the brakes on runaway
lawsuits while at
the same time ensuring product safety
and
restitution for victims?

The question is answerable, and may even be yes. In my research into yet another metaphoric illness I discovered an example of legislation that curtailed lawsuits, generously compensated victims, and at the same time protected manufacturers, who ended up producing a safer
product. The legislation, which created something called the Vaccine Injury Compensation Program, was instituted by Congress in 1986 as a kind of antidote to a countrywide hysteria that had begun four years earlier—on the evening of April 19, 1982, to be precise.

That night, during an hour-long news program titled “DPT: Vaccine Roulette,” broadcast on WRC-TV, the NBC affiliate in Washington, D.C., a new medical entity was given birth: the vaccine-damaged child. The program, illustrated with footage of severely handicapped children and heartbreaking testimonials from their parents, revealed that the pertussis (or “whooping cough”) part of the diphtheria-pertussis-tetanus (DPT) vaccine could cause horrible neurological disorders and even death. Over the coming weeks excerpts from “Vaccine Roulette” appeared on NBC’s “Today” show and in newspapers, effecting a media-generated panic. Pediatricians throughout the country were deluged with calls from panicked parents asking if their kids were going to die from the shots they had been given.
⁶²

Medical and governmental organizations promptly responded to the flawed expose. Physicians at the FDA issued a forty-five-page, sentence-by-sentence refutation, copiously footnoted with studies from top medical journals, showing that deaths and serious complications result from the DPT vaccine either never or extraordinarily rarely. Other health officials and individual pediatricians also went to the media with evidence of their own about the safety of vaccines and the dangers from whooping cough itself. They reminded parents too young to remember that prior to 1949, when the vaccine was introduced, 7,500 children died from whooping cough and another 265,000 came down with various of its symptoms, which persist for five to twelve weeks and commonly include vomiting, seizures, and pneumonia on top of the violent coughing fits that gave the disease its name.
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Injections of truth stand little chance of stopping the spread of a metaphoric illness, particularly early on. Much of the media downplayed the reasoned responses from physicians. And within weeks of the broadcast an organization called Dissatisfied Parents Together was formed by a victim-cum-expert, Barbara Loe Fisher, who recruited members and financial support with anecdotes about her son, whom
she “watched convulse, collapse and go into a state of unconsciousness within hours of his fourth DPT shot at age two.”
⁶⁴

By 1984, following media appearances, protest marches, and congressional testimony by Fisher and other parents, and mammoth lawsuits, two of the three manufacturers of the DPT vaccine had gotten out of the market, creating a dangerous shortage of the vaccine. Fewer children were being vaccinated, and health officials forecast an epidemic of whooping cough. They pointed to Japan, where a decade earlier panic over the vaccine had resulted in a ban on the drug, a tenfold increase in cases of whooping cough, and a tripling of the number of whooping-cough-related deaths. In England as well, although vaccines were available, immunization rates fell by 40 percent during a scare, and over an eight-year period 100,000 Britons came down with the illness.
⁶⁵

It was against such a backdrop that the U.S. Congress, in a rare show of clear-headedness, enacted the legislation in 1986 designed to do four things at once: prevent a public health crisis, shield major drug companies from inevitable litigation, assuage parents who believe their children have been damaged by vaccines, and free the courts of interminable and highly adversarial trials. Financed initially by an $80-million-a-year federal appropriation, and since 1988 through taxes paid by vaccine manufacturers, the no-fault Vaccine Injury Compensation Program has largely met all four goals.
⁶⁶

Public concern over vaccine dangers subsided after the program went into effect, due also to a couple of massive studies published in prominent medical journals and reported in the media. With a combined sample of nearly 1 million children, the studies demonstrated ever more definitively the relative safety of the vaccine. A child’s odds of brain damage or death from the disease of whooping cough, these studies showed, clearly exceed risks from the vaccine.
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I wish that were the bottom line on the great vaccine scare. I wish I could close this chapter with the encouraging news that strong action
by government, coupled with strong findings from medical science, put an end to superstition.

Instead, the vaccine scare underscores a fundamental if regrettable reality about metaphoric illnesses, and more generally, about the persistence of fear in American society. A scare can continue long after its rightful expiration date so long as it has two things going for it: it has to tap into current cultural anxieties, and it has to have media-savvy advocates behind it.

The vaccine scare had both. In the late 1980s and throughout the 1990s it resonated with growing concerns over the impact of government and medicine on people’s private lives. As Emily Martin, an anthropologist at Princeton, noted in a book on Americans’ views of the human body, “Accepting vaccination means accepting the state’s power to impose a particular view about the body and its immune system—the view developed by medical science.” And the vaccine scare had a tireless champion, Barbara Loe Fisher, who continually strove to tap into public prejudices. At the end of the 1980s and in the early 1990s, when concern over vaccines ebbed, she continued to publish a newsletter in which she inveighed against the “medical elite” and recast vaccination—a social responsibility if ever there was one—as an individual choice.
⁶⁸

Reporters seldom took Fisher’s bait during those dry years, but by the mid-1990s she made it back onto their Rolodexes. In 1994 NBC’s prime-time magazine show “Now” ran a sensationalistic report introduced by anchor Katie Couric and inspired by Fisher. “What if,” she asked, “we told you that one of the shots designed to protect your children might actually hurt or cripple them? It’s frightening.” Taking precisely the same approach as NBC’s expose of 1982, the program featured affecting tales from parents about their vaccine-damaged kids, shown drooling, stumbling, or being pushed in wheelchairs. This time, though, Fisher provided parents and children featured in the story, and her organization, which had changed its name to the official-sounding National Vaccine Information Center (NVIC), greatly profited. By their own count they received more than 65,000 phone calls to their 800 number as a result of the broadcast.
⁶⁹

A few weeks later NVIC enjoyed another bonanza, this time courtesy of the Miss America Pageant. When Heather Whitestone of Alabama, who is deaf, won the contest, news organizations reported, based on what her mother told them, that the cause of her disability was a DPT shot she received when she was eighteen months old. The vaccination “wiped out all but a tiny sliver of her hearing,” went the story in the
Atlanta Journal and
Constitution and other media, and reporters included comments from NVIC to the effect that this sort of tragedy occurs regularly.
⁷⁰

One can hardly imagine a clearer example of the ignorance that results when journalists eschew real experts in favor of advocates and intimates. A couple of days after the initial stories came out and doctors had reviewed her medical records, the American Academy of Pediatrics announced that Whitestone’s hearing loss had actually been caused by an infection. Ironically, the Heather Whitestone story, rather than being an occasion for frightening parents about vaccines, was an opportunity to educate them about the benefits of vaccination. The infection that left Whitestone deaf (haemophilus influenzae bacteria) can be prevented by means of a vaccine that became available in the late 1980s.

Some journalists did make a point of correcting the earlier reports, but tellingly, even during this subsequent phase of the coverage, NVIC spokespeople were given space to push their paranoias. An article in the
Washington Post,
for instance, included a comment from Fisher suggesting that medical records may be inaccurate because physicians discount parents’ reports.
⁷¹

In the years that followed as well Fisher and her group garnered respectful coverage for dubious contentions that vaccinations were responsible for everything from Gulf War Syndrome to increased incidence of asthma and diabetes to exorbitant profits by pharmaceutical companies. A long piece in Money magazine in 1996 provocatively titled “The Lethal Dangers of the Billion-Dollar Vaccine Business” referred to Fisher as an “expert.” And after a new DPT vaccine was approved by the FDA that same year articles in the Los Angeles Times and
Washington Post
went so far as to claim that “the doggedness of Fisher’s
group ... paid off.” Less likely to cause side effects such as swelling, fever, and irritability, which sometimes accompanied the old shot, the new vaccine is “a happy culmination of 15 years of effort” by NVIC, the media quoted Fisher saying.
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In fact the new vaccine was in development before the public panic began. Research and testing on the vaccine came to successful fruition thanks less to campaigns by Fisher and her compatriots than to the availability of new technology. Moreover, agitation over the old DPT vaccine may well have delayed introduction of the new one, at least in the United States. Drug companies and the FDA, fearful of lawsuits, took an especially cautious approach in testing and approval of the new product, which is not, in any event, as exemplary as its champions make it sound. Compared to the old vaccine, it is less effective and more expensive.
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Whatever else advocacy groups may achieve through fear campaigns about metaphoric illnesses, they rarely facilitate the advance of medical science.

Small Danger, Big Scare

U
pon landing at the Baltimore airport, as he taxied to the terminal, the pilot of my flight from Los Angeles announced: “The safest part of your journey is over. Drive home safely.”

He was right. We stood a greater chance of being killed driving the few miles into Washington from the airport than in the 2,500-mile trip across the continent. In the entire history of commercial aviation, dating back to 1914, fewer than 13,000 people have died in airplane crashes. Three times that many Americans lose their lives in automobile accidents in a single year. The average person’s probability of dying in an air crash is about 1 in 4 million, or roughly the same as winning the jackpot in a state lottery.
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The news media do make reference to these sorts of numbers. They may dish out exaggerated statistics about multiple chemical sensitivity, heroin use among the middle class, road rage, and innumerable other superfluous scares, but not about plane wrecks. They let their readers and viewers know that the likelihood of dying in an airplane crash is roughly on a par with “the risk of being brained by a meteorite,” as one editorial in
USA
Today put it. “U.S. airlines are so safe now that accidents are largely random events. The average passenger would have to take a flight every day for thousands of years before he would be in a plane crash,” Adam Bryant of the
New
York Times has noted.
²

The media’s record isn’t perfect, of course. Occasionally a set of numbers gets misreported. In 1988 the Washington Post ran the headline “Airline Accident Rate Is Highest in 13 Years,” even though the accident rate in fact had been declining for several years. The writers and editors had mistaken
incidences
for rates. While the total number of accidents had increased, the rate—or number of accidents per 100,000 departures—had declined. Put another way, more flights were taking off,
so there were more accidents, but the likelihood of being in one of those accidents had decreased. Indeed, since the 1960s the volume of flights had more than doubled, yet the accident rate had gone down by 85 percent.
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