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David Oshinsky, PhD Speaker biography | Summary | Audio | Q&A transcript | Q&A audio Transcript
DA Henderson: David Oshinsky…is listed here as the George Littlefield Professor of History at the University of Texas, although he does spend a good bit of time in Pennsylvania—but that’s a long story—where he taught some time before. He’s the author of two books. One is The Conspiracy So Immense: The World of Joe McCarthy. He then went on to talk about crime and punishment in the south, Worse Than Slavery: Parchman Farm and the Ordeal of Jim Crow Justice. Both of which won major prizes and were New York Times notable books. He wrote the book called Polio: An American Story. I have read it and it is the best book on the whole history of polio and one of the most dramatic. The whole saga of polio…it’s just remarkable that many people don’t appreciate what an influence this has had on the research in America, on philanthropy and many other things, which he will talk about. Yesterday, that book received a Pulitzer Prize. [Applause] I’ll add as a note, and I’ll remind you again that he is prepared to sign right after this. There are books out there, which you can buy at 20 dollars, rather than 30, and he will be happy to sign, so we’ll see about that at the time. It says cash, credit cards and checks accepted, and probably barter is not acceptable. At any rate, it’s a real great pleasure to have David Oshinsky here, and I’m sure you will enjoy this as much as we’ve enjoyed talking with him. David? David Oshinsky: Thank you for having me. When most people think about polio—I’m looking around the room, there are here my age and above—I know people born in the 1960s and after tend to think of polio as a vaccine. Those of us who were born earlier than that see it as a disease. I grew up—and in looking around, as many of you did—in the years before the Salk vaccine and the Sabin vaccine came to fruition. Those were frightening times. It was for me, and for millions and millions of children, in particular, a time when summer would come and a plague would descend. We couldn’t go swimming, we couldn’t go to the movies, and we couldn’t play with new friends because they might have the virus. Newspapers in my town, in New York City, actually kept box scores. They’d start around Memorial Day and they’d go through Labor Day, and they would actually list the number of kids who had come down with polio each week. I’ll talk a little bit later about some of the number of people who contracted polio. It wasn’t quite as widespread as you might think. Indeed, it was the March of Dimes—a truly revolutionary philanthropic organization—that helped turn polio into a national crusade following world war 11—and, perhaps, into our national obsession. Polio is a virus. It’s an intestinal infection. It’s caused by contact with fecal waste, unwashed hands, shared objects, contaminated food and water. The poliovirus enters through the mouth, travels down the digestive track and is excreted in the stool. Millions of people come down with a very mild case of polio without even knowing it. The symptoms are quite common, like a mild case of the stomach flu. Those who get it build up antibodies that create a lifetime of immunity. But, in a very small number of cases, perhaps one in 200, the virus travels through the bloodstream, into the central nervous system, destroying the motor neurons that stimulate the muscle fibers to contract, and that causes paralysis. It can be a lifetime of paralysis, and if it affects your breathing mechanisms in the diaphragm (which is called bulbar polio) it can cause death. Polio is a visual disease. Everyone my age can remember children in leg braces, on crutches, sitting in wheelchairs, or flat on their backs in terrifying iron lungs. The iron lung was for children who couldn’t breathe on their own, whose diaphragms had been temporarily or permanently paralyzed. The iron lung had been created in the 1920s by a Harvard professor to assist gas workers who were overcome for short periods of time. But we had children who were put into iron lungs for days, months, sometimes years. There are cases today of children from the 1950s still living in iron lungs. No one at that time could have possibly imagined the moral, medical, and financial issues that would surround such long-term care. Polio had been endemic in our world for many, many centuries. Yet for reasons that are still unclear it only became epidemic in the west, and particularly in the United States, early in the 20th century. There are many things about polio we will never fully understand. Once the vaccine became widely available after 1955 the questions surrounding it became moot because we now had a way of preventing the disease. For example, why did polio spread in the summer months? We really don’t know. It appeared to affect more boys than girls. Was that true? Perhaps. The theory was that boys played harder than girls, thus when they encountered poliovirus, their immune system was compromised. Most important, why did polio epidemics occur in the 20th century, and why mainly in the west? The best theory we have is that polio is a disease of cleanliness. In a cleaner, more antiseptic society, children are less likely to be exposed to the poliovirus at an early age, when the infection was milder and maternal antibodies offered a temporary protection. Put simply, in this case, good hygiene brings risks as well as rewards. I can remember my mother checking, literally, every week for polio symptoms. We had to wiggle our toes, we had to put our chin down to our chest, had to [bend our knees] and the like. The slightest cold, and particularly any complaint relating to stiffness in the muscles, would bring the doctor immediately. Polio also came at a time when penicillin and other wonder drugs were doing away with bacterial infection. Indeed, there were many scientists predicting that the world would soon be free of infectious disease. This made polio all the worse. Arriving in full force at the very height of the post-World War 11 baby boom, it was viewed as the crack in the idyllic, middle-class picture window. We must remember that, despite all the new antibiotics, polio could not then be prevented or cured. There was no way for a parent to protect against it. Polio chose its victims at random.
Every child was at risk. The battle against polio would have an enormous impact on American society. Indeed, it would change the way that both philanthropy and medical research are conducted in the United States. And it began with the March of Dimes in the late 1930s. And, as some of you know, the founder of the March of Dimes was President Franklin Delano Roosevelt. At the advanced age of 39, from a well established aristocratic family, a big strapping fellow, FDR came down with a children’s disease, infantile paralysis, in 1931. Why him? We don’t know. He may have been unlucky. There also may have been factors that increased FDR’s chances of getting polio. I’ll go into them briefly. FDR had been an Assistant Secretary of the Navy during World War I. He was very effective in this post, but he was also involved in a scandal involving homosexuality at a naval base in Rhode Island. It’s a long story, but he was accused of employing spies to uncover a “homosexual plot” there. FDR had run for Vice President in 1920; it was a grueling election and he lost. After the election, he is hauled down to Washington in the brutal summer heat of 1921 and grilled mercilessly—and publicly—by a hostile Republican-led Congressional committee. Some suspect his immune system was compromised by this emotional trauma. He then headed back to Campobello Island, off the coast of Maine, where he had a summer retreat, but on the way, he stopped at a Boy Scout jamboree in the Hudson Valley, north of New York City. The last photo we have of FDR walking unassisted—it’s a very poignant picture—is with these boy scouts. It’s very possible that that’s where he encountered poliovirus. He went on to Campobello Island and tried to drown his sorrows in frenetic physical activity for three or four days. At one point he fell off his yacht into the frigid Bay of Fundy. He spent that afternoon in a wet bathing suit, doing correspondence. The message here may be: listen to your mother; chilling, it appears, can be a dangerous thing. When you add all these factors together—the political scandal, the emotional trauma, the trip to the boy scout camp, the frenetic activity after the virus entered his body— FDR may have been a vulnerable candidate for paralytic polio. What we do know is that he would spend the rest of his days searching for both a cure for polio and a vaccine to prevent it—neither of which happened in his lifetime. FDR would go to Warm Springs, Georgia, which became a kind of second White House, where he tried every imaginable kind of therapy. But what he did—and this is far more important—was to set up the March of Dimes. The March of Dimes is really the key to “the people’s crusade” against polio. The first thing it did was to turn philanthropy on its head. Until the 1930s, if one wanted to create a charity in the United States, one approached a few rich people and convinced them to contribute several million dollars.
What the March of Dimes did was to ask for small donations from millions of people. In other words, everyone could give something to stop this children’s disease, and the dime became the symbol of that giving. I’m sure there are many people in the room who collected dimes, as I did, to end this horrible disease. The March of Dimes used Madison Avenue public relations razzmatazz in ways that have never been done before. It is the March of Dimes that instituted the poster child, which is used by every charity today. Each year, beginning in the 1940s, there would be little smiling, blond child—boy or girl—in leg braces, on crutches, surrounded by striking rays of sunshine, saying “With your dimes, we will conquer polio.” It was the March of Dimes that used celebrities for the first time. Elvis Presley and Bing Crosby sang for polio. There would be gala fashion shows at the Waldorf Astoria, in which Grace Kelley would walk down the runway with the latest Dior fashions. Dozens of other cities would imitate this with mini fashion shows. Celebrities loved the publicity of being attached to the conquest of a children’s disease. I have a picture in a book of then Vice-President Richard Nixon, in his suit, as always, pumping gas for polio. Most effective—and enduring—was the Mothers March For Polio, a strategy used by every major charity today (with walks and runs and marches). One night each year, on the anniversary of FDR’s birthday, the March of Dimes would mobilize tens of thousands of women to go door to door collecting for polio. The national slogan became “Turn Your Porch Light On,” and the beauty of this slogan was that the volunteer knew exactly where to go. If the light was on, the family was ready to contribute. The March of Dimes raised hundreds of millions of dollars in the 1950s through this and other devices. Indeed, it raised more money than every other charity in the United States combined, with the exception of the American Red Cross. Now, what did it do with the money? Well, some of it went back into advertising, as you would expect. But, funding was also used for rehabilitation, the long term care of patients, and a good chunk was used for medical research. This was a time when the federal and state funding for medical research was almost nonexistent. The March of Dimes used this money to find a cure for polio, which never came, and for a successful polio vaccine, which arrived in 1955. The March of Dimes brought together many of the best virologists, biologists, and epidemiologists in the United States. To create a successful vaccine, three problems had to be solved. First, how many types of poliovirus were there? This was vital, for a vaccine would have to contain every type in order to offer full protection. March of Dimes researchers tested poliovirus from all over the world. The process took a full year. It turned out there were three separate types. Second, how did one produce enough safe poliovirus for use in a vaccine? A researcher named John Enders, who won the Nobel Prize in 1954, discovered that poliovirus could be successfully grown in nonnervous tissue, which was safe for use in humans. This guaranteed a plentiful supply of poliovirus for the coming vaccine. Third, how did polio travel through the body? This was absolutely crucial, for the prevailing theory up until the late 1940s was that poliovirus entered the body through the nose, went to the brain, and then traveled directly into the central nervous system. If that were the case, if polio never entered the bloodstream, then a vaccine that produced antibodies in the blood would do no good against this particular disease. One of the beauties of polio research, is that it included the best minds in the field, regardless of race, gender, or pedigree. The March of Dimes recruited scientists who were young, smart, aggressive, and ambitious. At a time when there was tremendous anti-Semitism in the medical community, it gave out the largest grants to two Jews, Jonas Salk at the University of Pittsburgh and Albert Sabin at the University of Cincinnati. At a time when there was enormous discrimination against women in the field of medical research, the March of Dimes subsidized the work of Dorothy Horstmann, at Yale, and Isabelle Morgan, at Johns Hopkins—each of whom proved indispensable in polio research Horstmann was the first researcher to discover that poliovirus does enter the blood stream before it goes into the central nervous system. She was the one who found that a vaccine could work—a discovery of immense importance. Isabelle Morgan produced a polio vaccine—a killed virus vaccine—in the late 1940s, and it was quite successful. She was about to begin human testing; she was well ahead of Jonas Salk at this point. Then, as happened with so many women of that era—and many today—Morgan made a choice. In her late thirties, she decided she would get married and start a family; she left polio research forever. I believe that if she had stayed the course, remaining at John Hopkins which was well funded and filled with brilliant researchers, we would be talking today about the Morgan vaccine rather than the Salk vaccine. She clearly blazed the path that Jonas Salk took to completion. There would be no lone wolves in this research effort. The March of Dimes clearly encouraged competition—with Salk working on a killed virus vaccine while Sabin worked on a live-virus vaccine—but it also demanded cooperation. All information would be pooled. The March of Dimes was the first organization to give out long-term grants to researchers. Five years was the norm. The research was carefully monitored by a central committee dominated by top scientists in the field. Some grants were pulled after a year; others were fully funded and renewed. It was the March of Dimes that originated the notion of indirect costs. What does this mean? One of the first grants, for $50,000, went to John Enders at Harvard. Enders was thrilled, but Harvard turned it down, explaining: “Who’s going to pay for the supplies and the security and the heat and the lighting and the monkeys? We can’t do this.” So, in addition to funding the grant, the March of Dimes also paid for the indirect costs of the grant. Medical research in universities today would be hard pressed to survive without these indirect costs. Thus, as the March of Dimes revolutionized philanthropy in the United States, it also revolutionized medical research. In 1954, with little government interference or cooperation, the March of Dimes produced the largest public health experiment in American history. Well more than a million children were lined up and given either the Salk polio vaccine or a look-alike placebo. Nobody could be certain whether the vaccine worked, or whether it was even safe; but it tells you something about the enormous fear of polio in this era that parents rushed to line up their children to take part in that experiment. My mother was the type who accounted for every aspirin that we took in our house, yet she pushed me right into the polio line to get my shots. Now, my mother was a very tribal woman and I always felt that her thinking was, “We’re Jewish. Salk’s Jewish. How bad can it be?” [Laughter] This was a double blind experiment, meaning that neither the child getting the vaccine, nor the doctor or nurse giving the vaccine knew whether the child was getting the real vaccine or the look-alike placebo. Jonas Salk dramatically and publicly opposed a double blind study because he was confident that his vaccine worked and he felt, therefore, that it would unconscionable to deny children the real vaccine in the middle of polio season, when 50,000 kids a year were contracting the disease. But the scientific community demanded a double-blind study to ensure full confidence in the results, and the March of Dimes—and eventually Salk himself—went along. This was in an age when computers were still new and primitive. All of this material—three separate polio shots involving almost 2 million children—had to be coded and analyzed by a staff of evaluators at the University of Michigan. It takes a full year, but in April of 1955, at a dramatic press conference on the Michigan campus, Dr. Thomas Francis, the lead evaluator, declared the Salk vaccine to be safe, potent, and effective. A national celebration began. Schools closed, fire whistles went off, and church bells rang. It was as if a war had ended, and in fact a war had ended, the war against polio. Most amazing, it was all done voluntarily by millions upon millions of Americans who gave their time, their money, and their children to this cause. The Salk vaccine, as you know, had a dramatic impact on lowering polio rates in the United States. Unfortunately, I don’t have time to go into the Sabin vaccine, the live-virus vaccine that competed with Salk’s. Sabin believed it was far more effective—as did most members of the research community. Sabin and Salk had a wildly competitive relationship. Sabin was forced to go the Soviet Union to test his vaccine because so many children had already been given the Salk vaccine in the United States. Sabin later said that there’s just no better place than communist Russia to test. [Laughter] Everybody shows up and lines up. There are no laggards there. His vaccine proved to be extremely effective, and indeed, by the 1960s, it took over as the vaccine of choice in the United States. Because it creates a natural infection in the body, it produces stronger immunity. It is given through the mouth, rather than through injection, so it’s simpler and cheaper to use. The key problem with the Sabin vaccine is that one in several million children who take it, or a perhaps diaper-changing parent, will actually come down with polio from the vaccine itself. So, you might get down to 15 cases of polio in the United States each year , but you’ll never get below that level, because there’ll always be a tiny number of vaccine-induced cases. As some of you may know, we have now gone back to the using the Salk vaccine in the United States for just that reason—so that all cases of polio can be eliminated. A final word about the March of Dimes: There was some criticism that it over-hyped the perils of polio in the post-World War 11 America. By this I mean that the disease, even at its worst, was never a raging epidemic in comparison to other serious childhood diseases such as cancer. There were a maximum of 50,000 cases and maybe 5,000 deaths a year at the height of the polio epidemics in the 1950s. Still, the March of Dimes raised the lion’s share of charitable money, and it angrily refused to join the United Way or the Communist Chest, saying, essentially, “We have our mission, which involves both providing a lifetime of care for polio patients and finding a way to end the disease.” It also said, in effect, “We have made a compact with the American people: you give us your money and we will find you a vaccine.” So, there really are two ways of looking at it. The March of Dimes did, indeed, take a lion’s share of the charity dollar in this era, but—far more important—it made good on its promise to forever end the scourge of polio in the United States. The March of Dimes also created the first celebrity scientist in Jonas Salk. Salk became Sir Galahad in the white lab coat. His picture adorned time magazine. He went along with it, I suspect, because he understood it was good for the polio crusade. But, it also made him an outcast in the scientific community, and that is really remarkable. Albert Sabin was the scientist’s scientist and Jonas Salk was the people’s scientist. Jonas Salk is the only major polio researcher never to be inducted into the National Academy of Sciences. It’s sad when you think about it, but he was black-balled by Albert Sabin and others who claimed that he had never done anything original. Sabin actually said of Salk’s vaccine, “I could go into the kitchen and do what that guy did.” The competition between them was so fierce that neither won a Nobel Prize, but Jonas Salk once said, “I really don’t need it because everyone believes I did win it,” and there is, I think some truth in that. [Laughter] Finally, it was through the March of Dimes, I think, that we entered the modern era of extraordinarily focused medical research. The March of Dimes was really the first organization that set up a committee of virologists who determined what had to be done and the steps that had to be taken to do it. It found the best people, gave them the best facilities and lavish funding, and paid for the indirect research costs. In turn, it demanded cooperation as well as competition, and in the end its efforts gave us a vaccine—actually two vaccines—that have all but eradicated polio in the United States today. The crusade against polio in America took place before the federal government became deeply involved with protocols and research money and regulation. Some of you may know that much of the earlier polio testing was done on children in state facilities, without little heed to contemporary standards regarding informed consent. It was a very different time. But the real message of the polio crusade, I think, is the message of volunteerism. Millions of people gave their time, their money, and yes, even their children, to an extraordinarily worthy cause. Their unity reflected the steady faith of post-World War II American society in the progress of medicine and technology and the certainty of positive change. The fear of polio no longer haunts America, and, God willing, it will soon be gone from the world. As we look back today, that is a lesson well worth remembering. Thank you very much. [Applause] Proceedings of the May 23, 2006 Summit: Disease, Disaster, & Democracy Transcription by CastingWords |
