MR. KOJO NNAMDIFrom WAMU 88.5 at American University in Washington, welcome to "The Kojo Nnamdi Show," connecting your neighborhood with the world. Humans have always feared the diseases and toxins around us. Two-thirds of Americans are now concerned about a widespread Ebola epidemic in the U.S., even though officials assure us that our modern health care system can contain such an outbreak. Meanwhile, serious diseases like measles and whooping-cough are making a comeback. Somehow, the 20th century medical breakthrough of childhood vaccinations has been trumped by fears about the vaccinations themselves. And a rising number of educated, wealthy parents are opting out of vaccinating their kids.

MR. KOJO NNAMDIWhat does this conflicted relationship with disease and medicine say about us? Our guest, Eula Biss, has some thoughts. She joins us in studio. Eula Biss is a journalist, author and National Book Award winner. Her latest book is, "On Immunity: An Inoculation." She teaches at Northwestern University in Chicago. Eula Biss, welcome.

MS. EULA BISSThanks very much for having me.

NNAMDIYou can talk with Eula Biss by calling 800-433-8850, or send email to kojo@wamu.org. You can shoot us a tweet @kojoshow or go to our website, kojoshow.org and join the conversation there. Eula Biss, you could not have anticipated this when the book went to press, but now we have an Ebola outbreak that has triggered all kinds of responses -- the main one being, fear. You've spent quite a bit of time thinking about these issues for this book. What do you make of our state of mind over this?

BISSHmm. Well, I think the fear about Ebola makes sense in some ways. But really what this book pushed me into wondering is, what's the most responsible way to deal with our fear? We are going to be fearful. We are going to find things that threaten us. But how do we act responsibly from fear? So panicking over Ebola is obviously not going to be productive. But if we're afraid of it, perhaps we can turn that fear towards helping people who are suffering. But I think that all too often our fear gets turned in a direction that actually causes suffering to people.

BISSSo we live in a country where someone, for example, can feel fear of an unarmed teenager walking down the street and shoot them dead. And that's a consequence of irresponsible fear, I think.

NNAMDIWhat got you interested in looking at our conflicted relationship with disease, toxins and vaccines?

BISSI was pregnant with my son five years ago and I just began doing some -- what I thought would be some quick research on vaccination, to decide whether I was going to vaccinate him or not and whether on schedule or not. And I did make that decision fairly swiftly. But the topic was so expansive, it kept opening out into new questions, that long after my son was vaccinated, I continued reading and researching into the subject.

NNAMDIWhat I appreciated was that in this book you share that you, yourself, are someone who worries a great deal about toxins, about disease, about the environment. You are therefore not unsympathetic to fears -- rational or irrational.

BISSYeah. No, I don't think that the goal is to not feel fear or to not worry or not be anxious or to erase our misgivings, but to examine our own fears and figure out what they're really about. So the process of writing this book was, for me, a process of trying to figure out why I was somewhat reluctant to vaccinate my son and what those fears were really about.

NNAMDIOur guest is Eula Biss. She's a journalist, author and National Book Award winner. We're talking about her latest book, "On Immunity: An Inoculation." She teaches at Northwestern University in Chicago. If you'd like to join the conversation, give us a call at 800-433-8850. Did you vaccinate your kids on the recommended schedule? Do you have concerns when it comes to vaccinations? 800-433-8850 or you can send email to our -- to kojo@wamu.org. Or shoot us a tweet @kojoshow. The regular vaccine schedule for children approved by the CDC and the American Academy of Pediatrics includes 25 shots in the first 15 months of life. What are kids getting protection from?

BISSFrom 14 different diseases, and that includes measles, mumps, rubella, polio, HepB and several others that I'm probably forgetting. And some of these are diseases like measles and pertussis that are highly contagious and that, when vaccination rates fall even slightly, reemerge. And others are diseases like polio, that would take much lower vaccination rates to reemerge in this country. But we've seen polio reemerge in other countries around the world recently.

NNAMDIYou were kind of slow in the initial stages, after you had your son, getting vaccinations. You skipped the first shot, right?

BISSYes, I did. The first shot is recommended within 12 hours of birth. It's the HepB shot for newborns. And right before my son was born, I went to the pediatrician who was going to be his pediatrician, and I was overwhelmed with the research. At that point, I thought this research would be easy and quick and it wasn't. And I said, what is this shot for? And can you explain to me why I need this? And the pediatrician that I had been recommended to -- I'd been recommended to by many other women like me, so well-educated, white, upper-middle-class women -- and I didn't realize that this was a pediatrician who was recommended because he didn't advocate vaccination.

BISSAnd he said to me, people like you don't need the shot. This is something for prostitutes and inner-city women. You don't need this. And what I'm embarrassed about now is that I kind of breathed a sigh of relief and walked away from that appointment thinking, Oh, good. That's one I don't need to do. But on reflection, in the months following that moment, I began to think that I'd made a mistake -- especially as I began to research HepB. And one of the things I learned as I researched HepB is that part of what puts you in a risk group or can put you in a risk group is receiving a blood transfusion. And I received a blood transfusion right after my son was born. And the most common way that newborns get HepB is from their mothers.

NNAMDIRecently, The Hollywood Reporter did an investigation about the vaccination rates in L.A.'s wealthiest neighborhoods. They found that in neighborhoods like Santa Monica and Beverly Hills, they now have rates on a par with very poor, third-world nations and that there's a similar phenomenon in private schools in New York City. That might come as a surprise to some of us, but not to you. Why?

BISSYeah, that isn't surprising to me. In doing the research I did for this book, I began to understand that the attitude that leads people to resist vaccination in my demographic -- so, again, upper-middle-class white women with a college education, maybe a graduate school education -- is a kind of extension of privilege, actually. It's coming from a mindset that's accustomed to having things that other people don't have and being able to avoid risks that other people are subjected to. And when you're accustomed to thinking and living that way, it isn't that much of a stretch to believe that you ought to be spared the risks of vaccination while reaping its benefits.

NNAMDIBecause you are somehow different on the basis of your education, on the basis of other demographic factors, that what is likely to affect people who are poor or people of color is not likely to affect or infect you.

BISSYeah, there's these very classed and racialized ideas about disease. So that this idea that, yeah, only people with -- only poor people who are living in what I consider bad conditions will be prone to this. No my child. I will keep my child pure and clean. And that alone will protect my child from disease. These attitudes are very old. You can -- you see the same attitudes in Victorian England around disease, where people were, at that time, very convinced that disease was caused by poverty rather than something that occurred among people who lived in poverty.

NNAMDILet's take a phone call from Shannon in Annapolis, Md. Shannon, you're on the air. Go ahead, please.

SHANNONHi, thanks. So I wondered if you could comment on the possibility that some of this resistance is a product of people seeking certainty in their lives? The idea that somehow we can predict the end of the story before it gets to us or before we get to the end? And the idea that, you know, laymen's medical scientific knowledge is so readily available on the Internet now, and yet physicians themselves have still not come around to the idea that they really need to begin to discuss the nitty-gritty of this science with their patients in the exam room.

BISSMm-hmm.

NNAMDIEula Biss.

BISSYeah. And I'll start with the end of your comment, which I do think that one of the problems with our medical system is that most doctors don't have time to do patient education. And most doctors can't go into detail about the reasons why we're vaccinating because there just isn't time in the appointment for that. My child's second pediatrician actually did spend quite a bit of time with me talking about why I needed the vaccines that my son was getting. And that made a huge difference for me and prompted me to do deeper research. But that alone, I think, the information coming from the doctor alone isn't going to solve the whole problem.

NNAMDIThank you very much for your call, Shannon. Some parents say that not vaccinating makes intuitive sense. Can you talk about that and why we're so indifferent to real statistical risk, but so focused on perception?

BISSYeah. This was a -- this area of risk perception became really interesting to me when I was researching this book. Especially the idea that many of the things that -- many of the places where we perceive risk are not actually the places where we're experiencing risk in our lives. So we may, for example, fear cancer and hurricanes when there are many other less publicized things that are much more likely to kill us. And one of the examples I use in the book is that the two most dangerous consumer products are beds and bicycles. And these are two things that we tend not to be extraordinarily fearful of.

NNAMDITwo of my favorite places. Right now, we're fearing the heck out of Ebola.

BISSYes. Yeah, certainly. And that connects to what the caller was talking about, you know, where there's a lack of certainty and a lack of information and a sense that we don't yet know very much. I think that really exacerbates fear.

NNAMDIThe result of falling vaccination rates that we mentioned in places like Los Angeles is that diseases like measles and whooping cough are on the rise. What does it mean that we are dismantling the collective protection against these diseases that we built up?

BISSMm-hmm. Well, for certain people, it's very, very dangerous. So, for instance, with whooping cough, the people who are most in danger are newborn babies. And with nearly every disease that we vaccinate against, there is a minority of the population that is particularly vulnerable to that disease. So with whopping cough it's newborn babies, with rubella it's pregnant women, influenza it's often the elderly. And so though the majority of the population may not feel threatened by these diseases, when the majority does not accept vaccination, we're failing to protect a very vulnerable minority.

NNAMDIGot to take a short break. If you have called, when we get back, stay on the line, we will get to your calls. If you'd like to call the number is 800-433-8850. Are you worried about the return of illnesses like whooping cough and measles? And what about Ebola, 800-433-8850? You can send email to kojo@wamu.org or you can go to our website kojoshow.org, ask a question of Eula Biss or make a comment there. I'm Kojo Nnamdi.

NNAMDIWelcome back. Our guest is Eula Biss. She's a journalist, author and National Book Award winner. We're discussing her latest book. It's called "On Immunity: An Inoculation." She teaches at Northwestern University in Chicago. Going directly to the phones and Sarah in Silver Spring, Md. Sarah, you're on the air. Go ahead, please.

SARAHThank you. I just wanted to mention a couple things. First of all, as far as whopping cough, I know we had some whooping cough cases here locally here in Montgomery County. And they were vaccinated children. And there's even research to show that the Dtap vaccine is causing an increase in para pertussis infection and that this is what many of the children are infected with.

SARAHSecondly, I just want to bring up a huge concern for parents is the 1986 National Childhood Vaccine Injury Act in which all liability was removed from vaccine manufacturers. And it was at that time that the schedule increased so rapidly without study. I found my own vaccine record as a child. I receive the MMR, Dtap and the polio. And now like the author said, these children are supposed to be vaccinated within 12 hours of being born. And the amount of vaccines is just causing parents concern when there's no liability from the makers?

NNAMDIHere now, Eula Biss.

BISSSo there's a lot going on there. I'll start with pertussis. Pertussis is really complicated. And as you observed, the -- some of the epidemics we've seen recently have two causes. And one is falling vaccination rates. The other is fading immunity from the more recent pertussis vaccine. So the acellular pertussis vaccine, which we now use, replaced the whole cell pertussis vaccine.

BISSAnd pertussis is the correct name for whooping cough.

BISS...for whopping cough, yes, yes. And the reason that vaccine was replaced was it tended to be reactive. It gave a lot of fevers and reactions. And this was something that many parents pushed back against. So we're now using an acellular vaccine that is less reactive but it also doesn't produce, we're finding, incredibly long-lasting immunity. So many people may only be protected for a few years. I don't think it's yet known exactly how long. So, yeah, that definitely -- that vaccine needs to be improved. And that's definitely a factor in some of these epidemics.

NNAMDIRaises another interesting point though, is any vaccine failsafe?

BISSNo. And that's part of why mass vaccination is so important. So it's especially important when we're dealing with a vaccine that is not incredibly long lasting like Pertussis, the rates of vaccination that we need to offer protection are even higher than with a vaccine that's highly effective. But even highly effective vaccines aren't necessarily going to offer protection to everyone because everyone's immune system is different. And so some people's immune system might not actually mount immunity in response to a vaccine.

BISSSo when a vaccine introduces some killed or weakened virus to your system, most people, say 85, 90 percent of people will -- their systems will mount a response and they'll develop antibodies. But some people, maybe because of immune dysfunction or other reasons will not mount an immune response and will not be immune to that disease, even though they've been vaccinated. And that's why it's even more important for everyone around them to be vaccinated to offer protection.

NNAMDIHere's Barbara in Reston, Va. Barbara, your turn.

BARBARAHi. Thank you for doing a lovely show. I was very pleased to hear it. I will confess to being a pediatrician and I wanted to just quickly say, we don't give 25 needles to kids during their first year for vaccine because a lot of them are given in combo. So...

NNAMDIIt's only really about ten shots, right?

BARBARAYeah, even -- and it depends on how the combinations are given. And we actually do fairly good research -- actually good research on how the combinations are given, which combinations work most effectively, where they can be given. So I'm very pleased your author is talking about this. I really care about the vaccines and I hate seeing kids with whooping cough. It's so sad.

NNAMDIBarbara, thank you very much for your call. Care to call, Eula Biss?

BISSYeah, thank you for that. I think that that just points us towards how the numbers can be skewed sometimes to make it seem like what we're doing is incredibly excessive. And the caller before this one mentioned that sense that we're giving an excessive number of vaccines, when the decision for each one of these vaccines is very carefully weighed and usually takes many years to be okayed and determined.

BISSAnd for example the Hep B shot given immediately after birth. There was a decade in which we tried a different strategy with Hep B. And in 1981 when the Hep B shot was first introduced, it was only recommended for IV drug users, gay men and prisoners. And that did not bring out rates of Hep B. A decade later it was recommended for all newborn infants. And that recommendation was highly effective. It basically eliminated the disease in children.

NNAMDIOn now to Ann in Falls Church, Va. Ann, your turn.

ANNThank you. I want to thank you for doing this program and I want to thank the author for what she's doing. I have a 21-year-old son who has autism so I was kind of in the vanguard of the new explosion, if you want to call it. And for many years I helped counsel parents of newly diagnosed autistic children. And the science denying was just unbelievable.

ANNI actually had a very highly educated white upper middle class woman just like us say to me, I would rather 50 kids had died of the measles than this had happened to me. And I'm just shaking. I can't -- it's caused riff in my own family because I've said -- they're like, well, you know, we don't want to have happen to us what happened to you. I'm like, okay. You know, A. what's wrong with what happened to me and B. I cannot believe that you would put other children in your community at risk. It's just -- thank you for doing this in a non-emotional, rational way because a lot of us who agree with you, you know, we get crazy because other people get crazy. And it really is something that needs to be talked about.

NNAMDIAnn, thank you very much for your call. Here's Eula Biss.

BISSThank you for that. The immunologist Paul Offit wrote a book called "Autism's False Profits" where I think he addresses part of what's going on for you. One of the things he points out is how upsetting and isolating this is for parents of children who have autism and how the storm of theories and misinformation around autism creates a really difficult environment for parents who already have a difficult situation. And I think he speaks to that better than I can speak to it, but I think that "Autism's False Profits" is an excellent book kind of addressing that issue that you brought up.

NNAMDIAt the root of everything we're talking about is fear, isn't it?

BISSUm-hum.

NNAMDII'd like you to focus on that for a moment by reading from your book. I think it's on page 36 where you do write about the issue of fear.

BISS"Perceptions of risk, the intuitive judgments that people make about the hazards of their world, the historian Michael Willrich's observes, can be stubbornly resistant to the evidence of experts. We don't tend to be afraid of the things that are most likely to harm us. We drive around in cars a lot. We drink alcohol. We ride bicycles. We sit too much. And we harbor anxiety about things that statistically speaking pose us little danger. We fear sharks while mosquitoes are, in terms of sheer numbers of lives lost, probably the most dangerous creature on earth.

BISSDo people know which risks lead to many deaths and which lead to few, the legal scholar Cass Sunstein asks? They do not. In fact, they make huge blunders. Sunstein draws this observation from the work of Paul Slovic, author of "The Perception of Risk." In a study that invited people to compare various causes of death, Slovic found that people tended to believe that accidents cause more deaths than disease and that homicide causes more deaths than suicide, when the opposite is true in both cases.

BISSIn another study people significantly overestimated the fatality rates of highly publicized or dramatic dangers like cancer or tornadoes. One could interpret this, as Sunstein does, to mean that most people are just wrong about risk. But risk perception may not be about quantifiable risk so much as it's about immeasurable fear. Our fears are informed by history and economics, by social power and stigma, by myths and nightmares. And as with other strongly-held beliefs, our fears are dear to us. When we encounter information that contradicts our beliefs, as Slovic found in one of his studies, we tend to doubt the information, not ourselves."

NNAMDIEula Biss reading from her book "On Immunity: An Inoculation." She is our guest this hour. You can talk to her by calling 800-433-8850 or by sending an email to kojo@wamu.org. You can shoot us a tweet @kojoshow. You also remind us that in the year 1900, one in ten children died before their first birthday.

BISSYeah, that was a somewhat shocking statistic to me. I knew that infant mortality was much higher long ago but I didn't know that it was that high that recently. And one of the things to note is that very few of the vaccines that are available to us today were available in 1900. One of the vaccines that was in use then was the smallpox vaccine which has actually made itself obsolete. And that's something we haven't discussed yet, that very successful vaccination campaigns can actually make vaccines no longer necessary. So this happened with smallpox. It's theoretically possible with both polio and measles. We just haven't gotten there yet.

NNAMDIFascinated to learn that some of the earliest vaccines were developed because farmers in the 18th century noticed something peculiar about milkmaids. They didn't seem to get smallpox. Can you talk about that and how that evolved into what we know now as vaccinations?

BISSYeah, vaccination emerged out of folk medicine. And so this understanding that milkmaids or farmers who had contracted cowpox from cows were immune to smallpox was fairly widespread before any doctors decided to test it. And one of the first vaccinations was actually performed by a farmer on his two young sons and his wife. The farmer had already contracted cowpox from a cow and a smallpox epidemic was in his area. And he used a darning needle to push infectious matter from a cow into his son's arms and his wife's arm. And he indeed make them immune to smallpox.

BISSAnd it was many years, about 20 years later that Edward Jenner first began testing what was already known to be an effective preventative measure against smallpox.

NNAMDIThe term vaccination itself comes from the word cow. And inoculation goes back farther than those milkmaids, centuries before germ theory came about. Can you explain?

BISSYeah, yeah, so variolation which was the original form of inoculation was pioneered in China. And there's debate over exactly when but it may have been as early as the 10th century. It was at the very least many hundreds of years earlier than vaccination reached the west. It was also practiced in India. And variolation was a method of infecting -- purposely infecting usually an infant with a mild case of smallpox in order to prevent a very serious case that would be likely to kill the child.

NNAMDIOn now to Mary in Washington, D.C. Mary, you're on the air. Go ahead, please.

MARYYeah, hi. I just -- my comment is that I think fear mongering is one of the major things that plays -- that's one of the major arguments on the part of pro-vaccination people in the medical establishment. And I think it really detracts from the argument to vaccinate people's children. And my kids are all vaccinated and the reason they're vaccinated is because I think it's worth the risk that there could be an adverse reaction. But to pretend there is no risk of adverse reaction doesn't do anybody any favors.

MARYAnd I believe that your guest is very skewed pro-vaccine and not in an illogical way. And first of all, I find it impossible to believe that five years ago someone who was a journalist was not sure that they were going to get into a whole can of worms by looking into vaccinations. I don't believe that. And I don't think you're doing the pro-vaccination argument any favor by acting like the people who are scared to vaccinate their kids have absolutely nothing logical to say about it. I think there are a lot of logical reasons people would have concerns about vaccines. And to address that honestly is the only way that the medical establishment is going to be a trusted source of information for people to go to.

NNAMDIAnd what do you mean by addressing that honestly?

MARYWell, when we pretend that it's just a matter of being white and upper class and privileged and when we say, oh, there are really only ten shots, they're not multiple, the numbers are skewed. I mean, I think people are intelligent enough to know that if you give your kids ten shots and each shot has four vaccines in it, that's live vaccines. It doesn't matter if it comes in ten shots or 40 shots. We're talking about the amount that's going into the child's body.

MARYAnd when the CDC says, well, the chickenpox is now a dangerous childhood vaccine and, you know, you should be afraid your kid will die from chickenpox, it's just crazy. They should just say, chickenpox is an itchy inconvenient disease and we have a vaccine. You might as well get it. And when they pretend that all these diseases are suddenly super dangerous and scary, they're not helping people make decisions. They should just say there's a slight chance your kid could be harmed from the vaccine. There's a slight chance your kid could be harmed from the disease.

MARYAnd where in the case of polio there's a slight chance -- there's really a miniscule, zero percent chance that anyone who's probably going to ever be infected by polio in this country. But there's a miniscule chance but the chance of your kid being hurt by that is large. And then that's how parents can make their decisions. And so they're pretending that there's no good logical reason to not take vaccines for your kids.

NNAMDIEula Biss.

BISSYeah, I absolutely agree with you. I think there's a lot of legitimate fears that play into people's reasons for not vaccinating. I think people have legitimate reasons for being suspicious of the government, for instance. I think people have legitimate concerns about the medical system. I think people have legitimate concerns about American excesses in general.

BISSBut I also think that for me the primary motivator for vaccinating my child is actually not fear that he'll contract an infectious disease or fear that he'll die. It's a sense of moral responsibility that comes from the knowledge that some diseases that we don't consider very serious, like chickenpox, are actually quite threatening to certain people who are in a minority in our population.

BISSSo for instance, chickenpox can be deadly for a child who's being treated for cancer. It can be deadly for a child who's HIV positive. There's a number of different groups of people to whom chicken pox is considerably more threatening than it is -- then I suspect it is for my child. So for me the most compelling argument here is not a fear-based argument so much as it's a moral responsibility-based argument. And an argument based on what we, as citizens owe to each other.

NNAMDIBut is our caller correct to say that in her view what the medical establishment does is encourage people to have their children take vaccines by instilling fear into them?

BISSI think that that is out there, though I wouldn't place the blame on the medical establishment. I see that kind of exaggeration of the dangers and risks associated with some of these diseases for the general population. I see that happening, but actually, you know, when I talked to my pediatrician or when I look at the fact sheets that are distributed to parents before vaccination, I don't see fear mongering happen there.

NNAMDIWe got an email from Nathan, in Arlington, who said there was an interesting show on WAMU two weeks ago about food additives and processed foods. The overwhelming opinion was negative towards additives. However, I find that many of the same additives and preservatives are worse in vaccines. And worse, are in vaccines. But when people say they do not vaccinate because they do not want these chemicals pumped directly into their bloodstream, they're generally labeled crazy. I don't understand the double standard."

BISSI'm not sure what additives you're talking about. So to say that many of the same additives and preservatives we find in food are found in vaccines is probably a stretch. Some vaccines have preservatives in them to make them safe. So to prevent bacterial growth that could infect you. And those -- the amounts of those preservatives that you receive through vaccination are incredibly minimal compared to the other sources of those preservatives in your life. So you may -- if you receive all your vaccinations, you may not get the amount that you get through one food source in your life.

BISSBut also these preservatives and additives are very carefully monitored. They're -- I think that part of what I'm hearing and the anxiety behind that question is an anxiety about how well regulated our food is. And I think that sometimes we're transferring anxieties about where there's failure in our regulatory system to vaccination. Vaccinations are actually very well regulated, compared to, for instance, food or water or air. And I think that we would all be enjoying a better quality of life if our food, air and water were as well regulated as our vaccines.

NNAMDIGot to take a short break. When we come back we'll continue our conversation with Eula Biss. She's a journalist and author, National Book Award winner. Her latest book is called, "On Immunity: An Inoculation." You can still call us at 800-433-8850. Do you think fears about toxins in the environment are overblown? 800-433-8850. You can send email to kojo@wamu.org. I'm Kojo Nnamdi.

NNAMDIWe're talking with Eula Biss about her latest book. It's called, "On Immunity: An Inoculation." Eula Biss is a journalist, author and National Book Award winner. She teaches at Northwest University in Chicago. You spend some time exploring how alternative medicine fits into this. It's a fascinating aspect of the debate. Can you read a little bit from -- I think it's on Page 40?

BISS"One of the appeals of alternative medicine is that it offers not just an alternative philosophy or an alternative treatment, but also an alternative language. If we feel polluted, we are offered a cleanse. If we feel in adequate, lacking, we are offered a supplement. If we fear toxins, we are offered detoxification. If we fear that we are rusting with age, physically oxidizing, we are reassured with antioxidants. These are metaphors that address our base anxieties.

BISS"And what the language of alternative medicine understands is that when we feel bad we want something unambiguously good. Most of the pharmaceuticals available to us are at least as bad as they are good. My father has the habit of saying, 'There are very few perfect therapies in medicine.' True as it may be, the idea that our medicine is as flawed as we are if not comforting. And when comfort is what we want, one of the most powerful tonics alternative medicine offers is the word natural.

BISSThis word implies a medicine untroubled by human limitations, contrived wholly by nature or God, or perhaps intelligent design. What natural has come to mean to us in the context of medicine is pure and safe and benign. But the use of natural as a synonym for good is almost certainly a product of our profound alienation from the natural world."

NNAMDIEula Biss reading from, "On Immunity: An Inoculation." We have a desire for purity that stems most probably from our very unnatural world.

BISSYeah, I think that a lot of our anxieties about our environment, about our political situation, about many aspects of our modern lives get translated into a desire for purity. And sometimes that desire for purity is satisfied through kind of consumer culture that encourages us towards purified water, food that's organic or pure in some way, pure and natural clothing. And this can become a kind of fixation.

BISSAnd this is not historically new. So, again, the Victorians -- people in Victorian England also had a fixation with purity, and especially bodily purity and keeping their blood, in particular, pure. And it's easier to see when you look outside our time period and into that Victorian time period, how much that fixation with purity involves anxieties about, again, race and class. So people wanting to keep their blood pure involved a strong desire not to be polluted by the lower class.

NNAMDIYou write about the idea of children developing immunity naturally, without vaccinations. It certainly does sound appealing, but you see the nature versus science debate as a false one?

BISSYeah, I'd seen many of the things that are set up as polarities in this debate as false. And particularly the nature versus science debate. First of all, I don't think that vaccines are inherently unnatural. As I mentioned before their source is folk medicine. And the very original vaccination involved a purely natural substance which was pus from the sore on a cow. And our technology has evolved from that point.

BISSAnd that's for the better because vaccinating yourself directly from a cow could involve getting other diseases, like tetanus, which some cows carry. But it's this idea of a vaccine being unnatural is also challenged by the very way vaccines work. And I think it's quite a beautiful technology in that it's really enlisting our own bodies in protecting themselves. So vaccines aren't drugs that are given to us to do something to our bodies. They aren't chemicals. They are what are called biologicals.

BISSSo they're small bits of weakened or sometimes killed organisms that our bodies recognize as dangerous. And then our bodies move into the immune response that they typically have to dangerous things. The beauty is that we don't actually get sick in most cases, when all goes well we don't get sick. And we're left immune, not because a drug has made us immune, but because our own immune systems have produced the antibodies necessary to make us immune.

NNAMDIHere's Sandy, in College Park, Md. Sandy, you're on the air. Go ahead, please.

SANDYHi. I just wanted to mention that there are some of us educated college people who are not just classes. That -- and it's not that we don't have a moral sense that we don't vaccinate our children. For me, for example, our family has a genetic indicator that has a nerve conduction delay, which the doctor's probably familiar with, (unintelligible) and that's a very wide spread…

NNAMDIOur guest is not a doctor.

SANDYOh, okay. Well, anyway, (unintelligible) and it really affects your nerve muscle conduction delay. And when I was eight years old I got the three-in-one shot and got out of bed and fell down on the floor because my leg went out from under me. So when I was having children I thought well, I better research this. And a lot has been learned about (unintelligible) since I was a little girl in the 1950s.

SANDYAnd so I made the decision consciously not to vaccinate my children because I would rather them have the risk of getting some disease then imposing and injecting them with a substance that could cripple them. And there are people whose children have been crippled by a vaccine. And regardless of the hurt immunity aspect, if you're a parent and it's your child who can no longer walk because they've had a vaccine, you know, I would have felt like the worst criminal on the universe if I had done that to my child.

SANDYSo it wasn't that I was immoral or inconsiderate or privileged or just, you know, highfalutin educated, I took a responsible attitude to informing myself what was in the vaccine. I read a book, which told me what each vaccine was composed of -- and some of those ingredients are downright disgusting, if not dangerous. So I would say that…

NNAMDIDownright disgusting, if not dangerous, to all children or to children who had your particular family's genetic trait?

SANDYWell, downright dangerous to all children. Mercury is not one of those really good chemical -- heavy metals to put into your body. And when you're injecting that into a small infant with a very tiny nervous system, I don't care how small the dosage is, nobody would inject heavy metals into a -- when you talk about purity and you see a baby coming out…

NNAMDII want to talk about that for a second because you have -- you did write about that in this book, the mercury.

BISSYeah. So mercury is not in any of the vaccines that are on our childhood schedule. And it has not been in them for well over a decade. The mercury preservative that was once used in a number of vaccines, thimerosal -- it's important to note that this is a different kind of mercury than the kind of mercury that, for instance, we're worried about ingesting through certain kinds of fish. So these two kinds of mercury, ethyl mercury, and methyl mercury, are processed by the body quite differently.

BISSAnd one medical professional gave me a useful metaphor to help think about this because I'm not strong in chemistry. But he suggested the differences between ethyl mercury and methyl mercury are like the differences between ethyl alcohol and methyl alcohol. So one you can drink, one will kill you if you drink it. So those are distinct compounds, but it's almost a mute -- a moot point in this country because thimerosal is no longer in any of those childhood vaccines that we use today.

NNAMDIOn to Deborah, in Silver Spring, Md. Deborah, your turn.

DEBORAHYes. My name is Deborah and I'm calling from Silver Spring. I am a pharmacist. I see in all this discussion the contribution which pharmacists can serve or can make to the community. There's a lot of house information or down outright misinterpretation of the concept of vaccination. For example, this lady said since 1986 regulation, which was passed by Congress, there's been an increase in vaccination.

DEBORAHThere hasn't necessarily been an increase in vaccination, per se, but the reason there was that immunity for companies not to be (unintelligible) should something go wrong was primarily because Americans being a litigious society would just, I believe, incriminate everybody should even a vaccine be injected to the tendon or to the wrong muscle site.

DEBORAHThat's what -- that regulation was passed to -- rather than creating a fund of these billions of dollars for an injured parent or child, there's a common fund, which can (unintelligible) thus reducing the amount and thinking it would be incentive for litigation. Secondly, I would implore everybody, who might have questions about vaccines and vaccinations, speak to your local pharmacist. I just came off a course given by the American -- Association of American Pharmacists, APHA -- I'm not getting the acronym well.

NNAMDIOkay.

DEBORAHBut it's an (unintelligible) which we were really drilled and thought -- and this is a second -- this is the third time I'm going through that same cause. We, as pharmacists, would really do well and be useful to the community should they…

NNAMDIWe're running out of time, very quickly. But I think if you've made your point.

DEBORAHYeah, let them come to their pharmacists. Go to their local pharmacies and…

NNAMDIAnd seek as much information as they can get. We're running out of time very quickly. Many people believe that the middle ground is to vaccinate on an alternative schedule. Dr. Robert Sears, an influential author of parenting book recommends and alternative schedule for parents concerned about vaccinations. In the minute or so we have left, what does that mean when it comes to vaccinations?

BISSI don't believe that middle ground is splitting the difference between information and misinformation. I think that you still find yourself misinformed if you split that difference. And what the caller was just saying is very essential. I think where people are getting their information and how reliable that information is is really important. So when someone is saying that vaccines are full of disgusting things, I begin to wonder, and sometimes even know, where they're getting their information. And Dr. Bob is a poor source of information on this subject, in that much of his information is in some way badly analyzed or distorted or manipulated in some ways.

NNAMDIGiven that there's been research on vaccines, well, in a way, forever. Eula Biss is a journalist, author and National Book Award winner. Her latest book is "On Immunity: An Inoculation." She teaches at Northwestern University in Chicago. Eula Biss, thank you for joining us.

BISSThanks very much.

NNAMDIThank you all for listening. I'm Kojo Nnamdi.