Splendid Solution: Jonas Salk and the Conquest of Polio
By Jeffrey Kluger. G.P. Putnam's Sons. 373 pages. $25.95.
Polio: An American Story By David M. Oshinsky. Oxford University Press. 342 pages. $30.
For children growing up in the first half of the 20th century, there was hardly a scarier notion than being trapped in an iron lung. Flat on their backs, imprisoned in giant barrels that enclosed everything but the head and the feet, iron-lung kids could do little but stare at the ceiling and listen to the disturbing sound of air whooshing in and out, 21,000 times a day.
Leg braces, wheelchairs and crutches were other symbols of the day. So were closed swimming pools, shuttered theaters and quarantine signs slapped on homes. Come summertime, when epidemics tended to swell, many city-dwelling parents gathered their children and fled to the presumed safety of fresh air and open spaces.
It is against this backdrop that the development of an effective polio vaccine became the proverbial moon shot of 1950s America. Reporters streaming out of a press conference in Ann Arbor, Mich., where the vaccine's success was announced on April 12, 1955, were said to shout "It works!" and the phrase found its way onto headlines across the country.
Dr. Jonas Salk, whose vaccine was delivered to 1.8 million "polio volunteers" a year earlier, became America's first celebrity research scientist. "How does it feel to change the world?" actress Helen Hayes, who lost a daughter to the disease, asked him in a cable.
As present-day society struggles to overcome HIV and other microbial enemies, it is easy to romanticize polio's conquest. Those tendencies will surely be on display as the media celebrates the 50th anniversary of the Salk vaccine this month with reminiscences of a time when science, philanthropy and noble intentions combined to vanquish a fearsome foe. People should take care, however, because victory is never simple.
Two splendid books on the subject - Jeffrey Kluger's Splendid Solution and David M. Oshinsky's Polio: An American Story - remind us that ego, error and hubris were part of the story, too. Readers will recognize foreshadowings of the nation's early response to AIDS, when scientists clashed over credit for discovering the virus and activists clamored for unproven therapies, and of debate over the unintended risks of "miracle" drugs ranging from Prozac to Vioxx.
Salk's search for a preventive vaccine had the unfortunate if cautionary lesson of two earlier experiments that ended in disaster. In 1935, scientists who had inoculated 20,000 children watched in horror as some contracted the very illness they were supposed to be protected against. At a scientific meeting, one of the disgraced scientists rose from his seat and said, "Gentlemen, this is one time when I wish the floor would open up and swallow me."
The engine behind the war against polio was the National Foundation for Infantile Paralysis, created by a man whose optimism in the face of personal adversity was an example to thousands of children who suffered as he did.
Franklin Delano Roosevelt started the foundation so children could bathe in the soothing waters of Warm Springs, a ramshackle resort in Georgia that he adored and his wife, Eleanor, loathed. Even though the waters failed to rejuvenate muscles, as FDR fervently believed they would, the spirit shown by Roosevelt and his young fans spurred the foundation to tackle the loftiest goal of all - a protective vaccine.
In the late 1940s, the foundation began to bestow many thousands of dollars on Salk, a research scientist at the University of Pittsburgh who had helped in the development of the first vaccine against influenza.
He became a foundation favorite when he agreed to undertake the unglamorous job of identifying the strains (it turned out there were three) that a successful vaccine would have to target. Older, more established scientists regarded Salk as a young upstart dangerously misguided in his belief that the best hope lay in a vaccine containing polio virus killed in baths of formaldehyde.
His chief nemesis was Dr. Albert Sabin, a tall, mustachioed scientist at the University of Cincinnati who had been researching polio since the 1920s. His own vaccine - made from live, weakened polio virus - would eventually replace Salk's in the early 1960s, though the nation would return to Salk's version in 2000.
Sabin opposed Salk's vaccine from the start, warning that untold numbers of children could contract polio if a live, full-strength virus slipped through processing. Sabin could be caustic and cruel in his characterizations of the younger Salk, deriding him as a mere "kitchen chemist" even after the historic field trial proved the vaccine effective.
There is much about the vaccine trial to make the modern reader queasy. Among the earliest recipients of the vaccine, for instance, were retarded children in an institution outside Pittsburgh where the headmaster urged parents to sign consent forms. Alfred Sabin, who had decried another scientist's use of mentally handicapped children in a 1951 experiment, later proposed to do the same thing himself, though he ultimately switched to "mentally defective" adults.
Sabin's warnings were not without basis. Indeed, just weeks after the Salk vaccine was licensed, cases of paralytic polio began to crop up among children who had received vaccine contaminated by a live virus. The company at fault was shut out of vaccine production, and safety procedures elsewhere were tightened. Even so, the fiasco came close to derailing Salk's vaccine altogether.
"Now, [the] euphoria was gone, replaced by a fear that the Salk vaccine was a potential killer and that its licensing had been premature," Oshinsky writes. "Some naturally blamed the foundation for pushing too hard and too fast, creating a sense of 'breathless urgency' more suited to a mass advertising campaign than to a serious scientific quest."
Salk's behavior came under increasing fire. In announcing his vaccine's success, he unaccountably neglected to credit lab colleagues who had done much of the grunt work. His perceived arrogance and zest for publicity would be among the reasons given for his failure to win the Nobel Prize or gain election to the National Academy of Sciences.
The vaccine trial took place before government regulators ramped up their approval process, before standardization of institutional review boards and just as modern notions of medical ethics were taking root. It is interesting to consider whether, on one hand, today's safeguards would have prevented tragedies from occurring, and on another, whether they would have delayed a vaccine that kept thousands of children out of iron lungs and leg braces.
Prize-winning or not, Salk's achievement remains one of the most impressive of the 20th century and should rightly be celebrated. These two books are an excellent place to start, with Kluger's doing a better job depicting the impact of polio on the American psyche and Oshinsky succeeding more in rooting out the controversies of the day.
What should not be forgotten, however, is that ethics, oversight and careful balance of confidence and humility are necessary ingredients to good science. Avoiding personal differences is a nice goal, too.
Jonathan Bor is a medical reporter for The Sun.