>> please join me in thanking annette gordon-reed. [applause] >> annette gordon-reed is a history and law professor at harvard university, the author of the hearings is of monticello. his book -- her book on andrew johnson is part of the american president series. .. >> after his fall during the

height of his power and his presidency. so that interested me. because i think that these final journeys of lincoln and davis are as important as other great american journeys like lewis and clark or even the journey to the moon because it created so many myths about what america is and what our history is. i don't think the civil war's over. we still discuss the issues that lincoln and davis argued about, and i thought about doing one book about each of these stories, one about the lincoln funeral train and the package gent and another about the -- pageant and another about the davis escape. lincoln would often visit georgetown alone, and as i walked that path that abraham lincoln walked, i realized as i looked to my left one of the sons of jefferson davis was buried there, and i realized that abraham lincoln had to walk past the grave of the son of jeff -- jefferson davis to walk

to the tomb of his own son. as i started to research it, i found out that lincoln and davis had bizarre similarities, and that's what really inspired me to do the book about pote of them under -- both of them under one set of covers. in many ways, although you'd never think it, they were alike in so many strange ways and it was that insight that made me want to write the story in one book. >> and can you tell me where the title came from? >> yeah. it really comes from john brown and abraham lincoln. when john brown was awaiting execution, he was allowed to possess a kink james' -- king james bible, and he underlined his favorite passages, and one of them was make a chain for the land is full of bloody crimes. and then on the morning he was hanged, john brown handed a piece of paper to his jailer, and it said i, john brown, am now convinced more than ever that the crimes of this bloody land can only be purged by blood. and then lincoln helped me think

of the title, too, because we think of his second inaugural address as being of peace, brotherhood and reck reconcilia, but there's a very dark passage that's been completely forgotten, and lincoln says, essentially, that if all the blood drawn by 250 years of slavery and the slave master's whip has to be repaid by blood drawn by the sword, let it be so. so lincoln's discussion of blood and vengeance, and john brown's prophesy that there's blood to come really gave me the idea of the title for the book. >> what's your next project? >> well, i've spent the last several years surrounded by death, assassination, american mass tragedy, the crime of slavery, imprisonment, the death of 620,000 americans. so i think i'm going to take a break and do manhunt and the honor of winning the edgar award, i've been privileged to become friends with two great american thriller writers, and they've encouraged me to try fiction, so i'm going to try to

create a thriller novel series. there still might be death and destruction in it, but at least it won't be real. so i think i'm going to take a break from nonfiction and try to create a thriller novel. >> thank you. thanks for your time. >> thanks. >> you can watch this and other programs online at booktv.org. >> well, on february 16th of this year, the borders bookstore group declared bankruptcy. joining us now on booktv to discuss the impact of this bankruptcy is sarah weinman who is the news editor of "publishers marketplace." ms. weinman, how did borders get to the point of declaring bankruptcy? >> well, i think it's been a long time in coming. certainly, the last three years in particular as quarter after quarter borders has been losing money. they've also gone through a number of management changes, especially at the top. they've gone through, i think, something like four ceos in the

past four years. but this story can also date back to the beginning of the 21st century, i suppose. things like outsourcing their web site to amazon in 2001 and they didn't reclaim it until 2008. their e-book strategy was never at the same level as the kindle or barnes barnes & noble with t. it just always kind of seemed that borders was operating a few steps behind every other retailer and combining all the additional factors that has been, i guess, impacting the publishing industry especially on the print side in combination with various managerial mismanagement. it really didn't come as a particular surprise that borders declared chapter 13. >> sarah weinman, you mentioned the amazon connection. what exactly did borders do with amazon and, in your view, what kind of mistake was that? >> well, to reiterate, back in

2001 when borders had had its own web site, but instead of owning their own e-commerce selling books directly themselves, they -- [inaudible] to amazon. so, essentially, they were giving up revenue to their competitor in order to, essentially, make certain things easier. but in doing that, it was something of a devil's bargain because they didn't open their own online property. so by the time they changed directions, they had a new ceo who said this was not a good idea. but in reclaiming it in 2008, by then amazon had already introduced the kindle, barnes & noble's nook was already in the works, so that eventually when borders did develop its own e-book strategy in selling only additional e-readers, they just never were able to catch up in terms of appropriate market share. >> so what happens to the borders e-book reader, the cobo?

>> well, they say any e-books that have been fought through their web site are, in their words, perfectly safe. it's always interesting that cobo's other partner in australia which incidentally fran -- franchises the borders name, they've also declared bankruptcy over there. so i'm hoping the assertions are, indeed, true, but i think it will be interesting to see if, in fact, the e-books that people bought through borders' site are safe. of. >> so borders has about 642 big box stores across the country, how many are they closing? >> they are closing 900 -- 200, and the going out of business stores are, in fact, starting tomorrow. i believe the sales will be between 20-40% off, and those are already going to be in the works. they've actually already, i believe, started shutting down

the cafés at the super stores, and it will be very apparent walking into those 200 stores that have been designated for closure around the country that you'll see the going out of business sale signs and be able to get the books, cds, dvds and other appropriate merchandise at those prices. >> so why is it that barnes & noble has been able to maintain its big box strategy, but is it all about the e-books? >> i don't believe it's all about the e-books. i think with respect -- it may come down to this, which is that barnes & noble certainly most recently, they are run at the top by people who value books more than anything else. with respect to borders especially because there's been such a tremendous turn of management changes, they brought in people from outside companies who had experience in genre tail who may not have realized their experience did not necessarily translate into what's

appropriate for the book business. the book business is very quirky, and it's not always been the best fit with respect to what public companies in particular need. expecting and demanding higher and higher profits, the book business is on a very tight margin. 1% is about average, you're lucky if you get up to 3%. so as a result, this sort of uncomfortable fit operated by people who weren't as experienced with how the book business works probably added to borders' troubles. >> sarah weinman, when you look at the bricks mortar business -- bricks and mortar business of booksellers, what do you see in the future given what's happened to borders? >> it's interesting you say that because i'm starting to believe more and more we may also be witnessing the natural end of the chain bookstore business which essentially started in the late '80s and early '90s when we started seeing these

massive superstores that stood alone. some of them were part of malls, but most of them were entities that you could drive up to and park your car and go in. comfy chairs and be part of this greater experience than just browsing for books. and in hindsight i do wonder if we were, perhaps, fooling ourselves that this could last as long as it did. and maybe 20 years was the natural life cycle for such a thing. so we'll see, especially as digital sales keep going, perhaps we'll see a greater preponderance of smaller independent stores. a number of them have opened. certainly, they face many of the pressures that have been debated and bantied about over the last, i'd say, decade, but the ones that have opened and have a certain business acumen and try to engage within their communities and also develop even a small e-book strategy, they seem to have the best chance for survival. i think we'll, hopefully, see more of those. so the ecosystem is going to change.

it will certainly impact how publishers, perhaps, sign up authors and what sort of advances they're paying and what books will be most visible. but to say that the shrinking of the chain bookstore business means that the book industry is dead is a connection i would be deeply uncomfortable in making because there are too many signs that are pointing towards more optimistic waters. >> who are some of borders' biggest creditors, and what have they said since the filing? >> well, on the unsecured creditors side the biggest one is the penguin putnam group which i believe is owed 41 million. after that most of the big six publishers, for example, simon & schuster; 33 million, random house is owed somewhere around the mid 30 range, harpercollins, mcmillan, so on and o forth. i believe the only o publisher that has issued a statement is

penguin. others have stayed mum with respect to what's happening. and, of course, there are the larger secure creditors which are bank of america which held a credit agreement. they're still owed almost 200 million. i believe ga capital also is owed about 50 million off of their own tranche agreement as well. so they have to pay off the banks, their biggest publishers, and, of course, landlords are trying to get whatever they can as well as additional creditors. so all told i believe borders owes about 300 or so million to vendors, and they still have to figure out how they are going to get paid. >> can, in your view, borders emerge from bankruptcy or with its remaining stock of stores, etc., become a profitable company? >> i think it would be wonderful to see them emerge as a smaller, leaner, more profitable company. i also believe that many of the factors that have enabled them to go into bankruptcy may not be

so kind and forgiving. there's, to my mind, a little too much concordance with what happened with circuit city when they went into chapter 11 administration in late 2008, went to the courts and realized they didn't have an appropriate business plan and eventually went to chapter 7. numerous reports have indicated that publishers are not terribly happy with what borders seems to have in mind. their top priority, for example, seems to be highlighting their borders rewards plus card, but if cuts hearse know this company is in trouble, do they really want to sign up for a membership in a company they may feel doesn't have a future? so i think unless borders has a really rock solid strategy as to how they're going to survive, they may suffer the same fate as circuit city. at the same time, i don't think we're going to know for several months at the earliest. >> sarah weinman is the news

editor of "publishers marketplace." thanks for joining us on booktv. >> thanks so much for having me. >> publishers weekly has announced the nonfiction books that'll be released this spring. here are ten books in the category of history and military history in order of release date.

>> visit booktv.org and check out the news about books section. >> up next, a look at the antivaccine movement in the united states. dr. paul offit, chief of the division of infectious diseases at chirp's hospital in philadelphia, explains the reasoning behind and consequences of not vaccinating yourself and your children. dr. offit speaks at an event hosted by the manhattan institute, it's about an hour. >> i was, i was a resident in pediatrics at children's hospital in pittsburgh in the late 1970s, and at that time we would every week as interns and residents see children who

would come into the hospital with a bacterium called hib. it was an incredibly common cause of men anyone united states, it was a common cause of accept sis which is a bloodstream infection and when the tissue on top of the windpipe would swell up and cause suffocation. we saw it every week. it was our life, frankly, as interns and residents in the late '70s. by the late 1980s, a vaccine was developed which dramatically reduced the incidents of the disease. this was a disease that effected 20-25,000 children every year leaving -- killing many and leaving others permanently with permanent brain damage or kidney damage and others. so after that vaccine was introduced, we went from about

20-25,000 cases a year to fewer than ten cases a year until recently. there was, just to put this in perspective, about a year ago we had a child admitted to our hospital who had bacterial meningitis and died from the disease. every monday we have fellows from our division who come and listen to our presentations and make the presentations. of what -- when we presented that case, we asked them to go through the differential diagnosis of what back tier yo -- bacteria or viruses could have caused that. none of them lists hib even though that is what killed this child. and this child was one of several children who in the philadelphia area -- three, specifically -- that died of hib. died because the parents actually were more frightened of the vaccine than they were of the disease it prevented. i think it's a testament, actually, to how successful we've been with that vaccine

that these residents or these fellows didn't -- that bacteria didn't even come to mind. but this isn't, the outbreaks of hib which have occurred not only in the philadelphia area, but also in minnesota and a couple other states, it's not unique to that bacteria because there have been other outbreaks. for example, we had a measles epidemic in the united states in 2008 that was bigger than anything we'd had in more than a decade. we've had a mumps epidemic, as you know, in new york and new jersey that's involved sever hundred people -- several hundred people, whooping cough has caused ten young babies to die that is the biggest outbreak of whooping cough in california since 1947. so why is that? why is it that we've come to fear vaccines to the level that we now have outbreaks of infectious diseases, ha we've come to see this -- that we've come to see this life-saving medical product as something to

be feared rather than embraced? and i argue in this book i think the birth of the american anti-vaccine movement occurred on april 19, 1982. because on that day there was a one-hour television documentary. it aired on wrc-tv 4 in washington, d.c. which was an nbc affiliate. it was called dpt, vaccine roulette. diphtheria, pertussis, tetanus. and the show was dramatic. i don't know if you remember frederick wiseman in the '60s and '70s, made some famous films, but it had that quality. the stories were one of parents, and they were all the seam. the apartments told -- same. the parents told the story my child was fine, they got the vaccine and now look what happened. you would see children who had

mental retardation, epilepsy, who had withered, spastic limbs, who were in bicycle helmets, looking vacantly up into space. it was dramatic. it was like a sort of richard avadan picture in that it was you were far too intimately involved with the pictures of those children than you could stand. it was really very emotional and gripg, and it had an effect. there were a few people in the northern virginia or washington, d.c. area that day including fisher, kathy williams and jeff. >> bart who -- schwartz who got together actually through that local nbc affiliate, who called people in to get together, and they very quickly within a couple weeks formed a group called dissatisfied parents together or d.p.t.. that group has changed their name to the national vaccine information center which fisher was the head. this group was powerful enough

and connected enough early on that within one month of that show's airing, there was a congressional hearing headed by paula hawkins, a republican senator from florida. she was looking into whether or not vaccines, in fact, were doing more harm than good. the result was predictable. there was a flood of litigation claiming that vaccines not only caused epilepsy or mental retardation, but also caused unexplained coma, sudden infant death syndrome and other illnesses to the point that there were hundreds of millions of dollars in settlements and awards, and companies were largely abandoning the business. we went from six measles-containing vaccines u measle vaccine makers to one, and we went from eight whooping cough or pertussis vaccine makers to one. we were on the verge of losing vaccines for american children, so what happened in 1986 is the government stepped in and created the national childhood

vaccine injury act to put up a wall between the parent and the pharmaceutical company. you had to first go through this federal claims court before you could actually sue a pharmaceutical company in open court. but it had an effect. we went from 27 vaccine makers in 1955 to 18 in 1980 to basically five vaccine makers today. so although i think the act saved vaccines, that event that occurred in the early 1980s was a tremendous hit. what's interesting about that to me was at the time -- and john stossel remembers this well, he covered the story -- we didn't have the science to go up against the contention. the fear was that the pertussis vaccine caused permanent brain damage, but there wasn't in hand the studies looking at hundreds of thousands of children who did or didn't receive that vaccine to see whether the incidents of

permanent brain damage was greater in that group. by the time that science matured, we now know that the vaccine never caused permanent brain damage. of interest to me was it took another 15 years to figure out what really was happening. in 2006, almost 25 years after that event, after that television show, you now had in hand the kind of genetic probes to allow you to look at those children to see what really was the cause of epilepsy and retardation. and that work was done by sam berg vick at the university of melbourne where he went back to look at those children now in their 30s and 40s to see what was going on, and he found almost all of them had an scn-1 mutation. this is a genetic mutation, all of these children will develop mental retardation or epilepsy independent, obviously, of whether they receive vaccines. that public, that work was published in 2006 and got

absolutely no media attention. i mean, when you think about the media attention it was accorded, dpt vaccine roulette in magazines, newspapers, television shows, it was on the today show, it was on 20/20, now fast forward 25 years to where you really have the answer to the question that was raised by that show, and not a single journalist covered that story. remarkable. what's happened, though, is that the dissatisfied parents together one day became the national vaccine information center, really became the one-stop shop to scare parents about vaccines. and every time a new vaccine was introduced on to the market, the national vaccine information center was there. when the hib vaccine was introduced in the late '80s, early '90s. there was fisher on abc's world news tonight claiming that the hib vaccine caused diabetes. it doesn't. when the hepatitis b vaccine was first introduced, there again was fisher on world news tonight

claiming that the vaccine caused sudden infant death syndrome. there was actually a 20/20 place, and you can see fisher on the b roll so she was clearly giving advice there, you know, making the claim that this vaccine was causing permanent harm. and, again, these were very emotional shows. that hepatitis b show on 20/0 when hugh downs and barbara walters were the host showed a mother who had given her child a second dose of hepatitis b, and the child had within a day of that padsed away from sudden infant death syndrome, and the mother said my child was fine and this vaccine killed her. and then they showed the tombstone, you know, with the inscription our little angel, and i think anybody who's human is going to be moved by this and feel maybe this is a vaccine that should be avoided even though we now clearly know the hepatitis b vaccine doesn't cause sudden infant death syndrome. it's only designed to prevent

one specific pathogen, it doesn't prevent everything else that happens, and some of those things are going to happen associate with the the vaccine but not causeally. probably the greatest hit to vaccines in some way has been the human pamploma vie race advantage -- virus vaccine. there are a group of girls called the gardasil girls that are supported by anti-vaccine groups that claim they were fine, then they got the human pap loam ma virus vaccine and they developed blood clots and con went and strokes and heart attacks. data now clearly show that the vaccine doesn't do that. of but, you know, again, they're powerful stories, and there are people who were choosing not to get that vaccine because of those stories who then put themselves at risk of getting cervical cancer 20-25 years from now. and as you all know probably the biggest hit, i think, or certainly what most people

embrace as a consequence of vaccine is the the notion that vaccines cause autism. and. you know, we've gone sort of -- and, you know, we've gone sort of from one hypothesis to the next. thigh her sol, a mercury contained in vaccines now a more general, vague fear that too many vaccines given too soon cause autism and maybe we should separate them or delay them so we don't put children at risk for autism. by doing that, all we do is increase the period of time during which children are susceptible to preventable diseases which are on the increase without offering any bebb fits -- benefit. so i think that now what you have as a fallout is you have parents with, that have a vague notion that vaccines might be doing harm. it's estimated that four of ten parents now are choosing to delay one or more vaccines, and now you're starting to see these

outbreaks. i will say that i think there is a role for consumerism in vaccines. i think probably the best example of that is the oral polio vaccine. this was a vaccine developed by albert sabin, we started using it from the early 1960s until the late 1990s. that vaccine itself was a rare cause of polio. it caused it. it was called vaccine-associated paralytic polio, it's the only live vaccine that has the capacity, actually, to revert to neurovirulent type. now, it's rare, but every year in this country -- and we eliminated polio in this country in 1979 -- but every year after that we would see six to eight cases caused by that vaccine. one of those children who suffered polio from the vaccine was a child named david whose father actually had work with the the italian-american foundation here, i think in new york, and he made this a cause. and i was actually on the polio vaccine working group at the cdc

in the late 1990s, and he was asked to be on that group, and i can tell you his voice was important. when we move prd the oral polio vaccine and, thus, eliminated even this rare cause of polio caused by the vaccine, john had everything to do with that move. so i think vaccine activism is important as i think any consumer activism is important, but it has to be science-based. you can't just make stuff up. you can't say that you want vaccines to be safer so that they don't cause autism. they don't cause autism anyway. you can't make a vaccine safer if it doesn't cause the thing that you're arguing for. i do think that in some ways the pendulum is swinging back. i think that the media feels a little -- and i guess i shouldn't speak for the media because i don't work for the media, john should probably do this, not me -- but i think the media has gotten a little more suspicious about some of this anti-vaccine rhetoric.

certainly, the autism story is no longer carried by the mainstream media, and i think they have gotten much better about that. i mean, new york times had articles in the early 1990s as did the l.a. times, you know, claiming this to be a controversy when it wasn't. i think that's a change. so that's good. i think you're also starting to see hospitals starting to take stronger stands. our hospital is one of them. we, i work at the children's hospital in philadelphia. last year in 2009 we decided to mandate the influenza vaccine. since the early 2000s we had pushed to educate our health workers to get a vaccine, and by health workers i mean anybody who was walking the floor. so there's 9400 employees, anybody who could potentially walk on the floor where there would be a vulnerable child was asked to get an influenza vaccine and with a lot of conditioning, we were able to get imhue anyization rates up to

the low 90% range which puts us as one of the best hospitals in the united states. and we did it we had raffles and giveaways, we gave things away like eagles tickets, i mean, the philadelphia eagles actually good -- [laughter] not like sixers tickets which you can't give away. [laughter] and we got imhue anyizations up to the low 90% range, but that meant 10% still could walk op the floor of a vulnerable child. we basically said if you didn't want to get a flow vaccine in 2009, you had two weeks of paid leave. we fired five union employees, they took us to arbitration in may of 2009, that decision was made in december on behalf of the hospital. and the reason that we did it was since 2003 we had two children, both little girls, who came into our hospital with cancer. they hadn't been advantage si

candidated against influenza because it wouldn't have mattered. that vaccine wouldn't have worked. and is so they depended on those around them to be protected. they came into the hospital without influenza, they caught it in the hospital and died from that disease despite heroic, supportive measures on our part. and the question is, who's responsible for them? is it our responsibility to make sure that we put them in the position where they're least likely to get influenza? and be we think the answer's yes. we don't think it's your right as a health care worker to catch and transmit a potentially fatal infection. and you could make the same argument, actually, for the pertussis outbreak in california. so that outbreak has involved 9,000 people and ten children have died. all of the children who died were less than three months of age which is to say they were too young to be effectively vaccinated. they depended on those in the home to protect them. and so look at the immunization rates. in california all dlenltds are

recommended to receive the vaccine, 40% get it. all adults are recommended to receive the tdap vaccine, 6% get it. i'll give you an example. there was a child who came into our hospital, a two month old who got whooping cough and died from it. she got it from her mother. everybody else in the family was well. the mother got sick about two weeks after the child was born that was no doubt pertussis. when she delivered at a local hospital, the nurse came in within 24 hours of delivery and said you are recommended to receive the tdap vaccine, and the mother said i'd rather not get it, and the nurse said okay and walked out. that was the chance to save that child's life. and i think that moment has to be far more passionate from the clinician's side, from the nurse, doctor, nurse pack decisioner to let -- practitioner to let people know when they make that choice, it's a potentially dangerous one.

so you could argue that if parents, apartments deliver a -- parents deliver a child into the home that it be mandated that the, the father and the mother receive a tdap vaccine. there are certain religious exemptions, but you could argue that it's the only way they're going to protect that young child. and if you look at who dies from pertussis, it's always theless than six month olds because their windpipe is narrower. it's the home, it's the home from which they catch it. and, you know, you feel enormous sympathy, obviously, for anyone who watches a child suffer and die. it's the worst lots in the world, and you never want to come down on the parent, obviously, but it's that, that balance to me between the sovereign right of a parent to raise their child as they see fit and the right of society to sort of protect its children. and i think that balances. and, personally, just far too much on the side of the parent.

it shouldn't be the parent's right to transmit a potentially fatal infection to their child. so what changes all this? i mean, you know, we hear a lot of rhetoric about trying to sort of tighten, you know, philosophical, religious exemptions. i don't think force is ever going to change this. i think what has to change is the way we see ourselves. we see ourselves as part of an immunological commons, which is true. we're all in this together. there are about 500,000 americans who can't be vaccinated because they're too young in the case of children less than six months of age for pertussis vaccine, they can't be vaccinated because they're getting chemotherapy for their cancer or transplants or their asthma, you know? steroids for their asthma. they depend on those around them to be vaccinated because if not, they're the ones who are most likely to suffer and be hospitalized and to die. so i think we have to find a way to appeal to that societal

instinct. it's there. i think here in new york city when 9/11 happened, you know, we applauded that societal instinct of the new york police department or fire department to go save those who were at risk or the people in tucson who ran toward the gunshots because they wanted to try and protect their fellow man. and i do think it's in us. i just think we have to find a better way to appeal to it. so thanks for your attention. [applause] >> [inaudible] >> yeah. >> please wait until the microphone gets to you. >> yes, ma'am. >> was the whooping cough epidemic, is it considered 'em demick right now? >> endemick. >> endemick. >> yeah. >> should adults get a booster shot in general in the case

they're composed? >> adults are recommended to receive a tdap vaccine, so if it's been more than ten years since your last pertussis, you should get it. the recommendation is currently that adults get tdap. >> and they should go to their internist to get it, or where would they get it? >> probably best from the interns. >> and they generally have a suppliesome. >> should be. although, you're right. i think we think of vaccines generally as a kids' thing to do, we don't think of it as an adult thing to do. i think if you went to our infectious disease group and asked them what percentage of momentums have gotten a tdap vaccine, it's going to be well less than 100%. you're right. >> i've been having annual check-ups for as long as i can remember. but i can't remember ever being

vaccinated since i was a child. i can't remember a physician recommending an inoculation. so as an adult which inoculations should adults have? tdap or others? >> so the tdap, the pertussis, you should be getting a booster for tetanus, diphtheria, pertussis at least once and i think it's going to be tdap every ten years soon. you're recommended to receive a chickenpox vaccine if you've never had chickenpox. if you're over 60 it's so sliekly you've had it that what you're recommended to receive is a shingles vaccine. you're recommended to receive the hepatitis b vaccine if you've never had that vaccine. so, but you're right. i think, you know, internists aren't great at this. i think obstetricians aren't

good at this. >> and the flu shot. >> that's right. good point. the flu shot is also recommended. and the pneumonia cockal vaccine for those at risk. >> [inaudible] mr. foreman. [inaudible] [inaudible conversations] >> i'm a medical encologist here at mt. sinai, new york. congratulations for the wonderful work you've done. [applause] but the problem may be, to paraphrase shakespeare, the fault is not in our stars, it's in us. i think as physicians we've done a terrible job of public relations. we can't expect the media to do our job for us, and i'm going to give you -- if you'll bear with me, i'll give you several examples. the first one is that we've all probably read about avastin.

the day the fda said, you know, it shouldn't be given, there was a paper in the san antonio breast cancer meetings which is the most prestigious conference in the world that showed given to women before surgery had a 40% increased response rate in the entity known as triple negative disease which involves about 25-30% of people. there was no reaction to this at all. you just said we can't use a medicine that's going to help about 25% of women with breast cancer. it's outrageous. now, the media is there, they're all running around to find out which doctor do i bother, which company is good, and but they don't want to cover that. number two, i went to medical school, i remember walking down that hill to children's hospital where i trained. this is one of the great heros of modern day america. in spite of all resistance, he proved that women need a lumpectomy, not a mastectomy.

he also did this wonderful trial to prevent breast cancer. when he was doing this most important trial, they found out in 40,000, 50,000 cases that one researcher in french canada, i think it was montreal, typical french, the count had to be 150,000. they took a little, 145 was okay. great scandal. and he said let me finish the trial and address this. john dingell went after him viciously. he also went after david baltimore, someone who won the nobel prize and kept him out of research for over ten years, a nobel prize winner, and he was totally exonerated. he went in to fisher, it was outrageous. when at the american society of clinical encologists in the middle when bernie fisher walked in, there were more reporters there. 10,000 people gave him a standing ovation for five minutes, not a word of this anywhere else. and we should have had our spokesmen screaming this is one of the great heros of modern day

medicine. not a word. he was totally exonerated, and they fired him. it's a long story. when obama passed his health care law, there was john dingell standing -- i get mad when i say this -- standing next to the president. this man probably caused the deaths of women with breast cancer because the trial was delayed two or three years. and then when obama is passing his wonderful health care bill, he trots out a bunch of pelicans known as doctors in white coats. did anybody ever question who these doctors are, what their ec per tease? when betty mccoy had a forum here in finish. >> i'm sorry, doctor, could you -- >> i'm going to ask a question. my question is, what do we do to get our message across? do we train physicians in public relations? how do we go about it? we are doing work that no one knows about. >> yeah -- >> and we get pushed around. >> i completely agree with you

that i think as clinicians and scientists we are terrible at interacting with the media. i'll tell you whey i think -- why i think that is and how i think we can get better at it. i think the reason it's true and certainly as a pediatrician, i think you'd support this, we're nice people. we're not very good at confrontation, bad at it even. and as a scientist, you know, your scientific training is not only not a training to be, to interact with media, it's the opposite of that. i mean, as a scientist, you know, you're really taught to be very critical of of your data, d it's very hard for you to make a definitive statement like mmr doesn't cause autism because you know you can never prove never. on the other side you have people like jenny mccarthy or jim carrey who say it does. public money, it is your

responsibility to try and educate the public that pays you. and so i think -- but i think we've been terrible at it. god knows, we're not trainedded toot it. -- to do it. we need to get in the game even though it's not an easy game to enter. and when you're asked to take a complex issue and reduce it to a sound bite, not only does it feel wrong, it is wrong. it's sort of intellectually dishonest to do that in some ways, but the other side, the anti-science side is perfectly willing to do it. >> thank you. i like the talk, i like the work you're doing. stanley goldstein. are there other motivations in the anti-vaccine camp less altruistic than the ones we've heard about? >> i think those who are, who passionately believe that vaccines have hurt their children believe it. i think their child's fine, they got a vaccine, they're not fine,

i believe the vaccine did it. they don't want other children to be hurt. i think although some of the funding is a little concerning, upsetting because i think the personal injury lawyers and the anti-vaccine activists are connected is disturbing, but i think most of these parents truly believe what they're doing. i don't think they're lying about it, i think they're trying to help other children. the fact of the matter is the vaccine didn't cause permanent brain damage, so she's advocating for something which is not science-based which is too bad because she's a smart woman with a powerful voice, she could do a lot of good, and there are issues of vaccine safety that one could focus on. you know, the flu vaccine is made in eggs, so people who are severely allergic to eggs have a problem with that. could you make the vaccine in non-avian cells?

absolutely. gelatin can also be a pretty significant allergen. could you use another stabilizer? absolutely. i think if you had advocates for that, you would see changes. so there are things for which i think consumer activism would make a difference. it's so painful to watch these people who are so good at what they do advocate for something that isn't a problem with vaccines. >> but, also, i think you talk about this in the book, there's a cot an industry of expert d cottage industry of experts testifying in these cases, testifying to bad science. >> yeah. the compensation program has, you know, roughly $2 billion in it. that's a large pool for personal injury lawyers and those who testify on their behalf. >> i'm michael meyers, executive directer of the new york civil rights coalition. let's look at the science-based concerns and anxieties because science, not perfect, and very

often is not short term. it may require long-term studies. so if you have a vaccine today, say, for h1n1 and you develop a vaccine that scientists, the doctors say will prevent you from getting aids -- really -- maybe now ten years later, 15 years later somebody, the scientists, the doctors will find from the long-term studies that the vaccine had side effects they did not know about. so it's not just fear of vaccines, i think it's a science-based anxiety, and particularly respect to the notion because we are a society, we believe in civil liberties, the autonomy of the individual. and so my question to you is, what circumstances, for example, in h1n1 if it becomes epidemic in terms of new york and metropolitan areas and subways, stuff like that, other kind of

things like aids, what would require people to have vaccines, make it mandatory versus what we do now and people go and volunteer to get their, get their shots? >> okay. well, i think the -- thank you. i think the question isn't -- well, the way i see it it's not when do you know everything, it's when do you know enough? if you want to use the novel h1n1 example of 2009, that's fine. so here's a vaccine that's made with technology that's been used to make influenza vaccines since francis in the mid 1940s. so this is technology that's 60 years old. it's, we know that the influenza vaccine induces an immune response which is protective, we know roughly how protective. the question is whether this novel strain would induce that same level of protection to protect what we now know -- we had an asian come into the united states in april of 2009 which caused 47 million people to suffer which caused about 250,000 top hospitalized, 12,000

to die, 11 00 children. that's ten times more than typically during seasonal influenza. we had five children die in our hospital from influenza in 2009. none of them had been vaccinated. the odds are none of them would have died had they received the vaccine. i'm not dismissing your point. i think the question of, you know, could there be long-term effects certainly is a reasonable one, but what's an example of that? we've had vaccines have been around for the last 200 years. we have a lot of data on vaccines in terms of medical interventions. it's probably the lodgest and best-tested -- longest and best-tested medical interventions, so i guess i don't share that fear, although i understand it. i think when you choose not to get a flu vaccine as, for example, these children who died in our hospital had that choice made for them, you know, you

take a risk. a choice not to get a vaccine is not a risk-free choice. the question is what does that different risk look like? [inaudible] >> [inaudible] >> you may wait for the microphone. >> at what age do you start taking the shingles vaccine? >> 60. >> oh, 60. and also what this man said here about the fact that he hadn't had any vaccines, i thought it was mandatory to have vaccines in order to go to school in this country, no? >> well, it's -- yes. the question is are vaccines mandatory? they are. there are many pop-off valves, states have a religious exemption, 21 states have a philosophical exemption which is to say it's against your philosophy, love of wisdom, i'm not sure what the wisdom is in that. i don't understand the religious exemption either. you know, the generous vaccine as paul said when he introduced me, you know, was made in 1796.

the old testament was written between 1400b.c. and the koran around 600 a.d.. these are three major texts, none of them ever mention the word vaccine. they never predicted vaccine. [laughter] i'm not sure where that, frankly, comes from. christians -- no, i take it -- yes. christian science, 1875. it's 100 years roughly after the vaccine, that specifically says don't get vaccines, but i don't think most of those who choose exemptions are christian scientists. >> there in the back. >> everything we've discussed so far has been about the united states, and could you provide an international perspective both on the, whether these same issues and controversies exist elsewhere, the degree to which these populations are vaccinated in other countries and whether a vaccine industry is being encouraged or discouraged in other places around the world?

>> yeah. to put -- thank you for that. to put this in perspective, i think the united states is great at vaccinating our children. we ask them to prevent 14 different diseases in the first few years of life and another two in adolescence. that's 16 different diseases, and our immunization rates are in the high 80s. the problem is we have undereducated communities where you're seeing these outbreaks, and it's better than any other country. if you look at other countries where vaccines are never mandated, you know, england basically has -- measles is endemick in england. you know, mumps is endemick in england. that outbreak you had in new york and new jersey, that came from england to the united states, it was one of the camp counselors there. you know, the fears are also exported. you know, i claim that the birth of the american anti-vaccine movement was in 1982, that fear

actually originated in the england in 1973 with john wilson publishing a paper and making a big deal. and imnewspaperrization rates dropped from 80% to 30 percent, and they had about 35 deaths from pertussis because of that and tens of thousands of hospitalizations. france, actually, was the birth of the notion that the hepatitis b vaccine could cause multiple sclerosis. they shut down their school-based program for a while because of the fear that it caused multiple sclerosis which was just wrong. and england in the late 1990s. you know, first it's the tea tax and now this, i mean, it's england. the problem is england. [laughter] no, just kidding. but certainly, you know, other countries -- you know, if you look at the measles outbreak in 2008, you know, that actually -- the epicenter of that was in southern california where, you know, a mother takes her unvaccinated child to switzerland, catches measles, comes back to the united states and then, you know, proceeds to -- the children who come in contact with that child in the pediatrician's office and whole

foods store which is invariably true, by the way. if you ever look at these outbreaks, the whole food store is where at some point. [laughter] ironic. so, you know, and that was switzerland, you know, where measles was much more common. so i think western europe hasn't been great, israel hasn't been great. i think our country, actually, is doing very well. the problem is we're just now starting to see a fraying at the edges, and the question is, does this represent something bigger? right? all horror movies start the same way. did you hear something, at some point, somebody says. and that's the question, are we hearing something? >> gentleman? >> thank you. doctor, there are an estimated 10-15 million illegal aliens in this country, presumably many, if not most have not been immunized. has that any ramifications or is there any danger to public health since so many unvaccinated people are walking

among us? >> yeah. and that certainly is part of the story in california. it's not only that some people have chosen not to vaccinate their children which is part of the california story, it's also that there are those whose access to medical care is less and, therefore, have been less able to get a vaccine. if you look at who chooses not to get a vaccine, it's almost the opposite of what happened, say, in england in the mid 1800s where, you know, they were dealing with smallpox. if you looked at the anti-vaccine in england in the mid 1800s, it was among people who were not as well educated, who just feared vaccines because they didn't understand the biology of it. it's the opposite here. it's the upper middle class, well-educated person who tends to have a responsible position where they're in control who makes that choice. in philadelphia the hispanic population which generally is a lesser-served population and, to some extent a less-educated population, they actually get vaccines. i mean, they actually believe in the expertise of the doctors

that serve them. they think the doctors may know more about vaccines than them, they get vaccines. so it's ironicment. -- ironic. >> it's the general climate that makes vaccines unpopular causing us to miss opportunities like in aids or malaria where new vaccines could really have added powerful weapons, and are we underinvesting because of that? >> i don't think so. i mean, i think certainly there is a tremendous push and pull to make a malaria vaccine from the gates foundation and as the companies have, i think, the few companies who are actually in vaccines have made significant commitments, merck spent over a billion dollars on their hiv virus program which failed. but that was, they certainly were willing to spend the money. i don't think money is the problem with hiv or with, or

with malaria. so i don't think so. good news is i think that's not true. there are, unfortunately, not that many companies that do it. and i think that's some level of the tremendous amount of litigation in the early '80s. >> doctor, to what extent is there an unholy alliance, if you like, between the litigation industry and the anti-vaccine -- [inaudible] in your opinion? >> right. so when the national childhood vaccine injury act was created, the compensation program really, i think, is an exceptionally good firewall between the litigant and the jury trial. because the way it works there is that you have special masters, judges who previously -- who are lawyers that now serve as special masters who at least look through the data and make a recommendation. the autism proceeding is probably the best example of that. i mean, that -- there you had parents of 5,000 children, more

than 5,000 children who believed that vaccines caused autism. that was a trial that probably lasted from 2002 up until 2009 or '10. it was a long time. a lot of money spent, you know, looking at this, and the judgments were very clear and very strong, you know, vaccines don't cause autism. so it was turned away. if that had gone to civil court, states' courts, i can't imagine what would have happened. there are certain judicial hell holes, philadelphia being one of them -- [laughter] you know, mississippi where in jury trials i think those companies would have gotten murdered. so i think that's been good. there is a critical supreme court case which was heard in october which will probably be adjudicated on february 22nd which has at its heart the capacity to overturn that program, the vaccine recompensation program which would put us back to where we were in the early '80s. i don't think that's going to happen. i am very confident the supreme court will rule in favor of

wyeth and will overturn that program because they can't. there just would be too much at stake if they made that decision. >> last question? terrific. well, then please join me in thanking dr. offit. [applause] >> paul offit is the chief of the division of infectious diseases and the directer of the vaccine education center at the children's hospital of philadelphia. to find out more, go to paul-offit.com. >> here are a couple of upcoming book fairs and festivals from around the country.

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