Blaming the MMR vaccine for autism rather than one’s genes, or sheer bad luck, is a complicated displacement that implicates science and technology, the medical establishment and modernity in general. But it is also a pernicious way of blaming ourselves – we as parents put the child to the needle – and it is this tendency above all that the media exploits so cynically in scare stories of many kinds.
The effect of the anti-MMR campaign was to add to the defaulters who did not have their children immunized out of ignorance or idleness a large number of ‘active resisters’, who were, according to Michael Fitzpatrick, a doctor who wrote a parents’ guide to MMR and autism, ‘middle-class, well-educated parents who had chosen not to have their children immunized’.6 These parents pitched themselves against a government that refused to give the option of single vaccines, as is sanctioned in some other countries. The combined effect of these two groups pushed immunization in Britain well below the safety threshold for herd immunity.
It began to seem that matters would only be resolved the hard way. Cases of measles rose sharply in 2002–3 and again in 2006, when 739 cases were confirmed – a level not seen since before introduction of the triple vaccine. In March 2006, a thirteen-year-old boy became Britain’s first child measles fatality since 1992. Among the papers joining the chorus of alarm was the Daily Mail: ‘Measles epidemic fears as cases rocket’. The story that followed neglected to mention the paper’s own role in sustaining the MMR controversy that had produced this unhappy situation, and even nonchalantly dropped in a reference to Wakefield’s Lancet paper: ‘research that has been widely discredited.’
Sudden Death
‘Cot death link to lone parents’ Daily Express
Immunization is not the only worry facing parents of new-borns. Sudden infant death syndrome (SIDS) is any sudden and unexplained death of an apparently healthy infant aged over one month. The term cot death is often used in the UK and crib death in North America. The diagnosis of cot death is a so-called definition of exclusion, applying only to an infant whose death remains unexplained after the performance of post-mortem investigations, including an autopsy. Generally, the infant is found dead after having been put to sleep and exhibits no signs of having suffered. The fear of sudden infant death means that new parents regularly visit their sleeping baby to check that he or she is still breathing.
The extent of parental worry does not make much sense as SIDS is responsible for very few deaths. In the US, it accounts for roughly 50 deaths per hundred thousand births. The rate is a little higher, around 60, in Scotland, and a little lower, around 40, in England and Wales. This is far fewer deaths than caused by congenital disorders and disorders related to short gestation, though it is the leading cause of death in otherwise healthy babies aged one month to one year, albeit a category in which there are very few deaths. Moreover, the incidence of sudden infant death syndrome has fallen in all developed countries in recent years, in some cases dramatically. A fall of nearly 90 per cent in Australia over fifteen years is particularly noteworthy.
But the worry remains very real, reflecting both the horror of losing a young child and the ‘incomplete’ medical explanation for the event when it does occur. Very little is known for sure about the cause of SIDS, and there is no proven method for complete prevention. That said, many studies of babies around the world that have died suddenly and unexpectedly have identified a number of risk factors. Pre-natal risks include inadequate nutrition, a smoking mother, teenage pregnancy, alcohol and hard drug abuse and an interval of less than one year between subsequent births. It is striking that the rate of unexplained infant death in England and Wales is four times greater for children born to mothers aged under twenty than those born to mothers in their thirties, and six times higher for those children registered at birth only to the mother than for those children born to a married couple. Studies in the US have also shown that African American and Native American infants are two to three times more likely to die from SIDS than white infants.
Post-natal risks include low birth weight, exposure to tobacco smoke, excess clothing and overheating, excess bedding, soft sleep surface and stuffed animals and sharing the parental bed. It also seems that boys are more likely to suffer than girls – nearly two-thirds of deaths are accounted for by boys. Putting young children to nap in their own bedroom is also thought to be a risk.
Laying an infant to sleep on his or her stomach is widely thought to be one of the greatest risk factors. Accordingly, many governments have introduced ‘back to sleep’ campaigns, encouraging parents to put their children to sleep on their backs. There are various theories supporting the risk of prone sleeping. The first is the idea that small infants with little control over their heads may, while face down, inhale their exhaled breath or smother themselves on their bedding. A second theory suggests that babies sleep more soundly placed on their stomachs and are unable to rouse themselves when they have an incidence of sleep apnoea, breath holding, which is thought to be common in infants. It has also been suggested that the victims of SIDS might have abnormalities in or delayed development of the arcuate nucleus of the brainstem, contributing to their death. Whenever ‘back to sleep’ campaigns were introduced, in the early 1980s in the UK and the early 1990s in the US, SIDS death rates fell, often sharply.
Death might also be caused, some researchers say, by the toxic nerve gases produced through the action of fungus in mattresses on the chemical compounds frequently used to make mattresses fire retardant. A major plank in this explanation is the widely observed phenomenon that the risk of cot death rises from one sibling to the next. After one cot death in a family, the risk of recurrence for a subsequent child is up to five times the rate of the population more generally. No satisfactory biological explanation for this has ever been put forward. But the toxic gas explanation fits this neatly as parents generally buy new bedding for their first child, reusing it for later children, with a greater chance that there will be fungus which has become resident in the material, in turn leading to a higher chance of cot death. Single mothers or poorer families might borrow used or buy second-hand cots, perhaps accounting for the higher death rates among these groups.
A decade ago, the New Zealand government issued advice recommending that new parents either buy bedding free of the toxic compounds or wrap the mattresses in a barrier film to prevent the escape of gases. It is claimed by those supporting this view that no case of cot death has ever been traced back to such a manufactured or wrapped mattress. Of course, face-up sleeping could well reduce the death rate if this is the cause for SIDS, as the dense gases that cause death diffuse away towards the floor – a baby sleeping face-up is less likely to inhale them.
More recently a brain abnormality has been found in the victims of SIDS that could cause the babies to suffocate if they become smothered by bedclothes. The US researchers claimed that this was ‘the strongest evidence yet of a common cause for cot death’. The debate rumbles on.
One particularly sensitive issue is the link between cot death and child abuse. All professionals involved in cot deaths accept that there are a small number where a parent or carer has done something unlawful to contribute to the death. A number of paediatricians have said that they believe that some cases diagnosed as SIDS are really deaths resulting from child abuse. Their suspicions are particularly aroused in the case of multiple cot deaths within a family. Indeed a dictum known as ‘Meadow’s Law’, after the well-known former paediatrician, says that ‘one cot death is a tragedy, two cot deaths is suspicious and, until the contrary is proved, three cot deaths is murder’.
During the 1990s and early 2000s in the UK, a number of mothers of multiple apparent SIDS victims were convicted of murder. At one of the trials, Sir Roy Meadow, speaking as an expert witness for the prosecution, made one of the most infamous statistical statements ever in a British courtroom. He claimed that the chance of two children in the same affluent and non-smoking family both dying a cot death was one in 73 million.
In a complex, confusing and emotional case, the statement provided something definite to hold on to and was widely headlined in the national press. The mother, Sally Clark, who had had two children die of cot death, was convicted of murder.
Unfortunately, the figure was in all probability wrong and certainly misleading. The statistic was derived from the Confidential Enquiry for Stillbirths and Deaths in Infancy, a study of baby deaths in England in the 1990s. It estimated that the chances of a randomly chosen baby dying a cot death are one in 1,300, falling to around one in 8,500 if the child is from an affluent, non-smoking family, with the mother aged over twenty-six years. If, and it is a big if, there is no link between cot deaths of siblings, then the chances of two children from such a family both suffering a cot death is obtained by multiplying the odds, namely one in 8,500 by one in 8,500. This produces the probability of one in 73 million.
But all the evidence suggests that there are links between such deaths, which are not independent. If the odds of a second cot death in a family are around one in 100, the odds of a double cot death would fall to about one in 130,000. Since around 650,000 children are born every year in England and Wales, we might expect as many as five families on average each year to suffer a second tragic loss. This paints a far less dramatic picture than the one in 73 million figure. Interventions from a number of quarters including the Royal Statistical Society led to some high-profile acquittals at subsequent retrials.
The ambiguity, uncertainty and complexity in defining SIDS incidents has had an impact on the statistics we use to define the issue. Statistically in Britain, sudden infant death syndrome did not ‘exist’ until 1971, when the Registrar General first accepted it as a cause of death. Prior to that time, we had no idea of the true incidence of such deaths, and that in turn hindered the search for an explanation of those deaths that did occur. (Many of the infant deaths prior to that time were – wrongly – attributed to respiratory disease.) Throughout the 1970s and 1980s, the annual total of the newly defined SIDS deaths was stable around 1,000, but the ‘back to sleep’ campaign has contributed to a reduction in the numbers so that they have recently dipped in England and Wales to below 200 a year.
But defining cause of death is sometimes an imprecise science, and fashions change over time. In the last decade, while the number of sudden infant deaths in England and Wales has halved, the number of ‘unascertained deaths’ has increased from barely any to over 100. The rise in this category probably reflects the suspicions that some paediatric pathologists have that parental or adult intervention may have occurred in some of the cases where an infant dies suddenly. The Office for National Statistics concluded in a 2005 study that changes in certification practices meant that it had become so difficult to distinguish between the two causes of death that both groups are now presented together in any analysis of unexplained infant deaths. This means that, taking the two definitions together, the number of deaths has fallen but less steeply, from around 400 to 300 each year since the mid-1990s.
Several British government reports in recent years, notably the 2004 Kennedy report, have suggested that the parents of babies whose deaths are labelled as ‘unascertained’ unfairly face stigma which could reflect nothing more than differing practices among coroners. It recommended that the term ‘sudden infant death syndrome’ should continue to be used where appropriate, with ‘unexplained pending further investigation’ or the broader category of ‘sudden unexpected death in infancy’ being used for all other cases. The report called for a compulsory national protocol along these lines. It is quite possible, therefore, that the number of deaths in each category will change in the years ahead even if there is no underlying change in circumstances.
Whatever the definitional issues relating to the figures and the resulting trends, the bottom line would seem to be that parents can reduce to next to nothing the chances of an infant dying unexpectedly by putting it to sleep on its back, on a properly wrapped mattress and with little else in the cot. The odds also seem to favour girls, first born to a thirty-year-old couple compared to the second or third son born to a teenage mother. Nevertheless, while uncertainty about the causes of unexpected infant death remain – and money is thrown at researchers to pursue such a wide range of avenues – the media will stir up concern, leaving parents of young children with a nagging doubt for years to come.
As the children grow up, the parents can leave behind worries of SIDS but can begin to worry about the emerging phenomenon of ‘adult cot death’ or sudden adult death syndrome, which seems to strike mainly those in their teens and twenties. Evidence is emerging that the number of people who collapse and die suddenly without explanation could be much greater than is recorded in the official statistics, with the cause of the tragic deaths remaining a mystery. One study suggested that no cause could be identified for around 150 of the 3,500 apparently healthy adults who die suddenly each year in England. Campaigners say that this condition needs to be given a ‘name’ so that the problem will be addressed more seriously, as was the case with sudden infant death from the 1970s onwards.
3. Passing the Time
Pastimes designed for relaxation can also be panic inducing. Alcohol is a well-known demon, but art can also kill. Modern technology might threaten the cinema as we know it but it has made collecting easier.
Art Is Dangerous
‘Art – or accident waiting to happen?’ The Times
Artists have always relished the idea that their work is ‘dangerous’. Picasso, Duke Ellington and Anthony Burgess are among those who have made this claim in as many words. But the artist’s idea of what makes a work dangerous is perhaps not quite the same as everyone else’s.
When Carsten Höller became only the seventh artist to fill the vast Turbine Hall of London’s Tate Modern art gallery in October 2006, his temporary installation was greeted not with the usual gasps of awe but with whoops of glee from most – and trepidation from a few. The Times was most concerned. Was the piece ‘Art – or accident waiting to happen?’ Höller’s work, Test Site, was essentially a set of five glorified helter skelters, finely constructed in stainless steel and clear plastic. The longest of the slides was 55 metres, and it took just twelve hair-raising seconds to descend through its chutes and spirals. But were gallery visitors taking the ride possibly on ‘a slippery slope to disaster’?
The story originated on press night, when sliders reportedly emerged from the tubes at high speed with ‘swollen ankles, friction burns, grazed knees and bruised elbows’. Extra cushioning was hastily added. Nobody was going to worry much about a few injured journalists, but the safety of the public was naturally a concern as the slides were being assembled. Fortunately, the artist was able to offer solid reassurance: ‘These are built to German safety standards which the British inspectors are very happy with because they have the reputation of being the best in the world.’
As art critics were bruising their bottoms on Höller’s slides, controversy was also growing concerning Antony Gormley’s Another Place, an array of one hundred larger-than-life cast-iron standing figures staring out to sea, dotted over several square kilometres of the beach at Crosby in Lancashire. The pieces farthest out to sea were said to pose a hazard to navigation as well as to admirers, who might become so enraptured by them as to forget the advancing tide and be swept off to Davy Jones’s locker. Citing the danger to health and safety, the local council voted to have the work removed (it later won a reprieve). As this was due to take place, a woman viewing the figures did indeed become stuck in the mud, requiring the services of the Liverpool Coastguard. In reporting the story, a local newspaper exonerated the art with the headline, ‘Iron men not to blame for beach hazards, say rescuers’. The article quoted a lifeboatman, who pointed out: ‘Beaches are always a hazard.’
But perhaps there is good reason to be wary of art. A few months before these incidents, two women had been killed and a three-year-old girl badly injured when a giant inflatable artwork that they were exploring
broke free from its tethers and flew off into the air before snagging on a nearby CCTV mast. The work, Dreamscape by Maurice Agis, was on display at a park in Chester-le-Street, County Durham. The PVC structure consisted of colourful chambers linked by a network of tunnels. Wearing equally colourful capes, people could wander through the maze, ‘disappearing’ when their location matched their costume. Since 1996, versions of the work had been exhibited in Denmark, Italy and Spain without mishap, as well as in Liverpool, where it was vandalized with knives.
But the most notorious cases of death by art were in 1991. In October of that year the artist Christo, best known for his colourful wrapping of edifices such as the Pont Neuf in Paris and the Reichstag in Berlin, unveiled a massive installation of specially constructed metal umbrellas on either side of the Pacific Ocean – 1,760 yellow umbrellas in California, 60 miles north of Los Angeles, and 1,340 blue ones at Ibaraki in Japan.
The installations in California had been open little more than a week when they had to be closed to the public due to high winds, which were beginning to damage the umbrellas. Crews struggled in the gale with the dangerous job of cranking the giant metal objects into a furled position. People continued to come and see the artwork, however, and a few days later a woman was killed when one of the 200 kilogram structures blew free of its foundations and crushed her against a boulder, forcing the complete abandonment of the ambitious project. ‘Christo umbrellas close: crews dismantling project after woman is killed in accident,’ reported the San Francisco Chronicle.
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