By Dan Olmsted and Mark Blaxill
Polio is the iconic epidemic, its conquest one of medicine’s heroic dramas. The narrative is by now familiar: Random, inexplicable outbreaks paralyzed and killed thousands of infants and children and struck raw terror into 20th century parents, triggering a worldwide race to identify the virus and develop a vaccine. Success ushered in the triumphant era of mass vaccination. Now polio’s last hideouts amid the poorest of the poor in Asia and Africa are under relentless siege by, among others, the Bill & Melinda Gates Foundation. Eradication is just a matter of time, and many more illnesses will soon meet the same fate.
But based on our research over the past two years, we believe this narrative is wrong – and wrong for reasons that go beyond mere historical interest. The misunderstanding of polio has warped the public health response to modern illnesses in ways that actually make them harder to prevent, control, and treat.
The reality, we believe, is that the virus itself was just half the epidemic equation -- necessary but not sufficient to create The Age of Polio. Outbreaks were not caused solely by poliovirus – the microbe was an ancient and heretofore harmless intestinal bug -- but by its interaction with a new toxin, most often innovative pesticides used to treat fruits and vegetables.
This alternative narrative makes better sense of the natural history of polio, and it resolves a number of anomalies that remain to this day. It suggests why poliomyelitis outbreaks emerged, evolved, and exploded the way they did; it probably solves, for the first time, the enduring riddle of why Franklin D. Roosevelt was afflicted 90 years ago this summer on Campobello Island; and it may mean today’s billion-dollar-a-year eradication effort is misguided, if not downright quixotic.
These are large claims. Let us explain.
Polio was a strange illness, never fully understood even by those who devoted their lives to studying and subduing it. It was a summer plague, coming on in late spring and all but vanishing in the fall. Many thought contagion had something to do with water, and Americans kept their children away from swimming pools in droves.
There is a profound distinction between poliovirus – an enterovirus, one that enters through the mouth and takes up residence in the GI tract and bloodstream – and poliomyelitis, the paralytic form of the illness. In the vast majority of cases, the virus causes either a minor illness or an inapparent infection.
But in 1 or 2 in 100 cases, the virus somehow gets past multiple defenses and into the nervous system, where it finds its way to the anterior horn cells at the top front of the spinal column. There, it preferentially attacks the gray-colored motor neurons (polio means gray in Greek) and causes inflammation of the protective myelin sheath (myelitis). This interferes with nerve signals to the muscles and can lead to temporary or permanent paralysis of the limbs and the respiratory system. A small number of people who contract poliomyelitis -- on the order of 1 percent -- die.
The first recorded U.S. outbreak was in 1841 in West Feliciana, Louisiana (10 cases, no deaths). There was a half-century gap until the next cluster, in 1893 in Boston (26 cases, no deaths). Then, in 1894, came what is widely regarded as the first major epidemic, in Rutland and Proctor, Vermont (132 cases, 18 deaths). Thirty more outbreaks – from such seemingly disparate locations as Oceana County, Michigan, and California’s Napa Valley -- were reported in the United States through 1909. The worst by far was New York in 1907, with 2,500 cases and a five percent mortality rate, a harbinger of the 1916 epidemic in the Northeast that killed 2,000 in New York City alone.[i]
What is most remarkable about this list is that so few outbreaks of paralytic polio were recorded anywhere in the world before the latter 19th century. Poliomyelitis is considered an ancient scourge, but the evidence supporting that belief is quite threadbare. An oft-cited Egyptian drawing depicts a priest with a withered leg that could have stemmed from paralytic polio, but for most of recorded history there were few observations of the sudden-onset fever and paralysis in infants that characterizes the disease. The earliest well-documented case of infantile paralysis in an individual is widely considered to be Sir Walter Scott, afflicted as an infant in 1773.[ii]
There is little question that the poliovirus was endemic in humans for millennia; there may even have been isolated cases of poliomyelitis for much of that period. Yet the poliovirus did not trigger widespread outbreaks of poliomyelitis. Setting aside for now the 1841 Louisiana outbreak, reported retrospectively, something seems to have happened around 1890 to launch The Age of Polio in the United States. And something else must have changed around the end of World War II to create the large modern epidemics seared into the minds of older Americans, thousands of whom are poliomyelitis survivors and almost all of whom know someone who was afflicted.
While we have not written about polio, we have seen this pattern before. In our book, The Age of Autism – Mercury, Medicine, and a Man-made Epidemic, we argued that something happened in the 1930s to launch The Age of Autism.[iii] We proposed it was the commercialization of ethyl mercury compounds for use in pesticides – seed disinfectants and lumber preservatives – and in vaccinations; we offered evidence of those inventions in the family backgrounds of the first autism cases identified in the medical literature, in 1943. Similarly, we proposed that the sharp rise in autism cases beginning around 1990 tracks with the federal government recommending several more mercury-containing shots.
Our attention was drawn to polio during our autism research when a virologist mentioned, in passing, that poliomyelitis could be triggered in some instances by injections. Called “provocation poliomyelitis,”[iv] this can happen when a needle stick punctures a nerve in the peripheral nervous system. An active poliovirus infection – typically, in a child exposed to the virus for the first time and not yet immune -- can gain access to the nervous system through a process called “retrograde axonal transport,” traveling back to the spinal column and triggering the dreaded paralytic form, poliomyelitis.
Such cases of provocation paralysis, we learned, occurred in Eastern Europe when antibiotics were excessively administered by injection; this practice led to multiple cases of poliomyelitis.[v] Bulbar polio – of the throat and respiratory system – was recognized as more common after tonsillectomies, again because nerve endings had been exposed.[vi] Outbreaks, then, can unquestionably occur as a result of an environmental injury, in these instances either excessive injection or surgery that led to peripheral nerve damage, in the presence of poliovirus infection.
We began to look at the poliomyelitis literature and found that another and much more comprehensive environmental theory of the disease had been put forward almost immediately after the early outbreaks, although it never gained mainstream attention. This theory proposed that what is called “polio” is not caused by a virus at all, but by poisoning from pesticides. In this theory, lead arsenate triggered the early clusters, and DDT kicked off the large outbreaks after World War II. (The pesticide theory has been championed in recent years by Jim West[vii] and by Janine Robert[viii].)
That really got our attention. In our research for The Age of Autism, we investigated a paralytic illness we believe resulted from an unrecognized interaction between a toxin and a microbe. Called general paralysis of the insane, or GPI, it was a gruesome and universally fatal outcome in a percentage of people infected years earlier with the syphilis bacteria. We proposed that a manmade mercury compound -- ironically used to “treat” syphilis -- allowed syphilis to gain entrance to the brain. When penicillin was developed in the 1940s and actually killed syphilis infections, GPI disappeared because one of the two requirements for the illness – the microbe – was destroyed.
We suggested that a number of other illnesses may follow a similar pattern in which microbes and metals interact, including, in some instances, autism. So the idea that an environmental insult – whether a needle stick or surgery or a toxic metals exposure – could be at work in outbreaks of poliomyelitis intrigued us.
But we did not find the claim that polio was simply poisoning by pesticides alone to be persuasive. The strong versions of both the virus theory and the pesticide theory – that it was entirely one or the other – are too simple to explain the pattern of evidence. The strong viral theory can’t explain the sudden emergence of poliomyelitis; the strong pesticide theory can’t explain the sudden protective effect of poliovirus vaccinations. Rather, we propose that poliomyelitis outbreaks are man-made events that result from the synergy of microbe and toxin.
A threshold question – one that requires an answer for our argument to make sense – concerns what scientists call biological plausibility. What is the mechanism by which the virus and a toxin could cause such damage? We’ll look at the particular properties of lead and arsenate shortly, but our fundamental idea is that both the poliovirus and the pesticide enter the body by the same route -- they are ingested -- and both end up in the stomach. There, the toxin could damage the stomach lining in such a way that the virus gains access to peripheral nerves. This kind of virus-toxin interaction (perhaps with arsenic or lead acting alone as the toxin) took place sporadically before 1890 and increased dramatically, we propose, with the invention of more potent insecticides like lead arsenate. With the advent of DDT, the interaction became even more dangerous, dramatically increasing the number of cases.
The idea that toxins have played any role in poliomyelitis outbreaks is not widely accepted, to say the least. In his Pulitzer Prize-winning 1995 book, Polio, Peter Oshinsky dismisses it in a sentence: By 1952, the peak year of the epidemic, the search for answers had grown so desperate that “a few blamed the dumping of poisons into the environment, especially the pesticide DDT,” he writes.[ix]
Yet on the very next page, Oshinsky describes a farm family, frantic about the epidemic sweeping Iowa that awful summer. The parents “tested the well water – it was fine – and used extra DDT to drive away flies.” Still, nine of their 11 children were affected, two of them paralyzed. The family “had done everything they were told to do,” Oshinsky writes, “everything they could. Why had it happened to them?”
Why, indeed? The search for an answer begins in the 1850s in Medford, Massachusetts.
(Next: The rise of epidemic polio.)
Dan Olmsted is Editor and Mark Blaxill is Editor-At-Large of Age of Autism. They are co-authors of The Age of Autism -- Mercury, Medicine and a Man-made Epidemic.
[i] B. Trevelyan, M. Smallman-Raynor, Andrew D. Cliff, “The Spatial Dynamics of Poliomyelitis in the United States: From Epidemic Emergence to Vaccine-Induced Retreat, 1910-1971.” Ann Assoc Am Geogr., June 2005; 95(2): 269–293.
[ii] “Famous People Who Had Polio,” Post-Polio Resource Group. http://www.pprg.org/index.php?option=com_content&view=article&id=72&catid=35
[iii] Dan Olmsted and Mark Blaxill, The Age of Autism: Mercury, Medicine, and a Man-made Epidemic. (New York: Thomas Dunne Books, 2010).
[iv] H.V. Wyatt, “Provocation Poliomyelitis: Neglected Clinical Observations from 1914 to 1950.” Bulletin of the History of Medicine, 55:4 (1981:Winter), p 543
[v] Peter M. Strebel, et al. "Intramuscular injections within 30 days of immunization with oral poliovirus vaccine -- a risk factor for vaccine-associated paralytic poliomyelitis." New England J of Med (February 23, 1995), pp. 500-506.
[vi] “Medicine: Tonsils & Bulbar Polio,” Time, April 12, 1954. http://www.time.com/time/magazine/article/0,9171,823341,00.html
[vii] Jim West, “Images of Poliomyelitis – A Critique of Scientific Literature,” http://www.whale.to/m/west5.html
[viii] Janine Roberts, “Polio Research Resources,” http://www.sparks-of-light.org/polio-research-docs.html
[ix] David M. Oshinsky. Polio: An American Story. (New York: Oxford University Press, 2005). p 62.