Keep Out of Reach of Children: Reye¿s Syndrome, Aspirin, and the Politics of Public Health

by Mark A. Largent

Overview

“A fascinating history of a public health crisis. Compellingly written and insightful, Keep Out of Reach of Children traces the discovery of Reye’s syndrome, research into its causes, industry’s efforts to avoid warning labels on one suspected cause, aspirin, and the feared disease’s sudden disappearance. Largent’s empathy is with the myriad children and parents harmed by the disease, while he challenges the triumphalist view that labeling solved the crisis.” —ERIK M. CONWAY, coauthor of Merchants of Doubt

“Largent’s engaging and honest account explores how medical mysteries are shaped by prevailing narratives about venal drug companies, heroic investigators, and Johnny-come-lately politicians.” —HELEN EPSTEIN, author of The Invisible Cure

“Fascinating. . . . Thought-provoking.” —Booklist

“Well-researched. . . . A revealing work.” —Kirkus Reviews

Reye’s syndrome, identified in 1963, was a debilitating, rare condition that typically afflicted healthy children just emerging from the flu or other minor illnesses. It began with vomiting, followed by confusion, coma, and in 50 percent of all cases, death. Survivors were often left with permanent liver or brain damage. Desperate, terrorized parents and doctors pursued dramatic, often ineffectual treatments. For over fifteen years, many inconclusive theories were posited as to its causes. The Centers for Disease Control dispatched its Epidemic Intelligence Service to investigate, culminating in a study that suggested a link to aspirin. Congress held hearings at which parents, researchers, and pharmaceutical executives testified. The result was a warning to parents and doctors to avoid pediatric use of aspirin, leading to the widespread substitution of alternative fever and pain reducers. But before a true cause was definitively established, Reye’s syndrome simply vanished.

A harrowing medical mystery, Keep Out of Reach of Children is the first and only book to chart the history of Reye’s syndrome and reveal the confluence of scientific and social forces that determined the public health policy response, for better or for ill.

Mark A. Largent, a survivor of Reye’s syndrome, is the author of Vaccine: The Debate in Modern America and Breeding Contempt: The History of Coerced Sterilization in the United States. He is a historian of science, Associate Professor in James Madison College at Michigan State University, and Associate Dean in Lyman Briggs College at Michigan State University. He lives in Lansing, Michigan.

Product Details

ISBN-13:	9781934137888
Publisher:	Bellevue Literary Press
Publication date:	02/10/2015
Series:	Bellevue Literary Press Pathographies
Pages:	288
Product dimensions:	5.90(w) x 8.90(h) x 0.80(d)

About the Author

Mark A. Largent is the author of Keep Out of Reach of Children: Reye’s Syndrome, Aspirin, and the Politics of Public Health; Vaccine: The Debate in Modern America; and Breeding Contempt: The History of Coerced Sterilization in the United States. He is a historian of science, Associate Professor in James Madison College at Michigan State University, and Associate Dean in Lyman Briggs College at Michigan State University. He earned his PhD from the Universityof Minnesota’s Program in the History of Science and Technology and has taught history of science, science policy, and American history classes at Michigan State, Oregon State, and the Universityof Puget Sound. He lives in Lansing, Michigan.

Table of Contents

Prologue 11

Chapter 1 The Discovery of Reye's Syndrome 25

Chapter 2 Toxins: The Obvious Cause 42

Chapter 3 The Deadly Mist 57

Chapter 4 The Front Line in the Battle against Reye's Syndrome 7

Chapter 5 The Aspirin Hypothesis 98

Chapter 6 The Aspirin Industry Responds 122

Chapter 7 The Rise of Labels and the Fall of Reye's 146

Chapter 8 Labels, At Last 162

Chapter 9 Triumph and Dissent 178

Chapter 10 The Politics of Public Health 197

Acknowledgments 211

Notes 214

Index 257

Editorial Reviews

02/16/2015
In 1985, the federal government required that aspirin bottles warn about the drug's potential to cause Reye's syndrome in children. But was the claim true? This meticulous book by science historian Largent (Vaccine: The Debate in Modern America) says the answer is murky. Cases plummeted after a 1980 peak "in concert with the decreasing use of aspirin in children," precluding gold-standard causal proof. The toxic behavior of some involved parties, Largent found, was easier to spot. Despite studies finding a "strong" link between aspirin use and Reye's, the labeling movement was slowed by the anti-regulation mood of the 1980s. "Almost every area of vital concern to consumers was adversely affected by the Administration's relentless drive to deny the role of government in protecting citizens," said the National Consumer League. Unsavory tactics included one official's use of private calls and meetings instead of memos and testimony—to avoid "fingerprints"—during his anti-labeling campaign. Yet many labeling advocates were overly triumphant about the eventual labeling, Largent says, and mysteries remain, including the fact that Reye's disappeared "even in countries where aspirin consumption was always quite low." If one thing becomes clear in Largent's narrative, it's that the regulatory process itself is disordered. (Feb.)

Publishers Weekly

In this fascinating account, Reye’s syndrome–survivor Largent weaves his own tale throughout the bigger story about this puzzling medical condition. . . . This thought-provoking work certainly meets the goal of the publisher’s Pathologies Series to chart ‘the impact of disease on human individuals and populations from the biological, historical, and cultural perspectives.’” —Booklist

“A well-researched history of Reye’s syndrome that explores how science, medicine and politics interact. . . . As Largent examines the dispute over whether to require warning labels on bottles of aspirin, he also scrutinizes the actions and interactions—some might say the machinations—of pharmaceutical companies, consumer rights groups, epidemiologists, public health officials, courts and the U.S. Congress. . . . A revealing work.” —Kirkus Reviews

“An absorbing study of the interrelationships of science, business, politics, and public health. . . . Both professionals and lay readers interested in science will enjoy this work.”
—Library Journal

“Meticulous. . . . If one thing becomes clear in Largent’s narrative, it’s that the regulatory process itself is disordered.” —Publishers Weekly

“Far more than a story of parental interests or threats to children’s health. . . . Recommend[ed] for any concerned with public health management, research studies, aspirin and its management, or the processes of intervention, protection, and research that dictate the choices of public health as a whole.” —Midwest Book Review/California Bookwatch

“Explicates the difficulties of epidemiology and of turning their findings into effective, useful action in the face of political and economic resistance. . . . If you are sometimes bewildered by the current struggle for science to make a dent against ignorance, it’s all here in Keep Out of Reach of Children.” —Portland Book Review

“A fascinating history of a public health crisis. Compellingly written and insightful, Keep Out of Reach of Children traces the discovery of Reye’s syndrome, research into its causes, industry’s efforts to avoid warning labels on one suspected cause, aspirin, and the feared disease’s sudden disappearance. Largent’s empathy is with the myriad children and parents harmed by the disease, while he challenges the triumphalist view that labeling solved the crisis.” —ERIK M. CONWAY, coauthor of Merchants of Doubt

“Largent’s engaging and honest account explores how medical mysteries are shaped by prevailing narratives about venal drug companies, heroic investigators, and Johnny-come-lately politicians.” —HELEN EPSTEIN, author of The Invisible Cure

From the Publisher

02/01/2015
In the past, Reye's syndrome—a condition that causes swelling in the brain and liver— affected some healthy young children who were recovering from the flu or other minor maladies. They would become suddenly very ill, suffer liver failure, and often end up in a coma. Many died. The author (science, technology, public policy, Michigan State Univ; Vaccine) who survived this disease, documents the attempt to find a cause and prevent further cases. When the syndrome was first noted in 1963, researchers thought that the use of aspirin to lower fevers was the cause. Others suspected pesticides applied to eradicate spruce budworm or aflatoxins in moldy food. Congress held hearings and wanted warning labels put on aspirin, but the drug companies were against this. Eventually, a mild warning was added and physicians counseled parents about not using aspirin for children. Investigations never found anything more than correlation and the disease disappeared in the late 1980s. The book is an absorbing study of the interrelationships of science, business, politics, and public health. It is part of the publisher's "Pathographics" series, dedicated to the memory of popular science writer Dr. Lewis Thomas. VERDICT An intriguing look at research and its shortcomings. Both professionals and lay readers interested in science will enjoy this work. Academic and large public libraries will want to add it to their collections.—Barbara Bibel, Oakland P.L.

Library Journal

2014-11-15
A well-researched history of Reye's syndrome that explores how science, medicine and politics interact.Largent (Associate Dean/Lyman Briggs Coll. at Michigan State Univ.; Vaccine: The Debate in Modern America, 2012), a childhood survivor of Reye's syndrome and currently a historian of science, tackles a malady that is still not well-understood. Named for the Australian physician who described it in the 1950s, the syndrome was at first thought to be caused by aflatoxins, then by ingredients in a pesticide, and then, in 1980, by aspirin. Largent relates each of these stories of searches for a cause, focusing mainly on aspirin. There is a brief chapter on therapies developed to treat Reye's, which was often fatal or left survivors with severe disabilities, but the author's primary concern is not treatment approaches but rather the long controversy over its link to aspirin. As Largent examines the dispute over whether to require warning labels on bottles of aspirin, he also scrutinizes the actions and interactions—some might say the machinations—of pharmaceutical companies, consumer rights groups, epidemiologists, public health officials, courts and the U.S. Congress. In 1985, the Department of Health and Human Services ordered that warnings about Reye's syndrome appear on all bottles of aspirin sold in the United States, giving advocates of this measure the opportunity to create a narrative about the triumph of science over big pharma. However, as Largent points out, uncertainty remains. The incidence of Reye's declined sharply in the 1980s and then virtually disappeared, leaving scientists without cases to investigate to determine whether aspirin was indeed the culprit. The author's take-home message is that despite all the earnest efforts, sometimes there are no final answers. A revealing work that validates the statement that watching policy being made is like watching sausage being made—not a sight for the squeamish.

Kirkus Reviews