In general, these cases are reminiscent of the way that grief, physical injury, or some other stress often simply exacerbates the pre-existing miasmatic or chronic disease structure, rather than substituting the specific picture of IGNATIA, ARNICA, or the usual "never well since" remedies. In another large subgroup, the symptoms specific to the vaccine and those already latent or pre-existing in the patient are all mixed up together, and begin to disentangle only as the treatment progresses.

Far from being restricted to any particular category, vaccine related illness similarly encompasses the full range of chronic diseases in children, from asthma, eczema, and allergies to otitis media, far and away the commonest in my practice, as well as learning disabilities and emotional or behavior problems.

As documented in many of these cases, the evolution of otitis media in recent years exactly parallels the theoretical concerns outlined above. In the early 1960's, as a medical student, I saw acute ear infections daily in the emergency room, with high fever and violent earache. Almost always, they would respond dramatically to penicillin at levels of 100,000 units daily or less. If the eardrum had already burst, as often happened, the child would recover promptly and completely without any treatment at all.

Today, although such cases are still seen occasionally, otitis media is predominantly a chronic or relapsing illness, with significantly less fever and pain than in the past. In a surprising number of cases, there are no symptoms whatsoever, and the diagnosis is made solely on morphological grounds at the time of a routine examination. For presumably the same reasons, it is much less likely to heal spontaneously or to respond favorably to antibiotics, has a much greater tendency to relapse soon after the drugs are stopped, and is more often associated with chronic or residual symptoms such as behavior problems, learning disabilities, swollen tonsils, and hearing loss. Recent studies further indicate that tubes inserted to facilitate drainage, the most advanced technology presently available, are themselves an important cause of permanent hearing loss, the spectre always used to justify them (25).

To be sure, many immunosuppressive factors other than vaccines also have to be considered, such as the widespread use of antibiotics, the development of resistant organisms, urban and industrial pollution, and doubtless many more.

But my fear is that any other chronic disease would tell the same tale. In addition to their specific effects, only a few of which have yet been identified, each vaccine probably has immunosuppressive or nonspecific effects that would look quite different for each patient, promoting chronic at the expense of

acute responses, i.e., having to do with "style" rather than content. In the case of the DPT vaccine, and probably for the rest as well, the net will have to be widened to include enuresis, eczema, asthma, allergies, nervous and mental diseases, autoimmune phenomena, cancer, and indeed the whole spectrum of pediatric and adult medicine.

In conclusion, I want to address the most important and difficult problems of all: the research that will have to be done in the future, and the political will that will be needed to carry it out. Both questions are inseparably connected, and both will need radically new models to succeed.

Because current studies ignore and indeed preclude any concept of the total health picture over time, they cannot provide unambiguous information about how vaccines act. At the same time, controlled scientific investigations based on the totality of symptoms will require a large population of unvaccinated kids, just what the existing laws are designed to prevent. To those parents who decide not to vaccinate we therefore owe a considerable debt of gratitude.

Similarly, the accusation that unvaccinated children help propagate the various diseases and thus threaten the rest of the population cuts both ways. For the extent to which this argument is true also admirably quantifies the ineffectiveness of the vaccines: if the "immunity" they conferred were genuine and lasting, the unvaccinated kids would pose a threat only to themselves.

Furthermore, it will not be possible to study each vaccine independently unless we legally authorize parents to choose some vaccines but not others. At present, even the most liberal states allow parents to refuse all vaccinations across the board, on religious or philosophical grounds, but not to make informed medical decisions for their children. Once the vaccines are made totally optional, as in the UK, the experimental and control groups can become purely self-selecting for each vaccine, with those receiving it matched as closely as possible to those exempted.

Once these groups are in place, it will be necessary to follow them prospectively for at least a generation, if not a lifetime. For the present, pilot studies could also be done retrospectively, using older kids with known vaccination histories.