The Rabies Principle

September 15th, 2007

Why some health dangers inspire precaution — and some don’t

by Sandra Steingraber
Published in the September/October 2007 issue of Orion magazine

 

THE FINEST DESCRIPTION of the precautionary principle that I’ve ever heard came from David Gee of the European Environment Agency in a speech before a convocation of environmental ministers in Belgium. After arguing that benefit of the doubt should be granted to public health rather than to the things that threaten it, Gee said that precaution helps us avoid, during times of uncertainty, the construction of “pipelines of unstoppable consequences.” Gee’s remarks were met with stout applause.

On this side of the Atlantic, “precautionary principle” occupies the same rhetorical space as “socialized medicine.” They’re words best avoided in mixed company. Even the principle’s U.S. torchbearer, the Alliance for a Healthy Tomorrow, no longer uses the phrase in its name.

And yet, whatever you want to call a spade, the precautionary principle is already embedded in at least one corner of our environmental health system, as I learned when my children discovered a bat in their bedroom.

I had sent the kids upstairs to put on pajamas. When they reappeared, claiming an animal was under the bed, I pointed the way back to their room. “Pajamas. Now.”

Within minutes they were at my desk again. “Mama, we think you should come.” An electronic device of some kind was ringing. It occurred to me that we didn’t have any toys that sounded like that. The kids solemnly followed me upstairs. Piercing bleeps came from everywhere and nowhere all at once. Like a tape loop used to disorient the enemy.  Like the ring tone from hell.

I didn’t think to ask Faith and Elijah to leave the room. I just started tearing it apart. The beds. The bookshelf. The toy box. Finally, I dismantled the registers, and there it was inside the guts of the baseboard heater. Coppery fur. A greasy face. Ugly. Finally, I noticed the folded umbrellas of its wings, and a Latin name scrolled into my mind—Eptesicus fuscus, the big brown bat. It scrabbled along a pipe. Without the faceplate to create a resonating chamber, the volume of its vocalizations dropped to a series of pitiful twangs, like the plucked string of an unplugged electric guitar.

I ordered the kids out of the room, shut the door, and stuffed a towel under it.

In upstate New York, 2 percent of big brown bats are infected with rabies.

I knew that if I failed to capture this one, my son and daughter would be compelled to undergo rabies vaccinations, in accordance with Centers for Disease Control guidelines. Bats have razors for teeth. Their bites can be undetectable. And, although the odds are 98 percent that any given bat is rabies-free, rabies is a disease with a 100 percent fatality rate.

I squatted in front of the disassembled heating register and devised a plan. What I needed was a long-sleeved shirt, a yogurt container, and leather gloves. But these were all located in different parts of the house, and I didn’t want to leave my chirping intruder while I gathered the tools for its arrest. Through the door, I asked the seven year old to bring me the phone book. On the inside cover, alongside the numbers for the sheriff, fire department, and suicide counseling, was the after-hours number for the Rabies Prevention Hotline. I asked the four year old to bring me the phone. After two rings, a live person from the county health department answered. And with that phone call, a well-oiled public health apparatus swung into motion.

Within fifteen minutes, a wildlife removal specialist was standing next to me. Within another fifteen minutes the bat was inside a bucket in my freezer. By morning, its frozen corpse was in the hands of a pathologist. Twenty-four hours later, the head of the county’s rabies prevention program called me.

The bat was rabid.

I needed to come to county health for an immediate interview. During that conversation, I was asked if the children had been alone in the room with the bat. I learned that a four year old is on the cusp of what’s considered old enough to be a reliable narrator about whether direct contact has occurred. I was told that the decision to undergo the vaccination series was up to me. I was encouraged to decide swiftly. The initial shots needed to be given within seventy-two hours of exposure. The remaining four shots were given over twenty-eight days, according to a strict schedule. If I decided to go forward, county health would make all the arrangements. My upcoming lecture at the University of Montana? No problem. County health would arrange to send serum there. It would be waiting for me when I got off the plane. Oh, and by the way, he added, if your insurance does not reimburse, the county will pick up the cost of the vaccination series—which is several thousand dollars per person—because “we don’t want anyone making this decision on the basis of money. We want to err on the side of caution here.”

Those words were so amazing to me that I asked him to say that last part again. I’m a cancer survivor with enough outstanding medical debt that I was almost prevented from obtaining a mortgage for our house. In my whole medicalized life, no one has ever said to me: Look, we don’t want you to forgo a cancer screening because of financial worries, and so the government will guarantee payment. Or even: Look, we don’t know if you have been exposed, but we are removing environmental carcinogens from your neighborhood because we want to err on the side of caution.

The difference between bladder cancer and rabies is not one of scientific certainty. We have as much evidence that arsenic, say, causes bladder cancer as that the rabies virus causes a fatal form of encephalitis. The difference between bladder cancer and rabies is one of what physicians call disease specificity. If I forgo a rabies vaccination and, weeks later, am sucked down the pipeline of unstoppable consequences, we’ll all know what killed me. If I go on to die of bladder cancer, we won’t know if it was the arsenic in the drinking water or exposure to some other carcinogen.

There are other differences between bats and chemical toxicants that help explain why our public health system takes a precautionary approach to one and a risk approach to the other. To look into the eyes of a rabid animal is to confront a visible danger. To watch your children climb a wood play structure—even knowing that the wood is suffused with leachable arsenic—is not. To remove bat roosts from one’s attic—as we have subsequently done—is met with silence on the part of the bats. To remove arsenic-treated play structures from one’s community nursery school—as I have attempted to do—is not met with silence by their manufacturers. Believe me.

Back at home, I conducted some interviews of my own. Faith claimed that she never saw the bat when she was alone in the room with it. She only heard it. Elijah gave me a different story—“The bat flew around and landed on my hand. It was carrying a tiny . . . GUN!”—and I learned why the CDC considers the bat reports of young children unreliable.

We had the shots. Our insurance company paid. And so my children and I were afforded 100 percent protection against an environmental disease we may or may not have been exposed to. And I could go back to work investigating environmental diseases—cancer, birth defects, asthma, learning disabilities—and their known and suspected contributors—pesticides, solvents, soot, heavy metals—to which we are all exposed but for which no emergency hotline numbers appear in our phone books and no animals bleat SOS signals from the walls of our homes.