Immune To Reason

-by Brian Wallstin

The Houston Press, 6/3/99

Hundreds of thousands of Texas children, including 250,000 newborn babies are routinely vaccinated against hepatitis B each year. Why? Good question.

Like most people, Glenda Matheny didn't know much about hepatitis B, but when the family pediatrician recommended that her then-14-year-old daughter, Breonna, start receiving a three-dose vaccine against the virus, Glenda figured it had to be done.

Breonna handled the first shot without incident. However, on January 17, 1995, immediately after she received her second dose of the vaccine, Breonna became extremely ill. Three days later, after her daughter's symptoms -- headache, fever, nausea and general weariness -- failed to go away, Glenda took Breonna back to the doctor, who determined that the girl had suffered a "strong local reaction," as well as a "possible systemic reaction," to the hepatitis B vaccine.

The doctor opted not to give Breonna the third and final dose of the vaccine and assured her that the miserable symptoms she was experiencing were temporary and she'd feel just fine before too long.

But she didn't. After four months, Glenda recalls, "we were back to the doctor almost every day." Breonna was missing so much school that she had to withdraw from Bellaire High, where she was enrolled in the pre-international baccalaureate program for exceptional students. While her friends were meeting boys, going to dances and otherwise enjoying their teen years to the fullest, Breonna was taking a correspondence course at home.

And suffering. Breonna loved sports and was an especially good softball player, but after receiving the hepatitis B vaccine, her joints ached so relentlessly that it was futile to even try to play. Besides, just breaking a sweat would often cause Breonna to faint.

Breonna eventually earned her high school diploma late last year. She scored in the high 1300s on her Scholastic Aptitude Test, but college will have to wait because Breonna is still very sick. Some mornings she wakes up with her face so swollen she hardly looks like herself. When that happens, Glenda knows her daughter, who is 18 now, will probably spend the next three days in bed, too weak to do anything but sleep.

Glenda Matheny couldn't sleep, at least not until she knew what had happened to her daughter's health. She did a little of her own research and discovered, as have others, that hepatitis B actually posed very little risk to Breonna.

According to the Texas Department of Health, the overwhelming majority of the approximately 1,300 new hepatitis B cases reported each year in Texas occur in adults between the ages of 20 and 40, with the highest concentration -- more than 60 percent -- becoming infected between 25 and 30.

Children under the age of 14 account for an average of 37 new cases of hepatitis B each year in Texas. The reason for the low rate of infection among kids is simple: Hepatitis B is what's commonly referred to as a "lifestyle disease" that mostly strikes intravenous drug users, homosexual men and heterosexuals with multiple partners.

Moreover, the chance of developing chronic hepatitis B, which can lead to cirrhosis and liver cancer, is low, somewhere between 5 and 10 percent for people over five years old. Though younger children are at greater risk of chronic infection, which can lead to cirrhosis and liver disease later in life, as many as 95 percent of all hepatitis B infections pass without incident or serious illness. For most people, acute hepatitis B is typically no worse than a bout with the flu.

Clearly this is not information Glenda Matheny possessed when she agreed to have her daughter vaccinated against hepatitis B.

"The pediatrician had been my pediatrician when I was growing up," Glenda recalls. "He told me that because teenagers were at high risk, my daughter needed to be vaccinated. That was his medical recommendation, and I took it."

Even if she couldn't see it, Glenda Matheny at least had a choice. Most Texas parents don't, at least not since last August, when the state Department of Health began requiring that all children in the state be vaccinated against hepatitis B before they enter kindergarten. The mandate originated with the federal Centers for Disease Control, which began recommending universal childhood immunization against hepatitis B in 1991.

According to Kristin Hamlet of the Texas Department of Health, the CDC recommendation came about after health officials realized they weren't reducing the chance of the disease in higher-risk adult populations.

"The initial strategy was to target adults who were at risk due to social behavior, or through drug use or occupational exposures," Hamlet says. "But that wasn't really doing anything to lower the incidence of the disease, because you can't target these people. You can't tell who they are, and they don't tend to come in for preventative health care before they go out and expose themselves to infection."

Hamlet said the state's mandate makes sense because the CDC, which sets vaccine policy for the federal government, estimates there are as many as 1.25 million chronic carriers in the United States, including about 30,000 children. "Those are the cases we don't have any way of preventing other than through childhood vaccination," Hamlet says.

But the actual reported incidence of the hepatitis B virus in Texas is low, especially among young children. Only 58 new cases were reported between 1993 and 1997 in kids younger than five, according to state health officials. That's an average of less than a dozen new cases a year, with most of the cases occurring among infants born to infected mothers.

While young children are three times more likely to contract chronic hepatitis B than older kids and adults, transmission of the virus from one child to another is uncommon: Fewer than five new cases of chronic hepatitis B occur among children annually in Texas.

The first hepatitis B vaccine appeared on the market in 1982, when Merck & Co. licensed Hepavax. Like most vaccines being produced at the time, Hepavax was manufactured using purified plasma from infected blood. Four years later, after fears arose that certain shipments of Hepavax may have been contaminated with the HIV virus, the company received FDA approval for Recombivax, the first genetically engineered vaccine. In 1988 SmithKline Beecham licensed its hepatitis B vaccine, Engerix, which, like Merck's product, is manufactured from a reproduced DNA strand of the virus.

But, while the risk of hepatitis B appears minimal, the vaccine has been blamed for some 25,000 adverse reactions nationwide between July 1990 and October 1998, according to the federal Vaccine Adverse Events Reporting System, or VAERS, which collects "anecdotal" evidence from pediatricians, family physicians and other health care providers.

In 1996 Breonna was diagnosed as having chronic fatigue syndrome, an autoimmune disorder. Her doctor filed a VAERS report attributing Breonna's illness to a hepatitis B vaccine reaction. It was one of roughly 1,100 adverse reactions reported out of Texas between July 1990 and October 1998, including 33 deaths, 370 emergency room visits and 93 hospitalizations. About 20 more vaccine recipients became "disabled," though the length and severity of the disabilities are difficult to discern from the available data.

The consensus from the federal CDC down to local health departments, however, is that serious adverse reactions are extremely rare. A recent CDC report concluded that fewer than ten people per one million will become ill from the vaccine, while 1,200 people out of every one million are at risk of death from hepatitis B-related illness.

Moreover, public health officials who make and carry out vaccine policy in the United States say the mandatory vaccination of children is the only way to combat the spread of the virus among the higher-risk adult population.

"The notion of policy on this vaccine is, as it is with all vaccines, a trade-off between risk of the vaccine versus risk of the disease," says R. Palmer Beasley, dean of the University of Texas at Houston School of Public Health. "The trick is determining whether there is any causation [between the vaccine and the reaction]. The general belief has been -- and I still believe this -- that there are essentially no risks to the hepatitis B vaccine other than you get a needle and you get a little inflammatory action and it hurts for a few days."

But, citing the thousands of VAERS reports, parents groups and vaccine-safety advocates are raising questions about the safety of Recombivax and Engerix. The debate has intensified in recent months, starting in September, when the television newsmagazine 20/20 reported on the death and serious injury to a handful of American children who received the three-shot regimen. One month after the broadcast, France announced it was stopping its adolescent hepatitis B immunization program after studying the data on 800,000 immunizations. The vaccine has been blamed for some 25,000 adverse reactions nationwide between July 1990 and October 1998, according to the federal Vaccine Adverse Events Reporting System.

Congress joined the discussion on May 18, when a House subcommittee held a public hearing in Washington, D.C., to begin to gather evidence and testimony on the vaccine's safety. Dozens of people, including the parents of children who had died or suffered serious illness after receiving the vaccine, urged the committee to ask Congress to fund studies that would determine the safety of Recombivax and Engerix, particularly in newborns.

That's not necessary, says Isabel Claxton of the vaccine-research division of Merck & Co. Claxton says it's hard to know what to say to people who believe their children were killed or injured by the vaccine.

"They want to find blame. They want an explanation for this, where there is no explanation. So they decided it was the vaccine," Claxton says. "I can't even begin to understand their grief, because I haven't been there myself. What I do believe -- very strongly -- is that you cannot say it was the vaccine; you cannot prove it was the vaccine. But think about the number of grieving parents we're saving through vaccination."

Clearly this is the view held by public-health officials like Palmer Beasley, who points out that roughly one billion people have received the hepatitis B vaccine worldwide. Any large number of "adverse circumstances" have probably occurred by chance alone, he says.

"Coincidence doesn't establish causation," says Beasley, who was an adviser to the World Health Organization's campaign to implement universal hepatitis B vaccinations in Taiwan. "I have personallyadministered thousands of hepatitis B immunizations, and I have neverseen the kinds of severe reactions that are being reported. That's notevidence, that's just myexperience."

So where is the evidence? Does it even exist?

Every few years, a committee of the Institute of Medicine, a researchand advisory arm of the National Academy of Sciences, collects andreviews data on adverse vaccine reactions, as well as their possiblecauses. The committee's most recent report was issued in 1994, thoughit's difficult to determine what the committee members really thoughtabout the potential dangers of receiving a hepatitis B vaccination.

On the one hand, the committee cited "biological plausibility" for ahost of serious illnesses resulting from hepatitis B vaccine, includingGuillain-Barré syndrome, multiple sclerosis and rheumatoid arthritis. Iteven warned that the vaccines appeared to cause an allergic reactioncalled anaphylaxis that can be fatal. On the other hand, the committeesaid it didn't have enough evidence to make a definite connectionbetween the vaccines and the adverse reactions.

Last year the scientific journal Vaccine published a review of thereported adverse reactions to hepatitis B immunizations. Like theInstitute of Medicine, the authors came to the conclusion that, giventhe available information, the benefits of hepatitis B vaccines stillfar outweigh the potential risks. However, the authors offered thispiece of parting advice "In view of the campaign for universal hepatitisB vaccination in some countries, the appearance or exacerbation ofautoimmune disease may become frequent and should be actively sought andreported."

"This whole thing about hitting the newborns with all these shots beforethey get out of the hospital is really kind of frightening," says JaneOrient, an Arizona physician who is executive director of theAssociation of American Physicians and Surgeons. "They are not doing thestudies they need to do to put some of these fears to rest or verifythere really is a problem.

"There are so many unknowns that the children receiving theseimmunizations really are experimental subjects," Orient says. "They ortheir parents are not giving informed consent to this treatment, andthat's supposed to be against international law under the Nurembergprotocol."

Dawn Richardson is executive director of an Austin-based group called

Parents Requesting Open Vaccine Education, or PROVE. The organization isfighting expansion of the state's vaccine requirements, as well astrying to convince legislators to allow parents the right to reject theexisting mandates on philosophical and religious grounds. All thingsbeing equal, she believes most parents might want to know everythingthere is to know before immunizing their children, especially against adisease they are at minimal risk of contracting.

"If it's a disease that's highly infectious and highly debilitating tochildren, we ought to have a mandate," says Richardson, who sufferedadverse reactions to vaccines as a child. "But the reality is that, forthe parents I've talked to, the benefits of this vaccine don't outweighthe risks. So, why is every newborn getting vaccinated?"

In late fall of 1996, 13-year-old Paul Viscontini became so ill during afamily trip to Connecticut that his parents had to take him to theemergency room. The diagnosis was pancreatitis, a painful inflammationof the organ that helps the body digest food. In Texas, childrencurrently must receive 33 doses of nine different vaccines before theycan attend school.

"This kid's been sick for nine or ten months," the doctor told Paul'smother, Joan.

"You're off by a few weeks," Joan said.

"What happened?" the doctor asked.

And Joan replied, "He got the hepatitis B vaccine."

A few weeks before Christmas 1995, the family's pediatrician told Joanthat Paul should receive the shot because he played basketball and, ifthings should get rough, he might come in contact with someone else'sblood. Joan accepted that reasoning and gave her consent for Paul toreceive the three-shot regimen.

At the time, the Viscontini family, who reside in Friendswood now, livedin Holland, Pennsylvania. Paul was just a freshman in high school, buthe had already established himself as one of the area's top swimmers,particularly in the endurance events. His daily training scheduleincluded exhausting 3,000-yard workouts.

After he received his first shot, Paul came down with a bad cold. Butbecause it was that time of year, Joan didn't think anything of it. OnJanuary 28, 1996, Paul received his second hepatitis B shot. Withinhours, he was feverish, vomiting and doubled over with abdominal pain.Within days, he had lost a noticeable amount of weight, and all of asudden he had no stamina. At swim team workouts, he could barely make itacross the pool.

Joan had no idea why Paul was so sick. Neither did the doctors. No onemade the connection to the vaccine, partly because Paul's younger sisterhad also been immunized and had suffered no ill effects.

But after Paul received the third and final hepatitis B shot on July 31,1996, there was no doubt in Joan Viscontini's mind. She did someresearch and read about the illness and injury that were being blamed onthe hepatitis B vaccine. At one point, a physician noted that Paul'sliver was enlarged and suggested the possibility that Paul might haveactually been infected with the hepatitis B virus.

"I said, 'Doesn't all this give you guys a clue that something ishappening with that shot?' " Joan recalls. "They didn't want to hear it.They said that very, very few people have bad reactions. It wasextremely rare, they said."

By the time classes started that fall, Paul was so sick he could barelymake it through the school day. When an outbreak of the flu occurred,his teachers were particularly worried about Paul and sent him home. Ashis condition worsened, Paul's parents became frantic. One day, his father, Sal, was so frustrated and upset by his son's weight loss thathe threatened to have Paul hospitalized where they could pour liquefiedfood down his throat.

"This was a very normal, very healthy kid," Joan says. "One doctor saidit was because he was lifting weights too much, then another said it wasin his head. But 13-year-old boys just don't start dropping 15 to 20pounds for no good reason."

Eventually Paul was diagnosed with Crohn's disease, an autoimmunedisorder that strikes the bowels and intestines. Did the vaccine triggerthe disease? Joan is convinced it did. Yet, she says, not one physician-- not even the specialists at Texas Children's Hospital, where Paulstill receives monthly checkups -- has bothered to investigate thepossibility.

Joan says it has been suggested by the doctors and specialists who haveexamined Paul that she's "a crazy, hysterical mother" for trying toconvince them that the vaccine was responsible for his illness. Joanadmits that watching her child deteriorate for unknown reasons "almostdrove us off the deep end." And so did her attempt to talk reasonablywith doctors who had no answers but somehow knew it couldn't have beenthe vaccine that made her son ill.

About six months ago Paul's condition suddenly started improving. Hebegan to eat everything in sight. His stamina returned. He has sinceshaved 15 seconds off his best time in the butterfly, and recently heran a mile in under six minutes.

Paul will be ready for college in another year or so. Joan has heardabout proposals in some states that will require college freshmen toreceive a hepatitis B booster immunization before they can attend class.Joan says if that's the case, her son won't be attending college."There's no way," she says, and you can tell she means it, "I will everallow him to receive another shot."

Meanwhile, she's afraid other parents will have to go through the samemaddening experience she did before someone decides to get to the bottomof all the adverse reactions that are being blamed on the hepatitis Bvaccine.

"I object to [public-health officials] not doing the proper studiesbefore giving it to kids," she says. "But until people start standing upto be counted, that's never going to happen."

In Texas, children currently must receive 33 doses of nine differentvaccines before they can attend school, including three shots of DTP(diphtheria, tetanus and pertussis); three shots of MMR (measles, mumpsand rubella); four doses of oral polio vaccine; four injections of HbCV(influenza); and three doses of hepatitis B vaccine.

With few exceptions, Texas's vaccine requirements mirror the"recommended immunization schedule" issued every year by the federalCenters for Disease Control. Texas, like most states, quickly adopts theCDC's every recommendation as a mandate.

And why not? The cost is largely borne by the federal government, whichbuys the vaccine from the manufacturer and sells it to the states atreduced prices. States that administer enough vaccinations to meetcertain "compliance" levels set by the CDC are rewarded with grants. Insome states, including Texas, parents eligible for public assistanceface cuts in benefits if their children are not fully vaccinated.

"I call it vaccination without representation," says Michael Belkin, aWall Street analyst-cum-vaccine-safety-advocate from New York, whosenewborn daughter died 12 hours after receiving the hepatitis B vaccine."No one is representing the interests of children or their parents."

Indeed, the CDC doesn't even wait until a new vaccine is licensed forcommercial use before recommending that it be administered to thenation's children. In early 1998, for example, the CDC's AdvisoryCommittee on Immunization Practices voted unanimously to add a vaccineagainst rotavirus to the federal regimen after the manufacturer,Wyeth-Lederle, assuredcommittee members that approval from the Food and Drug Administrationwas in the works.

"Children's vaccines, once they are licensed, are automatically shovedinto the mandatory vaccine schedule," says Barbara Fisher, executivedirector of the Virginia-based National Vaccine Information Center, a watchdog group that bills itself as the oldest and largestvaccine-safety group in the country. Pressure from Fisher's group overcontaminated lots of DTP vaccine in the 1980s led to the creation of theNational Childhood Vaccine Injury Act, a federal no-fault program thathas paid out more than $1 billion in compensation for vaccine-relatedinjuries and death.

But while the act has been a good thing for some vaccine-injured people,it has also helped protect the drug companies that manufacture thevaccines from liability. The act authorizes an excise tax on certainvaccines, which is set aside to fund the compensation program. Accordingto Isabel Claxton, of Merck's vaccine division, the compensation act isneeded to protect theexisting vaccine supply. Right now, there are only two U.S. vaccinemanufacturers: Merck & Co. and Wyeth-Lederle, a company based in Europe.The rest, Claxton says, couldn't stand the heat from safety advocates.

"All the other companies that did research and development andmanufacturing and distribution of vaccines dropped out in the 1980sbecause of issues like this," says Claxton. "One dose of our mumps,measles and rubella vaccine takes 13 months to get to the market -- 13months -- from the petri dish to the pediatrician's office. For a lot ofcompanies, it wasn't worth the time to continue in that environment ofthe 1980s, which was so litigious."

Maybe so. But there's little doubt that the coordinated, worldwideeffort to eliminate disease through immunization has certainly made itworthwhile to be in the vaccine business today. In 1990 vaccines were a$500-million market. Today, they're worth well over $1 billion to just ahandful of conglomerates, including manufacturers of the two most widelyused hepatitis B vaccines, Merck and SmithKline Beecham. Wyeth-Lederle,which manufactures one of the longest-running vaccines on the, oral polio, has experienced a 300 percent increase in revenuesince 1986.

While ostensibly a public-health initiative, commercial interestsdominate the process by which new vaccines are developed and used.Public entities such as the National Institutes of Health help shapebasic research priorities, but there is very little governmentinvestment in the type of applied research that produces the technology.That work is almost exclusively being performed by pharmaceuticalcompanies, which, of course, base their priorities on the potential forprofit.

"The federal government says it wants improved, better and safervaccines," says Ronald C. Kennedy, a microbiologist and immunologist atthe University of Oklahoma Health Science Center. "But the reality of itfor researchers is, you never get funded. One way you can, though, is togo to the drug companies that have the patents and try to get them tosupport the work."

Not that long ago, vaccines, by definition, were not designed forlong-term profitability. That started to change with the measlesepidemic of 1989 and 1990, which involved more than 45,000 reportedcases, half of which were unvaccinated school children. More than 100Americans died from measles in these two years, according to the U.S.Department of Health and Human Services. Stunned public-healthofficials, who long believed measles to be under control, startedrethinking the national immunization strategy and decided thatvaccinating only those people at highest risk of contracting a diseasewasn't working.

In the last decade, the CDC has added a handful of new vaccines to thefederal schedule, including hepatitis B, chicken pox, rotavirus andhepatitis A. Kennedy says that while many public-health officialsbelieve this to be the best strategy against infectious diseases, tocarry it out they need the cooperation of manufacturers who may have aslightly different set of priorities.

"Early on, if you're a drug company, you don't make a lot of money offvaccines," Kennedy says. "Essentially, you didn't have return customers.I think what happened was that some of these companies got very smartand realized that their repeat customers could be infants, and that ifyou started mandating certain things, like requiring vaccines beforeschool, that was good and you could make money with vaccines."

That may be true, says Isabel Claxton of Merck & Co., but the decisionto implement widespread immunization against hepatitis B was basedsolely on public health.

"We don't have any secret moles at the CDC," Claxton says. "We wish wedid sometimes, but that's not the way it happens. Public health has nocommercial interest in this. We have a commercial interest in this, but[public-health officials] are very protective of influence fromindustry."

But since it was formed in the mid-1980s, the CDC's Advisory Committeeon Immunization Practices has been dominated by members who, accordingto financial disclosure statements, had research contracts with the samedrug companies whose products they were recommending for use in Americanchildren. In 1991 two prominent researchers on the committee werepressured to resign by a national vaccine-safety group after it waslearned that they had provided expert testimony on behalf of vaccinemanufacturers involved in lawsuits.

Prominent members of the Houston scientific community have beeninstrumental in the development of the hepatitis B vaccine, as well asstrong advocates for universal immunization of newborns and children.Invariably, they too have ties, direct and indirect, to drug companies.

F. Blaine Hollinger, a professor of molecular virology at Baylor Collegeof Medicine, is a prominent blood-borne-disease expert who, in his ownestimation, "knows as much about this vaccine as anyone around." Indeed,Hollinger has been involved in hepatitis B vaccine development from thebeginning and has made numerous contributions to the scientificliterature on the subject.

In the late 1970s and early 1980s Hollinger led a team of Baylorscientists working on something called a virus-derived polypeptidevaccine. The team had gotten so far as to immunize chimpanzees -- anextremely costly exercise that, if successful, invariably leads toclinical trials on humans. A 1981 journal article authored by Hollingerand his colleagues reported that the chimp trial "provided evidence forthe efficacy of this vaccine."

While Hollinger and company were injecting chimps with polypeptides,Merck & Co. was pressing ahead with the development of a plasma-derivedvaccine. Ron Kennedy was a student of one of Hollinger's collaborators.He recalls that Merck "had an interest very early on" in the polypeptideresearch and that company scientists paid numerous visits to Hollinger'slab at Baylor.

"Because Merck was developing their own set of vaccines, they wanted toknow more about our technology to see if it was complementary orcompetitive with ours and to see if they could get in on it early,"Kennedy says.

Apparently Merck did not view Hollinger's work as a threat to its ownresearch. In 1982 the company licensed Hepavax, its plasma-derivedvaccine. Meanwhile, Merck continued to develop what would eventually bethe state-of-the-art in immunizations: molecularly engineered vaccines.

That research paid off when Recombivax, the first recombinant DNAvaccine, was approved by the Food and Drug Administration in 1985. Thefollowing year it was licensed for commercial use and replaced Hepavaxas the hepatitis B vaccine of choice.

By then Hollinger had all but abandoned the polypeptide research. Hesays that, although he and his colleagues continued to have a "realinterest" in the technology, "the recombinant vaccine was doing anexcellent job, and therefore there probably wouldn't be a market forthis other vaccine. So we decided not to continue to pursue it."

At that point Hollinger contracted with Merck to perform prelicensingclinical trials on Recombivax. Since then, Hollinger has receivedresearch funding from Merck and has given expert trial testimony onbehalf of both Merck and SmithKline Beecham after they were sued bypeople or their families alleging they'd been injured by the vaccine.

Meanwhile, two of Hollinger's colleagues, Gordon Dressman and JimSparrow, continued the polypeptide research and in 1988 were awarded apatent. By then, however, Recombivax and SmithKline's Engerix dominatedthe hepatitis B vaccine market, and there was little interest incarrying out the additional research necessary to license thepolypeptide technology.

Hollinger says vaccine researchers are in a catch-22 situation, whichoften leads to the perception that they are beholden to themanufacturers. As it is, researchers have little choice but to partnerup with drug companies, which have lots of cash earmarked for drugdevelopment but may not necessarily have the technical expertise to doit themselves.

"The NIH would not fund a vaccine study," Hollinger says. "Who else isgoing to do the clinical trials? You want and need credible researchersto do these trials."

Hollinger rejects the notion that researchers would accommodate theircommercial backers by ignoring the scientific evidence that a particularvaccine may not be safe and effective.

"Let me tell you, the only thing a scientist has going for him is hiscredibility," he says. "If I lose my credibility, I have nothing. I amnot a scientist, and I can't be a scientist."

Few people would question Hollinger's expertise and commitment topreventing illness, particularly one as excruciatingly painful as livercancer. Nor would most people argue that vaccines that fight dangerousinfectious diseases shouldn't be made available to the public. No onelikes to be sick, and everyone hates to see a sick kid.

Yet it's difficult to ignore the role of both the scientist and the drugcompanies in shaping the "public awareness" that allows states such asTexas to implement vaccine mandates with relatively little opposition.Toward that end, vaccine manufacturers have recruited, or set upthemselves, nonprofit organizations that lobby government officials toinstitute vaccine mandates. Invariably, the boards of directors of theseorganizations are stacked with scientists who are advocates foruniversal immunization programs.

Consider, for example, an organization called Hepatitis FoundationInternational, a New Jersey-based nonprofit whose board of directorsincludes Blaine Hollinger and Palmer Beasley of UT-Houston. The group's motto is: "Each of us needs to be actively involved in protecting and maintaining our own health. Knowledge is our best weapon."

Apparently, though, the universal vaccination of children against viral hepatitis is a very close second. From the moment it was formed in 1995, Hepatitis Foundation International has breathlessly reported on the progress of, and need for, a vaccine against hepatitis A, which most recently was linked to shellfish