It was January 1925, and Dr. Curtis Welch faced a horrific problem: Diphtheria had taken hold in Nome, Alaska, and people were dying. His supply of diphtheria antitoxin was insufficient, and quarantine had failed to stem the epidemic. Nome, which sits two degrees below the Arctic Circle, was icebound—making delivery of antitoxin by ship impossible. Aircraft in 1925 were not up to the task of flying in subarctic temperatures.

Authorities picked up Welch's telegraphed plea for help. Territorial Governor Scott C. Boone ordered 300,000 units of antitoxin to be sent by railroad from Anchorage to Nenana. From there it would get to Nome via a dog sled relay. And as they say, the rest is history.

The Great Serum Run of 1925 covered 674 miles in five and a half days, through some of the harshest terrain and conditions imaginable. The mushers, particularly Leonhard Seppala and Gunnar Kaasen and their respective lead dogs, Togo and Balto, are etched into the national consciousness as heroes. The 38th running of the Iditarod Trail Sled Dog Race took place last month, in honor of the Great Serum Run of 1925 and the men and dogs who risked so much to save so many.

It's been decades since airplanes replaced dogsleds as the primary means to move people and supplies across Alaska's vast expanses. On the medical front, however, progress against diphtheria is taken for granted. Today in the United States, diphtheria—once called the "strangling angel of children"—is virtually unknown. The disease occurs, according to the Centers for Disease Control and Prevention, in only a handful of cases each year. But is this handful of cases on the verge of increasing? Is a disease that was thought to be essentially eradicated in this country biding its time to return? Will physicians once more need to consider diphtheria when doing a differential diagnosis on every child presenting with a sore throat and difficulty in swallowing?

It may never be known how many people Dr. Welch had to convince to be treated with the diphtheria antitoxin. The residents of Nome saw firsthand the disease's brutal symptoms and lethality. But today, medicine finds itself in confrontation with an anti-vaccine movement that claims that vaccines are not safe and can cause autism and other conditions.

In February, a special court ruled that there was no credible scientific evidence that thimerosal-containing vaccines contribute to immune dysfunction or that the measles-mumps-rubella vaccine is a contributing cause of autism or gastrointestinal dysfunction. The court has yet to rule on whether thimerosal-containing vaccines alone could have caused cases of autism.

Unfortunately, news reports indicate that the organized anti-vaccine movement rejects the court's findings. These groups will continue to agitate against vaccines and promote fear among the public that vaccines are inherently unsafe. This will no doubt lead to more children not being inoculated against childhood diseases and the public being placed at risk. Herd immunity only goes so far.

Perhaps you find yourself more often being challenged by patients about the safety of vaccines whose efficacy and safety were thought to have been proven long ago. On the plus side, these moments can serve as great teaching opportunities that can strengthen the doctor-patient relationship.

Air travel makes it improbable that we will ever see another great serum run like the one in 1925, in which life and death hung on the courage of 20 mushers and their dogs. More important, educated and informed patients who respect their physicians' judgment should render one unnecessary.

Contact the author at bfeigenbaum@advanstar.com
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