TERRY GROSS, host:
This is FRESH AIR. I'm Terry Gross.
The current controversy over childhood vaccinations and their possible side effects pales in comparison to the vaccine wars at the turn of the 20th century, according to my guest, Michael Willrich.
His new book "Pox" is about the smallpox epidemic in the early 1900s, when many people were afraid to be vaccinated and public health officials and policemen forced thousands of Americans to be vaccinated against their will, sometimes at gunpoint.
Those public health officials needed to stop the spread of this deadly disease, but the way they went about it raised civil liberties questions that ended up in the Supreme Court.
Smallpox killed 300 million people in the 20th century. That's more than all of the wars in that century combined. As the result of the vaccine's success, the World Health Organization declared the disease officially eradicated in 1980.
Michael Willrich is an associate professor of history at Brandeis University.
Michael Willrich, welcome to FRESH AIR. Why did you want to write about smallpox vaccinations at the turn of the 20th century?
Professor MICHAEL WILLRICH (History, Brandeis University; Author, "Pox: An American History"): Well, I was collecting material for a book on civil liberties during the period. This - I was writing this, just beginning this project not long after 9/11, and I think like many Americans, I was thinking a great deal about problems of national security and individual liberty and the clash between them.
So I set out to write this book on civil liberties, and as I was gathering material, I came across this small item in the New York Times that just absolutely sparked my curiosity.
It was about a vaccination raid on a set of tenements in Little Italy, New York. This was the Little Italy that was on the Upper East Side, in Italian Harlem. And this occurred right about February, 1901.
And a crew of vaccinators and police from the city, about 250 men in all, arrived on the scene of these tenements in the middle of the night and set about vaccinating everyone they could find, knocking on doors, breaking them down if necessary.
And people started running. So there were scenes of policemen holding down men in their night robes while vaccinators began their work on their arms, and inspectors were going room to room looking for children with smallpox. And when they found them, they were literally tearing babes from their mothers' arms to take them off to the city pesthouse.
And I just became fascinated by this episode. What did it mean for a big city government at the dawn of the 20th century to be battling an epidemic disease in this way? What did it mean for American notions of liberty?
GROSS: And how to balance the good of society with the liberty of the individual.
Prof. WILLRICH: That's exactly right. I mean, I just had the sense when I came across this very short article of having my hands on a - I don't know, a shard of glass from a broken stained-glass window and just having no real idea of what the big picture looked like. And that really got me started on this project.
GROSS: At the same time, were you seeing parallels to the controversies around vaccinations today?
Prof. WILLRICH: Always. Throughout this entire project there were resonances for me with the vaccine controversy today that really increased in intensity as I was working on this project. And I began this project around 2003, and at the time, I think, according to the CDC, it was something like, you know, 22 percent of American parents of young children were refusing one or more vaccines for their children.
And five years later, as I started to, you know, write the project up into a book, five years later that number had - the percentage had nearly doubled, to about 40 percent of all Americans.
So vaccine today, the vaccine controversy today is one of the most important public health crises we face in America. But these controversies today just simply pale in comparison to the vaccine wars of the turn of the 20th century.
GROSS: So let's talk about those vaccine wars at the turn of the 20th century. But let's start by talking about smallpox itself. People aren't really familiar with smallpox anymore. It's a disease, fortunately, that we seem to have eradicated. So I'm going to ask you to describe the symptoms of smallpox and why it was so deadly.
Prof. WILLRICH: So smallpox was caused by a virus, the variola virus. And it spread from person to person, usually through saliva, for a sneeze or a cough, and it had an incubation period of about 12 to 14 days. And after that period, people would experience the onset of a very high fever.
After a couple of days, that fever would subside and people would feel better. They'd start to feel ready to go back to work or back to school. But that's when they were just becoming their most contagious, at their most contagious state. And lesions started to form in their throat and then eventually on the skin.
And smallpox was famous for its horrific rash that doctors from the period called the eruption. People would suffer through this growing and spreading rash for a period of two or three full weeks, and along the way usually about a third of all people infected with smallpox would die, usually from acute respiratory failure.
And for the most part, most people who survived a bout with smallpox were severely scarred for life, on their faces most commonly. So even someone who had survived a battle with this loathsome disease bore its marks on their face for the rest of their lives.
GROSS: Now, the epidemic that you write about at the turn of the 20th century was a less lethal strain of smallpox that didn't kill as many people.
Prof. WILLRICH: Yes, it's a - part of the medical mystery of this book and this epidemic was that it was the first time that a new strain of smallpox, that is now described as variola minor, first appeared.
And this strain of smallpox, instead of killing 30 percent of its victims, only killed about one percent, which was a remarkably - remarkably attenuated form of the disease.
And the problem was that medical officials understood this to be smallpox, and they had no - they couldn't tell when this mild form of smallpox would turn into or revert back to the deadly form of smallpox that everybody feared.
And during this same wave of milder epidemics, epidemics of the classic type of smallpox were breaking out in American cities across the country. In New York, 730 people died. In New Orleans, 500 people died. In Boston, 270 people died. In Philadelphia, 400 people died from the disease.
So you have a real kind of perfect storm of factors to create a vaccination controversy: a milder form of the disease that is lowering people's sense of risk, of suffering from smallpox, and at the same time a strong belief among health officials and epidemiologists that this disease had to be brought under check by swift vaccination of the population or else it could turn into something truly horrific.
GROSS: So what was the vaccination for smallpox like at the turn of the century, the period that you document, compared to what it became later, as scientists learned more about immunization?
Prof. WILLRICH: Sure, well, we think about vaccination today as a shot delivered in the antiseptic environment of a trusted pediatrician's office. But a century ago, the smallpox vaccine involved someone taking a hold of your arm, scraping the outer layer of the skin with a sharp blade, a lancet or a needle, usually drawing a little bit of blood, and then dabbing on some of the virus material, the vaccine material, which was a live vaccinia virus that had been harvested literally from sores on the underside of infected calves.
So as you can imagine, people faced with the prospect of being vaccinated had all kinds of images in their head as they did so. Vaccines a century ago were far less safe than they are today.
GROSS: And you're talking about how people today have an image of getting the vaccine in a trusted doctor's office. What were some of the places the vaccines were administered at the turn of the century, during the smallpox epidemic?
Prof. WILLRICH: Well, especially for the poor, vaccine was a very public event. It often took place in the public schools, on factory floors. Sometimes when employers had agreed with public health officials to get their entire workforce vaccinated, they would have the doctors sitting at the desk as the workers came by to collect their pay envelopes at the end of the week. And the agreement was if you want to come back next week, you're going to get vaccinated right now.
GROSS: Really, outside of the coercive aspect of what you're describing, it doesn't sound that different from today. Like flu shots are given at workplaces. I was immunized against polio and I forget what else in school. I guess maybe it was just polio. You know, drugstores give flu vaccines now. So it has become something that you get outside of your doctor's office. I just thought I'd get that in.
Prof. WILLRICH: Sure, no, I think that's true. Consider this aspect of the environment that's so different today. You know, 110 years ago, vaccination was compelled by the state. There's a law - there were laws on the books compelling vaccination.
But there was no effort taken by the government to ensure that vaccines on the market were safe and effective. We live in a very different environment today, where there are extensive regulations governing the entire vaccine industry. And there's a system of compensation in place for people who are adversely affected by vaccines, that small number of people.
GROSS: So people had a reason to be afraid of vaccines at the turn of the 20th century because there was no oversight. There was no licensing of the pharmaceutical companies. So you really didn't know what you were getting.
Prof. WILLRICH: Well, vaccines were this marvelous product of the stable and the laboratory. Vaccines were produced literally by infecting cows with vaccinia virus, waiting for these sores to arise in their bellies, and then harvesting the pus coming out of those sores. And that is the essential vaccine product of the turn-of-the-century period.
GROSS: And since one of the - like in New York, for instance, public health workers, accompanied by police, would raid tenements and forcibly vaccinate people - and I imagine some of the immigrants were just terrified. A lot of them probably didn't even speak English. And here are these people forcing them to get inoculated. It must have been a pretty frightening experience.
Prof. WILLRICH: This is exactly right. I mean, you sense the terror in the documents as you read about people fleeing the scene of these vaccination raids that took place in the middle of the night in, say, in New York, in the city's crowdest(ph) and poorest immigrant neighborhoods.
And you had immigrants who had recently arrived from Europe, had often been fleeing very repressive regimes back in Europe, seeking liberty and asylum in the United States. And in their experience, a state official pounding on the door in the middle of the night could have meant anything from, you know, being conscripted into the army to being dragged off to prison.
And so given the language barriers, given the differences in political traditions and the like, there was no reason to assume that these health officials and police entering the tenements in the middle of the night were there for benign purposes.
GROSS: Now, you write that in parts of the South, smallpox was considered a disease that black people got. Why?
Prof. WILLRICH: Well, when variola minor, the new, milder form of smallpox, first started spreading through the South, it was documented first among African-American populations. This is a period of a very high level of racial segregation in the South.
So it's conceivable that, in fact, smallpox was spreading first more rapidly among one sector of the population, particularly a sector that had been completely neglected by the medical profession, a sector of the population that was malnourished and thus more susceptible to disease.
And the distinctive response in the South to the spread of this disease was: As long as it was confined solely to African-Americans or appeared to be, public health officials paid it very little mind. It was only when they concluded that uh-oh, this disease might spread across the color line, that they started to take action. And they usually started that action by rounding up blacks and getting them vaccinated.
Prof. WILLRICH: Often by force. In fact, there's one episode that really stands out in my mind, in Middlesboro, Kentucky, when the police and a group of vaccinators went into this African-American section of town, rounded up people outside this home, handcuffed the men and women and vaccinated them at gunpoint, as if that wasn't all quite redundant. But it's a shocking scene and very much at odds with our, you know, sort of dearly held notions of American liberty.
GROSS: You write that the Kentucky Board of Health in 1898 made it mandatory to travel with a certificate saying that you'd been inoculated. Tell us about that.
Prof. WILLRICH: It's a remarkable thing. I mean, the - many health officials, not just in the South, viewed a vaccination scar on the upper arm as a kind of passport to - that people should be required to have in order to enter a workplace or a school or any kind of public area.
But in the South, during this wave of epidemics in Kentucky, the health board actually came up with this order that blacks traveling through Kentucky needed to have a document or have a vaccination scar on their arms in order to be - in order to move about. And it really - it was, I think, a very harsh blow against the people whose right to travel freely had been so dearly bought just a few decades before in the Civil War.
GROSS: What about white people? Did they need a certificate?
Prof. WILLRICH: No, not - no, not at all to the same extent. In fact, this health measure singled out African-Americans.
GROSS: So another example of the conflict between inoculating people for the greater good, to protect society, and then violating civil liberties in order to do it.
Prof. WILLRICH: Absolutely, yes.
GROSS: So you say that the vaccine program, the vaccination program, is what spread federal power in the South during this period.
Prof. WILLRICH: Yeah, it's quite remarkable. I mean, the - today we associate public health with government at every level, from the local to the state to the federal level of government. But according to the sort of American constitutional traditions, this form of governmental action was largely a matter of local and state concern.
During the smallpox epidemics at the turn of the century, as one sort of Southern community after another proved defenseless against this disease, had a lot of difficulty sort of managing the disease, many called upon a federal health agency, the U.S. Marine Hospital Service, to provide help.
And the service sent down a number of surgeons through the South who became smallpox experts, and they'd go from town to town, advising local communities how to stamp out the disease. This really is, I think, a very important moment of transition in which the federal government becomes much more involved in everyday health measures in the South.
GROSS: Now, in a lot of places, if you did contract smallpox, you were quarantined in a place that became known as a pesthouse. Would you describe what the pesthouses were?
Prof. WILLRICH: The pesthouse was the most dreaded of American political institutions. In a place like New York, the pesthouse would have to be quite large. A pesthouse is an isolation hospital. And so in a place like New York they would set up a pesthouse for smallpox patients on an island, North Brother Island, up by Riker's Island, on the East River, completely isolated from the rest of the community.
But in most smaller places around America, a pesthouse would be just simply a ramshackle house on the edge of town that the local authorities had taken over for this purpose. And people would be literally dragged there against their will.
In the most poignant scenes - some of the most poignant scenes in the book are when mothers are fighting with health officials to keep their children in their own homes rather than have them be taken off to a pesthouse, because people at the time rightly associated pesthouses with death. That's where someone was taken to die.
GROSS: And the only treatment you could get there was to ease symptoms, because there certainly wasn't a cure for smallpox.
Prof. WILLRICH: No cure for smallpox and really very little effective treatment to bring the symptoms in check. So in fact the instincts of these mothers who were fighting to keep a hold of their sick children and keep them in their home, the instinct wasn't such a bad one.
Studies have shown that people with smallpox, particularly in developing countries - the United States at the turn of the century was very much of a developing country - particularly in a developing country with poor hospital facilities, people often had a better chance of survival if they were taken care of by loved ones in their own home.
GROSS: Let's talk about the anti-vaccinationists. There was an anti-vaccination movement. What did the movement stand for, and was it aligned to other causes as well?
Prof. WILLRICH: These people were remarkable. You know, in the whole world of people who were resisting vaccination during this period, the organized hard core anti-vaccinationists were just a small segment but they were very vocal. They conceived of themselves as part of a transatlantic movement dedicated to protecting individual liberty against the encroachment of a Leviathan state. They had produced some marvelously interesting publications that were filled with both some - the gory details of vaccination but also with principled claims for personal liberty. And some of the arguments that they make about liberty are arguments that we associate more with the much later movement for reproductive rights and family privacy in the late 20th century.
In fact, these early 20th century anti-vaccinationists are already arguing that the liberty protected by the U.S. Constitution included a right to bodily integrity, to medical liberty and to freedom of choice in the area of health.
GROSS: Well, the battle between people who took the individual liberty argument against vaccinations and the government who took the greater good mandatory vaccination argument came to a head in a Supreme Court decision. Tell us about that decision.
Prof. WILLRICH: This was a - so there was a wave of litigation at the local, state and the federal levels but it did come to into a head in 1905 in the Supreme Court's decision in Jacobson versus Massachusetts. Jacobson was a Swedish immigrant minister in the city of Cambridge, where Harvard is located, and during an outbreak, a very serious outbreak of smallpox in 1902, Jacobson was one of the handful of people who refused to comply with the city's vaccination order. When he explained why, he said he had been vaccinated as a child and it had made him very sick; that when his young son was vaccinated against smallpox, he too was made very sick, and that he knew many more cases like this.
And so he refused to be vaccinated. He was found guilty in a local police court. He appealed, he appealed, he appealed and it made it all the way up to the U.S. Supreme Court. And in that decision the Supreme Court upheld the right of a state like Massachusetts to order its citizens to be vaccinated during an epidemic of smallpox - upheld that measure as a collective right of the state to protect the people from a disease that imperiled the population.
But at the same time, the Court recognized certain limitations on that power -that this power of health policing was not absolute, it was not total, that there was in fact a sphere of individual liberty that needed to be recognized. That measures like this needed to be reasonable and that someone who could make a legitimate claim that a vaccine posed a particular risk to them because of their family history or their medical history...
GROSS: Or their religious beliefs.
Prof. WILLRICH: Well, the Supreme Court in fact did not recognize religious arguments as a legitimate defense against vaccination during this period.
GROSS: Oh, okay.
Prof. WILLRICH: Although many, including Christian Scientists, wanted exactly such an exemption. The most important exemption created in this decision was, or an implied exemption that, for a person for whom vaccine posed a particular health risk. So if you look at our laws today, the compulsory vaccination laws in the books now, particularly that apply to school children, I think 48 of the American states now have religious exemptions. Everyplace will recognize that someone who can get a doctor's certificate that vaccines pose a particular harm to them, everyplace recognizes that that's a legitimate excuse against vaccination. Some states are even now recognizing conscientious objectors, people whose beliefs, not necessarily religious beliefs, tell them that vaccination is unconscionable.
GROSS: Now the Supreme Court decision also said you couldn't forcibly vaccinate somebody.
Prof. WILLRICH: Yes. This happened actually at the state level, in the Supreme Judicial Court of Massachusetts, one of the most storied courts in American history. That court in its decision said as an aside - even as it upheld the right of the state government to order vaccination - that, of course, it would be unconstitutional and sort of beyond the pale for health officials to forcibly vaccinate anyone. That's not within their power. And I think that this was really a shout out to the Boston health authorities who were employing forcible vaccination all the time in the poorest neighborhoods in the city.
GROSS: So was the epidemic at the turn of the 20th century the last smallpox epidemic in the United States?
Prof. WILLRICH: For many of these communities it in fact was the last epidemic; for Boston, for New York. But no, there were still isolated epidemics of smallpox; outbreaks affected places like Detroit in the 1920s. And this new form, the milder form of smallpox sort of had a relatively low-level incidence throughout the first half of the 20th century, due to the fact that so many people were still refusing to get vaccinated against it. 1949 was the last reported case of smallpox in the United States. And by 1972, the government had decided that it was time to stop mandatory vaccination against smallpox because, you know, every year a few people would die from the vaccine.
GROSS: Now, it's through mandatory vaccinations that smallpox ended not only in the United States but around the world.
Prof. WILLRICH: That was a very big part of the story, was - it was not the only part of the story. Smallpox was not destroyed through universal vaccination -that is getting everybody across the globe vaccinated. But it was destroyed by targeted vaccination in smallpox-infected regions of the country and the world carried out by an international team during the decades of the '60s and the '70s.
GROSS: So in 1980, the World Health Assembly declared that the world and all its people had won freedom from smallpox. It recommended that countries discontinue smallpox vaccinations. But smallpox remained alive in research labs in the CDC in the United States and in labs in the USSR. And, as you point out, after the Cold War, the West was able to verify that the USSR had weapons-grade smallpox. In other words, it had weaponized smallpox, which is a pretty frightening thought. So do you know where that stands now, like what's left of that?
Prof. WILLRICH: I don't think anyone knows exactly where it stands. The big concern, of course, is that some of that former Soviet smallpox might have ended up in the hands of other countries. In fact, this was one of the - was part of the conversation leading up to the Iraq War in 2003 - was a concern stated by the Bush administration that Saddam Hussein had weaponized smallpox, which turned out, of course, not to be true.
GROSS: So if smallpox is ever used as a weapon, do we have vaccines stockpiled?
Prof. WILLRICH: Yes, we do. I believe we in fact have enough smallpox vaccine in our stockpile in the United States for every American, every person within the country's borders to receive the vaccine. And, in fact, the vaccine not only prevents people from becoming infected with smallpox; it also, if taken within a few days after infection, can cause there to be a much milder form of the disease.
GROSS: Let's fast-forward to today, when vaccines remain really controversial. And tell us some of the objections that a lot of, for instance, parents raise today about getting their children vaccinated with all the vaccines that are recommended.
Prof. WILLRICH: Well, the anti-vaccination movement of our own times really took off after the publication of a report in 1998 by the British medical journal The Lancet, that purported or suggested that there might be a link between autism - which was very much on the rise in the U.S. and the U.K. -between autism and vaccination, particularly the MMR vaccine.
GROSS: That's, yeah, measles, mumps, rubella.
Prof. WILLRICH: Yes, the measles, mumps and rubella vaccine - one of the most common childhood vaccines. This paper was thoroughly discredited and debunked. But the idea that vaccines might somehow be the cause of autism stuck in the public mind. And so, according to some of the most recent studies, something like one-fifth of all American parents believe that vaccines cause autism. This is simply not true, but it's a powerful association in the public mind.
GROSS: Well, the research paper that you cited by Andrew Wakefield connecting vaccines, the MMR vaccine with autism, that was published in 1998. And I think it was only in the past year that The Lancet, where it was first published, withdrew the study; that he was, he is no longer allowed to practice medicine in England. The editor of The Lancet, which first published his article, said that the research was based not on bad science but on a deliberate fraud. So, but the concerns...
Prof. WILLRICH: So just if I...
GROSS: Go ahead, correct me.
(Soundbite of laughter)
Prof. WILLRICH: I just want to correct you a little bit on that, so.
GROSS: Yeah, go ahead.
Prof. WILLRICH: The Lancet retracted the study, I believe it was maybe back in 2005. What happened very recently is that the British Medical Journal, which is another leading medical journal out of Britain, published a long-term sort of investigative report about the original Wakefield study that concluded that Wakefield had in fact, at the time that he produced this study, was on the, was receiving payment from a lawyer involved in a suit against a vaccine manufacturer. So that's what led the British Medical Journal to make the statement that this was not just about bad science, it was about fraud.
GROSS: So now that that Andrew Wakefield study connecting the MMR vaccine to autism has been discredited and he can no longer even practice medicine in England, is there a, you know, a concerted effort in the United States, an organized campaign to get the word out that that study was totally discredited?
Prof. WILLRICH: I think that the public health community in the U.S. could do much more with this moment. I think this is the time for redoubling their efforts to spread the good word about vaccines and also have a candid public discussion about the risks and benefits of vaccines. There's no more opportune moment than the present to launch a new publicity campaign around vaccines.
GROSS: You seem to see both sides in the story at the turn of the century, the people who were afraid of vaccines and the government who felt like everybody had to be vaccinated to protect the larger population; that it was essential to get people vaccinated. So do you see both sides in the controversy today?
Prof. WILLRICH: To this extent. It concerns me whenever I hear health officials or journalists characterize parents who are afraid of vaccines today as simply ignorant or anti-scientific denialists, right, that paint - I just think that's too broad a brush to paint these people and their concerns with.
Parents, we have to accept the fact and realize that parents, like the health officials, have the best interest of their children in mind. They understand those interests in different terms. They have these newborn infants they are responsible for, they have this intimate bond with, and to see them receive one shot after another to protect them against diseases that the parents don't see as present anyway, there's something kind of unnatural about this, as important as it is - and certainly counterintuitive.
So I think it's very important that health officials and members of the public health community at large never forget that this is the challenge of science in a democracy. It's a process of continuous education and education that has to be very candid and honest about the relative risks and the benefits of vaccines, and that this is their job as members of the public health community, and it's a job that's never going to go away.
GROSS: May I ask if you have children?
Prof. WILLRICH: I do. Yes.
GROSS: And did you have concerns about their vaccinations?
Prof. WILLRICH: You know, I was one of those parents who when the doctors let us leave the hospital with our first child about 12 years ago, I couldn't believe that they were letting us drive off with that...
(Soundbite of laughter)
Prof. WILLRICH: ...precious human infant. My wife and I both took the vaccination instructions very, very seriously and we got our children vaccinated for everything that they were supposed to be vaccinated for. But I will tell you, I have one story that may shed some light, or that for me shed some light on parents' fears about vaccines.
My son Max, when shortly after he was born, he was I think about five months, six months old, got the rotavirus vaccine. This was a new vaccine to protect children against a very serious disease. It had broken out in Houston where we were living at the time. So I said, of course, get him, let's get him the vaccine. He took the vaccine and within a number of weeks he started to develop this horrible sort of abdominal pain and was in great sort of distress and we were so concerned about him.
We finally took him to the emergency room, where he was diagnosed with and treated for a condition called intussusception, which involves the intestine literally telescoping in on itself. It's extremely dangerous and very, very painful. So they were able to resolve this problem, he was almost instantly better. And the next morning as I wake up in the hospital bedroom next to my son in his little hospital crib, someone brings me a copy of The New York Times and look, and there on the front page is a story, rotavirus vaccine pulled from the market because it causes, in one in 10,000 cases, intussusception.
So I feel people's concerns very much. But I, you know, there's a new rotavirus vaccine back on the market today. It's safer. They have timed it better so they give it to kids a little bit earlier. This problem has been resolved. But I'll tell you, it's no fun being, having your kid be the one in 10,000 cases who feels the very serious side effects of a vaccine.
GROSS: So I'm wondering what your thoughts are today about the need for mandatory vaccination.
Prof. WILLRICH: I think we can just say that vaccines work by giving a virus no place to go, essentially. Viruses spread in human populations from person to person and if you have a vast majority of a community vaccinated, protected against that virus, the virus will simply never be able to have a toehold in a community and spread from there. So universal vaccination, to the extent that it can be achieved, seems like a very laudable public health goal to me.
There's this very important concept of herd immunity that says that in any community there are bound to be people who cannot get vaccine because - a certain vaccine because it poses a health risk to them individually. There are also some people for whom the vaccine just simply won't work, who won't be protected from the disease against a vaccine. So it's important to get the entire community vaccinated in order that everybody can be protected and that a virus cannot successfully spread in a local population.
But people - and this I think may go for Americans more than just about any other people in the world - people don't like to think of themselves as members of a herd, and that's the real dilemma for public health today.
GROSS: Well, I want to thank you so much for talking with us.
Prof. WILLRICH: Oh, it's been my pleasure.
GROSS: Michael Willrich is the author of the new book "Pox: An American History." You can read an excerpt on our website, freshair.npr.org.
Coming up, Maureen Corrigan reviews "Please Look After Mom," a novel that's been a bestseller in South Korea and has just been published here.
This is FRESH AIR.