Dr. James Mason

Jim Mason

TORGHELE: It is June 2, 2017, and we are in Salt Lake City, Utah, with Dr. James O. Mason. Dr. Mason was in the Epidemic Intelligence Service class of 1959 and was the director of the Centers for Disease Control and Prevention from 1983 to 1989. My name is Karen Torghele, and I'll be talking with Dr. Mason for the Global Health Chronicles Oral History of Polio Project. I want to say welcome, Dr. Mason, and thank you for being here today.

MASON: It's wonderful to be here.

TORGHELE: I think maybe we could start by having you give us a little bit about your background--how you grew up, where you grew up, what your family was like--some things like that first.

MASON: I grew up in Salt Lake City, Utah. I had, of course, two parents and two sisters. My mother was a nurse. She was a working mother, and my dad was an 00:01:00accountant. We lived, oh, I guess about two miles from where we sit today, when I grew up.

TORGHELE: How did you get interested in medicine?

MASON: I was always interested in plants and animals. I had a lot of pets, and just enjoyed living things. My mother was a nurse, and often I'd walk over to the hospital and walk home with her after school, because where I went to elementary school was right next to the hospital. And so through her, I had a great association with medicine. I grew older, I became more and more interested in engineering, and when my mother tried to get me to go into medicine, I said that's the last thing I really want to do. But later, in my college career, I 00:02:00began to think that I'd rather work with people than with materials and mathematics and things of that nature. So I changed my mind and followed her advice, and got into medical school.

TORGHELE: And where did you go to school?

MASON: At the University of Utah School of Medicine.

TORGHELE: When you were in medical school, did you happen to take care of any polio patients? Or, when you were growing up, do you remember about polio and how it affected people?

MASON: I remember well, polio. Because when I was growing up--this would have been--I was twelve in 1942, and at that time there was grave concern. People were worried about polio. Every August or September, it seemed, they closed the swimming pools, they wouldn't let kids congregate at movie theaters, because 00:03:00they were fearful that we would spread polio from one person to another. So it was a disease that parents feared. And through their fear, all the kids were worried, too, about the disease. Our friends, schoolmates, and others were coming down with polio, and some of them had been very seriously crippled.

TORGHELE: And at the time, they didn't know what caused it, is that right?

MASON: Well, my mother taught me that it was caused by what she said was a virus, but that's about all we knew. And we really didn't know how it was communicated. They thought people coming together--and they closed the swimming pools, because they thought that swimming pools might be transmitting the disease. But they really cut back on all close communication of individuals, gatherings, when an outbreak occurred, and it was always in late summer.

TORGHELE: And later, when you were in medical school and residency, did you take care of polio patients, do you remember?

MASON: I entered at University of Utah Medical School in 1954, and as a freshman, I had a brief rotation on pediatrics at the old General Hospital in Salt Lake City, which was a teaching hospital, There was a great big ward, and in it were thirty, maybe forty, iron lungs. Every one of those huge iron lungs had a child or an adolescent inside, and you could hear the machines pumping away as they breathed for those patients that had been put in the lung. So my first experience with polio was on that scale.

TORGHELE: Must have made a huge impression.

MASON: It did. It did, and a lot of people were afraid of polio at that time.

TORGHELE: And that was 1954, you said.

MASON: 1954.

TORGHELE: And the next year was when the vaccine came out. Do you remember that?

MASON: You know, I have little recollection, other than I did know that they we were testing to see whether the vaccine was safe and effective. That was in the newspapers, and it was big news at that time. And I just have a very vague recollection that something like that was going on.

TORGHELE: When you were in medical school, did you know then that you wanted to go into public health?

MASON: No, I did not. I thought I wanted to be an internist.

TORGHELE: Do you remember what it was that influenced you to go to change that?

MASON: Well, it was really EIS [Epidemic Intelligence Service] and CDC [Centers for Disease Control and Prevention] that caused me to have a change of mind.

TORGHELE: And how did you get involved in that?

MASON: I was deferred during the Korean War. I had a draft obligation, but because I'd been accepted to medical school, that was postponed. When I completed my internship at Johns Hopkins Hospital, it was now time to pay back. Through the Berry Plan, I had a choice of either the United States Public Health Service or the United States Navy. The Navy wanted to put me on a cruiser that would sail out of San Diego. My father was an officer in the United States Navy during World War I, and that was attractive to me. But by that time, we had 00:07:00three small children. I had been away from home a lot during my internship, and I thought maybe it'd be better to go into the Public Health Service, where I could serve and be near my family.

I applied to the Indian Health Service because I was well acquainted with that part of the Public Health Service, and I would have liked to have worked on one of the Indian reservations. But I heard nothing from the Public Health Service or Indian Health Service, and was ready to take my Navy physical when out of the blue, Dr. Bruce Dull called and asked me if I'd like to become part of the Epidemic Intelligence Service. I asked him, "What is that?" He patiently explained what EIS was, what CDC was, and offered to fly me down to Atlanta for 00:08:00the April EIS conference. So I went down there, saw what was happening, and they offered me a position in the class that was starting that June. I was delighted to accept. He had found my application to the Public Health Service somewhere in Washington. Apparently, the Indian Health Service had never received it, and it was just lying there. He felt I qualified to be an EIS Officer and I might be interested in taking a position that had been vacated because one of the EIS class of '59 apparently hadn't met the physical qualifications and suddenly, at the last moment, they had a vacancy.

TORGHELE: That was a fortunate thing to happen for all of us.

MASON: Well, particularly for me.

TORGHELE: When you came, then, you moved your family to Atlanta then. It was 1959, is that right?

MASON: Well, I didn't move them to Atlanta, because I wasn't sure we were going to stay in Atlanta. So I came for the course, which was for six weeks. And then when I was selected to be the chief EIS officer, after the six-week course, I moved the family to Atlanta. I had driven them home, in Salt Lake from Baltimore, and they stayed there while I was taking the EIS course.

TORGHELE: Do you remember how long the course was then?

MASON: It was six weeks at that time, as I recall.

TORGHELE: Tell me about some of the teachers you had, because I know you had some really big names in public health at the time.

MASON: Alex Langmuir, who headed the epidemiology branch at CDC, was the number 00:10:00one teacher. Of all the teachers we had there, he was charismatic. You just were on the edge of your chair every time he lectured. He always had wonderful examples as he taught principles. He used the case history method of teaching, and was the number one instructor in terms of the time. He was willing to give that much time to this group of about twenty-five new EIS officers.

We had other CDC personnel--I remember [Dr.] Robert Serfling and Ida Sherman, who taught biostatistics. We had a whole series of people that came in from outside CDC, and they were top-notch medical school faculty, public health experts--K.F. Myers, for example, who was an expert in zoonosis--and they had 00:11:00veterinarians. We had the cream of the crop. It was one of the best educational experiences I've ever had.

TORGHELE: That's reflected in the notebook that you donated to the CDC Museum, too.

MASON: I kept it because it was such a good notebook, until I donated it.

TORGHELE: Yeah, we were very happy to get that. When you had biostatistics, you had Dr. Serfling and Ida Sherman--

MASON: That's right.

TORGHELE: And how did they make statistics interesting?

MASON: They were able to illustrate with epidemics, and we actually did problems and exercises that were related to epidemiological investigations. How one showed significant association. We could see how absolutely vital it was not 00:12:00just to collect data, but one had to do an analysis of that data. And they helped us see what went into such an analysis and how interesting it was, because you really couldn't make a conclusion until you'd done the biostatistics and the mathematics, and showed that the differences one was observing were statistically significant.

TORGHELE: And what tools did you have to work with?

MASON: Now we all have our cell phones, our handhelds, our computers. Then we were using slide rules and electric calculators that would add, subtract, divide, and multiply, and they were just starting to use file cards. We had something that was called a McBee card,--a card with little holes punched all around the periphery of it--and one would use an ice pick, and by punching out 00:13:00the right hole you could get correlation. It was a computer by hand.

TORGHELE: Isn't that interesting? When you got your assignment as a chief EIS officer, how were you chosen, and what can you tell us about that?

MASON: Well, I became interested in the job because Bruce Dull, who had recruited me into EIS, was serving as the chief EIS officer, and I saw what a great job he was doing and how interesting it was. We got our assignments at the end of the course. We could put down a selection of three positions that we would be willing to work at, and I put down chief EIS officer as one of those positions. And apparently, I was probably the only one that even listed the job. 00:14:00So I got it.

TORGHELE: You got it. What was that like for you? Can you sort of walk us through what a day might have been like for you in that job?

MASON: Well, first of all, I really wanted the job because it allowed me to work very closely with [Dr.] Alex Langmuir and the other key individuals within the epidemiology branch. And I thought maybe some of their enthusiasm and brilliance could rub off on me if I spent enough time with them. I really enjoyed working with Alex Langmuir, [Dr. E.] Russell Alexander, [Dr.] D.A. Henderson, and Bruce Dull--he was still there in another position. And it allowed me not only to keep in contact with all of my class--all of the graduates from my EIS class went out into the field or stayed in Atlanta, and so I had an ongoing association with 00:15:00them, as well as the class of the year before. And it also gave me opportunity to get acquainted with other parts of CDC: laboratory branch, technology branch, everything that was going on there. It was a real opportunity. And I communicated with all of the EIS officers, I correlated the Epi-Aid investigations--I worked with them when they were sent out to do epidemic investigations--and it just brought me in close contact with all the EIS officers, as well as the staff of epidemiology branch.

TORGHELE: Tell us a little bit more about the Epi-Aids and the role they played, and what was included in them.

MASON: Whenever someone requested epidemic aid--it might be a state health officer---it usually was a state that requested an Epi-Aid, it could have been a 00:16:00medical school or a school of public health that wanted some assistance, or someone--it could be a foreign government. And this came in as a request. And whenever a request came in that was accepted--we got a lot more requests than we could respond to. Some of them were beyond the scope of what EIS was established for. Some of them didn't turn out, and didn't look to be significant, and sometimes we just didn't have the resources to do the international travel to other countries. Conferring with Dr. Langmuir, we decided what investigations should be carried out. Then, immediately, a memo about the investigation was 00:17:00produced. It was distributed to all EIS officers and to the key staff at CDC. When an assignment was made, those who responded were included in the distribution, so once an Epi-Aid memo started, it was updated whenever there was significant new information--if something had happened, a numeration of cases, results that carried through until the epidemic was absolutely finished, including all the lab work and the conclusions. So it was just an ongoing method to stay up to date on what was going on with regard to every epidemic investigation that was carried out.

TORGHELE: And you were able, then, to document everything that was included in the investigation and the findings.

MASON: Absolutely.

TORGHELE: And use it for subsequent ones, I guess.

MASON: Yes, and often those Epi-Aids were used as case histories in teaching EIS 00:18:00officers. And that's what made it interesting, because most of those epidemics were not only exciting in terms of the content and how many cases and the severity of the cases, but how they had been analyzed. Sometimes it's very difficult to discover why something is happening, and it's intriguing to be able to have that spelled out in an Epi-Aid memo. There's a lot to learn just by reading and becoming associated with what was reported.

TORGHELE: So it sounds like you would gather the information from the EIS officers that were doing the outbreak investigation. And would you all meet together and talk about the possibilities and share your ideas about that? How did that work out?

MASON: We would if such was needed. Often, the people out there were doing 00:19:00everything that could be done, but they could communicate back, and those meetings, those councils, could be held if there was a need to do so. And often, EIS officers would call back and report, and we would be able to make comments and--I don't really say instruct them, but often they were looking for suggestions and ideas about what could be done, and so I could participate in that. But the backstopping was really Alex Langmuir and the entire superb staff that he had. So each EIS officer out there had the backing and the backstopping, not only from epidemiology branch, but you had laboratory branch--you could bring in laboratorians who could tell what kind of specimens would be needed, 00:20:00how to submit them, what kind of media--so all of CDC's resources were at the beck and call of that EIS officer who was doing the investigation.

TORGHELE: And you communicated by phone?

MASON: By phones, and that was about the only way. The only other way was to go out and visit them.

TORGHELE: Did you go on outbreaks as well?

MASON: I did.

TORGHELE: Can you remember some of those?

MASON: The first outbreak I went on was August, right after I finished the EIS course. The health officer in Arizona reported that there was an outbreak of an undiagnosed disease he thought resembled dengue fever. And I was given the responsibility of investigating that outbreak. We didn't think dengue would be 00:21:00occurring in Arizona, because it's a disease usually of moist tropics where it's warm year-round. But the cases were interesting, and there was a good cluster out in the desert. And so out I went to investigate what was happening.

To make a long story short, it was not dengue fever. I was able to pretty well conclude, after examining the first group of cases, that this was not dengue, and it was probably a disease related to polio caused by an enterovirus. And that's what it turned out to be--it was an enterovirus rather than a polio virus. The disease was waning anyway--it ended itself--but I was able to reassure them that it wasn't dengue, that the kids would get better. And so if I 00:22:00accomplished anything, it was to diagnose the disease and to let them know that there was little to worry about.

TORGHELE: And that was worth a lot to them, I'm sure.

MASON: Yes, it was. And then the next month I was sent to Charleston, West Virginia--Kanawha County--because they reported that they'd had fifty-eight cases of poliomyelitis. And so I went up there to what was thought to be a polio epidemic. It's true that some of the acute cases had mild paralysis, but after careful examination, this was not polio, and again, I thought it was probably one of the enteroviruses. And it turned out to be an ECHO [enteric cytopathic human orphan] 4 as well. We had wonderful laboratory backup at CDC, and we were able to again allay the concern, because there was a lot of concern that this 00:23:00was a major polio epidemic. And just to be able to tell them that this was not polio, that the paralysis would not be permanent, that they would all get better--and mothers and parents felt better, and so we were able to allay the concerns and the fears that were there. And the epidemic--not through anything we did--just waned because fall was coming on.

TORGHELE: It was a summer disease, wasn't it?

MASON: Exactly.

TORGHELE: When you were an EIS officer, it was past the time of the Cutter incident, but in working with Alex Langmuir, did you talk with him about that--outside, for instance, of your EIS class?

MASON: The Cutter incident was one of the case studies during our EIS class, and 00:24:00so we looked at that carefully during the six-week course. But I had opportunity on several other occasions to hear Alex talk about the Cutter incident, so I was well aware of it as an EIS officer.

TORGHELE: Was it Alex that named it that? Because that's what it's always been called since those days.

MASON: Alex always had a way to characterize a major epidemic. It always had a name. And this one, at least by the time I got there--the Cutter Incident occurred in 1955, it was now 1959 when I took the EIS course, and it was just the Cutter Incident. As soon as you heard that, you knew what he was talking about. It was very exciting, and a very important part of CDC's history, as well 00:25:00as the history of EIS.

TORGHELE: Would you relate some of the salient points about the Cutter incident and what you remember from your class--how you think, maybe, it changed CDC?

MASON: Let me talk about it first, and then I'll tell you how I think it changed CDC. This episode was one of the big issues of the Tommy Francis field trials that took place in 1955 to see whether the Salk vaccine--the killed inactivated polio vaccine--was effective and safe. Five vaccination manufacturers were 00:26:00brought together to produce enough vaccine quickly so that the field trials could be carried out. They were carried out in, as I recall, about thirty-eight different states. Hundreds of thousands of children would be immunized in this huge trial. And every mother in the United States, I think, was watching to see what would happen, because this was a fearful disease at that time. People were worried about polio. When you think of it, in 1955 before the vaccine trial, there were 58,000 cases in one year. And this was something that people dreaded. It was a major disease. With smallpox under control by smallpox vaccine, it was a major killer and crippler. And it was probably the most crippling disease that 00:27:00affected young people in the world. And so, when Jonas Salk produced a vaccine, and in small trials he felt that it was both safe and effective, this was big news in the United States.

So the field trial was launched. And at that time, polio cases occurred every year. This was April, so it was not the epidemic peak time. One wouldn't have expected a lot of polio cases, but there could be some polio cases at that time of year. But after the field trial began, there were a series of polio cases that occurred in Idaho and a number of other states. There was concern about this, and because of that concern, EIS and Alex Langmuir was brought in to the 00:28:00incident. And Alex rapidly sensed the significance of those cases. He sent out EIS Officers. They began investigating cases, doing case counts, looking at distribution. And with the data that was accumulated rapidly through the EIS system, Alex was able to speak confidentially that these cases that were being investigated, these small clusters, were directly linked to vaccine, but not to all five manufacturers. He was able to tease out and show that only vaccine produced by one manufacturer [Cutter Laboratories] was responsible for those cases. And based upon that and the information that he had accumulated, he was 00:29:00able to predict how many cases would occur, how many of those would be paralytic, and he also was able to predict that there would be some secondary cases in siblings and other people in the community who would get the polio from that vaccine. And he communicated those predictions, as well as his confidential analysis that this was vaccine-related.

As a result of his being able to do this, in a matter of days, he was able to persuade the company to withdraw their vaccine. Ultimately, they would have had to, but it was withdrawn much earlier because of Alex's conclusions and the certainty with which he expressed his results. And because of what he did, I think the whole nation began to look to CDC as a place that could report disease 00:30:00and do disease surveillance. And if they could do it for polio, and do it that quickly, and do it that reliability and accurately, then they could do this for other things. And of course CDC had the competence, but they hadn't been noticed to the extent they were doing the Francis field trials.

TORGHELE: So that was a beneficial result for CDC--

MASON: It was beneficial to the public and beneficial to CDC. And now, when we consider the magnitude of the polio problem, it left a significant legacy as a result of these vaccine trials and the disease itself. First of all, I think the public saw clearly that a vaccine could be developed that would stop an 00:31:00epidemic. Within three or four years after the Salk vaccine was licensed, the number of cases plummeted from 58,000. Within six years, there was only 161 cases in the nation, and they were almost all in unvaccinated children. So almost an elimination of that disease within six years of licensing of the vaccine, so that was a major contribution to how people felt about prevention of disease. It also had the interesting association that polio was of interest to a former president of the United States, President Roosevelt. And he had been instrumental in founding the--

TORGHELE: The infant paralysis--

MASON: Yes, the National Association for the Control of Infant Paralysis [National Foundation for Infantile Paralysis] or the dimes--what was it?

TORGHELE: March of Dimes.

MASON: March of Dimes. And so we had the March of Dimes involved, we had science involved, and for the first time philanthropy became part of disease control. There weren't heart associations and rheumatoid arthritis associations. The only one was the March of Dimes. And they played a significant role in vaccine development, vaccine testing, and care of patients with polio. So polio started a new culture with regard to philanthropy and voluntary organizations in control of disease. Out of polio came the understanding that rehab and physical therapy 00:33:00could help. It was with polio that physical therapy was used to really improve the performance of people with paralytic polio. So occupational therapy, physiotherapy, speech therapy, this really became into forefront and center during polio outbreaks. As a result of polio, laws that protect the disabled were enacted soon after polio became controlled. And the disabilities programs, the changes that relate to construction of buildings--they have to be able to accommodate the disabled--all of this came soon after polio and Salk vaccine, 00:34:00and then later the Sabin vaccine. So we had a lot of things that occurred in our culture as a result of polio.

And then the Cutter incident itself led to a number of developments. First of all, it showed that oversight of vaccine production and safety at the federal level was weak. And so there was strengthening of both FDA [Food and Drug Administration] and other federal entities in terms of later introduction of other vaccines. It gave CDC an ongoing responsibility to do surveillance for vaccine-preventable diseases, so that things like the Cutter incident wouldn't happen again. Now CDC had that responsibility.

Other things occurred. There was a flood of legal lawsuits against the vaccine 00:35:00manufacturer. And even though the court held that the Cutter Laboratory had not been negligent, nevertheless, the judge ruled in favor of the damaged. So this led to lawsuits--this flood started, and has involved lawsuits ever since then. And by the 1980s, lawsuits against vaccine manufacturers were so common that almost all of American laboratories producing vaccine went out. They dropped vaccines, and much of our vaccines for years had to be imported from European countries because of the legal system. As a result, and a fallout of the Cutter 00:36:00incident, we now have--the Vaccine Injury Compensation Program was enacted, so that a surcharge was placed upon vaccine. Not just polio vaccine, but subsequent vaccines. So a small surcharge is added, so that people that have a legitimate damage as a result of a vaccine can be compensated if it is shown that it was related to the vaccine. No vaccine is perfectly safe, but they are safe in comparison with the disease they are preventing. And we're talking about one in a million vaccine-related injury, and that's the price we have to pay, and those that are so injured are compensated. And so a whole culture, a legal culture and 00:37:00disability culture, philanthropy culture, have all been influenced by polio and getting polio under control.

TORGHELE: When the Cutter incident began, did Dr. Salk--Dr. Salk was made aware of it, I'm sure. Did he also work with you all to try to find out what the source of the problem was?

MASON: You know, I can't really well answer that. But I understand there was not a lot of communication during vaccine development, as well as during this period of time.

TORGHELE: When you approached the state and county health departments that had 00:38:00polio epidemics and other situations, how did that work? They requested your help, and then you would go to determine if it was polio. And then what would you do?

MASON: Actually, the communication could go two ways. With the two epidemics I mentioned, it turned out not to be polio, but one of them was thought to be polio. That was a request from the state health officer to CDC for epidemic assistance. With the Cutter incident, with Alex now being empowered to do something about it, then he notified those health departments in those states where cases were occurring. And of course he got their permission to come in, but all of them were delighted to have help in looking into these problems. So 00:39:00it can go both ways: the state can request it, or CDC EIS can say, hey, there's something interesting going on, would it be all right if we sent someone out there to look into it and work with you?

TORGHELE: So it was more that they were offering help, not insisting on coming. Is that the way it was?

MASON: Yes.

TORGHELE: Sounds like a good system that worked for everyone.

MASON: Yes, yes. And I guess if you had a national emergency, I guess there is power that you could require them to allow someone to come in, but I don't know that that has ever been exercised. It's always one of collaboration and cooperation. CDC began working even more closely with state and local health departments after the polio epidemic. Money was appropriated to CDC to help fund 00:40:00and help upgrade epidemiological and laboratory competence at the state level. So I see this relationship as one of total cooperation. It's people working together because they need to work together and because they like to work together.

TORGHELE: And you brought up the fact, too, that there were other organizations outside of the government that also helped in different ways.

MASON: Absolutely. And that has continued to the present time with I don't know how many different diseases. And probably, just an aside, the National Foundation, March of Dimes--probably because of their relationship to Franklin Delano Roosevelt--probably had more clout at the time of the Francis field trials for Salk vaccine than any of the current societies have. There was a 00:41:00stronger relationship and more power, because they were the only one--the only kid on the block that had that role--and they were well-funded.

TORGHELE: And they had Franklin Roosevelt and Basil O'Connor.

MASON: And a board--a science board as well as a board governing their day-to-day conduct.

TORGHELE: Do you remember when the CDC's Advisory Committee on Immunization Practices began, and how that started and what it was like?

MASON: You know, I know it started in 1964. But I was not with CDC at that time, 00:42:00and I was not closely involved with it, and I don't think that I could add anything on that.

TORGHELE: What were your next steps, then, after you did EIS?

MASON: After I did the EIS--actually, EIS was just the beginning of my relationship to CDC. At the end of my two-year military obligation, I was offered a career development program where I could go and get further clinical or public health training. And by now I was a convert to public health, and that was of great interest to me. And so I left CDC, still a commissioned officer in the Public Health Service, and completed my residency in internal medicine in Boston, and then was able to get a master of public health degree. And that led 00:43:00to a doctorate in public health from Harvard. Then I returned to CDC because I had a payback time.

TORGHELE: So they supported you during your fellowship and your MPH [master of public health], and then you paid back time by working at CDC?

MASON: Exactly, exactly.

TORGHELE: And did you come across some other public health people when you were in Boston that--names that we might know?

MASON: It was interesting in Boston, because not only did I become acquainted with the people in the School of Public Health, but Bruce Dull, who had recruited me to EIS, was working in Dr. John Enders's laboratory. And just across the street, Thomas Weller, who was also a Nobel Laureate with Robbins and Enders--he was just located across the street. And it was a wonderful privilege 00:44:00to get to know Tom Weller and John Enders, and later Frederick Robbins. And they were three just--not only great scientists, but wonderful, wonderful men. So, often, Bruce and I would talk together, or I would visit him when I had a minute during my residency, and we'd chat while we were in his lab. And I got to know Dr. John Enders well.

TORGHELE: What was he working on at the time, do you remember?

MASON: After growing the poliovirus in cell tissue culture in 1949, he then branched out and went into measles activity. And at the time that Bruce was working in his laboratory, he was attenuating the measles virus so that it could 00:45:00be used in a live attenuated vaccine. And that's what was going on while Bruce Dull and I were talking together in the laboratory. It was interesting to see the people that worked for him. And he was almost always in the laboratory himself, and they were doing passages of their measles virus to further attenuate it.

TORGHELE: And I understand that you were interested in that vaccine because you had young children of your own.

MASON: Exactly. At that time, I had four children, and they were all under ten. There was a measles outbreak in Boston where our kids were attending school, and I know they were going to get measles. So one day I just asked Dr. Enders how he was coming with his measles virus attenuation, and he said, "Well, it needs a 00:46:00couple more passages, but we're making a lot of progress." I explained to him that my kids were probably going to get measles, and wouldn't it be better if they got it from a slightly attenuated vaccine rather than getting it from wild measles virus vaccine? And I asked him if I might get four ampules of his virus, and he said, "Yeah, help yourself." So I went home and gave my four kids measles vaccine when it was in the process of attenuation. And I will say that the epidemic continued in the community, three of my children didn't get measles. One of my children got measles about seven days after they received the attenuated vaccine, and it's impossible to tell whether they got it from school--whether that child got it from school or from the attenuated vaccine. It 00:47:00was just a normal case of measles.

TORGHELE: It's a great story.

MASON: We were very happy to only have one case out of four.

TORGHELE: During the time you were at CDC, you knew Morris Schaeffer, is that right?

MASON: I knew Morris Schaeffer well for a number of reasons, but yes. He was the head of their public health laboratory in New York City. That was one of the best public health laboratories in the nation. So he ran a wonderful, well-qualified laboratory operation. He had had polio during his life and was--you wouldn't call him disabled because he was so mobile and got around and was everywhere. He didn't let his handicap bother him, but he had had polio.

TORGHELE: And he and Dr. [C.P.] Li made a contribution to polio. They determined the different strains, is that right?

MASON: That's right. When we talk about poliovirus, there are really three viruses, type 1, 2 and 3. And it had been determined earlier that there was type 1 and 2, but type 3 wasn't identified until somewhat later. And I think Morris and--who was the other person you mentioned?

TORGHELE: Dr. Li.

MASON: Yes--had contributed to that identification.

TORGHELE: Mm-hm. And I understand that he shared the strains that they identified with Dr. [Albert] Sabin. Did you ever talk to Dr. Schaeffer or know anything about what happened after that, how Dr. Sabin used them?

MASON: No, I don't have any details on that. Where I really got involved with Dr. Morris Schaeffer was with the Clinical Laboratory Improvement Program.

TORGHELE: Talk a little bit about that, if you would.

MASON: Dr. Schaeffer was one of the first people that really became aware of problems that were occurring in the nation's clinical laboratories. And I don't want to imply that all clinical laboratories were not doing creditable work, but there were some that were doing sink testing. They would take the specimen, pour it down the sink, and then give the doctor a report.

TORGHELE: Without testing it?

MASON: Without testing it. And some of them tested it but didn't have the reagents, they didn't have the controls, they didn't have the methodology or the trained personnel--and so the results were inaccurate, they were misleading. And 00:50:00so Dr. Schaeffer, in New York City, was able to get a law enacted so that all the tests, all of the laboratories had to meet certain standards: standards for personnel, standards for methodology, standards so that a glucose or a cholesterol determination from one lab would be equivalent to another. So there was a standardization between laboratories. So if a patient gave a blood specimen in one lab and then in another, they wouldn't come out different, they'd come out the same because they were using the same standards. And he standardized the work in New York City.

Bad laboratories, unfortunately, would just move across the river into New Jersey or Delaware and continue serving the same customers in New York City. And Morris and New York City had no power over those laboratories because this was 00:51:00interstate commerce. And so at that time, I was working in the laboratory branch of CDC rather than epidemiology branch. We worked together, and legislation was written that was then passed by the [U.S.] House [of Representatives] and the Senate, and became the Clinical Laboratory Improvement Act of 1967. And it required every clinical laboratory in interstate commerce to meet standards with regard to personnel, controls, methodology, and reagents. The United States made a big step forward in standardizing and making sure that clinical laboratory work was accurate and reproducible.

TORGHELE: It must have been a huge benefit.

MASON: It was. And the beginning of this was Morris Schaeffer.

TORGHELE: Now the year, if I'm remembering, was 1967?

MASON: Yes.

TORGHELE: That that passed.

MASON: Thank you for that.

TORGHELE: Now, at the time that you were finishing your EIS years would have been the time that Dr. Sabin had introduced the oral polio vaccine. And I wondered if you were privy to any of the decision-making that went into talking about whether to give the inactivated or the live attenuated vaccine?

MASON: I was not really involved in the decision-making, but this was a big issue. And probably the Cutter incident opened the door to the attenuated vaccine. If the Cutter incident had not occurred, there probably would not have been as much support for the attenuated vaccine. And I think it went further. 00:53:00Ultimately. United States and most of the world have agreed that the inactivated Salk vaccine is the way to go. The problem with the Sabin vaccines were that in a number of cases the virus was able to reconstitute itself, and so we know that cases of polio have occurred as a result of having used the oral vaccine. And I think that we would have made a decision long before we did, had it not been for the Cutter incident. It postponed the right decision.

And that's not in any way a reflection on Albert Sabin. He started a different line of work, and it worked perfectly with measles. And it just wasn't able to 00:54:00work as well with polio, because the poliovirus, even when it's attenuated, it more easily reverts back to wild stage. It wasn't Albert's fault, and no one can fault him for moving ahead, because had that not been a problem, it might have turned out to be the best vaccine in the end. We had to go through that, but I think it took longer.

TORGHELE: I don't know if you would have been at CDC or working with polio at all when the vaccine-associated paralytic polio was identified, and what you know about that.

MASON: Say that again please.

TORGHELE: The vaccine-associated paralytic polio.

MASON: I wasn't working at CDC at that time. I wasn't involved.

TORGHELE: You were one of the few people who worked in the laboratory branch and in epidemiology.

MASON: That's probably true.

TORGHELE: And apparently there were some ways of working together that worked and didn't work between epi and the lab. I wondered if you had some influence, having been on both sides, with bringing them together in situations.

MASON: There were two strong directors: Alex Langmuir, epidemiology branch, and U. Pentti Kokko, laboratory branch. We know a lot about Dr. Langmuir. Dr. Kokko was born in Finland, came to the United States, had an M.D. degree, as I recall, 00:56:00and was a superb laboratorian. I think Pentti did everything he could to serve Alex and the EIS, but I think it's just--and under a normal situation, the priorities of one are different than the other. And I don't think there was any ill will between the two. Resources are limited and you do what you have to do. And U. Pentti Kokko's main responsibility was to serve the public health, the state public health laboratories and city public health laboratories, like Morris Schaeffer's in New York. So in his attempting to serve his clients, and 00:57:00Alex trying to serve his clients, there may have been a gap in between. And I think, therefore, that's why Alex felt that he needed to develop some laboratory capability. And I think that's been good for CDC, it's been good for epidemiology and it's been good for the laboratory.

But on 95 percent of the epidemics, the collaboration between laboratory and epidemiology worked out well and was good and it was timely. But there were instances where, well, there were determinations that laboratory branch didn't do what epidemiology branch needed to get done. And so there are both priorities and direction. I think it was a good relationship. And the outgrowth of laboratory services in epidemiology branch was good and inevitable.

TORGHELE: You became the director of CDC in 1983. Can you tell us about how the selection process worked, and what that was like for you?

MASON: You know, that's rather difficult to express because I'm not--I was selected, so I can't say a lot about the selection process. But I heard from Bill Foege that he was going to step down, and he asked me to throw my hat in the ring. That was of great interest to me, but it was not the right time, I thought, in my life. We had seven children, we had children in high school, I 00:59:00had some rather significant responsibilities in my work and other things that I got involved in, and it just wasn't a good time to move from Salt Lake City to Atlanta. I told Bill that I was honored to be considered. I had been offered other jobs in both Washington and other places in the East, and I turned them all down. Yes, I would have loved to have been CDC director, but it just wasn't the time, and that was largely because of family. And so I said no. And discussion continued over a period of six months.

So I don't know what the process was. All I know was I kept getting calls, and not just from Bill Foege, but from a lot of other people. And six months after Bill had first called me, I was in a meeting on Long Island. It was a medical 01:00:00meeting, and [Dr.] David Sencer was there, who was the CDC director before Bill Foege. And Marie, my wife, had accompanied me to that meeting. And while we were having dinner together--Dave Sencer with Marie and I--he mentioned I should come to CDC as CDC's director. Of course, he couldn't offer the job, but he wanted to interest me in it. My wife listened, and when we went back to our hotel room that night she said--and this was the first time I'd ever had any interest from her in moving to Atlanta--she says, "Maybe you should consider going back to Atlanta." Dave had, some way, touched her. And we made it a matter of further thought that evening, and as we talked about it and thought about it, by the 01:01:00next day we had decided that maybe it was the thing to do.

And that was interesting, because I was the director of the Utah Department of Health at that time, and the very day I left to go to Long Island, I had dictated a letter and signed it, turning down being considered for the position of CDC director. And before I had got on the plane to fly with Marie to Long Island, I had directed my secretary to send it. And she had always done what I had told her. I told Marie, it's wonderful that we have these feelings, but I just signed a letter on Friday saying I had no interest in the position. When we got back to my office, I walked in and there on my desk was the envelope with 01:02:00the letter in it. And I said to Betty, "What is this?" And she said, "I just couldn't send it." She said, "I didn't think it was right." She wanted to get rid of me. But she had never done that before. She felt I shouldn't send that letter.

TORGHELE: That's very interesting.

MASON: So I sent out another letter saying I was interested in being considered.

TORGHELE: And she mailed that one.

MASON: She mailed that one, and got rid of me. After that, I was called to fly to Washington. I met Secretary of Health and Human Services Margaret Heckler, was interviewed by her and some of her key staff, and a week later I got a letter appointing me to be director of CDC. So that's what happened.

TORGHELE: That's very interesting. At the time that you were asked to be 01:03:00director, it was a political position, is that right? Because it hadn't always been.

MASON: Well, you know, that was one of the great things about CDC, it wasn't political. It was hidden away in Atlanta, away from Washington, and that's why it grew and thrived and could be excellent. Scientific integrity was the only consideration. And it was still that way. No one asked me what political party I belonged to. I don't know--Senator Orrin Hatch, who is still in the Senate, the oldest, longest-serving in the Senate--I don't know whether he put any word in for me. I didn't ask him to. I don't have the slightest idea whether there was any role there. But if it was, it was because someone in Health and Human Services asked him. But I don't know what role he played. But as far as I know, 01:04:00it wasn't political. I hope it wasn't. I didn't have any political clout. I was working for a Democrat governor of Utah, so who knows.

TORGHELE: It sounds like it was meant to be.

MASON: Maybe so.

TORGHELE: You had some interactions with C. Everett Koop, too. Can you talk about him a little bit?

MASON: Yes, I'd be happy to. I didn't meet C. Everett Koop until I became CDC director. And, of course, CDC director spends about as much time in Washington as he spends in Atlanta. And so I quickly became acquainted with him. But he's a 01:05:00neat guy. I enjoyed him. Surgeon, former pediatric surgeon, I think well motivated, I have good feelings about him. I think he did a magnificent job during the AIDS epidemic.

TORGHELE: When you were director of CDC, shortly before that was when smallpox 01:06:00was declared to be eradicated from the earth.

MASON: In 1978, about the same time that polio was eradicated in United States. Smallpox worldwide, polio in U.S.A. Yes.

TORGHELE: That was quite a time. Do you think that had anything to do with, then, the goal to eradicate polio globally?

MASON: Oh, I'm sure it did. If smallpox eradication had been unsuccessful, then I doubt that others would have had the dream to do the same thing with polio. And it's really a shame that we haven't been able to accomplish it with polio, because it isn't biological problems, it's--well, maybe it is biological. It's people's inability to get along with each other. Because if we have all the scientific resources whereby polio should and could be eliminated--and it will be.

TORGHELE: And do you feel that that's a worthy goal?

MASON: Absolutely. I mean, why should we keep giving polio vaccine? Why should we continue to have children and adults crippled with poliomyelitis? Why do we even need to worry about this disease? It needs to be put in the same drawer that smallpox is in.

TORGHELE: While we've been talking, I wondered if you have thought of other unusual circumstances under which you worked that would be related to polio or AIDS or smoking, or any of the other issues that you worked in that you feel like would be good public health messages?

MASON: Let me just mention one on polio, because that's our focus. I served a mission for the Church of Jesus Christ of Latter-day Saints in Denmark, and I was in Copenhagen in 1952 when they had their big polio epidemic. And I saw 01:08:00polio from the standpoint of this modern European nation. They did not have enough iron lungs to take care of all of the people with respiratory difficulty because of bulbar polio. So in 1952, they had young adults and children who couldn't breathe that had to be ventilated by people bagging. They literally had people, eight-hour--well, not eight-hour shifts, but just taking shifts and bagging respiration to keep people alive in that outbreak of the disease, three years before Salk vaccine was licensed. So I saw the impact.

I had seen the impact of polio in the United States, where I saw about 01:09:00thirty-five iron lungs in operation in Salt Lake City,. There must have been hundreds of them. An iron lung cost 1,500 dollars when it was invented in 1930. You could buy a house for 1,500 dollars in 1930. So an iron lung was equipment that a rich country could provide to its people. And even Denmark, a modern country, in 1952 didn't have respirators, and it had to be human beings pushing a bag to keep patients alive. Well, what do you think was happening in Africa or India or other countries like this? So when we don't eradicate diseases like smallpox and polio, even though the United States might be able to provide iron lungs and fund rehabilitation to help people to recover from, or at least overcome, some of their paralysis, for most of the world we're confining people 01:10:00to death or to severe disability. And that's just another play for, let's get polio eradicated, because you know, we might be able to manage it, and we haven't had a case because we keep our defense up with immunization, but look at the people that don't have those blessings.

TORGHELE: And speaking of vaccinations and opportunities, what would you say to the anti-vaccinators if you could give them a message that you think they would hear?

MASON: I would take each one of them back fifty or 100 years to a hospital or a cemetery. I'd let them talk to mothers who have children dying of smallpox or polio or diphtheria. I don't hold anything against them--they have these fears, 01:11:00these concerns, but I'm aghast that there are people who prey on those fears and promote those fears. And the Internet has made such promotion so easy and readily available. When I was involved in public health, we were striving to get the inner cities immunized. This is where polio and measles and mumps and diphtheria were occurring. And today, public health immunization has triumphed over the inner cities. We've been able to get the vaccine to those wonderful people. It's the well-to-do and the educated that get on the Internet and share vaccine fears that are so unfounded. I feel sorry for a mother that is so 01:12:00deluded that she denies this kind of preventive health to her children and encourages others not to use it. They need to really recognize how serious--how far back we'd go without vaccines. Their children are being protected by herd immunity because others are being immunized. If everyone stopped using vaccine, it wouldn't be long before they'd want vaccine.

TORGHELE: That would be a great message. You've had some other high-profile jobs besides those at CDC. Would you tell us about some of those, and some of the work that you did in those jobs?

MASON: Well, yes. I've had a lot of them, and so I'll be brief. I left CDC once to become an epidemiologist and infectious disease specialist at a hospital in 01:13:00Salt Lake City, the LDS [The Church of Jesus Christ of Latter-day Saints] Hospital. And I spent a year doing that, and then CDC lured me back as deputy director to David Sencer, so I enjoyed that job. And I made a number of attempts to get into clinical medicine, but I never lasted there because something else came up. So I spent a year as the CDC deputy director, and then the LDS Church asked me to come out and manage the hospitals that they owned in Utah, Idaho, and Wyoming. And so I left CDC and came out and did that, and spent from 1970 to 1977 managing the hospitals.

What I did was took fifteen hospitals and bound them together as a multi-hospital group, and then I was able to talk to the leaders of the church 01:14:00that it really shouldn't be in the hospital business. It didn't need to be in the hospital business. It wanted to take care of the poor and the sick and the needy, and there was no advantage to owning or operating the hospitals. Others could do that, and it diverted them from their religious responsibilities. So we created Intermountain Healthcare, which is the biggest multihospital group around here. It is grown since that time. So I worked myself out of a job, after working for about seven years as a hospital executive. And then I became head of the Utah Public Health Laboratory. So I went into the laboratory business and did that, and then joined the University of Utah as the head of family and community medicine. And then a new department of health was created in Utah, and 01:15:00Governor [Scott] Matheson asked me to assume the position of executive director of the Utah Department of Health, and I did that for about five years, and then became CDC director.

I left CDC because I had become very friendly with Dr. Louis Sullivan, who was the president of Morehouse Medical School. And CDC had always had a close working relationship with Emory [University] that was a very profitable relationship for both entities. I wanted to make sure that Morehouse was more closely wrapped into CDC. So Lou Sullivan and I became well acquainted, and when he became secretary of health and human services during the first Bush 01:16:00administration, he asked me to come up as assistant secretary for health, to be over the Public Health Service. And I had done that in acting capacity, while I was CDC director, for a year, so it was easy just to move to Washington and step into that position. And I did that until President [Bill] Clinton was elected, and then everyone handed in their resignation, and I handed in mine. And so I left there and I retired. And after I got back to Utah, I was called to a position that's called The Seventy and assigned to Africa for five years, where I--

TORGHELE: For the church?

MASON: Pardon?

TORGHELE: For the church?

MASON: For the church, for the Church of Jesus Christ of Latter-day Saints. And I served in Africa in more of an administrative position. I was responsible for 01:17:00missions, missionaries and ecclesiastical matters. But there was spare time. I gave a number of lectures on AIDS and on public health at medical schools in Africa, and saw a few patients. And so it was very fulfilling, wonderful experience. Marie and I were in Africa for five years, and then I came home. And it was not long after that that I was asked to be part of a long-term care association, Avalon Health Care, which is headquartered in Salt Lake. And I moved from its board of directors to becoming president and CEO of that for a number of years. And while I was there I established Bristol Hospice, and it grew, and now we have Bristol Hospice from Georgia to Hawaii, and it's become 01:18:00bigger than Avalon Health Care. I did that for a few years, and then I really retired. And since that time I've served on some boards, but I do more work with family and family histories than anything else now.

TORGHELE: Well, that sounds like a wonderful place to end up. I have enjoyed so much hearing all of your experiences, and how you've used all your skills and it came together to help all of us. So I wanted to thank you very much for participating in this oral history project.

MASON: Thank you for giving me an opportunity to talk to you. You are a wonderful interviewer.

TORGHELE: Thank you.