In the Midst of the Health Care Debate and the H1N1 Vaccine Crisis

November 25, 2009 at 8:28 pm (class war, Commentary, Economics, Health Care, science)
Tags: childhood poverty, coping, Crisis, disease, flu, H1N1, Health Care, health care access, heresy, hygiene, income, John McKinlay, lifetime, living, longevity, medicine, Milbank Memorial Fund Quarterly, Obama, patient, physician, poverty, science, socialism, Sonja McKinlay, sterilize, vaccine

“The modern “heresy” that medical care (as it is traditionally conceived) is generally unrelated to improvements in the health of populations (as distinct from individuals) is still dismissed as unthinkable in much the same way as the so-called heresies of former times. And this is despite a long history of support in popular and scientific writings as well as from able minds in a variety of disciplines.”

The Questionable Contribution of Medical Measures to the Decline of Mortality in the United States in the Twentieth Century

by John B. McKinlay; Sonja M. McKinlay

Published in 1977 in the Milbank Memorial Quarterly, Vol. 55, No.3. pp. 405-428

In this study, the McKinlays explore a steep decline in the top 10 communicable diseases. (Tuberculosis, Scarlet Fever, Influenza, Pneumonia, Diptheria, Whooping Cough, Measels, Smallpox, Typhoid, Poliomyelitis) This unified decline occurred over a period of about 100 years from 1900 to 1973 . Even the most virulent of these diseases were near their currently flat expression when science developed the means to mass produce vaccines in the years leading up to 1949.

Male and Female Mortality Rates Since 1900

As this chart from the paper shows, the decline in mortality from 1900 to the 1970’s for both males and females was markedly dramatic.

They compare this decline in mortality to similar declines in the communicable diseases listed previously.

Decline in Communicable Diseases since 1900

And also included is a graph charting causes of death from the early 1900’s in comparison to the years just prior to this paper’s publication.

Changes in Causes of Mortality since 1900

Which leads to the authors’ conclusion:

In general, medical measures (both chemotherapeutic andprophylactic) appear to have contributed little to the overall decline in mortality in the United States since about 1900-having in many instances been introduced several decades after a marked decline had already set in and having no detectable influence in most instances. More specifically, with reference to those five conditions (influenza, pneumonia, diphtheria, whooping cough, and poliomyelitis) for which the decline in mortality appears substantial after the point of intervention-and on the unlikely assumption that all of this decline is attributable to the intervention-it is estimated that at most 3.5 percent of the total decline in mortality since 1900 could beascribed to medical measures introduced for the diseases considered here.

This graph shows the diseases and their declines in comparison:

Compilation Graph

I would imagine that even the average lay reader, on viewing this graph of the mass decline, can easily imagine each disease effortlessly reaching current levels without the advent of commonly available vaccines. But if vaccines are not responsible for the dramatic decline in mortality, how else can it be explained?

It is widely known that a sea change in patient survival came after more stringent practices regarding hygiene and sterility of spaces and implements used in medical procedures were undertaken for both patient and physician. And as medicine and science progressed in their research of communicable disease and underlying factors that allowed them to spread. Along the way researchers and doctors also began to understand the things that create health.

Massive public campaigns, programs and projects were implemented. For instance swamps were drained to reduce breeding grounds for mosquitoes. And a broad swath of society, from low to high, were educated about cleanliness and hygiene.

From the CDC’s website:

In 1900 in some U.S. cities, up to 30% of infants died before reaching their first birthday (1). Efforts to reduce infant mortality focused on improving environmental and living conditions in urban areas (1). Urban environmental interventions (e.g., sewage and refuse disposal and safe drinking water) played key roles in reducing infant mortality. Rising standards of living, including improvements in economic and education levels of families, helped to promote health. Declining fertility rates also contributed to reductions in infant mortality through longer spacing of children, smaller family size, and better nutritional status of mothers and infants (1). Milk pasteurization, first adopted in Chicago in 1908, contributed to the control of milkborne diseases (e.g., gastrointestinal infections) from contaminated milk supplies.

Refrigeration became commonly available. That and other household inventions like window screens, indoor plumbing, and strategies to deal with outhouse placement in relation to well placement and other improvements made possible by gains in real income.

Because, according to the McKinlay’s paper:

With the appearance of his book, Who Shall Live? (1974), Fuchs, a health economist, contributed to the resurgence of interest in the relative contribution of medical care to the modern decline in mortality in the United States. He believes there has been an unprecedented improvement in health in the United States since about the middle of the eighteenth century, associated primarily with a rise in real income.

In light of a number of similar reports, which have been ignored or overlooked questions about vaccines begin to center on efficacy versus the potential for harm. There are those “skeptics” who are quick to label any such questions as the “heresy” described by the McKinlays’. One would hope, at this point, they might review the widely accepted definition of skepticism as one of continuing exploration. There are no concrete truths in science, only evolving theories that should, in the best of all possible worlds, be continuously re-examined and re-tested.

We should also consider similar themes of hygiene in relation to income levels through the lens of such ideas as: mandated control of working conditions, food preparation and storage, statutes for safe drinking water and the establishment of agencies dealing specifically with issues of public health. Upton Sinclair’s novel The Jungle can act as a literary touchstone for the ideas presented here.

Now is the time for us to ask ourselves: Would the money spent on the now all-but-neutered health care bill be used more effectively by developing jobs for the populace so that real income levels rise for those most affected by the downturn? Would a combination of public health education and income increases work to reduce the current spate of common causes of death as it did in the first half of the last century even though the cause of mortality has changed? I think we need to take a broader view of what has worked in the past, as it is evident that medicating the problems will not solve them now any more than it did then.