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

“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

Decline in Communicable Diseases since 1900

Decline in Communicable Diseases Since 1900 pt. 2

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

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

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.


Medical Nemisis (or: if you don’t stop it’s going to freeze that way)

I recently came across reference to Ivan Illich’s 1975 Medical Nemesis, in which he discusses the effect of the assumptions and processes of contemporary medicine on social and personal views of the body; including those of “alternative medicine”.

While it is widely accepted that the leading cause of death in the United States is that of modern medical practice as shown by recent studies, this was not the focus of Illich’s concern. It was, rather, the corrupting effects of the authority of institutions and of the economic culture of the West on our intuitive and conscious understanding of ourselves as entire beings.

Illich expressed concern over the medical establishment’s technological widening the mind-body split engendered by Descartes. Medicine’s technologically determined diagnoses result in the fragmentation of our physical and mental states into discrete “syndromes”.  We begin to see ourselves as units of systems-based, technological datum. We distance awareness of our messy, chaotic bodies and our ever shifting consciousness from that of the pure “self”.

When we are able to so completely fragment the “self” from our bodies, sensations and emotions detachment becomes the default in understanding the self and others. The logical endpoint is that it becomes increasingly easy to distance one’s self from the other and their lived experience; as we cannot truly see them as human. We see them instead as a distinct collection of physical and emotional syndromes, rather than someone who is experiencing a state of “dis-ease”. For example: we understand that Ms. X has diabeties with PTSD and varicose veins. Or Mr. Y has a urine fetish, high blood pressure and presents as an INTJ on the Meyers-Briggs personality scale.

I have long held a less than positive view of current medical establishments. They are literally “dehumanizing” in their practices. And while individual physicians, psychologist and other assorted professionals may have the best of intentions toward individual patients, they are overwhelmed and often overruled in their best efforts by corporate interests. Whether it’s the institution they work for directly or from for-profit insurance interests.

People, being binary thinkers, often assume this means I am in wholly in favor of “alternative medicine”. To put it succinctly, no. Any practice that partitions the “self” into parts is suspect. This includes allopathic medicine, psychology, psychiatry, some alternative medical practices and some specific religious and intellectual practices.

In America, much of popular alternative medicine is focused on the “filth” of the body, the “parasites” it harbors and on the entirely natural process of aging. The colon as a focus of anxiety is a holdover from John Harvey Kellogg in the last century’s version of alternative medical practice. Kellogg popularized fiber as a way to cleanse the colon and enemas to remove fecal remnants that were surely, in his view, pollutants and the cause of almost every physical and mental distress experienced by the body.

Anxiety over fecal material is normal, as it can cause severe and widespread illness if mishandled. But anxiety over the feces itself transferred to the body as a permeable container of feces, in particular the colon. So we continue Kellogg’s regimen of fiber, chemical laxatives and various types of enemas in the hopes that we will be able to rid our colon, our liver and other digestive functions, as things separate from us, from the degrading filth that contaminates “us” by proximity.

The embracing of food as “nutrition” creates the same dissonant separation of essence and esse. We don’t enjoy meals; we “get our carbs”, we ingest “fuel”. We take great care to incorporate regulated and discrete units of vitamins, minerals and other nutrients, which are seen as somehow superior to the delivery systems that are merely “food”. People develop unhealthy aversions to aspects of nutrition that are vital to our well-being. Fat, for instance, has become an epithet. So people develop an almost phobic reaction to any food which incorporates fat. Little do those people realize the major source of nourishment our brain cells utilize to communicate is a type of fat called cholesterol.

The other “disease” that is of primary concern in alternative medicine is aging. Yes, getting old is considered a disease. The post-war generation, popularly known as “Boomers” has so thoroughly embraced the Youth Culture ideal, that the entirely normal physiological process of aging has become, to them, a thing perverse and unnatural.

In their initial response, allopathic medicine placed their focus on gerontology and on coping with the slow systemic breakdown of older patients. Popular alternative medicine, being more responsive to the marketplace, developed a host of dubious processes and products designed to forestall time and entropy.

With more and more of their patients demanding a cure for the process of time, medical practitioners likewise, have moved their profit centers into plastic surgery, liposuction, joint replacement and other procedures related to “reversing” the aging process. Rather than finding an adaptive, creative response to the inevitable changes aging brings, both the patient and the physician find it more expedient to fracture the body; replacing the offending parts wholesale. Either that or physicians offer isolated chemical solutions to discrete aspects of a larger, individual process. This approach is not only lucrative for the physician and the attending corporate interests; it relieves pressure from patients insistent on a “cure”. In the end, it allows patients to feel some illusory measure of control over a process they have come to see as “unhealthy” and separate from themselves.

This separation also occurs in scientific fields addressing cognition and in the disciplines of psychiatry and psychology. We are taught to view conscious and unconscious processes as lacking integration with that which we consider “us”.  We have compulsions, we have disordered thinking, we have splintered personalities; as if these are things we hold or discard at our leisure. It is a convenient way for practitioners to discuss a syndrome or disease. But, by the shortcomings of language, it creates a crippling distance between a particular state of being and the person experiencing that state. This separation discourages understanding of the useful, functional aspects of a particular cognitive process and impedes progress in coming to an integrated resolution to a client’s “dis-ease”.

Within this framework, the fracturing and forced separation of the aspects of self are implicate in the current divide between those who view rational, scientific and critical understanding as completely separate and distinct from those favoring intuitive, spiritual and unconscious knowing. This simply parses a whole consciousness into discrete and segmented units. Cognitive modalities like religious fanaticism and skepticism as it is currently practiced or spirituality as an internal exploration and critical thinking as an external exploration, are then mistakenly considered distinct. In reality, they are all examples of a western worldview using identical thinking processes and methodologies; reaching conclusions that differ only in name.

To suggest that one can or should reclaim the whole self echoes a New Age philosophy that has long passed its uncorrupted zenith. There is no intention here to forward a particular “cure” for humanity’s fractured states of being. Instead, I am suggesting that it is possible, with intention, to consciously utilize adaptive and creative processes encouraging individual re-integration; moving toward a personal version of what Edward O. Wilson has termed consilience.