The Rob(xx) vs Rob(xxx) Debate
> > > Here are the questions to ask:
> > > 1) How much have vaccines contributed to health?
> > While HIV may be the scourge now, clearly in the '50's Polio was
> > something that caused a great deal of harm. A brief glance at
> > Fields Virology indicates that in the early '50's, Polio was paralyzing
> > 10-30,000 people a year.
"...Polio vaccine was licensed in the United States in 1955. During
1951-1954, an average of 16,316 paralytic polio cases and 1879 deaths from
polio were reported each year (9,10). Polio incidence declined sharply
following the introduction of vaccine to <1000 cases in 1962 and remained
below 100 cases after that year. In 1994, every dollar spent to administer
oral poliovirus vaccine saved $3.40 in direct medical costs and $2.74 in
indirect societal costs"
http://www.cdc.gov/od/nvpo/arttop10a.htm
> The US polio death rate was ~1/500 of the total US death rate when
> the vaccine was introduced. Not a negligible factor, but surely much
> smaller than many other influences on health. And the other vaccines
> had even smaller effects on total mortality.
"Every year, up to three million children's lives are saved by immunization.
But almost three million more lives worldwide are lost from diseases that
are preventable with existing vaccines. "
http://www.vaccinealliance.org/
> > I think you can attribute modern health to three things: (1) sanitation,
> > (2) antibiotics, and (3) vaccines. ... A fourth factor is the simple
> > understanding of germ theory and communicability and getting medical
> > practitioners to follow practices that minimized transmission. But
these
> > factors combined are what has extended average longevity from
> > ~30-40 years to ~75 years.
> This is completely wrong.
"Future Direction
Vaccines are one of the greatest achievements of biomedical science and
public health. Despite remarkable progress, several challenges face the..."
http://www.cdc.gov/od/nvpo/arttop10a.htm
"The two public health interventions that have had the greatest impact on
the world's health clean water and vaccines. Thanks to such pioneers as
Jenner and Pasteur, a handful of vaccines prevent illness or death for
millions of individuals every year. But there is still a long way to go.
Immunization, the most cost-effective public health intervention, continues
to be under-used.. It is profoundly tragic that almost two million children
still die each year from diseases for which are available at low cost . And
over 90 000 fall victim to paralytic polio, which could also have been
prevented by immunization."
http://www.who.int/gpv-dvacc/history/history.htm
> Medicine overall seems to have very little effect on health. This is the
> usual answer from statistical analyses, and from the few controlled
> experiments we have.
http://www.who.int/gpv-surv/graphics/Jan99graphics/estdeaths.htm
> The mortality rates of most diseases treated by
> antibiotics didn't change noticeably upon the introduction of that
treatment.
> I don't think we have controlled experiments regarding sanitation, but the
> statistical analyses we do have don't show any effect of sanitation on
health.
> I'd guess that Medicine of all forms probably contributes less than 1 year
> to that 40 year increase in lifespan.
"Deaths from infectious diseases have declined markedly in the United States
during the 20th century (Figure 1). This decline contributed to a sharp drop
in infant and child mortality (1,2) and to the 29.2-year increase in life
expectancy"
http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/mm4829a1.htm#fig1
> Since sanitation also doesn't seem
> that important, it is a big puzzle why exactly lifespan has increased so.
"Sanitation and Hygiene
The 19th century shift in population from country to city that accompanied
industrialization and immigration led to overcrowding in poor housing served
by inadequate or nonexistent public water supplies and waste-disposal
systems. These conditions resulted in repeated outbreaks of cholera,
dysentery, TB, typhoid fever, influenza, yellow fever, and malaria.
By 1900, however, the incidence of many of these diseases had begun to
decline because of public health improvements, implementation of which
continued into the 20th century. Local, state, and federal efforts to
improve sanitation and hygiene reinforced the concept of collective "public
health" action (e.g., to prevent infection by providing clean drinking
water). By 1900, 40 of the 45 states had established health departments. The
first county health departments were established in 1908 (6). From the 1930s
through the 1950s, state and local health departments made substantial
progress in disease prevention activities, including sewage disposal, water
treatment, food safety, organized solid waste disposal, and public education
about hygienic practices (e.g., foodhandling and handwashing). Chlorination
and other treatments of drinking water began in the early 1900s and became
widespread public health practices, further decreasing the incidence of
waterborne diseases. The incidence of TB also declined as improvements in
housing reduced crowding and TB-control programs were initiated. In 1900,
194 of every 100,000 U.S. residents died from TB; most were residents of
urban areas. In 1940 (before the introduction of antibiotic therapy), TB
remained a leading cause of death, but the crude death rate had decreased to
46 per 100,000 persons (7).
Animal and pest control also contributed to disease reduction. Nationally
sponsored, state-coordinated vaccination and animal-control programs
eliminated dog-to-dog transmission of rabies. Malaria, once endemic
throughout the southeastern United States, was reduced to negligible levels
by the late 1940s; regional mosquito-control programs played an important
role in these efforts. Plague also diminished; the U.S. Marine Hospital
Service (which later became the Public Health Service) led quarantine and
ship inspection activities and rodent and vector-control operations. The
last major rat-associated outbreak of plague in the United States occurred
during 1924-1925 in Los Angeles. This outbreak included the last identified
instance of human-to-human transmission of plague (through inhalation of
infectious respiratory droplets from coughing patients) in this country."
http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/mm4829a1.htm#fig1
> It is also a puzzle why the US spends 14% of GDP on medicine.
"Cost-Effectiveness of Immunization: Immunization is the most cost-effective
health measure. It is also an essential component in a nation's efforts to
boost economic development and reduce poverty. Even if the cost of a routine
immunization program incorporating new vaccines were to reach US$2 billion
per year to reach out to all children in low income countries, that would
still represent only about US$0.35 for every person on earth and less than
0.1% of what the world spends on health."
http://www.vaccinealliance.org/press/press_imm.html
"The Impact of Immunization on Economic Development "
http://www.vaccinealliance.org/press/press_econ.html
On Jan 31,2000 the Children's Challenge was launched at the World Economic
Forum in Switzerland. The Challenge: "Immunize every child, protect the
future." Sponsored by GAVI, the Global Alliance for Vaccines and
Immunizations...(World Health Organization, The World Bank, UNICEF, The
Rockefeller Foundation, etc.)
So, we appear to be gaining in the M&M via micro-organism and succumbing to
host-induced M&M.
ct
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