Re: HEALTH: Changes in Mortality

From: Robin Hanson (
Date: Mon Feb 07 2000 - 12:04:13 MST

Robert Bradbury wrote:
>Citing, John Cairns, MD (Harvard School of Public Health), from
>"Matters of Life and Death": ...
>"Advances in the treatment of diphtheria (as opposed to its prevention),
>in particular the discovery of antibiotics, have had only a minor effect
>on mortality." [p. 29]
>Based on Cairns comments, I would change my previous statement
>that modern longevity is due to: (1) Education; (2) Nutrition;
>(3) Sanitation; (4) Vaccines and (5) Antibiotics. His discussions
>regarding the health and infant mortality rates in modern countries
>would seem to confirm that public knowledge (e.g. prenatal nutrition)
>and government health regulations (e.g. for clean drinking water) probably
>contribute much more to longevity than do medical practices.

Can you admit you are just guessing? The evidence may have persuaded
you that medicine wasn't a big influence, and these other ideas are
plausible hypotheses, but that's all they are until you look at some
more data. From my reading of the data the only effect on your
list that we have clear evidence for a large effect is nutrition.
But it is hard to see nutrition as the whole effect, since rich people
long ago who had plenty to eat died a lot more than poorer people today.

>But considering his Table 1.2:
>Death Rates (per million) in England and Wales ...
>Total for all infectious diseases 12965 714
>Total for all non-infectious diseases 8891 4670 ...
>Source: T. McKeown, "The Role of Medicine, Dream, Mirage, or Nemesis", 1976
>I don't think you can discount sanitation and vaccines entirely.

Yes, the drop was concentrated in infectious diseases. And that
does make one think about sanitation and vaccines. But look further
at the evidence before deciding.

>I attribute the reduction in Cholera deaths & other food & water borne
>diseases directly to sanitation.

What evidence would you cite?

>Again, we may "split" hairs as to exactly what we call sanitation.
>Cairns cites the availability of washable cotten clothes allowing
>people to actually bathe more frequently.

What I know of data on is water sources and waste disposal sinks.

> > It is also a puzzle why the US spends 14% of GDP on medicine.
>Cairns alludes to the # of doctors...
>"And market forces will lead to an overabundance of doctors, becuase
>there is almost no limit to the opportunities for lucrative medical
>practice in countries with a rich aging population.

The opportunities are large because the demand is large. But why
is the demand large? That is just a restatement of the question.

Robin Hanson
Asst. Prof. Economics, George Mason University
MSN 1D3, Carow Hall, Fairfax VA 22030
703-993-2326 FAX: 703-993-2323

This archive was generated by hypermail 2b29 : Thu Jul 27 2000 - 14:03:31 MDT