Those of you who read my post about herd immunity may be asking yourself this question: “If America has never reached the medical standard of herd immunity, (a 95% vaccination rate), why aren’t people dying from disease left and right?” “Why aren’t people dying from as many sicknesses as before?”
Which leads to the question of, what caused the 74% mortality rate decrease from the late 1900s until now?
[I want to put in a caveat before I begin this post – I will specifically be speaking about mortality (or the death rate) dropping. This post is not specifically about morbidity, (or the number of people infected). I will address morbidity in a separate post, there is far too much to address both of these topics in one sitting.]
Mortality Rate Answers from the CDC:
So, let’s get back to answering the question of why mortality rates dropped by 74% in the twentieth century. First, I will turn to the CDC to answer what is not responsible for the 74% decline in mortality. In 2000 the CDC, along with doctors at John Hopkins produced a study in Pediatrics called, “Annual summary of vital statistics: trends in the health of Americans during the 20th century.” The study aimed to understand the large drop in Mortality in the twentieth century compared to centuries past. This was their explicit analysis:
“Thus vaccination does not account for the impressive declines in mortality seen in the first half of the century…nearly 90% of the decline in infectious disease mortality among US children occurred before 1940 when few antibiotics or vaccines were available.”
So, what did the CDC say was actually the cause of the great decline in mortality rates?
“Water treatment, food safety, organized solid waste disposal, and public education about hygienic practices.” As well as, “improvements in crowding in US cities,” playing a vital role in the drop of mortality.
So, to break it down, what stopped most people from dying from disease in the US was clean water, safe food/nutrition, toilets and treatment of waste, teaching people about hygiene, and improvements in living conditions.
Since these interventions, life expectancy has increased by 56%, according to the same study. Other great finds were, that these same things lowered maternal mortality rate by 90% since 1950 and that child deaths due to infectious disease dropped from 60% to 2%.
What an amazing discovery! In the words of the authors, “the overall decline in mortality during the 20th century has been spectacular.”
So, why do we continue to insist that it was medical interventions like antibiotics and vaccination that caused these declines? Keep this question in mind, I will come back around to it near the end.
Obviously, this is just one CDC study in Pediatrics, so let’s see if we can find any data to confirm these statements.
The McKinlay Study:
In 1977, The Millbank Memorial Fund Quarterly published a study by a Boston University epidemiologists, (husband and wife team), John and Sonja McKinlay who called their study, “The Questionable Contribution of Medical Measures to the Decline of Mortality in the United States in the Twentieth Century.”
This study states explicitly, “that the introduction of specific medical measures and/or the expansion of medical services are generally not responsible for most of the modern decline in mortality.”
Their claims are based on government mortality data, because, it is extremely easy to see that medical measures are most likely not the cause by just looking straight at the numbers.
Here are some of their big takeaways:
1) 92.3% of the mortality rate decline happened between 1900 and 1950 [before most vaccines existed and antibiotics had barely been introduced]
2) Medical measures “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.”
3) Of the large decline in mortality, only 1-3.5% may be contributed to vaccines, antibiotics, or other interventions.
The President of the Infectious Disease Society of America’s Findings:
They are not the only ones who were aware of these numbers and what they meant for society. In 1970, Dr. Edward H. Kass, President of the Infectious Disease Society of America gave a speech at its annual meeting about this very thing.
He spoke about knowing who were the true “great killers” of our pasts most infectious diseases, “tuberculosis, diphtheria, pneumonia, puerperal sepsis, etc.” He stated that the idea, “that medical research and our superior system of medical care were major factors extending life expectancy, thus providing the American people with the highest level of health available in the world [were] half-truths.”
Here are a few charts that he produced during this talk, based again on historical government records:
These graphs clearly show what the CDC and the McKinlay’s were both talking about. The mortality rate had dropped long before the man-made interventions that we attribute as our saviors.
Mortality Rates Visualized in Government Records
If that is not enough, here are a few more graphs, this time including data from the United States itself. The first few graphs will come from England and the rest from the US. Here is some information that may be helpful to you when looking at this data, the order in which the vaccines correlating to the infections below appeared:
- 1923– Diphtheria Antitoxin (not quite a vaccine, but close)
- 1926– the first vaccine for pertussis (although this vaccine was not actually used by the public until much later starting around the late 1940s-1950)
- 1963– the first vaccine for measles, (however, the first vaccine failed pretty widely and a more established intervention did not come into play until 1968).
- SOURCE: England and Wales mortality rates from various infectious diseases from 1838 to 1978. (Record of mortality in England and Wales for 95 years as provided by the Office of National Statistics, published 1997; Report to The Honourable Sir George Cornewall Lewis Bart, MP, Her Majesty’s Principal Secretary of State for the Home Department, June 30, 1860, pp. a4, 205, Visualization of data by Roman Bystrianyk and Suzanne Humphries, MD, “Dissolving Illusions,” graph 11.2)
I know this first graph can be a little overwhelming, so here is some of that data broken down into separate graphs:
- SOURCE: England and Wales whooping cough mortality rate from 1838 to 1978. (Record of mortality in England and Wales for 95 years as provided by the Office of National Statistics, published 1997; Report to The Honourable Sir George Cornewall Lewis Bart, MP, Her Majesty’s Principal Secretary of State for the Home Department, June 30, 1860, pp. a4, 205, Visualization of data by Roman Bystrianyk and Suzanne Humphries, MD, “Dissolving Illusions,” graph 11.3)
- SOUCE: England and Wales measles mortality rate from 1838 to 1978. (Record of mortality in England and Wales for 95 years as provided by the Office of National Statistics, published 1997; Report to The Honourable Sir George Cornewall Lewis Bart, MP, Her Majesty’s Principal Secretary of State for the Home Department, June 30, 1860, pp. a4, 205, Visualization of data by Roman Bystrianyk and Suzanne Humphries, MD, “Dissolving Illusions,” graph 11.4)
- SOURCE: United States whooping cough mortality rate from 1900 to 1967. (Vital Statistics of the United States 1937, 1938, 1943, 1944, 1949, 1960, 1967, 1976, 1987, 1992; Historical Statistic of the United States- Colonial Times to 1970 Part 1; Health, United States, 2004, US Records & Health Data Development Section, Michigan Department of Community Health; US Census Bureau, Statistical Abstract of the United States: 2003; Reported Cases and Deaths from Vaccine-Preventable Diseases, United States, 1950-2008.) Roman Bystrianyk and Suzanne Humphries, MD, “Dissolving Illusions,” graph 11.5.
- SOURCE: United States measles mortality rate from 1900 to 1967. (Vital Statistics of the United States 1937, 1938, 1943, 1944, 1949, 1960, 1967, 1976, 1987, 1992; Historical Statistic of the United States- Colonial Times to 1970 Part 1; Health, United States, 2004, US Records & Health Data Development Section, Michigan Department of Community Health; US Census Bureau, Statistical Abstract of the United States: 2003; Reported Cases and Deaths from Vaccine-Preventable Diseases, United States, 1950-2008.) Visualization by: Roman Bystrianyk and Suzanne Humphries, MD, “Dissolving Illusions,” graph 11.6.
- SOURCE: New York City diphtheria mortality rates from 1880 to 1911. (Twenty-Ninth Annual Report 1900 City of Boston, Coston- Municipal Printing Office, 1901, p.7; Thirty-Sixth Annual Report of the Board of Health of the City of Boston for the Year 1907, Municipal Printing Office 1908, p.17; Annual Report of the Board of Health of City of Boston for the Year 1911, Municipal Printing Office, 1912, p.243; Scientific Features of Modern Medicine, Frederic S. Lee, Ph.D., New York, Columbia University Press, 1911, p.92) Visualization by Roman Bystrianyk and Suzanne Humphries, MD, “Dissolving Illusions,” graph 11.8.
- SOURCE: United States diphtheria mortality rate from 1900 to 1967. (Vital Statistics of the United States 1937, 1938, 1943, 1944, 1949, 1960, 1967, 1976, 1987, 1992; Historical Statistic of the United States- Colonial Times to 1970 Part 1; Health, United States, 2004, US Records & Health Data Development Section, Michigan Department of Community Health; US Census Bureau, Statistical Abstract of the United States: 2003; Reported Cases and Deaths from Vaccine-Preventable Diseases, United States, 1950-2008.) Visualization by: Roman Bystrianyk and Suzanne Humphries, MD, “Dissolving Illusions,” graph 11.9.
The Findings of Scientists of the Past:
It seems that, even in the past, most scientists had known that medical interventions had not played a huge role in the drop in mortality. Here are a few quotes, and when I say few, I say it that way because there are numerous quotes of this kind from many medical professionals and notable sources. I have included just a couple.
“There was a continuous decline, equal in each sex, from 1937 onward. Vaccination [for whooping cough], beginning on a small scale in some places around 1948 and on a national scale in 1957, did not affect the rate of decline if it be assumed that one attack usually confers immunity, as in most major communicable diseases of childhood . . . With this pattern well established before 1957, there is no evidence that vaccination played a major role in the decline in incidence and mortality in the trend of events.”
– Gordon T. Stewart, 1977
“For forty years, corresponding roughly with the advent of the “sanitary era,” smallpox has gradually but steadily been leaving this country. For the past ten years the disease has ceased to have any appreciable effect upon our mortality statistics. For the most of that period it has been entirely absent except for a few isolated outbreaks here and there. It is reasonable to believe that with the perfecting and more general adoption of modern methods of control and with improved sanitation (using the term in the widest sense) smallpox will be completely banished from this country as has been the case with plague, cholera, and typhus fever. Accompanying this decline in smallpox there has been a notable diminution during the past decade in the amount of infantile vaccination. This falling off in vaccination is steadily increasing and is becoming very widespread.”
–Harry Bernhardt Anderson, State Medicine a Menace to Democracy, 1920, p.84.
“In 1838 in England 1228 persons died of fever, typhus and typhoid, per million of living. Twenty years later the figures were reduced to 918; in 1878 to 306 of typhoid to thirty-six of typhus fever. In 1892 only 137 died of typhoid fever, and only three of typhus per million living. In London the death rate was 307 in 1869; in 1892 it was 102. Three factures have been concerned in this extraordinary saving of life- the cleansing of towns, the purification of the water supplies, and the introduction of good sewers.“
–William Osler, MD, :The Relation of Typhoid on Mortality and Sewerage,” Maryland Medical Journal vol. XXXVIII, no.13, January 8, 18908, p.217
We see here, that the decline was so great, that even magazine’s like “Life” printed stories speculating that these diseases would go extinct of their own accord:
“From vital statistics of insurance companies, we learn that life for children in this country has been made infinitely safer. We have reduced death from principal communicable diseases of childhood- measles, scarlet fever, whooping cough, diphtheria- by 31% in a single year to a new record low, a point actually promising complete eradication of these diseases!” (“2 Inches Taller…15 Pounds Heavier,” Life, June 2, 1941, p.71)
Here is the actual report where these claims come from:
“Measles, scarlet fever, whooping cough, and diphtheria- the principal communicable diseases of childhood- declined 31 percent in the year, or from 4.2 per 100,000 in 1939 to 2.9 in 1940. Each of these diseases reached a new minimum in 1940, and all except whooping cough had a mortality rate of less than 1 per 100,000. Only a comparatively few years ago the death toll from this group of diseases was serious, but it has now been reduced to a point where their complete suppression may be expected. The public health movement is said to be responsible for the reduction in mortality from diarrhea and enteritis, which in 1930 had a rate of 20.4 per 100,000 and in 1940 had dropped to a rate of 4.6. Advances in sanitary science, including the Pasteurization of milk, the better refrigeration of foods, and the purification of water supplies, as well as the general rise in the standard of living are the main reasons for this improvement.“
–Handbook of Labor Statistics, 1941 Edition, US Department of Labor, pp. 396-397
Back to the Beginning: Why?
All of this brings us back to the question I stated at the beginning of this article. If we have known and it is so obvious that things like hygiene, nutrition, and better living conditions are the main cause of our lowered mortality rate from infectious diseases, why are we claiming that medical interventions deserve all the credit?
I don’t have a complete or scientifically backed up answer for you. I can only speculate. The best answer I have data for is: money.
The McKinley’s who we talked about earlier made this statement in their paper, “It is not uncommon today for biotechnological knowledge and specific medical interventions to be invoked as the major reason for most of the modern (twentieth-century) decline in mortality. Responsibility for this decline is often claimed by, or ascribed to, the present-day major beneficiaries of this prevailing explanation.“
It is common knowledge that pharmaceutical companies are some of the richest and most powerful in the world. A tiny snapshot of this is the rise in profits from vaccination over the past 6 years. Profits from vaccines have almost doubled from 32.2 billion in 2014 to 59.2 billion in 2020.
According to Statista, 511 billion dollars were spent on pharmaceuticals alone last year. That is more money than practically any other industry ever makes, let alone per year.
The idea that medical interventions saved humanity by drastically lowering our mortality rate is a big contributor to this. The reason being, that this story makes medicine our hero, trustworthy, and continually important in order to sustain our lowered mortality rate.
This narrative is baked not only into our healthcare system but into our laws, our perception of reality, and what will become of our future. Think about the many things doctor sign-off is required for: schooling, travel, sometimes even our jobs. It is no wonder that pharmaceutical companies are booming and doctors only have 10 minutes with each patient.
This mentality also makes it possible to suggest or mandate future interventions. Such as a required vaccination schedule, mask-wearing, or testing procedures in order to go to work or school. If we do not continue to trust medical professionals and use medical interventions, then we will “die” or “hurt someone else”– this is the central message.
This message allows for strenuous measures, lost freedoms, and shaming and discrimination of others.
I do not contest the fact that antibiotics may have saved thousands of lives or that it is possible that vaccination could have lowered, and may be lowering, the morbidity, (number of people getting an illness), rate of disease. However, attributing all lives saved to these two interventions did allow for the creation of our current ideology about health, especially when it comes to the responsibility of keeping people healthy.
We have downplayed so much the importance of proper nutrition, sanitation, refrigeration, emotional stability, and quality of life that these things are sometimes labeled as “woo-woo” or “worthless” when it comes to our health. We instead have become dependent upon someone else to take care of us. It is no longer our responsibility to keep ourselves healthy, it is up to our care provider and everybody else. Especially in the view that morbidity, (which we will talk about in a future post), is so much more important than mortality.
How would the world be different if we gave the proper sources of this great decline the credit?
A Closing Thought:
I close with this thought from the McKinlay’s study. They speak in the beginning of their article about “medical heresy” the idea that if you speak out of turn, you are labeled a heretic to the profession. There were many medical heretics who we revere today, for example Semmelweis, who was the first to begin the practice of handwashing. Many of these medical professionals, including Semmelweis, were laughed at, lost their jobs, and labeled as quacks. Where would we be without them?
It is so important to remember where we came from so that we can see that there is so much that we do not know. So much of what we depend on is just educated guesswork. We are continually evolving, however, just because ideas or research may evolve does not mean that it will be well received by the establishment or accepted as the consensus. But, that doesn’t mean it isn’t true.
There will be many who are “discredited”, shamed, and defamed, for reevaluating what we consider to be consensus or “truth” today, just as they always have been. Thus, it is important to keep an open mind and an objective eye when viewing studies, clinical trials, papers, controversial views, and even consensus. The point of science is change; it is never settled.
“History is replete with examples of how, understandably enough, self-interested individuals and groups denounced popular customs and beliefs which appeared to threaten their own domains of practice, thereby rendering them heresies (for example, physicians’ denunciation of midwives as witches, during the Middle Ages).
We also know that vast institutional resources have often been deployed to neutralize challenges to the assumptions upon which everyday organizational activities were founded and legitimated (for example, the Spanish Inquisition). And since it is usually difficult for organizations themselves to directly combat threatening “heresies,” we often find otherwise credible practitioners, perhaps unwittingly, serving the interests or organizations in this capacity.
These historical responses may find a modern parallel in the way the everyday practitioners of medicine, on their own altruistic or “scientific” grounds and still perhaps unwittingly, serve present-day institutions (hospital complexes, university medical centers, pharmaceutical houses, and insurance companies) by spearheading an assault on a most fundamental challenging heresy of our time: that the introduction of specific medical measures and/or the expansion of medical services are generally not responsible for most of the modern decline in mortality.”
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