[extropy-chat] Are vaccinations useless? was Re: Failure of low-fat diet

Hal Finney hal at finney.org
Tue Mar 7 08:45:05 UTC 2006

I found an interesting debate on the efficacy of medicine online in the
journal Annals of Internal Medicine, from 1998:


This is an editorial introducing the issue, but the nice thing is that
the two papers making their cases are available in full text form.
The actual issue being debated is slightly different, it is how to
reduce inequalities in health between different socioeconomic groups.
Should we improve access to medicine?  Well, not if access to medicine
doesn't improve health!  Quoting from the editorial:

> The macro-level debate was triggered by the interest in accounting for
> the impressive reductions in mortality that have been achieved in the
> past century. Such reductions have benefited almost all countries of
> the world and all social groups, although with enormous disparities in
> the extent and pace of progress. The coincidence of this process with
> the multiplication of efficacious medical technologies led to the almost
> obvious conclusion that the latter had to be the cause of the reduction
> in mortality, but this certainty was not to last long.
> In the 1950s, precisely when most countries were beginning to report
> important decreases in mortality, several influential criticisms were
> leveled against the conventional wisdom. In 1959, Rene Dubos published
> his now-classic book Mirage of Health [3]. In it, he demonstrated that
> mortality had begun to decline in the West much before the formulation
> of the microbial theory of disease and the availability of "magic
> bullets." Almost at the same time, physician and demographer Thomas
> McKeown was beginning the series of studies that would make him one of
> the most controversial critics of the role of medicine [4]. According
> to McKeown, the main reasons for the decline of mortality were to be
> found in better living conditions, especially nutrition, housing, and
> environmental sanitation. This was certainly not the first time that the
> effect of social conditions on health had been noted; this observation
> goes back at least to the ancient Greeks and finds an eloquent exponent
> in Rudolf Virchow. The important point was that both Dubos and McKeown
> were specifically trying to refute the common notion that medical advances
> were responsible for major gains in health.
> Medical intervention has always been accompanied by skepticism about its
> value. But what began to be expressed in this debate were not doubts
> about particular interventions but doubts about the entire medical
> enterprise, leading to what Paul Starr has called a new "therapeutic
> nihilism" [5]. This view implied a radical shift in public policy for
> health. Whereas a common policy goal throughout the world had been to
> achieve universal access to medical care, the notion of the relative
> irrelevance of medical care undermined the rationale for such a goal. As
> Starr [5] points out, if medical services make so little difference in
> health and life expectancy, "why worry about the poor-or, for that matter,
> anyone-not getting enough of them?" Ironically, therapeutic nihilism
> began as a critique from the left but was subsequently incorporated
> into the conservative justification for cutting health care budgets and
> tolerating socioeconomic inequalities in access.

I won't try to fill in the references, you can see them in the original
article.  Then at the bottom of the page it links to two articles which
make opposing cases about whether we should try to increase medical
access for the poor.

I was amazed to learn that such extreme skepticism about the fundamental
value of medicine goes back as far as the 1950s.  Apparently it is widely
known within the public health care field, but it certainly has not gotten
through to the general public.  Of course, it is understandable that it
would hardly be in the self-interest of medical professionals to tell
everyone that most of what they do is worthless!  And I suppose that in
truth, most people probably would not be eager to hear this bad news,
prefering to believe in the near-miraculous healing powers of modern
medicine, to provide comfort when they get sick.


More information about the extropy-chat mailing list