From: drarwingnuttephd@gmail.com   
      
   Doctors' Effectiveness--An Illusion    
      
      The study of the evolution of disease patterns provides evidence that   
   during the last century doctors have affected epidemics no more profoundly   
   than did priests during earlier times. Epidemics came and went, imprecated by   
   both but touched by neither.    
   They are not modified any more decisively by the rituals performed in medical   
   clinics than by those customary at religious shrines.8 Discussion of the   
   future of health care might usefully begin with the recognition of this fact.    
      
      The infections that prevailed at the outset of the industrial age   
   illustrate how medicine came by its reputation.9 Tuberculosis, for instance,   
   reached a peak over two generations. In New York in 1812, the death rate was   
   estimated to be higher than 700    
   per 10,000; by 1882, when Koch first isolated and cultured the bacillus, it   
   had already declined to 370 per 10,000. The rate was down to 180 when the   
   first sanatorium was opened in 1910, even though "consumption" still held   
   second place in the mortality    
   tables,10 After World War II, but before antibiotics became routine, it had   
   slipped into eleventh place with a rate of 48. Cholera,11 dysentery,12 and   
   typhoid similarly peaked and dwindled outside the physician's control. By the   
   time their etiology was    
   understood and their therapy had become specific, these diseases had lost much   
   of their virulence and hence their social importance. The combined death rate   
   from scarlet fever, diphtheria, whooping cough, and measles among children up   
   to fifteen shows    
   that nearly 90 percent of the total decline in mortality between 1860 and 1965   
   had occurred before the introduction of antibiotics and widespread   
   immunization.13 In part this recession may be attributed to improved housing   
   and to a decrease in the    
   virulence of micro-organisms, but by far the most important factor was a   
   higher host-resistance due to better nutrition. In poor countries today,   
   diarrhea and upper-respiratory-tract infections occur more frequently, last   
   longer, and lead to higher    
   mortality where nutrition is poor, no matter how much or how little medical   
   care is available.14 In England, by the middle of the nineteenth century,   
   infectious epidemics had been replaced by major malnutrition syndromes, such   
   as rickets and pellagra.    
   These in turn peaked and vanished, to be replaced by the diseases of early   
   childhood and, somewhat later, by an increase in duodenal ulcers in young men.   
   When these declined, the modern epidemics took over: coronary heart disease,   
   emphysema, bronchitis,    
   obesity, hypertension, cancer (especially of the lungs), arthritis, diabetes,   
   and so-called mental disorders. Despite intensive research, we have no   
   complete explanation for the genesis of these changes.15 But two things are   
   certain: the professional    
   practice of physicians cannot be credited with the elimination of old forms of   
   mortality or morbidity, nor should it be blamed for the increased expectancy   
   of life spent in suffering from the new diseases. For more than a century,   
   analysis of disease    
   trends has shown that the environment is the primary determinant of the state   
   of general health of any population.16 Medical geography,17 the history of   
   diseases,18 medical anthropology,19 and the social history of attitudes   
   towards illness20 have shown    
   that food,21 water,22 and air,23 in correlation with the level of   
   sociopolitical equality24 and the cultural mechanisms that make it possible to   
   keep the population stable,25 play the decisive role in determining how   
   healthy grown-ups feel and at what    
   age adults tend to die. As the older causes of disease recede, a new kind of   
   malnutrition is becoming the most rapidly expanding modern epidemic.26   
   One-third of humanity survives on a level of undernourishment which would   
   formerly have been lethal, while    
   more and more rich people absorb ever greater amounts of poisons and mutagens   
   in their food.27    
      
      Some modern techniques, often developed with the help of doctors, and   
   optimally effective when they become part of the culture and environment or   
   when they are applied independently of professional delivery, have also   
   effected changes in general    
   health, but to a lesser degree. Among these can be included contraception,   
   smallpox vaccination of infants, and such nonmedical health measures as the   
   treatment of water and sewage, the use of soap and scissors by midwives, and   
   some antibacterial and    
   insecticidal procedures. The importance of many of these practices was first   
   recognized and stated by doctors--often courageous dissidents who suffered for   
   their recommendations28--but this does not consign soap, pincers, vaccination   
   needles, delousing    
   preparations, or condoms to the category of "medical equipment." The most   
   recent shifts in mortality from younger to older groups can be explained by   
   the incorporation of these procedures and devices into the layman's culture.    
      
      In contrast to environmental improvements and modern nonprofessional health   
   measures, the specifically medical treatment of people is never significantly   
   related to a decline in the compound disease burden or to a rise in life   
   expectancy.29 Neither    
   the proportion of doctors in a population nor the clinical tools at their   
   disposal nor the number of hospital beds is a causal factor in the striking   
   changes in over-all patterns of disease. The new techniques for recognizing   
   and treating such conditions    
   as pernicious anemia and hypertension, or for correcting congenital   
   malformations by surgical intervention, redefine but do not reduce morbidity.   
   The fact that the doctor population is higher where certain diseases have   
   become rare has little to do with    
   the doctors' ability to control or eliminate them.30 It simply means that   
   doctors deploy themselves as they like, more so than other professionals, and   
   that they tend to gather where the climate is healthy, where the water is   
   clean, and where people are    
   employed and can pay for their services.31    
      
      
   Useless Medical Treatment    
      
      
   [continued in next message]   
      
   --- SoupGate-Win32 v1.05   
    * Origin: you cannot sedate... all the things you hate (1:229/2)