Medical Intervention Myth
By Hilary Butler

Amongst all the frenetic activity to prove how serious diphtheria was in 1998, Dr Ossi Mansoor was interviewed on Radio Pacific and said that in the early 1920’s the death rate was around 700 a year. He also promoted the view, in the media in general, that the reason we don’t see these deaths any more is because of vaccinations and treatments (antibiotics and antitoxin). All these measures are best described scientifically as "medical interventions".

Having taped the Radio Pacific broadcast, I re-played it to make sure I heard it right, and referred the figure to Peter Mancer, because I knew it was wrong. Peter decided that an e-mail should be sent to Dr Mansoor asking where he got his figures. We were told to look in the Immunisation Handbook. We then asked him where the Handbook got the figures. He gave us the reference, which we already knew – a study authored by Diana Lennon. We then asked him if he had checked the figures Diana Lennon published with the figures in the source book quoted in the article, and if so, how did he explain the discrepancy between the Immunisation Handbook and Diana Lennon’s article – two works essentially authored by the same person? So he did. And there he found, as we already knew, that the figure quoted in the Handbook was wrong.

The blind acceptance and subsequent use of wrong figures is one of the commonest ways to create myths. Someone takes original data, reads it incorrectly, and quotes it incorrectly, so it means something else. It becomes a myth, because no one thinks to check the original reference.

But that is not the only way to create a myth. You can magnify something, whether fact or not, and ignore every other aspect.

Let’s analyse Ossi Mansoor’s statement that 700 people died every year in the early 1920’s. The average person thinking about this, and listening to his implication that because of vaccination we don’t have these deaths any more, would think, "Yes, I must have this wonderful vaccine." This is a classic example of how to sculpture information to ensure the "desired outcome" is achieved i.e. maximum vaccine uptake.

However, there is a big difference between saying that 700 people died every year between 1917 and 1921, and what is revealed when you analyse the original published data, which is:

1917 237
1918 189
1919 149
1920 91
1921 103
TOTAL 769 (over 5 years)

What are the critical factors to consider about this data? Firstly the highest number of deaths were during the last two years of World War One. Talk to anyone alive during this time, and they will tell you of the stress and living conditions which spawned some of the worst years of infectious diseases on record, including the 1919 influenza pandemic. There was also a sharp increase in diphtheria after World War Two for similar but not so severe reasons. This confirms that stressful living conditions in war-time, as well as soldiers travelling around the world and bringing diseases back home, can have a considerable influence on the patterns of infectious diseases. These "real world" factors are also conveniently forgotten by the present medical writers when discussing diphtheria in Russia in the 1990’s. They blame a drop in childhood immunisations, ignoring the fact that most cases and deaths occurred in groups and individuals compulsorily jabbed and over-jabbed in the days of communist dictatorship. With the subsequent social breakdown of almost every facet of Russian society (except within the rich, the elite and the Mafia) these over-vaccinated poor dropped like flies.

In New Zealand, after the Second World War, deaths continued to fall away, and never again reached this level, despite the fact that there was no vaccine. When it finally became available, the vaccine uptake was abysmal (1946 = 15% of babies, 28% of pre-schoolers, and 38% of 5 – 6 year olds), and it was not used at all between 1955 – 1960 because of the polio epidemic. In 1961 it was introduced as part of the triple vaccine, and its use struggled to even reach a 50% uptake. So it would be fair to say that there is a whole generation, if not two, who were brought up at the time when diphtheria as a disease really featured, who had negligible exposure to any vaccine at all. This was one reason as to why the uptake was so slack.

The Appendices to the Parliamentary Journals regularly point out that parents who had lived through diphtheria themselves no longer perceived it as a health issue for their children, and were very likely to refuse to use the vaccine. That is a key reason as to why it was combined with whooping cough and tetanus – because on its own, it would not have been a success.

The other interesting issue with regard to diphtheria statistics in this country is that the mortality rate did not change over the whole period from 1914 to 1956. It remained at approximately one in every 24 cases, something which we brought to the attention of Ossi Mansoor. He was very surprised, and mentioned that the New Zealand Public Health people, in researching the same data, had also found the same thing. He explained that by saying, "anti-toxin had been available through the era. Still, one would have thought that antibiotics would make a difference."

According to the New Zealand statistics, antibiotics made not one jack bit of difference. And the role of vaccines is also debatable. In fact, the whole role of "medical interventions" is debatable, as shown in a very important article called "A Review of the Evidence Concerning the Impact of Medical Measures on Recent Mortality and Morbidity in the United States" by John B. McKinlay, Sonia M. McKinlay and Robert Beaglehole – who by the way, was one of New Zealand’s most forceful advocates of immunisation and "medical interventions". (International Journal of Health Services 1989, Vol. 19, No. 2, Pg. 181 – 208.) I found it interesting that he could put his name to this article in view of his published comments in the popular media about how wonderful vaccines are. But nevertheless, extracts are worth considering:

"Of the total fall in the standardized death rate this century, approximately 90 percent occurred prior to 1950. Most of this decline is due to the virtual disappearance of the major infectious diseases... Of major concern here is what contribution did specific medical measures make to that decline in mortality in the Unites States during the 20th century?

"Only reductions in tuberculosis and pneumonia related mortality contributed substantially to the decline in total mortality between 1900 – 1973 (16.5 and 11.7 percent, respectively). …only influenza, whooping cough and poliomyelitis show what could be considered substantial declines of 25 percent or more after the date of medical intervention. However, even under the somewhat unrealistic assumption of a constant (linear) rate of decline in mortality after intervention, only whooping cough and poliomyelitis even approach the percentage that would have been expected. The remaining six conditions – tuberculosis, scarlet fever, pneumonia, diphtheria, measles and typhoid – showed negligible declines in their mortality rates subsequent to the date of medical intervention…Clearly, the medical measures considered for tuberculosis, typhoid, measles and scarlet fever were introduced at the point when the death rate for each of these diseases was already negligible. Any changes in the rates of decline that occurred subsequent to the interventions could only be minute. Of the remaining five diseases (excluding smallpox with its negligible contribution), poliomyelitis is the only disease for which the medical measures produced any noticeable change in the trends. The other four diseases – pneumonia, influenza, whooping cough, and diphtheria – exhibit relatively smooth mortality trends that are unaffected by the medical measures, even though these measures were introduced when the death rates were still notable. If it were assumed that the change for the poliomyelitis rate was due to vaccines alone, then only about 1 percent of the decline following interventions for the diseases considered could be attributed to medical measures. Rather, if we were also to attribute, more conservatively, some of the subsequent fall in the death rates for pneumonia, influenza, whooping cough, and diphtheria to medical measures, the medical interventions for the major infectious diseases considered here will perhaps explain 3.5 % of the fall in the overall death rate. Indeed, given that medicine claims the most success in lowering mortality for these diseases, 3.5 percent probably represents a reasonable upper-limit estimate of the total contribution of medical measures to the decline in infectious disease mortality in the United States since 1900." (their emphasis, not mine).

Medical intervention includes all forms of prophylactic and remedial protocols available to the medical profession at that time.

Later on in the article, the authors state:

"Although it is now generally conceded that medical interventions (as opposed to public health measures) contributed little to the decline in infectious disease mortality, recent improvements in mortality related to major chronic diseases are still attributed to specific medical interventions (e.g., pre-hospital resuscitation, CCUs, coronary bypass surgery, and drug therapy for CHD; widespread surgery and drug and radiation therapies for cancer; antihypertensive drugs for stroke)."

After discussing each one of the above, the authors come to the conclusion that the claim to fame for all of the above is also unjustified, and ask the question:

"If medical measures and services were not primarily responsible for the decline, then how is it to be explained?…We are hopeful that continued discussion of the apparent modest contribution of medical care will serve as a catalyst for … research incorporating adequate data and appropriate methods of analysis in an effort to arrive at a more complete alternative explanation based on environmental or public health factors….there are however, influential students of public health who continue to attribute far more to medical measures than available facts warrant. Others continue to pay lip service to the importance of public health measures, while contradictorily supporting the perpetual expansion of more, but largely ineffective medical services. In the context of the present fiscal crisis and the limitation of resources, in which increased investments in medical care reduce support for public health initiatives, this attitude may even be a disservice to the field:

We remain perplexed by at least the following:

  1. The public health argument continued to be denounced by some influential figures as heretical, deliberately iconoclastic, or "just wrong."
  2. A spirited attempt is made by some policy experts, usually in the name of humanism, to shore up and amplify the modest contribution of medical measures.
  3. Decades of controversy are disregarded in an attempt to broaden the scope of medical care so as to encompass and subsume the contribution of public health and other changes.
  4. There are lingering methodological quibbles over data and their presentation as if their resolution would affect the explanation.

  5. Over the past decade at least, there has been no significant reallocation of finite resources away from traditional curative care to public health.
  6. There has been little change in the content of medical training that would suggest acceptance, or even appreciation, of the modest contribution of specific medical measures as against public health contribution to the modern decline in mortality.

Profound policy implications follow from our findings. If we should subscribe to the view that we are slowly but surely eliminating one deadly disease after another, largely because of medical intervention, then we may make little commitment to social change and may even resist a reordering of social priorities. Alternatively, if we can show that there has been no overall improvement in the health of the population – even, perhaps, some deterioration – despite the effort increasingly expended, then we may make some commitment to social change and a reordering of those priorities."

All these factors are operative in New Zealand as well, and the majority of those who presently publish incorrectly skewed material on vaccination would no doubt also perplex the authors of this article, as they continue to perplex us.

Because without the reordering of priorities away from medical intervention towards proper evidence-based public health, there will be no further improvement in any of New Zealand statistics, as evidenced by the fact that New Zealand still has the worst statistics in the world for Rheumatic Fever – a condition very much under control in most other developed countries in the world.

Until such time as the government politicians, medicrats and the media make a commitment to honesty, and promoting real preventive medicine, we will continue to have inflicted on us a system which, according to the article extensively quoted from, does not serve us at all well as a nation.

The article stated:

"Profound policy implications follow from our findings."

Policy implications? Pigs might fly. That might mean CHANGE!!

It won’t happen – because, if those who formulate medical policy were to be truthful, a public who suddenly realise they have been led down the garden path might resemble a lynching squad.

It won’t happen – because following that profound changes would be required from the top to the bottom of the whole medical system including how doctors are trained and the giving to parents of truthful information.

It won’t happen – because the medical system’s lifelines are pharmaceutical companies whose information modus operandi is on a "need to know" basis, required to generate maximum capital in the shortest possible time before side-effects or new research necessitates the next drug withdrawal from the market.

It won’t happen – because it is impossible for medical authorities to admit that they sculpture and design their propaganda to suit their own political purposes except where it is so minor that it doesn’t skin too many knees but gives the illusion of ongoing accountability.

It won’t happen – because it would require profound changes in the present biased media coverage, the reversal of decades of social conditioning brought about by constant propaganda pushed down the public’s throat every which way they turn.

It won’t happen – because it would require the total reordering of social public health priorities.

In short, there is too much to lose, too many reputations would be buried and what little respect the public still has in the medical profession would be lost. It’s all just too hard.

In my opinion what this statement implies is that if we were to be truthful for a change, profound changes would be required from the top to the bottom of the medical system today, including how we train doctors. But it isn’t going to happen, because we have too much invested in pharmaceutical companies, and the status quo to admit that we have sculptured and designed our paths to suit the ends we want.

This would also require profound changes in the present biased media coverage, and the reversal of social conditioning brought about by the constant propaganda pushed down the public’s throats every which way they turn.

And that is what the whole issue of the trumped up diphtheria scare was all about.

 [Vaccination]  [Hilary Butler]