Sanitation vs Medicine for Public Health

[Benguin]

I notice this has come up in the Homeopathy threads as (I think) the Homeopaths have tried to claim it is improved sanitation and not vaccination that has reduced disease incidence.

Though how they embrace one area of science to reject another I can't fathom.

Anyway, I've heard this argument presented in a completely different context and thought I'd share it for a tearing.

I trained as a Civil Engineer originally .... our history lecturer, one Ted Happold (http://www.addall.com/detail/0419240608.html), frequently introduced as a topic in tutorials (and, without fail, on the exam) ;

"It has been proposed that the Engineer has contributed more to public health in recent times than the Doctor, Discuss"

A somewhat leading question ... especially when it was part of his personal campaign to improve the public image of engineering. Still, he used to put up a good defense of the position with a discussion about provision of clean water, sanitation, greatly improved hospitals, etc etc. In fairness the guy had earned the right to campaign.

I never really thought about it in depth at the time, as the way to get a good essay mark was to bang on about Roman Aquaducts and good old Mr Brunel.

I couldn't find an actual discussion by him of the topic online (he used to publish in the Institute of Structural Engineers magazine) This is the closest (http://www.thersa.org/acrobat/dickson_210104.pdf)

What does anyone reckon?

[Capsid]

But you should remember that it was science through John Snow (http://www.bbc.co.uk/history/historic_figures/snow_john.shtml) that identified that water not bad air (miasma theory) was the source of disease and this led to improved sewerage and water quality.

[garys_2k]

So, if homeopathy works for whatever reason (and diseases are not caused by germs), how WOULD sanitation have anything at all to do with disease?

[Benguin]

But you should remember that it was science through John Snow that identified that water not bad air (miasma theory) was the source of disease and this led to improved sewerage and water quality.

Absolutely (and I'm not campaigning here!) but it was Isambard Kingdom Brunel (http://www.swopnet.com/engr/londonsewers/londontext1.html) who implemented sewer drainage in London to get all that bad air out of the place.

It took skilled architects to redesign the hospitals of the day to expel the bad air and draw in a fresh variety, without killing everyone with cold, heat or CO from the heating of the day. Admittedly, it took them a few attempts. Sorry I can't find an online reference, this book (http://www.amazon.co.uk/exec/obidos/ASIN/0226036987/qid=1083308574/sr=1-5/ref=sr_1_9_5/202-5739034-4204659) covers the subject in fascinating detail.

I'm not denying the contribution of Science (how could I?), engineers were and are absolutely dependent on the research of scientists to advance their discipline. It's just taking the theory and finding ways to use that to advance civilisation with practical projects.

By doctors I think Ted understood prescribing and practicing medics, and saw both they and us taking advantage of advancements in research and scientific understanding.

[richardm]

Originally posted by Benguin


Absolutely (and I'm not campaigning here!) but it was Isambard Kingdom Brunel (http://www.swopnet.com/engr/londonsewers/londontext1.html) who implemented sewer drainage in London to get all that bad air out of the place.


Actually, Brunel's contribution was a very small one. It was Joseph Bazalgette (http://www.bbc.co.uk/history/historic_figures/bazalgette_joseph.shtml) who did all the real work. He solved a number of seemingly intractable problems, and changed the face of London forever. Huzzah!

An interesting character. Yet hardly anyone's ever heard of him.

[Benguin]

Brunel obviously had better publicists.

And you're right I hadn't heard of him, I feel guilty about that!

[richardm]

Originally posted by Benguin
Brunel obviously had better publicists.


Oh yes, most definitely! And in fairness he did have one or two good ideas of his own :D

[Capsid]

Richardm, you must have watched the fascinating series run by the BBC last year entitled Seven Wonders of the Industrial World (http://www.bbc.co.uk/history/society_culture/industrialisation/seven_wonders_04.shtml) in which Joseph Balzagette was featured in one of the episodes. Of course, Brunel was in there too with The Great Eastern.

[richardm]

Originally posted by Capsid
Richardm, you must have watched the fascinating series run by the BBC last year entitled Seven Wonders of the Industrial World (http://www.bbc.co.uk/history/society_culture/industrialisation/seven_wonders_04.shtml) in which Joseph Balzagette was featured in one of the episodes. Of course, Brunel was in there too with The Great Eastern.

Yes indeed. As you say, fascinating stuff! I must admit I was ignorant of Bazalgette until that episode. It was a real eye-opener.

[Prester John]

Yes thats a fave of the anti vax campaigners. If you however look at the diesase rate graphs, you will notice that they fall off as vaccines are introduced, when vaccine uptake decreases, disease rates increases. This is observable in numerous diseases in numerous countries.

I don't have any links at present but they are easy to find.

[Benguin]

I've no idea what Ted thought about vax, it was in the days before the MMR debate really kicked off.

I was just interested that I'd heard the same argument (almost) being conducted from an entirely scientific standpoint, and wonmdered if it had been picked and misapplied.

[RamblingOnwards]

We were fed this line in sociology too - proper sanitiation and transportation (of food stuffs) show the most significant correlation to population size, whereas the correlation between modern medicine and population size wasn't very strong. I never took the time to research the underlying data though, so this could be nonsense.

[Eos of the Eons]

Where is Rolfe?

Okay, everytime there is a decrease in vaccination rates, there is a rise in rates of disease. Sanitation has nothing to do with it whatsoever for vaccine preventable disease. Most of them are aireborne, and are viruses. Sanitation helps more with bacteria.

In England and Wales, measles reporting began in 1940. Until the introduction of a vaccine in 1968, the number of annual cases varied between 160,000 and 800,000. At the end of the 1980's, reported cases dropped to between 50,000 and 100,000 per year. Though still too high, these levels can be explained by an immunization coverage that was insufficient to stop the spread of the virus. Between 1970 and 1988, there was still an average of 13 deaths from measles every year. Following the introduction of the triple MMR vaccine in October 1998 and improved coverage exceeding 90%, the number of cases dropped to all time records. There were only 9,612 cases of measles reported in England and Wales in 1993. Since 1988, only 11 measles-related deaths have been recorded (14).

From 50, 000 to 100, 000 in the 80's to less than 10, 000 in the 90's. There was no significant change in sanitation between those time periods in the UK. I would like to look into the Wakefield era, and the rates rise again when people stop vaccinating.

http://www.aventispasteur.com/Index.cfm?FA=MEASLES


Deaths from secondary infections (by bacteria) declined when people got pertussis. Ther rate of pertussis did not decline (1860-1870)
http://www.ssr.com/cgi-bin/ezmlm-cgi/1#b


The measles rate doubled between 1940 and 1960. In 1960 there were 800,000 cases in the UK. By 1970 there were 100,000. By 1990 there were only hundreds.


The sanitation between 1970 and 1990 in particular did not change significantly to explain the decline in measles rates. Vaccines caused the decline of measles.

Also look into the Japanese experience with rubella.

Then into polio in Africa. Vaccinations go down, rates of disease go up, no matter what the sanitation is like.

And on that note, more on vaccines and the vax liars:


http://www.mlive.com/news/grpress/i...53846466280.xml


Solid science and vaccines: No link between autism, shots; parentsshould immunize kids Wednesday, March 17, 2004

Suspicions about the MMR vaccine and autism have arisen because the vaccine is administered about the time autism is typically diagnosed. Interest has focused on thimerosal, a preservative used in the vaccine. No credible scientific evidence has implicated that organic mercury compound. In Denmark for instance, thimerosal was dropped from vaccines in 1992. Yet research shows the incidence of autism there has continued to increase. Other studies have similarly failed to establish a causal relationship.

The BMJ reports on an article from Pahrmacotherapy which looks at why the incidence of autism appears to have risen:
------------------------------------------------------------------------
http://bmj.bmjjournals.com/cgi/cont.../328/7436/364-b

"We documented that the number of children [in the United Kingdom] diagnosed with `behaviour' and `developmental' disorders, but not autism, tended to decrease by about 20% per year from 1992 to 2000. By contrast, the diagnosis of autism increased by 20% per year during this time period," said Hershel Jick, lead author of the study and associate professor of medicine at Boston University School of Medicine."

-------------------------------------------------------------------------
"Autism and Vaccines"
Wall Street Journal (www.wsj.com) (02/09/04) P. A26

For example, the National Alliance for Autism Research,
which is steadfastly independent, found through a rigorous Danish study it
co-funded that there is probably no association between the
measles-mumps-rubella combination vaccine and autism, yet naysayers immediately attacked the group and slandered its activities despite its record of thoughtful research...

But if the research disproves a connection--as it has up to now--the autism community needs to listen and move on," as research funding only stretches so far and "parents of autistic children deserve to see the money spent where it will do the most good."


----------------------------------------------------------------
Wall Street Journal
www.opinionjournal.com

Autism and Vaccines
Activists wage a nasty campaign to silence scientists.

Monday, February 16, 2004 12:01 a.m.


...We felt someone ought to point out that nothing currently exists in the medical world to justify this furor--that thimerosal has never been credibly linked to autism, and that recent studies in leading medical journals have also failed to find a link. That research is one of many reasons the medical community remains solid in its belief that vaccines are safe.

While we don't know what causes autism, we do know that diseases like measles cause blindness and brain damage. Doctors are already struggling to be heard over Internet rumors, and they report that parents are increasingly nervous about vaccines. That's how paranoia started in England and Ireland, where parents were swept up in autism claims and refused to immunize. Ireland, a country with a
population 77 times smaller than that of the U.S., reported
2,000 measles cases in 2002. The U.S. had 37.

As it happens, the thimerosal flap has already taken a human toll.
Health officials recommended taking thimerosal out of vaccines in 1999 to help calm fears--but this only fueled claims of a government cover-up.
Worse, as Dr. Offit reported in a recent issue of Pediatrics, some hospitals misinterpreted thimerosal-related recommendations and suspended some vaccinations for newborns. One institution later reported the death, from acute hepatitis B-induced liver failure, of a three-month-old infant who wasn't immunized.

---------------------------------------------------------------------

By Megan Rauscher
NEW YORK (Reuters Health) - The results of a large new study show no relationship between measles-mumps-rubella (MMR) vaccination and the development of autism.

In 2001, a panel of experts convened by the Institute of Medicine rejected the contention that MMR vaccination causes autism, based on overall data at a population level. The panel did, however, encourage additional studies to assess the possibility that there are a few children who might be at increased risk of autism from MMR vaccination.

With this in mind, Dr. Frank DeStefano from the U.S. Centers for Disease Control and Prevention in Atlanta and colleagues compared the MMR vaccination histories of 624 autistic children and a control group of 1824 school-matched non-autistic children.

In a telephone interview with Reuters Health, DeStefano said that "children with autism received their first MMR vaccine at similar ages as children without autism, so this study supports the weight of the evidence from previous studies that didn't find an association between the MMR vaccine and autism."

The majority of both autistic children (70.5 percent) and control (67.5 percent) children were vaccinated by the recommended age of 12 to 15 months, according to an article in the medical journal Pediatrics.

Likewise, when the team analyzed different age cutoffs, they found that similar proportions of case and control children were vaccinated before 18 or before 24 months of age, when developmental abnormalities are usually recognized.

The data also show no MMR-autism connection in any of the subgroups of children analyzed, including those who seemed to be developing normally and then regressed, and those who developed up to a certain point and then
reached a plateau.

"Of the subgroups that we've been evaluating, probably the one of most concern is regressive autism and we didn't find any association with the MMR
vaccine," DeStefano said.


http://www.cdc.gov/nip/vacsafe/conc...default.htm#aap

[Capsid]

I agree with you Eos that vaccination affects disease incidence but these are figures from times of vaccination when sanitation had already improved. Didn't disease incidence decline before mass vaccination at about the time sanitation measures were introduced (except your pertussis example I note, but then this is an airborne not waterborne bacterium)?

I think it is complicated and multifactorial. Scarlet fever has declined without a vaccine but then the virulence of this bug is known to fluctuate and antibiotics can deal with it largely. Polio incidence actually increased with improved santitation.

What the anti-vaxers seem to conclude is that the graph curve will continue downwards to eventually reach zero incidence (and would have happened without vaccines).

The only measure that has been shown to eradicate disease (smallpox) is vaccination

[epepke]

It's probably true that public sanitation has done more to improve public health in general than vaccination, but what of it? In 1952 in the US, we already had public sanitation, but we still had polio. The vaccine got rid of it, except for about ten cases a year. Good thing, too.

Besides, many of the viral diseases, such as smallpox, don't live very long outside the human host or a carefully maintained culture solution and are spread directly from person to person.

[Badly Shaved Monkey]

My overall summary is that both sanitation and vaccination have played roles but the relative contribution of each varies depending on which disease you are talking about. The anti-vax loons think they can debunk vaccines merely by saying sanitation helped with many diseases and pointing to the fact that infectious disease has declined in the West over the same overall timescale as the improvements in sanitation. What this fails to see is that sanitation and vaccination are both products of Victorian science so obviously the big picture trends are coincident in time, but if diseases like polio and smallpox, and indeed M, M and R, are looked at in detail disease incidence is quite tightly correlated with vaccine uptake.

As ever with alt. med. loons, they latch onto a single semi-fact and fail to interpret it properly.

Is there a proper name for the logical fallacy in which proof of one relationship is inappropriately used to disprove another relationship that has been incorrectly identified as a mutually exclusive alternative i.e. sanitation did help, so vaccines did not help? This is a biggy for the homeopaths with their persistent cries of 'evil medicine kills people sometimes' as if this in itself is proof for homeopathy.

[Benguin]

Well said primate, notice the wording of the proposition I originally related ....
"has contributed more to public health", no suggestion that modern medicine has not made a massive contribution.

Also, though the homeopaths make a simple comparison between vaccination and sanitation, there is a bit more to public health. The discovery of penicillin caused a bit of improvement too, to put it mildly. Understanding how the human body works so we can cure it when it gets ill and broken, such as in modern surgery, understanding of diet has improved our knowledge of the correlation between what we eat and our health.

In fact (from memory) one of the golden nugget mark scores in the (ever recurring) essay was to discuss the difference between the medical professions ability to cure disease, allieviate symptoms and prevent through mass vaccination as opposed to the engineer's ability to remove cause from the human living environment.

[Badly Shaved Monkey]

I think an interesting sub-question is to consider the balance between small changes in lifespan and life quality for large numbers of people versus large changes for small numbers of people.

It seems to me that in the West we have probably done all the big simple things (unless the anti-vaxers drive us backwards!). What remains to be seen is whether and accumulation of incremental changes can get us all to live actively to 120 and at what cost those incremental changes come. Overall it is interesting to note that as life expectancies creep upwards, the easy step (conceptually if not politically and practically) seems to be to get a nation to life expectancies in the 70s and even quite poor counties can do this, but somewhere at around 80 years progress suddenly stalls.

Ooh, er. I've just realised I've forgotten whether life expectancy is quoted as median or mean. It's median isn't it? Obviously it matters because, using the median, if almost everyone drops dead within 20years of the average it doesn't matter if a few live to 150, but if the mean is the conventional measure then the behaviour of the average in response to a change in the shape of the mortality curve is going to be quite different

This argument to be developed further once I get my facts straight!

Edited to add: A quick Google finds the word 'average' used a lot. Very helpful...not. As far as I can tell the consensus is that it is a mean.

Well in that case, the way to increase life expectancy of a population without limit is to stick some poor sod in a cryo unit and keep them 'alive' for ever so his/her contribution to the mean increases indefinitely and the population mean asymptotes to infinity. Hurrah. Is this what has happened to Ronald Reagan? The black helicopters flew him off to a vat of liquid N2 under Mt Cheyenne.

Hmm. Time for a lie down.

[Benguin]

Interesting proposition ... I'm not sure I'd use life expectancy (median or modal class or whatever) as a measure. living to 70 or 80 is good going, I'd be more interested in progressive reductions in ill-health and suffering in the interim period.

But I am a bit of a hedonistic penguin.

[Eos of the Eons]

I'd be more interested in progressive reductions in ill-health and suffering in the interim period.


I'm more concerned about children being disease free in order that they grow to their full potential. The damage vaccine preventable disease causes a large number of victims to become blind, deaf, brain damaged etc., not to mention paralyzed and suffering from the effects later on in life all over again with pain. Even chickenpox cause shingles later on. Of course the deaths really put a stop to things.

As far as living longer. Meh, I don't care, as long it is in a healthy state.

http://news.bbc.co.uk/2/hi/health/3296663.stm

Measles is the biggest killer of children under five in the world.

Today it is the biggest killer.

This article was brought to the attention of many by an anti-vaxxer whining about people getting vaccinated.
----- Original Message -----
From: "Misty" misty3@paradise.net.nz<misty3@paradise.net.nz>
To: "Health and Healing" <health_and_healing@yahoogroups.com>
Subject: [Health_and_Healing] 33 Million in Iran get MMR jabs

I have read that the vaccinatiosn have diseases which will be triggered off
by quantum potential weapons, which send out the signature of the disease.
Don't forget the east Indians found out a Nigerian vaccinations had a
chemical in which causes miscarriages. The Philippines and another country
already had a hepatitius vaccine which was produced by the WHO which causes
miscarriages.


Oh sure, now the MMR causes miscarriages, and WHO is our enemy. Hmm, so why would children be worried about miscarriages? Or are they suggesting that the vaccine will cause them to miscarry once they are trying to have children? I guess the autism thing is not considered a legit argument anymore at least. Of course there are no stats or proof on the miscarriages caused. Where was this crap the anti-vaxxer read? I can't answer these questions because I was denied access to the list (this was emailed to me from the healthfraud list).

Yes, sanitation is important. I don't think there is a contest about which discovery is the most important, as was already pointed out. I have to agree with Badly Shaved Monkey on all points.

[Eos of the Eons]

Originally posted by Capsid
I agree with you Eos that vaccination affects disease incidence but these are figures from times of vaccination when sanitation had already improved. Didn't disease incidence decline before mass vaccination at about the time sanitation measures were introduced (except your pertussis example I note, but then this is an airborne not waterborne bacterium)?

I think it is complicated and multifactorial. Scarlet fever has declined without a vaccine but then the virulence of this bug is known to fluctuate and antibiotics can deal with it largely. Polio incidence actually increased with improved santitation.

What the anti-vaxers seem to conclude is that the graph curve will continue downwards to eventually reach zero incidence (and would have happened without vaccines).

The only measure that has been shown to eradicate disease (smallpox) is vaccination


Yes, As was pointed out-sanitation helped with secondary infections. You can also note that the vaccine preventable diseases were not on the decline at all, and still are not, when we see vaccines not being used. Once you stop vaccinating you see the rates rise.

There are many links to show that no matter what era, vaccination leads to decrease in that disease rate. You can be clean clean clean, and you will still get polio, measles, pertussis, etc. You can click on the link provided in my earlier post to look all of them up.

Look at how chickenpox spreads still. There is a new vaccine for that now. My boys got that. They have never had chickenpox. I am hoping for a non-live vaccine for my daughter who has less of a chance to exposure to chickenpox now, but it may be too early for that since vaccine rates for it are low and the live vaccine is more effective. I'm not too worried about it though. My oldest got the live polio vaccine, and there has been no effects whatsoever. I was very glad to see the non-live version available to my other two though.

It's funny, I just got one of those emails that asks you a bunch of personal questions. On it my husband's friend listed chickenpox as the worst illness he ever experienced. Imagine if he had smallpox, polio, meales, mumps, etc to choose from? He and most of us have never had to pick from that list which of those we felt was the worst. He did choose chickenpox as worse than the flu, colds, etc.