Prevention vs cure
From Slate
The most important difference between the world today and 150 years ago isn’t airplane flight or nuclear weapons or the Internet. It’s lifespan. We used to live 35 or 40 years on average in the United States, but now we live almost 80. We used to get one life. Now we get two.
The medical developments in the story are important
- Adrian’s lung spontaneously collapsed when he was 18.
- Becky had an ectopic pregnancy that caused massive internal bleeding.
- Carl had St. Anthony’s Fire, a strep infection of the skin that killed John Stuart Mill.*
- Dahlia would have died delivering a child (twice) or later of a ruptured gall bladder.
- David had an aortic valve replaced.
- Hanna acquired Type 1 diabetes during a pregnancy and would die without insulin.
- Julia had a burst appendix at age 14.
- Katherine was diagnosed with pernicious anemia in her 20s. She treats it with supplements of vitamin B-12, but in the past she would have withered away.
- Laura (that’s me) had scarlet fever when she was 2, which was once a leading cause of death among children but is now easily treatable with antibiotics.
- Mitch was bitten by a cat and had to have emergency surgery and a month of antibiotics or he would have died of cat scratch fever.
but also tend to emphasize treatment over cure.
For example, St Anthony’s Fire and scarlet fever (both serious streptococcal infections) could kill, but only in a minority of cases. Type I diabetes and pernicious anemia used to be uniformly fatal, but Type I diabetes occurs in 1-25 per 100,000 and pernicious anemia in about 1 per 1000. Treatment of streptococcal infections was a breakthrough, and we should be really scared of the possibility than Strep. pyogenes finally learns how to beat penicillin, but they aren’t responsible for that much of the improvement in life expectancy.
Dehydration due to gastrointestinal disease, one of the really important killers of infants and children, isn’t mentioned, because the lack of it isn’t salient. Hardly anyone says “I shouldn’t be alive now because I should have caught rotavirus or cholera at age 2 and died, but didn’t because of clean water, ” but that’s probably the most important single change we have seen.
Prevention isn’t visible, but it’s still real.
Thomas Lumley (@tslumley) is Professor of Biostatistics at the University of Auckland. His research interests include semiparametric models, survey sampling, statistical computing, foundations of statistics, and whatever methodological problems his medical collaborators come up with. He also blogs at Biased and Inefficient See all posts by Thomas Lumley »