... luckily I took and kept lots of notes. This is an excellent book, and with the data then available to him, McKeown makes a clear and compelling case. Replying to Julie Masis' point, one example did illustrate a before-and-after scenario. In whooping cough the death-rate declined from over 1400 per million children in the 1860's to less than 100 in 1950/51 when immunization became available. On the accompanying graph in the book, there was even a slight rise in the death-rate during the winter of 1950-51, after which the graph resumed its previous trend. The introduction of vaccination did not even speed up the decline in the disease.
In measles, the death-rate per million children had already declined from its peaks of over 1200 in the 1860's and around 1890, to virtually nil in 1970, before immunization was introduced.
If paying consumers are making informed choices, then there is no problem. If medical, educational and social behaviors are being determined by "myths and dreams" it may help to look at facts.
I have not seen a better book on this subject since its publication 25 years ago, nor adequate refutation of its central thesis. If further data exist to modify McKeown's views, let's hope an equally clear and succinct writer presents it for us.
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