10 ms·

Sanitation conquered disease long before vaccines or antibiotics

134 points by jasoncrawford 7y ago

taneq 7y ago
There’s degrees of “conquered”. Seat belts ‘conquered’ motor vehicle trauma before airbags did. Each new thing helps fill in the gaps left by the already-existing things.
- deleted 7y ago
  [deleted]
- smileysteve 7y ago
  I question your example While airbags functioning properly with a properly sized adult reduce trauma, that's a lot of conditionals. Seat belts conquered ejection and death, but people still didn't wear them, so active restraint and airbags became policy to have at least their 13% chance of being effective. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4366828/#sec1-1title https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4366828/#sec1-1...
  - taneq 7y ago
    Seatbelts reduced the death toll dramatically compared with no seatbelts. Airbags and seatbelts together reduce the death toll dramatically compared with just seatbelts. In most of the world it's considered suicidal not to wear a seatbelt while in a moving vehicle.
    - njarboe 7y ago
      And unfortunately the US took the stance that airbag design should take into account that a seat belt will not be worn. US airbags explode with much more force and cause many more injuries than European ones.
      - muzika 7y ago
        First time I hear anything about difference in airbag systems between US and europe. You have any sources for this? Thanks!
    - smileysteve 7y ago
      Seat belts alone decrease fatalities by 48%. Adding airbags is much less significant, as combined they have a 52% overall fatality rate. Airbags alone only had a 13% reduction on fatalities. https://www.automobilemag.com/news/do-airbags-save-more-lives-than-seatbelts/ https://www.automobilemag.com/news/do-airbags-save-more-live...
- Spooky23 7y ago
  Yes and no. I'll use an anecdote from my personal life. If you by some misfortune end up in the hospital for an extended time, you have an ever-increasing risk of being infected by drug-resistant bacteria. This happened to a loved one, and it's a tragic thing that will significantly reduce that loved one's lifespan. Why does this happen? Antibiotics and filth. Antibiotics enable the awful management practices of this particular hospital. There aren't enough aides, the rooms and equipment are filthy, even the lunchroom is dirty. I sat visiting for weeks at a time a different times of day and night and never saw a mop, or a cleaning of surfaces that were soiled. Your average McDonald's kitchen is cleaner. The economics of insurance are such that the consequences of these infections don't damage the bottom line. For some people, airbags can discourage seatbelt use in the same way.
  - taneq 7y ago
    Wow, that sounds awful. I've only spent time in hospitals a couple of times but the ones I've been in (public or private) were always very professional and hygienic.
    - Spooky23 7y ago
      That was my way experience as well, although I was mostly exposed to OB when my kids were born or post-surgical areas. Those are the moneymakers. If you have an issue that requires observation and not ICU, it’s a different story. Look at the Medicare health ratings online and you’ll find plenty of examples unfortunately!
  - scarejunba 7y ago
    Was this in America? Which hospital was it?
    - Jamwinner 7y ago
      Most hospitals are like this. The main areas, bathrooms and ORs are clean, but many of the staff-only areas seem seldom touched by sanitation crews.
    - 7y ago
- dredmorbius 7y ago
  Auto safety has shown a very consitent rate of improvement with deaths per passenger mile halving about every 20 years, since 1920. That's the red line in this chart: https://upload.wikimedia.org/wikipedia/commons/thumb/4/4f/US_traffic_deaths_per_VMT%2C_VMT%2C_per_capita%2C_and_total_annual_deaths.png/1200px-US_traffic_deaths_per_VMT%2C_VMT%2C_per_capita%2C_and_total_annual_deaths.png https://upload.wikimedia.org/wikipedia/commons/thumb/4/4f/US... The period of most rapid car safety improvements came during a single ten-year period, from 1910 - 1920, where deaths, again, expressed per passenger mile, halved in only ten years.
  - hackerbabz 7y ago
    Any idea what major improvements there were between 1910 and 1920? I had no idea there were any improvements made before seatbelts in the 1950s.
    - WalterBright 7y ago
      The switch to hydraulic brakes was a huge improvement, but I'm not sure when that happened.
      - deleted 7y ago
        [deleted]
      - Jamwinner 7y ago
        Between 1918 and 1946 mechanical brakes were phased out. By ww2, they were nearly extinct except on the cheapest or older styled cars. I would argue the bigger advance was tires. Even mechanical brakes are plenty to lock your wheels, but tires are the actual road interface, and old ones are amazingly fragile. Vulcanization was not even known at the start of the auto age, and the rubber would tear off in chunks.
        dredmorbius 7y ago
        Vulcanisation was patented in 1844. If the technique wasn't known until the 1920s, the issue of the patent exhibits extreme prescience on the part of both Charles Goodyear (1800-1860) and the US Patent and Trademark Office. https://en.wikipedia.org/wiki/Charles_Goodyear https://en.wikipedia.org/wiki/Charles_Goodyear Synthetic rubber wasn't invented until WWII, when natural latex supplies were rendered unavailable due to WWII. https://en.wikipedia.org/wiki/Synthetic_rubber https://en.wikipedia.org/wiki/Synthetic_rubber
hprotagonist 7y ago
https://observablehq.com/@mbostock/the-impact-of-vaccines https://observablehq.com/@mbostock/the-impact-of-vaccines That figure is real hard to refute, or square with any other cause of reduction of measles infections except vaccination.
- DanAndersen 7y ago
  That's true -- though the figure you're linking focuses specifically on measles cases rather than overall mortality, which is what the OP article is focusing on. (as an aside, it's really weird that the (first few) comments here on HN seem a little adversarial; I wonder if maybe some people looked at the headline only and assumed it was attempting some sort of anti-vax argument, which the article isn't doing at all.)
  - manicdee 7y ago
    The problem is that anti-vaxxers will use the headline as their entire justification for their opinion which is not supported by the content under the headline.
  - jasoncrawford 7y ago
    So there is something odd going on with measles. I haven't dug into the data, but from a couple of data points I've seen, it seems that measles mortality was declining for a long time even while measles cases were not. That is, there was a decline in the case-fatality rate, without a decline in cases. The disease was still around but getting less deadly. Then the vaccine actually reduced the number of cases. So what was reducing the case-fatality rate? I don't know, but it might have been nutrition. There's evidence at least that Vitamin A makes measles less severe/deadly.
    - oldgradstudent 7y ago
      > So what was reducing the case-fatality rate? Sanitation, antibiotics, oral rehydration therapy, machine ventilation, nutrition, and so on. It's not the measles itself that was the cause of most fatalities, it was the pneumonia, diahrrea, and other opportunistic infections that come with it.
topspin 7y ago
rootsofprogress.org? Funded by "Emergent Ventures," some affiliate of Marginal Revolution University... Whose narrative am I looking at here? Honest question. Anyone know?
- brownbat 7y ago
  Popular economists Tyler Cowen and Alex Tabarrok maybe. And people can agree or disagree with them on a variety of issues. But describing "sanitation improves health outcomes" as just somebody's "narrative" feels a bit like responding to "The sky is blue," by asking "Yes, but who benefits?" Sometimes an idea is just an idea.
  - manicdee 7y ago
    Sometimes a poorly communicated idea turns into an anti-vax movement. Other times a poorly communicated idea is used as cover for malfeasance, such as “war on drugs” which is actually about oppressing an underclass.
    - catalogia 7y ago
      The article isn't poorly communicated. It says that vaccines are "extremely effective", backs that up with citations and numbers, and lauds the scientific revolution.
- jasoncrawford 7y ago
  “Whose narrative?” Uh, mine I guess. I'm an independent researcher. Used to be a tech founder. This blog was my hobby until I quit my last job. Now I do it almost full-time. I'm funded by grants from Emergent Ventures among others. But I've been doing what I do since long before I met them.
- dredmorbius 7y ago
  Jason Crawford was apparently investigating this topic before the somewhat notable / notorious article by Collison and Cowan's "We Need A Science of Progress" article (https://www.theatlantic.com/science/archive/2019/07/we-need-new-science-progress/594946/ https://www.theatlantic.com/science/archive/2019/07/we-need-...). He's increased efforts since. https://rootsofprogress.org/about https://rootsofprogress.org/about My read is that Crawford's hitting some good points, though he's bringing an ideology and some preconceptions to bear which are probably harmful to a full understanding. There's a fairly strong Libertarian bent (despite Cowan himself recently putting distance between himself and that theology). https://marginalrevolution.com/marginalrevolution/2020/01/what-libertarianism-has-become-and-will-become-state-capacity-libertarianism.html https://marginalrevolution.com/marginalrevolution/2020/01/wh... He's been making a point of hitting numerous podcasts and YouTube channels. Just gave a talk at the Presidio: https://www.invidio.us/watch?v=SCf44d7txcA https://www.invidio.us/watch?v=SCf44d7txcA While I'd challenge multiple assumptions and interpretations, his reading list (to the extent it's been mentioned in the few talks/articles I've read) is generally good.
not2b 7y ago
Note that the title chosen does not match the title of the article, which is "Draining the Swamp".
- dang 7y ago
  Obviously we can't use that title or the thread will lose its mind. Since the submitter's profile indicates that he is the author of the article, or at least the proprietor of the site, I think it's fair to stick with what he posted.
  - jasoncrawford 7y ago
    The HTML title is deliberately different from the header. The header is a catchy/literary title; the HTML title is more descriptive of what you'll get if you click through. So, all is as intended. Thanks.
qwerty456127 7y ago
People should not settle this dense in the first place. I hope more people are going to rural areas once StarLink an competitors deploy universal Internet connection coverage.
- scarejunba 7y ago
  That will be acceptable if we price in carbon externalities into things so that people who live rurally pay the costs they impose on the world.
  - catalogia 7y ago
    There's more to it than just carbon. It's certainly possible to have a carbon neutral lifestyle in rural areas, however that doesn't account for the habitat destruction innate to low density rural development.
    - zdragnar 7y ago
      Low density rural development can easily fit into existing habitat; I live on 5 acres of forest with maybe 1/2 acre set aside for house, lawn and garden plots. Aside from gasoline for vehicles, my house is nearly self sufficient resource-wise. The biggest destruction of habitat is massive fields for farming. Of course, when a "developer" comes along, buys up an entire field or three, and builds a mini-suburban style neighborhood in the middle of nowhere, the habitat was already lost, but it will do absolutely no favors to any wildlife that might try to come back... not to mention the absurdity of living on tiny half to 1 acre lots in a division miles from the nearest village.
      - scarejunba 7y ago
        In which case, I suppose pricing for restoration elsewhere will be low cost to you and high cost to the developer. As it should be. It's all just a matter of putting the externalities back in.
gumby 7y ago
Prevention vs treatment, indeed! I anticipate that as antibiotics become less effective that table manners and food handling hygiene will have a revival. For example we’ll go back to proper butter knives rather than everyone using their bread knife in the communal butter dish.
- dfsegoat 7y ago
  Related: First bacteriophage therapies are entering human trials and gaining steam. Antibiotics will likely become obsolete when you can target bacteria without the bystander side effects they have on our cells. They are the perfect antibacterial smart weapon really. https://medcitynews.com/2020/01/adaptive-phage-gets-10-from-dod-for-antibacterial-phage-therapies/ https://medcitynews.com/2020/01/adaptive-phage-gets-10-from-...
  - bsder 7y ago
    IF you can identify your specific bacterium and the phage that kills it before the disease kills you. Antibiotics will continue to be effective precisely because they are broad spectrum. A doctor can hit you with an antibiotic before they know exactly what you have. I am always happy to see new tools in medicine. However, I suspect phages are most going to be used initially in persistent, chronic, antibiotic resistant infections where everything else has failed.
    - dfsegoat 7y ago
      You are absolutely right, I failed to note that the increased specificity means you lose the broad spectrum effect. I still think in the cases you describe that they could stand to replace e.g. Vancomycin - BEFORE that fails. The side effect profile for that drug is horrendous: GI bleed, neuro/sensory damage, liver damage, retinal damage etc.. It seems like a blend of phages with slightly varied activity could also reproduce the broad spectrum effect, and CRISPR is going to make that pretty easy I think.
      - lxmorj 7y ago
bbeckerman 7y ago
I always love bringing up [Ignaz Semmelweiss](https://wikipedia.org/wiki/Ignaz_Semmelweis https://wikipedia.org/wiki/Ignaz_Semmelweis), the Hungarian physician who advocated for hand washing before germ theory was established, after observing that pregnant mothers were more likely to become infected when they were handled by doctors than by midwives. His fastidiousness made him unpopular though and he was ridiculed as a stickler by his fellow staff. When he refused to drop this theory, his colleagues convinced his wife to commit him to a mental hospital, where he died due to infection from an unsanitary operation.
- firethief 7y ago
  His story gives me hope... Sometimes, it is everyone else who's crazy.
  - hatsuseno 7y ago
    If by crazy you mean steadfastly clinging to the status quo due to human behavior at scale still being programmed by our herd mentality, then yes, everyone else is crazy. The only hope I derive from it is that there's a chance we'll overcome that nature at some point. But I'm not that optimistic about our chances.
- acqq 7y ago
  > he died due to infection from an unsanitary operation. Actually, he was beaten (per Wikipedia article): "He was severely beaten by several guards, secured in a straitjacket, and confined to a darkened cell." "He died after two weeks, on August 13, 1865, aged 47, from a gangrenous wound, due to an infection on his right hand which might have been caused by the struggle. The autopsy gave the cause of death as pyemia—blood poisoning.[64]"
dredmorbius 7y ago
A fantastic graphical representation of this is "The Conquest of Pestilence in New York City", produced by the Department of Health & Mental Hygine, showing progress from 1800 to 2002: http://1.bp.blogspot.com/-uTWEATUzgxk/TXQoTibILtI/AAAAAAAAAAM/eyirotYDmXo/s1600/2004_01_healthstat.jpg http://1.bp.blogspot.com/-uTWEATUzgxk/TXQoTibILtI/AAAAAAAAAA... This tracks mortality (rather than life expectency), but shows clearly the tremendous progress made from 1850, with a peak mortality rate approaching 50 deaths per thousand peak (from a baseline of ~30 - 40 per mille) to about 12/mm in 1920, and the present rate of about 6/mm. From 1950-1970, and for a briefer period in the 1980s, progress was reversed with mortality increasing. There's actually been an impressive (though small realtive to 19th century improvements) reduction since 1990. Looking at that chart, realise that virtually all the improvement through about 1950 precedes most of what we consider to be modern medicine: advanced cancer treatments, antibiotics, most vaccines, transplant surgeries, genetic therapy, pacemakers, and more. The progress instead comes mostly through increased sanitation and hygiene, as well as reduced environmental contaminations and hazards, though it includes both antisceptics and anesthesia. We've been paying a tremendous amount in medical advances for a very slight improvement in outcomes.
- kqr 7y ago
  It looks like the decline at the end of the 19th century coincides with our ability to vaccinate against cholera, diphtheria, smallpox, and the other major epidemics listed on the chart.
  - dredmorbius 7y ago
    Also: - Solid waste management and disposal. - Sewerage systems (New York's came relatively late). - As the somewhat provocative title of this article suggests, draining of swamps and other means of disease vector control. - Refrigeration. General food safety improvements. - Pasteurising milk. That would cut the transmission of TB markedly. - Indoor plumbing. - Indoor bathing -- showers and baths. I haven't seen a breakdown. Laurie Garrett (NYTimes contributor) has long written on public health and epidemics, had a couple of books in the 1990s / early 2000s: https://www.worldcat.org/title/betrayal-of-trust-the-collapse-of-global-public-health/oclc/950462143 https://www.worldcat.org/title/betrayal-of-trust-the-collaps... https://www.worldcat.org/title/coming-plague-newly-emerging-diseases-in-a-world-out-of-balance/oclc/862067004 https://www.worldcat.org/title/coming-plague-newly-emerging-...
hyfgfh 7y ago
I'm actually anti-sanitation, we mud people believe it causes allergies!
- jshevek 7y ago
  What is a "mud person"?
- oldgradstudent 7y ago
  There's a difference between mud and that other brown stuff.
  - socceroos 7y ago
    Unscheduled fecal transplant
kstenerud 7y ago
Sanitation is good, but too much sanitation is not so good. We're only just beginning to understand our relationship with bacteria, virii and micro-organisms. While sanitation was a great boon to reducing deadly pathogens, we're now in the process of swinging the pendulum too far, using antibacterial products that should really only be used in hospitals, keeping children out of the dirt (with growing indications that this leads to allergies), and generally living in fear of anything not institutional-clean. Our immune systems are beginning to atrophy from lack of "exercise". Have you ever wondered why lovers touch their lips together, effectively sharing the bacterial brew in their mouths with another? I can guarantee that such evolved behavior is not simply coincidental.
- daemin 7y ago
  Sanitation in terms of removing faecal matter and washing hands before dealing with food or wounds. The rest is probably overkill for most people.
- Valgrim 7y ago
  I prefer this much intimate/disgusting/sexier explanation: "Kissing in humans is postulated to have evolved from the direct mouth-to-mouth regurgitation of food (kiss-feeding) from parent to offspring or male to female (courtship feeding) and has been observed in numerous mammals.[59] The similarity in the methods between kiss-feeding and deep human kisses (e.g. French kiss) are quite pronounced; in the former, the tongue is used to push food from the mouth of the mother to the child with the child receiving both the mother's food and tongue in sucking movements, and the latter is the same but forgoes the premasticated food. In fact, through observations across various species and cultures, it can be confirmed that the act of kissing and premastication has most likely evolved from the similar relationship-based feeding behaviours." https://en.wikipedia.org/wiki/Kiss#Biology_and_evolution https://en.wikipedia.org/wiki/Kiss#Biology_and_evolution

134 points by jasoncrawford 7y ago

There’s degrees of “conquered”. Seat belts ‘conquered’ motor vehicle trauma before airbags did. Each new thing helps fill in the gaps left by the already-existing things.

deleted 7y ago
[deleted]
smileysteve 7y ago
I question your example While airbags functioning properly with a properly sized adult reduce trauma, that's a lot of conditionals. Seat belts conquered ejection and death, but people still didn't wear them, so active restraint and airbags became policy to have at least their 13% chance of being effective. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4366828/#sec1-1title https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4366828/#sec1-1...
- taneq 7y ago
  Seatbelts reduced the death toll dramatically compared with no seatbelts. Airbags and seatbelts together reduce the death toll dramatically compared with just seatbelts. In most of the world it's considered suicidal not to wear a seatbelt while in a moving vehicle.
  - njarboe 7y ago
    And unfortunately the US took the stance that airbag design should take into account that a seat belt will not be worn. US airbags explode with much more force and cause many more injuries than European ones.
    - muzika 7y ago
      First time I hear anything about difference in airbag systems between US and europe. You have any sources for this? Thanks!
  - smileysteve 7y ago
    Seat belts alone decrease fatalities by 48%. Adding airbags is much less significant, as combined they have a 52% overall fatality rate. Airbags alone only had a 13% reduction on fatalities. https://www.automobilemag.com/news/do-airbags-save-more-lives-than-seatbelts/ https://www.automobilemag.com/news/do-airbags-save-more-live...
Spooky23 7y ago
Yes and no. I'll use an anecdote from my personal life. If you by some misfortune end up in the hospital for an extended time, you have an ever-increasing risk of being infected by drug-resistant bacteria. This happened to a loved one, and it's a tragic thing that will significantly reduce that loved one's lifespan. Why does this happen? Antibiotics and filth. Antibiotics enable the awful management practices of this particular hospital. There aren't enough aides, the rooms and equipment are filthy, even the lunchroom is dirty. I sat visiting for weeks at a time a different times of day and night and never saw a mop, or a cleaning of surfaces that were soiled. Your average McDonald's kitchen is cleaner. The economics of insurance are such that the consequences of these infections don't damage the bottom line. For some people, airbags can discourage seatbelt use in the same way.
- taneq 7y ago
  Wow, that sounds awful. I've only spent time in hospitals a couple of times but the ones I've been in (public or private) were always very professional and hygienic.
  - Spooky23 7y ago
    That was my way experience as well, although I was mostly exposed to OB when my kids were born or post-surgical areas. Those are the moneymakers. If you have an issue that requires observation and not ICU, it’s a different story. Look at the Medicare health ratings online and you’ll find plenty of examples unfortunately!
- scarejunba 7y ago
  Was this in America? Which hospital was it?
  - Jamwinner 7y ago
    Most hospitals are like this. The main areas, bathrooms and ORs are clean, but many of the staff-only areas seem seldom touched by sanitation crews.
  - 7y ago
dredmorbius 7y ago
Auto safety has shown a very consitent rate of improvement with deaths per passenger mile halving about every 20 years, since 1920. That's the red line in this chart: https://upload.wikimedia.org/wikipedia/commons/thumb/4/4f/US_traffic_deaths_per_VMT%2C_VMT%2C_per_capita%2C_and_total_annual_deaths.png/1200px-US_traffic_deaths_per_VMT%2C_VMT%2C_per_capita%2C_and_total_annual_deaths.png https://upload.wikimedia.org/wikipedia/commons/thumb/4/4f/US... The period of most rapid car safety improvements came during a single ten-year period, from 1910 - 1920, where deaths, again, expressed per passenger mile, halved in only ten years.
- hackerbabz 7y ago
  Any idea what major improvements there were between 1910 and 1920? I had no idea there were any improvements made before seatbelts in the 1950s.
  - WalterBright 7y ago
    The switch to hydraulic brakes was a huge improvement, but I'm not sure when that happened.
    - deleted 7y ago
      [deleted]
    - Jamwinner 7y ago
      Between 1918 and 1946 mechanical brakes were phased out. By ww2, they were nearly extinct except on the cheapest or older styled cars. I would argue the bigger advance was tires. Even mechanical brakes are plenty to lock your wheels, but tires are the actual road interface, and old ones are amazingly fragile. Vulcanization was not even known at the start of the auto age, and the rubber would tear off in chunks.
      - dredmorbius 7y ago
        Vulcanisation was patented in 1844. If the technique wasn't known until the 1920s, the issue of the patent exhibits extreme prescience on the part of both Charles Goodyear (1800-1860) and the US Patent and Trademark Office. https://en.wikipedia.org/wiki/Charles_Goodyear https://en.wikipedia.org/wiki/Charles_Goodyear Synthetic rubber wasn't invented until WWII, when natural latex supplies were rendered unavailable due to WWII. https://en.wikipedia.org/wiki/Synthetic_rubber https://en.wikipedia.org/wiki/Synthetic_rubber

hprotagonist 7y ago

https://observablehq.com/@mbostock/the-impact-of-vaccines https://observablehq.com/@mbostock/the-impact-of-vaccines That figure is real hard to refute, or square with any other cause of reduction of measles infections except vaccination.

DanAndersen 7y ago
That's true -- though the figure you're linking focuses specifically on measles cases rather than overall mortality, which is what the OP article is focusing on. (as an aside, it's really weird that the (first few) comments here on HN seem a little adversarial; I wonder if maybe some people looked at the headline only and assumed it was attempting some sort of anti-vax argument, which the article isn't doing at all.)
- manicdee 7y ago
  The problem is that anti-vaxxers will use the headline as their entire justification for their opinion which is not supported by the content under the headline.
- jasoncrawford 7y ago
  So there is something odd going on with measles. I haven't dug into the data, but from a couple of data points I've seen, it seems that measles mortality was declining for a long time even while measles cases were not. That is, there was a decline in the case-fatality rate, without a decline in cases. The disease was still around but getting less deadly. Then the vaccine actually reduced the number of cases. So what was reducing the case-fatality rate? I don't know, but it might have been nutrition. There's evidence at least that Vitamin A makes measles less severe/deadly.
  - oldgradstudent 7y ago
    > So what was reducing the case-fatality rate? Sanitation, antibiotics, oral rehydration therapy, machine ventilation, nutrition, and so on. It's not the measles itself that was the cause of most fatalities, it was the pneumonia, diahrrea, and other opportunistic infections that come with it.

topspin 7y ago

rootsofprogress.org? Funded by "Emergent Ventures," some affiliate of Marginal Revolution University... Whose narrative am I looking at here? Honest question. Anyone know?

brownbat 7y ago
Popular economists Tyler Cowen and Alex Tabarrok maybe. And people can agree or disagree with them on a variety of issues. But describing "sanitation improves health outcomes" as just somebody's "narrative" feels a bit like responding to "The sky is blue," by asking "Yes, but who benefits?" Sometimes an idea is just an idea.
- manicdee 7y ago
  Sometimes a poorly communicated idea turns into an anti-vax movement. Other times a poorly communicated idea is used as cover for malfeasance, such as “war on drugs” which is actually about oppressing an underclass.
  - catalogia 7y ago
    The article isn't poorly communicated. It says that vaccines are "extremely effective", backs that up with citations and numbers, and lauds the scientific revolution.
jasoncrawford 7y ago
“Whose narrative?” Uh, mine I guess. I'm an independent researcher. Used to be a tech founder. This blog was my hobby until I quit my last job. Now I do it almost full-time. I'm funded by grants from Emergent Ventures among others. But I've been doing what I do since long before I met them.
dredmorbius 7y ago
Jason Crawford was apparently investigating this topic before the somewhat notable / notorious article by Collison and Cowan's "We Need A Science of Progress" article (https://www.theatlantic.com/science/archive/2019/07/we-need-new-science-progress/594946/ https://www.theatlantic.com/science/archive/2019/07/we-need-...). He's increased efforts since. https://rootsofprogress.org/about https://rootsofprogress.org/about My read is that Crawford's hitting some good points, though he's bringing an ideology and some preconceptions to bear which are probably harmful to a full understanding. There's a fairly strong Libertarian bent (despite Cowan himself recently putting distance between himself and that theology). https://marginalrevolution.com/marginalrevolution/2020/01/what-libertarianism-has-become-and-will-become-state-capacity-libertarianism.html https://marginalrevolution.com/marginalrevolution/2020/01/wh... He's been making a point of hitting numerous podcasts and YouTube channels. Just gave a talk at the Presidio: https://www.invidio.us/watch?v=SCf44d7txcA https://www.invidio.us/watch?v=SCf44d7txcA While I'd challenge multiple assumptions and interpretations, his reading list (to the extent it's been mentioned in the few talks/articles I've read) is generally good.

not2b 7y ago

Note that the title chosen does not match the title of the article, which is "Draining the Swamp".

dang 7y ago
Obviously we can't use that title or the thread will lose its mind. Since the submitter's profile indicates that he is the author of the article, or at least the proprietor of the site, I think it's fair to stick with what he posted.
- jasoncrawford 7y ago
  The HTML title is deliberately different from the header. The header is a catchy/literary title; the HTML title is more descriptive of what you'll get if you click through. So, all is as intended. Thanks.

qwerty456127 7y ago

People should not settle this dense in the first place. I hope more people are going to rural areas once StarLink an competitors deploy universal Internet connection coverage.

scarejunba 7y ago
That will be acceptable if we price in carbon externalities into things so that people who live rurally pay the costs they impose on the world.
- catalogia 7y ago
  There's more to it than just carbon. It's certainly possible to have a carbon neutral lifestyle in rural areas, however that doesn't account for the habitat destruction innate to low density rural development.
  - zdragnar 7y ago
    Low density rural development can easily fit into existing habitat; I live on 5 acres of forest with maybe 1/2 acre set aside for house, lawn and garden plots. Aside from gasoline for vehicles, my house is nearly self sufficient resource-wise. The biggest destruction of habitat is massive fields for farming. Of course, when a "developer" comes along, buys up an entire field or three, and builds a mini-suburban style neighborhood in the middle of nowhere, the habitat was already lost, but it will do absolutely no favors to any wildlife that might try to come back... not to mention the absurdity of living on tiny half to 1 acre lots in a division miles from the nearest village.
    - scarejunba 7y ago
      In which case, I suppose pricing for restoration elsewhere will be low cost to you and high cost to the developer. As it should be. It's all just a matter of putting the externalities back in.

gumby 7y ago

Prevention vs treatment, indeed! I anticipate that as antibiotics become less effective that table manners and food handling hygiene will have a revival. For example we’ll go back to proper butter knives rather than everyone using their bread knife in the communal butter dish.

dfsegoat 7y ago
Related: First bacteriophage therapies are entering human trials and gaining steam. Antibiotics will likely become obsolete when you can target bacteria without the bystander side effects they have on our cells. They are the perfect antibacterial smart weapon really. https://medcitynews.com/2020/01/adaptive-phage-gets-10-from-dod-for-antibacterial-phage-therapies/ https://medcitynews.com/2020/01/adaptive-phage-gets-10-from-...
- bsder 7y ago
  IF you can identify your specific bacterium and the phage that kills it before the disease kills you. Antibiotics will continue to be effective precisely because they are broad spectrum. A doctor can hit you with an antibiotic before they know exactly what you have. I am always happy to see new tools in medicine. However, I suspect phages are most going to be used initially in persistent, chronic, antibiotic resistant infections where everything else has failed.
  - dfsegoat 7y ago
    You are absolutely right, I failed to note that the increased specificity means you lose the broad spectrum effect. I still think in the cases you describe that they could stand to replace e.g. Vancomycin - BEFORE that fails. The side effect profile for that drug is horrendous: GI bleed, neuro/sensory damage, liver damage, retinal damage etc.. It seems like a blend of phages with slightly varied activity could also reproduce the broad spectrum effect, and CRISPR is going to make that pretty easy I think.
    - lxmorj 7y ago

bbeckerman 7y ago

I always love bringing up [Ignaz Semmelweiss](https://wikipedia.org/wiki/Ignaz_Semmelweis https://wikipedia.org/wiki/Ignaz_Semmelweis), the Hungarian physician who advocated for hand washing before germ theory was established, after observing that pregnant mothers were more likely to become infected when they were handled by doctors than by midwives. His fastidiousness made him unpopular though and he was ridiculed as a stickler by his fellow staff. When he refused to drop this theory, his colleagues convinced his wife to commit him to a mental hospital, where he died due to infection from an unsanitary operation.

firethief 7y ago
His story gives me hope... Sometimes, it is everyone else who's crazy.
- hatsuseno 7y ago
  If by crazy you mean steadfastly clinging to the status quo due to human behavior at scale still being programmed by our herd mentality, then yes, everyone else is crazy. The only hope I derive from it is that there's a chance we'll overcome that nature at some point. But I'm not that optimistic about our chances.
acqq 7y ago
> he died due to infection from an unsanitary operation. Actually, he was beaten (per Wikipedia article): "He was severely beaten by several guards, secured in a straitjacket, and confined to a darkened cell." "He died after two weeks, on August 13, 1865, aged 47, from a gangrenous wound, due to an infection on his right hand which might have been caused by the struggle. The autopsy gave the cause of death as pyemia—blood poisoning.[64]"

dredmorbius 7y ago

A fantastic graphical representation of this is "The Conquest of Pestilence in New York City", produced by the Department of Health & Mental Hygine, showing progress from 1800 to 2002: http://1.bp.blogspot.com/-uTWEATUzgxk/TXQoTibILtI/AAAAAAAAAAM/eyirotYDmXo/s1600/2004_01_healthstat.jpg http://1.bp.blogspot.com/-uTWEATUzgxk/TXQoTibILtI/AAAAAAAAAA... This tracks mortality (rather than life expectency), but shows clearly the tremendous progress made from 1850, with a peak mortality rate approaching 50 deaths per thousand peak (from a baseline of ~30 - 40 per mille) to about 12/mm in 1920, and the present rate of about 6/mm. From 1950-1970, and for a briefer period in the 1980s, progress was reversed with mortality increasing. There's actually been an impressive (though small realtive to 19th century improvements) reduction since 1990. Looking at that chart, realise that virtually all the improvement through about 1950 precedes most of what we consider to be modern medicine: advanced cancer treatments, antibiotics, most vaccines, transplant surgeries, genetic therapy, pacemakers, and more. The progress instead comes mostly through increased sanitation and hygiene, as well as reduced environmental contaminations and hazards, though it includes both antisceptics and anesthesia. We've been paying a tremendous amount in medical advances for a very slight improvement in outcomes.

kqr 7y ago
It looks like the decline at the end of the 19th century coincides with our ability to vaccinate against cholera, diphtheria, smallpox, and the other major epidemics listed on the chart.
- dredmorbius 7y ago
  Also: - Solid waste management and disposal. - Sewerage systems (New York's came relatively late). - As the somewhat provocative title of this article suggests, draining of swamps and other means of disease vector control. - Refrigeration. General food safety improvements. - Pasteurising milk. That would cut the transmission of TB markedly. - Indoor plumbing. - Indoor bathing -- showers and baths. I haven't seen a breakdown. Laurie Garrett (NYTimes contributor) has long written on public health and epidemics, had a couple of books in the 1990s / early 2000s: https://www.worldcat.org/title/betrayal-of-trust-the-collapse-of-global-public-health/oclc/950462143 https://www.worldcat.org/title/betrayal-of-trust-the-collaps... https://www.worldcat.org/title/coming-plague-newly-emerging-diseases-in-a-world-out-of-balance/oclc/862067004 https://www.worldcat.org/title/coming-plague-newly-emerging-...

hyfgfh 7y ago

I'm actually anti-sanitation, we mud people believe it causes allergies!

jshevek 7y ago
What is a "mud person"?
oldgradstudent 7y ago
There's a difference between mud and that other brown stuff.
- socceroos 7y ago
  Unscheduled fecal transplant

kstenerud 7y ago

Sanitation is good, but too much sanitation is not so good. We're only just beginning to understand our relationship with bacteria, virii and micro-organisms. While sanitation was a great boon to reducing deadly pathogens, we're now in the process of swinging the pendulum too far, using antibacterial products that should really only be used in hospitals, keeping children out of the dirt (with growing indications that this leads to allergies), and generally living in fear of anything not institutional-clean. Our immune systems are beginning to atrophy from lack of "exercise". Have you ever wondered why lovers touch their lips together, effectively sharing the bacterial brew in their mouths with another? I can guarantee that such evolved behavior is not simply coincidental.

daemin 7y ago
Sanitation in terms of removing faecal matter and washing hands before dealing with food or wounds. The rest is probably overkill for most people.
Valgrim 7y ago
I prefer this much intimate/disgusting/sexier explanation: "Kissing in humans is postulated to have evolved from the direct mouth-to-mouth regurgitation of food (kiss-feeding) from parent to offspring or male to female (courtship feeding) and has been observed in numerous mammals.[59] The similarity in the methods between kiss-feeding and deep human kisses (e.g. French kiss) are quite pronounced; in the former, the tongue is used to push food from the mouth of the mother to the child with the child receiving both the mother's food and tongue in sucking movements, and the latter is the same but forgoes the premasticated food. In fact, through observations across various species and cultures, it can be confirmed that the act of kissing and premastication has most likely evolved from the similar relationship-based feeding behaviours." https://en.wikipedia.org/wiki/Kiss#Biology_and_evolution https://en.wikipedia.org/wiki/Kiss#Biology_and_evolution