Fribble The Myth of the Cliff

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By Mark Vossler (vosslerm@home.com)
November 24, 2000

The "myth of the cliff" was a term I first heard in college in a course on the social history of medicine taught by Dr. Ted Brown. I revisited the concept recently while reading a book entitled The Greatest Benefit to Mankind: A Medical History of Humanity, by Roy Porter.

Porter eloquently discusses the rise in infectious diseases that occurred with first the use of domestic animals and second urban crowding. Porter doesn't use the term "myth of the cliff," but describes the phenomenon. In short, it is the fallacious notion that a pharmaceutical intervention can change the course of a disease in a population; it is the idea that once a therapy arrives the mortality rate of the disease in question "falls off a cliff."

In fact, it almost never works this way. What event do you suppose reversed the rapidly rising rate of death from infection in the "civilized" world?

Flemming's discovery of penicillin, of course. Wrong!

Jenner, Koch and Pasteur and all their microbes and vaccines. Wrong again (although their research did cause a massive paradigm shift in medical thinking).

Snow's discovery that cholera was spread by dirty water. Wrong yet again. (That improvements in sanitation made a dent in disease goes without much question, but infectious disease deaths were falling even before Snow.)

Lister and antiseptic surgery. Still wrong (this changed the mortality of surgery but did little on a population level).

What changed about 50 to 75 years after the French revolution was an improvement in the access to food for the urban poor. Starvation leads to immunodeficiency, which leads to infection. Once fed, the poor could mount an immune response to fight off infections even without the aid of antibiotics or vaccines.

We live in an age of technological miracles. The pace of change in my field of study alone is stupendous. Couple the advances in biology with those in electronics, optics, and computing and it's mind-boggling. The result of our advanced technology is industrial efficiency and a booming economy producing enormous wealth.

Despite this, there still are people in the U.S. who lack sufficient nutrition. All the Epogens and Alteplases and Embrels are nothing compared to a loaf of bread to a starving family.

My plea to all of you on the day after Thanksgiving is to remember�do something for
the health of our society and, if you haven't already, donate to your local food bank.

[The Motley Fool's Foolanthropy 2000 charity drive is underway now. Check out the organizations we're raising money for, and see if you'd be interested in giving this year!]