Comment by alejohausner | Hacker News Reader

Comment by alejohausner | Hacker News Reader

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I know I'm coming to the discussion late, but actually there is good evidence that improvements in nutrition, working conditions, and sanitation are a big factor in improving resistance to infectious diseases.

Look at "The Questionable Contribution of Medical Measures to the Decline of Mortality in the United States in the Twentieth Century", by Mckinlay and McKinley (1977). I know it's an old paper, but it has some fascinating and, to me, very persuasive time series. Those plots show mortality from various infectious diseases over the 20th century.

Example: death rates (per 1000) from scarlet fever dropped from 0.1 in 1900 to effectively 0 in 1940. There is NO VACCINE for scarlet fever.

Example: death rates from measles (lately very much in the news) dropped from 0.12 in 1900 to 0 in 1960 (a vaccine for measles was introduced in 1960).

A similar trend exists for many other infectious diseases: huge drops in mortality PRECEDE the introduction of vaccines or antibiotics for the disease. Surely we can't credit vaccines with such a drop in death rates. I don't see how anybody could come to such a conclusion.

No one is contesting the role of nutrition, working conditions, and sanitation in infectious diseases generally. What I asked was: what evidence is there that this is a significant contributor to infectious disease in countries like the US? (I should clarify that I'm referring to present-day US, because we're discussing in context of MAHA which is present-day US)

Yes, measles death rates had dropped precipitously (fortunately), however incidence (new cases) had only dropped a little. It wasn't until the vaccine was introduced that incidence dropped to nearly zero[1]. Yours is a common anti-vaxx talking point, and one that seems to neglect that death is not the only negative outcome from measles. It's understandable to take the talking point at face value when it appears to be scientifically-supported, though this is a good example of how a talking point uses a cherry-picked fact and reframes the issue for a presupposed conclusion (that vaccines are unsafe or ineffective), because the origin of that talking point had no interest in comprehensively informing people but converting them to believers.

[1] https://ourworldindata.org/grapher/measles-cases-and-death-r...

Yes, the measles vaccine is effective. It reduces cases of measles. But the paper in question says that deaths were reduced to almost zero before the vaccine was introduced. The graph that you linked to shows the same thing.

For me the paper shows not just that good sanitation and nutrition help reduce deaths from many infections diseases, but that they are the primary agent in that reduction. I thought it was a very cool paper, although you don’t seem moved in the same way as me.

When I was a child, my parents weren’t upset when I got measles (I was, because it meant missing a trip to the seashore). It meant that you were going to be miserable for a week, but would be immune afterwards. So I became one more case, but not one more death.

I mean, that good sanitation reduced infectious disease incidence and mortality was something I was already aware of so I've already been "moved" so to speak. As for nutrition, the paper cites one researcher who concludes nutrition was a major factor, and it probably was a factor, though the magnitude of its impact is not firmly established by that one researcher.

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