Superfreakonomics_ global cooling, patri - Steven D. Levitt [65]
To call the vaccine a “simple” fix might seem to discount the tireless efforts of everyone who helped stop polio: the medical researchers (Jonas Salk and Albert Sabin chief among them); the fund-raising volunteers (the March of Dimes, Oshinsky writes, was “the largest charitable army the country had ever known”); even the non-human martyrs (thousands of monkeys were imported to be given experimental vaccines).
On the other hand, there is no simpler medical fix than a vaccine. Consider two of the major ways we try to thwart disease. The first is to invent a procedure or technology that helps fix a problem once it’s arisen (open-heart surgery, for instance); these tend to be very costly. The second is to invent a medicine to prevent the problem before it happens; in the long run, these tend to be extraordinarily cheap. Health-care researchers have estimated that if a polio vaccine hadn’t been invented, the United States would currently be caring for at least 250,000 long-term patients at an annual cost of at least $30 billion. And that doesn’t even include “the intangible costs of suffering and death and of averted fear.”
Polio is a stark example, but there are countless cheap and simple medical fixes. New ulcer drugs reduced the rate of surgery by roughly 60 percent; a later round of even cheaper drugs saved ulcer patients some $800 million a year. In the first twenty-five years after lithium was introduced to treat manic depression, it saved nearly $150 billion in hospitalization costs. Even the simple addition of fluoride to water systems has saved about $10 billion per year in dental bills.
As we noted earlier, deaths from heart disease have fallen substantially over the past few decades. Surely this can be attributed to expensive treatments like grafts, angioplasties, and stents, yes?
Actually, no: such procedures are responsible for a remarkably small share of the improvement. Roughly half of the decline has come from reductions in risk factors like high cholesterol and high blood pressure, both of which are treated by relatively cheap medicines. And much of the remaining decline is thanks to ridiculously inexpensive treatments like aspirin, heparin, ACE inhibitors, and beta-blockers.
By the early 1950s, automobile travel had become fantastically popular in the United States, with about 40 million cars on the road. But at the thirty-fifth annual convention of the National Automobile Dealers Association, held in January 1952, a vice president of the BFGoodrich tire company warned that the smooth ride might be over: “If the death rate continues upward it will seriously hurt the automobile business, as many people will quit driving.”
Nearly 40,000 people died in U.S. traffic accidents in 1950. That’s roughly the same number of deaths as today, but a straight-up comparison is very misleading, because far fewer miles were driven back then. The rate of death per mile driven was five times higher in 1950 than it is today.
Why so many fatalities then? Suspects were legion—faulty cars, poorly designed roads, careless drivers—but not much was known about the mechanics of car crashes. Nor was the auto industry exactly burning to find out.
Enter Robert Strange McNamara. Today he is best remembered as the much-maligned secretary of defense during the Vietnam War. One reason McNamara was so maligned was that he tended to make decisions based on statistical analysis rather than emotion or political considerations. In other words, he behaved like an economist.
This was no coincidence. He studied economics at Berkeley and went on to the Harvard Business School, where he stayed on as a young professor of accounting. McNamara volunteered when World War II broke out, and his analytical skills landed him in the Statistical Control Office of the Army Air Forces.
His team used data as a weapon to fight the war. For example, the abort rate among American bombers leaving England for daytime sorties over Germany was found to be unnaturally high, about 20 percent. The pilots gave a variety of explanations for failing to reach