The Failures of Success

Abstract

Iwould like to begin by taking you back to theyears preceding the Second World War, because the problem I wishto discuss must be seen as a historical process if it is to be understood. I am going to talk about a particular chapter in the history of disease, a chapter characterized by the surprising fact that the net effect of suc-cessful technical innovations used in disease control has been to raise the prevalence of certain diseases and disabilities by prolonging their average duration. The beginning of this historical period coincided with the introduction of the systematic clinical trial and of the sulfonamides in 1937 and 1938. The health situation regarding modern man’s chronic diseases and disabilities immediately before that period was well described by Osler in 1904 in his famous textbook, The Principles and Practice of Medicine, and the same description was still present in the 1935 edition revised by