Part 16 (1/2)
Enter the Agricultural Revolution. A variety of innovations, none particularly complex-they included higher-yielding crops, better tools, and a more efficient use of capital-changed farming and, subsequently, the face of the earth. In late eighteenth-century America, ”it took 19 out of 20 workers to feed the country's inhabitants and provide a surplus for export,” wrote the economist Milton Friedman. Two hundred years later, only 1 of 20 American workers was needed to feed a far larger population while also making the United States ”the largest single exporter of food in the world.”
The Agricultural Revolution freed up millions of hands that went on to power the Industrial Revolution. By 1850, worldwide population had grown to 1.3 billion; by 1900, 1.7 billion; by 1950, 2.6 billion. And then things really took off. Over the next fifty years, the population more than doubled, reaching well beyond 6 billion. If you had to pick a single silver bullet that allowed this surge, it would be ammonium nitrate, an astonis.h.i.+ngly cheap and effective crop fertilizer. It wouldn't be much of an overstatement to say that ammonium nitrate feeds the world. If it disappeared overnight, says the agricultural economist Will Masters, ”most people's diets would revert to heaps of cereal grains and root crops, with animal products and fruits only for special occasions and for the rich.”
Or consider the whale. Hunted since antiquity, by the nineteenth century it had become an economic engine that helped turn the United States into a powerhouse. Every square inch of it could be turned into something, so the whale afforded one-stop shopping for a fast-growing nation: material for the manufacture of paint and varnish; textiles and leather; candles and soap; clothing and of course food (the tongue was a particular delicacy). The whale was especially beloved by the finer s.e.x, surrendering its body parts for corsets, collars, parasols, perfume, hairbrushes, and red fabric dye. (This last product was derived from, of all things, the whale's excrement.) Most valuable was whale oil, a lubricant for all sorts of machinery but most crucially used for lamp fuel. As the author Eric Jay Dolin declares in Leviathan, ”American whale oil lit the world.”
Out of a worldwide fleet of 900 whaling s.h.i.+ps, 735 of them were American, hunting in all four oceans. Between 1835 and 1872, these s.h.i.+ps reaped nearly 300,000 whales, an average of more than 7,700 a year. In a good year, the total take from oil and baleen (the whale's bonelike ”teeth”) exceeded $10 million, today's equivalent of roughly $200 million. Whaling was dangerous and difficult work, but it was the fifth-largest industry in the United States, employing 70,000 people.
And then what appeared to be an inexhaustible resource was-quite suddenly and, in retrospect, quite obviously-heading toward exhaustion. Too many s.h.i.+ps were hunting for too few whales. A s.h.i.+p that once took a year at sea to fill its hold with whale oil now needed four years. Oil prices spiked accordingly, rocking the economy back home. Today, such an industry might be considered ”too big to fail,” but the whaling industry was failing indeed, with grim repercussions for all America.
That's when a retired railway man named Edwin L. Drake, using a steam engine to power a drill through seventy feet of shale and bedrock, struck oil in t.i.tusville, Pennsylvania. The future bubbled to the surface. Why risk life and limb chasing underwater leviathans around the world, having to catch and carve them up, when so much energy was just waiting, in the nation's bas.e.m.e.nt, to be pumped upstairs?
Oil was not only a cheap and simple fix but, like the whale, extraordinarily versatile. It could be used as lamp oil, a lubricant, and as a fuel for automobiles and home heating; it could be made into plastic and even nylon stockings. The new oil industry also provided lots of jobs for unemployed whalers and, as a bonus, functioned as the original Endangered Species Act, saving the whale from near-certain extinction.
By the early twentieth century, most infectious diseases-smallpox, tuberculosis, diphtheria, and the like-were on their way out. But polio refused to surrender.
It would be hard to invent a more frightening illness. ”It was a children's disease; there was no prevention; there was no cure; every child everywhere was at risk,” says David M. Os.h.i.+nsky, author of the Pulitzer Prizewinning Polio: An American Story. ”And what this really meant was that parents were absolutely frantic.”
Polio was also a great mystery, spiking in summertime, its cause unknown. (In a cla.s.sic case of mistaking correlation and causality, some researchers suspected that ice cream-consumed in far greater quant.i.ties in the summer-caused polio.) It was first thought to target immigrant slum children, especially boys, but it struck girls too, as well as kids in the leafiest suburbs. Even Franklin Delano Roosevelt, who was far removed from immigrant slums and, at thirty-nine, from childhood as well, contracted the disease.
Every outbreak prompted a new round of quarantines and panic. Parents kept their kids away from friends, from pools and parks and libraries. In 1916, the worst polio epidemic to date struck New York City. Out of 8,900 reported cases, 2,400 people died, most of them children under five. The disease roared on. Nineteen fifty-two was the worst year yet, with 57,000 reported cases nationwide, 3,000 of them fatal and 21,000 resulting in permanent paralysis.
Surviving a bad case of polio was only marginally better than dying. Some victims lost the use of their legs and lived in constant pain. Those with respiratory paralysis practically lived inside an ”iron lung,” a huge tank that did the work of their failed chest muscles. As the population of living polio victims grew, the cost of their medical care was staggering. ”At a time when less than ten percent of the nation's families had any form of health insurance,” Os.h.i.+nsky writes, ”the expense of boarding a polio patient (about $900 a year) actually exceeded the average annual wage ($875).”
America was by now the most powerful country on earth, the victor in two world wars, possessor of a blindingly bright future. But there was legitimate concern that this single disease would consume such a large share of future health-care dollars that it would cripple the nation.
And then a vaccine was developed-a series of vaccines, really-and polio was effectively stamped out.
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, Os.h.i.+nsky 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 a.s.sociation, 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 a.n.a.lysis 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 a.n.a.lytical skills landed him in the Statistical Control Office of the Army Air Forces.