The disease afflicting Western societies have undergone dramatic changes. In the course of a century, so many mass killers have vanished that two-third of all deaths are now associated with the disease of old age. Those who die young are more often than not, the victims of accidents, violence and suicide.

  These changes in public health are generally equated with progress and attributed to more or better medical care. In fact there is no evidence of any direct relationship between changing disease pattern and the so-called progress of medicine.

  The impotence of medical services to change life expectancy and the insignificance of much contemporary clinical care in the curing of diseases are all obvious, well documented but well suppressed.

  Neither the proportion of doctors in a population nor the quality of the clinical tools at the disposal not the number of hospital beds is a casual factor in the striking changes in disease patterns. The new techniques available to recognize and treat such conditions as pernicious anaemia and hypertension, or correct congenital malformations by surgical interventions, increase our understanding of disease but do not reduce its incidence. The fact that there are more doctors where certain diseases have become rare has little to do with their ability to control or eliminate them. It simply means that doctors, more than other professionals, determine where they work. Consequently, they tend to gather where the climate is healthy, where the water is clean and where people work and can pay for their services.