Thomas McKeown (physician)

Thomas McKeown (1912–1988) was a British physician and medical historian.[1] Largely based on demographic data from England and Wales, McKeown argued that the population growth since the late eighteenth century was due to economic conditions rather than improved medicine and public health.[2][3][4][5] This became known as the "McKeown thesis".[6][7]

Personal life

McKeown was born in Northern Ireland and then moved to Vancouver, Canada with his parents.[8]

McKeown attended the University of British Columbia as an undergraduate in Chemistry and then McGill University as a post-graduate student before returning across the Atlantic to study at Oxford University as a Rhodes Scholar.[8][9] From 1945, he was professor of social medicine at the University of Birmingham.[8] He is also known for his work in geriatrics[8] and maternal-fetal medicine.[9]

Scientific contribution

McKeown developed and published his theories over a period of twenty years between 1955 and 1975 in four seminal papers in the academic journal Population Studies.[2][3][4][5] These papers did not attract much attention beyond the academic community until he merged the four papers, without adding significantly new data, in two books[10][11] and a public lecture with the polemic title The Role of Modern Medicine: Dream, Mirage or Nemesis?.[12]

McKeown challenged four theories about the increase of the western population since the 18th century:

  1. McKeown stated that the growth in population, particularly surging in the 19th century, was not so much caused by an increase in fertility, but largely by a decline of mortality particularly of childhood mortality followed by infant mortality,[2][4]
  2. This decline of mortality could largely be attributed to rising standards of living, whereby he put most emphasis on improved nutritional status,
  3. His most controversial idea, at least his most disputed idea, was that he questioned the effectiveness of public health measurements, including sanitary reforms, vaccination and quarantine,[3]
  4. The sometime very fierce disputes that his publication provoked around the "McKeown thesis", have overshadowed his more important and largely unchallenged argument that curative medical measures played little role in mortality decline, not only prior to the mid-20th century[2] but also until well into the 20th century.[5] For example, even the effectiveness of antibiotics, some of the most effective drugs discovered during the 20th century, could be questioned as a major contribution to the decline of mortality at a population level: Between 1901 and 1971, the age- and sex- standardized mortality from pulmonary infections dropped at a steady pace from 2.7 per 1,000 to 0.6 per 1,000. By the time of the introduction of the first effective antibiotics in 1938, the mortality rate had already dropped to half the mortality rate from pulmonary infections (~1.4 per 1,000), without changing the steady linear decline of mortality.

Influence & Criticism

The publication of The Modern Rise of Population (1976) provoked instant disagreement by demographers, but also yielded much acclaim from health critics such. In the 1970s, an era wherein all aspects of social, economic and cultural establishment were challenged, McKeown found a receptive audience with other health critics such as Ivan Illich.[13]

Books

References

  1. ↑ "Thomas McKeown". Oxford Dictionary of National Biography. Retrieved 8 August 2013.
  2. 1 2 3 4 McKeown T, Brown RG (1955). "Medical evidence related to English population changes in the eighteenth century". Population Studies. 9 (2): 119–141. doi:10.1080/00324728.1955.10404688. JSTOR 2172162.
  3. 1 2 3 McKeown T, Record RG (1962). "Reasons for the Decline of Mortality in England and Wales during the Nineteenth Century". Population Studies. 16 (2): 94–122. doi:10.2307/2173119. JSTOR 2173119.
  4. 1 2 3 McKeown T, Brown RG, Record RG (1972). "An interpretation of the modern rise of population in Europe". Population Studies 26:345-382. JSTOR 2173815.
  5. 1 2 3 McKeown T, Record RG, Turner RD (1975). "An Interpretation of the Decline of Mortality in England and Wales during the Twentieth Century". Population Studies. 29 (3): 391–422. doi:10.1080/00324728.1975.10412707. JSTOR 2173935.
  6. ↑ Colgrove, James (2002). "The McKeown Thesis: A Historical Controversy and Its Enduring Influence". Am J Public Health. American Public Health Association. 92 (5): 725–9. doi:10.2105/ajph.92.5.725. PMC 1447153Freely accessible. PMID 11988435.
  7. ↑ Grundy, Emily (2005). "Commentary: The McKeown debate: time for burial". Int. J. Epidemiol. Oxford Journals. 34 (3): 529–533. doi:10.1093/ije/dyh272.
  8. 1 2 3 4 Bynum, Bill (2008). "The McKeown thesis". Lancet. Elsevier Ltd. 371 (9613): 644–5. doi:10.1016/S0140-6736(08)60292-5.
  9. 1 2 Bradby, Hannah (2009). Medical Sociology: An Introduction. SAGE. p. 30.
  10. ↑ McKeown, Thoma (1976). The Modern Rise of Population. London, UK: Edward Arnold. ISBN 9780713159868.
  11. ↑ McKeown, Thomas (1988). The Origins of Human Disease. Oxford, UK: Basil Blackwell. ISBN 978-0-631-17938-2.
  12. ↑ McKeown, Thomas (1976). The Role of Medicine: Dream, Mirage or Nemesis? (The Rock Carlington Fellow, 1976). London, UK: Nuffield Provincial Hospital Trust. ISBN 0-900574-24-0.
  13. ↑ Illich, Ivan (1976). Medical Nemesis: The Expropriation of Health. New York, NY: Pantheon Books. ISBN 978-0714529936.
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