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TAC-ChinaAmerica Such was the provocative title under which Alexander Cockburn ran a recent column discussing my China/America article in The Week, a British-based news magazine which claims a total American print circulation of over 500,000. We’ll see whether anyone notices that column either.

Cockburn’s question referred to my examination of the American mortality figures surrounding the heavily-promoted anti-pain drug Vioxx, released by Merck in 1999 and pulled from the market in 2004 after a published FDA study indicated it seemed to double the risk of heart attacks and strokes and had probably been responsible for at least tens of thousands of American deaths. I had noted that the major shifts in total American mortality bracketed by Vioxx’s introduction and recall—shifts which were concentrated in exactly those age-groups taking Vioxx and were due to the aforementioned heart attacks and strokes—may actually point to a total death-toll an order-of-magnitude greater than that initial scientific estimate.

The lack of apparent public interest in these matters merely reflects the degree to which most Americans these days define their reality by what they see on the television or film screen, which also informs them what matters and what does not. Thus, the episodic foibles of a Lindsay Lohan or a Britney Spears carry enormous national importance because these are widely discussed on television, while the premature deaths of perhaps half a million American citizens from an aspirin-substitute does not. And nearly all our elected officials and other national leaders seem just as totally dominated by such television-produced reality. This is not a sign of a healthy society nor one likely to long survive in its current form.

An interesting and disturbing historical analogy presents itself. During the 1980s, the late, unlamented Soviet Regime allocated a hugely disproportionate share of its financial resources to military spending, and as a result possessed the world’s largest and most powerful armed forces. Partly as a consequence, most Soviet citizens endured decades of economic stagnation, while even that vaunted military was bogged down in an unwinnable war against scattered Afghan Muslim guerillas. These factors eventually led to a fatal crisis of internal ideological legitimacy and popular support, only partially masked by the constant Happy News of the official media.

There were many straws which helped break the back of the Soviet camel, but one of the greatest was the Chernobyl nuclear disaster, whose deadly impact was initially downplayed or even ignored by the dishonest Soviet media, and only became fully apparent when the national mortality figures were later examined. As ordinary Russians and Ukrainians gradually realized that tens of thousands had died from radiation-induced cancer but that their regime and its controlled media had covered up these facts, the strong popular reaction was a factor in the rise of Mikhail Gorbachev and his sweeping reformist agenda, an agenda which soon led to the complete collapse of the Soviet Regime. It is not impossible that a belated public discovery of 500,000 Vioxx-related deaths might constitute America’s own Chernobyl, but one with perhaps ten times the total death toll.

My late friend Bill Odom, the three-star general who ran the National Security Agency for President Ronald Reagan, had spent his entire career as a Soviet specialist, and prior to his death we both concluded that the American mainstream media of the 2000s had become increasingly indistinguishable from the Soviet Pravda of the 1980s. Whether America itself can avoid the fate of its doomed Cold War counterpart still remains an open issue.


Many others seem to be pondering this same question. The general reaction to my China/America package has been quite remarkable, surely reflecting widespread quiet recognition of America’s unfortunate national trajectory. Within just two weeks, my piece received more pageviews than the combined total of all my other articles over the last several years, and according to Google was discussed or excerpted on perhaps a thousand or more different blogsites. At least some Americans do seem concerned over the pending likelihood of what I entitled “America’s Fall.”

One very heartening aspect of the response was the extent to which the positive reaction crossed political and ideological lines, very similar to the trans-ideological stance I had attempted in writing the piece. Just as today’s Democratic and Republican ruling political elites have increasingly merged into a corrupt One Party Regime, many individual critics both of the left and of the right have gradually discovered that they have much more in common with each other than might seem to be the case in the false reality created by FoxNews vs. MSNBC political mud-wrestling tournaments on television.

Although my piece ran in The American Conservative (TAC), co-founded by Pat Buchanan, and received overwhelmingly positive comments from its right-leaning readership, the Left also had very favorable reactions. CounterPunch not only ran Cockburn’s own piece and the very generous column by Paul Craig Roberts, but also republished my entire Vioxx/Melamine sidebar, while additionally highlighting my article as a Website of the Day. The favorable reaction on the left seemed quite widespread, with several commentators being almost a bit shocked that “conservatives” could actually say such sensible things. A few prominent examples:

Meanwhile, MondoWeiss heavily excerpted my discussion of Hollywood’s enthusiastic role in fostering the official role of torture and other extremely dark aspects of recent American government policy:

Reaction elsewhere on the Right was also quite supportive, with John Derbyshire at tending to agree for his own reasons with my appraisal of China’s advantageous position compared to that of the U.S. Similarly, Steve Sailer highlighted the article, and the reaction among his generally rightwing commenters was mostly very favorable.


Prominent libertarian and anti-globalization websites such as and also republished my article, distributing the ideas to much wider and more disparate readerships than are normally drawn to TAC’s own website, and these alternate distribution channels probably accounted for the majority of the blogsite comments and discussions, as well as my short television interview on Russia Today news. Explorations via Google also revealed that my piece was getting considerable favorable mention in even the more extreme ideological fringes of the Left and Right.

Despite finding favor at the “extremes,” it also simultaneously received the most mainstream possible endorsement, being distributed with favorable comment by former U.S. Ambassador Chas Freeman, who had also served as co-chair of the U.S. China Policy Foundation and vice-chair of the Atlantic Council. Outside political circles, Michael J. Casey, Managing Editor and Columnist on Financial Markets for The Wall Street Journal, broadcast it out to his twitter feed and also posted it on his blogsite, notably including my graph of the relative economic performance of the Chinese and American economies over the last thirty years. After all, investors in financial markets prefer to make their business decisions based on reality rather than merely ideological propaganda.


The only significant demurrals, explicit or implicit, seemed to come from might be called the “Establishment Right.” A very prominent conservative scholar who thought quite highly of my piece and passed it along to his friends later pointed me to a column by Rich Lowry, editor of National Review, which denounced “China Envy” and appeared a week or so after my own, and he suggested it had been intended as a rebuttal although the purported targets were mainstream liberal figures such the NYT’s Thomas Friedman and former SEIU leader Andy Stern.

Meanwhile, a far more substantive and detailed critique of China’s strength appeared in the current NR print edition by policy analyst Reihan Salam, which argued that China’s economic growth rate was unsustainable. He also pointed as an analogy to the many prominent Western intellectuals who for decades had claimed that supposedly high USSR industrial growth rates were proof that the American system was hopelessly outmatched by its Cold War rival. While I agree that Salam’s USA/USSR parallel is an apt one, I would argue that the weight of the evidence today actually places America in latter slot, for a wide variety of different reasons.

As I noted in my original piece, most Americans have experienced almost no growth in their personal income for the last thirty years, in total contrast to the Cold War economic boom decades of 1945-1980; meanwhile, ordinary Chinese have grown richer, faster than perhaps any people in all human history, a sharp contrast to the notorious consumer failure of the Soviet Regime. Furthermore, the massive, rampant growth of our totally non-productive national security state has led experienced observers to note striking Soviet parallels. For example, a former international journalist I know who had travelled both behind the Iron Curtain and more recently to China remarked:

I have been through passport control in the USSR, which was very like the US today. In Houston for example the officials went through my camera photo by photo and examined all CDs I had with me. I arrived in Pekin a few years back, expecting something similar. The passport looker-atter took maybe twenty seconds to find my visa, returned my passport, and that was that. I looked for a customs-inspection operation. There–I am stone cold sober–was none. I got in a cab and went to my hotel.

And a seemingly knowledgable commenter on Paul Craig Robert’s website made similar, far more detailed remarks, which were sufficiently interesting that I have decided to quote in full:

My first trip to “Red” China was in 1984. I have been there several times since then, and attest to its enormous economic and social strides there. Their progress over the past three decades is simply amazing.

During Mao’s time, and for many years thereafter, it was simply obvious that the Chinese state was more oppressive than the US government. China is still an authoritarian state, but my visit last year makes me wonder whether it is still more authoritarian than the US. Seriously. As an old American, and formerly quite patriotic and anti-Communist, this is still difficult to comprehend.

I have travelled the thousands of miles by railroad in China freely without providing identification. Identification for air travel was required, but security procedures were civilized. In fact, I was never harassed by authorities while travelling, quite unlike the US travel experience. We did have one run-in with the police, however. My sons and I were caught by a thunderstorm while walking one night, and the cops invited us to come inside their guardhouse to wait out the storm.

WRT the “extractive elites”: both countries have them. I don’t have a statistically significant sample size, but I’ve met some of the state elites in both countries. My own anecdotal experience is that the Chinese elites have about a 20 IQ point advantage over their American counterparts. I hypothesize that the relative intelligence of the elites may have a bearing on relative performance. I can’t say that I was close enough to any of these elites to determine their relative virtuousness or viciousness. However, the simple fact is that Chinese state enterprises are buying African properties rather than conquering them. Meanwhile the US state sends one military expedition after another to Africa.

I was in Beijing when the high-speed train crashed last summer. News of the crash was public shortly thereafter, but the government had initially gone in cover-up mode and had destroyed some of the evidence that could point to wrongdoing. We were surprised that the Chinese press immediately launched criticism of the government for this. Especially surprising was a discussion on CCTV between an interview and a Chinese journalism professor on the the need for transparency in modern China and quite pointed criticisms of government coverup activities. I do not recall comparably vociferous mainstream media criticism of potential US government coverups following, say, Waco, OKC, 9/11, or Fast And Furious. (Note: unlike many, I’m not saying there were orchestrated coverups in any particular case, but evidence was destroyed and there has been a lack of transparency on a number of aspects these cases. And the US media has been mostly mum.)

I lived in a genuinely oppressive, authoritarian Middle East country for six years, so I kind of know that authoritarianism isn’t binary, but is relative. The US is not yet close to the extreme of oppressive authoritarianism. Neither is 21st century China. The US is worse than China in a number of ways, mostly in ways related to taxation and foreign affairs. China, on the other hand, is less respectful of the rights enshrined in the 1st Amendment and has a particularly bad track record with respect to the Tibetans and the Uyghurs. As for corruption, well, I’d just say that US political elites are more sophisticated. How is it that former NJ governor, former US senator, and top Obama campaign fund bundler Jon Corzine steals over a billion dollars from his customers and walks as a free man?

Almost the only direct criticism of my article and its analysis appeared on an anti-litigation website, run by the neoconservative Manhattan Institute and presumably funded by corporate business interests including the pharmaceutical industry. Adjunct Fellow Ted Frank briefly claims that later research proved that Vioxx produced almost no negative effects on American health and that in fact “Merck’s experience with Vioxx is certainly a damning indictment of the American justice system, but for reasons opposite than the ones Unz thinks.” Presumably, therefore, the large shifts in the American mortality rate—which coincided exactly in time, age cohort, and medical cause with the introduction and later withdrawal of Vioxx—were purely coincidental. It should be noted that Mr. Frank appears to have absolutely no scientific or medical background, and is instead a lawyer by profession, with extensive political and journalistic experience. I suspect that during the late 1980s Pravda could have benefitted from his argumentative skills in explaining away the sharp rise of cancer deaths occuring in the vicinity of Chernobyl.


Yet will any of these arguments make a difference? TAC has a tiny print circulation, and even the largest of the other website outlets which have now distributed the information probably have regular daily article readerships in the tens of thousands at most, while the mainstream media of American television and radio reaches tens of millions and is almost completely silent about these matters. Perhaps not. But the inherent nature of the Internet does tend to level the playing field of information distribution channels, and over time, public awareness may gradually rise.

Consider, for example, my Hispanic Crime article of a couple of years ago, also published in TAC and also discussed and analyzed—often with very sharp disagreement—on a variety of relatively small circulation political websites, with no mention whatsoever in the mainstream or electronic media. In prior eras, such a piece, lacking any organized publicity campaign or prominent public advocate, would probably have vanished without a trace, leaving almost no impact whatsoever on the policy debate. Yet today, when I google the simple phrases “Latino Crime” or “Hispanic Crime”, my article comes up #2 in the rankings out of the more than 100M combined search results, with other articles discussing my analysis also appearing in the top 10. Therefore, I would think that the vast majority of journalists or researchers investigating the topic soon encounter my analysis, and it may play a role in shaping their thinking.

The analytical weightings used by Google and the other major search engines are complex and time-dependent, being extremely variable for recent items, so estimating the likely long-term impact of my current China/America package is quite difficult. However, a quick Google test currently places my article at #2 of 314M results for the phrase “China America Rise” and also #2 of 408M results for “China America Fall”, with fully 6 of the top 10 results of the latter being copies or discussions of my piece. Even more remarkably, the basic phrase “America Fall” currently returns my piece at #4 of 1.6 billion results found by Google. So perhaps my arguments may eventually even penetrate some small portions of the television-addled American public.

Whether that might happen soon enough to help avert a cataclysmic “America Fall” seems a very different question.

P.S. It was recently suggested to me that I make my columns and articles more conveniently available to a wider Internet audience, so I have now established a personal website for this purpose. It includes as many of my various published and unpublished writings as I have been able to locate. As discussed in the Permissions/FAQ section, any of my recent writings may be freely distributed (with attribution) on any other websites.

(Republished from The American Conservative by permission of author or representative)
• Category: Economics • Tags: China/America, Vioxx 
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  1. A few more notes
    1. Vioxx
    volumes declined by 30% from 2003 to 2004. For the entire year of 2003, Vioxx
    was dispensed at a rate of 1.663 million prescriptions per month. For the first
    9 months of 2004, the rate was 1.555 million prescriptions per month. That’s a
    decline of 6.5%. Of course, after 2004-09-30 the prescription rate was zero.
    As the
    reader can see the decline in Vioxx usage, pre-recall was quite small.
    Note that Vioxx volumes peaked in 2001 and declined thereafter. Why is not
    clear. However, Bextra was approved in 2002 and was commercially
    Stated differently, if Vioxx usage fell significantly before
    the recall it would show up in the prescription numbers. It doesn’t. My data
    does show a 30% fall from 2003 to 2004. However, that is for the entire year.
    You can get similar data by checking, This is a “Voice
    of the Pharmacist” website. The data is retail-only. It very closely matches the
    statistics I have produced so far (ultimately derived from the same sources,
    2. Of course, the actual cost of manufacturing brand name
    pharmaceuticals is a small fraction of the price (much less true for biologics).
    However, the $8.4 billion cited below is not the “cost” of making the free
    samples. It’s almost entirely the cost of sending detail agents to doctor
    offices. If you check the link, you will see that the $8.4 expense included 116
    million detail agent visits to doctor offices. At an average cost of $72.41 per
    visit, obviously the money was spent on wages, salaries, and travel expenses,
    not manufacturing samples.
    3. It is very unclear if Vioxx caused
    front-end (the most vulnerable first) or back-end mortality (a cumulative
    effect). This is an important issue and contrary indications exist. See
    “Q&A: Vioxx’s Health Risks” ( Merck tried to claim that there was no adverse impact prior to 18
    months. See Figure 2 from “Cardiovascular Events Associated with Rofecoxib in a
    Colorectal Adenoma Chemoprevention Trial 2005/03/17” ( If this claim was/is correct, the entire 1999 / Vioxx thesis is
    falsified. However, it does not appear to be true (which is why I have avoided
    it so far).
    Based on additional data and some corrections to the
    methods used in the original paper, the NEJM published a correction. See
    “Correction – Cardiovascular Events Associated with Rofecoxib in a Colorectal
    Adenoma Chemoprevention Trial 2006/07/13” ( To get a better understanding of the correction, see “Adverse
    Cardiovascular Effects of Rofecoxib 2006/07/13” ( The letters from Nissen and Furberg (noted Merck critics) are
    instructive. They reject the 18 month thesis and suggest an essentially linear
    cumulative risk model. I quote (from Nissen).
    “The original article
    included a post hoc hypothesis that curves for confirmed thrombotic events would
    not begin to diverge until after 18 months of exposure to rofecoxib. However,
    all intention-to-treat analyses in the newly released report show that the event
    curves begin to diverge much earlier, generally within four to six months. The
    most useful Kaplan–Meier curves, involving intention-to-treat analysis of the
    APTC end point, show divergence after only three months of exposure to
    At least one author appears to support the 18 month
    hypothesis (maybe). See “Time-to-Event Analyses for Long-Term Treatments — The
    APPROVe Trial 2006/07/13” (
    Note that none of the NEJM data shows any hint of
    front-loaded risks. The Merck model claims no incremental risk before 18 months.
    The contrary analysis seems to show greater risk much sooner. However, the risk
    is cumulative and linear. The longer a person took Vioxx the more likely they
    were to have some kind of heart failure as a consequence. Stated differently,
    they were at greater risk starting soon after they took Vioxx and eventually the
    risks added up.
    As should be clear, this is deeply problematic for any
    effort to blame Vioxx for 1999 mortality. Vioxx was dispensed for 7.33 months in
    1999 at a rate of 661,000 prescriptions per month. In 2000, the rate was 1.719
    million prescriptions per month. It would appear that far more people took Vioxx
    in 2000, than in 1999. However, a person
    could try to argue that Vioxx usage accelerated in 1999 and that the full 2000
    rate was reached late in 1999. Perhaps. However, let’s assume that it is true.
    This means that very few 1999 Vioxx users would have been taking it for 4-6
    months (or even 3 months) in 1999. Let’s go further and drop any risk onset
    delay and assume a purely linear model (incremental risks start on day one).
    That makes the total Vioxx risk equal to the number of prescriptions (which
    quadrupled between 1999 and 2000). This falsifies the 1999 Vioxx thesis
    However, let’s go further and assume a very front loaded
    risk profile (you either die quickly or you don’t die at all) and that Vioxx
    prescriptions accelerated to the 2000 rate by the end of 1999. With that
    combination of assumptions, the incremental mortality should have been in 1999.
    However, it also means that in 2004 there was no one left to die. Clearly Vioxx
    wasn’t adding a lot of new users by 2004 (sales had been declining since 2001).
    With a front loaded model, the Vioxx recall should not have reduced 2004
    4. Another very important question is whether incremental
    Vioxx mortality persisted after each person stopped taking Vioxx. Of course,
    Merck claimed that the answer was no. However, that may not be true. See “Study:
    Health Risk Remains a Year After Quitting Vioxx” ( Quote “”It was very surprising to me,” says Steven
    Nissen, acting chief of cardiovascular medicine at Ohio’s Cleveland Clinic. “I
    had always assumed that if you stop taking the drug, the risk would go away.”
    Nissen says this data shows that’s not true.
    “What it shows us is that you can stop taking Vioxx, and
    based upon this study, for the next year, you’re still at increased risk. And,
    in fact, the amount of increase is almost exactly the same as we saw during the
    three years that people were actually taking the drug,” Nissen
    Note also the author (Nissen). Assuming Nissen is correct,
    the 2004 Vioxx recall thesis is wrong.
    5. As the reader
    can see, all of the Vioxx mortality models falsify the 1999 / 2004 Vioxx
    thesis. The 18 months to trouble model (See “Vioxx: 18 Months to Trouble? – rules out any connection between the introduction of Vioxx in 1999
    and any incremental deaths. The front-loaded model (die now or not at all)
    allows for a major 1999 impact (with sufficiently accelerated Vioxx adoption in
    late 1999), but falsifies the 2004 impact of the recall. The linear cumulative
    risk model (apparently preferred by Merck’s critics) falsifies 1999 and 2004.
    The persistent risk thesis contradicts the front-loaded model and undermines any
    claims related to the recall.
    6. The NVSS data and the CDC data show
    declines in CVD mortality from 1998 to 1999. The decline may have been less than
    other years, but a decline is a decline. If Vioxx was really responsible for
    500,000 deaths, the data should have a large spike. No such spike exists. The
    smaller decline in 1999 is certainly interesting and may have been related to
    COX-2 sales. Note that Celebrex was introduced very early in 1999 and reached
    huge volumes in that year (unlike Vioxx). That’s not to say that Celebrex is
    responsible for the lesser decline in CVD mortality in 1999. However, it is a
    better fit.
    7. The CDC noted the upsurge in
    mortality in 1999 and analyzed it. See “Deaths: Preliminary Data for 1999”
    ( Quote
    “The preliminary number of deaths in
    the United States for 1999 totaled 2,391,630, an increase of 54,374 from the
    1998 total. The crude death rate increased from 864.7 per 100,000 population in
    1998 to 877.0 per 100,000 in 1999. The two influenza outbreaks of 1999
    contributed to the large increase in the number of deaths (10–12), especially
    among the older age groups and for several chronic diseases.”
    A later
    report (Deaths: Final Data for 2004 – makes the same point. Quote
    “Since 1980, the age-adjusted
    death rate has decreased every year except 1983, 1985, 1988, 1993, and 1999.
    During these years, influenza outbreaks contributed to increased mortality in
    the United States (14,15).”
    See the 1998 – 2001 P&I mortality data
    online ( for additional information. Note that the first 1999 mortality
    spike was in March (two months before Vioxx was introduced). 2004 deaths were
    lower than 2003. Once again, the P&I data provides some insight. Note the
    huge spike in late 2003 and the absence of such a spike in 2004. See for a graph. Thank you Peter


  2. The TAC needs to do some fact checking before
    publishing something like this. If Vioxx actually resulted in 500,000 premature
    deaths it would have shown up in the overall death rate. It didn’t. See
    “National Vital Statistics Reports” ( The overall and age-adjusted death rates fell from 1999 to 2005.
    Indeed, the age-adjusted death rate fell faster after 1999 than it did


    If the 500,000 statistic was correct, there
    should have been at least 100,000 incremental deaths in the peak year from
    Vioxx. That’s 33 per 100,000 for the entire U.S. See any blips
    in the data of the magnitude? They don’t stand out…


    Of course, the incremental deaths
    should really show up in the CVD (cardiovascular disease) mortality statistics.
    They don’t. See “US Death Rates 1975-2009? ( Also see some Arizona specific data (“Trends in Age-Adjusted
    Mortality Rates of Deaths due to Cardiovascular Disease, Arizona and US,
    1980-2004? – The Arizona data is not by itself particularly important (state
    level death rate variations are huge). However, the Arizona data exactly tracks
    the U.S. overall data.


    Is it possible that Vioxx resulted in 50,000
    deaths over the period in question? Sure. I don’t have anything approaching the
    background to evaluate such a claim. I wouldn’t be surprised either way as to
    the truth. For the record, I do have opinions on topics like this. I spent years
    deflating Thiomersal / autism claims…


    However, there is a larger issue here.
    NSAIDs (Celebrex, Vioxx, Bextra, etc.) are all associated with incremental
    mortality. Indeed, even Naproxen (also a COX-2 NSAID) has been linked to higher
    death rates. However, these drugs are simply too valuable to give up. Ask the
    people who take them, if anyone has any
    doubts. For many, NSAIDs are the difference between a normal life and ongoing,
    severe pain.


    This is why the FDA panel voted 31-1
    to keep Celebrex on the market. The same panel also voted 17-15 to keep Vioxx
    for sale. Even excluding panelists with industry ties, the vote was 8-14
    (losing) to approve Vioxx. If Vioxx was really as bad as some allege, why did 8
    panelists (with no industry ties) favor its continued sale? Why was the vote in
    favor of Celebrex (which is also linked to CVD) almost unanimous? See “10 on FDA
    Vioxx panel had ties to companies ” (


    Thank you


    Peter Schaeffer


    P.S. I have no ties to the drug industry
    (other than as a customer). I was once prescribed Naproxen many years ago. It
    was astonishingly helpful even though I only took it for a week or two. I have
    taken Aleve (OTC Naproxen) from time to time.

  3. > I suspect that during the late 1980s Pravda could have benefitted from his argumentative skills in explaining away the sharp rise of cancer deaths occuring in the vicinity of Chernobyl.

    Was there a sharp rise of cancer deaths occurring in the vicinity of Chernoby?

    I don’t think so. Show us your data.

    I looked into it, and the only significant cluster of cancer deaths near Chernobyl was nine deaths from thyroid cancer. Since the more you look for thyroid cancer, the more you are going to find, (thyroid cancer is an ill defined and ambiguous form of cancer with large numbers of false positives) and the more you find, the more people are going to be killed for iatrogenic reasons (cancer treatment is itself dangerous and life threatening) that these deaths were caused by Chernobyl is unclear. Supposing it to be real, nine deaths over a long time period in a large population is small potatoes compared to other things causing variation in the death rate, like the cost of heating caused by lack of nuclear power.

    All the high estimates of cancer deaths in the vicinity of Chernobyl are claims about what must have happened, not observations of what did happen.

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