2hh6é Huidekoper Pl., N. Wey
Washington, D. C., 20007,
November 25, 1967.

Dr Joshua Lederberg, Columist,
The Washington Post,
Washington, D. G7

Dear Dr Lederberg:

I have just read your column on infant mortality, and how the Scandanavian countries
have a lower rate than the U. S. A. I heard an interview on the radio with a Swedish doc-
tor who says that this difference is largely due to the fact that Sweden uses different
criteria for what it considers a live-born or still-borm infant from those used in this
country. Now beginning here I am on uncertain ground, for I do not recall exactly what
the difference is, but I vaguely remember his saying something like the American doctors
regarding an infant as live-born if it shows any signs of life, while Swedish doctors
do so only if it responds to certain induced stimuli (which I do not recall to the extent
that it wold be worth mentioning my impressions); and that if the infant does show cer-
tain signs of life, but does not pass the demanding Swedish test and later'dies,! in Swe-
den it would never have been considered alive, whereas in the U. S. A. it would have heen
considered lLive-born and later to have died. Then he also went on to mention other pos-
sible (but little-understood) factors, such as an ethnic or hereditary causes as possible
influences which could induce the difference between American and Swedish figures.

Sweden is a small, prosperous, uniform nations; American a large conglomerate of wide
differences both ethnically and economically, The two do not make for meaningful correl-
ations between them. I mean, you segregated the Negro statistics from those for whites.

To arrive at statistics which are meaningful for comparison between Sweeden, or any country
like it, and America, it would be necessary to do the same right on down the line: to sep}
arate other groups within the white population according to ethnical (and thus vossibly
hereditary differences, (Think, for example, of the Puerto Ricans alone as a distinct
group: certainly it would not be meaningful to group then along with people of, let us say,
German ancestry.) And so done, the group that would represent the equivalent of the

Swedes in Sweden might well correspond to the Swedes in statistics about infant mortality.

Well all that concerns a small point, but it touches on a large issue. You physicians
have devised means of reducing infant mortality to a remarkable degree. In previous ages
infant mortality was nature's means of keeping populations "under control." (There were
others too, such as disease which also your vrofession has done an enormous amount to
reduce, but now we are not discussing that.) In primitive (and some not so primitive )coun-
tries it is habitual for families to have many children. Many of these die at an early
age, and many adults die prematurely from disease. It is not ethical for modern medicine
to "enter" a country bringing with it the means for preventing premature death, without
at the same time verfecting techniques for birth control. In fact, modern medicine--this
should become a professional vrinciple--should not be introduced into a country until
indoctrination about birth control is widely disseminated and practiced. This, of course,
has not been done, and we are now facing the problem of the population "explosion." But
to get further away from countries like India and China, which the last thought instinc-
tively brings to mind, and to come home, I would not be so distressed about the relatively
high rate of infant mortality in America, Many have argued--and they so argued long ago,
'way back when our population was 120 million--that it would be an unfortunate thing for
the population of the U. S. to exceed 200 million; and yet it not only has done so, but

is advancing at an increasingly greater rate} You may say that birth-control is a politi-
cal problem, and indeed it is. That everybody in America knows how to prevent childbirth
is certainly true, and therefore it is now, no’ longer up to physicians but up to the pol-
iticians to prevent increase, as by economic "fines" (best done through the income tax)

on families who have more than, let us say, two or three children, But you know very well
that the committment of these politicians, whether to initiate plans or to espouse them,
is determined by pressure, to dispense with delicacies, and some group must now begin to
raise the issue of poltttcal control of the population problem so that the public will
begin to discuss it and so that it will become a great problem of public concern, ‘ow you
have Written an article on infant mortality. You should also write one--write ten! on
population control, Yours was the profession, Sir, who “interferred" with nature in stop-
ping disease and in reducing infant mortality (and well that vou did). It therefore falls
to you to initiate the counterpoise of population limitation, If you do not, no one else
will (certainly not the politicians!) and in another generation or two we will be a nation
of 300 million, increasing geometrically from there to who knows what limit. Rut as usual,
we will probably begin our consideration of the issue only after it becomes a problem (i.€.,
in this case, after we have become over populated). So thal Ts my appeal to you. ~s

Si ep VOUurs, /
oY ¢, tos

7 - Toe ee.
W. P, Henry ,