In their response to my letter,1 Stuckler et al 2 refer to cancer outcomes and the Great Depression as if I were suggesting a link between them. But this is to muddle the issue. What I said is that cancer mortality decreased during the Great Depression of the early 1930s. It is not correct, as it was maintained in the paper that I criticised, that ‘[c]onsistent with longer-term patterns commonly referred to as ‘epidemiologic transition,’ chronic non-communicable diseases and injuries tended to rise during the Great Depression.’3

Second, Stuckler et al 2 say they found ‘that the mechanisms linking economic changes to infectious diseases are complex and time-varying, but we cannot identify a plausible mechanism by which the Great Depression might have caused a decline in deaths …