Citation for the River Story

“You know,” he said, “sometimes it feels like this. There I am standing by the shore of a swiftly flowing river and I hear the cry of a drowning man. So I jump into the river, put my arms around him, pull him to the shore and apply artificial respiration. Just when he begins to breathe, there is another cry for help. So I jump into the river, reach him, pull him to the shore, apply artificial respiration, and then just as he begins to breathe, another cry for help. So back in the river again, reaching, pulling, applying, breathing and then another yell. Again and again, without end, goes the sequence. You know, I am so busy jumping in, pulling them to shore, applying artificial respiration, that I have no time to see who the hell is upstream pushing them all in.”

In “The Case for Refocusing Upstream: The Political Economy of Illness” John B. McKinlay attributed this story to the medical sociologist Irvin Zola.


  • McKinlay, J.B. (1975). A case for refocusing upstream: The political economy of illness. In Applying Behavioral Science to Cardiovascular Risk (pp. 7-17). New York: American Heart Association.