Disease and Health

Part 1: A History of Disease and Health

A few miles south of Paris there is a small village named Pouilly le Fort. It is a quiet, sleepy, typically picturesque Frence village today. Just a hundred years ago, however, a large crowd of doctors, government inspectors,farmers, reporters, and public curiosity seekers were gathered here to witness a modern miracle.

Well, it wasn't exactly a miracle, though it seemd so at the time. It was a triumph, however, a scientific triumph, one of the most important in human history.

It happened on June 2, 1881. On the challenge of a local veterinarian, the famous chemist Louis Pasteur had come out from Pairs to demonstrate to one and all, once and for all, that it was germs that caused disease. More important, he had found a way to kill germs and prevent disease.

A few weeks before, Pasteur and his assistants injected twenty-four sheep, a couple of cows, and a goat with weakened anthrax bacteria. A control group of equal numbers was left without injection. Then, just a few days before June 2 all forty-eight sheep, all cows and goats, were given lethal injections of the deadly anthrax bacteria.

Now, with all present and eagerly holding their breath, Pasteur proudly let out into a field all of the sheep, cows, and the goat that he had injected earlier with his new vaccine. All were in fine health, with nary a sniffle.

Pasteur then proudly led the crowd to another part of the field where twenty-two of the non-vaccinated sheep lay dead, while the other two were fast approaching death, all from anthrax.

Unfortunately, all scientific demonstrations do not work that well. But for Louis Pasteur, a proud and contentious man, it was another in a series of dramatic personal triumphs over disease. Some of the first such triumphs in the long sad history of human disease and health.

Pasteur was not the first person to believe that diseases could be caused by germs. In fact it was his contemporary, the German bacteriologist Robert Koch, who first isolated the bacteria that caused anthrax, as well as the bacteria that caused the most dreaded killer of the nineteenth century, tuberculosis.

Until Koch and Pasteur's time, humankind as a whole, all over the known and unknown world, lived in almost total ignorance of the nature of disease. Theories to explain what caused disease, how to cure disease, and how to avoid disease were almost as numerous (and sometimes as deadly) as the diseases themselves.

All through the ages, people have relied heavily on magical and astrological theories. Disease was seen as an invasion of the body by evil spirits. The cure, therefore, must be found in magical words, objects, or actions that could drive the evil spirits out of the body and, in so doing, restore health. Ways of driving the evil spirits out ran a gamut from sacred herbs (which sometimes were helpful) to boring holes in the skull in order to let the spirits escape (seldom helpful).

Magical theories have often existed side-by-side with religious theories. Disease was seen as a punishment given to humans by a vengeful god or gods. The cure, therefore, must be found in prayer, in change of heart or in sacrifices to the gods. Here, too, the remedies could be helpful, as the patient gaining new confidence through faith and prayer, or they might be as destructive as sacrificing human beings in order to appease the gods and spare the rest of the community.

In both magical and religious theories, good health is seen as the absence of evil--evil spirits or evil sin. The person enjoying good health is either just plain lucky or, more likely in the religious view, morally upright.

Sporadic attempts at a more scientific approach to disease and health were made in many of the world's first great civilizations. One of the most influential was made of the island of Kos in the easter Mediterranean Sea. Here, in one of the world's first centers for healing, a man named Hippocrates worked to lay the groundwork for a more scientific approach to disease and health. "Diseases have natural causes," said Hippocrates, "and therefore, have natural cures."

Thus, while medical experts in nearby and far-off places were trying to appease the gods or drive off the demons by sprinkling bad dung over doorsteps or nailing human heads onto poles, Hippocrates was calmly prescribing rest, exercise, herbs, and healthy habits as more effective remedies.

Hippocrates also put into words some guiding principles of medicine, and indeed, of science. "It is valuable," he pointed out, "to know what attempts have failed, and why they have failed." His advice to a physician was as good then as it is now, "To help, or at least, to do no harm."

Despite this good advice, neither Hippocrates nor any of the succeeding schools of scientific medicine for the next thousand years made very much genuine progress in effectively treating disease. In fact, the sad truth is, the doctor of even a hundred years ago was almost as helpless as the doctor of two thousand years ago, or the medicine man or priest, when it came to actually preventing or curing any particular diseases.

One of the major problems was that people know so little about how their bodies were constructed or how they worked. By the time our country was founded in the late 1700's, advances had been made in descriptive anatomy, but physiology-the science of how the body parts work-remained mostly guesswork.

The Roman physician, Galen, wrote some of the first scientific treatises describing the anatomy of the body. Because of long-standing taboos against dissecting human cadavers, however, much of his work was based on the dissection of pigs and apes, and was highly inaccurate.

During the Renaissance, about the time Galileo was leading a revolution in our understanding of motion and astronomy, a man named Andreas Vesalius was looking more carefully at human bodies and correcting many of Galen's mistakes. Vesalius lectured in the most famous medical school in Europe, the University of Padua, Italy. Together with an artist, Jan Stephen van Calcar, he made some of the fist visual aids for medicine: charts sketching the bones, the muscles, the organs of the body in scientific detail.

These new charts were not only more accurate than any Galen or his followers ever had, they also marked a sharp change in attitude and approach. When earlier artists made sketches of the body, they were artistic perhaps, but they never bothered to be accurate in their rendition of particular parts or organs. They were intended, instead, to symbolize the prevailing astrological, magical, herbal, or scientific theory of the artist or author. Vesalius wanted to get the facts straight. The theory could come later.

Even the most careful and painstaking dissection of a dead human body, however, could never uncover many facts about how it worked in life. Physiology, the science of the working body, was still in its infancy.

The first breakthrough in physiology came from an English physician in the early 1600s. William Harvey, in a carefully worked out set of experiments and obvservations, was the first to propose and to prove that the blood circulates around the body in one continuous loop. It is pumped by the heart, is supplied oxygen by the lungs, food by the intestines and feeds the body cells with this food and oxygen before returning to the heart for another push.

Neither Vesalius nor Harvey had much effect on medical practice, however. Or on the terrible toll that disease had always taken and was still taking on human beings all around the globe.

Smallpox, syphilis, bubonic plague, typhoid, cholera, tuberculosis, diphtheria. Whole towns, whole countries would be decimated by these terrible diseases. More than once over a third of the entire population of Europe died in a plague called the Black Death. Smallpox was so common few people escaped having a pock-marked face. They were the lucky ones. Most people died.

Here at least-in smallpox-there was an early breakthrough. Around the time of the American Revolution, a country doctor in England, Edward Jenner, discovered a way to prevent smallpox.

Jenner noticed that milkmaids who got a similar but mild disease called cowpox never seemed to later get smallpox. Taking a chance, he injected himself and others with material from cowpox sores and found that this gave immunity to the dreaded smallpox. The basic technology of immunization had been discovered and given and early and successful trial. As yet no one knew how or why Jenner's vaccine worked, but it did work. That must surely rank as one of the greatest gifts humankind has ever received from science.

In the same eighteenth century another dreaded disease was conquered. Crews on long ocean voyages often got scurvy, a disease that maimed and killed. No one knew why. A surgeon in the British Navy, James Lind, experimented with diet and found that citrus fruit seemed to prevent the disease. After many years he was able to convince the authorities to provide lemons and limes on ships. Hence British sailors were called "limeys." It would be many more years before we learned why it worked- the citrus fruit contained Vitamin C, the lack of which, we know now, causes scurvy.

These two examples were exceptions in that day. Progress was slow otherwise. One of the big problems was that curing disease and achieving health has always relied heavily on advances in basic sciences like physics, chemistry, and biology. These sciences hardly existed in those early days.

Chemistry, for instance, came into its own as a science only in the late 1700s, when men like Joseph Priestley, Henry Cavendish, and Antoine Lavoisier began to unravel the mysteries of air, earth, water, and fire.

How could a doctor understand digestion or metabolism or respiration when no one up until the time of the American Revolution even knew there was a gas called oxygen, or an element called carbon. No one knew much about the chemistry of ordinary fire, much less human respiration.

How could a doctor know about germs until a city hall janitor in Delft, Holland named Anton van Leeuwenhoek, invented the microscope. In the seventeenth century Leeuwenhoek discovered a whole new world of life using his newly invented microscopes. He called these new microscopic plants and animals his "little beasties."

Once microscopes came into use, real progress toward understanding and controlling germ diseases became possible. Microscopes alone, however, were not enough. New laboratory techniques like ways to culture organisms and ways of staining and dyeing specimens, helped scientists identify and classify the microscopic germs they found in the blood of diseased patients.

Building on such advances, the chemist Louis Pasteur set up extremely productive laboratories in Pairs, Strasbourg, Lillie and in his ancestral home in the mountains of Arbois. Scientific work in these laboratories waved the French wine, beer and silk industries; cured rabies and prevented anthrax; proved life could only come from other life; and, most important of all, cleared away once and for all much of the thousands-of- years-old fog and superstition that surrounded disease. Work in Pasteur's laboratories offered genuine help to the poor physician in his age-old struggle to conquer pain and disease and to hold death at bay.

When the dam finally did break, the results were dramatic. Within the space of a few decades, humankind learned how to fight and conquer most germ diseases. Even the crusty cynic, H. L. Mencken, called it "one of the noblest chapters in the history of mankind." A chapter that brought giants like Pasteur, Koch, Ignaz Semmelweis, Paul Ehrlich, Florence Nightingale, Walter Reed, and so many other physicians, nurses, public health officials, politicians, and early environmentalists together to scientifically fight disease and restore health.

What these pioneers did was one-by-one to discover the germs that caused diptheria, tuberculosis, smallpox, childbed fever, syphilis, malaria, rabies, and dozens of other scourges of humankind from time immemorial. Using the new knowledge of how the diseases were transmitted, progress could be made in community and indivudual sanitation to prevent epidemics. They also in many cases-not all-were able to find effective vaccines (ways to immunize people against these diseases). Sometimes, though not nearly as often, they also found a cure for the disease.

In the nineteenth century, the groundwork was also laid for the modern hospitals of the twentieth century. In the twentieth century, new chemical antibiotics were discovered that could work miracle cures on diseases that were formerly fatal. Paul Ehrlich discovered an arsenic compound-they called it a "magic bullet"-that could cure syphilis. Alexander Fleming found a common mold, penicillin, that could tackle and kill a host of germs that caused diseases.

So much happened so fast, it is hard for us today to realize the debt we owe these pioneers. Over fifty percent (that's right, one-half!) of the children of England died before the age of ten in the sixteenth century. Before Pasteur, one out of twenty women who went to the maternity ward died in childbirth in the most advanced city in the world: Paris, France.

Robert Koch, who discovered the bacteria that caused tuberculosis, pointed out in a speech to a Berlin audience in 1882 that "even the most dreaded infectious diseases, such as bubonic plague, Asiatic cholera, etc. must rank far behind tuberculosis. Statistics teach that one-seventh of all human beings die of tuberculosis, and that if one considers only the productive middle age groups, tuberculosis carries away one-third and often more of these."

If you had surgery, the operation was unbelievably painful with no anesthetic beyond a glass of whiskey. To make matters worse, well over half of those who had surgery were doomed to a mercifully rapid death after the operation, as infection set in and took charge.

In my own lifetime, thousands of children, some of them my friends, were crippled or killed by a diseased called poliomyelitis. Scientists discovered a vaccine to prevent polio just in time to assure that my own children would not suffer from this terrible disease.

As the new scientific knowledge of medicine came into being, the average life span leaped from twenty-five years to forty-five in the space of a few decades. And then in the twentieth century the progress has accelerated even faster so that today the average life span in the developed world is over seventy-five years.

Does that mean that all our problems of disease and health are now solved?

Obviously not. But things are much better than they have ever been before. In the second part of this, we will look at disease and healthy today.

Part 2: Disease and Health Today and Tomorrow

There is an epidemic stalking the country today. Not too many people know about it. If it gets into the newspapers, it is on the inside pages. If it gets onto TV, it's not on primetime. If it gets into the magazines, on the posters or in government reports, it is seldom read.

It is an epidemic of wellness.

Never in all of human history has there been such good news. Some hospitals are advertising because they don't have enough patients to fill their beds. Doctors worry that there may be too many doctors in the coming decades. Most people who do get sick are getting well faster and staying that way. Even in the most dreaded disease of all, cancer, the death rate is slowly beginning to decline. If it weren't for cigarette smoking, especially among young women, the decline would be greater.

A few statistics to illustrate. Life expectancy in this country has increased steadily from forty-seven years in 1900 to over seventy-five years today. Age-adjusted death rates from heart disease, still the greatest killer, fell 18 percent between 1950 and 1970. Between 1950 and 1970 the death rate among young children fell 53 percent.

And yet the headlines and the best-selling books often read like a chamber of horrors. "Who's Poisoning America?" "The Plague on our Children." "The Politics of Poison." "The End of Nature." Television documentaries and movies claim the health care system in the United States is killing us instead of curing us.

You find cults and quacks in every city and town, offering the latest fads from miracle diets to psychic surgery. All to cure what ails us. Which is often surprisingly little. As the doctor and bestselling author Lewis Thomas says, "We seem to be a nation of healthy hypochondriacs, living gingerly and worrying ourselves to death."

So how can we today as a society and as individuals accelerate the century-long decline in disease, the century-long march toward wellness.

First let's look at what caused the wellness epidemic. Here the answers are clear. Two things. Better science and higher living standards.

For the better science we can thank the thousands of scientists, physicians, nurses, engineers, politicians, environmentalists and citizens who have led the way and are still leading the way to a more scientific understanding and control of disease. And toward a better understanding and nurturing of health.

For the higher living standards-better food, better shelter, better and safer transportation, better means of communication and the thousand and one other economic and cultural advantages that come with the highest living standard in all of human history-for all this we can thank the millions of creative workers yesterday and today upon whose shoulders we all stand. Workers who had the chance to work hard in a creative way because they lived in a free society such as ours.

Some might want to add a third point. This rapid decline in disease is so new in human history we have not had time to do much, or even think much about the other side of the coin, human health.

What would it be like to be exuberantly healthy? To be "fully awake" as the writer Henry David Thoreau once advised?

Recognizing these three background facts leads to a plainly laid out agenda for the future as well. For oneself and for world society as a whole. Just as many diseases of the past were conquered long before there was an accepted theory of disease, so today we can move toward more vibrant health even though we may have disputes about what health is.

Some experts today, for instance, say we must adopt a more holistic approach to health. That means we must concentrate our attention on the whole body, or better yet, the whole society, rather than getting too specialized in treating the ailing organ alone. Too often, these people say, we treat the symptoms of a social problem, neglecting the root causes.

Other experts say this is the same approach that failed in earlier centuries. What is needed is not philosophy but instead an even more intense search for ways to cure specific ills. For ways to cure specific diseases, individual or social. Each small advance can then be a real advance. It can create knowledge that works. The same approach used so successfully in the past by Pasteur, Koch, Semmelweis and others.

For two of the biggest health challenges we face today, drug abuse and the fatal epidemic disease AIDS, we may need to rely on the wisdom in both of these approaches. In both drug abuse and AIDS, progress toward health will require new scientific knowledge but it will also require new movement in social dimensions.

Let's take a brief look at the big picture today. Where are we in our search for health?

In all ages of the world before 1900, by far the greatest number of deaths were from infectious diseases like typhoid, tuberculosis, smallpox and malaria.

This does not mean we can afford to be complacent, of course. Scientifically or socially. Children still need their immunizations shots. All people need to be on guard to avoid exposure to infections and to deal promptly with them when and if they arrive.

We do still have serious infectious diseases that come seemingly out of nowhere. Diseases like HIV/AIDS that is now a pandemic affecting more than 38 million people world-wide. It takes time for research to come up with vaccines or cures for new infectious diseases like AIDS even though we now know where and how to look for them. We also know effective ways to limit the chances of infection. In the case of AIDS, for instance, since it is transmitted by intimate sexual contact, by blood transfusions or by drug addicts sharing dirty needles, we also know what directions to take in order to reduce the risks of infection.

By far the greatest killers today are heart disease and cancer. Neither of these is caused, so far as we know, by germs. Both attack older people much more frequently than young people. There are far more older people today than ever before and there has also been an increase in degenerative diseases like arthritis, diabetes, Parkinson’s and Alzheimer’s Disease.

For the young the greatest health problems today are automobile accidents and drugs (especially alcohol and cigarette smoking) and some would add today, obesity, especially in children.

What can we do about these killers?

Quite a bit. Plenty, as a matter of fact.

Just as immunization and antibiotics have proven their worth in preventing and curing infectious diseases, rather small changes in life style have proven their worth in preventing heart attacks, reducing your chances of getting cancer, and keeping you from getting maimed or killed in an automobile accident, or getting too fat.

For instance. By far the biggest thing most people can do to keep from getting cancer or heart disease is simple enough-don't smoke.

Similarly, by far the biggest thing all of us can do to prevent automobile accidents is also very simple-don't drink and drive.

It's that simple. Do it.

As for childhood obesity, changes in food habits can help. Cutting back on high sugar sodas, fast foods and high-fat foods as well as increasing the vegetable and fruit portions of a diet can not only lead to better health as a child but can help prevent serious health problems like diabetes and degenerative diseases as an adult.

Not smoking will not prevent all cancer, nor all heart disease. Not drinking and driving will not prevent all automobile accidents. And changing the diet will not prevent all obesity. But these simple measures could cut the rates in half or more. For the other half, we have to rely partly on the advance of medical science in the case of cancer and heart disease, on the engineering of roads and automobiles in the case of automobile accidents and on learning more about diet and genetics in the case of obesity. And we are making progress on all these fronts.

Despite our unfortunate tendency to poison ourselves with cigarettes, alcohol and other drugs, radical medical intervention has been able to prolong life and increase healthful activity by such new techniques as heart bypass surgery, kidney dialysis, heart pacemakers, radiation, surgical therapy, etc. Unfortunately these radical medical interventions are very expensive. When research makes more progress into a detailed understanding of causes, the prevention and cure will be cheaper and more effective.

New research into stem cells and other biotechnologies will be especially important in uncovering causes and inventing cures for many of the most difficult health challenges of the 21st century. And this research is also proceeding at a rapid pace today.

In the meantime, besides not smoking, there are other hints, both personal and environmental, that will help cut the chances of contracting heart disease or cancer. And, for that matter, the thousand and one other health threats that still and always will come with being alive.

What we eat and how much we eat is without doubt an important factor. While there is a great deal of controversy among the experts here, there does seem to be some consensus too. At least on a few points.

Like (1) not eating too much. That is, not becoming very fat. Being overweight increases your chances for heart attacks, cancer and a host of other unpleasant diseases. As well as cutting down your opportunities for healthy fun.

And (2) eating too little of the right foods. What are the right foods? Despite all the hoopla, all the money, advertising and propaganda promoting health foods, fast foods, organic foods, vitamin foods, fiber foods and heaven only knows what kind of foods, the great weight of scientific evidence still says "moderation in all things." Stick to making sure you get the basic foods on the USDA food pyramid every day.

The latest recommendations from the US Dept of Agriculture are in order of importance ... (1) breads and cereals (preferably whole grain ones); (2) vegetables (especially dark green and orange ones, along with peas and beans); (3) fruits (fresh, frozen, dried or canned—but go light on fruit juices) (4) dairy products (preferably low-fat or fat-free) and (5) meat, fish and/or nuts (preferably lean meat varied with fish, seeds, and nuts for protein).

The evidence seems to be accumulating that cutting down on fats and cholesterol (these are most plentiful in dairy products and meat), and increasing the amount of fiber in your diet (whole grains especially) are a good idea.

For the rest, three meals a day (with a good breakfast), plenty of vigorous exercise, seven or eight hours sleep, a good stretch of productive work and a healthy dose of fun and recreation. These kinds of common sense things can do wonders to keep you healthy, wealthy and wise.

As part of this common sense approach to good health, one final caution. If you hear of, or read of, or are offered a tool for good health that is almost too good to be true-be warned. It almost certainly is not true.

Past history and present reality are pock-marked with health quackery. The shelves of the supermarkets and health food stores, the magazine racks of the newsstands, even the stacks of the public library are chock- full of tempting invitations to instant health. Lose weight overnight; cure baldness; develop busts; cure arthritis; miraculous herb; cactus diet pills; vitamins for health; minerals for health; feel happier and healthier in thirty days or your money back.

Don't be taken in. As they say, a fool and his money are soon parted. More tragically, a fool and his health are soon ruined. At best, the majority of these highly touted health aids may make a few people feel better, as do "placebos" (see glossary) in standard medical practice. Rarely do they have any but chance effects on actual diseases. And rarely do they really do what they claim to do in promoting health, whether it be growing hair, expanding busts, preventing disease or protecting you from harmful chemicals.

Besides counting on the medical profession to accelerate its research into the root causes of various health problems, besides doing all you can to protect yourself from diseases and promote your own health, there is a third ingredient of disease and health today that we all must pay attention to. That third ingredient could be called public health, or community health.

Diseases are not all caused by germs or unwise and unhealthy personal habits. Nor can we always be cured by doctors or by ourselves as individuals. Nor can we all or any one of us-alone-achieve the vibrant kind of health Thoreau talked about. In other words, we need each other. All over the community, all over the world.

Gone are the days when an epidemic or war or drought or cloud of pollution or just plain craziness in one part of the world had little effect on another part of the world.

In these days of rapid transportation and almost instant communication, citizens of New England cannot isolate themselves from the toxic waste pollution coming from factory stacks in Chicago or St. Louis. Citizens of the United States, of India, of Germany, England, China or Russia cannot isolate themselves from the dangers of nuclear war. Nor from the dangers and the despair of poverty, prejudice, drug addiction and totalitarian suppression wherever it is found. Citizens in every country in the world, in other words, have a strong stake in the success or failure of citizens in every other country in the world.

In this world-wide quest to conquer disease and improve health, health-care systems—that is, doctors, nurses, hospitals, research scientists, etc.—are obviously important. Health care systems around the world today vary.

Many countries like Canada, England and most (though not all) European countries have adopted one-source national health care systems operated by the government, free to all citizens, and paid for from taxes. Others, like the United States, rely on a more diversified system--private insurance plans paid for by individuals or employers and supplemented by government grants for the poor, for children and for the elderly.

The national one-source plans seem to be a good deal cheaper but they also usually involve much longer waiting periods for some kinds of physician or hospital care.

Some claim that the system in the United States is inferior to the national health care systems of Canada and Europe. That is debatable. Horror stories of botched health care and hospital negligence are common in all health systems. No system is perfect, and every system can be improved. Despite its apparent higher cost, some facts seem to point to advantages in the diversified US system however.

For one. Many people from national one-source health care systems come to the United States for health care—and (except for crossing the border to Canada to get cheaper drugs) very few go the other way.

Two. Doctors, nurses and other health care professionals are emigrating to the United States in substantial numbers, sometimes to increase their incomes but also to take advantage of superior medical facilities.

Three. Most new drugs that offer effective help in coping with common as well as unusual diseases have been developed in the United States system rather than the government-led bureaucracies of many national health systems. Many of these drugs, especially new vaccines developed mostly by private companies in the U.S. in the 20th century, have been the major cause for a 30-year increase in life expectancy in the developed world, and major improvements in disease control in the under-developed worlds of Africa, Asia and South America. On the other hand, health care is not the same as health insurance.

For many people the peace of mind that comes with one-source free national health care systems for all citizens may outweigh the disadvantages. The system in the United States does leave over 30 million people without health insurance (though not necessarily without health care). Current political movements in the United States are attempting to remedy the defects of the US system without losing the advantages.

In spite of the many shortcomings and defects, health care everywhere in the developed world is many times better, if also more expensive, than it was even fifty years ago. You get what you pay for however. The increased cost has brought very large increases in life expectancy; huge decreases in infant mortality; huge decreases in chronic disease and pain. And substantial progress in preventing and in curing serious diseases like cancer, heart disease and HIV/AIDS. This progress can be expected to continue.

Unfortunately the health picture in some of the poorest countries of the world, especially in Africa, is not as encouraging. Diseases like malaria, dengue fever, river blindness and HIV/AIDS continue to take far too many lives, especially of children. Even here, bad as the situation might be right now, it was worse fifty or even fifteen years ago.

In other words in the last fifty years there has been genuine, in fact truly revolutionary progress everywhere in this world in conquering disease and promoting health. And with continuing progress in science and in improved living standards we can expect more of the same in the future.