Thursday January 8,1981
Vernonia Freedom — Page 7
Environment viewed as necessary part of health equation
by Rene Dubos
EDITOR'S NOTE: This is the first in a
series of fifteen articles exploring "The
Nation's Health." In this article,
microbiologist Rene Dubos discusses the
potential and limits of modem medicine.
This series, written for COURSES BY
NEWSPAPER, a program of University
Extension, University of California, San
Diego, was funded by a grant from the
National Endowment for the Humanities.
THE NATION S HEALTH I:
MEDICINE AND HEALTH
A generation ago, there was almost
universal faith in the miraculous power-of
modern medicine.
There have been numerous spectacular
medical advances since then, yet,
paradoxically, it has become fashionable
to downgrade the contributions of
medicine to1 health. -
Several learned physicians have even
stated that the steady improvement in
public health during this century has been
brought about not by medicine, but by
improvements in sanitation, nutrition,
housing, and our general standard of
living.
There is some truth in that statement.
But it is also true that several diseases
that used to kill large numbers of people
can now be readily cured, thanks to
modem medicine. I shall use my own life
as an example.
I was almost 79 years old when I wrote
these lines. I walked several miles every
day in any kind of weather. I climbed
three flights of stairs to my office and had
many
national
and
international
activities, carrying my own luggage
wherever I traveled.
All this sounds as if I had always been
in perfect Jiealth. But in fact, I have been
medically handicapped throughout my
life.
At age 8, I contracted a severe sore
throat and developed acute rheumatic
fever that resulted in a heart lesion, at the
aortic valve. This lesion is still with me
and has made me a cardiac cripple,
preventing me from playing the
conventional games.
Some 10 years ago, I developed
bacterial endocarditis, an inflammation of
the heart membrane. This disease used to
be uniformly fatal, but I recovered
because it can now be successfully treated
with antibiotics.
I have had several attacks of atrial
fibrillation, or irregular muscle spasms of
the heart, and in fact am fibrillating right
now. After each episode, I have tried to
rehabilitate myself by progressively
increasing my physical activities. I have
been so successful that at age 78, before
my last attack of fibrillation, I was
Copyright © 1980 by the Regents of the University of
California.
physically more vigorous than ever
before.
My medical history would have been
very different had I been born fifty years
later. Laboratory tests would have^shown
that my initial sore throat Was caused by
a hemolytic streptococcus, and doctors
would have known that infection with this
microbe commonly leads to rheumatic
fever. I would have been immediately
treated with an antibiotic and would
never have suffered from rheumatic heart
disease. In fact, as a result of modem
medicine, this type of heart condition is
becoming rare.
CHANGING CAUSES OF DEATH
Until the end of the last century, a very
large percentage of young people suffered
and died from malnutrition and infection.
Today, in contrast, poor nutrition is no
Such differences and changes in the
prevalence of fatal diseases make it
obvious that these diseases are not the
inevitable consequences of aging but are
largely determined by environmental
factors. This conclusion is supported by
the fact that ethnic groups who adopt
American ways of life also acquire the
disease
patterns
characteristic
of
Americans.
Social relationships are other aspects of
the environment that affect health and
disease. People who are. single, widowed,
divorced, dissatisfied with their jobs, or
The Nation's Health
longer a significant problem in the United
States except among very poor people or
in fringe social groups.
The most destructive microbial plagues
of the past have also been essentially
brought under control. For example,
tuberculosis,
lobar
pneumonia,
streptococcus infections, typhoid fever,
dysentery, smallpox, poliomyelitis, and
measles can either be prevented by
sanitation and vaccination or cured by
drugs. As a result of the control of
nutritional and microbial diseases, the
causes of • death are now completely
different from what they were half a
century ago.
For people under 40, the chief causes of
death are no longer diseases, but
homicide, suicide, automobile accidents,
and other forms of violence. After age 40,
although deaths from violence continue to
be common, more and more people die
from a small variety of chronic and
degenerative
«diseases,
particularly
arteriosclerotic heart disease, strokes,
various forms of cancer, and cirrhosis of
the liver.
The various causes of death now affect
similarly black and white people in the
United States, but their prevalence
differs profoundly from one part of the
world to another and changes with time.
During the 1970s, for example, the death
rate from coronary heart disease was ten
times higher in the United States than in
Japan!
As is well known, lung cancer has been
extremely high in American men for
several decades and is beginning to
increase in women, almost certainly as a
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undergoing life changes are more likely to
need medical care than are people with a
more satisfying life.
Thus, a person’s state of health seems
to be influenced by life styles and the
quality of the environment. To a large
extent we create our own environmental
pollution when we smoke or eat junk food;
many forms of stress come from our being
envious of others or too Ambitious.
CONTROL OF DISEASE
Nutritional and microbial diseases that
used* to be common in the past can be
controlled by methods requiring little
effort on the part of the person to be
protected or treated, for example, by
adding chlorine to public water supplies,«
giving
appropriate
vaccines,
administering a drug, supplementing food
with vitamins.
In contrast,
it takes personal
responsibility and a sense of discipline to
control, over a whole lifespan, one’s food
and alcohol consumption, cigarette
smoking,
driving
habits,
physical
exercise, and equanimity toward other
people.
There are good reasons to be skeptical
about the possibility of changing human
behavior, but there are also reasons for
hope. For example, deaths from heart
disease, which had steadily increased
since the beginning of the century, began
to decline in the 1960s and have continued
to decline ever since.
This improvement may be due in part to
the use of drugs against hypertension and
to better handling of heart attack victims,
but changes in our ways of life have
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result of smoking. In contrast, cancers of
the stomach and of the uterus have
markedly decreased in the United States,
whereas they have remained high in
several other countries.
429-8031
probably also played a role. Cigarette
smoking has markedly decreased among
adult men (although it is increasing
among women and teen-agers); we have
appreciably reduced the saturated fatty
acids in our diet; and we may have
increased our physical activity, as
indicated by the popularity of jogging
and other active sports.
The ideal goal of medical intervention
is, of course, either to prevent disease or
to achieve complete cure. There are many
situations, however, in which medicine
can contribute to the welfare of people,
even though it cannot prevent or cure
disease.
Medical care can relieve symptoms, for
example, by treating patients suffering
from arthritis or hypertension with drugs
and advising them as to the proper ways
of life. It can facilitate rehabilitation by
helping the patient to compensate for one
or another handicap —. as I have been
able to do with my own cardiac
insufficiency. Finally, it can relieve
anxiety by reassuring a patient, for
example, as my physician did when he
told me that atrial fibrillation is
compatible with a fairly normal life.
Disease is probably inevitable because
we can never achieve perfect adaptation
to the various environments in which we
live. I doubt, furthermore, that medicine
can ever develop methods for the
complete prevention or cure of all
diseases.
But I believe that medicine will be
increasingly capable of enabling patients
to function comfortably and effectively
even in the continued presence of organic
disease — a goal at least as important as
the prevention and cure of disease or the
addition of still more years to our lifespan.
NEXT WEEK: Dr. Lester
Breslow, Dean of the School of
Public
Health
at
the
University of California, Los
Angeles, discusses how and
why our health has been
improving.
ABOUT THE AUTHOR
RENE DUBOS is Professor Emeritus of
The Rockefeller University, where he first
joined the faculty in
1927.
A
microbiologist
and
experimental
pathologist, he was a pioneer in the
development of antibiotics. From 1946 to
1972, he edited “The Journal of
Experimental Medicine,” and he has been
a contributing editor to “The American
Scholar” since 1970.
The views expressed in COURSES BY
NEWSPAPER are those of the authors
only and do not necessarily reflect those
of the University of California, the
National Endowment for the Humanities,
or the participating newspapers and
colleges.
HILLIER, DO
is having office hours Friday, 9 am to 3 pm
starting Dec. 5.
Osteopathic physician and surgeon. Specializing
in pediatrics: newborn, infant, child adolescent
medicine.
General practice—Adults.
Phone number— 429 5061 or 653-0260, Milwaukie.
Address-622 E. Bridge- The Vernonia Clinic
Appointments preferred, walk-ins welcome.
Payment preferred at time of visit.