Making Disease History (Part of series: Disease as Reflection)

 

In one of the many incongruities of human society, the field of public health, which strives to give people longer, healthier lives, periodically declares war… and often ends up shooting itself in the foot.

 

Wars against various diseases: leprosy, tuberculosis, heart disease, AIDS, and the biggest of them all – Cancer. Stepping into the spotlight, the vainglorious leaders of the health profession announce the end of all suffering that a particular disease has wrought on human society, while sheepishly begging for more funds from government or appealing to the philanthropic side of the rich and mighty who have often made money by selling the very things that propagate these diseases.

 

The public health scientists promise that a particular scourge of humanity will be eliminated, or even eradicated, depending on how vain they feel on that particular day. They often say that very soon they will be “making disease history.”

 

“Making disease history” can be interpreted in two ways depending on where one places the invisible punctuation while articulating the phrase. One could read it as, and this would be the common interpretation: Making Disease — (into) History. This means that soon this particular disease will become history, a thing of the past, and no one will ever suffer from it. Although a very valuable and honorable goal, it is rarely questioned by the audience: Is it even possible to make “disease” history?

 

Nothing is more illustrative of the complexity of living on this planet than the phenomenon of disease, which is inextricably intertwined with life. The connection between the two is illuminated articulately by the opening lines of Susan Sontag’s (1978) essay Illness and Metaphor: “Illness is the night side of life, a more onerous citizenship. Everyone who is born holds a dual citizenship, in the kingdom of the well and in the kingdom of the sick. Although we all prefer to use only the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place.” [1]

 

“Making Disease History.” The phrase makes the endeavor sound simple. It has to be because all calls for war necessarily render the most complex of human phenomena simplistic. What other reason, except a very simple-minded one, can make people go to war anyway, even if it is against a disease?

 

At present, the medical care system, predominantly clinical and curative in approach, is the dominant arsenal in the war against diseases. Using the medical care system to wage a war against diseases seems paradoxical because the medical/hospital system depends on diseases for its survival and also to justify its existence. The proliferation of disease only means more patients, more prescriptions, and more diagnostic tests. A medical care system that sees billions of dollars in revenues, is responsible for the jobs of an increasing number of health professionals, and makes huge profits for the medical technology and pharmaceutical industries can scarcely be expected to wipe out diseases, for that would make it a victim of its own success.

 

Perhaps what the health leaders really mean to say is that they while they make one disease history, on the other hand they will allow another ten diseases to emerge; and if (new) diseases refuse to emerge then the health system will try and kill you. “Iatrogenic diseases” are among the top 5 killers (at least in the United States of America). The dictionary says the meaning of “iatrogenic” is that which is caused by the diagnosis, manner, or treatment of a physician. Iatrogenic diseases are those diseases or conditions caused by medical treatment or health professionals. These are diseases acquired in hospitals or during the seeking of treatment.

 

Researcher Barbara Starfield in a paper published more than 10 years ago in the Journal of American Medicine (JAMA, 2000) cited the Institute of Medicine (IOM) report titled “To Err is Human” which found that nearly 44,000 to 98,000 Americans died due to medical errors by hospitals or health professionals. Starfield writes that iatrogenic causes amount to the third leading cause of death — 225 000 deaths annually — in the United States, after heart disease deaths and cancer deaths. [2] [3]

 

If the truth is that the hospital system itself is one of the largest killers of human beings, then making Disease History would also include making hospitals history. The war against diseases would become a war against hospitals and health systems.

 

The question that we have to ask is: Would professionals with such high stakes, vested interest, and power willingly want to lose their position of advantage and become history themselves in trying to make disease – (into) history?

***    ***

 

The use of the existing medical care system in the war against diseases leads us to the second interpretation, which is probably more realistic – “Making — (it into the pages of) Disease History.” Disease-history like European, Japanese, or Roman History necessitates the writing of books about kings and courtiers, the villainous and the vanquished. Thus, by navigating the medical system successfully, discovering a gene for a disease, or making a profit of a billion dollars in a merger or massive retrenchment, one could very easily go into the history books. Thus “Making it into the pages of Disease-History.”

 

This history is similar to that of nations and kingdoms, where people keep fighting wars, never learning anything from their own past; and condemned to repeat history forever. It seems that most of the vainglorious leaders, who proclaim wars on diseases, are repeating the mistakes of our history, for very few of them have actually committed themselves to changing the present state of the health care system. They are perpetuating the inequities of the current health system and making unrealistic amounts of money while hypocritically making speeches about fighting diseases and saving the poor with public health.

 

If we were to truly attempt to make disease history, what kinds of processes and changes would be necessitated? Would we treat disease like an enemy and destroy it? Is disease merely an enemy agent that infiltrates our bodies or is it part of our bodies? What causes cancer? Is it the chemicals in the environment, the smoking, the stressors, the bad genes, or is it the interaction of all of the above? Is it even possible to selectively detect and destroy diseases without harming ourselves?

 

Rudolf Virchow who lived between 1821 and 1902, and was one of the early proponents of social medicine, expressed almost a century and a half ago that human culture is a decisive determinant of epidemic diseases:

“Epidemics of a character unknown so far appear, and often disappear without traces when a new culture period has started… The history of artificial epidemics is therefore the history of disturbances of human culture. Their changes announce to us in gigantic signs the turning points of culture in new directions.” [4]

 

William McNeill (1977) in Plagues and Peoples brings the history of infectious diseases into the realm of historical explanation by showing how varying patterns of disease circulation have affected human affairs in ancient as well as in modern times. [5] His book establishes the tremendous influence that diseases, especially epidemics, have had upon human history. Every time the precarious balance between microbes and the human host becomes imbalanced, serious demographic, economic and military crises occur in populations. He makes the connection between history of human populations and the history of diseases – thus, making disease the major factor shaping the history of human populations.

 

If diseases are as much part of society, the culture, and the times we live in as they are of individual bodies, then can a particular disease or an individual with a disease be taken apart of or separated from the social fabric? The making of diseases into history will call for treatment of the entire social fabric; the social, political, and economic arrangements that shape our present, including the individuals and diseases that are part of it.

 

Creating a future free of disease entails changing the present, and only then will we be able to talk of diseases as something of the past. Any attempt to change the present forces us to confront our own power and financial advantage. In a time in human society where self-preservation rises above all else, what cultural factors would permit that self-effacing step, even if it meant that one could “make disease — (into) history.”

 

If diseases are here with us to stay, then the singular factor that could distinguish us from previous eras is not the elimination of diseases, but our reactions and responses to their occurrence. Do we stigmatize and isolate patients, throw them out of society, label them deviant, and dangerous, and discriminate against them in many ways including not giving them the required medical treatment because they cannot pay or cannot afford?

 

Let us take the case of hunger. If hunger is labelled as a disease, then the basic treatment for hunger is food – simple, basic food items such as rice, wheat, potatoes, or fruits and berries that grow wildly on trees. Do we allow people in our society to go hungry without the very basic of food necessities because they cannot pay for the food that is sold in shops? If yes, then we need to ask ourselves: Why? Why has food that can be the treatment for the hungry become a high-priced commodity that is out of reach of many in the world? The earth allows trees, plants, food to grow everywhere, yet people are hungry everywhere. What are our values and beliefs that allow us to perpetuate this very basic injustice on a daily basis?

 

In order to truly make disease (into) history, we have to fight the enemy that has never been confronted – our values, our sense of oppression and our systems that perpetuate injustice. These only serve to entrench diseases in sub-groups of our population – sub-groups that are vulnerable, historically poor or discriminated. The manner in which we talk about disease today only fortify our narrow-minded ideas of the diseased in human populations. Do we possess the strength within our culturally-defined selfish and greedy selves to declare war on ourselves? Do we have the courage to fight a war against our own society and culture in order to realize the highly humane end of making all diseases history?

 

Dis-ease is simply defined as the absence of ease. We have become creatures of comfort – of ease. The simple question for each of us: Am I willing to put my-self at un-ease in order to eradicate disease for the other?

 

 

© Nilesh Chatterjee, 2014

 

 

References

1. From Sontag S. Illness and Metaphor. New York: Farrar, Straus and Giroux, 1978.

2. Barbara Starfield, MD, MPH. Commentary: Is US Health Really the Best in the World? Journal of American Medical Association (JAMA). 284(4):483-485.July 26, 2000. doi:10.1001/jama.284.4.483.

3. Institute of Medicine. TO ERR IS HUMAN: BUILDING A SAFER HEALTH SYSTEM. November 1999.

http://www.iom.edu/~/media/Files/Report%20Files/1999/To-Err-is-Human/To%20Err%20is%20Human%201999%20%20report%20brief.pdf

4. From Stamler J. Established major coronary risk factors. In Marmot M and Elliott P (eds). Coronary Heart Disease Epidemiology: From Aetiology to Public Health. Oxford: Oxford University Press, 1992: 35.

5.  From McNeill W. Plagues and Peoples. New York: Doubleday, 1977.


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