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The Mirage of Health BIOLOGY TODAY TheMirageofHealth MAURA C. FLANNERY, DEPARTMENT EDITOR I am writing this column in late August, so it's difficult to predict to antibiotics, that the reign of these drugs was likely to be short what the HI N I flu situation will be by like the time it is published lived and could only be extended by human ingenuity working towards the end of the year. Since there is already a pandemic, to keep one step ahead of the microbes. Dubos was born and the spread of the virus will likely have picked up more steam by educated in France at the beginning of the 20th century, when Downloaded from http://online.ucpress.edu/abt/article-pdf/71/9/558/55307/20565381.pdf by guest on 27 September 2021 that time, but how much steam it is difficult to forecast So I'm French microbiology was still very much under the sway of Louis not even going to try. Instead, Iwill make a prognostication that Pasteur's intellectual heritage. He came to the United States and is a safer bet: there will continue to be health issues of some kind spent most of his career as a researcher at what is now Rockefeller at the end of this year, at the end of this century, and on to the University in New York. There he discovered gramicidin, the first end of this millennium. I am using as my crystal ball a book by clinically tested antibiotic. While it didn't prove to be an effective Rene Dubos (1901-1982) called Mirage of Health (1959). It seems drug, Dubos's research did yield useful information on antibi appropriate to examine this book on the fiftieth anniversary of its otic dynamics both in culture and in living organisms. When publication, because it is at least as relevant today as itwas at the penicillin was discovered and being developed as a drug, he was time it came out. Also, since this issue of ABT is devoted to health involved in the early work done in the United States. He also did and medicine, this work is a great reminder of the limits of the research on tuberculosis and pneumonia. latter to ensure the former. It was Dubos's studies on how bacteria became resistant to The book's main argument is that, as the title suggests, the effects of antibiotics that led him to consider the theme of the quest for perfect health is an unending one, just as walking health as amirage. By this time, in addition to his journal articles, towards amirage is a fruitless task. Dubos contends that the idea Dubos had already published two books for the general reader: a that better days are coming, that ifwe get rid of the latest scourge biography of Pasteur (1950) and a book on tuberculosis (1952). to health, life will be wonderful and we will to a ripe old age in Inmidlife, he had discovered his gift for communication and went good health, just isn't going to happen. In other words, finding on to publish over a dozen more books, including So Human the "cure" for cancer or HIV infections or . isn't going tomake an Animal (1968) for which he received the Pulitzer Prize. The lifewonderful. He cites as support for his view the fact that find subtitle for The Mirage of Health is Utopias, Progress and Biological ing a cure for tuberculosis (TB), the scourge of the 19th century, Change, and Dubos addresses the question of health from each of did not lead to a health utopia. In fact, thanks to life style changes these three perspectives. He came from a European tradition of rather than medical advances, the incidence of TB had already deep and broad learning; he was well-versed in history so he situ decreased significantly even before an antibiotic treatment for this ates his argument in terms of past efforts to improve health. He bacterial infection became available in the 1950s. describes why any hope that persistent efforts will lead to a future without disease are hardly of recent origin, though attempts to I have been reminded of Dubos's book frequently over the achieve this goal may have been of very different kinds in the past. years since I first read it in the 1970s. Most particularly, it came Ponce de Leon's search for the fountain of youth was one manifes tomind in the 1980s when HIV and then Ebola virus entered our tation of this predilection because youth and health are obviously consciousness. For those who don't remember these times, both related to each other as are old age and illness. Others saw such infections came as rather a shock to the American public who had utopias as existing in unspoiled parts of the such as the become accustomed to the idea that infectious disease was no lon world, islands of the South Pacific, where civilization had yet to intrude. ger fatal. To put it very simply, bacterial infections could be treated The link between civilized life and problems was emphasized by with antibiotics and viral diseases prevented with vaccines. Then Rousseau who saw a move back to nature as the cure no only for AIDS arrived, an infectious, incurable and in those early years, physical but social ills. almost inevitably fatal, disease. This was not something we were prepared for because many of us, the baby boomers who had swelled the population, had never experienced the years when Balance and the Environment bacterial pneumonia was dangerously common and a bad cut Dubos also further back in to the time ancient could lead to an uncontrollable infection. goes history of the Greeks and of course, to Hippocrates who considered health a Microbiology result of balance in the body and ill-health to a disruption of that balance, due to too much or too little of one of the four basic How could Dubos have been so prescient when most Americans humors or fluids in the body: black bile, yellow bile, phlegm, and were shocked by this onslaught and the others to follow? First blood. This idea of health as balance continued to be an important of all, he was a microbiologist. He was already aware, more than theme in approaches to keeping people well and is still significant most people of the time, that bacteria were developing resistance today. We are warned not to: not eat too much or too little, not a THEAMERICAN BIOLOGY TEACHER VOLUME71,NO. 9,NOVEMBER/DECEMBER 2009 to over exercise but to exercise "enough," not to loaf or work too social and political turmoil. Such upheavals include not only wars hard, etc. Hippocrates saw the environment in which a person and revolutions, but also floods, earthquakes, and other natural lived as important to balance, so there needed to be equilibrium disasters. in interactions with nature as well as within the human being. However, Dubos looks at the other side of the coin as well Others saw illness in more specific terms, with different illnesses and examines the social and political environments which lead having different causes and resulting in different problems within to health improvements. He argues that tuberculosis, bacterial the body, what came to be called the "specific etiology" view pneumonia, and cholera had become much less lethal in the 19th of disease. This is obviously the dominant opinion in medicine century, well before the discovery of the specific etiologies of today, and Dubos traces its development and its consequences, these infections. Better sanitation and improved living conditions focusing on medical approaches to, not surprisingly, infectious were responsible for this improvement. When I first read this, it disease, especially in the 19th century. This was when microbiol really impressed me, and I have emphasized this when presenting ogy was beginning as a science, when Koch, Pasteur, and others infectious disease topic to students. Pasteur and his successors were identifying specific organisms as the cause of specific kinds did a very good job of indoctrinating the public with the idea that of illnesses. But this cause-and-effect relationship was not always if the infectious agent is removed so is the disease. But itmakes clear-cut and many in the field questioned it. They argued that a big difference when that removal takes place-before or after an diseases such as tuberculosis and cholera were not the result of individual is infected. Drugs may lessen the effects of infections, invisible organisms but rather of the conditions of life. but it's better not to get them. Itwas well-known that those who lived in poverty were more Downloaded from http://online.ucpress.edu/abt/article-pdf/71/9/558/55307/20565381.pdf by guest on 27 September 2021 likely to suffer and die from these diseases. Elie Metchnikoff, Life Style a leading microbiologist of his day who was appointed to the Dubos was looking at the other side of the coin, preventing con Pasteur Institute by Pasteur himself, was of the view that environ tact with infectious organisms, when he argued that environmen ment was the real cause of disease. To prove this in the case of tal change was such a powerful force for better health. It was in cholera, he drank a solution containing a large number of these the 19th century that sewage systems were installed in European bacteria, yet he didn't contract the disease. Of course, Pasteur's and American cities, thus separating waste water from drinking own work countered this view. He had found that cultures of water and keeping people from a significant infection source.
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