The Mirage of Health

Abstract

I am writing this column in late August, so it's difficult to predict what the H1N1 flu situation will be by like the time it is published towards the end of the year. Since there is already a pandemic, the spread of the virus will likely have picked up more steam by that time, but how much steam it is difficult to forecast So I'm not even going to try. Instead, I will make a prognostication that is a safer bet: there will continue to be health issues of some kind at the end of this year, at the end of this century, and on to the end of this millennium. I am using as my crystal ball a book by Rene Dubos (1901-1982) called Mirage of Health (1959). It seems appropriate to examine this book on the fiftieth anniversary of its publication, because it is at least as relevant today as it was at the time it came out. Also, since this issue of ABT is devoted to health and medicine, this work is a great reminder of the limits of the latter to ensure the former. The book's main argument is that, as the title suggests, the quest for perfect health is an unending one, just as walking towards a mirage is a fruitless task. Dubos contends that the idea that better days are coming, that if we get rid of the latest scourge to health, life will be wonderful and we will to a ripe old age in good health, just isn't going to happen. In other words, finding the "cure" for cancer or HIV infections or ... isn't going to make life wonderful. He cites as support for his view the fact that finding a cure for tuberculosis (TB), the scourge of the 19th century, did not lead to a health utopia. In fact, thanks to life style changes rather than medical advances, the incidence of TB had already decreased significantly even before an antibiotic treatment for this bacterial infection became available in the 1950s. I have been reminded of Dubos's book frequently over the years since I first read it in the 1970s. Most particularly, it came to mind in the 1980s when HIV and then Ebola virus entered our consciousness. For those who don't remember these times, both infections came as rather a shock to the American public who had become accustomed to the idea that infectious disease was no longer fatal. To put it very simply, bacterial infections could be treated with antibiotics and viral diseases prevented with vaccines. Then AIDS arrived, an infectious, incurable and in those early years, 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 bacterial pneumonia was dangerously common and a bad cut could lead to an uncontrollable infection. Microbiology How could Dubos have been so prescient when most Americans were shocked by this onslaught and the others to follow? First of all, he was a microbiologist. He was already aware, more than most people of the time, that bacteria were developing resistance to antibiotics, that the reign of these drugs was likely to be short-lived and could only be extended by human ingenuity working to keep one step ahead of the microbes. Dubos was born and educated in France at the beginning of the 20th century, when French microbiology was still very much under the sway of Louis Pasteur's intellectual heritage. He came to the United States and spent most of his career as a researcher at what is now Rockefeller University in New York. There he discovered gramicidin, the first clinically tested antibiotic. While it didn't prove to be an effective drug, Dubos's research did yield useful information on antibiotic dynamics both in culture and in living organisms. When penicillin was discovered and being developed as a drug, he was involved in the early work done in the United States. He also did research on tuberculosis and pneumonia. It was Dubos's studies on how bacteria became resistant to the effects of antibiotics that led him to consider the theme of health as a mirage. …