A policeman sees a drunk man searching for something under a streetlight and asks what the drunk has lost. He says he lost his keys and they both look under the streetlight together. After a few minutes the policeman asks if he is sure he lost them here, and the drunk replies, no, that he lost them in the park. The policeman asks why he is searching here, and the drunk replies, “this is where the light is.” – David Freedman
The streetlight of human consciousness occasionally moves from one corner of the park to another. The greater part of educated men in each successive generation look back on the knowledge and theories of the former with compassion, recognizing their limitations and appreciating their earnestness, while the streetlight is carefully unearthed and moved to its next location.
Our understanding of human health is at one such juncture. We have been looking at the matter – “Excuse me officer, can you help me find my health?” – primarily under the light of the germ theory of disease for a little over a century, and progress in hygiene coupled with the discovery of antibiotics, immunization and pasteurization dealt a seemingly decisive victory in the war against disease.
Unfortunately, the mid-20th century witnessed an epidemiological transition in which chronic disease replaced infections as the major source of disease. Researchers and doctors began to question the applicability of the germ theory to this new and puzzling rise in non-communicable, lasting and recurrent diseases which don’t seem to track back to a single microbial cause. It became clear that the germ theory didn’t provide the whole picture.
And now we hear the call again to move the streetlight. At present there is no germ theory equivalent to provide a unifying framework for understanding the etiology of chronic disease. Doctors continue to throw billions of dollars at the new problem using the old tools and what’s worse is that their misuse of the old tools (e.g. antibiotics) is now making it such that they are starting not to work against the old problem (i.e. infection).
Some say that chronic disease is simply an aberration, that things will smooth out once we get more used to the post-Industrial Revolution man-made world and its attendant stimuli, but I have to wonder if we’ll be able to move the streetlight fast enough to keep up with the repercussions of our own inventiveness. Fortunately our design and the design of the natural world around us is incredibly resilient, otherwise our progress would’ve been halted already.
What will be the 21st century equivalent to the germ theory of disease of the 19th and 20th centuries? I’d love to hear your thoughts.
To my mind, the worst that could and may very likely happen is that the war on germs will turn into a war on inflammation, a factor which seems to be present in many chronic diseases. And on that basis, the drunkard will continue to stumble around under the streetlight looking for his health. What I hope for, however, is an entirely different approach, one that breaks free of the notion that we must dominate our environment and control it all to be healthy.
As I see it, were part of a larger system. The individual is a component of the body of mankind and man is but one of many pieces of the whole in which we live. Life to me is less about war than it is about communion, less about competition than it is about cooperation.