Man & His Ills

Every time the cause of some baffling infection is found or a new wonder drug is discovered, the news is hailed as another step toward a hygienic utopia in which disease and premature death will have no place. Not so fast, says one of the world's top authorities on infectious diseases and a pioneer of the antibiotic age; disease is an aspect of man's adaptation to his environment, and as his environment changes, so do his diseases--but they do not disappear. In Mirage of Health, published this week (Harper; $4), famed Microbiologist Rene Jules Dubos of the Rockefeller Institute for Medical Research (though no physician) applies laboratory logic to visions of a medical utopia.

Remove the Handle. Modern science's role in defeating infectious diseases has been greatly exaggerated, says Researcher Dubos. Many of the most terrifying--leprosy, plague, typhus--had all but disappeared from Europe before serums, vaccines and drugs were developed to combat them. Other Dubos debunkings:

P: Discovery of the microbe that causes a disease is not necessarily the most important factor in halting its ravages. Dr. John Snow checked a cholera outbreak in London in 1854 merely by having the handle removed from the Broad Street pump that was gushing contaminated water. Then the cholera vibrio was found, but volunteers have guzzled billions of them without getting sick--and now the disease, if it develops, can be treated simply by replacing body fluids, without serums or antimicrobial drugs.

P: Medicine's apparent triumphs are mixed blessings. Insulin's effectiveness not only prolongs the diabetic's life but increases the risk that he will pass on a tendency to the disease to his children. If this happens often enough, "Society may face medical, economic and ethical problems for which it is not prepared."

No prophet of doom, Dr. Dubos is convinced that in the future, as in the last 100 years, social reforms will do as much as doctors and drugs to eradicate preventable disease. But man, he insists, must face hard facts with hardheaded realism. Disease does not surrender unconditionally. The very sanitary techniques that did so much to control infections in the 19th century set the stage for the ravages of polio in the 20th. German measles, once universal in childhood and then only a "trivial accident," now skips many sanitized youngsters; but if a woman gets it in the first three months of pregnancy, she may have a stillborn or malformed child.

Reward for Struggles. The modern American, says Dr. Dubos, is kidding himself about how healthy he is: a man past 45 has little greater life expectancy than had his grandfathers; he has the world's highest living standard, but 10% of his income* goes for medical care. "One out of every four citizens will have to spend at least some months or years in a mental asylum. One may wonder indeed whether the pretense of superior health is not itself rapidly becoming a mental aberration."

Too often the goal of health planners "is a universal grey state of health corresponding to absence of disease rather than to a positive attribute conducive to joyful and creative living." In fact, Dr. Dubos contends, as medicine becomes more truly scientific, it makes a full-cycle turn to Hippocrates' view of health as harmony between the individual and his environment and the various forces at work in the body. But this adjustment cannot be static, because man is forever evolving: "Wherever he goes, whatever he undertakes, he will encounter new challenges and new threats to his welfare . . . Disease will remain an inescapable manifestation of his struggles."

* Dubos' figure. Official statistics make it only about 5%.

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