CONCERNING ANTIBIOTICS AND THE GERM THEORY OF DISEASE

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CONCERNING ANTIBIOTICS AND THE GERM THEORY OF DISEASE

by Peter Morrell

July 2001

 

 

Domination by Theory and Bacteriological Reductionism?

 

" In attempting to reduce the use of antibiotics for respiratory

infections it is profitable to look at the incidence of several of

these problems. Ear infections in the US have increased from 9.9

million in 1975 to 24.7 million in 1990 (1). Though there are no

comparable large scale studies, sinus disease appears to be

increasing as well. All respiratory disease are primarilly caused by

bacteria colonizing the nasopharynx. " [1]

 

9.9 million to 24.7 million in 25 years, being 149% increase over 25

years, is a 6% annual rise in these conditions. Given the veritable

blitz on the bacterial world with antibiotics, sustained in rich

countries like the US over this very same period, how can bacteria be

the cause of these steeply rising infections? The one datum supplied

simply does not seem to warrant the conclusion drawn.

 

" Antibiotic use (and misuse) has soared since the first commercial

versions were introduced and now includes many non-medicinal

applications. In 1954 two million pounds were produced in the U.S.;

today the figure exceeds 50 million pounds. " [2]

 

1954 to 1998 is 44 years; a shift from 2 million pounds [1 kg. = 2.2

lbs] to 50 million pounds is 48 million; an increase of 48 million

over 44 years is 1.091 million per year and that represents an annual

increase of 54.5%. It is hard to interpret such figures against those

of ear infections given above, as these are global figures for all

antibiotics in the USA. However, some might say that a 6% rise in

such infections would be much higher without antibiotics. Others

might say such a war waged against the microbial world is

fundamentally unwinnable and therefore futile.

 

Let me open an historical window to gaze out of...

 

" Lest in the eager hunt for specifics against the bacillus, we lose

sight of that most important factor, the predisposition, the soil

upon which the bacilli seem to flourish...let the bacilli take care

of themselves, let us take care of our patients. " [3]

 

" Physicians who criticized the proposal to ground therapeutics in

bacteriology especially feared that domination by theory would

oversimplify practice...the complexity of clinical phenomena and the

exercise of judgment could not be bypassed by bacteriological

reductionism. " [4]

 

Has much progress in this view been made in 120 years?

 

" The flaws in nineteenth century bacteriology were evident to

everyone. Why did diphtheria bacilli cause disease in one person and

not another whose throat cultures showed the presence of virulent

bacilli? How did bacilli actually cause disease? All physicians were

ignorant of the answers to these and many other fundamental

questions. " [5]

 

And patently still are.

 

" Physicians were less concerned with how and why a therapy worked

than with the demonstrable fact that a therapy was medically valid,

demonstrable, and consistent. " [6]

 

Does not 'bacteriological reductionism' ignore, exclude and downgrade

the importance of previous medical history, general level of health,

hygiene, psycho-social factors, diet and lifestyle factors in the

development of infectious disease? Factors which, in fact, create the

very susceptibility to infection, which distinguish 'the infected' as

a category from 'the non-infected', not only in the same town, but in

the same house or family.

 

Therefore, we might conclude that bacteria, viruses, and other bugs

are not 'primarily the cause of all infectious respiratory disease',

but secondary, tertiary or even merely associative causes.

 

Finally, Professor Warner gives another clue that might explain both

why physicians in the 1890s despised the Germ Theory, and why

physicians today give antibiotics by reflex:

 

" Therapeutic conformity, or at least avoidance of criticism, was

important to the young practitioner trying to gain approval...regular

physicians' attitudes towards therapeutic change were molded by a

dialectic between their commitment to progress and their loyalty to

tradition. " [7]

 

Perhaps the force of conformity in medicine is far more powerful than

the desire to answer those 'fundamental questions' that Rothstein

lists above or to make progress in the use of antibiotics that Dr

Jones suggests in his e-letter.

 

 

 

Asking some fundamental questions

 

When Joseph Watine says, " let us hope that he does not forget that

antibiotics still have the ability to save the lives of many patients

suffering from bacterial respiratory diseases (legionellosis,

tuberculosis, etc). " [8], I would say it contains an outer meaning

and an inner meaning.

 

Joseph Watine, in making this statement, utters a declaration of his

own medical conformity in the presence of his medically qualified

brethren, 'beats the drum', and declares his belief in his own

training and its underpinning system of beliefs, like a declaration

of belief before members of the mother church.

 

If, 1000 years ago, I had criticised a dominant medical practice like

purging, medical practitioners would have similarly reacted and

pronounced their belief that above all, sickness was " regarded as the

finger of Providence. God used illness for a multitude of higher

purposes...as a punishment... " [9]. Disease " was routinely

interpreted as the consequence of sin, crime, or moral fault, as

precipitated by evil spirits, or as the work of black magic. Disease

was thus personalized and given a moral or religious meaning. " [10].

Doctors would also have declared the healing power of Christ in the

world, and that Antimony, prayer and fasting were the sole cures.

 

Such a reaction is broadly similar to that of Joseph Watine. His

remark not only reveals the unquestioning and deeply conformist

nature of medical training, practice and belief, and the desire to be

just another grey brick in a uniformly grey wall - a conformist who

questions nothing - but it also

denotes how belief-driven, how theory-dominated medicine is. That is

no less true today than it was in pagan or medieval times. The

beliefs might have changed, but the attitude hasn't. In " the

seventeenth century...the accent of therapeutics lay on expelling

toxic substances from the body - by purging, sweating, vomiting, and

the much favoured surgical technique of bloodletting... " [11]. Milder

shadows of these practices persist in herbal and proprietary

preparations with laxative, diaphoretic, expectorant or diuretic

properties.

 

Getting back to the superficial point his question raises, I would

say that because antibiotics do not and cannot even impinge upon, let

alone remove, the OTHER causes of disease [other than 'germs'], so it

is clear that their power over disease is limited. Indeed, their

curative power is very precisely limited to that narrow, specific

role. Therefore, in cases where removal of such 'germs' is most

urgently required as the main therapeutic objective, then yes, of

course, the effect of antibiotics is demonstrably spectacular, even

miraculous. However, such is not so commonly the case today as

compared to 50 or 100 years ago. It is not the full picture.

 

Today, especially in the rich countries, the power of antibiotics is

diminished precisely because the conditions or causes that create

infectious disease are largely constitutional, dietary and psycho-

social and not so overtly bacteria-driven. " Villermé [in 1828]...was

able to prove that morbidity and mortality rates were, in a sense, a

function of the living conditions of a given class...filth and

overcrowding were proved to act...as the indirect causes of fevers. "

[12]. And thus it became apparent that " cleanliness was in some way a

protection against disease. " [13]. Although " water-borne infections

were checked by a combination of bacteriological diagnosis and

improved sanitary engineering. " [14], many physicians remained

sceptical of the Germ Theory.

 

It was not unusual in New York for " well known physicians to get up

and leave the hall when medical papers were being read which

emphasised the germ theory of disease. They wanted to express their

contemptuous scorn for such theories and refused to listen to them. "

[15]. Some physicians " refused to believe that the horrifying effects

of many diseases could be traced to an almost invisible micro-

organism...nineteenth century bacteriology raised more methodological

and substantive questions than it answered...scepticism was…a

reasonable position…taken by many leaders of the profession. " [16]

 

Some, more reflective persons did exist. " One of Koch's students once

asked him why anthrax bacilli caused death in an animal. Koch

said, 'Why its vessels are plugged with bacilli!' The student

asked, 'A mechanical death?' to which Koch

replied, 'Certainly'...such questions, which should have raised

serious doubts about all bacteriology, do not appear to have

disturbed physicians very deeply. " [17]

 

Certainly, there are social, financial, economic and cultural causes

of disease every bit as potent as bacteria and just as active today

in certain parts of every town and city. Therefore, the power of

antibiotics to cure such 'infections' is correspondingly diminished

[to zero] and yet they are prescribed in a reflex manner like old-

fashioned palliatives to mollify patients and/or their concerned

parents, a point made in some letters to this article.

 

Adopting briefly the homeopathic cloak, I would have to say that

most 'ear infections' so-called are better treated with Pulsatilla or

Belladonna, whichever most closely matches the symptoms of the

individual case, and that the vast majority of childhood 'earaches'

resolve quickly with such treatment and in an uncomplicated manner.

Any practitioner can satisfy themselves on this point, very easily.

However, such a point does raise the deeper conceptual question of

whether 'the germs' were really there at all in the first place, and

what the real cause of such earaches actually is? " The craze of the

day is the somewhat hypothetical germ. " [18]. It also raises the

question of what any treatment actually achieves. We grope in the

dark and at best see only dimly through a dark lens.

 

For example, on whose 'side' do the homeopathic remedies work - do

they influence 'the enemy' or do they strengthen the innate healing

powers of the organism? Antibiotics only affect 'the enemy' and seem

to do nothing for the organism. All the natural therapies seem to

strengthen the organism rather than touching 'the enemy' at all.

Allopathy has a deeply ingrained tendency to attack the enemy and to

do little for the innate vital powers. That is predominantly the case.

 

Lest we do believe that 'germs' are the only cause we should

recall " A distinguished sanitarian Max von Pettenkofer of Munich…made

his magnificent gesture - which by all odds should have killed him -

of drinking a whole glassful of cholera bacilli without suffering any

harm. " [19]. Clearly, the deeper question is not the bacteria

themselves, but the 'soil they grow in', which is our relationship

with them. In an infection we must be clear about what has happened.

In health, we are just as surrounded by 'germs' as an ill person is,

but they do not affect us - our relationship with them is normally

balanced, harmonious and unproblematic. In the diseased state, this

previously harmonious relationship mysteriously somehow deteriorates

and 'the germs' come to proliferate.

 

It is certainly not 'the germs' that bring this shift about. It is

not a germ-driven change. It is those psycho-social, stress and

dietary factors, hygiene, etc, which cause the relationship to

deteriorate. No-one can say with certainty why this happens at

certain times and in any individual case. What is certain is that

these changes are internal to the organism, they are initiated

on 'our side', not from the side of 'the germs'. This recognition

does not seem to be emphasised in orthodox medicine, where the 'magic

bullet ', and attacking 'the enemy' are the central themes of

practice. Hence, I would say, that modern medicine can learn from

this situation and realise why it stands accused of looking in the

wrong place and treating the wrong thing. It should treat the

patient, not the disease; the person not 'the germ'. Thus, I would

repeat that bacteria do not cause disease, it is the deterioration in

our relationship with them that lies at the root of the matter.

The 'germs' are manifestly only secondary or merely associative

causes of infections. Clearly therefore, if bacteria are not the main

cause, then how can antibiotics comprise anything approaching

a `cure'?

 

In certain parts of the world it is still a widely held belief

that " disease is a supernatural phenomenon governed by a hierarchy of

vital powers...disharmony in these vital powers can cause illness.

Thus, ancestral spirits can make a person ill. Ingredients obtained

from animals, plants, and other objects can restore the decreased

power in a sick person and therefore have medicinal properties. "

[20]. Modern medicine seems too grounded in the study of disease

[pathology] and in its eradication and not enough in studying health

and how to create it. These are two very different medical attitudes

underpinning the great divide in medicine that need bringing together

for greater future progress.

 

When the acupuncturist says disease is due to an imbalance in the

energies flowing in the meridians, they are making a certain

conception of the disease process, which their treatment then seeks

to adjust. It is not necessarily an incorrect conception, merely a

different one from that of the bacteriologist. Likewise, when the

homeopath calls disease primarily a derangement of the life force,

echoing in this sentiment Stahl's animism. Or, when the naturopath

conceives disease to be a product of toxins, which fasting and enemas

will eliminate, he comes close to the sentiment that " disease is not

an entity...but is only the organic and functional forces, or powers

of life, modified by perversion of activity…remedies are relative

agents...they only act curatively by a judicious application to the

individual case in hand. Individualism, not universalism, attaches

therefore to all our therapeutic measures. " [21]

 

Such is still a valid sentiment. These are all different

apprehensions of the disease process due to different modes of

medical conception. All are equally belief-driven or theory-

dominated, but each stems from a very different mode of conception of

what is nevertheless the same disease process. They might well be

seen as different blind men describing the same elephant!

 

Sources

 

[1] BMJ letter, Re: Reducing antibiotics for respiratory infections,

6 July, Jones, Lon, Family Practice, Hale Center, Texas, USA

 

http://www.bmj.com/cgi/eletters/322/7292/939#EL7

 

[2] The Challenge of Antibiotic Resistance, Stuart B. Levy,

Scientific American 1998

 

http://www.sciam.com/1998/0398issue/0398levy.html#link4

 

[3] Eric E Sattler, The Present Status of the Tubercle Bacillus,

Cincinnati Lancet and Clinic, 12, 1884, 415; quoted in John H Warner,

1986, The Therapeutic Perspective - Medical Practice, Knowledge and

Identity in America 1820-1885, Harvard Univ. Press, USA, 280

 

[4] Warner, 281

 

[5] William G Rothstein, 1972, American Physicians in the Nineteenth

Century, From Sects to Science, Johns Hopkins Univ. Press, Baltimore,

281

 

[6] Rothstein, 281

 

[7] Warner, 183

 

 

[8] BMJ letter, Re: Domination by Theory..., Joseph Watine, Hôpital

de Rodez, France, (11 July 2001)

http://www.bmj.com/cgi/eletters?lookup=by_date & days=1#322/7292/939/EL9

 

 

[9] Roy Porter, 1987, Disease, Medicine and Society in England 1550-

1860, Macmillan, London, 27

 

[10] 'Disease' by Roy Porter, in Hutchinson Family Encyclopoedia:

http://ebooks.whsmithonline.co.uk/encyclopedia/52/F0000152.htm

 

[11] Porter, 1987, 14

 

[12] Richard H Shryock, 1966, The Development of Modern Medicine,

Pennsylvania Univ. Press, 220

 

[13] Shryock, 240

 

[14] Shryock, 311

 

[15] James J Walsh, History of Medicine in New York, 1919, quoted in

Rothstein, 265

 

[16] Rothstein66-7

 

[17] Rothstein, 281

 

[18] New York physician in 1883, quoted in Warner, 281

 

[19] Shryock, 282

 

[20] Kale, Rajendra, Education and Debate, South African Health:

Traditional healers in South Africa: a parallel health care system,

BMJ 1995; 310: 1182-85 (6 May)

http://www.bmj.com/cgi/content/full/310/6988/1182

 

[21] John P Harrison, Notes on Empiricism, Western Lancet and

Hospital Reporter, 8, 1848, 122, quoted in Warner, 63

 

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