DOMINATION BY THEORY AND BACTERIOLOGICAL REDUCTIONISM?

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DOMINATION BY THEORY AND BACTERIOLOGICAL REDUCTIONISM?

 

by Peter Morrell

 

 

 

" Domination by Theory and Bacteriological Reductionism? "

 

[July 2001]

 

" 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 primarily 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 infections - which are so steeply rising? The one

datum supplied simply

does not seem to warrant the conclusion drawn. Can Lon Jones please

give us the total US consumption of antibiotics in 1975 compared to

1990, so we might evaluate his theory that bacteria CAUSE " all

respiratory disease " ?

 

" 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 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

respiratory 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. Perhaps Dr Jones could comment upon this aspect?

 

Let me open an historical window for him 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

then 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 [of the patient], 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.

 

 

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

 

 

 

http://www.homeoint.org/morrell/otherarticles/bactreduct.htm