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The Diagnosis of the Unknown Physician

By Carolyn Raffensperger According to an old story told by Sun Tsu at the beginning of The Art of War, a lord of ancient China once asked his physician, a member of a family of healers, which family member was the most skilled at medicine.  The famous physician, replied, "My eldest brother is the most skilled since he sees the spirit of sickness and removes it before it takes shape, so his name does not get out of the house. My elder brother cures sickness when it is still extremely minute, so his name does not get out of the neighborhood.”  The greatest physician was unknown because he prevented disease rather than having to cure it.

*** I have the remarkable fortune of having great genes. Both my parents are alive, well and unusually rascally for Midwesterners. My Dad was in his late 60s when he sailed across the Atlantic and back. He published a novel last year under a pseudonym (so don’t look for it using my name) and regularly paddles out into the ocean in his homemade sea kayak. My Mom was in her mid-70s when she got a new job on the upper Peninsula of Michigan, moved into a log cabin and took up snow-shoeing and nature photography.  They have no history of cancer, diabetes, or cardio-vascular problems. Alas, my parents’ medical histories aren’t going to be much help in predicting what I will live with as I age and what I will die of. All the trends in things like cancer, Alzheimer’s, diabetes, and Parkinson’s, suggest that I along with my age cohort are going to be sicker longer and die after lingering, debilitating illnesses.

What’s going on? Basically our diseases are corollaries of our civilization. As Rene Dubos said "each type of society has diseases peculiar to itself -- indeed, . . . each civilization creates its own diseases."  Our bodies reflect the interaction of our genes with the manifestations of our civilization -- the built, social and natural environments.  In fifty years we’ve fundamentally altered all of these systems.   We get less exercise, we eat nutritionally-suspect food and we’ve filled our world with toxic chemicals. These changes (and many more) are documented in a report entitled Environmental Threats to Health Aging that we at SEHN did with our colleagues at Greater Boston Physicians for Social Responsibility.

Where are we headed given this trajectory? Here are my four predictions on the future of human health.

1) We will see more chronic diseases such as asthma, diabetes, and Alzheimer’s. The reason is that we have a whole long list of stressors like nutritionally deficient diets, inadequate exercise, and air pollution all of which lead to oxidative stress and inflammation—the biological mechanisms for disease. 2) Diseases that make people fundamentally anti-social will affect a much larger population. These illnesses include autism, Alzheimer's, and mental illness. These diseases are rising now in the population and render people unable to function within their families and communities. 3) We will suffer from an increased number of rapidly changing infectious, zoonotic pandemics (think swine flu, bird flu, hemorrhagic viruses.) because climate change, modern transportation, and industrial agriculture are disrupting ecologies setting up the conditions for rapidly evolving bacteria, funguses and bacteria that use multiple species as hosts.  In addition, we are moving people and stuff around the planet at an ever increasing rate.  Infectious agents are hitching rides and zipping around the planet in cargo ships and airplanes. 4) Subtle, difficult to diagnosis malaises like chronic fatigue, fibromyalgia, and suppressed immune systems will become the norm. Patients will exhibit multi-factorial, complex symptoms that defy categorization.

If we wanted to alter this course, where would we start? We’d start with decent definitions of health because how we define it determines how we maintain health and cure disease.

Wendell Berry defines health as membership--membership in the community of humans and membership in the Earth community. “Can our present medical industry produce an adequate definition of health? My own guess is that it cannot do so. Like industrial agriculture, industrial medicine has depended increasingly on specialist methodology, mechanical technology, and chemicals; thus, its point of reference has become more and more its own technical prowess and less and less the health of creatures and habitats.” Berry later says, “this, plainly, is a view of health that is severely reductive. It is, to begin with, almost fanatically individualistic. The body is seen as a detective or potentially defective machine, singular, solitary, and displaced, without love, solace, or pleasure. Its health excludes unhealthy cigarettes but does not exclude unhealthy food, water, and air. One may presumably be healthy in a disintegrated family or community or in a destroyed or poisoned ecosystem.”

A related definition to Berry's idea of membership comes from Aldo Leopold who defined health as the capacity for self-renewal. Leopold was referring to land  but it applies equally well to the individual. Leopold means that health is an intrinsic and internal biological process, not a static quality. It is the process of re-membering our communities.

Sun Tsu's unknown physician must have been working with similar definitions of health in order to prevent the diseases of his day.  Today, I imagine he would write a prescription to restore the Earth's resilience, and repair the social systems to alleviate the debilitating stresses of poverty, racism and hunger, and create built environments that nurtured living beings.