A Frugal Physician Prescribes
Common Sense and Enthusiasm

Germs and Disease

Medicine spends almost all of its time attending, studying, testing, manipulating, drugging, and operating on the human body. Devoting so much time, energy and money is akin to worship. Clinics and hospitals might not unjustly be called Churches of the Body. Physicians, then priests thereof.

The next layer of the medical dilemma seems to be a somewhat similar reverence to the relatively hidden world of germs. Oh, how we love to fear them. Bernard Dixon, in his book entitled Powers Unseen, says, “Always, microbes lie in wait as opportunists, ready to exploit any change in human behaviour or living environment . . . Microbes, not macrobes, rule the world.”

Still, we are not vanquished. There is hope. Real LIGHT at the end of a long tunnel of experience. Limited and shortsighted though it be, modern medical practice is slowly  - very slowly - drawing us toward a broader understanding of disease and healing. The passion of physicians and researchers for microbes hints that doors will eventually open toward real LIGHT on the subject of things that are now quite hidden even from microscopes. In the meantime . . .

“Germs cause disease.” That idea is akin to the modern belief in evolution. While there is some truth to both, there are large holes in each widely held hypothesis. The whole story is still out on Germ Theory and Darwinian Evolution.

Yes, I heard, “Germs cause disease.” Every child knows this long-held, concise and supposed fact. Many learn it before they go to school. The idea is driven into us day in and day out on TV, in the newspapers, by friends and neighbors. We are impressed to gargle Listerine, sanitize the bathroom, sterilize our dishes, take antibiotics prophylactically, etc.

I had a significant problem with that idea from early on in my medical training - even before medical school. I remember sitting in my crude medical aid station in the boondocks of Vietnam - not far from Cambodia - in 1968-69. I often had time on my hands and spent many hours reading and trying to make sense of the Merck Manual of Diagnosis and Therapy. It was a compact book crammed with fine print and seemed to say that most every illness or syndrome known to medicine could be caused by one microbe or another.

As in many disciplines in the modern age, “Things are complicated.” And so was and is disease and medical practice. There were lists and lists and more lists of causative agents for this or that problem. And, germs were almost always high among them.

After I completed college with a degree in Medical Technology, I took my first and only job in that field in hospital bacteriology. Ouch! I lasted just a few months and went back to nursing until I arrived at medical school. While working in the Bacteriology Deparment, we spent our time pursuing, culturing and plating bacteria. Hoping to find something to treat with the growing arsenal of antibiotics.

We not only tested human beings for bacteria but regularly cultured inanimate objects as well. Weekly, one of the three of us in the department had to go around the hospital wards and swab the floors. That’s right we took large cotton qtips, ran them across the footpaths of the hospital, and then stuck the swabs in individual tubes of growth broth.

Before long we made cultures on agar plates to see what kind of bacteria were collecting on our floors. They might be potential sources of contamination! At the time, carpets in hospitals were unthinkable because they could become hosts for even more of the ubiquitous microscopic critters!

Culturing the floor was practically the same as taking a swab to the streets or yards in the vicinity. Anything and everything there would certainly end up underfoot in the hospital. We made our regular “floor reports,” but who cared? I suspect the reports were filed for inspection purposes.

I quickly tired of chasing bugs. That experience might well have given me a clue about challenges and headaches I would have in coming years with the “germ theory.” Germs have been in vogue and blamed for practically every bad thing under the sun since the days of Pasteur and Koch. In many ways, it seems that evil germs took over where miasms, humors, and spirits left off in the Middle Ages.

Germs were one of several things in my craw when I made an appointment during my second year to speak with the dean of the medical school, Dr. Robert Tuttle. This was before I started working on the wards and encountered Dr. Kirkendall. I basically told Dean Tuttle that, “I don’t quite believe a lot of what they are teaching us in the academic end of school. I am having trouble swallowing all of it.”

I didn’t have quite the gumption to say I didn’t believe in the prevailing germ theory because I knew Tuttle had been professor of immunology and microbiology at Bowman-Gray School of Medicine in North Carolina prior to becoming Dean at UTMSH.

Tuttle listened gently without taking the slightest offense. Then, he talked to the tune of, “Our job is to teach medicine as we now understand it. It’s certainly far from perfect and changes frequently. Your job is to learn what we teach you. When you graduate and are on your own you will have some leeway on how you practice according to your own beliefs and understandings. Just go out and do what is expected of you and do it well. Your own time and opportunity will come soon enough.”

I listened and tried for a time. But, my own ideas and mouth got in the way soon enough. My ideas about germs were just some of the stumbling blocks along the way. I know I was an exceptional case in med school. My compatriots ate the traditional medical meal, chewed on it just a bit, while relishing the flavor.

Most physicians as well as the general public take it as established and irrefutable fact that germs cause disease. The idea is pretty much Gospel and influences so much of our behavior that to question it may seem sacrilegious. But, that hasn’t held me back and won’t now.

“Germs do not cause disease,” I say. “They are a part of the picture, but neither the biggest nor most important.”

“Prove it,” you might say. Well, I can’t prove it any more than medical people can prove the usual belief. Although they have lots of tests and research to support their case. As for me, I ask that we try to use some common sense as we take another look at this belief.

To begin with, the world and our physical bodies are hosts to uncountable numbers of bacteria, viruses, fungi and the like. (Germs in other words.) Many of these are said to “cause disease.” But, a thoughtful and economical physician might ask, “If these creatures are always with us, around us, and in us, how is it that we are generally undiseased and healthy appearing, and not overwhelmed by such microbial vermin? Explain that, please.”

It is quite clear that microbes rarely cause us harm, and more often than not are helpful to us because we live in a state of comfortable coexistence with them. Actually, we have many cooperative relationships with these microscopic creatures. We give them a place to live and they help us synthesize vitamins, break down foodstuffs, and eliminate waste products. Most of this action occurs, but is not confined to, the confines of our large intestines.

Microbes also have functions that support the health of our skin and hair as well. All of their helpful chores are likely not yet discovered. Possibly because scientists have been pointing their lights in the opposite direction, hunting for “those disease makers.”

One of their main tasks - as they fill an incredibly important niche in nature - is to aid in decomposition of dead, morbid, necrotic material wherever it may be found. Without the fulfillment of that function life would be impossible.

A basic premise which medicine largely ignores is that only when something goes wrong in our environment - internal and external - do bacteria seem to cause us harm, or at least make themselves more visible. Sometimes they just appear to cause harm or we perceive that they do. Bacteria and viruses have become “the usual suspects,” take the wrap for practically every human ill, and come out looking like evil personified. Even though they are tiny, tiny microscopic fellows.

The influential 19th century chemist, Claude Bernard, said, "The seeds of disease are everywhere to be found. Whether they take root depends on the terrain on which they land." Thus came the idea of the “terrain factor,” which gets too little attention in medical circles and the society in general. And, it may be that seeds are not the best analogy for germs as they are seen producing disease. Too often it seems that microbes are “accessories after the fact” in the crimes we call disease.

Many germs are opportunistic like weeds. They say, “Weeds are a gardener’s best critics.” They take over terrain which is not well tended. The real problem in that case is not the weed, but the gardener.

In a like manner, in human disease the real problem is rarely a microbe but the state of the affected individual and his/her environment. If we take a look at some of the most common “contagious” diseases, past and present, we will be able to understand the point of view of Claude Bernard and others of his ilk.

Who is most likely to come down with influenza? What people are at the top of the list to be given flu vaccine every year? What groups of people are most likely to become infected with West Nile Virus or SARS or Legionnaire’s Disease? Who is most susceptible to E coli diarrhea? Looking back in time, who was most likely to succumb to tuberculosis, leprosy, and even malaria and tropical diseases?

The answer to all these questions is older, debilitated, already diseased or injured people. Secondarily, it is the malnourished, the stressed and anxious, the injured and maimed and hopeless. The hale and hearty, vital and virile, active and energetic need worry little about any of these contagious diseases unless confined to the trenches and terrors of war, the filth and rot of disintegrating societies.

On the other side of the world, we see contagion affecting poor, starving and often war-ravaged civilian populations. In this case, many who become diseased are young but not robust for simple lack of adequate food and proper hygiene, for living in the dirt and being tormented by fear and trauma.

The medical profession has taken credit for increased lifespan and greater wellbeing in many populations because of vaccination and antibiotics. But, real credit is largely due to improvements in sanitation and hygiene, better food, and overall enhanced living conditions in most parts of the world.

Despite the general rap and hype which is so common, germs aren’t king of the mountain, barbarian invaders standing at the gate waiting for opportune moments to kill. They are not predators, but generally scavengers, feeders, members of the cleanup crew.

We ought to give credit and blame where they are due. Let’s not point the finger at the tiniest of creatures for problems which we create.

The enemy is not a germ. The enemy is us. A Wise Doctor knows that and so should you.

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