Heroes Not Zombies

If someone has an infection caused by a particular bug, and the doctor prescribes the best, most appropriate drug to kill that bug, what does the drug do?

The correct answer is “it kills the bug”.

The incorrect answer is “it cures the infection”.

You see, bugs and infections are not the same thing. Certainly a bug may “cause” an infection. You don’t get TB without the TB “bacillus” being involved. The TB bacillus can be isolated and grown in a laboratory, but it isn’t an infection until a person has it growing inside them. That might sound totally obvious but you’d be surprised how little doctors and patients think about this. There is no doubt that discovering the role of microbes in causing infection was a breakthrough in understanding and the availability of drugs to kill bugs is a real boon but the problem is thought often stops there. How do we help an individual to recover after the bug has been killed? Exactly how does a person repair their damaged body after an infection, and how can they increase their chances of defending themselves more effectively against future infections? How do we reduce the burden of infection on populations? Antimicrobials are only part of the solution, not the whole solution.

This is not a new thought. I’ve recently become a fan of Cabinet magazine (a magazine based on the idea of wonder rooms) and in the current issue there’s an article about Professor Max Joseph von Pettenkofer, a Bavarian chemist-apothecary who lived from 1818 until 1901 (when he shot himself in the head). He was a very colourful character who disputed the theory that germs cause infections. Koch and Pasteur’s discoveries were convincing the world that the cause of infections were microbes but Pettenkofer thought their theories were simplistic. He maintained that infection involved the interaction of three factors – factor x – germs, factor y – some condition of the region where the infection occurred, and factor z – susceptibility on the part of the patient. To prove his point, he conducted a very public, very dramatic experiment where he had a fresh culture of the germ which caused cholera (called at that time the “comma bacillus”) prepared in a laboratory. He then drank enough of this culture to kill a village and survived. (He claimed he did not suffer from the cholera at all but he did have stomach pains and some diarrhoea for a few days.) Despite this performance nobody was convinced. Pettenkofer ended up committing suicide. However, his conclusion that the way to prevent cholera was through sanitation to deal with factor y – the condition in the region, was actually spot on.

There’s a lesson here about the limits of reductionism. The simplest explanations are attractive, but in the real world, are often just too, well, simplistic. And there’s also a lesson about “this or that” or “black or white” ways of thinking. Often “and” is a better explanation than “or”. Narratives need not cancel each other out. They can complement each other and produce a greater, instead of a lesser, understanding.