Readers will note that this article is nearly twice the length of the normal MR piece, but because of the importance of the subject we are publishing it in its entirety. The text is based on a talk given by the author at the Brecht Forum in New York. —Eds.
The scientific tradition of the “West,” of Europe and North America, has had its greatest success when it has dealt with what we have come to think of as the central questions of scientific inquiry: “What is this made of?” and “How does this work?” Over the centuries, we have developed more and more sophisticated ways of answering these questions. We can cut things open, slice them thin, stain them, and answer what they are made of. We have made great achievements in these relatively simple areas but have had dramatic failures in attempts to deal with more complex systems. We see this especially when we ask questions about health. When we look at the changing patterns of health over the last century or so, we have both cause for celebration and for dismay. Human life expectancy has increased by perhaps thirty years since the beginning of the twentieth century and the incidence of some of the classical deadly diseases has declined and almost disappeared. Smallpox presumably has been eradicated; leprosy is very rare; and polio has nearly vanished from most regions of the world. Scientific technologies have advanced to the point where we can give very sophisticated diagnoses, distinguishing between kinds of germs that are very similar to each other.
But the growing gap between rich and poor make many technical advances irrelevant to most of the world’s people. Public health authorities were caught by surprise by the emergence of new diseases and the reappearance of diseases believed to be eradicated. In the 1970s, it was common to hear that infectious disease as an area of research was dying. In principle, infection had been licked; the health problems of the future would be degenerative diseases, problems of aging and chronic diseases. We now know this was a monumental error. The public health establishment was caught short by the return of malaria, cholera, tuberculosis, dengue, and other classical diseases. But it was also surprised by the appearance of apparently new infectious diseases: the most threatening of which is AIDS, but also Legionnaire’s disease, Ebola virus, toxic shock syndrome, multiple drug resistant tuberculosi, and many others. Not only was infectious disease not on the way out, but old diseases have come back with increased virulence and totally new ones have emerged.
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