The Mechanical Patient and Communicable Diseases

Up until the 20th century the vast majority of deaths were a result of communicable diseases, very often at epidemic levels. People were infected by pathogens, germs which caused particular diseases, and during epidemics large numbers would become ill and many would die. Diseases like the plague, smallpox and cholera killed untold millions of people and were the greatest cause of death for millennia.

Left to right: Louis Pasteur (1822-1895), Robert Koch (1843-1910)

A series of breakthroughs by medical scientists, notably Louis Pasteur and Robert Koch, showed that micro-organisms caused communicable diseases and they developed vaccines against anthrax, rabies and similar diseases. More generally the identification of the pathogens that cause diseases also enabled the development of other strategies to avert them. Cleaning up the water supply, eliminating rat-infested areas, and other environmental improvements were found to be effective in averting the spread of many communicable diseases.

The chemical/mechanical model of the body was ideal for understanding, preventing and treating communicable diseases. This improved understanding accelerated its adoption in the late nineteenth century. Today the model is deeply ingrained in all our thinking however the great killers have become chronic instead of communicable diseases. People die of heart disease, cancer and diabetes instead of cholera, small pox and tuberculosis. But we continue to speak of these chronic conditions as if they were communicable diseases. We even continue to look for the pathogens that cause them using the chemical mechanical model of the patient.

Over the last quarter century or so it has become evident that the non-communicable diseases that now kill us have social and relational causes as well as environmental and chemical ones. They do not make us sick in the same way as the germs that infected us with communicable diseases. Social and relational causes, though identifiable, are hard to measure; and there are no medications that enable friendship and other strong social connections. Chronic non-communicable diseases cannot be averted in the same way as pathogen based communicable diseases were in the past. Our healthcare systems are structured to best treat these conditions once they affect us chemically or mechanically. In fact the conditions are identified by chemical tests or imaging. Because there are no vaccines for them, attempts to avert them include ever earlier pharmaceutical interventions, and diet (chemical) and exercise (mechanical) management.

The most expensive and elaborate surgical and medical interventions occur at the acute stage of chronic diseases like cancer and heart disease. Heart attacks and strokes, malignant tumours bring with them acute manifestations of these diseases. They are treated in acute care hospitals by highly skilled physicians and surgeons using increasingly complex technological aids.

Today it has become clear that, social and relational factors are even more responsible for the development of chronic diseases than genetic or environmental ones. We now recognize, for example that social isolation and loneliness are at least as closely correlated with mortality due to chronic conditions than heredity or diet and exercise. We are also beginning to see that social and relational deficits early in life are closely correlated with chronic conditions later in life.

Now that we understand that we will not likely die of infectious diseases, and that our social and relational wellbeing is critical to our health, some of us recognize that we must rethink the medical model of the patient as an isolated chemical mechanical being.

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