Thesis #22: Civilization has no monopoly on medicine.
by Jason GodeskyIn the previous thesis, we saw some of the many ways that civilization has been catastrophic for human health: the introduction of epidemic disease, the promotion of a diet utterly divorced from the expectations–or even abilities–of human digestion, and the adoption of a generally unhealthy, maladaptive lifestyle turned civilization into a Pandora’s Box of horrors unleashed on the human race. If that is the case, though, then, like Pandora’s Box, civilization also offers hope to deal with all of those terrible afflictions, in the form of medicine. Interestingly, the Cherokee tell a similar story, wherein the plants take pity on humans and give them medicine. That in itself gives the lie to the terrible trick played on us; though we have more than paid for it in diseases and generally terrible health, the hope we have thus bought is universal among all human cultures. Every culture has its own ethnomedicine–and though our afflictions are greater, our medicine is not proportionally more powerful.
This is not to say that Western biomedicine is ineffective in the least. The very fact that it is powerful enough to sufficiently balance the disastrous health effects of civilization and not only keep us alive, but even allow us to live nearly as long as the natural human lifespan is a great testimony to it. That said, we have also often over-valued its contribution. In thesis #16, we discussed the great hygenic efforts of the early twentieth century to clean up the cities, and how that medical victory led to the rise of polio. Then, another medical victory was won with the polio vaccine, but there is some evidence to suggest that that victory may have created AIDS. No medicine is 100% effective–not even ours. Any doctor can tell you a series of terrible stories of patients they could do nothing for. Our pharmaceuticals, as powerful as they are, still owe most of their effectiveness to the placebo effect. For all the diseases our medicine has cured, they are more often cured by our own bodies–or they simply run their course. For all the strides we have made, Western biomedicine has–and will always have–its limitations.
Some of those limitations are systemic. There is a growing awareness, even among the professional practitioners of Western biomedicine, that the Cartesian duality of mind and body is very misplaced. The brain is an organ like any other, and its operation is as integrally tied to the condition of the body as the operation of the heart or liver. Though many quarters have been resistant to the notion, the natural implication of this contention is that psychological is basically a biological phenomenon, like heart rate or the immune response. Given the deep, indivisible interrelationships between all the regions of the brain, and the brain with the body as a whole, it should not be at all surprising that the brain can also have an effect on the condition of the body, just as the body forms the conditon of the brain. That is to say, because Descartes’ duality of body and mind is no longer defensible, we should not be surprised that our psychology impacts our physical health–as the objection to such notions has always been a reiteration of such disproven Cartesian duality.
Evolution has not left us without a certain ability to see to our own health, and as any medical student knows, the human body is replete with any number of systems to fight infection and disease, ease symptoms, or simply kill the pain. When the brain expects to be cured, that becomes something of a self-fulfilling prophecy, as the brain activates those systems. This is what we call the placebo effect, and it is probably the single most powerful force in any medicine. The reverse is also true; believing ourselves ill can have observable, negative, physical effects, too. This is called a nocebo effect, but the division is largely arbitrary, based on our perceptions of “good” and “bad”; in both cases, the body’s own, internal systems work to match one’s health to the expectations in one’s mind.
This has led to the distinction adopted by many medical organizations, including WHO, of “illness” and “disease.” Marshall Marinker’s distinction is still the most generally accepted form:
Disease … is a pathological process, most often physical as in throat infection, or cancer of the bronchus, sometimes undetermined in origin, as in schizophrenia. The quality which identifies disease is some deviation from a biological norm. There is an objectivity about disease which doctors are able to see, touch, measure, smell. Diseases are valued as the central facts in the medical view…
Illness … is a feeling, an experience of unhealth which is entirely personal, interior to the person of the patient. Often it accompanies disease, but the disease may be undeclared, as in the early stages of cancer or tuberculosis or diabetes. Sometimes illness exists where no disease can be found. Traditional medical education has made the deafening silence of illness-in-the-absence-of-disease unbearable to the clinician. The patient can offer the doctor nothing to satisfy his senses…
Sickness … is the external and public mode of unhealth. Sickness is a social role, a status, a negotiated position in the world, a bargain struck between the person henceforward called ‘sick’, and a society which is prepared to recognise and sustain him. The security of this role depends on a number of factors, not least the possession of that much treasured gift, the disease. Sickness based on illness alone is a most uncertain status. But even the possession of disease does not guarantee equity in sickness. Those with a chronic disease are much less secure than those with an acute one; those with a psychiatric disease than those with a surgical one … . Best is an acute physical disease in a young man quickly determined by recovery or death—either will do, both are equally regarded.
Western biomedicine, with its historical basis in the naturalism of Hippocrates, and later Cartesian dualism, has excelled in the treatment of disease, but has been utterly abysmal in its treatment of either illness or sickness. This emphasis has led to a maligning of the single most powerful healing effect we have ever found, the placebo effect. We speak of something as “just a placebo,” and when someone recovers by placebo, they believe there was never any physically wrong with them in the first place if, after all, it was “all in my head.” This laser-like focus on only one dimension of health has made Western biomedicine myopic, and constitutes its single greatest institutional limitation.
Western biomedicine is an ethnomedicine, comparable to other ethnomedicines. The fact that it is our ethnomedicine means we believe it a priori to be more effective than all other ethnomedicines, which are only superstitous mumbo-jumbo. Of course, other cultures say the same of us. This is merely an expression of ethnocentrism–an evolutionarily adaptive attitude to hold, but not necessarily related to reality in any way.
Where Western biomedicine tries to eliminate the placebo effect, most traditional ethnomedicines are built around enhancing the effect. They spend more time treating illness and sickness, and thus are usually less effective at treating disease. Overall, though, the effectiveness of other ethnomedicines remains roughly comparable to our own, more specialized variety. For example, Michael Winkelmann makes a strong case in Shamanism: Tne Neural Ecology of Ecstasy and Healing that shamanism helps to activate and enhance the body’s natural healing systems. He revisits many of those same arguments in his 2002 paper for American Behavioral Scientist, “Shamanism as Neurotheology and Evolutionary Psychology,” [PDF] where he writes:
Shamanic ASCs [altered states of consciousness] and their slow-wave synchronization patterns activate functions of the paleomammalian brain involving self, attachments, and emotions. Shamanic cognitive capacities based in presentational symbolism, metaphor, analogy, and mimesis express the dynamics of the lower brain systems and provide a medium for ritual and symbolic manipulation of these systems. These physiological aspects of ASCs facilitate healing and psychological and physiological well-being through physiological relaxation; facilitating self-regulation of physiological processes; reducing tension, anxiety, and phobic reactions; manipulating psychosomatic effects; accessing unconscious information in visual symbolism and analogical representations; inducing interhemispheric fusion and synchronization; and facilitating cognitive-emotional integration and social bonding and affiliation. The neuroendocrine mechanisms of meditation indicate that stress reduction also occurs through enhancement of serotonin functioning and stimulation of theta brain wave production.
While shamanic healing differs from Western biomedicine in its emphasis on–rather than its shunning of–the placebo effect, neither is this the entirety of ethnomedicine. While these methods are extremely effective at treating illness and sickness, and are far more effective even at treating disease than we normally give them credit for, most traditional ethnomedicines also have more directly physical means of treating disease.
Perhaps the most impressive example would be the archaeological evidence that foragers in the Mesolithic successfully performed brain surgery. The procedure, called trepanation, involves boring a hole in the skull, and is often effective to treat head trauma or pressure. A news brief in Archaeology magazine described one such discovery:
New accelerator radiocarbon dating of the Dnieper Rapids cemeteries near Kiev in Ukraine by the Oxford Radiocarbon Laboratory has produced evidence that trepanation, the surgical removal of bone from the cranial vault, was performed during the Mesolithic period. During a study of 14 individuals at the Vasilyevka II cemetery, Malcolm C. Lillie, a geoarchaeologist and palaeoenvironmentalist at the University of Hull, found one skeleton (no. 6285-9) to have evidence of trepanation. The cemetery, excavated in 1953 by A.D. Stolyar, has been dated to 7300-6220 B.C., making the trepanned cranium the oldest known example of a healed trepanation yet discovered. The skull, which was originally reported in Russian by I.I. Gokhman in 1966, has a depression on its left side with a raised border of bone and “stepping” in the center showing stages of healing during life. The complete closure indicates the survival of the patient, a man who was more than 50 years old at his death. The dates for the individual are 1,000-2,000 years earlier than those of the skull at Ensisheim in France, recently reported by Kurt Alt to be the earliest evidence for trepanation.
Today, trepanation is still done around the world and with great success by many primitive peoples, including the Gusii and the Tende from the hills east of Lake Victoria.
There is also an interesting point that, having past its point of diminishing returns (see thesis #15), medical research is increasingly relying on ethnobotanical knowledge of medicinal plants for drug development, by isolating the active compounds in traditional remedies used by shamans for millennia. Perhaps the single most effective drug ever developed by Western biomedicine is aspirin–originally isolated from willow bark, a remedy for headaches used by Native Americans as much as by Hippocrates in the fifth century BCE. One pharmaceutical company built on this premise, “Shaman Pharmaceuticals,” explains its rationale thus:
Tropical forest plant species have served as a source of medicines for people of the tropics for millennia. Many medical practitioners with training in pharmacology and/or pharmacognosy are well aware of the number of modern therapeutic agents that have been derived from tropical forest species. In fact, over 120 pharmaceutical products currently in use are plant-derived, and some 75% of these were discovered by examining the use of these plants in traditional medicine. … Yet while many modern medicines are plant-derived, the origins of these pharmaceutical agents and their relationship to the knowledge of the indigenous people in the tropical forests is usually omitted.
In both of these cases, traditional medical knowledge is often rejected on the basis of the religio-philosophical frame it is placed in. When shamans speak of good or evil spirits, Western researchers usually stop listening. This neglects the fact that shamanic knowledge usually operates on multiple, simultaneous levels, and they are usually fully aware of the physical level. For instance, one example of shamanic “fraud” often cited is the practice of some shamans to spit out rolled up plants and tell the patient that they are the evil spirits sucked out of his body. In fact, the shaman placed those plants in his mouth prior to the ritual and hid them there. This is often cited as an example of shamans as charlatans, but it actually fits in well with the shamanic worldview. The plants hold the same spirit that is being sucked out of the patient–the shaman holds them in his mouth to “catch” the spirit so he does not become infected himself. When they are spat out, the shaman indicates that they are the evil spirits–and to him, they are: the evil spirits were trapped inside of them. This display prompts a stronger placebo effect, and is not in the least bit deceitful from the shamanic worldview.
Under this same notion of disease coming from invasive evil spirits, we have a means for shamans to memorize ethnobotanical information. By placing plants and diseases into a mythic context, the shaman can keep a full medical library in his memory using the same mnemonic tricks that help astronomers keep track of the stars by reference to a full mythology of constellations. It is also interesting to ponder the strange similarities between “evil spirits” and germs: neither can be seen, both invade our body, both have “good” analogues that actually help us; both make us sick by the way they seek to use our bodies; both can be driven out by ourselves, or by introducing new elements to fight them. The distinction between germ theory and the superstitions of “evil spirits,” in that regard, seems to become little more than insistence that another culture express one’s same ideas in the same, mechanistic terms.
Every culture believes its own ethnomedicine to be the only valid one. Every ethnomedicine is based in a given view of the world, a given understanding of human nature and the world. Each culture’s ethnomedicine is based in that. The inustrialized West sees the world as a physical clockwork mechanism, and though we can easily recognize the fallacious cornerstones of other cultures’ worldviews, we are blind to our own, such as the bankruptcy of Cartesian dualism. Our ethnomedicine–Western biomedicine–is based in our worldview. We see other ethnomedicines as superstitious poppycock, because they are not based in our mechanistic worldview. They are based in the worldview of the culture they come from–in the case of foragers, that is usually an animistic worldview. Yet, we cannot deny their effectiveness, even as they cannot deny ours–even when we can’t explain that effectiveness (and when they can’t explain ours).
In the final analysis, the effectiveness of Western biomedicine has been greatly exaggerated and its limitations conveniently forgotten, while traditional ethnomedicines have been denigrated. A correction for these problems reveals that our ethnomedicine, while unique in many ways, by no means has a monopoly on medical knowledge or effectiveness. In fact, though an overall comparison is difficult, most ethnomedicines fall within a fairly narrow general range of effectiveness. Even our own does not significantly outclass the others, while there is a minimum effectiveness required to keep a society competitive.
Thus, the protest that civilization improves our health is utterly without merit. The overall effect of civilization on human health has been disastrous, introducing innumerable diseases and maladies unknown before. A more nuanced argument cites a “Pandora’s Box”: civilization has unleashed these terrible diseases on the world, and we cannot rewind time to undo the damage. We need civilization now to produce the medicines necessary to combat the diseases civilization unleashed. But, as we have seen here, that is not the case, either. Most of those diseases are the effects of the civilized lifestyle, and would be cured as a consequence of rewilding. Of those that remain, their ability to sweep across the world as an epidemic would be greatly reduced in a world of small, nomadic bands. And finally, as we have seen above, every culture–civilized or not–has medicine. Other forms of medicne tend to be less specialized in treating disease only, and instead also treat illness and sickness, but none of them are much more effective than any other, including our own. Our ability to treat disease would not be diminished without civilization, only the means by which we do so. It would mean a shift in emphasis from the dehumanizing, clinical introduction of foreign substances to combat invasive pathogens by an aloof, unquestionable authority to a method that emphasized communal bonds and deep emotions in a process that helps the patient take control of his own illness and, ultimately, empowers him to heal himself.
Future groups will be even better prepared for epidemic diseases, merely because civilization has really shaken the genetics of the world up. In the western hemisphere especially, the number of possible immune responses has skyrocketed due to our incredible hodgepodge of genetics. While a forager band before civilization may have had (at a high) two or three haplogroups present, human groups in the future may expect dozens, making the bands far more resilient to epidemic diseases. Our descendents may be able to resist future civilizations better for the simple reason that their diseases won’t annihilate “native” populations like they did before.
- Chuck
Comment by Chuck — 3 January 2006 @ 7:55 PM
As much as I appreciate what you’re trying to do, both in this article and in general on Anthropik, I have to disagree with this statement: “Our pharmaceuticals, as powerful as they are, still owe most of their effectiveness to the placebo effect.”
I am familiar with the workings of clinical trials, and I think there is a common misperception in the general public of what “placebo” means. Certainly, for non life-threatening diseases it can be simply a sugar pill. But for life-threatening diseases, the control group always gets at least the “standard of care”, which is typically another pharmaceutical agent or regimen consisting in part of existing/approved pharmaceuticals. (I’m talking here about Phase III trials, as Phase I and Phase II trials are dicier.) Just because both treatment groups of patients get better (or live longer) doesn’t mean that the mind is doing all the work in the control group, in absence of an active biological agent. Even for non life-threatening diseases the control can be an existing approved treatment that is still pharmacologically active (although perhaps weaker or less precise).
I am not arguing against the mind/body connection, and I agree with much of your general analysis about our toxic physical and memetic environment. I just think that some of your statements (this one in particular) are a little sloppy. The way this site is structured, you are setting up an expectation of intellectual rigor, and it is disappointing when there is a lapse.
Comment by slomo — 4 January 2006 @ 12:05 AM
Of course not. I’m quite familiar with the way clinical trials are handled, myself. I’m not referring to a straight comparison of experimental and control groups. For nearly all diseases, we know what recovery rate the standard of care provides–being standard. There is almost always a significant rise in that recovery rate in the placebo group, compared to the standard recovery rate. An effective drug will have an even higher rise than that, but even for very effective drugs, 75% of its rise over the standard is attributable to the placebo effect. In other words, if the standard recovery rate is 80%, and the drug raises that to 90%, then just the placebo group will see at least 87.5%.
At least, that’s what I’ve read over the years. I’d have trouble producing a citation for that, as it’s simply something stuck in my memory, so if you have anything that says otherwise, I’d love to read it.
Comment by Jason Godesky — 4 January 2006 @ 12:43 AM
I’m sorry Jason, but I can’t quite parse this statement, “There is almost always a significant rise in that recovery rate in the placebo group, compared to the standard recovery rate.” You seem to be saying that “A > A”. Unless you are saying that, over time, survival attributable to a particular treatment regimen increases. But to support such a statement, you would need to conduct a meta-analysis that would be subject to the kinds of errors that can crop up in observational studies (not to mention various types of selection biases). And even if you can show that dA/dt > 0, there are plenty of other explanations that make no use of mind/body connection.
I don’t want to argue, because I respect your work and I think that your overall thesis is correct, in spite of some details that could either be better supported or left out entirely.
For the particular point in question, it would be more advantageous to dig up case studies of outlier individuals who are/were able to stave off disease far longer than expected, and who attribute their success to meditation. (If I recall correctly there are some examples in HIV, although I doubt they would appear in JAMA, Lancet, or the like.) These case studies would not prove your point statistically, but I don’t think you need that. There may in fact be some peer-reviewed papers on the subject, but I would be careful with those. There was that article a few years back that purported to prove that prayer could improve medical outcomes, but turned out to be fraudulent and became a huge embarassment for the journal that published it.
Comment by slomo — 4 January 2006 @ 1:36 AM
No, the standard rate of recovery of all those people not in the study, recieving the standard of care. That’s the baseline–not the control group.
Comment by Jason Godesky — 4 January 2006 @ 2:05 AM
I wonder if this is what was stuck in my mind…
Then there’s this, from Carol Hart, “The Mysterious Placebo Effect,” Modern Drug Discovery, 1999, 2(4) 30-40:
Comment by Jason Godesky — 4 January 2006 @ 3:20 AM
I think, you underestimate the scale on which Western medicine uses various plant derivatives to make new medicines. Since most of the plants from around the world are available to civilized medicine for research, the variety and quality of medicines produced by this research will always be much greater than that of any localized tribe without access to healing plants from 6000 miles away.
Comment by _Gi — 4 January 2006 @ 11:25 AM
Hey –
The problem with modern medicine is the same engineered complexity vs organic complexity that we find in ecology… the natural plants have many chemicals with many properties that we don’t always understand… so modern medicine isolates the compounds that they do understand the use of… and perhaps adds other compounds that they understand. The natural plant, however, may be more healthy in ways that we simply don’t get.
I think of willow bark and aspirin. Willow bark can cause a little stomache discomfort, but it also has a much more subtle effect. So modern medicine extracted aspirin, making the nausae much more pronounced and removing any secondary effects the plant may provide.
Obviously this can go both ways. Some useful compounds may be naturally bound with compounds that are quite bad (again — the stomache discomfort of aspirin), but I can’t help but think that there may be a whole lot more going on than we really grasp.
Janene
Comment by Janene — 4 January 2006 @ 11:35 AM
Gi — That advantage is balanced by the time and money it takes to research the drug, isolate the active ingredient, produce a fabrication method, and mass produce it, particularly in an age of declining marginal returns on medical research. Furthermore, the general hostility of Western biomedicine towards other forms of ethnomedicine also keep us from appreciating or using the full ethnobotanical database available. A culture may know 600 cures in the rain forest, of which we’ll develop one. These two effects combine with Janene’s point to counterbalance the advantage you speak of, so that the overall effect levels off to round about the same.
Comment by Jason Godesky — 4 January 2006 @ 11:39 AM
If we don’t know or understand something, we do research, and improve our knowledge and understanding.
Molecular biology is getting very powerful tools which allow synthesis of compounds specifically targeted to the source of the problem.
Accumulation of medical knowledge never stops in our medicine, it accelerates, unlike primitive medicines which accumulate knowledge very slowly. This accumulation sometimes leads to breakthroughs which produce whole new fields of knowledge and bring new effective treatments unknown to primitive cultures. Our surgery and emergency medicine is the best in the world by far. We can patch up our warriors and restore them to fighting condition like no other culture in the world. And don’t forget the simple things like tetanus vaccine. No primitive culture has it, therefore tetanus is almost always fatal in rpimitive life, but it is not for the civilized people.
Comment by _Gi — 4 January 2006 @ 11:50 AM
Please define “standard rate of recovery”. This is not a widely used term in epidemiology. If I’m interpreting correctly, it would have to be based on population data such as Medicare or SEER sources, or else meta-analysis of clinical trials data. If the former (standardized population data), then I would caution against over-interpretation of how a control group fares against the population average, since clinical trials populations are not random subsets of the general population. The latter (meta-analysis) would not make sense because a meta-analysis simply reproduces an average response (under a particular set of distribution assumptions), so asserting that the control group does better than the “standard” is like saying E(X) > E(X).
Your examples — one involving an antidepressant and another involving pain management — are essentially psychological. In that case, a mechanism for placebo effect is clear, and not very interesting. What is more interesting is when HIV positives do not progress to AIDS or cancer patients unexpectedly experience remission. This happens, although not frequently enough to study systematically because the population of individuals who are proficient at yoga or tai-chi is quite small.
I’m not trying to be an a**hole here. In general, your work is interesting, provocative, and I agree with much of what you say. I’m basically subjecting your work to the same standards I would apply to a paper I was reviewing for a peer-reviewed journal, since that is the tone of the site. I don’t think this flaw (or others that have been pointed out in your other theses) is at all fatal, but it would be the kind of statement that a reviewer or thesis committee would want fixed.
Comment by slomo — 4 January 2006 @ 11:50 AM
Hey –
Gi_ we can do all of the research that we want — but modern science suffers from a distinct lack of systemic approach. Everything is way to compartmentalized to achieve a true holistic understanding of natural compexity.
Just a ‘pulled out of my butt’ example: imagine a plant with a laxative effect that also can have side effect of headache. Modern medicine, typically, would isolate the laxative compound and leave the rest. But, perhaps the headache side effect is caused by a secondary compound that enhances the diuretic effect of the first compound just enough to induce a natural desire to drink lots of water. Overall health effects would be positive and warning labels would be unneccessary.
Instead, our science pulls out the first compound, tells us to drink water and then crosses thier fingers. It is unneccessary formalized complexity replacing natural/organic complexity. And of course, it costs a lot to boot…
Janene
Comment by Janene — 4 January 2006 @ 12:04 PM
Gi wrote:
That’s precisely what this thesis disproves, Gi. Every culture has that, primitive, civilized, or otherwise. Primitive cultures don’t have a tetanus vaccine, but they also don’t have tetanus. They do have a number of effective treatments, ranging from ethnobotany to surgery to shamanic rituals to provoke the body’s own healing response, that is sufficient to overcome pretty much all the health problems they do face.
As for how “quickly” we learn, that pace is not accelerating, but dropping–as was shown in thesis #15, where the diminishing returns of medical research was an explicit example. There, I quoted Tainter thus:
In other words, the more medical research we do, the harder medical research becomes. It takes longer and costs more for effects that either remain the same, or diminish. It took a few months and what, $20,000 to develop penicillin? It took years and millions of dollars ofr Pfizer to give old men boners. Diminishing returns–our pace is slowing.
Our medicine is not the best in the world–not by far, not even by a little. It is highly specialized; it’s good at what it does but little else. I’m not one of those people you’ll meet trying to tell you that Western biomedicne is worthless–I’m saying it has its place, but that place isn’t “Most Supreme Ultimate Medicine EVAR.”
slomo,
I appreciate your criticism very much, and now that you’ve made me revisit the evidence I was half-remembering when I wrote that line, I realize that maybe it’s not quite so impressive as all that–as you said, and as occurred to me once I discovered the articles in question in again, if it’s all psychological drugs we’re talking about, a large placebo component is hardly unexpected.
By “standard rate of recovery,” I simply meant the percentage of people who normally recover from disease X, which should be a fairly readily available statistic. I’m not an epidemiologist by training, it’s merely an interest of mine, so I hope you’ll forgive me if my terminology reflects my status as an interested layman.
Above, I also cited a passage suggesting acetaminophen’s effectiveness due to placebo may be “as high as 70% or 82%.” Acetaminophen is certainly not a psychological drug, but is that especially high? I’ve read similar things for other drugs in the past, as well as more general statements that most drugs hovered about 75%, but without being able to find any citations for that, you’re quite right, the statement is somewhat indefensible.
Naturally, anything less than 100% means that the drug is more effective than placebo, and thus effective and valuable in its own right, but such high percentages would suggest that as useful and effective as drugs may be, they are still not as effective as the body’s own ability to heal itself.
But I do thank you again for your criticism. “The Thirty Theses” are an online rough draft for a book, and the comments section a set of notes for editing. I’ll be sure in the second round to either find some more solid evidence to back that statement up, or delete it entirely, as you’re quite right–I certainly don’t want anything in there that I can’t defend.
Comment by Jason Godesky — 4 January 2006 @ 12:17 PM
The second sentence is wrong. Tetanus is an anaerobic bacterium that lives in the soil. If it is introduced into the blood stream due to trauma and contamination by soil, it produces a toxin which is fatal before there is an effective immune response.
A tetanus vaccine produces antigens that block the tetanus toxin.
It is easy to get tetanus, and it is everywhere, civilization did not invent it, it is not found in animals, it is in the soil.
Comment by _Gi — 4 January 2006 @ 12:39 PM
Usually farmed soil, because of its occurence in horse droppings, no? Wikipedia seems to think so, given this from the “tetanus” article:
(Whatever you may think of Wikipedia’s general reliability–and I generally view it as reliable as any other encyclopedia (that is, not terribly)–Wikipedia’s accuracy in biology specifically is routinely lauded by medical researchers, such as this news brief from Nature: “Internet encyclopaedias go head to head“: “Wikipedia comes close to Britannica in terms of the accuracy of its science entries”)
Comment by Jason Godesky — 4 January 2006 @ 12:51 PM
Jason says: By “standard rate of recovery,” I simply meant the percentage of people who normally recover from disease X, which should be a fairly readily available statistic. An easy quantity to define, but not so easy to estimate. Devil is in the details: what population are you drawing from? Developed world? U.S.? European-Americans? Those who have participated in clinical trials? Each of these would require its own data source and statistical methodology, and use of each resulting index would require a special set of assumptions.
Re: acetaminophen. Acetaminophen is primarily a pain reliever: “Acetaminophen relieves pain by elevating the pain threshold, that is, by requiring a greater amount of pain to develop before it is felt by a person.” While there is without a doubt a neurochemical component, pain is essentially a subjective experience and therefore falls within the domain of afflictions that one could reasonably expect to be affected by purely mental processes. The more interesting phenomena involve afflictions upon which, under the prevailing view of Western science, one would not expect important effects from purely “mental” processes.
Janene says: we can do all of the research that we want — but modern science suffers from a distinct lack of systemic approach. Everything is way to compartmentalized to achieve a true holistic understanding of natural compexity. I would tend to agree with this statement. There are some attempts in certain disciplines (most notably sociology and ecology) to integrate data from various sources, but in general science doesn’t do that very well.
My own long-term professional interests — if you can’t tell already, I’m in the science business — involve developing techniques for more integrative research. Compared with mystical/shamanic modes of inquiry, this is the long way around things. But, you gotta pay the bills somehow.
Re: tetanus (and life-expectancy in general, discussed in one of Jason’s earlier theses). I would doubt that primitives experienced less trauma or trauma-induced infections than the civilized human. How they might cope with injury or infection is another matter. I think it would be quite difficult to obtain a representative estimate of life expectancy for hunter/gatherers (but I’m no anthropologist so I can’t say for sure). However, the real issue is quality-of-life (QoL). Even if life expectancy was lower for the primitive, one could argue that “quality-adjusted survival” was higher. Of course, you have to define what you mean by QoL, and I think this is where Jason’s strengths lie.
Comment by slomo — 4 January 2006 @ 1:10 PM
Life expectancy with foragers is a very tricky issue, indeed; we’ve had quite a few long debates about that one here, most recently in “The Best Kept Slaves.” Comment #3604 sums up pretty much everything I have. Now, what happens when you consider “quality-adjusted survival”? I have no idea how you’d even measure that.
For the record, I’m a big fan of science, and I think Western biomedicine is at least as good as any other ethnomedicine on the planet. My disagreement is with statements like, “Science is the only way we can ever know anything,” or, “Western biomedicine is the greatest medical system EVAR!” I’m all for science, and I’m relatively certain that we can find some way to continue it even when civilization is gone, but it’s certainly not the only way to know. Among those ways, I’d be unwilling to even pick a “best” one.
Science creates a very rigorous, reliable, minimalist base of knowledge. We test and retest everything in that base, to make sure that we have this foundation of, “OK, this is the stuff we’re pretty damn sure about.” That’s invaluable! It’s an incredible starting point. But often times, it’s useful to make intuitive jumps and not be so rigorous. Thinking mythologically is healthy and normal, and it’s something we’ve denigrated far, far too much.
On this site, I try to be as rigorous and academic as possible, especially in the theses, because I’m trying to lay a foundation. But I hope when you go home at night, like me, you’re still able to appreciate the mythic side of life, too–not for anyone else, but just for your own sake.
Comment by Jason Godesky — 4 January 2006 @ 2:52 PM
Quality-adjusted-survival (QAS) is essentially a weighted life-expectancy, where the weights are utilities. It is used to compare treatments when there are tradeoffs between life expectancy and QoL (suitably defined); much of the methodological development appears in the breast cancer literature.
QAS has spawned some controversy for a couple of reasons. One, its original development was geared towards the clinical setting, but there is a temptation to make population-based interpretations, which is problematic in a health policy setting. Two, a particular QAS estimate is strongly dependent on how you define QoL, i.e. the utilities.
If you wanted to use this construct, you could go about defining various QoL indicators (e.g. stress induced by position in hierarchy, morbidity related to sub-optimal nutrition, social relationships). Doing this in a fair and academically rigourous manner would be a doctoral dissertation in itself. The mathematical development should be straightforward, since any anthropologically-based utilities will probably not have tricky age-dependence. It would take some work to counter some of the objections to using a population-based QAS, but this objection is regularly overcome in outcomes research.
Comment by slomo — 4 January 2006 @ 3:12 PM
From the same article:
There is plenty of animal dung in places where hunters get injured.
Comment by _Gi — 4 January 2006 @ 4:04 PM
Not so much. Those areas are all primarily agricultural now. Farms are covered in a LOT more animal dung than just wilderness. Farms are literally covered with it (manure), but wilderness, not so much. Go walking through the woods, and count up how many droppings you see. Then go to a farm and count up how much manure there is….
Finally, you’ll notice that the above list of animals carrying tetanus are all domesticated, or at least animals that flock to large, agricultural settlements (like rats).
Seems similar to malaria … it probably occured infrequently in the Paleolithic (and I’d guess, as usual, in a milder form that was more easily treated), that became far more deadly because of the practice of agriculture. In the case of malaria, it was the stagnant pools of water next to large human populations that made malaria the killer we know today.
Comment by Jason Godesky — 4 January 2006 @ 4:10 PM
Re: infections such as tetanus. I think it’s quite likely that foragers had better immune systems than we do. Some of the reasons are mechanistic and can be documented (e.g. selection pressures), but I also think there is a mind/body connection that Jason was alluding to [before I tried to shoot him down :)]. There has been some research on associations between mental health (e.g. depression, stress) and immune response; one good place to look for this is in the asthma literature, especially theories about “exposure to violence”.
I don’t think it is erroneous to extrapolate that the mental health benefits of forager society would lead to improved immune response.
Comment by slomo — 4 January 2006 @ 4:32 PM
That said, injury and infection were definitely part of forager life. The bone fractures in Neanderthal match up fairly well with the bone fractures in rodeo cowboys, and there’s plenty of archaeological evidence for foragers who sustained traumatic injuries. Extant foragers often get infections.
That said, as bad as those things can be, it’s still a far cry from the Plague, innit?
Comment by Jason Godesky — 4 January 2006 @ 4:39 PM
This is not at all obvious. 99% of the American natives were wiped out by unfamiliar diseases to which their immune systems could not adjust.
The civilized humans have much larger selection pressures caused by infectious diseases and much wider set of immunities as a result. Additionally, constant expansion of civilization inevitably leads to more thorough genotype mixing which also improves resistance to infections. Just like we couldn’t be maintaining our health without our medicine, it would be impossible to maintain civilized lifestyle without a robust immune system as a general feature of the civilized population.
Comment by _Gi — 4 January 2006 @ 5:04 PM
And the Plague of 14th century is a far cry from the bacteriological weapons of the 21st. Why is that?
The survivors of civilization acquired resistances and partial resistances to a wide range of infections. But we really accelerated the natural process by mass application of vaccination. Now, only 1 in a million has to die to acquire resistance to civilization’s most common diseases, and most of the rest become immune.
I mentioned bacteriological weapons, because they are the easiest to use, they require no high technology to deploy, and in any collapse scenario they are most likely of all WMD’s to be used. It will be as difficult as it ever was for hunter gatherer bands of tomorrow to withstand the application of biological warfare directed at them by their civilized neighbors who retained access to current stockpiles. Ofcourse I don’t expect you to be dumb enough to pick up smallpox blankets, but will your grandchildren have your caution?
Comment by _Gi — 4 January 2006 @ 5:24 PM
Gi has a point. Certainly foragers would be immunologically naive with respect to microbes not typically encountered in their environment. On the other hand, there is a difference between immunological maturity and the ability to mount a response to a disease never before encountered. I’m not an expert in this matter, so I’d have to defer to somebody else.
Comment by slomo — 4 January 2006 @ 5:25 PM
OK, I have to take off my scientist hat here and put on my shaman hat (an accessory that I really have not earned). I believe that the key to survival is going to be cultivation of precisely the kind of mind/body connection that Jason alludes to in his discussion of the placebo effect (and, in retrospect, this is why I jumped on the weakness of his justification for that particular point).
This is precisely the issue: the power asymmetry is so pronounced that it cannot be overcome by technologies grounded in 20th century scientific principles.
Comment by slomo — 4 January 2006 @ 5:30 PM
So, Gi. You’re saying that a group of people who have never experienced a particular virus had no immunity to that virus? I agree. But this is a far cry from saying that that group of people had an inferior immune system. More likely is that the immune resposes of foragers were as high as any very active and healthy people with an impecible diet. But, those immune responses would be generally geared towards infections and diseases they encountered. When the spanish flu hit civilized populations with no experience with it they were decimated. Same with the bubonic plague. The difference being that civilized populations experience continuing and unrelenting population growth, which over came the deaths. Foragers do not, and their populations were greatly diminished. There is nothing I see here that would directly indicate a flawed or inferior immune system, merely an inexperienced one.
Comment by Benjamin Shender — 5 January 2006 @ 11:41 PM
Excuse this comment, it’s a little off topic.
I did a study once in college for a little extra credit to see what if any anti-microbial effects common cures had on various common infectuous diseases.
As a control, we used penicilin in some peteri dishes to observe what definite prevention of growth would look like.
To make a long study short, we found red pepper to be slightly more aggresive in preventing pathogen growth than penicilin. While penicilin inhibited growth in the area it was physically at, the pathogen seemed to grow around the red pepper. So beyond inhibition, it showed signs of prevention.
I know as a scientific fact that infection is preventable and avoidable. SO maybe I am a little on topic here. But last itme I checked, red pepper has been around a much longer time than penoicilin, and I know of no mutant capsicum-resistant(the active ingredient in the pepper) microbe.
Civilization not only does not have a monopoly over medicine, doing everything themselves is leaving them thousands of years behind…
Comment by TonyZ — 6 January 2006 @ 3:00 PM
A common mistake people make that somehow poor people, colored people, anyone not white and from America, are not leavers. We all want to be on top of the pyramid. It’s just a matter of walking way before you are TOO sucessful at fullfiling your childhood dreams….
Comment by TonyZ — 6 January 2006 @ 3:06 PM
I am saying more than that. I am saying that the civilized populations inevitably did encounter much more virii than non-civilized. I am saying that it is much more likely for civilized populations to have much wider immunities. Not only our civilization is a more complex way of life, it forces our immune systems to be more complex, with a high number of full and partial immunities, and it forces us to develop these immunities much quicker than foragers can do it. Also, growth of civilized population ineviably leads to more thorough gene mixing which makes it harder for the pathogen to infect the whole population. And now we also have mass vaccinations.
That program further increases the number and power of our immune responces. In other words, we are much better adapted to living in sickness-inducing environments.
Comment by _Gi — 6 January 2006 @ 6:14 PM
Civilized populations have more immunities, yes. That is not a “more complex immune system,” that’s more antibodies.
The greatest genetic diversity is still in Africa, where civilization has always had a hard time lasting for very long, so your argument about genetic diversty flies in the face of the realities of genetic diversity.
Mass vaccinations don’t impress me, though, but perhaps that’s because I watched them nearly kill my brother by giving him a meningitis vaccine that gave him meningitis.
But overall, I would agree with you that civilization has a superior immunity to disease, because they’re afflicted with more diseases. They need more antibodies just to survive all of the horrific ailments the civilized life introduces.
Civilized people becoming foragers … well, we’d enjoy the antibodies of civilized people, combined with a way of life that means almost never encountering a serious pathogen, anyway. Like an armored truck to protect you from a nerf gun.
Comment by Jason Godesky — 6 January 2006 @ 6:24 PM