CONCERNING ANTIBIOTICS AND THE GERM THEORY OF DISEASE

by Peter Morrell

Concerning Antibiotics and the Germ Theory of Disease
[July 2001]

Domination by Theory and Bacteriological Reductionism?

"In attempting to reduce the use of antibiotics for respiratory
infections it is profitable to look at the incidence of several of
these problems. Ear infections in the US have increased from 9.9
million in 1975 to 24.7 million in 1990 (1). Though there are no
comparable large scale studies, sinus disease appears to be increasing
as well. All respiratory disease are primarilly caused by bacteria
colonizing the nasopharynx." [1]

9.9 million to 24.7 million in 25 years, being 149% increase over 25
years, is a 6% annual rise in these conditions. Given the veritable
blitz on the bacterial world with antibiotics, sustained in rich
countries like the US over this very same period, how can bacteria be
the cause of these steeply rising infections? The one datum supplied
simply does not seem to warrant the conclusion drawn.

"Antibiotic use (and misuse) has soared since the first commercial
versions were introduced and now includes many non-medicinal
applications. In 1954 two million pounds were produced in the U.S.;
today the figure exceeds 50 million pounds." [2]

1954 to 1998 is 44 years; a shift from 2 million pounds [1 kg. = 2.2
lbs] to 50 million pounds is 48 million; an increase of 48 million
over 44 years is 1.091 million per year and that represents an annual
increase of 54.5%. It is hard to interpret such figures against those
of ear infections given above, as these are global figures for all
antibiotics in the USA. However, some might say that a 6% rise in such
infections would be much higher without antibiotics. Others might say
such a war waged against the microbial world is fundamentally
unwinnable and therefore futile.

Let me open an historical window to gaze out of...

"Lest in the eager hunt for specifics against the bacillus, we lose
sight of that most important factor, the predisposition, the soil upon
which the bacilli seem to flourish...let the bacilli take care of
themselves, let us take care of our patients." [3]

"Physicians who criticized the proposal to ground therapeutics in
bacteriology especially feared that domination by theory would
oversimplify practice...the complexity of clinical phenomena and the
exercise of judgment could not be bypassed by bacteriological
reductionism." [4]

Has much progress in this view been made in 120 years?

"The flaws in nineteenth century bacteriology were evident to
everyone. Why did diphtheria bacilli cause disease in one person and
not another whose throat cultures showed the presence of virulent
bacilli? How did bacilli actually cause disease? All physicians were
ignorant of the answers to these and many other fundamental
questions." [5]

And patently still are.

"Physicians were less concerned with how and why a therapy worked than
with the demonstrable fact that a therapy was medically valid,
demonstrable, and consistent." [6]

Does not 'bacteriological reductionism' ignore, exclude and downgrade
the importance of previous medical history, general level of health,
hygiene, psycho-social factors, diet and lifestyle factors in the
development of infectious disease? Factors which, in fact, create the
very susceptibility to infection, which distinguish 'the infected' as
a category from 'the non-infected', not only in the same town, but in
the same house or family.

Therefore, we might conclude that bacteria, viruses, and other bugs
are not 'primarily the cause of all infectious respiratory disease',
but secondary, tertiary or even merely associative causes.

Finally, Professor Warner gives another clue that might explain both
why physicians in the 1890s despised the Germ Theory, and why
physicians today give antibiotics by reflex:

"Therapeutic conformity, or at least avoidance of criticism, was
important to the young practitioner trying to gain approval...regular
physicians' attitudes towards therapeutic change were molded by a
dialectic between their commitment to progress and their loyalty to
tradition." [7]

Perhaps the force of conformity in medicine is far more powerful than
the desire to answer those 'fundamental questions' that Rothstein
lists above or to make progress in the use of antibiotics that Dr
Jones suggests in his e-letter.

Asking some fundamental questions

When Joseph Watine says, "let us hope that he does not forget that
antibiotics still have the ability to save the lives of many patients
suffering from bacterial respiratory diseases (legionellosis,
tuberculosis, etc)." [8], I would say it contains an outer meaning and
an inner meaning.

Joseph Watine, in making this statement, utters a declaration of his
own medical conformity in the presence of his medically qualified
brethren, 'beats the drum', and declares his belief in his own
training and its underpinning system of beliefs, like a declaration of
belief before members of the mother church.

If, 1000 years ago, I had criticised a dominant medical practice like
purging, medical practitioners would have similarly reacted and
pronounced their belief that above all, sickness was "regarded as the
finger of Providence. God used illness for a multitude of higher
purposes...as a punishment..." [9]. Disease "was routinely interpreted
as the consequence of sin, crime, or moral fault, as precipitated by
evil spirits, or as the work of black magic. Disease was thus
personalized and given a moral or religious meaning." [10]. Doctors
would also have declared the healing power of Christ in the world, and
that Antimony, prayer and fasting were the sole cures.

Such a reaction is broadly similar to that of Joseph Watine. His
remark not only reveals the unquestioning and deeply conformist nature
of medical training, practice and belief, and the desire to be just
another grey brick in a uniformly grey wall - a conformist who
questions nothing - but it also
denotes how belief-driven, how theory-dominated medicine is. That is
no less true today than it was in pagan or medieval times. The beliefs
might have changed, but the attitude hasn't. In "the seventeenth
century...the accent of therapeutics lay on expelling toxic substances
from the body - by purging, sweating, vomiting, and the much favoured
surgical technique of bloodletting..." [11]. Milder shadows of these
practices persist in herbal and proprietary preparations with
laxative, diaphoretic, expectorant or diuretic properties.

Getting back to the superficial point his question raises, I would say
that because antibiotics do not and cannot even impinge upon, let
alone remove, the OTHER causes of disease [other than 'germs'], so it
is clear that their power over disease is limited. Indeed, their
curative power is very precisely limited to that narrow, specific
role. Therefore, in cases where removal of such 'germs' is most
urgently required as the main therapeutic objective, then yes, of
course, the effect of antibiotics is demonstrably spectacular, even
miraculous. However, such is not so commonly the case today as
compared to 50 or 100 years ago. It is not the full picture.

Today, especially in the rich countries, the power of antibiotics is
diminished precisely because the conditions or causes that create
infectious disease are largely constitutional, dietary and psycho-
social and not so overtly bacteria-driven. "Villermé [in 1828]...was
able to prove that morbidity and mortality rates were, in a sense, a
function of the living conditions of a given class...filth and
overcrowding were proved to act...as the indirect causes of
fevers." [12]. And thus it became apparent that "cleanliness was in
some way a protection against disease." [13]. Although "water-borne
infections were checked by a combination of bacteriological diagnosis
and improved sanitary engineering." [14], many physicians remained
sceptical of the Germ Theory.

It was not unusual in New York for "well known physicians to get up
and leave the hall when medical papers were being read which
emphasised the germ theory of disease. They wanted to express their
contemptuous scorn for such theories and refused to listen to
them." [15]. Some physicians "refused to believe that the horrifying
effects of many diseases could be traced to an almost invisible micro-
organism...nineteenth century bacteriology raised more methodological
and substantive questions than it answered...scepticism was...a
reasonable position...taken by many leaders of the profession." [16]

Some, more reflective persons did exist. "One of Koch's students once
asked him why anthrax bacilli caused death in an animal. Koch said,
'Why its vessels are plugged with bacilli!' The student asked, 'A
mechanical death?' to which Koch replied, 'Certainly'...such
questions, which should have raised serious doubts about all
bacteriology, do not appear to have disturbed physicians very
deeply." [17]

Certainly, there are social, financial, economic and cultural causes
of disease every bit as potent as bacteria and just as active today in
certain parts of every town and city. Therefore, the power of
antibiotics to cure such 'infections' is correspondingly diminished
[to zero] and yet they are prescribed in a reflex manner like old-
fashioned palliatives to mollify patients and/or their concerned
parents, a point made in some letters to this article.

Adopting briefly the homeopathic cloak, I would have to say that most
'ear infections' so-called are better treated with Pulsatilla or
Belladonna, whichever most closely matches the symptoms of the
individual case, and that the vast majority of childhood 'earaches'
resolve quickly with such treatment and in an uncomplicated manner.
Any practitioner can satisfy themselves on this point, very easily.
However, such a point does raise the deeper conceptual question of
whether 'the germs' were really there at all in the first place, and
what the real cause of such earaches actually is? "The craze of the
day is the somewhat hypothetical germ." [18]. It also raises the
question of what any treatment actually achieves. We grope in the dark
and at best see only dimly through a dark lens.

For example, on whose 'side' do the homeopathic remedies work - do
they influence 'the enemy' or do they strengthen the innate healing
powers of the organism? Antibiotics only affect 'the enemy' and seem
to do nothing for the organism. All the natural therapies seem to
strengthen the organism rather than touching 'the enemy' at all.
Allopathy has a deeply ingrained tendency to attack the enemy and to
do little for the innate vital powers. That is predominantly the case.

Lest we do believe that 'germs' are the only cause we should recall "A
distinguished sanitarian Max von Pettenkofer of Munich...made his
magnificent gesture - which by all odds should have killed him - of
drinking a whole glassful of cholera bacilli without suffering any
harm." [19]. Clearly, the deeper question is not the bacteria
themselves, but the 'soil they grow in', which is our relationship
with them. In an infection we must be clear about what has happened.
In health, we are just as surrounded by 'germs' as an ill person is,
but they do not affect us - our relationship with them is normally
balanced, harmonious and unproblematic. In the diseased state, this
previously harmonious relationship mysteriously somehow deteriorates
and 'the germs' come to proliferate.

It is certainly not 'the germs' that bring this shift about. It is not
a germ-driven change. It is those psycho-social, stress and dietary
factors, hygiene, etc, which cause the relationship to deteriorate. No-
one can say with certainty why this happens at certain times and in
any individual case. What is certain is that these changes are
internal to the organism, they are initiated on 'our side', not from
the side of 'the germs'. This recognition does not seem to be
emphasised in orthodox medicine, where the 'magic bullet ', and
attacking 'the enemy' are the central themes of practice. Hence, I
would say, that modern medicine can learn from this situation and
realise why it stands accused of looking in the wrong place and
treating the wrong thing. It should treat the patient, not the
disease; the person not 'the germ'. Thus, I would repeat that bacteria
do not cause disease, it is the deterioration in our relationship with
them that lies at the root of the matter. The 'germs' are manifestly
only secondary or merely associative causes of infections. Clearly
therefore, if bacteria are not the main cause, then how can
antibiotics comprise anything approaching a 'cure'?

In certain parts of the world it is still a widely held belief that
"disease is a supernatural phenomenon governed by a hierarchy of vital
powers...disharmony in these vital powers can cause illness. Thus,
ancestral spirits can make a person ill. Ingredients obtained from
animals, plants, and other objects can restore the decreased power in
a sick person and therefore have medicinal properties." [20]. Modern
medicine seems too grounded in the study of disease [pathology] and in
its eradication and not enough in studying health and how to create
it. These are two very different medical attitudes underpinning the
great divide in medicine that need bringing together for greater
future progress.

When the acupuncturist says disease is due to an imbalance in the
energies flowing in the meridians, they are making a certain
conception of the disease process, which their treatment then seeks to
adjust. It is not necessarily an incorrect conception, merely a
different one from that of the bacteriologist. Likewise, when the
homeopath calls disease primarily a derangement of the life force,
echoing in this sentiment Stahl's animism. Or, when the naturopath
conceives disease to be a product of toxins, which fasting and enemas
will eliminate, he comes close to the sentiment that "disease is not
an entity...but is only the organic and functional forces, or powers
of life, modified by perversion of activity...remedies are relative
agents...they only act curatively by a judicious application to the
individual case in hand. Individualism, not universalism, attaches
therefore to all our therapeutic measures." [21]

Such is still a valid sentiment. These are all different apprehensions
of the disease process due to different modes of medical conception.
All are equally belief-driven or theory-dominated, but each stems from
a very different mode of conception of what is nevertheless the same
disease process. They might well be seen as different blind men
describing the same elephant!

Sources

[1] BMJ letter, Re: Reducing antibiotics for respiratory infections, 6
July, Jones, Lon, Family Practice, Hale Center, Texas, USA

http://www.bmj.com/cgi/eletters/322/7292/939#EL7

[2] The Challenge of Antibiotic Resistance, Stuart B. Levy, Scientific
American 1998

http://www.sciam.com/1998/0398issue/0398levy.html#link4

[3] Eric E Sattler, The Present Status of the Tubercle Bacillus,
Cincinnati Lancet and Clinic, 12, 1884, 415; quoted in John H Warner,
1986, The Therapeutic Perspective - Medical Practice, Knowledge and
Identity in America 1820-1885, Harvard Univ. Press, USA, 280

[4] Warner, 281

[5] William G Rothstein, 1972, American Physicians in the Nineteenth
Century, From Sects to Science, Johns Hopkins Univ. Press, Baltimore,
281

[6] Rothstein, 281

[7] Warner, 183

[8] BMJ letter, Re: Domination by Theory..., Joseph Watine, Hôpital de
Rodez, France, (11 July 2001)
http://www.bmj.com/cgi/eletters?lookup=by_date&days=1#322/7292/939/EL9

[9] Roy Porter, 1987, Disease, Medicine and Society in England
1550-1860, Macmillan, London, 27

[10] 'Disease' by Roy Porter, in Hutchinson Family Encyclopoedia:
http://ebooks.whsmithonline.co.uk/encyclopedia/52/F0000152.htm

[11] Porter, 1987, 14

[12] Richard H Shryock, 1966, The Development of Modern Medicine,
Pennsylvania Univ. Press, 220

[13] Shryock, 240

[14] Shryock, 311

[15] James J Walsh, History of Medicine in New York, 1919, quoted in
Rothstein, 265

[16] Rothstein66-7

[17] Rothstein, 281

[18] New York physician in 1883, quoted in Warner, 281

[19] Shryock, 282

[20] Kale, Rajendra, Education and Debate, South African Health:
Traditional healers in South Africa: a parallel health care system,
BMJ 1995; 310: 1182-85 (6 May)
http://www.bmj.com/cgi/content/full/310/6988/1182

[21] John P Harrison, Notes on Empiricism, Western Lancet and Hospital
Reporter, 8, 1848, 122, quoted in Warner, 63

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