From Library Journal
Is it possible to eradicate disease? Grob (history of medicine, Rutgers) addresses this question while offering a history of disease in America to illustrate the ongoing relationships among society, environment, and human health. Beginning with evidence from prehistoric skeletal remains and continuing to the present day, Grob demonstrates that disease is a natural part of our existence. Many historians see the discovery of antibiotics as a turning point in modern medicine, yet Grob provides interesting evidence showing that many diseases were on a decline even before the widespread use of antibiotics. In addition, as life expectancies increase, long-term and chronic diseases become more evident. While Grob contends that the eradication of disease is probably an unrealistic goal, he argues that we can still work to delay the onset of diseases and make them more manageable. The text is loaded with statistics on mortality rates and life expectancies that have been pulled from a vast collection of resources. Since some basic knowledge of genetics and immunology is assumed, this well-researched volume is recommended for academic library and health science collections. Tina Neville, Univ. of South Florida at St. Petersburg Lib.
Copyright 2002 Cahners Business Information, Inc.
From The New England Journal of Medicine
Perhaps the most important, if frequently overlooked, development in American history is the dramatic increase in life expectancy since the early 19th century. During the past 150 years or so, life expectancy at birth has more than doubled, and the average American has evolved from a young person to a 35-year-old adult. Until the appearance of Thomas McKeown's iconoclastic works in the mid-1970s, observers commonly attributed this achievement to the therapeutic triumphs of scientific medicine. But as medical historians since then have debated the causes of this demographic revolution, four other possible explanations have attracted considerable attention: improved living conditions, especially diet (McKeown's favorite), which increased resistance to infectious diseases, the leading killers of the past; public health measures, such as quarantine, filtered water, and effective waste removal; the decreasing virulence of some diseases; and serendipitous environmental changes. Twenty years ago, the distinguished medical historian Gerald N. Grob joined the debate with a brief for the fourth explanation in "Disease and Environment in American History," in Handbook of Health, Health Care, and the Health Professions, edited by David Mechanic (New York: Free Press, 1983). In The Deadly Truth, the first book-length survey of changing mortality in America, Grob expands (and somewhat modifies) his earlier explanation, examining the patterns of disease from the pre-Columbian period to the end of the 20th century. Animated by skepticism about the current tendency to identify the risk factors responsible for such ailments as cancer, diabetes, and cardiovascular disease -- and by Rene Dubos's pessimism about a disease-free world -- Grob insists (at least twice in nearly identical language) that "the faith that disease is unnatural and can be conquered rests on a fundamental misunderstanding of the biological world." Physicians rarely appear in Grob's narrative. Instead of focusing on heroic healers, Grob stresses the role of "unforeseen environmental changes," from the catastrophic effects of European diseases on Native Americans and the devastating toll of disease during the first two thirds of the 19th century to the dramatic decline of infectious diseases in the late 19th and early 20th centuries and the rise of chronic illnesses, such as cancer and coronary heart disease, after World War II. The waxing and waning of malaria and yellow fever provide the most striking examples of the results of environmental changes "shaped less by conscious design than by serendipity." In explaining the decline of such diseases as scarlet fever and rheumatic fever (and, to a lesser extent, smallpox and yellow fever), Grob stresses the diminishing virulence of the bacteria and viruses involved -- another factor obviously unrelated to human intent. He does, however, credit public health measures with helping to eradicate cholera and reducing the incidence of typhoid fever; and he concedes that therapeutic intervention (specifically, the deployment of an antitoxin after 1894) contributed to the declining death rate from diphtheria. Only after 1945, he claims, did "biomedical research [have] a major role in transforming medical practice." He may be right about this, though it depends on what is meant by "major" and "transforming." However, any fee bill, casebook, or patient testimony would show the error of the assertion offered on the first page, and repeated late in the book, that "before 1940 . . . the major function of medicine had been the diagnosis of disease." Grob concludes that, despite the indisputable improvement in the health of Americans, "the precise reasons for the changes in mortality and morbidity rates (and therefore life expectancy) remained murky." True, but readers of The Deadly Truth will find such reasons far less opaque than they may have before reading this book.
Ronald L. Numbers, Ph.D.Copyright © 2003 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
