Mirage of Health by René Dubos (review)

MirageofHealth. By RENé DuBos. New York: Harper & Bros., 1959. Pp. xv+236. $4.00. This is a book that is much easier to read than to review. For its originality and charm lie chieflyinthe luminous, lively style and the choice ofillustrative material garnered with great skill from an impressive array ofauthors ancient and modern. In these respects this long essay, which is as much philosophical and literaryas scientific, is clearly in the distinguished tradition of French critical and philosophical writing although the language is English. It is easy to imagine the shades ofMontaigne, ofthe seventeenth-century Encyclopedists , ofRenan, ofClaude Bernard hovering in the corners ofthe author's study as he wrote. The two major theses ??Mirage ofHealth conform also with the classical French essay. The first is a denial ofthe possibility ofutopias—past, present, or future—and the corollary affirmation, "Complete freedom from disease and from struggle is almost incompatible with the process ofliving." As support is marshalled for this premise, the second is soondeveloped: While man cannot hope to refashion and dwell forever in a new Garden ofEden,he may, ifheuseswiselyallhisintellectualandemotionalresources, lookforward to bettering his condition to such a degree that he may approximate at least for a time a true state ofhealth and happiness. Approximation to even transitory Elysiums, however, will not be achieved by merely solving all the problems ofdisease through application of the scientific method, but only through "a kind ofwisdom and vision which transcends specific knowledge ofremedies and treatments and which apprehends in all their complexities and subtleties the relation between living things and their total environment." The basic ideas are not new, as in much French criticism, but they have been selected because the author senses that the time is ripe for a re-emphasis oftheir essential truths in the light ofcontemporary conditions and knowledge. Having stated and expanded his fundamental postulates in the first chapter, Dubos thereafter occupies himselflargely with an exposition ofsome ofthe complexities and subtleties ofthe relation between living things and their total environment. This leads him first to consider man's past adaptations to the natural world and then to those adaptations that he has made or is failing to make to the new physical and social conditions that he continues to create for himselfat an ever accelerating rate. Stressed here, and highlighted again and again, is the fact that "by changing the physical world to fit his requirements— or wishes—he has almost done away with the need for biological adaptations. Mankind has "thus established a biologic precedent and is tempting fate, for biological fitness achieved through evolutionary adaptation has been so far the most dependable touchstone ofpermanent success in the living world." In the remaining chapters, a wealth of fascinating data serves to convince the most skeptical that many diseases, whether microbial in origin or otherwise, are not the direct result ofa single determining factor (e.g., a pathogenic bacterium) but rather the indirect outcome of a "constellation of circumstances" which may on the surface appear to be quite unrelated. Modifications in these intricate patterns ofcircumstances through man's efforts to gain complete control over his physical environment—internal as well as external —may result in the emergence ofnew diseases or unexpected changes in the mani435 festations ofthe old which, like man himself, are biologically stubborn and refuse to be altogether "liquidated." From this generalization a number of important and perhaps disturbing conclusions are drawn. For example, the etiologic complexity ofdisease, whether ofthe individual or the herd, often imposes definite limitations on specific therapy, especially when this consists ofdrugs. "Gonorrhea has been readily amenable to drug therapy ever since 1935—its microbial agent, the gonococcus, is so vulnerable to penicillin that the overt form ofthe disease can now be arrested in a very short time. Yet gonorrhea has not been wiped out in any country or social group." In such cases "the need is to discover and reform those aspects ofthe physical and social environment which brought about an increase in the prevalence ofthe disease peculiar to our times." But, as Dubos takes pains to point out, sometimes reformation ofenvironmental factors based on the most logical premises may lead to new difficulties. For example, paralytic poliomyelitis is far more...