Biological Basis of Disease and Behavior

BIOLOGICAL BASIS OF DISEASE AND BEHAVIOR JONAS E. SALK* Attitude toward the Nature ofDisease We are a long way beyond the days when disease was interpreted as the act ofa vengeful god or retribution for having sinned. We now look upon disease as something over which man should exercise control; we believe that illness and premature death represent evidence ofman's failure either to understand adequately the nature of a disease or to act when specific knowledge is available. The extent to which life can now be prolonged increases the importance ofconcern with the meaningfulness and effectiveness ofliving. The possibilities are now greatly augmented for enrichment oflife through wisdom that could accrue to many more whose life span will reachlong beyond the minimum necessary to perpetuate the species—and could be used in the service ofthe generations to follow. The concept ofthe biological basis ofdisease has been so well established and so fruitful that it would seem to be unnecessary to dwell upon the subject. However, I have chosen to do so because I have the feeling that it bears repetition, and especially because the phrase "biological basis ofdisease and behavior" indicates how this concept serves as a guide in seeking solutions ofman's problems. We are all aware ofthe extent to which advancing clinical knowledge and diagnostic skills can reduce suffering and save many from premature death. We are alsoaware thatultimate solutionsto problems ofhumandisease come from understanding the relevant biological mechanisms that become disordered, giving rise to disease. Understanding ofthis kind leads inevitably to insights into the development of means for treatment and, sometimes, prevention. * University ofPittsburgh, School ofMedicine. This paper is from an address given at the dedication ofthe Goldblatt Memorial Pavilion, University ofChicago Clinics,June ?, 1961. 198 Jonas E. SaIk · Biological Basis ofDisease and Behavior Perspectives in Biology and Medicine · Winter 1962 You will observe that I am leading you to the familiar position ofall who try to spread the gospel that the development ofa useful practice or procedure for the control ofdisease comes through knowledge and understanding that is built by a great many who, like those who fashion bricks or girders, often do not see the ultimate structure to which they have contributed essential parts. I am certain that you know this and that you are aware of the importance of basic and unrelated observations often made without any idea ofthe place they may later have in solutions that are soon taken for granted. Among those who possess the means to make it possible for free and uninhibited imaginative work to be done, there are few who become enthusiastic without a promise that the work in question does have a defined relation to the solution of some immediate problem. I say this because I have in recent months been in touch with men of means and with those who are intrusted with disbursing funds for foundations. The conservatism that prevails in the face ofthe obvious need to continue to experiment in new and bold ways convinces me that our errors are more often those of omission than ofcommission. I mention this personal experience to draw your attention to the possibilities ahead through the recognition of the biologicalnature ofdisease and behavior. Thesepossibilities can berealized only by deeper and broader exploration ofbiological systems and the construction of biological concepts that may serve to unify knowledge and understanding ofthe organization and processes oflife—that such knowledge and understanding may then be applied to the art ofliving as well as to problems ofdisease. Biological Basis ofNeoplastic Disease I want to illustrate the idea behind the term "biological basis ofdisease." A question-asking attitude as well as an answer-finding attitude is implied in it. A question must be asked before it can be answered. To discover the right question may be the secret. The right answer may already have been found but, since the question has not been asked, the answer cannot be given. It might almost be said that all answers pre-exist; the questions do not. How does one go about asking questions that are interesting to try to answer? I believe I can illustrate this by beginning with such popular questions as: "What is the cause...