Man and His Environment—: Biomedical Knowledge and Social Action

MAN AND HIS ENVIRONMENT—BIOMEDICAL KNOWLEDGE AND SOCIAL ACTION RENÉ DUBOS, Ph.D., ScD.* I. The University and Diversity ofMankind Any medical problem presents itself under two aspects which are sharply different, but complementary. On the one hand, all phenomena ofhealth and disease reflect the biological unity of mankind; on the other hand, all are conditioned by the diversity ofthe social institutions and ways of life. The duality of man's nature—unity and diversity—creates a medical paradox that is responsible for the complexities of the problems faced by the Pan American Health Organization (PAHO). The paradox is that all men, irrespective of origin, have fundamentally the same biological constitution, physiological requirements, and responses to stimuli; yet despite this biological uniformity, their diseases and medical needs differ profoundly according to their habitats, social institutions, and ways of life. Any one concerned with problems of health and disease must, therefore, keep in mind both the universal aspects of human biology and the social diversity ofmedical problems. The dedication ofa new building provides an opportunity to reexamine the goals ofthe institution that it serves. For this reason, I shall take the liberty to make a few general statements that may help to sharpen the contrast between the universal requirements ofman's life and the special medical needs of his societies. This contrast will bring into relief some unsolved health problems which are in the province ofPAHO. The prehistorical and historical events of the human adventure in the Americas constitute perhaps the most convincing evidence for the unity * Member and professor ofthe Rockefeller University, New York, New York 10021. This speech was delivered at the inauguration of the new Pan American Health Organization building in Washington, D.C. PAHO is publishing it in booklet form in English, Spanish, French, and Portuguese. The Spanish text appeared in the monthly Boletín. 523 ofmankind. As far as can bejudged, various populations of ancient man began to move into the Americas during the late Paleolithic period. After their initial penetration, they rapidly spread over the whole American continent, but they appear to have remained almost completely isolated from the rest ofmankind for more than 10,000 years. During that period, they progressively developed several great civilizations profoundly different from those of Asia and Europe, yet very meaningful to those of us whose cultural evolution took place on other continents. Obviously, the most fundamental and universal characteristics of the human mind were already fully developed by the time ancient man first penetrated the Americas. During the past five centuries, many waves of immigration brought other human races from all parts ofthe earth into intimate contact with the various tribes of Amerindians. These mass migrations resulted in an immense number of highly varied and successful racial mixtures. The genetic and physiological compatibility of human races that had been separated for so many thousand years thus confirms the cultural evidence that all human beings originally derive from the same evolutionary stock. Because oftheir biological similarity, all men are potentially liable to the same kinds of diseases—a fact well documented by anthropological studies and by recent medical surveys of primitive tribes. Furthermore, all men can derive benefits from the same kinds ofmedical care, as proven by the uniformity of their response to the prophylactic and therapeutic procedures of modern medicine. But despite these medical similarities, experience shows that each geographical area, each type of society, and each economic group is characterized by its own pattern of diseases and has special medical needs. For example, the control of disease in tropical lowlands obviously presents theoretical and practical problems far different from those encountered on arid plateaus or on high mountains. The contrast is even greater between the disease problems most prevalent in impoverished rural communities and those emerging at present in prosperous industrial agglomerations. Individual persons differ, of course, in their genetic constitution and, consequently, in their innate resistance to disease. But in most cases, genetic endowment and racial origin play only a very small role in determining the types and severity ofthe diseases characteristic ofa particular region, or a particular social group. Whether they be ofAfrican, Amerin524 Rene Dubos · Man and His Environment Perspectives in Biology and Medicine...