Prevention is better than cure
The medicine practised today is characterised by a biomedical view of itself that is based on animal experimentation. But it is becoming increasingly evident that this dominant orientation of medicine is not up to the tasks it faces. In spite of an immense outlay of research, with millions of animal victims in the laboratories, more and more people are suffering from the diseases caused by today's lifestyle, such as cancer, heart and circulation diseases, diabetes, allergies, rheumatism and so on. The costs for the health service and the treatment of illness are constantly rising. Billions are flowing into animal research, and the consequences of conditions that we partly cause ourselves through our lifestyle are costing us further billions. If our health service is not to totally collapse in the near future, we must see to it that these conditions do not even occur and that the people remain healthy. Medical disciplines which provide the basis for this, and furthermore involve no animal experimentation whatever, are epidemiology, prevention, social medicine and public health.
»July 1846. Next week I take up my position as a doctor in the first ward of the maternity clinic at the General Hospital in Vienna. I was dismayed when I heard about the percentage of patients who die in that clinic. This month no less than 36 of the 208 mothers died there, all of them from childbed fever. Giving birth to a child is just as dangerous as first-grade pneumonia.« (1)
These lines from the diary of Ignaz Semmelweis (1818-1865) illustrate the devastating effects of childbed fever, an infectious disease from which many women died in the 19th century following the birth of a child. The doctors, including Semmelweis himself, were fully in the dark as to the cause of childbed fever. Semmelweis wrote in his diary: »December 1846. Why do so many women die from this fever after a fully unproblematic birth? For centuries science has taught us that it is an invisible epidemic that kills mothers. Changes in the air, some extraterrestrial influences or a movement of the earth, an earthquake, are said to be possible causes.« (1)
Nowadays, hardly anyone would entertain the idea of extraterrestrial influences or an earthquake being possible causes of a fever. However, in the times of Semmelweis many did so, including scientists. Semmelweis did not let matters rest there but gathered data on the fatalities resulting from childbed fever and established that doctors and medical students who had dissected corpses prior to examining the women who had recently given birth apparently transmitted a sort of 'corpse poison'. He introduced the disinfection of hands, thereby drastically reducing the number of sick cases. Although nobody so far had any inkling of infectious bacteria, Semmelweis had identified the problem by means of careful observation and had taken remedial action. Instead of gaining recognition, however, he attracted the enmity of his professional colleagues, who did not want to accept that they were themselves causing the malady which they wanted to heal. The opposition of the scientific world was so resolute and hostile that Ferdinand Hebra, one of the few supporters of the Semmelweis theory, wrote: »When the history of human errors is written one day, it will be difficult to find such a striking example, and people will be amazed at how such able and specialised persons could be so blind and stupid in their own field of science.« (2)
Semmelweis did not survive to see his discoveries confirmed. He died in 1865, two years before the Scottish doctor Joseph Lister (1827-1912) introduced disinfection and hygiene into surgery and thereby radically lowered the death rate in the operating theatre.
Semmelweis reached his findings by means of observation and comparison. The investigation of groups of people in their natural environment, or in relation to specific diseases, is called epidemiology. The method used in epidemiology is not experimentation, but observation. The aim is not merely to heal ailments, but above all to avoid them.
Death through poverty
Throughout the 19th century Europe was repeatedly plagued by deadly epidemics of diarrhoea. The cause of the deadly scourge named cholera was suspected to be evil vapours, or a sort of poisoning - until 1854, when the cholera raged once again and the London doctor John Snow recorded the fatal cases in the Soho district of the city on a street plan. He discovered the connection between the fatal cases and the polluted water from a water pump. He had the pump's lever dismantled and the cholera epidemic in Soho was ended.
In the 18th and 19th centuries the people of the lower classes lived in conditions which are hardly imaginable today. They lived in narrow, damp and filthy dwellings without any fresh water supply or sanitary fittings. Their work was harsh and there was no social security. Their nourishment, poor in both quality and quantity, saw to the rest. Doctors committed to social reform, such as Salomon Neumann (1819-1908) and Rudolf Virchow (1821-1902), recognised in the mid-19th century the connections between epidemic outbreaks and the catastrophic social conditions of the working class. As in the case of Semmelweis, this new teaching at first won little approval. In 1948 Virchow lost his post at the Charité Hospital in Berlin because he had, as an opponent of the emergent bacteriology of Robert Koch, publicly stated that the typhoid epidemics in Upper Silesia were attributable to social causes. But the facts proved him right. The introduction of hygienic conditions and improved working and living conditions led to a dramatic fall in the infectious diseases of that time, such as tuberculosis, pneumonia, influenza, whooping cough, measles, scarlet fever, diphtheria, typhoid and dysentery. In the case of most of the above diseases, incidentally, this fall not only occurred long before the medical developments such as vaccinations and antibiotic therapy, but was also largely uninfluenced by them. (3)
Today's standard of living and its consequences
The drop in the major infectious diseases, which only flared up again during the two world wars with their accompanying social deprivations, led to a significant increase in life expectancy in the western world and to a change in the sprectrum of illness. The fact that we nowadays grow older and are ill less often in comparison with earlier centuries is due less to medical care than to the fact that we now enjoy a high standard of living. However, the modern way of life has brought some drawbacks. And once again it was epidemiology that provided the keys to the causes of the ailments that have now come to the fore.
The fact that smoking causes cancer is as clear to us nowadays as the need for hygiene in the operating theatre. But the injurious effects of tobacco were still doubted in the nineteen-fifties, not least because of the misleading results of animal experiments. There were already some first inklings, but the breakthrough came with the publication of the 'Surgeon General's Report on Smoking and Health' in the year 1964. The analysis of 7000 scientific articles which already existed at that time left no more room for doubt: cigarette smoke causes lung cancer and chronic bronchitis. (4) A new issue of the report has been published every year since then. The latest findings from the 2004 Report: the consequences of smoking are far worse than had hitherto been supposed. Cataract, pneumonia, leukaemia and cancer of the kidneys, pancreas, stomach and the mucous membrane of the uterus are the latest additions to the list of smokers' ailments.
Epidemiology is complicated detective work. Mountains of information have to be processed in order to find out the causes of disease complexes. The investigation is directed towards the human being, not to a laboratory animal or even a tissue, cell or molecule. The human is examined within that group of the population in which he or she naturally lives: in the population group as a German (or other national), perhaps as a young or old person, as a sufferer from kidney disease, as a nurse, as a war victim, as a victim of rape or an accident, and within the population as resident within the vicinity of a nuclear power station or a well polluted with nitrates, or living within a specific region. (5)
Certainly the best-known and most long-term epidemiological study is the Framingham Study, in which the inhabitants of that town in Massachusetts, USA, have been under observation since 1948 with regard to the health of their heart and circulation. Most of the original 5209 citizens have meanwhile died, but the study is being continued with their children and grandchildren. The data gathered over the past 59 years has produced breakthrough discoveries as to the risk factors, the origin, the development and the consequences of heart and circulation ailments. It already became evident in the sixties that smoking, a high cholesterol level, high blood pressure, obesity, lack of movement and psychosocial factors increase the risk of heart and circulation ailments. (6)
A further example of how epidemiological studies have enabled lifestyle to be revealed as the cause of an ailment is provided by allergies. Nowadays every third person in Germany and many other western countries suffers from hayfever, asthma, neurodermatitis, etc. The dramatic rise in allergies in recent decades - 30 years ago only 1 per cent of the population was affected - is, apart from those cases arising from a hereditary disposition or environmental pollution, largely attributable to our living conditions and surroundings. Epidemiological studies have shown that people living in the less industrially developed nations suffer from allergies much more seldom than those in the affluent nations. Also impressive is a study comparing the former West German and East German federal states.
There were hardly any allergies among German children born in the post-war period, in either the west or the east. When the Berlin Wall was built, the risk factor to which children were exposed developed in contrary directions. Despite a higher level of environmental pollution in East Germany, significantly fewer children suffered there from allergies. Childhood infections play an important role in this. Contact with pathogens - in the East German day nurseries, for example - acted like a fitness programme for the immune system. In the west, on the other hand, it was shown that exaggerated cleanliness, e.g. through the frequent use of disinfectant cleaning products, leads to an increased susceptibility to allergies. Since the reunification of Germany the frequency of allergies has steadily increased in East Germany. Similar studies from other countries also confirm a connection between the 'western' lifestyle and an increased occurrence of allergies. (7, 8)
Health is attainable - without animal experiments
Today, one half of all the people in the western world die from avoidable heart and circulation ailments, one quarter from cancer. 80% of the cancer cases are caused by smoking, malnutrition, environmental pollutants, alcohol and other avoidable factors. The avoidable risk factors for heart and circulation ailments are likewise smoking, bad nutrition and alcohol, in addition to stress, obesity and lack of movement. The social security contributors in Germany alone have to pay out around 71 billion Euros per year for the treatment of diet-caused illnesses (9) and 75 billion for the consequences of smokers' ailments. (10) Thanks to epidemiological studies, it has been possible to identify the causes of today's 'main killers' and of many further diseases.
Just as Snow, in his time, simply dismantled the lever of the polluted pump, the logical conclusion as regards today's diseases must also be that prevention is better than cure. Instead of vainly attempting to mimic human ailments in so-called 'animal models,' by adopting preventative measures we could - by avoiding the risk factors - drastically reduce not only heart and circulatory illnesses and cancer, but also AIDS, diabetes, rheumatism, allergies and so on.
However, it is easier said than done to persuade large sections of the population to adopt a healthy lifestyle. Around 40% of German adults have claimed that they pay attention or even great attention to their health (11), but, as the Health Report of the Federal Statistics Office for 1998 stated: »The majority of the population does not follow up its very positive attitude to health with real action. ...The main reason given is that there is not enough time, they have too little influence, individual circumstances get in the way, and it is difficult to change external circumstances. In addition, health-orientated behaviour often conflicts with the consumer demand created by the media and advertising. ....Also, people often feel overwhelmed by the mass of information available concerning health.«(11)
The appeal for people to take over the responsibility for their own health falls on deaf ears in large sections of the population. It is precisely the population groups that live particularly unhealthily that are especially difficult to reach with preventative measures. Instead of modifying their own way of life many people prefer to rely on modern medicine, which they assume will put things right. The bypass patient fresh from the operating theatre who secretly smokes on the hospital balcony, the regular McDonalds customer who would rather have her fat liposuctioned away than eat vegetables, the manager with a stress-induced heart attack who carries on as usual from his sickbed with his mobile phone and laptop - they are all perpetrators and victims within our affluent society.
Due to the frequent failure to adopt a health lifestyle, preventative measures should not be limited only to appeals for health-conscious behaviour. The conditions in which people live also need to be improved. This is possible, for example, through governmental measures. From social welfare legislation on health and accident insurance and old age pensions (inaugurated in Germany around 1880), via industrial health and safety regulations (re. youth employment, working hours and protective clothing, etc.) to hygienic refuse collection and drinking water purity regulations, literally thousands of 'invisible regulations' exist to safeguard our health welfare. (12) These also include governmental and often quite unpopular legislative measures requiring changes in our behaviour (safety belts in road vehicles, smoking bans in public buildings, tobacco tax). Governments could achieve still more in this way, one example being the ban on smoking in catering establishments introduced in Ireland and Norway in 2004.
There are naturally limits to measures of this kind; one could (unfortunately) hardly introduce a tax on schnitzel to force people to take up a vegetarian or vegan lifestyle. In the final analysis, health largely remains the responsibility of each individual.
What makes people healthy?
Health is not merely the absence of illness, it also encompasses the spiritual, physical and social well-being of a person.The science which deals not only with the question 'What makes people ill?' but also with 'What makes people healthy, despite being confronted with a multitude of health risks?' is known as public health. Factors that have a positive influence on health - so-called health resources - are, for example:
Confidence, a positive sense of self-esteem, good family relationships, good educational opportunities, good workplace conditions (a positive working atmosphere, ample scope for decision-taking, social recognition); voluntary activities also have health-promoting effects. The home plays an important part in achieving a self-determined pattern of life, as does an intact environment (clean air, water, earth, refuse disposal). Of particular importance is the social environment in which we live. Investigations have shown, in fact, that among the disadvantaged social groups not only is the level of negative influences (smoking, alcohol, bad nutrition, unawareness of dangers to health) particularly high, the level of health-promoting resources is also particularly low. (12)
Animal experiments are a cruel and unscientific method of acquiring knowledge. For many significant medical discoveries, experiments on animals were not only of no help, they were actually counterproductive. It is an illusion to believe that we can simulate the complex influences to which man is exposed and which affect man's health and illness, even as a starting approach, in an 'animal model.' Vital discoveries about the causes of the major infectious diseases of past centuries and the diseases resulting from today's lifestyle are attributable to epidemiological studies - i.e. observation of people and their living conditions.
Preventive measures pushed back the epidemics of earlier times and could also drastically reduce today's mass diseases of the western world. But instead of utilising this potential and investing money in prevention and health promotion, enormous sums continue to flow into senseless animal experimentation which is so disrespectful of life. It is obvious that the pharmaceutical industry has no interest in prevention, but the fact that political decision-takers likewise set their priorities wrongly is incomprehensible in view of the explosion in costs within the public health service. In the final analysis, an appeal must be made to every individual person to share in the responsibility. By following a healthy lifestyle we not only do ourselves a good turn, we cut away the roots of research centred upon experimenting on animals.
Naturally, even given the best precautions people can become ill. For these cases an effective and harmless system of medicine must be available to ease suffering and heal ailments. But for this purpose, too, animal experiments are the wrong method. The development and testing of new medicinal drugs can be carried out by means of systems not involving animal experiments, such as cell cultures or computer simulation or combinations of various methods. In addition, holistic healing procedures such as acupuncture, homoeopathy, natural remedies and so on are often an alternative to the orthodox medicine based on biomedical science.
(The subjects 'non animal-based testing methods' and 'holistic medicine' are dealt with in detail in other articles).
Dr. Corina Gericke D.V.M.
(1) OECD Programme for International Student Assessment: Pisa 2000, Beispielaufgaben aus dem Naturwissenschaftstest
(2) Di Trocchio, F.: Newtons Koffer - Geniale Außenseiter, die die Wissenschaft blamierten, Campus-Verlag, Frankfurt
(3) McKeown, T.: Die Bedeutung der Medizin. Suhrkamp Verlag, Frankfurt/Main 1982
(4) 1964 Surgeon General's Report on Smoking and Health. National Centre for Chronic Disease Prevention and Health Promotion
(5) Liszt, A.: Klinische Epidemiologie - Eine Strategie zum Ersatz von Tierversuchen. Gaia, Winter 1994/95
(6) Framingham-Herz-Studie, Wikipedia, retrieved 10.1.2010
(7) Larbolette, O.: Allergien auf dem Vormarsch, Spektrum Akademischer Verlag (http://www.wissenschaft-online.de/abo/lexikon/biok/423), 04.12.2004
(8) SWR PG-Multimedia, 04.12.2004
(9) Die Welt, 10.06.2004
(10) Deutsche Gesellschaft für Nikotinforschung e.V., 06.12.2004
(11) Statistisches Bundesamt 1998, S. 82ff. zitiert nach Waller, H.: Gesundheitswissenschaft, Kohlhammer-Verlag 2002