Friday, May 29, 2009

Why we love smallpox?

In this week’s New York Times, Dr. Abigail Zuger reviews two books dealing with what she calls the “insatiable fascination with contagious illness” that is “hard-wired into all of us.”

The first—"Dread," by epidemiologist Philip Alcabes—argues that epidemics are intriguing because they “hit us right at the nexus of self-interest and altruism, that exquisitely uncomfortable spot where our brother’s misfortune nudges us just enough that we need to examine it and distance ourselves from it.”

"Dread" reviews the history of human attitudes towards epidemics. In particular, it appears to argue we’ve undergone a collective shift from an individual to a more public health mentality towards illness: rather than focusing on distancing and protecting ourselves, we now also reach “through the wall and [protect] the well by treating the ill.”

Alcabes discusses the use of the word “epidemic” to inspire public reaction, as in the case of the “obesity epidemic” in the United States today.

The second book—"The Lassa Ward" by Dr. Ross Donaldson, recounts personal experiences as a medical student in Sierra Leone. It focuses on the atmosphere at the center of epidemics; particularly, at how that environment can be “strangely orderly," and at the “bizarre stubbornness that often permeates stricken communities and prevents the very changes that might save lives.”

Although "Dread" does appear to focus on the reasons for our fascination with disease, it is, according to Zuger, written “with the trademark mumble of the social scientist.” "The Lassa Ward" sounds like a better read, but, aside from Dr. Donaldson’s personal fascination with epidemics, doesn’t seem to deal directly with the question of our contagion fascination.

As someone who shares that fascination, it’s certainly a question I’ve wondered about. Zuger suggests it is something "hard-wired"; I’m sure evolutionary psychologists could offer a wealth of explanations for our interest. Maybe fascination with disease is related directly to self-preservation (it makes us more aware of what can kill us?), or maybe it evolved as a byproduct of some more useful evolutionary trait. Maybe, on the other hand, we’re fascinated because of the media, our current culture, or our increasingly globalized world that spreads disease faster and more broadly than ever before. Or, maybe we're not, actually, that fascinated--at least, not any more so than we are by horror films or romance novels.

A 2007 JAMA article by Howard Markel looks at the poplarity of epidemic literature skeptically. “Every year,” writes Markel, “a teeming petri dish of popular and occasionally bestselling contagious narratives appear on bookstore shelves.” These, Markel argues, are significant because they have the power to shape how the public thinks about public health, which leads to an influence on public policy. He also worries that people have a “dangerous propensity to forget about [epidemics’] remarkably destructive powers once they subside,” thus losing the memory of something that could provide important lessons for the future.

Markel’s concerns seem overblown—sensationalist literature doesn’t, to me, appear to have much of an influence on health policy. But, I think that he—as well as the two authors reviewed by the Times—are right to believe that thinking about public attitudes towards epidemics (whether fascination, fear, or indifference) is incredibly important. In the same way that understanding different cultural beliefs about smallpox ended up being key to its eradication, so understanding cultural attitudes towards all types of critical infectious diseases, like HIV/AIDS and Malaria, is key to successfully tackling them from a public health perspective. Understanding those attitudes is what the whole field of medical anthropology is about!

And it’ll be a bonus if, in the process, we can figure out why at least some of us are so oddly obsessed with all things infectious.


1 comment:

  1. Hard to know how Zuger can't find "human interest" in this fascinating and quick-paced read that details the murders of Jews in the middle ages,the ravages of AIDs and the heartbreak of obseity and autism. You might be interested to know that *Dread* cites the work of Markel; and Markel has written about the book. You can see Markel's comments at Alcabes's site: