Investigate the emergence of epidemics in the late 20th and 21st century, based on reported published well written literature. What function does Chinese Medicine offer?
Author: Mark Mayes. This article is from my undergraduate days studying at Victoria University Bachelor of Chinese Medicine (Acupuncture and Herbs) double degree course. This is a third year assignment for the subject: MAJOR CLASSICS. Its been slightly updated to allow smoother transitions between ideas with relevant links included.
Introduction
The definition of epidemic is a disease that rapidly affects a significantly large number of people with the same demographic segment of the population or geographical area (Harris, Nagy & Vardaxis, 2006). Throughout human history emerging infectious disease is not a new concept, in many instances there have been constant swellings of epidemics throughout the world. As recent as the twentieth-century, British physician Thomas McKeown debated with colleagues how a potential symbiotic relationship can exist between humanity at the local community level, together with their environment (Drexler, 2002). In other words, its not solely medical treatments or products that reduce the mortality rates of infection but rather its an overlapping set of circumstances. Microorganisms thrive and cause disease, in conditions that are squalid with people living in close quarters, eventually pathogens will contaminate food and/or water with the potential for epidemic outbreaks. This potential can be prevented if people together with public health procedures are implemented. The aim of this paper is to examine the published literature on the emergence of epidemics during recent times and to recommend where Chinese Medicine can be integrated into the global health paradigm.
Conditions which contribute to recent epidemics
Upon examination of the literature concerned with epidemics, today the global population is confronted with increasing levels of pathogenic microorganisms. The natural characteristics of these organisms is ‘survival,’ distinguished by their perpetual evolution and adaptability to new environments. Likewise, human beings have similar mechanisms, the difference is, that new generations of pathogens are conceived every thirty minutes, adding ever increasing pressure on medical science to adapt to them (Drexler, 2002; Mandell, Douglas & Bennett, 2005; Newman, Kelly, Harper, File & Carmago, 2007).
During the twentieth century science evolved rapidly with the development of penicillin (Penicillium notatum), thanks to the Scottish bacteriologist Alexander Fleming who made the initial discovery in 1928. This advancement had accomplished exceptional results in therapeutic efficacy by reducing deaths caused by for example staphylococcus infections (Staphylococcus aureus), today these strains are considered a multi-drug resistant bacteria, increasingly becoming resistant to penicillin treatments.
As the decades past complacency developed amongst the medical profession due to over prescribing and under their noses microorganisms became evermore resistant to their interventions. By the 1970’s and 1980’s new pathogenic microorganisms emerged, for example, acquired immune deficiency syndrome (AIDS), Lassa fever and severe acute respiratory syndrome (SARS) turning the established attitudes upside-down (Drexler, 2002; Huber, 2004).
Since the 1980’s globalization has been a major contributor to microbial spread, resistance and escalation of potential epidemics for example, Mandell et al. (2005) states that ‘today’s highly globalized and interconnected world enhances the rapid spread of infectious pathogens.’
The following points contribute to and enhance the emergence of epidemics;
1. Changes in human demographics and behavior
2. The impact of new technologies
3. Economic development and changes to land use
4. Increased international travel
5. Microbial adaption and change
6. The breakdown of public health measures
7. Global trade increasing carbon emissions
8. Increased movement in goods, services and people
9. Climate change
Moreover, a further negative effect of globalization deprives low income countries from self development, adding further to the proliferation of pathogenic microorganisms. In these countries their financial services funnel resources into long standing debts, creating slow economic growth leading to inadequate investment in education, health services, wellbeing and quality of life (Peoples health movement, 2005).
Climate Change
In the last ten years (2007) we have witnessed nine of the warmest years on record and it’s anticipated to increase (Peoples health movement, 2005). Consequently, expert predictions of what will manifest is uncertain, but the effects of rapid climate change could invoke increased outbreaks in vector-borne epidemics. Such as, malaria and dengue fever emerging in periods of drought and sudden spring rains (Drexler, 2002 p.64).
Integration
Firstly, it has to be said infection control and treating febrile disease is a complicated issue, especially when fighting pathogens that have evolved over millions of years. Having said that, it does not excuse poor application or lack of discipline in prescribing antibiotics which has also lead to the proliferation of resistant pathogens and their extension into the community, hospitals and general medical practice. This has not occurred without warning, Alexander Fleming also discovered antibiotic resistance and in 1945 he coined the term ‘evolutionary selection,’ where some bacteria prospered and took over in penicillin. Within four years staph infections in hospitals increased from 14 to 59 percent and today almost 100 percent are penicillin resistant (Drexler, 2002), although this last fact could be argued.
The outcome of overuse from broad-spectrum antibiotics and prolonged exposure has resulted in wide spread infections, increased severity, mortality and costs due to protracted illness worldwide. For instance, a conservative statistic from Weber (2006) points out that hospital acquired infections increased over a twenty year period (1975 to 1995) from 7.2 per 1000 hospital days to 9.8 per 1000 hospital days an increase of 2.6 days. Not only can the medical profession be held accountable for lack of initial knowledge or over prescribing, but, also farming practices as well. Yes, I said it - farming practices. A downstream effect occurs in food supplies due to the over administration of antibiotics to live stock also exposing the public to resistant strains (Chiang et al, 2002; Drexler, 2002; Johnson, Stilwell, Fritsche & Jones, 2005; Weber, 2006).
So why integrate Chinese Medicine with current practices of western medicine? There are several reasons for this recommendation; firstly from a public health perspective physicians have a responsibility to provide ‘optimal’ care of those who are sick (Huber & Wynia, 2004). Secondly, the Chinese have a long history of clinical experience dealing with emerging epidemics and thirdly the fundamental role of Chinese Medicine is to ‘do no harm’ when dislodging pathogenic invasion which has favorable clinically road tested outcomes for more than one thousand years. This last point is a clear weakness in biomedical medicine when treating of multi-drug resistant microorganisms.
For instance, when providing safe and optimal health care for hospitalized infections the initial treatment is flawed because biomedicine is based on laboratory blood culture results. Until such time the results are determined together with focused treatment, inappropriate broad-spectrum empirical therapies are utilized which may substantially increase the mortality risk, antibiotic resistance or be the incorrect medicine. In such situations, Weber (2006) suggests that an infectious disease specialist could have a profound impact in the management of severe bacterial infections. The amalgamation of both medical paradigms can have an even more profound effect whereby the Traditional Chinese Medical specialist administers a herbal formula according to diagnosis before exact pathogen is known, during and after blood culture results are determined. This integration I would suggest shortens the patient recovery time and reduce the number of days in hospital (Espo