Spring 1997 - Radical Ground? Karl Virchow Revisited

xxAACP Newsletter, Volume 11, Number 2, Spring 1997

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Radical Ground?
Karl Virchow Revisited

"Medicine is a social science and politics is nothing but medicine on a grand scale." -- Rudolph Ludwig Karl Virchow, 1847

One hundred and fifty years ago this idea of Karl's was new to society and radical to medicine. It shouldn't be anymore. Virchow's vision is still astonishingly relevant to community health care today and to the ongoind debate about health care in America. As progresssive physicians of the twenty-first century, we must bring to bear the noble visions of men like Karl Virchow to today's healthcare problems. It falls upon us to find a realistic way to apply the dreams of the near and distant past to our future.

Maybe it's my own fin de siecle cynicism, perhaps we are a jaded lot, but isn't there something ironic about the nineties' place in the generational parade: what's new about the nineties is that there is nothing new. Our music, mixing and sampling. Our high fashion, retro seventies. Our low fashion, grunge, is beatnik surfer meets blue collar mechanic. Our politics, a confusing hybrid of sixties idealism, eighties realism, and MTV nihilism. When I look at the health care debate, the feeling is the same: the debates of '93 and '94 have been shaping up since Reagan Year One. All of the possible positions have been taken, the terms spelled out, and the playing field defined. So where does that leave us? Since it has all already been said, it will be our job to do. We shall witness, suffer, and hopefully shape the outcome of a historical encounter in health care policy and therefore society; the Great Deregulation vs the Great Society.

Before the crudest foundations of medical science had been defined, e.g., the origin of the cell, Virchow stated that, "If disease is an expression of individual life under unfavorable conditions, then epidemics must be indicative of mass disturbances of mass life."

He grasped a fundamental notion that must become ours again: the health of the individual directly reflects the health of the community. In addition to being the first to scientifically describe thrombus formation, pulmonary embolism, leukocytosis, leukemia, my coses, and echinococcus infection, he discovered the etiology of trichinosis. But this is not where his particular greatness lies. Because instead of setting up a specialty clinic, editing a rarified journal, organizing a new medical society, etc. in the modern style, he led a ten year campaign to establish compulsory meat inspection, the first "national" policy of its kind ever. He went on, in a single lifetime, to drive the Prussian regime to build in Berlin the first sewer system in the world to mmet minimally reasonable health standards. His insights were bold and noble in the nineteenth century. Today they should be common sense.

If the economic interests of the insurance companies and the market intersts of the HMO shareholders continue to define health care policy, we will see in painfully clear light what Virchow told us 150 years ago: health care may be a commodity to be distributed within society like wealth and opportunity, but disease is more democratic. Vancomycin resistant staph, aureus does not respect gated communities. Bad drivers do not discriminate between expensive cars with air bags and cheap cares without them. Ex-cons who carry drug resistant T. B. do not breath only "poor people's air." Small children from all walks of life have an enduring fascination with forbidden objects, like handguns. Heroin addicts only share needles with each other, but they share bacteria with all of us. If and when we open our eyes to our opportunity, we must not shy away from the scary big picture, the fate of the least of us is the fate of all of us.

One hundred fifty years ago, Virchow set out four principles of medical reform:

The health of the people is a matter of direct social concern.
Social and economic conditions have an important effect on health and disease, and these relations must be investigated scientifally.
Measures taken to promote health and combat disease must be social as well as medical.
Medical statistics must be our standard of measurement.

Today heart transplants and radical immunosuppression are nearly routine but preventive medicine and population studies are marginalized. It would be unfair not to mention the great medicasl and social successes of our century: polio and influenza vaccines, the erradication of smallpox, the regulation of homes for the mentally ill including least restrictive care legislation, nutrition education, widely available anti-hypertensives, childproof caps, drunk driving restrictions, and seatbelt laws to name a few. The average life span is longer. The infant mortality rate is lower. The United States is a much safer place to grow old then it was in the 1030's for almost everybody, but not quite. Have we done enough? That's a personal question. But when the conversation about equal access to health care or public vs. private good comes up, don't be distracted by the jargon or by novelties. Health care today, like health care one hundred fifty years ago, is still about social justice. So take a risk and stand on radical old ground.

Alex Isaac
AMSA Representative

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