Saturday, January 19 2013
Here is something I already knew, more or less: my history of ear infections as a small child likely contributed to my developing IBD later in life.
Granted the study is only correlational, but the mechanism is plausible and meshes with our growing understanding of the relationship of healthy bacteria to bowel disease. We’ve long known that there is an ‘environmental’ factor along with the genetic component to IBD — which is actually a stupid way of describing it, as if spotted owls and snail darters were giving people diseases. When people talk about ‘environmental’ causes, they usually don’t mean the woods or the ocean, but instead society — the chemicals and foods and objects and habits that structure our lives. These are societal causes, more than environmental causes.
In the case of IBD, we know that the societal factor probably has to disrupt the immune system in the gut at a formative stage, and that it is more common in industrialized societies than in the developing societies. In my own experience, the most obvious source of that disruption was the amoxicillin I drank by the gallon as a young kid, when I had chronic ear infections. I seem to remember there always being a bottle of the pink stuff chilling in the fridge. And it’s entirely reasonable to suspect that either the amoxicillin itself screwed up my immune system, or it did so by killing off some fraction of my gut flora that was essential to healthy immune function.
I probably beat this drum too often, but is my blog and I do what I like here: consider the implications of this study for our health care system. If IBD is something caused — or exacerbated — by human intervention at a societal scale, then it makes no moral sense to force patients to bear the burden of that disease individually. For IBD and a whole range of other diseases — including lots of cancers, and including probably most chronic illnesses — there is likely some societal cause contributing to the prevalence of disease. In which case a societal response — a just, equitable health care system — is the only moral response. The fact that we don’t know yet how extensive those societal causes are, and are all the time learning more about them, is reason to err on the side of providing as broad a health care system as possible.
I am not the sort of person who spends a lot of time wondering how I got sick. Wondering doesn’t make me well. But there are lots of folks who will say it’s God, or luck, or even some flaw in my character — which is an archaic and ignorant prejudice in an era when we know better. We as a society cause lots, maybe most illness — and we ought to be accountable to the people harmed by those illnesses.