The Coming Age of Ecological Medicine

Among the many immigrants who arrived in New York City in the summer of 1999, none made a name for itself more quickly than West Nile fever. Traced to a virus spread by mosquitoes, the disease had never been seen in this country, or even in the Western Hemisphere. It first struck birds, then people, killing seven and sickening dozens more.

The city hoped to control it by killing the mosquitoes with malathion, a pesticide chemically related to nerve gas. Though many protested, Mayor Rudolph Giuliani insisted the spraying was perfectly safe.

Within months, scientists at the U.S. Environmental Protection Agency were debating just how wrong the mayor had been. The EPA was on the verge of declaring malathion a "likely" human carcinogen when its manufacturer protested. The EPA backed off, saying malathion posed no documented threat, though some in the agency continued to insist the dangers were being downplayed. More suspicion was raised upon news of a massive die-off among lobsters in Long Island Sound near New York. Malathion is known to kill lobsters and other marine life, but officials denied the connection.

Though no direct causal link can yet be drawn, some infectious-disease experts say anomalous outbreaks such as West Nile may be tied to human impacts on the environment, including climate change and the destruction of natural habitats. As noted by Dr. Paul R. Epstein, associate director of the Center for Health and the Global Environment at Harvard Medical School, "West Nile is getting veterinarians and doctors and biologists to sit down at the same table." What they are unraveling is a complex knot linking human health and the state of the natural world.

Welcome to a preview of the health issues awaiting us in the 21st century. Indeed, we're already living at a time when vast social and biological forces are interacting in complex ways -- and with unpredictable impacts. War, famine, and ecological damage have caused great human disruptions, which in turn have transformed tuberculosis, AIDS, and other modern plagues into global pandemics.

Even more disturbing, many of our efforts to fight disease today are themselves symptoms of a deeper illness. Spraying an urban area with a substance whose health effects remain unknown is one glaring example, but there are many others. Think of certain compounds used in chemotherapy that more often kill than cure. Or the 100,000 people who die in hospitals every year from drugs that are properly prescribed. Or the many IV bags and other plastic medical products that release dioxin into the air when they are burned.

That last example contributes to perhaps the most heartbreaking metaphor of our environmental abuse and its unforeseen consequences -- the discovery that human mother's milk is among the most toxic human foods, laced with dioxin, a confirmed carcinogen, and other chemical contaminants. All these cases suggest our culture's deep dependence on synthetic chemicals, and our long refusal to acknowledge how profoundly they've disrupted our ecological systems.

There's a widespread sense that mainstream medicine is blind to this reality, and is even part of the problem. This growing disillusion, coupled with the fact that high-tech medicine costs too much and often doesn't work, has led to a widespread public search for alternatives. One result is the rise of complementary medicine, which combines the best of modern health care with other approaches. Add the immense new interest in traditional healing methods, herbs, and other natural remedies and you get a sense of how much the health-care paradigm has changed over the past 30 years.

What I see happening is a deeper shift that all these approaches are edging us toward, even if we don't fully realize it yet. It's a new understanding of health and illness that has begun to move away from treating only the individual. Instead, good health lies in recognizing that each of us is part of a wider web of life. When the web is healthy, we are more likely to be healthy. But the environmental illnesses we see more and more of these days -- rising cancer rates spring to mind -- are constant reminders that the web is not healthy. How did we reach this tragic place? And more to the point, where do we go from here?