The Coming Age of Ecological Medicine
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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?
The first step toward a healthier future, I believe, lies in ecological medicine. Pioneered by a global movement of concerned scientists, doctors, and many others, ecological medicine is a loosely shared philosophy based on advancing public health by improving the environment. Its central idea is that industrial civilization has made a basic error in acting as if humans are apart from rather than a part of nature. Just as the knee bone is connected to the thigh bone, human and environmental health are inseparable.
And in a biosphere that is rampantly toxic and woefully depleted, a mounting number of our health problems can only be understood as part of a larger pattern. Ecological medicine could well emerge as a force for dramatic cultural change. It proposes to reshape how industrial civilization operates, in part by redefining the role that the public plays in making the decisions that affect all life on earth.
Simply stated, improving human health is inextricably linked to ecological well-being. The interconnectedness of all life is a fundamental biological truth. What's more, all life is under threat. There simply is no "elsewhere" to dump the hazardous by-products of industrial society. Eliminating them from our production systems is the only solution, and a well-informed public is crucial to realizing it.
In the words of Carolyn Raffensperger, executive director of the Science and Environmental Health Network (SEHN), a "truly holistic medicine extends beyond the mind-body connection to the human-planet whole."
Here are some basic tenets of ecological medicine:
- The first goal of medicine is to establish the conditions for health and wholeness, thus preventing disease and illness. The second goal is to cure.
- The earth is also the physician's client. The patient under the physician's care is one part of the earth.
- Humans are part of a local eco-system. Following the ecopsychological insight that a disturbed ecosystem can make people mentally ill, a disturbed ecosystem can surely make people physically ill.
- Medicine should not add to the illnesses of humans or the planet. Medical practices themselves should not damage other species or the ecosystem.
The main tool for putting these ideals into practice, ecological healers say, is what they call the precautionary principle. As articulated by Raffensperger and many others, the precautionary principle basically argues that science and industry must fully assess the impact of their activities before they impose them upon the public and the environment. Societies around the world have begun to incorporate some version of the principle into law, hoping to rein in bioengineering and other new technologies. That science should objectively prove the safety of its own inventions might seem like common sense, but that's not how most science operates today.
For decades, the scientific and medical community has accepted that a certain amount of pollution and disease is just the price we have to pay for modern life. This is called the "risk paradigm," and it essentially means that it is society's burden to prove that new technologies and industrial processes are harmful, usually one chemical or technology at a time. The risk paradigm assumes that there are "acceptable" levels of contamination the earth and our bodies can supposedly assimilate. It also allows a small, self-interested elite to set these levels, undistracted by the "irrational" fears and demands of the public. The "science" behind it is driven by large commercial interests and can hardly be considered either impartial or in the public interest. Viewed with any distance at all, the risk paradigm is at best a high-stakes game of biological roulette with all the chambers loaded.
There is a global effort afoot today to replace the risk paradigm with the precautionary principle, which is based on a recognition of science's limits in fully predicting consequences and possible harm. The precautionary principle acknowledges that all life is interconnected. It shifts the burden of proof (and liability) to the parties promoting potentially harmful technologies, and limits their use to experiments until they are proven truly safe.
The idea is not new -- a version of it first appeared in U.S. law back in 1958 in the Delaney Amendment, which governed pesticide residues in food and set standards for environmental impact statements. Nor is it radical. At its essence, the principle harks back to grandma's admonitions that "an ounce of prevention is worth a pound of cure," that we're "better safe than sorry."
The model is already used, in theory, for the drug industry, which is legally bound to prove drugs safe and effective prior to their use. Critics call it anti-scientific; they say it limits trade and stifles innovation.
Ecological medicine advocates disagree.
"The precautionary principle actually sheds a bright light on science," says Dr. Ted Schettler, science director of SEHN. "It doesn't tell us what to do, but it does tell you what to look at." Germany and Sweden have incorporated the principle into certain environmental policies. The United Nations Biosafety Protocol includes it as part of new guidelines for regulating trade in genetically modified products, its first appearance in an international treaty.
As people and their governments face ever more complex scientific decisions, the precautionary principle can serve as what some have called an "insurance policy against our own ignorance." After all, we can't even predict next week's weather or the economy a year out, much less the unfathomable complexity of living systems.
The Hippocratic oath tells doctors to "First, do no harm," yet our medical practices often pose serious environmental threats. In 1994, for instance, the EPA reported that medical waste incinerators were the biggest source of dioxin air pollution in the United States. Dioxin finds its way into our food and accumulates in our fat; it's been linked to neurological damage in fetuses. Even a simple thermometer contains mercury, another potentially deadly neurotoxin.
The medical-waste problem does not stop there. Along with generating radioactive waste from various treatments, the medical industry is now the source of a new peril: pharmaceutical pollution. Creatures living in lakes and rivers appear to be at special risk as antibiotics, estrogen, birth-control pills, painkillers, and other drugs find their way into the waste stream. Fish are already affected; intersex mutations (showing both male and female characteristics) have been reported in various species around the world. But humans are not immune. The war on drugs may soon take on a new meaning as entire populations are subjected to constant low doses of pharmaceuticals in the water supply.
Groups like Health Care Without Harm ( www.noharm.org) have made it their mission to halt or curb such damaging medical practices, especially the use of mercury thermometers and the industry's reliance on burning its waste.
With 300 member organizations in 27 countries, the coalition has had a major impact, in part by directly confronting the companies that make such products. Another group, the Greater Boston Physicians for Social Responsibility, has published a report with the Clean Water Fund called In Harm's Way that documents the many toxic threats to child development ( www.igc.org/psr/).
Ecological medicine suggests first doing no harm to the environment, then going further, creating a medical practice that itself minimizes harm. Like virtually all earlier healing traditions, it emphasizes prevention, strengthening the organism and the environment to avoid illness in the first place. Ancient Chinese healers, for instance, expected compensation only if their clients remained well, not when they got sick.
But an ecological approach to healing also looks to deeper tenets embedded in nature and how it operates. Again, the new vision reveals itself to be in many ways an old one. It borrows from the insights of indigenous healing traditions, many of which are now being confirmed by modern science -- including the fact that nature has an extraordinary and mysterious capacity for self-repair.
However resilient the biosphere may be, it's crucial to understand that the planet's basic life support systems are in serious decline. From climate change to plummeting biodiversity to gargantuan quantities of toxic wastes, the ecological stresses are reaching dangerous thresholds. Much of the damage can be traced to the 20th century's three most destructive technologies: petrochemicals, nu-clear energy, and genetic engineering.
- Apart from helping to induce potentially cataclysmic climate change, the petrochemical industry has un-leashed 80,000 or so synthetic compounds that now permeate our land, water, and air as well as our bodies. While some may be benign, the truth is that most have never been adequately tested -- and even fewer have been measured for their cumulative effects or how they interact with other chemicals.
- Nuclear energy has concentrated and spread radioactivity and virtually indestructible toxic waste products into living systems worldwide. While public dread may focus on cataclysmic accidents like the Chernobyl meltdown in 1986, other ill effects may come from steady exposure to low levels of radiation.
- Genetic engineering is introducing yet another threat: biological pollution that literally has a life of its own, a gene genie that cannot be put back in the bottle.
In addition to instructing healers first to do no harm, Hippocrates also instructed them in a lesser-known passage to "revere the healing force of nature." For years, that's been my quest: working with nature to heal nature. I founded the Bioneers Conference in 1990 to bring together people exploring ways of doing this -- biological pioneers from many cultures and disciplines, and from all walks of life. All had peered deep into the heart of the earth's own living systems to understand what we can learn from 3.8 billion years of evolution. Their common purpose was to heal the earth.
Their basic question: How would nature do it? They were all using their knowledge of living systems to devise solutions to our most pressing environmental and societal problems. I now realize these people are modern healers, too.
As their work repeatedly illustrates, we already have many of the technologies we need to retool our industrial system. Many of the bioneers show how we can replace existing industrial practices with sustainable alternatives that run on clean, renewable energy sources. Government has a role to play in this process too. Several years ago Sweden imposed a steep tax on pesticides, a measure that greatly reduced their use. Europe recently banned four antibiotics from animal feed. On the other side of the equation, governments are using tax subsidies to promote sustainable technologies such as chlorine-free paper production and organic farming. The city of Munich pays German farmers to grow organically in the watershed that supplies drinking water.
The ecological medicine movement, one focus of the Bioneers conference to be held this fall, aims to do something similar for the health care industry. Medical errors, for instance, now constitute a leading cause of death in the United States. Influenced by the success of safe, effective, popular alternatives, mainstream medicine could become safer itself.
The ethic of preventing harm as seen in both environmental protection and ecological medicine will continue to spread, but what about existing messes? Many treatment methods modeled on living systems have shown dramatic capacities for bioremediation -- that is, for detoxifying land, air, and water.
Visionary biologist John Todd's "living machines" mimic natural ecologies by utilizing bacteria, fungi, plants, fish, and mammals to purify water and industrial "wastes." The work of mycologist Paul Stamets has shown that fungi can help digest diesel spills and even chemical and biological weapons components.
Similar success stories are found across many fields. By looking to the principles of ecological healing to restore the earth and ourselves, we create not only the conditions for individual health, but also the basis for healthy societies and robust economies.
Biology is not rocket science. Rather, it is the superb art of relationships in the fantastically complex web of life. By mimicking nature, these approaches foster the healing that is the essence of living systems.
Consider again the relationship between a nursing mother and her child. Despite the toxins that are now found in mother's milk, it is still the best food for babies. Children fed breast milk are healthier because the mother also confers immunity and unmatched nutrition. Which brings us back to the essence of ecological healing: In the wisdom of nature also lies the solution.
Alternative medicine is arguably the single largest progressive social movement of our era. As it goes ever more mainstream, those working to advance public health are increasingly linking with those working to restore the earth's ecological health. Growing public awareness of the direct links between our personal health and environmental health is stirring as a potent force in global politics. As suggested by Michael Lerner, founder of the Commonweal Institute, environmental health could well emerge as the central human rights issue of our age. We all have the right to be born free -- from poisons.
As human beings, we have a remarkable ability to reinvent our societies very rapidly. The task now is to create an earth-honoring culture founded in the sanctity of life and the sacred human-nature relationship. Along with many others, I herald for this new century a Declaration of Interdependence, flowing from the simple recognition that all life is connected. At its heart is ecological medicine, teaching us that we are the land and water and air.
By restoring the earth, we restore ourselves.
Kenny Ausubel is the founder of the Bioneers Conference, which this year will focus on ecological medicine.