Ewald has observed that conventional medicine has failed to link epidemiology to
evolutionary theory, and that in the absence of such linkage, the goal of improving physician understanding of the evolution of pathogen virulence cannot be achieved:
"I argue that improved understanding of the evolution of virulence...can make this goal more feasible in two ways: 1) by facilitating identification and blocking of pathogens that represent the greatest threat should they become established in human populations...and 2) by providing methods for inhibiting the emergence of particularly virulent variants of pathogens that are already established in human populations (e.g....virulent, antibiotic-resistant strains of Staphylococcus aureus).
The pathogens at issue can be separated into two categories:
Category 1. Pathogens that achieve benign coexistence with human hosts; and,
Category 2. Pathogens that exploit hosts to a far greater degree than those in Category 1.
Whenever pathogens achieve more overall success across transmission cycles by exploiting their host than can be achieved by benign coexistence with a host, then benign coexistence becomes an unstable situation. Increased levels of pathogen reproduction within hosts, and/or increased pathogen shedding from infected hosts ( i.e., increased pathogen propagation) correlate with increased toxin virulence."
Ewald has further emphasized this point as follows: "[M]utations that increase the level of host exploitation [also] tend to increase harmfulness."
It would be difficult to find in today’s literature a more coincidental or compelling set of arguments than Ewald’s to support the contention that contemporary medicine has gone astray because of the inadequacies of its intellectual underpinnings, and of the consequently erroneous content of its dominant mechanistic paradigm. Ewald has correctly observed that the "traditional view" in medicine serves to increase the uncertainty about the ability of physicians to effectively manage the dangerous epidemics of the future. His angle of vision on where the medical field must look for a correction of its traditional views may be discerned from the subtitle of one of his articles: "Guarding Against the Most Dangerous Emerging Pathogens: Insights from Evolutionary Biology:"
"Emerging hospital-acquired pathogens may pose one of the greatest and most controllable threats to people in countries like the United States, where more than 5% of hospital admissions and about 14% of intensive care patients acquire infections during their stay. According to some estimates, nosocomial infections rank among the ten leading causes of death in the United States with dangerous bloodstream infections approximately doubling during the 1980’s. ...Without an evolutionary framework for understanding pathogen virulence, researchers would have no reason for expecting to find particularly virulent endemic pathogens in hospitals. The only serious attempts to explain the apparently high-level of pathogen virulence in hospitals involved the linking of virulence to another characteristic associated with hospitals: antibiotic resistance. ...Almost no work has been done to determine the potential of pathogens thought to be almost exclusively associated with nosocomial infection (e.g., Enterococcus, C. difficile) to take hold in the outside community. ...Any transmission of durable nosocomial organisms like P. aeruginosa from patients after discharge heightens the threat to the outside community by providing an avenue for further adaptation to humans. ...I propose that integrating evolutionary principles with epidemiology would enhance our ability to stay ahead of the curve. Evolutionary insights should increase our ability to distinguish emerging pathogens according to the long-term threat that they pose and thereby adjust investments in accordance with the threat."
The goal of conventional medicine ought to be to predict and prevent the emergence of those pathogens with the potential of doing the greatest damage. Instead of dedicating itself to the achievement of this goal, however, the medical guild is instead consistently behaving in ways that tend to increase the potential harmfulness of nosocomial pathogens. The latest approach is to blame the victim, and if the Commonwealth of Virginia permits the medical profession to continue along this corridor of "corrective action," not only will a significant opportunity have been missed, but also deaths from MRSA are bound to explode.
Just how prepared are the leaders of American medicine are to effectively cope with "one of the greatest and most controllable threats to people in countries like the United States?" Joseph M. Mylotte, MD, a professor at SUNY/Buffalo, presented the results of a study of "endemic nosocomial multiresistant ACB" at the 1996 annual meeting of hospital epidemiologists—eleven years ago. His presentation ended with these unsettling words:
"Understanding fully the epidemiology of nosocomial pathogens and the explanations for the findings in the present study would provide considerable insight into the development of rational control measures for these organisms."
The Washington Post story of May 14, 2007 demonstrates the fact that physician understanding of the epidemiology of nosocomial pathogens has not advanced by one iota. Among other things, this leading epidemiologist is at the least implying that there are no "rational control measures" in place to combat the spread by physicians, nurses and other "cultural vectors" working in hospitals of increasingly virulent nosocomial pathogens. In fact, there is as yet not a shred of evidence to suggest that the development, promulgation, and enforcement of such rational control measures has found a place on the action agenda of the American medical guild. Instead, the victims are being blamed.
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