The Politics of Disease

GUEST: June Goodfield
VTR: 9/21/85

I’m Richard Heffner, our host on The Open Mind. When I first got word that a new public broadcasting series had been inspired and much more by a modern-day Paul de Croif, that her Quest for the Killers television enterprise was considered by some a video counterpart to The Microbe Hunters, it might inspire this generation with dreams of medical achievement as that other wonderful book had inspired my own, I knew that I wanted its creator to join me here on The Open Mind.

Medical historian, Dr. June Goodfield is the English gentlelady whose rigorous pursuit of the scientific endeavor, that of the healing arts, took her around the world from New Guinea to Greenwich Village to the West Indies, Nepal, and Bangladesh. Everywhere she documented the medical research, its visions and failures and triumphs that led ultimately to stunning breakthroughs against disease that bettered man’s lot everywhere. And since so much of that basic research was done in third-world countries, I want to ask Dr. Goodfield not only about this search for truth, but whether these truths about health and illness may ever free the third world from much of the human misery that besets it now.

GOODFIELD: That’s a very serious topic.

HEFFNER: A big one, I know.

GOODFIELD: It’s a real big one.

HEFFNER: what do you think the answer to that is? Do you think that the medical researches you traced and stayed with so assiduously, that your book, The Quest for the Killers and your television series document, do you think they’re going to enable us someday to free the third world from these miseries?

GOODFIELD: In theory they could enable us to free the third world from many of these miseries tomorrow. One of my problems about this is that I think, Richard, that what is at issue here is political will, not medical terminology.

HEFFNER: Their political will, or our own?

GOODFIELD: Both our political wills. If you think about third world disease – I’ve got two aspects of this – if you think about third world disease, the issue is horribly stark. Only 20 percent of people in the third world have access to doctors, have access to any kind of medical care whatever. Most of them suffer from malnutrition. Most of them suffer from bad water, diarrheal diseases. Most of them suffer from lack of education that will make them understand what you do, A, not to fall ill, and what you do if you do fall ill. I suppose if I wanted to put it starkly, the difference between our health condition and their health condition can be summed up very simply. You and I, on the whole, have the freedom to choose to be well. Sure, we might get run down by a bus. Sure, we might, God forbid, be stricken with childhood cancer or a brain tumor or a dementia for which we have, we’ve done nothing in our lives to make this, determined that this is going to happen. But on the whole, we can choose not to smoke, we can choose not to get lung cancer, we can choose to live well and sensibly. As Lou Thomas has said before now, we’re getting a little hypochondriac about it all. In fact, we think that we’ve got to search for total and ideal health. And we, on the whole, search for this on the one hand, while failing to recognize that even the degree of minimal health which we’ve got which is absolutely superb, we are well-fed, we have resistance to disease, we start off life with an immune system in mighty fine shape, and from then on, by and large, it’s in our hands. Most people in the world do not have that option.

And to change this calls for two kinds of things, three kinds of things. One is a medical technology which we have at our disposal. It’s very simple. It’s getting better. We could apply it. The second thing is political will. Our political will and their political will. Because if a government like Ethiopia or Marcos in the Philippines or whoever, cares nothing about the health of the rural poor, and these are the people we’re talking about, then there’ nothing that you and I can do about it. Yes, we can make a lot of noises, but if Ethiopia chooses not to deliver medical technology to the refugees in Tigue because they think they’re ideologically just beyond the pale and it’s best to bomb them to Hades, then all we can do is to make a noise about it. If a government says, “You know, I’m really not interested part of society, and It’s a small part of the population, and they are the poor,” we can do very little about that except make noise. But the next thing, suppose everybody agrees yes, we will do something. Suppose the political will is there. Then the third and final step is somebody is going to have to pay for this. And actually, I sum it up by saying it would be a miracle if we did it, and this miracle comes extremely cheaply.

HEFFNER: Are you saying that there in the third world the question is political will in terms of interest or concern and with us the problem is one of dollars?

GOODFIELD: I think there in the third world the interest is one of political concern and will. With us the problem is dollars and willingness to give our dollars for things which I actually personally consider are highly significant and important in the sense that, I’ll go on record, I’ll say it again, I believe that putting the third world on its economic and its physical healthy feet is going to do much more for the world, for world peace than any Star Wars program you care to mention.

HEFFNER: Is there a different approach to the question of the health and the well-being of the third world, east and west?

GOODFIELD: By “east and west” you mean china and…

HEFFNER: The Soviet Union perhaps.

GOODFIELD: No, I don’t really know the answer to that. I would be incorrect if I could say yes, I do know the answer to that. I think that there is one kind of unity, whether you talk to people at WHO from all over the world, whether you talk to people who were from all over the world caught up on the smallpox program. Twenty-four people from, 24 representatives from 24 different nations worked together on that program for 11 years and actually banished a disease from the face of the earth and came out with a complete understanding, a much better understanding of what is going to be required to take the next steps. And I think there are also certain very fundamental, basic principles which they now all agree. That if we could bring fresh water to everybody, that if we could improve sanitation, these are lessons we learned in the nineteenth century. These are lessons that New York learned around the turn of the century. That if we could give a basic level of nutrition, that if we could give basic immunization to most children, then half the problem is already solved. If they start off with a good beginning in life and they are on the road to a healthy future of a kind that we have given, we take for granted, absolutely take for granted.

HEFFNER: Dr. Goodfield, in The Quest for the Killers – and I’m looking at the book but I’m thinking of the television series, too – as you went around the world and saw what scientists were doing, medical scientists were doing, come back to this question not for political reasons really, but out of curiosity, was this a western world phenomenon or was it western and eastern?

GOODFIELD: Extraordinarily, it was not, absolutely not a western world phenomenon. Because what was…And it wasn’t that for a number of reasons. Firstly, let’s take the very first episode, the first chapter in the book. If I had said to you, “Richard, I’ve got a marvelous idea for a book. I’m going to write a novel. You see, there’s a disease in a stone age tribe and they haven’t met any white men for years, and this disease is dessimating them. They think, of course, it’s due to sorcerers, but it’s killing off all of the women and children. And then a crazy, obsessive, brilliant, young American pediatrician comes and he stays with this problem for 25 years and he eventually finds the cause of the trouble. The cause, which is a new virus never seen in the world before, which hides like a lethal time bomb in their bodies and 25 years later comes out and wreaks neurological havoc. And “do you know what, Richard?”, I go on , you know, trying to sell you my best-seller. “Do you know what? When this was all done, when it was unraveled, the cause of this disease lay at the heart of those diseases which are reaching epidemic proportions in western society, namely the dementias, brain dementias of old age.” You would tell me to go take that idea to somebody else, because, I mean, it just is too fictional. It happens to be true. And the most extraordinary thing was that it didn’t matter what disease I looked at, whether this trembling sickness in the foray that leads us to Alzheimer’s, whether it is our trying to understand the basic problem at the heart of leprosy, why is it that of every hundred people continuously exposed to the leprosy bacillus, only four out of every hundred are going to get the disease? And in unraveling that mystery to which many people in the third world make contributions in the unraveling of that mystery, we come to understand why it is that some people in our societies fail to see their cancers.

HEFFNER: But you know, you say we come to see that about our own society. One of the questions that came to me as I read Quest for the Killers had to do with the people that you’re talking about, this wonderful young pediatrician and all the others you chronicle here. What is it that informs these people in terms of their picture, if anything, in terms of their sense of what it means to be a human being, man’s relationship with himself, with others, with God, with nature, that enables them to do the kinds of things that you described in this book and in this television series? What common denominators are there?

GOODFIELD: I think there are two or three common denominators. They are really quite extraordinary, and yet we have to remember they represent a group of people who in some presence, some degree or other, have always been within the scientific enterprise. Ever since the heyday of Crick and Watson and all that jazz, and I’ll say “all that jazz,” all the great excitements in molecular biology, the way to get ahead, the thing to do is stay there in the laboratory, get on with your work, go for that Nobel prize, and eventually perhaps, you of course hope so, but it isn’t really your business, the fruits of your research will filter down an important product, a pharmacological product or therapies or vaccines or preventative measures to the diseased populations wherever in the world or in western society. But there always has been a strong tradition in science, and it still exists, and these people exemplify it. For whom just saying in the laboratory doing their work was not enough. Their motive force, the impetus that drew them into the problems in the first place was an awareness of sickness and disease problems in less fortunate people. When Carlton Gaduset met the Foray tribe, he began a love affair. And his love affair was a two-way love affair. It was a love affair with the nature of the difficult intellectual problem which was going to lead him to understanding dementias in the third world. The second thing that he, the second aspect of his love affair was a deep concern with the patients who were before him. And you see this twin aspect in everybody in this book and the television series. They are compassionate people who use working at the very cutting edge of knowledge, scientific, medical, pharmacological knowledge, move toward humanities problems, and that is their…

HEFFNER: You know, Dr. Goodfield, I still want to pursue this question of what attitudes inform these brave, patient, determined scientists, and I particularly want to ask what their senses of themselves in relation to nature and to nature’s god. Is there some commonality there?

GOODFIELD: I don’t really know. I suspect there has to be something, but some of them are very reticent. Some of them just really wouldn’t give this a second thought. Some of them would…

HEFFNER: Really?

GOODFIELD: Yes, some of them wouldn’t, you know, “I just care about this work. I’m doing it, and I’m going forward. I care about people and I’m going forward to do it.”

HEFFNER: As a historian, though, of science, what do you think informs their actions?

GOODFIELD: I think one very deep sense of whether this, the origin of this sense comes from God, comes from their education, comes from their upbringing, comes from whatever, some very, very deep sense that we are all part of one common family on this earth. And that there are many imperatives which are imposed upon us who are in more privileged societies to actually do something for those of us who are less privileged. And if not only that there are these moral imperatives which can have from whatever source you like, but also I think that if we take these steps, if we demonstrate the nature of our common bonds with everyone everywhere, it just makes quite simply for a better world. And a better world, as I’m forced to answer your question…

HEFFNER: And you are.

GOODFIELD: I am. And you’re forcing me to think. I think there’s one other thing that they do all have, this strong sense. And that is that they are all people who think very, very carefully bout what kind of a world are we going to be leaving not only to our children but our children’s children and to their children. They don’t stop to bother about the question: Is there going to be a tomorrow? Is the nuclear holocaust going to blow us away? They take it for granted it is not going to blow us away, or that by our very actions in demonstrating that you can make a difference that we can improve the lot of people, that these problems are eminently soluble. They simply take it for granted that there is going to be a tomorrow and it is our job to make that tomorrow better. They share something, if I can just finish, Richard, with this thought, they share something which I knew the late Margaret Meade shared and which I admired her for very greatly. It is that this sense that if in the end the human race is defeated, it is not because the problems were too great or were not, or possibly we couldn’t solve them; it simply was because we’ve allowed ourselves to be defeated.

HEFFNER: You know, it’s so interesting that you quote Dr. Meade, and I was coming to that quotation because you had said it in an interview, and something you had said earlier in the program when we just began made me think of another mutual friend, Max Lerner, who sat at this table with Margaret Meade a number of times. Max defined himself as a possiblist. That was his philosophy. And I thought, as you answered the first question that I asked, here is another possiblist. And I wonder if you’re not saying that about these medical researchers, that like yourself, like Max Lerner, like Margaret Meade, they believe in possiblism. If it’s possible, we’re going to do it. And it is possible.

GOODFIELD: I think so. And I think there’s something more besides. I mean, we all have to come to terms with not only the frailty of human life but also the fact of our own mortality. And some of us do believe in God; some of us don’t believe in God. Some of us believe that we will survive into a hereafter; some of us believe that actually we will not survive into a hereafter. And I think for some of us, and I count myself amongst this lot, that the sense of being able to have made a contribution, to just edge the whole movement a little bit downstream for the better is almost the only consoling, one of the few consoling facts we have to console ourselves for the time that one day we may not be there. And if you’re like me, you don’t have any children, neither will there be any one remembrance. Philosophers could impale me with this and say, well, you know this is just another one of these extremely non-altruistic reasons for doing things, and it’s all to do with your own deep self-interest. Okay, so be it, if that’s what they say. I don’t believe it is exactly like that. And I mean, I’m 58. I’m coming to the age when I ought to , you know, be going around uttering such phrases as, “I don’t know what the world is coming to.” And of course, Richard, I don’t know what the world is coming to. And yet, as I went around the world looking at these people, seeing how these small efforts, compared to many of the major issues of political war, famine, pestilence, rape, murder, you name it, now these small efforts are not only actually working but making a significant difference to the way people think and behave, I’ve come, I mean, I’ve come out of it a convinced opportunist. I believe the world is going to go on until the sun dies.

HEFFNER: But of course you’re talking now about the individuals who were doing the creative work, who were conducting the researches, the people who risk their lives in these endeavors. At the beginning though you talked about what was necessary to achieve what you feel we can achieve, and that was political will and economic support. Now, do you see both the will and the support?

GOODFIELD: Sometimes I see it. (Laughter) Now you see it; now you don’t. Sometimes it’s stronger and then it isn’t. I’ll give you two examples, one from the story of eradication of smallpox. In the late 1960s, every member of WHO, delegates to the WHO general assembly went and put up their hands and said, “We vote to eradicate smallpox, and preferably within about ten years.” But we all vote to eradicate smallpox. Absolutely fine. Any delegate, it would be like asking a delegate who didn’t vote it, like asking the American not to vote for Mom and apple pie. I mean, nobody is not going to vote – you’ll forgive the double negative – nobody’s not going to vote for eradicating smallpox. But then the problem begins, because the campaign was led by an extraordinary, charismatic, very, very energetic American who had absolutely no use for bureaucracies, and I love him for that, whether it’s the inertia posed by the bureaucracy of the local government or the inertia posed by the bureaucracy of an international agency which can sometimes be so absurd it’s unbelievable. And his job then was to go around to every country where there was endemic smallpox and say, “Okay, we’re going to come in. We’re going to come in, we’re going to ask you to mobilize your own health workers, we’re going to mobilize everything you have in the country to eradicate smallpox.” And he said, “It was a devil of a job getting them to agree! Even though their minister of health had been at the assembly just two years back and put his hand up.” Of course, in many countries there’d been a coup, there’d been a dictator, there’d been an assassination, and the minister of health who had gone out to vote was and so was his government. But nevertheless, you would have thought this would be very, very easy. In fact, it was extraordinarily difficult. Getting the money was difficult. Getting the vaccine was, getting good quality vaccine was not easy. Getting good people was the least of his problems. He got magnificent people from all over the world. But getting the indigenous countries who had the problem to agree to do it was horrendous.

HEFFNER: What is the – the answer is going to be, “There is none.” –what is the answer to this problem?

GOODFIELD: It varies a great deal. Look, we see this beginning all over again because the next great campaign is called the children’s revolution. It’s the only revolution that I absolutely, unequivocally support. It is the idea to try to bring immunization to all children in the world, as I was saying earlier in the program, of a kind we take for granted for our own children. And all the preliminary meetings have got going, and things are going along very nicely, with James Grant at UNICEF you have an extremely charismatic, extremely forceful character who is playing a similar role to the role that Donald Henderson played when he led the campaign to eradicate smallpox. But periodically from time to time the thing stalls in the mud. You get the slowness of the bureaucracy. You get the management, you get the people who play safely. And the problem is going to be overcoming, in somehow getting enough enthusiasm generated by one person to create this in another group of people, to overcome the inertia of human institutions. You’re the historian. Let me turn the question to you. Why are institutions so full of inertia?

HEFFNER: Because they’re run by, administered by, thought up by human beings. That’s the problem it seems to me. But I then detect, and you tell me if I’m wrong, that you’re saying you see administrative frontiers to break through, administrative problems. And I wondered whether there are specific scientific, medical research problems that you would identify for us that we’re coming to, that we’re working on.

GOODFIELD: Richard, it’s quite extraordinary. Let’s go back to the 80 percent of people in the third world who have no access to medical care and say, “How are we going to improve their health?” We’re going to do it, we’ve got to do it by bringing water, we’ve got to do it by sanitation, but immunization, by teaching mothers bout breast feeding, about anti-diarrheal diseases. The technology is totally simple and we have it. Sure, we are making one great advance, one very important advance in the area of vaccines. I mean, the nice thing about smallpox was you could just vaccinate somebody by scratching their skin with the cowpox virus. Whereas for most things like measles and whooping cough and things like that you’ve got to inject people with a needle, and you’ve got to keep that needle sterile otherwise you’ll be spreading AIDS around the place. You’ve got to keep the vaccine cold. And so you’re immediately into logistic problems of the kind that were not present with smallpox. Now, one such frontier that you’re interested in, scientists in this country are just doing something stunningly clever. They are taking the crucial molecules of all those diseases I’ve mentioned, the viral diseases I’ve mentioned, and they managed to splice them onto the old cowpox virus. And it is perfectly possible that we will be scratching children with cowpox virus and by doing so immunizing them against measles, hepatitis B and all those diseases. That’s a stunning medical advance. But we can gear up the countries in the world, and they are to increase the coverage of the immunization of their children with national immunization days, mobilizing their health structures, etcetera. And when we’ve done it, we will have done it, and the problem begins. Children keep on coming. How are we going to keep this interest which we can get them to do it once in their history to make them realize they are going to have to do this every five years if this revolution is to persist? Smallpox was like a parachute jump. You went in, you did it, the disease went. But for the next stage it’s going to be much more difficult.

HEFFNER: Well, I come back though to the question, do I understand correctly that your position is, well, classic position of a person who is public health oriented, and administrative concern, that you’re saying that we are there now and what we need to do is organize the will and the economics to accomplish what we must?

GOODFIELD: Yes, sir. Absolutely, that is precisely what I’m saying, precisely what I’m saying. We are there now. We are on the verge if we choose of making a major impact on global health. One thing that I would like…You know, we’ve had a decade of water, Richard. I don’t have to repeat all the arguments for bringing fresh water to everybody. I’m sure everyone in this audience knows them. We’ve had a decade of water where we tried to get enough money to bring water to everybody. We’re failing to produce that money. It’s peanuts. I’ll just give you the example. If every nation in the world agreed to donate the money that they spend on arms between January 1 and January 15 of every one year for five years, that would be the end of the problem.

HEFFNER: That’s one of those iffy things.

GOODFIELD: Terribly.

HEFFNER: We have a minute and a half left. Again you’re the medical historian. Is there any indication in the past of mankind that that kind of quantum jump in intention, not capacity, but intention and delivery is going to occur?

GOODFIELD: Oh, yes, I think so. I think every age has always said, you know, isn’t it ghastly and they’ll never do these things. And actually if you look at the history of the world, I mean don’t – I nearly said, “Don’t you remember” – don’t you remember, Richard, John Snow in the middle of the nineteenth century was the one person who identified the pump in London which was the cause of cholera? There was the Sanity Reform Commission. Nobody took a blind bit of notice of it, but eventually they did. You know, one just has to keep plugging away, not despairing, and eventually it happens.

HEFFNER: It’s incredible to me – and I don’t mean unbelievable – that this optimism nourishes you so to say that so positively as you did before that yes, we’re there scientifically, now it’s a matter of organizing human resources and modern medical information. And it is that point, and it’s a very, very optimistic point at which I, well, want to call attention again to your book, Quest for the Killers, and thank you for joining me today.

GOODFIELD: I’ve had a lovely time, but I fear I didn’t answer the questions properly.

HEFFNER: Well, you answered the major one properly by saying we’re there. Thank you.

And thanks, too, to you in the audience. I hope you’ll join us again next time on The Open Mind. Meanwhile, as an old friend used to say, “Good night and good luck”.

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