"The Iraqis are sick people and we are the chemotherapy," US Marine Corporal Ryan Dupre told the Times of London reporter Mark Franchetti (The Times, Mar. 30, 2003) shortly after a bloody battle outside the Iraqi city of Nasiriya.
How interesting that a young soldier should turn to a medical metaphor to describe his mission. For more than a century, allopathic medicine has embraced military metaphors to describe its practices, as Gladys McGarey, MD, eloquently points out (p. 13). The link is more than semantic: it reflects a world view in which something undesirable or threatening must be destroyed, eliminated, eradicated. Perhaps what is missing, both in interventionist medicine and interventionist foreign policy, is an understanding of the conditions in which the problems arise.
The stated purpose of the US invasion of Iraq is prevention of terrorism, elimination of a ruthless dictator, and establishment of a free, democratic society. Assuming for a moment this is true, one must ask whether warfare is the best means to this end? Do we really know what are the necessary conditions in which a free, democratic society flourishes? And conversely, do we understand the conditions that generate monomaniacal dictatorships?
The questions are not so different in medicine. As we progress further with ever more sophisticated, costly interventions, are we forgetting to look at the processes and conditions—many of them modifiable—that generate disease?
Foreign policy based on supporting "friendly" dictators who later become problems to be eliminated is not so different from tacit or overt promotion of lifestyles and environments that generate serious diseases that must later be treated at huge cost. We don't need massive NIH studies to know why teens are becoming obese and diabetic; we need adequate funding for our education systems, so they don't need to put vending machines in schools in exchange for grants from junk food kingpins.
As Joe Pizzorno, ND, who recently joined the Medicare Coverage Advisory Committee, points out (p. 1), it is more profitable to focus on treating advanced disease than on preventing it. World affairs seem to show the same pattern: it is more profitable—at least for some—to handle foreign policy through military intervention than to concentrate on cooperative development policies that might prevent violent extremism.
The reality of war in Iraq is that many innocent people are being killed, in part because the boundary between civilians and combatants appears to be blurred. Anxious American troops, unable to distinguish between helpless civilians and armed resisters, are in a difficult position. Often, it seems, they choose to shoot first and differentiate later. Here, too, Cpl. Dupre's chemotherapy analogy is apt. When treating cancer, how much healthy tissue must be destroyed, how many debilitating side effects must be endured in order to eliminate a malignancy? And what of the aftermath? In both cases, the patient may be "saved," but in what condition? And at what cost? And who will pay that cost?
There are indeed situations in which armed intervention and invasive therapies are absolutely necessary. But in both medicine and international policy, these situations must be the exception, not the rule. I do not claim any answers or great insights regarding either the crisis in Iraq or the crisis in American medicine. But part of a journalist's role is to ask questions, even if the answers are not easy to find. Our future health, as individuals, as a nation, as a species, may very well depend on our willingness to ask those questions.