What do you know about health? What do you know about how to stay in good health? About how to get back to good health? About preventing the onset of ill health?

The 20th Century philosopher Ludwig Wittgenstein observed that most of what someone knows comes from what he or she has been told by someone else. Not really a theory of knowledge. More like a portrait.

And, of course, it’s important to remember that what those people you heard it from know comes from what they were told by yet someone else. These include the experts upon whom you rely.

A friend was recently diagnosed with cancer. The doctors encouraged her to start chemotherapy. They said that people who took this particular course of chemotherapy had a 60% survival rate whereas those who did not had only a 30% survival rate. She took them at their word. But she’s also consulting with three alternative physicians, including an energy healer. All of which consists of knowing what you know by having someone tell you.

Not a bad thing, just how we know most of the things we know. Even her doctors. Chances are good that her oncologists didn’t do the research that came up with those survival rates or chemotherapy methods or cancer diagnostics. Someone told them.

What was true for the doctors and became true for my friend is that what they (and she) know makes sense given what else they know. What they know has as much (or even more) to do with how they fit together what they know into something like a portrait of that makes sense to them.

You likely know the work of the Renaissance artist Giuseppe Arcimboldo. He’s famous for painting portraits using fruits, vegetables, books, and other objects as the elements of a face. Each portrait is recognizable as a human face because it’s made coherent by him in his selection and placement of each piece of fruit, vegetable, or other object, and by the viewer in how he or she recognizes the face in what might otherwise be a jumble of vegetables.

The portraits are more than a collection of objects. By Arcimboldo’s art, the vegetables hang together as a portrait. And we do some of the work in making sense of it as a face.

That’s more about how we know things about health than it is about what we know and what sense we make of it. Start changing the individual vegetables and you’ll get a different face. Change one thing you know, get a different picture of your health. For example, what if you knew not only that 60% of people treated with chemotherapy survive but also that an alternative cancer treatment based on features of the immune system also resulted in a 60% survival rate? If that were the only thing that was added to the portrait, would you choose a different course of action?

And that, of course, is the key question: would you do something different?

Because there’s no simple answer to that question, I want to start with an historical perspective based on the book Dissolving Illusions: Disease, Vaccines, and the Forgotten History by Suzanne Humphries and Roman Bystrianyk.

At the beginning of the 19th Century, vaccination against smallpox was promoted in England and Wales. The physician Edward Jenner is credited with conducting the first experiments on children in the late 18th Century. He became a primary expert and chief promoter of the practice.

By the mid-19th Century, vaccination against smallpox was both heavily promoted and widely accepted as a medical practice. However, smallpox epidemics still erupted, even among vaccinated populations, sometimes especially among vaccinated populations; vaccinated people died from other diseases transmitted by the vaccine; and, contrary to the experts, sometimes vaccinated people often contracted smallpox earlier and with worse symptoms than unvaccinated people.

In response, local governments and the national government passed laws for compulsory vaccination, particularly of children. Parents could be punished by fines and jail for preventing their children from being vaccinated.

By the 1870s, vaccination rates for children were over 90%. Yet smallpox outbreaks occurred at regular intervals. In 1873, when vaccination was at its highest, so was the death rate from smallpox. Popular resistance increased. In 1885 what was called the Great Demonstration occurred in city of Leicester. The city government was replaced. The new government stopped compulsory vaccination and proceeded to implement what was called the Leicester Method—consisting of quarantining smallpox patients and disinfecting their homes. The vaccination rate dropped to near zero, yet the smallpox death rate was the same as that for the nation as a whole.

In Leicester vaccination made no difference in controlling smallpox outbreaks nor in reducing smallpox deaths.

Medical experts and government authorities ignored Leicester’s success and continued to promote and enforce smallpox vaccination. The narrative we’ve inherited is that the decline in smallpox deaths that occurred in the late 19th Century resulted from the medical intervention of vaccines. It is hailed as a great triumph of science over superstition. It is held up in the narrative of public health as proof that state intervention is a proven method for ensuring the prevention of disease through the application of science.

More generally, experts promote the narrative that medical interventions, principally vaccination and antibiotics, supported by the power of the state, were the principal cause for the dramatic decline of infectious disease from the late 19th to the mid-20th Century. It’s what everyone knows. And it’s likely not true.

I don’t intend for this to be a diatribe on the dodgy science and history of vaccination. What I do intend is to illustrate the power of social forces in creating a narrative of what you know about health and how you come to know it.

One social force is the role played by experts in creating and maintaining the dominant ideology of health—which has to do with how and why experts become sources of knowledge and how and why you take them to be sources of knowledge. Just because Edward Jenner promoted himself as the smallpox vaccine expert it didn’t follow that he would be successful at promoting the practice. It was his social class and his status among physicians, themselves of elevated status, and so on that created the cadre of smallpox experts that then used their status to affect government policy and action.

A second social force is the role of the state or other social authority in enforcing the dominant ideology of health—which has to do with the state as the social force that maintains social stability by sanctioning some knowledge and discouraging other knowledge—with force when necessary. Smallpox epidemics are of necessity socially disruptive. Governments needed a solution that was socially acceptable. Jenner and vaccination were socially acceptable. The Leicester Method was not.

A third social force is the capacity of civilians (that would be you and me) to make their own sense of what’s coming from experts and social authorities and acting on that knowledge—and when necessary, taking things into their own hands. The people of Leicester rebelled and organized. They were not alone in rebelling, but they were alone in successfully organizing.

A final social force is the power of commerce, something not on display in dealing with 19th Century smallpox outbreaks. Unlike today,there were no large pharmaceutical companies busily working to shape the science and politics of disease treatment, control, and prevention.

Instead of pursuing those issues, right now I want to discuss the dominant idea that vaccination eliminated smallpox. That victory claimed by conventional medicine extends to the other infectious diseases rampant before the late 19th Century when their dramatic decline began, ending in the mid-20th Century. The narrative is that vaccination and antibiotics marked a victory of science over disease.

An article written 40 years ago titled “The Questionable Contribution of Medical Measures to the Decline of Mortality in the United States in the Twentieth Century” looked carefully at the data on death rates from major infectious diseases: tuberculosis, scarlet fever, influenza, pneumonia, diptheria, whooping cough, measles, smallpox, typhoid fever, and polio. It’s clear by just looking at the data and comparing it to when the vaccine or antibiotic for each disease began that the declines in deaths from every single infectious disease began well beforehand.

In other words, medical practices might have contributed to reducing the health risks of a particular disease, but the reductions had already started—which suggests other causes. And those would be changes to people’s social and physical environments: increased incomes and standards of living, improved nutrition through safer food supplies, clean water, and sanitary waste disposal. These came about through labor movements, public health movements, and social justice movements.

The relative contribution of medical practices to the reduction in death rates from all infectious disease was less than 40%. Deaths from tuberculosis and pneumonia were most significantly affected by the introduction of antibiotics (contributing 28%), whereas deaths from whooping cough, measles, and polio by vaccination contributed little (a total for all three of less than 3%).

The point here is not that medical practices were entirely ineffective, but that they were not the heroes of the story. The heroes were public health and environmental health from labor and social reform activism.

To take an even wider perspective, the dominant ideology of what you know about health is that medical interventions generally have been responsible for the dramatic improvements in life expectancy over the last 150 years. That ideology has made “health care” synonymous with “medical care.”

Daniel Engster’s article “The Social Determinants of Health, Care Ethics, and Just Health Care” examines research on increased life expectancy in the 20th Century. People now live 30 years longer than they did in 1900. But only about 5 years of the increase, that is about one -sixth, can be attributed to medical interventions.

There’s more. Only 10% of preventable premature deaths in the United States results from a lack of medical care. Based on Medicare and Medicaid data, people living in areas with high rates of spending on medical care and high utilization rates of medical care do not live longer nor do they have better health generally than people living in low spending, low utilization areas.

On the contrary, a study in Winnipeg Manitoba found that health actually improved during a decade in which hospital access was restricted and hospital spending decreased.

Yet other researchers looked at health outcomes for the wealthy as compared to health outcomes for the very poor. They projected what would happen if medical care was entirely denied to the wealthy while medical care for the poor was made free and without restrictions. What they found was that even in this extreme case of reverse disparity in access to medical care, the wealthy with no access would still live four years longer than the poor with unlimited access.

So there’s more than ample reason to doubt that medical care is health care. That medicine is the health colossus astride the world. That it is medicine to which you must turn for what you know about health. What you know about how to stay in good health. To recover your health. To prevent ill health.

The history and research I’ve discussed suggests that you should principally turn to your social and physical environments for what you know about health and its maintenance, recovery, and promotion. Knowing what you can from medicine might help. Sometimes it might help critically. But always in the context of your social and physical environment.

Before leaving the topic of mortality, permit me to tell you about something called iatrogenic mortality. Iatrogenic deaths are the third ranking cause of death after cancer and heart disease. Iatrogenic mortality consists of deaths due to medical mistakes. In other words, along with all those medical miracles come medical risks—and not the expected risk that a medicine might not work for a particular person, that some unexpected reaction kills the patient. Iatrogenic mortality is death from a medicine or procedure or circumstance that’s already known to be lethal. It’s giving a patient the wrong drug. It is dying from methicillin resistant Staphylococcus aureus (MRSA) contracted in a hospital.

As for iatrogenic mortality ranking number three, I remind you that cancer and heart disease became significant killers only in the 20th Century. In my opinion, they are environmental illnesses. What medicine has succeeded in doing is not curing them but turning them into chronic diseases by discovering ways to keep the machinery of the body going.

So if what you know about health is a portrait, it should principally consist of what you know about your social and physical environment. What I’m suggesting is not that health care should be organized along the lines of Black Lives Matter or Occupy Wall Street or Sea Shepard. I’m saying that Black Lives Matter, Occupy Wall Street, and Sea Shepard are health care.

On the other hand, the dominant ideology of health care is a portrait of engineered medical technologies designed to solve discrete problems that afflict your body—but has little to do with you. It is a portrait of technologies brought to you by one business or another. It is a portrait of magic and miracles.

Don’t count on the so-called progressive media to keep you well-informed. I recently heard the host of a daily program syndicated on the Pacifica Network use the phrase “vaccine deniers” during an interview about climate change. She was making a point about climate deniers who, allegedly like people who do not want their children to be vaccinated, ignore the science.

That’s the dominant ideology: vaccines are a miracle; nothing bad ever happens; the government, protecting our health and safety, should force vaccine deniers to do what’s right—for the sake of the children. It’s clear to me whose ignoring the science—certainly the science that doesn’t conform to the dominant ideology of health as medicine.

It’s interesting to note that in the first half of the 20th Century, the involuntary sterilization of people deemed defective was legally sanctioned based on existing policies for mass vaccination.

In their book, Humphries and Bystrianyk discuss therapies for infectious diseases that were actively ignored during the 19th Century. These include what would come to be understood as vitamin deficiencies resulting from malnutrition. They also included what we would now call natural remedies such as cinnamon, jicama, fruit juices, apple cider vinegar, cod liver oil, and colloidal silver.

What you know about health is what makes sense to you. What makes sense is the face that emerges from the portrait composed of the vegetables of what you know. And it’s not just the vegetables, it’s what you bring to them and their arrangement. It seems obvious to me that what needs to dominate that portrait is the vegetables of social and environmental justice.

For example, the Zika virus has the CDC worked up. President Obama has asked for $1.9 billion. A good chunk of that is for developing a vaccine, which will be manufactured and sold by a pharmaceutical company. Funds will also be used to prevent the spread of the mosquitoes that carry the virus. Two methods are being examined: spraying infested areas with pesticides and releasing genetically modified mosquitoes into the environment so that the insects don’t breed successfully. Both of those solutions are products of profit-making enterprises.

Just talking about this issue has drawn our attention to one kind of science while ignoring another. We don’t see or hear headlines about microencephaly, let alone pesticide induced microencephaly. What we see and hear are headlines about the Zika virus.

That’s created a nice panic both in government and among people in general. There are reports of women showing up in emergency rooms fearing for their reproductive health because they were bitten by a mosquito. Given the information at their disposal, it’s a perfectly rational concern.

But is the information frightening those women helpful or even accurate?

The Zika virus and its clinical symptoms have been known for 70 years. It’s related to the Dengue fever virus and so has the potential to cause neurological problems. So it’s no joke. On the other hand, clinically less than 1 in 5 cases manifests with overt symptoms. That means that for five people infected with Zika, only one will show any signs at all.

But the health issue is not the virus itself but the effect of a Zika infection on pregnant women who give birth to children having the microencephaly birth defect—that is, the baby’s head is unnaturally small and with that comes neurological problems.

So the health problem isn’t the virus’s usual clinical, flu-like symptoms—previously characterized as relatively harmless. It’s the unexpected occurrence of a particular birth defect associated with infection by the virus.

This association between Zika virus infections and microencephaly birth defects has only bee seen in a specific region of Brazil. It is a region where a particular kind of pesticide called Pyriproxyfen was sprayed the year before the cases of microencephaly showed up. In early 2016 a group of Brazilian and Argentinian doctors calling themselves Physicians in the Crop Sprayed Villages described it as a pesticide problem. They’ve been ignored.

Subsequently, researchers reported in the New England Journal of Medicine that cases of Zika infection in Colombia were not associated with cases of microencephaly in any greater numbers than for uninfected women. In other words, while there were cases of microencephaly, there was no association with Zika infection. They’ve been ignored.

Finally, an independent research group called the New England Complex Systems Institute recently examined the science and concluded that the Zika virus was not the cause of the microencephaly outbreak in Brazil. They’ve been ignored.

At least ignored by the CDC. The World Health Organization has not yet committed to the Zika theory of microencephaly—which is somewhat odd in itself, as typically global health organizations take the lead of the CDC. However, the World Health Organization isn’t giving much credit to the alternative theory that it is pesticides that have created the outbreak.

Pyriproxyfen, the pesticide used in Brazil that has been implicated, is designed to disrupt mosquito development, causing mosquito birth defects. Microencephaly is a birth defect that results from the disrupted development of a human fetus. Is this really that hard to believe?

Apparently so. The CDC committed early to the Zika theory—half of the $1.9 billion President Obama asked for was to be spent on further study of the link between the virus and the birth defect. The other half was for developing a vaccine. It was only two months after submitting this request that the CDC announced definitively that Zika was the cause. The basis was an article in the New England Journal of Medicine written by four CDC employees.

The funding issue is currently stalled for partisan political reasons, the Zika train has left the station. The government as well as the media (including the progressive media) are on board. The US government has declared as state of emergency in Puerto Rico. Health officials are citing widespread health effects, including cases Guillain-Barre syndrome “linked to the Zika virus” according to the Associated Press.

But no cases of microencephaly.

In Florida, Miami is spraying pesticides to kill mosquitoes that might carry the Zika virus, tourists are being warned about the dangers of mosquito bites, and in Key West the pest control district wants to release male mosquitoes that have been genetically modified to pass on a gene to their offspring that will make them sterile. This latter technology is the product of a five year development project by a biotech company. The people of Key West are fighting back.

Remember how I spoke about the social forces that maintain the dominant ideology of health as medicine? On one side sanctioned experts, the state, and commerce. On another side are experts who are ignored by that first bunch—and you. Here they are on display again. That’s something important you should know about your health.