Last week I commented on an FDA panel of experts recommending the continued sale of COX-2 inhibitors, drugs used for pain that also cause heart attacks.

In this weeks news it was reported that 10 of the 32 experts have ties to the drug industry. Those 10 voted overwhelmeingly (9 to 1) to keep the COX-2 inhibitors on the market. The remaining 22 experts voted in a substantial majority (14 to 8) to pull the drugs off the market.

I know. I’m as surprised as you are.

Where this sent me first was: I’m really tired of talking about the drug companies. But then it sent me to thinking about why the drug companies are this 500 pound gorilla in our health care system. And that made me think of cholera.

What killed most people during the 19th Century was an infectious disease like cholera. The miasma theory was the dominant explanation: the theory that filth and squalor and unsanitary conditions created an atmosphere, an environment that made people sick.

The germ theory was its competitor: the theory that a specific, microscopic agent caused disease. Throughout the early and mid 19th Century, the germ theory lost ground to the miasma theory. Then in a series of experiments in the 1870s, the bacteria that caused diseases like cholera were discovered.

With those discoveries, the miasma theory allegedly lost all credibility.

The model of a single agent as the cause of disease leads to a model of treatment which attacks that agent. The first miracle drug was penicillin, which killed bacteria, the agents of infectious disease.

This approach was so successful that the germ theory and its model for treatment came to dominate medical thinking. “Treatment” has come to mean finding the agent of disease and then making a chemical that will vanquish it. For every disease agent, a drug. Even when the “agent” is something like a diabetic’s high blood sugars, which isn’t an agent at all.

What kills us now are chronic diseases like diabetes and heart disease. But our health care system treats these as though they were infectious diseases caused by a bacteria.

The 19th Century epidemics of cholera were stopped long before penicillin. They were stopped by clean water and sanitation. Justified by the miasma theory. Which said that:

What caused illness was a foul environment. What prevented illness was a clean environment.

And so the miasma theory in fact lives on in fields like environmental health and environmental toxicology.

Sometimes you don’t need to know anything more than an environment makes you sick. To get well, what you need is to change it. Not take a drug.