Frank Bowden - Infectious: A doctor’s eye-opening insights into infectious diseases

INFECTIOUS

FRANK BOWDEN is an infectious diseases physician at the Canberra Hospital in the Australian Capital Territory. He trained at Fairfield Infectious Diseases Hospital in Melbourne in the 1980s, worked in the Northern Territory in the 1990s and undertook postgraduate study at Oxford University in the mathematical modelling of infectious diseases. He is a former director of the Canberra Sexual Health Centre and was the inaugural professor of medicine at the Australian National University Medical School. His first book, Gone Viral (NewSouth), was shortlisted for the Science Writer prize in the 2012 Queensland Literary Awards.

To the Grizz and Deedy there when I needed you, though I didnt know it at the time.

INFECTIOUS

A DOCTOR'S
EYE-OPENING
INSIGHTS INTO
CONTAGIOUS
DISEASES

FRANK BOWDEN

A NewSouth book

Published by

University of New South Wales Press Ltd

University of New South Wales

Sydney NSW 2052

AUSTRALIA

newsouthpublishing.com

Frank Bowden 2016

First published 2016

This book is copyright. Apart from any fair dealing for the purpose of private study, research, criticism or review, as permitted under the Copyright Act , no part of this book may be reproduced by any process without written permission. Inquiries should be addressed to the publisher.

National Library of Australia

Cataloguing-in-Publication entry

Creator: Bowden, Frank, author.

Title: Infectious : a doctors eye-opening insights into infectious diseases / Frank Bowden.

ISBN: 9781742234595 (paperback)

9781742247663 (ePDF)

9781742242293 (ebook)

Subjects: Communicable diseases.

Infection.

Medical misconceptions.

Dewey Number: 362.1969

Design Stan Lamond

Cover design Design by Committee

Cover images Bigstock Photo

All reasonable efforts were taken to obtain permission to use copyright material reproduced in this book, but in some cases copyright could not be traced. The author welcomes information in this regard.

AUTHOR'S NOTE

W hen doctors tell stories about their patients they walk a very high, very tight rope. Respecting patient confidentiality is a central tenet of medical practice and to betray it is a serious ethical breach. The idea is as old as the Hippocratic oath, part of which goes:

Whatever, in the course of my practice, I may see or hear (even when not invited), whatever I may happen to obtain knowledge of, if it be not proper to repeat it, I will keep sacred and secret within my own breast.

Apart from privacy being a fundamental human right, there is a practical reason for making patients feel safe when they divulge sensitive personal information. While some details may be embarrassing your bowel habits, urinary stream or menstrual cycle, for instance others may actually be secret: a recent affair, an undeclared sexual orientation, a bankruptcy. It may be necessary to know these personal details in order to make a diagnosis and institute the most appropriate treatment. If it be not proper to repeat it may seem a convenient escape clause for the casuist or the careless, but it is clear that patients expect that things said within the confines of a medical consultation will not find their way onto the front of the newspaper or the pages of a book like this.

To protect the people who have afforded me the privilege of sharing the story of their illness, I have made changes to details such as age, gender, profession and location. The patients who appear are an amalgam of several I have seen with the disease in question. If you recognise yourself, or someone else, in these stories then you are recognising a type rather than someone specific. Some may consider this unsatisfactory but I intend to keep seeing patients for at least another decade, and it would not be in the interests of good patient care to have them feel inhibited when I ask about them about the sensitive stuff.

Everything I have written about my family, on the other hand, tells it exactly as it happened.

INTRODUCTION

H uman history shapes, and is shaped by, infectious diseases. Where the movement of human populations into tribes, villages, towns and cities allowed the emergence of modern culture, it also afforded microorganisms new opportunities. Typhoid, cholera and plague only appeared when the density of human habitation reached a critical point. SARS, MERS, avian influenza and Ebola are just variations on what may be the same Malthusian theme.

Infections can be caused by a myriad of bacteria, fungi, viruses and parasites, and spelling some of their names still trips me up. They range in size from the submicroscopic to those easily seen with the naked eye. For 150 years, medicine has been learning about these human pathogens (disease-causing agents) and how to deal with them.

It has been a wonderful journey, each step made possible by the successive development of new technologies. Refinements in the light microscope allowed the detection of the largest of our tiny companions (the parasites and bacteria), while the invention of the electron microscope in the early 20th century revealed the structure of viruses. The discovery of the double-helix structure of DNA in the 1950s heralded the scientific revolution that has allowed us to unravel the genetic code of our microscopic competitors and, as it turns out, friends.

In more recent times we have been unearthing tantalising information about the thousands of bugs in the human body that have not been associated with human infectious disease in the past. These non-pathogenic (non-disease-causing) organisms, which number in the trillions in each of us, make up what is known as the human microbiome, and the way we interact with them very likely plays an important role in many non-infectious human diseases.

I have never tired of infectious diseases because I have had to apply more than just my knowledge of the biology of the bugs that cause themmore suffering and death in the developed world than the headline-grabbers ever do.

Infectious disease is the public health specialty par excellence. We can successfully change the course of an epidemic by altering the way humans behave (e.g. safe sex and needle exchange for HIV), by vaccinating them (smallpox and polio), by engineering their environment (housing, sewerage and clean water), or by treating them (meningococcal disease and HIV). The implementation of some or all of these methods during the 20th century led to a remarkable decline in the burden of infectious diseases in the developed world. The developing world, of course, remains a completely different story.

From a purely intellectual perspective, bugs are great fun to get to know. I have tried throughout this book to bring them to life by giving them humans to live on. In many instances the microbes are there to form a backdrop to a discussion of broader issues that challenge contemporary Western medicine and society. How, for example, does the evidence-based medicine movement counter the emergence of half-baked ideas and pseudoscience? How do doctors maintain their integrity in the face of powerful pharmaceutical industry and medical appliance marketing? How do we train medical people to meet the needs of a society that no longer blindly accepts our nostrums?

This book is divided into three themed sections: the first focuses mainly, but not exclusively, on the bugs themselves; the second on the last gleam of twilight for antibiotics; and the third on the disturbing tendency of some patients and doctors to diagnose and treat diseases that either dont exist or, if they do, should never be looked for.