Panacea and Hygeia

In ancient Greece, Asklepios was the god of healing. In fact, the classic symbol of medicine is a staff around which is wound one snake, the staff of Asklepios. Asklepios had two daughters, Hygeia and Panacea. Hygeia was the guardian of health and champion of common sense practices as the basis of wellness. Panacea, greek for "all healing" was primarily responsible for the use if interventions such as surgery and the use of chemicals with curative properties.

Today there is the continued dichotomy of Hygeia and Panacea. As a physician, I am more likely to be a hand of Panacea. Public Health is the acting arm of Hygeia. I see many patients each day, and I would like to think I have a benefit in lives. Hygeia is at an entirely different level. No matter the amount of work I do, the number of lives I save will never be equal to that saved by simple practices such as mosquito spraying, water filtration or appropriate garbage treatment. Hygeia has the possibility of saving untold numbers of lives. Imagine being at the forefront of the discovery of the link between fleas and the bubonic plague, or contaminated water and cholera.

Unfortunately, the relative importance of Hygeia versus Panacea has never been reflected monetarily. Treating individual patients is more lucrative. A surgeon that removes one tumor or a physician that prescribed one round of chemotherapy is rewarded much more than the number cruncher that connects bladder cancer with analine dyes and then increases the protection of those that work with the dyes, possibly saving thousands of lives.

The most pressing problem with Public Health is that it is designed to self-combust. With each new disease outbreak, the populace presses for an answer. The tireless soldiers of public health may isolate the contagion and then work endlessly to inform the public and reinforce preventive measures. If their work is successful, they are put out of business. The disease in question decreases in prevelence, public worry decreases, and funds dry up.

Such is the case in Winston-Salem. The pathogenesis of syphilis is treponema pallidum, and treatments have been available since 1908. We know how the disease is spread. By all accounts, syphilis should have gone the way of smallpox by now, almost 100 years after the definitive organism was found and a treatment made available. Unfortunately, syphilis is an STD, and as such, will always have a stigma. Not allowed in popular conversation, syphilis is a disease that must not be advertised. In addition, it is a disease that most people assume has been eradicated and so they do not seek medical care for the treatment of what is seen as a disease of an old world. Combine this with HIV, and syphilis is on the rise. In Winston-Salem and 9 other N.C. towns, syphilis rates have been 10-20 times the national average.

With the high rate of syphilis against national averages, the public health threat was noticed. Money was funneled into syphilis education and an education campaign was instituted to inform the population of these affected areas. As you can see from the graph, in 1998, money began to be funneled into educating the public in Winston-Salem about syphilis. The results were remarkable. The rates of syphilis dropped to less than 1 case in 100,000.

What was the reward???

Money spent towards education about syphilis has been moved elsewhere. As such, the rates will begin to rise. Money spent towards Public Health was successful, so much so that it will now be removed, to the detriment of this area.

However, the issue is not as cut and dry as it may seem. Yes, the disease is now on the rise, but the money is now being spent in other areas of the country where it will begin to decrease. In addition, continuously reminding a population with advertising of a disease will begin to have less of an effect as time goes by. Would this increase in syphilis (and thus the activities responsible for same) have occurred anyway, just as a corollary of our brains' tendency to focus on that which is new? Are we destined to always play with prey in the microbe predator-prey relationship? Does Panacea exist to save the individuals that fall in the cracks of Hygeia?