Prime Time Replay:
Dr. Robert Desowitz
on the Transmission of Diseases from
the New World to the Old
MsgId: *breakthrough(2)
Date: Wed Jun 18 20:58:39 EDT 1997
From: Rob_Killheffer At: 205.198.117.138
Good evening, everyone, and welcome to another edition of Breakthrough Medicine. I'm Rob Killheffer, and I'll be the host for tonight -- Madeleine Lebwohl's on vacation. Tonight our guest is Dr. Robert S. Desowitz, a parasitologist and expert in tropical diseases, who has written several excellent popular books, including THE MALARIA CAPERS and, most recently, WHO GAVE PINTA TO THE SANTA MARIA?, which takes a look at the transmission of diseases from the New World back to the Old. Welcome, Dr. Desowitz!
MsgId: *breakthrough(3)
Date: Wed Jun 18 21:00:25 EDT 1997
From: Robert_Desowitz At: 207.172.74.220
Thank you! It's my pleasure to be here on your program.
MsgId: *breakthrough(4)
Date: Wed Jun 18 21:02:06 EDT 1997
From: Rob_Killheffer At: 205.198.117.138
Glad to have you. Most people are familiar with the devastation wrought by some of the diseases that Europeans introduced to the Americas in the sixteenth century -- particularly smallpox -- but the idea of diseases travelling in the other direction hasn't gotten as much attention. Why is that, do you think?
MsgId: *breakthrough(6)
Date: Wed Jun 18 21:05:24 EDT 1997
From: Robert_Desowitz At: 207.172.74.220
I'm not sure. It's probably a bit of show business. We're not used to the concept of diseases going back and forth and I think we have a concept in our minds that before the landing of Columbus, the New World was kind of, as far as pathogenic microorganisms concerned, sterile, a peaceable kingdom. Of course, that is not true. The book's title takes the epidemiological event that most historians believe that syphilis was carried from the New World to the Old.
MsgId: *breakthrough(7)
Date: Wed Jun 18 21:07:44 EDT 1997
From: Rob_Killheffer At: 205.198.117.138
But that's not entirely a settled issue, is it? I've followed the debate loosely and it seems there are many who think syphilis -- at least a variety of it -- was present in Europe already. What's your take on the matter?
MsgId: *breakthrough(8)
Date: Wed Jun 18 21:10:56 EDT 1997
From: Robert_Desowitz At: 207.172.74.220
Well, I'm certainly open, I give both sides of the debate in the book. My take, and I must qualify that as a parasitologist more interested in malaria than syphilis is that there is no evidence of true syphilis in the skeletal remains in the pre-Columbian Old World and a year after Columbus returned, Europe was literally ignited with a highly virulent form of syphilis and the high and low were infected, up to and including His Holiness, Pope Borgia, and Europe didn't recover population for about four hundred years. There is indication also of a non-pathogenic form of the micro-organism in remote tribes now in the Amazon Basin -- probably a relic of the ancient form of the spirochete that mutated. That's my belief and that's what I think the evidence shows.
MsgId: *breakthrough(9)
Date: Wed Jun 18 21:13:38 EDT 1997
From: Rob_Killheffer At: 205.198.117.138
Your book gives an impression of how difficult it is to determine such matters -- even in the millenia before Columbus, there were apparent contacts that muddy the waters. Even the small pox question -- I think I read somewhere that smallpox virus was found in a pre-Columbian mummy somewhere?
MsgId: *breakthrough(10)
Date: Wed Jun 18 21:17:20 EDT 1997
From: Robert_Desowitz At: 207.172.74.220
It is. And the first part of my book describes just how muddy and how fascinating those waters are. The footprints of disease are not always highly accurate, such as the bone changes that are specifically related to syphilis. There's an exciting new field in medical archaeology where DNA in the micro-organisms is found to remain in part and are being traced.I just returned from an international symposium in Jerusalm on the archaeology of emerging diseases and the techniques are still in its infancy, but I would predict that the next 10 years, we're going to get new and very positive information on the transmigration not only of people, but of diseases they carry. And indeed, what I was trying to show in the book is how those diseases in skeletal remains, in relict populations can be extremely important to human migrations throughout the world.
MsgId: *breakthrough(12)
Date: Wed Jun 18 21:20:02 EDT 1997
From: Rob_Killheffer At: 205.198.117.138
And that the effects of migrating diseases are not just a thing of the past, yes? I saw an article on taking precautions as a traveller expecting to be exposed to different diseases, and with the number of people travelling all over the world these days, there's bound to be a lot of microbe movement as well, yes?
MsgId: *breakthrough(13)
Date: Wed Jun 18 21:22:59 EDT 1997
From: Robert_Desowitz At: 207.172.74.220
Well, there is a tremendous amount of movement today. Rapid transit and in the cauldron of disease of tropical countries, ecological changes have occurred that put humans at new risk as they meet new vectors of disease and new natural reservoirs. We have little signs of exotic diseases arising from immigrant populations. The pig tapeworm in an Orthodox Jewish community in Brooklyn, Chagas from South America in nice suburbanites in California, malaria in the Girls Scouts in California. So these are little signals of what immigration can bring us.
MsgId: *breakthrough(14)
Date: Wed Jun 18 21:25:14 EDT 1997
From: Rob_Killheffer At: 205.198.117.138
That recalls another of the issues that you address periodically in your book: the way even familiar microbes undergo occasional mutations that result in resistant strains or especially-deadly strains, so that even populations thought immune suddenly fall to a plague. Is that one of the things that you think happened in Europe with syphilis?
MsgId: *breakthrough(15)
Date: Wed Jun 18 21:28:10 EDT 1997
From: Robert_Desowitz At: 207.172.74.220
I'm not sure what happened with syphilis. It would appear that one of those rare-but-deadly mutations occurred which made the spirochete much more virulent. And here, I would interject that the mechanisms and the nature of virulence, as opposed to non-virulence, is still poorly understood, but we do know, from many examples, that there can be rapid alterations and a seemingly benign micro-organism can become a great, great killer. I think such an occurance, biological occurance, happened with the syphilis organism when it was transported to the Old World. Unlike malaria, there was no natural immunity.
MsgId: *breakthrough(16)
Date: Wed Jun 18 21:30:05 EDT 1997
From: Rob_Killheffer At: 205.198.117.138
Did I understand from your book that malaria was actually introduced to the New World by the Europeans? It's typically thought of as such as "tropical" disease, I hadn't realized it hadn't already existed in the tropical areas of Central and South America.
MsgId: *breakthrough(17)
Date: Wed Jun 18 21:33:25 EDT 1997
From: Robert_Desowitz At: 207.172.74.220
The general opinion is that malaria did not exist in the New World in pre-Columbian times. The evidence for that is that there are no records of malaria which is very typical in its clinical signs and symptoms from the Conquistadors or the writings of the AmerIndian population, their medical codex. The other genetic inference is that malaria has probably had the greatest effect on shaping the human genome than any other factor and where there has been malaria, there have been evolutionary response. Blood polymorphisms, such as sickle cell anemia or something called negative Duffy factor, that gives evidence of malaria's trespass and no such blood polymorphism is seen in any of the AmerIndian peoples.
MsgId: *breakthrough(18)
Date: Wed Jun 18 21:36:16 EDT 1997
From: Rob_Killheffer At: 205.198.117.138
That seems to underline one of the other main points of your book: how many of the "tropical" diseases have been just as natural a part of the experience in temperate zones throughout history -- that it's something of a mistake for Americans to think of malaria and cholera and other such diseases as alien and unusual, when they've had some very dramatic effects on us before, yes?
MsgId: *breakthrough(19)
Date: Wed Jun 18 21:39:04 EDT 1997
From: Robert_Desowitz At: 207.172.74.220
Well, these diseases that we call "typically tropical" have been as American as the heart attack. Malaria which used to range as far north as New York City was entrenched in the south until 40 or 50 years ago and had a profound affect on the economy and whole society of the South. Yellow fever almost wiped out Philadelphia in the 1700's. I could go on and name typical infection after typical infection which really can affect temporate populations. And with global warming, the setting can now become fertile for recurrence of these so-called tropical infections as well as the introduction of new ones such as Denghe.
MsgId: *breakthrough(20)
Date: Wed Jun 18 21:40:23 EDT 1997
From: Rob_Killheffer At: 205.198.117.138
So should we expect to see increasing outbreaks of diseases like this here in the U.S. in coming years?
MsgId: *breakthrough(21)
Date: Wed Jun 18 21:42:48 EDT 1997
From: Robert_Desowitz At: 207.172.74.220
Yes, I think we will see foci or small outbreaks of diseases like this in the coming years. A combination of ecological disasters in the third world, massive migration to our worlds, new diseases coming into, and new strains coming into, populations. I think the possibility is very great and my concern, and the concern of many, is that we don't have the therapy or the actual public health mechanisms other than the military to deal with any threats from new diseases.
MsgId: *breakthrough(23)
Date: Wed Jun 18 21:45:36 EDT 1997
From: Rob_Killheffer At: 205.198.117.138
There's been so much hysteria surrounding things like Ebola, hantaviruses, and the "flesh-eating" strep virus in the last couple of years -- do you think it's merited? Are we primed for a devastating plague like those that wiped out Italy in the sixteenth century, or will our medical services and greater santitation keep a plague from growing that far out of control?
MsgId: *breakthrough(24)
Date: Wed Jun 18 21:48:40 EDT 1997
From: Robert_Desowitz At: 207.172.74.220
I believe that if we had a outbreak of a highly-virulent organism such as Ebola, government would rapidly impose such strict (and probably repressive) public health measures that it would be brought under control, although you would have to forget civil liberties. The great concern is, of course, that an organism may appear as if it's from out of nowhere, for which there is no therapy nor understanding of its transmission to make any logical control processes feasible. You could almost take the analogy of how they tried to quarantine against yellow fever in the American South of the 1800's. So the possibility is there and that possibility is growing in a period when pharmaceutical strength is being lost.
MsgId: *breakthrough(25)
Date: Wed Jun 18 21:51:40 EDT 1997
From: Rob_Killheffer At: 205.198.117.138
I noticed that at one point in your book you mentioned that "of the western world" only the U.S. doesn't have a tropical diseases institute. Should we be preparing more aggressively? And about the weakening of our pharmaceutical armaments, is there anything we can do about that? Do you see promising new developments coming down the road?
MsgId: *breakthrough(26)
Date: Wed Jun 18 21:55:57 EDT 1997
From: Robert_Desowitz At: 207.172.74.220
The answer I think is discouraging. The Cold War is over and we don't have to buy the hearts and minds of the Third World so our interest in tropical diseases (which can be transferred to the United States) is waning even to a point where malaria, which can kill 3 million people a year, has become an orphan disease. And pharmaceutical industry, despite the best of intentions, has responsibility first to their stockholders and drugs for impoverished Third World people does not make any economic sense, particularly in the course of R&D and initial testing for licensing.There are a few bright spots on the horizon such as the DNA vaccine, but it's too early to predict how far any of the radically new technologies will take us. Infectious diseases, despite a good press and all the theatrical showmanship, is getting less and less support in terms of research funding.
MsgId: *breakthrough(28)
Date: Wed Jun 18 22:00:23 EDT 1997
From: Rob_Killheffer At: 205.198.117.138
We're just about out of time, and it's a shame to end on such a distressing note -- even if that is the state of affairs at the moment. Maybe we should return briefly to what started our conversation -- the research into the diseases of the past and how it might lead to better understandings of the transmission and mutation of pathogens. Are you aware of ongoing research into this possibility at the moment that we might keep an eye on as things develop?
MsgId: *breakthrough(29)
Date: Wed Jun 18 22:03:44 EDT 1997
From: Robert_Desowitz At: 207.172.74.220
Not really. And what I think is more distressing is that the relatively easy technology of making a benign organism virulent or a virulent organism even more virulent is part of biological warfare can be carried out in countries such as Iraq, Pakistan, not only the United States or Europe. The research is often taken after the barn has burned down, such as has happened with Ebola in Africa. My feeling is that we have to rethink our priorities in biomedical research, particularly as they apply to infectious diseases. And here, I hope that books such as mine will be of service. Good night! Thanks for inviting me!
MsgId: *breakthrough(30)
Date: Wed Jun 18 22:04:26 EDT 1997
From: Rob_Killheffer At: 205.198.117.138
Thanks, Dr. Desowitz, for joining me here tonight. I recommend to our viewers that they take a look at Dr. Desowitz's new book, WHO GAVE PINTA TO THE SANTA MARIA?, for more details and insights into the ever-developing landscape of infectious diseases around the world. And come back next week, when Madeleine Lebwohl will be back!
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