War as a Metaphor for Disease
I never liked the idea of a war. I understand the rationalization, but in reality, I think war does a lot more harm than good. And over time, as war has become more complex, it seems increasingly difficult to demonstrate beneficial effects.
The first war I remember in my lifetime was the war in Vietnam. It looked terrible on the televised nightly news reports. One teenage boy from my neighborhood was drafted into the army and had to go to Vietnam, so I was terrified of the draft. It seemed like senseless human tragedy. Around the time I turned eight years old, I wrote a letter to the President, Richard Nixon. In the letter I asked why we were sending so many young people so far away and why we don’t stop the war – we can simply stop fighting.
Fast forward to today, how should we attack something so complex and scary as the COVID-19 virus? Our lower brain inclination is to fight the virus like an enemy in a war. I’ve heard many people describe the COVID-19 pandemic as a war against the virus. But what if that’s not an appropriate metaphor? What if the virus is a normal biologic entity that emerged as a part of the complex interaction between humans, animals, and our world? What if attacking and trying to eliminate the virus is part of the problem?
Joshua Lederberg was a 1958 Nobel prize winner who actively argued against using war as a metaphor for addressing infectious disease. In addition to his work as a molecular biologist, he worked in artificial intelligence and with the NASA Mars program. He understood that our real biologic world is complex, constantly changing and that the idea of treating a microbe as an enemy was naive. He wrote about this in an essay titled “Infectious History” in Science. This effort led to a workshop and publication by the Institute of Medicine in 2006 and another workshop after his death in 2008.
War as a metaphor allows us to accept divisiveness, destruction, and collateral damage as an acceptable part of the fight. We tolerate treatment side effects, including death, as a necessary evil to kill the enemy – whether it’s a microbe or a malignancy, it can inappropriately turn our focus towards fighting rather than caring. This language and thinking can also harm patients by inducing feelings of shame or blame for losing their “battle” with a disease.
Research has shown that non-violent means of addressing conflict are much more effective than methods that involve violence. In their recent book, “Why Civil Resistance Works: The Strategic Logic of Nonviolent Conflict,” Erica Chenoweth and Marcia Stephen studied over 300 conflicts since 1900. To their surprise, non-violent efforts were about twice as likely to be successful throughout the 20th century, and the success rate is improving as our world continues to be more interconnected. Non-violent efforts were five times more likely to be successful in conflicts between 2000 and 2006.
Instead of President Nixon responding to my letter about the war in Vietnam, I received a letter dated March 9, 1971 from Michael Collins, the Assistant Secretary for Public Affairs. He was hired the year before to help deal with the growing anti-war sentiment in young people (particularly in college students). Here’s his response:
But Collins never had a job in public relations, he was one of the astronauts on Apollo 11 – the one who piloted the command module while Neil Armstrong and Buzz Aldrin walked on the moon. He was one of the first human beings in the history of the world to experience what is called “The Overview Effect”. When the earth is seen from space, the awe and wonder can result in a cognitive shift in how a person views our world. The conflicts and borders that divide us become less significant and the fragility of our world becomes obvious; the need for us to be unified in our effort to heal and improve our world seems clear.
Maybe we can use the awe and curiosity of an astronaut to apply a similar concept to the metaphors we use for disease, including the COVID-19 virus. Instead of imploring each other to pick up arms and fight, we could engage our higher brain and look at our healthcare journey as an adventure; a collaborative effort where the experience is a part of the solution. With humility and curiosity, we could implement a decentralized learning infrastructure to help us along the way. Maybe we don’t need to endure endless wars on disease in healthcare. We could become proactive explorers, all on this global healthcare journey together to discover new and valuable knowledge, eventually leading to less disease and more health and healing.