The Deadly Truth

by Gerald N. Grob
Harvard University Press, 2003
Review by Mark Welch, Ph.D. on May 6th 2005

Gerald Grob has taken on an enormous challenge and accomplished it superbly. In The Deadly Truth he seeks to chart the history of human and social interactions with disease, death and their responses from pre-Columbian times to the present day. He does this with a command of a huge literature of demographic statistics, medical reports and locates them within a social and cultural context that shows both relative and historical value.

In a very careful and precise manner Grob begins to describe, according to the best verifiable sources he can find, what he calls the "reality of the disease, rather than the manner in which different generations interpreted them". He seeks to explain the relationships within his data, and to give balance, even to let the facts speak for themselves. But he is not a disinterested observer, and he is capable of moving descriptions of the conditions of the poor and benighted. He knows very well, and conveys his understanding of the terrible experience of child mortality, maternal death, shocking survival rates and a life riddled with chronic infection and disease.

His consideration of the pre-Columbian period is well-researched with great use of original sources. He makes an interesting comparison with the state of health in the Europe of the time, and the health of the First Nation peoples, and shows that in some surprising ways Europe was not all that advanced.

He describes how with the increasing urbanization of America, the overall health status of the population in fact began to decline. Generally, throughout the early Nineteenth Century the standard of healthy living was much worse on the cities than in rural areas. Proper access to clean drinking water, cramped living conditions and often a greater exposure to novel diseases and viruses, all made city living a more hazardous option than life on the farm. However, with a series of public health measures many of the common diseases became less prevalent and more controlled, but as Grob emphasizes a number of times, medicine is more like the boy holding back the dyke than the conqueror or pestilence.

He is particularly interested in the effects of industrialization and iatrogenic disease. He describes the use of heavy metals and the effects of environmental pollution, he speaks of industrial health and safety (well what little of it there was) and it is no great leap of either the imagination or of logic to argue that this is currently a problem of immense importance in the developed world whence so many of these industries and their work practices have been exported.

But, just as the infectious diseases seem to be coming under control, Grob surprises us with the "discovery of chronic illness". This has therefore had a major, and unforeseen, effect on the nature of medical services. The bullish optimism that might have predicted the eradication of disease and a health for all, seems sadly misguided. In the developed world many of the usual statistical markers of health, life-span, disease prevalence and incidence and so on, may be positive, but the quality of life, chronicity and the end of life issues are all queering this particular pitch. It may be that the crusading nature of medical ventures will give way to something far more modest.

The book is magisterial in style. It makes its points carefully and slowly. But it is not ponderous. It uses the evidence to bring the reader to a conclusion, rather than providing the conclusion first. Indeed, there are over 60 pages of notes and references. It is academic and scholarly, and a major contribution to the literature.

However, it is not a paeon to the triumphs of medicine. In fact Grob seems to be rather pessimistic about the long term ability of medicine to do very much more that stem the tide of disease and relieve the suffering of the sick. He seems to be careful of any hubris or triumphalism; diseases seem to have a way of coming back and biting you on the ankle. There is, as his final chapter has it, no final victory.

Mark Welch, Ph.D., Assistant Professor in the Faculty of Nursing at the University of Alberta, Edmonton, Alberta and Co-Director of the PAHO/WHO Collaborating Centre for Nursing & Mental Health.

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