Moulin A M
CNRS-INSERM U 158, Hôpital Necker, Paris.
Rev Epidemiol Sante Publique. 1996 Nov;44(6):519-29.
Man's conception of nature is a historically dated phenomenon. Thus the recent development of infectious diseases in industrialized countries could either be a real phenomenon or simply an artifact related to our current conception of medical progress and research. Is the return of infectious disease a natural process or has modern civilization been less prudent than its predecessors? What are the characteristic features of modern pathogenesis? Are these "changes" the result of some natural dynamics or an evolution in our means of investigation? Modern civilization has not invented technological deviation or diseases of civilization, phenomena well know in the past, but what is new is the fact that science today, with an ever growing amount of information on molecular epidemiology, is still raising questions about infection, recognized new unsuspected forms of the living world which do not fit into our well-knitted outline of infectious agents. We have applied our simplistic and mechanistic schemas designed for the timespan of human life to the evolutionary processes. The effects of evolution and history are thus combined today in a novel way composing a new future for infectious diseases. This new way of looking at infectious diseases is not totally natural nor totally historical. It is perhaps an epistemological revolution going on within epidemiology. The return of infections disease would appear to have a direct effect on magnifying the knowledge and the delinquency of our culture.
人类对自然的观念是一种具有历史局限性的现象。因此,工业化国家近期传染病的发展情况,可能要么是一种真实的现象,要么仅仅是与我们当前对医学进步和研究的观念相关的一种人为现象。传染病的回归是一个自然过程,还是现代文明不如其先辈们谨慎?现代发病机制的特征是什么?这些“变化”是某些自然动态的结果,还是我们调查手段的一种演变?现代文明并没有发明技术偏差或文明病,这些现象在过去就为人所知,但新的情况是,如今的科学,随着分子流行病学信息的不断增加,仍在对感染提出疑问,识别出不符合我们精心构建的传染病原体轮廓的新的、意想不到的生命形式。我们将为人类生命跨度设计的简单化和机械化模式应用于进化过程。进化和历史的影响如今以一种新的方式结合在一起,为传染病谱写了新的未来。这种看待传染病的新方式既不完全是自然的,也不完全是历史的。这或许是流行病学正在发生的一场认识论革命。传染病的回归似乎对放大我们文化的知识和过失有着直接影响。