This month’s Letters section includes a couple of scathing epistles taking me to task for my January column on Legionella.

This month’s Letters section includes a couple of scathing epistles taking me to task for my January column, which reported on a presentation by Richard Toder of the ASSE Legionnaire’s Disease Task Force at last fall’s ASPE convention reviving a theory that phosgene gas causes Legionnaire’s Disease (“Is Legionnaire’s Disease Caused By Bugs Or Gas?”). Any fair reading of that article would conclude that I was highly skeptical of the phosgene theory, but this is not good enough for letter writers Marx and Hodgson. They charge that even publishing such an article reeks of irresponsible journalism.

That assertion makes my blood curdle.

The weight of all the evidence does indeed suggest that Messrs. Marx and Hodgson are probably correct about the phosgene theory being a bunch of hogwash. That’s not the issue. What bugs me (excuse me, I couldn’t resist) is their sanctimonious posturing.

Fanaticism has two defining characteristics: 1. absolute certainty of a cause; 2. a compulsion to crush all different modes of thought. Although normally associated with religion and ideology, fanaticism easily blends into the world of science, where the guardians of conventional wisdom frequently are soul mates of those exalted high priests inclined to stone infidels or burn heretics at the stake. In science no less than religion or politics, the power of ideas and logic sometimes gives way to megalomania.

Institutional Arrogance

The genesis of Legionnaire’s Disease falls short of the kind of certainty associated with, say, Newton’s equations for the law of gravity. That’s because as knowledgeable as its practitioners think themselves to be, medicine is not an exact science. The road to validation is long and often ventures into blind alleys. Medical journals are filled with studies that eventually prove to be false or immaterial due to bad protocols, misinterpreted data, wrong conclusions, researcher bias, and on occasion, outright fraud. This applies to all science, yet medical research tends to be the most specious, owing to the complexity of the human organism coupled with a tradition of institutional arrogance.

I’m told that about 20% of those afflicted with Legionella die from the disease. This suggests the medical community does not have a complete handle on its diagnosis and treatment. Instead of patting themselves on the back about how much they know for sure about this affliction and dismissing all contrary opinions as “irresponsible,” clinicians and physicians would do well to keep their minds open a tiny crack to the possibility they might be missing something fundamental.

Pay attention to the passage in Mr. Marx’s letter in which he acknowledges that outbreaks of legionellosis are traceable to potable water, “especially in hospitals.” This acknowledges one of the dirty little secrets of the medical profession, i.e., that hospitals are among the worst places to put a sick person. Partly this is because of their fog of infectious organisms, and partly because of the threat to life and limb presented by doctors and their assistants. I’m referring to last year’s study by the Institute of Medicine that attributed between 44,000 and 98,000 accidental deaths each year to medical errors in hospitals.

However, hospitals are convenient places for doctors to work. So don’t expect any serious attempts at reform.

No Apologies

No, I refuse to make amends for having raised the phosgene theory in print, benighted though the theory may be, and even though I don’t agree with it, this research is supported by ASSE and was deemed worthy by ASPE’s educational programmers to be included in its convention lineup. If I’m irresponsible, at least I’m with distinguished company.

Besides, I absolutely love promulgating heresy!