The fight against infectious disease presents a revealing truth to medical practice: as hard as it is to understand the intricate variations in the life cycle of a single pathogen, it is harder still to understand the larger effects from that pathogen’s relationship to its even more complex human hosts. Ultimate success in finding new treatments depends on how well researchers relate to the environmental factors that shape – and often distort – interactions between the pathogen and the patient. These include the mode of transmission, the distinctiveness of symptoms and the capacity to identify and diagnose the illness in normal clinical practice. Remove these from the physician playbook and you have the makings of a crisis in the administration of care – one where a transmissible condition is known to exist but for which there is no accompanying consensus on a single source of contagion or on the various ways it presents in the human population.
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