A Tale of Three Patients - Germs vs. Terrain
On a mailing list, my friend Rob and I have been talking about fiat currency on one hand, and about societal orientation to conquest, domination, and extractivism on the other. I wanted to talk in general about how causes and symptoms are always interrelated, using health and disease as a way to talk about it.
This essay was written in collaboration with Claude Sonnet 4. I take responsibility for the whole essay. It is dedicated to the public domain, although attribution to Peter Kaminski is appreciated. This is version 2025-07-17-001.
Prologue
Today's mainstream medical approach follows germ theory - the idea that specific pathogens (bacteria, viruses, etc.) directly cause disease. Louis Pasteur championed this view, which led to enormous advances like antibiotics and vaccines. Under this model, if you find staph bacteria in a wound infection, the bacteria are seen as the primary cause that needs to be eliminated.
Terrain theory, associated with scientists like Antoine Béchamp and Claude Bernard, offers an alternative perspective. This view suggests that the "terrain" (the body's internal environment, immune system, overall health) is the primary factor. From this perspective, pathogens are opportunistic - they proliferate when the body's defenses are compromised, but the underlying weakness or imbalance is the real issue to address.
Modern integrative medicine often tries to bridge these approaches, recognizing that both the pathogen and the host's condition matter. A healthy immune system can often handle bacterial exposure that might overwhelm a compromised one.
Modern medicine has a complicated relationship with terrain theory. While it doesn't embrace the theory in its classical form, many of its core insights have been incorporated into mainstream medical thinking, though often without using that terminology.
The medical establishment now strongly recognizes that host factors matter enormously. The microbiome research explosion has shown that bacterial balance, not just pathogen presence, is crucial for health. Immunology emphasizes how a person's immune status determines disease susceptibility. The concept of "commensal" bacteria - normally harmless organisms that cause problems only when conditions change - is very much terrain thinking.
Preventive medicine focuses heavily on lifestyle factors, nutrition, stress management, and overall health optimization. The recognition that chronic diseases often involve inflammation, metabolic dysfunction, and immune dysregulation rather than just single pathogens reflects terrain-like thinking.
However, mainstream medicine still tends to focus on specific mechanisms and interventions rather than holistic "terrain" approaches. The emphasis remains on identifying and targeting specific causes rather than broadly supporting the body's self-healing capacity.
Many doctors remain skeptical of treatments that claim to "boost immune function" or "detoxify" without clear mechanisms. The evidence base for many alternative approaches remains limited by conventional research standards.
The practical reality: Most modern physicians implicitly use both approaches - they'll prescribe antibiotics for infections (germ theory) while also recommending rest, hydration, and immune support (terrain theory). The integration happens more in practice than in explicit theoretical framework.
Let's make this concrete and look over the shoulders of three doctors: Dr. Germ, Dr. Terrain, and Dr. Integration as they diagnose and treat three different patients. This is a parable. None of the characters are meant to represent real people, particularly not Rob or me. :)
Grandpa Joe
Grandpa Joe arrived at the clinic with a red, swollen wound on his arm.
Dr. Germ examined the lab results and said, "You have a staph infection. These bacteria are multiplying in your wound and causing inflammation. Let's get you on antibiotics right away to clear this up." The doctor's approach was direct and effective - target the bacteria causing the immediate problem.
Dr. Terrain examined the lab results and said, "Joe, staph bacteria live on your skin every day without causing trouble. I'm curious about what might have changed recently - your sleep, stress levels, blood sugar, immune system. Let's see if we can figure out why your body's usual defenses didn't handle this." The doctor's approach focused on the underlying conditions that allowed the infection to take hold.
Aunt Sarah
Aunt Sarah came in with burning urination and frequent trips to the bathroom.
Dr. Germ looked at the lab report showing E. coli bacteria. "Here's what's causing your symptoms - E. coli bacteria in your urinary tract. These antibiotics will eliminate the infection and get you feeling better quickly."
Dr. Terrain looked at the report and explained, "Sarah, E. coli normally lives peacefully in your gut. I'm wondering what allowed it to migrate and multiply in your urinary tract when your body usually prevents this. Let's explore some factors that might have weakened your natural barriers - things like chronic stress, blood sugar imbalances, hormonal changes, dehydration, or poor gut health that could be disrupting your body's usual defenses." The doctor acknowledged that the E. coli needed addressing, but emphasized restoring Sarah's body's natural ability to prevent future infections rather than just killing the current bacteria.
Uncle Sam
Uncle Sam had an economic fever - inflation, inequality, and instability wracked the land.
Dr. Germ analyzed the economic indicators and zeroed in on the primary culprit. "The problem is clear - your fiat currency system is creating these economic distortions. We need monetary reform to address the root cause of these issues."
Dr. Terrain analyzed the economic reports and studied Sam's condition more deeply. "Sam, many countries manage similar monetary systems without these severe symptoms. Something has weakened your economic immune system - perhaps the corruption in your institutions, the breakdown of civic trust, or the loss of long-term thinking in favor of short-term gains." The doctor proposed strengthening Sam's social fabric and collective wisdom, knowing that a healthy society could manage any monetary system while also exploring what made this nation's decision-making processes less resilient than others.
Dr. Integration
Dr. Integration saw all three patients. For Grandpa Joe, she prescribed antibiotics to handle the immediate infection while also addressing his sleep deprivation and stress that had weakened his immune system. For Aunt Sarah, she treated the current UTI with medication while implementing hydration and lifestyle changes to prevent recurrence. For Uncle Sam, she proposed both targeted monetary policies to address immediate economic symptoms and longer-term reforms to strengthen democratic institutions and social trust.
Who Cares?
All three doctors care deeply about their patients and want to help. They simply focus on different aspects of the same problem - one emphasizes eliminating the immediate threat, another emphasizes strengthening the system's natural defenses, and the third takes a more holistic approach. Sometimes the wisest approach recognizes that both the pathogen and the terrain matter, and that sustainable healing often requires addressing both the symptoms and the underlying conditions that allowed them to flourish.
Epilogue: About Fiat Currency
Comparing fiat currency and misplaced E. coli colonization is not a bad analogy. Fiat currency sickness can be very painful and damaging.
To explore fiat currency some more, I offer this two-part prompt for you to give to your favorite LLM to learn more about fiat currency. I find Claude Sonnet 4 works very well, but others will be good, too. There are two parts, meant to be used in the same conversation. Start with 1A, then after the LLM answers, give it 1B in the same conversation.
PROMPT 1A START >>>
Analyze the US transition from gold standard to fiat currency (1933-1971) and its cascading effects on American society, institutions, and global relationships across interconnected systems:
1. Political & Institutional Impact
* How did removing monetary constraints alter the balance of power between government branches, federal vs. state authority, and democratic accountability?
* What were the effects on fiscal discipline, government size, and the relationship between citizens and the state?
* How did this change the nature of political promises, electoral incentives, and policy-making horizons?
2. Systemic Effects Across:
* Social Structure: How did monetary expansion affect wealth distribution, class mobility, asset ownership patterns, and generational wealth transfer?
* Economic Behavior: How did the shift influence savings rates, investment patterns, debt accumulation, and entrepreneurial risk-taking?
* International Relations: How did dollar privilege reshape America's global role, trade relationships, and influence over other nations?
* Cultural Values: How did moving away from "hard money" affect American attitudes toward thrift, delayed gratification, and financial responsibility?
3. Historical Progression & Consequences
* Trace the key decision points (1933 gold confiscation, 1944 Bretton Woods, 1971 Nixon Shock) and their immediate justifications versus long-term outcomes
* Compare the promised benefits of monetary flexibility with actual results across different time periods
* Examine how temporary emergency measures became permanent institutional changes
4. Winners & Losers Analysis
* Which groups, sectors, and generations benefited from increased monetary flexibility?
* Who bore the costs of inflation, currency debasement, and reduced monetary constraints?
* How did the change affect different regions, social classes, and economic sectors?
Use concrete historical examples and accessible explanations. Focus on how this monetary transformation reshaped American society beyond just economic metrics, examining the interconnections between monetary policy and democratic governance, social cohesion, and national character.
<<< PROMPT 1A END
PROMPT 1B START >>>
Let's examine why the US would do this to itself. Some ideas:
- Emergent behavior of a complex, adaptive system
- Societal orientation to conquest, domination, and extractivism, dissociating humanity from living values and replacing them with mechanistic greed
- Individual players seeing a way to gain advantage over others
<<< PROMPT 1B END