12 MESSAGES FROM ENTERIC INFECTIONS FOR SCIENCE AND SOCIETY

Diarrheal diseases hold profound messages as well as opportunities tha t range from public health to basic science. From the spread of choler a around the world, we are reminded of the global impact of tropical d iseases, that disease may provide a litmus test for poverty to drive a sanitary revolution, that disease spread may be worsened by political denial, and that many ecologic and epidemiologic secrets such as inte repidemic microbial niches remain poorly understood. Diarrheal disease s other than cholera teach us that heavy disease burdens do not contro l population growth but are associated with population overgrowth (i.e ., improved health is key to controlling the population explosion), th e societal impact of diarrhea morbidity may exceed even that of its mo rtality, that new agents continue to emerge, and that nosocomial diarr hea is an underrecognized threat in our hospitals. Finally, from the l aboratory of the developing world also come messages for basic science . Microbial toxins continue to elucidate a new understanding of cell s ignaling, and mechanisms once thought to be clear (such as that of cho lera toxin) now appear much more complex. Traditional remedies hold ne w pharmacologic secrets, e.g., such as gingko extracts that inhibit pl atelet-activating factor. Finally, from basic physiology can come wide ly applicable practical solutions such as oral rehydration therapy and simplified diagnostics for inflammatory diarrhea. Health problems suc h as diarrheal diseases that plague the disadvantaged are linked to po pulation overgrowth and provide some of the greatest challenges to mod ern science and the industrialized world.