Is an enemy still an enemy if you can’t see them? I think most people would balk at the question. Seriously? You think a malicious entity is not an enemy so long as he hides from view? Of course an enemy is still an enemy as long as the enemy remains a threat to our well-being. What if the malicious entity is ab extraterrestrial species? Possible but unlikely? What if the malicious entity is a microscopic virus or bacterium? Highly likely? Already is an enemy? See, I think there is a flaw in the main stream perspective on this. There is the sense, in this nation, that our Constitution makes provisions for our common defense but only in a restricted way that coincides with 18th century tactics. So much has happened since then. We’re on the other end of an entire industrial revolution and age of scientific discovery. One of the things we’ve learned along the way is how to see microscopic enemies. Of course just because the entity is microscopic, doesn’t mean it doesn’t have massive effect.

In the middle ages there wasn’t a war that even came close to the human damage caused by the Black Plague. And today, while we take the fight against Muslim extremists to their own lands it’s the insidious Ebola virus silently catching a ride from Africa to Texas that really freaks people out, probably because we know that we have no real common defense against Ebola.

For every war prior to the 20th century for which statistics have been recorded, more people died from disease than from actual battle.

During the American Civil War 660,000 soldiers died. Two thirds of them from disease, not battle. Meanwhile, what is widely thought to be the largest holocaust in history was decimating the North American Indians, and yet despite the intentional genocidal efforts of the U.S. Army, an estimated 70 to 90 percent of the indigenous population died not from battle but from diseases introduced by the “white man” for which natives had no immunity. Such diseases included small pox, measles, influenza, whooping cough, diphtheria, typhus, bubonic plague, cholera and scarlet fever – all of which were too small to actually see but the effects were massive.

With the 20th century medicine made a huge difference but even then, tiny germs still rivaled the destruction caused by battle. During WW1 a whopping 10 million soldiers died, one third of them from disease not battle. Meanwhile, 7 million people died from the Spanish flu between 1918 and 1919 alone.

During WW2 an estimated 22 million soldiers died while about 55 million civilians died. Of those civilians about 23 million of them died from disease and famine roughly equaling all the military deaths in the largest war in history.

Now, I along with most historians will admit that casualty estimates have always been quite rough, but across the +/- range the pattern that consistently emerges is that disease is a major factor and it should be a major concern and it should certainly be even more a concern now that we are seeing more and more applications of biological weapons. Of course in 1789, when the Constitution was ratified medicine was still for the most part limited to saws, whiskey and leeches. Of course pioneers in optics were already making early models of microscopes, but they weren’t strong enough to identify viruses yet and they existed more as a curiosity than a weapon against disease like it is now. So, it’s no surprise that the microscopic threat wasn’t recognized – at least not as anything that we could actually defend ourselves against.

But as Thomas Jefferson suggested, the Constitution, along with the government that it prescribes, should adapt to the times. I tend to agree that government policy should indeed adapt to the times and not be preserved in a jar of alcohol. This thinking is what most likely led to the “letter vs spirit” debate, where the Federalist Party argued for a looser interpretation of the Constitution in the interest of adaptability while upholding the “spirit” of the law. On the other hand, the Democratic-Republicans argued for a more literal interpretation in the interest of limiting federal power. It may seem ironic at first that Jefferson, who indicated the importance of adaptability was in fact a Democratic-Republican, but then again, he also suggested that each generation have it’s own Constitution. Maybe he was also suggesting that each generation’s constitution be limited to the letter.

Either way… a loose interpretation of the laws or their literal replacement, the point is to adapt to the times and there is no better example than the handling of new tools and weapons such as modern medicine to assist in our common defense against threats the founders didn’t know about.

And yes, medicine *is* a common defense weapon as been proven by efforts in disease control which reached it’s height in the 1950s. In 1962, Sir McFarland Burnett stated, ‘By the end of the Second World War it was possible to say that almost all of the major practical problems of dealing with infectious disease had been solved.’ In the two decades leading up to this statement yellow fever was already under control per an effective vaccine and more recently, small pox, that microscopic agent of mass destruction that decimated the North American Indians, was effectively eradicated… by medicine, not guns or tanks or ballistic missiles, but medicine. It was thought that poliomyelitis (polio) and dracunculiasis were close to eradication too, but then things changed.

As Harrie Van Balen writes in his article, Disease control in primary health care: a historical perspective “in a democratic setting, preventive measures imposed on people without their consent could hardly be maintained.” Indeed, as third world countries developed independent democracies, the ability to control disease by imposing measures on the population diminished. Since then the re-emergence of known disease and the emergence of new diseases have increased.

In 1991, the Institute of Medicine of the National Research Council in the US appointed a 19-member multidisciplinary expert committee to study the emergence of microbial threats to health. They found that six categories of factors could explain the emergence or re-emergence of infectious diseases:

1. Human demographics and behavior
2. Technology and industry
3. Economic development and land use
4. International travel and commerce
5. Microbial adaptation and change
6. Breakdown of public health measures

Of these six factors, the last one is the indication of failure to deal with the other five and this is a really bad time for this to be happening. While economic factors continue to decrease the threat of war between states (to paraphrase George W Bush, “democracies don’t wage war with each other”), problems like climate change along with the other five categories presented by the aforementioned committee are increasing the threat of disease. For instance, some of the most severe pandemics, such as malaria are currently constrained to the tropics and the potential for climate change to that is increasing.

There are many reasons for this break down of public health measures, some of which can be described as politically positional, from self-serving business agendas to an increasing distrust of government, but it seems that when confronting efforts to fix public health, a common rally point for opponents is indeed the letter interpretation of the U.S. Constitution, specifically Article I Section 8, which is headed by this statement.

The Congress shall have Power To lay and collect Taxes, Duties, Imposts and Excises, to pay the Debts and provide for the common Defence and general Welfare of the United States; but all Duties, Imposts and Excises shall be uniform throughout the United States;

Manipulative arguments that claim to be literal, actually make the assumption that “Common Defence” means the provision of a military and NOT the provision of health care. As far as I can tell, that is NOT a literal interpretation but a subjective one. The Constitution doesn’t actually define what “Common Defence” OR “Welfare” is – at least not literally. I believe the assumption is most commonly due to the interpreters preconceived idea of what defense is and to the subsequent text that enumerates more specific details of that section, which includes the following keywords… “war”, “army”, “navy”, “naval forces”, “militia”, “forts”, “magazines” and “arsenals”. Clearly, these enumerations are referring to military applications. But, semantics suggest that the very purpose of these enumerations is declared in the introduction which I quoted and it seems reasonable to recognize that they only cover the means to achieving this purpose that they were aware of at the time. The provision for amending the Constitution more or less confirms that the founders were smart enough to recognize this.

Note how these “literal” interpreters dismiss the fact that the Air Force is not actually mentioned in the Constitution and yet they insist it’s an extension of the same purpose which becomes hypocritical the moment they discount health care as a form of defense simply because it’s not literally mentioned.

* http://www.pbs.org/wgbh/americanexperience/features/general-article/death-numbers/
* http://historynewsnetwork.org/article/7302
* http://facts.randomhistory.com/world-war-i-facts.html
* http://en.wikipedia.org/wiki/Letter_and_spirit_of_the_law
* http://ije.oxfordjournals.org/content/32/5/684.full
* http://onlinelibrary.wiley.com/doi/10.1111/j.1365-3156.2004.01261.x/full#ss2