Anemia of Chronic Disease
Its Ramification in Current Geopolitical Competition
As a hospitalist, I treated mostly older patients. Most of my patients have multiple medical disorders. Probably half of them have anemia of chronic disease. Therefore, this disease is of particular interest to me, intellectually and professionally. In this article, I will explore anemia of chronic disease, discuss its application in the siege of Avaricum, and investigate its implication in the current geopolitical context.
Anemia
Hemoglobin is an iron-containing protein that facilitates the movement of oxygen in the blood. The normal range of hemoglobin at my hospital is 13 - 17 grams per deciliter of blood. A level lower than that range denotes anemia. There are many different types of anemia. The two most common types of anemia are: anemia of iron deficiency and anemia of chronic disease.
Anemia of iron deficiency
Anemia of iron deficiency is self-explanatory, in which low level of iron storage prevents the production of adequate amount of hemoglobin. This type of anemia intuitively is more common in women due to elevated consumption of iron during pregnancy and routine iron loss during menstruation.
Anemia of chronic disease
In contrast to anemia of iron deficiency, anemia of chronic disease actually has normal or even elevated iron storage level. However, it appears that the body has problem with using its iron storage.
A model of anemia of chronic disease1
Logistically, iron also plays significant role in cellular production, including that of infectious bacteria and malignant cells. Therefore, the body is kind of engaging in a war of attrition in cases of infection, autoimmunity, and malignancy. Modern science reveals that the body produces hepcidin in these conditions. Hepcidin in turns inhibits the use of iron by both the body and its opponents, be it foreign bacteria, malignant cells, or out-of-control immune cells.
In other words, the body resorts to scorched-earth strategy in these situations. A scorched-earth policy is a military strategy of destroying everything that allows an enemy military force to be able to fight a war, including the deprivation and destruction of water, food, humans, animals, plants and any kind of tools and infrastructure. Its use is often employed by a retreating army to leave nothing of value worth taking, to weaken the attacking force or by an advancing army.
In the case of anemia of chronic disease, a scorched-earth policy leads to symptoms for the patients, like weakness, shortness of breath, and syncope. The patients are alive, but do not function at full potential.
Life is full of trade-offs.
The siege of Avaricum
Avaricum was an oppidum in ancient Gaul, near what is now the city of Bourges. An oppidum is a fortified settlement or town, associated with Celtic culture. Avaricum, situated in the lands of the Bituriges Cubi, was the largest and best-fortified town within their territory, situated on very fertile lands. The terrain favored the oppidum, as it was flanked by a river and marshland, with only a single narrow entrance.
Around 52 BC, Vercingetorix, chief of the Averni tribe, united the Gauls to revolt against Rome. He recognized that Julius Caesar had difficulty with obtaining supply from Rome; therefore, he decided to pursue a scorch-earth policy. Knowing that Caesar had his eyes on Avaricum, Vercingetorix led his forces there first. He tried to persuade the people of Avaricum to burn down their town. But he failed.
I highly recommend the dramatized scene below for its emotional and intellectual values.
Instead of burning down Avaricum, the Gauls decided to defend it, against the wishes of their king.
I won’t discuss how and why Avaricum fell. I want to note that only about 800 of its 40,000 inhabitants survived after the siege. I am pretty sure that the people of Avaricum would pursue a different course of action, only if they had hindsight.
Current geopolitical context
China - US competition
As previously discussed in my article on benign indifference and neglect, the US outsourced its manufacturing capacity to China in the past few decades, allowing the rise of China as an industrial giant. Confidently, China outlined the ‘Made in China 2025’ initiative in 2015. Since then, the US and its partners have aggressively pursued actions to curtail China growth. The recent tariff action against China was just a continuation of that policy. However, tariff is indeed a strong medicine, as theorized by President Donald Trump.2 Like the situation in anemia of chronic disease, the economic war between China and US involves trade-offs.
I won’t discuss in details the competition between China and US. I just want to emphasize an aspect of difference between the two competitors. China is generally more homogeneous in comparison to the US. This homogeneity is relative and not absolute. But I think it is very important in the current situation. Any scorched-earth policy entails a degree of sacrifice. Sacrifice is more acceptable if it is shared among all participants.
As Vercingetorix asserted, “I would burn Gergovia, my own town, if I have to.”
Being more homogeneous, it is easier for China to make sacrifices. Having one party system is also conducive to conducting this policy. Meanwhile, the US is more diverse and is proud of its independent nature. In this aspect, it is more difficult to pursue a strategy of scorched-earth.
“One life for a city. I offer you the innocent life of my child. If you really believe that it would serve the cause of Gaul, great king Vercingetorix, kill him,” as the lady in the above scene proclaimed.
Therefore, I expect the American government to utilize its resources to convince its population of a common goal, destiny, and heritage. In the process, it would curtail the diversity of thoughts and actions, as I alluded in my article on the Battle of Maling.
Russo-Ukraine War
By now, most observers probably agree that the Russo-Ukraine War has many characteristics of total and attritional war. It has shared aspects with anemia of chronic disease, requiring trade-offs and shared sacrifices. However, it is hard to ask non-Ukrainian, be it American, German, British, etc., to sacrifice for Ukraine.
It is very difficult, perhaps, impossible, especially for the long-term. I think that is why President Putin has pursued his objectives slowly but methodically. Perhaps, too slow, for some people.
Time will tell.
In conclusion, anemia of chronic disease is a manifestation of the body fight against chronic infection, autoimmunity, and malignancy. Its requires shared sacrifices among all normal organs of the body. Evolutionally, it comes about through compromise, via a complicated system of hormone and chemical messengers within a living organism. It shares characteristics with competition among nation-states. Unlike body organs, however, individuals in nation-states have different opinions, behaviors, and goals. This quality makes geopolitical competition more complicated and interesting.
We live in interesting times. Take care of yourself and your loved ones.
https://www.cmaj.ca/content/179/4/333
https://www.reuters.com/world/more-than-50-countries-have-contacted-white-house-start-trade-talks-trump-2025-04-06/
An interesting subject and a very good association. I imagine the human body does not resort to the scorched earth tactics without first trying various kinds of surgical strikes. But for older folks with multiple chronic diseases, I guess the immune system has been exhausted. I guess the same sequence should have been applied to the diplomacy. Two nations don't start a trade negotiation by launching a tariff war first. If there is a stalemate in negotiation, then resort to a symbolic tariff to make a point. A doctor will not send a patient with flu symptoms into chemotherapy for the same reason.
I agree with you that the endurance of the American public will be low during this trade conflict. Looking at the actual trade contents, China can find substitutes much more easily than the Americans. If the Americans are not willing to pay more for cellphones and PCs, how can the government ask the lower-middle-class working families to pay more for shoes and power tools? Chinese slang says that national leaders should think deeply and look into the farther horizon. Launching dramatic actions without proper preparation is going to hurt. And we are not in an energy crisis as yet. Once Satanyahu makes up his mind, then who knows?
I was wondering where the biology lesson was taking us...
fascinating style as usual :-)