Drug-resistant tuberculosis
April 5, 2007 11:37 AM Subscribe
Drug-resistant TB strain raises ethical dilemma. A man in Arizona who has a virtually untreatable strain of extensively drug-resistant tuberculosis (XDR TB) has been locked up indefinitely because he failed to take precautions to avoid infecting others, even though he has not commited a crime. The new strain of TB is described as a nightmare by health officials, and though mainly found in Africa and Asia, it is slowly beginning to spread in the U.S. [Via Technoccult.]
I'm not going to feel too bad about quarantining an individual who is highly contagious and not taking precautions to avoid infecting others.
posted by NationalKato at 11:44 AM on April 5, 2007
posted by NationalKato at 11:44 AM on April 5, 2007
"There's a storm coming; his storm." - Abagail Freemantle
posted by banshee at 11:50 AM on April 5, 2007
posted by banshee at 11:50 AM on April 5, 2007
Since when is reckless endangerment not a crime?
posted by Freon at 11:51 AM on April 5, 2007 [1 favorite]
posted by Freon at 11:51 AM on April 5, 2007 [1 favorite]
Can't we just put him on an deserted island?
And maybe, if others come down with a similarly untreatable condition, we could form a colony on that island.
posted by 517 at 11:56 AM on April 5, 2007
And maybe, if others come down with a similarly untreatable condition, we could form a colony on that island.
posted by 517 at 11:56 AM on April 5, 2007
... what ethical dilemma? He poses a definite, quantifiable, and significant risk to everyone around him just by breathing, and refuses to wear a mask to mitigate that. He needs to not go out in public without taking steps to avoid infecting others. If he won't take steps, then he needs to not go out in public.
posted by kafziel at 11:57 AM on April 5, 2007
posted by kafziel at 11:57 AM on April 5, 2007
He said sheriff’s deputies will not let him take a shower — he cleans himself with wet wipes — and have taken away his television, radio, personal phone and computer.
I understand putting him into involuntary quarantine - the guy is a danger to the public...but why take away all of the above mentioned items? Don't people in jail typically have access to television & radio at least? And ... I'd think you'd want a sick person to be able to bathe for their own well-being.
posted by tastybrains at 12:04 PM on April 5, 2007 [1 favorite]
I understand putting him into involuntary quarantine - the guy is a danger to the public...but why take away all of the above mentioned items? Don't people in jail typically have access to television & radio at least? And ... I'd think you'd want a sick person to be able to bathe for their own well-being.
posted by tastybrains at 12:04 PM on April 5, 2007 [1 favorite]
I understand putting him into involuntary quarantine - the guy is a danger to the public...but why take away all of the above mentioned items?
That part's to punish him for having TB in the first place, the dirty lunger.
posted by Divine_Wino at 12:13 PM on April 5, 2007 [3 favorites]
That part's to punish him for having TB in the first place, the dirty lunger.
posted by Divine_Wino at 12:13 PM on April 5, 2007 [3 favorites]
The TB strain is most deadly to people coinfected with HIV, so while it's a cause for concern for everyone, it's not the "nightmare" that it might seem from the headlines.
The last link also points out that drug-resistant TB is created in part by people who quit taking their medication because they can't afford it anymore. Universal health care, anyone?
posted by footnote at 12:14 PM on April 5, 2007 [1 favorite]
The last link also points out that drug-resistant TB is created in part by people who quit taking their medication because they can't afford it anymore. Universal health care, anyone?
posted by footnote at 12:14 PM on April 5, 2007 [1 favorite]
If you think he's a problem now, wait till he escapes from Hell.
posted by localroger at 12:17 PM on April 5, 2007
posted by localroger at 12:17 PM on April 5, 2007
Yes, that is breaking the law, and he should be locked up. If you have life threatening disease, and you know about it, and you do not take precautions to prevent the spread, then it's no different that walking into a mall and spraying people with bullets.
posted by tadellin at 12:26 PM on April 5, 2007
posted by tadellin at 12:26 PM on April 5, 2007
Oooh, I just saw that he's locked up in Maricopa Co, Arizona, terrain of the notorious Sheriff Joe Arpaio. Sheriff Joe is known, among other innovations, of reinstituting the chain gang and putting a webcam in the jail, streaming live 24/7 from the pretrial detainee cell.
That makes me really doubt if this TB patient should be where he is and whether he's receiving the treatment to which he is constitutionally entitled.
posted by footnote at 12:33 PM on April 5, 2007 [2 favorites]
That makes me really doubt if this TB patient should be where he is and whether he's receiving the treatment to which he is constitutionally entitled.
posted by footnote at 12:33 PM on April 5, 2007 [2 favorites]
Since when is reckless endangerment not a crime?
Since when has this person been convicted of a crime?
posted by ryoshu at 12:40 PM on April 5, 2007
Since when has this person been convicted of a crime?
posted by ryoshu at 12:40 PM on April 5, 2007
Can't we just put him on an deserted island?
It's been done...
posted by kmennie at 12:42 PM on April 5, 2007 [1 favorite]
It's been done...
posted by kmennie at 12:42 PM on April 5, 2007 [1 favorite]
whether he's receiving the treatment to which he is constitutionally entitled.
From reading the article, it appears he was offered the treatment to which he is constitutionally entitled, refused to follow said treatment, and only now understands that he fucked up. Lesson learned, but that doesn't mean he can just walk free and cough on people.
posted by NationalKato at 12:44 PM on April 5, 2007
From reading the article, it appears he was offered the treatment to which he is constitutionally entitled, refused to follow said treatment, and only now understands that he fucked up. Lesson learned, but that doesn't mean he can just walk free and cough on people.
posted by NationalKato at 12:44 PM on April 5, 2007
I think if we give him a 'puter with broadband Internet, once he discovers all the porn sites, we'll never hear a peep out of him again.
posted by pax digita at 12:45 PM on April 5, 2007
posted by pax digita at 12:45 PM on April 5, 2007
If we can keep how many hundreds of people locked up in Guantanamo as vague threats to the public security, why get excited about this guy, who poses a genuine threat?
(And drug-resistant TB isn't caused by people who "can't afford their medications anymore," fer crying out loud. It's caused by people who lead such disorderly lives, that the simple regularity of taking certain pills every day is too much for them.)
posted by Faze at 12:47 PM on April 5, 2007
(And drug-resistant TB isn't caused by people who "can't afford their medications anymore," fer crying out loud. It's caused by people who lead such disorderly lives, that the simple regularity of taking certain pills every day is too much for them.)
posted by Faze at 12:47 PM on April 5, 2007
Since when is reckless endangerment not a crime?
Since when has this person been convicted of a crime?
FTA:
County health authorities obtained a court order to lock him up as a danger to the public because he failed to take precautions to avoid infecting others.
This isn't a case of some rogue doctors 'in r base, quarantinin' r dudez.' It seems every step taken by the health officials so far has been done with transparency and in the bounds of the law.
Now if you want to argue that the conditions in which he's being kept are needlessly punitive, I'll happily concur. But the framing of this story in the post, the linked articles and many other blogs carrying it are of the 'OMG LOCKING UP THE INNOCENT' variety which is silly in this context and detracts from real issues such as Gitmo.
Enforced isolation of a plague carrier? I see it as a no-brainer, but I might just be brain damaged.
posted by Freon at 1:17 PM on April 5, 2007
Since when has this person been convicted of a crime?
FTA:
County health authorities obtained a court order to lock him up as a danger to the public because he failed to take precautions to avoid infecting others.
This isn't a case of some rogue doctors 'in r base, quarantinin' r dudez.' It seems every step taken by the health officials so far has been done with transparency and in the bounds of the law.
Now if you want to argue that the conditions in which he's being kept are needlessly punitive, I'll happily concur. But the framing of this story in the post, the linked articles and many other blogs carrying it are of the 'OMG LOCKING UP THE INNOCENT' variety which is silly in this context and detracts from real issues such as Gitmo.
Enforced isolation of a plague carrier? I see it as a no-brainer, but I might just be brain damaged.
posted by Freon at 1:17 PM on April 5, 2007
footnote I'd argue that there's definate nightmare potential there, even if we assume (falsely) that only people with AIDS are significantly at risk from the new TB.
There are parts of the world where a significant percentage of the population has AIDS, some African nations are estimated at nearly 50%, or higher. If they start dropping dead in huge numbers it will be impossible for the bodies to be properly disposed of, which will lead to the spread of secondary diseases (cholera, etc), as well as a boom in vermin (rats, mice, etc) as vectors for the secondary diseases, and presumably for the primary TB. It could result in some parts of the world becoming essentially depopulated.
On topic, I'll agree with the people who say keep him locked up. It was court ordered, it is definately based on cause, it ain't like Bush's Constitution stomping.
posted by sotonohito at 1:38 PM on April 5, 2007
There are parts of the world where a significant percentage of the population has AIDS, some African nations are estimated at nearly 50%, or higher. If they start dropping dead in huge numbers it will be impossible for the bodies to be properly disposed of, which will lead to the spread of secondary diseases (cholera, etc), as well as a boom in vermin (rats, mice, etc) as vectors for the secondary diseases, and presumably for the primary TB. It could result in some parts of the world becoming essentially depopulated.
On topic, I'll agree with the people who say keep him locked up. It was court ordered, it is definately based on cause, it ain't like Bush's Constitution stomping.
posted by sotonohito at 1:38 PM on April 5, 2007
Freon-- agreed.
This is done with mental commitments all the time. And as the second page of the first linked article says, the guy's got a lawyer, and he's going to have a chance to request release at a hearing soon. It sucks that he's not being allowed to have a computer, etc., but other than that, it seems like the system's doing okay here.
posted by palmcorder_yajna at 1:38 PM on April 5, 2007
This is done with mental commitments all the time. And as the second page of the first linked article says, the guy's got a lawyer, and he's going to have a chance to request release at a hearing soon. It sucks that he's not being allowed to have a computer, etc., but other than that, it seems like the system's doing okay here.
posted by palmcorder_yajna at 1:38 PM on April 5, 2007
But the framing of this story in the post, the linked articles and many other blogs carrying it are of the 'OMG LOCKING UP THE INNOCENT'
That was not how I was trying to frame the post. I think it's absolutely appropriate that the guy was isolated, especially after his stupid behavior with the mask. The supporting links were meant to convey how serious XDR TB is. But it is noteworthy that he has lost his freedom indefinitely even though he's never been convicted of a crime. The possibilities for abusing a situation like that are considerable, and as superbugs become more common, how we treat people like this is going to be important. That makes this an interesting case.
posted by homunculus at 1:40 PM on April 5, 2007
That was not how I was trying to frame the post. I think it's absolutely appropriate that the guy was isolated, especially after his stupid behavior with the mask. The supporting links were meant to convey how serious XDR TB is. But it is noteworthy that he has lost his freedom indefinitely even though he's never been convicted of a crime. The possibilities for abusing a situation like that are considerable, and as superbugs become more common, how we treat people like this is going to be important. That makes this an interesting case.
posted by homunculus at 1:40 PM on April 5, 2007
actually, Faze, as Dr. Paul Farmer's extensive research and hands-on experience shows, drug-resistant TB is not caused by "disorderly people," it's caused by medical treatment regimens that fail to take into account the real effects of socio-economic phenomena - matrices of poverty - as they are mapped onto people's lives.
You might consider getting a copy of "infections and inequalities" - perhaps then you won't blame tuberculosis on people who have been mis-treated by problematic medical system.s
posted by entropone at 1:46 PM on April 5, 2007 [2 favorites]
You might consider getting a copy of "infections and inequalities" - perhaps then you won't blame tuberculosis on people who have been mis-treated by problematic medical system.s
posted by entropone at 1:46 PM on April 5, 2007 [2 favorites]
Faze got entropwned.
posted by boo_radley at 1:49 PM on April 5, 2007 [2 favorites]
posted by boo_radley at 1:49 PM on April 5, 2007 [2 favorites]
But it is noteworthy that he has lost his freedom indefinitely even though he's never been convicted of a crime.
This is the "land of the free." No one would ever abuse such power.
posted by ryoshu at 1:54 PM on April 5, 2007
This is the "land of the free." No one would ever abuse such power.
posted by ryoshu at 1:54 PM on April 5, 2007
From reading the article, it appears he was offered the treatment to which he is constitutionally entitled, refused to follow said treatment, and only now understands that he fucked up. Lesson learned, but that doesn't mean he can just walk free and cough on people.
posted by NationalKato at 3:44 PM on April 5 [+]
I definitely agree that he should be civilly committed if he's refusing to comply with treatment & harm reduction measures. It's just that if the state is going to lock him up because he's spreading disease, the state is then obligated to provide him treatment to cure that disease. According to the CDC link in the FPP, up to 30% of people with the condition can be treated. Based on what I know of Maricopa Co., Arizona jail, I tend to doubt that it's the best place to get that medical care.
posted by footnote at 1:57 PM on April 5, 2007
posted by NationalKato at 3:44 PM on April 5 [+]
I definitely agree that he should be civilly committed if he's refusing to comply with treatment & harm reduction measures. It's just that if the state is going to lock him up because he's spreading disease, the state is then obligated to provide him treatment to cure that disease. According to the CDC link in the FPP, up to 30% of people with the condition can be treated. Based on what I know of Maricopa Co., Arizona jail, I tend to doubt that it's the best place to get that medical care.
posted by footnote at 1:57 PM on April 5, 2007
After some quick googling, the only information I could find on mass quarantine protocols was from the WHO [warning: pdf]. It basically amounts to rushining in, quarantining all carriers and pumping them full of anti-(biotics/virals). Which seems pretty woefully inadequate should a true superbug get loose. Hopefully some of Metafilter's resident medical minds could chime in with some info on this score.
But as for abuse? I link to think I'm as paranoid as the next person, but I'm having trouble finding an angle. Wouldn't it be far easier to have someone declared an 'enemy combatant' or, hell, just plant a big ol' bag of heroin in their pocket as opposed to get a board-certified panel of epidemiologists declare you a medical disaster area so that a court can issue an order to have you isolated?
Our course of action is clear, people. We have to lock up all the impoverished mastodons. For freedom's sake.
posted by Freon at 2:07 PM on April 5, 2007
But as for abuse? I link to think I'm as paranoid as the next person, but I'm having trouble finding an angle. Wouldn't it be far easier to have someone declared an 'enemy combatant' or, hell, just plant a big ol' bag of heroin in their pocket as opposed to get a board-certified panel of epidemiologists declare you a medical disaster area so that a court can issue an order to have you isolated?
Our course of action is clear, people. We have to lock up all the impoverished mastodons. For freedom's sake.
posted by Freon at 2:07 PM on April 5, 2007
Footnote, there are jurisdictional issues involved. It would have been a local Arizona court that issued the court order to confine him, and as such he would have to be confined within the regional which is the jurisdiction of that court.
To do otherwise would be to violate his constitutional rights, as strange as that may seem.
posted by Steven C. Den Beste at 2:08 PM on April 5, 2007
To do otherwise would be to violate his constitutional rights, as strange as that may seem.
posted by Steven C. Den Beste at 2:08 PM on April 5, 2007
SCDB - I agree that this isn't about jurisdiction. What I mean is that just like any other inmate who needs medical treatment not available or not being provided at his place of confinement, he has the right to that care somewhere. In the civil context (which I think this is, but I'm not sure), he should probably also have the right to treatment in the least restrictive setting like a person committed for mental illness would have.
posted by footnote at 2:17 PM on April 5, 2007
posted by footnote at 2:17 PM on April 5, 2007
actually, Faze, as Dr. Paul Farmer's extensive research and hands-on experience shows, drug-resistant TB is not caused by "disorderly people"...
Mr. entropone:
You misquote me. I did not say "disorderly people." I said "disorderly lives." I am a disorderly person, myself, but I make an effort to lead an orderly life (with varying degrees of success). I am not familiar with the matrices of poverty, and I will certainly look up Dr. Paul Farmer's work. But one of the causes of social inequality is the fact that some people lead orderly lives and some people either prefer not to lead, or cannot lead orderly lives.
posted by Faze at 2:22 PM on April 5, 2007
Mr. entropone:
You misquote me. I did not say "disorderly people." I said "disorderly lives." I am a disorderly person, myself, but I make an effort to lead an orderly life (with varying degrees of success). I am not familiar with the matrices of poverty, and I will certainly look up Dr. Paul Farmer's work. But one of the causes of social inequality is the fact that some people lead orderly lives and some people either prefer not to lead, or cannot lead orderly lives.
posted by Faze at 2:22 PM on April 5, 2007
Based on what I know of Maricopa Co., Arizona jail, I tend to doubt that it's the best place to get that medical care.
That's not where he is:
"Daniels has been living alone in a four-bed cell in Ward 41, a section of the hospital reserved for sick criminals."
The part that really confuses me was mentioned earlier, that they "took away"(?) his TV, radio, and Internet (why do I actually believe he never had them?)
I suspect it has to do with his being in the effective custody of the sheriff's dept, who usually deal with criminals (and everything's a nail), and this (Maricopa Co.) department in partciular is notoriously harsh.
I wouldn't want him walking around creating the next chapter in a Chrichton novel, but he should get Internet porn and beer while he's quarantined.
posted by Bokononist at 2:29 PM on April 5, 2007
That's not where he is:
"Daniels has been living alone in a four-bed cell in Ward 41, a section of the hospital reserved for sick criminals."
The part that really confuses me was mentioned earlier, that they "took away"(?) his TV, radio, and Internet (why do I actually believe he never had them?)
I suspect it has to do with his being in the effective custody of the sheriff's dept, who usually deal with criminals (and everything's a nail), and this (Maricopa Co.) department in partciular is notoriously harsh.
I wouldn't want him walking around creating the next chapter in a Chrichton novel, but he should get Internet porn and beer while he's quarantined.
posted by Bokononist at 2:29 PM on April 5, 2007
MetaFilter: I link to think.
posted by homunculus at 2:33 PM on April 5, 2007 [1 favorite]
posted by homunculus at 2:33 PM on April 5, 2007 [1 favorite]
Well, that's marginally better. Still, you'd think they'd be able to figure out some way for him to get a shower!
posted by footnote at 2:35 PM on April 5, 2007
posted by footnote at 2:35 PM on April 5, 2007
Quarantine has always represented a tension between individual liberty and the safety of the populace as a whole, because of the fact that the infected individual usually became infected inadvertantly so there is no "guilt" involved. Even so, to let such a person wander freely represented a serious hazard to the safety and wellbeing of those around him. What to do?
My own answer is that sometimes we, as citizens of a free state, are called upon to make sacrifices for the whole. It is part of our duty as citizens to do so. Thus, for instance, it is a duty for citizens to serve on juries or to testify in court even though it's a pain and a disruption of our lives. But there have to be juries and there has to be testimony, and that means there have to be jurors and witnesses. For jury trials to be as fair as possible the pool of potential jurors has to be as wide as possible. For trials to be fair, defendants have to be able to compel testimony (which is why the Sixth Amendment says so).
That means citizens are legally compelled to serve on juries or to give testimony even if they do not want to, and if you refuse to do so you can be punished for it.
Is that an infringement of the rights of a free citizen? Arguably it is, but it's a necessary infringement in order to defend the greater right of criminal defendants and society as a whole to a fair trials by jury.
By the same token, in time of war the state sometimes compels young men to join the military involuntarily (the draft) and to fight, and often to die, in order to protect the state from its enemies. Clearly that's an infringement of their rights, but it's always been judged by the courts to be constitutional because without that ability the state itself might not survive -- and if the state is defeated, every citizen's rights, all of their rights, are in serious peril.
Quarantine is the same kind of thing. Yes, this guy's rights are being infringed. But it is not an unconstitutional infringement. It is something he must suffer for the greater good of his fellow citizens; it is his duty as a citizen to sacrifice his own rights for the greater good.
[Yes, I am aware that this argument is subject to abuse. I do not claim that this principle is valid in all applications -- just in these particular ones, all of which have been tested in our courts over the course of decades.]
posted by Steven C. Den Beste at 2:45 PM on April 5, 2007 [1 favorite]
My own answer is that sometimes we, as citizens of a free state, are called upon to make sacrifices for the whole. It is part of our duty as citizens to do so. Thus, for instance, it is a duty for citizens to serve on juries or to testify in court even though it's a pain and a disruption of our lives. But there have to be juries and there has to be testimony, and that means there have to be jurors and witnesses. For jury trials to be as fair as possible the pool of potential jurors has to be as wide as possible. For trials to be fair, defendants have to be able to compel testimony (which is why the Sixth Amendment says so).
That means citizens are legally compelled to serve on juries or to give testimony even if they do not want to, and if you refuse to do so you can be punished for it.
Is that an infringement of the rights of a free citizen? Arguably it is, but it's a necessary infringement in order to defend the greater right of criminal defendants and society as a whole to a fair trials by jury.
By the same token, in time of war the state sometimes compels young men to join the military involuntarily (the draft) and to fight, and often to die, in order to protect the state from its enemies. Clearly that's an infringement of their rights, but it's always been judged by the courts to be constitutional because without that ability the state itself might not survive -- and if the state is defeated, every citizen's rights, all of their rights, are in serious peril.
Quarantine is the same kind of thing. Yes, this guy's rights are being infringed. But it is not an unconstitutional infringement. It is something he must suffer for the greater good of his fellow citizens; it is his duty as a citizen to sacrifice his own rights for the greater good.
[Yes, I am aware that this argument is subject to abuse. I do not claim that this principle is valid in all applications -- just in these particular ones, all of which have been tested in our courts over the course of decades.]
posted by Steven C. Den Beste at 2:45 PM on April 5, 2007 [1 favorite]
From what I've heard, one of the problems with XDR TB carriers isn't that they are "disorderly", necessarily -- it's that they're uninformed. Part of the time, at least, people start feeling better after a couple months, stop the drug regimen...and then the bacterial troops rally.
It was alluded to in an article in today's NYT, actually, about TB treatment in Bangladesh.
Quoth the article:
"Patients the world over stop their medication too early once they start feeling better, which usually takes no more than a couple of months. The danger is that the disease lingers in the body and can become drug-resistant — and a far more dangerous blight."
posted by theoddball at 2:55 PM on April 5, 2007
It was alluded to in an article in today's NYT, actually, about TB treatment in Bangladesh.
Quoth the article:
"Patients the world over stop their medication too early once they start feeling better, which usually takes no more than a couple of months. The danger is that the disease lingers in the body and can become drug-resistant — and a far more dangerous blight."
posted by theoddball at 2:55 PM on April 5, 2007
I understand the need to isolate him, quarantine him to keep him from spreading the disease. However, to put him in a cell where the light remains on 24 hours a day, refuse him access to TV or radio, is just cruel. The punitive nature of our criminal-justice system is awful, but to treat this guy--who admittedly and definitely screwed things up--is horrible. For the life of me, I don't understand this ugly urge to humiliate and further abuse people already under lock and key.
posted by etaoin at 2:56 PM on April 5, 2007
posted by etaoin at 2:56 PM on April 5, 2007
That has been a problem with TB treatment for a long time, but the XDR TB we're discussing here is the end result of that process, and the problem with it is that there isn't any treatment that works.
posted by Steven C. Den Beste at 2:57 PM on April 5, 2007
posted by Steven C. Den Beste at 2:57 PM on April 5, 2007
Soros Donates $3 Million to Fight TB
Must be a liberal conspiracy!
posted by delmoi at 2:58 PM on April 5, 2007
Must be a liberal conspiracy!
posted by delmoi at 2:58 PM on April 5, 2007
The Bill and Melinda Gates Foundation has been massively funding anti-TB efforts, including work to develop a vaccine.
posted by Steven C. Den Beste at 3:17 PM on April 5, 2007
posted by Steven C. Den Beste at 3:17 PM on April 5, 2007
Yes, this guy's rights are being infringed. But it is not an unconstitutional infringement.
SCDB: you're missing the point, dude. Yes, extreme TB patients should definitely be involuntarily quarantined if they cannot maintain it themselves, but medical ethics dictate that the quarantine be applied with the fewest possible restrictions to protect his health and the health of the community.
Lock him up in a room: necessarily restrictive.
Leave the light on 24 hours a day,
prevent incoming calls,
cut off outgoing calls after 10 minutes,
no TV, radio, books, or newspapers,
and so on: unnecessarily restrictive.
This was reported by Rene Gutel on Day to Day a few days ago. She spoke with Mr. Daniels on the phone.
posted by muddgirl at 3:36 PM on April 5, 2007
SCDB: you're missing the point, dude. Yes, extreme TB patients should definitely be involuntarily quarantined if they cannot maintain it themselves, but medical ethics dictate that the quarantine be applied with the fewest possible restrictions to protect his health and the health of the community.
Lock him up in a room: necessarily restrictive.
Leave the light on 24 hours a day,
prevent incoming calls,
cut off outgoing calls after 10 minutes,
no TV, radio, books, or newspapers,
and so on: unnecessarily restrictive.
This was reported by Rene Gutel on Day to Day a few days ago. She spoke with Mr. Daniels on the phone.
posted by muddgirl at 3:36 PM on April 5, 2007
Has anyone else heard anything about a case of completely drug-resistant tuberculosis in Italy a little over a month ago? I read about it in this New Scientist article, but I can't find any other mention of it that doesn't reference the same article.
posted by H-Bar at 3:59 PM on April 5, 2007
posted by H-Bar at 3:59 PM on April 5, 2007
theoddball : From what I've heard, one of the problems with XDR TB carriers isn't that they are "disorderly", necessarily -- it's that they're uninformed. Part of the time, at least, people start feeling better after a couple months, stop the drug regimen...and then the bacterial troops rally.
Damn skippy, treatment for your average run-of-the-mill TB infection can mean taking a daily dose of anitbiotics (isonizaid and rifampin are the 1st line drugs) for up to a year. Of course, TB drugs tend to have deleterious effects on liver functions, which means sometimes treatment has to be stretched out a bit to avoid liver transplants. With XDR-TB, treatment (if it is even possible) can take years. Back in the 1990s, when TB made its big comeback tour in the US, the big innovation was enrolling TB+ individuals in Direct Observation Treatment (DOT) programs, which literally meant the patient had to report a health clinic and take their pills under the eye of a nurse, or other health practicioner. Of course, since TB disporportionately infects prisoners (who tended to hide their pills for later sale), parolees (who tended to abandon the rigourous treatment for economic or social stigma reasons), and the homeless (who are not exactly the most stable of populations), there was a disproportionate amount of people with incomplete treatment, which led to the development of the MDR and XDR-TB we see today.
ok, moving on.
Footnote : The TB strain is most deadly to people coinfected with HIV, so while it's a cause for concern for everyone, it's not the "nightmare" that it might seem from the headlines.
In the sense that the common cold is more deadly to anyone who is immuno-compromised, you're right. However, TB is incredibly infectious, given the right conditions. If Mr. Robert Daniels happened to be sitting in the same theater as you, or riding in the same subway car, or standing next to you in the grocery store line, and he started having a little coughing fit, you've got a pretty good chance of at least getting a latent infection from him. Then, the next time your immune system is distracted (say, the next time you get the flu), your latent TB infection could rear its head. Now the news article doesn't specify how resistant his TB is, but there are XDR-TB strains to which there, literally, is no treatment. That's why this guy, who apparently refuses to follow precautions of infecting others, needs to be isolated. Now, taking away his TV and leaving the lights on all night, that's a whole other story.
OK, I'm done, sorry about the ramble, but it seemed like there was some gaps in the conversation that needed to be filled in.
posted by TheSpook at 4:21 PM on April 5, 2007
Damn skippy, treatment for your average run-of-the-mill TB infection can mean taking a daily dose of anitbiotics (isonizaid and rifampin are the 1st line drugs) for up to a year. Of course, TB drugs tend to have deleterious effects on liver functions, which means sometimes treatment has to be stretched out a bit to avoid liver transplants. With XDR-TB, treatment (if it is even possible) can take years. Back in the 1990s, when TB made its big comeback tour in the US, the big innovation was enrolling TB+ individuals in Direct Observation Treatment (DOT) programs, which literally meant the patient had to report a health clinic and take their pills under the eye of a nurse, or other health practicioner. Of course, since TB disporportionately infects prisoners (who tended to hide their pills for later sale), parolees (who tended to abandon the rigourous treatment for economic or social stigma reasons), and the homeless (who are not exactly the most stable of populations), there was a disproportionate amount of people with incomplete treatment, which led to the development of the MDR and XDR-TB we see today.
ok, moving on.
Footnote : The TB strain is most deadly to people coinfected with HIV, so while it's a cause for concern for everyone, it's not the "nightmare" that it might seem from the headlines.
In the sense that the common cold is more deadly to anyone who is immuno-compromised, you're right. However, TB is incredibly infectious, given the right conditions. If Mr. Robert Daniels happened to be sitting in the same theater as you, or riding in the same subway car, or standing next to you in the grocery store line, and he started having a little coughing fit, you've got a pretty good chance of at least getting a latent infection from him. Then, the next time your immune system is distracted (say, the next time you get the flu), your latent TB infection could rear its head. Now the news article doesn't specify how resistant his TB is, but there are XDR-TB strains to which there, literally, is no treatment. That's why this guy, who apparently refuses to follow precautions of infecting others, needs to be isolated. Now, taking away his TV and leaving the lights on all night, that's a whole other story.
OK, I'm done, sorry about the ramble, but it seemed like there was some gaps in the conversation that needed to be filled in.
posted by TheSpook at 4:21 PM on April 5, 2007
Imprisonment and all the punitive restrictions just make it more likely that the next TB carrier will try to hide and evade treatment.
posted by gimonca at 4:55 PM on April 5, 2007 [1 favorite]
posted by gimonca at 4:55 PM on April 5, 2007 [1 favorite]
How is that worse than if we let them run loose and infect everyone anyway? At least this way one of them is out of circulation.
posted by Steven C. Den Beste at 5:56 PM on April 5, 2007
posted by Steven C. Den Beste at 5:56 PM on April 5, 2007
Imprisonment and all the punitive restrictions just make it more likely that the next TB carrier will try to hide and evade treatment.
posted by gimonca at 4:55 PM on April 5 [1 favorite +][!]
How is that worse than if we let them run loose and infect everyone anyway? At least this way one of them is out of circulation.
posted by Steven C. Den Beste at 5:56 PM on April 5 [+][!]
Or we could provide patients with a reasonable quality of life instead of creating false dilemmas! But maybe I'm crazy.
posted by mek at 6:44 PM on April 5, 2007
posted by gimonca at 4:55 PM on April 5 [1 favorite +][!]
How is that worse than if we let them run loose and infect everyone anyway? At least this way one of them is out of circulation.
posted by Steven C. Den Beste at 5:56 PM on April 5 [+][!]
Or we could provide patients with a reasonable quality of life instead of creating false dilemmas! But maybe I'm crazy.
posted by mek at 6:44 PM on April 5, 2007
Faze - I misquoted you! apologies.
I take a bit of issue with the notion that poverty stems from people who chose disorder, rather than the exploitation of powerful nations, multinational corporations, and trade agreements.
however, if, as you admit, some people cannot live what you call "orderly lives," than what is the point of medical treatments that do not take this into account?
tuberculosis treatment regimens that are impossible for poor people to follow are idiotic to perscribe, and have directly led to instances of multiple drug resistant TB in many places - Haiti and Peru, among them.
Dr. Farmer addresses this directly in his work, while being extremely affable and readable. I'm glad to hear that you will look into his work. He does inspiring and transformative work.
And by the way - "Mr."?
posted by entropone at 6:47 PM on April 5, 2007
I take a bit of issue with the notion that poverty stems from people who chose disorder, rather than the exploitation of powerful nations, multinational corporations, and trade agreements.
however, if, as you admit, some people cannot live what you call "orderly lives," than what is the point of medical treatments that do not take this into account?
tuberculosis treatment regimens that are impossible for poor people to follow are idiotic to perscribe, and have directly led to instances of multiple drug resistant TB in many places - Haiti and Peru, among them.
Dr. Farmer addresses this directly in his work, while being extremely affable and readable. I'm glad to hear that you will look into his work. He does inspiring and transformative work.
And by the way - "Mr."?
posted by entropone at 6:47 PM on April 5, 2007
The punitive nature of our criminal-justice system is awful, but to treat this guy--who admittedly and definitely screwed things up--is horrible. For the life of me, I don't understand this ugly urge to humiliate and further abuse people already under lock and key.
Imprisonment and all the punitive restrictions just make it more likely that the next TB carrier will try to hide and evade treatment.
This is the most incomprehensible part of the whole story. I agree with the need to keep him quarantined, at least for now, but the way he's being treated is sadistic and ultimately counterproductive. If infected people think they're going to be treated this poorly, then they have much less incentive to cooperate, which just puts everyone at greater risk anyway.
posted by homunculus at 6:56 PM on April 5, 2007
Imprisonment and all the punitive restrictions just make it more likely that the next TB carrier will try to hide and evade treatment.
This is the most incomprehensible part of the whole story. I agree with the need to keep him quarantined, at least for now, but the way he's being treated is sadistic and ultimately counterproductive. If infected people think they're going to be treated this poorly, then they have much less incentive to cooperate, which just puts everyone at greater risk anyway.
posted by homunculus at 6:56 PM on April 5, 2007
Or we could provide patients with a reasonable quality of life instead of creating false dilemmas! But maybe I'm crazy.
You are clearly mad and probably ill, and should be quarantined immediately.
posted by homunculus at 6:59 PM on April 5, 2007
You are clearly mad and probably ill, and should be quarantined immediately.
posted by homunculus at 6:59 PM on April 5, 2007
The extra special measures of degradation are horrible.
However, his being locked up really has little to do with the particular strain of TB he's got. TB patients who refuse treatment can be jailed in Maryland, and the TB need not be DR. There is a long long history of intersection between public health aparatuses and the police.
In Maryland, where we're a relatively rich state and have a fair number of TB cases, we get federal money that we use for directly observed therapy with folks who have trouble following the regimen. There are also a lot of CDC folks running around tracking outbreaks, but a lot of that has to do with our HIV rates. Probably all of it.
posted by OmieWise at 7:39 PM on April 5, 2007
However, his being locked up really has little to do with the particular strain of TB he's got. TB patients who refuse treatment can be jailed in Maryland, and the TB need not be DR. There is a long long history of intersection between public health aparatuses and the police.
In Maryland, where we're a relatively rich state and have a fair number of TB cases, we get federal money that we use for directly observed therapy with folks who have trouble following the regimen. There are also a lot of CDC folks running around tracking outbreaks, but a lot of that has to do with our HIV rates. Probably all of it.
posted by OmieWise at 7:39 PM on April 5, 2007
Excellent use of the 'Mastodons' tag.
posted by Slithy_Tove at 7:41 PM on April 5, 2007
posted by Slithy_Tove at 7:41 PM on April 5, 2007
tuberculosis treatment regimens that are impossible for poor people to follow are idiotic to perscribe, and have directly led to instances of multiple drug resistant TB in many places - Haiti and Peru, among them.
The only other choice is to not prescribe anything.
TB is very unusual as fatal diseases go. Most bacteria will divide about every half hour in favorable conditions (e.g. inside of people they've infected). Antibiotics target essential life functions of those bacteria, and since they live fast, the drugs work fast, so a 10 day treatment is usually sufficient (which is what finally cured my walking pneumonia three years ago, after I was sick as a dog for about two months).
But TB divides maybe once every 12 hours. Since it lives slow, the drugs work slow, and that's why it takes 6 months or a year for the drugs to complete their work. There isn't any treatment regimen which is faster than that.
Do you expect doctors to look at their patients and to say, "You're poor, and you won't stick with a proper treatment regimen, so I'm not going to prescribe anything for you. Go away and die." Do you?
posted by Steven C. Den Beste at 7:50 PM on April 5, 2007
The only other choice is to not prescribe anything.
TB is very unusual as fatal diseases go. Most bacteria will divide about every half hour in favorable conditions (e.g. inside of people they've infected). Antibiotics target essential life functions of those bacteria, and since they live fast, the drugs work fast, so a 10 day treatment is usually sufficient (which is what finally cured my walking pneumonia three years ago, after I was sick as a dog for about two months).
But TB divides maybe once every 12 hours. Since it lives slow, the drugs work slow, and that's why it takes 6 months or a year for the drugs to complete their work. There isn't any treatment regimen which is faster than that.
Do you expect doctors to look at their patients and to say, "You're poor, and you won't stick with a proper treatment regimen, so I'm not going to prescribe anything for you. Go away and die." Do you?
posted by Steven C. Den Beste at 7:50 PM on April 5, 2007
You are incorrect, Steven C. Den Beste. I have referred several times to Dr. Paul Farmer's work with tuberculosis. I strongly encourage you to read Infections and Inequalities.
Work led by Farmer has made an incredible difference with regard to multiple drug resistant tuberculosis in Haiti and Peru, among other places.
posted by entropone at 8:23 PM on April 5, 2007
Work led by Farmer has made an incredible difference with regard to multiple drug resistant tuberculosis in Haiti and Peru, among other places.
posted by entropone at 8:23 PM on April 5, 2007
The only other choice is to not prescribe anything.
That's an incredible and painfully false dichotomy. There's a reason TB continues to persist, and its not a choice of "prescribe" or "not prescribe," it has a lot more to do, as entropone noted, with who is getting TB and how they're getting treatment. In America, prisons serve as the main resevoir for TB, and while programs are technically in place to identify and treat infected individuals, in reality those programs are underfunded and hard to get into; assuming the prisoner is even informed the program exists. Then, of course, there's the problem of stigma. Prisons aren't exactly filled with a community of kind hearted individuals who are eager to help their troubled comrade survive a difficult healing process. Neither is the outside world. There's a reason the drop-out rate for TB treatment of parolees can sometimes reach 80%. Inconveniently placed treatment centers, equally inconvenient treatment times, ostracization from the community, rude health center staff, etc. These are all reasons that have been cited for people dropping out. I know, it all sounds like a bunch of sorry excuses, and they are, no doubt. But, if you're a recent parolee trying to hold down 1, probably 2, jobs, in a addition to finding housing, meeting with your PO, reconnecting with family, and all the other crap that comes with re-entry into society, finding your way to your (not so) local hospital 3-4 times a week if not exactly high on your list of things to do. Besides, your cough isn't that bad today, is it?
There are a lot of ways to implement effective treatment plans for TB. After the spike in TB cases in the ealy 90s alot of work was done to fight TB, and it worked; TB cases in the general population are at historic lows. Unfortunately, TB keeps hanging around in the kind of groups (prisoners, homeless, certain immigrant groups) who are living rough chaotic lives not helped by the fact that most people would rather ignore them. Back when smallpox was being eradicated the WHO was literally kicking in doors and forcibly vaccinating people, because it was just too risky to leave a resevoir for a dangerous infectious disease around. I hope we never get to that point with TB, and we shouldn't, because there are plenty of improvements to extant treatment programs that could be implemented to make them more effective. What's really lacking is the political and social will to make those improvements.
PS - NERD ALERT! While the slow rate of mycobacterium tuberculosis has a lot to do with its long latent period, its unusual cell wall, which resists a great deal of antibiotics, along with its ability to colonize macrophages of the immune system and its ability to form highly highly resistant granulomas, are much bigger contributors towards TB's long and difficult treatment.
posted by TheSpook at 9:00 PM on April 5, 2007
That's an incredible and painfully false dichotomy. There's a reason TB continues to persist, and its not a choice of "prescribe" or "not prescribe," it has a lot more to do, as entropone noted, with who is getting TB and how they're getting treatment. In America, prisons serve as the main resevoir for TB, and while programs are technically in place to identify and treat infected individuals, in reality those programs are underfunded and hard to get into; assuming the prisoner is even informed the program exists. Then, of course, there's the problem of stigma. Prisons aren't exactly filled with a community of kind hearted individuals who are eager to help their troubled comrade survive a difficult healing process. Neither is the outside world. There's a reason the drop-out rate for TB treatment of parolees can sometimes reach 80%. Inconveniently placed treatment centers, equally inconvenient treatment times, ostracization from the community, rude health center staff, etc. These are all reasons that have been cited for people dropping out. I know, it all sounds like a bunch of sorry excuses, and they are, no doubt. But, if you're a recent parolee trying to hold down 1, probably 2, jobs, in a addition to finding housing, meeting with your PO, reconnecting with family, and all the other crap that comes with re-entry into society, finding your way to your (not so) local hospital 3-4 times a week if not exactly high on your list of things to do. Besides, your cough isn't that bad today, is it?
There are a lot of ways to implement effective treatment plans for TB. After the spike in TB cases in the ealy 90s alot of work was done to fight TB, and it worked; TB cases in the general population are at historic lows. Unfortunately, TB keeps hanging around in the kind of groups (prisoners, homeless, certain immigrant groups) who are living rough chaotic lives not helped by the fact that most people would rather ignore them. Back when smallpox was being eradicated the WHO was literally kicking in doors and forcibly vaccinating people, because it was just too risky to leave a resevoir for a dangerous infectious disease around. I hope we never get to that point with TB, and we shouldn't, because there are plenty of improvements to extant treatment programs that could be implemented to make them more effective. What's really lacking is the political and social will to make those improvements.
PS - NERD ALERT! While the slow rate of mycobacterium tuberculosis has a lot to do with its long latent period, its unusual cell wall, which resists a great deal of antibiotics, along with its ability to colonize macrophages of the immune system and its ability to form highly highly resistant granulomas, are much bigger contributors towards TB's long and difficult treatment.
posted by TheSpook at 9:00 PM on April 5, 2007
PPPS - (last post on this, I swear to Farmer I really do have better things I should be doing)
Here's some reading material:
Latest WHO Report of XDR-TB
WHO Guidelines for TB Control in Prisons
posted by TheSpook at 9:05 PM on April 5, 2007
Here's some reading material:
Latest WHO Report of XDR-TB
WHO Guidelines for TB Control in Prisons
posted by TheSpook at 9:05 PM on April 5, 2007
We have to lock up all the impoverished mastodons. For freedom's sake.
Public Enemy #1
posted by homunculus at 10:44 PM on April 5, 2007
Public Enemy #1
posted by homunculus at 10:44 PM on April 5, 2007
Regarding Farmer on quarantines - I haven't read a lot of his work, but I have gotten through a few chapters of Pathologies of Power. He writes favorably of Cuba's AIDS quarantine, but doubts that a country as repressive as the US could ever pull off a similar policy balancing human rights and public health. I'm not sure what to make of that.
posted by footnote at 5:55 AM on April 6, 2007
posted by footnote at 5:55 AM on April 6, 2007
I fail to see the ethical dilemma. He is sick, hence society punishes him. What am I missing?
posted by JeNeSaisQuoi at 11:44 AM on April 6, 2007
posted by JeNeSaisQuoi at 11:44 AM on April 6, 2007
More details about the conditions of his incarceration.
posted by homunculus at 4:51 PM on April 6, 2007
posted by homunculus at 4:51 PM on April 6, 2007
« Older Keep On Googlin' | The good, the bad and the completely eggsellent. Newer »
This thread has been archived and is closed to new comments
posted by homunculus at 11:41 AM on April 5, 2007