succumbing to peer pressure

Wednesday, May 30, 2007


Some of you may have no idea what that collection of letters means, but to me, and to plenty of my colleagues, it's the stuff of nightmares. It means extreme-drug-resistant tuberculosis. Multi-drug resistant TB is resistant to at least two frontline drugs. It's still incredibly treatable, just with more expensive second-line drugs (they also feature ickier side effects). Extremely drug resistant TB is resistant to all frontline and at least one second-line drugs. It's easily, and frequently, fatal. And a gentleman with it is currently under federal quarantine here at a local hospital. They put him there after he flew to Europe for vacation. This is my favorite part of the article:

“I’m a very well-educated, successful, intelligent person,” said the man, who declined to give his name. “This is insane to me that I have an armed guard outside my door when I’ve cooperated with everything other than the whole solitary confinement in Italy thing.”

I could ring his neck! Except for that one tiny little thing, you know, where I potentially exposed hundreds, if not thousands, of people to a deadly disease!

This type of attitude is also exactly how we get drug-resistant illnesses. I hope I'm preaching to the choir here, but the flippant, oh yeah, I took most of my antibiotics, I only left one dose, or two doses, or three doses, but I feel better, I'm sure those doctors are just exaggerating, is really unacceptable! It isn't some big conspiracy (and you know I'm no fan of big pharma), you really honestly do need to take every single pill that is prescribed to you (if it's an antibiotic).

This is also, for me, a really interesting area of public health, because it's where health and human rights are actually in conflict. Individuals have rights that entitle them to freedom of movement and access to employment, both of which are unequivocally violated under isolation and quarantine. Personally, I think justifiably so, but you can get into some good arguments about it. For example, this man, if his boss fires him for missing too many days of work, can he sue his employer? Can he sue the federal government, since they physically restrained him from going to work? Is it the federal government's job to prevent him from losing his job? If he isn't receiving a paycheck, who pays his rent? The federal government, since they are the cause of the absence of a paycheck?

It gets really fun when you expand the scenario to an entire town. But lucky us, Bush has pretty much taken that debate off the table with his latest expansion of power. NSPD-51/HSPD-20 consolidates all federal, state, local, territorial, and tribal governments plus private sector organizations under the president's direct authority in the event of a national emergency. And the best part? The president is the one who declares something to be a national emergency! Under the National Emergency Act, a president could declare a state of emergency, but that had to be immediately confirmed by Congress. This appears to supersede that act, and includes absolutely no mention whatsoever of Congress or any sort of approval or oversight.


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