Tuberculosis (TB) is an infection caused by the bacteria mycobacterium tuberculosis. The infection mainly targets the lungs, but the kidneys, bones, lymph nodes, and brain can also be attacked. Symptoms of TB include evening fever, night sweats, blood spitting, weak pulse, diarrhea, and emaciation. TB has had several names throughout history, to include: Phthisis (Greek), Tabes (Latin), and Consumption (Latin). High population density and poor sanitation created the perfect environment for TB to thrive in. When John Harvard died of TB, society romanticized the death and erected a statue of Harvard looking sensitive.

Tenements which epitomized poor living conditions fostered TB. Sanatoriums began appearing as a treatment for TB; however, these could only help a small number of people in comparison to the number infected. As it turns out, death rates were the same in sanatoriums and in victims of the disease home. Upon the end of World War II, streptomycin experiments began as a possible treatment for TB. This worked, but toxicity and resistance proved to become problems. However, the following drugs were found to be effective if taken correctly and for the duration of treatment: isoniazid (INH), rifampin (RIF), ethambutol (EMB), and pyrazinamide (PZA).

TB has since become resistant at different levels to drugs, ranging in lethality. There is normal TB, which is not resistant to drugs. The next is multidrug resistant TB (MDR-TB), which is resistant to isoniazid and rifampin, but not all drugs. MDR-TB can be treated with a combination of drugs and be effective. Lastly, the deadliest is extensively drug resistant TB (XDR-TB), which is resistant to isoniazid, rifampin, any fluoroquinolone, and at least one of three injectable second-line drugs. Treatment options for XDR-TB are much less affective due to its drug resistance. Thus, making XDR-TB the deadliest.

The only way to eradicate the world of TB is to treat and cure everyone. This would need an extensive amount of money to fund all the treatment. This movement would also need a social revolution in America. The individualist culture would not abide by taking money from some and giving it to others that cannot afford to pay for healthcare. A collectivist culture would foster the right environment for this movement to take place because it would do the most good for the society as a whole.

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If one thing is for certain, America currently does not appreciate the potato as much as Ireland did in the 1800s. Even now, many Americans do not consume potatoes because they are worried about eating too many carbohydrates and getting fat. The Irish had a different perception of the potato. They saw it as something that could be mass produced with little labor. This was important for the Irish because their population grew from 3.5 to 8 million in the matter of a century. The potato combined with milk—and sometimes cabbage and salt—provided the Irish with all the essential nutrients to stay healthy. The potato was adapted and largely grown because of its’ ability to grow in cool, moist conditions.

When three-quarters of potatoes was lost to blight, the Irish began experiencing widespread starvation, diseases, and emigration. This killed around one million of the population, and another million emigrated from Ireland—largely to North America. In 1847, the United States responded to the massive wave of Irish immigrants by increasing the cost of passage. The United States also began confiscating ships that were overcrowded. The pathogen that cause this disaster is known as phytophthora infestans. This originated from Mexico by the HERB-1 strain of phytophthora infestans and spread through potatoes carried on ships to North America and Europe.

In March of 2017, scientists created three genetically modified potatoes resistant to potato blight and approved by the FDA and EPA. These genetically modified potatoes contain genes from the Russet Burbank, Ranger Russet and Atlantic potatoes. It should be noted that only potato genes were used to create this new potato. There have been no potential harms found associated to the genetically modified potato. However, some people have found ethical issues in eating something that has been genetically modified.

Scientists are now genetically editing foods rather than genetically modifying them. Gene-editing is when DNA is essentially cropped—as in part of the DNA are removed. Gene-modification is when new genes are introduced to and grow into DNA. I believe people will be more open to the idea of gene-editing compared to gene-modification because nothing is being added. Thus, there is less of a likelihood of genetic disruption because there is more control in where to cut the DNA rather than trying to insert a new gene. These ideas are still being developed and I am excited to see where they go in the future and how society reacts to them.

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Known as one of the most devastating diseases humanity has ever faced, Smallpox killed 300 million people in the 20^th century. The disease is transmissible by face to face contact, infected bodily fluids and scabs, contaminated objects, and airborne. It has been eradicated since 1980, and in the 1970s, routine smallpox vaccination ceased.

If you had smallpox when it first appeared, everyone could tell because of the pustules on your skin. In the 17^th and 18^th centuries, approximately one-third of the population in London was scarred and two-thirds were blind. The variola major type of smallpox had a 30% mortality rate; whereas, the variola minor type of smallpox had a 1% mortality rate. The spread of smallpox was rapid due to wars, movements of populations, trade routes and caravans, and the slave trade. There were many supposed remedies for smallpox, to include, bloodletting, leeches, fasting, laxatives, purgatives, diuretics, heat therapy, and cold therapy.

There was nothing that had any effect on the mortality of smallpox until inoculation was created. Inoculation involved having a sample of smallpox scraped onto the arm—or thigh for some women. This cause a few pustules to appear; however, they did not become infected with smallpox. In 1746, data from the London Smallpox and Inoculation Hospital showed that the mortality rate for smallpox was 20%. If patients had inoculation, their mortality rate was lowered to 1%. In the 1760s, changes were made to inoculation to make it more safe. These changes included smaller incisions, less preparation time, isolation of inoculees, and simultaneous inoculation of groups.

In the 1760s, it was also discovered that chickenpox is not the same as smallpox. In 1796, Edward Jenner discovered the smallpox vaccine. Jenner had heard about milkmaids who had gotten cowpox and then were resistant to smallpox. Jenner tried his first experiment with smallpox vaccination on his son. Jenner inoculated his son with swinepox. His son then was inoculated with smallpox and did not become infected. Jenner made the inference that it must have been the swinepox inoculation that prevented him from getting smallpox. Jenner published his work and word traveled around Europe. The vaccine was passed from arm to arm of orphaned children to keep the vaccine viable.

Although this vaccination could prevent many people from dying of smallpox, it was still not supported by everyone. Reasons for being anti-vaccine included inoculators losing money, idea of reduction in poor population, interference with God’s plan, questions of safety, source of vaccine, and unknown duration of immunity. Even with these objections, data was provided which supported the vaccine as far as prevention. Data was collected from 1919-1928 on incidences of smallpox in areas with compulsory laws, local options, no laws, and laws prohibiting compulsory vaccination. In areas with compulsory laws, there was a 6.6% incidence rate of smallpox. For areas with local options, there was a 51.3% incidence rate of smallpox. In areas with no laws, there was a 66.7% incidence rate of smallpox. Lastly, in areas with laws prohibiting compulsory vaccination, there was a 115.2% incidence rate of smallpox.

Luckily, smallpox was eradicated using surveillance and containment. When someone was found to have smallpox, they were isolated to contain the disease. Then everyone around them was vaccinated to prevent the disease from spreading. The difficulty with this was finding those infected with smallpox before they transmitted the disease to others. WHO declared eradication of smallpox in 1980.

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Ethics in studies have been, and continue to be an issue. Since ethics may differ from person to person, it is hard to generalize to create guidelines for research. Should we be able to isolate people because they might have an infectious disease? Should we be able to require everyone to get a vaccination? These are just a couple of questions that infectious diseases have seen controversy over.

An example of a study that had major implications on the guidelines for ethics of infectious diseases is the Tuskegee syphilis study. In this study, government doctors offered treatment for black men infected with syphilis. The subjects were not told that they had syphilis and endured painful spinal taps. The research was done to see the long-term effects of syphilis. This study was unethical because it denied patients treatment, which caused many of them to die. The doctor who oversaw the study was—and still—believed what he was doing was ethical. He rationalized the harm of the subjects with the benefits he thought it would give to society and medicine.

Another example of a study that had a large impact on the guidelines for ethics of infectious diseases is the Guatemala venereal disease study. In this study, researchers infected prisoners in Guatemala with gonorrhea or syphilis. They were not told they were being infected, and again, many of the subjects died because of the study.  The study was also rationalized in the same manner as the Tuskegee study.

One of the many problems unethical studies create is the distrust for medical professionals. Who would want to go to the doctor thinking you could end up a part of a study where you are infected with a disease or not properly treated? In addition, no one would want to participate in other studies that do not cause harm and would benefit society. If no one trusts the doctors, who is going to treat those that do become ill? A lack of trust in the medical field would probably result in a dramatic increase in illnesses.

So how do you overcome these ethical dilemmas? By setting guidelines for research, ethics may still be held at a standard allowing for trust in medical professionals. Although there are always ethical dilemmas occurring in the medical field, these guidelines can keep the medical professionals from veering into the wrong direction that will harm society.