Tuberculosis: A Silent Killer with a Not So Silent History

            Tuberculosis, commonly called “the people’s plague,” was highly romanticized in culture. Ranging from movie characters romantically dying from it to famous musicians like Chopin having it, people saw it as beautiful. The people of the time referred to the disease as “consumption” and believed that TB made faces look sensitive and eyes sparkling. People thought this even though TB at the time meant an absolute death.

Although Tuberculosis or TB dates back further than recorded history, having been found in the spines of Egyptian Mummies, it is well known during the 19^thcentury when immigration to U.S. tenements was causing malnutrition, crowding, and poverty. A big reason for why immigration like this made people susceptible to TB was because of poor working conditions and overcrowding. Since TB is spread through spit and coughs, a crowded area allows TB to spread like wildfire with everyone in range to receive it from nearby coughers with it. In most of the crowded city tenements there were no windows or ventilation, so the disease remained essentially trapped with those inside.

In a more contemporary spotlight, TB is prevalent in more impoverished countries today. For example, in the film Silent Killer, TB is seen throughout families in the South African nation of Swaziland. A big thing to note here is that HIV is also very prevalent in this nation, which makes the immune system very weak and more susceptible to getting a disease such as TB. Similar to HIV, TB in this area also comes with a social stigma where people do not want to go near those infected. As a result of this, many people here try to hide the fact that they have TB which only allows it to spread more. While trying to hide this disease, they often won’t seek treatment for it, which just keeps them sick and contagious, making it difficult to put an end to TB. In addition to HIV, malnutrition and poverty play a similar role as well. Just like the historical example of immigration into overcrowded tenements, the people in Swaziland do not have the best living conditions either. In a specific example from the film, a brother and sister took care of their mother who suffered and died from TB. Shortly after her death, it was found that the little sister had contracted TB from their mother, most likely due to the close contact she had with her mom. Since these areas in South Africa are impoverished, the home the brother and sister live in only has one bedroom, so the sister has to leave to go to a hospital, so her brother does not get the disease from her.

Some factors that have led to Multi-Drug Resistant TB (MDR-TB) and Extremely Drug Resistant TB (XDR-TB), are people either not seeking treatment once sick with TB or people quitting their medication before they’ve completed them. These evolved forms of TB are much more difficult now because they require drug cocktails that may not even work once it’s at the point of XDR-TB. Also, if it weren’t already difficult enough to deal with the side effects of the drugs for regular TB, the concoction of drugs for the evolved forms of it prove even worse. For example, a known side effect for treating MDR-TB is permanent hearing loss.

Overall, there are a few things that must happen to conquer TB. One thing that was more prominent in the 19^thcentury but may still remain alive today due to romantic films, is the romanticizing of TB. That needs to stop in order to get over TB because if people still find the disease beautiful, they will avoid seeking treatment for it and even possibly want it like people did in the 19^thcentury. More applicable today is the notion that people need to straight up seek treatment when they get TB. The social stigma associated with it needs to vanish or be seen past so people don’t need to try and hide that they have it. By hiding it and not getting the treatment they need, the disease is able to spread to more and more people. Lastly, people need to stick with and complete their medication once they begin it, so MDR-TB and XDR-TB become less prominent and stop mutating. Once these evolved forms of TB start to occur, treating TB is very difficult especially in impoverished countries that usually don’t have all the proper medication. It’s important to seek an absolute end to TB because the disease is a miserable one that often proves fatal. In addition, now that it has begun to evolve, it is becoming so much harder to treat and will continue down that path until it is stopped.

References (Help Received)

Sherman, I.W. (2017). The Power of Plagues (2^nded.). Washington, D.C.: ASM Press.

Silent Killer film

Tuberculosis PowerPoint

The Killing Potatoes & A Current Attempt to Fight it with Technology

            With an increase from 3.5 to 8 million, the Irish population more than doubled between 1700 and 1840. With increases this big, housing and food resources often become a large problem. That being said, the Irish depended on the potato as a main source of food due to its high calories with nutrients and its easy labor. However, between 1845 and 1852, their potatoes became ruined by blight. The pathogen associated with this blight was a fungus calledPhytophthora infestans. Some factors in society that lead to this blight infestation were the changes in migration since the strain of infestans were thought to have made its way to Ireland after cruising on ships from Mexico, North America, and Europe. A huge consequence of this blight was the large increase in starvation and therefore a direct decrease in the Irish population. Another major consequence of the potato blight aside from starvation and malnutrition, were that those that were already malnourished became more vulnerable to other diseases such as Measles, diarrhea, TB, and Cholera. As for Diarrheal diseases, these came as a result of the subpar hygiene, poor sanitation and alteration in diets (lack of potato’s nutrients).

With technology increasing constantly, plant/animal modification has become a large controversy. Although it has many benefits, people are still skeptical about altering life. Some benefits of these modifications include creating crops that cannot be harmed by pathogens such a blight as we saw between 1845 and 1852. This is obviously important because crops can be protected from many different fungi that can harm humans. In addition to this, these genetically modified potatoes have been approved by the FDA deeming them safe. Another positive of these newly approved genetically modified potatoes, is that they reduce the use of fungicide in half. Even though these GMO potatoes have been deemed safe, many people consider their use unethical since nature is being altered. Certain food establishments refuse to use them including McDonalds. Another positive for genome editing crops is a rapid increase in food production. However, with this comes a negative of taking away jobs that farmers currently hold. If their crops rapidly increase, their value will decrease, and the farmers could be driven out of work. Another negative of genome editing is the lack of knowledge we still have on connecting genotypes and phenotypes. As a result of this lack of knowledge, many of these genome-edited crops have in the past and currently struggled with being regulated by the government, FDA, and publicly accepted. Personally, my view on GMOs and genome-edited crops is a positive one. I believe in a quick paced economy and life like the one we live in, efficiency is important. In addition to more rapid production, many of these GMOs, such as the potatoes, have been created to actually be safer and help us avoid bacteria and fungi. However, I do agree that these GMOs should have to be approved by the FDA before they’re accepted but once approved I believe they are safe.

Help Received

Irish Potato Famine PowerPoint

Irish Potato Blight PDF (supplementary reading)

Irish Potato Blight films

FDA approved genetically engineered potatoes (supplementary reading)

Genome editors take on crops (supplementary reading)

Tuskegee Syphilis Study: When Research Goes Too Far

When it comes to ethical issues, there are some that surround infectious disease and the treatment/research involved with them. Sometimes the best way to keep an infectious disease from spreading is to keep the infected person in quarantine, or isolated from the rest of society. This is a difficult area, ethically, because sometimes the infected person does not consent to being isolated. Ethical issues also come into play with vaccinations. For example, with the smallpox vaccine, certain countries began to make the vaccine lawfully mandatory. Some people felt this was unethical and against their rights. Therefore, this method of required vaccines drifted away with smallpox at the time.

As for the Tuskegee Syphilis Study, there were many ethical issues involved. For one, only one race and gender of people were used in the study, African men. This clearly shows discrimination of subjects. However, even worse was the fact that these men were all poor and could not afford health care, so a study like this appeared to be a good opportunity for them to get health care even if it were experimental. Once the study began, the researchers lied to the participants telling them that the spinal tap was a treatment they were lucky to be getting. This made the painful spinal tap, seem like a privilege to the poor men involved. The arguably most unethical part of the study, however, was the fact that treatment for syphilis had been found but the study’s participants were withheld from using it, so they could further be studied. The study was rationalized originally for learning more about syphilis and a cure. Then it was said to be studied because the researchers believed that African Americans responded to syphilis differently. Lastly, the researchers attempted to justify their study as being ethical because they were researching the effects of syphilis over time on untreated participants.

The potential consequences for unethical studies such as the one mentioned above, is a lack of trust in future research studies. For example, since the Tuskegee Syphilis Study contained only African Americans, there’s a high possibility African Americans will no longer consent to participate in future studies on anything. This is because they may have lost trust in this kind of research just because of one horribly unethical study. Even further, they might not even trust medical professionals at health centers and hospitals due to the research done on the African American men in Tuskegee.

References/Help Received

• Tuskegee Syphilis Film
• Canvas Page Syphilis

Prompt 2:Smallpox: Quack Treatments as Well as Effective Treatments

            As smallpox progressed and killed many, people started turning to any remedy or treatment possible. Examples of early, but futile, remedies were bloodletting, leeches, fasting, laxatives, purgatives, diuretics, heat/sweat therapy, and cold therapy. Similar to the black plague, many of these remedies were used because medicine was not very advanced, but people believed them to be effective. In addition to these treatments, ceremonies to appease the Goddess of Smallpox was publicly held since many turned to religion for answers. More so, many Gods and Goddesses were worshipped as a means to try and end the spread of the disease. For example, in Hindu culture, the Goddess Shitala was worshipped and in Japanese culture Red Treatment was used through wall hangings/art. Red treatment was the idea that heat therapy worked so anything red like fire would get rid of smallpox (red clothes, red walls, open fire). This treatment started in Japan and continued to be used in Europe. Another practice of defense against smallpox was inoculation which meant “giving eyes.” This was punctures put in areas of the skin and believed to cure smallpox since some random cases of it had worked. This practice was furthered continued by Sutton who made modifications for them to be further accepted in England (1760’s). His modifications included smaller incisions, less preparation time, insolation of inoculees, and simultaneous inoculation of groups.

A truly effective treatment was introduced in 1796 when Edward Jenner discovered a smallpox vaccine. Jenner had been inoculated at age 8 and was studying to become a surgeon. As for his vaccination, he had collected milkmaids who had cowpox and were resistance to the smallpox inoculation. The responses Jenner got for his vaccine were positive and grateful, referring to it as a precious discovery. Even though most were positive responses, some objections still remained, including: that smallpox reduces the poor population, that the vaccine interferes with God’s plan, and uncertainty about its safety. Another problem with the vaccination that remained was the chance of other bloods diseases being spread by use of the arm-to-arm method. In countries that had compulsory vaccine laws, lower mortalities were seen, however, many countries still protested these laws. Many people believed it was considered cruel and inhumane to have a law requiring vaccines since many believed them to be unsafe.

In order to officially eradicate smallpox, many surveillance and containment efforts were used by medical professionals and scientists. For one, propaganda posters were enforced in many areas to influence people to willingly get the vaccination. These scientists and medical professionals kept an eye on where in the world outbreaks were still occurring once people began obeying the need to get vaccinated. For example, Canada was recorded to become smallpox free in 1944 while small outbreaks still remained in the U.S. due to imports. Luckily, the few outbreaks scared much of the nation into pursuing vaccination to avoid the disease, therefore containing it to small outbreaks that eventually died down. More so, potent vaccinations were being used for tropical climates in the 1950’s to contain the disease. Selective control methods were further implicated as the disease dwindled down rather than mass vaccination. This meant scientists were finding specific cases of people and then vaccinating all those they had contact with. Eventually easy to use needles known as Bifurcated Needles, came out, making it much more practical and simpler for anyone to inject the vaccine anywhere. This helped to further contain the disease since people desiring the vaccine, did not have to go out of their way to find it. Finally, with the last case of smallpox appearing in Jenner’s homeland due to its escape from a research facility, smallpox became eradicated. However, the U.S. still has enough vaccination for each citizen in case of an emergency outbreak.

References

Sherman, I.W. (2017). The Power of Plagues (2^nded.). Washington, D.C.: ASM Press.

PowerPoint: Smallpox- The Speckled Monster

In class handouts