Tuberculosis, or TB, is caused by the bacteria Mycobacteria tuberculosis. Though not as prevalent as it was in the past, TB is still a major killer throughout the world. It is a horrible disease, which eats away at patients from the inside out. Efforts are being made to reduce the prevalence of TB, however, a lot must be done in order to move towards the end-goal of TB eradication.

Tuberculosis has quite a long history, with several different outbreaks through the ages. It seemed to really come to a head during the 19th and early 20th centuries at the same time as the Industrial Revolution in Western societies. With the Industrial Revolution came many jobs in large cities, which caused people to urbanize.

The great migration into cities from native citizens along with masses of immigrants (mainly into the US) created the perfect environment for TB. High population numbers and crowded conditions contributed to this deadly environment. Many immigrants were forced to live in tenement housing, adding to the perfect environment for TB. They were overcrowded, poorly constructed, and dirty. In addition, they had little to no ventilation. All of these factors, along with the lack of sanitation or pollution regulation created a cesspool of filth from which TB grew.

Many people, if they became infected with TB, never reported it. This impacted the speed at which the disease was spread from person to person because those who were sick were not being treated. Even if people did report their illness and were treated, many hospitals did not take later-stage infections for fear of wasting precious resources on someone with low survival odds. This only further contributed to the spread to TB.

In addition, there was little knowledge about the disease, how it spread, and how to treat it. For several decades, “Rest, sunshine, [and] fresh air” were prescribed treatments. Several different treatment facilities arose from the efforts to treat those infected and isolate them from healthy individuals. Barges were one such treatment facility, used to keep those with TB out of the cities. Sanatoriums began to open to provide treatment. Though a noble effort, these sanatoriums ended up having the same death rate as patients who stayed at home and were not treated. As another effort to treat TB, the plombage technique was developed. This included a surgical procedure to fill the holes in the lungs caused by TB. This technique was also unsuccessful and even led to secondary infections.

Only with the emergence of antibiotics did effective treatment for TB begin. Streptomycin discovered in 1943 and found to be effective against TB. However, with the use and overuse of antibiotics to treat TB, resistance started to emerge. This is the cause of many of the MDR-TB and XDR-TB problems we face today.

There are not only examples from the past that contributed to the spread of TB, but also many modern ones. One of the biggest factors in the spread of TB is poverty. Overall, poor living conditions foster many diseases. Poor housing, food, water, and infrastructure all contribute to poor living conditions. Most importantly, these conditions are not sanitary. As they did in the past, these same conditions lead to the perfect environment in which TB can thrive. As a result of poverty, malnutrition is also a contributor to TB. The poor food quality and selection for those in poverty, along with not getting the right amount and type of foods lead to a weak immune system.

There is a definite social stigma for those with TB today. Many infected with TB are shunned because people close to them are worried about becoming infected, themselves. TB patients often lose their jobs, friends, and family. Due to the social stigma, many people with TB do not report their illness, and thus continue to be a threat to those around them.

HIV is another factor in the spread of TB today. HIV is associated with a compromised immune system, so it would be easier to get diseases like TB. This disease also happens to be prevalent in areas where TB is also prevalent, leading to dual infection. In many ways, HIV and TB are linked.

Today, drug-resistant TB is an ever-increasing issue. There is Multi Drug Resistant TB (MDR-TB) and Extensively Drug Resistant TB (XDR-TB) which have arisen due to several factors. One factor is that people often do not complete their medication plan, take medication correctly, or take medication at all. This might be due to the arduous process that is TB treatment. The treatment protocol lasts a long time, there are a lot of drugs to take, and the side effects can be very adverse. Cost is also an issue for patients, especially in poverty-stricken countries. The result of TB patients not taking medication is the possibility of increased transmission and drug resistance. Finally, the overuse of TB drugs contributes to drug resistance. Drug resistance might not be tested often, leading to a continuation of treatments that might be leading to the TB bacteria becoming resistant.

Overall, I believe there are two major areas that need improvement in order to reverse the tide of TB. First, we need to do everything we can to alleviate poverty in countries effected with TB. Alleviating poverty would lead to more sanitary conditions, which would decrease disease, in general, but especially TB. This would also involve giving these people better access to healthcare. Better healthcare infrastructure would ensure those who are infected better treatment, leading to less TB transmission. Directly observed therapy would also need to be a part of this better healthcare infrastructure to make sure those with TB are actually taking their treatments. Finally, we would need to work against the TB stigma. This would take the form of TB education, showing people what TB truly is and how it affects those infected. Along with this, reporting cases needs to be encouraged in order to get those infected the help they need before they can infect others.

Tuberculosis is a disease with an extensive past and is an ever-present danger. Without addressing the factors leading to its spread and its increasing resistance to drugs, it will continue to exist as a global threat.

HR: TB PPT on Canvas, PBS American Experience: The Forgotten Plague, https://timesofindia.indiatimes.com/city/mumbai/rise-rise-of-mdr-tb-in-india-a-man-made-crisis/articleshow/68543639.cms, file:///C:/Users/John%20David/AppData/Local/Packages/Microsoft.MicrosoftEdge_8wekyb3d8bbwe/TempState/Downloads/TB%20building%20a%20tb%20free%20world%20Lancet%20Commission%20TB%20(1).pdf, Spellcheck, https://media.npr.org/assets/img/2013/06/06/3093183-1–f723a4bc373b17b3ff09717af1aee197562cb432-s6-c30.jpg for image 1, https://www.msf.org.za/sites/default/files/styles/standard_lg/public/msf177475_medium_1.jpg?itok=8OZaZfdB for image 2

The Irish Potato Famine was a devastating historical event. The island of Ireland was not prepared for such widespread hunger and disease. This event, though, is not isolated in the past. It causes us to consider the technology we have today that can prevent such a famine from happening again. But this technology must be carefully examined in a moral light.

The potato was an incredibly important crop to the Irish in the 1800s. It was a dietary staple of the Irish people. It was eaten for every meal. Unfortunately, only a few types were grown in Ireland at the time.

Societal and political factors played a role in setting the stage for the famine. The reason why Ireland was so dependent on the potato was because they were forced to export many of their other crops to England. This left almost exclusively the potato as the main food supply in Ireland. Also, the Irish were already living in poor living conditions prior to the famine, which eventually led to the associated diseases.

There were several biotic and abiotic factors that led to the potato blight. The blight, itself, is caused by the fungus Phytophthora infestans. The HERB-1 strain of P. infestans was thought to be the cause of the Irish Potato Famine. This strain was thought to most likely come to Europe from North America by ship. In addition, weather had a great deal to do with causing the blight. P. infestans needs warm temperatures with some rain, and Ireland had these conditions in 1845. The summer before the blight came to Ireland was recorded as having good weather with one week of cold rains. These were the exact conditions P. infestans needed to flourish.

The Irish Potato Famine had many devastating effects. In the first year of the blight, around one third to one half of the land planted with potatoes was affected. The following year in 1846, around 75% of potatoes were destroyed by the blight. Because the Irish depended so heavily on these potatoes, several negative consequences followed with the blight. There was mass starvation in Ireland from 1845 until 1852. Due to the lack of food and increasingly poor conditions, diseases outbreaks resulted. Some of these diseases included measles, tuberculosis, whooping cough, various parasites, and cholera. An estimated one million people died. An additional million immigrated to North America between 1846 an 1851. These immigrants brought diseases with them from Ireland and infected the ships on which they traveled and the tenements in which they settled. Overall, Ireland’s population dropped around 20% to 25% and recovered very slowly.

Diseases, such as the blight which caused the Irish Potato Famine, have inspired numerous biological technologies aimed at altering the genetic makeup of organisms to help prevent disease. One of those technologies is CRISPR. There are numerous benefits to being able to alter genomes through CRISPR. First, organisms can be made to resists different disease. As an example, scientists have made a strain of potato that can resist potato blight.

Also, plants and animals we eat as food can be altered to produce more of that food. There are strains of apples that are larger and more juicy than non-modified apples. The genetic makeup of chickens can be altered so that they have more muscle mass. There are many examples of how genetic modification has led to increased amounts of food.

Gene editing can also be used to exterminate different diseases. Recently, scientists have modified the genome of mosquitoes to cause their offspring to become infertile, which will stop the spread of malaria.

Along with theses benefits, there are also numerous risks. Most of these risks are unknown. Genetic modification has not been around long enough to observe any long-term effects. To use the genetically modified mosquitoes as an example, many scientists are wary of the risks of taking mosquitoes out of the ecosystem. They are afraid there are far reaching effects that we cannot see now.
This technology also has the opportunity to fall into the wrong hands. Though this technology can be used for much good, it can also be used for bad; it can become weaponized. With it, scientists can create super-diseases that cannot be cured with treatments we have now.

Using this technology, ultimately, sets a dangerous precedent. If gene editing can be proven effective and safe, should it be used on humans? Designer babies are already under ethical debate as this new technology is being increasingly used.

The Irish Potato Famine has had lasting historical affects. It is a painful reminder of our susceptibility to disease in ourselves and our food sources. Steps have been taken to create technology that can permanently change the genetic makeup of organisms that can eradicate diseases. However, we must tread carefully, as this technology can be used for as much bad as it can be used for good.

Help Received: Irish Potato Famine PPT on Canvas, “The Great Famine” Part Three: A Mass of Rottenness on Canvas, “The Great Famine” Part Four: The Epidemic on Canvas, https://www.npr.org/sections/goatsandsoda/2019/02/20/693735499/scientists-release-controversial-genetically-modified-mosquitoes-in-high-securit, https://www.npr.org/sections/goatsandsoda/2018/09/24/650501045/mosquitoes-genetically-modified-to-crash-species-that-spreads-malaria, https://en.wikipedia.org/wiki/Great_Famine_(Ireland)#/media/File:Skibbereen_by_James_Mahony,_1847.JPG for Image 1, http://www.beaumonthospitalschool.ie/2015/10/23/the-legacy-of-the-irish-potato-famine/ for Image 2, Spellcheck

Ethics in research, particularly biomedical research, has been a reoccurring issue since its inception and is closely examined in current studies. This topic is particularly examined due to the unethical conditions in which numerous studies have taken place, major examples being the Tuskegee Syphilis Experiment and the Guatemala Syphilis Studies. During these experiments, several ethical protocols were broken in the name of science. The horrific outcomes still influence us today.

In dealing with infectious diseases, several ethical issues come into play. First, the disease must be understood. In order to fully understand an infectious disease, research must be conducted by infecting living things. One ethical question that arises from this is: can humans be test subjects? Mice and other mammals are routinely substituted for human subjects, but do not always closely reflect the disease mechanism found in humans. This is one ethical consideration when studying infectious diseases.

Another ethical issue includes testing treatment options. Most drugs have detrimental side effects. What happens if the side effects are worse than the disease? What if the treatment kills the subject before the disease does? In addition, every scientific study requires a control group. This inherently means some people in the study do not get treated, even though they have the disease. Is this right? These are some ethical considerations regarding testing treatment.

Finally, if research is complete on a particular infectious disease and treatments are approved, treatments are sold commercially. This involves pharmaceutical companies in competition with one another to make money. What if the price for treatment is so high only a select few can afford it? Also, supplies are not infinite. What happens if stock runs out? Who gets treated? There are many ethical issues associated with infectious diseases, in general.

Two studies stick out as examples of unethical medical scientific studies. These include the Tuskegee Syphilis Experiment and the Guatemala Syphilis Studies. Both were rationalized in their own way.

The Tuskegee Syphilis Experiment was mainly rationalized through discriminatory ways. Scientists believed that Macon County, Alabama was an ideal location do run their experiment. The majority of the population did not have much education, syphilis was prevalent, and it was believed that the population often engaged in sexual activity. Not to mention, the majority of the population was African American. Scientists wanted to better understand the pathology of untreated syphilis and also wanted to see if African Americans had a different type of syphilis than whites. They also wanted to be better able to treat syphilis based on the results of this study.
As the study continued, researchers continued to justify its existence. Scientists wanted to see the conclusion of this experiment. They argued that they were getting valuable data about untreated syphilis. Towards the end of the study, researchers believed that too much damage had been done to the subjects that treatment would be ineffective.

The Guatemala Syphilis Studies were similar in rationalization. At the time of the study, there was a large push in the United States to get rid of STDs, especially in the military. To do this, researchers wanted to better understand how gonorrhea, syphilis, and chancroid affected the body. In their studies, research subjects included prisoners, Guatemalan soldiers, and prostitutes. These people were not valued. In addition, there was much political turmoil in Guatemala, so the government did not object to the American studies. Finally, some of the participants of the study were treated in the end. These are a few ways the Guatemala Syphilis Studies were justified.

There are many examples of how the Tuskegee Syphilis Study, in particular, was unethical. First, the study was discriminatory. The only participants selected were African American men. Second, researchers did not fully disclose their plan to the participants. Subjects were under the impression that they were being treated for “bad blood.” The researchers did not even clearly define what “bad blood” truly meant. Third, the study was not stopped once it was confirmed that the study was causing harm. Researchers kept the study going in order to see the full effects of untreated syphilis. Finally, the study was not stopped once an effective treatment was found. Penicillin was a new antibiotic at the time and was found to be effective against syphilis. Despite this treatment option, subjects were actively denied treatment for the purpose of the study.

The unethical practices of the Tuskegee Syphilis Experiment still effect perception of medical research and physicians today. There is an overall distrust of research scientists among the African American community largely due to the Tuskegee Syphilis Experiment. According to a study by Shavers et al. (2000), 51% of African Americans versus 17% of whites in Detroit did not trust research scientists after 81% of African Americans and 28% of whites said they knew about the Tuskegee Syphilis Experiment. In addition, 49% of African Americans versus 17% of whites said they would not volunteer for a medical study.

In addition to a distrust of scientists, there also exists a distrust of physicians. A study by Katz et al. (2008) found that this distrust was particularly prevalent in Macon County, Alabama and mostly in men. More than likely as a result of this distrust, there was a tuberculosis outbreak in Marion, Alabama in 2014.

Unethical studies, such as the Tuskegee Syphilis Experiment and the Guatemala Syphilis Studies, have greatly impacted both science and society today. From new ethical standards required and reviewed for scientific research to a culture of distrust, these studies still affect us today. These were horrific historical events in science that have led to current change in bioethics.

Help Received: Tuskegee Syphilis Experiment video from class, class discussion, Guatemala experiment article (Matthew Walter) from Canvas, Knowledge of the Tuskegee Study and its Impact on the Willingness to Participate in Medical Research Studies article on Canvas, In Rural Alabama, a Longtime Mistrust of Medicine Fuels a Tuberculosis Outbreak article from Canvas, Did Infamous Tuskegee Study Cause Lasting Mistrust of Doctors Among Blacks article from Canvas, http://media.urbantabloid.com/wp-content/uploads/2014/11/The-Tuskegee-Syphilis-Experiment.jpg for image 1, https://allthatsinteresting.com/wordpress/wp-content/uploads/2017/10/human-experiments-guatemala-lineup.jpg for image 2, Spellcheck

The deadly disease of smallpox is known for directing the course of history. It had a particularly large impact on the New World. From discovery and first settlements, to armed conflict and slavery, smallpox shaped the history of North, Central, and South America greatly.
When Spanish conquistadores under the command of explorer Hernan Cortés invaded the Aztec Empire in modern day Mexico, they brought violence and disease. Cortés attacked the Aztec capital city of Tenochtitlan and was met by a strong Aztec army. The Aztecs forced the Spanish to retreat, but by this time, the Aztecs were already exposed to smallpox. When Cortés had reorganized his men, they marched back to Tenochtitlan. This time, however, there was barely any fighting force defending the city. Smallpox had devastated most of the population. The Aztecs, as well as many other Amerindian tribes, were very susceptible to smallpox because up until this point, this disease known only to the Old World. The great epidemic that swept over the Aztecs contributed to the belief that the Spanish had supernatural ability, thus establishing their power. These events allowed the Spanish to dominate the Aztec Empire.

The Aztecs were not the only Amerindian tribe effected by the arrival of Europeans. The Incan people suffered a decimating outbreak due to exposure before explorers had even reached their land. By the time the explorer Pizzaro and his troops arrived in what is now Peru, the Incan Empire was in shambles. Most of the population had already been wiped out by smallpox. Events such as this happened throughout the New World, contributing to its colonization by European powers.
Indirectly, smallpox paved the way for slave trade in the New World. With the native population dying off from smallpox, colonists began to run out of a labor force for their growing plantations. The colonists turned to West Africa for their new source of labor. Many West Africans had already been exposed to smallpox, which made them even more valuable in the New World. This began the slave trade to the Americas, which would influence history through the present.
Many of these instances have involved what is now Central America, South America, and the Caribbean, however, the settlement of North America was also impacted by smallpox. The pilgrims that landed in Plymouth in 1620 found very few native people. This is because most had been killed by an outbreak resulting from colonists who had arrived three years earlier. During the Seven Years War, the British at Fort Pitt decided to gain an upper hand on their Native American adversaries by giving them blankets infected with smallpox.

Smallpox also played a role in the American Revolutionary War. During the occupation of Boston by British forces, George Washington and his men were camped outside of the city just after being beaten at Breed’s Hill and Bunker Hill. General Howe of the British Army, however, could not press the attack because there was an active outbreak of smallpox going on in Boston. Washington could not attack the city for fear of losing soldiers to smallpox. This resulted in a stalemate. Meanwhile, Washington had his men variolated. When the British left Boston, Washington sent 1,000 variolated troops to take back the city. In addition, smallpox impacted the Continental Army’s invasion of Quebec. General Benedict Arnold took 2,000 troops to attack the British force in Quebec. However, his men got sick, and many men could not fight. The British troops had been variolated, so they were not as affected by the sudden outbreak. In the end, General Arnold was forced out of Canada for good.

Smallpox had a profound impact on the discovery and development of the New World. Without its influence, much of what we know today may be different. It is hard to believe that one disease could do so much on the world stage. Without smallpox, the western hemisphere would be completely different.

Help Received: The Power of Plagues Chapter 9, History Channel documentary from class, class discussions, http://desertoss.pbworks.com/f/aztecsmallpox.jpg for image 1, http://www.indianz.com/News/2015/11/19/smallpoxblankets.jpg for image 2, https://www.history.org/Foundation/journal/Spring04/images/war_immunization.jpg for image 3, Spellcheck