Reflective Essay

Corey Johnston

5/2/19

BI-245X-01

Reflective Essay

Throughout history, infectious diseases have had an everlasting impact on society. Plagues, sexually transmitted diseases, zoonotic diseases, and insects have all played significant roles in how such diseases are spread. There have also been many cultural and societal factors that have increased the risks for such diseases to cause havoc. Humans, have had perhaps the largest of impacts, from the way in which humans live, to how governments have regulated certain activities, all of which have taken their toll in the spread of infectious diseases. The development of health organizations, vaccines, and the promotion of medical research have all been the most significant counters to stopping the spread of diseases. Without all of these things, this world would continue to harvest diseases that cause mass casualties and pose the biggest threat to the human race.

The spread of infectious diseases, for a long time, seemed to be inevitable, but these diseases led to many outcomes in wars, and altered the course of medicine, religion, and science. During the Middle Ages, the Black Death struck the world, killing off about half of the world’s entire population. Mongolian conquest was brought to a halt due to the constant deaths from this disease. This disease not only caused panic, but people began to point fingers at particular religions, such as those practicing Judaism, and many were killed because of this disease. Thus, many people were forced to convert to Christianity for the fear of being publicly shamed and/or killed (Artifact 3). The rich began to flee and leave the poor helpless, and people began to lose their compassion and abandoned their loved ones. Basically, fear of the unknown caused many people to evade their morals and beliefs for the benefit of themselves (Artifact 3). When HIV/AIDS hit the world, people, again, began to point their fingers, this time at the homosexual community, and this stigma caused this disease to spread to millions of people because the government did not want to give these individuals the time of day because they believed it was a sign from God of their wrongdoings (Artifact 9). The Black Death also led to many developments in medicine and education. Practical methods for disease spread were researched and the development of the printing press led to the increased abundance of knowledge for many (Artifact 3). When Smallpox struck the world, it led to the development of arguably the greatest discovery in all of history. Edward Jenner and Louis Pasteur’s discoveries of the immune defense and vaccines gave all of humanity hope for a prolonged life (Artifact 4). These discoveries saved millions and billions of lives over the course of history. Overall, infectious disease epidemics/pandemics have caused people to invest more money, time, and effort into finding ways to not only prevent the spread of these diseases, but to find ways to cure them as well.

Throughout of all the epidemics that have occurred in history, society has had, arguably the greatest impact on the spread, emergence, and re-emergence of the diseases. During the Black Death pandemic, trade helped the spread of this disease. Little knowledge was known about this disease, but as people began to access various ports around the world, the disease was introduced to new populations (Artifact 3). Dense living quarters also helped the spread of many diseases, such as the Black Death. In the Smallpox epidemic, the spread of this disease occurred even after vaccines were produced. There were social objections that included the loss of fees for inoculators, and the idea that smallpox reduced the poor population. There were people with religious objections who thought that the discovery was an interference with God’s plan. There were also scientific objections to include: objections of the safety of the vaccine; that the source of the vaccine is from an animal’s disease; and the unknown duration of immunity was not known (Artifact 4). In the last century, the emergence of HIV/AIDS was caused by cultural methods used in Africa and South America. Here, people used monkeys as sources of food, and some of these animals carried the disease which was transferred to humans. This disease was spread sexually and through other body fluids, and lack of contraception and education on the disease helped it to spread worldwide (Artifact 9). In Yemen, humans have helped diseases spread. This already, low class economy was impacted from wars. Medical buildings, houses, and water treatment facilities were all destroyed from bombings. This has helped diseases such as cholera to develop and become an epidemic in this area, because not only do people lack clean water, but they lack the supplies needed to treat the disease, and they lack ways to contain the disease (Artifact 1). In summary, humans have had a huge role in the development and spread of diseases throughout history.

Modern society is constantly impacted by both established and emerging/re-emerging of infectious diseases. Governments have to continually take serious measures for the containment of certain diseases. With HIV/AIDS, the government has continually increased medical funding to find cures for this disease as it poses a threat to all of society. Education centers and the availability of health centers are substantial in containing the spread of this disease (Artifact 9). Diseases develop resistances to antibiotics as did MRSA to methicillin. All of such things show that diseases and especially zoonotic diseases can be detrimental but are an inevitable part of nature due to human to animal interaction (Artifact 2). This understanding helps health organizations to develop ways to prevent disease susceptibility. The CDC and WHO are organizations that are constantly doing research on diseases so that they are contained before they can be detrimental to society. Also, our modern society will always have the fear of both established and emerging/re-emerging of infectious diseases. This fear causes more money and time to be spent in disease control. This fear also helps diseases spread because people sometimes don’t trust medical professionals, such as instances from the Tuskegee Syphilis Experiment. This unethical experiment led people to distrust doctors, and it also led people to not seek help from medical professionals for the fear of being mistreated (Artifact 5). All of such things help diseases spread throughout the world.

The role that today’s societies have in promoting the emergence and re-emergence of infectious diseases is astounding. Areas that have low living standards and lack of clean water, such as those is Brazil, tend to harvest diseases more so than any other area. Also, in many cultures such as the one in Bangladesh, the consumption of foods that are at high risk for disease susceptibility due to poor sanitation, can lead to major outbreaks, such as the Nipah virus outbreak (Artifact 2). Urbanization also poses huge threats to society because it allows diseases to take advantage of crowded areas. Poor living conditions, poor sanitation, and poor health education are often accompanied by urbanization, and these all pose threats of spreading diseases. Also, as there are more and more “free-minded” people in society, the threat of anti-vaccinators also cause havoc. There has been a current outbreak of measles, which should have been contained, but people who have disbelief in vaccines for the fear of I am not sure what, have allowed this disease to spread and harbor itself in America. There has also been the threat of complacency within people in this country. Many people believe that diseases like HIV are no longer of serious concern and this could be very detrimental down the road. What I have learned is that viruses do not discriminate, and as long as this holds true, HIV, along with many other diseases will continue to pose a threat to society for as long as they are around (Artifact 9).

Sources

Artifact 1: The appearance of plagues. 2019

Artifact 2: Is society prepared for the next big pandemic. 2019

Artifact 3: Historical implications of the plague and it’s impact on today’s society. 2019

Artifact 4: Smallpox: Jenner’s role and eradication. 2019

Artifact 5: Ethical implications surrounding medicine and society’s perception of medical professionals. 2019

Artifact 9: HIV/AIDS: national implications. 2019

Artifact 9

Corey Johnston

4/23/19

BI-245X-01

HIV/AIDS: National Implications

Human Immunodeficiency Virus (HIV)/ Acquired Immune Deficiency Syndrome (AIDS) has been a huge dilemma for the past century in the United States, as it has led to the death of millions of people, and for a long time, accompanied by a lack of hope for a cure. This disease was thought to have originated within the homosexual community. It was also thought that it isolated itself within the homosexual community as it was viewed as a direct punishment for an ignorance to Christian morals and standards. This political stance on the issue led to a lack of government funding and support for many years. During the Reagan administration, there was little done to help with any scientific breakthrough, as he thought that it was up to the scientists to find a cure, being ignorant to the fact that funding research could have sped this process up and saved the lives of many. For many years, homosexuals feared public shame and the social stigma behind this particular group. They feared coming out as gay, all because they would have been placed in such a harsh category. It is true that this disease spread tremendously throughout the homosexual community, but later on, it was thought that this was due to a lack of abstinence, contraception, a large use of drug abuse, as well as group orgies that helped this disease spread. When President Clinton took over, he made it clear that he was willing to offer as much aid as he could to help these individuals suffering from this disease. During his Presidency, research was booming and it was found that this disease came from foreign cultural traditions of eating chimps carrying a similar disease that was able to cross into a human form. All across the globe were instances of this disease, and it was later found out that this disease was a sexually transmitted disease, and a blood borne disease, that could spread though sex, sharing of needles, as well as contact of bodily fluids. This was very scary, as it showed that it could pass from male to female heterosexually, and this allowed the disease to spread more rampantly. Many of the episodes that patients faced are contained within the film, Dallas Buyers Club, epitomizing the effects that this disease took, specifically on the homosexual community, and how they had to fight for a way to find a cure. Without the help on a global scale, this disease would be perhaps the largest threat in the nation today by a long shot.

The factors that helped this disease spread in the U.S. was first and foremost a lack of care from politicians, and their views on the homosexual community as infidels. What I mean by this is that the government dismayed any effort to prevent the spread of this disease because they had little care and compassion for the homosexual community. The lack of funding and research helped this disease spread throughout the U.S. as it allowed more time for the disease to spread from person to person. If this disease was thought to be a larger threat at first glance, then it could have been contained at an early stage in history.

The factors that limited the further spread of this disease in the U.S. were mainly due to the development of the triple cocktail. This cocktail consisted of antiretroviral medications that halted HIV from developing further into AIDS. Also, public education of the disease played a huge part in the limitations of this disease. More importantly however was the national intent to stop the spread of this disease. During and after President Clinton, research was conducted to find a cure for this disease and ways that it could spread. All of these breakthroughs allowed people to know how to protect themselves from getting this disease. Also, in order to give blood, you must be HIV negative so that this disease does not spread through blood transfusions as it did in the past.

The overall impacts of HIV in the U.S. are astounding. I think most importantly, it has caused the government, specifically, politicians to take medicine more seriously. These individuals must partner with the World Health Organization and CDC to help stop future disease outbreaks. Also, in society today, the stigma amongst the homosexual community has deteriorated a lot and more and more individuals are able to express themselves freely. It has, however, brought about a fear of acquiring sexually transmitted diseases. This fear can be good as it requires people’s attention, but it can also cause people to hide from getting treatment or expressing themselves to their partner, thereby helping the spread of such diseases. The fight to find a cure has, however, been on the rise over the past decade, and there have been many current breakthroughs.

There has been a ton of progress made in the U.S. To help prevent HIV from taking hold of and spreading throughout your body, Pre-exposure prophylaxis (PrEP) has helped with this. People who are at extreme risk for getting HIV take this medication on a daily basis to prevent themselves from getting HIV. According to the CDC, it reduces the risk by 90%. Post-exposure prophylaxis (PEP) is the means of taking antiretroviral medicines (ART) after being potentially exposed to HIV. These medications are used to prevent one from getting the disease altogether after he or she believes they were exposed. There are also many challenges still to face. The main issue in the U.S. is that this disease is taken up largely by the black community, specifically in the South. Here, the stigma and the fear of societies views prevent many from getting treated or even tested, as well as the financial costs of these things all pace burdens of poor black people in the US. African Americans account for 43% of HIV diagnoses, and Latinos account for 26%.

The current status of HIV prevention, according to the CDC is a multitude of things. The first is the ART. This treatment improves the health of people with HIV, and also reduces the risk of spread by 96%. The goal here is to keep HIV in the blood below detectable levels. The second is through PrEP. This allows people to reduce their risk of contracting this disease by 90%. The third is through diagnostics. Antigen/antibody tests allow researchers to routinely diagnose the acute form, which is the form in which this disease is most likely to spread.

With all of the research and findings in HIV prevention, the threat still comes from people with the disease. What I mean by this is that many people who have this disease do not receive any treatment for it. This not only helps the spread of the disease, but it allows the disease to stick around for longer periods of time. Also, the minority groups need equal access to preventative measures. This involves government funding. These individuals have poor access to health care and are in poor socioeconomic status. Lastly, with any serious threat, the view of complacency causes the threat of a recurrent issue. Many people believe that this disease is no longer of serious concern and this could be very detrimental down the road. What I have learned is that viruses do not discriminate, and as long as this holds true, HIV will continue to pose a threat to society for as long as it is around.

Help Received

CDC, sources on canvas, class discussions, NLM

Corey Johnston

Artifact 8

Corey Johnston

4/7/19

BI-245X-01

Cholera: A Crappy & Lethal Disease

When discussing Cholera, there are many societal and cultural factors that increased its virulence and its ability to spread throughout the world. Colonization, trade, and urbanization all helped this disease leave its mark around the world, as it created 7 pandemics within the last 2 centuries. In the 16^thcentury, Cholera was first documented in India. As Britain began to spread its empire, it led to the colonization of India. As such, British explorers and leaders helped to bring this disease back to Europe and at a deadly cost. Also, a huge part in the spread of cholera was through trade. As exploration reached its peak and countries began to understand the values of various parts of the world, trade became a booming industry. The first cholera pandemic occurred from an outbreak in Calcutta, India. This disease was spread along trade routes to China, Japan, the Philippines, Africa, Central Asia, and Russia. This disease soon came to a halt out of the blue. However, it began to creep its way back and led to a second pandemic in Russia, where it soon spread rampantly throughout Europe. Here, Irish immigrants brought this disease across the Atlantic to Canada and New York. It continually spread to the west coast and even onto Mexico. The third pandemic is known to be the most lethal and left a huge mark in Africa, U.S., Middle East, Europe, and India. The London pandemic is known to be considered within this category. London suffered awful living conditions. The city wreaked of stench and people blamed the disease on this miasma. Urbanization in London created worse conditions. This city was heavily populated and relied on the Thames river for water supply. They had poor sanitation and oftentimes dumped their sewage directly into the river from which they drank from. There were also cesspools in their cellars that built up and they cleaned these out by dumping the sewage into the river. People thought that the low-income population became infected more because there were accustomed to the stench and “the ‘moral depravity’ of poor people weakened their constitutions so they were more vulnerable to disease.”

There were also factors that limited the spread of this disease. If people did not drink from contaminated water supplies, they were not susceptible. If there were high levels of sanitation methods used on food and water, people did not get sick. This is why sanitation improvements and public health infrastructure was so important and why it is important to this day. Public outhouses that stopped the bacteria from reaching water supplies was essential. Boiling water, cleansing hands, and cleansing food are all important concepts that were needed to stop the spread of this disease. That is why this disease tends to isolate itself in poor countries, because there are little measures that can be carried out to prevent the spread of this disease, e.g., India’s lack of bathrooms available to households. Also, there is a type of cholera biotype that wreaks havoc among the world. The El Tor biotype is a much hardier organism because it can survive long periods of time in aquatic environments. It also leads to mild symptoms or no symptoms which helps it gain an edge by allowing it to spread as people are able to travel. This helps it rapidly spread from one place to another.

Then, John Snow came along. He developed a hypothesis that contaminated water was the cause of the disease, and if this were so, then people getting their water from Lambeth Company, which got its water from a less polluted region of water, would have a lower mortality rate. He began to calculate death rates based on water supply and used his “spot map” to sort of pin-point which well looked to be the verdict. He found that the well on Broad St. had the most deaths surrounding it. He also was able to pinpoint the starting point of the disease by discussing with a priest, Henry Whitehead. Whitehead knew the community, knew about their lives, who got sick, and led Snow to the conclusion that this all started from a sick baby whose diaper contaminated the well. Their studies led to the new science of epidemiology, and expressed the role of public health to the world. Also, an Italian researcher by the name of Filippo Pacini identified the culprit as Vibrio cholera, a comma shaped gram-negative bacteria. He did autopsies on dead bodies and found the comma-shaped bacillus. He published several papers on his work but nobody paid attention to it because it directly contradicted the miasma theory. He described the symptoms of the disease and described ways to prevent it through intravenous injection of salt and water. He would later be recognized for his publications and efforts to put an end to this disease. Robert Koch later named the bacteria, Vibrio cholera. He also conducted autopsies of people who died from this disease and found the comma-shaped bacteria in the intestinal mucosa of the deceased. He was later able to isolate the bacteria and found that animals were not susceptible to the disease. The miasma theory was finally laid to rest.

In Haiti, a cholera outbreak took its toll on the population. In 2010, after the devastating Earthquake that hit, the El Tor biotype emerged. Scientists suggested that this biotype was probably brought over from humanitarian efforts from other countries. About a million people died from this disease and then flooding hit and intensified the outbreak. All of these issues have spiked because there has been a lack of sanitation and a lack of ways to manage feces. Humanitarian efforts have been made to provide people here with food, shelter, and clean water. Then efforts have been made to provide vaccines to these individuals as well as ways ensure they get chlorinated water and develop ways to store clean water. There have also been facilities built and supplied with rehydration fluids, antibiotics, and zinc. There has also been an increased urge for the oral cholera vaccine (OCV) to be administered to the public. Surveillance systems were also established for an improved response to any outbreak. All of these measures have helped to slow down the cholera outbreak, but without further attention and medical assurance, cholera will still be a recurrent episode in the community. It has been shown that the outbreak has slowed down substantially, and in 2018, only 3,786 cases were reported, which is a decline of about 72% just from 2017. Like I mentioned above, there still needs to be more done to get rid of this disease altogether.

Like Haiti, cholera has had its effect on other countries like Yemen and Iraq. These incidents spur from problems associated with war and weather. In Yemen, before war devastated its lands, it was ranked as one of the poorest countries in the world. Hospitals and clinics have been destroyed and infections have taken its toll on the community, exemplifying this is its most recent cholera outbreak. Also, a water treatment plant was blown and this has helped the spread of these diseases. In East Africa, heavy rains and mudslides carry the cholera bacteria to remote places that can could get worse with El Nino conditions. It can stay in areas of little water and spread with flowing water. These are just a few brief examples of why action needs to be taken place to help those who have been infected with these diseases.

Artifact 7

Corey Johnston

3/31/19

BI-245X-01

Tuberculosis: The Forgotten Plague

Tuberculosis is an infectious disease that is lethal if left untreated. According to Irwin Sherman, “tuberculosis is not only an infectious disease, but a societal one as well.” Unfortunately, millions of people have died due to the continual spread of this disease, and if matters aren’t treated more seriously, this disease will continue to take its toll on society, particularly in poor countries. In poor countries, with limited resources, risk of contracting TB is substantially high. Without the proper medical supplies, drugs, and sanctuary that hospitals give, contracting tuberculosis will be deadly. It will spread from person to person, and won’t back down. This is the unfortunate truth people in this world must realize. Without educating poor countries of this disease and up-regulating medical spending and research, tuberculosis will continue to cause devastation in places around the world.

In the 1800s, in Western Europe, people believed that those with tuberculosis were beautiful and erotic. It is believed that tuberculosis produces a sense of euphoria, increased appetite, and a strong sexual desire. It led to “extreme thinness, long neck and hands, shining eyes, pale skin, and red cheeks. All of this stigma behind the unknown disease increased TB’s spread through western Europe. Little was understood at the time and these people drowned in their own blood because of this disease.

In the 19^thcentury, as immigration to the United States had begun to boom, so did the “boom” of TB. Improper use of ventilation systems allowed for TB to take a huge spread in urban areas. “As more and more impoverished immigrants arrived in the United States, they were forced to live crowded together in these miserable tenements.” These places usually housed about 8 to 10 people and in filthy conditions. The lack of ventilation helped the spread of pulmonary TB in the United States. Much of this spread however was placed on the Jews and was used as an anti-Semitism tool to justify the spread of the disease. Many Jews were poor, malnourished, and living in terribly crowded spaces and so many of these people became infected with this disease and were put to blame.

Later in the century, it was found that the microbes that cause this disease are called mycobacteria. It is an opportunistic infection, meaning it takes advantage of certain poor health situations of its host, e.g., people with AIDS. People who have contracted AIDS, are at higher risk of this disease and it becomes very hard to treat at that point. As a treatment method, people were isolated from their families in order to recover and prevent the spread. At a minimum, people are isolated for 6 months, and could be treated for up to several years. Because of being isolated, and the feeling of being outcasted from the community, there became a social stigma with developing tuberculosis. People soon began to not want to get treated because of the fear of being an outcast or isolated from all family members and friends. The consequence to this is that it led to the continual spread of this silent disease.

Also, as TB continues to spread and drugs are made to stop this spread, the disease became clever and developed a drug resistance and demolished any hope of being treated. These diseases emerged, as treatments became available and used to save many. They emerged in order to remain alive and viable. Just as people develop certain antibodies for diseases, diseases mutate in order to survive, as did TB. There are two types of drug resistant TB. The first is MDR-TB, multi-drug resistant TB. This disease requires more drugs to cure the patient, a lot of times resulting in death and other complications. The second is the more severe case, called XDR-TB, or extensively drug-resistant TB. This disease offers little hope of a cure, and the justification for many, of feeling hopeless, and that no person wants to spend a life with them.

Tuberculosis, as well as its drug resistant strains, require the attention of many to conquer the disease. In order to achieve a TB “free” world, there needs to be a greater attention to the struggle. People in poor countries can neither access nor afford medical aid for this disease. Also, preventative care is not even offered in “high-burden countries”. Thirdly, research and development is severely underfunded. Lastly, this situation needs to be taken seriously by political figures and financial investors if any of this is going to take place. The priority needs to be a person and family-centered service to all who have contracted this disease so that spreading this disease is halted. This strategy is plausible, and if people want to stop the unfortunate truth that this disease offers, then steps need to be taken in order to save the lives of millions.

Artifact 6

Corey Johnston

3/17/19

BI-245X-01

The Irish Potato Famine and How Molecular

Technology Has Saved the Lives of Millions

During the period from 1700 through 1840, the overall population in Ireland grew tremendously. However, as the population increased and economic tension grew with England, Ireland was on the verge of a devastating disaster. Land owners often took advantage of people by offering high wages for small pieces of land. Crops were often taken away from Ireland’s growing population and were forcefully sent to England. Also, as population grew, living conditions deteriorated and housing became troublesome. All of these factors increased the need for the potato. This crop was essential to Irish dwellers because of its high nutritional value. Oftentimes, people relied solely on potatoes and milk for their source of nutrients. This crop was so essential that, by the early 1840’s, about half of Ireland’s population relied solely on this crop. In 1846, the Britain’s Parliament reduced British financial commitment to Ireland as well. During the years of 1845 to 1852, blight caused the escalating downfall of potato production. The potato blight was caused from a fungal-like organism called Phytophthora infestans. This organism was found to be originated from North America and brought back to Europe during trade in the form of the strain, HERB-1. By 1846, three-quarters of the potato crop was lost to the blight. Infection of the crop spread from plant to plant through microscopic spores that took passage in the wind and rain caused them to stick to the leaves of the potato. The fungus has tube-like threads that insert themselves into the plant and basically suck the nutrients out of the plant until it withers. The potato blight resulted in millions of deaths, from starvation, disease, or the journey to America, which was inquired by a lack of food and poor health. This emigration to North America was so disastrous that people often referred to these ships as “coffin ships” because of the many deaths that took place on them. Population fell by about 20 and 25%. As a result of malnutrition and terrible living standards, people became very vulnerable to many infectious diseases. Diseases such as measles, diarrhea, tuberculosis, whooping cough, and cholera began to take its toll on the many souls that were able to push through the famine. Without the development of molecular innovation, diseases like such would still be spread worldwide.

As mentioned above, molecular technology led to reduction of famines, insect vectors for diseases, as well as innovative production of human embryos. CRISPR is an innovative modification that allows for the substantial growth of crops across the world. Food sources, such as salmon are genetically modified and result in the faster production, as well as larger growth of these fish. This, in turn, allows the ever-growing population to have the availability of more food for nutrition. Also, genetically modified crops, such as corn and potatoes have been engineered to resist certain fungi and are rapidly produced to maintain such large populations around the world. Gene drives have been put in place to reduce the number of insect vectors made available to the world. Many species of insects have been wiped out completely to reduce the number of insect-spread diseases. Many ethical implications have been surrounded by the idea of the riddance of certain mosquito species as there has not been a solution to whether these insects impact the environment in a positive way. A recent scientist developed babies using genome editing to resist infections by HIV. These just go to show the technological advances humans are making to resist disease and outlast overpopulation. There are also certain risks that are involved in these advances. There has not been any evidence to show the negatives to gene-modification of crops and so this poses as a potential threat to society. Also, in gene drives, people do not always know environmental implications of getting rid of certain species, and so this also poses as a threat. Lastly, genome editing is such a new topic, that there is no information of long-term illnesses that could arise from them. All of these things however have been used in society to better the world, and as of now have rid the world of many diseases.

Artifact 5

Corey Johnston

3/10/19

BI-245X-01

Ethical Implications Surrounding Medicine

and Society’s Perception of Medical Professionals

Throughout history, there have been many situations regarding unethical circumstances in practicing medicine. This was flagged at the end of WWII in the Nuremburg Trials. Since, there have been ethical codes which medical professionals must follow in order to take part in things like clinical trials or clinical studies. Much of these codes came not only from Nazi experiments during WWII, but from experiments such as those in the Tuskegee Syphilis Study. There are also a number of ethical issues surrounding infectious diseases, such as vaccinations, along with population biases to certain ethnicities. The consequences of these unethical studies in regards to gender, race, and social status, have all impacted societies trust in medical studies as well as medical professionals.

There have been many ethical issues when dealing with infectious diseases. In an article by Heather Ann Thompson, she writes that in many prisons, such as Attica, doctors have performed many disgusting, under-the-table experiments on prisoners, whom “happily” volunteered for his or her study. At Attica, the medical professional there asked for volunteers to perform in an experiment where he would be ultimately presenting these prisoners with leprosy. For many, the answer was yes, simply because it was an easy way to get money while incarcerated. Little is known to what extent these prisoners were told the full story behind the experiment, but it is known that the doctor was influencing these prisoners with an awful and disfiguring disease in that of leprosy. There have been many unethical studies in regards to infectious disease, far beyond those of these prison experiments. This has been a custom for many centuries, as many doctors want answers to certain diseases, losing sight that we are all human, and no matter what race, social background, or stage we are in life, we all deserve the same rights as people and deserve to be treated as such.

The Tuskegee experiment is one of the prime examples of unethical studies being conducted in the United States, during a time of civil reform. Individuals in this study were not given details about the nature of the study, but were simply told that they would be treated for syphilis, but in fact were not. Government doctors in the US public health services supposedly wanted to learn whether syphilis showed different symptoms in different races. They targeted older, black males, who were not economically stable. They told these individuals that they had “bad blood” and “this was their last chance for special treatment”. These doctors broke the Nuremburg Code which was developed after the study had started. Also, even after penicillin was found to be the cure for syphilis, and these individuals sought help from other professionals, they were quickly re-directed back to the study and told that they were getting the help that was needed. This ties in with the issue of informed consent in today’s society. That people who are being put in clinical studies/trials are to be informed of the nature of the study and each study has to have a set of guidelines for participants to follow. This study ended after 50 years, when a press release of the study was informed to the public. All that was owed to the participants was a “lump sum” of $38,000. For all of the pain and suffering that these individuals faced over the course of these experiments, surely, they deserved more. Also, this does not even consider the people who died because of the experiment/ “study”. There has also been reports of unethical studies as shown in the Guatemalan venereal disease study. US government researchers and their Guatemalan colleagues experimented without consent on more than 5,000 Guatemalan soldiers, prisoners, people with psychiatric disorders, orphans, and even prostitutes. They exposed 1,308 adults to syphilis, gonorrhea, or chancroid. This is another prime example of why ethical panels are used in today’s medical studies, to prevent awful acts of humans such as these.

All of these unethical studies have had a huge impact on how people perceive medical professionals in today’s society. Unethical experiments such as those listed above have caused a mistrust in medical professionals worldwide and nationally. Prime examples are shown in the Tuberculosis outbreak in Alabama, where people lost trust in doctors and thought that they would be ostracized if seen by doctors. These people say, “I don’t want nobody knowing my business”. This is the stigmatism of that area and has been that way since word of unethical practices have been released. Also, after the Tuskegee Syphilis study was released to the public, many people, especially those in the black community, did not want to rely on medical help simply because they could not trust doctors to treat them with respect and could not ensure that doctors wanted to help their patients. This has caused the mistrust in medical professionals around the US for a long time, and a prime reason that clinical trials suffered to achieve many volunteers for a long time. Until people start to find trust in medicine, this will be a issue for a long time to come, especially in regards to vaccination.

Artifact 4

Corey Johnston

3/3/19

BI-245X-01

Smallpox: Jenner’s Role and Eradication

For many centuries, smallpox took a devastating tole on the human race. It led to the death of hundreds of millions of people. Many people took to futile remedies consisting of bloodletting, leaches, fasting, laxatives, purgatives, and diuretics. Others included heat or sweat therapy, or even cold therapy. Many people took to worshipping Hindu gods and goddesses such as the Hindu goddess, Shitala, to help prevent or even to cure smallpox. The Chinese took to nasal insufflation, which involved putting crusts into the nose of people. The Moslem approach involved a term called variolation or inoculation. Here, a needle probed the patient resulting in a few pustules developing. This approach was advocated by people such as Lady Mary and even Voltaire, “for the sake of staying alive and keeping women beautiful.”

“Smallpox was indiscriminate, with no respect for social class, occupation, or age; it killed or disfigured princes and paupers, kings and queens, children and adults, farmers and city dwellers, generals and their enemies, and the rich and poor.” This was the inevitable result for many, until Edward Jenner took part in the story and changed history. In 1789, Jenner conducted an experiment to investigate the stories of milkmaids being “immune” to smallpox. Here, he gave his son swinepox, and later inoculated his son with smallpox, and to his relief, his son did not show any smallpox symptoms. Therefore, Jenner assumed that since there was no symptoms, cowpox must have conferred immunity to the smallpox. This was the breakthrough that this world needed.

However, there were many reactions to Jenner’s discovery, some good, and some bad. There were social objections that included the loss of fees for inoculators, and the idea that smallpox reduced the poor population. There were people with religious objections who thought that the discovery was an interference with God’s plan. There were also scientific objections to include: objections of the safety of the vaccine; that the source of the vaccine is from and animal’s disease; and the unknown duration of immunity was not known. Originally, the method used for propagation of the vaccine included an arm-to-arm method. This, however, led to the possibility of spreading other blood diseases, such as hepatitis and syphilis, both of which were detrimental without a treatment. The benefits of getting the vaccination is that it decreased the risk of getting smallpox entirely, as well as increased the chance for herd immunity, that is, those who did not get vaccinated could become masked from the disease by those who did get vaccinated.

The years preceding the discovery of Jenner, proved to have its difficulties as well. In England, vaccines were compulsory and this was quickly protested. Louis Pastuer came up with the term of vaccination after a discovery of vaccine for chicken cholera. Leicester became a site where compulsory vaccination laws were frowned upon. Also, there was a radical experiment in Leicester, where patients were isolated, contacts were quarantined, mandatory notifications of cases, all of which foreshadowed “selective epidemiological control”. After protests, parents allowed for conscientious objection to vaccines.

In the coming years, progress was made. The global war on Smallpox was led by the World Health Organization Smallpox Eradication Program, which focused on a Global effort to improve international reporting and the production of international reference labs to monitor vaccine quality. Intensive searches for smallpox were carried out, and in 1980, the World Health Organization certified that Smallpox had been eradicated from the world.

Artifact 3

Corey Johnston

2/24/19

BI-245X-01

Historical Implications of the Plague and

 It’s Impact on Today’s Society

During the time of the Middle Ages, and the development of worldly trade, a global pandemic struck which killed roughly half of the world’s population. The Plague or the Black Death was a bacterial disease which arose in fleas, and spread like a wildfire as trade progressed in the Eastern world. People did not know how to deal with the spread of the disease, often feeling powerless. As disease spread, people began to point the blame to many others who, as we know now, were innocent. People also came up with extreme ways of ridding the Plague out of Europe. The plague also led to many developments in medicine, education, as well as out casting of particular religious groups. In today’s society, plague transmission is heavily controlled by organizations such as the Center for Disease Control and the World Health Organization. These organizations attempt to find out the cause of disease and trace the disease back to its original source simultaneously. In Madagascar, the plague re-emerged in part to a delay in diagnosis and particular living quarters which are devastating. Throughout history, epidemics, such as the Black Death have caused many organizations to put full effort in finding ways to limit the next great epidemic from occurring again.

During the Middle Ages, the Black Death struck and killed roughly half of the world’s population. There were many contributing factors that led to the spread of this disease. Mongolian trade to Europe brought the plague with it as rats traveled in the cargo. Also, the Mongols had a battle in Europe to gain access of a particular city, and sent their dead bodies over the walls of the city, and along with them, the Black Death. One of the biggest contributing factors was the trading ports in Sicily which brought dead bodies and rats to the heavily populated city in Italy. Also, symptoms of the plague included: fever, chills, buboes, septic shock, and organ failure. As family members began to die, people wanted to be alongside them, and thus the disease spread from person to person. Also, the dense living quarters of European cities helped spread the disease. This is thought to be some of the origins of the disease throughout Europe.

Societies response to the disease included fear, frustration, chaos, a sense of powerlessness and blame to those who were innocent. As disease spread, and more and more people died, the rich people to flee their cities, and leave the poor behind to suffer. Priests refused to offer last rights to the dying. People began to lose compassion, and began to abandon their loved ones. As this proceeded, mass murder began. Blame began to arise as Jews were killed in hopes to “regain God’s grace”. Many skeptics thought the disease spread because the planets were aligned leading to the release of toxic vapor. People were quarantined from society to reduce the increase in virulence. However, all of these attempts failed to stop the spread. Drastic measures began as cities were burned to the ground, and in some cases, this was found to be successful.

The Black Death had a huge impact on societies’ culture. As the plague began to deteriorate, people began to devote more time into developments in medicine. There was more research into why this disease occurred and medicine was thought in a more practical way. The flagrants were killed off. They also wanted to search for who was responsible, but in the wrong manner, i.e., killing of the Jews. The printing press was developed which helped with documentations of epidemics like this one. Also, the Renaissance grew out of the ashes. In summary, the spread of the Black Death increased societies awareness of diseases and ways to further prevent them.

In today’s society, people have an understanding of global pandemics and ways to prevent them. Organizations arose such as the Center for Disease Control and the World Health Organization to better educate the public on global diseases, as well as develop ways to prevent them and keep them from spreading. Outbreaks are traced back to their original source in order to stop the spread of disease and find out every person involved in the disease. We know about plague transmission because we know how they have spread in the past. Cases occur in the U.S., when trade arises, or when people traveling to foreign countries bring in the disease. When an epidemic arises, these health organizations are contacted and bring awareness to the public and find ways to find the source. One it is found, they can develop ways to prevent it.

In Madagascar, the plague re-emerged due to poor living conditions and a delay in diagnosis. Health care workers were not used to seeing the plague and this was the main cause of the delay. It took on the form of the pneumonic plague and so it was much more virulent than previous ones. It was spread from person to person from coughing and sneezing. The thing that made it worse was that it affected urban areas, and people here had strict burial traditions of being around their loved ones after passing to celebrate them. Health organizations had to find out every person who came into contact with the infected and treat them. As populations begin to grow and expand and become mobile, these diseases that are isolated can reach the wrong city and spread like a wildfire.

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Corey Johnston

2/17/19

BI-245X-01

Is Society Prepared for the Next Big Pandemic

             Throughout history, diseases have been a detrimental, yet inevitable factor that has caused millions of deaths. Emerging diseases has become a vital role in understanding how people interact with the environment and how much information humans still have to learn. Re-emerging diseases also play a large role into understanding these factors. A centerpiece to many of these diseases lies in those passed from animal to human host, referred to as zoonotic diseases. There are also many social and cultural factors that lead to major outbreaks. There are many human responses to epidemics that have led to the term outbreak culture, that will all be discussed. Lastly, I will discuss whether I believe we are ready for the next pandemic and things we can do to prepare for it.

Emerging and re-emerging diseases play a huge role in understanding just how much humans interact with the environment and how many animals can lead to the increased spread in diseases. The diseases that comes to mind are Zika, Ebola and Nipah viruses. Nipah, specifically, is a serious disease that became an epidemic in Bangladesh. Many people thought this disease came from tree sap that was an important part in the culture, but after further investigation, the culprit was the fruit bat, which spread infection by eating the sap at night and peeing in the sap that people ate. These diseases show that interactions with wildlife can be deadly but without these animals, the balance in wildlife would be skewed and so they are essential to nature. Re-emerging diseases play a big role in that they help explain just how smart diseases can be in order to survive from an evolutionary standpoint. If you take a look at MRSA, and trace this infection back to its early years, you will see just how smart this disease has gotten in order to survive in humans. Disease develop resistances to antibiotics as did MRSA to methicillin. All of such things show that diseases and especially zoonotic diseases can be detrimental but are an inevitable part of nature due to human to animal interaction.

Just as diseases can be important, so can social and cultural factors that lead to major outbreaks. In an article by Kathryn Moeller, she discusses that risks for exposure mirrors racial, class, and geographical-based inequalities. She discusses that the Zika virus in Brazil affects more lower-class working females than upper class females. This is in part due to the living standards that these people are facing and the lack of clean water environments hosting as ideal pools for mosquito growth. Also, in an article by Rebecca Voelker, she discusses that people are more vulnerable to the flu today than a century ago. This is in part that there are more than 3 times the people on Earth than a century ago, and living spaces keep getting crowded. Also, less than 1% of the world’s population had access to the vaccine, due to lack of substantial egg-based product. Also in many cultures such as the one in Bangladesh, the consumption of foods that are at high risk for disease susceptibility due to poor sanitation, can lead to major outbreaks, such as the Nipah virus outbreak.

When an outbreak hits, humans usually respond in a chaotic way. Many times, humans are on the clock to trace the steps of the outbreak, but bystanders react in a fearful way. Outbreak culture is a term used to describe how people react to major outbreaks. Take for instance the Ebola outbreak from 2014-2016, where many political practices were taken out that were not ethical simply because it was a chaotic situation. Oftentimes, these scenarios are a test to humanity and unpredictability. Like occurrences such as the Ebola instance, we often fail. That being said, humans do find ways to come together to help others out, more often than not however, at the expense of many.

Lastly, I believe that humans have a long way to go to prepare for the next pandemic. I believe that regulations need to be instituted in order for people to come together and find ways to fight infections. These actions start with the development of worldwide vaccines that make it easier for low-income areas to have access. This is a huge step for people. However, many pandemics are unpredictable as previous ones have been, but I do believe that people are not prepared for it, as I think it is hard to predict for the unpredictable, but I believe humans are doing their best with what information and knowledge that we have available.

Artifact 1

Corey Johnston

2/10/19

BI-245x-01

The Appearance of Plagues

Throughout history, there has been a plethora of factors that have influenced the risk for infectious disease outbreaks. With the constant spread of globalization and technological advances, diseases have become a constant threat to society. Along with this threat, comes the risks involved with climate change and societal issues involving past and present economic and political structure. These topics have had an outstanding influence on how epidemics have been spread throughout history, as well as throughout the current society.

Society is continually growing and spreading as time progresses. With this spread, comes the constant threat of food shortages and the loss of biodiversity. The need to maintain food supplies in an ever-growing society is a huge risk in of its own (Haines and Ebi, 2019). There has been an increasing number of people consuming red meats, meaning more animals are being created to sustain this need, in turn, these animals produce large amounts of methane which has been shown to be a green-house gas and a consequent cause of global warming (McMichael, 2013). Global warming is a huge threat in society, because it causes the annual hospitalization and death rates due to extreme heat to rise, as well as increases in injuries and death due to weather disasters to increase (McMichael, 2013). Without the aid of society, all of these factors can be a deadly consequence to the constant need for more.

Globalization has also had a huge impact on changes in infectious diseases. As the population continues to grow and migrate, so does the ability of the influenza virus to develop new strains. As, shown in a video on the Great Influenza outbreak in the WWI era, the process of people migrating from one place to another led to the estimated death toll that some believe is in the hundreds of millions, but is quite hard to say. Climate change has also played a huge role in the coastal outbreaks of cholera due to the warming of coastal waters (Haines and Ebi, 2019). As you can see, all of these things play a huge part in the expansion of infectious diseases.

Another contributing factor to the appearances of plagues is under-developed countries. In an article explaining the issues involved with Yemen, the author discusses how a lack of healthcare and sanitation has caused the spread of infectious diseases such as cholera and other diarrheal diseases (Mohareb and Ivers, 2019). Places such as Yemen experience the constant threat of an outbreak, simply because there is no way to treat diseases due to societies harm to that country. Without proper treatment facilities and sanitation methods, Yemen and other under-developed countries will experience outbreaks for years to come.

The last important factor that needs mentioning is the effects of economics and societal issues on disease susceptibility. In an article on the American Epidemic, the author explains that researchers believe that the rise of infectious diseases in America, specifically, is due to economic inequality, especially in the urban environments (Moyer, 2018). The constant use of urban transportation poses the threat of disease spreading on a daily basis. Diseases such as Legionaries, are created in water towers above most infrastructure throughout the city. Also, homeless people are at extreme risk for developing some type of infectious disease and are susceptible to spreading these diseases (Moyer, 2018). All in all, society needs to change if people want to remain in good health and avoid the next plague that could be here before anyone knows it.

Works Cited

Haines A. and Ebi K. 2019. The imperative for climate action to protect health. The New England Journal of Medicine. 380(3): 263-273.

McMichael A. J. 2013. Globalization, climate change, and human health. New England Journal of Medicine. 368(14): 1335-1343.

Mohareb A. M. and Ivers L. C. 2019. Disease and famine as weapons of war in Yemen. The New England Journal of Medicine. 380(2): 109-111.

Moyer M. W. 2018. American epidemic, resurgent outbreaks of infectious diseases are sickening thousands, and the causes are societal. Scientific American. 44-57.