Tuberculosis, a bacterial infection that affects the lungs, kidneys, bones, lymph nodes, and brain, can be greatly exacerbated by factors such as poor sanitation and high population density (slides 3 and 35). In fact, such factors are largely what made 19^th Century America so susceptible to the disease. With immigrants coming to the United States in large numbers, tenements were extremely crowded, and their working conditions were poor (slide 49). 18,000 people even lived in cellar apartments with mud floors (slide 50). To make a bad situation even worse, there were oftentimes not any windows or ventilation (slide 53). With 8,000 to 9,000 annual deaths attributed to tuberculosis at the tie, most such deaths came in the poorest and most unsanitary areas of the city (slide 56).

Such problems still exist today and still increase susceptibility to tuberculosis. An additional, newer problem that also increases susceptibility is HIV (slide 97). However, a larger problem today when it comes to tuberculosis is drug resistance. Currently, there are 10 drugs approved by the FDA for use against tuberculosis. Patients receive multiple drugs and are to take these drugs exactly as prescribed. The problem lies in that some patients stop taking the drugs too early, leading to reinfection as well as the remaining live bacteria becoming resistant to the drugs (slide 92). For this reason, many patients are put on directly observed therapy (DOT), wherein the care provider personally observes the patient taking the medication until the treatment is complete. This has been shown to improve adherence and reduce drug resistance and treatment failure (slide 93).

With these factors being known at this point, why are we still facing a problem with tuberculosis today? The Lancet Commissions cites some reasons for this. For one, insufficient investment and political will: “Efforts have been hampered in low-income countries because of a failure to recognize the profound negative economic impact of the pandemic and to advocate for increased donor financing in high-burden” (p. 6). They also cite broken care cascades and poor quality of care, failure to optimize private sector engagement, failure to target resources at hot spots, drug resistance, and more. Thus, as partial solutions, they advocate using ‘network optimization and big data analytics to ensure all patients have access to services’ and ‘improving quality management to ensure high-quality service delivery’ (p. 14). They also suggest prioritizing high risk groups, as well, in order to find cases more quickly and hopefully reduce transmission (p. 17).

Part 1: In the 1700s and early to mid 1800s, the Irish population largely depended on potatoes for nutrition. In fact, in the 1840s, half of the Irish population was entirely dependent on the potato (slide 3), consuming it as an appetizer, dinner, and dessert. Combined with milk, potatoes provided all essential nutrients (slide 3).

However, from 1845 to 1852, blight devastated potato production, accounting for the loss of 1/3 to ½ of all acreages in 1845, and the loss of ¾ of potato crops in 1846 (slide 4). Thus, the Irish were left starving and diseased (to include measles, diarrhea, TB, cholera, etc.). The pathogen associated with the blight was Phytophthora infestans, specifically a strain of P. infestans HERB-1 (slides 31 and 32), which made its way out of Mexico to North America and Europe in 1842 or 1843 (slide 32). The weather was just right for this host: “cool, with high rainfall (or watering of crops) and humidity” (Irish Potato Blight article, page 30). Eventually, around one million Irish died and millions more emigrated, primarily to North America (slide 5).

With such a famine and the widespread presence of disease, the Irish sought refuge elsewhere outside of Ireland. A hotspot was the United States, into which ships overcrowded with sick Irish were sent at a rapid rate. U.S. tenements were then packed with Irish, particularly in Boston and New York. These individuals – sick, poor and incapable workers – were despised by many Americans, to whom they transmitted their diseases (article page 31).

Part 2: Such tragedies could have potentially been prevented through gene editing/modification. For example, some plants and animals have already been made immune to certain diseases through the editing of their genes. CRISPR has made the idea of pig-to-human organ transfer more possible by getting rid of certain retroactive diseases. Clearly, this concept of gene editing thereby provides a lot of benefits, both big and small. However, if used unethically, the same methods can be used for harm. As an example, militaries could use a virus as a weapon by introducing it to a population whose certain genes would then be edited upon inhalation of the virus, thereby making them extremely likely to develop lung cancer.

A critical factor in dealing with infectious diseases is recognizing the ethical issues that accompany them. For example, some individuals do not agree with the use of vaccines, as they believe that the risks outweigh the benefits (for whatever reason). With that being said, despite the science behind vaccination, nobody can physically force another to be vaccinated. Similarly, nobody can be forced to take part in experimental research. Many things go into conducting such studies: informed consent, risk/benefit analysis, respect for persons, etc. Thus, just because somebody would be a good case to study does not entitle any researcher(s) to utilize them. Furthermore, it is not a simple decision to quarantine/isolate somebody. Such action takes them away from friends, family, work, school, etc. Accordingly, we must pay attention, be careful, and make sure we are making the proper decision before doing so.

Clearly, as just discussed, there are a number of ethical issues associated with studying infectious diseases. A lens through which we can examine these issues is the Tuskegee Syphilis Study. Taking advantage of poor, African-American males, the researchers in this study denied penicillin (a known effective treatment) to their participants, 399 of whom had latent syphilis, in an effort to see the progression of the disease when untreated (which was their justification for the study). Though the study itself was extremely unethical, it had drastic effects on scientific research. The resulting Belmont Report established three principles to which all scientific research must abide: (1) respect for persons – all participants should be treated as autonomous beings, and non-autonomous beings should be protected; (2) beneficence – benefits of the research should outweigh the risks; (3) justice – selection and assignment of participants should be fair and just.

On the note of fair and just selection of participants, the effects of unjust selection can be devastating. For instance, having selected only African-Americans to participate, the Tuskegee Syphilis Study makes it harder for the African-American community to trust scientific researchers. As a result of such research, they are less willing to participate and are more likely to distrust the medical profession in general.