Tuesday, March 24, 2009

the Morality of Tuberculosis

Tuberculosis used to be dangerous but now we can cure it...right?

Not any more. Now there's a strain that's resistant to most drugs--and a second strain that's currently incurable and kills within weeks.

Where'd these monster TB breeds come from?

The Third World. [The map shows incidence of TB per 100 people, the worst in red, the best gray.]

You see, TB requires taking pills daily for 6-12 months. You feel lots better pretty quickly though. So people stop taking the pills. And within their bodies, where all but a few resistant bacilli have been killed off, a monster is growing that imperils us all.

The people know the doctors told them to keep taking the pills. But they feel better. And remember, these are people who often put more faith in folk medicine than in Western medicine. They might have even gotten a treatment from the witch doctor/curare/etc. at the same time and been pronounced cured by him/her.

The numbers of people dying from--and spreading--hard to cure or incurable strains of TB are proliferating--particularly in areas with an AIDS epimec as well, since AIDS makes people far more prone to get TB in the first place.

Mostly these people stay put in the third world. But some are entering America and other advanced nations that have porous borders, as illegal immigrants. Others are sometimes getting on airplanes and endangering dozens or even hundreds of fellow passengers.

And a recent news item on PBS about this issue said that in South Africa around a quarter of poor people fail to complete their TB treatments. It didn't say whether this cohort was different in any quantifiable way from those who did complete their treatments.

So--this raises both moral and practical issues. On a purely practical basis there's an argument for denying medical treatments to poorly-educated people when the treatments are protracted and those who quit treatment early endanger others--unless those offering the treatment can hospitalize such patients for the duration of their treatment.

But they don't, and as a consequence a group of people trying to bring first world medicine to the third world are completely responsible for developing drug-resistant strains of TB that endanger the rest of the world. They have helped many deserving people. But I doubt that they've considered the price: these human TB time bombs.

Just another example of how much evil in the world is caused by saintly people who only wish to do good. Many do-gooders need to work harder at pondering the long-term consequences of their actions.

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