My defense of the TB guy has drawn a lot of traffic and some of the comments imply my view is colored by a case of misplaced compassion. Since I’m a physician I won’t shy away from being called compassionate. Whether true or not in my case, it is a desirable trait for a doctor and nothing to be ashamed of. However I don’t think my opinions about this case are due to sentiment. I would defend them on the grounds they are sound judgments of a public health professional. Since I am unlikely to convince the doubters by repeating my arguments (you can find them at these links), I will do something else. I’ll let other public health professionals repeat my arguments.
In particular, I’ll let the Center for Biosecurity at the University of Pittsburgh Medical Center do it. They do not reference this blog as one of their sources and despite the close similarity to my arguments I am quite confident they arrived at them independently. I am not always in agreement with the Center. In particular I do not always agree about the value of biodefense. One thing for sure, however. They cannot be accused of sentimentality. They are seasoned and hardheaded public health professionals who know this area well. Here’s some excerpts from what they think about the TB story, which you can compare with my version. The whole thing is here if you wish to satisfy yourself I haven’t taken things out of context (I have omitted their discussion of the need to invest in diagnosis, treatment and prevention of infectious diseases of global significance like TB):
Careful examination of government and public responses to the recent case of Extensively Drug-Resistant Tuberculosis (XDR-TB) is critical. However, in the course of this assessment, there has been so much focus on border control issues that the broader public health implications of this case and the associated events might be missed. Specifically, this case raises important questions about the nation’s ability to detect and respond not only to tuberculosis (TB) outbreaks, but also to other major outbreaks of serious infectious diseases, whether they are the result of a natural epidemic or a bioterrorist attack.
[section of background on TB prevalence, mortality and drug resistance omitted]
The fact that one person with XDR-TB flew on several commercial flights should not be as alarming as the fact that millions of contagious TB patients are intermixing with and potentially exposing uninfected people every day throughout the world. There can be little doubt that many TB patients (including those with MDR-TB and XDR-TB) have traveled many times locally by public transportation and over longer distances by airplane.
According to news reports, the patient recently diagnosed with XDR-TB was first suspected of having TB in January 2007 on the basis of an incidental finding on a chest x-ray. It appears that he had an appropriate routine and methodical work-up that resulted in a diagnosis of XDR-TB 5 months later. This long path to diagnosis is a direct result of the current state of TB diagnostics.
The patient with XDR-TB has said he decided to fly home from Europe against the direction of public health authorities because he was frightened that he would be confined to an Italian hospital, that he would never get home, and that he would never get well. This refrain is common in the history of epidemics. When people become so frightened by the possible government reaction or by the possible public reaction to their illness, they avoid medical attention and sometimes disappear. This has been documented in past U.S. smallpox outbreaks,in the HIV/AIDS epidemic, and in the 2003 SARS outbreak in Beijing and Hong Kong.
If infected individuals are made into public scapegoats, it may increase the likelihood that in the future people with highly contagious diseases will be reluctant to seek proper medical attention. It is in society’s great interest to avoid doing anything that makes it so frightening to get diagnosed and/or treated for infectious diseases that people decide not to seek diagnosis and care. Addressing this critical issue is not only a matter of common decency–it is also a matter of collective enlightened self-interest.
You may still disagree with me. But you will also be disagreeing with other public health professionals about a public health problem.
Update: Other posts here.