Tuesday, June 5, 2007

Our view: Disease fight depends on law as well as medicine

Many of the old scourges of mankind, once beaten down to near extinction, are making a comeback. Diseases such as tuberculosis and malaria have morphed into new, drug-resistant variants. Childhood diseases such as measles, mumps and scarlet fever are on the rise as parents have become less vigilant about vaccinations. Newer threats such as SARS and avian flu loom.

Some of these diseases are highly infectious and deadly. In the late 19th century, tuberculosis was a leading killer in the United States. It still kills 2 million a year, mostly in the undeveloped world. Public health officials fear that, with the ease of worldwide travel today, new drug-resistant strains of the disease could spread across the country.

Last week's globe-trotting adventures of a Georgia man with a dangerous form of tuberculosis illustrate that infectious disease is a challenge not only for public health but our legal system as well.

Andrew Speaker had been told he had tuberculosis before he boarded a flight to Europe for his wedding and honeymoon. Health officials say they advised the 31-year-old lawyer not to fly because he risked infecting others. Speaker says he received no such warning.

After hopping around Europe, Speaker was reached in Rome by health authorities who confirmed he had a rare, extensively drug-resistant form of TB. They ordered him to turn himself over to Italian health officials and to stay off commercial flights.

Speaker said he feared for his survival without U.S. medical care. So he boarded a flight from Prague to Montreal and drove back into the United States. He voluntarily entered a hospital in New York. Health officials flew him under armed guard back to Atlanta before sending him to a Denver hospital specializing in TB treatment.

Authorities are searching worldwide for the innocent people Speaker may infected on his selfish jaunt.

Speaker is under the first government-ordered quarantine since 1963. He may have to remain in the hospital for several months, whether he wants to or not.

So far, Speaker is cooperative and apologetic.

But what happens if Speaker - or some subsequent TB patient - grows tired of government-ordered quarantine after a few weeks and claims his or her "rights" are being violated? Given modern courts' distaste for even the most minor restrictions on individual behavior, what are the odds a judge turns such a patient loose to wander freely among the public?
Quarantine is an effective way to prevent a highly infectious disease like tuberculosis from spreading like wildfire. Given the opportunity to treat cases on a small scale, doctors can keep the problem under control.

The question is: Can Americans count on their legal system to give their health system a fighting chance?

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