Getting What We Deserve: Health and Medical Care in America

Notes

115 6 Notes Chapter 1. Genesis 1. The first major outbreak of plague followed the return of Genovese merchant ships to Sicily from the plague-wracked Crimea in October 1347. By 1351, Florence’s population had been cut in half. In parts of Italy, France, and Spain, 75 percent of the population perished. The pestilence returned repeatedly over the next couple of centuries, more or less disappearing as a serious health threat when transmission declined. For the most part unknowingly, humans erected more effective barriers between themselves and disease-carrying rats: houses were sturdier structures; the gray, ground-burrowing rat replaced the brown house rat as the dominant species; and better sanitation, quarantine, and other public health measures were deployed more widely and effectively. Few modern depictions of the cultural dislocation and abject fear generated by the fourteenth-century plagues match Ingmar Bergman’s classic film from 1957, The Seventh Seal. 2. C. P. Snow, The Two Cultures (Cambridge: Cambridge University Press, 1998), 83. 3. Rousseau, quoted in W. H. Foege,“In search of a national agenda for international health problems,”American Journal of Tropical Medicine and Hygiene 42 (1990): 293–97. 116 Notes to Pages 9–19 4. J. B. McKinlay and S. M. McKinlay,“The questionable contribution of medical measures to the decline of mortality in the United States in the twentieth century,”Milbank Memorial Fund Quarterly: Health and Society 55 (1977): 405–28. Chapter 2. Disease Is the Sum of All Evils 1. Even “ordinary”tuberculosis now requires long treatment with multiple antibiotics to ensure a cure. Unfortunately, patients feel much improved long before their six- to nine-month course of treatment is completed. Every time a patient fails to complete the treatment because he or she is feeling better, the few remaining, hardy tubercle bacilli receive a reprieve—and all too frequently re-emerge, months to years later, resistant to everything in our antibiotic arsenal. 2. The strategy on which the entire global eradication effort had originally been based was to vaccinate everyone. Unfortunately, public health programs never reach everyone. A sample survey of the population of Delhi, conducted before the initiation of a program meant to vaccinate everyone in the city, indicated that 85 percent of the population displayed the residual scars of prior vaccination. After the intensive campaign reportedly vaccinated more than 100 percent of Delhi’s population , the prevalence of vaccination scars remained unchanged, at 85 percent! One can never come face to face with much more than 85 percent of a population, whether for a health intervention or for an electoral campaign. 3. More than 90 percent of U.S. children receive their recommended immunizations. But those who don’t, often clustered in communities of doubters, risk becoming infected (often by an unimmunized individual returning from overseas). A local outbreak then threatens the lives of those too young or too immunologically compromised by illness to be vaccinated. Parents who refuse immunizations exemplify the inequitable nature of the “tragedy of the commons.”They withhold immunization from their children to preclude the rare possibility of vaccinerelated complications, trusting that immunization of other parents’ children will protect theirs from the spread of disease—a perceived personal gain at the expense of the public’s good, except their child remains at risk! During 2008, the United States experienced more mea- Notes to Pages 20–45 117 sles cases than during any year in recent memory; unimmunized children were twenty times as likely to become ill as those who had received their measles “shots.” 4. Drs. Luc Montagnier and Françoise Barré-Sinoussi received the 2008 Nobel Prize for having discovered the HIV virus in 1983. 5. What we can predict is that new influenza viruses will constantly emerge. During April and May of 2009, as page proofs for this book were being assembled, a novel (“swine”) influenza A (H1N1) virus emerged in the Americas and quickly circled the globe. It also stole the headlines from avian (H5N1) influenza. While the novel influenza (H1N1) virus is far more contagious than avian (H5N1) virus, so far it is (thankfully) much less lethal. It also remains sensitive to Tamiflu. But seasonal H1N1 was also sensitive during the 2007–2008 flu season but now is almost entirely resistant. 6. Dr. Harald zur Hausen, of Heidelberg, Germany, received the 2008 Nobel Prize for having discovered that human papilloma virus was responsible for cervical cancer and that some strains were...