XDR TBC and the Fallacy of a Moat
Steven Miles, physician and ethicist from the University of Minnesota has given me permission to post here his retelling of a classical story and his challenging commentary to his colleagues which he sent to a bioethics listserv.
With admiration from Edgar Allen Poe:
THE "Red Death" had long devastated the country. No pestilence had ever been so fatal, or so hideous. Blood was its Avatar and its seal -- the redness and the horror of blood. There were sharp pains, and sudden dizziness, and then profuse bleeding at the pores, with dissolution. The scarlet stains upon the body and especially upon the face of the victim, were the pest ban which shut him out from the aid and from the sympathy of his fellow-men. And the whole seizure, progress and termination of the disease, were the incidents of half an hour.
But the Prince Prospero was happy and dauntless and sagacious. When his dominions were half depopulated, he summoned to his presence a thousand hale and light-hearted friends from among the knights and dames of his court, and with these retired to the deep seclusion of one of his castellated abbeys. This was an extensive and magnificent structure, the creation of the prince's own eccentric yet august taste. A strong and lofty wall girdled it in. This wall had gates of iron. The courtiers, having entered, brought furnaces and massy hammers and welded the bolts. They resolved to leave means neither of ingress or egress to the sudden impulses of despair or of frenzy from within. The abbey was amply provisioned. With such precautions the courtiers might bid defiance to contagion. The external world could take care of itself. In the meantime it was folly to grieve, or to think. The prince had provided all the appliances of pleasure. There were buffoons, there were improvisatori, there were ballet-dancers, there were musicians, there was Beauty, there was wine. All these and security were within. Without was the "Red Death."
It was toward the close of the fifth or sixth month of his seclusion, and while the pestilence raged most furiously abroad, that the Prince Prospero entertained his thousand friends at a masked ball of the most unusual magnificence. ... And now was acknowledged the presence of the Red Death. He had come like a thief in the night. And one by one dropped the revelers in the blood-bedewed halls of their revel, and died each in the despairing posture of his fall. ...
XDR TB is not a new act of bacterial creationism, it is a killing automaton which we have made as a living testament to our failure to detect and treat TB. It is not hard to treat TB, $25/cure suffices in developing countries. We locked ourselves in game rooms to fret about face transplants, reality television, and fantasy sports. Globally TB treatment is in shambles, few cases are found, fewer than 30% of those found complete therapy. International agreements, like the bioethics ignored TRIPS, have put the cost of routine treatment out of reach of those most likely to be infected.
XDR TB is in 37 countries at least. Now a telegenic and selfish yuppie couple, one of Prince Prospero's favored guests, show the fallacy and porousness of our "castellated abbey."
An idiotic press and pithed congressmen demand to know why we did not build a better moat so that our slumber party could proceed without being so rudely disturbed.
Will the bioethicists say "Here! Here!" ?
I suggested to Steve that it was my impression that our current U.S. administration was, perhaps until recently, presenting the issue of greenhouse gasses leading to global warming with the same "moat-like" defense. He replied "On global warming, the US has acted the same way, ie Kyoto protocol, although the problem is much more complex and less amenable to rectification. TB treatment is especially infuriating because TB treatment was available, affordable. TB eradication was recognized as needed; it was proposed and it was possible. XDR-TB was the predictable alternative outcome."
By the way, for those of my visitors who don't know to what Steve referred to as "TRIPS", the acronym stands for "Agreement on Trade=Related Aspects of Intellectual Property Rights". This was the international agreement that some felt had prevented AIDS victims in developing countries to get the best AIDS therapy.