Tough Call?
Radley Balko | April 3, 2007, 2:50pm
This is pretty horrible :
Behind the county hospital’s tall cinderblock walls, a 27-year-old tuberculosis patient sits in a jail cell equipped with a ventilation system that keeps germs from escaping.
Robert Daniels has been locked up indefinitely, perhaps for the rest of his life, since last July. But he has not been charged with a crime. Instead, he suffers from an extensively drug-resistant strain of tuberculosis, or XDR-TB. It is considered virtually untreatable.
County health authorities obtained a court order to lock him up as a danger to the public because he failed to take precautions to avoid infecting others. Specifically, he said he did not heed doctors’ instructions to wear a mask in public.
Now this guy softened the hard question a bit by refusing to take what I'd say were relatively unobtrusive precautionary measures. But I'm curious, what do H&R readers make of the collision of individual rights and the state's arguable (I'd say convincing) duty to protect us from highly-communicable, untreatable fatal diseases?
The idea that someone who's done nothing wrong could be condemned to an isolation cell for the remainder of his life is pretty horrifying. And certainly we should be thinking ahead, so that those who are infected with the allegedly approaching "super bugs" are as comfortable as possible. But even then, is it acceptable to lock someone up in isolation for life? What criteria must a disease meet to merit such drastic containment measures?
And what measures should we put in place to ensure that the government doesn't abuse whatever powers it claims (or if you're idealistic, that we grant it) in the name of fighting these diseases?
I don't have answers. Just questions. Have at it.
tros | April 4, 2007, 8:18am | #
http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2007/03/04/MNG2EOF84U1.DTL&type=health
The government is on track to approve a new antibiotic to treat a pneumonia-like disease in cattle, despite warnings from health groups and a majority of the agency's own expert advisers that the decision will be dangerous -- for people.
The drug, called cefquinome, belongs to a class of highly potent antibiotics that are among medicine's last defense against several serious human infections. No drug from that class has ever been approved in the United States for use in animals.
The American Medical Association and about a dozen other health groups warned the Food and Drug Administration that giving cefquinome to animals would probably speed the emergence of microbes resistant to that important class of antibiotic, as has happened with other drugs. Those super-microbes could then spread to people.
Echoing those concerns, the FDA's advisory board voted last fall to reject the request by InterVet Inc. of Millsboro, Del., to market the drug for cattle.
Yet by all indications, the FDA will approve cefquinome this spring. That outcome is all but required, officials said, by a recently implemented "guidance document" that codifies how to weigh threats to human health posed by proposed new animal drugs.
The wording of "Guidance for Industry 152" was crafted within the FDA after a long struggle. In the end, the agency adopted language that, for drugs such as cefquinome, is more deferential to pharmaceutical companies than is recommended by the World Health Organization.
Industry representatives say they trust Guidance 152's calculation that cefquinome should be approved. "There is reasonable certainty of no harm to public health," Carl Johnson, InterVet's director of product development, told the FDA last fall.
But others say Guidance 152 makes it too difficult for the FDA to say "no" to some drugs.
"The industry says that 'Until you show us a direct link to human mortality from the use of these drugs in animals, we don't think you should preclude their use,' " said Edward Belongia, an epidemiologist at the Clinic Research Foundation in Marshfield, Wis. "But do we really want to drive more resistance genes into the human population? It's easy to open the barn door, but it's hard to close the door once it's open."
