Abstract
Do medical professionals have a moral obligation to relieve the misery of people far away? The world is increasingly starkly divided geographically, into lands of long life and lands of early death. In the wealthy world, we are followers of Herman M. Biggs, who said that “health is purchasable”: medical professionals warn of impending epidemics and attend to reducing risk. In the poor world, people live in misery and die in disasters. The word “epidemic” is used to designate perceived threats to the long life of the wealthy, such as obesity, but “epidemic” is not applied to the sources of greater misery, including malaria, tuberculosis, and diarrheal diseases, which are responsible for more widespread mortality. The experience in 2009 with H1N1 flu illustrated the danger of the excessive focus on forecasts of epidemic risk: expenditures for flu vaccine were far in excess of spending for prevention of illnesses that cause greater mortality. In the end, billions of euros were transferred from public funds into private hands, yet flu immunization was irrelevant to the outbreak, and the outbreak was relatively mild. To learn from lessons like this, health professionals should attend to the main purpose of medical science: to make the world better.
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References
Nashe T. In time of pestilence, 1593. The quotation is from the second stanza.
US Central Intelligence Agency. Country comparisons: Life expectancy at birth. World Factbook 2009. Washington, DC, Central Intelligence Agency. at https://www.cia.gov/library/publications/the-world-factbook/index.html accessed 5 August 2010.
Shapiro RL, Hatheway C, Swerdlow DL. Botulism in the United States: A clinical and epidemiologic review. Ann Intern Med 1998;129(3): 221–228.
Vanderwagen WC. Testimony to U.S. Congress on safeguarding our nation: U.S. Dept. of Health and Human Services emergency preparedness efforts, 22 July 2010. Available at http://www.hhs.gov/asl/testify/2008/07/t20080722a.html accessed 5 August 2010.
Lipsman J. Disaster preparedness: Ending the exceptionalism, Medscape 3 Oct 2006, at http://www.medscape.com/viewarticle/544741 accessed 5 August 2010.
US Centers for Disease Control and Prevention. US obesity trends by state, 1985–2009, July 2010, at http://www.cdc.gov/obesity/data/trends.html#State accessed 12 August 2010.
World Health Organization. Information sheet on obesity and overweight, 2003, at http://www.who.int/entity/dietphysicalactivity/media/en/gsfs_obesity.pdf accessed 7 Aug 2010.
Wrigley EA, Schofield RS. The population history of England 1541–1871: A reconstruction. Cambridge, MA, Harvard University Press; 1981, pp. 234, 250.
Drolet GJ, Lowell AM. A half-century’s progress against tuberculosis in New York City, 1900–1950. New York: New York Tuberculosis and Health Association; 1952, p. 7.
Tomes N. The gospel of germs: Men, women, and the microbe in American life. Cambridge MA: Harvard; 1998, esp. 48–87 and 157–182.
Winslow C-EA. (1929) The life of Hermann M. Biggs, MD, DSc, LLD, physician and statesman of the public health. Philadelphia PA: Lea & Febiger; 1929, p. 120.
Sontag S. Regarding the pain of others. New York: Farrar, Straus & Giroux; 2003, 102–103.
UK National Statistics. Annual update: Births in England and Wales, 2006 Population Trends 2007;130:2 at http://www.statistics.gov.uk/downloads/theme_population/Births_update_web_supplement.pdf accessed 10 Aug 2010.
US Centers for Disease Control and Prevention. Press release: Increase in unmarried childbearing also seen in other countries, 13 May 2009, at http://www.cdc.gov/media/pressrel/2009/r090513.htm accessed 10 Aug 2010.
Hoffman E, quoted in Schulte B. The search for solutions. Washington Post 22 May 2008, at http://www.washingtonpost.com/wp-dyn/content/article/2008/05/09/AR2008050900666.html?sid=ST2008050900732, accessed 10 August 2010.
Stoate H. Quoted in (no author) Obesity threatens children’s lifespan. BBC News World Edition May 2002, available at http://news.bbc.co.uk/2/low/health/2606323.stm, accessed 10 July 2010.
American Public Health Assocation. Obesity and overweight children: The hidden epidemic. May 2008, at http://www.apha.org/programs/resources/obesity/defaulttest.htm accessed 12 August 2010.
Grundy SM, Brewer HB, Cleeman JI, Smith SC Jr., Lenfant C. Definition of metabolic syndrome: Report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Circulation 2004;109:433–438.
Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults: Findings from the third national health and nutrition examination survey. JAMA 2002;287:356–359.
Trevisan M, Liu J, Bahsas FB, Menotti A. Syndrome X and mortality: A population based study. Am J Epidemiol 1998;148:958–966.
Manson JE, Willett WC, Stampfer MJ, Colditz GA, Hunter DJ, Hankinson SE, Hennekens CH, Speizer FE. Body weight and mortality among women. N Engl J Med 1995;333(11):677–85.
Must A, Spadano J, Coakley EH, Field AE, Colditz G, Dietz WH. The disease burden associated with overweight and obesity. JAMA 1999;282:1523–29.
Allison DB, Fontaine KR, Manson JE, Stevens J, Vanitallie TB. Annual deaths attributable to obesity in the United States. JAMA 1999; 282:1530–38.
Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. JAMA 2002;291:1238–45 (correction published in JAMA 2005;293:298).
Flegal KM, Graubard BI, Williamson DF, Gail MH. Excess deaths associated with underweight, overweight, and obesity. JAMA 2005;293(15):1861–67.
Dietz WH. Health consequences of obesity in youth: childhood predictors of adult disease. Pediatrics 1998;101:518–525.
US Centers for Disease Control and Prevention. Early release of selected estimates based on data from the January-June national health interview survey, 20 December 2007, at http://www.cdc.gov/nchs/data/nhis/earlyrelease/200712_06.pdf accessed 12 August 2010.
US Centers for Disease Control and Prevention. Vital signs: State-specific obesity prevalence among adults—United States, 2009. MMWR 2010; 59 (early release):1–5.
Slynkova K, Mannino DM, Martin GS, Morehead RS, Doherty DE. The role of body mass index and diabetes in the development of acute organ failure and subsequent mortality in an observational cohort. Critical Care 2006;10(R137):1–9.
Livingston EH, Ko CY. Effects of obesity and hypertension on obesity-related mortality. Surgery 2005;137:16–25.
Gerberding J. CDC Director’s press conference, 2 June 2005, reported in Kolata G, CDC investigates outbreak of obesity. NY Times, 3 June 2005, A18.
Christakis NA, Fowler JH. The spread of obesity in a large social network over 32 years. N Engl J Med 2007;357(4):370–79.
Freud S. Totem and taboo, tr. James Strachey. NY: Norton; 1950, p. 76.
Campos P. The obesity myth: Why America’s obsession with weight is hazardous to your health. NY: Gotham; 2004.
Doshi P. Are US flu death figures more PR than science? BMJ 2005;331:1412.
Doshi P. Trends in recorded influenza mortality: United States, 1900–2004. Am J Public Health 2008;98:939–945.
Klevens RM, Edwards JR, Richards CL Jr, Horan TC, Gaynes RP, Pollock DA, Pardo DM. Estimating health care-associated infections and deaths in U.S. hospitals, 2002. Public Health Rep 2007;122(2):160–166.
US Agency for Healthcare Research and Quality. Budget estimates for appropriations committees FY 2011, online performance appendix. February 2010, at http://www.ahrq.gov/about/cj2011/cj11opa7.htm accessed 13 August 2010.
Lister SA, Redhead CS. The 2009 influenza pandemic: An overview. Washington, DC: Congressional Research Service Report; 2009.
Stein R. First swine flu vaccine arriving in cities. Washington Post. October 6 2009, A1.
USAID, US Department of State. Remarks of Paul Weisenfeld. U.S. relief efforts in Haiti six months after earthquake (press conference transcript) 19 July 2010, at http://www.america.gov/st/texttrans-english/2010/July/20100720141102su0.1158869.html accessed 13 August 2010.
Deutsche-Welle. France joins neighbors in sell-off of swine flu vaccine, 4 January 2010, available in English at http://www.dw-world.de/dw/article/0,,5079423,00.html accessed 13 August 2010.
Der Spiegel (no author). The swine flu business: Should Germany gamble millions on more vaccine? 9 September 2009, available in English at http://www.spiegel.de/international/world/0,1518,647666,00.html accessed 13 August 2010.
CBC News. Canada to order 50.4 million vaccine doses. 6 August 2009, at http://www.cbc.ca/health/story/2009/08/06/swine-flu-vaccine.html accessed 13 August 2010.
RNCOS. Global vaccine market forecast to 2012, 1 March 2010, at http://www.marketresearch.com/product/display.asp?productid=2621517&xs=r&SID=43635241-485810916-510472397&curr=USD accessed 13 August 2010.
Chan M. WHO Director-General’s letter to BMJ editors. 8 June 2010, at http://www.who.int/mediacentre/news/statements/2010/letter_bmj_20100608/en/index.html accessed 13 June 2010.
US Bureau of Justice Statistics. Gun violence, 2010, at http://bjs.ojp.usdoj.gov/content/glance/tables/guncrimetab.cfm accessed 14 June 2010.
Menken M, Munsat TL, Toole JF. The global burden of disease study. Arch Neurol 2000;57:418–420.
World Health Organization. Road safety is no accident, 7 April 2004, at http://www.paho.org/English/dd/pin/whd04_info.htm accessed 13 August 2010.
Cohen D, Carter P. WHO and the pandemic flu “conspiracies” BMJ 2010; 340:c2912 doi doi: 10.1136/bmj.c2912.
Snow CP. The two cultures. The Rede lecture, Senate House, Cambridge University, 7 May 1959. Text available in Snow CP. The Two Cultures and the Scientific Revolution. Cambridge: Cambridge University Press; 1960.
Acknowledgments
The author thanks Dr. Tom Jefferson for expert opinion and conversations about influenza immunization. Material in this chapter was originally presented at the Infection and Immunity in Children conference, Oxford, UK, 28 June 2010.
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Alcabes, P. (2012). Our Time of Pestilence: Purchasing Immunity and Ignoring the Misery of Others. In: Curtis, N., Finn, A., Pollard, A. (eds) Hot Topics in Infection and Immunity in Children VIII. Advances in Experimental Medicine and Biology, vol 719. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-0204-6_1
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