Tag: medical

Ebola Outbreak Kills an American, Highlights Need for Improved Travel Screening

On By The Social CriticIn Health & EnvironmentLeave a comment

A 25-year-old man who in March was diagnosed with tuberculosis was arrested some 15 miles outside of Bakersfield, California, after vacating a motel room in which he was ordered to remain while receiving treatment.

Half a world away, The World Health Organization has confirmed more than 800 Ebola cases in three West African nations. Thus far, one American has died and two more are gravely ill.

Appearing Tuesday, July 29 on CNN to address the concern that Ebola’s emergence outside of West Africa may be but one airline flight away, Dr. Marty Cetron, director of the CDC’s Global Migration and Quarantine Division, indicated that preparation, recognition and containment is “more important than speculating on propababilites of disease moving around by plane”.

The CDC describes the risk of Ebola showing up in the United States as “remote”. The American widow of a top official in the Liberian Ministry of Finance, whose spouse collapsed and later died, sees it differently. Decontee Sawyer told a Minnesota news station that the outbreak “is as close as the front door”.

The contrasts are stark: On the one hand, long-accepted efforts to contain the spread of TB have allowed for the arrest and forcible quarantine of an uncooperative patient in California. On the other hand, the CDC has done little more than issue an advisory to U.S. doctors regarding the West African outbreak. Notably missing from the CDC’s response is the means by which the agency is working to prevent Ebola’s emergence here on the home front.

Perhaps fear of public panic has shuttered what are, in fact, more proactive containment efforts behind the CDC’s closed doors. Whatever the case may be, the public face of the CDC on the heels of several domestic near-misses would appear to be oddly passive. Impacted nations in West Africa have begun to shut down borders and to screen prospective airline passengers, yet prevention efforts within the U.S. are at best low key. The CDC’s efforts to assure reporters that North Americans have little to fear may signal reassurance to some, but may also play like a case of institutional hubris: “It won’t happen here.” and “Our medical system is too sophisticated to have it go far if it does.”.

Anyone who has sought timely treatment from the Veteran’s Administration or shown up at a suburban emergency room, as I did earlier this year, without so much as an available wheelchair or gurney might beg to differ with the notion that the U.S. health care system is in any way, shape or form prepared for a natural disaster on the order of Hurricane Katrina, let alone global pandemic. But we live in a society in which saying that we’re safe often passes for the real thing, thanks to a coping mechanism known as the “normalcy bias“.

Call it denial or call it overconfidence, our vulnerabilities tend to remain unchallenged until the unthinkable occurs. Ebola notwithstanding, we remain at risk of “medical terrorism” — that is, terrorists’ use of infectious people as biological weapons. As efforts to board airliners with conventional explosives fail, it is not beyond the scope of possibility that terrorists will board seriously ill passengers on international fights as an alternative.

Isn’t it time we walked the walk of public safety, not merely talk the talk?

In view of the gaping security hole we have tolerated all these years as we focus on shoe and even cell phone bombers — and now with the impetus of the Ebola outbreak at our backs — might it be appropriate to implement a brief health screening, executed in tandem with the screening procedures international travelers are already accustomed to?

Step 1: Check for fever. There are non-invasive means of doing so, and as a timesaver this could be done while passing baggage through scanners.

Step 2: Using multilingual pamphlets as an aid, ask prospective international travelers six questions:

1) Have you or someone you are traveling with recently come into contact with an individual hospitalized for a communicable illness?

2) Have you or someone you have recently come into contact with experienced nausea or diarrhea, not related to a previously diagnosed medical condition?

3) Are you presently experiencing body aches not related to physical exertion or a previously diagnosed medical condition?

4) In the past 72 hours have you experienced unusually severe or persistent headaches, not related to a known condition such as a migraine?

5) In the past 72 hours have you developed a sudden, persistent or severe cough, not related to a previously-diagnosed condition?

6) Have you experienced rapid or severe irritation of the throat or skin within the past 72 hours, not related to a previously-diagnosed medical condition?

Thanks to technology, public health officials could be made available over Skype to address any questions that may arise out of such screening. Alternately, nurse practitioners could be employed by the Transportation and Security Administration (TSA) to evaluate travelers who are flagged for fever and/or for answering “Yes” to two or more questions indicated above. To be clear, these efforts would not reveal the cause or seriousness of such symptoms. Even so, with cancer patients, the very young, the very old and the immuno-compromised vulnerable even to ordinary communicable illnesses, a greater emphasis on infectious disease prevention can only help, not harm, society. In the broader view, moreover, efforts to normalize screening measures could perform a valuable public service. It could help drive home a universally-relevant message — that it is best to stay home while ill — and thus prime the public to take proper precautions and/or heed public health warnings in the event of a genuine pandemic threat.

Ebola in West Africa may indeed come and go, leaving the developed world largely untouched. But tragedies like this are opportunities, too. The Ebola outbreak highlights the need for authorities to make international travel by airline and cruise ship safer. Far from triggering panic, routine screening efforts are likely to become accepted in due time. In this way, should an even greater pandemic threat emerge, there will already be people and procedures in place to identify and curtail the spread of infectious diseases at international travel hubs — all without raising undo alarm. If public health officials are at all concerned that new or intrusive efforts to step up prevention will only provoke needless panic, a desensitizing strategy in which such screenings become the norm, not the exception, would go a long way toward putting to rest much of the debate: Do we act now or do we wait?

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We are the World — and the World Killed Michael Jackson

On By The Social CriticIn Art & EntertainmentLeave a comment

Michael Jackson, the “King of Pop“, made an untimely exit from the stage of life after suffering a cardiac arrest Thursday, June 25, Brian Oxman, a Jackson family attorney, reports. More shockingly, Oxman told a CNN reporter that he warned the Jackson family that the star may be headed for a fate not unlike Anna Nicole Smith, who died little over two years ago following prolonged prescription painkiller dependence. Smith also lost her teenage son to a fatal drug interaction in 2006. In Jackson’s case, Oxman says the entertainer suffered chronic pain from a multitude of former stage injuries, among them a fractured vertebra and a broken leg.

Prescription drug abuse often starts legitimately enough. Life happens. We suffer injuries and accidents. And we don’t want to live like cripples before our time. But oftentimes the so-called cure comes with its own consequences.

The similarity between the average Jane or Joe and the Jacksons of the world seemingly ends in the doctor’s office. The average American who suffers a chronic pain condition, whether it is arthritis or severe back pain, is more likely to end up disabled as opposed to receiving pain management that succeeds in restoring one’s lifestyle. Celebrities, on the other hand, encounter the opposite: Eager to satisfy the demands of their high-power clients whose careers and lives must go on in a very public fashion, doctors are less likely to deny their well-known patients powerful forms of pain relief whether such medications are needed or not. The assumption on the part of the medical establishment, ostensibly, is that successful people who “have it together” are not going to throw it all away in pursuit of an addiction. Far be it from the public, all the while, to view a figure who is vibrant, charismatic and larger than life as weak, sickly or disabled. With enough drugs to combat the pain, life goes on as normal — until the consequences catch up.

The exact cause of Jackson’s fatal cardiac arrest, to be clear, is not yet known. Some suspect the superstar’s undernourished appearance, implying that the rigors of Jackson’s physical training program in preparation for a comeback tour are to blame. To that we now add the all-too-familiar specter of drug dependence. Let us not forget that Los Vegas headliner Danny Gans also died this month as a result of cardiac toxicity brought on by a legitimately prescribed painkiller. This is a story, sadly, that never ends. And that is the point. It should end, but it doesn’t.

Aside from the obvious — that drugs, even legitimately prescribed drugs — may lead to an untimely end, what does this tragedy have to teach us?

When singing sensation Susan Boyle, a contestant in the Brittish equivalent of “American Idol”, showed signs of stress and later admitted herself to a treatment facility, Simon Cowell, among others, cited her fragile mental state as the cause of her concert cancellations and erratic moods. In truth, however, the spotlight drives a lot of performers and public figures nutty. Eccentric behavior is much easier to brush off, however, when blamed on prescription tranquilizers, alcohol or illicit drugs. From Elvis Presley to Marilyn Monroe, celebrities of all generations, it seems, are pressured — if not explicitly than implicitly — to turn to drugs for answers rather than to allow anyone to see that their bodies, if not minds, cannot keep up with the frenetic pace of their lives. Were each of them, like Boyle, “unfit” and “ill prepared” for their success? Or would it be more accurate to say that this is the dark underbelly of celebrity — the reality check our celebrity-obsessed culture never confronts no matter how many famous people succumb to the inability to live up to their own or others’ expectations?

Let’s face it: We never want to accept deblitation. We never want anyone to grow old. But for a few fashionably naughty exceptions for sex, drugs and rock ‘n roll, we never want anyone to seem all that human, either. As the Susan Boyle “case study” shows, cruelty is aimed at those who are too old, too overweight, too fragile, too offbeat, too ordinary. We like our stars airbrush perfect, immune from the unglamorous slowdowns associated with age and chronic medical conditions. From concert promoters to ordinary fans, we the people seem more inclined to tolerate rumors of substance abuse than to accept the news that a superstar has reached the limits of their physical and mental stamina. Drug abuse and stardom may go hand-in-hand, whereas honesty doesn’t get you very far in a world where image is the only reality that counts.

To live in the fishbowl that is celebrity you have to be a little bit crazy. And if you aren’t off kilter to begin with, living in the glare of paparazzi camera flash will surely induce as much. But the blame belongs to society too. We are the ones who idolize celebrities’ lives, never willing to hear the admission that the pressures are too much and they can no longer live up to fans’ expectations. Doctors, too, are not immune. There’s a pill for that. A surgery that will fix it. And an expectation that enough is never enough.

We are the world — and the world killed Michael Jackson.

May he rest in peace.

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