Urban Epidemics

The first decade of the emergence of HIV/AIDS epidemic was marked—perhaps marred—by the emergence of terrible stigmas against those who were infected with the disease, or associated with the disease. However, to say that the stigmas that came from the HIV/AIDS epidemic were something new and something to do solely with the emergence of this new disease is not correct. Rather, the stigmas associated with the emergence of HIV/AIDS were, as we well recognize today, merely a repackaging of the stigmas associated with certain groups of people. Primarily, this was homosexual individuals, but also individuals who engage in risky sexual behavior or peruse illegal drugs.

Dr. James Colgrove, in Epidemic City addresses the early years of the HIV/AIDS epidemic in his fourth chapter. He describes the various reactions to the disease, primarily within New York City. In particular, he discusses the dispute between the city’s Board of Education and two individual community school boards in 1985 over whether children infected with HIV/AIDS should be allowed to attend school. Of course, looking back upon this, we can easily recognize the flawed understanding inherent in suggesting that individuals possessing a disease spread only through direct exposure to certain bodily fluids. We recognize this dispute as a manifestation of the stigma harbored against those infected with the disease.

The source of the stigma is readily understood from the early history of the disease’s recognition. Dr. Jeffrey Week’s in his chapter “AIDS and the Regulation of Sexuality” describes the affiliation of the disease with homosexual individuals. He describes how the public health mobilization to this disease (in England, but we understand the same principles to have been at work in the United States as well) was closely intertwined with (changing) social and political approaches to homosexuality. So much so, in fact, that the disease was originally called Gay-related Immunodeficiency Disease.

Looking back upon the history of the disease, many would find fault with the early reaction to the disease. We recognize the unfairness of the close association of the disease with the homosexual community, and to a lesser extent, needle-drug users (and by extension, the poor/minority individuals stereotypically considered inclined to be needle-drug users). However, the next two decades, right until the present day, have not revealed any willingness to divorce the HIV/AIDS stigmas from the homosexual or poor/minority stigma.

Rather, our society may be promoting a perpetuation of the harmful convolution of HIV/AIDS and certain populations. We do so in that we characterize the evolution of the HIV/AIDS epidemic and the social views associated with it as connected to the evolution of social views regarding homosexuals (and needle-drug users). Both Dr. Weeks and Dr. Ronald Bayer, in the readings, reinforce this notion. Dr. Bayer makes particular mention of milestones in the history of social and political views relating to homosexuality such as the Supreme Court case Bowers v. Hardwick (imagine if Dr. Bayer had written following Lawrence v. Texas), proving that tracing the history of views pertaining the HIV/AIDS epidemic is contemplated through the lens of changing views on homosexuals.

In my view, it is necessary to separate HIV/AIDS and its stigmas from homosexuality or needle-drug users and their stigmas. HIV/AIDS is, and has always been, a terrible debilitating disease. As a society, we must accept those suffering from the illness with the utmost compassion and do our part to ensure the availability of treatment and education to those afflicted. We must realize that infected individuals do not present a bald threat to public health. There is no acceptable reason that we would look on the predicament of HIV/AIDS with anything less than total empathy.

Approaches to homosexuality, drug use though, are much more nuanced and controversial. Acceptance of homosexuality is neither absolute nor universal and cannot be in a society that is largely defined by religious and moral sensibilities. While we cannot discriminate against homosexual individuals, views that proscribe homosexual behavior are valid. While many push “needle-exchange” programs as progressive and successful—and they surely are—they shirk the glaring illegality (and hence, immorality) of drug use.

Therefore, to fully appreciate and properly approach the HIV/AIDS epidemic we must separate the wrong and harmful stigmas associated with HIV/AIDS from the complex societal views on homosexuality, drug use, and deviation from monogamous behavior.

HIV/AIDs has been, for the past three decades, one of the most recent epidemics and quite possibly the most feared contagious disease. AIDs is unique compared to other contagious diseases that were a great challenge to bring to an end, such as cholera, due to its infection patterns and delayed symptoms. HIV infection and transition into AIDs is unique, because the disease attacks the immune systems of the host, allowing other opportunistic infections to easily attack and kill the host. What has made HIV/AIDs so feared in society is its base in unaccepted social behaviors, and the stigma that is associated with these behaviors. These behaviors include homosexuality, injection drug usage, and the sex trade (prostitution). These groups were initially first groups to be affected by AIDs, which allowed the stigma of AIDs to grow. However as time went on, the disease also affected heterosexual people as well. It became public knowledge that this was a contagious disease, and one that did not discriminate amongst social groups. This fostered fear of the disease, and logically fear and stigma unknowingly work against any positive measures in testing, treatment, and rights of people living with AIDs.

 
From the article “Routine HIV Screening — What Counts in Evidence-Based Policy?” in the New England Journal of Medicine, by Ronald Bayer and Gerald Oppenheimer, we are given a glimpse of the Public Health community as well as the distinct division within it. The CDC continues to argue for routine testing, especially after the passage of the “Affordable Care Act” in 2010, as a necessary preventative measure. The U.S. Preventative Services Task Force, besides having a long and annoying bureaucratic name, has since 2005 determined that the evidence present did not justify routine testing as a preventative measure. We are exposed to the age old public health dilemma of doing what is scientifically exact, or doing what is necessary to fight the epidemic and save populations from harm. Since 2011, the USPSTF has been called to reconsider its 2005 determinations, to allow routine HIV screening to be considered a preventative measure, and therefore covered by the ACA.

Many in this class have experienced the AIDs epidemic’s later effects, which manage to be less surrounded by stigma and more involved in preventative measures and the search for a vaccine. In the year “1992, AIDs had become the leading cause of death of men between the ages 25 and 44” (Bayer, Oppenheimer). Most of us in the class were born in 1993, and it’s interesting to see how our perspectives of the disease differ from those who were alive when the disease first appeared in the 1980s. When I asked my father about his perceptions of the disease when it first came to light he responded “I wasn’t really worried, it was said to only affect gay men so I didn’t really think much of it.” Now we aren’t as much worried, however we understand that the disease is completely capable of being transmitted to anyone* and that we must act responsibly and using preventative measures to ensure we do not get or transmit the disease. As of the CDC report of leading causes of death in males, all ages, all races, “HIV disease” does not even rank in the top 10. This says a lot about the advances in treatment and how profoundly effective it has been. As Bayer states in “Public Health Policy and the AIDs Epidemic,” “the broad political context within which decisions will be made about the availability of resources for prevention, research, and the provision of care, will be affected by the changing perspective on AIDs.” This statement alone justifies that the decrease in stigma and fear, coupled with increase in education of the disease (changing perspectives), has resulted in the advancements in treatment, and continues the government funding for research for a cure. As preventative measures go, the ACA encompassed most, but as long as routine testing is fundamentally left out of the preventative measures group, routine testing will not be a significant preventative measure due to its patient cost and the amount of time it may take to show positive results.

 
From the Anastos article, “Women and AIDs,” we are presented with images and descriptions of the stigma that lies in AIDs. Anastos discusses the treatment of women infected with AIDs, and the how the AIDs stigma is reinforced by sexist and racist stigmas. Luckily as a society we have been moving constantly moving away from that stigma, to now promoting human and sexual rights of people with HIV/AIDs. People infected do have rights, we cannot just quarantine them or treat them like Typhoid Mary. We must treat them like humans, not criminals or agents of transmission. In part the increase and protection of rights for people living with HIV/AIDs may be due to the successes of the Gay Rights Movements, and legalization of gay marriage in several states including New York. Also, the fact that treatment decreases transmissions is key, because those who are undergoing treatment will also be following preventative measures against transmission. This brings us back to the routine testing argument. Imagine if everyone who was infected with HIV/AIDs knew that they were infected, and could use that information to prevent themselves from transmitting the disease. The disease would become almost nonexistent in any perfect scenario. Since we do not live in a perfect world, we can only attempt to use the same idea to decrease the amount of transmissions by about 20%. This is why routine testing of all adults in the U.S. is so important, and the difference between the cost of testing and the expected benefits in decreased transmissions is why it is still being argued.

In the 1950’s the cause of cancer was not yet well understood, and while statisticians had correlated cancer of the lung with smoking, a direct causative effect was not yet established. This week’s readings discuss the controversy surrounding smoking and a meta-issue that arises as a result of public health, stigmatization.

There has been a long history of stigmatization in public health. The poor, the foreign-born, and ethnic and racial minorities have all been the subject of scrutiny because of the negative connotations associated with them in terms of public health. In “Epidemiology in the United States after World War II: The Evolution of Technique”, Susser states that the obligation of epidemiologists is to “cultivate awareness and to see that what is learned is not misused”. While cancer of the lung was correlated with smoking, there was no concrete proof that tobacco smoke contributed to the development of carcinoma. Conflict and controversy erupted and in turn, public health interventions centered around denormalization and stigmatization instead to reduce smoking.

In “Smoking and Cancer of the Lung”, Berkson suggests that the controversy over linking smoking to cancer of the lung has the effect of an advertising campaign, and the tobacco companies benefited from the publicity. Here, Berkson argues that the publicity has not advanced public health and the larger danger lies in inciting “an epidemic of cancerphobia and causing neuroses in people who continue to smoke”.

In the Bayer paper “Tobacco Control, Stigma, and Public Health: Rethinking the Relations”, the author introduces the idea of stigmatization in the context of public health. With the AIDS epidemic, the stigma attached to AIDS worked to buttress the “social subordination of those who were already marginalized”. The stigma associated with AIDS also had a large effect on those with the disease, their loved ones, and affected their decisions about seeking assistance. Bayer compares this to the stigma attached to smoking and asks whether the stigmatization of smokers is justified despite the risk of “exacerbating already extant social disparities or having long-term counterproductive consequences. “

In “Nowhere Left to Hide? The Banishment of Smoking from Public Spaces”, Colgrove discusses the denormalization of smoking and its effect on the mental and physical health of smokers. Colgrove argues that measures to restrict smoking are paternalistic and overly restrictive and instead suggests that the central question in reducing rates of smoking should be “how far we want to go in reducing individual autonomy, including what can be perceived as self-destructive behavior.”

Denormalization of smoking has become the central prong of antitobacco efforts and while public health is largely concerned with minimizing actions that can have a detrimental effect, we must be aware that the same measures used to protect, can unintentionally cause harm as well.

In the early 1900s, when scientific research truly began being a systematic study, the American Medical Association (AMA) set up a list of regulations to follow when dealing with animal experimentation. It made it clear that the animals should not suffer. However, ethical codes were not truly followed until the 1940s when the AMA required consent of the subject and animal testing before human subjects were tested on. The opening of the Rockefeller Institute started of the era of animal testing. Anti-vivisection groups formed to prevent the testing on animals. They stressed that researchers were insensitive when it came to testing on children, when the Tuberculin experiment was being carried out. The Rockefeller Institute was criticized because its founder, John D. Rockefeller, was deemed a robber barron who only started the organization to prolong his own life. This short history shows how researchers put their own agendas before ethics. As with public health, researchers sometimes put the needs of the many before those of the few. Politics and economics comes into play because sometimes, good intentions may be tarnished by the man in question’s past, namely John D. Rockefeller. Pharmaceutical companies still come under fire for tainting medical data and making a drug look like it works better than it really does, just because a successful drug can make billions of dollars in profits, making the lengthy, expensive trials worth it.

What we learned from the Tuskegee Syphilis Experiment had to be how not to conduct clinical trials. Even though ethical guidelines were already in place, there were so many things wrong with how the experiment was conducted, perhaps the biggest being that there was already an effective treatment against Syphilis at the time the experiment began, meaning that the results would just show what would happen if the disease was not stopped. The sample of individuals was not diverse; it targeted poor, black males, who were said to have “strong sexual appetites” (Brandt, 3). The sample was chosen based on stereotypes and not on a scientific basis at all. The participants were not informed properly. They believed they were receiving free treatment but they clearly were not. The physicians also found the subjects more interesting post mortem, waiting for the autopsies more than result while the subjects were alive. Fearing that the hospitals would lose its black patient population if this fact got out, the researchers kept this step in the procedure a secret. It is not clear if even the blacks helping the physicians were aware of this. In the conclusions, the doctors admitted that they had contributed to an early death of the patients. Even after a CDC panel met to discuss the trials, they recommended continuation. All in all, the Tuskegee Syphilis Experiment showed more about race relations at that time than about the disease itself.

In America, the ACTG 076 is “the standard of care for HIV positive women” (Lurie & Wolfe, 853). It reduced the incidence of HIV infection of one in every seven infants born to HIV positive mothers. However, this treatment is too expensive in places like Sub-Saharan Africa. There have been debates about how to best go about researching for a less expensive alternative to reduce perinatal transmission of the virus. In 1994, World Health Organization came up with the statement that placebo controlled trials are the best at determining whether the potential treatment is effective. But the use of a control group in this manner is unethical when a potential treatment method is being proposed. In trying to find a less expensive or less toxic regimen, how can researchers find solutions without compromising their ethical values? The answer may lie in the way the researchers plan their experiment. Instead of using a placebo group as a control, they can compare the standard, administering ACTG 076, with the new trial. This way, transmission can still be prevented and effective data can be compared. Some researchers are defending the use of placebos by saying that the unproven regimens or no treatment is the standard of care in place in that country so administering the placebo is the same as if they received the standard of care. The problem is that this is not based on scientific information but on economics. The government cannot afford to give expensive drugs to their people. The double standard is exposed when the “acceptance of a standard care that does not conform to the standard in the sponsoring country” (Lurie & Wolfe, 855). This means that some researchers get away with placebo driven trials because they are conducting it in another country where treatments are not the standard but they are ethically bound to ensure this does not happen. Those in poor nations are being manipulated into participating in research trials and setting an international standard of ethical research will ensure that this practice will not continue.

The selections covered in this week’s reading raise several questions. Are researchers justified in hiding information from test subjects if their research produces results that may save lives? Should research being conducted in third world countries be held to the same standards of studies being conducted in the US, even though they may have fewer resources than we do?

The Tuskegee experiment is a quintessential representation of the progression of ethical standards in research.  Funded by the United States Public Health Service (USPHS), the study examined few hundred black men who tested positive for syphilis, from 1932 to 1972.  Participants were chosen from five counties in the south, namely Tuskegee, Alabama, where high instances of syphilis were discovered.  An all black sample was chosen partially because researchers believed that the disease affected this population differently, as a result of both biological predispositions and social factors.  Participants were told that they would be treated for the disease and to not accept outside treatment.  Even with the discovery of penicillin as a known cure for syphilis, participants were denied access.  This was justified on the grounds that these “conditions existed ‘naturally’ and that the men would not be treated anyway” (8).  Clearly this was untrue, but performing the experiment under these terms resulting in, as asserted by Reverby, a “self-fulfilling prophecy” (8).

The study, as confirmed by the Tuskegee Syphilis Study Panel in 1972, was unethical on numerous grounds.  Informed consent was not provided, participants were not treated when remedies became available, control group members were simply added to experimental group if infected, and perhaps worst of all, researchers were essentially waiting for autopsies to confirm their results.  As Reverby reflects, “the Tuskegee study revealed more about the pathology of racism than it did about the pathology of syphilis” (18).  Not only were subjects poor and unassuming, they were uneducated on the nature of the experiment itself.

This study is proceeded by roughly three decades of intense debate over research ethics.  Concerns rose over whether employing animals or humans was more morally sound, as passionate disputes between vivisectionist and anti-vivisectionists dominated clinical studies.  Questions regarding animal welfare, ease of gathering results, the similarities (or lack thereof) in animals and humans, and financial gain all played into the development of newfound ethnical standards.

These concerns are further complicated when extending to research performed in Third World Countries.  According to Angell, participants must receive the best possible treatment available, even in the placebo group.  It is tempting for researchers to be careless in complying with ethical standards in the search of swift and clear results, arguing that those involved would not typically be receiving any treatment at all.  As Rivers argues, “unless the law winks occasionally, you have no progress in medicine” (Reverby 16).  As Reverby illuminates, just before the Tuskegee experiment, prisoners in Guatemala were horrendously inoculated with syphilis and subsequently treated with penicillin.  This study in particular demonstrates the importance of America’s ethical guidelines, although they were still not adequately followed.  However, the well being of those involved must always take precedence over scientific discovery. Lurie and Wolfe provide a solution to this dilemma, illustrating how a shortened regime of a proven solution, juxtaposed with the ordinary placebo can offer similar results without the ethical hurdles and excessive cost.

Domestically, more commercially based matters also exist, like the anti-smoking debate, coming to a head in 1964.  Common knowledge at this point believed smoking to be poor for one’s health.  However, Americans needed further statistical support to believe these rumors. The advisory committee, formed in 1962, determined that evidence is causational rather than correlational if it is:

“1. Consistent

2.Strong

3.Specific

4. Supportive of appropriate temporal relationships

5. Coherent” (Brandt 164)

However, even when smoking was deemed to directly result in adverse health effects, the surgeon generals warning initially only implied that smoking “May Be Hazardous to Your Health” (Brandt 165).  Years passed before this slogan was adapted to comply with its causative negative consequences.  Conflict arose and continues to occur over influence the government possesses over issues like cigarette smoking.  As Brandt explains, there is minimal support for an outright ban.  Nonetheless, the question remains whether the government is justified in outlawing the practice in public places.  The discussion again revolves around at what point a public health issue becomes a political responsibility.

In scientific research, there are almost always ulterior motives at play.  Researchers want to be commemorated in their field, special interest groups want to make a profit, and politicians want to adhere to public opinion.  Ethical guidelines are socially constructed, and thus are subject to the confusing, variances in human behavior.  In order to advance humanity as a whole, individuals often must make sacrifices and take risks in aiding the advancement of empirical research.  It is the responsibility of both government and the scientific community to regulate the system and ensure that all people, regardless of race, gender, ethnicity, or country of residence are fairly treated.   Nonetheless, the question I leave you with is this: is it ever acceptable to abandon some ethical guidelines for the benefit of society overall?

-Jacqui Larsen

This week’s readings explore the connection between immigration and stigmatizing immigrant groups as the root of certain diseases that have occurred throughout history. Since the founding of America up until the twentieth century, there had been a connection with “whiteness” and citizenship (Jacobson 31). Europeans felt that it was their right to conquer indigenous Native American groups because they saw themselves as reforming their “barbaric” customs and “heathenish” beliefs (Jacobson 31). By the nineteenth century, these reasons would morph into outright racism. A new scientific outlook was created, which provided an alternative to the religious beliefs held by Europeans in the seventeenth and eighteenth centuries. People were now ranked by their “capacity” and the idea of polygenesis emerged, which stated that people are so divergent that different groups may have different origins (Jacobson 32-33). The idea of polygenesis even influenced Darwin’s theory on natural selection and led to the rise of white supremacy.

The Irish immigration during the 1840s was the beginning of fragmentation within the white race. Prior to this time, the white race as a whole in the United States was considered to be superior to all other races, primarily because almost all were of Anglo-Saxon stock. However, the Irish were seen as barbarous and unsophisticated (Jacobson 38). This image of the Irish was also bolstered by the centuries-old animosity between the English and the Irish. As we progress further and further through immigration history, the fragmentation within the white race was further and further broken down.

A prime example of how Irish immigrants were stigmatized with certain diseases was the case of Mary Mallon, better known as “Typhoid Mary.” She was an Irish immigrant cook who worked for some of New York’s wealthiest families. Mallon was the first-known healthy carrier of typhoid (she did not have typhoid; she was perfectly healthy but as a carrier of the disease she had the ability to spread it). In each of the houses Mallon worked in, almost all of the inhabitants fell ill (or even died) from typhoid. There was no real proof that it was indeed Mallon spreading the disease, but because she was a lower-class Irish immigrant woman, she was seen as “dirty” and a carrier of disease. Mallon freely admitted that she rarely washed her hands, which only made things much worse for her. Mallon was then forcibly arrested and sentenced to permanent exile. There was never any concrete proof that Mallon was spreading typhoid, but her social standing and immigrant status did not help matters for her.

The polio epidemic of 1916 was another example of how immigrants were used as scapegoats for the spread of disease. At that time, polio was seen as a disease that afflicted only the unsanitary and the immigrants, which were often one and the same in the eyes of the higher classes (Rogers 115). Doctors, who knew next to nothing about polio, were surprised to find the disease more in “clean” children (the children of wealthy parents and who practiced good hygiene) than in “dirty” children (lower-class immigrant children). Despite this, doctors were still convinced that the disease began with immigrant children, especially the Italians. People so strongly believed that the Italians were the cause of the disease that public health officials closely monitored any public events held in Italian neighborhoods and would  forcibly inspect the homes of Italian immigrants. The Italians constantly denied any association with the disease and felt that these visiting nurses and public health officials might in fact be spreading the disease. Other immigrant groups, such as the Germans and the Eastern Europeans were also considered dirty, and the Jews were blamed for the spread of tuberculosis.

This stigmatizing of immigrant groups by association with certain diseases even goes on in the present day. In a 2007 episode of The Daily Show with Jon Stewart, Stewart addresses the topic of the tightening security of the U.S./Mexico border by stating that it is believed that Mexican immigrants are bringing diseases such as tuberculosis and leprosy back into the United States. He also spoke about the image of Mexican immigrants as gangsters, druggies, and rapists. It’s easy to accept the blatant white supremacy of the nineteenth and early twentieth centuries, but it is hard for us to realize that it is still in our culture, just much more subtle.

The question I want to close my post is one that was addressed in the “Typhoid Mary” reading: is it okay to take away the liberties of an individual for the sake of public health? Is it justifiable to suspect and stigmatize an immigrant group in order to keep the rest of the population safe? Just how far is too far when it comes to maintaining public health?

This week’s readings focused on the role of ethnicity in public health, namely the way that a certain people were blamed almost entirely for the spread of disease in an area. It seems expected that this would be a prevalent way of thinking in bygone eras, yet certain prejudices are, shockingly enough, alive today. From the first waves of immigrants to those arriving in the past decades, the readings detail the role of preconceived beliefs on theories of health.

The fact that others can blame a group of people for the outbreak of disease relies on the notion that some people are better than others. Matthew Jacobson’s chapters recount the conclusions of highly regarded scholars, such as Samuel Morton, Arthur Comte de Gobineau and James Crowles Prichard, of the superiority of the white race, and the subsequent inferiority of everyone else. Not only were other races physically unappealing in their perspective, they were mentally and socially underdeveloped. As time went on, this viewpoint was not limited to people of “uncivilized” countries but included all races that didn’t fit the stereotype. In the early nineteenth century, when the immigrant population in America increased exponentially, all people not of Anglo-Saxon origin were considered inferior, particularly the Irish and the Italians.

Not only were the Irish and Italians genetically inferior to the Anglo-Saxon stock, they were also predisposed to spreading deadly disease. According to Alan Kraut, much of the blame for the outbreak of polio fell on the Italians’ shoulders. Immigrants in general were highly suspect, regarded as carriers of disease from the cesspool of over-packed ships that brought them into the country, but Italians were on an especially low rung of the social hierarchy. They were described as “huddled together in miserable apartments in filth and rags, without the slightest regard to decency and health, they present a picture of squalid existence degrading to any civilization and a menace to the whole community.” In addition to their living conditions, their old-country customs, such as kissing the dead, were severely frowned upon as unhealthy.

Though the Italians and the filth they lived in were considered to be the major culprits of polio, and particularly infuriating ones at that because of the way they resisted interference by public health officials trying to contain the disease, it was eventually discovered that polio did not come from dirt. The experience of the Italians and other immigrant groups as a whole parallels the case of an individual widely known as Typhoid Mary.

Typhoid Mary’s infamous story goes that she infected hundreds of people by spreading her disease through the food she cooked and constantly eluding authorities who tried to contain her. Leavitt, however, seeks to tell Typhoid Mary’s untold story, namely that she was incarcerated for no reason at all. Typhoid Mary never actually had typhoid; she was merely a carrier of the disease and would only be a threat to other carriers. Yet she was subjected to capture, quarantine and humiliating tests, and upon being granted the release she fought for on the grounds that she was never to work as a cook, and breaking that promise, she was quarantined once more and never lived as a free woman again.

Mary’s story is a frightening one when we consider the lengths that officials took to secure their agenda. The measures they took were in the best interest of the general public, but that doesn’t change the fact that a person’s individual liberties were sacrificed for that goal, not to mention that accounts of her disease were greatly exaggerated. This seems to suggest that Mary, a coarse woman belonging to the working class, was somehow subhuman, and not granted the same rights as others.

These seem to be issues that belong to another day and age, but disease-related racial and ethnic prejudice is still around. The unrest Kraut refers to, when a mob of angry Haitian-Americans protested a policy which prohibited them from donating blood on the baseless assumption that a large percentage of Haitians were carriers of HIV, occurred a mere 12 years ago, in 1990. The Daily Show with Jon Stewart clip shows John Hodgeman reporting on the connection between illegal immigrants and disease such as leprosy and tuberculosis. Though the show is poking fun and these ridiculous claims, and decisive data clearly shows that the facts they are referencing are erroneous, this doesn’t change the fact that the news media literally reported that there have been 7,000 cases of leprosy in the past three years. The only redeeming thing we might say about today is that, instead of calling these people scholars, we refer to them as bigots, and regard their views with incredulity and scorn.

Dr. Joseph Goldberger was a physician employed by the government in the early 20^th century that worked tirelessly to study the disease of pellagra in the South. Goldberger was born in Hungary and emigrated to the United States at the age of nine where his family settled in the Lower East Side. Goldberger started his college education at City College, where he planned on becoming an engineer. However, in 1892, he transferred to Bellevue Hospital Medical College where he earned his M.D.

I found it interesting to note the relationship between government and public health in Kraut’s chapter about Joseph Goldberger. During the early 20^th century, the American South faced a huge public health problem: pellagra. According to the chapter, pellagra rates in Mississippi were huge: “in 1914, 10.954 cases of pellagra were reported to the Mississippi State Board of Health, compared with 6.991 for the preceding year. The number of deaths reported for 1914 was 1,192, compared with 795 for 1913. Officials could only guess at the number of cases that had not been reported.” (Kraut) Because of the huge numbers of pellagra in the South, the Surgeon General at the time assigned Joseph Goldberger to study and find a treatment for the disease.

The governor of Mississippi at the time, Earl Brewer, took a big political risk in helping Goldberger. There was a lot of political turmoil going on at the time because of an earlier incident where Governer John Slaton of Georgia provoked his state’s anger towards him for commuting a convicted murderer’s sentence. Brewer, despite the potential for backlash, did the same thing to help Goldberger. Brewer decided to commute the prison sentences of eleven Mississippi criminals so they could become human subjects in Goldberger’s pellagra study. Brewer rationalized this by having the benefits outweigh the possible problems. Brewer knew that having a treatment for pellagra would cause a huge increase in the workforce’s productivity and therefore would attract much more investment money into the South.

I found Brewer’s situation to be very interesting and drew many parallels to Mayor Michael Bloomberg and his public health initiatives. In terms of government and public health policy, lawmakers always have to choose between two things: the potential that there can be legal and political problems from passing public health policy and the potential benefits that can be gained when public health policy is effective. For Earl Brewer, on the one hand, he was knowingly and consciously releasing criminals back into society where they had the opportunity to return to a life of crime and cause problems for local law enforcement. Furthermore, he was also risking public denouncement by Mississippi citizens due to the current anti-government feeling in the South. However, Brewer found that these potential limitations were eclipsed by the potential health benefit. If Goldberger found the reason for pellagra and found a cure, thousands of people that were missing work and were taking up healthcare money could go back to work. This was mainly an economic move but had huge social ramifications as well.

Mayor Bloomberg’s situation is also quite similar despite there being an almost 100 year gap between Brewer and Bloomberg. In terms of the anti-smoking ban that I will be working on for the final paper, Bloomberg recognizes that banning public smoking in restaurants, bars and public parks can be considered an infringement on civil liberties. Who is he, as part of the government, to say that a person can and cannot smoke in certain places? Although these places are public, some may still consider these places not to be under the Mayor’s jurisdiction to ban smoking. However, on the other hand, smoking is a huge health problem for both those who smoke and those who do not. Smoking and tobacco use in general accounts for one in five deaths in the United States. A huge amount of health care money is also spent on treating those harmed by cigarettes (both smokers and non-smokers). After considering both the benefits and potential problems, Bloomberg has decided that he would rather risk public disapproval and enact the smoking ban than not. Something that I think opponents of Bloomberg and the smoking ban should keep in mind is that although the law can seem imposing and restricting for smokers, the potential health benefits are huge for not only smokers but also for secondhand smokers as well.