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Tuesday, September 4th 2007

Public Health Crushes Liberty In WWE Cage Match

I’m really fascinated by when public health comes into conflict with personal liberty. You can image where I fall in the debate. The public health risk needs to be remarkable to infringe upon personal liberty. There may be a place for criminalizing knowingly exposing people to a dangerous health risk, but acting preemptively is a slippery slope.

Minority Report?

I bring this up because we have a story of a scared teenager with TB trying to return to his home in Mexico and instead ending up in a Georgia prison.

They put Santos in jail Friday evening, in a rare act of a government agency confining a sick person. Santos is the only inmate in a special medical isolation cell designed for inmates with contagious conditions. The cell, which measures about 15 feet by 20 feet, has a special ventilation system that keeps the air from reaching other inmates.

The 5-foot-5 teenager has a toilet, sink, bed and a mirror made of polished metal. Two deputies guard him and the other medical inmates.

[T]he county health attorney, said Santos was detained because he is a public health threat.

“He has active, contagious TB,” Will said Saturday. “He is at risk of communicating that with anybody he comes in contact with.”

Will said Santos is being held under a court order for confinement. He’ll stay in that cell until either he starts cooperating and accepting treatment, or a judge makes some other decision at a Sept. 5 hearing. At that commitment hearing, the judge could decide to place him in a hospital with security.

In a bit of a surprise I’ve actually cared for my share of TB patients since I’ve started my rotations (here is hoping my ppd doesn’t convert next year) and I think I’ve got a sense of the public health risk.

While ‘casual’ contact is a risk factor for catching TB from someone who is contagious (see here and here) the odds of getting a really bad disease from such are still remarkably small. The role forced treatment, observed treatment has played in killing the great TB epidemics in the first world is minimal. The applause for that instead goes to education, to the fact effective treatment now exists, to sanitation.

Would there be more cases of TB in this country if the government didn’t commit TB patients against their will; if the government didn’t force TB patients to be registered; if the government didn’t force observed treatment on TB patients? Of course. But the speed limit could be 15 miles per hour as well to save lives. We could always be safer at the expense of something else in life.

A third of the world is infected with TB. Unless they’re immunocompromised only 5-10% will ever become symptomatic.

Even with that out there this kid got to sit in a prison cell because he didn’t want to swallow some pills? Hear the sarcasm: It’s wonderful the value we put on people’s liberty.