The Difference a Germ Makes

TB Andrew reminds us what a real public health threat looks like.

TB Andrew is no Typhoid Mary. Starting in 1900, Mary Mallon infected 47 people with typhoid fever while working as a cook, many of them after she had been warned she was a carrier and had promised to stop handling food for a living. At this point it seems unlikely that Andrew Speaker, the Atlanta lawyer who has been widely reviled for traveling by air after being diagnosed with drug-resistant tuberculosis, infected anyone.

Notably, both those who condemn Speaker's recklessness and those who sympathize with him agree the relevant question is the danger he posed to other people, which was the justification for his forcible isolation in a Denver hospital. At a time when everything from eating French fries to playing Grand Theft Auto has been labeled a "public health" problem, the case of the TB-infected traveler helps clarify the grounds for government interventions aimed at preventing disease or injury.

When Speaker left for his wedding and honeymoon in Europe on May 12, he knew he had a drug-resistant strain of tuberculosis but did not know he had extensively drug-resistant (XDR) TB, a rare variety that's very hard to treat. He had no fever, he was not coughing, and tests of his sputum found no TB bacteria. He says his doctors had assured him he was not contagious.

According to Speaker, local public health officials, while recommending that he not fly, repeatedly told him he would not pose a significant threat to fellow passengers. That account is confirmed by Speaker's father, who says he has an audio recording to prove it.

Speaker's father-in-law, a tuberculosis expert at the U.S. Centers for Disease Control and Prevention, did not try to stop the trip. "I would never knowingly put my daughter, friends or anyone else at risk from such a disease," he said in a prepared statement, suggesting he agreed the risk of contagion was negligible.

While Speaker was in Rome, the CDC informed him he had XDR TB, told him he was on the U.S. "no fly" list, and recommended that he report to an Italian hospital for indefinite isolation. Knowing his best shot at successful treatment was in Denver, Speaker took a circuitous route home, flying to Montreal by way of Prague and driving across the U.S. border.

Speaker and his family insist he never would have traveled if he thought he might transmit tuberculosis to others. His sputum continues to be clear of TB bacteria, and none of the people with whom he has had extended contact, including his wife, has tested positive for tuberculosis exposure.

In situations like this, there is room for argument about how to balance the safety of bystanders against the civil liberties of disease carriers. Even in the case of Mary Mallon, who apparently never accepted the idea that she could feel perfectly healthy but still pass typhoid on to others, the government's ultimate response—isolation for the rest of her life—seems excessive, especially compared to the treatment of other recalcitrant carriers.

But at least in dealing with potentially deadly microorganisms that move from person to person, the rationale for government action is to prevent people from harming each other. By contrast, much of what passes for "public health" today is aimed at preventing people from harming themselves.

Activists and politicians use the language of public health to legitimize government efforts to discourage a wide range of risky habits, including smoking, drinking, overeating, underexercising, gambling, driving a car without a seat belt, and riding a motorcycle without a helmet. Unlike typhoid fever and tuberculosis, the risks associated with these activities are not imposed on people; they are voluntarily assumed.

In a society that loses sight of that crucial distinction, the government has an open-ended license to meddle in what used to be considered private decisions. Anyone who exposes himself to the risk of disease or injury becomes a menace to public health.

© Copyright 2007 by Creators Syndicate Inc.

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