Tuesday, April 03, 2007

Disappearing the sick

You may have heard about the increasingly-common practice of jailing people carrying highly-contagious, drug-resistant tuberculosis. I've seen more than one news article on the subject over the past year, but was really surprised when I heard this report on NPR yesterday, where the reporter was unable to get ahold of the patient, Robert Daniels, and had to resort to slipping her number to him through a messenger so he could call her collect, only to be cut off after ten minutes. He's been totally isolated in a criminal facility because he happened to catch the wrong bug.

While I recognize the real danger someone unknowingly or recklessly spreading dangerous diseases, I just can't believe that this is the best approach. A few years ago, Moscow had a with similar attributes, where a local man was convicted on felony charges of "knowing he was HIV-positive and transferring or attempting to transfer body fluid to women in Moscow without informing them he was infected." The problem with this when it comes to actually stopping the spread of disease is that if the man in the HIV case, Kanay Mubita, had never been tested for HIV, he would never have gotten in trouble. It creates a perverse incentive against being tested.

On the other hand, I do recognize that knowingly exposing others to deadly disease is not behavior that should go unpunished. If we're going to make what Mubita did a crime, we also need to make HIV testing mandatory. And if we're going to jail people like Daniels, we need legislation that defines his behavior as criminal, and to try them in court. I would accept some distinction between diseases that manifest themselves obviously (like TB) and those that one might not know they were carrying. But as it is, there are plenty of idiots out there who don't wash their hands before leaving the bathroom or undercook hamburgers, and they're not facing jail time. Mubita and Daniels have both put people around them at risk, but unlike the guy who didn't wash his hands, they're carrying sensationalistic diseases that people get excited about. Legislation can be a useful tool for preventing public health problems, but it needs to be tailored towards actual risk reduction, and not just making people feel less scared or more vindicated in the face of the latest scary disease.

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