We can’t handle a utopia

There is this one scene in “The Matrix” where the antagonist of the film gives a speech to one of the protagonists. Here it is:
 

httpvh://youtu.be/nb6yOklzHMI

 
The antagonist, Agent Smith, tells Morpheus that humans rejected “The Matrix,” a computer program designed to simulate reality for captive humans, because the reality being shown to humans was too perfect. So the machines who rule the humans redesigned the program to reflect the misery existent in human existence. I tend to agree.

I went to a lecture at Johns Hopkins given today by Dr. Marcos Espinal, an epidemiologist with the Pan American Health Organization. His talk was about how the focus is shifting in the Americas from communicable diseases to chronic diseases. The wealthier countries are pushing this shift because, after all, they provide a lot of the cash for the health interventions in the continent. In the north, Canada and the US want more attention to obesity and diabetes and diseases of an older population, like chronic obstructive lung disease and prostate cancer. In the south, Chile, Brazil, and Argentina want more attention to diseases of an older population, and they don’t want diseases of a privileged population (obesity and diabetes) to get out of control.

Yet there are a whole bunch of countries in the middle for which communicable diseases are still a problem. In Peru, for example, influenza and pneumonia are still big contributors to death and disability. Other countries in the continent are struggling with dengue, tuberculosis, and malaria. Tuberculosis was mentioned with special emphasis by Dr. Espinal. He told us that TB has been around since before recorded history, and we still haven’t gotten rid of it.

It’s true. We have the technology to do away with so many of these diseases, and we won’t. We have safe and effective vaccines against measles, and there are still children catching it, and outbreaks in the United States from it. We have tests to screen for and detect tuberculosis, with safe and effective antibiotics to treat it. We also know that clean water and sanitation can take care of malaria, yet there is still plenty of it in the Caribbean and Central America. (Malaria was endemic in Washington, DC, but it was eliminated.)

When it comes to infectious/communicable diseases, we certainly have the know-how to take eliminate those diseases once and for all. So it is quite embarrassing as a human, especially one who works in public health, to acknowledge that there are things out there like dengue and malaria, or even cholera. If aliens were to land tomorrow, they would probably have a good laugh at us for knowing how to deal with infectious disease but not dealing with them. At the very least, they would find it humorous that we treat people of different ethnicity and nationalities differently. I don’t think it’s funny, but you have to acknowledge that there is a certain degree of “dark comedy” in the fact that we let certain people out in the periphery of progress while we allow others to fully participate in the wealth.

So, while we will never reach a utopia when it comes to public health, we can get quite close. We can eradicate measles, chickenpox, and mumps. We can get rid of cholera again, like we did before. But it seems to me that we can’t handle a utopia. We seem to like for problems to continue to exist because, without those problems… Well, I don’t know. I certainly would have an easier day at work if those diseases didn’t exist anymore. I’d probably focus on other public health problems. Investigating outbreaks of measles take up a lot of time and resources. The same can be said for outbreaks of hepatitis A, another vaccine-preventable disease. It boggles the mind why these things are allowed to continue.

Yes, while other diseases and conditions (and even violence and car accidents) are important to look into and take care of, we cannot take our foot off the accelerator and de-fund efforts against infectious disease to fund efforts against chronic conditions… Which is easier said than done, I know. Yet one more thing to think about for my DrPH adventure.

 
Featured image credit: Drawn and engraved by F. Bate. Published by “The Association of all Classes of all Nations”, at their institution, 69, Great Queen Street. Lincoln’s Inn Fields, London, 1838. / Foter.com / Public Domain Mark 1.0

I'm a fourth-year doctoral candidate in the Doctor of Public Health program at the Johns Hopkins University Bloomberg School of Public Health. All opinions posted here are my own, of course, and they do not necessarily reflect the opinions of my school, employers, friends, family, etc. Feel free to follow me on Twitter: @EpiRen

8 thoughts on “We can’t handle a utopia

  1. One problem with attempting to eliminate dengue and malaria is that the way that the US eliminated (or nearly eliminated dengue, as it had a resurgence in Florida last year) was by the use of DDT to eliminate mosquitoes.
    DDT is a highly persistent poison that easily bioaccumulates and has been linked to developmental problems in humans and with chronic exposure, diabetes.
    In the United States, these chemicals (DDT and DDE) were detected in almost all human blood samples tested by the Centers for Disease Control in 2005, though their levels have sharply declined since most uses were banned in the US. Estimated dietary intake has also declined, although FDA food tests commonly detect it. (copied from Wikipedia’s entry on DDT)

    Hence, the reluctance to begin spraying, as DDT is the agent of choice in mosquito abatement programs even today.

    But then, I saw Silent Spring when it came out, I remember the near extinction of the bald eagle, osprey and peregrine falcon.
    While we eliminated malaria and dengue in the US, we very nearly eliminated our national bird.

    As for space aliens, if I were a space alien headed for Earth, after intercepting our news services and personal communications, I’d alter course and warn everyone about an planet inhabited by homicidal maniacs.

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    • Yeah, but there are other ways to prevent mosquito-borne infections that are just as effective as DDT. We can put screens on windows and nets for sleeping. Chlorinate the water and, even if left standing, the mosquito eggs will have a hard time with it. Install proper drainage systems for the rainy systems. Air conditioning and draining swamps can come later.

      Again, easier said than done.

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      • You need another Gorgas. He was relentless, and made sure that any tiny container of water was drained. The Panama Canal project was in the domain of the Army Corps of Engineers, and he had supreme power in that venue. Read Panama Fever. (note: I was born in Gorgas Hospital, and twelve years later was tested for tuberculosis there… as an Army brat).

        Also, the major problem with DDT was overuse, which meant that mosquitoes became resistant to it. Just like some bacteria become resistant to antibiotics.

        By the dengue scares me. I caught it out in the boonies of Venezuela, and its nickname “bone break fever” is appropriate. The thing is that I am not immune. If I catch another strain I have a higher chance of getting the hemorrhagic version. I will not be visiting Florida any time soon.

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      • Oh, good grief, I gave the link to the CD audio book. The paperback has pictures. Though, really, do what I do: read it from the library.

        I also read a little bit about Gorgas in a book I bought from a used bookstore: The American Plague by Molly Caldwell Crosby. It is about yellow fever in the USA, starting with an epidemic in Memphis. It is in the pile of books to be sold back to the used bookstore, even though it is a good book. I just don’t have the space to keep all the books I read.

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      • Sure. Email me your mailing address.

        It is written by a journalist, so your mileage will vary. She did actually travel to Cuba to get pictures of a yellow fever test site. I’ll see if I have any others that I have read, like the one on the 1960s rubella epidemic (it is a dreary academic text book, something you should get used to).

        The rest of the books are children’s books and Bill Bryson’s A Short History of Practically Everything.

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        • Considering how journalists reported back in the 1960’s? I’d call that a cool beans deal.
          In the 1960’s, until some later 1970’s Watergate thing came along, the press played along with government stories and otherwise, reported and actually educated in mild ways to the public.
          Their specials furthered said education by a lot, by my day’s standards, senior year high school. But then, we had donated electron microscopes, worked with live reagents and dissected animals, even with formalin and formaldehyde present.
          When our kids went to school, they never touched a dead animal, never looked through a microscope, didn’t know what an electron microscope was and their chemistry class involved M&M’s.
          TALK about an utter rejection of what Saint Reagan wanted.
          Yes, that is a prod at the far right. I’m more centrist. In some areas, I’m left, even far left. In other areas, I’m right, even far right.
          In most, I’m center of the road that could redefine straight and narrow.
          I reject the living word model of the Constitution, it was worded to expand or retract as society grows and future amendments may be needed.
          However, the second amendment was already well and truly qualified back when the ink was drying and the second amendment was penned.
          Hence, restrictions were imposed on the most dangerous of arms.
          Hence, why we can’t own or possess a nuclear or thermonuclear weapon, why we need to go through an SSBI to acquire an NFA firearm (NFA firearm means, short barreled shotgun or rifle, silencer, disguised firearm, destructive weapon (aka artillery, grenade launchers, etc), fully automatic or selective fire fully automatic, three round burst and semiautomatic or any permutation thereof and that ends the day. That last grouping was due to both organized crime crimes and random crimes committed by a handful of miscreants that caused massive mayhem throughout the land. Or at least, a significant amount of the land.
          Hence, the NFA. Want a machinegun? No problem, just pass an SSBI. The very same background investigation that is used to acquire a Top Secret security clearance or SCI clearance.
          Hell, I don’t see a problem with putting my black rifle under a new class of the NFA that requires the same background clearance as a Secret, with possible SCI clearance (aka the long secret, which isn’t that long).
          Been through all background investigations and was cleared.
          Repeatedly.
          For over three decades.
          And I’m notorious for a handful of things.
          I smoke, I drink, I use profanity profligately.
          I’m also known to keep a trust, honor my word and defend that which I am sworn to defend. Be it my family or my nation, as both were and are still effective. As I’m retired, I’ll suggest you consider which one is still in effect.

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      • The Yellow Fever book is from 2007. The author is a 21st century journalist.

        The rubella fever book is Dangerous Pregnancies written in 2010 by a legal historian who teaches at University of Illinois.

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