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What might have otherwise been individual illness, limited to one or two cases of Ebola, was magnified in a hospital setting in which unsterile equipment and needles were used repeatedly on numerous patients." (Garrett 220).
Even with the significant accomplishment of learning to genetically engineer biologic material, the means did not exist to apply this new knowledge where it was needed most. Economic, social, governmental, and geographic barriers prevented this advancement from having the impact it could have. As a result, the microorganisms continued to outpace the medical scientists.
It is important to understand that, largely, what has determined the direction of the American medical industry during the post war -- for profit -- era has been the market for new drugs and treatments. It has already been established that this market is relatively unconcerned with those who cannot afford service: uninsured Americans and poor foreigners. Therefore, it should be expected that the services that were in the highest demand during the dawn of such potential plagues as Ebola and AIDS were things that were completely unrelated to these treacherous threats. In accordance with this theory, it should be noted that some of the most expensive research and products came out of the search for new methods to treat cancer -- a disease that was and is prevalent among the elderly and insured. Magnetic Resonance Imaging and CAT scans were in development at this time. Although their immense medical value cannot be denied, it still provides an illustration of the priorities set by the American medical system.
Tied in with the idea of demand is the idea of public awareness. News coverage of the beginnings of Ebola and AIDS was relatively unclear as to what the threat was while these diseases were first being discovered. These far-off diseases "boiled down to the same set of troubling perceptions for the American public, and, to a lesser extent, the Canadian, Mexican, Australian, New Zealand, and European publics: something new and very scary was coming; nobody was sure what it was, but the experts were certain that it was dangerous; the federal government seemed quite distressed about the matters, but the experts and authorities didn't seem to agree as to what, if anything, should be done to protect the public; and it was all costing taxpayers a pretty penny." (Garrett 153-154). In the midst of such ambiguous interpretations of impending doom, which seemed to appear in the news weekly, the natural response of a public thousands of miles away is to ignore it. With a lack of general concern from the American public the medical industry had little incentive to invest potentially millions or billions of dollars into stopping another African disease.
By 1982 AIDS, a serious epidemic threat, reached America. In that year the Centers for Disease Control closed their report on the disease by saying, "Of the 788 definite AIDS cases among adults reported thus far to CDC, 42 (5.3%) belong to no known risk group (i.e., they are not known to be homosexually active men, intravenous drug abusers, Haitians, or hemophiliacs).... This report and continuing reports of AIDS among persons with hemophilia a raise serious questions about the possible transmission for AIDS through blood and blood products." (Garrett 309). Suddenly AIDS had become a clear and present danger to the United States and since the modes by which it was transferred were unclear, it provided fuel to the fire of those who looked to blame the homosexual community.
Consequently, the need for the American medical community to act had finally come -- the public was finally sufficiently scared to demand that action be taken. Unfortunately, too much time had been wasted. Attacking the disease from a biomedical standpoint was fairly ineffectual. The best advice that the medical community could give was for individuals to alter their lifestyles appropriately with latex contraceptives and monogamy. Regardless of the gross failure of the American medical practices, still millions of dollars have been invested to develop drugs and treatments that slow the onset of AIDS and prolong the life of infected individuals. So in this sense, the industry has responded; and although they have yet to yield a cure, they have still found a way in the face of existing demands to generate a profit out of their shortcomings.
The already desperate state of the poor in the United States with the new threat of HIV and AIDS threatened to overrun the medical facilities in place to support them. "Any disease that hit the poor urban Americans disproportionately would tax the public hospital system. But AIDS, which was particularly costly and labor intensive to treat, threatened to be the straw that broke the already weakened back of the system." (Garrett 506). Combating this potential epidemic meant treating those who could not afford it, and the system was forced to find some sort of answer.
One problem was, "A significant percentage of the nation's HIV-positive population was also homeless, living on the streets of American cities." (Garrett 507). As aforementioned, the poor and uninsured often receive sub-standard medical treatment or sometimes no treatment at all. Homeless men infected with HIV or AIDS, additionally, may not be able to afford proper contraception. Consequently, they spread the disease to others -- particularly, prostitutes -- who have more unprotected contact with different individuals. These facts created a state of unbelievable risk for individuals living in the most economically deprived areas of the United States. To quantify these risks, "Harlem Hospital chief of surgery Dr. Harold Freeman calculated that men growing up in Bangladesh had a better chance of surviving into their sixty-fifth birthday than did African-American men in Harlem, the Bronx, or Brooklyn." (Garrett 508).
In order to address the risks of possible epidemics many physician suggest that care management teams adopt specific "disease management strategies." (Jennings 93). In fact, some medical institutions are joining forces to develop specific protocols for how to handle potentially dangerous diseases. "Innovative partnerships between health plans and academic centers such as Tufts in Boston and Cedars-Sinai in Los Angeles are leveraging clinical information to create improved disease-management tools, which will further enable health plans to understand and implement best practices across various disease states." (Jennings 93). Essentially, what the future might possibly hold is a nationwide electronic database that would be capable of immediately cataloging medical histories and providing possible diagnosis for infected individuals. Not only that, but such a network would alert various medical organizations around the country as to specific locations and occurrences of future epidemics -- which could be very useful to stopping the spread. Such an efficient plan "requires careful management to bring people and technology together in creative and innovative ways. The care plan must collect and process a tremendous quantity of information about members' health risks, histories, habits, and hopes." (Jennings 101).
The advantage of having a network that could carry all of this information has many advantages; however, the limited scope of this plan is also evident. It is relatively easy to imagine this plan being implemented in North America and Western Europe, but as evidenced by history, this is merely another isolationist type solution -- albeit an extremely efficient one. Sub-Saharan Africa, Central and South America, as well as portions of Asia would be neglected by these new initiatives. And clearly, if a preventative plan is to be enacted that will be effective it will be forced to address the health concerns of all of the nations around the world.
With a complete form of global economy looming in the future of the planet earth, it is essential that the planetary spread of microorganism also be considered and planned for. As our experience with AIDS has shown the problems that envelope the third world can only be ignored for so long. It is true that it may not be possible to make profitable ventures into these lands. Our current system, bent on generating profit, sees only the short-term. The medical history of the last half-century in the United States illustrates a pattern of response and reaction, rather than of prevention and planning. Clearly, the evolution of the methods for treating biologic and viral diseases lag behind the evolution of these diseases themselves. Threats of plague and epidemic must be identified immediately in time and space for medicine to even have a chance of keeping pace. Evolving information technologies are emerging as a valuable tool for achieving just that. For the best possible prevention these networks need to be spread worldwide, and treated equally around the globe. It is likely that our current health care organizations are incapable of this feat at this time or at any other time in the near future. William Foege "felt that international and domestic American health were so thoroughly integrated by the 1990's due to globalization of the microbes that it was impossible to ensure a disease-free existence for people in North America without…[continue]
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