From Chaos To Coercion: Detention And The Control Of Tuberculosis

From Chaos to Coercion: Detention and the Control of Tuberculosis

From Library JournalNew York City suffered an outbreak of multidrug-resistant tuberculosis in the early 1990s. The disease threatened to expand beyond its usual victims in the homeless, drug-addicted, and incarcerated populations to afflict society at large. The public health system responded with detention and the coercive treatment of individuals who were noncompliant with treatment protocols, and the epidemic abated. Coker, a British physician, examines the social, legal, medical, and ethical issues surrounding this chapter in the history of tuberculosis. He presents historical and epidemiological evidence linking tuberculosis to high levels of institutionalized social inequity. And he shows how the New York City response, while successful in turning the tide of the epidemic, failed to address these root social causes and perhaps even deepened inequities by violating the rights of individuals and providing a smokescreen for the inadequacies in our political and healthcare systems. The book's careful scholarship belies its passion. It is a thoroughly documented and convincingly presented argument that inspires a reassessment of cultural assumptions and reflection on the epidemiological effects of these assumptions. Recommended for academic and larger public libraries and for collections with a focus on the history and sociology of medicine, social justice, human rights, or ethics.-Noemie Maxwell Vassilakis, Seattle Midwifery Sch.Copyright 2000 Reed Business Information, Inc.In the 1980s and early 1990s, New York City experienced an unprecedented outbreak of tuberculosis. Inadequate healthcare services, an increase in social alienation of the poor, and the emergence of drug-resistant strains led city health officials to respond with draconian policies to ensure compliance, including the use of detention of non-infectious individuals--sometimes for up to two years--that violated individual civil liberties. The New York TB epidemic has since been controlled, but this public health triumph has come at great cost. This gripping narrative of medicine and morality raises ethical issues that are of increasing importance in the world of modern medicine. Richard J. Coker warns the international community against assuming a fortress mentality, advocating a more just balance between health, liberty, and the burdens society should be prepared to accept in the pursuit of both.From The New England Journal of MedicineTuberculosis-control workers in the United States may very well be stunned by Richard Coker's assessment of their efforts in From Chaos to Coercion: Detention and the Control of Tuberculosis. After all, the rates of tuberculosis in the United States and specifically in New York City, which is the focus of Coker's analysis, have dropped precipitously since the height of the epidemic in the early 1990s. Yet Coker argues that these accomplishments relied too heavily on the use of coercion, both in the detention of noncompliant patients and in the use of directly observed therapy.Directly observed therapy, by improving patients' compliance with drug therapy, has been lauded as the key to the recent success of American tuberculosis-control efforts. In programs of directly observed therapy for tuberculosis, health care workers strictly supervise the administration of medications to patients in clinics, in the patients' homes, or on the street. Because so many persons affected during the recent outbreak of tuberculosis had concurrent problems, such as psychiatric illness, homelessness, or injection-drug use, officials involved in the implementation of directly observed therapy have emphasized the need to assist patients with social issues. Indeed, one tuberculosis-control official has even characterized directly observed therapy as TLC (tender loving care). Many patients receiving directly observed therapy have expressed genuine thanks for the attention they have received.Yet Coker remains wary of this