Epidemics in Western Society Since 1600 - Audio Frank Snowden

Professor Snowden describes the final exam, and takes questions from students.

SARS, avian influenza and swine flu are the first new diseases of the twenty-first century. They are all diseases of globalization, or diseases of modernity, and while relatively limited in their impact, they have offered dress-rehearsals for future epidemics. As information about SARS spread internationally in 2002, in spite of China's campaign of silence, the global response had a curiously twofold character: on one hand, the mobilization of biologists and epidemiologists across national frontiers was rapid and unprecedented, while on the other hand, public health strategies on the ground were largely familiar from previous eras. If the spread of information and collaboration on international health regulations have been two positive aspects of public health response in the first decade of this century, more worrying questions have been raised concerning the production and distribution of drugs and the capacity of for-profit healthcare systems to cope with a major epidemic.

The Global Polio Eradication Initiative, the largest public health campaign ever launched, began in 1988 with the ambition of achieving its goal by the year 2000. In the decade since this deadline was missed, the initiative has suffered a number of setbacks, notably in the tropical world. Four major types of problems have impeded the eradication effort: operational, biological, political and religious. Northern Nigeria offers a case study of all of these factors, with domestic political and religious conflict, unsanitary conditions, and suspicion of Western medicine all undermining the anti-polio campaign. One of the questions raised by the campaign's struggle is whether or not eradication is itself a realistic public health goal, and to what extent smallpox furnishes a model precedent or a potentially misleading dream scenario.

Dr. Margaret Craven discusses HIV/AIDS from the perspective of a front-line clinician. AIDS is unprecedented in both the speed with which it spread across the globe and in the mobilization of efforts to control it. It is a disease of modernity. Along with the relative ease and velocity of modern transportation methods, other background conditions include Western medicine, with hypodermic needles and bloodbanking, intravenous drug use, and the development and concentration of gay culture. In the U.S., early public health attempts at understanding and combating the virus were hindered by right-wing domestic political and religious forces. Successful containment of epidemics cannot be achieved under the spell of hypocrisy and politicization; rather, medicine and education must be evidence-based and practical.

The global AIDS pandemic furnishes a case study for many of the themes addressed throughout the course. While in the developed West the disease largely afflicts concentrated high-risk groups such as intravenous drug users and the sexually promiscuous, in Southern Africa it is much more a generalized disease of poverty. In countries such as Botswana and Swaziland, the economic and social consequences of the disease have created a vicious circle, whereby the devastation wrought by AIDS severely impedes public health efforts and prepares the way for further infection. One important lesson that has been drawn from the past decades of struggle against the epidemic is therefore to take account of the specific, local characteristics of each affected area, making provision for the social as well as purely biological factors of transmission.

The Tuskegee Syphilis Study, carried out in Macon, Alabama, from 1932 to 1972, is a notorious episode in the checkered history of medical experimentation. In one of the most economically disadvantaged parts of the U.S., researchers deceived a group of 399 black male syphilitics into participating in a study with no therapeutic value. These "volunteers" were not treated as patients, but rather as experimental subjects, or walking cadavers. Even after the development of penicillin, the Tuskegee group was denied effective treatment. Despite regularly published scholarly articles, forty years passed before there was any protest in the medical community. The aftereffects of the study, along with the suffering of its victims, include a series of congressional investigations, the drafting of medical ethics guidelines, and the establishment of independent review boards.