Although some detainees are past the contagious stage, health officials say detention is necessary because patients who repeatedly stop their treatment often develop deadly, drug-resistant strains of TB. When the medication is stopped too soon, the illness can recur, making patients contagious again.
Last year New York reported 3,811 cases of TB--highest in the nation. The city has attempted to balance public health concerns against civil liberties by providing due process protections to patients, including the right to a hearing and a lawyer paid for by the city.
The hospital is not like a jail: patients have color TV with cable, can make telephone calls, can receive visitors, and have activities planned from 9 am to 8:30 pm. But they cannot leave until health officials determine that they are cured or that they will take their medicines under less restrictive conditions.
Of the 15 people at the hospital, 11 have a history of drug use, 6 have tested positive for HIV, and some are homeless. All have developed resistance to the drugs commonly used to treat TB. All have been treated in regular city hospitals for tuberculosis. One patient refused to stay in his isolation room at the city hospital, walking around to visit other patients, so he was sent to Roosevelt Island.
Patients can get drug treatment, psychiatric counseling, and other health services, as well as educational tutoring and applications for government benefits. The hospital gets $450 per day per patient from Medicaid, but pays $300,000 per year in salaries for TB workers and public health advisors.
Should California adopt a similar program?
Single parent families are much more likely to experience poverty than those headed by two parents, as well as other trauma such as crime or drug abuse. About 80% of children born to unwed teenage high school dropouts will live in poverty. Conversely, only about 8% of children born to married parents who finish high school and wait until age 20 to have children will be poor.
The reasons are complex and not well understood. Among the possible causes is increased sexual activity among teens and diminishing economic prospects for teens in the poorest neighborhoods. Possible approaches to the problem include 'abstinence-plus,' which discourages sexual activity for teens under age 15, and responsible actions for those over 15.
The student body president of Fabens High School, Arlena Palacios (age 16), was expelled from school for distributing contraceptives (condoms) to classmates at the Homecoming Parade (October 16, 1992). The condoms were handed out but also thrown into the crowd during the parade by Palacios and five others. Some children picked up the brightly wrapped condoms, thinking they were candy, and their parents got offended.
The honor roll student was asked to resign as president by school officials but refused. "My mother had me when she was my age--16," Palacios said. "She didn't know about condoms or other contraceptives. Her life was tough--she never married my father. And if I can prevent that from happening to another girl, I will." There are no sex education classes at Fabens. And there is a school district policy against distributing contraceptives. One parent said, "If they're going to be distributed, it has to be in a logical manner."
Should the school district's policy be revised?
Polls indicate strong support for the measure. Sixty percent say they favor the measure, with 37% opposed and 3% unsure. If approved, a patient could obtain a prescription for lethal medicine if a doctor found the person had less than 6 months to live and a second doctor agreed. The patient would have to make three requests, with the third in writing.
A Catholic Archbishop called the proposal "murder in the name of mercy." Catholic churches raised over $1 million to defeat the measure. The Hemlock Society of the USA, which champions the right of the advanced terminally ill to end their lives, endorsed the proposal, as did the State Democratic Party, the American Civil Liberties Union, and the National Organization for Women.
Another backer was a man whose wife had Alzheimer's disease and committed suicide with the aid of Dr. Jack Kevorkian. "The medical profession and hospitals have found a very positive correlation between cash flow and blood flow," he said.
The Oregon Medical Association has not taken a position on the issue, but some doctors have. "We're asked to be judge and jury but I don't think doctors are wise enough to be both," an opponent said. Another warned that allowing suicide might encourage the ill to choose death. "Those people, in order to be heroic and save their family from a financial burden, will seek the suicide option."
Would you support such an initiative for California?
If you have an old bull which is about to die, you can take sperm cells and freeze them for later use. But now scientists can duplicate an infinite number of sperm cells using new techniques. One application might be to preserve the fertility of men undergoing some treatment which makes them sterile, for example, chemotherapy.
However, the most controversial aspect would be the genetic modification of an individual's sperm, for example, eliminating a gene for an inherited disease, or adding a gene to make the person healthier.
Ethicists find these possibilities troubling. Could experiments go awry, creating new inherited diseases with no cure in generations to come? Or could it become routine for parents to change their genes to ensure their children are smart and athletic and free from inherited disease? What about the gene that makes people obese: is that gene therapy or eugenics? If it becomes acceptable to eliminate obesity, will it become required? Will gene therapy make children into a commodity intended to please the parents with, for example, musical or artistic talent?
Arguments for the therapy are that the health professional have a moral obligation to use the best available treatment methods; parents have rights to access to available technologies for the purposes of having children; modification is more cost-effective than later treatment; and the value of freedom of scientific inquiry and the intrinsic value of knowledge supports such work.
Arguments against the therapy are that the process is expensive and not available to all equally; alternatives for preventing diseases should be explored; risks are unavoidable and mistakes would be irreversible; and there will be pressure to conform to social standards of what is desirable in offspring.
If there is no way to hold back this knowledge, what is the best policy
to deal with it?
Doctors now perform more than twice as many knee surgeries on skiers as on football players. The surgical team at Vail had increased its surgeries on skiers from around 1,500 in 1985 to 2,406 in 1995. And many skiers leave the slopes not realizing the extent of their injuries until later, when what was thought to be a "sprained knee" is diagnosed as actually something more serious and requiring surgery.
The United Ski Industries Association reports that catastrophic ski injuries have tripled in the U.S. since 1985. Injuries are three times more likely to occur than they were 10 years ago. Expenses to patients and insurance companies come to $200 million per year.
Most people do not live near ski slopes, so people must have a certain level of affluence to ski. That means many are in their middle ages, when learning a new athletic skill is more difficult than at younger ages.
Most sports try to minimize injury to participants, for example, helmets on football players and roll bars on sports cars, and rules against tactics that can cause injury, e.g., "clipping." Skiing, however, has done little to make the sport safer. In fact, the introduction of snowboards on the same slopes with skiers has made it more dangerous (like mixing powerboats with sailboats). But the ski industry is reluctant to talk about injuries, because it increases people's fears.
What should be done is to require skiers to take courses and become certified, like scuba divers. Rules and safety measures should be adopted and enforced. Real police should patrol the mountains. Skiers can be taught how to fall so as to minimize the possibility or extent of injury.
Ski schools must be forced to include safety instructions
in their lesson plans. Also, ski schools and instructors should be required
to purchase malpractice insurance in case of liability suits if people
do fall and injure themselves. We need to stop this senseless danger and
reduce this costly source of so many avoidable injuries.
Ascarate Lake was closed to fishing and boating after ducks and fish began to die off, leading health officials to discover unhealthy levels of sewage in the stagnant water. On busy weekends, as many as 35,000 people may use the popular park. It is the only public fishing lake within 200 miles.
Local public health officials have posted no fishing and no boating signs which will stay up until the water is found to be safe, even though the number of fish and ducks dying has leveled off. "As a public health official, I feel it is my duty to leave those signs up," one said. Another commented that "you can't have motor boats and have excellent fishing; you can't have polluted water and have excellent fishing. It's their choice."
A state official said it was "a shame that we have to lose a fishery that's so active. My job is to get the most out of our fisheries for our Texas fishermen. I had to look long and hard before taking this lake away from a million people."
Proposals to fix the troubled lake have included draining and dredging the bottom, installing sprinkler systems for aeration, limiting the number of ducks, and adding chemicals to kill the bacteria. But nothing has been done while tests are being processed at a state laboratory. "We can't do anything until we know the results of the tests," one official said, "because we don't know what we're fighting down there."
What should be done?