[e-drug] Request to review excerpt PhD thesis

[Donna van Bogaert <ljfvanbo@lantic.net>]

E-drug: Request to review excerpt PhD thesis 
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Hello E-drug Users,

Here's an odd request for you :-)
I am doing a doctoral dissertation in philosophy on Moral
Responsibility and Global Drug Resistance. Briefly, I argue that drug
resistance is a phenomenon that requires conceiving it beyond the
traditional biomedical ethical approach viz. anthropocentrism; that it
lies in the human-health-environmental-health conundrum.

My request is that one of you fundi's in the field will read the
excerpt below (part of a chapter that includes human reactions to
infectious disease-expulsions, quarantines and so on) and tell me if
it is factually correct.

Many thanks,

Donna

Dr. D. van Bogaert
PostNet Suite 7 Private Bag x 8689
Groblersdal 0470
South Africa
Telephone/ Fax (auto) +27 013 262 4339
Cell: 083 321 1612

email: ljfvanbo@lantic.net

-----------
The 'Disease Situation'

As defined by the Centers for Disease Control (CDC b 2001),
"Emerging Infectious Diseases" are defined as "diseases of
infectious origin whose incidence in humans has increased within
the past two decades or threatens to increase in the near future".
The United States Department of Defense (USDD)adds to this
definition by adding ". (increased incidence in human) ... animal,
and plant infections[i] " (USDD 2002: 1). I will use the USDD
definition.

Now a new 'situation' has developed. Included under the heading of
Emerging Infectious Diseases (CDC b 2001; USDD 2002: 1 [ii]) are
varieties of diseases:

Completely new diseases
Re-introduced old diseases
Old diseases occurring in new places
Old diseases occurring in new populations
New diseases with increased virulence
Diseases newly resistant to available drug therapies

As 'Diseases newly resistant to available drug therapies' are now
'classified' as an Emerging Infectious Disease this can work in
different ways according to the disease 'situation'. Let us
investigate this further with an example:

Diphtheria, largely eradicated in the West because of immunisation
practices, is a notifiable medical condition. Should it be identified
that during the last twenty years there has been or is suspected to
be an increase in diphtheria, then it will be classified as an Emerging
Infectious Disease. Let us suppose I become ill with a sore throat
and pharyngitis. My doctor suspects diphtheria. A throat culture is
performed and Corynebacterium diphtheriae of gravis biotype is
identified. I am immediately given 100,000 units of an equine
antitoxin in an IV solution to which there is no response. Then I am
given Procaine penicillin in 2 divided doses. There is no response to
this treatment either. Subsequently I am given the gamut of
antimicrobials commonly used as first, second and third-line drugs
to treat diphtheria: erythromycin, penicillin V,azythromycin, and
clarithromycin to no avail. The gravis biotype of C.diphtheria
microorganisms I have somehow acquired are drug resistant to
available therapy. While the phenomenon of drug resistance is
biological, a fact resting in microbial adaptation and change, it does
not erase the reality that they are in my body; they are a part of
me. While pathogenic microorganisms are involved (in an attempt to
eradicate them as a disease source), it is I (myself, my person, my
moral self) that will become the primary focus of any action or
inaction concerning 'my' drug resistant disease-dependent on the
disease situation.

Looking at it differently, what if I acquire microorganisms that are
totally resistant to, say, penicillin? Both my penicillin-resistant
microorganisms and I could spend our existence quite happily
unless by chance I acquire a disease for which I am given penicillin
as a treatment. Then the (whatever) disease will not respond to the
treatment because the microorganisms I harbour are drug resistant.
So, right now I do not have a 'disease newly resistant to available
drug therapy'. But should I acquire whatever) disease, then I will. If
others also carry penicillin-resistant microorganisms and acquire the
same disease and it increases or tends to increase in twenty years
then it will be classified as a 'disease newly resistant to available
drug therapy'. Thus, while the problem of classifying a disease
resistant to available therapy in the 'situation' of epidemiological
purposes is understandable, in another sense it is a rather
incomplete description of the total problem.

[i] Nearly all emergent disease incidences of the past ten years have
involved zoonotic agents (Murphy 2002: 2). Many different
determinants contribute to the emergence of zoonotic disease
agents and rarely do they act alone.

[ii] Examples of emerging infectious diseases in animals and plants
include (ASM 2001): BCE (Bovine Spongiform Encephalitis)
considered as the agent for a variant form of Creutzfeldt-Jacob
disease in humans (ibid: 6, 7). TB in cattle showing drug-resistant
strains (ibid: 7), Mycoplasma galliseptum in captive and wild finches
(ibid: 10), Microsporidosis, an ancient animal parasite now emerging
in humans, particularly in the immunocompromised (8), a
Mycoplasma galliseptum species member infecting commercial
poultry, different host-adaptive rabies viruses (ibid: 12) and
"whirling disease" in certain trout species (ibid: 14-16). The
Geminivirus-whitefly complex (whiteflies transmit the Geminivirus)
cause serious damage to cassava, tomatoes, mungbeans, peppers
and cotton. Through clonal migrations; Phytophthora infestans, the
cause of the 'Irish Potato Famine', believed eradicated over 150
years ago is now creating a scourge world wide"(Ibid:19).

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