Reporting on tuberculosis is not most reporters’ idea of a glamor assignment. It’s an ancient disease, drug companies aren’t keen to develop blockbuster medicines, and, anyway, few people get it, right? Wrong. A powerful expose by Stacey Singer, the health reporter for The Palm Beach Post, has revealed a serious outbreak of TB in Jacksonville—the worst the Centers for Disease Control and Prevention has investigated in 20 years. Thirteen deaths and 99 illnesses are linked to the outbreak so far, which Singer reports, “was, and is far from contained.”
Beyond the scary numbers, what makes Singer’s piece so intriguing is that it is a tale for our time. It touches on the current narrative about cutting government spending, which inevitably involves trade-offs between public health and public dollars. And it touches on the trend toward government secrecy at all levels, which made it hard for Singer to do her job.
Over the past two years, 3,000 people may have had close contact with contagious people—residents of Jacksonville’s homeless shelters, jail inmates, and patients at a mental health clinic. “Other health officials throughout the state and nation have reason to be concerned,” the Post said. Only a fraction of the sick people’s contacts had been reached. And a third of those who were reached tested positive for TB.
In April, Gov. Rick Scott, a Republican, signed a bill shrinking the state Department of Health. As it happens, nine days later a federal Centers for Disease Control and Prevention investigator wrote a 25-page report describing the outbreak and what was needed to contain it, a report that, as we’ll see, wasn’t made public until Singer’s relentless push for it was successful last week.
One victim of the state’s budget ax was the A.G. Holley State Hospital, an old-fashioned TB sanitarium that had treated difficult cases of TB for 60 years. The state apparently was in such a hurry to shut down the facility that the health department ordered that the hospital close six months ahead of schedule.
In an interview, Singer told me that the hospital had treated about 70 TB patients each year—all ordered confined by court order because they were a risk—at a cost of about $10 million, half paid for by the federal government and half by the state. She said that after it was ordered closed, the state put out bids for private providers to take care of these patients, but “nobody in the private sector wanted those folks.” Florida Medicaid covers only 45 days of in-patient care and some patients with drug-resistant TB need care for a lot longer. After the Holley facility closed, most of the patients were housed in motels.
Singer got on to her story via a tipster who advised her to read an article in the American Journal of Psychiatry, which revealed a TB outbreak in Florida in 2008. A single schizophrenic patient had moved from hospital to jail to homeless shelter to an assisted living facility, coughing all the way. Although officials documented his chronic cough, it was not treated until he was sent to the A.G. Holley facility, which subsequently received a $275,000 grant from the CDC to contain the outbreak. Dr. Bob Harmon, who directs the Duval County Health Department, told Singer that after the money ran out, staff members were redeployed.
But last year the number of active cases suddenly increased. “We thought after 2008 that we had it contained, Harmon said, but: “It was not contained.” For 2012, Harmon told the Post, his department needs more resources to contain the current outbreak—at least $300,000 to hire teams of experts to track down people who may not know they are infected. But staff and revenue for his department have been cut. In 2008, when the first TB outbreak hit, Harmon’s staff was 946; now it is 700.
One might argue that the public should know about a disease outbreak of this magnitude, but state and federal officials didn’t see it that way. Singer reported that the public learned nothing about the outbreak until early June, even though the same TB strain had popped up in other parts of the state, including Miami.

The arrogance of Science, Medicine, Politics, and Business (and Big Business Education) is going to get us into a terrible fix.
Every medical student in America should be studying Mann's sharp novel:
The Magic Mountain: Course of Illness - Lapham's Quarterly
www.laphamsquarterly.org/.../the-magic-mountain-course-of-illness....
(Even today, despite the drugs available to treat it, TB remains a
major public health problem in many developing countries.) Mann sets
The Magic Mountain in ...
They should also assimilate this sharp editorial:
The [Washington] Post’s View July 10
Resistance to antibiotics is becoming a crisis
--Some bacteria, such as those causing tuberculosis and gonorrhea, have become resistant to multiple antibiotics. In the past few years, researchers discovered a new enzyme known as NDM-1 that can confer resistance to antibiotics on bacteria and can easily jump among different species. As the first-line antibiotics are lost, the replacement treatments are often more expensive, and more toxic.
There is just no excuse for this state of affairs.
Medical faculties should be sharp in practice so that every medical student in America would absorb the most fundamental contribution in psychology, Mark Ashcraft's "Cognition."
There is just no excuse for lazy bad practice. If instead of deleting comment to protect a friend, the monolithic and somewhat obtuse Science were to get on top of these issues, we might be able to deal with them.
Textual and discourse cohesion and coherence are subjects in linguistics. You might think that in undergraduate programs the students would be swarming the COBUILD English Grammar, chapter 10, to learn.
#1 Posted by Clayton Burns, CJR on Wed 11 Jul 2012 at 12:43 PM
For several years my colleagues and I have argued that the social determinants of health and the operational viability of health systems are threatened by peak oil, which is the lead but not the only resource scarcity issue facing the human world as it reaches the limits to growth. The end of perpetual growth coupled with the inability to perceive it leads to governments protecting elites and imposing "austerity" on the common citizen in the name of restarting growth.
#2 Posted by Dan Bednarz, CJR on Thu 12 Jul 2012 at 07:28 AM