Can America cope with a resurgence of tropical disease? | Hacker News Reader

Can America cope with a resurgence of tropical disease?

arstechnica.com

69 pointssong36 comments

America has some very serious problems. This is partly an outgrowth of our lack of good healthcare policies at the national level. I find this so frustrating. No one seems to know what thread to pull to get these messes to start unraveling. The haves don't seem to understand that this is a bad thing to have going on in your back yard. Just because you are wealthy doesn't mean you are immune.

But people don't want to hear anything like that.

It's so frustrating because it isn't something we can't improve. It stays this way because of social inertia.

>It stays this way because of social inertia.

Its not inertia, its the same thing that happened to the $75K minimum wage guy. US people HATE when someone less successful than them gets something "for free".

Not just US. Ever tried to bring up the topic of Basic Income in Poland? "Why those lazy subhumans should get money for free?! They'll all become drunks, or will sit in front of TV all day, getting fat and bringing about the future from Idiocracy."

This type of approach makes me sick.

It's not "for free" it is free. No quotes.

Every dollar taken out of their pocket to pay someone else's bills is less money they have to spend on their children's education and for taking time to travel, among other things.

Generosity is a private choice and government has no business in making it public, except that it buys votes to empower politicians.

They do understand. That's why they're willing to fund, even out-of-pocket, disease prevention efforts... Just so long as the disease is highly contagious or something they already have or likely will have (like Sergei and Parkinson's disease), because doing so protects them as well: http://www.businessinsider.com/google-ceo-larry-page-bought-...

Naked pursuit of self-interest cleverly disguised as altruism. For other stuff, don't expect Larry to open his wallet for you.

The United States funds research into medicines and treatments for conditions that people in the United States have. We do it in the form of direct government support for research, and also in the form of high royalties paid to drug and medical companies. Most other countries don't spend nearly as much on medical research. They "free-ride" on the advances that US companies make. For example, a lot of medicines that are expensive in the US are distributed in India at a very low cost that would not allow the drug companies to recoup their research investments.

How about some gratitude for the advances that we've already made, and the billions that people like Bill Gates are already giving to the third world?

The politics of envy and blame is an ugly thing. If we work together, perhaps we can arrive at a real solution like wiping out the particular mosquito species that carries malaria (before you post, no, I don't mean all mosquitos... just that one).

Implying that all other institutions throughout the world don't do basic research in pharma, or that the US benefits tremendously from the brain drain of researchers that to American research institutions and do stuff there that they could be doing in other countries.

The US spends a huge amount on medical research compared with other countries-- both in the form of direct government subsidies and high drug prices. We also spend a huge amount on direct and indirect foreign aid, and privately funded programs by US citizens... like the Gates Foundation that explicitly funds medical research and cures for tropical diseases.

From the article, in the section titled "History":

"Tropical diseases have been affecting people in the American South as long as humans have been living there. In 2003, archaeologists discovered that mummified remains in the Rio Grande Valley from more than 1,000 years ago showed signs of Chagas disease. Transatlantic trade brought the mosquito Aedes aegypti over from Africa, and it thrived in the long, humid summers south of the Mason-Dixon Line. Human travelers brought pathogens that could be transmitted by imported and native mosquitoes. As a result, European settlers in North America were cut down by repeated epidemics of malaria, yellow fever, and dengue."

That's why the article title carefully says "resurgence," not implying that this is anything we haven't seen before. This will be a challenge for medical personnel and public health personnel in the United States, especially for people trained farther north in the Temperate Zone like where I live, but information can travel even faster than disease vectors, and I expect the long-term trend of age-adjust all-cause mortality, including infectious disease mortality, dropping over time[1] to continue.

[1] http://www.cdc.gov/nchs/data/hus/2014/018.pdf

I assume this is only going to get worse with rising global temperatures? One of the biggest disease vectors being insects moving north...

As an aside. I hate to be that HN commenter, but in what scenario is white text on black readable for articles? Mine eyes are weeping.

You can switch themes on mobile by pulling down the hamburger menu and selecting black on white.

Thanks! I guess then maybe the reasoning is that mobile lighting conditions (outside/direct sunlight) meant the white text was more readable, possibly.

That's one of the reason smart people should be moving North. Just try to extrapolate problems 10-15-20 years from now. And try to imagine the migration flows and all the repercussions. Don't wait!

I'm seeing black text on a white background...

It's white on black for the mobile styles.

If you are interested in reading more about diseases that have seen recent emergence (or rather, emergent diagnosis[1]), The Coming Plague[2] by Laurie Garrett, ISBN 0140250913, is a good read. It details the modern origin cases that led to the characterization of a number of diseases, including Marburg, Ebola, Legionnaires' Disease, and Lassa fever. It also talks about their epidemiology and the optimism of the mid-20th century for eradication of things like malaria, as well as the resulting challenges. The book reads like a thriller because the scientists involved are heroic and colorful, and have stories worth telling.

1. http://www.sciencemag.org/content/338/6108/750.full

2. http://www.amazon.com/The-Coming-Plague-Emerging-Diseases/dp...

The same warnings were issued in the late 1980's in Texas but the medical community was slow in accepting them. I remember circa 1990 telling a medical student about Chagas' disease in East Texas - she adamantly objected "No, we don't have that in Texas or North America for that matter. Chagas' is endemic to South America." I gently suggested that perhaps her textbooks were out of date and pointed out a report on a local childrens' hospital where Chagas' was not uncommon. Sounds like they still haven't updated the textbooks BTW.

These diseases are largely been brought in by human immigrants, i.e., it's not so much infected _bugs_ that are coming North as infected _humans_. Once here, the diseases spread among the local population. This is another unintended consequence of modern immigration policy: you get the cooties along with the people. Once upon a time, long ago, people with seriously infectious diseases were not allowed into the U.S.

This is also a major problem in Europe with tuberculosis.

In some parts of London the infection rate is higher than Africa and resistance is found in over 10% of cases.

The cost of drug treatment for resistant TB is over £50,000 (not including the high staff costs for specialists, to track down everyone they have been in contact with etc)

downvoted for telling the truth? HN, becoming Reddit one new user at a time

One of the most important factors in eliminating mosquito vectors in the 40s & 50s was absolutely rampant use of DDT. It remains the most cost effective insect killer. Perhaps soon its use in certain areas will be reconsidered.

There are two problems that I have with this romantic view of DDT:

1. Mosquitoes become resistant to DDT over time, as is the case with most pesticides.

2. DDT might possibly be "cost effective" when considering direct costs, When you start factoring in the indirect costs, it doesn't look so good. DDT bio-accumulates and decimated many bird species, including insectivorous birds, the last time it was used. In the intervening years, habitat and bird populations have continued to decline. The cost today, especially to ecosystem services, could be very great.

DDT is still allowed for anti-malaria campaigns but those old approaches aren't used because they don't work: resistance was already recognized as making that approach untenable by the mid-1950s. Even major proponents recognized that they had only a short window for widespread usage before it became ineffective:

http://link.springer.com/article/10.1007%2FBF02749227?LI=tru...

“There is an urgency today about malaria eradication. Insects are revealing a disconcerting ability to develop resistance to the new insecticides. For example, houseflies in many areas can no longer be killed with DDT. In a few cases, malaria-type mosquitoes are also resistant. Apparently, it takes six or seven years for the malaria-type mosquitoes of an area under continuous spraying to develop resistance.”

WHO's current position allows DDT for disease control – but not agriculture – but it's also with the kind of controls you'd expect to minimize collateral damage and avoid breeding resistant mosquito populations:

“WHO recommends DDT only for indoor residual spraying. Countries can use DDT for as long as necessary, in the quantity needed, provided that the guidelines and recommendations of WHO and the Stockholm Convention are all met, and until locally appropriate and cost-effective alternatives are available for a sustainable transition from DDT”

http://apps.who.int/iris/bitstream/10665/69945/1/WHO_HTM_GMP...

(Ars had a great Ed Yong piece last year on the history of resistance through the present: http://arstechnica.com/science/2014/03/a-field-report-from-m...)

Interestingly enough, the DDT boosterism of recent years was apparently funded by tobacco companies trying to discredit the public health agencies which are also behind anti-smoking campaigns. A few researchers connected the dots between that campaign and right-wing cash-for-sciency-veneer activists like Steve Milloy and Roger Bate:

http://www.prospectmagazine.co.uk/magazine/rehabilitatingcar...

My father likes to tell me how they had DDT sprayed in their hair when he was in school in the 50s to control head lice.

When asked what he thinks of this he just says "Well, it killed the lice".

Isn't this just trading with different bad outcomes, e.g. damaging children from DDT in breast milk?

DDT has been demonised with much good cause, predator bird egg fragility leading to extinction and near extinction being a red light of many environmental issues. However, there maybe sensible case for usage of it or analogues that is prevented because of prejudgement.

We defend against DDT and ignore names we don't know at all.

If you are from NZ you'll understand this.

https://www.youtube.com/watch?v=3nOU3jUf1Cg

Also Dr Ropata is the same actor that plays the clones in the new star wars films. http://4.bp.blogspot.com/-9pPYDAvBFkA/VH8gH4O5qTI/AAAAAAAAw_...

Yes.

This is quite distressing, showing how our quality of life has actually regressed by some metrics rather than improved as is normally assumed. Americans of the 1960s did not have to worry about Chagas, Malaria, or Bed Bugs. These were parasites that had been eradicated. It even seemed possible then that TB, a scourge on humanity for centuries, might soon, at least in the US, meet a similar fate. Now it, like the parasites, has come back full force.

Though neither the author nor the posters here will identify the culprit, I think it should be obvious to all but the most deluded progressive that this is a consequence of unchecked mass immigration to the US--a consequence I doubt economists factor into their models when trying to justify conclusions about its benefits.

Bed bugs are back because we realized the pesticides that kept them at bay had lots of unwanted consequences so we stopped using them. Actually, they would've resurged anyways as there's evidence bed bugs were becoming resistant to many pesticides.

Considering they don't actually carry disease, they're just creepy, I'd hardly put them in the same category as serious tropical diseases. Buy yourself a PackTite and relax.

Bed bugs were eradicated in the US, not kept at bay. They only came back through their reintroduction by foreigners.

Bed bugs were never eradicated in the US. In any case, you're just as likely to run into them in a five-star Manhattan hotel as you are a fleabag motel in the Deep South.

Jesus, you act like we haven't made any progress at all. In the late 1800 more than half of the US had malarious areas.[1]

[1]http://www.cdc.gov/malaria/about/history/elimination_us.html

I think you misread my post. I compared the prevalence of certain parasites and infectious diseases in the 1960s with the present and observed a regression. I said nothing about the state of affairs in the 19th century.

If it's a consequence of immigration then why doesn't it happen in Florida and New York? Do you know at all how vectors work?

We'll develop better pesticides (and alternative vector control) as soon as people are willing to pay for it. Not before.

or travellers. you know.

more immigration will solve this problem! Immigration from that affected area will have a natural resistance, and so america will win again.

Reply on news.ycombinator.com