This post marks the beginning of what we here at Global Health Nexus hope will be our extensive Tuberculosis Coverage. So however we do it, considering that we are now about three months past World TB day (March 24), we best get started.
Now initially I was planning to begin the journey of our coverage through a trio of stories, all of them illustrative in their own particular way of the issue of tuberculosis in our time. One quite scary, one historical, one hopeful.
First was the emergence last year of identifiable XDR-TB, an 'emergence' which continues to this day. Second is that this year marks the 125th anniversary of the discovery of the mycobacterium tuberculosis by the great Robert Koch. And the third would be the recent announcement by the WHO that "the tuberculosis epidemic has leveled off for the first time since the WHO declared a TB a public health emergency in 1993.".
But then, as I was planning all this, along came the bizzare, almost surreal case of Andrew Speaker, and all of a sudden tuberculosis, and in particular XDR-TB (extensively drug resistant tuberculosis) was everywhere, media-wise; all over the news.
Now, I have been in the planning and researching phase of a documentary about international tuberculosis control, off and on for over four years now (don't ask. And thusly, I have thought long and hard about TB imagery with all its baggage and meaning and stigma; and the best, and even what would be best - i.e. the 'proper' way to accurately cinematically portray tuberculosis in its contemporary context. And I had been well aware of the development, and certainly the potential development of XDR-TB, for some time. But even in light of all that I have to admit that when this Andrew Speaker story first broke, I avoided it like the plague (forgive me, I'm weak). I'm not sure why, I just did. I did follow it somewhat peripherally, but I didn't read the stories very carefully, and I certainly avoided it on the old TV. Perhaps its part of larger avoidance thing that I have going in my life, perhaps its because I knew that it would impact upon what I am trying to do here. As I said, I'm just not sure. But alas, I have face it now, and admit that not only is this Speaker thing unavoidable, it may even be an opportunity.
An opportunity you say? Why not.
I think we can take this Speaker Story as an opportunity to engage in some deconstruction (already, always) of not only this story itself, but of the way the mainstream media, in particular the mainstream, corporate American television media, (the popular agenda-setting mind of not only America, but so much of the world) not only deals, and has dealt with this story, but of the way, given its profound limitations, it handles, or more specifically (as with so many other stories) ignores, the larger issue of international tuberculosis control, and why.
So now, for our collective consideration, I would ask you to ponder and view the following references as a kind of rough architecture for a template through which we will try to comprehend this whole Andrew Speaker story:
First, there is this quote (once again) from Richard Appignansesi's and Chris Garrets's< ahref="http://tesugen.com/archives/05/03/pomo-for-beginners-2">Postmodernism for Beginners:
The crux of postmodernity is that there are 'two presents. One is a 'spectre' present, a Virtual Reality techno-media simulacram that makes the other 'real' present appear borderline, fugitive, elusive.
A de-materialization of the real is haunting us, making our opposition to it ineffectual. A typicle example of this is the Western world's media representation of a disaster - the relief of the mass famine in Ethiopia is stage-managed as a rock concert charity event. Tragedy is a momentary virtuality not 'really' permissable in postmodernity.
We know (or at least - it is asserted) from Susan Sontag, in her famous book Illness as Metaphor that we have a tendency as - what? A Culture?, People? - to think that Illness can (in fact) be a Metaphor; a representation, a symbol for something other than just itself. As she writes:
"Nothing is more punitive than to give a disease meaning - that meaning being invariably a moralistic one. Any important disease whose casualty is murky, and for which treatment is ineffectual, tends to be awash in significance.". ... "Epidemic diseases were a common figure for social disorder.".
And we know from Neil Postman that we are in fact Amusing Ourselves to Death - i.e. that we live in age where we get most of our information through television, which means, implicitly, that we can only think, popularly, publicly about things, stories, issues, the way television thinks about them; (The Media as Epistimology, the epistimology of television. Postman: "We do not see nature or intelligence or human motivation or ideology as 'it' is but only as our languages are. And our languages are our media. Our media are our metaphors. Our metaphors create the content of our culture.". And "Form excludes content").
However, I also think that the both of the last two references need to be be qualified:
Firstly, with regards to Postman, I think that an argument can be made concerning his views about television. Though television is indeed the most powerful and popular medium going, isn't it in fact, in and of itself, relatively neutral? That is to say - it is what is done with it no? At its best Television can be incredibly informative and even thrilling, at its worst it can feel like your precious short time on this earth is dripping away into an abyss of asinine, meaningless sludge, complete with a laughtrack. One thing we know for sure is that television must somehow be paid for. And though there are many Postmanian elements to consider when critically examining television, and certainly television news, I would submit that much of his argument has to do with the dominant corporate model imposed upon television in order to finance it, and profit from it, maybe even more than it is a criticism of just the medium itself. But I may be wrong.
Remember one of the basic arguments put forth in both the film and book < ahref="http://www.thecorporation.com/index.cfm">The Corporation:
"The corporation's legally defined mandate is to pursue relentlessly and without exception its won economic self-interest, regardless of the harrmful consequences to others.".
Its a very large question. And nothing is forcing you to watch. You can always turn it off. And at least now we have the Internet.
And secondly, with regards to Sontag, the pervasive 'metaphor' of and for tuberculosis which she describes in her book is of TB as represented primarily in books and opera from the nineteenth century, and even before. Romantic. Nihilistic. Doomed. . She writes:
"TB was a disease in the service of a romantic view of the world." ... "TB was represented as the spiritualizing of conciousness ..."However much the disease was dreaded, TB always had pathos(italics mine) . Like the mental patient today, the tubercular was considered quintessentially vulnerable, and full of self-destructive whims. Nineteenth, and early-twentieth-century physicians addressed themselves to coaxing their tubercular patients back to health.".
Ah, (sigh) Pucini's La Boheme:
But what happens when the 'treatment' for said disease - tuberculosis - is in fact - 'effectual', as opposed to 'non'. Would 'we' be remiss if we were perhaps to read some significance into it then? All Sontag's examples and allusions, are essentially, pre-bacillus. She doesn't tuberculosis in the Post-Kochian age.
The great Robert Koch discovered the tubercle bacillus - the cause of the disease tuberculosis - in 1882, and then evolving out of the discovery of several antibiotics by Selman Waksman (he coined the term) - came the discovery of the first drug, the first successful drug - Streptomycin ( 'first isolated by Albert Schatz) - 'the first anitbiotic remedy', 'the first cure', for tuberculosis.
So the drugs which can treat and cure tuberculosis have been around since basically the early fifties, and yet, as the WHO points out, (and which we will continue to repeat often) two billion people - one third of the world's total population- are infected with TB bacilli, and one in every ten of those people will develop active TB in their lifetime. And in 2005, approximately 1.6 million people died of tuberculosis. 1.6 million people then - overwhelmingly poor, from overwhelmingly poor countries - dead from a curable disease. Do they die because the drugs don't work? Well, in the cases of MDR-TB and XDR-TB they may, but for the most part they die because they don't have access to the drugs, or because the systems are not in place to provide them with these drugs. (Though much is afoot to remedy this, as we have talked about in our earlier discussions about The Global Health Movement') And to treat tuberculosis you have to treat the people who have tuberculosis. And obviously, its incredibly complicated and incredibly difficult.
So in the face of all that one could make that argument that tuberculosis does become - in addition to being a moral imperative - a symbol, or symbolic of something. A metaphor for - what? Global inequality and an international inequality of health outcomes. Basically. System failure. System absence. Even moral failure. If this puts me in jeopardy of 'romantically' projecting a kind of 'social disorder on to a epidemic disease', as Sontag would say, in order to assert a political opinion than so be it. It is certainly a romance that I am prepared to live with.
But irregardless, this then, is the story. In all its depth of complexity concerning questions of politics, history, economics, class, global inequality, biology, medicine, epidemiology, sociology, race and even gender. 1.6 million people! But do the major networks cover it? No that I'm aware of. Is it because they are bad, ignorant people? Well I guess that's an open question - but I would submit that they don't cover it because they wouldn't be allowed to cover it. If they tried to cover it they would probably be fired. The system that they work for can't cover it - is incapable of covering it! They're Corporate. And the subject is basically Tragic. And tragedy just isn't profitable, thus impossible, unless approached through a narrative of redemption. Then it might be possible. When was the last time anyone watched Network News? Why, with every thing going on in the world, and with all their reach and resources, is that system incapable of ignoring:
Because they have no choice. They're Corporate. Its the cheapest, most efficient and undeniable way to maximize their quarterly profits which is their entire reason for being, and to which they are legally bound. And everybody else is doing it. They are a business first and foremost. Am I being completely cynical if I speculate that the fate of entire multi-billion dollar corporate media entities, and the careers of the people who run them, ultimately rest upon the weekend plans of maybe four, five young women in the United States. All of them white, and all of them very rich. (Paris, Lindsay, Britney and the Olsen Twins. Okay. Maybe Brad and Anjelina. Princes William and Harry. The late Anna Nicole Smith. Tom and Katie. And maybe O.J. Simpson. And maybe, perhaps even Osama bin Laden.) Probably. Okay, so I'm losing the script here a little bit. (though I don't think I am too far off) But you get my meaning. I think its that bad. And so thats why like my health care, as I prefer my broadcast news - public. (Incidentally, much thanks to the good people at CelebrityNews.com for their generous donation of that incredibly exclusive video. Anything for the cause.)
Fortunately , we here at Global Health Nexus don't have that problem. (Although, apparently, judging by what has just occurred, we still may.) But we will cop to an abiding interest, bordering on an obsession, as to when, why and how the larger, complex political tragedy of the world enters into the neurotic corporate controlled media of the West. How the Second Present, enters into and impacts upon The First Present. It is a theme to which I am sure we will return.
(**And just as an aside: Though not specifically about this, but still about the effects of this system, anyone interested in watching a great film about how 'Corporations' unknowingly and almost unconsciously ultimately 'killed' the music industry could and should take the opportunity to watch the great PBS Frontline documentary The Way the Music Died**)
I have digressed. (It happens) But it does brings us full circle back to the story of Andrew Speaker.
For those few of you who don't know the story I'll do my best. Andrew Speaker is an Atlanta attorney who knew that he had tuberculosis which he apparently picked up in Viet Nam, while he was doing some kind of charity work over there or something or other. What Mr. Speaker did not know, he says, was that he was ill with XDR-TB and that he was 'sputum positive' and was indeed infectious. ('sputum positive' means that the bacilli in his system would be visible in a sample of his sputum when viewed under a microscope, and it would also mean that he was in fact 'infectious' to other people around him. TB being an airborn virus.) Mr. Speaker was in fact in dialogue with officials with at the Center for Disease Control and Prevention about this very subject, and he insists that they told him that they were legally bound to tell him that he may be infectious, but that they privately assured him that he was not infectious and that it would be okay for him to go celebrate his wedding in Greece. This seems to be the central point. And to back it up Mr. Speaker's father and legal partner in fact, actuallytaped these very conversations. (Tapes that he has now played before a Congressional Commitee in order to prove their point, and obviously, as ammunition in the inevitable lawsuits to come.) So with this knowledge Mr. Speaker left with his fiance Sarah and family over to the Greek Isles for their wedding, only to learn later on when they were in Rome, through another conversation with the same officials at the CDC, that not only was he in fact infectious, but that he was in fact infectious with XDR-TB. CDC officials claiming that they got the official results of all his tests back, only while he was away in Rome. So Mr. Speaker and his new wife found themselves in Rome, and the only place that could save his life was apparently back in Denver. And so in a panic, he and his wife flew back to Montreal and then rented a car and drove over the border and down to Denver. A customs official at the American/Canadian border apparently knowing and seeing that Mr. Speaker was on some kind of HEALTHWATCH LIST or something, let them through anyway. And anyone who came into contact with Mr. Speaker at this time - including all his fellow passengers on that enclosed airspace of the plane - could now also be at risk. And then the story broke.
Now I have no intention of casting any more opprobrious language in Mr. Speaker's direction than has already been cast. But I think obviously, he could have done everybody a favour and not flown over to Europe for his wedding. Until he knew for sure he could and should have just had his wedding in Denver; in the hospital even. He and his father (whose legal firm's website - The Speaker Law Firm - has as its motto, amazingly: 'Experience You Can Depend on') were obviously concerned enough about his health status as to actually tape their conversations with the CDC, so thus I find it hard to believe that they were totally oblivious to the gravity of his health situation. They could have thought beyond merely - 'are we covered here?' And furthermore it has now come to light that Mr. Speaker's Father-in-Law is a PHD and researcher in, what else?, tuberculosis at the CDC itself. So, granted, it is all pretty bizarre.
Perhaps my long, discursive point here is nothing other than to be amazed at the small twists of fate where an incredibly complex story (XDR-TB) with all its implications, which tells us so much about the state of the world we live in, a story that would not otherwise be covered by the major networks - is suddenly catapulted on to and into the embrace of those same networks in terms and definitions that were perfectly suited to their incredibly limited parameters of discourse: Mr. Speaker, white, American, lawyer, Southerner and his incredibly attractive blonde wife Sarah, suddenly sitting across from Diane Sawyer on Good Morning America while Diane does all that she can to milk the situation of all its potential weepy emotion, and cheap lazy moralizing while never once going beyond it to give at least a little bit of context. XDR-TB as an episode of Dr. Phil. Its actually quite amazing. Stunning even. But now, thanks to the glories of Youtube, you can watch it for yourself:
I guess my favourite quotes have to be the referring to Andrew Speaker as - 'Patient Zero', or 'The Man Behind The Mask' . The way Diane professes to wanting to get to 'his anger and his fears'. Mr Speaker himself talking about living in 'constant fear and anxiety' And that 'he wouldn't want anyone else to feel that way. Its awful.'. Indeed it is , and indeed it must be. When the subject arises about whether or not Mr. Speaker could have chartered a private plane to bring him back from Rome, Diane states that yes it would have cost a hundred thousand dollars and 'a hundred thousand dollars is a lot of money, but not impossible.'; a statement to which Mr Speaker stays silent. And then there is a heart-rendering interview with Mr. Speaker's wife Sarah - 'in sickness and in health', hasn't been able to kiss him etc. Amazingly it seems that they both have been reading blogs (help me) where they are constantly referred to as 'terrorists'. 'We are not terrorists', Mr Speaker says. We learn that that there are presently 14 000 people registered in the United States as having active tuberculosis.
Two other telling points I think emerge from this interview: The first has to do with the fact that when the Speakers were in Rome and they finally got the news that Mr. Speaker was infectious with XDR-TB, how they felt, as Americans, that their government had abandoned them - and thus that their government had some responsibility in helping them: 'Your government is just going to leave you there, and you are going to die?'. 'At least send a military plane or something.'. And the second point is the deeply ironic one about how much all of this Speaker business revolves around choice - choices he could have made, choices that he did make. choices the CDC made. Choice, agency, going to the essence of so many issues surrounding tuberculosis, since for the overwhelming majority of those who are actually ill - they basically have no choice. No choice in where they live, and certainly no choice with regards to health care.
"There is so much more to this than I would imagined before seeing this", says Diane's very cute Good Morning America co-host whom I have no idea what his name is.
Well, indeed there is Mr. Co-Host, and in the spirit of that statement we here at Global Health Nexus intend to stay on this story and give it as much depth as we can in the weeks and months ahead, for we indeed do think its quite important.
And we do genuinely wish the Speakers all the best. We don't think they're terrorists.
And now to finish off this little post/film festival, for your consideration:
Here is another another story of an American man - Robert Daniels - currently suffering with tuberculosis.
And here is one last Youtube video . One that at least touchest on the fuller, more complex international story of emerging XDR-TB:
Oh my! Stop the presses!
UPDATE: New Diagnosis! Turns out that Andrew Speaker was misdiagnosed. Turns out, that he doesn't have XDR-TB at all, but MDR-TB. In a statement "Speaker says that he is "incredibly relieved that tests that show he doesn't have XDR-TB. He noted that his understanding is that he does not have - and has has never had - XDR-TB. Speaker also indicated that today's news doesn't change the attention tuberculosis has recently gotten in the media, given that tuberculosis is a serious global health problem." Hear hear Andrew. And good luck.
Or not so good. Turns out that a bunch of Canadian passengers on that same flight to Montreal are now going to sue him for US 1.3 million, collectively. From a legal standpoint then, good thing he flew to Canada, for only a bunch of Canadians, when given an opportunity like this would sue for a measly 1.3. Now word yet from Speaker whether or not he is going to CDC. Stay tuned.
FURTHER UPDATE: Andrew Speaker is < ahref="http://www.webmd.com/news/20070726/andrew-speaker-released-from-hospital">released from the hospital!:
July 26, 2007 -- Tuberculosis patient Andrew Speaker took an air ambulance back to Georgia today after being discharged at 6 a.m. today from a Denver hospital.
Speaker, an Atlanta lawyer, got eight weeks of treatment for multidrug-resistant tuberculosis (MDR TB) at Denver's National Jewish Medical and Research Center. On July 17, Speaker had lung surgery to remove a tennis-ball sized piece of his lung that was infected by tuberculosis.
"Treatment for Mr. Speaker went very well, and we were able to release him more quickly than we originally anticipated," says Gwen Huitt, MD, in a National Jewish Medical and Research Center news release.
Speaker's TB treatment isn't over yet. He'll keep taking antibiotics for two years, though his TB is no longer detectable and isn't contagious.
"Although we believe there are still a few tuberculosis bacteria in his lungs, ongoing antibiotic therapy should kill those. We expect him to return to a full and active life," says Huitt, who directs the Adult Infectious Disease Care Center at National Jewish Medical and Research Center.