Final Policy Paper - Jessica Rix

Jessica Rix
March 14, 2008
Dr. Rachel Robson

Fighting Tuberculosis
Tuberculosis (TB) is a serious communicable disease. One third of the world’s population is infected with a dormant form of TB. Stress on the immune system allows the TB to become active. This is infectious and deadly. TB is acquired by breathing the air with TB bacterium. Once TB is contracted into the lungs of a person, it begins to multiply. The bacteria are capable of damaging the lungs to the point of coughing up blood and leading to death. Active TB infects about one-third of the world’s population and millions of people die from it each year (Salyers & Whitt 2005).
Tuberculosis is a larger problem in developing countries than in the United States. This is because there are fewer opportunities for medical treatments, and a higher prevalence of other diseases, such as HIV (McKinney, Jacobs, & Bloom 1998). TB has the potential to be a problem in Sioux City, IA, because of recent immigrants into the U.S. that live in Sioux City. These immigrants are from the underdeveloped countries that have a much higher prevalence of TB than the U.S.
In Sioux City, there was a 249.1% growth of the Hispanic immigration population in the year 2000 (Johnson-Webb 2001). It can be assumed that those numbers have increased in the past several years. The prevalence of TB in Mexico is much higher than in the U.S. About 277 people out of 100,000 have TB in Mexico, where only about 8 out of 100,000 people have TB in the U.S. (Sánchez-Pérez, Flores-Hernández, Jansá, 2001). This alone creates a need for TB to be treated in Sioux City.
TB treatment is essential in controlling the spread of TB. Treatment for TB requires taking oral antibiotics for more than six months. There are also side effects such as nausea connected with the treatment. The long duration and side effects of treatment are the reasons why patients may not take their pills regularly. Non-compliance rates are affected most by alcohol abuse and homelessness (Burman, 2007). The infrequent doses of medication in the patient’s body can create complications such as the TB bacteria becoming resistant to the medication (Salyers & Whitt 2005). This can be a serious problem if an outbreak of TB were to occur. Therefore, the medication given for the treatment of TB needs to be taken regularly for the entire duration of six months or more, until the TB is completely cured. The DOTS (directly observed therapy short course) program was created to help control the treatment of TB, and make sure that the strict regulations for treatment were being followed.
In the DOTS program, TB patients either go to a clinic daily, where they receive their medication, or a health worker visits the patient’s home to supervise them taking the TB medication. The current rate of TB in Sioux City is unknown. It is important and necessary to find out the current rate of TB in Sioux City and to decrease the spread of it. In order to decrease the spread of TB in Sioux City, the DOTS program needs to become more efficient. TB treatment needs to be required and taken regularly to prevent the spread and mutation of the disease.

To stop the spread of TB, the DOTS program should be required in Sioux City. This will ensure that the disease is not spread and that drug-resistant TB does not evolve.
1. The DOTS program will be used to help and observe patients during the six to eight month treatment. Requiring a nurse to visit the TB patient every day or a visit to the nearest health clinic to ensure the completion of the patient’s TB treatment.
2. According to the marginal estimates from India, we can assume the cost of DOTS per person in Sioux City to be about $300 per person (Centers for Disease Control and Prevention 2007). There are roughly 4 documented cases of TB per in Sioux City per year. We can also assume that there are 3 undocumented cases of TB in Sioux City per year. The total cost of treating TB would be around $2,100. The estimated cost of publicizing free PPD, purified protein derivative, testing for TB is $10,000. The cost of the PPD testing would amount to about $10,000 dollars. The total costs for the program would equal $22,100. The CDC budget would cover the costs of the TB treatment and PPD testing. The publicity for the free PPD testing would be provided by stations as a public service announcement. The CDC has a budget for tuberculosis amounting to $136,791 (Centers for Disease Control and Prevention 2007). The DOTS program would fall under this category.
3. Testing for TB will be done at local clinics around Sioux City. A PPD, or purified protein derivative, test will determine if patients have TB or not. The PPD test will be free for all residents of Sioux City. The free tests will be publicized in the local T.V. stations, on the radio, and on billboards around town. If tested positive, patient will be required to follow TB treatment under the DOTS program. The CDC budget will pay for TB treatment expenses.

It is arguable that the cost of this program makes it unreasonable for the program to exist. The need for TB to be under control outweighs the importance of how much the program costs. If TB is not handled correctly, then many people could become infected, and TB could evolve into a drug-resistant disease. In either of these cases, the resulting expenses would be even greater than the expense of running the program. There would be more people with TB to treat, and there would have to be more research to find a new treatment for the drug-resistant TB. Even more people would die because of TB, if the disease was spread and another drug-resistant strain of TB developed. Therefore, the initial costs of the program are relatively low, compared to the potential costs if the program were not in place.
Another argument against the DOTS program is that it is not ethical because it takes away individuals’ rights. The people with TB are required to take the treatment and be watched while taking the treatment, violating their privacy. While some might think that this is unethical, it is not. There are only a few individual rights that are affected with this program. The rights that are taken away are for the greater good of the entire population (Goodin 1995). Other people could become infected with TB very easily, if those who are sick do not take treatment. The risk of having another drug-resistant form of TB would also be a negative outcome to letting people take the TB medication without supervision. Patients are likely to take their drugs carelessly, which would give the opportunity for drug-resistant TB to evolve (Salyers & Whitt 2005). In either case, patients not taking the TB treatment or taking it carelessly would result in more cases of TB that would be harder to get rid of. Therefore, more people would die from TB. The few rights of the patient should be limited to provide the protection that is needed against TB.

Works Cited
Bloom, B. R., & Murray, C. J. L. (1992). Tuberculosis: Commentary on a Reemergent Killer. Science, 257, 1055-1064.

Burman, W. J., Cohn, D. L., Rietmeijer, C. A., Judson, F. N., Sbarbaro, J. A., and Reve, R. R. (1997) Noncompliance With Directly Observed Therapy for Tuberculosis: Epidemiology and Effect on the Outcome of Treatment Chest, 111, 1168-1173.

Centers for Disease Control and Prevention. (2007) Budget Request Summary. Retrieved February 22, 2008, from

Ginsberg, A. M. (1998). The Tuberculosis Epidemic. Scientific Challenges and Opportunities. Public Health Report, 113, 128-136.

Goodin, R. E. (1995). Utilitarianism as a Public Philosophy. New York: Cambridge University Press.

Johnson-Webb, K.D. (2001). Midwest Rural Communities in Transition: Hispanic Immigration. Rural Development News, 25, 4-5.

McKinney, J. D., Jacobs, W. R., Jr., & Bloom, B. R. (1998) Persisting Problems in Tuberculosis. In R. M. Krause (Ed.), Emerging Infections (51-183). San Diego, California: Academic Press.
Sánchez-Pérez, Flores-Hernández, Jansá, (2001) Pulmonary tuberculosis and associated factors in areas of high levels of poverty in Chiapas, Mexico. International Journal of Epidemiology, 30, 386-393.

Salyers, A. A., Whitt, D. D. (2002) Bacterial Pathogenesis A molecular Approach. Washington, D. C.: American Society for Microbiology Press.

Salyers, A. A., Whitt, D. D. (2005) Revenge of the Microbes: How Bacterial Resistance Is Undermining the Antibiotic Miracle. Washington, D. C.: American Society for Microbiology Press.

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