If you get tuberculosis in the US and aren't insured, you're fucked.

[raccoon]

I dreamed I said that to somebody. But isn't it true?

I'm sure it doesn't occur to those who oppose a national health plan that that sort of thing creates a public health hazard. And even if you're rich, it could affect you. It could be your maid who has TB--your yard man.....

[SheilaT]

1. And what makes tuberculosis

special?

In this country if you get any serious illness and have no health insurance you're pretty much fucked.

[raccoon]

2. True. But tuberculosis is communicable, whereas many chronic illnesses

aren't, nor most kinds of cancer (that I know of).

To me that makes it special.

It is disgraceful this country has no national health plan.

[hlthe2b]

3. Actually, probably not.... TB is a public health threat so...

there would be every impetus to get you treated, at least to the extent you are no longer infectious. So, no, your local and state health department would step in to ensure you are treated.

[raccoon]

4. Would they, do you think? Even if the patient didn't have money? nt

[hlthe2b]

5. Yes... I have worked in public health for nearly two decades...

Individuals with active Tb cases do get treated, regardless of their ability to pay. I'm not saying they all get sent to the cadillac of institutes, like National Jewish Hospital in Denver, but they do get treated.


Public Health is the unsung advocate for Americans--they ae fighting against regressive anti-immigrant policies that would preclude vaccination or communicable disease control care for undocumented individuals, as well as for the need to provide this care to the uninsured, underinsured. Obviously there is a much bigger problem with respect to compehensive health care, but you should support your local and state public health departments... Their activities are protecting you too.

[raccoon]

6. Thanks for the heads up. I'm surprised in Bushistan they do that much. nt

[hlthe2b]

7. See my edit above... It is not without major struggles...

Every health agency from CDC down to your local county or city health department is struggling in Bush* world....But, they have managed to keep some critical programs in place, those that protect all of us.

[crikkett]

8. thanks for the good news n/t

[TechBear_Seattle]

10. Thank you

Living in a big city, I have seen the effects of the general lack of medical care. It is good to know that there are people working on public health issues; your work is not publicized enough.

:toast:

[hlthe2b]

12. Don't thank me... Just give your county commissioners or

other local government holy hell when they want to divert all funding away from the critical mission of public health, ditto your Congressional delegation with respect to CDC. Much of CDC's funding is funneled down through the state health departments to local public health, where we all see the "bang for the buck."

Oh, and educate your neighbors.... ;)

[SidDithers]

18. It's probably a bigger worry that infected individuals...

may not seek early care, and may wait until they're really, really sick before seeing a doctor. Diagnosis and treatment (and quarantine?) may be significantly delayed.

As bad as the SARS outbreak was in Toronto, we at least didn't have a financial component to the decision to get checked if we started feeling sick. I'm convinced that if SARS had hit a major American city, the situation could have been much worse, because of the number of uninsured who might choose to pay their rent instead of going to the doctor.

Public Health is a vastly underappreciated field, and Public Health officials do good work for people without them even knowing it. :)

Cheers.

Sid

[hlthe2b]

23. I have to agree with you about SARS

The US had a few cases, but had we had a Toronto situation, we would have had a tremendous struggle. That is definitely one time when nationalized health care teamed with strong public health made the difference.

:7

[TechBear_Seattle]

9. In theory, there is strong impetus to get everyone vaccinated

In reality, if parents cannot afford to vaccinate their children, the kids are kicked out of school and not allowed back in until either the parents can scrape together the funds or a private sector charity steps in.

Why should tuberculosis be treated any differently than measles, mumps, pertussis, polio or influenza?

[Horse with no Name]

13. because we don't immunize for TB here in the US n/t

[hlthe2b]

15. We don't immunize for TB because it is ineffective...

[Horse with no Name]

16. Not necessarily because it is ineffective

but the BCG interferes with skin testing for the disease which is much cheaper and safer than having repeated exposure to radiation from xrays.

[hlthe2b]

19. Re: effectiveness (or lack there of) of BCG

**BCG, or bacille Calmette-Guerin, is a vaccine for TB disease that is used in many countries. However, BCG is not generally recommended in the United States because there is a low risk of infection with M. tuberculosis and because the effectiveness of BCG has varied substantially--from 0% to 76% in eight major studies. In a recent meta-analysis, data from all clinical trials of BCG were combined and analyzed. The protective effect of BCG was found to be 50% against all forms of TB and 64% against TB meningitis. --CDC Core Curriculum on Immunization


**A comparison of BCG protective effects against TB in HIV positive and HIV NEGATIVE was 22% and 26% respectively in a recent study from Brazil. http://ije.oxfordjournals.org/cgi/content/full/29/6/1085



In general, the only area where there is consensus on the utility of BCG vaccine worldwide is specifically in childen living in highly endemic areas against disseminated forms of the disease...

[Horse with no Name]

21. I'm very well read on it but thanks for the info

:)

[hlthe2b]

22. Back at ya...

;)

[happyslug]

24. Even in Third World country, the Vaccine of TB is discouraged.

The Vaccine is only to be given to people who are exposed to someone with TB and that exposure can NOT be stopped (i.e. children living with adults who have TB, but there is no where else for the Children to live). The main reason for lack of use of the TB vaccine is that given the low rate of TB in the US AND the rate one gets TB from the Vaccine, the Center for Disease Control's position is that to use the Vaccine would INCREASE the number of TB cases in the US not reduce them (i.e. more people will get TB from the Vaccine then would NOT get TB if vaccinated).

For more details see:
http://cdc.gov/tb/pubs/tbfactsheets/BCG.htm
http://www.who.int/vaccine_research/diseases/tb/vaccine_development/bcg/en/index.html
http://www.immunizationinfo.org/VaccineInfo/vaccine_detail.cfv?id=18

Remember the TB vaccine is a weaken form of TB. Thus you back to the Salk-Sabin polio vaccine debate. Sabin in considered superior, but it uses live polio virus which can evolve into full blown Polio. Salk used Dead polio Viruses, and thus while considered "weaker" than Sabin, Salk vaccine does NOT contain the risk of manifesting itself as full blown polio (When Salk first came out, do to a manufacturing error, a batch did produce Polio, but no cases of Polio leaked ot the Salk vaccine has appeared since that event in the 1950s, Sabin had cases from its introduction in 1964 to the time it was removed and replaced by the Salk vaccine do to number of people who came down with polio from using the Sabin Vaccine).

This is further complicated by the fact TB is a bacterial infection NOT a Viral infection. Vaccination works best on Viral infections, it is generally better to treat bacterial infections with some sort of penicillin type drugs (Which are ineffective against Viral infections). It is unknown to this day how your body defeats most Viral infections, but exposure to the Virus gives your body a better chance (Thus why we vaccine people, to expose them to a weaken or dead form of the virus so your body can develop anti-bodies and other agents to defeat the Virus quicker). Thus it is better to treat bacterial infections with penicillin type drugs (if effective on that disease, some are some are not) then to prepare the body to fight off the infection. The opposite approach is done for viral infections, given that they is little if anything one can do to help the body fight of the infection (Besides, rest, food and water).

[Horse with no Name]

25. No more links on this please

I am very well educated on vaccines and their usage...including the BCG vaccine.

My statement regarding the BCG Vaccine was in a reference to the statement made by Tech Bear
"Why should tuberculosis be treated any differently than measles, mumps, pertussis, polio or influenza?"

and my response to it was "because we don't vaccinate for TB in the US"

It was a very limited response to his statement...and nowhere do I advocate the use of that vaccine.

[hlthe2b]

14. There remain strong programs for childhood vaccination...

All one needs to do is call your State Health Department's Immunization progam and ask them to identify a VFC (Vaccine for Children) provider or your local public health department's vaccination clinic locations.

Now, vaccines for adults-- that remains a major challenge

[w8liftinglady]

26. I have to agree-we have a tb clinic associated with our county hospital

meds are provided

[Horse with no Name]

11. TB is a public health threat

If you don't take your medicine willingly and they can prove it...they CAN institutionalize you.
There were a couple of stories last year...one was the rich guy whose FIL worked at the CDC who was sent to a fancy hospital in Colorado I think...and the other was a poor guy who was put in prison. The difference in treatment for the haves and have nots is staggering though.:(

[HughBeaumont]

17. In the US, if you get ANY major illness and you aren't insured . . .

. . . well, really, it doesn't matter whether you ARE or AREN'T insured, you're still fucked. You know, unless you're a multi-millionaire. In that case, you're covered.

[alphafemale]

20. Oh...they wouldn't let you just "walk away" with active TB.

That's one of the few diseases out there that would get you IMMEDIATE medical attention.

You might not like the medical attention. But you would get it. I don't have much doubt about that.