4th Global Conference
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Monday 4th July - Thursday 7th July 2005
Mansfield College, Oxford
Conference Programme, Abstracts & Papers
Session 9A: The Social and Political Contexts of Health (2)
Chair: Sebastian Bechman
A Jefferson Davis Problem: The 1958 Staphylococcus
Aureus Epidemic at Houston’s
Public Charity Hospital
Mari Nicholson-Preuss
University of Houston, Texas, USA
In the 1950s antibiotic resistant staphylococcal
infections surfaced in
hospitals throughout North America and Europe. Particularly virulent
among the
epidemic strains of staphylococcus, type 80/81 possessed a tendency
to produce
nursery outbreaks. The epidemics challenged the modern image of
the safe
and sterile hospital environment as well as the wonder-drug status
of
antibiotics and raised concern amongst medical professionals, public
health
authorities and the media. Epidemiologists warned that all hospitals
possessed
the potential for an outbreak, but especially those with substandard
antiseptic
procedures, overcrowding and staffing shortages. While the epidemic
did surface
in some private suburban and non urban institutions, the urban public
hospitals, often both overcrowded and underfunded, suffered the highest
morbidity and mortality during the outbreaks.
Jefferson Davis Hospital,
Houston's public charity institution, provided care
for the area's indigent and minority, specifically African-American,
populations
and possessed a reputation for being dirty, overcrowded and terribly
underfunded. From the fall of 1957 to the summer of 1958 a staphylococcus
epidemic in the hospital's maternity ward claimed the lives of thirty
six pediatric
patients and infected over four hundred others. The local newspaper
coverage
focused on the conditions in the hospital and rumors of an extensive
conspiracy
of silence orchestrated by Baylor College of Medicine and the hospital's
board
of directors. However, the press also endeavored to allay public
fears that the
epidemic could appear elsewhere. Repeatedly, the newspapers balanced
stories of
the outbreak at Jefferson Davis with stories about the safety measures
in place
at the private institutions. The epidemic and hospital became fused and
any
appearance of the disease outside of the hospital led to questions of
the
patient's contact with Jefferson Davis. Referred to as a "Jeff
Davis problem",
the outbreak was framed in the larger context of the institution and
bore its
local economic and racial stigmas.
This paper explores how the rhetoric
of the media and the hospital's board of
managers reveal the different standards and expectations for public and
private
hospitals. It also argues for closer investigation of the public meanings
attached to modern nosocomial infections.
The Social and Political Context of Disease Outbreaks:
The Case of SARS in Toronto
Harris Ali and Roxana Salehi
Faculty of Environmental Studies, York University, Toronto, Canada
Although infectious diseases have a biological expression, the distribution of such diseases is largely determined by social and political factors. As such, the movement of disease pathogens between locations and bodies can be influenced by a myriad of socio- political factors that influence the context and manner in which a given pathogen moves. Indeed, a newly recognized or novel disease is rarely a purely virological event, rather, it is now increasingly acknowledged that a wide range of factors are involved in the onset of disease epidemics, including: ecological changes; human demographic changes and behavior; travel and commerce; technology and industry; microbial adaptation and change; and breakdown of public health measures. Despite the increasing awareness of the importance of these types of factors, they are not typically taken into consideration in conventional epidemiological accounts of pathogen tracking. In this paper, this neglected dimension of disease outbreak analyses is addressed by using the Severe Acute Respiratory Syndrome (SARS) outbreak in Toronto as an empirical referent to investigate how “globalizing” socio-political forces affect the dynamics of infectious disease diffusion in the contemporary world. In particular, we employ the concepts of microbial traffic and the flow of human contacts within the context of what has been referred to as the “global cities network” to investigate the issue of how social and political conditions influenced the transmission of the SARS virus between cities around the globe, as well as between individuals in the City of Toronto itself. Secondly, we investigate and discuss the implications of emerging trends within contemporary global health politics for the local and international responses that were observed during the SARS outbreaks in Toronto; particularly in the limitations faced by local public health authorities to respond to the outbreaks such as these in an increasingly borderless globalized world. Further, we explore the issues and implications pertaining to the ability of the state powers to engage in new methods of surveillance and the governance of the body and space during times of disease outbreaks and other states of emergencies.
Debates over the Safety of SSRI
Linsey McGoey
BIOS Centre, London School of Economics, London, United Kingdom
Throughout the past two years, debates over the safety of SSRI (selective serotonin reuptake inhibitors) antidepressants have become headline news; almost daily the British and North American media report another aspect of the growing controversy. Debates over SSRIs are focused on three main areas: Questions about the safety and efficacy of SSRIs, questions about how and when psychiatrists and GPs should prescribe such drugs, and questions about the regulation and licensing of pharmaceuticals in Britain. The second area of contention noted above “the debates over how SSRIs should be prescribed, and the clinical uncertainty created by such debates“ is forming the basis of my ongoing doctoral research into the influence of the SSRI controversy on the perceptions and beliefs of British psychiatrists. The paper presented at the Making Sense of Health, Illness and Disease conference would draw on this research in an initial exploration of how the debates over antidepressants are affecting psychiatrists' perceptions of clinical practice, their perceptions of the design, process and publication of randomised controlled trials, and their perceptions of the regulation of pharmaceutical drugs in Britain. The paper would focus on two theoretical approaches. Firstly, it would discuss the role of credibility and personal reputation in the acceptance or the rejection of medical discoveries, drawing on Rabinow's Making PCR and Shapin's A Social History of Truth. Secondly, drawing on Bourdieu's analysis of the Barthes-Picard Affair in France, the paper would discuss Bourdieu's concept of illusio in relation to how practitioners perceive, internalize and seek to manage controversy.