July 31, 2013
When I used to think of tropical diseases, or any disease for that matter, the word “sexy” never came to mind. I imagined a pitiful quality of life, a shortage of medication, or a doctor’s interaction with a dying patient. But, I have come to learn all diseases are not equally sexy. Through our learning at Oxford University, it became apparent that severe symptoms, shocking statistics, and publicity all play key roles in the “sexiness” of a disease. This sexiness translates into interest in the public, coverage by the media, and investment into research and management by wealthy donors.
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However, as Dr. Tom Darton said bright and early in the first lecture on a Monday morning, “typhoid is not sexy.” He went on to explain that the symptoms are not obvious. It doesn’t tend to kill people. It’s not one of the “big three,” (malaria, tuberculosis, and HIV/AIDS) which have research money constantly poured into researching them. It also is not an illness prevalent in children, which is a major contributor to the current attention to malaria. People suffering from typhoid “suffer in silence.” They are absolutely miserable, but usually not to the point of death. They are just sick enough so that it seems like living might not be worth it, but they have to live through the pain anyways. The problem with this is that many people, researchers and donors included, do not recognize that there can be things worse than death.
As mentioned earlier, the manifestation of typhoid is not as impressive as some other diseases. Not to say that a giant goiter from iodine deficiency or the swollen legs of elephantiasis are “impressive” in the general sense of the word, but they are strong, visible symptoms that something is wrong. They signal to the outside world that that person is suffering. In this day and age, presentation is important. These symptoms and their effects impress people into donating money and time into research on potential treatments and cures. Take HIV/AIDS, for example. Everyone wants to find a cure because an estimated 34 million people are living with HIV. The malaria situation is similar, as it kills about 750,000 people per year, mostly children. These statistics are the driving force behind the desire to understand and research these diseases. There are willing donors and even more willing researchers. Typhoid, on the other hand, makes people withdrawn, internally battling the abdominal pain, headaches, discomfort, constipation, fever, lethargy, aches, and characteristic rash that are symptoms of the disease. Since these are not necessarily visible symptoms, it’s hard to observe the disease in others, and therefore harder to recognize suffering. Additionally, death is not always a common result; so many people fail to see the importance in finding a cure or a vaccine.
Not only are the symptoms less than interesting for most people, the transmission of the disease is very off-putting. Similar to cholera, typhoid is transmitted via the fecal-oral route. In layman’s terms, this means that it is carried in people’s feces and passed along when someone ingests infected feces. This usually occurs when water is mixed and contaminated with sewage. Sadly, one of the easiest fixes for typhoid would be giving people clean drinking water. Somehow, Coca-Cola has managed to be shipped to every corner of the world, but clean drinking water has not. There’s no monetary gain in figuring out a way to do so since the people who would benefit from clean water are unable to afford the costs it would require to transport the it there.
The lack of apparent sexiness in typhoid’s presentation and transmission has been the kiss of death in researching and understanding the disease. Donors, drug companies, and researchers do not want to put effort into solving a disease that they do not see as deadly and that the media has not deemed “interesting.” This can be for a variety of reasons, but the major driving factor is that the people who would be receiving the treatment would be unable to pay for it, so there is hardly any money in researching typhoid. As stated earlier, what many people overlook when it comes to typhoid is the idea that there are things worse than death. Living with some of the symptoms of typhoid is worse than death. But the lack of fascination in the disease makes that idea irrelevant.
This mentality is a hard thing to accept about the global medical community. It would be nice to think that researchers are donating their time and donors their funds because they want to better the world. Many of them do. But terrible diseases are overlooked or ignored because there is no glamour in finding a cure for them. It’s also hard to accept the long road that exists between an idea and reality. Drug testing can take years before medicines are available to the general public, and it can take even longer for prices and costs to be negotiated before the poorest, and usually those in the direst need, can afford to purchase the medicine.
The major reality check that I experienced from this lecture as well as others is that there are inherent pitfalls with every medical system. There is no perfect plan that can cater to everyone’s needs in a cost-effective and sustainable way. If there were such a system, most countries would already be using it. At first, this demystification of the glory of healthcare was hard for me to stomach. However, there are glimmering aspects of some medical systems that show that the good of the people is being considered. For example, the inclusiveness of medical care in the UK and the specialty practices available in the US are impressive benefits to those systems. These aspects need to be understood on a global scale and implemented both nationally and internationally to improve health care for all. However, the massive costs of healthcare in the US offset some of the impressiveness of the available specialists. Corruption needs to be addressed, and the greed of many doctors needs to be limited if we want to achieve a sustainable system. While my faith in medical and healthcare systems has changed, I still believe that, through education and communication, we can achieve a more cohesive global healthcare system that encourages consideration, care, and good practice in a cost-effective manner.
Kenzi Roof is a sophomore majoring in Neuroscience and minoring in Business Administration from Westport, CT. She hopes to enter medical school upon completion of her undergraduate degree.