America’s Descent into Third World Status: Tropical Diseases Rise Among Poor (Update)

To the extent that middle class and more affluent people think about poverty in America, they likely have blurry, partial images due to distance and lack of direct experience. Their remedies might include better education and training, higher minimum wages, more affordable housing.

New Scientist thinks otherwise. Its headline for a blistering editorial: Want to fix US inequality? Begin with worming tablets.

Reader Francois T, who is a doctor as well as a research scientist, confirms that this piece is as damning as it sounds:

Your first reaction may be: “Worming tablets?? Come on! Tell me this is not about what I think it is!”

Well, sorry to be a Debbie Downer but…Yup! These the ones that, we, doctors, use to cure intestinal parasites so prevalent in so-called third-world countries. Turns out we need to use them here at home too…and a LOT more than anyone cares to admit.

Can there be a more scorching indictment of the sorry state of affairs in this country?

The New Scientist editorial tell President Obama that his checklist for combatting poverty – higher wages and labor bargaining rights, education, social security, and more growth – is incomplete. Readers will also know it’s not serious, since Obama has been trying to weaken Social Security and Medicare, and the Democrats know well unions have nowhere to go, so mere lip service will keep them in the fold. But here is the evidence on how rising inequality is producing even more desperation conditions among the poor:

Something Obama could also have mentioned was buying worming tablets and other remedies for tropical diseases.

This is no joke. Intestinal worms have traditionally been a huge drain on humanity, causing weakness and debilitation and perpetuating poverty. Nowadays such parasites are mainly a problem in Africa and Asia. But millions of the poorest people in the US also have worms – and they perpetuate poverty there, too.

It isn’t just worms. A dozen chronic parasitic diseases that plague the tropical poor also plague people in the US …They include Chagas disease, a relative of Africa’s sleeping sickness, and dengue, which has lately been spreading within the US…

Most of these diseases are easy to prevent and cure. They are linked to poor sanitation, lack of basic medical care and homes infested with vermin – all of which are associated with poverty.

And poverty is growing: the percentage of US homes living on less than the World Bank’s threshold of $2 per person per day has doubled since 1996. Some 20 per cent of all households with children get by on that or less at least sometimes.

Chagas? I first heard about it in Texas about a year ago. The person who gave me an earful has a doctor for a brother, and gave an alarmed reading on how quickly it was spreading (although he was also inveighing on illegal immigration, as opposed to poverty, as the culprit).

Chagas is nasty and pretty much never diagnosed. From a second New Scientist article, America’s hidden epidemic of tropical diseases:

When the letter arrives, it must come as a shock. Would-be blood donors are politely rejected because they’ve tested positive for a deadly tropical infection – and their doctors aren’t much help. Kristy Murray at Baylor College of Medicine in Houston, Texas, recalls one doctor telling a patient: “The test is wrong. That disease doesn’t exist in the US!”

But an estimated 330,000 US citizens, and possibly as many as a million, carry the parasite that causes Chagas disease. It is a chronic, silent infection that leads to lethal heart or gut damage in 40 per cent of cases. It is the most common parasitic disease in the Americas, and it can be treated – if the doctor is aware of it. Most US doctors aren’t.

Revealingly, Wikipedia is out of date on the status of chagas in the US, but it does give a good (as in grim) overview of how it spreads:

Chagas disease is contracted primarily in the Americas, particularly in poor, rural areas of Mexico, Central America, and South America; very rarely, the disease has been found in the Southern United States…Large-scale population movements from rural to urban areas of Latin America and to other regions of the world have increased the geographic distribution of Chagas disease…

In Chagas-endemic areas, the main mode of transmission is through an insect vector called a triatomine bug.A triatomine becomes infected with T. cruzi by feeding on the blood of an infected person or animal. During the day, triatomines hide in crevices in the walls and roofs. The bugs emerge at night, when the inhabitants are sleeping. Because they tend to feed on people’s faces, triatomine bugs are also known as “kissing bugs”. After they bite and ingest blood, they defecate on the person. Triatomines pass T. cruzi parasites (called trypomastigotes) in feces left near the site of the bite wound.

An article in Austin CERT explains why it often goes undiagnosed:

Chagas can be hard to detect because it can look like the flu at first, with symptoms similar to pains and fever. The symptoms appear to go away but the disease can live in a person for decades, sometimes reappearing in the form of digestive or heart failure.

In Texas, where most doctors are not familiar with the disease and are not required to report it to public health officials, they may misinterpret its late-onset symptoms as an old age problem…

And I’m taking the liberty of providing a lengthy excerpt from a widely-cited 2012 article that compares chagas to HIV:

Neglected tropical diseases (NTDs) are among the most common conditions afflicting the estimated 99 million people who live on less than US$2 per day in the Latin American and Caribbean (LAC) region [1]….With approximately 10 million people living with Chagas disease, this condition is one of the most common NTDs affecting the bottom 100 million in the region, a prevalence exceeded only by hookworm and other soil-transmitted helminth infections [1], [2]. Moreover, among the NTDs in the Americas, Chagas disease ranks near the top in terms of annual deaths and DALYs [disability-adjusted life years] lost [1], [2]…

Among those living with Chagas disease around the world today, 20%–30% (roughly 2–3 million people) are either currently suffering from Chagasic cardiomyopathy or will develop this clinical sequela [7]. Chagasic cardiomyopathy is a highly debilitating condition characterized by cardiac arrhythmias, heart failure, and risk of sudden death from ventricular fibrillation or tachycardia or thromboembolic events [7]. Another estimate suggests that up to 5.4 million people living today will develop Chagasic cardiomyopathy [8], [9]. Damage to the gastrointestinal tract can also produce debilitating megaesophagus and megacolon [7].

There are a number of striking similarities between people living with Chagas disease and people living with HIV/AIDS, particularly for those with HIV/AIDS who contracted the disease in the first two decades of the HIV/AIDS epidemic. Both diseases are health disparities, disproportionately affecting people living in poverty [1], [2]. Both are chronic conditions requiring prolonged treatment courses: a lifetime of antiretroviral therapy for HIV/AIDS patients, and one to three months of therapy for those with Chagas disease [7]. Treatment for HIV/AIDS is lifesaving, although it seldom if ever results in cure, while for Chagas disease, the treatment has proven efficacy only for the acute stages of the infection or in children up to 12 years of age during the early chronic phase of the infection [10]. For both diseases the treatment is expensive—in the case of Chagas disease, the expected cost of treatment per patient year is $1,028, with lifetime costs averaging $11,619 per patient.

New Scientist says that American doctors can get the drugs to treat chagas only by applying directly to the FDA.

And chagas isn’t the only so-called “neglected tropical disease” on the march in the US. Despite the name, these are aliments of poverty, not geography. For instance, for chagas, comparatively simple measures such as encouraging people to store wood away from their homes, encouraging living in concrete rather than wood or adobe structures, and selective pesticide spraying have reduced disease incidence considerably. But consider this depressing recap from New Scientist:

The more researchers look for these diseases, though, the more they find. In 2008, [Peter] Hotez [of Baylor College of Medicine] made initial calculations of the number of cases in the US for several NTDs, most of which still stand as the best estimates available. Updated work on two parasites, however – Trichomonas vaginalis and Toxoplasma gondii – shows that many more people have the infections than was thought five years ago. Much is specific to minority communities: 29 per cent of black American women carry T. vaginalis, versus 38 per cent of women in Nigeria. In the US, black women are 10 times as likely as white or Hispanic women to have the parasite, which increases the heterosexual spread of HIV and boosts the risk of a low-birthweight baby. Highly sensitive diagnostic tests were recently developed, and trichomoniasis can be cured with one oral dose of a common drug, metronidazole. But the startling prevalence of the disease suggests neither test nor treatment is routinely used…

Hispanic people in the US are also more likely to ingest eggs of the pork tapeworm, shed in human faeces, which can cause epilepsy if they lodge in the brain. Called cysticercosis, this now causes 1 in 10 seizure cases taken to Los Angeles emergency rooms. Poor white people in Appalachia, meanwhile, suffer from the intestinal threadworms Strongyloides stercoralis and Ascaris lumbricoides, a leading global cause of impaired childhood development.

The mosquito-borne dengue fever virus was chased from the US by DDT spraying in the 1950s, but is making a comeback. This year [Kirsty] Murray [of Baylor College of Medicine] found that dengue is being transmitted in Houston. Next year she will start testing random hospital patients for antibodies to see how widespread it is

Neither the Administration nor Congress so far has not roused itself to take interest in and fund even data collection on the incidence of NTDs. And it’s not as if poverty-linked diseases stay neatly contained in low-income ghettos. Consider, for instance, this 2012 report from the Palm Beach Post, Worst TB outbreak in 20 years kept secret:

The CDC officer had a serious warning for Florida health officials in April: A tuberculosis outbreak in Jacksonville was one of the worst his group had investigated in 20 years. Linked to 13 deaths and 99 illnesses, including six children, it would require concerted action to stop…

As health officials in Tallahassee turned their focus to restructuring [aka shrinking the Department of Health], Dr. Robert Luo’s 25-page report describing Jacksonville’s outbreak — and the measures needed to contain it – went unseen by key decision makers around the state. At the health agency, an order went out that the [Lantana] TB hospital must be closed six months ahead of schedule.

Had they seen the letter, decision makers would have learned that 3,000 people in the past two years may have had close contact with contagious people at Jacksonville’s homeless shelters, an outpatient mental health clinic and area jails. Yet only 253 people had been found and evaluated for TB infection, meaning Florida’s outbreak was, and is, far from contained.

Predictably, Obamacare provides for free preventive care like blood pressure tests, flu shots, mammograms, and obesity counseling, while expected to 30 million uninsured, many of whom will fall in these at risk categories. Enriching Big Pharma and health insurers was more important than addressing festering public health problems that perpetuate poverty and create conditions for the spread of contagions into the population at large.

But this is the world that neoliberalism creates: widening income disparity and falling levels of social well-being, particularly poorer health, even among the wealthy. Unless the rich decide to embrace these diseases as causes, as Bill Gates has of malaria (and Carlos Slim is taking an interest in chagas), the policy elites appear to prefer to sweep this indictment their new world order under the rug as long as the possibly can, even if the neglect is to their detriment.

Update 6:00 PM: Reader Francois T adds by email:

People won’t be treated for Chagas in the US because unless one has a high index of clinical suspicion, no one will look for it. Now, give me a Brazilian or Peruvian-trained doctor now practicing in the US and voila!

As for treatment, I will let the excellent Mayo Clinic Web reference take it away:

Treatment for Chagas disease focuses on killing the parasite and managing signs and symptoms.

During the acute phase of Chagas disease, the prescription medications benznidazole and nifurtimox may be of benefit. Both drugs are available in the regions most affected by Chagas disease. In the United States, however, the drugs can be obtained only through the Centers for Disease Control and Prevention.

Once Chagas disease reaches the chronic phase, medications aren’t effective for curing the disease. Instead, treatment depends on the specific signs and symptoms:

• Heart-related complications. Treatment may include medications, a pacemaker or other devices to regulate your heart rhythm, surgery, or even a heart transplant.

• Digestive-related complications. Treatment may include diet modification, medications, corticosteroids or, in severe cases, surgery

This is why I was so shocked by the NS article. Letting Chagas run rampant is the stupidest idea one can think of in terms of public health, unless we are willing to let people die in the streets without care.

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49 comments

  1. JGordon

    Uhg, what a scary post. Thanks for bringing chagas to my attention. Now I have to think on strategies of avoiding that crap.

    1. Jim Haygood

      Well, if you’re in your late teens through mid-twenties, why not enlist? Get dewormed by military doctors, while you bring the gift of democracy to oppressed nations. Win-win!

      1. bluntobj

        As I recall, JGordon is a vet, but that does not help him or others now. I may have to rethink my old decision to not live in Alaska. At least the frigid temps kill most pests.

    2. afisher

      While this may be a new disease / infection to many, it has been discussed by many in the medical community. Well at least in the Transfusion / Transplantation Section of the Medical Community. Developing a testing process for this disease, is much like the West Nile Virus that most should have heard about previously – it takes time and money to develop that testing.

      It has been discussed by the AABB ( American Association of Blood Banks) since 2002.

      Just sayin.

  2. JL Furtif

    Descent?
    The United States are a 3rd world nation. People living in trailer parks, police brutality, lack of health care, lack of public education, rampant corruption ..
    In what other country are you so much at risk of being shot at by the police?

    1. Yves Smith Post author

      I have been saying the US is a banana republic with nukes since I believe 2008. But not everyone has gotten the memo.

          1. sleepy

            The US is of course the “cutting edge” of the world’s market economies with all the pathologies that implies. Imho, all that means however, is that we are just a few years further down the road than most others. In that sense the US is not particularly exceptional, just the first to get there.

      1. Anarcissie

        I seem to recall a letter from J. K. Galbraith to the Times of many years ago arguing that the United States was a Third-World country, based on its economy of resource extraction and agriculture traded for manufactured goods, its fascination with military and police power, its prevalance of fundamentalist religion, and some other attributes. There was a certain amount of humor in the letter, yet I think Galbraith was kidding on the square, as they used to say.

    2. neo-realist

      Americans of color have been subject to those conditions practically forever—but now white americans are more and more starting to get a taste of what it is to be a person of color—not all the flavors, but at least the economic and a bit of the police state one.

      1. John Mc

        Good point.

        This plays into the Tea Party triangulation-gun toting mantra co-option of conservatives and the shaming guilt of hypocritical self-justification by the left during the last 40 years of the neoliberal fear machine.

        All the while, the prison system, pay to play justice system, and communities of color experience economic, social and relational hardships at 2, 3 and 10 times the rates of the dominant and affluent culture. In fact, there was a story today about a teenager (16 year-old) who killed 4 people with his care while blowing a (0.24) blood-alcohol rate. He is getting 10 years probation. His main argument was “affluenza” from the book by De Graaf et. al 2001 – that the dogged pursuit of more is painful and contagious”. http://www.huffingtonpost.com/2013/12/11/ethan-couch-sentenced_n_4426722.html

        If this Ethan Couch’s name were Tayvon Martin, there would be a very different outcome. Good point Neorealist.

        1. from Mexico

          That’s a fascinating story. Do you think characters like Jamie Diamond and Lloyd Blankfein also suffer from “affluenza”?

          Also, do you think the United State’s [in]justice or just-us system dances more to skin color, or to cold, hard cash? I thought the fact that Couch’s father had the wherewithall to plunk down the $450,000 per year to pay for some exclusive treatment facility to be telling.

          I realize that cultural and material considerations are inextricably intertwined. They cannot be separated as the polarization of continuum inherent in realist ontology dictates. But here in Mexico they do, nevertheless, have a popular saying that captures at least some of the truth: Con dinero, baile el perro. It translates to something like this: With money, the dog dances.

          1. John Mc

            Very reasonable questions. I think this hits one of Yves earlier points with the Pilkington piece, that we do not know our economic history very well collectively.

            As a result, it is difficult for many to remember how our estate tax laws have changed so drastically recently. Or how redlining and access to credit really prevented generations upon generations of workers of color along with poverty and sub-poverty level wages to build net worth to be able to consider paying for a legal defense.

            Lastly, when you look at some of the biggest heists (financial crises brought about by forgery, fraud, and manipulations with standard operating procedures of payday lenders, insurance scams, and casinos in all 50 states), we see a disproportionate number of those financially abused unable to participate in their own liberation from high interest rates, predatory/opaque terms and leading to a whole entire generation who is has learned helplessness around financial issues.

            At this present time and place, we now see why “financial literacy” industry is four to five decades late and Helaine Olen’s book: Pound Foolish (about the rise of an industry which assumes everyone should know how to manage money) as a non-mainstream critique as the privatization of financial education. You are correct, race and finances are intertwined and we do not know our history.

            Peace

    3. LucyLulu

      “In what other country are you so much at risk of being shot at by the police?”

      Fixed it for ‘ya.
      And no first world country has a higher incidence of gun deaths than the US.

  3. Ben Johannson

    Falling social wellness is to be expected given neoliberalism obsessive focus on individual consumers and firms. An atomistic viewpoint leads to atomistic policy and a dismantled social framework. We tend to forget the way in which we think influences outcomes more than our deliberate, conscious efforts.

    Unless you’re a right libertarian, in which case you are intentionally plotting misery and death.

  4. vlade

    Dengue and malaria is making a comeback in Europe too – and not only in areas where it historicaly used to be (such as Northern Italy), but more north. At the moment it’s being pretty much ignored.

  5. DakotabornKansan

    Thank you for this most important post!

    “There are in fact two things, science and opinion; the former begets knowledge, the latter ignorance.” – Hippocrates

    Guess who’s winning the “war on terror?”

    It is the simpler life forms, the viruses and microorganisms that live in or on us.

    It is not only the world that neoliberalism creates, it is also the dangerous and deadly result of science deniers that poses the serious threat to society. Their subversion of the truth and the resultant widespread scientific ignorance has increased the risk of global catastrophes and deaths due to the spread of diseases that could easily be prevented.

    “Up yours scientists!”

    “This snake-oil science stuff that is based on global warming, Gore-gate stuff.” – Sarah Palin

    The loons will never get it. Critical thinking and evidence-based science never reaches them.

    “Doubt is our product since it is the best means of competing with the ‘body of fact’ that exists in the mind of the general public. It is also a means of establishing a controversy.” – Tobacco company memo

    What is going on out there (described in the post above) and the level of threat is scary.

    “Reality must take precedence over public relations, for Nature cannot be fooled.” – Richard Feynman

    Peter Doherty, “In writing ‘Their Fate is Our Fate: How Birds Foretell Threats to Our Health and Our World,’ what I came to appreciate is the enormous importance of the “citizen science” done, for example, by Audubon Society members as they record the numbers and distribution of different avian species. Then, as the first person with a veterinary training to win a Nobel Prize, I’ve been privileged to hear intriguing stories about how birds monitor the world for environmental toxins, global warming and the habitat degradation that is an inevitable consequence of human development.”

    Doherty writes in his book:

    “The basic message is that any sudden, human-induced change has consequences when it comes to natural ecosystems, which is just one of the many reasons why widespread ignorance of science and the resultant failure to grapple with reality are dangerous.”

    “Birds in the wild function as a roaming, natural detection system… Birds detect danger to our health and the environment before we do…our free-flying, wide-ranging avian relatives serve as sentinels, sampling the health of the air, seas, forest and grasslands that we share with them and with the other complex life forms on this planet… they are like the proverbial canary in a coalmine… harbingers of danger – particularly in relation to climate change and environmental degradation.”

    Doherty notes, “It says something profound about the human condition that history takes much greater account of wars and military mayhem than of the enormous losses caused by communicable disease…as recently as the 19th century, people made no connection between infestation with visible parasites like worms and ticks and the unseen world of infection with microbes.”

    1. from Mexico

      The notion that science is some sort of silver bullet that can solve our political and moral problems has been shown to be problematic, to say the least. How did that philosophy work out for the Nazis?

      In this paper, Francois Haas explains how it was science that provided the intellectual building blocks for the Nazi master race ideology. And these weren’t some fringe scienctific theories. As he demonstrates, they were the leading scientific theories of the day embraced throughout Western civilization:

      “Although notions of race have a long history, it was ironically the Scientific Revolution followed by the Enlightenment and then the Age of Reason, emphasizing science and rationality, that were the wellsprings for biologically based racism.”

      –FRANCOIS HAAS, “German science and black racism — roots of the Nazi Holocaust”
      http://www.fasebj.org/content/22/2/332.full.pdf+html

      Another person who has done a great deal of work in this area is the science historian Naiomi Orestes. Guess who it was the tobacco companies hired to carry their message? It was none other than some of the worlds most distinguished and prestigious scientists, as she explains in this interview:

      “Naomi Oreskes, Tom Levenson: Virtually Speaking Science”
      http://www.blogtalkradio.com/virtuallyspeaking/2012/04/12/naomi-oreskes-tom-levenson-virtually-speaking-science-1

      And Oreskes asserts that the scientists who proselytized the tobacco companies’ message didn’t do it just for the money. They were true believers in neoclassical economic science.

      The epistemology and ontology that informs neoclassical economics is the same one that informed Nazism and Soviet communism. As John Gray explains:

      “The Positivists believed that as societies came to be based on science they were bound to become more alike. Scientific knowledge would engender a universal morality in which the aim of society was as much production as possible. Through the use of technology, humanity would extend its power over the Earth’s resources and overcome the worst forms of natural scarcity… Through the power given it by science, humanity would be able to erect a new world.”

      –JOHN GRAY, Al Qaeda and What It Means to Be Modern

      “There has always been disagreement about the nature of this new world,” Gray continues. For the Nazis, paradise on earth would be a world populated by the master race. For Marx and Lenin, it would be a classless egalitarian anarchy. And for neoclassical economists and the neo-liberals a universal free market. But what all of these have in common is a fundamentalist belief in Positivism. And as Oreskes explains, physicists are some of the most avowed acolytes of this fundamentalist secular religion.

      1. James Levy

        But if you go the Sara Palin route and throw doubt on the whole scientific enterprise, what is the alternative? You can always point out bad science, bad ideology, bad scholarship–but if one was to take this line to its logical conclusion, you would have no means whatsoever to find out what was going on or persuade others of the danger you perceive, other than appeals to their emotions, and if the Nazis screwed up science, it doesn’t take a genius to see what they did with appeals to the emotions.
        Science is the best tool in our tool chest. Charles Saunders Peirce proved that to my satisfaction. It is VERY different, however, from applied science (various forms of engineering). You are correct if and only if you are saying that applied science is no kind of magic bullet. It isn’t, because one involves finding out what is, the other involves using your limited knowledge to try to effect things in an uncertain future whose outlines you can only know dimly. This distinction is essential to our survival. By knowing what is going on, we can apply “do no harm”, i.e. stop doing what is dangerous or destructive. Without that knowledge we are sunk. But it doesn’t mean, “let the applied scientists run amok and just try some simple, linear solution to what ails us.” That is a different story, and that demands caution and a healthy respect for what we don’t know.

        1. from Mexico

          But where did this notion that the “whole scientific enterprise” is anything but doubt and skepticism come from?

          I personally, like Einstein, look favorably upon Kantian epistemology and ontology, which Einstein does a beautiful job of elaborating upon in these essays:

          http://www.sacred-texts.com/aor/einstein/einsci.htm

          But of course neoclassical economic science, Nazi science and Soviet communist science didn’t follow Kant’s philosophy of science. Instead, as Hannah Arendt explains:

          “[I]t is true that without Kant’s unshackling of speculative thought the rise of German idealism and its metaphysical systems would hardly have been possible. But the new brand of philosophers — Fichte, Schelling, Hegel — would scarcely have pleased Kant. Liberated by Kant from the old school dogmatism and its sterile exercises, encouraged by him to indulge in specualtive thinking, they actually took their cue from Descartes, went hunting for certainty, blurred once again the distinguishing line between thought and knowledge, and believed in all earnest that the results of their speculations possessed the same kind of validity as the results of cognitive processes.”

          –HANNAH ARENDT, The Life of the Mind

          And that’s exactly where we are today, and especially, though certainly not uniquely, when it comes to mainstream economic sciences.

          1. Benjamin

            Most scientists couldn’t give two shits what Kant or any other philosopher had to say. And I’m inclined to share the same position.

      2. DakotabornKansan

        I visited Dachau on the 25th anniversary of its liberation. Hearing the personal experiences of camp survivors made it one of the most profoundly moving experiences of my life. When living in Germany, I always asked myself how did these people become killers? Later, when I entered the medical profession and also became the father of a severely disabled child, the question of how the German medical professionals could join the Nazi killers haunted me. How did Nazi doctors, and Nazis in general, come to do what they did?

        “Psychologically speaking, nothing is darker or more menacing, or harder to accept, than the participation of physicians in mass murder.”

        Robert Jay Lifton’s The Nazi Doctors – Medical Killing and the Psychology of Genocide is one of the most important works on medical ethics ever written. Lifton’s psychological interpretation of Nazi Germany and its crimes is an excellent analysis and history of the monumental evil done by human beings trained to heal and cure.

        They were ordinary men…“neither brilliant nor stupid, neither inherently evil nor particularly ethically sensitive, they were by no means the demonic figures – sadistic, fanatic, lusting to kill – people have often thought them to be.”

        “What I have struggled with throughout this study is the disturbing psychological truth that participation in mass murder need not require emotions as extreme or demonic as it would seem appropriate for such a malignant project. Or to put the matter another way, ordinary people can commit demonic acts.”

        “…how, with our universal potential for murder and genocide, we for the most part hold back from such evil…we learn from the Nazis not only the crucial distinction between impulse and act, but the critical importance of larger ideological currents in connecting the two in ways that result in mass evil. Those connections and steps are my witness – not the undifferentiated moral condemnations of everybody.”
        “One listens to … the dark murmur that rises from the abyss beneath us, and that draws us with uncanny fascination and realizes that the murmur is our own, a whisper of danger that must be heard before it becomes a hopeless scream of genocide.”

    2. Francois T

      as recently as the 19th century, people made no connection between infestation with visible parasites like worms and ticks and the unseen world of infection with microbes

      And in the 21th century, we have people who refuse to see any connection between better public health and vaccines. They even go further by demonizing these products as the Incarnation of Pathos, with a fervor that would make Senator James Inhofe look like a reasonable skeptic on climate change!

  6. Brian Buchbinder

    Dengue, which you did not treat in detail, is increasing in the Southern US, and is both painful and after a 2nd infection, frequently lethal. It’s common name…”Bonebreak fever”. Climate change is improving the environment for its insect vector, the aedes aegyptae mosquito. According to the CDC, the most effective prevention is avoiding mosquito bites. Who lives in houses without screens? Hmmm.

    1. Francois T

      Thanks for mentioning climate change. It is indeed a big factor in the emergence of tropical diseases in this country.

      I can’t wait to watch a “Special Report” on CNN with Sanjay Gupta addressing these threats. If he displays the same kahunas toward elected officials than what he did with “Weed”, some Congressional glutes shall be had, roasted and salted, for Election Night Supper around the Homeland.

    2. sleepy

      Some good maps that are current for various tropical diseases in the US.

      http://diseasemaps.usgs.gov/del_us_human.html

      While most cases of dengue fever in the mainland US are considered imported via overseas travel, south Florida and Bexar County, TX (San Antonio) have had a total of 23 local cases as of Dec. 3rd.

      Puerto Rico has had over 7000.

    3. LucyLulu

      While growing up in S. Florida, certain times of year the mosquito truck would come around to spray the neighborhood once or twice weekly with a substance that briefly left a dense white fog in the air. When he came we ran and shut all the windows until the fog cleared. Who knows what it contained but I’m still here, no cancer, knock on wood. This was the 1960’s and 1970’s. I don’t remember when they stopped as I flew the coop north (only direction I could), but the foggings kept the populations somewhat under control in an environment that was noted by contemporary mosquito yuppies (muppies) to be a high-rolling gated version of reckless single living.

      Are municipal budget shortfalls and budget-cuts contributing to an increase in the insects and parasites spreading the disease? If effects on health of chemicals are a concern, there are typically other methods of insect control, e.g. natural predators or sterilization of mates or terrestrial hookworm nanodrones or something.

      And great job on the article in Salon, Yves! Excellent and important read!

  7. from Mexico

    The World Health Organization’s ranking of 190 countries by quality of healthcare is instructive.

    The U.S., ranked at 38, is below several Latin American countries: Columbia at 22, Chile at 33, Argentina at 34, and Costa Rica at 37.

    Cuba comes in only slightly below the U.S. with a ranking of 40. Venezuela at 55 and Mexico at 62 are still in the top third of the countries examined.

    And it’s not that the U.S. is failing to dedicate sufficient economic resources to healthcare. It’s the efficiency, stupid! If we define efficiency as bang for the buck, the U.S. healthcare system is by far and away the most inefficient in the world. In a recent graphic in one of Lambert Strether’s posts, he showed that Mexico spends about 1/10 per capita on healthcare as what the U.S. does, and yet it’s quality of healthcare is not that much worse than the US’s.

    1. sleepy

      The US has a few cases of the plague every year.

      http://www.cdc.gov/plague/maps/

      According to the chart, in 1983 there were 40 cases in the US. Since then, it appears to average around 10 per year.

      I know that folks in the southwest are at some risk, particularly people who backpack or camp in the Colorado Plateau area in any dusty area with ground squirrels, i.e., much of the area. Some of the state parks there have warning signs to that effect.

    2. sleepy

      To address your concern, the plague is treatable, and if your family has access to medical care or doesnt live in an infected region, probably not too much worry. I would guess that there are far more endemic diseases in Mauritius to worry about than the plague.

      1. anon y'mouse

        tell them to minimize contact with wild animals, and take precautions against fleas.

        and yes, you can get fleas from roaming around outside without direct contact with an animal, just by being in the places they tend to hang out. don’t ask me how I know 9-/

  8. Dave of Maryland

    Civilizations have traditionally been based on abundant money and the engineering it bought. The best engineering was of course sanitation: Abundant fresh water and sewers. Rome was not an accident.

    The money part was based on slavery of one form or another. Slavery is, essentially, not paying someone fairly for his work. Rome had slaves, which is where they got the money to build the aqueducts. The Americas were founded as slave-based, get-rich-quick empires and for the most part still are. (Was the trans-Atlantic slave trade any different from unfettered international capitalism, or the Euro? I have a hard time seeing much difference. Industrialization was slavery on a massive new scale.) Some small fraction of the ill-gotten gains have to cycle back to the general populace, or disease and privation overwhelm everyone and the civilization is lost. The struggle has been and will always be to get enough to fund that. I note with distress that home owners are charged sewer fees at a time when toll roads are sweeping the nation. Sewers, like roads, must be free to all.

    The prevalence of STD/VD clinics in America is a hopeful sign. Every town in America that I’ve ever lived in had a free, no questions asked, VD clinic, though few are aware of them. Why? Not for any fake welfare or social improvement reasons. There are free VD clinics because the mayor, the chief of police, the head judge, the school superintendent can’t keep it in their pants but cannot come home and infect the wife. If we were to run health care like VD clinics, we would not have TB outbreaks in Florida. Back in the days when I was sexually active – not that long ago, ONE FOURTH to ONE THIRD of my partners were diseased. Even though there were clinics. I doubt the percentages are any different now. Which is how I learned of the clinics. My god, but private heath care is dangerous. There may not be anything in the world more dangerous.

  9. Francois T

    One of the most galling aspects of this parasitosis health scourge is knowing how ancient it is. For a country that regards itself as so exceptional and advanced, it is beyond shameful.

  10. diptherio

    Remember when that African political leader caught all that flack for saying that AIDS isn’t caused by HIV, but by poverty? He was right, you know, especially now that effective anti-retroviral treatment is available. Chagas isn’t caused by a virus or a bacteria, it’s spontaneously generated when you combine greed, avarice, and destitution in high enough concentrations.

    I’m reminded of the time my friend Rabi exploded with anger once while we were listening to the local news on the radio in Nepal. The news-anchor was detailing the demise of a dozen or so people in the south of the country (the Terai) due to an extreme cold snap. “Cold leads to death in the Terai” the announcer intoned, and Rabi just about lost his sh!t.

    “The cold?!? The cold?!? What is he talking about?!? Let me tell you something, brother, the cold didn’t kill those people, poverty did! If they could afford a blanket, then the cold is no problem! Lots of people live in Terai and don’t die when cold comes! Cold doesn’t kill people, not having blankets kills people!!!”

    1. different clue

      What that South African leader (Thabo Mbeki) meant was that there was no HIV involvement in “Aids”. He got that theory from Peter Duesberg, I believe. He acted on that theory to oppose the use of anti-retrovirals, “don’t spread HIV” campaigns, and etc. (if I remember correctly what I have read). The number of HIV infected people in South Africa rose by millions during Thabo Mbeki’s “HIV has nothing to do with AIDS” tenure of office and policy.

  11. clarence swinney

    QUOTES
    fREEDOM OF SPEECH DOES NOT MEAN FREEDOM TO BUY OUR GOVERNMENT BERNIE SANDERS
    iT IS NOT DEMOCRACY WHEN IT IS HARDER TO VOTE THAN BUY AN SSAULT GUN BILL CLINTON

  12. Teejay

    The number of directions and the speed with which our society could be decimated is
    staggering. Putting aside a terrorist event, consider an economic hit centered around the
    massive derivative exposure of the top banks (the last number I’ve seen, $229 T, maybe out of date) or the Frontline story about antibiotic resistant NDH1, KPC or gram negative bacteria or a computer virus that manages to shut down the electrical grid from coast to coast. We’re a blink or a sneeze away from scenarios like that.

    http://demonocracy.info/infographics/usa/derivatives/bank_exposure.html
    http://www.pbs.org/wgbh/pages/frontline/hunting-the-nightmare-bacteria/

  13. craazyboy

    Maybe Janet Yellen will lower interest rates? That might help.

    I have read some herbal folklore remedies for worms/parasites. A combination of Black Walnut extract, Wormwood supplement caps and ground clove is supposed to do the trick.
    But I don’t know if it really works, and if it is as effective as Doc prescribed “worm pills”.

  14. Andrea

    Yes. But, besides the duo of extremely poor health care and poverty, there are two other factors:

    Global warming, new spread of infectious diseases in new regions that are unaware / unequipped to deal.

    Globalization exchanges of different materials, such as tires, which contain a lot of surprises in their treads, as the surface permits retention of small droplets of water that can harbor mosquitoes and other organisms. This is just an example, but it speaks, as anyone can visualize a tire.

    In Switzerland, for ex. we have the new threat of dengue fever and malaria (mosquito borne) appear starkly in the most Southern part of country, the Ticino, which is of course far warmer than the usual stereotype of Switz. projects (cold, snow, mountain peaks, fur coats, etc.) as it has gotten warmer, far warmer than the ‘average stats’…

  15. different clue

    Once again I suggest considering the following question: if the transnational Overclass wanted to kill several billion people over several decades and make it look like fate and bad luck, how would they engineer that outcome?

  16. different clue

    If that’s all that is required, then no fingerprints will be left. Only the organized Armed Forces of the world could exterminate the Overclass and set course away from the “let several billion people die” plan.

  17. Wade Riddick

    Just because bacteria kill people with pneumonia, you wouldn’t want to kill all bacteria in the human body. Among other things, bacteria in your gut help you digest food, regulate your immune system and maintain your insulin sensitivity. Killing them all is a really bad idea. Patients like me who have been placed on broad spectrum antibiotics for long periods of time often develop autoimmune diseases and allergies.

    Just as it’s a bad idea to kill all bacteria, it’s also a bad idea to kill all helminths (worms) in the human body. Some of these species are quite innocuous. Helminths regulate the immune system and prevent asthma, allergy, autism and autoimmunity. If you’re going to completely deworm Americans (like I was), be sure to inform them that this is one of the central risk factors in developing these modern immunological diseases.

    By the way, I’ve used pig whipworm eggs to control my allergies and joint inflammation for about seven years now. Unlike NSAIDs, antibiotics, mercury fillings and a number of other FDA approved “treatments,” these worms haven’t done anything bad to me. While they should be freely available as a part of our natural heritage as homo sapiens, they are ridiculously expensive for most patients. This is another example of Washington rent-seeking. The FDA has taken something natural and in the public domain and has manipulated its risk analysis to protect expensive, patented, riskier alternative treatments (like Remicade).

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