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May 31, 2007

Public Health, Booze, and the Drug War

Public Health,  Alcohol, and the Drug War  (politial/medical)
The flap over Public Health officials' inability to stop a honeymooner from flying round-trip to Europe with a rare, drug resistant form of Tuberculosis begs comparison with the tactics of the drug war, in which heavily armed SWAT teams routinely serve search warrants to look for drugs. The drug war  can thus be thought of as merely a variant of Public Health––  one practiced by police in accord with Department of Justice standards –– a kind of Epidemiology run amok.

The TB story resonated with me because during my intership at San Franciso General Hospital in 1957, its treatment was then very much in transition; we still had long-term patients who'd been hospitalized for years with far-advanced disease that was too extensive to be removed by recently developed surgical procedures. The surgery had only become possible because of new drugs which allowed it to be performed with relative safety in relatively early stages of the disease. Thus newer cases in younger patients could undergo arduous, but potentially curative, treatment, but more advanced cases, judged too sick for surgery, faced a lingering death on the hospital's chronic wards. Because they  often had cavities that were shedding organisms, many weren't allowed to go home. Some, judged uncooperative, were essentially incarcerated on 'legal orders of isolation' and their rooms were sometimes locked between staff visits.

Since a high percentage of TB patients were chronic alcoholics, visitors were often searched; on Sunday mornings, it was common to find ward bathrooms littered with empty whisky and wine bottles supplied the night before by certain compliant orderlies. That was ten years before the Summer of Love; pot use was almost unknown (except by those scandalous and newly-christened 'beatniks'). My impression, formed during internship, was that San Francisco must be the alcohol capital of the world.  Half our emergency admissions, whether from trauma, assaults, burns, seizures, DTs, or cirrhosis, seemed directly related to excessive drinking. At any one time, it seemed that perhaps fifteen percent of the patients on male medical wards were deeply jaundiced; we interns could count of doing a minimum of five needle biopsies of the liver during our one month rotations.

When I returned to 'The City' ten years later, the Summer of Love was in full swing, pot and LSD had replaced alcohol, and cirrhosis was on the wane.  Surgery for Tuberculosis was a thing of the past because the newer TB drugs were usually curative by themselves, and most of the sanitoria, like mental hospitals, were either closed or in the process of closing. Four years later (1971), after leaving the Presidio for private practice, I was told by surgical residents working at the 'General' that heroin addicts had replaced the alcoholics and they were being kept far busier with abscessed injection sites than with drunken misadventures. Also, the gunshot and stab wounds, so common in both eras, had become both more frequent and deadlier when related to drug trade disputes.

Come to think of it, pot was never mentioned as a cause of hospital admission...

Doctor Tom

Posted by tjeffo at May 31, 2007 09:18 AM