Too Real

I have a neighbor who is worried about Avian Flu. Lots of people are; it's in the air and on the airwaves. There's just one thing: plague, endemic among rodents in the Rocky Mountains, has now broken out among the prairie dogs living cheek by jowl among the people right in the city limits of Boulder. Plague is a real disease that kills real people. And it's right here, right now. Want something to worry about? If you live in Boulder, it's rational to worry about plague. Avian Flu is a hypothetical disease which might at some point in the future cross the species barrier and might or might not be virulent. And it's on the other side of the world. And that's the point.

There was an outbreak of plague in Santa Fe that killed a bunch of people some years ago, coming into the human population from the critter population. You don't hear too much about that. Nor, I expect, did you hear about the plague breaking out among the prairie dogs right next to people's houses in Boulder. Like the Oklahoma City possibly Muslim bomber, certain facts seem to get suppressed. Not necessarily because the press is nefarious but because the audience really doesn't want to hear it. Being scared of things far away and highly implausible is far more satisfying than contemplating the dangers that lurk right around the corner or right at our feet.

This excellent article in today's New York Times by a physician makes the same point. Instead of the danger of plague, she focusses on dangers more endemic to New York, such as AIDS and emphysema.

Just in time for Halloween, the usual yearly ritual of terror by headline is now playing itself out in medical offices everywhere. Last year it revolved around flu shots; a few years ago it was anthrax and smallpox; a few years before that it was the "flesh-eating bacteria"; and before that it was Ebola virus, and Lyme disease and so on back into the distant past. This year it's the avian flu....

A few years ago, a young woman waited patiently to be seen in our office after hours. She was a patient of one of my colleagues, but she couldn't wait for their scheduled appointment; she needed to see someone right away.

"I'm worried I have Lyme disease," she said. "I have all the symptoms. I think I need to be treated."

"But you have AIDS," I said.

"I'm tired and weak and I have fevers and sweats. I've lost my appetite. I can't think straight. I'm losing so much weight!"

She had seen a TV news report on Lyme disease, and then she had checked the Internet. All her symptoms were right there.

"But you have AIDS," I said. "And you don't want to take meds. That's why you're feeling so bad."

"I'm really scared about Lyme disease," she said. "I really need to get treated."

"If you want to be scared, how about that untreated AIDS of yours?"....

Eventually she coerced my colleague into testing her for Lyme disease and treating her despite negative tests. Then she decided her symptoms might actually be due to a brain tumor, instead. And so it went, until she died of AIDS.....

If you want something to be scared of, how about the drug-resistant Klebsiella that is all over this very hospital, an ordinary run-of-the-mill bacterial strain that has become so resistant to so many antibiotics that we've had to resurrect a few we stopped using 30 years ago because they were so toxic.

That Klebsiella is one scary germ. It's in hospitals all over the country, and by now it's probably killed a thousandfold more people than the avian flu.

But you don't hear much about our Klebsiella. Like our bad habits and our dismally insoluble health insurance tangles, our antibiotic-resistant bacteria are with us, right here, right now. Apparently they all lack the drama, the suspense, the titillating worst-case situations that energize our politicians and turn into a really newsworthy health care scare.

They're all just too real.