In 1978 New York City recorded its fewest tuberculosis cases ever; in 1992 it counted 3,811. A dismantled control program met AIDS, mass homelessness and crowded shelters, jails and prisons, and drug-resistant strains spread through hospitals and a state prison system. The city answered with observed therapy, incentives and locked detention, and the episode counts the cost and the critics who said compulsion was aimed at the poor.
Who's who
- Thomas Frieden+1 more episodeLed the Bureau of Tuberculosis Control from 1992; later CDC director
- Margaret HamburgNew York City health commissioner from 1991 to 1997
- BrudneyHarlem Hospital physician who documented treatment failure in 1988 patients
- DobkinPhysician who co-authored the Harlem Hospital study
- Rose GasnerBureau lawyer and lead author of the 1999 study of legal orders
- Barron LernerColumbia historian of medicine who critiqued 1990s TB detention
- Richard CokerBritish physician who criticized American use of TB detention
Where it happens
- New York City+13 more episodesCounted 3,811 TB cases in 1992
- Harlem Hospital Center, New York+1 more episodeSite of the 1988 study and an observed-therapy program
- Bellevue Hospital, New York+1 more episodeRan a hospital-based observed-therapy program from 1992
- Goldwater Memorial Hospital, Roosevelt IslandHosted a locked detention ward for TB patients
- New York State prisonsWhere eight people with multidrug-resistant TB died in 1991
Timeline
- 1978New York City records 1,307 cases, the fewest ever counted
- April 1991A citywide survey finds a third of strains resistant to at least one drug
- 1992The city counts 3,811 cases and 441 multidrug-resistant cases
- 1993The city amends its Health Code to allow observed therapy orders and detention
- 1995A state court upholds an order detaining a patient with active TB
- 2000The city counts 1,332 cases, its lowest rate reported
Still debated
No study isolated the effect of observation from incentives, outreach, laboratory speed, infection control and funding, so what ended the epidemic is unclear. Whether detention was justified is argued, since the city's review found it rare while critics said the burden fell on disadvantaged groups. The weight of AIDS versus program decline is a matter of interpretation.