Disease and Society Final

evolution of stigma

disease avoidance

disease avoidance

• visible/contagious

• label/contagious

• visible/contagious

• label/non-contagious

• also observed in animals

a disease-avoidance model of stigmatization

visible/contagious and visible/contagious

emotional-visible and cognitive-disease disease cues directly activate disgust and contamination 

evolution of pathogens

pandemic II - a stimulation game in which you much evolve a disease to wipe out the human race

strategy: low visibility 

• asymptomatic but infectious (SARS-CoV-2)

in regions that have historically suffered from high levels of infectious diseases, ppl report lower means levels of

sociosexuality, extraversion, openness

bad prior experience w/ infectious disease outbreaks makes ppl

more suspicious of others

how personal contact will change post - COVID-19

not wanting to be in a crowd

social distancing works with animals

seen w/ lobsters when they know someone had a disease

carrier stigma

stigmatization of ppl who carry a disease, carry the gene but don’t have the disease

who figured out what causes sickle cell disease on a molecular level in 1949

Linus Pauling (1901-1994)

sickle cell anemia

autosomal recessive disorder

S = sickle cell trait

2 faulty copies of the hemoglobin gene result in sickle-cell anemia 

25% chance that parents each carry 1 faulty copy of the hemoglobin gene produce offspring w/2 faulty copies

gene screening for carrier status

carrier stigma 

1970s: sickle cell screening program

developed to identify individuals w/ the sickle cell trait w/ the aim to reduce sickle disease

problem: inadequate education & disease

led to stigmatization and discrimination

sickle cell discrimination

sickle cell testing was used to exclude African-American employees from jobs

anti-discrimination laws-court barred the use of a genetic test to discriminate in job placement of benefits

Linus Pauling believe that ppl who have sickle cell gene

should be marked

the nickname molecular disease for sickle cell disease

pertains hemoglobin

sickle cell disease and antibiotics

help patients prevent infections

why did couple counseling about the sickle cell trait run into accusations of racial genocide

b/c the trait is common in black Americans, many whom were advised to not have kids

disease in movies, Oscar-winning

Dustin Hoffman was autistic (1988)

Still Alice (showed Alzheimer’s)

Disease in different movie genres

disease of the week movie

actual movie genre

staple of ‘80s prime-time TV

relatable drama

tearjerker

terms of endearment (1983)

tearjerker

winner, most realistic Portrayal of Illness (cancer)

disease movies: why so popular?

why do we watch a movie that acknowledge our own mortality and frailty?

disease makes a good story 

morbid curiosity

safe exploration of fear

sense of control

empathy

hope and meaning

comedy

cancer diagnosis = 50/50

shows what it means to have cancer, gives hope

another genre: horror

cabin fever = a horror tale about a group of 5 college friends on vacation at a remote mountain cabin when 1 contracts a flesh-eating virus 

28 days later = 4 weeks after a mysterious incurable virus spreads throughout the UK, a handful of survivors try to find sanctuary, director = Dany Boyle

Action Genre

Mission Impossible 2 = pharmaceutical company BioCycle, genetically created disease called chimera, vaccine called Bellerophon

outbreak (1995) - Motaba virus from Africa reaches the US, leads to a strong military response to quarantine the affected area, like Ebola virus 

Hollywood and infectious disease

contagion greatly exaggerated

worst-case scenarios 

over-the-top gov. response, ethical question

Sci-Fi genre

I am legend = re-engineered measles virus meant to cure cancer goes wrong

the sole survivor in NYC struggles valiantly to find a cure

the science doesn’t make a whole lot of sense

interstellar = fungus blight destroys all crops on Earth, astronauts travel through wormholes to search for new planets to colonize

the andromeda strain = a group of scientists investigate a deadly extraterrestrial microbe causing rapid blood clotting

• based on the novel by Michael Crichtan (also made Jurassic Park)

• science is absolutely correct

hollywood misrepresenting disease

ex= Tourette’s syndrome = only focusing on profanities and not tics

cancer: often terminal w/ no cure mentioned

many movies misrepresent ppl w/ mental health problems = The Dark Knight 

steal magnolias = young women w/ type 1 diabetes gets pregnant, decides to have baby but pays for it w/her life

• movie moved diabetic women away from having babies

drama genre

the band played on = story of the 1st years of the AIDS epidemic in the US

• doctors dealing w/ the mystery surrounding the 1st AIDS cases

• the gay community’s reaction during these 1st years

• rivalry b/w Dr. Robert Gallo & Dr. Luc Montaginer: Who was 1st to identify the AIDs virus?

Contagion is also a good movie

temple grandin = real person

• help-functioning autism

• American doctor of animal science and professor at Colorado State University 

disease named after a movie

named after the movie ‘urban cowboy’ starring John Travolta and Debra Winger, ‘urban cowboy syndrome’ is characterized by symptoms = injuries from falling off mechanical bulls

typical patient: 1) no previous bull-riding experience, 2) consumed alcohol

documentaries

typhoid mary

final itch = polio

Disney and disease

the winged scourge (1943)

Disney and general disease education

educated people a lot more

very detailed

showed VD attack plan (1973)more entertaining, informative. and engaging

shown to teenagers and young adults

easy metaphor - VD is the enemy and we must fight it

VD = sexual disease

Disney’s cleve twist: focus on animated germs

syphilis (Treponema pallidum)

gonorrhea (Neisseria gonorrhoeae)

timeless humor to convey message 

progressive: same-sex sexual contact/condoms

Otzi

the iceman

mummified and found by hikers in 1991

he died during the Copper Age (3,300 BC)

died about 5,200 years ago

based on otzi fingernails

he may have gone w/no or little food for a while

had beau’s lines in his nails

shows that he had a previous infection

stopped growing for a little causing a line

helicobacter pylori

a deadly pathogen, found in Otzi’s gut

how did otzi die

died b/c he was hit by a arrow

otzi’s health

had whipworm = causes diarrhea and abdominal pain

had arthritis in his joints, as had tattoos where the pain was, maybe was there to help the pain 

cared birch fungus (antibiotics)

otzi’s place in time

not a lot of ppl on Earth at the time

big increase during the industrial revolution

black death killed a lot of ppl

hunting and gathering shifted to agriculture = During about 7000 BC

cities around 4000 BC

trade routes around 1000 BC

colonization around modern time 

Disease in pre-agricultural times

small tribes

nomadic ways of life 

from skeletal remains we can see trauma and malnutrition/starvation are ways to die

TB symptoms on 500,000 year old fossil fragment of skull from a young male Homo erectus 

prehistoric doctors

shaman or medicine man/women

Paleolithic cave painting of a shaman from the cave at torois-freres near Montesquieu-Avantes in France

intermediaries b/w the natural and spiritual world

skills were passed down orally 

a 12,000 year old shaman burial (Isreal)

female

important b/c grave had offerings

close relationship w/animal spirts

shaman practices

ask help of the spirits to deal w/disease

in animal form

drumming, singing, etc. 

psychoactive plants/mushrooms 

healing herbs

earth, clay, ochers (some places see that eating dirt could help infectious (medicines)

• clay used like casts

• ochers = tattoos

trepanation

making a whole in the skull

releasing evil spirts from the body

early agriculture

wheat, barley, rice, soybean, maize. millet

when ppl went from meat → crops

caused iron deficiency anemia - seen from porotic changes on skull and eye orbits

• low iron diet

• poor iron adsoprtion 

• iron loss from body 

What did teeth show in early agriculture times

wear b/c stones to grind seeds, sometimes you accidentally bite a piece of the stone that broke off

prehistoric drilling in 5,000 - 7,000 BC

dentists at the time 

domestication of animals

18,000 - 8,000 years BC: hunting species

10,000 years BC: dog

9,000 - 7,000 years BC: sheep and goats, cattle, and pigs

4,000 years BC: draught animals (ex ox)

3,000 years BC: cats, horses, donkeys, camels

2,000 years BC: poultry, elephants 

most infections we kknow come from animal counterparts

measles animal counterpart

rinderpest of cattle

TB animal counterpart

tb of cattle

small pox animal counterpart

cow pox

influenza animal counterpart

influenza in swine and fowl

whooping cough animal counterpart

similar disease in pigs and dogs

falciparium malaria animal counterpart

malaria in bird (perhaps chicken and ducks)

from tribes to cities

a lot of ppl staying in 1 spot for an extended period of time

increased and more constant food supply ]

shortened birth interval 

boom in population: centers of civilization = roman empire, fertile crescent, india, china 

priest physicians in ancient egypt

mediators b/w patients and goddess sekhmet

• warrior goddess

• bringer of disease 

• providers of cures 

physicians are generally well-respected

severely punished in cases of malpractice

ancient Egypt priest physicians methods

use of spells

observation and diagnosis diseases

document and write down disease

most famous = Imholep (27th c. BC

mummification helped gain an understanding

of human anatomy

organs were placed in urns

didn’t know a lot about the function of organs 

medical treatments on papyrus 

• anatomical observation

• ailments 

• cures

hebrew medicine

doctors drawn from the priestly Levi tribes

held in high esteem

not only doctor, also counselor and teacher 

required to be native to the community in which he practiced

hebrew, rules of hygine

moses the microbiologist

• following the rules will allow you to survive longer 

wound, skin, and discharge precautions (don’t touch it)

• many examples in the old testament 

• if it’s wet and not yours, dont touch it

hebrew waste disposal

also in one of the books in the old testament

stop spread of fecal oral

hebrew isolation

seen in the old testament

hebrew burial precautions

be careful in touching dead things

hebrew food and drinking water safety

could be things like microbes

the greeks

asclepius, greek god of medicine

healing temples (or asclepieions) (1st hospital/doctor office)

god as a stick w/ a snake around it, sign of health and medicine

stick is called asklepian

• in ancient times w/ parasitic worms was quite common (looked like snakes)

• worm was called dracunculus medinesis aka the fiery serpent

• used a stick to rap the worm around and pull it out

dracunculiasis

affliction w/ little dragons

aka as guinea worm disease

acquired by drinking of water that is contaminated w/ parasite-infected water fleas

travels to foot b/c it is the easiest way to get out and lay eggs in the water

use a special straw so no worms when they drink the water

cases down from 3.5 mil 1986, just 14 cases in 20

limited contact w/ animals and small population groups most likely

influenced disease in pre-agricultural societies

prehistoric healers sometimes dress as

animals during healing rituals to symbolize spiritual power and connect w/ animal spirt for healing 

unique about Egyptian priest physicians

they combined religious practices w/ medical treatments

cleanliness best characterizes

ancient Hebrew medicine

one major consequence of animal domestication for disease is

disease began to spread from animals to humans

crowd disease

more opportunity for infectious disease (animal-humans, human-human)

close social contact

proximity to human and animal waste

greeks dealt w/ crowd disease

seen through the plague of Athens (430-427 BC), seen through documentations

happened b/c of trade and war

Athens built a wall around the city and trade route to protect them 

b/c of wall it leads to a crowded situations 

breeding ground for disease

killed about 75-100,000 ppl, about 25% of the pop. and removed key leadership (btw Sparta won)

written record

greeks had everything written down, like their wars

thucydies (460-495 BC) historians

Cause of the plague of Athens

what ppl at the time thought = divine punishment

real: a form of typhus fever, caused by a bacterium, transmitted by lice

hippocrates (460-377 BC) physicians 

very important physician

worte a lot of books about specific diseases

hippocratic oath

ideal conduct for the physician, an oath

new Hippocratic oath asks doctors to fight racial injustice and misinformation

classic version of hippocratic oath

i will apply dietetic measures fro the benefit of the sick; keep them from harm and justice

i will come for the benefit of the sick, remaining free of all intentional injustice, no mischief w/ patients, be they free or slaves

no deadly drug to anybody who asked for it; women not abortive remedy

modern version of hippocratic oath

benefit of the sick

no ashamed to say IDK, call other colleagues for help

be warm, sympathy, understanding 

remember the patient is a human being

hippocratic school of medicine

the four humors, bodily fluids

• blood 

• phlegm

• black bile

• yellow bile

4 humors explanation for disease persisted more than 2,000 years in the west 

blood letting - removing blood to restore the balance if you had too much blood

ate citrus fruit (restore balance)

disease results when the fluids are out of balance

the romans

many physicians were greek imports

not well respected

even roman educated doctors weren’t trusted

• not standard training

• no regulatory oversight of practitioners

• if doctor messed up then no punishment

quakerly/medical incompetence

galen

born in AD 129

from Pergamum (modern-day Turkey)

prominent Roman physician

prolific writer

big fan of hippocrates

his theories dominated and influenced western medical science for well over a millennium

interested in human anatomy

made drawings based on dissections (dead animals) and vivisection (live animal) on animals

physician to gladiators

saw body parts coming off

had surgical tool

middle ages from 5th -15th c. AD

based on hippocrates/galen (4 humors)

catholic church beliefs

sins of the soul: relief through prayer and pilgrimages 

diff. types of doctors

• physicians 

• barber-surgeons

medical physicians

university education

licensed to practice

entitled to teach at university 

• medical school oof salerno, Italy Town of Hippocrates associated w/ monastery

charged for their services

professional class in 1215

privilege (ex: exempt from tax)

diff. approaches

• 4 humors - bleeding (w/lyches), sweating, vomiting

• bad air or miasma - masking 

• masks protect from bad air (disease in air)

back luck - prayers and superstitions

barber surgeons

council of tours (1163): bloodletting sacrilegious priests and clergymen were no longer allowed to do this 

so barbers took over this task

cut hair and bloodletting

also did surgery and dentistry

13th c; Paris: 1st school for instruction of barbers in the practice of surgery

became the model for schools of surgery during the middle ages

renaissance

15th - mid 18th c.

galen debunked (1530s) by Belgian anatomist and physician Andreas vesalius 

• cut up cadavers to look at anatomy of humans 

• translated Galen’s greek texts to latin 

• used printing press tor spread his ideas and drawings

disease concept

germ theory = robert koch (1843-1901) and louis pastuer (1822-1895)

lead to hygiene and antibiotics

throughout the years, we focused less on divine power and more science for diseases

19th century

germ, anesthetics

koch pasteur 

Crawford long patients under during surgery - anesthetics, experimented on Black slaves 

anesthetics

drug that induces a reversible loss of consciousness

can be achieved by: 

• nitrous oxide

• ether

• chloroform - Dr. Snow put down Queen Victoria w/ chloroform to deliver Leopld

less pain for patients 

more time for surgeon 

antiseptics

idea of killing germs w/ antiseptics

1823 onset of pathological anatomy

some doctors refused to believe that a gentleman’s hand could transmit disease

seen with COVID: WHO didn’t recognize airborne transmission

• the thought before was that disease came from bad air

Ignaz Semmelweis made contributions to the advancements of antiseptics

recognized childbed fever: bacterial infection of the female tract following childbirth or miscarriage

suggested ppl to wash hands, this helped 

they used to work on dead bodies then helped women give birth, in early 1840s

• cadaverous poisoning

semmelweis reflex

reflex-like tendency to reject new evidence or new knowledge b/c it contradicts established norms, beliefs, or paradigms

john snow said that diseases

are mainly from touch (1850)

1950s realized that diseases can be airborne (TB and measles)

joseph lister

founder of antiseptic surgery carbolic acid (phenol) put instruments in this, decontamination, no germ spread

named a bacteria after him = Listeria monocytogenes (listeriosis)

robert liston (surgeon)

the fastest knife in the west end

pre-anesthesia era

amputated a leg in under 2 ½ minutes (patient died of gangrene)

amputated by accident the fingers of his assistant (who died of gangrene)

slashed through the coat tails of a spectator, who was terrified that the knife had pierced his vitals he dropped dead from fright 

only operation his history w/a 300% death rate

20th c. medical innovations

blood transfusions - bring your own donor when you need it, now we don’t need to bring our own donor when you need it

plastic surgery - skin grafts

organ transplants - heart transplants 

in vitro fertilization - bring sperm in a test tube and put it in the mother

incubators for pre-term babies

• came from Luna Park (1903) Coney Island, NY 

• had babies that were born too early, Dr. Martin Couney, used incubators. ppl could come look at them

decrease in the number of deaths by infection

1940-2000, fast and significant decline of death

happened through: 

• sanitation = soap, chlorine, germ free conditions

• antibiotics = penicillin

• vaccination

helicobacter pylori

in the wall of the stomach

stomach juice is very acidic

has a gel layer b/w cells

mucous layer protects stomach cells from acid

H. pylori lives in the mucous layer 

can cause inflammation in epithelial cells (gastritis)

can evolve into ulcers (burning pain) and stomach cancer

a pathogen

regulates acid production in the stomach

ulcers

were though to be cause by stress or spicy food

robin warren and barry marshall in 1984 dicovery of H. pylori

can be cause of ulcers

to prove they were right, drank a beaker full of H. Pylori

• developed gastritis 

• cured himself w/antibiotics 

• got a Nobel prize in 2005 for effective treatment of ucler w/antibiotics

there is a decline rate by H. pylori

younger ppl have low rates

industrial countries

this can be b/c of antibiotic use

reduced incidence of ulcers and stomach cancer

increase in acid reflux and esophageal cancer

is H. pylori a pathogen

Yes

its presence may cause ulcers and stomach cancers

its absence may cause acid reflux and esophageal cancer