From Chaos to Coercion: Detention and the Control of Tuberculosis

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In the 1980s and early 1990s, New York City experienced an unprecedented outbreak of tuberculosis. Inadequate healthcare services, an increase in social alienation of the poor, and the emergence of drug-resistant strains led city health officials to respond with draconian policies to ensure compliance, including the use of detention of non-infectious individuals—sometimes for up to two years—that violated individual civil liberties. The New York TB epidemic has since been controlled, but this public health triumph has come at great cost. This gripping narrative of medicine and morality raises ethical issues that are of increasing importance in the world of modern medicine. Richard J. Coker warns the international community against assuming a fortress mentality, advocating a more just balance between health, liberty, and the burdens society should be prepared to accept in the pursuit of both.

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Editorial Reviews

From the Publisher
“The book's careful scholarship belies its passion. It is a thoroughly documented and convincingly presented argument that inspires a reassessment of cultural assumptions and reflection on the epidemiological effects of these assumptions. Recommended . . .” —Library Journal

“This book is well researched and cogently argued....” —Choice

Thomas Dormandy
In one other and more heartening respect, the New York epidemic resembled bygone crises. At the grandiose tuberculosis conferences of the late nineteenth and early twentieth centuries, pressure and persuasion were never entirely successful: one or two individuals usually braved the opprobrium of their colleagues and openly expressed dissent. From Chaos to Coercion by Richard Coker, a London physician, is in this splendid tradition. Coker's book is lucid and intelligent, but not always an easy read. It is part reportage, part socio-political tract, part analysis of national characteristics.
New England Journal of Medicine
Coker's book deserves to be read by those involved in tuberculosis control and other public health campaigns. It is telling that the most aggressive challenge to the use of coercion in New York has come from Coker, a British clinician, rather than from the local advocates for civil liberties and patients' rights who criticized, but ultimately condoned, the strategies of the health department. Coker is also correct in urging that programs of detention implemented during periods of crisis be reconsidered as the threat to public health diminishes. Finally, given the current epidemic of tuberculosis in the Third World, Coker's reminder that the disease is connected to global politics could not be more timely.
Recommended...This book is well researched and cogently argued....
Library Journal
New York City suffered an outbreak of multidrug-resistant tuberculosis in the early 1990s. The disease threatened to expand beyond its usual victims in the homeless, drug-addicted, and incarcerated populations to afflict society at large. The public health system responded with detention and the coercive treatment of individuals who were noncompliant with treatment protocols, and the epidemic abated. Coker, a British physician, examines the social, legal, medical, and ethical issues surrounding this chapter in the history of tuberculosis. He presents historical and epidemiological evidence linking tuberculosis to high levels of institutionalized social inequity. And he shows how the New York City response, while successful in turning the tide of the epidemic, failed to address these root social causes and perhaps even deepened inequities by violating the rights of individuals and providing a smokescreen for the inadequacies in our political and healthcare systems. The book's careful scholarship belies its passion. It is a thoroughly documented and convincingly presented argument that inspires a reassessment of cultural assumptions and reflection on the epidemiological effects of these assumptions. Recommended for academic and larger public libraries and for collections with a focus on the history and sociology of medicine, social justice, human rights, or ethics.--Noemie Maxwell Vassilakis, Seattle Midwifery Sch. Copyright 2000 Cahners Business Information.
Coker, a consultant physician at St. Mary's Hospital and lecturer at the Imperial College School of Medicine in London, uses the lens of tuberculosis and the regulatory changes that ensued from New York City's contemporary tuberculosis epidemic to examine the American response to those who pose a threat to others through their failure to conform. He discusses moral issues regarding detention of infected persons who can not or will not comply with treatment and prevention. Annotation c. Book News, Inc., Portland, OR (
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Product Details

  • ISBN-13: 9780312222505
  • Publisher: St. Martin's Press
  • Publication date: 2/28/2000
  • Edition description: REV
  • Pages: 284
  • Product dimensions: 5.50 (w) x 8.50 (h) x 0.75 (d)

Meet the Author

Richard J. Coker is Consultant Physician at St. Mary's Hospital and Honorary Senior Lecturer at the Imperial College School of Medicine in London.

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Table of Contents

Coercion and the Public Health

• The Seeds of an Epidemic

• When Push Comes to Shove

• Canute’s Apotheosis

• A Real Threat to Public Health

• Culture, Morality, and Tuberculosis

• Lessons for Europe

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