Rosemary Taylor

		Rosemary C.R. Taylor © Mark Morelli

'Modern plagues' prey on society's worst fears
by Helene Ragovin

In her 1978 essay "Illness as Metaphor," author Susan Sontag grapples with the language and imagery attached to two of the most dreaded diseases in American history: tuberculosis in the 19th century and cancer in the 20th.

The popular way of speaking about TB and cancer, she writes, says more about the state of the national psyche than our understanding of biology or medicine. In the 19th century, "consumption" was romanticized as an "inward burning"Ña passion that literally "consumed" the body. Later, cancer became emblematic of "repression."

In both cases, an often-fatal disease of uncertain origin came to symbolize society's most troubling anxieties.

That idea can also apply to "modern plagues" and how nations react to the threat of epidemics and infectious disease, such as last fall's anthrax scare, says a Tufts sociologist.

"Especially when there is scientific uncertainty about how a disease is caused or diffused, it can take on the form of what society most fears," says Rosemary C.R. Taylor, associate professor of sociology and community health.

The aftermath of September 11
Last year, Taylor developed a course on "Peoples and Plagues," a subject that became especially timely in the wake of September 11 and newfound concerns about bioterrorism.

The idea that an unseen enemy could be lurking somewhere in the country, ready to launch a biological attack, struck at the emotional center of a nation that had suddenly become vulnerable within its own borders.

In the months since then, doomsday scenarios focusing on such varied threats as the resurgence of smallpox or the unleashing of "designer viruses" have surfaced everywhere from talk radio to intellectual organs like The New York Review of Books.

Much of this, Taylor says, mimics the advent of other "uncontrollable" threatsÑthe appearance of AIDS in the early '80s, for example, or the early years of the nuclear age. But, she says, it's important to put the issue in perspective, to define who, or what, poses the "threat" and how the United States should best respond.

"At the moment, post-September 11, bioterrorism is linked in the popular imagination with external threats," Taylor said. "In the anthrax case, the immediate assumption was that whoever had flown planes into the World Trade Center and the Pentagon was following up with bioterrorist weapons."

Although the investigation into the anthrax mailings is not yet complete, "now, however, the authorities, such as the FBI, seem fairly sure that the anthrax mailing was initiated domestically," Taylor said.

Yet discussion and commentary still focus on the "apocalyptic threat" of a disease introduced into the country by outsiders.

"People's fears are epitomized by the image of an Al Qaeda terrorist [infected with smallpox] stumbling around O'Hare Airport coughing on everyone," she said. "It's ironic that the attention has shifted to smallpox, the one disease that has been eradicated worldwide, yet it plays so heavily in the popular imagination."

'We need to get it right'
The chances of terrorists being able to obtain or spread smallpox through the United States are slim, Taylor says, and fears of such events should not drive our public policy.

"At the moment, these scenarios are very scary," she said. "But we need to get it right." In other words, public policy needs to move beyond the immediate uncertainty and take a broader view.

"The public heath system is in disarray," she says. Taking care of many basic needsÑsuch as increasing resources at emergency rooms throughout the countryÑwould not only help if a catastrophe occurred, but would reap day-to-day benefits.

Another issue, she says, is whether money spent preparing for "worst-case" scenarios might be better used fighting existing medical crises. "What about the threats that we have been living with for a long time?" she says. "While not minimizing the threats [of bioterrorism], it is appropriate to ask whether we are so afraid of the apocalypse that we're not paying attention to the epidemics we do have."

The majority of Americans, she notes, will die of cancer or cardiovascular disease. And the fatal infectious disease that poses the biggest threat to the countryÑAIDSÑcontinues to grow within many segments of the population, particularly poor, urban communities of color.

"After September 11, there was a huge awareness of anthrax," she says. "But December 1, World AIDS Day, passed without much notice."

Beyond our borders
A global outlook is required, Taylor maintains. "Should we be producing smallpox vaccinations for the U.S. population alone? It depends if we just want to keep the threat out of the United States and contain our borders, or if we're looking at global health. There is a resurgence of infectious diseases worldwide, both old and new. That's important if we think the United States has some responsibility in the world.

"And with a large immigrant population, the United States is not an island," she says. "The United States has to think of itself as a global player."

As a "comparativist," Taylor explores how different societies deal with public health issues. "I'm interested in how countries in a changing world encounter new threats, new needs for protection. How the threats have changed and how people's perception has changed.

"Correctly or not, what people really worry about is social protection in a global age," she says.

She first taught her course on epidemics last spring and will offer it during the upcoming summer term. The course looks at the interactions among biology, behavior, culture and political economy during times of disease, from medieval leprosy to Creutzfeldt-Jacob Disease (vCJD), the human equivalent of mad cow.

There are many popular misconceptions about the development and spread of epidemics, Taylor says. When her students begin the course, for example, many assume epidemics are a thing of the past for industrialized societies or that modern health care is all that's needed to avert them.

Not so, Taylor points out. Just look at AIDS or vCJD.

"Epidemics emerge for many reasons," Taylor says. "Not every new pathogen turns into a plague. It's a fascinating intellectual challenge to figure out the circumstances under which that happens."