Defining News Worthiness
雖然台灣的媒體除了聯合報和蘋果日報以外，沒有太多人關注以下這條國際新聞，但是自身感染抗藥性肺結核病菌、卻依舊攜帶女友前往歐洲結婚兼度蜜月，現年31歲的亞特蘭大的執業律師斯皮克(Andrew Speaker)，的確在美國引起了輿論的關注及紛擾。
尤其Speaker的岳父庫克西(Bob Cookey)身分特殊，是疾病控制與預防中心(CDC)的微生物學家，專責預防肺結核病及其他細菌的研究，這個既弔詭又諷刺的巧合更使Speaker成為眾矢之的。儘管Speaker5月31時在隔離病房接受ABC獨家採訪時，以對自己給與L搭乘同一航班的其他乘客所造成的潛在危險表示道歉並請求原諒，但仍擋不住後續一波波輿論的撻伐。
CNN醫療主播記者Dr. Gupta針對這個事件在blog上po了篇名為 Defining Contagiousness 的文章，試圖為既有沒有溝通餘地的對立<對於Speaker的責難 vs. Speaker的澄清說詞>情勢，創造一點點對話的可能。
文章中Dr. Gupta誠懇地解釋科學 (醫學)本質上的不確定性和風險，希望能藉由剖析一般對「傳染性 (傳染力)」定義的建構過程及其所牽涉的繁複或然率，避免整個議題陷入「帶原vs.非帶原，有良心vs.沒良心，善vs.惡」這種過度簡化且偏頗的二元對立。
不過，接著幾篇回應還是避免不了選邊站的情況。畢竟自抗生素問世之後，醫學幾乎就等同於抽象的數學或邏輯一樣，大眾只想要聽到 either/or, yes/no,100%/0%這種簡單明瞭的回答，解釋再多聽起來都像想用專業術語為自己開脫的虛偽把戲(這不也是台灣醫病關係的寫照？)。
直到一個醫學院學生提出了這樣的想法:
"......However it would be nice if, when people argue that 1.6 million people die from TB every
year - that more people would be willing to donate money to drug programs in those
impoverished nations where those millions of people are dying!
That is something more news worthy than one man making a mistake!"
的確，Andrew Speaker's case對於整個CDC的TB防疫體系乃至於美國所有人民甚至是全世界的健康權，到底有什麼意義呢？是把一個沒有良心沒有道德的人罵到臭頭或抓去關起來，伺機炒作他岳父的特殊身分，讓他岳父也丟掉CDC的頭路，這樣就可以安心地宣告天下太平"case closed"了嗎？難道這樣從此就降低TB傳染風險，給大家的健康更穩固的保障嗎？
整個新聞值得關注的就只是個單一事件，只和一個人(頂多一家人)有關係而已嗎? 只是這次感染有沒有因為幾個不道德的人而擴大而已嗎？還是有更多更大的社會時空體制等情境脈絡可能牽涉其中、值得檢討改進，未來面對類似的情況時，能夠及時採用更有效的TB篩檢或隔離辦法？
This piece of news is much more than defining contagiousness.
It is about defining news worthiness.
As a reporter capable of gate-keeping and agenda-setting,
can we ever be satisfied with what we have done so far?????
Defining contagiousness
As a general rule, doctors hate saying "maybe." It shows a lack of confidence and a degree of uncertainty to which medicine is unaccustomed. So, you can imagine my consternation when I had to say it repeatedly this morning on television. The question: Is Andrew Speaker contagious or not?
Well, maybe... sort of. Alright, yes is he is contagious, but not very. Make sense? There are several things doctors look at when determining whether someone is likely to transmit an infectious disease. One is whether he or she is sick (coughing, sneezing with fever). A second is whether a sputum test is positive - meaning bacteria are present in the saliva. In Andrew Speaker's case, both those tests suggested he was not contagious, and may not be now. He did, however, have a third test come back positive, which is a culture test. That means, doctors had Speaker cough onto a slide, and, although no bacteria were initially present, after a few days they did show up when placed in a culture medium. Based on all of that, the hospital where Speaker is staying issued a statement saying he is "relatively non-contagious" and may even consider taking him out of isolation, although he would still wear a mask.
To be clear, there is still a lot of concern surrounding Speaker. Here is one way of looking at it: When examining risk, you really have to balance the likelihood of transmitting the bacteria with the seriousness of the disease. In this particular case, it sounds like the likelihood of spread is low, but the potential consequence is very high. That is especially true with XDR-TB, where there are very few treatment options.
So, now after hearing all of this, which is admittedly confusing even for the medical establishment -- does it make you more or less understanding of Speaker's decision to fly internationally?
Well, maybe... sort of. Alright, yes is he is contagious, but not very. Make sense? There are several things doctors look at when determining whether someone is likely to transmit an infectious disease. One is whether he or she is sick (coughing, sneezing with fever). A second is whether a sputum test is positive - meaning bacteria are present in the saliva. In Andrew Speaker's case, both those tests suggested he was not contagious, and may not be now. He did, however, have a third test come back positive, which is a culture test. That means, doctors had Speaker cough onto a slide, and, although no bacteria were initially present, after a few days they did show up when placed in a culture medium. Based on all of that, the hospital where Speaker is staying issued a statement saying he is "relatively non-contagious" and may even consider taking him out of isolation, although he would still wear a mask.
To be clear, there is still a lot of concern surrounding Speaker. Here is one way of looking at it: When examining risk, you really have to balance the likelihood of transmitting the bacteria with the seriousness of the disease. In this particular case, it sounds like the likelihood of spread is low, but the potential consequence is very high. That is especially true with XDR-TB, where there are very few treatment options.
So, now after hearing all of this, which is admittedly confusing even for the medical establishment -- does it make you more or less understanding of Speaker's decision to fly internationally?
