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From Superbugs to Zika

Tenth Annual Student Medical Ethics Society Conference Explores History, Challenges and Ethical Dilemmas of Infectious Diseases

On December 4, the Tenth Annual Fuld Family Conference organized by the Yeshiva University Student Medical Ethics Society (MES) and the Center for the Jewish Future (CJF) brought together medical professionals and experts in Jewish law to explore the history of infectious diseases, the challenge posed by drug-resistant “superbugs,” and the ethical questions raised by epidemics like Ebola and Zika.

Yael Mayer, co-president of MES, said that the impetus for the focus of this year's conference, titled, "Humanity's Oldest Rival: Infectious Diseases — Then, Now and Beyond," came in part from the fear and anxiety provoked by the media about these topics. “Many fears that people have about infectious diseases can be alleviated by access to greater and more accurate knowledge," she said. "People need to know how far we’ve come in the fight against our ‘rivals’ – think of the eradication of smallpox and polio – and understand that we may be able to achieve a similar success if we apply past epidemiological concepts to our current and future medical conditions.”

mes2 From left to right, Dr. Neil Vora; Rabbi Dr. Aaron Glatt; and Rabbi Mordechai Willig discussed the Zika and Ebola epidemics.

Applying what we know to what we are facing now was the focus of the first plenary, which featured Dr. Nancy Tomes, a history professor at Stonybrook University specializing in medicine, and Rabbi Dr. Edward Reichman, professor of emergency medicine and bioethics at YU-affiliated Albert Einstein College of Medicine (Einstein).

Tomes reviewed the factors leading to the greater velocity at which diseases spread: climate change, expanded global travel, more cross-over diseases from animals to humans and rapid genetic mutations. To keep up with this rapidity, countries can’t just rely on pharmaceutical “silver bullets.” They also need to employ what successful pre-antibiotic disease eradication campaigns used: public education campaigns combined with infrastructure reform (e.g., clean water, sewers, and healthful living spaces). “Health infrastructures around the world,” she noted, “need to be upgraded—we are a global health community now.”

Reichman added an interesting gloss on Tomes’ historical narrative by reviewing the pre-modern rabbinic literature on diseases and prevention, where Torah laws form a guide for hygiene (e.g., kashrut and the washing of hands). “Halacha has much to say about the challenges posed by infectious diseases,” he said, “from fasting in times of plague to the moral guidelines for treating infected patients.”

In the second plenary, Dr. Priya Nori, medical director of the antibiotic stewardship program and professor of infectious diseases at Einstein, spoke about the need to control the overuse of antibiotics, which has led directly to the evolution of approximately 40 drug-resistant “superbugs,” such as C. difficile and MRSA. “There is no doubt that the overuse of antibiotics is the main driver of this situation, and this includes oversubscribing by medical professionals and their unnecessary use in the food system,” she said.

Nori heads Einstein’s antibiotic stewardship program, an effort promoted by the Centers for Disease Control (CDC), the United Nations, and many other global health organizations to “match the right drug to the right bug,” create educational campaigns about cutting personal and industrial use of antibiotics, and foster research into new antibiotics.  “Antibiotic overuse affects everyone,” she said, “and it can only be overcome by everyone working together.”

mesconference1The third plenary took on the Ebola and Zika epidemics. Dr. Neil Vora, an epidemiologist with the CDC and the New York City Department of Health and Mental Hygiene, narrated his personal experiences with both Ebola in West Africa and Zika in the United States and reinforced the message throughout the conference that better information and more informed practices are the best antidotes to panic and anxiety.

Rabbi Dr. Aaron Glatt, chairman of medicine and hospital epidemiologist at South Nassau Communities Hospital as well as an international lecturer on medical and halachic issues, examined how a disease like Zika, which can have a catastrophic impact on pregnant women, not only raises thorny halachic debates about abortion and contraception but also about mundane matters like whether one should travel for work purposes to an area known for Zika infections if one plans on being a parent in the future.

Rabbi Mordechai Willig, the Rabbi Dr. Sol Roth Professor of Talmud and Contemporary Halachah at YU, outlined the complicated rulings in these debates about Zika because of the way the disease affects pregnancy, fetal health, abortion, contraception and the decisions of non-parents about being parents in the future.

Many people stayed after for informal discussions with the speakers, clearly eager for more knowledge and to share their own experiences. Ari Garfinkel, MES co-president, felt the conference achieved its goal. “What we try to do in these conferences is bring a personal interest to these important problems, to tie together the academic perspective and the real world," he said. "And you can see, from the way people are staying here to talk, that they take these important issues very personally.”

Rabbi Yaakov Glasser, the David Mitzner Dean of CJF and one of the conference organizers, noted that CJF takes great pride “in providing mentorship and assistance to the leaders of the YU Medical Ethics Society as they bring their vision of a substantive and inspiring medical conference to life and, in the process, use their education to initiate their roles as leaders in the broader Jewish community.”