Mark Lambert (University of Chicago) offers the first word in our scholars’ roundtable on healthcare and religion. The September issue of the Forum explores the place of religion and the academic study of religion vis-à-vis the healthcare debate. In light of Congress’s ongoing effort to reform the US healthcare system, we have invited a handful of scholars of religion to discuss the role of religion in the broader national conversation about health and healthcare as well as the potential contribution(s) of scholars of religion to this national dialogue. Over the next few weeks, we will publish essays by scholars from different subfields in the study of religion on various aspects of the debate surrounding healthcare. At the end of the month, Ray Barfield (Duke University) will conclude our roundtable with a final response to the contributors. We invite you to join the conversation by sharing your thoughts and questions in the comments section below.

Posted essays:

 

by Mark Lambert

 

Tom Price testifies during his confirmation hearing in January (Al Drago | The New York Times)

During his confirmation hearing before the Senate Finance Committee, now-Secretary for the Department of Health and Human Services, Representative (Dr.) Tom Price was interrogated on a predictable spectrum of issues concerning everything from stock trades, to views on vaccination, to the Affordable Care Act. But in a particularly striking moment of the exchange, Democratic Senator Bob Menendez asked Price: “In your medical opinion, have immigrants led to outbreaks of leprosy in the United States?”1

Wait, what?

Bewildering though the question may have appeared, the inquiry was actually a direct reference to a 2005 study, “Illegal Aliens and American Medicine,” published under the auspices of the Association of American Physicians and Surgeons, an ultra-conservative advocacy group of which Price is a member.2 Although it fancies itself as “non-partisan,” the AAPS advocates an ardently Republican and libertarian approach to health care, particularly with a vehement opposition to the Social Security Act of 1965 (the website prominently provides instructions for physicians to opt-out of Medicare) and the Food and Drug Administration.3 I argue that beneath the surface of Senator Menendez’s leprosy query festered the consequences of a mixture of media sensationalism, the healthcare debate, xenophobia, and religious rhetoric—a toxic petri dish disturbingly prescient to our present situation and therefore worth exploring.

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The article, “Illegal Aliens and American Medicine,” by Madeleine Cosman, takes the position that: “The influx of illegal aliens has serious hidden medical consequences. We judge reality primarily by what we see. But what we do not see can be more dangerous, more expensive, and more deadly than what is seen. Illegal aliens’ stealthy assaults on medicine now must rouse Americans to alert and alarm.”4 The author first decries the Emergency Medical Treatment and Active Labor Act as a draconian measure forcing American hospitals to treat undocumented immigrants and resulting in numerous hospital bankruptcies. Next, the author adds: “American hospitals welcome ‘anchor babies.’ Illegal alien women come to the hospital in labor and drop their little anchors, each of whom pulls its illegal alien mother, father, and siblings into permanent residency simply by being born within our borders.”5 But the most sensational evidence is a purported stark increase in once-vanquished diseases, listed as: drug-resistant tuberculosis, malaria, leprosy, plague, polio, dengue, and Chagas disease. Cosman devotes the most textual space to tuberculosis, and perhaps rightly so, since it is still the largest global killer among communicable diseases. Excluding malaria, the remaining diseases are classified as neglected tropical diseases (NTDs), an unfortunate euphemistic designation for those infections which primarily afflict the global poor in developing regions of Africa, Asia, and the Americas. Nevertheless, it is the author’s remarks on leprosy (a paragraph) that captured attention and headlines—including the attention of the senator from New Jersey.

Leprosy, also known as Hansen’s disease, is an infection caused by a slow-growing and minimally-contagious bacteria called Mycobacterium leprae. In her article, Cosman reports that: “Leprosy, Hansen’s disease, was so rare in America that in 40 years only 900 people were afflicted. Suddenly, in the past three years America has more than 7,000 cases of leprosy.”6 This claim was so dramatic that Lou Dobbs wielded it as an evidentiary centerpiece on a 2005 episode of “Lou Dobbs Tonight.”7 There was no mention of dengue fever, Chagas disease, or malaria. So why is there such a focus on leprosy? Well, I believe one answer is religion. Cosman’s section on leprosy starts: “Leprosy, a scourge in Biblical days and in medieval Europe, so horribly destroys flesh and faces it was called the ‘disease of the soul’. Lepers quarantined in leprosaria sounded noisemakers when they ventured out to warn people to stay far away.”8 Before citing any of her statistical evidence regarding Hansen’s disease, Cosman’s “disease of the soul” appellation burdens the disease with allusions of sin, impurity, and a context more suited to Sunday school and Ben Hur than Biology 101. The recourse to medieval references is nothing new, as will be referenced below, and portraying leprosy as a vehicle of sin and impurity plays well with populist warnings against undocumented immigration.

The problem is that Cosman’s claims about leprosy are categorically false. All of them.

To begin, Cosman, herself a medievalist with a PhD in English and Comparative Literature, cited as her primary source Saul Brody’s The Disease of the Soul: Leprosy in Medieval Literature, a now widely discredited work on medieval leprosy. For example, Hansen’s disease frequently damages the vocal cords and thus, individuals with leprosy utilized a bell or noisemaker as a vocal substitute to attract others for alms (think Salvation Army bell-ringers).9 The claim of 900 cases in 40 years is laughably false and could have easily been corrected by consulting the National Hansen’s Disease (Leprosy) Registry.10 While these official statistics do report about 7,000 diagnosed cases—that’s over the last thirty years, not the three years prior to Cosman’s publication—a wishful and stunning error on her part!

In a May 6, 2007 segment of “60 Minutes,” hosts Lesley Stahl and Amy Goodman confronted Dobbs on this incorrect and unsubstantiated report on leprosy, to which Dobbs angrily countered: “Well, I can tell you this. If we reported it, it’s a fact.”11 While Dobbs refused to fully dismiss the numbers, he eventually placed the blame with Cosman even calling her a “wackjob.” Unremorseful and unbowed, the following night on his own program, Dobbs (in conversation with the original correspondent, Christine Romans) indicated his full support for the original report, repeated the claim verbatim, and added that the number of 7,000 was likely a gross underestimate.12 Cosman was indeed controversial: several of her credentials were fabricated, she was monitored by the Southern Poverty Law Center, and she had infamously stated that “most Mexican men” were serial rapists (a despicable claim that may sound familiar).13 But unfortunately, there is nothing new about the rhetorical link between immigration/xenophobia, religious rhetoric, and leprosy.

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On January 3, 1865, the Kingdom of Hawaii enacted An Act to Prevent the Spread of Leprosy, establishing a patient settlement on the isolated island of Molokai. Betraying concern about the colony’s financial relation with the United States, the act explicitly utilized the language of criminalization in allowing for the arrest and delivery to the colonial Board of Health of anyone suspected to have the disease—often with an accompanying monetary reward for those who reported suspected individuals. Such segregation would almost exclusively affect native Hawaiians, in fact, Arthur Mouritz, resident physician at the Molokai settlement, described Hawaiians as “the weak link in [America’s] chain of national health defense” due to their “too brief emergence from primitive life.”14 In parallel fashion on the mainland, California medical professionals blamed leprosy on the presence of Chinese immigrants and used the disease as justification for targeting the population as a threat to white residents.15

On February 3, 1917, Senate Bill number 4086, an act to establish a National Leprosarium in Carville, Louisiana, was passed by the US Senate. | Courtesy of the Health Resources and Services Administration

Fears about leprosy intensified when Norwegian Dr. Armauer Hansen discovered the causative bacterium of leprosy in 1873, lending significant credence to the contagion thesis. As historian Carole Rawcliffe has noted: “to an already explosive brew of racialism, social Darwinism, imperialism and religion was thus now added the gelignite of scientific medicine.”16 Anglican clergyman H. P. Wright ensconced the subsequent hysteria surrounding the disease in his 1889 book, Leprosy an Imperial Danger. That same year, the U.S. Surgeon General, with the approval of the President, ordered that all those with leprosy attempting to enter the United States be returned to their country of origin, or (if detected within three years of arrival), deported.17 A treatment “facility” was opened at Carville, Louisiana in 1894 (the first patients were housed in the former slave quarters of a repurposed plantation), which after years of debate in Congress, was finally declared the national leprosarium in 1917. The first proposal for a national leprosarium was submitted to Congress in 1905. Provisions for confinement were not decided on medical grounds, but rather emotional and ideological grounds that encoded leprosy with overtones of pandemic fears—the 1905 proposal even included a clause providing “hazard duty pay” to those detailed for service at the leprosarium.18 The study upon which the 1905 proposal was based had only detected 278 national cases of the disease, still, the number managed to be sensationalized with the claim that “Lepers are like rats and rattlesnakes—where there is one, there is or was another not far off.”19

To support programs of forcible segregation of those with leprosy, contagionists appealed to two principle sources: religion, specifically passages in Leviticus, and medieval history. American physician Albert Ashmead’s article, “Leprosy Overcome by Isolation in the Middle Ages,” was a widely circulated appeal to the medieval past—even though the article was more propaganda than legitimate scholarship. Referencing a largely fabricated medieval model, Ashmead wrote: “Strenuous efforts were made to bring the diseased parts out of contact with the healthy community. In this no charitable regard was had to the victims of the scourge: the weal of the sane majority alone was considered.”20 Accurate or not, the rhetoric was effective: mandatory quarantine of those with leprosy would remain national policy until 1969.

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So how did Dr. Price respond to Senator Menendez’s query? Did he take the opportunity to dismiss the connection as the spurious claim of a discredited study? Did he acknowledge our country’s painful, historical treatment and stigmatization of those with Hansen’s disease?

No.

After twice trying to avoid the question, Price responded: “Any time you get two individuals together in any relationship whatsoever, whether it’s an immigrant or visitor, and one individual has an infectious disease, then it is possible that individual transmits that infectious disease.”

Senator Menendez criticized Price for his tepid response, and in my opinion, rightly so. In September 2016, Fox News reported “Leprosy suspected in 2 California kids: How could they contract it?” Although the article emphasized that about 95 percent of the population is naturally immune to the disease and it remains easily treatable and curable (never mind that it can be contracted from armadillos), dozens of online comments pointed to these two cases as inconvertible justification for Trump’s border wall.21 Two cases. Though far more troubling, one week after announcing his candidacy, now-president Trump released a three-page, incoherent screed which intensified his rhetoric against Mexico and specifically stated: “Tremendous infectious disease is pouring across the border.”22 It would not be surprising if Trump, who is a notoriously avid cable-news consumer, had contracted the misconception from Mr. Dobbs.

I believe that physician and bioethicist Daniel Sulmasy has offered one of the most helpful frameworks for understanding illness. His “biopsychosocial-spiritual” model insists that human persons are intrinsically spiritual beings-in-relationship with the consequence that “sickness, rightly understood, is a disruption of right relationships.”23 This model addresses the astute observation that illness is rarely, if ever, viewed from a purely biological perspective. All too easily, questions of value and blame are raised and the ongoing healthcare debate is prime evidence of this. Our country’s historical past also illustrates how easily debates about healthcare and religiously-inflected diseases like leprosy can become instrumentalized to xenophobic ends, in effect devaluing entire population groups.

As a medievalist who also works in medical ethics, I find myself in an uncomfortable position vis-à-vis Madeleine Cosman and am appalled at her work. I am further convinced that to assume the healthcare debate is one purely about politics and economics would be a gross mistake. Theologians, ethicists, and scholars of religion have a responsibility to engage in the conversation. ♦

 

Mark Lambert is a PhD student in Theology at the University of Chicago Divinity School. His scholarship focuses on the theological complexity of medieval attitudes about leprosy, specifically, how Franciscan theologians conceived of leprosy in eucharistic terms. By linking this approach to the eucharistic theology of Father Damien of Molokai, he hopes to address the ongoing stigmatization of illness, whether Hansen’s disease, HIV/AIDS, or mental illness.

 

* Feature image: John Holcroft | Getty Images | Ikon Images

  1. Hearing to Consider the Nomination of The Honorable Thomas Price to Secretary of Health and Human Services, Before the United States Senate Committee on Finance, 115th Congress (24 January 2017) (statement of Bob Menendez, Senator of New Jersey).
  2. Madeleine Pelner Cosman, “Illegal Aliens and American Medicine,” Journal of American Physicians and Surgeons 10, no. 1 (Spring 2005).
  3. “About AAPS,” Association of American Physicians and Surgeons, accessed August 2, 2017, http://aapsonline.org/about-aaps/.
  4. Cosman, “Illegal Aliens and American Medicine,” 6.
  5. Ibid., 7.
  6. Ibid., 8.
  7. Lou Dobbs and Christine Romans, “Border Insecurity; Criminal Illegal Aliens; Deadly Imports; Illegal Alien Amnesty,” Lou Dobbs Tonight, CNN, April 14, 2005, http://transcripts.cnn.com/TRANSCRIPTS/0504/14/ldt.01.html.
  8. Cosman, 8.
  9. Carole Rawcliffe, Leprosy in Medieval England, (Rochester: The Boydell Press, 2006).
  10. “Hansen’s Disease Data and Statistics,” Health Resources and Services Administration, U.S. Department of Health and Human Services, accessed August 6, 2017, https://www.hrsa.gov/hansensdisease/dataandstatistics.html.
  11. David Leonhardt, “Truth, Fiction and Lou Dobbs,” New York Times, 30 May 2007.
  12. Lou Dobbs and Christine Romans, “Tornado Levels Kansas Town; National Guard Stretched Too Thin?; War on the Middle Class,” Lou Dobbs Tonight, CNN, May 7 2007, http://transcripts.cnn.com/TRANSCRIPTS/0705/07/ldt.01.html.
  13. Susy Buchanan and Tom Kim, “Madeleine Cosman,” Southern Poverty Law Center Intelligence Report, November 2, 2006, https://www.splcenter.org/fighting-hate/intelligence-report/2006/nativists-0#madeleine.
  14. Arthur Mouritz, The Path of the Destroyer: A History of Leprosy in the Hawaiian Islands and Thirty Years Research into the Means by Which it Has Spread, (Honolulu: Honolulu Star-Bulletin, 1916).
  15. Michelle T. Moran, Colonizing Leprosy: Imperialism and the Politics of Public Health in the United States, (Chapel Hill: University of North Carolina Press, 2007), 25.
  16. Rawcliffe, 25.
  17. Zachary Gussow, Leprosy, Racism, and Public Health: Social Policy in Chronic Disease Control, (Boulder: Westview Press, 1989), 130.
  18. Annual Report of the Surgeon General of the Public Health and Marine-Hospital Service of the United States, 1905 (Washington, D.C., 1906), 208.
  19. R.D. Murray to the Leprosy Commission, 15 November 1900, in Senate Committee on Public Health and National Quarantine, Leprosy in the United States, 94.
  20. A.S. Ashmead, “Leprosy Overcome by Isolation in the Middle Ages,” Janus 1 (1896-97), 558.
  21. Rachael Rettner, “Leprosy suspected in 2 California kids: How could they contract it?” Fox News Health, 12 September 2016, accessed August 10, 2017, http://www.foxnews.com/health/2016/09/12/leprosy-suspected-in-2-california-kids-how-could-contract-it.html.
  22. Hunter Walker, “Donald Trump just released an epic statement raging against Mexican immigrants and ‘disease’,” Business Insider, July 6, 2015, accessed September 3, 2017, www.businessinsider.com/Donald-trumps-epic-statement-on-mexico-2015-7.
  23. Daniel P. Sulmasy, “A Biopsychosocial-Spiritual Model for the Care of Patients at the End of Life,” The Gerontologist, Vol. 42, Special Issue III, (2002), 25.
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