Penn Bioethics Seminar Series: Ramnath Subbaraman, MD - Virtual Only

On the obsession with observation: the narrow vision of tuberculosis care delivery from the sanatorium to the digital era

Ramnath Subbaraman, MD, MSc, FACP
Assistant Professor, Department of Public Health and Community Medicine, Tufts University School of Medicine; Attending Physician, Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center

Abstract: Prior to the COVID-19 pandemic, tuberculosis (TB) was the leading infectious cause of death globally from a single pathogen. Since the discovery of the TB bacillus by Robert Koch in 1882, public health approaches for TB have evolved through three care delivery models: the sanatorium, directly observed therapy, and, more recently, monitoring using digital adherence technologies. 

In this talk, I will explore the implications of these three delivery models for the care of people living with TB, with a specific focus on the challenges faced by those living in low- and middle-income countries (LMICs) . Although major international funders and TB programs frame the shift towards digital monitoring as an embrace of "patient-centered care," I will argue that current deployments of digital adherence technologies follow a striking continuity with basic logic of the directly observed therapy and sanatorium eras. In particular, by emphasizing "observation" as the central task of care provision, each of these models may violate patient autonomy while also compromising public health effectiveness, by creating systems that are too challenging for many LMICs to implement and by excluding people with TB who cannot engage with these systems. Leveraging concepts from technology critic Kentaro Toyama, I will argue that, rather than focusing on observation, a renewed focus on "human capacity"--that is, the direct needs of both people with TB and healthcare providers--will be critical to improve global TB outcomes.

More information: Mary.Pham@pennmedicine.upenn.edu