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Table 1 Typhoid Mary and Minority Report

From: Precision public health to inhibit the contagion of disease and move toward a future in which microbes spread health

The premise of “Minority Report” (a dystopian science fiction story by Phillip K. Dick (1956), made into a film (2002) and a television series (2015)) is “predictive policing” that allows authorities to forecast who will commit a crime. The “pre-offender” is preventatively detained or killed before any crime has actually taken place. Mary Mallon, better known as “Typhoid Mary” was an asymptomatic carrier of the typhoid fever bacillus whose unfortunate choice of occupation was to be a cook. Epidemiologists tracked her down, but she escaped surveillance, changed her name and again took up the only trade she knew. Repeatedly located by investigators who tracked down the shared source of multiple infections, she was eventually confined against her will with no prospect of release [113]. Finding and acting to prevent contagion from Typhoid Mary saved lives and reduced a significant local burden of enteric disease, even though it compromised her civil rights. The molecular version of “Minority Report” would be to prospectively identify Typhoid Mary rather than relying on reactive surveillance to follow the trail of disease backwards to find its source.
Typhoid Mary is a singular and extreme case. It is also a century old. The moral calculus has not changed with more recent cases although the information-dissemination and decision-making machinery has, and not always for the better [114, 115]. By considering the role that information plays in more recent cases we try to consider how better and different information may inform future public health policies. Anticipated technical advances to prospectively screen carriers of transmissible disease universalize this possibility which is both an opportunity or a threat. This commentary article discusses enabling technologies and also considers implications for both public health and private rights.