June 06, 2007
TB Or Not TB
We know what you're thinking, has the Bird Flu Babe let drug resistant TB pass unnoticed? Has she ignored the subject of Andrew Speaker's bacteria sluffing honeymoon entirely? Of course not.
One need only read Tracy Kidder's biography of Paul Farmer "Mountains Beyond Mountains" to understand why drug resistant strains of TB develop. It is a disease bred in poverty and fueled by inadequate, inconsistent medical care. It's still a mystery how Andrew Speaker, a privileged member of society, contracted this illness. He evidently did not get it from his new father-in-law, a TB researcher at the CDC. Where then does a middle class personal injury lawyer from the big city with enough money to stage a destination wedding in Europe with today's deflated American dollar, contract such a rare strain of TB, and why isn't anyone else asking that question?
John Donnelly of The Boston Globe writes
But TB specialists said Monday that the real importance of the case is that it is a warning to all Americans: The United States should brace itself for many more cases of the drug-resistant airborne germ in the months and years ahead."This is the tiniest tip of the iceberg," said Dr. Paul Farmer, a Harvard professor who has treated drug-resistant TB in Haiti, Peru, and Siberia. "We need to take excellent care of our own but also acknowledge that we're lucky as a nation: We have little TB, drug resistant or otherwise. We need to think about this much more globally."
Farmer said poor countries need laboratory diagnostic tools, more drugs, better trained doctors who could perform surgery if necessary, and a cadre of community health workers. Those workers visit patients in their homes, which ensures they are taking their drugs properly and protects them from hospital-acquired infections or illnesses.
The Babe has turned her attention to her favorite epidemiologist, Revere, at Effect Measure who has written eloquently and at great length on the subject. To summarize a few of his many cogent points: 1) although this strain of TB is resistant to medicine, it is not more contagious than other forms of TB, it's simply almost impossible to treat 2) Since Speaker wasn't highly infectious, and didn't have a cough or fever, the damage to others probably wasn't too bad 3) the risk of contracting infection on a plane isn't much worse than the risk in any other public setting. 4) the CDC has been raped, pillaged and politicized and Bush has appointed another arrogant incompetent at its head, so we had best not count on the CDC to protect us 5) Civil liberties are at stake when quarantines are implemented He quotes Dr. Michael Osterholm "Short of a military state where you have 24/7 surveillance on someone, you have to count on the good will of the individual."
The good will of others is often not that reliable. Revere asks us to ask ourselves if we might have done the same thing were we in Speaker's shoes.
Peter Sagal of NPR's "Wait, Wait Don't Tell Me" wasn't as kind. He said about Speaker "His TB is curable but his obnoxious behavior isn't"
The fact is that bird flu, drug resistant TB (and probably the plague and ebola) breed in conditions of terrible poverty. If we the privileged care to protect ourselves from contagious disease, maybe we should stop spending our money on war and overconsumption and use it to improve the conditions under which these dread diseases flourish.
The Bird Flu Babe thinks that Andrew Speaker is a canary
Addendum: global health statistics made palatable
Photo note: A sweet bilingual sentiment engraved in granite on a cliff at Tiger Leaping Gorge, Yunnan Province, China
Posted by Dakota at June 6, 2007 05:13 PM