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Tuberculosis May Become A Global Threat Again
Iphtashu Fitz writes "The journal Nature Medicine is due to release a report today on how highly drug-resistant strains of tuberculosis are on the verge of becoming a global epidimic. Strains of TB that are highly resistant to antibiotics are becoming increasingly prevalent in places like Russia, eastern Europe, and China, and only small changes are required to make these strains start spreading quickly. Treatment for multiple-drug-resistant strains of TB requires a carefully monitored cocktail of drugs taken for months on end, a regimin that many, especially in poorer countries are unlikely to follow to completion. The strategy used by the World Health Organization to combat TB, the "directly observed treatment, short course" or DOTS, involves using trained health workers to watch patients take their long courses of drugs, since even a little carelessness could result in TB mutating into a more drug resistant form within the patient." Oh, Alexander Fleming ? where art thou now?
This is why:
(1) If you're proscribed antibiotics, you should take them exactly as instructed; take them for the whole course, do not stop in the last couple days or when the symptoms go away;
(2) Do not attempt to "chase off" what you think might be an oncoming infection by taking a "leftover" pill or two from a previous subscription
(3) Realize that many infections are viral; do not expect or demand to be proscribed antibiotics contrary to your doctor's wishes
Doctors are now becoming very aware of bad behaviors which cause bacteria to become antibiotic-resistant, but convincing people to follow good practice is apparently harder.
My father lost his father when he was a mere 9
years old to TB. I don't understand why people
treat this as "someone elses problem" - it isn't a
SEP. It *will* bite you. You'll never have to worry about new diseases because the old ones are doing nicely...
The irony with TB is that
people think they are getting well, and stop taking
the drugs (which are making them feel ill). End result: great selection pressure to make resistant bugs).
I for one pray that we can stamp out that big disease called ignorance (hey, look at what happened in Nigeria with that dumb fuck (who cares
what religion?) and Polio). Damn. I had a friend
with scars from hell and calipers when I was a kid
and I'm a mere 45 year old. I never want to see
such things, not even in my nightmares...
Even things as simple as the commom cold are highly mobile conpared to a "few" years ago. Given air travel what it is today; a small outbreak of anything highly contagious can spell absolute disaster on a global scale. It's easy to forget people have only recently become the global travelers we now are. TB and all the others are no longer isolated to the point of initial/original concentration. Adds new meaning to "just off the jet".
Having the largest prison population in the world is a much bigger threat to America than H1B workers ever will be. Prisons are a breeding ground for communicable disease.
Er...yes, but what does that have to do with the decision to not vaccinate against TB, which is what the parent was talking about?
Reality has a conservative bias: it conserves mass, energy, momentum...
Personally, I hold doctors highly liable for the abuse, misuse and general over-use of antibiotics. Of course the patients are pretty damned stupid too, but I have seen cases where the doctor didn't see anything but a blood test before prescribing the antibiotics.
There are so many natural ways to inspire your own immune system to build and strengthen itself and it seems to me that for capitalistic reasons alone medical professionals do not prescribe them.
I'm not a doctor or medical expert either. But I'll say this much -- from the time I decided I was done taking pills and crap for every minor problem out there and let my body do its own healing, I have been a healthier, stronger person and I can't remember the last time I was sick... I remember what it was -- the flu -- but it was great than 5 years ago and basically, I just waited it out -- fever and headaches and agony and all. I recognize the fact that extreme situations call for the use of medicines and other modern medical techniques. But I think they are way over-used and in my opinion (guess) it's so they can way over-charge people.
Where does that statistic come from? I work in natural products biosynthesis I always thought it was much, much greater. What's the other 75%? And don't say combinatorial chemistry.
If it's "worldwide" it should be called a pandemic threat, not simply an epidemic threat.
I hear you loud and clear. I sympathise with your opinion. I too relish a 'prime directive' of non-intervention where it might impact our ability to deliver medical care to our own countries in the 1st world...
BUT...
Once you start making decisions on 'who is worthy of medecine' it gets really ugly really fast. Of all the areas of society and science and fields of study, I suspect 'the slippery slope' is most evident in the world of medecine. Today, its "don't give out TB anti-biotics to those who won't finish it"...then its "don't bother treating AIDS patients against opportunistic infections...they'll die anyways." Then its "some cancers of the lympatic system deplete immune systems like AIDS, lets not treat these people either...".
Who gets to make that decision? That's a tough one, and whatever mechanisms are in place will be prone to abuse and misuse and cultural/societal/scientic bias of the day.
Aggressive screening of visitors from infected regions is probably the best bet. Also, blanket policies like "if you've done time in an asian or russian prison, you're not allowed in." are probaby more effective, and perversely more humane.
Not really, since eventually most prisoners are released. Also prison warders come into contact with the prisoners, and then frequent other places outside the prison. If you want to lock up all prisoners forever, for even minor crimes, and also never let the warders mix with the general population again then you have quarantine.
Is it wrong to think we shoulda withheld medical technology from people incapable of using it properly so it would still work for us?
No. It would be wrong to refuse to TREAT those people, and wrong of us not to teach them the proper way to use the tech, but not wrong to think "man, we shouldn't give that kid a gun without teaching him how to shoot."
As dark as his humor tries to be, he does have a point. What happens if something like this reaches India or Pakistan, or perhaps one or more of several nations in South America, in which shantytowns with no sanitation and crushing population density? It's entirely possible that we could see millions die before it could be brought under control. But what of the political upheaval? TB can kill in weeks to months once it takes hold, and spreads via airborne particles. Most of those nations aren't that stable to begin with, and those that are (like India and Brazil) have significant undercurrents of tension that could erupt into even bigger problems.
While the world's resources could use the strain of a few hundred million fewer people, this is probably not the best way to achieve that.
You can never go home again... but I guess you can shop there.
Yeah, I'm a Gen-X'er, and I know how glad I was to have an effective AIDS vaccine when I was growing up.
If the doctors are at fault, it is for bowing to the demands of ignorant, demanding patients who want antibiotics for every sniffle that little Tyffany or Brett get. I have had several co-workers who just wouldn't give up the belief that they could blast the common cold by having their pediatrician shoot up Junior with penicillin.
The Mexican practice of selling antibiotics over the counter doesn't help either. They're treated as a cure-all down there, and immigrants continue the practice.
Like the poster said, you're better off living a clean and healthy lifestyle, putting up with minor ailments, and saving antibiotics for actual bacterial infections.
Stefan
And sometimes its worse than that. If my kids get a runny nose, various relatives start crying "OMG! Give him some cold medicine!", even if the cold isn't even really bothering the kid. Infected noses get runny for a reason, and millions of years of evolution have worked out the optimal behavior for minor colds. Trying to dry it up with artificial chemicals just isn't going to help, and might create a blockage of sticky infected debris.
It's the same with fevers "OMFG! He's got a fever of 101 degF!!! We've got to bring it down!!!". Fevers also serve a purpose for the immune system. Why try to bring it down unless it's getting dangerously high?
Too many people assume that anything at all has to be done to treat a minor illness that the body is perfectly able to deal with on its own.
"Alright, I'm a practicing lung doctor so I've got to say a little bit."
[...]
"Using INH for a long enough duration will not cause resistence. Dead bugs can't develop resistence."
[...]
"In the grand scheme of things, TB may be getting worse worldwide, but here in the states it seems well controlled. We have a huge immigrant population, and I have seen on a couple cases of active TB over the last 5 years."
The article we're all discussing in this thread reports the incipient global TB epidemic caused by carpetbombing TB exposees with bacteriocides, which leaves the few mutants resistant to the drug to inherit their food supply: us. The principle of using a drug like INH "long enough" to kill all of the bacteria, even the more resistant mutants, depends on "long enough" being both less than the human lifetime, and humans nearly always following the long program. The biology of TB, or any other very large population fought with merely systematic techniques, allows at least a small population to survive, which can then reproduce. If large enough, that population can overcome the human immune response that resists the original infection (if the immune system hasn't been damaged too much, along with the liver damage, from the medication). Unless each bacterium is destroyed individually, systematic is all we've got, and we're dealing with statistics. The same reality applies to human behavior - highly variable across populations of millions, inevitably slopping across any thresholds. This attitude is solid biochemistry, but bad medicine. And it's the unchanging environmental factor within which TB has adapted. Without an alternative, the MDR epidemic seems inevitable, making inroads in the US more slowly, but just as inexorably as abroad.
--
make install -not war
About 10 years ago, 60 Minutes ran a story on the upswing of TB in the US, focusing on some studies done by -- NIH?? (don't recall specifically, but one of the major gov't health outfits). One of their case studies involved the shipyards at Long Beach (which for the geographically-challenged, is just south of Los Angeles proper). Turns out EVERYONE who worked there had been exposed, and many had active infections!! (These were American workers, not immigrants.) The thought was that because it's a relatively closed work environment, there was no chance NOT to be exposed if even one infected person entered the facility. (Much akin to the prison environments discussed down this chain a ways.)
:)
Another study involved airliners -- and the conclusion was, if you're flying, you're going to be breathing recirculated air that has a strong risk of someone's wandering TB germs floating in it -- and that if you saw anyone coughing, you should consider yourself exposed. They (the NIH or whoever it was) went so far as to recommend wearing surgical-quality masks during long flights, especially to/from countries that are a TB hotbed. (Think of it as a condom for your lungs
While this may sound alarmist, remember when AIDS was something that only happened to other people?? Better paranoid than epidemic.
~REZ~ #43301. Who'd fake being me anyway?
As an FYI, we're currently seeing a trend of the older population spending their kids inheritance.
Traditionally, parents bequeath their homes, money, etc.. to their children, and this was a big part of the economy.
Now, with people living longer, the parents are far more likely to spend the money on travel, dining out, etc. (assuming they are in good health) Couple this with the fact that the ones in poor health have their money given to Nursing homes / Prescriptions / etc.
I don't know how, but this definately changes the economy.. So, I don't see the "leaving behind more money" argument.
Rest sound ok, though.
Is. A few years ago(2001) it was found that 70% of all antibiotics in the US are fed to food-animals. Not just animals to be eaten, but animals that produce milk and eggs as well(hence my use of food-animal). If 70% of antibiotics is given to animals, the diseases have a leg-up before they hit the humans. And yes, when we eat food made with antibiotics, we do absorb some of those antibiotics, helping to created MDR's (as well as the animals creating MDR's).
What idiot modded this funny?
I know we all hate Microsoft's business practices and Bill Gates' view of OSS, but it's impossible to deny the great things his foundation has done worldwide.
Please, folks, separate the man from the business.
The global economy is a great thing until you feel it locally.
But the difference between TB and HIV/pregnancy/broken bones, is that TB is airborne disease. You can not go spread TB/plague around.
In theory there is no difference between theory and practice. In practice there is. - Yogi Berra
I have a friend, who is a pulmonologist in Russia. He told me that in the past doctors rarely became infected even if exposed to TB constantly. Nowadays, doctors themselves lack vitamins and put under stress in Russia. This pulmonologist was infected once, and other doctors fall ill regularly.
In theory there is no difference between theory and practice. In practice there is. - Yogi Berra
You're forgetting that the other component in drug resistant TB is availability of antibiotics. In the US, I'm fairly sure that prisons are a fairly nice source of drug resistant TB. Especially since prisoners may get on a course of drugs and stop partway through the 6-9 month course. Add in the infections in the native population and the availability of the latest antibiotics and you have a great way of incubating a drug resistant population and spreading it.
It also doesn't help that immunosupressed people (AIDS, organ transplants, etc.) can easily get infected by multiple strains increasing the possibility that different strains swap resistances.
"When you sit with a nice girl for two hours, it seems like two minutes. When you sit on a hot stove for two minutes, it
Useless solutions. The prison population has to be maintained to prevent our unemployment from increasing dramatically. Even if we let out the drug offenders, the resulting rampant unemployment and poverty due to oversupply of the labor market will lead to an increase in crime, so the prison population will not ultimately shrink.
Our prison population is so big because our productivity is high enough that there is not useful work for the entire labor class. The only ways to solve this are to increase demand in some way or to reduce the work accomplished per person (perhaps by reducing the work week to 35 hours).
The fake-drug scandals showed that the justice system in Texas is quite broken, and it's easy to convict the innocent. Thus, our "fast-track" execution model is probably a moral disaster, and I'd hesitate to recommend it to others.
Somebody already replied that whoever moderated parent as Funny is a fucking moron.
The problem with TB is it is poor man's disease (mostly), so there is not much money in it as patients with tuberculosis have no money for so called innovative drugs. Because of that there is not much research going on new treatments of TB. This makes Mr Gates' foundation even more valuable.
OK, this guy is a blood thirsty businness shark but this doesn't mean everything he does is mean. It is better if he spends some of his enormous amounts of money on TB research than hoard it or build yet another billions of dollars worth house.
Raf
P.S. OK, as there are already more than 200 posts in this subject, probably all I've written is redundant, but what the heck...
Sorry, but the economics of this are terrible. Open jobs don't create wealth, production creates wealth - meaning that filled jobs create wealth. The US saw an economic boom in the 80s and 90s as the boomers have been part of the workforce. Of course, as they retire and stop being productive, that will be bad for the economy; thus the complaints about the increasing burden of social security, medicare, lower benefits.
Saw this coming from 20 years ago.
I remember sitting in high school science class going over the details. Our Birkenstock-wearing teacher was probably breaking the rules by telling us what he'd learned. Darned socially aware hippies!
Livestock farmers mixing non-lethal doses of antibiotics into the feed to keep bacteria at controllable levels. (Creating bacteria breeding boilers.)
Junkies, who destroy their immune systems with their chemicals of choice, would normally die off fairly fast but for black-market/clinic-distributed, improperly used antibiotics. Concentrated junkie populations, like those I've walked among in Vancouver and Amsterdam are super-breeders for germs. Chilling and very real.
And then of course, there's the regular citizenry and drugs like 'Contact-C' which allow people to ignore symptoms which would normally put them in bed (where one can properly recover without drugs), and thus keep them at work where they spread the virus and wear themselves down further until a simple viral infection can graduate into a full-fledged bacterial bloom. --Then it's off to the doctor for antibiotics which many don't bother finishing properly once they feel their symptoms fading. --Doesn't matter how often you explain the Hows and Whys to a drone about why they HAVE to finish their antibiotics prescription. People who have been programmed to glaze over when confronted with important knowledge are both common and dangerous.
Humanity is getting exactly what it designed for itself.
Fortunately, ignorance is self-punishing and awareness protects those who choose to learn and act upon what they learn. --Viruses can be avoided if one has groomed their awareness, health and energy. I've not been sick in several years now, and I certainly don't manage it by allowing some drug-salesman 'doctor' to jab me with thimerosal/mercury-laced flu shots! (Which dull the brain, and I strongly suspect, reduce the strength of one's natural immune system, thus increasing the perceived need for just such profitable pharmaceuticals).
But you know, 'Science' is good and great and all that, precluding the need to question the intent behind the needle. Far too many people have traded their critical minds for easy, false trust and never question when they see the 'Science' label and hear an authoritative, soothing voice.
Remember; it's okay to be wrong. You will constantly be faced with false data if you choose the road of continual learning. Just be sure to correct it accordingly as you discover it. You WILL be punished for your mistakes by those who want to stop you from learning, but that's part of the journey. --In the long run, the lemmings are the ones who get sick, and they want your (enforced) company.
How much do you value your social acceptance?
-FL
Holy cow.
It's rare that I see a post of blatant fear mongering lies such as this one.
Tell me, is your tin foil hat working today? Good, because TIN has been off the market in foil form for YEARS in trade for aluminum. You better check what metal it really is! It might not be protecting you the way you think!
Ack the panic!
I only have time to punch a few holes in your nonsensical arguments, so I'll focus on big ones.
Some 6600 people have contracted SARS worldwide, and that _is_ an epidemic
Yes, however SARS takes down otherwise healthy adults, does not seem to have a normal low frequency background infection rate, and is fairly new to modern medicine. It's an epidemic for that reason.
For the paragraph below, I leave it as is with the lies in bold;
AIDS is the best. Its an untreatable/uncurable disease that is supposedly spread by contact with fluids such as blood or sex goo. We've all been told that "AIDS does not discriminate", but it does! In the US, its mostly black gay men (and some IV drug users) that get it, whereas in Africa its black heterosexual women that get it. After 20 years and I'm guessing millions if not billions of dollars in research have not even provided any kind of explanation of AIDS nor has the virus even been isolated.
"untreatable" There are many drugs and treatments available on the market. Ask your doctor! Remember AZT? Maybe interferon boosters? Try going to Google and searching on "aids treatment" for once eh?
"supposedly" AIDS is spread by and present in many fluids; blood, plasma, tears, saliva, seminal fluids, vaginal fluids, feces. All forms of transfer require fluid or moist environments very similar to transmission of sexually transmitted diseases. AIDS is caused by the HIV virus, the HIV virus is spread through close contact. There's no "supposedly" about it, it's a medical fact.
"AIDS does not discriminate" is absolutely true. Once exposed every human has a more or less equal chance once the exposure type and frequency has been accounted for. YES there are various types of populations that one can define that have different infection rates. YES gay men got it more frequently because they were a) trading semen b) doing so anally (causing bleeding during/after sex). The hertrosexual women in Africa are getting it because they have OTHER STDs (many are prostitutes full time or engage in prostitution) that cause open sores in their sexual organs... so when exposed to a male that has it they are much more likely to get an AIDS infection. Same for the IV drug users, trading needles is trading blood. By your reasoning, there would be no relation to your mom walking down the street licking DOG FECES to her getting stomach and intestinal bacterial infections all the time.
"explanation of AIDS". All I have to say is this, there are TENS OF THOUSANDS medical studies that closely or directly link the HIV virus with the collection if symptoms collectively known as "AIDS".
Furthermore, AIDS (so far) is one of the few diseases that could potentially be completely stopped with the combination of not taking stupid risks (inprotected sex, IV needle sharing, turning tricks, etc.) and relatively easy upgrades in the health care processes that would make tissue sharing done only on known AIDS free blood/organs.
If you are worried about the number of black people getting the disease (which your post implies) maybe the black people should wise the fuck up and start heeding the warnings.
You sir, are a paranoid, FUD spreading cunt. What is the address of your "earth is flat" web site? Or are you this guy? Also, whomever modded you as insightful is a MORON.
- The CDC (U.S. center for disease control) inTrends in Tuberculosis --- United States, 1998--2003 states
- Khaled Mohammed Abu Khadra's thesis abstract (Ph.D. thesis?)
(the thesis itself was not directly linked), but the abstract gave hard numbers of preventive vaccination (vaccination prior to exposure) for the BCG vaccine in Jordan.
The last paragraph of the abstract reads:
- However, vaccines appear to become less effective after widespread usage (try googling on Ineffective TB vaccine), so they may be ineffective after all (a BBC Article gives 70% effectiveness ratings).
- Potential Public Health Impact of New Tuberculosis Vaccines by Ziv E, Daley CL and Blower, S.
describes the outcome of a mathematical epidemiological model of Tuberculosis, which appears to indicate that vaccination
AFTER exposure (post exposure) is likely to be more effective than pre-exposure vaccination at preventing disease (the authors make an interesting point that disease prevention is more important than preventing infection).
I wasn't able to directly refute the claims, and I suspect some of them may be true given the information turned up."During 2003, a total of 14,871 tuberculosis (TB) cases (5.1 cases per 100,000 population) were reported in the United States."
While Eurosurveillance in 2002 reports on data (which may have been gathered in 2000) at Tuberculosis control in Europe needs expanded DOTS, linked HIV/TB control, and improved surveillance reports:
"In most countries of western Europe, reported TB incidence is below 15 per 100 000 and continues to decrease slowly. In central Europe, reported TB incidence ranges from 20 to 40 per 100 000 and is decreasing in most countries. TB incidence is much higher in Bosnia-Herzegovina (65/100 000) and Romania (124/100 000), where it has increased significantly in recent years. In eastern Europe, a further increase in reported incidence was observed in 2000 to an overall 89/100 000, a 56% increase since 1995. In countries providing representative data, the overall levels of drug resistance at the beginning of treatment remained low both in Western and Central Europe (less than 1% of patients never previously treated had primary multidrug resistance) and remained extremely high in the Baltic states (9-12%)."
So the U.S. may have a lower rate of TB than western europe, and definitely has a lower rate than central or eastern Europe. However, I was not able to find a supporting reference for the U.S. having the lowest Rate of infection.
"The overall vaccine effectiveness was 88% ; 85% for pulmonary TB and 95% for Extra-pulmonary TB. The vaccine was more effective (92%) when given shortly after birth, compared to 62% when given at school age."
No. It's completely misleading to say that penicillin has any mentally-induced effects on the cell wall of a pneumococcus. It very well make the patient subjectively feel better in that they know that their disease is being treated, but that has no objective effect whatsoever in the actual physiological healing mechanism.
and lastly, *any* kind of treatment, if it works, should not be discredited for the person using them.. even if it's a minute doasge of a plant that may or may not actually be helping them, even if it doesn't work for everyone..
Yes, it should be loudly and repeatedly discredited. Pain is a legitimate target for non-physiological "treatments", in that much of the subjective experience is due to how the patient expects to feel. A placebo may help a patient expect to feel better and therefore actually make them feel less pain, although recent studies would indicate that this effect is far less powerful than previously thought.
However, there is no "placebo effect" that can counteract infectious agents. People who believe that there is only present a health threat to themselves and those around them. Do you honestly think that Pamela Anderson can really cure her hepatitis with "alternative medicine"? No way! It could (possibly) help her to believe that she should be experience less discomfort from her illness and therefore help her to feel less subjective pain, but that's it - she'll still have a virus chewing through her liver regardless of how spiffy her fake-doctor makes her feel.
BTW, my post and its parent were both modded down -1: Troll until the instant you posted. Thank you for having the courage to change your mind and discuss this instead of hiding behind your previous down-mods.
Dewey, what part of this looks like authorities should be involved?
Sorry, I don't want to drag this off-topic into another screed about the evils of extended copyright, but it is mildly relevant.
My grandfather was a well-respected medical researcher. The works that he developed his fortune and reputation have been superceded, but toward the "mature" part of his career in the 1930's he did a lot of work on tuberculosis especially with animal tests on cattle. The articles my grandfather wrote are still under copyright. He's been dead for decades, and tuberculosis has been a non-issue for most Americans for years. Now that a more vicious strain of TB is starting to emerge, I find it disturbing that this material is still illegal to share.
If you can't see what I'm talking about, look at the two-digit year rollover problem framed in the media as Y2K. All of the research into the causes, identifications, and solutions to the "millenium bug" will remain under copyright for close to 90 years under current copyright law. Imagine though that copyright was extended yet again and these works weren't public domain until AFTER the next two digit rollover in 2100.
Just as people have already started to build two-digit years into databases again, so have people given up on many practices that might minimize the spread of TB. Some people can't even identify these practices or understand why they're at issue.
I realize that the research into Y2K and bovine tuberculosis isn't "gone" that it's still around under lease, but it seems that having only the choice of paying for out-of-date information on a tangential problem or recreating the works someone else did is a waste of resources (money or time) that could be better applied toward whatever problem is causing researchers to look back on these old issues.
I'm thinking about digging into my grandfather's work papers (what's left anyway) and trying to digitize some of his data, notes, and private letters on the subject of bovine TB. Some of this data probably can't be collected today because of regulations on animal testing that didn't exist in the 1930's. I know full well that it would be irrelevant to the current threat of drug resistant tuberculosis strains, but it might let some researchers or problem-solvers keep their money and time focused where the real problem is rather than paying/recreating old research.
While I'm not against people making money from their research and creative works, the length of time that this stuff remains under protection is absurd. The money made either for my family or the publishers trailed off to nothing decades ago. The potential monteary profit of his work is far outweighed by my own interests in not becoming a victim of a drug-resistant version of this affliction. The benefit of this work today is only as part of a contextual frame or foundation for research into other communicable diseases.
Viruses are basically just coated bits of DNA or RNA, so it's hard to call them alive in the first place. I don't think it is possible for a chemical to actually destroy them all by itself without killing the host body. Binding them with antigen is more feasible, especially if it's made by your own cells in response to a vaccine.