Totally drug resistant TB panics India

The “totally drug resistant” tuberculosis outbreak in Mumbai has created panic in India, but the government appears as much concerned with calming people down as it is with addressing the danger.

Even as it cleared more than $1 billion in new funds to fight the disease, on Tuesday the government issued a statement that declared “totally drug resistant” — the phrase of the news cycle – to be "non-standardized" and "misleading," the Times of India reports.

The government’s press release stated that the cases should be referred to as extensively drug-resistant-TB (XDR-TB) as per the World Health Organization norms.

At the same time, however, India's Tuberculosis (TB) control division has asked the health ministry to declare it a "notifiable disease" across the country, according to another Times of India report. That would mean that every doctor and clinic across the country would have to report cases that they identify to the government.

But that's hardly practical.

The article blithely claims “undiagnosed and mistreated cases continue to drive the epidemic in India.” But doctors on the frontlines contend that overdiagnosis through outdated and inaccurate testing methods is India's biggest problem, according to an excellent New Yorker article by Michael Specter.

Tuberculosis can be cured, but taking several antibiotics nearly every day for six months is not easy, particularly in parts of the world without running water or refrigeration. In 1994, the W.H.O. instituted a program called DOTS, which stands for “directly observed treatment, short course.” DOTS requires health workers to provide medicine—and then to watch people swallow it every day until they complete their treatment. Compliance is essential, because stopping treatment in the middle permits the most resilient strains of the bacteria to thrive, greatly increasing the chance that they will become resistant to basic, inexpensive drugs.

To put it bluntly: Every year, millions of people in India receive anti-biotics to treat TB – even though a goodly portion of them don't even really suffer from the disease. And because the treatment regime is so lengthy, presumably, overtreatment necessarily means an increase in drug resistant forms of the disease.

As the Times of India says:

What makes India a time-bomb as far as TB is concerned is the growing incidence of drug resistance. The few studies done so far by the BMC and the Foundation for Medical Research show that Mumbai should anticipate 3,000-4000 new cases of drug-resistant TB every year, said the foundation's Dr Nerges Mistry, who has conducted many research papers on TB in the last decade. Considering that each patient can infect up to 15 persons each year, the drug-resistant trial in India can grow really long and worrisome.

Tragic? Extremely. Scary? Totally.

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