Of Drug Resistant Tuberculosis

Talking of places to go in health care, and of the Totally Drug Resistant (TDR) strain of Tuberculosis, it turns out that the drug resistance appears mostly because of the simplest reason: incomplete dosages of medicines. Instead of killing the virus, incomplete doses actually help to make the virus immune to the medication!

[…] At the best of times, TB treatment is difficult, requiring at least 6 months of pill combinations that have unpleasant side effects and must be taken long after the patient begins to feel well.

Because of the mismatch between treatment and symptoms, people often don’t take their full course of drugs — and from that (and some other factors I’ll talk about in a minute) we get multi-drug resistant and extensively drug-resistant, MDR and XDR, TB.

[…] WHO predicted there would be 2 million MDR or XDR cases in the word by 2012.

That was before TDR-TB.

How does this happen? It’s complex, of course, with no single simplistic answer. Often patients will stop taking their medicines when they start feeling better. But the condition of health care professionals is pretty bleak:

A study that we conducted in Mumbai showed that only 5 of 106 private practitioners practicing in a crowded area called Dharavi could prescribe a correct prescription for a hypothetical patient with MDR tuberculosis. The majority of prescriptions were inappropriate and would only have served to further amplify resistance, converting MDR tuberculosis to XDR tuberculosis and TDR tuberculosis.

This needs some serious attention. Tuberculosis is dangerous in India without having the TDR strain over our heads. As I said in my last post—there’re still places to go.

Good news: One year without Polio. But what about the bad news?

Surely, if you follow Indian news, you’ve seen this—maybe even at more than one place:

[…] this Friday will mark a full year since the last case of wild poliovirus was detected in India. This is a huge milestone in the history of global health.

Yes, I agree—excellent news! There is much to rejoice over. India has taken painstaking efforts for a few years now at combating polio, and it is an achievement to have at least some control over it.

But while you saw the above news in big lettering, did you see this one?

Over the past 48 hours, news has broken in India of the existence of at least 12 patients infected with tuberculosis that has become resistant to all the drugs used against the disease. Physicians in Mumbai are calling the strain TDR, for Totally Drug-Resistant. In other words, it is untreatable as far as they know.

Not very good news at all, is it? Quite a terrible piece of news, actually—and something that needs to be brought swiftly under control.

Both the above pieces of news were published on the same day—9th Jan—but while the polio achievement was all over the social networks, the TB setback was nowhere to be found even among the uber-connected amongst us.

While it’s great that we’re making progress in strides, let’s not forget, and let’s not brush under the carpet, that we still have places to go.