Mass Hysteria, and a real issue

No doubt all of you have by now packed your survival kit and are heading for the mountains to escape the coming mass epidemic of incurable tuberculosis. No? Good for you, but to judge by the screaming headline coverage you ought to.

For anyone who missed the details of this story, I'm only going to link to Lawrence Altman's report in the New York Times, for two reasons:

a) It was on page 14, where it belongs;
b) Altman, who is an actual, real expert on the subjects he writes about, knows the difference between isolation and quaratine.

Point b is a matter of intense annoyance to public health experts. Just so you can avoid embarassing yourself at the cocktail party, contrary to what CNN, the Boston Globe, the AP and just everybody except Altman are saying, the gentleman with XDR-TB is not in quarantine. He is in isolation. Isolation is when you confine an infected, potentially contagious person to prevent transmiting the infection. Quarantine is when you exclude people from an area which you believe an epidemic has not reached. Got it?

Now, as for Page 14 vs. Page 1 or the entire upper half of your web site, Extensive (or extreme) Drug Resistant Tuberculosis (XDR-TB) is indeed a big problem - in the former Soviet Union, in South Africa, and elsewhere in Africa and Asia. But it has been for a few years now. Not only that, but it has shown up in the U.S. previously, maybe a hundred times or more, although we didn't necessarily always know it. (Once again, I'm too lazy to look up a number that doesn't really matter.) We didn't necessarily know it because nobody tried to find out. Some patients had what's called Multi Drug Resistant TB, which is not susceptible to the two main drugs used nowadays to treat TB, which are called isoniazid and rifampicin. If these don't work, doctors fall back on any of six other classes of antibiotics. XDR TB is resistant to at least 3 of these. It was first described and named last year, however, and probably has existed for at least a couple of years before that.

Now, put away your survival kits! This is not a problem in the United States. We have very effective TB control policies and programs in the U.S., and TB is not going anywhere within our borders. This story could be useful as a hook to explain to the public what's going on in the rest of the world, but of course your corporate media aren't very likely to do that responsibly or effectively.

As our legions of fans know, drug resistant pathogens, including this one, emerge largely because of poorly managed treatment. Give people a course of antibiotics that is too short, or has too low a dosage, or which the person doesn't take correctly, and you cause (cover your ears kiddies, here comes an affront to the deity) evolution to happen. Organisms which happen to have mutations that confer resistance to the drug survive, and multiply to occupy the space vacated by their non-drug resistant brethren, and voila, you have XDR TB, or Multi-Drug Resistant Staphyloccocus aureus, or drug resistant C. difficile, or any of a number of nasty bugs that plague humanity.

But TB control is not just about antibiotics and isolation. Healthy people with robust immune systems are not very susceptible to TB. Even if they are infected, they are usually not contagious because their immune systems suppress the organism, they have no symptoms, and they shed little or none of the TB bacillus. That's why TB nearly disappeared from the U.S. and Europe even before antitbiotic treatment was available, as the impoverished, overcrowded conditions of the industrial revolution gave way to greater prosperity and better diets.

But in poor countries, where there are a lot of immunocompromised people with HIV, TB is a big problem today, and XDR TB is scary because it's very hard to kill. Here's the WHO's primer on the problem. Yeah yeah, it's from the satanic one-world government, but it's true anyway. This shouldn't make us worry about ourselves, or our own country, at least not for now; but it should make us want to do more about international poverty and inadequate public health and medical systems in the less fortunate countries. After all, something like XDR TB might come and get us some day.

But not today.