A NEW LIFE FOR A DEADLY DISEASE

[xchrom]

http://www.newyorker.com/online/blogs/elements/2013/04/drug-resistant-tuberculosis-deaths-antibiotics-health.html



You can hear it before you see it. Most of the time, it starts with a wracking cough. Damage to the lungs advances; if infection enters the bloodstream, it may spread throughout the body. Then the patient grows weak, and as the infection advances, the body seems to melt away. When the end comes, as it does for more than a million each year, death arrives like a train wreck of blood and phlegm and spit. It used to be called “consumption,” or “the White Death.” Don’t think of Camille, lounging in soft focus whilst romantically fading away. Tuberculosis is a ferocious killer.

Tuberculosis is caused by an infection of one of a handful of members of the Mycobacteria family, usually Mycobacterium tuberculosis, though four other related bacteria can also cause it. It is a disease of crowds. An infected person coughs, sneezes, or spits—or even sings with gusto—he can release an aerosol of thousands of tiny droplets. It doesn’t take many bacteria to produce an infection: some estimate that fewer than ten can be enough to set the disease process in motion. Those most at risk are people living packed together (in range of sneezes) and those who spend a great deal of time with an actively contagious person.

Mere contact with M. tuberculosis doesn’t mean that an active case of tuberculosis will follow. After inhalation, the invaders travel until they reach cavities deep within the lungs. There they invade cells involved in immune response; those cells then invite reaction from other types of cells in the immune system, forming clumps in which the infected cells can fall into dormancy, becoming a latent TB infection. Most otherwise healthy people will never develop active disease. But for about one in ten, the infection flares, producing tissue damage around each clump. Sometimes the immune system can mount another counterattack, and the disease may wax and wane. Left untreated, active TB is the stuff of nightmares: up to two-thirds of its victims will die if no help comes to them.

That help has been available for almost sixty years. But not for seventeen desperately ill people in the Eastern Cape province of South Africa whose fate suggests that we may not enjoy our sense of invulnerability in the face of TB—and other infectious diseases we’ve conquered—for that much longer. Those afflicted suffer from a strain of tuberculosis that seems to resist every drug available to treat it. Seventeen is a tiny number, but the question those desperately ill people embody is whether we will do what is necessary to keep their numbers so small.

[raccoon]

1. Drug-resistant TB scares the crap out of me. Off to greatest with you. nt

[DreamGypsy]

2. Yes, drug resistance a major and growing problem.

My wife is a biochemist and entrepreneur. She is co-founder of a small company that has developed techniques for rapid development of new drug candidates to overcome drug resistance. The approach uses technology licensed from a local university. The drug that is furthest along in their pipeline is a cure and preventative for malaria, but they also have candidate anti-bacterial drugs. They have completed preclinical trials for the malaria drug, but to move on to clinical trials, which are very expensive, requires further funding, as does further work on the anti-bacterial drugs. Cuts to the NIH budget has slowed the company's progress and private funding has proven very difficult to obtain.

These two paragraphs from the New Yorker article highlight some of the economic challenges of solving the growing problem of drug resistance (emphasis mine):

Working against pathogenic microbes is not simple altruism. Keeping the lid on bad diseases in the age of air travel is a matter of self-interest, at least as much as it is a duty to our neighbors. And the invisible hand of the market is not currently taking care of this particular business. We are in the midst of a persistent antibiotic-development drought—only two new classes of the drugs have been identified in the last thirty years or so. Drug companies have been withdrawing from antimicrobial research for several reasons. Antibiotics are a lousy business, for one. While blockbuster drugs treat chronic diseases for years at a time, when antibiotics work patients take them for a little while, and then they’re done. For such perfectly rational economic reasons, the pharmaceutical industry is unlikely to keep pace with the need for a social good whose benefits don’t translate into profits that can be readily captured. That makes this a political matter: some other institutions will have to do the work.

But the current state of American politics doesn’t look up to the job either just now. Gamesmanship over the federal budget increases our vulnerability—to TB and to the whole spectrum of resistant disease organisms. In particular, the budget sequester fixed in place by the House G.O.P. caucus increases the risks we face daily. Definitive decisions about the implementation of the sequester are still taking shape, but the Centers for Disease Control alone is losing four hundred and seventy million dollars, and estimates of the damage include the loss of TB services in eleven states. More than four hundred thousand H.I.V. tests won’t get done this year. As many as twelve of the twenty border-quarantine stations the C.D.C. may close, and its Global Disease Detection centers—the front line of U.S. defenses against emerging diseases—are also under threat. In the long term, the sequester threatens to cut out a generation of basic biomedical research. All the while, M. tuberculosis continues to evolve.

Thanks for the post, xchrom. Stay healtthy.

[Warpy]

5. The problem is that TB is so hard to kill and the drugs

must be taken daily for a very long time. Some people forget, some can't afford a full course of medication, and some just stop taking the pills when they feel better. Any bacilli left in their system are the ones that were able to resist the drugs the longest, becoming resistant bacteria that infect other people.

TB is incredibly scary to me. They called it "consumption" because that's what it did, consume its victims, rendering them thin and weak before the disease breached a major vessel and drowned them in their own blood.

Republicans must love TB because they're creating optimum conditions for its spread.

[bemildred]

3. A great killer, we should have wiped it out when we had the chance. nt

[xchrom]

4. +1