Nader conference eyes TB's 'dull tools'
Nader conference eyes TB’s dull tools’
Smallpox expert blasts drug, lab arsenal
TB experts who met last month at Johns Hopkins University at a conference called by consumer advocate Ralph Nader were fed a spoonful of bitter medicine and judging from their response, were willing to choke down more.
For starters, the former director of the program for smallpox eradication at the World Health Organization (WHO) told the audience of about 60 TB experts and onlookers gathered at the Johns Hopkins campus in Baltimore that TB control needs to go back to the drawing board.
"Your tools are dull, and you need some better ones," said Donald A. Henderson, professor emeritus and former dean of the School of Public Health at Johns Hopkins. Henderson inventoried the contents of the TB tool kit: a vaccine that doesn’t work, drugs invented 30 or more years ago, and a cabinetful of diagnostic tools so clumsy that the best they can do is say a person has a 10% chance of becoming infected, he said.
Given such dire shortcomings, the first thing TB experts need to do is stop making unrealistic projections about the future, he added.
"Beware the evangelists," with their programs that promise to eliminate TB if only every nation on earth toes the doctrinal line, he said. Such evangelism, though misleading, isn’t uncommon in public health, he added, citing similar examples from measles. (Why waste money on looking for a measles vaccine, experts used to ask, since measles would be eradicated within a few more years?)
Anne M. Ginsberg, MD, PhD, program officer for TB, leprosy, and other mycobacterial disease at the National Institutes for Health, buttressed Henderson’s points with data from a model developed by researchers at Harvard University.
If TB controllers continue to employ directly observed therapy, short-course (DOTS), at the present rate of increase, the Harvard model predicts that the TB epidemic will stabilize by the year 2,030 but that even so, 80 million people will die of the disease. Even if nations mount an aggressive and well-funded expansion of DOTS, tens of millions of people are still projected to die of TB, she added.
When it came to the topic of multidrug-resistant TB around the world, speakers scrambled for metaphors of sufficient gravity and gloominess. George Comstock, MD, retired professor of medicine at Johns Hopkins, likened the worldwide phenomenon of emergent multidrug-resistant TB (MDR-TB) to "a fire in a peat bog" a slow-burning disaster that will gather force and prove devilishly hard to extinguish. To Michael Iseman, MD, chief of the clinical mycobacteriology service at National Jewish Hospital in Denver, the MDR-TB picture is even worse: "Our smoke detectors are not nearly sensitive enough," Iseman said. "And realistically, we have no fire extinguishers."
At least part of the remedy lies in closer collaboration, said Fran Dumelle, chief of government relations for the American Lung Association. Pulling various lobbyists together into a consortium can be an especially effective tool, she said.
As it stands now, TB experts simply aren’t getting their messages across, she charged. When WHO released the first installment of its findings on MDR-TB around the world, what ensued was hardly the galvanizing media event the report deserved. Indeed, not a single senator or member of Congress got a visit from any TB experts, and the press reacted to the news release with a collective yawn.
The upshot is that donor agencies and wealthy corporations will stay in the dark, and TB control experts will keep limping along on small budgets, scrapping over money, and cutting programmatic corners, DuMelle said.
Nader concluded the proceedings by briskly proposing a series of follow-up meetings, including a special pow-wow for executives of large corporations. Quoting a Chinese proverb, he added, "To know and not to do is not to know at all."
Iseman, for his part, privately resolved to engage Henderson, the day’s biggest hit, as a keynote speaker for the next conference of the International Union Against Tuberculosis and Lung Disease.
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