"THE HEART OF THE MATTER"
a special program of the National Emergency Medicine Association (NEMA)


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Week: 599.6 Pt.1 

Guests: Dr. Michael Iseman, U. of Colorado; Dr. Lee Riechman, Nat’l Tuberculosis Program; Dr. Paul Nunn, World Health Organization  

Topic: Tuberculosis returns 

Reporter: Aaron Cohen 

Host/Producer: Steve Girard 

NEMA: Thanks for joining us today. A couple of stories for you today...first: One of the most deadly infectious diseases mankind has faced over its history is making a strong comeback...a stubborn strain of tuberculosis has proven resistant to more than one drug commonly used to treat it, worrying health officials both in the United States and around the world. Aaron Cohen has Health on the Hill.... 

COHEN: Since traces of tuberculosis were first found in the Egyptian mummies over 44 centuries ago, man has been plagued by what was, in antiquity, called consumption. TB continues to consume lives, over three million die every year...more than all other infectious diseases - combined. The persistence of the disease led the World Health Organization, the Centers for Disease Control, and the International Union against Tuberculosis and Lung Disease to study 50 thousand cases of TB in 35 countries. University of Colorado Professor of Medicine Michael Iseman says the result of the study is not good news...one in ten cases of TB are incurable... 

ISEMAN: Anyplace where the delivery of tuberculosis services is not what it should be can become a hot zone of tuberculosis. When the resurgence of tuberculosis started in the mid to late 1980’s, and multiple drug resistance was noted in the early 1990’s, it was in places with high numbers of HIV infected people, of homeless people, of foreign-born people. So, an area like New York City, an area like Newark, New Jersey, like Miami, like San Francisco, Chicago or Houston are places where there’s lot of TB. But when the TB epidemic was noted, and resources were given in the early 1990’s, that really reversed itself. 

COHEN: The hot zones Dr. Iseman described range from India to Latvia, from the Ivory Coast to Argentina and as close to our shores as the Dominican Republic. Dr. Iseman warned that the U.S. of far from immune to the incurable form of TB... 

ISEMAN: Today, this study shows definitively, and for the first time...what we have most feared, but could not previously prove: our world again faces the specter of incurable tuberculosis. We have found tuberculosis hot zones in all 5 continents, in which multi-drug resistant strains are threatening to overwhelm local public health systems.  

COHEN: American has fought a long running war of attrition against tuberculosis - once the leading cause of death in the United States. Scientists in the 1940’s discovered drugs to treat the airborne malady. After the comprehensive treatment, TB was nearly eradicated here in the 1980’s. But complications from the AIDS virus, a new wave of poor immigrants from TB hot zones, and poor health care in places like nursing homes, prisons and homeless shelters, allowed TB to stage a comeback. Dr. Lee Reichmann, who treats TB patients in Newark, New Jersey, and runs the National Tuberculosis Program, says success shouldn’t be an excuse for complacence... 

REICHMAN: It is impossible to check for bacteria at the border, or as a traveler going through customs. This is not an immigration problem, it is a medical problem. Each of these hot zones poses a clear and present danger to global security.  

COHEN: TB is a threat today because people either don’t take their medicine or because some poor countries don’t have the wherewithal to get life saving drugs to critically ill patients. That’s particularly vexing because TB is curable if treated correctly. And the course recommended for treating TB is DOTS...that’s an acronym for Direct Observable Therapy Shortcourse...a six month long course of 4 drugs that, for mere pennies, relatively speaking, will cure tuberculosis. But the discount price tag becomes sticker shock in remote countries like Latvia, where the medical infrastructure is primitive. Dr. Paul Nunn with the World Health Organization says that obstacle must be overcome... 

NUNN: We must put in a control strategy, the DOTS strategy, that will prevent these cases from becoming multi-drug resistant. The hard fact of economic life is that in the poorest of countries, the cost of treating MDR-TB is prohibitive. All the more reason for ensuring that proper TB controls are instituted in those places. If you go back to when the HIV epidemic started, the response in the developing countries was, to a large extent, insufficient to prevent the enormous explosion there has been in HIV and AIDS in those countries. What this report today does, I think, is declare a call to arms ...that we must respond to the potential epidemic of MDR-TB, and the actual epidemic of MDR-TB in order to prevent virtually incurable strains from becoming widespread. 

COHEN: Dr. Reichman, with the Newark based National Tuberculosis Program, says the multi-drug resistant strain of TB has declined in the U.S. in total numbers, but has spread from a dozen states to 42. He and his colleagues are fearful many people will not hear the alarms they’re sounding because Hollywood stars don’t wear red ribbons and athletes don’t run marathons to call attention to a disease that is remarkably and dangerously persistent. For Health on the Hill, I’m Aaron Cohen.