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8. The Return of Tuberculosis

Source: WORLD WATCH, Date: July/August 1994, Title: “Why Don’t We Stop Tuberculosis?,” Author: Anne E. Platt

SYNOPSIS: Tuberculosis, thought to be a disease of the past, has surged back with a vengeance and now kills more people than any other infectious or communicable disease in the world-despite the fact that it is curable.

Today, the reemergence of tuber­culosis, also called TB, threatens more people than AIDS, cholera, dengue fever, and other infectious diseases combined. In 1993, TB killed 2.7 million people around the world; it infected another 8.1 mil­lion people; and an estimated one­-third of the world’s population, or 1.7 billion people, were infected but had not yet developed the dis­ease. In the United States, the U.S. Centers for Disease Control and Prevention reported 26,000 cases of TB in 1992, an increase of nearly percent from 1985.

Further, the current TB epi­demic is expected to worsen, espe­cially in the developing world, because of the lack of adequate health care, the evolution of multi­-drug-resistant strains, and the emergence of AIDS, which compro­mises human immune systems and makes them more susceptible to infectious diseases. For a person with an immune system under severe stress-from HIV, diabetes, or chemotherapy for cancer, for example-the chances that the infection will develop into disease increase to as much as 10 percent in a single year.

A person who has active TB can spread the infection simply by coughing, sneezing, singing, or even talking, while another person has only to inhale the bacilli to become infected. If the infection is not detected and treated promptly, one person with active tuberculosis can infect an average of 10 to 14 people in one year and sometimes even more.

By the year 2,000, the global incidence of TB alone is expected to increase to 10.2 million cases per year, an increase of 36 percent over 1990’s 7.5 million cases. And; overall, tuberculosis deaths are pre­dicted to increase by one-sixth, to 3.5 million by the year 2000, killing 30 million people in this decade alone.

However, “this tragedy is totally unnecessary” according to Dr. Hiroshi Nakalima, Director-General of the World Health Organization. The medical knowledge to treat and cure TB exists and the costs are not prohibitive.

In 1993, the World Bank identi­fied short-term TB treatment as one of the most cost-effective ways to reduce the global burden of the disease. In China, it costs only $13 for a supply of drugs to cure one person. In most developing coun­tries, it costs less than $30 to save a life and prevent further transmis­sion of the disease. In the U.S., it costs up to $10,000 to treat an active case of TB compared to $200,000 to treat an active TB infection that has become drug­-resistant.

The growing TB epidemic is a classic case of a public health crisis that can be resolved inexpensively. However, governments and public health officials need to invest up front in prevention and early inter­vention. If they do so, early treat­ment could prevent nearly 12 million deaths worldwide in the next decade and save vast amounts of money.

SSU Censored Researcher: Jessica Nystrom

COMMENTS: Author Anne E. Platt felt there was little coverage on the rise of tuberculosis outside the United States in 1994 and few substantive pieces on the global nature of the disease that put things into perspective. “During a year when health care reform was the number one issue on the domestic political agenda,” Platt said, “there was surprisingly little coverage of the resurgence of tuber­culosis. The majority of media attention was in a reactionary vein, i.e. it tended to create fear and mis­understandings rather than clarify the issue. When a crisis occurred or an outbreak was reported, media attention focused on that particular event, usually with limited reporting on underlying causes.”

Many reports tended to feed off the public’s fears that foreigners, immigrants, and outsiders were bringing TB back inside our country’s borders. Here’s a sample of some national headlines in 1994 that promoted xenophobia and played on people’s fears:

`TB case sparks hunt on Indiana Univ. campus’ — Chicago Tribune `Reluctant TB patient hunted by police’ — San Francisco Chronicle `TB Increase Found in Immi­grants’ and `TB an Unwelcome Hitchhiker With Immigrants’ — Los Angeles Times.

Platt notes that while the head­lines don’t tell the whole story, unfortunately, they are usually the focus of people’s attention.

The immediate benefit of more coverage about TB would be educa­tional, according to Platt. “There are many misconceptions and myths about how TB is spread, what causes the infection vs. the disease, and how to take care of it. With greater media attention, people would understand the dis­ease and the need for vigilance. Knowledge is power to change and redirect policy. Again, by under­standing that the poor, AIDS patients, and immigrants do not actually cause the spread of TB, but simply increase the chances that the infection will progress to the dis­ease stage, the public can push for change. Legislatures and health care providers can then target underserved populations and high-­risk groups.

“Wider exposure would also open up the health care debate to discussion and evaluation of pre­vention and targeted treatment, rather than cures and medical tech­nology. Using TB as a case study for preventive and low-tech treatment, we could promote changes in how we treat other infectious diseases. Finally, wider exposure would show how TB is a greater threat in the developing world. The media could show how it is within our scope of choice to determine funding and aid to other parts of the world. Also, it is within our powers to influence and redirect international attention to the issue of TB and AIDS.”

Platt feels there are several groups which benefit from the lim­ited coverage given the subject. “l. The medical research community: With a limited pool of public research dollars, the research industry does not want health care providers to rely on low cost, low-­tech treatment, because the industry would lose research funding. Cures are more profitable than prevention, so the industry wants to steer attention away from solutions that might hurt their business. 2. Medical care providers: The medical care community does not want to admit the failings or short-comings of the shift away from preventive care, health educa­tion, and low-tech solutions to their current focus on cures and high-tech intervention. Addition­ally, medical care providers have shifted care away from the poor and at-risk populations to the wealthier populations (who are at a lower risk of developing tuberculosis in the first place). There is more money to be made by treating drug-resistant strains of TB than treating the thousands of cases that require testing, screening, basic interven­tion, and low-cost pills spread out over, six to eight months. 3. Ourselves: We have put too much faith in technological fixes. We dared to think we could control nature and wipe out TB.”

Platt received several letters to the editor in response to her article in World Watch. One was from a public health worker in New Mexico who suggested the real question was “Why we can’t con­trol TB.” Platt says she agrees that the infection is difficult to detect, difficult to treat, and that in devel­oping countries there are still mil­lions of people who have no access at all to modern health care. However, Platt says her question is why don’t we stop TB? “My article examines the bureaucratic inertia; the public’s lack of understanding and the myths that are perpetuated by the media; our fears of TB coming from immigrants, the poor, the mentally disabled, and AIDS patients; and our failure to fund and provide treatment in other countries, especially where the people are at greater risk from the co-infection of HIV and TB. It may be impossible to completely eradi­cate TB, but we can certainly do a better job of controlling it-espe­cially in our global community.”

Reinforcing Platt’s thesis, the San Francisco Chronicle carried a wire service story on November 18, 1994, which warned that drug-resis­tant strains of tuberculosis are spreading rapidly because of improper use of existing drugs and the failure to develop new ones according to a new report by the World Health Organization.

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