Archive for June 2011
My husband is a diabetic and has been one for more than 25 years. His diabetes was diagnosed with ease decades back, and his condition has been managed so well by the private healthcare sector that he leads a full and healthy life. Recently, when he developed a foot infection, it was treated successfully with antibiotics. But as a measure of precaution the doctors decided to also check whether his diabetes had affected any of his vital organs. It took them all of three or four days to determine that his kidneys, heart, liver and other vital organs were untouched by his long years of living with diabetes. The tests were non-invasive and simple and at the end there was relief.
At around the same time, a young girl (25) I know was diagnosed with TB. But this diagnosis came at the end of a traumatic six months – months during which she had been treated by the same private healthcare sector for common cough and cold, pneumonia, bronchitis and some despite manifesting all the symptoms of TB such as fever, weight loss, severe cough etc. When her condition turned critical she decided to seek the help of government doctors, who diagnosed that she was actually suffering from TB and put her on the right medication. She is now showing signs of recovery and is also back at work.
A friend recounted her experience with TB and the private healthcare sector.”For over two years I suffered from intensely painful periods. I saw 7 or 8 doctors; no one thought it was anything more serious than dysmenorrhoea. They gave me lot of medication to ease the pain but the problem remained. One doctor even suggested that I have a child and said that it would solve the problem. I was living from one nightmare to the next – a child was the last thing I could think of. I had a whole bunch of tests but none for TB. Things came to a head when I had to travel extensively on work and was by then on Voveran injections to ease the pain. I once recall driving through the city with a colleague from one pharmacy after another. They all refused to give me the injection because I had no prescription. Finally, my colleague took me to slum area to a little shed where a person was treating patients. He was some sort of a medical worker and didn’t look like a doctor. He agreed to give me the injection. I had the injection and went back to work. The pain reduced but I almost passed out twice. My doctor in Delhi suggested that I pay a visit to a doctor at All India Institute of Medical Sciences (AIIMS). I had carried my reports but there too the doctor drew a blank. Then I decided to head back to Calcutta to consult my husband’s uncle who is a general physician. He recommended me to a gynaecologist, who said that no pain from dysmenorrhoea could be so bad and suggested a laparoscopy to see what was wrong. I agreed to the procedure – they drilled a few holes into my stomach – I understood from my husband later that the surgeon had stepped out of the operation theatre and suspected the presence of tubercular tissue. They sent the tissue sample to Ranbaxy SRL lab in Bombay. The results came back confirming TB and apparently it had spread quite a bit. The doctor also said that no one had done the test earlier because it never occurred to them that a woman in my socio-economic group could be suffering from TB. Sadly enough even after I was diagnosed, thanks to the regular use of very high dosage of painkillers my gastrointestinal systems had packed up. I could not take the TB medication on a regular basis. The months of medication were very rough on me; I had to quit my job and stay at home for three of them. I had also lost weight and was weighing just 38 kilos.”
We now come to the question of what ails TB. Why is there such a paucity of reliable diagnostic tools for TB? How is TB different from diabetes or hypertension? In fact, while the latter are lifelong conditions, TB is a condition that can be completely cured. So why are we lagging behind so much in the development of robust diagnostic tools? What do we currently have? For pulmonary TB we have the antiquated smear microscopy which, according to doctors, misses half of all the positive cases. Tests such as cultures take a long time and require sophisticated laboratories. For the other forms of TB, we have serological, antibody tests that are discouraged by WHO, as they are not reliable at all. For want of any other tools, the private sector uses them and this results in huge costs for the patients, with very little benefits as the cases above demonstrate. Is this a question of inadequate R&D? R&D requires large investments. Is inadequate support for R&D a result of the perception that TB is a disease of the poor and companies could therefore be reluctant to invest money for TB diagnostics fearing poor uptake of the tests.
It is not enough to recognize that TB is a huge global problem. It is important to recognize that it all starts with diagnosis. If other ailments can be managed easily and efficiently because they were diagnosed on time, it is time to get efficient with TB as well. The truth is that TB is not a disease of the poor, and even if it were, considering the numbers we are faced with, it’s time we got our act together and invested in getting better diagnostics. Because better diagnostics translates into better rates of recovery and less chances of the disease spreading. The world community has to come together to find the money for R&D and come up with tools that both, the private and government healthcare sector can use – whether it is the poor or the rich that are accessing them. Failure to do so can cost dearly in terms of loss of lives and productivity. It is important that choices are given to people, as even the poor, when faced with dire situations, do muster up the finances required. It is time people suffering with TB get assurance that timely cure is possible because the diagnosis was right.
It is to debate these very issues that TB diagnostics in India – From importation and imitation to innovation is being hosted by St John’s Research Institute in Bangalore on 25&26 August 2011. More information about the conference available at http://www.sjri.res.in
One of the world’s most widely used vaccines, the Bacillus Calmette-Guérin (BCG) vaccine that protects against tuberculosis, is celebrating its 90th birthday. The vaccine was first given to a human on June 18, 1921 and is currently being given to about 100 million children worldwide each year. Nonetheless, a new, safer and more effective TB vaccine is urgently needed.
BCG, the only currently available vaccine against tuberculosis, protects many children against severe forms of childhood TB. However, the vaccine is not safe for babies infected with HIV and it provides very limited protection against pulmonary TB in (young) adults. Research shows that a more effective vaccine, in partnership with more accurate diagnostics and more efficient drug therapies, would save tens of millions of lives.
Around 1.7 million people die of tuberculosis every year. Many millions more suffer from the disease that hampers parents’ ability to take care of their children and slows down economic growth. The cost of TB amounts to 0.52% of the world’s Gross National Income per year, several hundreds of billions of dollars and contributes to political instability, famine and security issues.
The World Health Organisation writes in a position paper on tuberculosis vaccines that “Despite its shortcomings, BCG vaccination is considered a life-saving and important part of standard TB control measures in most endemic countries.” Still, after 90 years of existence, we would like to allow BCG to retire. Let’s not wait for the BCG vaccine to see its 100th birthday but combine forces to find worthy successors.
Jojanneke Nieuwenhuis works at TBVI, an organisation that facilitates the development of more effective tuberculosis vaccines.
The views expressed here are entirely of the author.