E-DRUG: TB: An Old Disease Needs New Cures
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[Letter to the New York Times from MSF; copied as fair use;
http://www.nytimes.com/2005/03/26/opinion/26bedelu.html?
WB]
New York Times
March 26, 2005
OP-ED CONTRIBUTOR
An Old Disease Needs New Cures
By MARTHA BEDELU
Khayelitsha, South Africa
The World Health Organization released its
global tuberculosis figures on Thursday, World Tuberculosis Day, and much
was made of the news that incidence rates are declining or stable in five
of the six regions of the world. Yet the global incidence rate is still
rising, and every day, tuberculosis kills 5,000 people, nearly all of them
in underdeveloped countries. We are still losing the battle against the
disease, and it is time to admit that prescribing more of the same just
won't work.
A big part of the problem is the increasing number of patients with the
deadly combination of TB and H.I.V., which renders both diagnosis and
treatment more difficult. From my native Ethiopia to Cambodia, tuberculosis
is the No. 1 killer of people with H.I.V. and AIDS. In Khayelitsha, the
poor township where I work, one in every four adults is infected with
H.I.V. Tuberculosis incidence rates here are 1,122 per 100,000 people per
year, nearly 10 times the global rate. Often, the only diagnostic tool I
have is the sputum test, a procedure invented in 1882. In ideal conditions
and in the absence of H.I.V. infection, the sputum test detects 75 percent
of pulmonary tuberculosis infections. But for children, people with
extra-pulmonary tuberculosis, and the majority of H.I.V. patients with TB,
the test is virtually useless.
Like the sputum test, the only available medicines to treat the disease are
from another era. They were invented three to five decades ago, and require
patients to take four to six pills every day for up to eight months. In
many countries, patients have to go to separate clinics run by national
tuberculosis programs several times a week to receive their medicines, and
then wait for a counselor to watch them swallow their pills. This direct
observation is intended to prevent the development of multidrug-resistant
strains of tuberculosis, an especially grave concern since no new drugs are
yet available to counter it. If the patients are also being treated for
H.I.V. they must go through all of this in addition to their daily regimen
of antiretroviral therapy. These burdens cause many patients to abandon
treatment.
I refuse to believe that we cannot find better methods of diagnosis and
treatment. We urgently need an easy-to-use blood, urine or sweat test that
quickly detects active tuberculosis.
We have to make a regimen that is simpler for patients, creating innovative
ways of improving treatment adherence and reducing the need for direct
observation, as we have done here with antiretroviral therapy for the
treatment of H.I.V. It should also be standard practice to integrate
tuberculosis and H.I.V. care so patients receive their medicines for both
diseases in one place, as they can at our clinic in Khayelitsha.
In the longer term, we need newer, more potent medicines that shorten the
duration of treatment. Patients with multidrug-resistant tuberculosis, for
example, have to endure up to two years of hospitalized treatment with
expensive drugs whose severe side effects can include acute psychosis.
Research and development of new drugs over the last 35 years has been
nearly nonexistent.
To this end, the World Health Organization and governments need to create a
research and development program based on public health needs as an
alternative to the pharmaceutical companies, which are motivated by profit.
When the commercial interests of pharmaceutical companies threaten to
hamper the development of potential TB treatments, governments should step
in by finding ways to make promising tuberculosis compounds available to
groups willing to develop them into medicines.
Promises will not be enough to tackle this resurgent scourge. In an age of
unparalleled medical advances, we must refuse to accept that millions of
people will be left to perish at the hands of this antique disease.
Martha Bedelu, a physician, works with Doctors Without Borders.
---
Rachel M. Cohen
U.S. Director, Campaign for Access to Essential Medicines
Doctors Without Borders/MC)decins Sans FrontiC(res (MSF)
333 Seventh Avenue, 2nd Floor * New York, NY * 10001-5004 * USA
Tel: +1-212-655-3762
Mobile: +1-917-331-9077
Fax: +1-212-679-7016
E-mail: rachel.cohen@newyork.msf.org
http://www.doctorswithoutborders.org/
http://www.accessmed-msf.org/