New defense against TB

April 06, 1999

The following is an excerpt of an editorial in yesterday's New York Times:

The biggest infectious killer in the world today is not AIDS or malaria, but that old devil tuberculosis. Ironically, the same antibiotics that cured tuberculosis decades ago have made it deadly again. Tuberculosis becomes drug resistant when patients receive an incomplete mix of antibiotics or stop taking their pills when the symptoms begin to subside. The World Health Organization, which found that a third of the countries it studied had resistant TB, estimates that 50 million people are infected worldwide. Drug-resistant TB is particularly common in the former Soviet Union, where medicine was widely available. But it was of poor quality and badly administered.

Fortunately, a new treatment cures normal TB and prevents new drug resistance. The WHO calls DOTS, for Directly Observed Treatment Short-Course, the biggest health breakthrough of the decade, which could prevent 10 million deaths in the next 10 years. DOTS ensures that patients finish their treatment by having health workers watch them take their pills, every day, for the six- or eight-month minimum necessary to cure TB. Since New York began using DOTS in 1992, new cases have declined by 60 percent, and drug-resistant cases dropped by 92 percent. Health workers went into crack houses to watch patients swallow pills. DOTS has nearly doubled cure rates where it has been tried all over the world.

But DOTS does require that countries have a steady supply of medicine and the organization to carry it out. The WHO estimates that about 12 percent of patients worldwide receive DOTS. Russia is now trying DOTS in six prisons, in a project carried out mainly by the New York-based Public Health Research Institute and financed with $12 million from the Soros Foundation. It would take only $100 million to put DOTS into every prison in Russia.

The United States spends about $12 million annually on international TB control. An increase, to spread DOTS and facilitate curing the superbugs, would be a wise investment for world and American health. TB is proving that no bacterium is an island.

Pub Date: 4/06/99

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