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Superbugged

with 12 comments

There has been much brouhaha in India during the last two days  over a recently published paper in the journal, Lancet Infectious Diseases. The paper outlines the emergence of major antibiotic resistance in enterobacteria isolated from patients in  UK, India, Pakistan and Bangladesh. The appearance of bacteria resistant to the strongest of antibiotics is a cause for global concern, especially in these days of globe-trotting and in light of lack of new antibiotics developed by drug companies recently.

The authors conjecture is that patients in the UK who were found to harbor this ‘superbug’ picked it up during surgeries – some during health tourism visits – from the subcontinent. Needless to say, the results of the study  has been (excuse the pun) a bitter pill for Indians. The medical community is upset, the politicians and media are outraged and screaming ‘Western conspiracy‘.

Unfortunately most of this anger is highly misplaced. I strongly recommend reading Bhalomanush’s well-argued (and in the face of some of the stunning ignorance out there, highly restrained) response debunking much of the media outrage.

I just wanted to add a few words of my own.

1. The main problem I see with the Indian reaction is the  usual cry of victim-hood  (MNCs and the ‘West ‘are out to get us and our health tourism industry) that is unbecoming of a country that wants to be global player.

The mature (and the right) way of dealing with such a publication would have been a statement explaining that India has taken serious note of this study in major journal and will be conducting its own investigations, at the same time reassuring people with numbers (number of cases small compared to the vast number of patients in India) etc. Instead we’ve taken on a jstrange ingoistic tone mixed with juvenile petulance: blaming the scientists for spreading falsehoods and finger-pointing like a school kid (suggesting that the virus is everywhere, why point to us?).

The best (worst) example of this over-the-top reaction is the idiotic notion that naming the protein that confers resistance to the bacteria (NDM1 = New Delhi metallo-beta-lactamase 1)  after our capital is somehow a huge insult to our nation.

National pride that is so easily dented is not really a pride worth having.

2. There seems to be no concern in the media about the actual consequences of antibiotic resistant bacterial strains. The rise of resistant strains is a real, fearful possibility in our antibiotic munching culture. What is anyone doing to ensure that such strains do not turn into a large public health problem in our country?

The medical tourism industry and most private hospitals in India are restricted to an elite population. These are the places where disinfection and sanitary methods are at their best. One wonders about the consequences of these bugs turning up in regular hospitals.

I am quite surprised that the supposed champions-of-the-underprivileged Indian media is rather silent on this (OTOH, actual medical and health concerns such as this don’t make good screaming matches on TV).

(Sakshi has a longer post detailing this concern)

3. This is not to say the western media is not totally guilty of hyping things a bit and spreading panic and fear. As Bhalomanush has pointed out, the misrepresentation of the UK and other international media is equally disgusting.

But again, a kicking and screaming response to such smearing doesn’t do anyone any good.

But, do also read the very balanced pieces by LA Times and Discover Blogs

4. The Indian media claims that the lead author of the study, an Indian doctor, Karthikeyan Kumaraswamy, has ‘retracted’ the study or at least distanced himself. If this is true, then there has been gross misconduct on the part of either Dr. Kumaraswamy or Lancet. As is true for any scientific publication, final manuscripts have to be vetted by all authors. As the footnote in the paper says:

All authors were involved in the compiling of the report and approved the final version.

If something was added after Dr. K looked through the draft and it was something he did not agree with it, he can and should take it up with Lancet. Retracting is not done in front of TV.

[actually, if you see the actual video of the interview with Dr. Kumaraswamy, he doesn’t really say anything that’s related to dissociating himself!]

5. Finally, thrown into this conspiracy theory mix is the fact that Glaxo-SmithKline recently published a paper in the online version of the journal Nature, where they have identified a compound that binds to a bacterial processive enzyme. It is possible that such a compound could escape the antibody destroying enzyme of the resistant bacteria and kill them.

Firstly, do note: the paper describes the snap-shot of the protein in its inhibited state i.e in a state where it is in a crystallized form. How such a compound succeeds as a drug is anybody’s guess with details such as efficacy, safety and stability that needs to be worked out (over a period of years).

And to those seeing another conspiracy in this, I really doubt that GSK could have pulled off the timing of their publication  (which btw is currently an advanced publication online only, has not come out in an issue) to coincide with the Lancet publication. More likely, it was a fortuitous occasion and the GSK PR department has jumped on it seeing a great opportunity to raise share prices. This is borderline dishonesty because, as I mentioned above, there is really no way to determine if the compound will be an actual drug and such drugs aren’t expected to be produced in a short time.

There are few other issues e.g the constant touting of the supposed ‘conflict of interest’ that have been covered by fellow bloggers, so I am not going there.

Written by BongoP'o'ndit

August 14, 2010 at 6:20 pm

Posted in Desi Connections, India, Rants

Tagged with ,

12 Responses

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  1. Reacting to an enzyme being named new delhi b-lactamase is just as bad as naming such a enzyme that hastily and perhaps unjustly.We can have all the righteous national pride we want but the medical tourists WILL be influenced by half-informations and unless such a name is justified, it is wrong to name it after a country.
    Unless you are suggesting that our undentable national pride will supply the forex deficit.

    somebody

    August 14, 2010 at 6:27 pm

  2. […] additional points related to the unnecessary outrage, I highly recommend reading Sakshi’s and Bongopondit’s responses to some of the other relevant […]

  3. I apologize to the owner of this blog for commenting, perhaps, out of turn.

    Somebody, your comment struck me as Machiavellian – that the “ends”, in this case that of mitigating forex deficits, justifies the “means” which of course are spreading untruths about how strains are named.

    There is nothing malevolent about how the strain was named. Thanks and regards.

    Anirban

    August 14, 2010 at 8:38 pm

  4. […] morning, a friend forwarded me this blog post on the Superbug controversy. The post condemns India’s ‘over-reaction’. I beg to […]

  5. @bhalomanush i dont think there is malevolent intention, but that there is nothing wrong in protesting the name when there are concerns over whether it is justified. Furthermore, even if justified, it is not neccessary to name it afer a country, especially if it may affect medical tourism by uninformed laypeople, which all medical tourists naturally tend to be.
    As people have pointed out, nobody calls it British CJD, or American HUS, or Mexian Swine Flu or HongKong SARS although they well could, without malevolence.
    It can just be named a number and the studies would be no less valid, the only benefit being, uninformed laypeople may not associate new delhi with a lifethreatening enzyme when they next think of having a surgical procedure there, in a hospital which quite possibly adheres in every way to the protocol.

    somebody

    August 15, 2010 at 12:29 pm

  6. @somebody
    But there are other (more deadlier) examples of things named after countries: Lyme disease, Rocky Mountain Fever (both US cities), Ebola (Democratic Republic of Congo), Marburg (Central Africa) – just to name a few.
    This is common practice and not malicious in intent. You dont associate Congo with Ebola or US with Rocky Mountain or Lyme, do you?

    Secondly, I hope people are aware of the dangers and ask the hospital policy on antibiotics use and monitoring of resistant strains. Because the data points to rising cases of NDM-1 positive strains even in hospitals adhering to the protocol.

    a__muse

    August 15, 2010 at 2:07 pm

  7. Do illuminate me and really I dont know this. When people say that “Wellcome is a charity” are we supposed to not ask where Wellcome’s investments are? For instance from their website they say:

    “The merger between Glaxo Wellcome and SmithKlineBeecham in 2000, which created GlaxoSmithKline (GSK), left the Wellcome Trust with a shareholding in the new company of less than 3 per cent. It sold a further tranche of shares in 2002 for £1.78 billion”.

    So we still dont know how much they invest in the company formerly known as Glaxo Wellcome ! Now I am sure there will be no conflict of interest seen here (as I said on Bhalomanush’s blog if this was Lalit Modi and IPL there would all kinds of corruption sirens blaring by this time) but isnt it unfair to characterize Wellcome foundation as a “charity”.

    “Professor Tim Walsh from Cardiff University, the lead researcher on the study, said he was “disappointed” by reports of intimidation against several of his India-based co-authors. He stressed that the Wellcome Trust was a charity and that just 2 per cent of support – a travel grant – came from Wyeth, while a key antibiotic that could kill the superbug had long been off patent.”

    [From Financial Times]

    Greatbong

    August 15, 2010 at 4:19 pm

  8. Let me provide a simple analogy. Private universities in the such as United States, Harvard, Princeton, Yale are funded by endowments that are invested by financial advisors. That is the business side of the operation.

    Many of these multi-billion dollar endowments provides salaries for professors.

    Now take the academic side of the operation. What happens if any professor at any private university makes ANY research discovery that even has the slightest impact on the holding of the business end of the university? Is that a conflict of interest?

    What happens if I discover something that has the potential to influence one of the shares in my retirement fund? I should disclose it yes, but should my work be dismissed on these grounds?

    What I am saying is that one end of the scale is direct conflict-of-interest (which I argue that this is not) and on the other end is the butterfly effect.

    As I mentioned, I’d love to meet up and discuss further.🙂

    Anirban

    August 15, 2010 at 5:55 pm

  9. @a_muse as a matter of fact, one does associate all these places with these diseases.
    But never mind, that is not the substance of my argument which is : You cannot fairly protest that it is wrong to protest the naming of an enzyme after new delhi because
    1. The enzyme is found everywhere strong antibiotics are used, and everywhere there are very sick patients, just because the study was done on a sample from india, it does not indicate origin.
    2. The enzyme is found even where hospitals use stringent protocol, as all of the previous resistance enzymes that came before carbapenem- resistant blactamase over the years have.
    3. India as a destination for medical tourism protesting that associating its name with a dangerous resistance strain is harmful to its medical tourism is perfectly justified; while it is very idealistic of you to hope for an educated patient who can do a risk analysis on what this means and decide whether or not they still want to come, i hope you realise that that is not the patients’ job. They come only to save money and get well.
    Surely you are not suggesting naming the enzyme nd-b-lactamase is a good way to scare patients into researching a little more about the hosiptal they choose! In that case, don’t leave the patients who go to other destinations also out of the good turn! They may not do their homework considering there’s no enzyme named after those countries!

    somebody

    August 15, 2010 at 7:19 pm

  10. @a_muse and @bhalomanush: thanks a lot for jumping in and taking up some of the arguments. I just haven’t had time for the last two days.

    @somebody: a quick reply:

    just because the study was done on a sample from india, it does not indicate origin.

    The naming of NDM-1 was not part of this study. The name was designated a year earlier as a part of this paper: Link.

    Very simple Google search reveals this. Please read the paper, and we can continue the argument.

    A point to think about before we go on: why didn’t Indian media, politicos, medical establishment etc protest this in 2009?

    bongopondit

    August 16, 2010 at 12:36 am

  11. @somebody: You do realize that the other resistant strains are also monitored by regulatory bodies in UK (and other countries)? Just because the stories dont get blown out of proportion (wrongly)in the media, does not mean that they dont exist. The NDM-1 advisory in US came out early this year. This is old news to people in the field.

    Secondly, I am more concerned with Indian patients who go to these hospitals. They are likely to not know they have caught any resistant infections. Guess why? Because we lack any monitoring bodies. That is what I meant by having informed patients.

    a__muse

    August 16, 2010 at 1:00 am

  12. And @somebody – this particular enzyme is *NOT* found everywhere. If it was, we would be in really deep trouble. So far all isolates have one thing in common – they come from people who have traveled to India/Pakistan/Bangladesh and were hospitalized there.

    a__muse

    August 16, 2010 at 1:06 am


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