An editor's notebook
Jordan, Patrick
BREEDING A ICU L THE HIGH COST OF NEGLECT There is an epidemic in the making. Its first victims have already died. It is caused by a wellknown killer, once tamed but now, like Hannibal Lecter in...
...This is a public-health crisis and therefore demands a concerted, public response...
...In two subsequent budget requests, it sought a total of only $19 million...
...According to Dr...
...Because proven methods of treatment were not maintained (monitored compliance gradually diminished as public-health staffs were cut back and defunded...
...new attention to completing therapy (including more supervisory personnel, rewards that reinforce compliance, and efficient legal controls when called for...
...rapid diagnostic services...
...That means both personal and governmental...
...Like our crumbling infrastructure and the rage in our inner cities, its reentry was evident years ago to those willing to look...
...because of overcrowding in prisons and shelters...
...And governmental: broad-scale public education and screening...
...These medications chiefly isoniazid, rifampin, and pyrazinamide-are not expensive: under $300 for the course of treatment...
...While the rich and the healthy are not likely to be its victims, it can strike anyone...
...isolation of infectious patients, particularly in prisons, shelters, and hospitals, and improved means of purifying air in such settings...
...It is tuberculosis...
...In the United States, however, thanks to the use of several highly effective drugs, TB had been brought largely under control over the last twenty years...
...It went on a rampage in a New York state prison last year, killing a guard and twenty prisoners...
...but we must attack the disease: in our legislatures, our laboratories, and in our health-care goals and practices...
...It is loose again largely because of official dereliction...
...but because of the swift spread of the disease in the interim, experts are now calling for $90-$125 million annually...
...In the last three years it has been detected in seventeen states...
...Anthony S. Fauci of the National Institutes of Health, unless there is a serious effort to contain it, the spread of new forms of drug-resistant TB could become a public-health threat as serious as AIDS...
...Why this outbreak...
...A recent study of one New York City hospital found that only 11 percent of those on TB AN EDITOR'S NOTEBOOK 4: 22 May 1992 Commonweal itt least five days a week most of these old houses are alone in the care of their alarm systems, but it was not always that way...
...We must all take precautions...
...According to a report in Newsweek (March 16), it can be 50 to 80 percent fatal...
...What then needs to be done...
...It is caused by a wellknown killer, once tamed but now, like Hannibal Lecter in The Silence of the Lambs, once more virulent in a new and menacing guise...
...and the effect of abandoning treatment before it has been completed can be catastrophic...
...It could have been controlled by common-sense precautions, and for years it was...
...But more alarming: since the early 1980s, drug-resistant TB has increased from 3 to 7 percent of all cases...
...Not only can the disease return to the carrier, but it may do so with a vengeance: made impervious by previous types of treatment, drug-resistant TB can ravage the patient and become highly contagious...
...Worldwide, TB causes more deaths than any other infectious disease...
...But the treatment can be long, from nine months to two years...
...Its spread was fostered in part by official neglect, by the increase of poverty and homelessness, and by the outbreak of HIV and AIDS...
...The reemergence of TB as a major public health concern in the United States should not be a surprise...
...and of suspecting TB in themselves or others if such signs as persistent coughing, abnormal weight loss, and fever are observed...
...In earlier times, when salespersons walked from door to door carrying heavy cases, treatment were completing the full regimen (in contrast, Tanzania, one of the world's poorest countries, has a completion rate of 85 percent...
...When it comes to TB, the best defense is clearly a good offense...
...An opportunistic, airborne infection, drug-resistant TB could become the norm...
...ongoing screening of health-care workers exposed in the line of duty, as well as HIV patients...
...In 1990, TB in the U.S...
...The Bush administration never asked for the money...
...and because health-care programs in poorer neighborhoods were gradually weakened...
...Personal: individuals should be taught the effectiveness of covering their own sneezes and coughs (one sneeze can launch 1 million infectious droplets, only one of which is needed to infect a weakened victim...
...rose 16 percent (25,701 cases) over '84, and in New York state it reached its highest level in twenty years...
...and a massive effort to: (1) develop new and quicker diagnostic tests, and (2) find new, effective medications for drug-resistant TB...
...PATRICK JORDAN 22 May 1992: 5...
...The failure of the federal as well as other strata of government to contain this new outbreak may now be compounded by an unconscionable refusal to deal with the epidemic fully and forcefully...
...Clearly, for every dollar well-spent now, many more will be saved in the future...
...because of the spread of HIV...
...For 1993, it has finally asked for a substantive increase ($66 million...
...Three years ago, a Department of Health and Human Services report called for $30 million a year to eliminate TB...
Vol. 119 • May 1992 • No. 10
