By now, you've all heard about Andrew Speaker, the man who brought extensively drug-resistant tuberculosis to full-blown US attention.

The case is undeniably bizarre. Man has deadly infection, health officials try in vain to get him to stop flying, he puts hundreds of passengers at risk despite being on a so-called "no-fly" list, a customs official lets him in because he doesn't look sick... oh, and most bizarrely of all, his father-in-law is a researcher at the Centers for Disease Control and Prevention specializing in, wait for it, TB.

My first response was to think that the US was over-reacting. After all, XDR-TB has been found everywhere in the world. What's so special about this one case? And it's not as if the US is teeming with HIV-infected individuals, who are most at risk of catching TB. The reports all said too that his wife hadn't become infected despite presumably spending lots of time with her husband.

But then the newspapers started detailing the many missteps that led to Speaker's dangerous jaunts across the Atlantic. Now I, and no doubt every health official in the world, am wondering how we can ever hope to sucecssfully contain something like a flu pandemic, if we can't get one guy to stay put. I'm not really for the idea of quarantining people. When SARS hit, some governments went a little 1984-ish nutso with nonstop surveillance and what-have-you. But I can't argue that in the end, that's what stopped SARS in its tracks, nor that most models show that containing the first few infections will be key in stopping a flu pandemic.

What I think we need is some updated quarantine laws, that make sense and take into account individual liberties. But even before that, I hope governments quickly learn how to stop infected people from putting everyone around them at risk.

Posted by Apoorva Mandavilli at 05:12 PM | Permalink | Comments (3)

Well, sort of. For the past few days, I've been in rainy Vancouver, where TB researchers from all over the world have gathered for a Keystone meeting on the topic. As we reported in our free TB special this month, TB kills 4,400 people every day and together with HIV, is creating a serious crisis in Africa, Asia and eastern Europe.

Not that you would know it from the WHO's press release on the occasion of World TB Day (today, although the release came out Thursday). The WHO takes a self-congratulatory tone, announcing that TB has leveled off for the first time since 1993. It's not until the third para that you find out in actual numbers, TB continued to rise in 2005, just more slowly than it had in 2004. That's worth trumpeting?

TB scientists complain that one of their biggest obstacles is the abysmal funding, about a tenth of the money available for research on HIV/AIDS. It seems to me that the WHO's positive spin is going to make donors even less likely to chip in. I don't doubt that the situation could be worse, but when a disease kills nearly 2 million people a year, that's no time for pats on the back.

A few scientists at the meeting have said that they find the WHO's stance unhelpful and demoralizing. Fortunately, it dosn't seem to be affecting their research too much. This is my first TB keystone meeting, but people here have been marveling at how well attended it is this year.

Even better, many of the attendees are young grad students and postdocs. After decades of no drugs, no vaccines and absolutely no money, TB is making a comeback. You could almost say that attention from celebrities like Angelina Jolie and Bono has made TB sort of... sexy.

As offensive as that might sound, anything that brings this horrible killer more attention is all right with me. I'm heading back now to hear more about clinical trials for new TB vaccines, the first good candidates to be tested in almost a 100 years.

Posted by Apoorva Mandavilli at 07:07 PM | Permalink | Comments (2)

Did you know that one out of every three people is infected with the bacteria that cuase tuberculosis (TB)?

There's this mistaken impression that TB is no longer a problem, that 'consumption' as it was once called, long ago lost its power to kill. But in fact, 125 years after Mycobacterium tuberculosis was identified, the disease kills nearly 2 million people a year.

24 March 2007 is World TB day and partly in recognition of that, we've put together a special supplement about TB in our March issue.

News from the special is chock full of statistics, features and profiles of key players. One feature article exposes a power struggle between scientists who work with HIV and those who work with tuberculosis (TB), which is undermining the fight against both diseases.

TB is the leading cause of death among those infected with HIV and in some African countries, about 60% of those with TB are also HIV-positive. Yet, the two communities continue to work separately, diagnosing and treating one disease without taking the other into account.

One sore point for TB scientists is that TB research gets less than a tenth of the money allotted to HIV/AIDS each year. Existing drugs and vaccines for TB were developed decades ago so the infrastructure and expertise for TB need to be built up from scratch. But without enough money, says another article in the special, researchers are struggling to do the research needed to find new drugs and vaccines.

Other news articles describe the public-private partnerships that are helping to solve this funding crisis and the new drugs, vaccines and diagnostic tests in the pipeline.

The special also carries scientific commentaries about the threat of extensively drug-resistant TB, which is virtually incurable, and about the scientific challenges in developing new TB drugs.

We'd love to hear your thoughts about this special. Tell us what you liked--and what you didn't like--about our coverage.

Posted by Apoorva Mandavilli at 12:45 PM | Permalink | Comments (0)

Did you know that although AIDS and TB kill about the same number of people, AIDS research gets roughly 20 times the money given for TB research? I didn't either, until I went to a meeting last week organized by MSF (Doctors without Borders). The theme of the meeting was the urgent need to get some more money--a common cry in science, but in this case, fully warranted.

The numbers are shocking:TB gets about $120 million, less money than even anthrax and smallpox. Of that, only about $20 million goes to clinical trials. That's maybe enough for one large trial, but that's it. Scientists are meanwhile desperate to test combinations of drugs we already have, but just don't have the money.

Who should pay? Europe, which has a rising problem with drug-resistant TB, sets aside a pittance. At the moment, most of the cases are in poor eastern European countries, but If their richer Western neighbors don't take this seriously, they'll soon start to see outbreaks of drug-resistant TB.

Despite the bleak numbers, though, I was really inspired by the meeting. TB researchers, maybe because they're so used to adversity, are an energetic bunch. Unlike in many other scientific fields, most TB researchers get out into the field and see the need for their work first hand. To them, whether to continue doing this important work and push for more money is not really a question.

Posted by Apoorva Mandavilli at 01:39 PM | Permalink | Comments (0)

When I worked at Fred Hutchinson Cancer Research Center in Seattle I was struck by the chemicals researchers routinely tossed away—often down the drain. It seemed paradoxical that the attempt to understand cancer involved the manufacture of some nasty carcinogens.

Of course, in the big scheme of things the amount of chemicals used in cancer research is small. And almost any positive endeavor has its shades of grey.

Take the Bill and Melinda Gates Foundation. Its role in public health has been extraordinary—but as a report in the Los Angeles Times reveals, the financial arm of the foundation invests in companies that spew some pretty toxic stuff, and may otherwise undermine the mission of the foundation.

These investments include oil companies that pollute regions of Africa where the foundation operates and a health care company embroiled in lawsuits for allegedly unnecessary surgeries. The Times claims that at least 41% of the foundation’s assets, or $8.7 billion, are in companies that “countered the foundation’s charitable goals or socially concerned philosophy.

Unlike some other philanthropies, such as the Ford Foundation, the Gates Foundation has apparently set up a firewall between its investment and granting arms—to try to keep the fund as flush as possible.

It may be easy to quibble with some of the standards used by the LA Times to criticize the Gates Foundation. Nonetheless, with an endowment boosted by Warren Buffett to more than $60 billion, it seems that the foundation could wield its substantial investment power in ways more in keeping with its public health mission.

Posted by Charlotte Schubert at 05:33 PM | Permalink | Comments (1)