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It takes six months of treatment
with several drugs - the most common are isoniazid, rifampin and pyrazinamide
- to actually cure the disease. But because TB symptoms are relieved or disappear
within a few weeks, six months of therapy seem superfluous to most people and
so they stop taking the medicine. In addition, some people experience side effects
from the pills - such as nausea and fatigue - that may seem worse than the TB
itself.
The problem is that any partial treatment can lead to the development of resistant
strains of Mycobacterium tuberculosis, and these strains are harder to treat.
Reichman says that Strain W, which was identified in New York City during the
epidemic of the early '90s, is resistant to almost all existing tuberculosis medications.
Some of the Russian strains are resistant to five or six of these drugs.
"Unfortunately, human nature dictates that when you feel better, you stop
taking the medicine," says the TB expert, "and this goes for everyone,
even doctors."
In the U.S., the sputum of those with active disease is cultured and when the
culture results come back - indicating which, if any, of the drugs will not work
- the regimen is tailored to the individual patient. Reichman says that if the
standard drugs don't work, others that are both more toxic and more expensive
- and may take up to two years to be effective -must be used to combat the disease.
The cost for treating one patient with MDR TB can run over $200,000, and the fatality
rate can be as high as 45 percent.
Enter an old-fashioned, and also a somewhat novel, idea called Directly Observed
Therapy or DOT. Its premise is: If you can't count on people to take their medicine
for the prescribed period, send someone to watch the medicine go down. The program
links each person known to be infected - even if they do not have active disease
- with an outreach worker who teaches the patient about the disease, the importance
of the long regimen of therapy and about nutrition. Most important of all, the
outreach worker shows up at the patient's "door" every day - at home,
at work or school, and even on the streets - to watch him take his medicine. And
this routine continues until the person is pronounced cured.
DOT works. It was initiated in this country in the 1970s for noncompliant patients,
and now only 1.5 to 2 percent of all TB cases are multi-drug resistant, which
adds up to less than 500 cases nationwide. In Newark, the incidence of MDR TB
is negligible because of the Center's pioneering TB Outreach Team that combs the
streets of Newark to supervise daily treatment.
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| Visiting Russian physicians learn about TB and American TV. |
If this highly labor-intensive practice
seems like much ado about nothing, you need only look at what's happening in Russia
today. Russian doctors have insufficient drugs - and also inadequate knowledge
- to treat the disease effectively. According to Reichman, this is precisely what
has fueled the rise of resistant strains in Russia. Those patients who are medically
treated for their TB are not taking the drugs for a long enough time period. Consequently,
they are becoming breeding grounds for the resistant bugs. And many Russian doctors
are still treating TB patients by cutting out the affected lung.
Reichman says this is cause for great concern: "Half of those untreated or
inadequately treated for TB will die. The other half will go on to spread the
disease." And it is this grave problem that has brought the eight Russian
doctors to study with Reichman and his team for an entire month. They will then
bring their knowledge of the disease and of DOT back to Russia to teach other
physicians and health care workers, and to try to get control of this frightening
situation in their country. TB drugs will be provided by the Public Health Research
Institute's Soros Russian TB program.
The Russian epidemic could clearly impact on the spread of MDR TB in our country
as well. Reichman says that 40 percent of tuberculosis in this country was brought
in by foreign-born individuals. There already have been several cases of MDR TB
brought here as a result of infected Russians coming to this country and many
parents who have or are planning to adopt Russian children have called UMDNJ's
TB hotline seeking information. Although immigrants need to bring an x-ray showing
they are free of TB when they come here, he says many buy “clean“ x-rays
or bring the x-ray of an uninfected relative or friend.
Reichman says the answer to controlling tuberculosis worldwide does not lie in
adopting laws blocking immigration from areas where the disease is rampant, but
in developing user-friendly drugs and educating health professionals to prescribe
them correctly.
"MDR TB is manmade, so it's preventable," says Reichman. "We make
it by treating with the wrong drugs and for the wrong length of time." "But
to control TB anywhere, you have to control it everywhere," he concludes.
"We're all in on this one together."
"60 Minutes" will air the
episode in September. Tune in to see and hear the rest of the story.
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