In this day and age, we import fruits and vegetables, toys, oil, clothes and pretty much everything in between. All this may seem good and all, except for one minor detail: we are importing another good. It is one that doesn’t seem to be desired in the same demand, but still lurks in the shadows. Yes, all the while that we are importing commercially viable goods, we are also paving the way for the transmission of disease.
With more of this thing called globalization, we are endangering the lives of countless others through the spread of infectious diseases, notably TB. In fact, according to the U.S. News and World Report Vol. 142, No. 22, “In a world I nwhich one tird of the population is infected, the occasional traveler who goes to places steeped in TB brings it home. And in a country dependent upon the talent and energy of people migrating from high-Tb areas, the microbe has become a regular import. Moreover, the tubercle bacillus, a survivor that mutates around the drugs designed to wipe it out, is a formidable foe for a public-health system that has just shown itself to be inconsistent, disconnected, and underfunded.” Wow. Stepping back, it appears that we have a long way towards improvement. In this current society, we try to be all noble, helping others avoid political persecution, delivering military and financial aid and even providing jobs. Yet, there is always a dark side. In this case, it appears that we are in fact endangering the lives of others through TB.

Renovating Society

As we have already established, the plan to just find a new drug to treat MDR-TB is not a convincing solution. Yet, this does not mean that the disease will continue to mutate until everyone in the entire world is hopeless. No, instead it just means that we need to find a different kind of solution.

Though there are surely many possible solutions, one that sounds particularly interesting would entail a broader outlook that those presently under consideration. If in fact, MDR-TB is viewed as just another form of a disease that mutated into a resistant strain, then we can look at MDR-TB and all the other diseases at the same time. The plan would need a total renovation of our society. We need to start looking at all the resistant forms of the disease with the acceptance that a Fix-All-Society is not the right answer.

We need to find out how we can live in a society with a little bit of bacteria. Bacteria are not always bad for society. In some cases they can actually be beneficial. If we let the weak survive, then the strong will not necessarily mutate so quickly. Then, just maybe, disease as we know it will not be as deadly. Then, we will not be worrying about the possible new deadly form of a disease. Instead, we will find other worries to occupy our mind.

The Problem With Our Solution

There is all this hype about how we can cure MDR-TB. Yet, is it really possible to cure this highly lethal form of tuberculosis? At the present, I am very skeptical.
Though it would be very nice to banish MDR-TB from our vocabulary, we have to face reality. MDR-TB is not like TB at all. MDR-TB is not something that just magically developed thousands of years ago for some inexplicable reason, as in the case of TB. We created it. We are the ones who brought the drugs into environments in which the public was not ready to be cured. Granted, it is not really the fault of the public at all. The areas that are suffering the highest outbreaks of TB are the poor ones. In many cases, the infected in these areas does not have the choice to always get the treatment plans. Sometimes there are not enough drugs to cure the patients and sometimes there are not enough medical practitioners to ensure that the proper dosage is delivered. Even the most diligent people can be infected with the strain of MDR-TB by another person who cannot complete his/her treatment plan. So when it comes down to it, it is not really the fault of the people in the public.

Yet, this does not mean that the public is to blame. Though it is not the fault of the individual members of the general public, it is the fault of the general public as a whole. It is our fault that we nourish this insatiable desire for a Fix-All Society. We want to find a cure for everything. As a result, we kill the weak and help the strong. In the case of TB, this means that the more resistant strains mutate and become even more potent killers.

Developing new drugs for MDR-TB is not the option because the new drug will only aggravate the problem. People will just become resistant to that particular strain of TB and we will be in a larger predicament than when we started.

Is there hope for TB? Well, the CDC sure thinks so. In fact, they are working towards improving the protection plan in the hope of reducing the spread of the infectious Tuberculosis bacteria. They are concentrating their efforts in the hospital. Their aim in the improve hospital procedures to prevent drug-resistant forms, notably MDR-TB, from spreading. According to the latest update, the panel has a long way to go, but they are hoping for drastic improvements.

Starting at the hospital, while it may seem a bit strange, is actually a good idea. First of all, many people in developed worlds often get treated at the hospital for their TB. This means that if a person were to develop MDR-TB in the hospital, the CDC and the hospital officials could work towards learning more about the spread of the resistant form of the disease. Similarly, the hospital is also home to both sterile and extremely dirty environments. This too would help in both the further discovery of the path of mutation of the disease and the potential cure of the disease.

Epidemics in the US: Stories and Meaning

Though we have discussed various TB epidemics in developing worlds, we have hide away from those in the developed world. This is not to say that the developed world is exempt from TB epidemics. In fact, in 1995 there was an outbreak in Minneapolis.

The story goes as follows: One person in Minneapolis entered a bar on evening. This person happened to be infected with TB. Consequently, he infected 41 people in that neighborhood bar that evening. Stepping back, this story seems a little daunting. I do not believe that the customers of the bar that evening expected to be put into a dangerous situation.

This bar situation is not entirely unique. In Western Canada, a healthcare worker infected over 100 other people with TB. A postal worker in Tampa, Florida, also infected his coworkers. Clearly, developed worlds are not exempt from TB.
Yet, these outbreaks are not as prevalent as similar ones in developing worlds. Those in poorer countries occur more often and can often lead to more serious consequences. In developing worlds, the public does not have access to the drugs that it needs to cure the infected. Similarly, there is not enough staff to ensure proper completion of treatment plan. Consequently, developing worlds have a much higher death rate.

So then, how should the few cases in developed worlds be viewed? Are the unfortunate instances in which the public was put into danger? Does it reflect on the poor public security plan? Or, more likely, should these cases be seen as insightful instances that depict the disparity between the disease in developed worlds and that in developing worlds?

A Pleasant Way to Die

Tuberculosis is not the only disease that is facing mutations as the world becomes increasingly more globalized. In North America, clostridium difficile is making headway. Scientists are worried that it will become the next great killer. This superbug has a deadly resistant strain. In fact, “here are certainly dozens, perhaps hundreds of strains of C. difficile, most notably a superbug known as the epidemic strain. This hypervirulent variety has killed thousands of people -- often elderly patients in hospital -- across North America over roughly the past five years, particularly in Quebec. There, C. diff. killed an estimated 2,000 patients in 2003-2004 alone. Typically, the victims have been on antibiotics, which in addition to combatting infection, also wipe out the good bacteria normally found in the gastrointestinal tract. In their absence, C. diff. has no competition and thrives. The connection to recent exposure to antibiotics is so pronounced it is considered a virtual prerequisite for coming down with Clostridium difficile. Until now.”

The are multiple problems with this superbug. One of the most pressing issues is the fact that this bacteria is now spreading outside of hospitals and “into the community-at-large.” It has already reached some communities in Quebec and it could easily spread to many, many more. Another problem is that this superbug has spread to some foods. “The audience of scientific sleuths in Atlanta had heard much of this and more by the time Songer got up to speak. Songer said his lab had screened for the bacterium in meat bought in Arizona grocery stores.(In addition to striking humans, C. diff. also causes disease among commercial farm animals.)The samples included ground beef, pork and turkey, as well as a selection of beef, beef-pork and pork sausages. Incredibly, one-quarter of the samples were tainted with strains of Clostridium difficile. The workshop participants, who had been quietly listening, immediately broke into peals of nervous laughter intermixed with groans of disbelief.” Making matters worse, cooking does not kill it.

I’ve explained what the superbug is and the problems associated with it, but I have not explained how it kills. Let me elaborate. “There are few good ways to die, and lying in a pair of soiled diapers while waiting for the merciful end to arrive certainly isn't one of them. But patients fighting a severe Clostridium difficile infection frequently suffer that indignity, enduring 10 to 20 bowel movements a day. In addition to chronic diarrhea, the epidemic strain can cause a ruthless inflammation of the colon called colitis that sometimes necessitates surgical removal of that part of the large intestine. Sepsis, or blood poisoning, can also occur. Patients endure horrible abdominal pain, perilously low blood pressure and anemia that leaves them too weak to crawl out of bed.” Sounds fun, doesn’t it?

The Looking Glass

MDR-TB has many forms. It can range in severity, meaning that it can be a little harder to treat or it can be deadly. In 2006, South Africa had to learn this lesson the hard way. In Tulega Ferry, part of South Africa, “a deadly new strain of extremely drug-resistant tuberculosis discovered in South Africa is likely to have spread beyond the rural area where 52 of the 53 people diagnosed with it have died.” While it is very difficult to pin point the origin of outbreaks, especially when the outbreak happens to be in a developing country that lacks the adequate resources to fully evaluate the outbreak, it is presumed to have originated in Kwazulu-Natal. It is a region in the eastern part of South Africa. This outbreak was so severe that it is presumed to be across the country and maybe even across the world.

This outbreak is nothing unusual for MDR-TB. In fact, “drug resistance is a common problem in TB treatment, but the new strain appears particularly virulent. Worldwide, about 2 percent of drug-resistant TB cases are classified as extremely drug-resistant.” With our global practices, this percentage will only increase. As we become more mobile, it becomes even easier to transmit life-threatening diseases. The South Africa outbreak was just an extreme of this case. Because it was the MRD-TB strain that was spread and not simply a group of people who became resistant, the outbreak was more severe. According to Dr. Tony Moll, the doctor who discovered the super bug, “the strain was very highly troubling and alarming because of the very high fatality rate.” The strain was especially fatal because of the high percentage of the infected with already weakened immune systems, mostly from AIDS. Yet the severity of the outbreak should not be seen as the exception to the rule. Rather, it should be viewed as the looking glass to our growing epidemic.