New Yorker examines global TB diagnostic challenges

Nov 8 2010

The New Yorker examines the challenges associated with treating tuberculosis across the world and looks at whether a rapid diagnostic test could prevent millions of deaths from the disease. "Vaccines and antibiotics have long been seen as touchstones of medical progress. To stop tuberculosis, however, particularly in the developing world, an accurate diagnostic exam is needed even more. In India, China, and Africa, at least two billion people have latent infections. Yet every day thousands are told, mistakenly, that they are sick and need treatment," the magazine notes.

To illustrate the problem, the article focuses on the situation in India, which has "nearly two million new cases each year, and every day a thousand people die of the disease, the highest number in the world. ... With India's urban population expected to double in the next thirty years, to seven hundred million, its cities will remain fertile ground for an infectious epidemic. Yet - no doubt owing to the fact that rich people in the West rarely get the disease - tuberculosis receives fewer resources, fewer research dollars, and less attention from the global health community than either AIDS or malaria," the magazine observes.

It highlights the GeneXpert, a device "that allows doctors to diagnose TB in under two hours - without error or doubt," according to the New Yorker, which writes that the technology "might help countries like India escape the endless cycle of mistaken diagnoses and haphazard treatment." Shamim Mannan, the Indian government's chief TB consultant in the Bihar region, who is quoted throughout the piece, said, "The machine is so powerful that it could help end tuberculosis ... I don't think that is an exaggeration."

The article reports on the challenges of making the technology available in India and other parts of the developing world. "As long as there is electricity, the tests could be carried out by unskilled workers in any village. Training them would be easy, and the potential benefits - saving billions of dollars and millions of lives - worth any effort," according to Peter Small, the director of TB programs for the Bill & Melinda Gates Foundation. "The question is how do we get there. I have heard people say that we should trust the government bureaucracy. But others say let's put our faith in an unregulated collection of free agents. It's hard to know which approach is more ludicrous," he said.

"The uncertainties and dangers of diagnosis remain the greatest obstacle to successful TB treatment, in India and throughout the developing world. For that to change, investments from international aid organizations and from private companies will be necessary. That may seem unlikely, but it has happened before, most notably with AIDS drugs," the New Yorker writes. "A similar effort will be required to lower the cost of diagnosing tuberculosis. There will also have to be a transformation in how TB medicine is regulated. That may seem like an insurmountable barrier, but, with the proper incentives, the system could work," according to the article (Specter, 11/15).