A lot of furore was generated last week over a scientific study published in the respected medical journal The Lancet, which claimed to have uncovered a new "superbug" - multi-drug resistant strain of bacteria, which reportedly originated in India, and is spreading worldwide from Indian shores due to medical tourism. The study was by a British research group, and involved a few scientists of Indian origin too. The furore it created in India was over a couple of issues;
While the first issue according to me is pretty trivial and not worth a debate, the second one is quite serious, as it directly aims at our economy as well as national reputation. Many have argued that it is NOT the job of a medical journal to act as a travel advisory. They could have just presented the facts of the study and let people draw their own conclusions. The Lancet has come under the scanner as much as the research group for this publication. Though I do not feel qualified to comment on the issue without having read the actual paper, from what I have heard on T.V. and read on the Web, it does seem that the findings of the study, their method of sampling, and data obtained are not enough to taint the surgical procedures done in India as potential risk factors, not yet anyway. To quote Wikipedia "NDM-1 was first identified in December 2009 in a patient hospitalised in New Delhi with a Klebsiella pneumoniae infection. It has since been detected in bacteria in India, Pakistan, the United Kingdom and the United States" ................................................ "The NDM-1 enzyme was named after New Delhi, the capital city of India, as it was first described by Yong et al. in December 2009 in a Swedish national who fell ill with an antibiotic-resistant bacterial infection that he acquired in India. The infection was unsuccessfully treated in a New Delhi hospital and after the patient's repatriation to Sweden, a carbapenem-resistant Klebsiella pneumoniae strain bearing the novel gene was identified. The authors concluded that the new resistance mechanism "clearly arose in India, but there are few data arising from India to suggest how widespread it is." In March 2010 a study in a hospital in Mumbai found that the majority of carbapenem-resistant bacteria isolated from patients carried the blaNDM-1 gene. In May 2010 a case of infection with E. coli expressing NDM-1 was reported in Coventry in the United Kingdom. The patient was a man of Indian origin who had visited India 18 months previously, where he had undergone dialysis." .................................... "A study by a multi-national team was published in the August 2010 issue of the journal The Lancet Infectious Diseases. This examined the emergence and spread of bacteria carrying the blaNDM-1 gene. This reported on 37 cases in the United Kingdom, 44 isolates with NDM-1 in Chennai, 26 in Haryana and 73 in various other sites in Pakistan and India"
Ok, that is a LOT of quoting! But the question that arises from this study is that is the data sufficient to malign the entire hospital industry in the country? When Barkha Dutt asked one of the main authors in a program that how can they confirm that the nodal subject of the study, the Swedish national, didn't pick up the infection from somewhere outside India, or in Sweden, his response was Sweden is a much cleaner country, with better disease control policies. Does he mean to say that no one ever gets a bacterial infection in Sweden? Quite an absurd reasoning from a scientist.
But anyway, the point that I realized from that program was, how serious the problem of antibiotic abuse in India is. And as usual, instead of addressing the key issue, we collectively as a nation chose to focus on the purported strike against our false sense of national pride. The few sane voices on that show all stressed on one thing only, that naming of the gene after the national capital and other issues are secondary. The main thing is to recognize this as an opportunity to set out own house in order, and be glad that this controversy has at least opened up a debate on antibiotic abuse and emerging drug resistance. No one can deny the fact that these are major healthcare issues all over the world, and especially in our country. We have developed a dangerous culture of self-medication , reliance on over-the-counter (OTC) drugs and taking the word of the local chemist instead of bothering to consult a doctor. Pill-popping has become alarmingly popular in society and there is a serious lack of awareness about its ill-effects. Its a pill right? It can only do good, no harm in popping one!!! Well guess what, it's more likely to do more harm than good.
While I was watching that debate on NDTV, I realized how clueless my mother was about the whole thing. I ended up explaining the entire thing to her in detail, and realized that this is the core problem. Lack of awareness among the general population in India. We don't think twice about reusing old, left-over pills for similar symptoms, buying the same meds from the last prescription, not bothering to complete the prescribed dose as soon as the symptoms seem to subside, buying OTC based on recommendations from "well-wishers", and so on. People have to be made aware of what such abuse of antibiotics can do to you. Awareness camps in schools and colleges, pamphlets at healthcare centers, TV commercials in public interest, whatever it takes!!
Antibiotics, are chemicals which prevent microbial growth or kill them by targeting one or the other metabolic pathways in bacterial cells. Now, micro-organisms evolve at a much faster rate, and adapt to their environments quite easily. They do this by accumulating beneficial mutations in their genes over generations. And generation time in bacteria is of the order of a few hours. So when confronted with a drug which threatens their populations, a few resilient specimen survive by evolving alternate mechanisms to the ones which the drug targets, or by devloping means to flush the drug out of their cells. When these surviving bacteria reproduce and establish populations which inherit these defense mechanisms, the bacterial popualtion is said to have developed resistance to that particular drug.
Antibiotic resistance is a major threat to the health security and scientists and labs all over the world are fighting against time to develop methods to counter drug resistance, and/or develop newer drugs. However, Developing a new drug requires at least 15 years of time and more than a Billion dollar investment, with no guarantee of success. Hence the number of new drugs launched in the past 2 decades is negligible. And it often takes less than 10 years for resistant bacterial strains to emerge after a new drug is launched. So it should be evident how grave a problem drug resistance is.
When we indiscriminately use antibiotics against infections without medical supervision, or discontinue or prolong a drug dose at our own whim, what we unintentionally do is to equip the bacteria to get used to the drug, and evolve mechanisms which enable them to work around it and survive. This is how antibiotic resistance spreads through their abuse. And in fact a major problem is MDR, or multi-drug resistance in bacterial strains, which implies that the bacteria is able to fight the assault from a range of antibiotics and not just one. This makes healthcare very difficult, as no one drug is able to cure an infection. This has been a major reason why we still have no fool-proof weapon against diseases like tuberculosis. And in this context the threat from NDM-1 is even more worrying, as NDM-1-carrying bacteria are resistant even to carbapenems, a group of antibiotics often reserved as a last resort for emergency treatment for multi-drug resistant bugs.
So it is no wonder that our healthcare system should come under the scanner. People are just not aware of the dangers of pill-popping. And is it really their fault? Whose job is it to make them aware? Who is responsible? The obvious answer which pops up is the usual scape-goat - our Government. Well yes, of course the Government has a major stake in this responsibility. But I feel the real culprits in this scenario are our esteemed doctors. This I say from my own experience, which has been restricted to the government healthcare centers like CGHS dispensaries, AIIMS and Safdurjung Hospitals. Doctors I have encountered, are just not bothered to explain to the patient what is his/her condition, what is the cause, what is the course of treatment and more importantly its basis, and the need to follow the proper dosage. They are more than content to perform a quick diagnosis, and write a prescription and inform the dose to be taken. Questions are not welcome!! Being from the science field, when I do ask questions pertaining to the illness or the medicine, the docs are just taken aback!! They don't expect you to question them, and most don't take to it kindly. It is just assumed that the patient, or common man, is not going to understand the medical details and need not be bothered. Some don't even tell you what the disease is! People too are more often than not just content to receive their prescription and walk away. This mutual understanding between the lazy doctor and the blissfully ignorant patient has proved to be a fertile ground for drug abuse. But then again, the number of patients these doctors in Govt. hospitals are forced to cater to per day is so huge that one can't really blame them for not having the patience to counsel each patient.
One can only hope that this study, which just now I read in the newspaper, has received the backing of WHO, may be a blessing in disguise, and more debates like the one on NDTV the other day, may be a small step in creating awareness about this major threat to our society's health. If it saves lives, I don't mind the bug being named after New Delhi. And just to make it clear, its the gene/enzyme responsible for conferring the resistance in bacteria that has been named NDM-1, not a bacteria per se, as most of the Indian media seems to think. :-P
- One, the gene encoding for the particular enzyme responsible for conferring this deadly resistance to bacteria was named NDM-1 or New Delhi Metallo-beta-lactamse.
- Two, the paper concluded with remarks which the growing industry of medical tourism, i.e. people from other countries coming to India for affordable, world-class healthcare, responsible for this superbug spreading across the globe, effectively serving as a travel advisory and dissuading people from receiving such services in India.
While the first issue according to me is pretty trivial and not worth a debate, the second one is quite serious, as it directly aims at our economy as well as national reputation. Many have argued that it is NOT the job of a medical journal to act as a travel advisory. They could have just presented the facts of the study and let people draw their own conclusions. The Lancet has come under the scanner as much as the research group for this publication. Though I do not feel qualified to comment on the issue without having read the actual paper, from what I have heard on T.V. and read on the Web, it does seem that the findings of the study, their method of sampling, and data obtained are not enough to taint the surgical procedures done in India as potential risk factors, not yet anyway. To quote Wikipedia "NDM-1 was first identified in December 2009 in a patient hospitalised in New Delhi with a Klebsiella pneumoniae infection. It has since been detected in bacteria in India, Pakistan, the United Kingdom and the United States" ................................................ "The NDM-1 enzyme was named after New Delhi, the capital city of India, as it was first described by Yong et al. in December 2009 in a Swedish national who fell ill with an antibiotic-resistant bacterial infection that he acquired in India. The infection was unsuccessfully treated in a New Delhi hospital and after the patient's repatriation to Sweden, a carbapenem-resistant Klebsiella pneumoniae strain bearing the novel gene was identified. The authors concluded that the new resistance mechanism "clearly arose in India, but there are few data arising from India to suggest how widespread it is." In March 2010 a study in a hospital in Mumbai found that the majority of carbapenem-resistant bacteria isolated from patients carried the blaNDM-1 gene. In May 2010 a case of infection with E. coli expressing NDM-1 was reported in Coventry in the United Kingdom. The patient was a man of Indian origin who had visited India 18 months previously, where he had undergone dialysis." .................................... "A study by a multi-national team was published in the August 2010 issue of the journal The Lancet Infectious Diseases. This examined the emergence and spread of bacteria carrying the blaNDM-1 gene. This reported on 37 cases in the United Kingdom, 44 isolates with NDM-1 in Chennai, 26 in Haryana and 73 in various other sites in Pakistan and India"
Ok, that is a LOT of quoting! But the question that arises from this study is that is the data sufficient to malign the entire hospital industry in the country? When Barkha Dutt asked one of the main authors in a program that how can they confirm that the nodal subject of the study, the Swedish national, didn't pick up the infection from somewhere outside India, or in Sweden, his response was Sweden is a much cleaner country, with better disease control policies. Does he mean to say that no one ever gets a bacterial infection in Sweden? Quite an absurd reasoning from a scientist.
But anyway, the point that I realized from that program was, how serious the problem of antibiotic abuse in India is. And as usual, instead of addressing the key issue, we collectively as a nation chose to focus on the purported strike against our false sense of national pride. The few sane voices on that show all stressed on one thing only, that naming of the gene after the national capital and other issues are secondary. The main thing is to recognize this as an opportunity to set out own house in order, and be glad that this controversy has at least opened up a debate on antibiotic abuse and emerging drug resistance. No one can deny the fact that these are major healthcare issues all over the world, and especially in our country. We have developed a dangerous culture of self-medication , reliance on over-the-counter (OTC) drugs and taking the word of the local chemist instead of bothering to consult a doctor. Pill-popping has become alarmingly popular in society and there is a serious lack of awareness about its ill-effects. Its a pill right? It can only do good, no harm in popping one!!! Well guess what, it's more likely to do more harm than good.
While I was watching that debate on NDTV, I realized how clueless my mother was about the whole thing. I ended up explaining the entire thing to her in detail, and realized that this is the core problem. Lack of awareness among the general population in India. We don't think twice about reusing old, left-over pills for similar symptoms, buying the same meds from the last prescription, not bothering to complete the prescribed dose as soon as the symptoms seem to subside, buying OTC based on recommendations from "well-wishers", and so on. People have to be made aware of what such abuse of antibiotics can do to you. Awareness camps in schools and colleges, pamphlets at healthcare centers, TV commercials in public interest, whatever it takes!!
Antibiotics, are chemicals which prevent microbial growth or kill them by targeting one or the other metabolic pathways in bacterial cells. Now, micro-organisms evolve at a much faster rate, and adapt to their environments quite easily. They do this by accumulating beneficial mutations in their genes over generations. And generation time in bacteria is of the order of a few hours. So when confronted with a drug which threatens their populations, a few resilient specimen survive by evolving alternate mechanisms to the ones which the drug targets, or by devloping means to flush the drug out of their cells. When these surviving bacteria reproduce and establish populations which inherit these defense mechanisms, the bacterial popualtion is said to have developed resistance to that particular drug.
Antibiotic resistance is a major threat to the health security and scientists and labs all over the world are fighting against time to develop methods to counter drug resistance, and/or develop newer drugs. However, Developing a new drug requires at least 15 years of time and more than a Billion dollar investment, with no guarantee of success. Hence the number of new drugs launched in the past 2 decades is negligible. And it often takes less than 10 years for resistant bacterial strains to emerge after a new drug is launched. So it should be evident how grave a problem drug resistance is.
When we indiscriminately use antibiotics against infections without medical supervision, or discontinue or prolong a drug dose at our own whim, what we unintentionally do is to equip the bacteria to get used to the drug, and evolve mechanisms which enable them to work around it and survive. This is how antibiotic resistance spreads through their abuse. And in fact a major problem is MDR, or multi-drug resistance in bacterial strains, which implies that the bacteria is able to fight the assault from a range of antibiotics and not just one. This makes healthcare very difficult, as no one drug is able to cure an infection. This has been a major reason why we still have no fool-proof weapon against diseases like tuberculosis. And in this context the threat from NDM-1 is even more worrying, as NDM-1-carrying bacteria are resistant even to carbapenems, a group of antibiotics often reserved as a last resort for emergency treatment for multi-drug resistant bugs.
So it is no wonder that our healthcare system should come under the scanner. People are just not aware of the dangers of pill-popping. And is it really their fault? Whose job is it to make them aware? Who is responsible? The obvious answer which pops up is the usual scape-goat - our Government. Well yes, of course the Government has a major stake in this responsibility. But I feel the real culprits in this scenario are our esteemed doctors. This I say from my own experience, which has been restricted to the government healthcare centers like CGHS dispensaries, AIIMS and Safdurjung Hospitals. Doctors I have encountered, are just not bothered to explain to the patient what is his/her condition, what is the cause, what is the course of treatment and more importantly its basis, and the need to follow the proper dosage. They are more than content to perform a quick diagnosis, and write a prescription and inform the dose to be taken. Questions are not welcome!! Being from the science field, when I do ask questions pertaining to the illness or the medicine, the docs are just taken aback!! They don't expect you to question them, and most don't take to it kindly. It is just assumed that the patient, or common man, is not going to understand the medical details and need not be bothered. Some don't even tell you what the disease is! People too are more often than not just content to receive their prescription and walk away. This mutual understanding between the lazy doctor and the blissfully ignorant patient has proved to be a fertile ground for drug abuse. But then again, the number of patients these doctors in Govt. hospitals are forced to cater to per day is so huge that one can't really blame them for not having the patience to counsel each patient.
One can only hope that this study, which just now I read in the newspaper, has received the backing of WHO, may be a blessing in disguise, and more debates like the one on NDTV the other day, may be a small step in creating awareness about this major threat to our society's health. If it saves lives, I don't mind the bug being named after New Delhi. And just to make it clear, its the gene/enzyme responsible for conferring the resistance in bacteria that has been named NDM-1, not a bacteria per se, as most of the Indian media seems to think. :-P
ye itna bada hai... :P dint read it :P but wil do it smtime soon ;)
ReplyDeletesach mein lamba tha.. :) but read it. i dint know abt it...
ReplyDeletend.. no1 knows if it originated in india.. mayb source is sm oder place v r stil unaware of... just waiting to b uncoverd to know d real danger f d scene.
hehe..... thanks 4 showing ur support Prek, by commenting even without reading the thing!!! :P n I'm surprised u didn't know about it!!!
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