The Hindu new year has started and so is the new enthusiasm to work harder for Tuberculosis.
The recent 42nd meet on Tuberculosis at the Union at Lille, France,was a great one, which started with the discussions on the problems faced by the children's, then proceeding ahead with the vaccine, diagnostics, funding, poor countries, and so on.With the Seven Billionth Baby born, and with the recent prediction that the population on earth we will be 9 billion by 2050, our responsibility to protect the coming generations from neglected communicable disease increases.
The thing which really hurts is that Tuberculosis has been a threat to many innocent people, it lays its icy hands on them and people don't come to know about it unless they are in the later stages of the infection. In a country like India the burden is extremely high, so does the responsibility of finding a cure for the disease. (I feel myself proud to be a part of the OSDD community who has been working round the clock for finding a affordable cure.)
After reading so much about tuberculosis, attending conferences, meeting and talking to different people, I have realized is that its very important to look at the disease with a different prospective. Tuberculosis affects all age groups of people, both the sexes, and round the year. However, the effects which are seen differ and shows lots of variation symptomatically. Children's have low immunity power, hence they fall prey to this disease and life expectancy is hardly for few years then if not diagnosed earlier. In adults the power to resist the bacterial infection is more. Genital tb affects the pregnancy in women and causes problems in them to conceive. HIV infection greatly increases the risk of getting a Mycobacterium tuberculosis infection. The statistical figures shows that most of the TB cases are to the one who has been infected with HIV. Thus, the disease can affect a person in numerous ways and so does the symptoms, diagnostics, life expectancy variates accordingly.
Then why shouldn't the drug discovery and development process should be carried keeping in mind the above prospectives? The problem which we are well aware of is that rifampicin/isoniazids is administered for over 40 years now for all the above cases. The toxicity of the drugs is killing many kids around the world, because there is no specific drug guideline for them. Women face lots of hormonal disturbances due to these medicines. The treatment time is undefined for each of the specific types. Hence, there is lot of scope for the researchers to improve the way of the drug research. Using a multi pronged approach may give us a molecule for any of the types, which can be then improved and developed for other types of the disease.
The other things on TB apart from drug discovery, is that, millions of people in India still remain undiagnosed of TB. Over 70% of population lives in over six hundred thousand villages, of which many till today do not have electricity, roads, proper living conditions and shelter, the disease is not possible to get diagnosed. Hence the figures keeps on increasing year by year in the conferences and we are unable to do anything. If a change has to be brought our way of working on TB should change. Awareness on TB is very poor amongst population in many countries, hence, special emphasis should be there to raise awareness between them. Vaccine development is also a brighter side, as we can protect the future generations from TB. Funding is required most urgently now, and the the funds should flow appropriately to all the discussed domains to see a substantial change in the number of TB cases.Overall, an integrated approach is the answer to eradicate tuberculosis from planet Earth :)
The thing which really hurts is that Tuberculosis has been a threat to many innocent people, it lays its icy hands on them and people don't come to know about it unless they are in the later stages of the infection. In a country like India the burden is extremely high, so does the responsibility of finding a cure for the disease. (I feel myself proud to be a part of the OSDD community who has been working round the clock for finding a affordable cure.)
After reading so much about tuberculosis, attending conferences, meeting and talking to different people, I have realized is that its very important to look at the disease with a different prospective. Tuberculosis affects all age groups of people, both the sexes, and round the year. However, the effects which are seen differ and shows lots of variation symptomatically. Children's have low immunity power, hence they fall prey to this disease and life expectancy is hardly for few years then if not diagnosed earlier. In adults the power to resist the bacterial infection is more. Genital tb affects the pregnancy in women and causes problems in them to conceive. HIV infection greatly increases the risk of getting a Mycobacterium tuberculosis infection. The statistical figures shows that most of the TB cases are to the one who has been infected with HIV. Thus, the disease can affect a person in numerous ways and so does the symptoms, diagnostics, life expectancy variates accordingly.
Then why shouldn't the drug discovery and development process should be carried keeping in mind the above prospectives? The problem which we are well aware of is that rifampicin/isoniazids is administered for over 40 years now for all the above cases. The toxicity of the drugs is killing many kids around the world, because there is no specific drug guideline for them. Women face lots of hormonal disturbances due to these medicines. The treatment time is undefined for each of the specific types. Hence, there is lot of scope for the researchers to improve the way of the drug research. Using a multi pronged approach may give us a molecule for any of the types, which can be then improved and developed for other types of the disease.
The other things on TB apart from drug discovery, is that, millions of people in India still remain undiagnosed of TB. Over 70% of population lives in over six hundred thousand villages, of which many till today do not have electricity, roads, proper living conditions and shelter, the disease is not possible to get diagnosed. Hence the figures keeps on increasing year by year in the conferences and we are unable to do anything. If a change has to be brought our way of working on TB should change. Awareness on TB is very poor amongst population in many countries, hence, special emphasis should be there to raise awareness between them. Vaccine development is also a brighter side, as we can protect the future generations from TB. Funding is required most urgently now, and the the funds should flow appropriately to all the discussed domains to see a substantial change in the number of TB cases.Overall, an integrated approach is the answer to eradicate tuberculosis from planet Earth :)
Thanks :)
Dear Pushpdeep,
ReplyDeleteWell you have mentioned about some of the cons that make the TB an incurable desease as of today. But I would like to put to your notice the other aspects besides the "research".
1) Timely diagnosis of TB (u have already mentioned). We just do not have the resources to cater to the needs of all the patients. And I do not see a change in this for the coming decade and I can tell you that this is not because of the research not being done. It is because of pure under management of the authority and no well defined plan. (I guess the government cant help either if the population is too high).
2) The existing drugs(provided as DOTS) though good for the initial treatment of TB but surrender against MDRs and XDRs. I can think of two reasons behind this:
- The drugs do not reach the patients. The delivery system is so poor that many of the patients do not even know that there is a therapy for TB.
- Discontinuation of the treatment. This is the major reason for the development of MDRs and XDRs. When patients start their medication they feel better in a few months and think that they are cured. But that is far from the truth. the bacteria goes into latency and tries to survive and when we stop the treatment it reemerges as the bad ass TB.
3) An off shoot of the above reasons is the wrong diagnosis of the disease. If you go for a check up, there is high chance that there would mycobacterial colonies in you. But we need to be sure that they are infecting you and then prescribe accordingly. This is something like being HIV+ but not having AIDS as yet. If not, you might be given treatment even if you do not need one. (Hence loss of resources and may cause toxicity)
In conclusion, although finding new drugs and drug targets are important in any treatment of disease, it is nonetheless important to manage the existing resources to be used up to there fullest potential.
Anurag, you have very clearly mentioned the drawbacks of the current system. I empathize with you that we first need to utilize the full penitential of the current facilities. Corruption is one of the key reasons that India is number one on TB map. The Big Question still lies.. ow do we save the hundreds of who are dying daily. by the time you and me come out with a drug, may be the numbers will be doubled or tripled. we are making promises to save the future generation.. the main worry lies, in how to save the people who are dying right now with each ticking second.
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