Limited good and limited vision: multidrug-resistant tuberculosis and global health policy

Kim, Jim Yong; Shakow, Aaron; Mate, Kedar; Vanderwarker, Chris; Gupta, Rajesh; Farmer, Paul

doi:10.1016/j.socscimed.2004.08.046

Cited by 47 publications

(17 citation statements)

References 31 publications

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“…The design of NTP retreatment regimens depends on the epidemiological context, the program's performance, and the means available. However, MDR-TB treatment should no longer be a heavily conditioned option; it is a must, for public health, as well as human rights reasons [23]. Extrapolating prudently the results of our study to the rest of the country, a recommendation for the diagnosis and treatment strategy for retreatment patients could presently be formulated as follows: 1.…”

Section: Discussionmentioning

confidence: 99%

Early results of systematic drug susceptibility testing in pulmonary tuberculosis retreatment cases in Cameroon

Noeske¹,

Voelz²,

Fon³

et al. 2012

BMC Res Notes

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BackgroundThe number of pulmonary tuberculosis (PTB) patients reported with resistance to first-line anti-tuberculosis drugs after a standardized retreatment regimen in Cameroon is increasing. Hence, the National Tuberculosis Control Program (NTP) implemented, in one of the ten Regions of the country, a pilot programme aimed at performing routine drug susceptibility testing (DST) for previously treated PTB cases. The objectives of the programme were to evaluate the feasibility of monitoring drug resistance among retreatment cases under programme conditions and to measure the presence and magnitude of anti-TB drug resistance in order to inform NTP policies.FindingsThis retrospective cohort study was conducted in the Littoral Region of Cameroon in 2009. It included all sputum smear positive (SM+) PTB cases registered for retreatment. TB cases were identified and classified according to World Health Organization (WHO) recommendations for national TB programs. Bacterial susceptibility testing to first-line anti-TB drugs was performed using standard culture methods. In 2009, 5,668 TB cases were reported in the Littoral Region, of which 438 (7.7%) were SM + PTB retreatment cases. DST results were available for 216 (49.4%) patients. Twenty six patients (12%) harbored multi-drug resistant (MDR) strains. Positive treatment outcome rates were particularly low in retreatment patients with MDR-TB (46.2%; 95% CI: 27.1-66.3). Thirteen MDR-TB patients were treated using a standardized MDR treatment regimen. Delivery of laboratory results took on average 17 (12-26) weeks.ConclusionsWHO-recommended routine DST in retreatment patients seems feasible in Cameroon. However, coverage needs to be improved through better management. Moreover, diagnostic delay should be shortened by introducing more rapid diagnostic tools. The high risk of MDR in standard regimen failure cases virtually rules out the standard retreatment regimen for such patients without prior DST.

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Section: Discussionmentioning

confidence: 99%

Early results of systematic drug susceptibility testing in pulmonary tuberculosis retreatment cases in Cameroon

Noeske¹,

Voelz²,

Fon³

et al. 2012

BMC Res Notes

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“…Paul Farmer and his collaborators argue that World Health Organization efforts in the 1990s to make first-line antibiotics cheap and short-course chemotherapy for tuberculosis readily available, coupled with World Bank policies aimed at decentralizing health care, created an ecology of sub-optimal short doses of first-line antibiotics. Thus drug resistant tuberculosis proliferated, particularly in nations such as Peru (Kim et al, 2005). The effect of any intervention, in which antibiotics are viewed as specific to certain pathogenic targets, is lateral, potentially multiple and latent; a route by which social management of disease becomes infectively heritable through populations.…”

Section: From Mutation To Horizontal Gene Transfermentioning

confidence: 99%

Antibiotic Resistance and the Biology of History

2016

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Beginning in the 1940s, mass production of antibiotics involved the industrial-scale growth of microorganisms to harvest their metabolic products. Unfortunately, the use of antibiotics selects for resistance at answering scale. The turn to the study of antibiotic resistance in microbiology and medicine is examined, focusing on the realization that individual therapies targeted at single pathogens in individual bodies are environmental events affecting bacterial evolution far beyond bodies. In turning to biological manifestations of antibiotic use, sciences fathom material outcomes of their own previous concepts. Archival work with stored soil and clinical samples produces a record described here as ‘the biology of history’: the physical registration of human history in bacterial life. This account thus foregrounds the importance of understanding both the materiality of history and the historicity of matter in theories and concepts of life today.

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“…If prices are used instead of costs in a cost-effectiveness analysis, the analysis may not lead to the socially efficient outcome ( Jena and Philipson, 2010; Basu and Philipson, 2010). Indeed, in the case of multiple drug-resistant tuberculosis treatments in developing countries, global health leaders were able to negotiate the price of drugs down by as much as 90 percent, suggesting that many cost-effectiveness ratios using prices should be viewed as opening bids in a process of price negotiation (Kim et al, 2005). …”

Section: Towards the Gold Standard: Adding Costs To Effectiveness Anamentioning

confidence: 99%

The Pragmatist's Guide to Comparative Effectiveness Research

Chandra

Jena

Skinner

2011

Journal of Economic Perspectives

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Following an acrimonious healthcare reform debate involving charges of "death panels," in 2010, Congress explicitly forbade the use of cost-effectiveness analysis in government programs of the Patient Protection and Affordable Care Act. In this context, comparative effectiveness research emerged as an alternative strategy to understand better what works in health care. Put simply, comparative effectiveness research compares the efficacy of two or more diagnostic tests, treatments, or health care delivery methods without any explicit consideration of costs . To economists, the omission of costs from an assessment might seem nonsensical, but we argue that comparative effectiveness research still holds promise. First, it sidesteps one problem facing cost-effectiveness analysis—the widespread political resistance to the idea of using prices in health care. Second, there is little or no evidence on comparative effectiveness for a vast array of treatments: for example, we don't know whether proton-beam therapy, a very expensive treatment for prostate cancer (which requires building a cyclotron and a facility the size of a football field) offers any advantage over conventional approaches. Most drug studies compare new drugs to placebos, rather than "head-to-head" with other drugs on the market, leaving a vacuum as to which drug works best. Finally, the comparative effectiveness research can prove a useful first step even in the absence of cost information if it provides key estimates of treatment effects. After all, such effects are typically expensive to determine and require years or even decades of data. Costs are much easier to measure, and can be appended at a later date as financial Armageddon draws closer.

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Limited good and limited vision: multidrug-resistant tuberculosis and global health policy

Cited by 47 publications

References 31 publications

Early results of systematic drug susceptibility testing in pulmonary tuberculosis retreatment cases in Cameroon

Early results of systematic drug susceptibility testing in pulmonary tuberculosis retreatment cases in Cameroon

Antibiotic Resistance and the Biology of History

The Pragmatist's Guide to Comparative Effectiveness Research

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