The Medical Debate Over Speaker's TB Flight

Andrew Speaker set off a firestorm this week after choosing to fly back to North America from Europe despite the fact that the CDC told him he had the most virulent form of tuberculosis, called extremely drug-resistant TB.

The incident raises questions about his case and emergency preparedness. How contagious was Speaker? And are health authorities truly prepared to deal with this dangerous, and possibly deadly, form of TB as it travels the world?

"People talk about how could I put all those people on the plane at risk," Speaker told ABC's Diane Sawyer in an exclusive interview. "I repeatedly asked doctors, 'Is my family at risk' ... I was told I wasn't contagious, not dangerous."

Dr. Neil Schluger specializes in tuberculosis at Columbia Medical Center in New York, and he agreed that Speaker faced quite a dilemma.

"I think we all want to get the best treatment" Schluger said. "I certainly understand his desire to come back and get treated at an excellent hospital like the National Jewish in Denver. It's an understandable thing.

"What he might have been able to do was travel back more safely, get government transportation where fewer people might have been exposed," Schluger added.

Speaker, however, said the CDC wasn't willing to offer that. Federal authorities have said otherwise.

The government has now contacted more than 70 passengers who were on that flight. They are being tested, and so far none show symptoms.

"It seems likely that he's not very contagious," Schluger said. "His wife apparently has not been infected with tuberculosis and presumably she's had close contact with him for an extended period of time. ... Secondly, when he coughs up phlegm and it's examined under the microscope, we don't see a lot of TB germs in the phlegm -- and that's also a sign that he's probably not very infectious."

TB is relatively rare in the United States. There about 13,000 cases a year.

Doctors say this case has put a new spotlight on the disease, which is still a killer around the world. Globally, eight million people are infected, and two million will die from it this year.

Moreover, 450,000 have a drug-resistant form, and that number is growing. The reason for the increase is patients are failing to take the full course of treatment, especially in the developing world, where authorities aren't equipped to monitor patients.

Speaker suspects he might have contracted the disease doing charity work in Vietnam, showing just how easily it can travel back to the United States.

"The world is a very small place and undoubtedly, there are people with tuberculosis who get on airplanes and go on trains and buses in all corners of the world everyday and we just don't know about it," Schluger said. "And I think it really points out that TB some place is TB every place."

He pointed out that the United States has not developed a new antibiotic for TB in nearly 40 years. He said drug companies make more money from other drugs, but argued with drug-resistant tuberculosis increasing around the world, this is not the time for the government to be complacent.

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