Andrew Speaker’s T.B.: Just the “Tip of the Iceberg”?
Email"We dodged a bullet," said Rep. Bennie Thompson, who chairs the House Homeland Security Committee. Andrew Speaker, the Atlanta lawyer who’s become the world’s most famous tuberculosis patient, does not appear so far to have made anyone else ill, and, with luck, will ultimately be okay himself. But there was a lot of finger-pointing today, not just on Capitol Hill, but all around the circle of doctors who worry about public health. More, if you haven’t seen it, is HERE. Many of you, posting on our site, say Speaker ought to have been more responsible. Speaker himself, on a phone hookup to a Senate subcommittee: "I was repeatedly told that I was not contagious, not that I was ‘hardly’ contagious, but I was not contagious." Dr. Steven Katkowsky, director of the health department for Fulton County, Ga., which includes Atlanta, insisted they urged Speaker not to leave the country for his wedding in Europe. "Was he ordered not to travel? The answer to that was no. The local health department does not have the authority to prohibit or order somebody not to travel." Julie Gerberding, who heads the Centers for Disease Control and Prevention, may have been in damage-control mode: "We gave the patient the benefit of the doubt, and in retrospect we made a mistake." But enough–"The issue of who’s to blame here is totally beside the point," Dr. Nils Daulaire told us. He’s president of a group called the Global Health Council, and he said the Speaker case is "the tip of the iceberg." Daulaire is one of many–including the World Health Organization–warning that T.B. is spreading in the world’s poorest countries, and mutating in ways that make it resistant to the existing drugs in a doctor’s arsenal. "We’re at real risk if we don’t take aggressive action today of facing, eight or ten years from now, a wave of totally drug resistant T.B.," he said in our interview, "which would take us back to the 19th Century, where this was a dread disease in Europe and the United States and was totally untreatable." Of course, "aggressive action" takes money, and effort, and the people we reached today said it will have to come from governments. Tom Inglesby, of the Center for Biosecurity at the University of Pittsburgh Medical Center, said "the market won’t fix this." "Last year we spent $79 million, total, on T.B. medicines, vaccines and research. That’s the equivalent of a gumball’s worth of medicine per taxpayer." Complex stuff. Thoughts, as always, welcome.
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I’m one of the minority of readers who posted several comments on ABC’s site over the past couple days to the effect that we really needed to wait for the facts to be established, before jumping to conclusions during this medical “fog of war.” The “official” story emanating from the CDC and local health authorities just didn’t ring true to me. If the CDC and local authorities were really as informative, helpful and timely in all of their actions as they claimed, why would Mr. Speaker have run, via Prague and Montreal—especially since his new father-in-law was a senior CDC TB researcher who could have hammered their informed, sensitive and timely point home? It’s turning out now that the CDC was most likely the catalyst for the patient’s dangerous and much-criticized flight to Canada. Patients who receive news like this, delivered as hamfistedly as the CDC apparently delivered it, with as few palatable options as Mr. Speaker apparently was given (i.e., none), are entirely likely to behave unpredictably—especially when they do not have world-class TB researchers in their immediate family.
Posted by: Itzajob | June 6, 2007, 8:10 pm 8:10 pm
Well, I always understood that tuberculosis is a contagious disease. Even if I did not know about this disease and was diagnosed with it I would still research and try and find as much information as I could about this disease because not all doctors are reliable doctors. If the information I research contrasted to what my attending physician told me I would get a second even a third opinion immediately-before I would make any decisions including making a decision before going to work, getting married or even borrowing a cup of sugar from the next door neighbor. Here is a man who is a lawyer who researches cases, who researched cases in law school-to make a clear cut, well thought out decision about anything-importantly ones health-you need to find out as much as you can about the problem-namely in this case-the disease. He should know this. What is particularly disturbing is this man’s father-in-law researches TB and yet supported this infected man in leaving the country? Am I missing something here? Or did I miss the new research on drug resistant TB that announced that TB-drug resistant or not-is now not contagious? I’m not done. Who in the world would allow her husband or husband to be out of the house sick and contagious anyway? Let’s all step back and look at this situation–Because I am sick and tired of hearing this “boy’s” excuses using up important newspace.
Posted by: M Watts | June 6, 2007, 9:54 pm 9:54 pm
The CDC has to make itself look like the experts here, but they clearly are not. Of course they are in “damage control mode.” They didn’t think things through in advance. They hadn’t established workable protocol, so they have been caught in class without having done their homework.
I don’t blame Speaker for his actions. I hope this hysteria subsides quickly and he goes back to leading a normal, happy, TB-free life.
How many people are flying across international borders who don’t live in countries with CDC’s and who have active TB but don’t know it?
Speaker is young, otherwise healthy, and doesn’t have a productive cough, so he’s not shedding TB bacilli. I hope someone at least started him on an INH regimen before he left home (which so far nobody seems to have asked Speaker), but he’s free to travel as far as I’m concerned. And this was probably the reasoning of the CDC docs who originally counseled him.
Now higher branches of the CDC and (heaven forbid) Homeland Security are involved and this thing is spinning faster and faster.
What the CDC need to do is stop pointing fingers and learn from this – establish clear, rational protocol for treating and handling infectious diseases cases. And of course our wonderful government needs to fund more research on controlling drug-resistant TB.
Posted by: James | June 6, 2007, 10:07 pm 10:07 pm
Just a quick comment. IF I am to believe that Andrew Speaker didn’t think he was doing anything wrong by travelling to Europe, then why, on their return from their honeymoon, did they fly into Montreal and then rent a car?
Posted by: dianne | June 7, 2007, 12:49 am 12:49 am
“IF I am to believe that Andrew Speaker didn’t think he was doing anything wrong by travelling to Europe, then why, on their return from their honeymoon, did they fly into Montreal and then rent a car?”
I don’t know, Dianne. Maybe he couldn’t get a flight directly into the US. Or maybe he wanted to drive to Niagara Falls with his new wife. But I don’t think your question is going to shed any new light on this.
And even if he WAS trying to evade authorities, why wouldn’t he? He’d already encountered a federal bureaucracy that had gone on record as being willing to sentence him to die overseas. How else was he going to get home – swim? I don’t know, maybe I’d have done the same thing. Maybe you would have too. What difference does it make?
We’re all in the world and we are all subject to risks every day, many of which we never know about. Let’s not get hysterical about an event that might have occurred but didn’t. So far nobody on any aircraft has popped PPD positive, and they probably won’t because apparently Speaker was not (and is not) spreading TB.
20 years ago everyone was hysterical about AIDS. Today nothing’s changed really – AIDS is still with us, but now nobody talks much about it. We just deal with it and the wheels of science grind on, hopefully toward a cure.
We need to stop fearing for our own individual, worthless lives and get behind research into infectious diseases, especially in other countries where these things evolve and incubate. That takes intelligence, wisdom, money, and political will – most of which our current government administration lacks. They’d rather do damage control and find someone to hang than do the necessary work.
Posted by: James | June 7, 2007, 1:35 am 1:35 am
It seems to me that everyone is being just a little bit disingenuous here: the local health authorities for not having made it clear and unambiguous to Mr. Speaker that he is contagious and should not travel, Mr. Speaker himself for changing his travel plans by leaving several days earlier than planned and then taking a cirsuituous route to return to the US, Mr. Speaker’s father-in-law for not having explained the dangers (which I’m sure he knows quite well) of exposing others to the TB germs, and the CDC which is now in full “damage control” mode, trying to shift all blame to the Canadian Border Patrol guard for his failure to properly detain Mr. Speaker. If nothing else, this case has made many people aware that TB is still a disease to be reckoned with, and that more resources are needed to deal with it.
Posted by: chuck | June 7, 2007, 8:29 am 8:29 am
I guess am not as concerned about him spreading TB as I am where he got it from.
Posted by: Anita Burke | June 7, 2007, 9:07 am 9:07 am
Chuck is right that nobody’s story seems to be adding up. But of all the parties involved, I am most horrified at the actions of the CDC and local Fulton County health authorities. Many of the readers posting comments on ABC’s prior stories have suggested that Mr. Speaker should be disbarred. Maybe it is in fact the CDC doctors who dealt with him ought to lose their professional licenses.
When a medical organization that’s supposed to control public health risks calls up an American patient (who happens to have a world-class TB researcher in the family to advise him) overseas where they knew he would be and apparently tells him his test results finally came back a week before and he’s at serious risk of dying after all, but he can’t come home where they’ve already told him the only hospital that can treat XDR cases is, because they can’t let him fly commercial any more, but neither can they let him use the CDC plane that the Secretary of the Department of Health & Human Services likes to jet around in, so unless he can come up with $100,000+ to charter his own medivac plane, they’re going to have him incarcerated in Rome indefinitely until he dies–and if Mr. Speaker did misinterpret what they told him, don’t you think his father-in-law the TB expert would have cleared that up for him–shouldn’t that medical organization expect that their patient is going to run or otherwise behave unpredictably?
We’ve all heard and experienced horror stories about “doctors from hell” who seem incapable of dealing sensitively with their patients as human beings, doctors who deliver death sentences to patients in bored tones while drumming their fingers because they’re late for their golf game. This is how our medical schools teach many of our doctors to behave, and it seems that the ones who learned those lessons best all wound up in Atlanta. Usually, this kind of behavior only hurts the patient and his loved ones. When the CDC practices this kind of medicine, it has the ability to pour gasoline on a medical forest fire.
The CDC is fortunate that this patient really didn’t seem to be contagious. They next time they callously and cluelessly drive a dangerously ill patient into a globe-spanning run for his life, they may not be so lucky.
Posted by: itzajob | June 7, 2007, 9:52 am 9:52 am
Right on, Chuck. And, Anita, you bring up a chilling point: What if his father-in-law is dragging TB around with him?
Chuck’s point further illustrates the dysfunctionality of Homeland Security. They have yet to do anything right or as thoroughly as required to guard us from any lunatic who wants to spread whatever mischief he feels like.
Posted by: Andy | June 7, 2007, 9:53 am 9:53 am
Anita, from what I understand in this case, Mr. Speaker did some volunteer work in Vietnam and it was there that he was exposed to the TB strain he now has. Andy, you’re so right about that dysfunctional entity known as DHS. It couldn’t protect us from a swarm of gnats!
Posted by: chuck | June 7, 2007, 11:26 am 11:26 am
Mr. Speaker is like so many Americans,
self centered and self absorbed.
Does he not understand responsibility of citizenship out wieghs his inalienable rights?” Is it any wonder that so many “Islamists” idealize the 16th century and desire us eradicated.
Posted by: Jerry | July 8, 2007, 12:55 pm 12:55 pm
We do not live in a pathogen free world, and Mr. Speaker is not the only carrier of TB! I guess those who are suing Mr. Speaker would prefer that the CDC establish isolated TB colonies- much like leper colonies.
Posted by: Connie | July 14, 2007, 8:01 am 8:01 am