Friday, April 08, 2011

The NDM Virus controversy is back!

The recent controversy over the NDM-1 bacterium a.k.a "superbug" is important - any drug-resistant infection needs to be stamped out, wherever in the world it occurs. So while I am not suggesting that the findings of the researchers are wrong, I am suggesting that the focus on New Delhi and India almost exclusively is as a result of a deep game played by Big Pharma.
Naming the bacterium after New Delhi and conducting follow-up surveys, taking samples surreptitiously from the Indian sub-continent, and warning the rest of the world about this "superbug" from India is an insidious game being played by Big Pharma to detract attention from the fact that the same bacterium was discovered being repeatedly introduced into the UK from the US and 3 other European countries, before it was discovered in a Swedish patient transiting India en route to the UK. Given below is this story, which no  newspaper has so far written about. More ...

It all began with an article in The Lancet published in August, 2010 (requires free registration to access) that first christened the NDM-1 bacterium as such. The article had this last paragraph, apparently written blithely and off-the-cuff, and has nothing whatsoever to commend it scientifically.
"Several of the UK source patients had undergone elective, including cosmetic, surgery while visiting India or Pakistan. India also provides cosmetic surgery for other Europeans and Americans, and blaNDM-1 will likely spread worldwide. It is disturbing, in context, to read calls in the popular press for UK patients to opt for corrective surgery in India with the aim of saving the NHS money. As our data show, such a proposal might ultimately cost the NHS substantially more than the short-term saving and we would strongly advise against such proposals. The potential for wider international spread of producers and for NDM-1-encoding plasmids to become endemic worldwide, are clear and frightening."
The authors of this article, all in the service of the NHS, were apparently  stung by this article published in The Independent, that suggested that NHS "could save millions" by flying patients for treatment to IndiaWhat is totally beyond me is how can such obvious personal biases be allowed to creep in into articles that are published after being scientifically peer-reviewed in a journal that many think is the holy grail of medical science?
There is a Health Protection Report put out by the UK's Health Protection Agency  which contains something that indicts other European countries and the UK's close friend, the US, as the source of the same health risks. Consider this extract from that Report: 
"Laboratories should be especially alert to carbapenem-resistant isolates from patients with a history of hospitalization in countries where carbapenemase-producing Enterobacteriaceae are prevalent - particularly Greece, Turkey, Israel and the USA, as these have been a repeated source of introduction to the UK."
Reading the above leads one to muse that the bacterium better deserves the moniker, USAM-1 bacterium than its current name. 
Surprisingly, the same HPA issued another National Health Alert a bit later in which it refers to its earlier (30 Jan 2009) report and quotes it thus: "that many producer isolates were from patients previously hospitalised in Greece, Turkey and Israel." The mention of USA as a source of repeated introduction into the UK has been quietly edited out in the more recent National Health Alert. 
What's worse, queries of the public are directed to one Dr David M Livermore who is also a co-author of the September 2010 article in the Lancet cited above. Despite his otherwise sterling reputation, he is apparently compromised by severe conflicts of interest: He admittedly "has received conference support from numerous pharmaceutical companies, and also holds shares in AstraZeneca, Merck, Pfizer, Dechra, and GlaxoSmithKline, and, as Enduring Attorney, manages further holdings in GlaxoSmithKline and Eco Animal Health.
Now that controversy has been resurrected by publishing the results of a study involving surreptitiously acquired water samples from various places in New Delhi, widely reported in the Press and Television all over the world. This article starts with this paragraph: 
Not all patients infected with NDM-1-positive bacteria have a history of hospital admission in India, and extended-spectrum β-lactamases are known to be circulating in the Indian community. We therefore measured the prevalence of the NDM-1 gene in drinking water and seepage samples in New Delhi.   
It is time that India demands that they carry out such a study in Greece, Turkey, Israel and USA, which the UK's HPA has stated to be "a repeated source of introduction to the UK" of the bacterium. Especially because the article concludes, "International surveillance of resistance, incorporating environmental sampling as well as examination of clinical isolates, needs to be established as a priority."
Let us see whether they will try to collect sewage and water supply samples from New York surreptitiously and publish the results similarly.

PS: I had blogged on this point on August 22,2010, with a post titled, The New Delhi bacteria should have been named the USA bacteria

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