plus 4, Pressure Rises to Stop Antibiotics in Agriculture - ABC News |
- Pressure Rises to Stop Antibiotics in Agriculture - ABC News
- Unhealthy habits are what's killing us - CNN
- 2009 Golf Year In Review - WOAI
- Breast Cancer Surgery Can Sometimes Cause Chronic, Persistent Pain - YAHOO!
- Drug-resistant tuberculosis found in US - KHOU
| Pressure Rises to Stop Antibiotics in Agriculture - ABC News Posted: 28 Dec 2009 11:50 AM PST
The mystery started the day farmer Russ Kremer got between a jealous boar and a sow in heat. The boar gored Kremer in the knee with a razor-sharp tusk. The burly pig farmer shrugged it off, figuring: "You pour the blood out of your boot and go on." But Kremer's red-hot leg ballooned to double its size. A strep infection spread, threatening his life and baffling doctors. Two months of multiple antibiotics did virtually nothing. The answer was flowing in the veins of the boar. The animal had been fed low doses of penicillin, spawning a strain of strep that was resistant to other antibiotics. That drug-resistant germ passed to Kremer. Like Kremer, more and more Americans — many of them living far from barns and pastures — are at risk from the widespread practice of feeding livestock antibiotics. These animals grow faster, but they can also develop drug-resistant infections that are passed on to people. The issue is now gaining attention because of interest from a new White House administration and a flurry of new research tying antibiotic use in animals to drug resistance in people. Researchers say the overuse of antibiotics in humans and animals has led to a plague of drug-resistant infections that killed more than 65,000 people in the U.S. last year — more than prostate and breast cancer combined. And in a nation that used about 35 million pounds of antibiotics last year, 70 percent of the drugs — 28 million pounds — went to pigs, chickens and cows. Worldwide, it's 50 percent. "This is a living breathing problem, it's the big bad wolf and it's knocking at our door," said Dr. Vance Fowler, an infectious disease specialist at Duke University. "It's here. It's arrived." The rise in the use of antibiotics is part of a growing problem of soaring drug resistance worldwide, The Associated Press found in a six-month look at the issue. As a result, killer diseases like malaria, tuberculosis and staph are resurging in new and more deadly forms. In response, the pressure against the use of antibiotics in agriculture is rising. The World Health Organization concluded this year that surging antibiotic resistance is one of the leading threats to human health, and the White House last month said the problem is "urgent." "If we're not careful with antibiotics and the programs to administer them, we're going to be in a post antibiotic era," said Dr. Thomas Frieden, who was tapped to lead the Centers for Disease Control and Prevention this year. Also this year, the three federal agencies tasked with protecting public health — the Food and Drug Administration, CDC and U.S. Department of Agriculture — declared drug-resistant diseases stemming from antibiotic use in animals a "serious emerging concern." And FDA deputy commissioner Dr. Joshua Sharfstein told Congress this summer that farmers need to stop feeding antibiotics to healthy farm animals. Farm groups and pharmaceutical companies argue that drugs keep animals healthy and meat costs low, and have defeated a series of proposed limits on their use. ——————— Five Filters featured article: Chilcot Inquiry. Available tools: PDF Newspaper, Full Text RSS, Term Extraction. |
| Unhealthy habits are what's killing us - CNN Posted: 28 Dec 2009 11:07 AM PST Editor's note: David Frum writes a weekly column for CNN.com. A resident fellow at the American Enterprise Institute, he was special assistant to President George W. Bush in 2001-2. He is the author of six books, including "Comeback: Conservatism That Can Win Again" and the editor of FrumForum. (CNN) -- Health care reform is proceeding toward the president's desk, likely to become law in the new year. Supporters promise the bill will cut costs and extend coverage. But here's the real test: What will the trillion-dollar expense of this bill actually buy? Will it improve America's health? My guess: No. For all the money Americans spend on health care (60 percent more per person than any other advanced country), Americans are not an especially healthy people. Life expectancy at 50 in the U.S. ranks 29th in the world, three years behind world leader Japan, one and a half years behind Canada. Other indicators -- infant mortality, life expectancy at birth -- look even worse. This poor performance is often blamed on the fact that millions of Americans lack health insurance. But as a recent paper for the National Bureau of Economic Research found, the U.S. -- despite its kludgy health insurance system -- does a remarkably good job of extending disease-fighting treatment to all. Authors Samuel Preston and Jessica Ho observe: • The U.S. screens a higher percentage of women for cervical cancer than any other country in a sample of 15 advanced countries. • Americans have the highest survival rates for breast, lung, colon or rectal cancer in a sample of 20 advanced countries. • Compared with Australia, Canada, Denmark, Finland, Sweden and Great Britain, the U.S. had the third-lowest fatality rate for male heart attack victims ages 40-64, the second-lowest for men ages 85-89 and the best for women aged 85-89. • Americans 50 and older with heart disease are more likely to receive medication than similarly aged Europeans. Ditto stroke. Ditto high cholesterol. Cancer and heart disease are not any old ailments. These are the leading causes of death for people 50 and older. So if the U.S. health system does such a good job saving its middle-aged and elderly sick, why do Americans die comparatively young? Answer: because Americans are much more likely to get sick in the first place. And that likelihood owes very little to the health care system and a great deal to the bad choices American individuals make. If you eat too much, exercise too little, drink too much, smoke, take drugs, fail to wear a seat belt or ignore gun safety, there is only so much a doctor or hospital can do for you. And Americans do all those things, more than other people. One-third of Americans are overweight. That one single fact accounts for almost 10 percent of all health care spending. At any given moment, one out of six motorists is unbelted. American children are nine times more likely to be injured in a gun accident than children in other developed countries. If all Americans quit smoking, if everybody wore a seat belt, if gun owners consistently secured their weapons, if we all drank in moderation and abjured illegal drugs and if the one-third of the country that is overweight would drop the extra pounds, those individual actions would do more to improve health and extend lives than any contemplated by Congress or the president. Acting on this information won't be easy: It violates too many taboos. Americans understandably treasure their right to make their own choices, including the choice to super-size it. And many are uncomfortably aware that self-destructive behavior is most often found among the poor and among minorities: Black women are more than three times as likely as white women to be severely obese. In the near term, public policy can achieve only a limited impact against these problems. There is evidence that youth obesity can be reduced by zoning rules that forbid fast-food restaurants to be sited within 200 yards of a school. More and better gym classes, better cafeteria menus and a ban on soda in schools would all help too. Over the longer term, we will have to rethink the deeper structure of American food policy: subsidies to corn and soybean growers, the paving over of exurban land that might provide nearby cities with less expensive fruits and vegetables. Ultimately, though, these are decisions that individuals must make for themselves. In this respect, the present concept of medicalized health care sends some unwelcome messages. By "outsourcing" the concept of health as something that doctors, hospitals and now government do for you -- rather than something that depends considerably on your own choices and efforts -- we ask the medical system to do more than any medical system can do. As you consider your new year's resolutions, remember: better habits will benefit not only your family and yourself -- but all your neighbors and countrymen as well. The opinions expressed in this commentary are solely those of David Frum. Five Filters featured article: Chilcot Inquiry. Available tools: PDF Newspaper, Full Text RSS, Term Extraction. |
| 2009 Golf Year In Review - WOAI Posted: 28 Dec 2009 10:53 AM PST This was shaping up to be a pretty interesting season anyway. It got a little more interesting Thanksgiving night.Technically, early Friday morning. Everything changed and it didn't have anything to do with turkey leftovers. A fire hydrant, a tree, a low-impact accident, some snoring and possibly the most important nine-iron shot by a Swede in golf history shook up the normally reserved golf world in a huge way. PLAYER OF THE YEAR - Tiger Woods Runners-up: Jiyai Shin, Phil Mickelson. Michael Sim Woods won last year's U.S. Open in a 91-hole marathon. "That's just Tiger" is what you might have thought. Realizing that he did it on a broken leg, you marvel just a little more at the man. So Woods shut it down for the remainder of the season. As if anyone doubted him, Woods worked hard and made it back for the 2009 WGC-Accenture Match Play Championship. He didn't do great (knocked out in second round), but he showed no side effects of the surgery. About a month later, Woods won for the first time since going under the knife and did it in vintage Tiger style. He stared down his final-round partner, Sean O'Hair, came from behind, birdied the last and won the Arnold Palmer Invitational. That kicked off a consistent summer for Woods. He tied for sixth at both the Masters and U.S. Open, but missed the cut at the British Open. Woods sprinkled in some wins at the Memorial, AT&T National, Buick Open and WGC-Bridgestone Invitational. At the PGA Championship, Woods was bound to make this yet another year with a major. He held the 54-hole lead and considering he was 14-for-14 with a piece of the third-round lead in majors, the Wanamaker Trophy was destined for Woods' mantle. Funny thing happened. Little-known Y.E. Yang tamed the Tiger on Sunday at Hazeltine. Yang toppled Woods on the back nine of a major championship and sealed the title with an amazing hybrid approach on the 72nd hole that preserved the championship. Finally humanized, Woods responded. Two weeks later, at the start of the FedEx Cup playoffs, Woods finished second at the Barclays. He tied for 11th at the Deutsche Bank Championship, then won the BMW Championship. That victory allowed Woods to finish second to Mickelson at the Tour Championship, yet still win the season-long FedEx Cup title for the second time. The year obviously turned sour for Woods. His single-car, early-morning accident the day after Thanksgiving led to confirmation on his Web site of marital infidelity. Woods has taken an indefinite leave of absence to work on rebuilding his family and he lost some sponsors for his mistakes. But the on-course Woods was the Tiger of old. The PGA Championship loss was a blip that was inevitable. He was once again the best and did it on healthy legs. When Woods returns is anyone's guess, but when he does, you can probably expect much of the same from Woods. Winning. ROOKIE OF THE YEAR - Jiyai Shin Runner-up: Marc Leishman It's hard to argue with someone who very nearly won the Player of the Year race. Shin lost the official LPGA Tour Player of the Year award to Lorena Ochoa. The Mexican star and world No. 1 took second place at the final tournament to squeak by Shin in the season-long points race. The Sports Network split the honor between the two. Shin also had a great 2008 season with a major victory at the Women's British Open. She had no official status on the LPGA Tour in '08, so she entered this season as a rookie, albeit perhaps the second-best player in the world. She didn't disappoint. Shin won three times, which matched Ochoa's total, and actually won the money title. Granted, Shin played three more times than Ochoa, but money's money. Ochoa had more seconds, Shin had more thirds. Both had eight top-fives and Ochoa's 13 top-10s barely beat Shin's 12. So an argument can be made that Shin had the best year by a female golfer. No matter if you like Shin or Ochoa, you have to love Shin as the best rookie in golf for 2009. TOURNAMENT OF THE YEAR - British Open Championship Runners-up: PGA Championship, Kraft Nabisco Championship Seeing Tiger Woods cough up a major title was, so far, a once-in-a-lifetime thing. So too was this year's British Open Championship. We narrowly missed seeing one of the greatest stories in golf history. Thomas Sturges Watson, the five-time British Open champion, just shy of his 60th birthday, had a very strong first three rounds and found himself atop the leaderboard with one round to go. The year prior, Greg Norman, about six years younger than Watson, was on top with nine holes to go. The Shark lost to Padraig Harrington down the stretch, so when Watson, who looked to be an old 59, was in front, there were few believers. On Sunday at Turnberry, Watson began the day with a one-stroke lead and after a trying round, that's where he found himself on the 18th tee. A par would have made him the oldest major champion. Hell, a par would have made him the oldest PGA Tour winner. Watson hit an eight-iron from the rough and the ball bounced into the deep grass behind the green. The best he could do was knock his ball eight feet short, where a holed putt would have given him his sixth claret jug. Watson barely made contact and the putt wasn't close. Stewart Cink clocked Watson, admittedly quite tired, in the four-hole extra session and won his first major championship. For Watson, it was an amazing week. From an opening-round 65, Watson believed he could win the title and said as much. No one may have believed him, but there he was on the 72nd hole. If he'd have pulled a nine-iron instead of an eight-iron, who knows? It's easy to come up with what-ifs and excuses, but Watson wanted nothing to do with it in the press center afterward. "This ain't a funeral, you know," Watson joked as the press conference was beginning. Watson was actually consoling the media because everyone wanted to see the story completed. Watson couldn't do it, but for a week during the summer of 2009, he almost gave us the greatest story in golf history. STORY OF THE YEAR - Tiger's downfall Runners-up: Tom Watson's British Open run, LPGA Commissioner turmoil Poor Tom Watson. He had this baby wrapped up until the day after Thanksgiving. A little car accident led to huge rumors. Why did Tiger hit a fire hydrant after exiting his own driveway? Where was he going at 2:00 a.m.? What did Elin do, knock him out with the club or free him from the car? There were so many questions and since this is 2009, everyone expected the worst. Turns out they were right. Woods eventually admitted to marital infidelity, but only after mounting accusations, including a woman who came forward with a voicemail from a man who sounded like Woods. Another woman who the National Enquirer identified as a previous Woods dalliance acknowledged, after denials, that she and Woods had been involved. The details aren't important -- we all know them by now -- but Woods took a hit. He is now the subject of late-night monologues, New York Post clever headlines and bad Internet jokes. In the public eye, Tiger Woods lost some of his shine for sure. Hard to say what will happen to Woods going forward. If you believe People magazine, he's going to get divorced. Accenture dropped him. Tag Heuer is lowering his profile. Woods took a leave of absence to work on his marriage. It's anyone's guess when he starts back on the PGA Tour, but when he does, people will be looking at him much differently. GOOD YEAR Bernhard Langer won another Champions Tour Player of the Year award. He captured four tournaments, won the money title and scoring title. He finished fourth in Charles Schwab Cup race and became the fourth player in tour history to win Player of the Year in consecutive seasons. Michael Sim was mentioned as a runner-up for our overall Player of the Year award and that's because he made Nationwide Tour history. He established tour records in single-season earnings with $644,142 won and scoring average with a 68.81. Sim won three times to get to the PGA Tour and was the highest-ranked player in Nationwide Tour history when he got to No. 53 in the world. Michelle Wie was tabbed by Beth Daniel to join the Solheim Cup team and represent her country. Wie had the time of her life, her teammates embraced her and Wie went 3-0-1 as the U.S. won the Solheim Cup. Then, at Lorena Ochoa's event in Mexico, Wie visited the winner's circle for the first time on tour. Phil Mickelson won the Northern Trust Open, WGC-CA Championship, The Tour Championship and the WGC-HSBC Champions event. He anchored a strong U.S. Presidents Cup team and has emerged as the American leader in team competition. BAD YEAR Phil Mickelson may have had success on the course, but at home, it was a different story. His wife Amy was diagnosed with breast cancer in May and he stopped playing to be with her. Not two months later, Mickelson's mother Mary was also diagnosed with breast cancer. Lefty missed the British Open and extended times during the summer to be with his family. Vijay Singh and Sergio Garcia both had horribly disappointing campaigns. Singh was 68th on the tour's money list after early-season knee surgery slowed him all year. He finished with only three top-10s and the last one came Fourth of July weekend. Garcia also had three top-10s in 2009, but didn't have any injuries to use an excuse. Michael Campbell's downward spiral since winning the 2005 U.S. Open might be complete. In 21 starts on the European Tour, Campbell made the cut three times, earned 19,655 euros and finished an embarrassing 249th in the Race to Dubai. And finally, with perhaps the worst year of them all, let's quote Gerard Gallagher: "Dorothy Delasin, a four-time LPGA Tour winner, missed the cut in all 16 events she entered this season and lost her playing status. She tried to get it back during Q-school, but shot a dreadful 61-over 349 to miss the cut in last place." ©2009 Sports Network. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed. Five Filters featured article: Chilcot Inquiry. Available tools: PDF Newspaper, Full Text RSS, Term Extraction. |
| Breast Cancer Surgery Can Sometimes Cause Chronic, Persistent Pain - YAHOO! Posted: 28 Dec 2009 11:57 AM PST
It isn't something that women talk much about, nor does the breast surgeon inquire about it once the patient is several months beyond her breast-surgery date. The fact is, however, a fair number of women experience pain in their breast/chest area following breast surgery. Researchers in Denmark found that 47 percent of the patients who had had either mastectomy without reconstruction or lumpectomy followed by radiation were still reporting pain 2 to 3 years after surgery. Further, the pain was severe in 13 percent of the patients, while 58 percent reported having sensory disturbances and discomfort, such as numbness and tingling. What causes these symptoms? We don't entirely know, but a lumpectomy does leave the nerves in the breast still intact. Radiation can also change sensation in the breasts and can even cause some women problems with their breast swelling due to lymphedema in the breast. What I find especially fascinating, though, are those who have had mastectomy surgery without reconstruction and still report having "breast pain" or "breast sensation." How is this possible? Well, you've heard about phantom-limb sensation, haven't you, where a person loses an arm or leg and still experiences "phantom" feelings or pain in that limb? Some women following mastectomy surgery experience this same phenomenon where their breast had been. I know about phantom pain all too well myself. After my first mastectomy, I awakened from the surgery to find that my breast felt 3 times its normal size and as if it had been hit with a sledgehammer. It even felt like my nipple was clamped in a vice. Of course, all the tissue that was supposed to be causing me pain was technically "gone"--or it was at least sitting quietly in the pathology department. The same thing happened several years later with my second mastectomy. The strangest sensation was when my left nipple continued to itch for more than 2 years after the surgery--until I finally found a spot deep in my armpit that I could scratch to get rid of the annoying sensation. By the way, when I underwent DIEP (deep inferior epigastric perforator) flap reconstruction 10 years later, the phantom-limb sensation stopped completely. So, if you ever experience this strange neurological condition, please don't think you've lost your mind: It does happen. Five Filters featured article: Chilcot Inquiry. Available tools: PDF Newspaper, Full Text RSS, Term Extraction. |
| Drug-resistant tuberculosis found in US - KHOU Posted: 28 Dec 2009 12:33 PM PST
It started with a cough, a cool-season hack that refused to go away. Then came the fevers. They bathed and chilled the skinny frame of Oswaldo Juarez, a 19-year-old Peruvian visiting to study English. His lungs clattered, his chest tightened and he ached with every gasp. During a wheezing fit at 4 a.m., Juarez felt a warm knot rise from his throat. He ran to the bathroom sink and spewed a mouthful of blood. I'm dying, he told himself, "because when you cough blood, it's something really bad." It was really bad, and not just for him. Doctors say Juarez's incessant hack was a sign of what they have both dreaded and expected for years - this country's first case of a contagious, aggressive, especially drug-resistant form of tuberculosis. The Associated Press learned of his case, which until now has not been made public, as part of a six-month look at the soaring global challenge of drug resistance. Juarez's strain - so-called extremely drug-resistant (XXDR) TB - has never before been seen in the United States, according to Dr. David Ashkin, one of the nation's leading experts on tuberculosis. XXDR tuberculosis is so rare that only a handful of other people in the world are thought to have had it. "These are the ones we really fear because I'm not sure how we treat them," Ashkin said. Forty years ago, the world thought it had conquered TB and any number of other diseases through the new wonder drugs: Antibiotics. U.S. Surgeon General William H. Stewart announced it was "time to close the book on infectious diseases and declare the war against pestilence won." Today, all the leading killer infectious diseases on the planet - TB, malaria and HIV among them - are mutating at an alarming rate, hitchhiking their way in and out of countries. The reason: Overuse and misuse of the very drugs that were supposed to have saved us. Just as the drugs were a manmade solution to dangerous illness, the problem with them is also manmade. It is fueled worldwide by everything from counterfeit drugmakers to the unintended consequences of giving drugs to the poor without properly monitoring their treatment. Here is what the AP found: - In Cambodia, scientists have confirmed the emergence of a new drug-resistant form of malaria, threatening the only treatment left to fight a disease that already kills 1 million people a year. - In Africa, new and harder-to-treat strains of HIV are being detected in about 5 percent of new patients. HIV drug resistance rates have shot up to as high as 30 percent worldwide. - In the United States, drug-resistant infections killed more than 65,000 people last year, more than prostate and breast cancer combined. More than 19,000 people died from a staph infection alone that has been eliminated in Norway, where antibiotics are stringently limited. "Drug resistance is starting to be a very big problem. In the past, people stopped worrying about TB, and it came roaring back. We need to make sure that doesn't happen again," said Dr. Thomas Frieden, director of the U.S. Centers for Disease Control and Prevention, who was himself infected with tuberculosis while caring for drug-resistant patients at a New York clinic in the early 1990s. "We are all connected by the air we breathe, and that is why this must be everyone's problem." This April, the World Health Organization sounded alarms by holding its first drug-resistant TB conference in Beijing. The message was clear - the disease already has spread to all continents and is increasing rapidly. Even worse, WHO estimates only 1 percent of resistant patients received appropriate treatment last year. "We have seen a huge upburst in resistance," said CDC epidemiologist Dr. Laurie Hicks. Juarez' strain of TB puzzled doctors. He had never had TB before. Where did he pick it up? Had he passed it on? Could they stop it before it killed him? At first, mainstream doctors tried to treat him. But the disease already had gnawed a golf ball-sized hole into his right lung. TB germs can float in the air for hours, especially in tight places with little sunlight or fresh air. So every time Juarez coughed, sneezed, laughed or talked, he could spread the deadly germs to others. "You feel like you're killing somebody, like you could kill a lot of people. That was the worst part," he said. Tuberculosis is the top single infectious killer of adults worldwide, and it lies dormant in one in three people, according to WHO. Of those, 10 percent will develop active TB, and about 2 million people a year will die from it. Simple TB is simple to treat - as cheap as a $10 course of medication for six to nine months. But if treatment is stopped short, the bacteria fight back and mutate into a tougher strain. It can cost $100,000 a year or more to cure drug-resistant TB, which is described as multi-drug-resistant (MDR), extensively drug-resistant (XDR) and XXDR. There are now about 500,000 cases of MDR tuberculosis a year worldwide. XDR tuberculosis killed 52 of the first 53 people diagnosed with it in South Africa three years ago. Drug-resistant TB is a "time bomb," said Dr. Masae Kawamura, who heads the Francis J. Curry National Tuberculosis Center in San Francisco, "a manmade problem that is costly, deadly, debilitating and the biggest threat to our current TB control strategies." Juarez underwent three months of futile treatment in a Fort Lauderdale hospital. Then, in December 2007, he was sent to A.G. Holley State Hospital, a 60-year-old massive building of brown concrete surrounded by a chain-link fence, just south of West Palm Beach. "They told me my treatment was going to be two years, and I have only one chance at life," Juarez said. "They told me if I went to Peru, I'm probably going to live one month, and then I'm going to die." Holley is the nation's last-standing TB sanitarium, a quarantine hospital that is now managing new and virulent forms of the disease. Tuberculosis has been detected in the spine of a 4,400-year-old Egyptian mummy. In the 1600s, it was known as the great white plague because it turned patients pale. In later centuries, as it ate through bodies, they called it "consumption." By 1850, an estimated 25 percent of Europeans and Americans were dying of tuberculosis, often in isolated sanatoriums like Holley where they were sent for rest and nutrition. Then in 1944 a critically ill TB patient was given a new miracle antibiotic and immediately recovered. New drugs quickly followed. They worked so well that by the 1970s in the United States, it was assumed the disease was a problem of the past. Once public health officials decided TB was gone, the disease was increasingly missed or misdiagnosed. Without public funding, it made a comeback among the poor. Then immigration and travel flourished, breaking down invisible walls that had contained TB. Drug resistance emerged worldwide. Doctors treated TB with the wrong drug combinations. Clinics ran out of drug stocks. And patients cut their treatment short when they felt better, or even shared pills with other family members. There are two ways to get drug resistant TB. Most cases develop from taking medication inappropriately. But it can also be transmitted like simple TB, a cough or a sneeze. In the 1980s, HIV and AIDS brought an even bigger resurgence of TB cases. TB remains the biggest killer of HIV patients today. For decades, drug makers failed to develop new medicines for TB because the profits were not there. With the emergence of resistant TB, several private drug companies have started developing new treatments, but getting an entire regimen on the market could take 24 years. In the meantime, WHO estimates each victim will infect an average of 10 to 15 others annually before they die. A.G. Holley was back in business. Holley's corridors are long and dark, with fluorescent tubes throwing harsh white light on drab walls. One room is filled with hulking machines once used to collapse lungs, sometimes by inserting ping pong balls. Antique cabinets hold metal tools for spreading and removing ribs - all from a time when TB was rampant and the hospital's 500 beds were filled. Only 50 beds are funded today, but those are mostly full. More than half the patients are court-ordered into treatment after refusing to take their meds on the outside. Juarez came voluntarily. In the beginning, he was isolated and forced to wear a mask when he left his room. He could touch his Peruvian family only in pictures taped to the wall. He missed his dad, his siblings, his dog, his parrot, and especially his mother. "I was very depressed," he said. "I had all this stuff in my mind." He spent countless hours alone inside the sterile corner room reserved for patients on extended stays - dubbed "the penthouse" because it is bigger and lined by a wall of windows. His moods ran hot and cold. He punched holes in the walls out of frustration, played loud reggaeton music with a thumping beat and got into fights with other patients. He covered his door's small window with a drawing of an evil clown to keep nurses from peering inside. He made friends with new patients, but was forced to stay long after many of them came, got cured, and left. Early on, Juarez's treatment was similar to chemotherapy. Drugs were pumped into his bloodstream intravenously three times a day, and he choked down another 30 pills, including some that turned his skin a dark shade of brown. He swallowed them with spoonfuls of applesauce, yogurt, sherbet and chocolate pudding, but once they hit his stomach, waves of nausea sometimes sent him heaving. He would then have to force them all down again. "When he first came in we really had to throw everything and the kitchen sink at him," said Ashkin, the hospital's medical director, who experimented on Juarez with high doses of drugs, some not typically used for TB. "It was definitely cutting edge and definitely somewhat risky because it's not like I can go to the textbooks or ... journal articles to find out how to do this." After 17 years of handling complex cases - including TB in the brain and spine - Ashkin had never seen a case so resistant. He believed he would have to remove part of Juarez's lung. Ashkin dialed Peru to talk to the young man's father. It is a rare disease, said Ashkin, hard to define. Your son is one of two people in the world known to have had this strain, he said. "What happened to the other person?" his father asked. "He died." Juarez's adventure in the United States had turned into a medical nightmare. About 60 million people visit the U.S. every year, and most are not screened for TB before arrival. Only refugees and those coming as immigrants are checked. The top category of multidrug-resistant patients in the United States - 82 percent of the cases identified in 2007 - was foreign-born patients, according to the CDC. The results are startling among those tested, said Dr. Angel Contreras, who screens Dominicans seeking to enter the United States on immigrant visas. The high rate of MDR-TB in the Dominican Republic coupled with high HIV rates in neighboring Haiti are a health crisis in the making, he said. "They're perfect ingredients for a disaster," he said. Juarez's homeland, Peru, also is a hotspot for multidrug-resistant TB. DNA fingerprinting linked his disease to similar strains found there and in China, but none with the same level of resistance. "So the question is: Is this a strain that's evolving? That's mutating? That's becoming more and more resistant?" asked Ashkin. "I think the answer is yes." Doctors grappling with these new strains inadvertently give the wrong medicines, and so the TB mutates to become more aggressive and resistant. Poor countries also do not have the resources to determine whether a patient's TB is drug-resistant. That requires sputum culturing and drug-susceptibility testing - timely, expensive processes that must be performed in capable labs. WHO is working to make these methods more available in high-risk countries as well as negotiating cheaper prices for second-line drugs. "There's a lot of MDR and XDR-TB that hasn't been diagnosed in places like South Africa and Peru, Russia, Estonia, Latvia," said Dr. Megan Murray, a tuberculosis expert at Harvard University. "We think it's a big public health threat." Experts argue if wealthy countries do not help the worst-hit places develop comprehensive TB programs, it puts everyone at risk. "You're really looking at a global issue,"' said Dr. Lee Reichman, a TB expert at the New Jersey Medical School Global Tuberculosis Institute. "It's not a foreign problem, you can't keep these TB patients out. It's time people realize that." Juarez spent a year and a half living alone in a room plastered with bikini-clad blondes, baseball caps and a poster of Mount Everest for inspiration. There were days when he simply shut down and refused his meds until his family persuaded him to keep fighting. "I was thinking that maybe if I need to die, then that's what I need to do," he said, perched on his bed in baggy jeans. "I felt like: `I'm never going to get better. I'm never going to get out of here."' When put side by side, his CAT scans from before and after treatment are hard to believe. The dark hole is gone, and only a small white scar tattoos his lung. "They told me the TB is gone, but I know that TB, it doesn't have a cure. It only has a treatment like HIV," he said, his English now fluent and his body weight up 32 pounds from when he first arrived. "The TB can come back. I saw people who came back to the hospital twice and some of them died. So, it's very scary." His treatment cost Florida taxpayers an estimated $500,000, a price tag medical director Ashkin says seems like an astronomical amount to spend on someone who is not an American citizen. But he questions how the world can afford not to treat Juarez and others sick with similar lethal strains. "This is an airborne spread disease ... so when we treat that individual, we're actually treating and protecting all of us," he said. "This is true homeland security." In July, at age 21 - 19 months after checking in - Juarez swallowed his last pills, packed a few small suitcases and wheeled them down the hospital's long corridor.
The last time doctors saw him, he was walking out of the sanitarium into south Florida's soupy heat. Five Filters featured article: Chilcot Inquiry. Available tools: PDF Newspaper, Full Text RSS, Term Extraction. |
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