TB Disparities & Discrepancies

A couple observations/questions about this ongoing saga of TB Andrew. 1) He's now in Denver, under confinement, and recent reports peg his treatment at 18 months with a cost of $500,000. Evidently his HMO - Kaiser Permanente - is footing the bill. I'm a bit mystified as to how they're arriving at these costs and duration, given that the WHO's STOP TB program is working in countries dealing with not one case, but dozens of cases of XDR TB. Surely the WHO isn't paying/can't afford to pay half-a-million dollars for each case of XDR-TB that shows up worldwide - estimated at nearly 20% of cases in Latvia, for instance, which has many TB cases, compared to the US. Which brings me to...

2) There's clearly a fundamental difference between how the US responds to TB and how it's treated in the rest of the world. As this case is demonstrating, we seem to treat TB like a plague, or rather like a disease whose very appearance is reason for hazmat suits and congressional investigations. In the rest of the world, however, TB is an unfortunately frequent guest, the proverbial one that won't go home. Two million people die of TB a year - but that's not the most stunning stat. It's this: 2 billion people - 1/3 of the world - is infected with the TB bacteria. That's the largely unmentioned (at least in all these reports) part of the disease: there are active cases and latent cases. Most people carry TB without ever knowing it, or betraying symptoms, and they can live their whole lives without developing the disease. But some fraction of those - between 10 and 20% - will develop active TB, and then they are on a dire course. If it's spotted and diagnosed, there are antibiotic treatments (ornery, months-long treatments), but if it's not (and many cases aren't), then these cases spread other cases, and so on.

In fact, the difference between the US and the rest of the world is evident in how the disease is actually defined. In the US, latent cases are defined as TB, and if it's recognized you're a carrier, even if you don't have active TB, you'll get treated (some stories have referred to Andrew Speaker as having 'active TB', though by the description of his non-symptoms, I wonder if he doesn't have latent TB). Globally, it's a different story: latent TB isn't even classified as official disease - the WHO recognizes only active cases, of which there are about 14 million worldwide. Those are the cases it goes after, rather than the all-in US approach. In fact, the CDC's TB program is officially called the Division of Tuberculosis Elimination, meaning eliminating it from the US. The division web page used to be a pretty bureaucratic page that talked about how TB was on the ropes in the US, and mainly a problem of screening foreign visitors. But I just went to that division website, and it's been changed. Now it redirects to this page, and it's all about the case of Andrew Speaker. Funny that.