TB

Consumption

noun

1. The using up of a resource.

"industrialized countries should reduce their energy consumption"

synonyms: use, using up, utilization, expending, depletion; More

the eating, drinking, or ingesting of something.

"liquor is sold for consumption off the premises"

synonyms: eating, drinking, ingestion More an amount of something that is used up or ingested.

"a daily consumption of 15 cigarettes"

the purchase and use of goods and services by the public.

"an article for mass consumption"

the reception of information or entertainment, esp. by a mass audience.

"his confidential speech was not meant for public consumption"

2. Dated 

a wasting disease, esp. pulmonary tuberculosis. -Google

... Tuberculosis, once thought to be a disease of the past, now infects more than 8 million people each year?

... New, drug-resistant strains of the disease are emerging faster than ever?

... Passed by a cough or a sneeze, TB is the second leading cause of death from an infectious disease on the planet?

Tonight on FRONTLINE, don't miss the premiere of TB Silent Killer from filmmaker Jezza Neumann -- a special, eye-opening look at the rise of drug-resistant TB through the stories of children and families living at the epicenter of this global health crisis.

Bacteria don't discriminate between the homeless and the affluent; the contagion does not respect neighborhood boundaries. -Sandy Banks, March 8th 2013, L.A. Times

   I live near the Skid Row Area of downtown Los Angeles (roughly defined as being the area  east of Main Street, south of Third Street, west of Alameda Street, and north of Seventh Street). We enjoy a libertarian paradise of sunny days, a carefree happy go lucky lifestyle, colorful inhabitants, lively conversation, dynamic architectural structures utilizing the latest in cardboard technology, a vigorous evangelical community, abundant culinary dispensaries, unique security resources provided by the Los Angeles Police Department, 24 hour siesta breaks, vast entrepreneurial opportunities (drug dealing, panhandling, aluminum can collection, etc.) peer fellowship, and a virtual panoply of other fun and uplifting activities that are peculiar to the area. 

   We even have our own special disease, Skids Duc Tuberculum, or Skid Row Tuberculosis translated from the Latin.

   Some call it the “Skid Row Strain” (Did it come from outer space like the Andromeda Strain? No).

   Early last year public health officials swooped into the skid row area trying to contain this outbreak (speaking of “Outbreak,” the 1995 techno/drama starring Rene Russo, Dustin Hoffman, Kevin Spacey, and the lovely and talented Morgan Freeman... fortunately tuberculosis requires close and prolonged contact with an infected individual in order to acquire the disease (it is transmitted through the air when an infected person coughs, let’s say, or sneezes, or even laughs too hard and too close), and is not as infectious as the  Motaba strain depicted in the film, and will not require the use of a  fuel-air (thermobaric) bomb in order to eradicate the disease... unless federal, and state officials decided that course of action could answer the problem of homelessness in L.A. as well, killing two birds with one stone, so to speak. We’re still here though, thank Zeus), and not just your average public health officials. Some of these guys came all the way from the Centers for Disease Control and Prevention, which is based in Atlanta, Georgia (I don’t know why). 

   These officials say that since 2007, 11 people have died due to this outbreak, so it’s been here awhile. 78 confirmed cases have been reported and documented, 60 of these from the general homeless population. 

   Scientists linked the outbreak to a strain of tuberculosis that is unique to Los Angeles, with a few isolated cases outside the area (a single case was found in Glendale last November).

   "This is the largest outbreak in a decade," said Jonathan Fielding, director of the Los Angeles County Department of Public Health. "We are really putting all of our resources into this."

   The L.A. Times reported “Health workers have identified about 4,650 people who were probably exposed and are trying to track them down for testing and treatment. Local and federal officials are particularly concerned because the cases are linked to one relatively small geographic area and one vulnerable population. But officials are concerned that the outbreak could spread beyond skid row if action isn't taken.” Anna Gorman and Andrew Blankstein, February 21st, 2013.

   But on March 6th we were assured by Los Angeles County Public Health representative Kristin Mundy, "The general public is not at risk. There is no danger to the general public."

   Tuberculosis is an infectious disease. It’s been an infectious disease for a long time, as long as I can remember at least. I don’t see how anyone could have made that statement, that assurance, with any degree of accuracy. Unless you mean by “general public” anyone who doesn’t reside on skid row. 

   But still, skid row does, or did not exist in isolation. There was no quarantine. People were free to come and go as they pleased. People who worked in the skid row area but did not live there could have been infected and spread the disease. 

   Fortunately that didn’t turn out to be the case. 

   So why did this happen in skid row (other than the conservative notion that God hates the homeless)?

   Well it could be that there are a lot of people here who are more or less concentrated into a small area, making possible infection rather easy. Life on the street for up to 5,000 people at any given time might not be as sanitary as one would like. Some folks, might be HIV positive, a higher concentration than the public at large, whose immune systems may have been compromised, making it that much easier to become infected with TB. Tuberculosis is also linked to malnutrition (which also weakens the immune system), and thus linked to poverty, yet unless some are physically unable to move around, which would be rare in skid row, people here are normally well fed, considering the number of various social service outlets that provide food on a daily, or semi-daily basis. 

   You’ll never starve in skid row (similarly with clothes. The general public often brings bags and boxes of clothing to skid row to distribute to those who live on the streets. One need never walk around naked on skid row, though many do).

   As I write this my refrigerator is chalk full of lovely split pea something with little bits of ham in it, and lots of salad, all free and courtesy of the Hippie Kitchen.

   I’m going to have some later tonight as a matter of fact.

   Maybe tomorrow too.

   “It’s a well-defined population and a relatively small geographic area with a difficult population to work with, so we’re putting a concentrated effort into making sure these individuals who are already vulnerable are getting attention,” remarks Dr. Fielding. 

   Concern about tuberculosis has been in the community long before the 2007 through 2013 outbreak. I remember being tested for it upon entering the Harbor Light facility back in December of 2001, as were all potential clients, with an emphasis placed on those working with food.

   Fortunately I didn’t have it, even though I cough a great deal (I’m allergic to smog and other people). 

   "There's a good deal of people out here who don't care whether they get [a TB test] or not and there's people who do care but take their time about caring, like putting off their doctor's appointment for later," says Fred Christopher (actual homeless person).

   Back in 2013, those public health officials issued an alert to doctors at emergency rooms, clinics and urgent care centers informing them about the investigation. Specific emphasis was placed on 300 high-risk individuals, who may have had prolonged exposure to the strain during their stay at a local homeless shelter.   

   The health department also issued new guidelines for shelters on how to screen and identify patients at risk of tuberculosis. They were urged to have dedicated staff members on the look out for clients with persistent coughs... like me.

   County officials also suggested that employees and volunteers be screened as well.

   Thankfully, that particular strain of tuberculosis was susceptible to drugs (some are not). If diagnosed in its early stages, a six to nine month regiment of antibiotics would cure the disease. 

   Apparently their strategy worked. There have been no new stories about TB outbreaks in skid row since March of last year, and no news of that outbreak significantly spreading beyond it’s boarders. 

   Good.

   However, in 2007, there were an estimated 13.7 million active cases of  chronic mycobacterium tuberculosis (MTB) globally, while in 2010, there were an estimated 8.8 million new cases and 1.5 million associated deaths, mostly occurring in developing countries. A disease that in 1987, the American Medical Association’s Advisory Council for the Elimination of TB projected that by 2010 would become extinct worldwide, like smallpox. Currently one third of the world's population is thought to have been infected, with new infections occurring in about 1% of the population each year. Why? New strains of the bacteria that causes tuberculosis have developed antibiotic resistance to treatment.

   The good news, the absolute number of tuberculosis cases has been decreasing since 2006, and new cases have decreased since 2002.

   Of course rates of the spread of TB vary across the planet. Stunningly, about 80% of those tested in Asian and African countries test positive in tuberculin exams, compared to 5 to 10% here in the U.S. The reason for the disparity? There are many countries in Asia and Africa that are poor compared to the United States, and developing, displaying many of the same disease prone circumstances that exist in L.A.s skid row... crowded conditions, prevalence of HIV infected individuals, true instances of malnutrition, and unsanitary conditions (and scarcity, or contamination of water. Derek Markham writes for Care2, “Almost 3 ½ million people die every year because of water and sanitation and hygiene-related causes, and almost all of them (99 percent) are in the developing world. That’s like the population of a city the size of Los Angeles being wiped out each year.” And, “More than 1 billion people still practice open defecation every day... which can not only pollute the immediate area, but can also contaminate community water supplies. Sanitation and clean water go hand in hand.”).

   Some of the infected develop active tuberculosis soon after becoming infected, before their immune system can fight off the bacteria. Other’s may get sick much later, when their immune system becomes weak for some other reason or reasons.

   Babies and young children often have weak immune systems. Others with any of these conditions: substance abuse; diabetes mellitus; silicosis; cancer of the head or neck; leukemia or Hodgkin's disease; severe kidney disease; low body weight; certain medical treatments such as corticosteroid treatment or organ transplants (which typically require the use of immunosuppressants to facilitate organ acceptance); specialized treatment for rheumatoid arthritis, or Crohn's disease are susceptible. 

   Where did this disease come from? Funny you should ask.

   The Mycobacterium tuberculosis complex evolved in Africa and most probably in the Horn of Africa (a peninsula in Northeast Africa that juts hundreds of kilometers into the Arabian Sea and lies along the southern side of the Gulf of Aden. It is the easternmost projection of the African continent), approximately 40,000 years ago.

   Human bones from the Near East dating back five thousand years show the telltale signs of TB. Mummies from Egypt 2400 BCE (Before the Common/Current/Christian Era (a regional alternative to Before Christ, abbreviated BC) show tubercular decay in their spines. The ancient Greeks described it, too. Around 460 BCE, Hippocrates identified phthisis, or consumption, as the most widespread disease of his age. It was almost always fatal then and because of that, he advised his followers and students against treating the disease in it’s late stages, not for fear of contamination, but to avoid damage to their reputations as healers.

   The English physician and author of “A New Theory of Consumption (1720),” Benjamin Martin,  thought that TB resulted from the actions of “wonderfully minute living creatures.” Once those creatures established themselves in the body, Martin hypothesized, they would generate the characteristic symptoms of tuberculosis. He further theorized about the mode of transmission, that close contact with a infected patient, including frequent conversation so close as to “draw in part of the breath he emits from the Lungs,” was enough to transmit the disease.

   Despite Dr Martin’s theories, up until the end of our Civil War, 1865, the common thought was that tuberculosis arose spontaneously in susceptible individuals. That year, a French military doctor, Jean-Antoine Villemin, demonstrated that tuberculosis could be passed from humans to cattle, and from cattle to rabbits. That was a big deal, because he demonstrated that the disease was passed from person to person by way of a causative agent, not the wrath of God let’s say, or susceptibility. 

   In 1882, the German physician Robert Koch (no relation to Charles and David... I think),  conclusively demonstrated that a bacterial infection caused TB. Later investigations proved it was transmitted through the air.

    Tuberculosis is one of history’s great killers of people. Although not as aggressive as the bubonic plague, TB has killed more people in history than it has, and other such diseases as leprosy, or HIV. An estimated 1 billion people around the world have been killed by TB in the past two centuries alone, and the fatalities continue (influenza is still the number one killer of humans in history).

   The discovery of penicillin in 1928 was a boon to mankind, and great if you suffered from diseases like syphilis, or other gram-positive bacterial infections, but proved ineffective against TB. 

   Streptomycin, first isolated from the Streptomyces griseus on October 19th, 1943, was the drug  that tuberculosis researchers had been looking for. It combined low toxicity with high inhibitory effects, and on November 20th, 1944, the first critically ill TB patient was treated, with remarkable results (they got better).

   Several anti-TB drugs followed, and they were important because therapy with a single drug soon sparked  tuberculosis resistant strains. Multidrug therapy was used to avoid this difficult  problem.

   And many scientists concluded that like smallpox, which was labeled as being eradicated in 1979, TB would be gone as well, as in the second half of the 20th century rates of tuberculosis infection dropped throughout the developed world.

   But by 1985, for the first time, the number of new cases of TB began to rise. The World Health Organization now calls TB a “fire raging out of control” in developing nations, among the poor, in prisons, on skid rows, and in people with HIV. Worldwide, someone becomes infected with tuberculosis every second. 

   Last Tuesday night I watched “Frontline” on one of my local PBS stations, as I often do. 

   “Frontline,” as you may know, is a public affairs television program that produces and broadcasts in-depth documentaries about various subjects, usually of a social and political nature, originating out of WGBH-TV in Boston, Massachusetts,  and distributed through the PBS network, and is owned by the infamous WGBH Educational Foundation.

   “WGBH is proud to be PBS’s single largest producer of Web and TV content (prime-time and children’s programs). Some of your favorite series — Nova, Masterpiece, Frontline, Antiques Roadshow, Curious George, Arthur, and The Victory Garden, to name a few — are produced here in our Brighton studios.” -WGBH

   The show, entitled “TB, the Silent Killer,” documented a few cases of tuberculosis infection in the tiny (it is no more than 120 miles north to south and 81 miles east to west) south African country of Swaziland, which is currently riddled with an active TB epidemic.

   Michaeleen Doucleff of NPR writes: “Two weeks ago, 12-year-old Nokubheka (picture above)'s mother died from drug-resistant tuberculosis.

   ‘I love singing and dancing to the song,’ Nokubheka says as she marches around in a hot pink skirt and sweatshirt. ‘When I'm dancing, I forget that my mother passed away.’

   Now the young girl from Swaziland has learned she has the same disease.

   Nokubheka will have to take painful injections for months to stop the infection. She'll have to move away from her family to a hospital. And she'll miss two years of school.

   The world has a new epidemic on its hands, and it's insidiously veiled as an old one.”

   I strongly suggest you follow the above link and watch this thought provoking, painful, and yet hopeful program.

   "The multidrug regimen that was developed not long after the discovery of streptomycin is effective if it is taken continually, in regular doses, for 6–8 months, and therein lies the problem. For various reasons, many patients are noncompliant. Some stop taking the drugs when they feel better—a common problem with antibiotics. Others stop because of the cost or inconvenience or because they distrust the medical establishment."

   Particularly troubling is the link between TB and HIV which have formed a new and deadly combination. The World Health Organization estimates that HIV produces 1.4 million cases of TB each year that otherwise would not appear.

   “It’s a classic story of artificial selection. The initial doses of the antibiotics kill off the susceptible microbes, leaving the resistant ones to reinfect the consumptive. It is estimated that more than half of the isolates from relapsed TB cases are resistant to at least one drug. It takes three years on average to develop a new antibiotic; it takes three months to develop a resistant bug." -Christopher S. W. Koehler 

   Our conservative friends at times rally against science when it suits them, when their perceived economic interests seem to be threatened. Prodded on by the Republican Noise Machine (media) much of the American population disclaim the fact of evolution, climate change, and cosmic history, as matters that are unsettled and very much up for debate. They are misguided. 

   We face many problems and difficulties that urgently need to be addressed. Every generation, it seems, face their own set of unique concerns that are of paramount importance to that generation. Ours happen to be a warming planet, over fishing, changing water resources, ocean acidification, deforestation, and treatment resistant diseases, and they are just some of the problems that we  face.  

   The admission that some of these issues even exist threaten certain economic concerns, so it is in their vested interest to deny that they exist, and spend whatever it takes to muster up support for their position. The oil and gas industry finances climate change deniers, and the groups they belong to. They claim a false parity with the established science which has warned us of these dangers. Is this a responsible position to take? Hardly.

   The promise of short term economic gain trumping long term environmental concerns sadly fuels powerful interests that choose not to care that their own descendents will have to live with the consequences of their actions... or they live in a fantasy world of their own creation in which they actually, and truly believe the same lies they tell others, which makes them delusional. Delusional to such a degree that they are a danger to themselves and the rest of humanity. 

   Like the hosts of “Fox and Friends.”

   In any case (unless you happen to be a Christian Scientist, who are free to chose their own fate), if we are to meet the threat of the spread of antibiotic resistant diseases head on, which we will need to do, we have a tool. An advantage over the viruses and bacteria that have always plagued mankind. 

   We have science, and the medical breakthroughs that science has provided and will continue to provide. 

   If it makes some feel better we can state the matter like this: science is God’s gift to us to help us solve the problems that Satan throws our way from time to time because he’s Satan, and that’s 

what he does (Bill Maher recently pointed out on his HBO program, “Real Time with Bill Maher,” that it is at times best to frame an issue in such a way that the majority of citizens may be amenable towards acceptance of it who otherwise would be disinclined to consider the issue. For example: instead of advocating for the harvesting of solar energy, we should say “Let’s just steal the Sun’s oil”).

   It is disingenuous to hold the position that science is okay, that it works in certain aspects, for certain problems and not for others when it’s inconvienent 

   Science is, and always will be our best bet to deal with these difficult problems that we always seem to face. 

   Yes, maybe science has caused some of these problems, like the Industrial Revolution leading to climate change, or the invention of the atomic bomb leading to nuclear proliferation.  

   But science can get us out of these difficulties too.

   If we use it.