More Disturbing News About the Speaker TB Case

Revere at Effect Measure addresses a troubling article, published in yesterday’s Atlanta Journal-Constitution, about the Centers for Disease Control and Prevention’s handling of the Andrew Speaker tuberculosis case. You might remember the case, because it got a lot of media attention. Speaker was the Atlanta lawyer who was thought to have XDR TB and boarded a plane to return home from Italy despite having been told not to by health authorities. CDC issued an isolation order for Speaker, and held a press conference about how he could’ve spread the disease aboard his international flight. It was later determined that Speaker had multi-drug-resistant (MDR TB) rather than the more-feared XDR form.

Now, Alison Young reports in the AJC, “The handling of the Speaker case was so unusual that it has raised questions among other TB experts, including whether CDC publicized Speaker’s case in a quest for more money.”

Here’s Revere’s summary of the desperate situation in which the CDC’s TB program found itself before this case burst into the national consciousness:

The TB program at CDC has been level funded for several years. In practice, this means it has been experiencing 4 – 5% cuts every year. So the program was naturally eager to boost its funding … [If] you are a TB person and you are looking down the barrel of the XDR TB gun, desperation is probably not too mild a word. XDR TB is an emerging problem major public health problem. Instead CDC Director Gerberding is talking about bioterrorism and obesity. If you in TB control this must seem like Alice in Wonderland.

Young reports that minutes from a December 2006 meeting of the CDC-based Advisory Council for the Elimination of Tuberculosis show that advisors suggested taking “drastic action,” which might include efforts to publicize the threat of XDR TB. Five months before the Speaker case hit the headlines, the council wrote to Health and Human Services Secretary Michael Leavitt and warned that “our nation is facing an imminent airborne biological threat” from XDR TB.

None of this seemed to help. After Speaker’s case made headlines around the country, though, efforts to combat TB in the U.S. got a 4% boost in federal funding. (It was slated to be a 9% increase before Bush’s veto.)

Some experts have been questioning whether the isolation order and press conference, which touched off the media storm, were justified. Young notes that out of CDC’s investigations of 100 TB patients who boarded planes over the last 18 months — including five patients who flew with MDR TB — the agency only held a press conference in Speaker’s case. He was the only one believed to be ill with XDR TB, and the CDC claims that it needed to hold the press conference because it would otherwise be too difficult to find passengers from his international flight for tracking and testing. Since Speaker wasn’t highly infectious, though, some of the advisory council members have questioned whether all that tracking and testing was necessary.

Effect Measure was puzzled for some of the same reasons:

We wondered the same thing at the time but didn’t accuse CDC of manipulating it for budgetary reasons. We don’t have enough information now to settle that issue but from the outset this whole case had a bad odor to it (again, see you coverage, in many posts linked here). It isn’t clear if or when we will ever know the answer. CDC is refusing to release any information on the case, even under valid Freedom of Information Requests. I assume the rationale is to protect the privacy of the miscreants.

And Revere links this incident to larger problems with CDC:

I don’t know who did what and for what reasons. But the atmosphere at CDC is one of general suspicion and a pervasive feeling among science professionals that management is too concerned with sucking up to the administration and too little concerned with CDC’s mission. In such a setting people might make judgments in desperation they wouldn’t otherwise.

I hate to see this happen to CDC. Whatever the truth of the matter, the fact it is even being talked about in this way says it’s time for Director Gerberding to join her Bush administration colleagues Ashcroft, Gonzales, Rumsfeld, Thompson, etc., etc. in retirement. It must be very tiring carrying all that water. Take a rest.

A change in top officials could indeed improve things at CDC, and in U.S. public health in general, but there’s also a reminder about how diseases overall have been addressed over the past decades. Young notes that “the world of medicine is acutely aware of how HIV and breast cancer have become well-funded through aggressive advocacy and putting faces to the diseases.”

A country with as many resources as ours ought to be able to respond appropriately to diseases that represent a major threat to its population – even if no high-profile victim or event ignites a media frenzy.

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