Opinion The brain-eating superbug

Instead it caused conniptions of righteous anger. How dare these foreigners (they weren’t all foreigners) come here and tell us our hospitals are germ cultures (they didn’t)! The paper was a conspiracy! It was scientifically illiterate! The naming of the bug — New Delhi metallo-beta-lactamase-1,gently abbreviated NDM-1 by everyone except the more choleric residents of New Delhi — was a studied insult! Give us back our dignity,and the Kohinoor with it!

Each step of this reaction was ridiculous,and more important,dangerous. Let’s start with the paper. Ignore for the moment that Lancet is the world’s second most respected medical journal in terms of impact,and rubbish doesn’t often get through. After all,our entire medical establishment has announced that this paper is rubbish,and surely they know what they’re talking about,don’t they?

In terms of the mechanics of resistance,perhaps. But that isn’t what they’re attacking. They’re saying that even if the gene exists,the causal chain linking it from the UK to an origin in India is false; and that claims of its prevalence in India are,too. Examine each attack,coldly,calmly,commonsensically.

The paper points out UK samples that possessed the NDM-1 gene were not directly similar to the Indian samples of the NDM-1 gene. Aha,say the flag-waving doctors,surely that holes the India-UK link. Sadly,not quite. Of the 37 UK specimens — not a sample,mark you,but the entire set of NDM-1 genes discovered by the UK’s central lab — 17 came from people who’ve travelled to India in the previous year alone. The flag-wavers will have to claim that’s a coincidence. Which is utterly ridiculous: seven lakh British tourists visit India a year,out of a population of 6 crore. That’s one in every 100,nowhere near half. There’s no selection bias possible here; there is a link between going to India and being a Brit NDM-1 carrier.

And we have a clear idea of what the link is: 14 of those 17 had been in hospital in India. Does our medical establishment have so low an opinion of India’s public health that they think that every single tourist — okay,14 out of every 17 tourists — has to be hospitalised? One hopes not. We’re left,therefore,with the unfortunate fact that they’re so busy wrapping themselves in the tricolour it’s escaped their notice that they don’t have any ground to stand on. Nobody expects our finest doctors to have mastered the intricacies of causality and correlation,but a willingness to wilfully ignore either doesn’t make one feel secure of their diagnostic brilliance.

And claims of the superbug’s spread in South Asia? The medical establishment has made a big deal of the claim that “only” strains from hospitals in Haryana and Chennai were analysed. Actually,it was detailed only for them. But the paper actually says that NDM-1 was found in a pretty comprehensive list of cities: Guwahati,Mumbai,Varanasi,Bangalore,Pune,Calcutta,Hyderabad,Port Blair,and Delhi. Again,our public health bigwigs haven’t bothered to read things right.

And of course,as this newspaper has documented,we don’t have to rely on the Lancet team at all. The spread of NDM-1 in India was first documented in peer-reviewed work by an all-Indian team from Hinduja hospital in Mumbai,who said that the number of resistant blood samples from their intensive-care patients had jumped from nothing in 2006 to 8 per cent in 2009. And remember: carbapenems are tried only as a last resort,if all other common antibiotics have failed. Growing resistance to antibiotics was already a severe crisis in our hospitals well before the horrible racist white people (they weren’t) viciously pointed it out.

And how has our medical establishment responded to it finally becoming widely noticed? By denial. The health secretary has announced that the paper has “clearly no science behind it”; her first reaction was actually to complain that specimens were sent to be tested in the UK without filling out forms in triplicate at the health ministry. Unsurprisingly,her political masters have in the past complained that the ministry’s bureaucrats are particularly mired in “red-tapism”,and said that “recent graduates”,rather than senior IAS officers,would do a better job. Unfortunately those masters aren’t much help either: MoS Dinesh Trivedi claimed the paper has been written with an “ulterior motive”. This is the same minister who said that his secretary was blocking a nationwide electronic medical information system — a major function of which,paradoxically,will be to cut down on diagnostic uncertainty,and hence on the haphazard over-prescription of antibiotics! So quick is the denial reflex,that the obvious opportunity to hammer home his pet scheme’s usefulness was ignored.

Nothing can be expected from the “official” leadership of our medical community,so often exposed now as corrupt time-servers. And as for the leaders of our private medical fraternity,they spent their time emphasising (irrelevantly) that the Haryana and Chennai hospitals were “government-run”. Ignoring both the fact that the Haryana tests revealed that its strain was hospital-independent,out there in the community,and that such thinking will lead to private tertiary hospitals hesitating to admit patients referred from government hospitals,something politically untenable for them.

Meanwhile nearly half of our patients with intestinal infections are treated with antimicrobial agents,even though less than 15 per cent actually need them; our pharma companies produce generics with two antimicrobial agents,medically dangerous nonsense; we play games with the world’s swine flu response by making Tamiflu available over the counter; and antibiotic levels in water sources near our pharma factories are 100,000 to 1,000,000 times higher than in waters that receive sewage effluent in China or America.

And our public health leaders are worried primarily about a conspiracy against medical tourism — I beg its promoters’ pardon,“medical value travel”. Hawking was wrong: it’s not our biologists who will destroy civilisation.

mihir.sharma@expressindia.com