How did TB return to public consciousness?  The story will change in the retelling, especially when it becomes a TV movie of the week, but at the moment it goes like this:

         Thirty one year old Atlanta personal injury lawyer (have you been harmed?) Andrew Speaker develops tuberculosis.  He receives treatment, but it looks ineffective.

          He’s scheduled to wed in Greece the daughter of a renowned CDC TB investigator.  Dr. Cooksey throughout gives Mr. Speaker “typical father-in-law advice,” not in a professional capacity. At a meeting with Fulton County public health officials, Speaker says he’s told he can go to his wedding.  The officials are vehement they told him not to leave the U.S.

         Speaker moves up the wedding date, and flies to Greece.  County officials finally learn that he has the XDR version of TB, meaning extreme drug resistance – no drugs really work.  They find out “through the grapevine” that Mr. and Mrs. Speaker are in Rome, and get the phone number from Dr. Cooksey, who is “extremely helpful,” according to CDC director Dr. Julie Gerberding, though still only acting in the capacity of father-in-law.  (There’s no worry Mr. Speaker contracted the illness from his father-in-law’s lab.  The CDC assures everyone Dr. Cooksey was working with different strains of mycobacteria, not XDR.)

         In Rome, attorney Speaker is told to turn himself in to the Italian health authorities.   He fears, however, what may happen, saying, “He might die there.”  He flies to Montreal, and drives to the U.S. border.

         Greece, Italy, and Canada are contacted only after he has absconded.  The Italians have, however, tried to contact the Americans earlier, learning “informally” they have an XDR vector on their shores.  CDC officials explain that “complications” prevent them from contacting foreign health officials expeditiously, complaining that World Health Organization guidelines “don’t tell you who pays for transporting the patient.”

         At the American border, a loud buzzer goes off at the customs booth.  Mr. Speaker is on a watch list.  Yet he is nevertheless freely allowed into the country by the customs agent; after all, he’s not a terrorist.

         A few lessons may, may be learned from this public health farce.  They include:

         1.  We don’t have a functioning national public health policy. An administration blinkered by “The War on Terrorism” doesn’t have an effective policy for preventing a nuclear weapon coming in by container ship, either.  But public health is not an administration priority.  If Mr. Speaker had not been bringing into the US a potential superinfection but instead a few ounces of potential suicide material, he would have been shackled on the spot.

         2. Borders are porous in most of the world.  We can’t keep out all the people who have potentially lethal infectious diseases.

         3. Infection is global, which means that public health requires global strategies.

         Extreme drug resistant TB, though “rare,” is a particular problem in South Africa and Russia.  There are over a half million people in the world with other drug resistant TB, including lots in the US.  We have to have effective treatments for people where they live.

         4. When infection is potentially global, as proved true with SARS, information about infection must be quickly and freely available.   Organizations like GPhin which track infectious worldwide must be directly supported by the WHO and governments worldwide.  People will cross borders, not knowing they are infected, or fleeing epidemics.  We need to have prompt, international information on biological outbreaks, and have it quickly in the hands of public health officials worldwide.

         5. Antibiotic resistance is a growing threat everywhere, especially with long-term human scourges like TB and gonorrhea.  The American stance on antibiotic resistance engages the same level of denial as does other aspects of our laissez faire public health policy. Understanding very different national conditions, it’s high time for international agreement on antibiotic use guidelines, no matter what Big Pharma says.   

         6. Setting up an increased police-state network will not stop the spread of international infections.  When people are scared, as Mr. Speaker was scared of Italian doctors, they move with their feet.  They’ll make it through borders and elude legal barriers.

         We recently had a large-scale massacre on American soil.  It did not come from a “terrorist.”  It came from a psychotic American undergraduate whose teachers were afraid to teach him, who was known as “Jelly Skelly” because he claimed to have a girlfriend from Outer Space.  Cheong-Sue Lee never went to his court mandated involuntary mental health outpatient treatment, and no one followed up.

         The laws will not save us in such situations, especially when the laws themselves are crazy, as when the FBI was not allowed to look at gun owner records after 9/11. What may save us is a sense of social community, that whether we like it or not we are stuck together on the same planet and need to protect it and ourselves from infections and scourges that can kill us all.   Having a national public health policy, especially from a government interested in protecting the entire public, would be a good place to start.

Dr. Matthew Edlund, M.D., M.O.H., director of The Center for Circadian Medicine, is an expert on applied public health, sleep medicine and psychiatry. A former professor at Brown and University of Texas medical schools, he can be reached via email to DocME@DoctorEdlund.com. And CLICK HERE to subscribe to our new Fitcast, via the iTunes Store.