August 23, 2010

'New Delhi Superbug’ - ‘Named’ to kill Indian Medical Tourism

Naming of a new superbug after the name of Indian capital by a UK based research team, is seen as a move to scare the UK patients from India while hospital acquire infection rates in UK itself , especially MRSA, continue to be alarming.

Within few days of India’s top IT outsourcing company Infosys was called ‘Chop Shop’ by a US senator, a UK infection control research team led by Prof Timothy Walsh, in a study published in Lancet, has dropped another bombshell by naming a new Superbug gene NDM-1 after the name of Indian capital, as ‘New Delhi metallo- lactamase-1’ and blaming Indian Medical Tourism industry especially Cosmetic Surgery centres for its worldwide spread.

“This act of naming Superbug after New Delhi, while none of the samples collected was from Delhi and its presence in UK itself indigenously, appears a ‘Racially’ and commercially motivated act to malign Indian Medical tourism sector.” said Dr K M Kapoor, Senior Consultant, Cosmetic Surgery at Fortis Hospital, Mohali and a Medical Tourism exponent in India. The charge of the name being racially biased gets all the more credence as Prof Timothy Walsh had reported a similar, but far more dangerous Superbug from an infection outbreak in a hospital in Houston, Texas in 2006. This bug was named VIM 7 rather than being called ‘Houston Superbug’ and was never publicized much. VIM 7 was more dangerous than NDM 1 as it was resistant to all the drugs except Polymyxin B (Source: http://aac.asm.org/cgi/content/short/52/9/3099) while NDM-I is susceptible to Tigecyclin and Colistin.

I3-IRG researcher Prof Timothy Walsh, PhD, who is still in the process of obtaining his MRCPath (London) and DSc (Australia) (source http://www.uq.edu.au/events/event_view.php?event_id=6418#expand/collapse), had earlier also resorted to publicity gimmicks to draw world’s attention to his pet topic of Metallo-β-Lactamase gene, but failed to do so in his previous attempts. This time by deliberately naming the ‘Superbug’ after New Delhi and implicating India’s burgeoning Cosmetic Surgery tourism industry for its spread, he has raised a big controversy and has managed to get all the attention. Moreover the credibility of this study suffers from another account as this study has been funded by EU, Wellcome and Wyeth, with Wyeth being the manufacturer of Tigecyclin, one of the two drugs effective against NDM 1. The lead author has reported receiving a travel grant from Wyeth and another author has reported holding or managing shares in AstraZeneca, Merck, Pfizer, Dechra, GlaxoSmithKline, and Eco Animal Health.

By creating a false scare and a doomsday scenario, Prof Timothy Walsh is trying to gain international limelight .The proof of how serious is the threat, of NDM 1 gene, can be had from the excerpts of a press release from Hong Kong’s public Health Dep’t. ‘ According to test results of Public Health Laboratory Services Branch (PHLSB), there was one isolate of E. coli harbouring NDM-1 in a 66-year-old male patient attending a government out-patient clinic in October 2009.The organism was however susceptible to oral antibiotic agents commonly used to treat urinary tract infection, the spokesman said. The patient fully recovered.’ (Source: Press release dated 12 August 2010, http://www.webnewswire.com/node/563610 ). In this case patient has recovered even after contracting the ‘dreaded’ NDM-1 E Coli infection.

Prof Timothy Walsh had earlier also tried to create scare with this Super bug theory in 2004 through his article (Published in 2005 in American Society of Microbiology), titled ‘Metallo-ß-Lactamases: the Quiet before the Storm?’ (Link: http://cmr.asm.org/cgi/content/short/18/2/306 ) .The ‘ Quiet before storm’ has lasted well for over 6 years now without a major international outbreak and now Prof Timothy Walsh is again back with his pet topic, trying to serve the same old wine in a new bottle.

UK’s own record in infection control is dismal and high infection rates due to ‘MRSA Superbug’ are driving patients abroad to safer destinations. The EARSS (European Antimicrobial Resistance Surveillance System) monitors antimicrobial resistance in Europe. It maintains a comprehensive surveillance and information system that provides comparable and validated data on the prevalence and spread of major invasive bacteria such as MRSA. Its 2002 data shows that in UK hospitals, 44.5 % of Staph infections were of MRSA type, carrying 15 % mortality. (Source: http://www.treatmentabroad.com/medical-tourism/mrsa-infection/ ).

In a report ‘Superbug fear drives NHS patients abroad’ written by Sophie Goodchild, Health Editor , London Evening Standard on 11th March 2008, it has been mentioned ‘About 22,000 people in the capital and 100,000 from UK went overseas for surgery and dental treatment last year - a rise of nearly a quarter on 2006. Fear over infection from superbugs is now a major reason for them opting to go private instead of receiving treatment on the NHS. More than half of surgery patients said they were worried about contracting an infection such as MRSA in a British hospital. This comes a day after the Evening Standard revealed more than nine patients a week are dying from hospital acquired infections. The findings are published by research group Treatment Abroad from its international medical tourist survey.’(Source: http://www.thisislondon.co.uk/standard/article-23451698-superbug-fear-drives-nhs-patients-abroad.do ).

Another report had quoted- Keith Pollard, a director of Treatment Abroad, a website on medical tourism, told the media: "We are getting reports that worries about hospital infections such as MRSA are driving people abroad." Katherine Murphy, of the Patients Association, said: "Hospital infections are the number one concern from callers to our helpline. It comes as no surprise that some people are going abroad because they're frightened of NHS infection rates in this country. The government is not doing anything to reassure the public, particularly when we know key people are being lost from hospital infection posts and cleaning budgets are being cut" ( source: http://www.hindustantimes.com/Infections-in-UK-hospitals-drive-patients-to-India/Article1-216196.aspx ). High costs and fear of UK Superbug, MRSA, led to the growth of outbound medical tourism from UK with India as one of the top beneficiary. As per a study by treatment abroad , in 2006, for cosmetic surgery procedures like Breast augmentation, tummy tuck, liposuction and facelift , around 14,500 patients traveled outside the UK, spending around £3,500 each, creating an estimated market worth £50 million(cosmetic surgery getting 31% of total market share). This trend has been increasing rapidly since then.

Dr K M Kapoor also shared story of one of his patients from UK, a leading glamour model, Toni Samantha Wildish, who underwent a Breast Implant surgery in Czechoslovakia and contracted a major infection in right breast during surgery and was discharged and sent back after 3 days. ( http://www.indiaplasticsurgery.com/case-studies-toni.htm ). By the time, she reached back home in UK after 5 days, she had started developing features of septicemia. She was taken up for emergency surgery and her right breast implant was removed, leaving her with asymmetric breasts. This left her with no option to look for a better place outside Europe and finally she was operated successfully in India at Fortis Hospital, Mohali by Dr K M Kapoor. Her previous left side breast implant was also removed and a new set of implants were placed to put her modeling career back on track. “Why this case was not much publicized by ‘Infections from other countries’ experts like Prof Timothy Walsh could be anybody’s guess but one reason could be that Czechoslovakia is part of EU” said Dr Kapoor.

By Implicating Indian Cosmetic Surgery industry for the spread of NDM- 1 gene, without any substantial supporting evidence, this UK based research team is trying to help UK’s floundering Cosmetic Surgery market due to popularity of less expensive and safer Asian destinations like India, Thailand, Malaysia etc, amongst UK population. It is important to note that while samples were collected from India, Pakistan and UK, the bacteria gene was deliberately named after New Delhi. The reasons are not very far to see as India in recent years has risen to become one of the top medical tourism destinations in Cosmetic Surgery. The same bacteria could have been named ‘Islamabad bug’ but as Pakistan is not yet a significant player in Medical Tourism, so it was spared.

Cosmetic Surgery, one of the safest surgical specialties, is the biggest contributor to the medical tourism revenues in India. The UK team had reasons to discredit India’s dominance in the field of Medical Tourism as western medical industry has started seeing Asian countries led by India as their major competitors and fear that Medical outsourcing industry could go the IT way. They have found a potent weapon in the form of NDM-1 to win their patients from India by scaring them with this superbug. Dr K M Kapoor, while concluding said, “It is high time Indian government takes a tough stand on this issue to protect its medical tourism industry and asks the UK govt for a clarification & removal of word ‘New Delhi’ from the name of this Superbug.”

Dr K M Kapoor, MS, MCh, DNB
Sr Consultant, Cosmetic Surgery,
Fortis Hospital, Mohali.

Link: Original Article

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