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HOUSE CALL WITH DR. SANJAY GUPTA
Man With Deadly Strain of Tuberculosis; How TB is a Threat to People Worldwide
Aired June 2, 2007 - 08:30 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
NGUYEN: You know, some people like rings, others skulls. This bizarre piece of art out of London. The artist created a cast from an 18th-century skull and covered it with all things: diamonds.
HOLMES: Yes, why? More than 8600 flawless diamonds, even to be exact, including a large pink one in the middle of the forehead. $98 million this will take out of your account. And the teeth are real, by the way.
Well, the latest on the tropical storm Barry, that is at the top of the hour.
HOLMES: But first, a special edition of HOUSECALL with Dr. Sanjay Gupta starts right now.
SANJAY GUPTA, HOST: I'm Dr. Sanjay. And this is a special edition of HOUSECALL from Denver, Colorado. The medical story that got the most attention this week involves an Atlanta lawyer who traveled overseas infected with a deadly strain of tuberculosis. CNN's "AC 360" devoted an hour to the topic. And we're bringing you the encore highlights of that show.
We begin by looking at what tuberculosis does to the body.
SANJAY GUPTA, HOST: So this is the operating room where you perform these tuberculosis operations?
MARTIN POMERANTZ, DR., INFECTIOUS LUNG DISEASE CENTER: This is the operating room.
GUPTA: Now let me ask you really quick, these masks, how effective are they?
POMERANTZ: They're quite good. They have a greater level of filtration than the normal mask, and supposedly protect the surgeons and the nurses at the operating table.
However, if you're doing the operations right, you shouldn't expose anyone to the organisms in the operating room, because when you ressect the part of the lung, you should be far away from the cavities and the diseased lung where the organisms reside. So actually, it's fairly safe in the operating room. GUPTA: I mean, you're actually operating on somebody, taking out a piece of their lung that has all the tuberculosis in it?
GUPTA: And that's potentially dangerous, though, isn't it?
POMERANTZ: It's potentially dangerous if you open into the cavities of the lung that contain the tuberculosis organisms. There are billions of organisms in a cavity. So if you expose that cavity or open into it, that could get out into the air. And that would be potentially dangerous.
There are also special precautions we take with the patient. If a patient comes down to a special room because he's an infected case, he comes into this room. And from here, he either goes back to that room, or to a negative air flow room in the intensive care unit. So all the rooms that this patient should be in would be negative air flow.
GUPTA: When you do this operation, are you concerned about your own health or the health of your staff?
POMERANTZ: We're concerned, but in all the 180 operations we've done with all the staff and myself, none of us have ever come down with tuberculosis or converted our skin tests. My skin test is still negative.
GUPTA: After all those cases.
POMERANTZ: After all those.
GUPTA: You've never done a case of extensively drug resistant tuberculosis?
POMERANTZ: That's right.
GUPTA: He'd be making medical history.
POMERANTZ: He'd be the first one that we've done here. And I don't know if any have been operated on in other parts of the world, but they certainly aren't published if they do.
GUPTA: Is that the plan, to operate on Mr. Speaker?
POMERANTZ: It depends. I have not seen his films yet. And I've only talked to the people at National Jewish. If he has localized disease -- and I don't know if he does or doesn't -- if he has localized disease, the remaining part of his lung being normal, then logic would say if you took out the localized disease, since you have very few good antibiotics to cover his infection, that the chance of curing him might be better.
GUPTA: So I mean, he'd be cured? He'd be done?
POMERANTZ: Well, I wouldn't say that, because you can't cut out all infection. You have to assume that there is some microscopic infection elsewhere. And it just depends upon the continued use of antibiotics for up to two years.
GUPTA: If you did nothing at all with him, what would happen?
POMERANTZ: Nothing at all, he'd eventually die of the infection.
GUPTA: What would happen to his body?
POMERANTZ: Well, he'd end up looking like a concentration camp victim. The old name for tuberculosis was consumption, because it consumes the body. And that's the way these patients look untreated in the old days.
GUPTA: Of course, Dr. Pomerantz's job is to treat his patient, not judge them. Others, though, aren't holding back. They turned Andrew Speaker into a water cooler topic at best. And at worst, some kind of modern Typhoid Mary.
CNN's Rusty Dornin now on the friends who say he's no international TV villain.
RUSTY DORNIN, CNN CORRESPONDENT (voice-over): Those who know him as Drew say Andrew Speaker's no villain.
RYAN PRESCOTT, FRIEND: He's not a selfish person. He honestly believed that he was not putting others in danger.
DORNIN: Law school buddy Ryan Prescott says people have made rash judgments about his friend. He knew speaker had TB way back in April.
PRESCOTT: He wasn't hiding it. He told his friends. People that knew him knew that he had TB. He was told that he was not contagious. He was told that he wasn't dangerous to us. And I was not afraid to be around him.
DORNIN: Neither was his fraternity brother Greg Fansler. Fansler was Speaker's roommate more than two years, right up until last December. You lived with him up to two years, perhaps during the time that he contracted tuberculosis?
GREG FANSLER, FRIEND: Yes, we're not sure.
DORNIN: Did the CDC contact you?
FANSLER: I contacted them when I actually went and visited with Drew on Wednesday and called him Wednesday night, and then was on the phone with him yesterday, and just gave them names of people that he was close with.
DORNIN: Did they ask you to be tested? FANSLER: As a person who lived with him, I'm probably a little bit more wanting to be tested than the other folks, but no real urgency.
DORNIN: Brandon Smith also went to law school with Speaker. Smith, like the others, has spoken with Speaker since he was placed in isolation. They all believe he tried to do the right thing by coming straight back to the U.S.
BRANDON SMITH, FRIEND: For him, it was a matter of life and death. He knew that the American states have the best healthcare system there is. And he just, he wanted to get back to that.
DORNIN: But what about endangering people on the flight back from Europe, after he'd been told he had the extremely resistant form of TB?
SMITH: He had a form that was going to jeopardize his life more, not a form that was jeopardizing others' life more.
DORNIN: Well, people might argue if they had an immunosuppressive program, it might endanger them more.
SMITH: And I could argue that there's not a single reported case of tuberculosis being transmitted on an airplane.
DORNIN: The three friends are unanimous in their belief that there's one person Drew Speaker would never place in harm's way, Sarah Cooksey.
FANSLER: He would not put the person that he cared the most about in danger. And that would be Sarah. If she's sitting next to him, I do not - I cannot fathom him wanting to put her life in jeopardy, and especially the little one as well.
DORNIN: The little one is Sarah's eight-year-old daughter. His friends say Speaker is a family man, an outdoorsman. He and his fiancee did everything from running to rock climbing, even after he was first diagnosed with TB. But they wondered, where did their friend Drew get this disease? He traveled to Peru three years ago, and last year went on a charity trip to Vietnam and Cambodia. Maybe there, they say.
SMITH: From our understanding, he visited an orphanage, visited a hospital. It could have been a place where he picked it up.
DORNIN: Speaker told his friends this week he's received some e- mails wishing him anything but well.
SMITH: And there is a lot of people out there wishing him a horrible death. Drew would not wish harm on anybody. And yet, these people are coming forward telling him that they want him executed.
Reporter: So they stand united behind a friend who they say stands wrongly accused.
Rusty Dornin, CNN, Atlanta.
GUPTA: Straight ahead, more on Andrew Speaker, tuberculosis, and the threat to people here and all around the world.
GUPTA: We're just outside the hospital where Andrew Speaker, who touched off an international health scare, is being treated for extensively drug-resistant tuberculosis. He says he's sorry for endangering anyone, but he's also defiant.
Tonight, the battle over what health officials told him about traveling with a deadly disease, the Homeland Security breakdown, and the risk of more cases coming to the United States, as well as the fight against tuberculosis around the world. TB threat, a survival guide. Let's start, though, with the patient.
GUPTA (voice-over): Andrew Speaker told ABC News he's sorry. The Atlanta attorney with a deadly and rare form of TB was contrite when he apologized to the hundreds of airplane passengers he put at risk.
ANDREW SPEAKER, TB PATIENT: I don't expect those people to ever forgive me. I just hope they understand that I truly never meant to put them in harm. I never meant to hurt their families or them. And I just hope they can find a way to forgive me for putting them in harm, because I didn't mean to.
GUPTA: Speaker found out he carried a drug-resistant strain of tuberculosis, but two days later went ahead with his trip around Europe. But with his wife seated next to him, Speaker was defensive about his decision to travel, insisting health officials told him he never posed a danger to others.
SPEAKER: I said what's changed? When I left I was told I wasn't a threat to anyone. When I was left, I was told that I wasn't contagious. What's changed? Why are you abandoning me like this and expecting me to turn myself over for an indefinite time? What has changed? And they didn't have an answer to that.
GUPTA: Speaker says he has that conversation on tape, but he has not made it public. Fulton County health officials insist they told him not to fly. Speaker also says the Centers for Disease Control abandoned him, telling him he couldn't take a commercial flight back to the United States because it could jeopardize fellow passengers.
The CDC says they were working to get him back to the U.S. safely, even considering a cargo ship, but he flew back commercially anyway, saying a private jet would cost $100,000, and getting to Denver's top TB hospital was his own only chance to save his life. In a tearful interview, his wife also claims they were never warned that her husband carried a potentially lethal threat. SARAH COOKSEY, SPEAKER'S WIFE: Up until six days ago, obviously, we no one ever told me that I was at any kind of risk.
DIANE SPEAKER: A kiss, a kiss was not...
COOKSEY: Yes, I haven't, you know, kissed my husband. You don't know what that means. It's our honeymoon. In a week. So now there's no, I mean, I'm not in contact with him. You know, before that, you know, nobody ever said anything, nobody ever said that we should be careful.
GUPTA: Tuberculosis is a bacteria that lodges deep down in your lungs. And the small air sacks known as the alviolai. Now when your body realizes there's an invading organism, it tries to destroy the bacteria, but this particular bug has the ability to deactivate those first-line immune cells. Once it shuts down those defense cells, the bacteria begins to grow and multiply in an uncontrolled way.
Next comes a second-line defenders. In many cases, these immune cells are able to kill most of the bacteria. But when they die, they form this thick, cheese-like substance in your lungs. These deposits can migrate to other parts of your body and sprout even more infections, but they can also harden in your lungs, making it very difficult to breathe.
Often, the worst symptoms come from your body trying to fight off the infection, not from the bug itself. Left untreated, the bacteria can take over your whole body and wreak havoc on your immune system. Of course, tuberculosis used to be called consumption for that very reason. Untreated, the bacteria will consume your entire living infrastructure. It's an awful way to die.
GUPTA: Tuberculosis actually killed one person on that list, Eleanor Roosevelt. She died from complications of TB in 1962. 45 years later, TB remains a deadly threat here in the United States. Like Andrew Speaker, an estimated 10 to 15 million Americans are infected with the bacteria. About 10 percent of them will actually develop active TB.
Here's CNN's Randi Kaye.
RANDI KAYE, CNN CORRESPONDENT (voice-over): Andrew Speaker's got company. The Centers for Disease Control says he and 13,767 others in the U.S. were diagnosed with tuberculosis last year. 1,000 people in New York City alone, says health commissioner Thomas Frieden.
THOMAS FRIEDEN, DR., NYC HEALTH COMMISSIONER: Tuberculosis is not so rare. In New York City, every week on average, we do one investigation of someone with active tuberculosis who is working in a worksite, in a financial institution, in a business, in a school. KAYE: TB is here, coast to coast. And it's been here for a while. 1998, Norfolk, Virginia, 2100 sailors aboard a Navy warship underwent TB tests after two crew members got sick.
UNIDENTIFIED FEMALE: Very anxiously waiting. I mean, hopefully, he doesn't have it.
KAYE: 2005, Broken Bow, Oklahoma, 220 people were tested after it was confirmed an employee at a Tyson chicken plant had the disease. And just this year at New York City's St. Barnabus Hospital, hundreds of patients, including more than 200 newborns, were screened after contact with an infected employee. In America, the CDC has recorded 49 other cases of extremely drug-resistant TB like Speaker has in the last 13 years. How many other Andrew Speakers might be out there?
FRIEDEN: It's really pretty rare. People with TB feel sick, they seek care. And once they're in care, they're effectively treated.
KAYE: So you don't expect that there are a lot of globe-trotting TB patients out there?
FRIEDEN: It happens, we see this. And when it happens, you have to take appropriate measures.
KAYE: TB is often considered a poor man's disease because of its roots in poverty-stricken countries. So why is it that a country as advanced as the United States is battling a disease more commonly found in developing countries?
FRIEDEN: Tuberculosis is a global epidemic. Most of our cases in New York City and nationally are among people who are born overseas. We can't hermetically seal our borders, even if we wanted to.
KAYE: Globally, the CDC estimates one-third of the world's population is infected with the bacteria that causes TB. Last year, the rate among foreign born people was nearly 10 times greater than among American born. Ethnic minorities in the U.S. are at a disadvantage, too. Asians, for example, are 21 times more likely to have TB as Caucasians.
(on camera): With thousands of cases in the U.S. every year, how are you supposed to know if the person walking next to you is one of them? Frieden says there really is no way to know, no obvious signs. That's pretty alarming to some people, since we're all connected by the air we breathe.
FRIEDEN: It's in our best interests to help the countries of the world control tuberculosis better.
KAYE (voice-over): Another reason the United States is suffering, outdated tools.
FRIEDEN: The tests that we have is for the sputum test is 100 years old. The skin test that you may have had, that's about 90-years old. We haven't had a good, new, first-line drug for tuberculosis in nearly 50 years.
KAYE: Weak tools, no match for a terrible epidemic.
GUPTA: The fact that tuberculosis remains a global killer in the 21st century is more than sobering. It raises some tough questions. The bacteria that causes TB was identified 125 years ago. The first cure and antibiotic arrived in the 1940s. You would think that by now, medicine would have won the fight against this ancient disease, which by the way, has been around since the pharaohs. To understand why it hasn't, well, you need to follow the money.
CNN's Joe Johns is keeping them honest.
JOE JOHNS, CNN CORRESPONDENT (voice-over): The most recent figures are alarming. In 2005, TB killed 1.6 million people around the world. But make no mistake, much is being done to fight the disease.
The problem is that currently, the best medicine available to treat it is a combination of four drugs that dates back more than four decades. That treatment remains effective, but -- and this is a big issue -- it's only reliable if patients follow it completely.
And that's really hard. Why? Because TB patients take the medication every day for months. And they must be carefully monitored. It's called directly observed treatment. That's why TB thrives in many developing countries, where there is a stigma attached to the disease, and where people living hand-to-mouth can't make the commitment of time and energy to go see a healthcare provider every day.
MARIA FREIRE, TB ALLIANCE: So you can imagine, for example, a woman that leaves her family every day to get the care she needs and then has to walk back to her home. And it becomes a very cumbersome thing for them to do. It's very difficult.
JOHNS: So why isn't there a vaccine or a more practical treatment that's easier and quicker for the patient and less hassle for the caregiver? Answer -- money.
NICOLE LURIE, DR., RAND CORP.: Because TB is a disease of poor people and people in developing countries, there haven't been really good incentives in the private sector to develop a vaccine, to develop new drugs, etcetera, and that also needs attention and a real boost.
JOHNS: In case you didn't get it, incentives means profits for drug companies.
Here's how the numbers work. The Global Alliance for TB Drug Development estimates global sales for first-line TB drugs at $315 million a year. By way of comparison, Viagra sales around the world raked in $1.7 billion last year. Plus, there are the costs of developing better TB drugs. The Global Alliance says it would take ten years and nearly $5 billion just to get them to market. So those numbers don't work for the drug companies. In other words, no money, no incentive to make a cure.
FRIERE: This market is not large enough for a big pharmaceutical company to enter with the idea of making money. So we have to find a way of lowering the hurdles for companies to invest.
JOHNS: But better treatment may come anyway, because with the currently available drugs and the ordeal of taking them daily and under supervision, people give up and don't follow through on the treatment.
MYLES DRUCKMAN, DR., INTERNATIONAL SOS: And if it's not treated effectively or inappropriately, you can get a lot of these diseases that are now drug resistant, which puts the whole, you know, globe at risk.
JOHNS: And that is what happened with Andrew Speaker. With air travel, a contagious disease can move around the world in a matter of hours.
Joe Johns, CNN, Washington.
GUPTA: Thanks for joining me for this special edition of HOUSECALL. And remember, this is the place to answer all of your medical questions. Thanks for watching. I'm Dr. Sanjay Gupta. Back to the latest news now on CNN.
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