MUMBAI, India
IT is doubtful when he wrote a letter to a medical journal about patients in Mumbai afflicted with an untreatable form of tuberculosis that Dr. Zarir Udwadia was seeking to become the source of controversy himself. But instead of provoking an all-out attack on the disease, as he had hoped, the letter set off a global health alarm and, at least initially, prompted a backlash from the government.
Until writing the letter in late 2011, Dr. Udwadia was perhaps best known as the pulmonologist to the elite in Mumbai, where his physician father had become known nationally for saving the life of a Bollywood superstar, Amitabh Bachchan. Hardly anyone outside public health circles knew of the free weekly TB clinic that the younger Dr. Udwadia had run for more than two decades.
Dr. Udwadia wrote about four of his clinic patients for whom none of the commonly used medicines worked to combat the disease, a deadly bacterial infection that can be transmitted through a sneeze or a cough. The idea that people could contract such a deadly disease sitting next to someone on a bus or on an international flight aroused concern among global health authorities and created a problem for the Indian government.
TB is so old that it has been discovered in the skeletons of Egyptian mummies, was recorded by Hippocrates and is mentioned in the Rig-Veda, a collection of ancient Sanskrit texts. The disease disproportionately affects the poor because it spreads easily in crowded places among people whose resistance is low from malnutrition or illness. It has been curable for decades with a regimen of several antibiotics taken for six months. But often patients fail to follow the whole course of treatment, and the disease mutates into a more virulent form.
India is of particular concern, having the most TB patients in the world — more than two million of the more than nine million active cases globally. India also has the most drug-resistant patients, about 100,000 with multidrug resistance, in which the two most powerful TB medicines do not work.
Mumbai is especially problematic because of its overcrowded slums, with almost a third of TB patients in some neighborhoods having a resistant form of the disease. Drug-resistant disease is more expensive and even more difficult to defeat than the traditional form, requiring two years’ treatment with such a toxic course of medicines that many patients drop out. Even if they do complete the regimen, studies show there is only a 60 percent likelihood of a cure.
In the media storm that followed Dr. Udwadia’s journal letter, government officials publicly denied the problem and accused him of wrongly setting off a panic. A Mumbai health official seized his patient samples for retesting.