Opinion

The Great Debate

Combatting TB 2.0

Earlier this month, health officials in Los Angeles confirmed they are treating a patient for extensively drug resistant tuberculosis — a deadly form that does not respond to most of the antibiotics. The United States is one of 100 countries that have reported cases of “XDR-TB” since it was discovered in South Africa less than a decade ago.

Congress is holding public briefings Tuesday and Wednesday to look into the threat posed by tuberculosis, seeking expert recommendations to help develop a U.S. response. To be effective, public health efforts must adapt to the ways TB is evolving.

Tuberculosis is often described as an “ancient” malady, evident in Egyptian mummies. But today’s tuberculosis epidemic, which kills around 1.3 million people a year, is unlike its predecessors genetically, clinically and epidemiologically. Defeating TB 2.0 will require innovative approaches designed to fight this modern epidemic.

Many of the TB strains today come from “modern” genetic lineages rather than the “ancestral” strains common throughout human history. Modern TB strains now predominate in India, which has the world’s highest TB burden, according to recent research published in the International Journal of Tuberculosis and Lung Disease. Some modern strains are more virulent and progress more rapidly, studies suggest, making the disease far more dangerous.

Clinically, today’s TB is “partnering” with a number of modern diseases, creating complex illnesses that are more challenging to treat. While TB has historically been perceived as a lung disease, in people with HIV it often presents elsewhere — lymph nodes, spine, eyeballs, brain — with atypical symptoms. TB kills roughly 320,000 HIV-positive people every year, the leading cause of death for those HIV positive. Yet less than half of the people infected with HIV have been screened for TB, and vice versa.

from Stories I’d like to see:

Cigarette companies’ final days, high-speed trading, and how rich is Ringo?

1. Cigarette companies’ final days:

This article last week from the Associated Press, “U.S. health experts predict…a cigarette-free America,” highlighted the release of a 900-page report on smoking from the U.S. surgeon general. “Though the goal of a cigarette-free America has long seemed like a pipe dream,” the AP noted, “public-health leaders have started throwing around phrases like ‘endgame’ and ‘tobacco-free generation.’”

Smoking has declined significantly in the United States in the five decades since the surgeon general’s first report pinpointing the dangers of cigarettes. It is still a multibillion-dollar industry, however, that sells more than 300 billion cigarettes a year here.

Yet smoking rates continue to decline as the evidence of tobacco’s lethal effects becomes accepted wisdom. At the same time, venues forbidding smoking have become nearly universal, even as the sale of smoking products becomes more constricted. CVS’s decision two weeks ago to stop selling tobacco is the latest example. (I wrote about that here.) Several states are now considering raising the legal age for buying cigarettes to 21.

Why is Bloomberg keeping New Yorkers smoking?

New York City Mayor Michael Bloomberg’s aggressive nanny-state policies — such as his crusades against trans fats and large-size sodas — have been annoying and, at times, unconstitutional. While some of his critics have suggested sinister motives, the most charitable assessment has always been that Bloomberg is well-intentioned; it’s just that his policy solutions are misguided.

Now, news leaked last week that Bloomberg is getting ready to push for a series of ordinances intended to drive electronic cigarettes off the market in Gotham. In doing so, Bloomberg is making it evident that he really does just want to boss people around — even if it’s not for their well-being.

For decades lawmakers and bureaucrats have tried to mitigate smoking and the harm it causes through punitive taxation and heavy regulation. However, the technological breakthrough behind electronic cigarettes could be a disruptive technology — letting the free market provide a solution to a problem that social engineers have not been able to address through stiff government regulations. It’s one reason why businessmen like Sean Parker, an early investor in Facebook and founder of Napster, have become big boosters of electronic cigarettes.

Protecting Americans from tobacco’s damage

Three years ago, President Obama signed the Family Smoking Prevention and Tobacco Control Act into law. Those of us present knew we were witnessing history. With the stroke of a pen and strong bipartisan support from Congress, the Food and Drug Administration was charged with protecting public health from tobacco use – the nation’s single most preventable cause of disease, disability and death. More than 1,200 people die each day in the United States because of cigarette use. That is one person every 71 seconds. Today, I am pleased to report that the law is working.

In passing the Tobacco Control Act, Congress recognized that the linchpin of any successful strategy to reduce adult tobacco use must be to prevent young people from ever starting. More than 80 percent of adult U.S. smokers begin smoking as teens. Each day more than 3,800 young people under age 18 smoke their first cigarette, and more than 1,000 become daily cigarette smokers. Reversing this trend requires aggressive action on two fronts: reducing the attractiveness of tobacco products to children and ending their access to them. That’s exactly what the FDA is doing.

During our first 12 months of regulating tobacco, the FDA pulled candy and certain other flavored cigarettes off the market; issued tough new regulations to halt sales of cigarettes, cigarette tobacco, and smokeless tobacco to young people; banned brand-name sponsorship of sporting events and concerts; and implemented requirements for new warning labels for smokeless tobacco products. The FDA also has begun funding state authorities to assure vigorous enforcement of these new actions to protect our children.

Cool, refreshing legislation for Philip Morris

– This article by Paul Smalera originally appeared in The Big Money. The views expressed are his own. –

Indulge me in a thought experiment. Pretend that drinking something called “lethalcoffee” has been found to cause cancer. There are five or six kinds of gross-flavored lethalcoffees that hardly anyone drinks, like chocolate, cherry, banana, and vanilla. But there’s one flavor, mint, that 30 percent of all lethalcoffee drinkers are hooked on. And there’s one particular group of lethalcoffee drinkers—let’s call them investment bankers—who drink mint lethalcoffee like there’s no tomorrow.

Allow 40 years for several million lethalcoffee-related deaths to pile up before the pandemic is taken seriously by the government. (Try to put aside any negative feelings you harbor about investment bankers.) Finally, Congress introduces a Lethalcoffee Safety Act that has a chance of becoming law. Would you imagine that law would:

A) Order the FDA to regulate lethalcoffee but withhold from the agency the power to ban it?
B) Ban every flavor of lethalcoffee except mint, the one most people drink?
C) Make it really hard for people to sell badcoffee, a new but much less hazardous cousin of lethalcoffee?
D) Be co-authored by Starbucks (SBUX)?

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