The Hidden Epidemic: Tuberculosis

An affordable alternative to the costly and burdening threat of Tuberculosis in the United States.

In 2012 Tuberculosis (TB) rates in the United States reached an all time low, dropping below 10,000 confirmed cases for the first time since national reporting began in 1953; however, the evolution of drug resistance to Myobacterium tuberculosis over the last 20 years poses a costly and burdening threat.    Nearly one third of the world’s population is infected with Tuberculosis bacteria, either in a latent or active form.  According to the World Health Organization (WHO) approximately 8.7 million new cases of TB occurred in 2011, with 1.4 million people dying of the disease. [1] In the United States, TB disproportionately affects ethnic minorities, low-income communities, and persons with compromised immune systems. [2, 3] 

Current treatment for TB in the US involves taking several drugs for a prescribed time ranging from 6-9 months.  There are 11 drugs approved by the Food and Drug Administration (FDA), including an accelerated approval for Bedaquiline, the first novel drug for treating TB in the last 40 years, just this past January. [4] The efficacy of which will be examined over the next decade.

The Centers for Disease Control and Prevention (CDC) emphasize the importance for TB patients to complete the continuation phase of their medicine regimen, taking the drugs exactly as they are prescribed for the full course of treatment.  This notion is so important that a public health initiative called Directly Observed Therapy (DOT) has been implemented.  DOT has become the recommended standard of care in TB treatment in the US since the 1960s. [5] It means that a trained health care worker or designated individual provides and watches the TB patient swallow every dose of the medicine every day.  One study found that 86-90% of patients receiving DOT completed therapy, compared with 61% for those not on this program. [6]

The mandate to complete the drug regimen is a critical aspect to reducing the spread of drug resistant Tuberculosis, but as you can imagine, DOT is not a viable option for many, especially low-income, marginalized populations, the like of which are at greatest risk for acquiring TB.  In the US multi-drug resistant TB (MDRTB) continues to increase annually and antibiotic resistance has been called one of the world’s most pressing public health problems. [7]

Drug resistant TB is a direct result of repeated and improper use of antibiotics. [7] This is precisely where Chinese Herbal Medicine can be undoubtedly effective.  People with latent TB bacteria do not show any symptoms of the disease and cannot spread it, but if the bacteria become active and multiply the spread can be rapid and detrimental.  For this reason, those with known latent TB are started on a drug course of therapy right away, despite the fact that antibiotics are generally much less effective against non-replicating, or latent, bacteria.  This would be the ideal time to introduce an herbal program instead. 

One study surveying Traditional Chinese Medicine (TCM) practitioners in New York suggested using Chinese herbal formulas to expel the pathogen and build the yin and qi. [8] Tonifying qi, in a Western sense, builds the immune system, which is ultimately what keeps the latent bacteria at bay.  Chinese herbs could effectively minister to the disease, while not subjecting latent TB patients to the risks associated with overuse of antibiotics, specifically referring to promoting the spread of antibiotic resistance. 

In an even broader sense, health care workers in the United States could advocate for the use of Chinese herbs instead of antibiotics for numerous illnesses.  Drug resistance is known to develop with overuse as well as improper use of antibiotics.  Continuous antibiotic treatment can disrupt both good and bad bacteria.  When antibiotics are prescribed for viruses, such as colds or the flu, they are actually hurting the body’s normal ecology more than helping it.  For these manifestations, Chinese herbs could help control the illnesses without putting the body’s good bacteria at risk.  Improper use, such as not taking the full course of the antibiotic, which ultimately kills off the weaker bacteria and allows the stronger ones to survive and mutate to avoid being killed, greatly enhances the microbe’s ability to become drug resistant.  Initially treating a disease with an herbal regimen could ultimately be more beneficial to the body.  Furthermore, studies have shown that administering Chinese herbs with antibiotic properties in conjunction with antibiotics can potentiate the effectiveness of the antibiotics.

The Global Fund, an organization dedicated to fighting AIDS, TB, and Malaria, is currently pushing for a huge financial investment.  It reports a shortage of $1.6 billion annually to adequately carry out the global target of ensuring universal access to diagnosis, treatment, and care for all people affected by Tuberculosis. [9] Numerous petitions are soliciting senators and representatives, as well as the community, for financial support.  Perhaps, US public health initiatives are beset with tunnel vision and are not exploring less monetarily reliant projects. 

The minimal cost of Chinese herbs to treat latent TB and adjunctively treat active TB could save at least 50% in medical expenses.  In industrialized countries like the US, treatment of TB costs about $2,000 per patient and significantly increases to $250,000 per patient with MDRTB as compared with $6 per day for Chinese herbs. [8] [10]  The decrease in antibiotic exposure could lower the chance of microbes becoming resistant to drugs.  Currently, the United States estimates spending $4 billion to treat 4.5 million DOT cases and 90,000 MDRTB cases. [11] Imagine in this economically fraught time, we as a nation could find a cost-effective alternative to the treatment of the second deadliest infectious disease epidemic in the world by going back to our “roots”.

To learn more about how Traditional Chinese Medicine is being used to alleviate the symptoms of Tuberculosis, please visit moxafrica.org to check out the profoundly important work our friends at MoxAfrica are doing.

1.             Organization, W.H. World Tuberculosis Day, 24 March 2013. 2013  [cited 2013; Available from: http://www.who.int/campaigns/tb-day/2013/event/en/index.html.

2.             Prevention, C.f.D.C.a., Trends in Tuberculosis, 2011, in CDC 2/7: Saving Lives. Protecting People.2012, CDC Division of Tuberculosis Elimination (DTBE). p. 2.

3.             Prevention, C.f.D.C.a. 5 Things You Need to Know about Tuberculosis (TB). 2011 June 13, 2011 [cited 2013 Mar 23, 2013]; Available from: http://www.cdc.gov/Features/Tuberculosis/.

4.             Pipeline Report: HIV, H., TB, Bedaquiline (TMC207), 2013. p. 1.

5.             Bayer, R., Wilkinson, David, Directly observed therapy for tuberculosis: history of an idea. The Lancet, 1995. 345(8964): p. 1545-1549.

6.             Hygiene, N.Y.C.D.o.H.a.M., Tuberculosis in New York City, 2002: Information Summary: Pathway to TB Control is Directly Observed Therapy, in Bureau of Tuberculosis Control Information Summary:2002, N. Health, Editor 2002, Department of Health and Mental Hygiene: New York City. p. 36.

7.             Prevention, C.f.D.C.a. Get Smart: Know When Antibiotics Work. Antibiotic Resistance 2009 May 1, 2012 [cited 2013 Mar 23]; Available from: http://www.cdc.gov/getsmart/antibiotic-use/antibiotic-resistance-faqs.html.

8.             Ho, M.-J., Perspectives on Tuberculosis Among Traditional Chinese Medical Practitioners in New York City's Chinatown. Culture, Medicine and Psychiatry, 2006. 30(1): p. 105-122.

9.             Hurst, A. Tuberculosis Threat Cited by World Health Organization and Global Fund. News Release 2013  [cited 2013 Mar 18 2013]; News Release]. Available from: http://www.theglobalfund.org/en/mediacenter/newsreleases/2013-03-18_Tuberculosis_Threat_Cited_by_World_Health_Organization_and_Global_Fund/.

10.          Stop Tuberculosis (TB) Now Act, in H.R. 40572000. p. 1.

11.          Irlam, G. How much does it cost to treat a case of TB? Tuberculosis Treatment 2011  [cited 2013 Mar 23]; Available from: http://www.beguide.org/tuberculosis-treatment.html.