In a drug fix

The credibility of a recent Lancet report blaming India for spreading a cure-resistant superbug is in serious doubt. Sanchita Sharma writes.

A deadly hospital-acquired superbug that cannot be treated using existing medicines is spreading from India to Britain and the rest of the world, claimed an international study last week.

The Indian government promptly retaliated, with Union Health Minister Ghulam Nabi Azad calling the study "alarmist and motivated".

The study, published in The Lancet Infectious Diseases on Wednesday, said a new superbug - provocatively named The New Delhi metallo-ß-lactamase (NDM-1) - was being brought to the UK through patients returning after getting surgery done in India.

India hit back, saying that the accusation was yet another desperate attempt to stop thousands of pounds from leaving the floundering British economy to boost India's Rs 1,200-crore medical tourism industry.

According to Confederation of Indian Industry estimates, 1.1 million foreigners travel to India each year for cheaper treatments and surgeries.

In 2009, about 60,000 British patients travelled abroad - including to India - for treatment, shows the Medical Tourism Survey 2008 conducted by European Research Specialists, using survey data from 132 providers of overseas treatment and medical tourism services to UK patients. Of these, 97 per cent said they would go again for treatment.

What the medical fraternity in India is objecting to is the scientific paper's advice against travel to India for surgery.

To begin with, the link between NDM-1 infections in India and the UK is tenuous. The Lancet paper reports 50 superbug-infected patients in the UK, of whom - it states - 17 had "travelled to India or Pakistan within the past year, or had links with these countries". The paper does not clarify how many had travelled for surgery or what the "links" with India are.

That apart, even UK doctors are hesitant to blame the new superbug as the cause of death of the two people who died while infected with a strain of the superbug.

"We are aware of patients who have died with infections caused by bacteria with this type of resistance. What's much less clear is whether the infection caused their deaths or the patient's underlying disease. This is always very, very difficult to distinguish, where you are dealing with patients who have got severe underlying illness," said David Livermore, director of Antibiotic Resistance Monitoring at the Health Protection Agency, in a statement in London.

Despite its failure to establish a clear link, the study ends in a sweeping statement: "India also provides cosmetic surgery for other Europeans and Americans, and it is likely NDM-1 will spread worldwide."

So embarrassed was Chennai-based lead author Karthykeyan K Kumarasamy with the conclusion that he promptly dissociated himself from it.

"The conclusion that the bacteria was transmitted from India is hypothetical. Unless we analyse samples from across the globe to trace its origin, we can only speculate," said Kumarasamy.

"Ever since antibiotics were made available, drug resistance has been reported from all over the world. Methicillin-resistant Staphyloccus aureus (MRSA) is a menace in the UK, while The Lancet study itself mentions drug-resistant superbugs causing major problems in the US, Greece and Israel. Why, then, should India be blamed for exporting a worldwide public health threat?" said Dr V M Katoch, director general, Indian Council of Medical Research.