Controversy over NDM-1 'Superbug' Ignites Uproar in India

By: Charles Cooper
Topics: In The News ,; Tech Talk

Klebsiella pneumoniae, the bacterium in which NDM-1 was identified.

(Credit: Wikipedia)

A study in a British medical journal reporting the existence of a drug-resistant "superbug" has ignited a controversy within Indian medical circles.

The Lancet Infectious Diseases reported that antibiotics have proved so far ineffective against a bacterial gene, which was found in patients traveling to South Asia for medical treatment. NDM-1 has been linked to the overuse of antibiotics. Lancet found that 37 Britons receiving medical treatment in South Asia carried NDM-1 back with them to the United Kingdom.

"The potential of NDM-1 to be a worldwide public health problem is great, and co-ordinated international surveillance is needed," Lancet wrote on its website.

The Indian health establishment has since downplayed the report. Karthikeyan Kumarasamy, lead author of a March report in the Journal of the Association of Physicians in India outlining the risks posed by NDM-1, now says the warnings have been overblown.

"It's all hype and not as bad as it sounds," Kumarasamy was quoted by India's Hindustan Times. "The threat of the NDM-1 is not that big as, say, H1NI (swine flu),the popular press has since deemed it."

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

NDM-1, an acronym for New Delhi metallo-lactamase-1, was identified last year after an Indian hospital admitted a patient from Sweden. Meanwhile, AFP is reporting the first NDM-1-related death, an unidentified Belgian man who was treated in Pakistan following an automobile accident.

The controversy over the report of a so-called superbug has also left the Indian government particularly displeased with some officials pointing a finger of blame at foreign pharmaceutical firms for fanning the flames. Speaking with the Bombay News.net, Health Minister Ghulam Nabi Azad said the Lancet study had been underwritten by foreign drug makers.

"It (superbug) is universal and is found in the intestine of humans and animals. It is wrong to say that it is found only in India and Pakistan. They say it was found in patients who visit India and Pakistan. The study nowhere mentions if the bacteria were found even before those persons visited India." In a similar vein, opposition leader S.S. Ahluwalia was quoted in the The Hindustan Times quoted saying: "It may be a sinister design of multinational companies around the world," he said, adding that with globalization, it was not just populations that were migrating, but also virus [sic] and bacteria."

Charles Cooper is an executive editor at CNET News. He has covered technology and business for more than 25 years, working at CBSNews.com, the Associated Press, Computer & Software News, Computer Shopper, PC Week, and ZDNet. E-mail Charlie.

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by DrEdoMcGowan August 15, 2010 12:25 PM EDT: The issue of over prescribing antibiotics may now be vastly over-shadowed by the generation and release of pathogens and superbugs by sewer plants. This is well described by the Michigan study (http://www.ur.umich.edu/0809/May18_09/19.php). The US/EPA has known about this since the later 1970s or early 1980s but has been moribund to deal with it, see:(http://www.ncbi.nlm.nih.gov/pmc/articles/PMC241834/pdf/aem00183-0119.pdf). There have been some good studies coming out of India on the augmentation and generation of sewage assisted superbugs derived from hospitals, see: (http://www.indmedica.com/journals.php?journalid=6&issueid=21&articleid=179&action=article).

The upshot here is that the regulatory community, including the CDC have been asleep at the switch when it comes to how superbugs are made and then multiplied in sewer plants. Along the great rivers in the U.S. each successive city gets its drinking water from the immediate up-stream sewage outfall of the preceding city. This cycles these bugs and each time they get stronger. The fact that we are now finding pharmaceuticals in drinking water shows one that the system is not working. Unbeknown to most, there are antibiotic resistant genes, so small that they pass through most water treatment plants and are in fact now found in drinking water. These are not affected by chlorine at currently used levels. They easily transit within the human gut to the gut bacteria and there wait like tiny time bombs for an incoming pathogen, thus arming this pathogen with yet more resistance and virulence. Once in the gut biota they can remain for years and also because of the very large number of bacteria in the normal gut biota, there are opportunities for creating higher level pathogens. Antibiotic resistant infections now cause more death than AIDS. This is not an easy issue for regulators who want you to believe all is well and rosy, to accept. But unless we want to return to amputation as the cure for infections, the regulatory community needs to wake up.

Dr Edo McGowan; Reply to this comment


by kishaloy August 14, 2010 11:28 AM EDT: This is a classical example how British colonialist,looting & enslaving the native people of India become rich,become 1st world country,become civilized country.We the Indian sub-continent people are 'They' & the British are 'Us'.It is us who write the history of India.British ruler thought those native savage was unable to represent them-self! This is the motto of ex-colonialist & imperialist.This has been clearly exposed by Edward Said in his book "Orientalism"!How many indigenous people were killed by imported diseases by British colonialist? And how many of those diseases named after them,should be explored.The faces of ex & current economic colonialist are same.In the name of globalization & free market economy they have now created a new type of colonialism & imperialism! We('they')should aware of this new kind of exploitation of them('us').Human history will be rewritten thereafter!!; Reply to this comment


by medtrawell August 13, 2010 6:35 PM EDT: There are a lot of uncomfortable questions being raised about the way western media covered superbug NDM-1. The truth seems to be that western media just seems to be looking for sensationalism. Also, information about other superbugs is available nowhere. What about the naming of the gene? nobody seems to be telling the truth about that.
more on this can be found here: http://medtrawell.com/Medical%20Tourist%20Discussion/the-truth-behind-super-bug-ndm-1-set-to-destroy-indian-medical-tourism-1; Reply to this comment


by medtrawell August 13, 2010 6:32 PM EDT: There are a lot of uncomfortable questions being raised about the way western media covered superbug NDM-1. The truth seems to be that western media just seems to be looking for sensationalism. Also, information about other superbugs is available nowhere. What about the naming of the gene? nobody seems to be telling the truth about that.
more on this can be found here: http://medtrawell.com/Medical%20Tourist%20Discussion/the-truth-behind-super-bug-ndm-1-set-to-destroy-indian-medical-tourism-1; Reply to this comment


by YankeePoodle August 13, 2010 6:24 PM EDT: There a tacit way of saying that some how things that are related to "China" and "India" are lower quality or unclean or dirty etc. I am tired of this campaign. Even though India has years to go to reach any comparable level in human indices with OECD countries, due to the sheer size there are large number of people exceeding the population of any country in Europe who have comparable life with Europe standard of living. So, Ignore or mock at your own peril. Western hubris is the best friend of emerging powers of Asia.; Reply to this comment