New Delhi Superbug : ‘Famed’ to save dying UK Health protection agency?

##ad_1##

UK’s HPA has been buzzing with a flurry of activities these days. The reason for this is not very far to see. Ever since the secretary has announced the death of HPA, by declaring it redundant as a stand alone entity, HPA seems to be in combat gear to save its independent existence. Interestingly this report has been titled ‘Liberating the NHS: report of the arm’s length bodies review’ dated 26th July, 2010 (http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_118053.pdf ). Following a review of the UK’s 18 “arm’s-length bodies”, the Department of Health has recently announced plans to scrap or reform over 10 national health organizations as part of a bid to make over £180m of savings by 2015. Functions of the HPA are to be transferred to health secretary Andrew Lansley, along with the functions of the National Treatment Agency for Substance Misuse, which is also to be abolished. (Arm’s-length bodies: An “arm’s-length body” (ALB) is defined by the DoH as a stand-alone organisation that works at a national level, but at an arm’s length from the department. There are currently 18 ALBs in the UK, which work closely with the NHS, care services and other ALBs. They are accountable to and usually funded by the DoH. )

##ad_1##

In a recent interview in The Telegraph, Dr David Livermore, who is director of the HPA's Centre for Infection's Antibiotics Resistance and Monitoring Reference Laboratory, has said: "Carbapenems have had to be used more and more as bacteria have become resistant to antibiotics. Therefore it is a worry when we see Carbapenem resistance emerging. Increasingly over the last year we have seen small numbers that can destroy carbapenems.” A close look at Dr Livermore’s past researches would, however, clearly contradict his statement that he is seeing Carbapenem resistance   over last one year and shows that he himself had reported about Carbapenems resistance and Carbapenemases (the carbapenems destroying enzymes) way back in 1997 (Acquired carbapenemases by David M. Livermore, Journal of Antimicrobial Chemotherapy (1997) 39, 673–676; Link: http://jac.oxfordjournals.org/cgi/reprint/39/6/673 ). Dr Livermore along with his old friend Dr Woodford, ( both are last on the list of authors of controversial NDM-1 study in Lancet) again tried to scare the world with impending doom due to carbapenem resistance by raking up the same issue 3 years later in his article ‘Carbapenemases: a problem in waiting? Authors: Livermore D.M.; Woodford N. (source: Current Opinion in Microbiology, Volume 3, Number 5, 1 October 2000 , pp. 489-495(7) )

Further HPA’s newsletter ARMRL News,  Winter 2004/5 issue with David Livermore as its editor, carried an article ‘Carbapenem-resistant Acinetobacter in London’  has mentioned  “The Summer Newsletter flagged the growing issue of carbapenem-resistant A. baumannii, especially in intensive care units in and around London. A fuller article was published in November’s Journal of Hospital Infection (Coelho et al., 2004 JHI 58, 167).” Also Dr David Livermore was HPA representative in a meeting ‘Interim Working Party Guidance on the Control of multi-resistant Acinetobacter Outbreaks’ on 3rd June , 2005 which classified bacteria resistant to Carbapenems as follows- ‘The working party have defined multi-resistant Acinetobacter spp “MRAB” as Acinetobacter spp. isolates that are resistant to any aminoglycoside (e.g. gentamicin) AND to any third generation cephalosporin (e.g. ceftazidime, cefotaxime). An even more multi-resistant Acinetobacter spp designated “MRAB-C” is defined as an MRAB that is also resistant to carbapenems (imipenem or meropenem).’ 

(Source:   http://www.bsac.org.uk/_db/_documents/Acinetobacter_Draft_Guidance.pdf )

 ##ad_2##

Dr David Livermore’s desperation , due to the possibility of losing his coveted status with demise of HPA, is clearly visible from the fact he selectively disclosed the news of ‘So Called Superbug’ to The Telegraph, a UK newspaper (http://www.telegraph.co.uk/health/healthnews/5978455/A-new-superbug-foun... ) , four days before it actually got published in online edition of Lancet infectious diseases on 11th August , to create media hype just before the actual publication date. This pre publication interview by this high ranking HPA official also shows that it was the last two persons in the long list of authors of this controversial study, who were the real architects of this ‘ Indian Medical Tourism will kill the world’ theory rather than the  lead author.

 

 The above mentioned examples clearly show that Carbapenem resistance has already been a major threat in UK hospitals for last more than 10-15  years, much before the carbapenems were launched in India about 7 years ago. The renewed attempts to show Carbapenems as ‘Last Man Standing’ in the war against the deadly bacteria by UK research team is laughable as according to their own studies Carbapenem resistance is present in UK hospitals  for more than 15 years now . 

“Holding India and its Medical tourism and Cosmetic Surgery industry for developing ‘Carbapenem resistance’ producing bacteria or genes is clearly biased and commercially motivated” said Dr K M Kapoor, Senior Consultant, Cosmetic Surgery at Fortis Hospital, Mohali and a Medical Tourism expert in India.”  Dr Timothy Walsh, a co author, has gone even a step further to implicate India’s rivers and wildlife too for NDM-1 spread (source: http://www.telegraphindia.com/1100812/jsp/nation/story_12801819.jsp  ) , pointing obliquely at perhaps Himalayas and Kerala, the hot tourist destinations in India. On closer examination, it seems this old, outdated issue, of ‘Carbapenem resistance’, has been pulled out of cupboard to create a universal health scare to probably save HPA from the certain death.