- All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident.
- Arthur Schopenhauer
German philosopher (1788 - 1860)
Even as evidence of the spread of the NDM-1 resistance enzyme in India grows, Indian health officials and politicians are adamant in their denials that:
1) a problem exists and
2) if a problem does exist, that it is in any way unique to India.
NDM-1, or New Delhi metallo-ß-lactamase-1, is an enzyme that can confer resistance to certain gram negative bacteria like E.coli and Klebsiella against a class of antibiotics called carbapenems.
Last August a Lancet Infectious Diseases article was published on its growing prevalence on the Indian sub-continent and its recent importation into the UK, US, and other countries.
The Lancet Infectious Diseases, Early Online Publication, 11 August 2010
doi:10.1016/S1473-3099(10)70143-2Cite or Link Using DOI
The immediate reaction out of India was disappointing. Condemnation of the use of `New Delhi’ in the naming of this resistance gene, and broad denials that medical tourism to India was responsible for its spread.
The naming convention for pathogens typically invokes its place of discovery or emergence.
In 2001 a similar gene was discovered in Brazil and was dubbed SPM-1 (Sao Paulo metallo-beta-lactamase). Another, discovered in 1999 in Italy, is called VIM (Verona integron-encoded metallo-β-lactamase), while SIM stands for Seoul imipenemase found in Korea.
Last August Indian officials took umbrage over the naming of NDM-1, called the claims of its emergence and spread from India a `conspiracy theory’, and rejected The Lancet paper out of hand.
12 August 2010 Last updated at 10:44 ET
India rejects UK scientists' 'superbug' claim
By Geeta Pandey BBC News, DelhiIndia has rejected a claim by British scientists that a new superbug, resistant to even the most powerful antibiotics, has entered UK from India.
The rest of the world, however, was less sanguine (see Public Health Agencies On NDM-1) regarding NDM-1’s spread..
Since that time the NDM-1 gene has been the subject of much international concern, particularly since it can be carried on a plasmid – a snippet of DNA - that has the potential to jump to other strains of bacteria.
Last week the original authors of the NDM-1 study came forth with new data in The Lancet that found evidence of the resistance enzyme in New Delhi’s tap water and sewage sites.
They also found evidence that this enzyme had been passed on to 11 other types of bacteria (see Lancet Study: NDM-1 In New Delhi Water Supply).
Indian reaction to this latest paper has been swift and strong, with new denials that a problem exists, or that NDM-1 posed a public health threat in New Delhi.
This from The Economic Times.
11 Apr, 2011, 02.55PM IST,PTI
India being wrongly blamed for bacteria in drinking water
NEW DELHI: Accused of "supressing the truth" about drug resistant bacteria reportedly found in Delhi's public water supply, the Union Health Ministry today said India was being "unnecessarily and wrongly blamed" and singled out in the matter.
Indian officials have claimed that the researchers `illegally transferred’ samples of tap water out of the country, have stated that the research was `unscientific’ and insist that the researchers are intentionally biased.
The stakes for Indian officials are admittedly high, as medical tourism is a profitable sector of the economy and continual discussion of emerging `superbugs’ cannot possibly enhance their medical reputation.
Additionally, the costs of trying to rectify deficits in New Delhi’s water and sewage systems (and those elsewhere across the nation) would be enormous and prohibitive.
The authors of the study remain adamant that their findings are correct, and that the Indian government is `in denial’ and suppressing information.
This from The Statesman.
India suppressing truth about NDM-1: Lancet
10 April 2011
NEW DELHI, 10 APRIL: Notwithstanding the Union government’s persistent denials of the presence of a drug-resistant bacteria in the public water system, an international health journal Lancet has charged the government with “suppressing truth” about the presence of a drug-resistant bacteria in Delhi’s public water system by “threatening” and “abusing” its own scientists. It has dubbed the government’s denial of presence of such a bacteria as “unfortunate” .
While one could certainly debate the `sensitivity’ of naming pathogens after their place of discovery, the fact is that is a long-standing convention used worldwide (ie. West Nile Virus, St. Louis Encephalitis, Hong Kong Flu, Asian Flu, etc.).
The Indian strategy of `shooting the messenger’ solves nothing, and delays in determining the scope of the problem could end up costing many lives.
Rather than simply maligning the researchers, now is the time for Indian officials to call for an open, independent, and outside investigation into the NDM-1 threat in India.
Only then can the truth be satisfactorily determined.
The problem with Arthur Schopenhauer’s quotation is that it can take a long time to reach the third stage – accepting the truth as being self-evident.
Time, that frankly, the world can ill afford to waste.
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