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“We are unhappy about the personal attacks after this report,” Walsh told The Indian Express from Cardiff, “but we want to make clear that Lancet is not in the habit of publishing rubbish. The conclusions that we draw are rational and well-balanced.”
Countering the criticism over naming the bug after New Delhi — New Delhi metallo-beta-lactamase-1 — Walsh said that this wasn’t an unusual practice.
“We named the bacteria NDM-1 because the original patient who was investigated had flown back to Sweden from India with the infection. It was known that the origin of the infection was India and not Sweden. (It was) in the tradition of naming these types of bacteria after the city of origin,” he said.
For example, the Verona Integron encoded metallo-beta-lactamase 1 (VIM1) was first reported in Verona, Italy, in 1997 in Pseudomonas aeruginosa, a very common bacteria reponsible for hospital-acquired infection, mostly found in burn and post-surgical infections. The gene was later traced in Greece, France, South Korea, Taiwan, Venezuela, Japan, Belgium etc.
The Sao Paulo Metallo-beta-lactamase1 (SPM1) was first isolated in Sao Paulo, Brazil, in 1997 in the same bacteria. The German Imipenemase1 (GIM1) was isolated in Dusseldorf, Germany, in 2002 and was reported in a research paper published in 2004. And the Seoul Imipenemase (SIM) was a gene reported in Seoul.
On the Government’s claim that the report is meant to dent the medical tourism business here as it advises people against going to India for corrective surgeries, Walsh clarified: “If people want to go for surgeries to any country that is up to them. We have just advised that those funded by the British government should be careful. Seventeen of 37 patients in the UK travelled to India and got infected. How can we shut our eyes to this? In fact, it becomes the moral obligation of the Indian Government to recognise this resistance. These conclusions have been drawn based on NHS patients only.”
Saying that Indian researchers were fully in the loop before the study was published, Walsh said he had a declaration from all co-authors that “they have read the paper and happy with the contents.” The final draft (a copy of the full paper) was sent to the Indian researchers on July 12 and July 13 and nobody raised any objection. “We also have clear evidence in the form of emails that these authors did see final versions of the paper and they signed their agreement with its content and findings. (July 27 and July 29).”
While Union Health Minister Ghulam Nabi Azad criticised the report today, its authors stood by their data and findings. One of them, Kartikeyan K Kumarasamy, admitted that “Lancet is scientifically correct and the draft was shown to us all before they published it.” He said that he “did not notice the paragraph which cautions people from visiting to India for corrective surgeries.”
Anil V Kumar (co-researcher) from the Department of Microbiology, Amrita Institute of Medical Sciences, Kerala, said that the study is invaluable for the Indian health establishment. “If they had not spent their time and money here, we would not have known about the presence of superbug ever. Earlier, too, they have given names to bacteria after cities but nobody has made such a fuss. They have given the name to identify it, there should not be any hard feelings,” he said.
According to the study, NDM-1 positive bacteria are around 89-100 per cent susceptible to an antibiotic called colistin and 56-67 per cent susceptible to another antibiotic called tigecycline. In other words, these two antibiotics work on or kill NDM-1 positive bacteria.
Colistin, which gave the best results, was tested on NDM-1 positive bacteria at Pandit B D Sharma PG Institute of Medical Sciences at Rohtak in Haryana and at the University of Madras in Chennai. At Rohtak, the bacteria was found to be 100 per cent susceptible to colistin. In Chennai, it was found 94 per cent susceptible. However, the problem with colistin is that it is not considered safe and used as a last resort.
Doctors say that bacteria developing resistance to certain antibiotics is nothing knew. “This has been happening ever since bacteria developed resistance against the first antibiotic penicillin in 1940s. Regulating the antibiotic policy in the country will also help in containment of the resistant bacteria,” said Gopal Nath, professor of Microbiology at BHU.
The Lancet study says that NDM-1 positive bacteria are resistant to carbapenems, which are the latest antibiotics. Nath said this wasn’t surprising. “Carbapenems were introduced some time in 2001 and research on NDM-1 began in 2003”, he said.
His colleague, Dr M R Sen, who led one of the six teams of researchers that contributed to the Lancet study, said that the problem with NDM-1 was that the gene was found in E. Coli which is a very common bacteria and is resistant to even the latest antibiotics.
Sen, however, disagreed with the recommendation in the paper advising patients against going to India for elective, cosmetic surgeries. “Such a recommendation seems pointless and wrong...such an occurrence could have happened anywhere and for that matter, the gene is already traced in other parts of the world, including UK.”
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hello friends, this is really sad that people are fighting on the nomenclature rather than growing for solutions. it would be nice if we find the cure for that and invent a drug before any one does and name it on india and sell it at high cost. make the best use of international opinions on the bacteria and use to cure the infection. for this get the best doctors united and make held a meeting and produce it in newspaper as what steps is thid committe taking. Come on docs get the work done and finish off the the matter.
If the principle for naming a bug, is, by giving it the name of the place of origin. Why is Influenza causing organisms also NOT named after the place from where it is said to have originated?
Finally what does it mean? Will it be of any harm to the common man? It has the possibility of spreading easily? Is it deadly? Has the drug been invented? Rather than discussing about How much it will dent the image of India, I find it rationale to discuss about the steps to control it. Let the people invent a drug and name it after an Indian city.
Why should the bacteria be named NDM-1 and not the place of treatment? Was the person treated in Delhi proper? Govt's reaction appears "Knee jerk". It could have conducted an investigation and set the record straight instead of going to the Press with denials. When will our people learn to "Get things done" instead of creating unnecessary noise?
If, all this medical jugglery of words is directed towards the discouraging foreign patient treatments in India, then I am the happiest person. Just because of these patients, health services have become mirage to ordinary citizens of India. They have added exoitic location tours to lure the patients. If these experts are able to convince their local patients about the danger of Delhi bug then patients in India can have relief. But what is not certain is how west is going to tackle its under staffed and high cost medical issues. Neither they reduce their costs nor they allow patients to go out . Rediculous ! Man may have to return to his home remedies.
Let us shut down all hospitals worldwide, then there will be no hospital acquired infections. The only way a greedy pack of rats will come down is when they start biting each other. And the greedy pack of medical-pharmaceutical-journal industry have started biting each other. This is good news for the world.
i am depressed to see condemnation of the indian lead author of the article Mr.Karthikeyan kumarasamy. he is my colleague now in university of Madras. though he is the lead author, Dr.Walsh is the corresponding author and the discussion part was written without his concern. As we know the full story of how and why he went to UK we feel pity for him. after sacrificing much of his life, his wealth and all happiness the dubious fame he is getting for an inappropriate reason is heart breaking. He finished most of his work in INDIA and as there was no other way to progress with his studies he moved to UK. this is the truth and he doesn't gained anything monetarily, but has sold much of his land to fund his research. I personally feel his work should be appreciated and taken as an inspiration, rather critcising him that he sold the nation's pride for few GBP scholarship.
If a resistant bug is discovered to India then it should be our concern to find a way to contain and combat it. It not only affects the foreifgn patients but more importantly for us it will affect our patients too. Since there were indian scientists also include and who endorsed the findings let us acceptthat there is truth in the article. Let us shed our persecution mentality' imagining that westerners are out to defame us and our achievements. Rather let us show to them that we can devise methods to overcome the issue by regulating the overuse of antibiotics which is the true reason why a resistant bug has developed
The scientific community should focus on the bug and address its serious threat rather then cribing over its real origin. It originated on Earth. Right? And we reside on earth. There are Indians among the authors of this paper published in Lancet. What's in a name? If an invaluable treasure is found in Indian Ocean, will it belong to India? Can any Indian lay claim on that? Let's be broad.
All i want to say is we indians do get carried away if something like this appears. Now what the hell is medical tourism. Any given day the practices of Foreign hospitals are 1000 times better than govt hospitals in india. There is always a chance of infection after surgery...even bedsheets for patients stink. So we shd look at the aspect of corruption in every area of this country rather than blaming Lancet....does anyone know how much effort it takes to get the work published in 'Lancet'.....it has impact factor of 30.....the work is credible, all we need to do is act fast and swiftly rather than uninformed media project this as an attack on so called free india!!
The study seems to be purely scientific with multi centric involvement, including India. This super bug is dangerous to all patients,including Indians, these findings will help to develop better antibiotic & chemotherapeutic agents against this bug. Linking names with city, patient,doctor, country, is a common practice in Medical Research.I read the full article in Lancet, & I differ with most of the readers & my colleagues (doctors)that the advice(mentioned in the article) was to harm the Medical Tourism in India deliberately. Every govt. has a right to give advice to their citizens, we too are doing same in our country. I have no love for white race, particularly Britons. We should not over react but try to improve our hospitals.
I agree that we could use the report to improve our hospital conditions. BUT, I have major problem with the 'advise'. The govt does have right to give advise, BUT this study was funded by two pharmaceutical companies, not govt. Also, the reports published in scientific journals should be facts, not advice. In my opinion, the lead researcher did more than just present scientific facts. If you think it is govt advise, it should have been from govt health official, not from a group whose member holds shares in numerous pharmaceutical companies.
Many thanks. The government and those in authority in India have no respect for science. We tend to believe more in success resulting from turning the chair in a certain direction etc. We therefore find it easier to react to any such study by inventing imaginary threats instead of doing something concrete on a scientific basis about the criticsm. Wonder if people like you can knock some sense in those who rant and make noise.
This is impossible and unbelievable.Because that infected person came from Sweden to India to get the treatment.So How can LANCET publish "IT S ORIGINATED FROM INDIA" ?? and it folly statement and not possible from originated from india..SO Sweden didnt check properly that treatment person who came to INDIA. THIS IS ONLY TRUE .and hereafter NO ONE belive that LANCET will publish ..Because this didnt analyze to get the truth.There are blaming on india .
If the scientific team researching a CASE isolates a VIRUS that has IATROGENIC ETIOLOGY it is simply the TRUTH to say it is from INDIA, Specifically from New Delhi. The LANCET is one the most prestigious and RIGOROUS med journals out there. I am Indian but the truth is that the government must STEP UP to changing the malpractices in the medical fraternity related to ANTIBIOTIC ABUSE rather than crying foul and asking for sympathy for the medical tourism BUSINESS.
A reputed medical journal of more than 100 years, with a high rate of rejection, would perhaps take all possible care before an article which is certain to raise a lot of dust! Secondly there is also a peer review which is expected to go through every aspect in a published study. Medical tourism has been recent phenomenon in India it is obvious that many hospitals who are attracting foreign patients have reacted. let us also investigate further and prove that these observations are biased
It is not just the quacks but some doctors also prescribe high potency medicines for normal infections. I have seen some instances like that. We all to be get well as soon as possible and love the doctors who give these kind of 'magic bullets'. Combine effect of 4 conditons namely. 1. High number of quacks 2. Doctors prescribing medicine with highest commision to them(Usually the most potent medicine) 3. Unregualted Over the counter availabily of drugs 4. And poor safety standards in many research labs We have a perfect recipe for making MDR(multi Drug resistant) bacteria.
The report is totally biased and didn't carry any theoritical support. Many articles are reporting the same bug they found in the patients who never visited India. The report should not answer this point at any point. If the bug is originated in India then the patients must be manifold in India than any other country in the world. Which is not evidenced...... At the end the conclusion is simple....it is totally biased and double standard artical against Indian Medical Industry. American President already threatning the developing countries particularly India and China for exporting services and products respectively. But they export human killing wepons to all the countries across the world and nobody should object them. This is the western media hype...and their mentality.
The issue in this particular case, which suggest bias , is advising the people not to travel in India for elective surgery. lancet is a journal for medical practitioner and not for common man.so they should have restrain from unnecessary comments. and this particular comments, taking high moral ground suggest that LANCET HAS THEIR OWN AGENDA. other issue are also debatable as antibiotic strains changes as per environment and if you go in search you will find not only Delhi strain but also all other city strains. you must look for it and you will find. lancet lost its prestige and good practice with this biased comments.
There is indiscriminate use of antibiotics in rural areas by quacks which has got no control,people also have dangerous habit of self medicating themselves as they do doctor shopping . There is no control on prescription , even in diseases like TB i have seen so many cases of MDR TB working at rural hospital which is difficult to imagine. Reason either people donot finish full course of 9 months which leads to resistance or quacks give them steroids for quicker relief. Our climate also being hot country we should have strictest control on drugs control and distribution given huge population. Our health minister should focuss more on how to stream line health care infrastructure connecting villages to towns to cities to bigger cities . It is not impossible in modern era of communication so that last person in chain receives same type of health care. There are huge problems no body is addressing them , this was bound to happen. So much needed so little done.
Dear doctor, it is true that indiscriminate use of antibiotics happen, the reasons are as much quacks as is irresponsible and arbitrary high charging private practioners who often provide shoddy treatment while charging high, thats the reason patients are forced to do doctor shopping. There is no sanctity of hippocrates oath for private majority of private practitioners
Lancet doesn't publish 100% correct articles.previously they were criticised after articles they published on iraq war n mmr vaccine & its link wid autism.later it was proven dat data was fabricated on those articles.dis time ndm1 article came just after a report dat india now in d list of top 5 places of best cosmetic surgeries.two pharma companies welcome trust n wyeth funded 2 publish dis article.it has been tried only 2 scare medical tourists away frm india.
point is we dont care if the virus is here and we condemn just for naming after newdelhi. if it is named after karachi it is ok for us!!!!! nobody talks here how we are going to be affected - prevention methods -whether it is spreading from foreigners to indians and these super speciality hospitals just to earn money shut their mouth ignoring safety of indians.or our hospitals dont care for safety and interested only in foreign medical tourists..... nobody is talking on these lines including press . they want only sensation. after they name another virus they stop talking this. nonsense.
Mr Walsh, is New Delhi same as India or vice versa ?
The report is silent whether the 37 Patients who visited India for their treatment, were also tested before leaving UK for India, for the so called Superbug. If the answer is negative, then there is seriuos doubts that the Patients might have been infected with Superbug in UK itself, before their departure. Secondly, on what basis 37 patients were picked up for checking in UK after their return, as there are thousands of such patients visiting India for medical treatment. It is also shocking to learn that some Indian Research scholars were also involved in the publication of the report undermining Medical treatment in India and also going out of the way to issue Advisory for not visiting India for such medicare. It looks like that our Indian Scholars (?) are ready to sell the Nation's pride for a few GBP scholarship. Shame to such Indians!
Science is truth and you can't fudge it to make it look pretty as the Indian Government and the politicians would like to have it. England recognized Ramanujam while he was languishing in Kumbakonam. Brilliant Tagore achieved his glory with his British mentor, Y. B. Yeats. Science and English were taught by English to men like Gandhi and Nehru and many scientists. Instead of questioning Dr. Tim Walsch as to why the Superbug was named NMD-1 and get snubbed by him with scientific explanations and prior examples, the Indians should have reminded themselves of the bon mot, %u201CFools rush in where angels fear to tread%u201D and studied the Nomenclature rules in Enzymology, etc . Incidentally, the supposedly prodigious brains of IITs could in no way have cracked this microbiology/biochemistry question , since all they deal with are inanimate computers . It was left however, to a science graduate, Karthikeyan K Kumarasamy, from some unknown College in Namakkal, Tamil Nadu, to delve for answer.
So you agree, that brilliance is breeding in Indian villages and after looting our country and filling your pockets you have guts to do reverse research to prevent other countries doing their best. what an hypocrite?
Indian parties have mastered the art of what pakistan has been using successfuly - junk patriotism. Instead of addressing a grave threat to the Indian people, Indian government has gone to the extent of attacking the people who have been exposing this carelessness of Indian Health ministry. It is known fact doctors in India prescribe wide spectrum anti-biotics for all mild fevers and infections. They do it because people want immediate results. This reckless attitude of Indian medical community, the governments and health organizations has created this monster.
Dr. Walsh is defending a politically pressurised decision. Lancet is known to publish politically motivated articles. That is why it does not have good ratings. Why didn't Dr. Walsh publish in Nature or Science? They have higher standards of scrutiny.
This is pure propaganda. Western doctors and pharma companies have monstrous hold over their politicians. They charge arm and leg for even simple surgeries and hence dont want the status quo changed. They also ridicule the time tested ayurveda and all that because it eats into thier business. The medcial union here is the worst type of union holding people's lives hostage
As explained by Mr. Walsh, the bacteria is detected has been detected in Sweden (not in India), therefore, the naming of the bacteria should begin with S not with I. It is ridiculous to say that the bacteria originated in India just because the patient was treated in India. In fact, the chances of bringing the bacteria to India from the infected Swidish person is severe, as the person who came to India from Sweden was for his treatment. Did the Swidish medical authorities scanned the person before leaving Swidish to determine which bacterias/viruses he was carrying or not?