In Russia, MDR-TB used as weapon against DOTS
Treatment failures show DOTS doesn’t work’
In Russia, the fight against TB has gotten harder, and multidrug-resistant (MDR) disease is playing a role in the debate, says Alex Goldfarb, PhD, associate director of the Public Health Research Institute in New York and director of financier George Soros’ Russian TB project.
Recently, the fight lost a leading exponent, with the death from pancreatic cancer of Aleksander Khomenko, head of the academic body known as the Moscow TB Institute. Khomenko had long argued for the adoption of directly observed therapy, short-course (DOTS), the Western-style regimen regarded by many Russian TB experts as a patronizing dismissal of a sophisticated and honorable tradition of Russian-style TB control.
In the wake of Khomenko’s death, Mikhail Perelman, a surgeon and TB expert who opposes the adoption of DOTS, has emerged as a powerful and vocal opponent to the World Health Organi zation strategy, says Goldfarb. "It’s a political argument, mostly, and framed simplistically," he says. The Patriotic School, as it’s known, says that DOTS exponents "view Russia as if it were Africa" — that is, as if it were an impoverished developing country. In that view, DOTS’ only aim is "to sweep aside Russia’s army of highly trained clinicians, its long tradition of TB control, its tens of thousands of TB doctors, TB institutions, and all the rest." The Patriotic School argues that if only for national pride’s sake, it is important to preserve the country’s traditional approach to controlling TB.
Adding fuel to the debate nowadays is the problem of MDR-TB, Goldfarb adds. "We [advocates in the West] have always argued that the reason Russia has so much MDR-TB is because 10 years ago, when it had the chance, it failed to implement DOTS." Now, with the spread of drug-resistant strains resulting from years of neglect, the solution is more complex and expensive than DOTS alone but still must be implemented in conjunction with DOTS, he adds.
But that’s not how the Patriotic School sees it. "They are saying, See, we told you DOTS was not working,’" he says. "They are now using MDR as an argument to say DOTS is no good."
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