Advice needed – charitable giving on TB

Last year, my husband and I decided to organize our charitable giving. Instead of making haphazard choices all along, we now give a set percentage of our income at the end of every year. Any smaller donations through the year don’t count toward that amount. That means that I can give to my friends’ pet causes without guilt or doing tons of research – it doesn’t take away from the real charitable giving.

This year, we’re giving to fight drug resistant tuberculosis. I think it’s one of the biggest threats to global health, and we’re really at a point now where investment can avert a disaster. We haven’t chosen our recipient yet; we’re just starting our research and I could use some help. Here’s who we’re looking at:

Partners in Health was one of the first organizations to recognize the threat of MDR TB and look for ways to stop it. Giving to them would be support for patient care.

PATH is doing a whole range of anti-TB activities, and I like their focus on health systems and service integration.

The Stop TB partnership is the big global group that provides grants, works on policy, and does advocacy work on TB issues. It’s closely connected to the WHO. Giving to them would address everything at once, but we’d also be funding (admittedly possibly important) bureaucracy.

MSF – Doctors without Borders – was also quick to recognize the threat of MDR TB, and they ran some of the first MDR TB programs in the former USSR. They explicitly don’t do development work, though, and I worry about how that philosophy fits with the need to integrate TB care into overall health services.

The TB Alliance supports science and research for better TB care and treatment. So giving to them would help stop TB at its source. On the other hand, they seem to be pretty well funded already.

We could chose a small NGO project on TB from Global Giving, and totally make their day.

Finally, we could go one level up and give to the Alliance for the Prudent Use of Antibiotics. They support research and policy on antibiotics in general, not just for TB.

I’m starting my research now – everything I outlined in this old blog post, plus talking to TB experts I know and people who work for the NGOs I’ve mentioned. I tell everyone that the commenters on this blog are way smarter than me, though, and I’d love your input. Who should we give to? Why? Am I missing any good organizations? Would you argue for something other than TB?

photo credit: isafmedia


Briefing: Tuberculosis

I recommend that before you read this entry, you go here. Right click, open it in an another window. Then come back here, and read.

Tuberculosis (TB) is mostly an illness of the poor. It is caused by a bacterium called Mycobacterium tuberculosis. It’s hard to get tuberculosis if you have a fully functioning immune system and a nutritious diet. It’s easy to get tuberculosis if you are sick, hungry, or have HIV. People who have HIV in developing countries are very likely to also get TB. There are three kinds of tuberculosis. All are equally infectious, but some are much more fatal once you are infected.

1. Regular, which can be cured with a standard regimen of drugs, most often the regimen recommended by the “directly observed therapy short-course”, or DOTS. If your get proper treatment, it is pretty easy to survive regular tuberculosis. (And training doctors to use the DOTS drugs will ensure that the largest percentage of TB patients get better.) People in the developing world are often afraid to go for treatment, but tuberculosis can be cured, and treatment is free in many countries.

2. Multi-Drug Resistant Tuberculosis (MDR TB). This is a TB infection that cannot be cured with the usual drugs. Doctors must prescribe second-line drugs to cure this form of TB. There are two ways to get MDR TB. You can get regular TB, and be prescribed the wrong combination of drugs, or fail to take your drugs. This will mean that the weak bacteria in your body are killed by antibiotics, leaving the stronger ones to breed and take over. These survivor bacteria cannot be killed by the usual drugs. You may also get tuberculosis from someone who has gone through this process and has MDR TB; your bacteria will therefore be the stronger, survivor bacteria even at the beginning of the infection.

CDC MDR TB fact sheet

Wikipedia entry on MDR TB

3. Extremely Drug-Resistant Tuberculosis. (XDR TB) This is the worst kind of TB to be infected with. It cannot be treated with the normal, first-line drugs, or the less common drugs used for MDR TB. It requires rare, third-line drugs to cure it. These drugs are more expensive, harder to store, and may have severe side effects. 50-80% of XDR TB can be treated or cured.

Medical News Today on XDR TB

The Stop TB alliance on XDR TB

For a long time, drug companies didn’t bother to research and develop new antibiotics. They were cheap and didn’t make a huge profit margin, and so effective that new ones were not really necessary. When drug-resistant TB first showed up, there were no second and third-line drugs. Doctors used veterinary drugs never used for people, and old-fashioned antibiotics that had been discontinued because of dangerous side-effects.

We can stop TB by improving the availability of good TB drugs, reducing the incidence of HIV/AIDS, or making poverty less common. Your money is well spent on any of those things.

This entry was inspired by James Nachtwey, and his TED Prize wish.

(Photo Credit: Saad Akhtar)

Two on Tuesday – Tuberculosis

Yesterday was world TB Day. In honor, I’ll offer two resources about multi-drug resistant Tuberculosis. MDR TB is very very scary. It also shows the challenges of any kind of health treatment program. It’s hard to keep patients in engaged in a long course of treatment and it is highly infectious.

This article talks about MDR TB in the Kyrgyz Republic. As an added bonus, using an x-ray to diagnose TB, as described in the article, is not all that accurate. You can’t identify specific strains. You really need sputum smear microscopy to make it work.

For more information on MDR TB, you can check the WHO MDR TB report. I attended the presentation of the report in DC and it’s both seriously researched and as frightening as one would expect.

An addendum: Another interesting TB document: notes on communicating with the media about TB. The WHO did a brilliant job of this, as their fairly dry report on a technical medical topic got all kinds of news coverage, including the New York Times.

Friday Fear – 1 February 2008

Friday Fear:Friday fear is a new weekly feature which offers you a list of five or six things to be very, very, afraid of.

1. Internet outage in the Middle East Aside from losing access to your gmail, can you picture what would happen to the US economy if we lost internet access completely? Also – could terrorists do this on purpose?

2. Double dipping your chips really does spread bacteria. Perhaps someone at the party with you has XDR TB ?

3. You can’t trust your doctor. Or the FDA. Or the coroner.

4. Bats and bees are dying.

5. And, finally: Weaponizing the Climate.