This is a page of frequently asked questions along with answers to them, and contains amongst other things some unsettling facts about TB in our world today. Hence "FAQTS". Wherever we quote these facts, they are sadly far from controversial. Almost all are sourced from the World Health Organisation (WHO), the Stop TB Alliance and/or from Medecin sans Frontieres.
Why are we so keen to investigate whether moxa might help TB in Africa?
- It was used for centuries in China to treat TB.
- It was used in the 1930s and 40s in Japan to treat and cure TB and was investigated at the time.
- It is an extremely low-tech type of treatment.
- It is basically safe.
- It is extremely cheap, and cannot be patented for profit.
- As s basic treatment approach, it is extremely easy to teach.
- Because the disease is out of control on the continent, incidence rates rising five-fold in the last fifteen years.
- Because the highest rates of co-infection of TB with HIV/AIDS are in Africa.
- Because the highest rates of latent infection are in Africa.
- Because the highest rates of mortality are in Africa.
- Because of the desperate lack of diagnostic infrastructure on the continent which is vital for proper drug treatment of TB.
What is latent infection?
- TB generally initially infects people and then lies in wait in the lungs before becoming active, often for many years.
- It comes out of its latent phase as and when changes in the health or constitution of the patient change in its favour.
- Globally 32% of the world's population is estimated to be infected with TB (that's over 2,000,000,000 people).
- In a developed country this rate is more likely around 4-5%.
- In Africa ,a staggering 80% of the population is estimated to be currently latently infected with TB.
- That's 640,000,000 currently directly actively threatened by this disease.
- Normally 10% of infected people develop active infectious TB.
- With high rates of AIDS in the community this rate is MUCH MUCH higher.
Why is TB so dangerous with HIV/AIDS?
- These two diseases feed off each other.
- The drugs to treat AIDS exacerbate TB and vice versa.
- TB is the leading cause of death for HIV patients in Africa.
- 50% of HIV patients in Africa develop TB, in some countries this is much higher.
- Latent TB infection is at least 30 times more likely to activate to full TB following HIV infection than in an uninfected individual.
- If you are HIV+ in Africa and contract TB your average survival time is estimated to be only 5-6 weeks.
- HIV anti-retroviral (ARV) drugs often can't be used on co-infected patients until the TB is brought under control.
What is Drug Resistant TB?
TB is a bacillus with an inherent capacity to mutate.
The first instance of a drug resistant mutation was observed within only a year or two of the introuduction of the first drug to treat TB.
Drug resistance has increased in the last fifteen years with strains occurring which are resistant to more than one of the drugs used to treat TB (Multi-Drug Resistance).
- Drug-resistance is stoked by several factors: inadequate diagnosis of drug resistance and consequent misprescription of drugs; inadequate supply of the drugs; patient non-compliance with the treatment; or failure to complete the treatment..
- There are up to fourteen drugs which help to combat TB. Many are accompanied by debilitating side-effects. Some require up to two years of treatment. Some are also very expensive and in short supply and rising in price.
- The worst instance of drug-resistance anywhere in the world occurred in 2005 in Kwaza Zulu Natal, South Africa, in which an outbreak of a strain of TB occurred which was resistant to twelve of the anti-TB drugs. Thankfully the outbreak was isolated and contained in a hospital,but it killed all but one of the fifty-three infected in a matter of weeks (unbelievably quickly for TB). Two of those who died were health workers.
How bad is Drug Resistance in Africa?
- Frankly no-one knows but they know it's getting worse.
- In 2008 the WHO conducted a global survey of drug resistance. The highest percentage rates of drug resistance were recorded in countries which were former satellite states of the Soviet Union. The highest numbers of cases were in India and China. But only six countries in Africa responded to the survey, and there are over forty countries in sub-Saharan Africa. There was no explanation in the report for this deficiency, but it is most probably because the provision of appropriate expensive diagnostic facilities needed to confirm drug resistance is almost entirely absent from the continent, so the survey would have been seen to have been irrelevant..
- The 2010 WHo survey incorporates data for Africa whis is hopelessly out of date. The data for Uganda, for instance, is 13 years old and the current statistics have been "mathematically modelled" from them.
- It is epidemiologically estimated that 640,000,000 Africans are cureently latently infected with TB - if 3.1% of these are carrying drug resistant strains then already 20 million Africans are already infected with a disease which is incriable in most of Africa.
- 3.1% is a recent calculation of the new cases of TB worldwide which are diagnosed as drug resistant. This has been rising year on year, and is almost certainly hopelessly modest as a percentage to apply to Africa.
- Only 1% of Africans have access to appropriate diagnosis to identify proper drug treatment.
- As a result it is estimated that only 25% of Africans actually receive correct drug treatment even when drugs are available - recipe for further drug reisstance.
- It can be assumed that as drugs are becoming (rightly) more available in some countries in Africa than before, without the proper facilities for diagnosing drug resistance, the rates of resistance will grow (and almost certainly already are growing) very rapidly.
Do we consider that moxa might help in treating Drug-Resistant TB?
- We don't know but we suspect it may.
- The treatments recorded in Japan predate any modern drugs, let alone any drug-resistance.
- The mechanisms of moxibustion, however, are understood to work by stimulating the host immune system to fight the infection and to aid recovery by pushing the disease back into latency or by eradicating it.. As such, strains which have become immune to particular drugs might well respond in exactly the same way as TB was reported to respond to moxa in the 1930's.
- This may be particularly relevant if the access to diagnostics in Africa does not massively increase.
- The current scenario in which drugs are routinely being mis-prescribed because of the lack of diagnostic facility is making Africa a continental incubator for increased drug resistance. Any possibility to avoid this needs urgent investigation.
Do we consider Moxa might help in cases of co-infection of TB and HIV/AIDS?
- Again we don't know, although the findings we have made in Kampala suggest strongly that it might.
- The treatments recorded in Japan predate the onset of the AIDS pandemic.
- Some individual case histories of our own with HIV patients on ARV drugs, together with some limited Japanese research (conducted on healthy individuals), suggest that levels of CD4 can improve. CD4 is a lymphocyte which reduces in numbers as AIDS progresses reflecting the progress of the acquired immune deficiency.
- Because the prognosis is so dire with co-infection, and in some countries in Africa the rates of co-infection are estimated to be as high as 70%, we consider that it is vital that the possibility that moxa may help with this desperate patient group be properly investigated.
Why aren't there better drugs being developed for TB?
- The pharmaceutical industry has a chequered history in TB research. The last drug developed is now well over 40 years old.
- TB research remains unattractive to an industry which is primarily motivated by the potential of return on its investment. TB primarily affects the poor with little capacity to return profit for the industry.
- Nevertheless persistent pressure from advocacy groups has resulted in a belated response to the problem, and new drugs are under investigation.
- No new drugs are expected until 2014.
- Research is focused primarily on new vaccines. This is because it is seen by the industry as the most profitable area. Better vaccines, however, as useful as they will certainly be to many, will be of no benefit at all to those already infected either actively or latently (over 2 billion people worldwide).
Are we seeing moxa as being an alternative to existing drugs?
- We seriously see it, however, as being potentially helpful when drugs are available, particularly so if they are in inadequate supply as is currently the case.
- We also seriously see possible benefits in connection with any one of the following:
- reduced periods of infection if moxa supports the patient to enable the drugs to work more effectively;
- possible resultant reduction in disease spread;
- shorter drug regimes resulting in improved rates of overall recovery;
- potential reduced rates of mortality;
- better tolerance to drugs and reduced side effects;
- possible improved results with DR-TB when appropriate diagnostics are absent; consequent possible reduction in the growing incidence of drug resistance;
- indications for innovative possible approaches to treat patients co-infected with TB and HIV/AIDS.
- However, in circumstances in which drugs are unavailable (as is also often currently the case) we also speculate that moxa may be helpful and may even provide the possibility of an emergency "barefoot" treatment when nothing else is available.
Why aren't we proposing conducting our investigation in the UK in premier research establishments?
- We'd like to and we've tried.
- We have been asked why such an investigation as we propose is necessary given that effective treatments already exist. Whilst this is true for those of us living in the affluent world, for most of those living in Africa where this disease is so dangerous this is obviously far from the case.
- Individual responses from the medical status quo have varied. In some cases they have been basically dismissive. In some cases they have been cautiously encouraging, this encouragement often being accompanied by what might best be described as a kind of worried pat on the back. In some cases we have received simple honest encouragement. Institutionally, however, in every case to date there has been clear and consistent disassociation from direct support for any investigation we might suggest.
- The bottom line, of course, is that conducting research on any disease like TB which is out of control in one particular environment (the develoiping world), but doing this in another discrete environment (the "first" world) in which it is basically already controlled tends to point towards relevant research results.
Do we think moxa offers an answer to TB?
- No, no and no!
- We do believe that it just might have a part to play, however, in the campaign against this dreadful disease, particularly in those environments where the might of scientific medicine is as remote as a clean supply of drinking water.
- The TB plague has been correctly identified by Dr Paul Farmer (co-founder of Partners in Health) as a symptom of a global blind spot towards one particular human right - the universal right to decent health care. This is such an important concept, and our proposals do nothing to challenge it. It has become perhaps an even more challenging idea in a world which is now engulfed in economic recession, and the last thing we would wish to offer in association with our project is an idea that TB can be controlled by moxa "on the cheap".
- TB cannot be controlled on the cheap, it can only be controlled by concerted effort and investment .
- In the meantime we wonder whether moxa may offer at least a much needed rest-stop on the roadmap to better global health care. At best it may offer an effective slingshot against a ancient giant of a disease which has re-awoken in the modern era to be even more lethal than it has been in the past.