All people with TB should be treated with antibiotics

Thank you to Con. I'm glad to see he is apparently very formidable in his knowledge on the subject. With that, I will launch into some counter rebuttal. I'll endeavor to group arguments. Con's initial qualm is with my statement that 10-15 new people every year are infected. He says he couldn't find the original source on the WHO website. I did.[1] I respectfully disagree with the book Con has cited, as does the CDC, which states that it can be spread through the air by coughs, sneezes, speaking or singing.[2] But this is just strange on the whole; I really don't understand why Con is arguing this. He needs the rate of spread to be substantial. If it's not, then on what basis does the antibiotic resistance matter to the general community? He then contests my list of treatments. Let's examine them individually. Thioamides: This response is perplexing. I don't know what Con thinks an antibiotic is, but it is only an agent that kills or inhibits the growth of any microorganism. There are several thioamides that do this, namely ethionamide and prothionamide.[3] Aminoglycosides: Streptomycin isn't the only antibiotic in this group that affects TB. They include kanamycin, amikacin and isepamicin. They've been evaluated, at great length.[4] Cycloserine: It wasn't on your list. And it is quite effective, even against MDR-TB.[5] Cyclic peptides: Again, sort of lost on how Con is evaluating what is and is not an antibiotic, but these do exist, and they are effective. I've actually provided an example: lassomycin.[6] Fluoroquinolones: They're not solely used for UTIs. They're actually quite effective, especially sparfloxacin.[4] PAS: Old and expensive though it is, it is an alternative for when drugs like rifampin encounter resistance.[7] Yes, there are toxicity issues, but an alternative is an alternative, and each one suffices as an opportunity when another fails. Now, let's get back into Con's explanation of his case. I'm still really unsure of what the boundaries are for being too poor, though it seems that only those who lack insurance and lack funds are problematic. Con still doesn't specify how poor an individual has to be in order to be denied access; even if they can pay in the long term, their current finances may leave out many individuals, as may a lost insurance card. Recall that this is a complete denial of treatment " Con isn't providing for any short term treatment options. He remains unresponsive to my point about how this would require that patients entering the emergency room be checked for available funds before they receive treatment, which condemns many, even among those who do actually have the resources. To his credit, Con does clarify substance abusers. Sadly, this only hurts his case. Let's look at what the link says marks a substance abuser: Tolerance, withdrawal, high doses, persistent desire, spending large amounts of time getting it, giving up other activities, and continuing despite knowing the harm. Those are seven aspects, and only 3 are necessary to be considered a substance abuser. Frankly, I think I met it when I was addicted to World of Warcraft. Many smokers experience withdrawal, massive intake, and have trouble quitting. Alcoholics often deal with tolerance issues, increased use, and avoiding other activities. Con drops my argument that patients who are not substance abusers can easily be mistaken. How are doctors going to decide that a random person is a substance abuser? How will doctors determine whether someone has quit? What's more, Con never provides a reason for why this group is should be specifically denied access to antibiotics. Con still doesn't provide a strict boundary past which a person won't be able to get antibiotic therapy due to toxicity. He provides no analysis as to how someone would be tested for these toxicities, nor does he say anything about testing them before treatment. He's solely assuming that these are patients with medical backgrounds that point to vulnerabilities. Con says a patient can't be trusted to make these decisions, but he's is outright ignoring doctor consultation. He's essentially stating that they can never make a good decision, so they should never be allowed the opportunity to decide whether they're willing to endure the toxicity to deal with a disease that may literally be killing them, as TB often does. Lastly, Con has decided to ignore many of the most important questions on my list. He hasn't explained what the structure will be for denying patients access to treatment. He hasn't explained who will make the decision. Without this information, his case remains incredibly vague. But let's go back through the rebuttals. 1) Con's responses harm his case. None of these problems are lessened by Con's case. Doctors can still prescribe to patients who don't actually have TB. Doctors can still prescribe too small of a dose. Doctors can still use the wrong antibiotics. In fact, only my case seeks to solve the first and last issues, through DOTs and the Xpert device. All he does it force them to discriminate for all the wrong reasons against all the wrong people. Allowing patients to die is not the solution to the problem, especially when the increased spread of TB that is likely to accompany such a policy is certain to enhance, not reduce, epidemiological concerns. And yes, patients should be checked for physiological concerns, but denying treatment outright is not good policy. 2) Con brushes this off too quickly. Three problems with his response. First, it doesn't address the fact that patients will die and suffer without treatment. Directly denying that treatment gives plenty of reason for individuals to find fault with their doctor's practices, no matter what their guidelines might be. And it can lead to solid grounds for a lawsuit. Second, even if the guidelines somehow prevent some judges from agreeing that these doctors are actively hurting people, there are judges who will decide to play activists and force tremendous costs on doctors. Third, the court clog and time spent by both doctors and patients in court is enough of a harm that, even if doctors win every single case, it's a net detriment. 3) I got to this earlier. 4) Con outright concedes this point. At the point that he's telling the poor that they should die rather than receive necessary medication, Con is effectively treating the poor as disposable for some greater good he can only assume. In fact, his only defense of this is that the poor won't be able to afford the long-term costs of medication, but that's nothing but a gigantic assumption, as are all of his benefits to society. The only certainty here is that the poor will die and suffer en masse. 5) I'm not misrepresenting anything. Con's own DSM link supports the very same problems I've stated here. 6) Con misses the point. He's not effectively doing anything to resistance in TB when all he manages to do is affect the small U.S. population, which already has checks in place to prevent its spread. This is a solvency take-out " Con has to state why affecting the U.S. in the way he's stated will reduce the disease burden on the U.S. or any other nation. He hasn't done so. 7) I provided a list of drugs that avoid the harms depending on the patient. On that list was 6 drugs without any recorded nephrotoxicity. Pro has responded to one of those " aminoglycosides. I'll grant that he's right here, I made a mistake placing them there. But that leaves 5 effective drugs that cause none of these kidney harms. Where Con really fails to impress, however, is on responses to my counterplan. He basically leaves the majority untouched. To hit on the issues he did address: 1) It would be funded by normal means, which means increased taxation. You're right, it doesn't ensure that the homeless will seek healthcare, but neither does yours. However, only my case encourages them to come, as my second plank provides incentives. Only my case ensures that no one breaks the bank paying for these medications, even if they can afford them. And yes, this plank doesn't ensure adherence, the next does. 2) Again, normal means. Con proceeds to drop DOT, which has been shown to be extremely effective at keeping patients to their correct dosages over a long period of time.[8][9][10] Studies have been done to show that dosing can be modified and still lead to the same cure rates.[11] I explained that monitoring can be used to deal with toxicity issues and ensure that patients are taken off of certain medications before they become deadly. Con doesn't solve for the toxicity issues " if anything, he just ensures that the only people who are normally closely monitored (those whose toxicity is well known) are now going to have no access whatsoever. My case provides higher certainty of better health outcomes for everyone that's treated for TB, whereas his ignores the majority. 3) No, it doesn't fix the problem, but it certainly ensures better outcomes for pretty much everyone with TB. Only this device ensures that patients will be treated with the right antibiotics early. That can reduce the duration of treatment, the expense, ensure better adherence, and better health outcomes. Only this device ensures early detection, making that treatment more effective. Con's case does nothing for the majority of TB patients. My case benefits all of them. Back to Con. 1. http://www.who.int... 2. http://www.cdc.gov... 3. www.ncbi.nlm.nih.gov/pmc/articles/PMC2118422/ 4. http://www.ncbi.nlm.nih.gov... 5. http://www.ncbi.nlm.nih.gov... 6. http://www.cell.com... 7. http://www.ncbi.nlm.nih.gov... 8. http://www.ncbi.nlm.nih.gov... 9. http://www.ncbi.nlm.nih.gov... 10. http://www.ncbi.nlm.nih.gov... 11. http://www.thecochranelibrary.com...