Thursday, May 31, 2007
TB: bigger questions raised
As I have been covering the story of tuberculosis, specifically XDR - TB, several things have occurred to me. So, I thought I would just muse for a few lines and get a sense of what you are thinking as well.

I think, after looking at the science and talking to most people involved, the likelihood of anyone getting infected is incredibly small. Even the TB patient's wife, who was just on a honeymoon with him, has tested negative so far. That's the good news. The bad news is that a lot of people on those flights have been incredibly confused, and a little angry. I spoke to a few of them this morning.

First off, they were first contacted by CNN, not the Centers for Disease Control and Prevention - even though they had sat in the same exact row as the infected man. They were tested after seeing news reports on television. One man was immediately placed into a temporary quarantine and asked to wear a mask at his local hospital. The doctors had no idea how to deal with this problem. Many others who were not in the nearby two rows were told to get tested only if they were concerned. Well, what does that mean? Shouldn't everyone be concerned?

Now, the latest CDC advisory simply says everyone who flew on those planes should get tested. That's the confusing part. The anger part: the passengers seemed to think that this infected man was not malicious or out to hurt anyone in particular, but that he was selfish and unnecessarily put many people at risk and created anxiety and worry.

More than anything, I think this one case reflects deeper failings in our public health system. What if there were ten cases, instead of just the one? What if it were smallpox or a bioterrorism attack? Are we ready?
I couldn't agree more with your thoughts and here are a few more. I firmly believe the man should not have been allowed to board a plane period. I believe when there is a potential life threatening situation it should be posted on a website the FAA can monitor. As this could have been a potentially deadly situation that could have brought and may still sanctions from other countries on us as well for the patients's disrespect for other's well being. Here's a question going further, can co-travelers sue the carrier for harm if they do contract the illness? I think there should be accountability when you knowingly expose others to this level of disease. But in the end, I hope he recovers and no one else is affected.
On the TB story, that should just prove to you the power of the press. The press has the capability to report to people on a wide scale. So please use your power wisely. Don't put a panic into the general public if it is not necessary. Although I'm extremely big fan of yours Dr. Gupta and basically a fan of CNN in general, I still sometimes wonder where you get your stories and what makes the news REAL NEWS. Sometimes I just think that other stories that don't make it into the news are just so much more important that what is getting reported.

But in all, I thank you for all the hard work you do, when I grow up I want to be just like ya. (kidding, maybe someone similar to you). You're an excellent role model Dr. Gupta.

PS: I love the stories that CNN has been doing on the wounded soldiers. Keep up the good work. Don't let out government forget what our soldiers have been though.

Ann Stewart, Nashville, TN
I was suprised that this patient originated from a metropolitan area such as Atlanta. Were there restrictions put in place for travel within his surroundings? I was also suprised to see CNN post with the article the picture of what looks like an African man? Is this the media bias we have been talking about. From the look of the background graphics I assumed that this person was from Africa even without reading the story. From what I read from the article it seemed that the man is caucasian.
With a name like CNN I must say I was a little disappointed that the editor's choice of picture
I'm a doctor myself and find the whole thing very concerning. It's scary either way you look. I find it as plausible that failings in communication led to this man truly being ignorant to his condition as much as it being plausible he ignored his doctor's request and took the flight anyway. We may never know, because now that this has happened everyone is trying to cover themselves. It's important for patients to listen to their doctors, but no more so than it is for doctors to "tell it like it is". I think we can have a tendency to sugarcoat bad news to make it easier on us to divulge it. I hope that's not what happened here.
I agree with your article completely. I would like to believe most Americans would not put tens if not hundreds of lives at risk in order to improve their own chance of survival. His actions were selfish and negligent. I don't believe he has actually committed a crime, but his actions were certainly untrustworthy and somewhat immoral. I hope he is ashamed of himself.
I read yesterday about a man in Arizona who has been in hospital-jail for not wearing a mask when he went outside. Why aren't charges being pressed against this man? He willfully and wontonly exposed people on multiple continents after being told not to travel. He admitted purposely evading authorities by changing his travel mode and returning to the US through Canada. And he wants people to know that he is intelligent and successful. He is arrogant and obnoxious. I would sue him so fast if I were infected.
I think this man was incredibly selfish. He may not have known how dangerous a strain of TB he had, but he knew he had TB of some sort. What about other passengers with suppressed immune systems such as people with cancer, elderly, etc. He could have killed them with any type of TB. He obviously was only thinking about himself. Why couldn't he postpone his plans until he was deemed not contagious? He should not need the CDC to tell him not to fly. Common sense should have told him that. Another symptom of today's society--the world revolves around me!
I think people should also be aware that illegal immigrants sneaking in across the Mexican border have also been found to have TB. The cases in the US have actually been rising.

The man in question did tell the medical personnel that he would wear a mask when traveling. I guess he forgot? lied? I think he was also incredibly selfish to put others at risk. He was on several flights during his time out of the USA and there are quite a lot of people on those flights. They may have not heard of this situation yet and spreading to many others. I think the medical personnel should have immediately told their concerns to the authorities when the person told of his plans to travel even when they advised him not to. He KNEW he shouldn't have travelled that is why he snuck back into the states thru Canada. So much for secure borders. But that's another story....
I am surprised more people aren't appalled at this man, based on his decision to expose hundreds (if not thousands; I believe he was on 5 additional flights within Europe) of others to this particularly virulent form of TB. All important lessons aside, I think that at the very least, this man should be subject to public humiliation; CNN...release his name! Someone who knowingly and willingly put so many others at unnecessary risk shouldn't be allowed to cower behind a veil of privacy.
More than anything this episode demonstrates:

1. How little systems have changed since 9/11. What became of the plans to create a database available to all government agencies? Was that all just talk to ease the public mind? Did we not have the funding - again - to protect ourselves and our society because we're building bridges in Iraq?

Had there been a central location to enter this information it might have been available to the airlines when the man reserved his seat.

2. The lack of WILLINGNESS of civil servants to protect us. Even though his physician is not a government employee, medical personnel are considered among the "front line first responders" in emergencies. If there's a vaccine for anthrax or small pox or the terrible flu - that doctor is going to get it long before the average citizen even knows it is available. Whoever his physician is - bore a great responsiblity to the public at large. Everyone is so afraid of litigation that they're not saying anything. I will NEVER believe that the physicians who diagnosed this didn't know immediately how dangerous it was. Knowing the danger, I'm sure they notified the CDC and if not - their local county health dept. Yet no one was willing to order this patient into quarantine to protect society.

Is it because he is a man? The government has a history of imprisoning women with contagious diseases. Why isn't that applied equally?

3. How totally open to just this kind of medical crisis we are. We hold ourselves to be a mighty world power yet we don't have national health care? Meanwhile, Europeans have developed modern health care systems that aren't broken and underfunded. The nordic countries have the best Mental Health care system on the plant. They have all sat back and allowed us to waste our money on foreign aid - feeding people who hate us. We've spent billions on foreign aid what good could those dollars have done here? There are people in rural states who don't have floridated water. There are children in inner cities who don't have dental care. There are millions of working poor who can not afford to vaccinate their babies.
I don't think people appreciate the real cost to the public of this behavior. We live in a medium sized town in NH. My daughter has been exposed to TB somewhere, most likely at school. No one else in the family has been exposed. She tested positive at the age of 16 during a pre-employment screening. She had to go through 9 months of antibiotic treatment in the hope that when she is an older person or if she becomes immuno-suppressed for some other reason, the disease will not flare up. For the rest of her life, she will always test positive and will always have to explain her condition. In discussing this with her doctors during her treatment, they said that this was not at all uncommon, and yet we persist in believing that TB is not a public health threat.
Unlike yourself, health people do not seem to talk to each other. For instance, when I gave birth to my son, I had a concern that there was a slight chance that he had G6PD. I had to stand on my head to get him tested while I was in my hospital bed. The nurses had never heard of G6PD and had a lot of confusion passing the requests to the doctor. Even before delivery, I had asked the doctor to request the test but it kept falling by the way side. Instead, I got multiple inquiries as to whether or not I wanted to circumcise my child. I had to keep saying no. I felt like I had just ordered off the menu at a McDonalds'.

As far as the nurses, they gave pretty good care, but they don't seem to agree with each other on breastfeeding techniques and such.

Thanks for bringing this issue to light. If we can't even take care of the day to day, mundane things like postnatal care, how can we deal with a disaster. For all the money that we pay into insurance, our nation should be flooded with quality health care people. And I have heard that we do have that. I just wish that there are more distinctive guidelines on communicable diseases and every healthworker should go through training on bioterror prep.
That person need to be in jail. His acted was criminal, he knew he could spread his sickness to others
could be million, and he intended to do that. He has an illness mind, and he should not be free to go around in this society.
Justice should do something to
prove our system to protect innocent and prevent such thing in the future.
Of course we are NOT ready...this is an unfortunate event that exposes the terrifying truth that when a bioligical terrorist attack happens we are not only NOT prepared but horribly ill equipped to handle it...don't think for a moment that the terrorist "sleepers" in this country are ignorant to this disgraceful flaw! I so hope that the government agencies that are suppose to be protecting us are paying attention!!!!!!
I think that more than selfish this man is very irresponsible. He could have infected many people for he doesn't know/understand the power of bacteria.
The airline is not to be held accountable for any possible outcome, but this man should be.
I think this man's actions are beyond selfish and reprehensible.
Did he not think of people with weakened immune systems, children, etc. Worse, why was he not stopped? I agree with all of the above posters that he flat out should not have been allowed to travel until his infection was cured.
Further, he called him self 'an intelligent, educated man' and was outraged that there was an armed guard posted outside of his room. Most importantly, have we learned nothing from 9/11? As a New Yorker, this confirms to me the fact that so much of what the government does to protect us is mostly for show. Clearly, we are not prepared for any sort of biological attack; especially outside of the New York City area.
I agree. I personally am extremely angry that this man could be so selfish. The chances of infecting other people may be extremely small, but they are still there. If he did infect anyone else, they could die. I think his selfishness in this matter is incredulous.
I think this man is selfish and he should be charged for endangering the life of others. His behaviour seems typical of the selfishness pervasive in North American society. Very sad indeed.
He acted selfishly and put many people at unnecessary risk. Based on previous articles regarding this subject, it appeared as if he knew what he was doing (i.e. ignoring doctor's warnings, slipping back into the US via the Canadian border) This was clearly not a case of ignorance.

I wouldn't be surprised if there was a lawsuit (class-action if that is possible) as a result of his actions.
I am surprise to hear from reporters that the patience called himself 'educated'. For his own pleasure, he traveled not only on one but several planes and countries, spreading this deadly decease across the Atlantic and North America. God knows how many people were infected because of his selfish and irresponsible act.

Centers for Disease Control and hospitals should have done something to alert the airlines. The patience has the right to travel, but airlines have the right to denial his boarding.

Back in 2003, a professor carrying 'severe acute respiratory syndrome' from China visited Hong Kong, resulted over 290 deaths when the disease was finally under controlled. Likewise, the professor knew he was sick before traveling. Sounds familiar, isn't it? This is just an example how pandemic started.

If you happened to sit next or behind the patience during those flights, this is not the time to get frustrated. Do the right thing for your family and visit the nearest hospital.
If I had kids on that flight and they got sick I would sue this moron into oblivion. People pay attention only when it costs them money.
It is amazing to me that when there are news discussions regarding illegal aliens, there is no discussion of the number of communicable diseases that have been brought by them into the United States. HIV, Hepatitis and TB have greatly increased in this country due to this problem. It is so naive for a border agent to say a person doesn't look sick. If the news media wanted to do an eduacational service to this country, it might offer indepth coverage of current communicable disease status in the United States, modes of entry, quarentine policy and modes of treatment, instead of the heartstring stories regarding immigration.
Regardless of what this man was told or not told to do pertaining to travel, this much is certain: the man's wantonly selfish behavior reinforces some of the negative stereotypes many foreigners already have about Americans. Beyond the reports about how freely he could travel, as well as the safety of other passesngers on the flights in question, this is certainly not the type of international publicity US. citizens need right now. In my view, he did all of us a profound disservice.
Why are we always so quick to put the blame on someone else? Certainly everyone flying knows they are breathing the germs from others. This is not fresh air we are breathing in plane's cabin. I have respiratory problems and I wear a mask. Step up to the plate people and protect yourself. I do.
I agree that the actions of this man were wrongful but question whether his intent was because of not knowing any better or malicious. What is confusing is the varied news reports that his strain of TB is not very contagious - some saying even if he breathed right on you it would be near impossible to catch it. What if you had an immune system disorder? I worked in a hospital microbiology lab and this is totally against what they taught us when handling specimens for TB testing. Treat everything like it could infect you and in case of spillage (in a special pressure room with bio-hoods with gowns and masks on) HOLD your breath and leave!

Now that I work at a state college, I was amazed that upon employment I was NEVER asked about my TB status or any other vaccination history. Just think about all the staff that could spread a disease to the student body and community and beyond on a large campus!

I hope this story makes the US re-examine its views on public health and makes everyone think about just how ready are we in the case of an outbreak.

- A NY resident
this incident remimds of the famous President Kennedy's quote -- "ask what you can do for the govt and not what the govt can do for you". Probably the person who had TB -XDR should not have travelled in the aircraft as still there is a remote chance for infecting fellow passengers. But then the CDC has utterly failed as its official already knew that the person had a bad disease and should have been advised not to fly and should have been marked on no-fly list. If needed the person should have been quarantined without endangering the life of others. In case of major epidemic or bio-terrorism the individual will have to play a responsible role in not spreading the disease and govt should be ready to take quick, apprpropritate action, and sometimes drastic measure for example, quarrantine of a huge group of infected or likely infected people, to prevent further spread of the disease.
This guy was told what he had and not to travel; he did. They tracked him down in Italy and they told him NOT to take a flight back, he sneaked back in the US via Canada. What a great act of selfishness to expose all the people in two transcontinental flights, and everyone else he came in contact with including his wedding party!! What a guy!!! I understand that the incubation period for this type of TB is lengthy so even people he had contact with in the last few weeeks could test positive. A real American hero!!
Incredible in this day and age with the levels of surveillance available that something of this magnitude could occur. Which leads me to believe, in general, we here in the US are under a cloque of false security if we truely believe that we will be protected in scenarios equivalent to a bioterrorism act on our homeland. Wake up and smell the coffee!
Forget just suing this idiot; throw his ass in jail and let him rot there for a while. Maybe send him to Gitmo, or back to Haiti so he can take up space in one of their jails instead of ours? And do we know for sure this guy didn't do this intentionally--trying to make people sick--as the biologic equivalent of a suicide bomber?

Charlotte, NC
He snuck into the USA via the Canadian border? This is laughable, considering he is a US citizen and his travels originated in the USA. He should not have been allowed to leave the US to begin with.

The US continualy blames Mexico or Canada for illegal immigrants or other so called undesirables that enter their country when it is their own customs agents that allow these people in. Perhaps the custom agents in Canada and Mexico should become more selective in who they allow into their countries.
Folks! WAKE UP! The CDC is TOO CAUTIOUS to a fault. Rather than take a stand they chose a course of action that not only would have infected everyone on those planes but also the rest of the people he came in contact with All over Europe, Canada AND the United States! Politics is a mind numbing game and it infects every walk of life we have including the state of our health (or not). When this came up they should have taken his passport away and stopped him from any kind of travel. Do I feel safe? NO!
I was recently exposed to the measles in Albuquerque at an international science fair. There were over 1500 hundred students there, plus chaperones, judges, hotel and convention center workers, caterers, airline passengers, etc., etc. The person who was sick with the measles was a student from India, also the nationality of the person who caused the last measles outbreak in the U.S. in 2006. I found out the student was sick when she came to the U.S. and was sick the whole time she was here. All in all, there were several thousand people exposed to this disease. Why aren't there standards for vaccinations for people coming to the U.S. from these third-world nations? Why was this student allowed to come here when she was sick? It's ironic that this TB scare comes a two weeks after all of this. Maybe it's time the U.S. got a little tougher screening, quarantining or keeping people out altogether who carry these infectious diseases?
Although the infected man did not maliciously try to harm other passengers, he did, according to the medical community, pose a harmful threat to other people. Even after been having tracked down on his honeymoon in Europe by health officials, who warned him not to travel, he did so anyway. Thus, I find it very ironic that this man is a personal injury attorney in Atlanta.
I am appauled that CNN aired the persons' name who carried the TB infection. That person has a right to privacy. HIPPA was violated! If it is going to be "public news" about someone's Health why don't we start posting faces and names of people infected with HIV and Hep B. These are diseases that are killing thousands of people everyday. Many of these people ARE aware they are infected and continue being intimate with people who are unaware. Come on, it was unethical to post his picture and name. I am so disappointed with CNN.
The problem in this particular case is not the failed response of public health officials, nor is it a case of being ill-prepared. The problem was quite simply the patient's noncompliance. While this man was most likely a latent carrier of TB infection, public health officials reacted quickly and decisively to try and stop this man from spreading the disease.

Generally, XDR-TB is by and large the result of patient noncompliance. This deadly form of resistant TB is mostly the result of patients not completing their entire TB treatment regiment therefore allowing the bacteria to gain immunity. This is especially true in areas outside of the US with poor health infrastructure where XDR-TB is highly endemic.

The reason this particular instance has gained such attention in the media is that it involves an educated US citizen who was ultimately apprehended because he knowingly avoided treatment. This “hospital arrest” by CDC officials has raised the more important question of where privacy laws end regarding individuals who are the carriers of specific deadly diseases.
I was surprised to hear criminal defense attorneys and prosecutors state that the behavior of this XDR TB patient could most likely not be prosecuted. Passengers may not board planes with knives, but if they knowingly board a plane with a potentially fatal disease that is airborn transmissible there is no crime?
What does this say about our society? We suspend a kid from school for a month because she brings aspirin to school to alleviate menstrual cramps, and do nothing to a putz who knowingly endangers thousands of lives during a selfish, me-first honeymoon tour of the planet. I say pitch his butt in jail for endangering the public health. Once his TB is dealt with, of course. Intelligent and educated, my eye.
XDR TB exists in many (most?) parts of the world and the US is visited by thousands of people from these areas every year. In this day and age of easy travel, long distance flights (I think newer planes do have HEPA filters to trap some organisms) and far greater interaction between people from far corners of the world -how does one monitor them all for XDR TB and potentially other dangerous conditions that are communicable where the patient may not be obviously sick. During the SARS epidemic body temperature monitoring was used at some airports in SE Asia and Canada - but that was a disease where there is a measurable red flag. The US has far more advanced systems to monitor these diseases that are realtively rare in this country - in some other countries there is no monitoring at all and carriers of such diseases may freely travel wthin and outside the countries.
this is an example of our lack of infrastructure due to misguided priorities and perspectives, our republican politicians are so busy pandering to radical religous zealots and our democrats boud by it that %20 of our population are skewing the business of the nation, educated people are screaming about the impending dangers we NEED to face up to such as the growing drug resistance of of many viruses and such that plague us not just TB, our government is so busy discussing alternate sexuality, serving corporate interests that foot thier reelection bills, flag burning and other such silliness and in general doing anything that feed thier personal ego's and cofers such as this rediculous "war on terror" and equally poorly thought out and implemented "war on drugs" that they simply are not doing the business of the american people which would be to DIRECTLY improve the quality of our lives and what would more directly effect us than to make our health a SERIOUS priority, throw out the ideology and get to work on what we have been warned for something like 30 years is a pending crisis, a real understandable demonstratable immediate crisis, the "bushies" are so good at scaring people about abstracts that are %90 BS it is amazing to me that we have educated scientists and doctors warning about these super bugs and we're complacent as a country, it is a shame that it really looks like our country is heading downhill and the only thing that may bring us out is if some health crisis or such DID happen and we would see our priorities as they should be and stop voting for such egocentric dullards with an ideological bias AGAINST governing and instead get some folks who genuinely have the ability to do the job who will WORK for US
Dear MKB:

Please, if you are going to quote someone, get the wording right. President Kennedy said, "Ask not what your COUNTRY can do for you. Ask what you can do for your COUNTRY." He did not use the word "government." But perhaps you think country and government are the same thing?
This selfish man knowingly exposed hundreds of people to TB. He should be criminally prosecuted and imprisoned for engangering the lives of others. He obviously has no regard for anyone other than himself and a man like this should not be out in society where he can harm others. How can someone be so self-centered and selfish? He represents the worst elements of our society. I hope he is locked away for a very long time.
Dr. Gupta,

I thank you for your honest reports. It has truly shown the world how another epidemic can start, and this, relatively easily.

This man, a lawyer, 31 yrs old, who considered himself intelligent, knowingly, traveled, the US, Canada, Europe. 7 flights I believe! All those people potentially exposed, and also the airports themselves, (where there are a lot more people.

From various movies, and books, where we read about these type of virus's, and how they can spread, one can now readily see, how this selfish, and unconcerned man, basically was ready to take the world down with his disease!

Let us hope, and pray, and send everyone concerned the message, that we hope that he indeed has not started a world wide epidemic.

But it is very apparent, that the US, Canada, and Europe, do not have their acts together,either in communication, law-enforcement, and media,and medical laws, which could enforce, and ensure prompt action inorder to respond quickly enough, in stopping, and apprehending such an individual, before he could inflict all this possible damage.

I believe international cooperation, and perhaps, signed treaties should be done, in order to protect the world from these selfish and "failures" as human beings.

L.Conlin, Montreal, Quebec, Canada
Thousands of people enter this country everyday carrying some or other virus or bacteria. The person with the TB is not the first or the last. We do not live in a sterile world. Get used to it. Take a chill pill and take a deep breath.
In this age of technology I am amazed on how people can be so uneducated. We are constantly exposed to health hazards. Ever ride public transportation? Guess what the person sitting next to you may be infected with TB, symptoms don't appear immediately. It is ashame that this has happened, but people want to just point a finger at someone and put the blame on someone, the patient, the physician, the government. Wake up, this is not a perfect world, humans make mistakes. If you think the world is almost perfect, you are living in a bubble. It should be obvious that we live in a society with warped values. We expect doctors and nurses to be infallible yet don't want to compensate them appropriately for the jobs they do. But yet, we don't put up a protest for stock brokers and politicians who get paid millions. We live in a materialistic, money hungry society people!
If I was faced with this, there is no way I would put anyone else at risk. If I was his wife to be, I would refuse to go along. So to me, she is just as responsible. While I feel bad for his situation, his selfish behavior and lack of concern for other peoples well being is just one more notch in the worlds negative view of Americans in general. He and his wife thought their wedding was more important that other peoples lives. Thats beautiful. Elitist #$^&*(!
The man attended the US Naval Academy, U. of Georgia Law school, and worked at DA office. He certainly knew of both the ethics and his civil rights in this situation. I hope the bar association takes immediate action to discipline him.
Dr. Gupta, being a doctor, I assume more readers are going to listen to and read your comments about this TB situation. CNN initially stated that anyone 2 rows in front of or behind the infected person is at a potential risk of contracting the disease. Here you say, the risk is extremely minimal. I don't see why CNN wouldn't have you report on this issue from the getgo. The passengers do have a right to be scared. As a medical student, I, too, know the dangers of TB. Perhaps not nearly as much as you, however, I know that TB is one bad momma. So anyone would definitely be upset that this man boarded the same plane as him/her knowing he had TB, and a rare form at that. I do believe he should face legal action. Suppossedly he is a lawyer, which only fuels the flame behind the stigma of lawyers being selfish. This man knowingly endangered, though according to you only a small risk, the lives of everyone on board and in the airports and wherever else he traveled. I would have hoped that someone from the US traveling abroad would set an example for our country and do the right thing. Instead, he thought only about himself. And after all this, I have yet to hear an apology. Have you? Instead he said something to the effect of, "I didn't think it was that big of a deal." Please do what you do best about keeping the public informed on the necessary information regarding TB. Like another person commented, the media has the real power in today's society. Use it to better us, not scare or misconstrue information. As a med student, I hope to become as successful as you and perhaps even more. Good job on your reports.
What an incredibly selfish man, I am stunned by his utter lack of concern for the well-being of other people. What if he had been sitting next to small children, the elderly, or people with compromised immune systems, who are at greater risk of this potentially fatal disease? This man should be ashamed of himself. It's frightening to know that arrogant people like that put the rest of us at risk.
Please address the following in your upcoming reports:

1) Where, How, When did Andrew Speaker get exposed and become infected? Is there another individual(s) in the Atlanta area already causing more to be at risk? Is USPHS tracking down the root of this infection?

2) Under what law can the U.S. Govt. hold someone under quarantine without violation of their constitutional protections?
He's a lawyer..'nough said..
If this is any indication of how safe our borders are...The guy flew to Canada & the n came back although there were suppossed alerts to stop him! Terrorists could bring in dreaded diseases through any point here & who would know or care??? We are so lax at taking care of ourseves, perhaps we deserve wretched things to hap-
pen.If you don't watch out for yourself, no on else will!
This situation is not analogous to smallpox. Patients who are infectious with smallpxo are obviously very sick, even if they do not yet have the characteristic rash. This patient showed no signed of illness. The only one who could have screened him out of the airplane would have been the patietn himself, whereas even untrained individual could see that a patient with smallpox was toxic and fgeverish
As many have said before me, this man was acting selfishly and may have endangered the lives of many, possibly (although unlikely) causing an epidemic. People who knowingly expose others to HIV are punished by the law. If this man survives, he to should face consiquences for his self centered actions.
After much thought I can only say, the Dr. should have reported the pompous lawyer to the CDC and the man his a 'horses patut' for knowingly and willingly spreading his infection throughout the world, so he could have the wedding of his bride's dreams, let alone his own neighborhood store. If someone sues the airline, the airline should sue him. How horribly selfish of both of them. They owe the universe an apology.My heavens!
Nobody will get anything unless they get TB, this should not happen ever again.L-Bedford,TX
My comment is more of a question: Where did this young man get exposed to the infection, or did he just manufacture this infection??
I don't understand why even simple precautions were not taken. The most reliable protection against the spread of tuberculosis (which is airborne by droplets) is the use of a face mask by all contagious (or even potentially contagious) persons. This is standard procedure in medical clinics and hospitals. If it was clear that he had tuberculosis, no matter what type, he should certainly have used a face mask to protect all others with which he might come in contact. Obviously, the population of people he exposed is much greater than those solely within a few rows of his seat on the plane. He also exposed people in the airport, all of the airline staff he spoke to, as well as others on the flight which were not in his immediate proximity (due to the air circulation and passenger movement in the plane). It seems that there were several infectious disease protocols which were not followed at all. Of course, the biggest risk will be to young children, the elderly, and persons who may have weakened immune systems. Certainly, this man's thoughtless exposure of others to his tuberculosis may have much greater consequences than he considered.
Having worked in Public Health as an investigator, the release of this patient's name is SHOCKING to me. How will a trained investigator obtain the necessary cooperation of an infected individual when the potential is there for this patient's confidential information being leaked or disclosed to the public? SHAME on everyone who is reporting this patient's information!

This case has exposed the clear problems with public health preparedness and the public's seemingly uninformed preception of what public health does.

In relation to public health surveillance, this was my specialty and it is only as good as they systems in place. NO surveillance system is perfect because they all lack a reporting enforcement component. I can count on my hand the number of times a doctor, who was required by law to report certain diseases, actually took the time make the required report.
Gotta love how everyone screams that he was "selfish" like being selfish is a bad thing. Being selfish is nothing more than doing what you think is right for you. What's wrong with that? It isn't "the world revolves around me," it's acting in your own best interest.

I will agree with "irresponsible." He should have taken his doctor's advice. But he did nothing criminal. He's a criminal on what charge? Because you decided that he should be? It is ironic that the people who scream "lock him up" are the same people who complain about the erosion of freedoms and liberties in this country.
If this had been a pregnant woman who was planning to do something that would endanger her unborn child, you can bet that health officials wouldn't have just said, "Oh, well. We have no legal authority." This selfish man should not have been allowed to travel. And yes he is selfish. While I understand that he wanted to enjoy the wedding he had been planning, there's no excuse for endangering other people's lives. The only person he was thinking about was himself. His wife should be ashamed of herself as well for not insisting that they 1. Put off the trip and 2. once they found out he had a rare form of the disease, not having the good sense to say were going to stay put. Italy is not a third world country and he could have got medical care that was just as good if not better than what he's going to get here. He should face criminal charges.
This is absolutely ridiculous. This "intelligent, educated" man should be sued for everything he has, but, even more appropriately, placed in jail. He deliberately endangered the lives of countless others, which is inexcusable, even if it was his wedding. I am appalled that they let him sneak back into the country, despite an alert. If he hadn't been a young, probably well-dressed, white male, the authorities likely would have carted him off to a Canada hospital faster than you can blink. How lovely this country is.
Here's what I don't understand: this man KNEW he had a form of super-resistant TB, was told NOT to travel, and did so anyway? Potentially risking the lives of many, many people...including his wife? What type of dunce IS this guy?
This man should be put in JAIL. He knowingly and selfishly exposed others do a deadly disease. He acted in a CRIMINAL manner, in addition to irresponsible. One does not exclude the other. He is not an uneducated immigrant who does not understand the consequences of his actions! PUT HIM IN JAIL!
I find it very ironic that this many is a lawyer, and wonder if he will represent himself in the class action suit when folks start to sue the pant off of him.
This man has a complete and utter disregard for others. He clearly acted selfishly and with great premeditated deceit, especially in returning to this country.
He owes everyone more than an apology. He should be responsible for paying for everyone's tests, and anyone that becomes ill because of him should be allowed to sue him to the full extent of the law! What he does to himself and his new bride is their business, but he has no right to irresponsibly infect and potentially ruin other's lives. Shame on him. Take away his lisence to practice law, and have him serve community service on the highways.
"Are we ready?"

With NIH funding to medical research being drastically cut every year (I work in cancer research at a major academic institution) because of the obscene cost of our activities in Iraq, should it come as any surprise that we seem uninformed and unprepared for a potential health crisis? Labs are closing, researchers working on our most pressing health concerns are being forced to scrap their work.

Taxpayer money is funding a war in the middle east instead of improving public health and the health of future generations at home.
I,too, looked at the science but didn't get the assurances that Dr. Gupta conveys in his blog. First, I have no idea of what he means by incredibly small liklihood of infection. Does he just mean probability? If so, I think he missed the most relevant issue. What is most important to me is the risk and I would guess for most people. Risk is a two dimensional varible...product of frequency(probability) times consequence. As noted by an earlier responder, the consequence for those with impaired immune systems is grave. As a cancer surviver, I wouldn't view my risk as incredibly small no matter what the probability, especially when that probability is not well defined. It varies widely from person to person and situation to situation. Like the doctor responder, I wonder if sugarcoating is a factor here.
His name is Andrew Speaker. That's why he is not arrested and in jail. If his name were Abdul Mohammed Hassan, the story will be much more explosive and he would be in jail. I bet my farm on it.
If a highly educated young lawyer whose own father-in-law works on TB research for the CDC ignores common decency and travels on 7 flightrs putting so many people at risk, what does that say about the rest of us who don't know much about TB at all?

It seems to me this man was extremely selfish in his decision making process. I believe he should be made financially responsible for all the problems he has caused.

I would not want him representing me in any legal proceedings--I would be concerned about his common sense and lack of good judgement.

I wonder how many people who do not have medical insurance, do not get tested for TB or other infectious diseases, and are roaming around in society unknowingly infecting other people!

I wonder where he contracted TB. Did it have anything to do with his father-in-law's job?

People in this young man's position don't just turn up with a highly infectious case of TB out of the blue.

I do not feel particularly sorry for this man because of his actions, but in the long run, it is a shame that somebody so young (and with apparent bad judgement) has such a problematic disease.
I'm with the majority of people who've been posting that this piece of crud needs to be punished, but I think that suing him isn't enough. He's essentially knowingly carrying a biological weapon, and spreading it around the air travel system.

Sounds like a terrorist if you ask me - maybe the better term is fullofhimselfist, but you get the point.

So, what do we do with people who use bio weapons on civilians? Lock them up. This guy should be shipped of the Guantanamo post haste, no trial, no jury, just lock him up. See if he can buy his way out of that one...
I also echo the comments here. This was an incredibly selfish, deliberate and irresponsible act by this individual. The fact that he describes himself the way he did in his interview only reinforces my opinion of him. Common sense would tell most of us not to fly if we found out we had a communicable, airborne, and deadly disease. But even more, morality and a sense of decency would dictate that once we're told we have a DEADLY, drug-resistant strain of that disease, we'd follow the directions of the people who know better. He didn't want to be isolated in Italy? Boo-hoo. The CDC was working on flying him back home, all he had to do was wait. Instead he took off, fled to another country and changed his itinerary.

He deliberately evaded a no-fly order, endangered countless people, and has the nerve to be indignent about the whole thing. Why are there armed guards outside your door? Because you've already demonstrated that you have no regard for others and will do what suits you at the moment. And his fiance/wife is just as culpable. There's no way I'd be party to this nonsense if I were her. If he doesn't take it seriously, then the other half of the relationship should excercise some common sense. If TB doesn't kill him first, charges should be filed and they should both be prosecuted under every statute that applies.
In the past I worked as a laboratory technologist and have performed microbiological analysis of sputum specimens for TB at a major medical center. I am now an environmental engineer and not an lab tech any longer. I find it exceedingly interesting that his new father-in-law works at the Centers for Disease Control. His father-in-law, Robert C. Cooksey, is a microbiologist who has conducted research on tuberculosis for CDC. The likelihood of this just being a coincidence is extremely small. I bet that the father in-law somehow is the source for the infection. He probably he brought the contamination home via a soiled lab coat, etc. and exposed his son-in-law.
This raises a collateral issue, how did Andrew Speaker contract this strain of TB?
Here in Phoenix, the same thing has happened. An ill man with drug resisant TB did not follow Dr's orders and he is now jailed. Put that on the news.
Dr. Gupta, I really wish you would address situations like this from a medical point of view, and not from a general reporter's view... asking "Are we ready?" for a bio-terror attack. This situation is being viewed from a purely medical standpoint - i.e., are people at risk for contracting this disease based on their exposure. You barely even scratched the surface of that question.
You are a real doctor ... right?
This man was extremely irresponsible. While it's true-anyone can be exposed to diseases on public transportation, most people who are sick don't realize it. This man knew he had TB. Even without knowing the extent of it he showed an appalling lack of concern for his fellow passengers when he chose to fly several times. He knew he was ill-he did not know if the people surrounding him are particularly suscepible to disease. Members of my own family are cancer survivors and at a higher risk of contracting diseases. If I found out that he was sitting near them, I would be extremely upset. There is no cause to be so selfish! I believe he should be prosecuted and if, God forbid, someone else does get sick with TB, I think he should be held accountable.
There is no question that this man knew the risk he posed to others. This is evident from the fact that he re-entered the US from Canada - not aboard the June 5th flight he was originally scheduled to return on. This just proves what an incredibly callous and selfish individual he is. Even if he thought there was only a small chance that he may put others at risk its still inexcusable to put himself in a situation where others could contract this virus. It is unconscionable to board a plane with severely restricted air flow and not even think about those sitting around you. Could he live with himself if a 3 year old child or someone's grandmother was sitting next to him and contracted the disease and died. What if it had been the other way around?
This attorney should be stripped of his right to practice law. His willful actions defy the concept of ethical behavior. Given the premise that he understood he was carrying a transmittable airborne disease onto the confines of an airplane, he chose to put his personal travel plans above the health and welfare of his fellow passengers.

I hope that he also bears some fiscal accountability for the costs the government and affected parties are enduring, both compensatory and punitive. (As an attorney, I am sure he would understand!)

From a prevention standpoint, there needs to be some information systems and business processes developed with tie the intelligence available on such medically ineligible travelers and the travel infrastructure within the U.S.
Another demonstration of Canada's inability to effectively control her boarders. The USA properly alerted her boarders as regards to his travel. Canada once again falls short, letting anyone and everyone in as long as they are alive.
He is a personal injury attorney. Nothing further needs to be said about his character or moral values.
This man is a grossly selfish individual.
i think this tends to point out the typical alpha male stereotype too. my grandpa was sick for a long time but didn't think it was a big deal and then died from stomach cancer because he didn't go to the hospital fast enough. men seem to think that they are stronger than any illness and don't assume that they should seek help or that they could be contagious. this guy was extremely selfish and stupid for not getting educated about the symptoms and risks of both having and spreading this nasty TB. i think this should be a sign to everyone out there that it's OK to seek help and you don't have to pretend to be "macho" or "strong" because it's actually more important to get yourself checked out and healed for the benefit of you and others. and i actually think he should face consequences from this. it seems unlawful.
Educated as a lawyer, this man clearly has no emotional intelligence. Everyone that has not had to go through TB tests, missing work, be in hospital, or even if anyone gets sick or dies, there should be a class action suit against this selfish idiot. His wife should divorce him. Does not his father-in-law have some sort of ethical responsibility in advising him not to travel?
I agree that this person acted with ultimate selfishness. But it seems to me that something vital is being overlooked here. Has anyone asked how, when and where HE contracted the TB? It would seem that many more people than just this guys co-travellers are potentially being exposed if the source has not been identified.
How utterly selfish was this man who so callously put many at risk and created what is now a panic --
just because he wanted to go overseas and get married and have a honeymoon? He should face criminal charges at the very least.
Before his identity was revealed my friends and I were talking that this guy must be white, wealthy, and well connected guy.
Imagine if this was a poor minority sneaking back to the country. . .
He is so arrogant and he definitely should be punished along with his wife.
I'm afraid, most of you are being way too nice. This guy deliberately endangered hundereds of people. He should spend some time in the slammer for total disregard for his fellow man. I'm stunned at his stupidity...but he is a lawyer, isn't he. If I was on that flight, I'd want to smack him down!
The man's an attorney for christ's sake.. Need I say more?? Another example of someone who's got some intelligence, money or power, who thinks they're above the law, or can wiggle around it.
This whole story is a little strange in how it's being reported by the media, and even the extent of the reports. If TB, even this drug-resistant strain, seems to be fairly common throughout the world and there have even been recent cases in the U.S., why so much hype over this particular man?

Secondly, why is there so much focus on these people on the airplane? Aren't others he would have come in contact with anywhere be at risk? His wife - hardly anything is being mentioned about her. Secondly, if this man was just in a small bathroom or in close proximity to, say, a ticketing agent at the airport, or at a home with other people, what about them? Simply no mention by CNN or other news agencies of these issues. Very odd reporting decisions.
In one sense, this incident shows how far removed we are from the days when TB, and other diseases, were a much bigger problem, and when the need for aggressive public health initiatives was more obvious. Our success, unfortunately, has lulled us into a false sense of security. This should be a wake-up call not just for public health officials, but for physicians and other medical professionals in private practice.

As for Mr. Stewart, I supect he's going to find his skills as a lawyer tested mighty soon, having already flunked the test for common sense and decency. His wife behaved stupidly and selfishly, too.
I cannot believe this selfish man thumbed his nose at the warnings from his doctor, his father-in-law who happens to work for the CDC, and the CDC itself for the gravity of his illness and the strong likelyhood of infecting others. Based on his elusive behavior, he had zero intentions of following any orders and doing exactly what he pleased, regardless of whether he could harm others. I hope he is fined and jailed for his negligence. I certainly hope that he also does not cause a wider outbreak that could prove to be lethal.
This situation is so unfortunate. It shows you the mentality of someone who just cares about himself and his life. You wonder how he would feel if he or his family found themselves exposed unknowingly.

For those who just look at what you want, wake up and realize you live in a society with other people. Your actions have a bearing on others.

For those quick to criticize the government officials for what was done or not done, are you one of those who believe in cutting taxes, smaller government and less regulation? I do not enjoy paying taxes any more than the next person, but time after time whether it is the CDC, FDA, EPA or Homeland Security, people have huge expectations. Don't forget your expectations when officials talk about cutting taxes or shrinking the government.
The man should not have been allowed to travel until he was treated given that only 30% of cases are successfully treated.

While they were not able to prevent him from traveling from a criminal point of view, I have to believe there are some civil liabilities that he could have. At the very least, the other crew members should ban together to pursue repayment for ALL costs associated with medical treatment that they themselves needed to undergo (ie. TB testing, Physician costs, parking, childcare, lost work wages, etc). Not to mention any liability associated with pain and suffering. I* am not typically a litigious type of person but in this case, when someone knowingly travels with a contageous disease and expects the others to pick up the bill for testing, then I think they should be held accountable. Why should others have to foot the bill for one selfish and self centered person.

As far as the country's ability to prevent / control a great outbreak, the CDC is definitely lacking. It does not have the clout or authority and the political agenda is typically to hush it up so that there will not be a panick. So consequently, many unfortuante individuals would needlessly be infected before any real action would be taken.
I am unbelievably shocked that CNN would post the patient's name and photo on their website. Doing so is a clear violation of a patient's rights under HIPAA. It is illegal to disclose who has HIV, Hep C, and other chronic illnesses, so how is it possible that this patient's identity was revealed?
I agree with the general sentiment of the previous comments: this man was selfish and has placed innumerable individuals at risk for a potentially fatal disease. As a health care professional, I have a few other comments:

1.) Health care providers in the United States have essentially no legal ability to quarantine an individual. In fact, even government officials lack that power, or are wary of exercising what power they have due to substantial "gray area" in legislature. Due to the bloated ideal of autonomy shared by most Americans, legislature that extends the ability of professionals to act on behalf of the public good has been turned down time & time again. Physicians are constantly frustrated by the fact that legislature is made with individual rights in mind, often at the expense of the public good. The medical field is utterly unable to change unless the general public becomes educated about the situation and allows for changes in the current system.

2.) Infectious diseases are equal-opportunity. None of us, unless you are Native American, are actually "native" to the United States. We are a country of immigrants, and that is what makes our country so rich in culture. Please don't use this horrible situation as an excuse to point fingers to immigrants, minorities, or other underrepresented peoples. Case in point: this man was not an immigrant; in fact, he was an educated Caucasian man, probably of high socioeconomic status.

This is an incredibly unfortunate situation. The only good that can come of this is if we are able to learn & make lasting changes. Pointing fingers and making accusations only hurts us all.
There will be some law that this man will be prosecuted under, also his wife for her role. Think of the countless people who stood in a queue near him, entered a WC near him, walked by him as he coughed (if he did), the people who dont speak English and/or dont read the paper/listen to the news how will these people ever know that they should see a doctor? This idiot should be sent to Guantanamo with no trial, locked up on a cage and thrown leftovers. He has probably inflicted more harm to the USA and other countries than some of the accused terrorists in Guantanamo. Maybe he is a terrorist, he should be examined for mental stability. Just because he is white and went to school does not mean that he did not have an agenda. He belongs below a snakes's belly. When he dies he will go to hell.
To the poster that blamed Canada - Excuse me? We allowed the man to leave OUR country. Then we allowed him back into OUR country. It is our US agents who screen who leaves and enters our country.

Canada would have no reason to deny him entry as I doubt he was honest with them about why he flew into their country.

Another example of someone selfish just thinking about his needs v. all the other people affected by his behavior.

He was quoted as saying he was an educated professional person. I would have hoped he would have used better reasoning than he did.

You have to wonder how he will feel if he finds he infected other people.
Not only this man's full name, but his address, place of employment, age, everything about him should be made public as a partial punishment for his careless, selfish actions. I am all for the names and identities of people him being given out by the media. Why should this immature idiot be given the protection of privact?
What a reckless individual. He needs to go to jail for his acts which are borderline criminal. And shame on the CDC for not doing their job and protecting us. I don't want to think of what can be next.
I've read a lot of responses, and I've seen some support of him (on the Denver Post site), even some people stating that to be quarantined with this TB is spending life imprisonment. I'm also a medical student who has worked in respiratory research.

First of all, I want to applaud Dr. Gupta for addressing the larger issue of the failings of the public health system. It is true that many patients slip through the cracks and pose a serious threat to the larger community as a result. Mr. Speaker is in many ways an exception- but not completely. In his case, he defied warnings he was given and traveled anyway. However and the knowledge that he MIGHT be traveling and that the strain of his TB was not identified yet should have led to an immediate alert to border crossings and airports. In that respect, the public health service did fail.

Now to address some of the comments I've seen, both here and on the Denver Post.

This form of TB does NOT result in life imprisonment in quarantine. Firstly, the hospital he is at has successfully treated several other cases with this particular extensive resistance. He is apparently young and otherwise healthy. While it may take longer to treat, and surgical resection of the infected portion of his lung may be needed to eliminate the infection, there is a good chance he WILL recover. In the meantime, sputum samples will determine if he is actively contagious, and the degree of isolation required. The fact that his new wife tests negative now means nothing. It could take up to 12 weeks for her to seroconvert and test positive- along with anyone else exposed.

2. ANY person who is diagnosed with TB is asked not to travel via public transportation, due to the risk of contagion. It doesn't matter if it's a resistant strain. ALL TB is difficult to treat, and requires several months of multiple antibiotics. It was inconsiderate and selfish for him to not postpone his wedding until a time when the risk of him spreading the contagion is eliminated. Furthermore, to defy the CDC's request when the strain was identified and to circumvent the "no fly" restriction was downright criminal. He is a lawyer. His father in law actually researches TB at the CDC. He should have had enough sense and consideration to take ALL warnings seriously and comply. In addition, apparently his shorter travels through Europe also involved air travel, exposing even more people.

The positive... TB isn't all that easy to contract. I had daily face to face exposures over two months several years ago when I was studying abroad in a 3rd world country and seeing patients in a hospital there... and I even have a history of immune deficiencies (IgA, which is mucosal immunity). To this day, I've not converted to test positive. I currently work in a lab that does some TB research (although I myself don't do it), and no one in the lab has converted. It generally takes a large exposure, often prolonged, or some sort of compromise to immunity or respiratory function in order to contract it.

The negative... it can take a long time to actually convert, and even longer to develop the disease. If anyone else HAS contracted it from Mr. Speaker, they may be off the public health radar by the time they are ill, and by then the disease may have progressed beyond a point where treatment can succeed.

This man SHOULD be prosecuted in a criminal court of law. He knowingly placed others at risk... and even worse, crossed borders in doing so, making follow-up with all contacts nearly impossible.
Nothing was ever mentioned whether his wife is in quarantine too. Since he most definately had close contact with her, one would presume that she needs to be isolated, but is she?
Here is a thought: His father in law works with the virus... Hmmm? don't you think there is a chance he was the one passing it along to this maybe not so liked son-in-law. Based on his actions I am pretty sure no one like this individual. Not so difficult to imagine a future father in law plotting something so the weeding will be delayed.
This "intelligent, educated" man's actions borders on criminal. Clearly, he knew his TB was not the "run of the mill" strain, since he acknowledged that he would be undergoing "cutting-edge treatment" at the Denver hospital after his honeymoon. Less resistant TB strains would not require warrant "cutting-edge treatment". From my perspective, it's no different than drinking and driving, knowingly doing something to endanger the lives of others.

Sure hope he's a good defense lawyer - he's gonna need it.
Let the litigation begin. His action was selfish, premeditated and his condition (with recommendations against travel) was explained to him by more than one doctor. Truly the kind of behavior that causes us all to lose a little faith in our fellow citizens to do "the right thing" - profoundly disappointing. Even if everyone is fine, they should sue this guy for their time. Forget pain and suffering, my time and their time is worth compensation. All these folks will have to be tested repeatedly over the next few years - you won't convince me otherwise.
Punish his selfish arrogance (of course he's a lawyer - how did I know) - and get him where it hurts. Make sure the civil suits against this guy get televised - with a little luck he'll represent himself.
Another post hit on a very important point that most of you completely overlooked. THE MAN's FATHER IS A TB RESEARCHER AT THE CDC IN ATLANTA! This is quite the coincidence.
Not only should this man be held accountable, his father-in-law should be suspended from his government job with the CDC. A man who works for the CDC and still allowed his son-in-law to expose so many people should not be trusted in his position. Also, at the point the man was put on the no fly list he should be held accountable by the countries he traveled in and all the people he came in contact with. Right now the only person being punished is the border guard. Okay maybe he should have caught the guy, and I would hope he would be more alert in the future, but how many of you would have thought this guy would disregard the no fly, go into Canada and drive into the US?
Dr. Gupta:

I couldn't have said it better. It was irresponsible for the young man to travel while knowing he could expose others, and the conflicting messages from CDC made things much worse.

Not only did our public health system fail us, so did Homeland Security. What if, like you said, bioterrorism (or worse) was involved? This man's passport was flagged AND he was put on the no-fly list. Even so, he managed to jet to and from Europe, into Canada and drove into the U.S. via Champlain, NY. This incident highlights how easy it would be for someone to circumvent the security precautions that are supposedly in place.

I pray for this man's recovery and that anyone who came into contact with him will be fine. And, I pray that the government will pay attention to what I would label "a profound wake-up call."
Not only is it a failure in our public health, but a HUGE failure on his part in morality. I mean this Andrew Speaker looks educated on paper, but is apparently stupid! Charges should be filed, he should lose his right to practice law and should have to reimburse every cost for every single person that must get located and tested since his honeymoon was more important than the lives of innocent others. What kind of person knowingly travels any where with that type of infection. He obviously does not care about humanity and should be made an example of. I'm sad that such an idiot is an American.
If I thought there was even the slightest chance that I could infect one person with a drug-resistant disease that I'm carrying, there is no way I'd be selfish enough to get on a plane - domestically or internationally. Weddings can wait, lives can't. He makes the excuse that he wasn't ordered NOT to fly by county officials. I'm not sure if I believe that, but assuming it's true, why do they have to order you to stay put? I won't contribute to the generalizations made here about his gender or profession, but his actions speak louder than anything at this point.

I understand that the CDC's main goal is to trace his infection and treat his illness, but I hope federal law enforcement steps up and files charges. He's already confined, but I'd like to see something "on paper" from the feds holding him responsible for his behavior.
It is obvious that we are not prepared, despite all of the training for such a scenario.

Also, based on the way that this person re-enter the US, he should be brought up on charges of treason based his premediatated attempts to circumvent all safe guards that failed.
I think this man should be charged with a crime for intentionally and willfully exposing people to a deadly disease. And the fact that the man is an attorney is even more disgusting to me. Is that why he was able to elude authorities? What happened to people trying to do the right thing (by not permitting him entrance into the country or allowing him to board an aircraft)? So much for homeland security. I was recently on a plane last week, you mean I could have been exposed to another man such as this who may have been able to elude authorities and may not even be known by the health department yet to have the disease? Please refund my passenger security fee because obviously the money we pay in addition to an airline ticket for security is not being used wisely if they cannot stop people with infectious diseases from boarding aircraft and slipping into the country. I am angry and disgusted. I hope someone will not wait until they are infected with this disease before they sue. All passengers exposed should file a class action lawsuit against the goverment, the flight carrier and this idiot for not preventing them from being exposed to this deadly disease. C'mon America this is 2007 and we cannot stop this? Is anybody else angry about this?
"Another demonstration of Canada's inability to effectively control her boarders. The USA properly alerted her boarders as regards to his travel. Canada once again falls short, letting anyone and everyone in as long as they are alive.
Posted By Anonymous : 3:12 PM ET "

Dear Anonymous - read the news - US officials didn't get the no fly information to Canada until AFTER he boarded - he would then go through US Customs - sorry, but it is your government officials (and this idiot) who let you down.
Dr. Gupta,
Looking at the patients picture, the X-ray and the microscopic image of TB bacteria, I cannot resist the notion that it could be a laboratory "superfinfection" or an artificial result. As an older doctor, I would prefer to check the reliability of the laboratory result first. Is this information available?
Worldwide air travel allows for disease and germs to spread quickly around the globe. This individual knew he had extreme drug resistant TB. Many others who travel have it but are unaware they are a carrier. *Note, one third of the worlds population are carriers of the TB bacterium. Of this number a small percentage have the extreme drug resistant form. So yourself or that person sitting next to you could be carriers of TB and not even know it. It is usually when an individuals immune system is weakened that TB that has been dormant will start to grow. There is no quick or easy answer to this problem. As long as people travel, germs will travel with them.
Hopefully, he will be disbarred for his intentional and dangerous conduct and will be unable to earn the kind of livelihood that afforded him the opportunity to take extravagant trips and endanger innocent, unknowing people. . . But then again, he's going to die soon anyway, so he probably doesn't give a damn what happens to him, much less anyone else.
I totally agree that this is an astonishing individual moral failure... middle class, American, lawyer guy thinks his own fancy European wedding and honeymoon are more important than possibly exposing dozens of strangers to a rare, potentially fatal disease.... Nothing I've read indicates that he was lacking in information. His father-in-law, a biologist for the CDC who works on this very issue informally "advised" him? And yet the poor fool didn't quite realize the implications of what he was doing? Tell me another one, please...
This incident underscores several common themes I observe in America today:

1. Lack of national leadership. The CDC feared the potential backlash from Congress; they weighed political correctness factors higher than fulfilling their legal authority.

2. The incompetence of the Homeland Security. Who amongst us feels 'safer' after this agency was established? The billions they spend, the joke of the COLOR CODED SECURITY alerts, the TSA harrassment and consfication of lipstick from little old ladies' could be better spent on public health infrastructure and enforcement.

3. The arrogance and selfishness of this guy. Like too many people today, he is spoiled, self-centered, and acts like he's the center of the universe.
CDC is just too politically-correct. A "COVENENT OF TRUST" with a person with a DEADLY disease? Was CDC afraid of Congressional backlash? Is it lack of leadership or gaps in legal authority?

Homeland Security cannot protect us. Was the border guard's performance due to incompetence or lack of training? Could the billions spent on administrative frivolity like the color-coded security system be better spent on a public health infrastructure and true national security?

But the real villain is the TB carrier. He had the education and intelligence to understand the implications. He is spoiled, self-centered, and arrogant.

The victims are the innocent fellow travelers who have a COVENANT of TRUST that their government officials are doing their jobs.
Why would anyone pray for the health of this jerk? He needs to know what it feels like to be seriously ill so he can understand why his actions were so dispicable. Also - I have to take medication that suppresses my immune system and I have to fly next week. Where can I get one of those masks that supposedly will block dangerous germs like this?
I was listening to the new tonight. They were optimistic about the exposed passengers being uninfected. They didn't state that it takes 8-12 weeks to know if they are truly testing negative. The news haven't stated that these exposed people can keep this organism in their systems for years without any signs or symptoms. When these people get old and/or immunocompromised this organism can rear its ugle head. Communicable diseases are just that. They can spread far and wide before we can possible contain them.

There are many ways of protecting yourself from communicable diseases. Handwashing is the most important way to prevent the transmission of infectious agents and yet is the least used.

Most people acquired tuberculosis without having any idea where the got it.

This man is an lawyer, a well educated man whoes father-in-law is extremely knowledgable regarding tuberculosis. This man nor his father-in-law will supply the finances for the location, testing, and treatment of these exposed people. No event, even a wedding, is worth the lives of the people who can possible become infected. I hold the father-in-law more accountable for this situation. He new better but did not act appropriately. His actions indicate he is not an honorable person who upholds the CDC philosophy.
This guy is another self-centered lawyer/yuppie. He should be prosecuted and disbarred. He deliberately ignored directions not to fly to Europe and then proceeded to act as a fugitive with his covert travel. This was intentional, reckless and selfish. He should be prosecuted criminally and a class action suit should be filed by all passengers on those flights. And if his wife is smart, she'll dump him -- now! She picked a real loser.
Aside from the inexcusable actions of the extremely selfish Andrew Speaker -- who knowingly avoided flying into the US after being told not to even leave the country -- what concerns me most is the fact that this extremely selfish man took MULTIPLE airline flights... isn't the air on airplanes "recirculated"? How do we know the airplanes he traveled on are virus-free? Perhaps he is educated, but he's certainly not intelligent -- given his dangerous, thoughtless behavior -- I certainly hope Mr. Speaker is paying for the $250-300,000 treatment costs out of his own pocket.
This man, Andrew Speaker, is a discredit to America, to the code of conduct at the Naval Academy (from which he supposedly graduated, according to his biography) and to the law school that prepared him for a legal career. Unfortunately, what he apparently took away from his educational oppor-tunities was a highly-inflated sense of his own importance, rather than a sense of responsibility and a strong ethical code that should accompany those kinds of educations. This man needs to be humiliated in every possible way - legally (through criminal charges), financially (through fines and civil lawsuits), and socially (by avoidance and widespread publicity of his actions)- so that he may somehow come to an understanding of the enormity of his egregious disregard for other people.
What a selfish prick. He was diagnosed with a form of drug resistant TB, and instead of going into quarantine takes his wife on a honeymoon trip across ? There's no telling how many people he came in contact with. He knew he was on a no-flight list into the US, so he flew to Canada and crossed the border ?

I hope he sees jail time and has to pay for the notification and testing of people he came in contact with on the flights.
Am I the only one who thinks this is all a bit alarmist? Nobody seems to be paying attention to the fact that the doctors are saying odds are he's not even contagious. And if you think he's the first passenger on a plane with TB (or worse) you're living in a dream world.
I am a huge fan of Sanjay Gupta's but I am upset that he down-played the TB story. I understand he doesn't want to alarm the public but in my opinion Mr. Michael Speaker should be sent to jail. I was relieved by Jeffery Tubin's take on the matter. I am immunosupressed on steroids and chemotherapy for an autoimmune disease and have been afraid to travel. Now I am more paranoid than ever. I know my situation is not unique and my heart goes out to the people with whom "Mr. Selfish" shared his disease. Sanjay, I hope that your response wasn't tempered by the Mr. Speaker's profession or socio-economic status.
I think the guy should compensate everyone on the plane. I think that his action was a bio-terroristic act even though it was unrealized at the time by the other passengers at the time of travel.
Normally I would just read the comments of others, but this story has compelled me to write a response.

I am so angry that this man would act so selfishly and not consider how he could have seriously affected the lives of others. How can this not be a crime? This man knowingly traveled with an infectious disease and his only concern was getting to his honeymoon. I am sure that if this man had children and were exposed to the same situation, he would be the first person to sue. I hope that people do sue him for the anguish and inconvenience that he has caused.

I have to ask, if this man had not been of Caucasian race, would he have been treated the same? I think there would have been a greater outcry to the government to punish the individual and instead it appears as though people are defending his actions.
The individual should not have traveled outside of United States despite his doctor's advice. However, CNN is NOT right in publishing his name and details and thus create personal hatred. In this society, we come across people with many infectious diseases in common public areas. It seems unfair to publish this individual's name and his family details.
His behavior equates to someone knowingly being HIV positive and continues to have unprotected sex with multiple partners!!!
Every child that was potentially exposed on those flights should lead to a criminal charge of endangering the welfare of a child against Mr. Speaker.
Great article Dr. Gupta. Your point is quite valid regarding bioterrism and obviously, no, we are not prepared since he got through Canadian borders. I think however that CNN needs to change it's tone of reporting. Instead of heading the article with the patients relative working on TB, the "patient" or recently reffered to as "attorney", needs to be the focus. His new relative, or the fact that he happened to have worked with TB is not the real issue here. The REAL issue is that this selfish, yes, selfish, person needs to go to jail and be punished for what he did. CNN editors, please read this!
Heather S.
Beverly Hills,CA
I'm with the camp that sees this as an example of incomprehensible selfishness and have nothing but praise for CNN for identifying Speaker. If people want a stringent regard for patient privacy they need to follow medical advice when it comes to the impact their condition could have on others. When Speaker chose to ignore the advice he was given and knowingly put others at risk he gave up his right to patient privacy, and as far as I am concerned, crossed over into the realm of criminally negligent.

He/they certainly got their memorable wedding but where is the love? In my book it is not love when you continue to put your beloved at risk. And her father is a TB specializing microbiologist for the CDC! Does he love his daughter? Did he council her to wait until the strain was identified? One would assume he was familiar with his future son-in-law's extensive travel history. I wonder who was the most financially invested in the wedding. Was the determination to go on with the wedding based on romance or money? Was there a collaboration of self-centered motives?

Is the new Ms. Speaker allowed to go out in public without a mask? Do both she and he have to wear masks when she visits him? Since she has had the time in a close space and likely intimacy in terms of saliva, shouldn't she be quarantined until she has been proven not to have this scary form of TB?

And for the person whose comment champions selfishness, it is one thing to to honor your physical, emotional and spiritual needs, it is quite another to do so in a way that shows absolute disregard for others. I believe the idea behind the golden rule is mutual respect, the key word being mutual. What was it Donne said? Ahh… No man is an island, entire of itself...

theresa VA

No man is an island, entire of itself...any man's death diminishes me, because I am involved in mankind; and therefore never send to know for whom the bell tolls; it tolls for thee. (John Donne)
How nice for Andrew "Me First" Speaker that he can afford the "cutting edge" $350,000 treatment in Denver for his XDR TB. What about the flight attendents, students, and the hundreds of others that might not be as healthy, rich, or otherwise capable of battling this disease? I too hope he is sued into oblivion should even one person contract this strain from him.
I wonder what would have the press and the entire US have reacted if the fellow had been a foreigner? Would he be prosecuted? Would he be legally responsible for damages? Would he be now at a prison? Most likely the answer to all of the above would have been yes, just ask Lou Dobbs.
As appalling as this story is, unfortunately, it's probably indicative of times to come. Everyone seems convinced that with an increasingly interconnected world, we are just biding our time until a truly catastrophic event takes place. Do you think all of the people affected are going to diligently go home and stay put? Or will they go about their daily lives -- flying to Europe, traveling to see family, attending concerts and other public events, going to the grocery store -- because that is what suits them? The previous commentators have exclaimed over how selfish this man is. Well, we live in a world of selfish people. Speaker should absolutely be held accountable, but this should serve as a wake-up call to the rest of us.

What truly boggles my mind is the number of resources expended for him. I can't believe that the CDC felt it was "appropriate" to fly him from New York to Atlanta so he would be "closer to family." It's sickening to know that our tax dollars are being spent to make such an irresponsible, arrogant man more comfortable after he willfully put hundreds upon hundreds of people in harm's way.
I had a similar thought to a previous poster - shouldn't the father-in-law be disciplined by the CDC if he is determined to have advised Mr Speaker to travel since the risk of infection was low?

I also wonder who is footing the bill for his treatment? I believe the figure is somewhere around $300k.
I'm confused as to why his now wife hasn't tested positive for TB. if this is so contagious, why isn't she quarantined as well? Why would people sitting a couple of rows from him be at more risk?
There is no excuse for Mr. Speaker's behavior. He should know because he is a personal injury lawyer! It is selfish, unethical and probably illegal.

I think not only he should be penalized under the law, he should also be disbarred.

This just gives lawyers a bad name. Imagine if he was representing people on the flight!
Unfortunately this selfish individual cannot be put in prison for his actions. I do however believe that those exposed to the risk of TB by his selfish behavior could successfully sue him for the distress they suffered. They should sue him. He is an absolutely self centered individual with no sense of social responsibility whatsoever.
People need to wake up. If you travel outside the US, especially to third world countries, you stand a good chance of being exposed to TB or some other infectious disease. There are probably thousands of people in the US who have acquired TB overseas. They have TB bacteria in their body and don't even know it. Most are asymptomatic and not contagious. It all depends on how well their immune system is keeping it in-check. Some even have the XDR form. There have already been a couple of dozen cases of XDR in the US, this is just the first one that most people have heard about. Generally it doesn't get diagnosed until there are symptoms, which means many people who live and work the infected person are probably already exposed.

This is shades of what is to come. Every year more and more bacteria become resistant to antibiotics at a much faster pace than new drugs are being developed. Many doctors predict that within 50 more years, it will be as it was before antiboitics were discovered. All thanks to over-prescription of antibiotics and poor patient compliance. So we should probably expect to be see more and more quarantines for nasty bugs in the future.

As long as we live in an open society, we will always be vulnerable to this risk. There is just no way to screen people coming in. At any given moment, we are literally one day away from a deadly virus from Africa or Asia finding it's way to a major US city. The person carrying it might not even appear sick yet still be contagious.

The best course of action is to support world health initiatives because ocean's won't protect us anymore.

(Boy, that half a trillion dollars we spent in Iraq sure would have gone a long way towards this issue.)
It worries me to see how easily this man (who was barred from flying) was able to get on and off SEVEN flights! If ever there was a wake-up call for public health officials and national security agencies, this is it. We need to do better and the public needs to endorse and support the funds to do it. The inadequate health controls, the inept border guard, the unpreparedneass of hospitals, the non-action of CDC - all worked together to enable this arrogant, selfish man to endanger hundreds of people. He should thank God no one's sick yet and pray that those hundreds don't sue him for their medical bells.
This imbecile is a lawyer. He is not some retarded peasant. I think he knew exactly what the risks were and, secure in his selfishness and American egotism, chose to put others at risk: in my view if anyone knowingly outs others at risk of a life-threatening disease, he/she should be looking at potential manslaughter charges. What a bastard!
I agree that what this guy did was selfish and irresponsible. To all the people that want to throw him in jain, I ask: do you really want your tax dollars being spent on him? Maybe we could make him pay for room and board while in jail...
Marty R. posted this earlier:

He is a personal injury attorney. Nothing further needs to be said about his character or moral values.

Well put Marty.

Furthermore the arrogance of this man is truly astounding!! I cannot imagine how he could come up with legitimate reasons for what he did, and disobeying health officials.

I hope a methodical US and International investigation and prosecution is forthcoming against this guy. He needs to be made a public example that this type of arrogance when it comes to world health will not be tolerated. I hope this guy is tied up in legal troubles for the rest of his days. What a moron!!
We will never be ready as long as we have selfish, above-the-law people who feel they can go ahead and do whatever they want. Obviously, the people who diagnosed this man had no training or concern.
How ironic that a personal injury lawyer would be the one to expose many other people to his illness. You can be sure that if it was someone else who did the exposing he would be there ready to file a lawsuit on behalf of the victims. I think they should sue him! He obviously knew he shouldn't be flying since he snuck in through the Canadian border.
Here's a question. In another article written yesterday, we got the man with TB's side. According to him, the CDC was well aware he was traveling outside of the US for his honeymoon and he asked if that would be okay. The CDC, according to the man, did not tell him he could not fly.
According to the CDC, it was only caught that the TB was resistant to antibiotics AFTER he already left and landed in Rome.
The CDC contacted the authorities there and stated he had to be treated there. The man was placed on the no-fly list. The man, already being treated in the US, did sneak back into the US by way of Canada to go back to his original place of being treated for the TB. If his story is correct, this is not his fault. Everyone, according to him, who knew his condition knew he was leaving, and all gave the "OK".
I hope this personal injury attorney soon finds himself on the other side of the law. His actions were incredibly selfish, arrogant, and stupid.

I am sure that if the shoe were on the other foot, he'd be preparing a lawsuit right now against the infected person, all of the airlines involved, the US and Canadian governments, each country visited, and any other entity he could think of.

Mr. Speaker you are not intelligent and you put one more black mark on the reputations of all worthy attorneys out there.
I could not agree with you more Dr. Gupta, In this day of bio-terrorism this case demonstrates our extreme unpreparedness. Also, what a jerk, for this man, a personal injury lawyer no less, to willfully and knowingly board an aircraft with hundreds of other people. He did that just because he did not want to change his wedding plans.
Think of all the people on two continents, two international flights, the wedding party, and his new bride affected by the monumental selfishness of this person. He should be prosecuted to the fullest extent and capacity of law for almost causing a public health catastophy. His CDC father in-law, who knew about this and did not immediately turn him in should be fired and fined.
Maybe the Father-in-law saw an opertunity for the ultimate experiment. Just because there are security measures in place where he works, does not mean he could not have had access. Knowing his Son-in-Law was a Lawyer and that treatment was sick as this sounds, I think it HAS to be considered and pursued by the trusted powers that be. I agree that after the fact when he knew, it seems that he was determined to expose others and those actions were either selfish or it was part of the plan...We may never know the truth.
I for one do not believe that our government has been honest with its people. If this man had been labeled a potential terrorist, would he still have gotten through the border? What difference does it make why he would be denied entry?

Just another example of how unprepared, disorganized, and how mismanaged the Department of Homeland security really is.
I too find this story sad and amazing -- that anyone knowingly put others at risk -- but I think this guy may be more a product of our time than just some selfish idiot. How many of us have gone to work or the market when we have the flu -- which kills too? How many have sent kids to school when they're still coughing -- even though for some kids with respiratory disease this could be dangerous? We've become very unconcerned about our personal role in public health -- and frankly we have to go to work because sick days are so few and we have to send the kids back to school because there's no more sick days to take off. We've become a society where, unless it's labeled deadly (like this form of TB or SARS), we don't really see illness as any big deal - it's just something to get through. That attitude, in the end, is why this young man could get on planes and be passed through border checkpoints -- unless you seem "really sick" you're OK and certainly no threat to others.
I do think it was wrong for him to choose to travel. However, never having the financial means to travel overseas, I am certainly approaching it from a different perspective. There are plenty of nice places to go for weddings and honeymoons right here in the lower 48; he would have never needed to get on an airplane.

This thought begs the question - according to the news articles I've seen posted, his passport was flagged, but were there any other alerts for him? He could have theoretically driven to every state in the country and stayed in at least one hotel in every one of them. He could have visited crowded theme parks like Disney World or he could have taken a cruise on one of our own Great Lakes. The point is, he could have come into contact with just as many people very easily without ever setting foot on an airplane.

I'm not overly concerned about this problem, aside from the fact that I'll likely never afford to be on a plane or leave the country, and here's why: people of the lowest income levels, like myself, regularly contract and spread diseases, usually without ever knowing it. I have no health insurance, nor do I have money to pay for health care. When I'm sick, I just buck up, take a Tylenol, and hope I don't pass out at work. I know plenty of others who do the same, and who travel for a living - my husband is an over the road truck driver, as are many in my extended family and our friends. The world hasn't died of disease yet, and there's plenty of who-knows-what potentially floating around the country.

This gentleman with TB apparently appears normal and has not shown signs of illness. Yes, he was advised that he was ill and should not travel; however, I'm guessing that in some part of his mind he saw all these people all around him - including some tossing tissues at kids with runny noses and some with scars, band-aids, coughing into a cell phone or what have you - and thought, "If these people can travel and go about their daily lives, why can't I?"

Perhaps the solution isn't to tighten border security (again, for what good it's done) but to instead find a way to ensure that all Americans can have the health care they need so that the population as a whole is healthier and better able to maintain their health.
This Mr. Speaker should be criminally charged immediately. At this time, we DO NOT KNOW if anyone has contracted TB yet - it is too early to assess the situation. I also find the statement from his father-in-law to be utterly selfish and ridiculous - the simple fact that he works for the CDC in the TB unit speaks volumes of the irresponsibility not only on his part but that of the CDC in general. He should be fired. This Mr. Speaker has a strain of TB that is deadly and obviously, his fahter-in-law would be aware of that - he not only participated in this deadly escapade, he encouraged it as far as I am concerned. The american people need to stop sitting back and saying " . . . it did not affect me directly so . . ." Well, next time it might be your wife, your husband, your child on that plane. How would you feel if you 2 year old died from TB exposure? Think about that! This selfish society we all live in has got to stop somewhere people.
Nobody has mentioned personal responsibility. Mr. Speaker obviously has no sense of personal responsibility towards his wife, family, friends, colleagues, much less the public at large. His wife knew about his illness and is therefore complicit in this crime. And, yes, this is a crime that should be prosecuted to the fullest extent of present law.
This man (and his wife) have not taken responsibility for their own actions. Going on TV and trying to make himself out as the victim is the last straw. Had he listened to his doctors' advice and not traveled, he would not have had to feel like he was abandoned by the U.S. government in Italy and he wouldn't have had to sneak back in to the U.S. He made the decision to travel knowing he had TB and he should have lived with the consequences of his actions. Now others are the ones who are suffering. His apology is as hollow as his brain.
The photo attached to the CNN story about Mr. Speaker does not make him look "African-American"...He looks Causcasion to me and I certainly wouldn't be able to guess his ethnicity from his last name either. I frankly don't know why his race/ethnicity would have bearing anyway on the story. He very possibly was exposed to the disease in his "extensive travels"...
I will NEVER understand the total
ALL-ABOUT-ME attitude exhibited
by this sorry excuse for a human
being. His wife is NO BETTER.
I'm thankful his name HAS been revealed. Society now knows what
WORTHLESS, USELESS human beings they both are. Sooo thankful I don't have to carry the shame of something like this the rest of my life the way those 2 ignorant people WILL HAVE to do.
THIS CONTAGIOUS DISEASE? I personally believe that he & his wife would be among the first to try to take legal action against
whomever, considering this jerk
is already a self-centered, egotistical,EXTREMELY SELFISH
"Lawyer"!!!! Pray for all the
people involved. This moron & his
moronic wife need prayers, too.
i am outraged by this self centered, self absorbed individual. i hope federal authorities bring severe charges against him, including jail time. it is the only way to lessen the possibility of someone else knowingly doing the same in the future!!
What makes all this more sickening is the intellectual level of the people involved. If there is a case where nobody can claim ignorance, well, this is it.

Now I read on the BBC on-line that he has a taped conversation with health officials proving that he was not forbidden from traveling.

I just hope this isn't true: it would be yet another example of this person playing all the possible legal angles to do what he pleased and "tough luck for the rest of the world." How very very sad all this, and - as someone already noticed - even more so because it reinforces splendidly all the toxic stereotypes that America is suffering from abroad.
Absolutely outrageous. I saw the exclusive interview on GMA and the answers given by Andrew Speaker and his wife were unacceptable. He is irresponsible, selfish and to put his wedding trip before anything/anyone else is beyond...His father-in-law keeps stating that he gave "fatherly" advice. I cannot believe that he would encourage traveling, even not knowing the exact strain of TB at the time. He is fully deserving of being sued by his fellow airline passengers and I hope there are other legal ramifications towards him.
Dr. Gupta seems to be downplaying the severity of it. Why risk the health of hundreds if not thousands of people?
How was this man allowed to cross the border after his name popped up on CBP computer? Was it because he's a smooth-talking wasp male? Would a Middle Eastern-lookin American in the same situation be allowed in the country? Terrorists come in all forms, or did you forget about ole' Timmy already?

As for his punishment, can we all say class action? How ironic would that be?
I cannot believe he is an personal-injury lawyer? He did not just exposed the disease to other that he doesn't know, he also exposed it to his friends and family. How about his wife and her family. What a stupid stupid stupid guy he is and he is a lawyer?????!!!!! People who are exposed should just sue him for all the aniexty or any mental worry he has cost them.
By changing his flight, & sneaking back into the US, Speaker proved he knew exactly what he was doing. I think he should be charged & punished as a criminal. What an incredibly selfish sense of entitlement! Too few Americans today realize the extreme danger of TB; but since it wiped out a whole generation on my grandmother's side, right here in the US, I do. Perhaps worst is that if a person gets one of the "simple" versions, if they miss even a few doses of medication, if rapdily morphs into the more dangerous type. My own county is now home to many recent immigrants, most illegal, so they went through NO health screening. Now an entire division of our public-health system is devoted to treating them, at enormous expensive. There is an entire team of para-professionals who spend all day going from patient to patient to Make Sure they take their medication daily. This is on the verge of happening nation-wide. This selfish brat should be made an example & treated as harshly as possible, as a lesson to others. One terrorist could kill many people, but that would be the end of it. One person with TB could throw this country into a horrific health crisis, as unknowingly infected people pass it on & on, in rapidly widening circles. The bacteria spread by simply breathing, and can remain potent for hours, just floating in the air around you!
Hopefully the American Bar Association Model Rule of Professional Conduct (RPC) 8.4(c) applies in the state(s) where Mr. Speaker is licensed to practice law. RPC 8.4(c) states that "It is professional misconduct for a lawyer to engage in conduct involving dishonesty, fraud, deceit, or misrepresentation." While this obviously includes breaking the law, the ABA also places an emphasis on behavior that indicates the lawyer is untrustworthy.

Maybe this guy is a really stupid lawyer that is ignorant of the possibilities of infecting others, despite an extensive education that should've equipped him to easily find out about that danger. I doubt it, however, and even if he is that stupid, he's probably not competent to practice law.

More likely, he ignored warnings out of self-interest, both in travelling at all without taking precautions when he knew he had TB, then in flying back to Canada to avoid being stopped from flying after he was informed he had the extra-dangerous strain of TB. This is not trustworthy behavior, in my opinion - this man has put the public at risk for his sole gain. What's to stop him from doing the same to a client, when there's not even lives at stake?

Lawyers get a lot of ridicule in general that isn't warranted. A lot of them are hard-working, ethical people that have devoted their lives to upholding the law and helping their clients obtain justice. The state bar association that licensed Mr. Speaker is ultimately responsible for ensuring that his unethical, immoral, and deliberately reckless actions do not continue to refelect on all of the lawyers that it licenses, and on lawyers in general.
To state something positive about this debacle, it is a good way for our disaster recovery processes to be a real-world scenario. Hopefully, our people and our government will become more educated in how to treat a potential disaster occurrence like this, and be able to cross-over this training to other potential disaster management scenarios.

On a more personal note, I believe this individual knew exactly what he was doing and that his doctors described to him the risks. However, I believe the government DOES NOT have the right to punish this dishonerable ner-do-well; all of us are absolutely capable of making our own decisions and bearing the consequences of those decisions. The government should not OWN us....unless socialism is more your style.
If your healthy with no immune dficits, you should be ok. however, he was supposedly healthy too. he knowingly put others at risk and premeditated his travel knowing... he shouldbe criminally charged just as someone with AIDS has been for knowing wat they're doing. morals sould be addressed or lack of.
A previous post made the point that Speaker has received an extraordinary amount of resources funneled to his case: private CDC planes to chauffeur him around the U.S.? I agree to that is an atrocity and a complete waste of public money.

What if Speaker was not a Caucasian, male lawyer? What if the individual in question was more representative of the majority of patients seen at Atlanta's Grady Memorial Hospital: African American, of lower socioeconomic status. I have a feeling that government agencies & the media would not be even marginally as accommodating.

What if Speaker wasn't a white American citizen? What if he was from another country? What if he was an ethnic American citizen? I have a feeling that he would have been taken into custody and treated like a criminal, instead of being shuttled around in private jets, sent to expensive treatment centers & being able to defend himself in public.

Can you imagine how this makes the United States look on an international stage? We are coming across as a nation of racist, self-righteous bigots who are ready to screen every foreign-looking person at the airport, but who let wealthy white people get away with murder (literally). After seeing how the media & government have reacted to this situation, can you blame outside parties if that is their perspective on America?
Why is CNN NOT reporting the fact and making it crystal clear that although Mr. Speaker didn't know (yeah, right), how contagious he was, HE STILL knew it when he decided to SNEAK back into the US through Canada!!!!!
Yes, it's a big deal that the borders weren't better sealed, but what about PERSONAL accountablity? Andrew Speaker needs to be held accountable for the fact that he did know quite well what he was doing when he chose to sneak back into the US putting many others at grave risk. I really hope that his law practice suffers as a result of his actions. It is looking like the only way that he will actually be punished.
Bigger question--how did he get tb in the first place?
"I hope they will forgive me" is a selfish, it's-all-about-me statement. Blatantly ignoring instructions to stay where he was, knowing he was infected with a disease that warranted being put on a no-fly list and intentionally circumventing the system is criminal. Speaker may be able to claim ignorance in terms of how contagious he was when he left the country but he knew, and chose to travel anyway on the return trip. While I can understand fear of not getting the best care available for a life-threatening disease America has a history of going to extraordinary lengths and expense to bring home its citizens in uncommon situations. Releasing his plight to the media would have brought in more than enough timely donations to arrange safe, private transportation to the clinic in Denver. Surely, a foreign government would have been happy to expedite his departure. One bothersome thing, if there was truly no inkling of the contagious aspect of his situation, why would anyone think to record a medical conversation before he left?

My heart goes out to everyone impacted by the choices made by Speaker and his family members. Hopefully, this will be a wake up call that will lead to improvements in the system.
We are missing the larger question about Mr. Speaker. Where did HE contract his TB? Travels? Father-in-law? There lies true concern for us all.
He says he has proof that noone told him he "couldn't" fly and he posed no risk to others. I find this unbelievable - I cannot wait to hear it so we can parse the meaning of words as Mr. Clinton enjoyed so much.
Some incredibly naïve and ignorant posts have been left regarding this story. Below is a sample of some particularly egregious errors in thought or rationale with explanations following the quoted post.

“I think people should also be aware that illegal immigrants sneaking in across the Mexican border have also been found to have TB. The cases in the US have actually been rising.”

**In fact the exact opposite has occurred over the past few years. The CDC reports that in 2006 the United States has the lowest case rate since reporting began in 1953 ( Cases in the US have NOT been rising. The person who made this comment is factually incorrect and should not make such assertions, especially when they link them to stigmatized groups. Although it is true that TB is generally more prevalent among immigrants from endemic countries around the world, no evidence exists to show that current precautions and procedures are not controlling the spread of TB within the United States. It should also be noted that immigrants tend to be healthier than the general population, leading researchers to coin the phrase, "the healthy immigrant paradox".

“I will NEVER believe that the physicians who diagnosed this didn't know immediately how dangerous it was.”

**Tuberculosis is undoubtedly a dangerous disease and precautions should be taken immediately to prevent the spread of this disease. HOWEVER, to come to the conclusion that a patient has XDR-TB takes extensive testing and could take more than two weeks to complete. Cultures must be grown which limits how quickly tests may be performed to how quickly the bacteria grows. Whether or not an individual believes this factual reality is up to them.

“We hold ourselves to be a mighty world power yet we don't have national health care? Meanwhile, Europeans have developed modern health care systems that aren't broken and underfunded. The nordic countries have the best Mental Health care system on the plant. They have all sat back and allowed us to waste our money on foreign aid - feeding people who hate us. We've spent billions on foreign aid what good could those dollars have done here?”

**The argument implied in this comment is that our health care system suffers because we provide foreign aid to other counties. It also implies that industrialized countries with universal health care spend more money domestically than in international aid. In fact, the United States generally spends the least amount of money on foreign aid out of industrialized nations (regardless of health care system). “The U.S. gives 13¢/day/person in government aid, roughly one cup of Starbuck’s coffee a month. American’s private giving—another 5¢/day—is high by international standards but does not close the gap with most other rich countries. Norway gives $1.02/day in public aid and 24¢/day in private aid.” ( I would argue that our money is not likely being wasted on foreign aid, but a bloated military budget that grows by the day.

“Forget just suing this idiot; throw his ass in jail and let him rot there for a while. Maybe send him to Gitmo, or back to Haiti so he can take up space in one of their jails instead of ours? And do we know for sure this guy didn't do this intentionally--trying to make people sick--as the biologic equivalent of a suicide bomber?”

**The question of whether or not this man was a “biologic equivalent of a suicide bomber” suffers from ignorance of infectious disease. Although this case involved an infectious disease that is inordinately deadly, the level of infectiousness of this particular patient seems to be very low. His tests have shown so far that he is “sputum-smear negative”. This indicates that the TB bacilli was NOT in his mucous and would not likely be spread through sneezing or coughing. (Subsequent testing make change his status as "sputum-smear negative" and alter his level of infectiousness.) It is still possible to spread the infection. However, somebody attempting to create intentional biological harm would pick other diseases that are far more infectious than this man’s TB.
One of the odd things is that the TB traveller said that he left Rome on a commercial flight because he was told that "Denver was the only place where he could get treatment" and he was concerned that he only had one shot at getting proper treatment. But he was told that Denver was the place to be treated BEFORE he left the United States to go on his honeymoon.

Wouldn't logic have dictated that he not leave the United States and Denver in the first place?

Incredibly selish man.
While Mr. Speaker may not have looked sick, looks can be deceiving. Why did his father-in-law not stop him? Things just look bad for Mr. Speaker because someone could sue him!!
Mr. Speaker is a very selfish man. He has no right to put public health at risk!
If Mr Speaker has no syptoms why was he checked for TB several months ago?
Boarding a plane just became even more dangerous. Now we have possible bio-terrorists. I think that it was bound to happen, just like the airline steward who went around the world infecting people with HIV. Flying makes travel faster, ie..germs can travel faster. There are Asian cultures that have workers out sanatizing hand rails, phone boothes, or any public area that could harbor germs. It is not uncommon for someone to be seen with a mask because they are trying to prevent the spread of a cold virus. We are not using our head or hearts when it comes to safety and common courtesy. We are more so than ever at risk for a pan-demic, whether it be TB, bird flu, or who knows what! BE thoughtful, don't travel if you are ill, keep your %$$ at home!
Do you think this guy might have contracted TB through improper social interactions during his reported extensive travels in Southeast Asia?
To the poster who brought up Lou Dobbs name, my gosh how Mr Dobbs must be infuriated. Thank you for bringing Mr Dobbs name up.

The idiot Speaker who felt it more important to risk infecting 100s, 1000s innocent people is like an illegal alien. He looks like a narcissist: has demonstrated congnitive disortions, had a strong sense of entitlement to his wedding, took advantage of innocent others to achieve his means.

So many people could be affected, even the clerk at the corner store
Speaker visited. What is sad too is the innocent people in Greece, Rome who do not read papers, do not watch news, even do not listen to radio, and therefore may not be aware of the danger to their health. All those people who now have to interrupt their lives and be tested for TB, the cost and anxiety of testing is something to consider too.

Can't they just put him in jail and treat him there. Charge him with something!!
As a flight attendant working for a major airline, I'm always surprised that people will fly with any kind of illness - contagious or not. Whether it's a business trip or pleasure, they HAVE to be on an airplane?? Yes, we live in the land of the free, but as others have mentioned, we are also the society of selfishness and entitlement. I travel the world and see the Americans who do, too. Believe me, the reputation of Americans being selfish is perpetuated by their actions in foreign countries and on airplanes.
I only casually browsed through the comments in this blog, but many of the ones I have read seem to have missed this point in Dr. Gupta's original post.

[b]I think, after looking at the science and talking to most people involved, the likelihood of anyone getting infected is incredibly small.[/b]

I wish that CNN had spent more time stressing this point.

Just looking at the responses to this blog, most do not seem to understand this.
I don't seem to understand why some of the following questions and concerns are not being raised:
If he wasn't stopped would he sought treatment properly? Would this have gotten worse in 10-30 days where he would be extremely contagious? Also, it's mindboggling to think that this "rare" strain of TB is with someone who's father-in-law happens to work in TB research for the CDC. Now what are the odds of that. There is more to this story than we know.
I also think the man should have known he was a risk. I can understand his desire to get home, but no mask even?
The most striking difference is that he is in a hospital and has a , treadmill and comforts while another man from Maricopa county in Arizona was in jail and not allowed those things only a few months ago? A difference in their connections, socio-economic status, perhaps?
Nothing I've seen on TV or read on the Internet has addressed the potentially dangerous side effects of the medication given to TB patients. My spouse was exposed while working on an Indian Reservation several years ago. He took his medication religiously, didn't drink a drop of alcohol, and followed all of his physicians directions. He was otherwise in excellent health. He developed drug-induced hepatitis from the medication, and due to a miscommunication between the lab and his doctor, nearly 3 weeks passed before he was informed that his liver function tests were "off the charts". Months of a strict diet followed, with first daily and then weekly liver function tests. It could have been fatal in a less healthy person. Now he can never again take the medication for TB. All we can do is stay healthy and pray that it never develops in full-blown TB.
It seems everyone is blaming the Lawyer with TB, when in fact the blame should be with the CDC. Isn't it amazing how quick the CDC placed this person in quarantine when it hit the news. Prior to this why didn't the CDC place this person in quarantine, or give him orders to report to a medical facility. They failed to do their job, and only did so when the news media got involved.
Andrew Speaker is no better than the 911 terrorists. He should be charged with attempted murder at the least. He knew and was only concerned about himself as he clearly states he was worried about dying! He had no regard for the other people he came in contact with. He new what he was doing and had a chance to charter a plane back. Many people are in the position to have to charter a plane for medical emergencies. What about the children on patient lists that have to travel across country. He couldve have made payments like the rest of the patients.
Speaker is a terrorist! He had planty of opportunity to charter a plane backl as many patients have to when emergency medical situations arise. Make payments like the rest of us. He risked all the people is ever came near and should be charged with attempted murder! He needs to pay for what he did. He is an embarrassment to this country!!!!!!!!!!!!!!
Why didnt this father in law do as most concerned parents would- advise him not to come back. We never hear about the father in law trying to protect us. After all he does work for the government. What kind of people are they? Mr Speaker may not have looked sick but then again most do not when first diagnosed. Look at all the cancer patients etc. He is selfish and ignorant and must be punished. He didnt want to die. Who does???? So you risk other peoples lives because you think you are above the regulations and laws. Is it because you are an attorney and they are the ruin to this country. MURDERER!!!!!!!!!!!!!!!!!!!!
Having family in the marines in Iraq I am appalled to find one of are own right here betraying us. A terrorist living breathing among us. Speaker needs to be prosecuted just as the other terrorists. He is no different. He risked lives of innocent people and children. He was told not to come back. That is that. He did. Oh because he didnt want to die. What about the people he came in contact with. Touching and signing papers etc. He knew exactly what the circumstances were. He is trying to cover himself by saying he asked. What a joke and slap in the face to our authorities. If they buy that we are in trouble as a country.
When I hear about things like this, all I think about are those IDIOT parents out there who still refuse to get their children immunized because of some anecdotal drivel they've read on the internet.

TB is still real. Polio is still real. Measles are still real. Mumps are still real (recall: the only group who was NOT affected in the recent Iowa outbreak were the fully immunized children). Smallpox is still real. Whooping cough is still real. The list goes on and on. Protect your self and your children.

This man is not at fault for this. The fact that he turned himself in so quickly speaks to that. And, I don't blame him for not wanting to stay in a foreign country where people still DIE from these things.

It is the result of a very, very broken system. If he was contageous, and a real public health threat, a system needed to be in place to keep him from ever boarding a plane anywhere in the world.

It's sad, but I really think that for many, many reasons, we need to bring back the Ellis Island type of check in / check out and not allow people who are ill to enter this country. Of course, that would require border control... but who wants to vote for that?
I think the fact that this person was on a plane is happenstance. Even if he had never left his hometown, it still takes 2 weeks to get results from this testing, and no one told him explicitely to stay home. He could have gone to a ballgame in a stadium packed with thousands, an amusement park, or even the local mall - and he would have exposed exactly the same amount of people!

Unfortunately, those who like to use political "we're losing our freedom" scare tactics make it nearly impossible to do what the CDC should be empowered to do - involuntary quarantine for suspect individuals until a difinitive diagnosis is made. If we don't know what it is, or how bad it is, you can't leave this hospital. Sorry Charlie. If this had happened with the first HIV case to ever hit the US, it may never have gone any further. The CDC needs to have blanket immunity from prosecution when/if they err in the best interest of protecting public health, too.

The needs of the many definitely outweigh the "civil liberties" of the one in this case. Wake up, America...
I reside in a South American "megacity" where half the population lives in poverty. I probably share buses with TB patients periodically. Some of those cases may be multi-drug resistant. Most of the TB patients are probably too poor to afford plane tickets, but some may fly. And some people may not even know they have TB.

Can we really expect to control exposure with legislation and regulation? Would most of us have wanted our movements restricted? Would we have wanted to be hospitalized against our will in a foreign country for an indefinite time?

The issue is not, as some respondents have commented, that undocumented immigrants may be ill; the point is that with as much movement of people as there is in our globalized world, we need to change the way we look at prevention of and protection against disease.
I have been following this case fairly closely but have not read anything about how Mr. Speaker contracted TB. From what I gather transmission of the disease can only occur with close contact to an infected person. So who infected Mr. Speaker. Maybe I have read too many Tom Clancy novels, but shouldn't we be trying to find out who case zero is?
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