Tuesday, July 17, 2007
Speaker's hope for a cure
Andrew Speaker is hoping today will mark the beginning of the end of a bizarre odyssey that began with his complaint of a sore rib last January and ballooned into a global health scare, with Speaker squarely in the middle.

Speaker is having surgery today at the University of Colorado Hospital, a surgery he hopes will cure his multi-drug resistant tuberculosis. (Full Story)

He has an area of infection about the size of a tennis ball in his lung.

The surgical team, lead by Dr. John Mitchell, will be using a technique called video assisted thoracic surgery, or VATS, to remove the upper lobe, of Speaker's right lung. They'll actually "suck out" the infected tissue. It will be fascinating to see the diseased tissue that turned Speaker's life upside down contained in a plastic bag.

As the only journalist invited to witness this surgery on perhaps the world's most famous TB patient, I'm struck by what a teaching moment this is.

Here are a few things of which I was reminded:

Many people don't realize that tuberculosis even exists in the United States. In fact, according to the CDC, there were 49 cases of extensively drug resistant TB in the U.S. between 1993 and 2006. And, there were 124 cases of MDR between 2004 and 2005. This isn't a condition relegated only to the Third World. What I'll witness today has value not just for Speaker, but for doctors all over the world as they struggle to treat a disease for which many drugs simply don't work.

I've performed countless operations but have never been in on one like this, where there are risks not only for the patient, but for the doctors and nurses as well. Every precaution, including specially outfitted masks, will be taken to keep everyone safe. There is little doubt from Andrew Speaker's doctors that his infection will be gone after today, but not his other troubles. A class-action lawsuit has been filed against him seeking more than $1 million dollars in damages.

So, now that we are starting to wind down this tale with a dramatic operation, do you think Andrew was at fault or do you believe health authorities mishandled the situation?
Some of the public hate written here on this man is totally uncalled for. The public comments I read here almost make him out to be a murder. Has anyone died from being around him yet? Has anyone even gotten sick? Do the people he's come into contact with have the right to do a lawsuit against him, if they never get ill from this?

Until someone gets ill from this, the press is making a mountian out of a mole hill, and it's making the public hate this man.

Now if someone who was in contact with speaker gets TB, than it's a real story...until than, stop it with drama.
Health authorities weren't perfect here, but it would be unreasonable to expect them to be. He ran off to another country (actually multiple other countries) against their recommendation, left little way to be contacted, and then dodged them when they tried to catch him and snuck back into the country, where they suggested he be all along. Sometimes in awful situations, you're only left with bad and worse choices. Health authorities chose bad ones. Andrew Speaker consistently chose the worse choices. He certainly didn't leave room for an honest dialogue about options.

We've all met people like Andrew Speaker. He does what he wants in spite of the consequences and then is shocked that there are any. But this time there are. I wouldn't want to be the people stopping my life to get tested multiple times, getting the fluke positive, and going through x-rays because it would have been a hassle for him and his wife to go to the justice of the peace rather than to Greece for the wedding. And this time the consequence is a lawsuit.
It is clear to me that Speaker is the victim of a government system that mishandled the situation.

If he was a serious risk, then public health laws should have allowed authorities to take action and restrain his activities.

Candidly all of this sounds a lot like the government doing a bit of CYA when it realized it may have dropped the ball and allowed a potentially dangerous strain to go "in the wild" rather than contain it.
It is clear to me that Speaker is the victim of a government system that mishandled the situation.

If he was a serious risk, then public health laws should have allowed authorities to take action and restrain his activities.

Candidly all of this sounds a lot like the government doing a bit of CYA when it realized it may have dropped the ball and allowed a potentially dangerous strain to go "in the wild" rather than contain it.
I think Andrew is specifically responsible for his actions. In todays world there isn't a person I don't know that would not have gone online the second they were given diagnosis and learned everything they could about their disease. This would have lead them to know enough to ask educated questions...or in this case to avoid asking the right questions as he already knew the answers and it was throwing a huge glitch into his wedding plans. And even if I'm wrong and he got to Europe ignorant, he still chose to get on the plane again putting his own fear over medical quality over the lives of every person he came into contact with. Personal lawsuits are the least he deserves.
Andrew Speaker is absolutely at fault. At numerously times he bucked professional and family advice not to mention his own personal health and that of the public only to satisfy his desires and wishes. Any educated person understands that tuberculosis is a grave illness, yet despite learning of his infection--irrespective of its drug resistance--Andrew Speaker didn't seem to take it seriously. Months transpired without treatment while his soon-to-be infamous world-trotting plans were prepared.
He flew to Europe against the wise advice of CDC officials and then complained of the expense and of a special flight back to the States, expressing also a 'fear of dying' by having to resort to therapy in another oh-so scary first-world European county--only now thinking of his health. Well, Andrew Speaker, there would be no expensive jets if you had of properly prioritized your life, postponing--not forgoing--your travels. Nor would you have been able to cite a 'fear for your life' due to treatment location, given that you would still be stateside. Andrew Speaker's statements are calculated, contrived, and clearly lawyered but, unfortunately, for him they are also transparently self-serving and insincere. Not only is he a disgrace to the United States of America but his selfishness makes me wonder how his new marriage could possibly last--in sickness more than in health...
He really never was in a 'highly contagious' stage.
This episode reminded me very much of the anthrax
foibles, much ado about nothing. Sometimes my bones ache from all the knee-jerking by our "leaders".
Speaker was acting like a spoiled baby, worried only about himself.

He deserves to lose a lawsuit and his livelihood.

How self-centered can a person be? Ask Andrew Speaker.
Another great saga in the American legal system. I am going to sue my co-worker for giving me a cold, my employer for the office I work in as the indoor air quality is poorer than at Ground Zero, the airline he flew on as I am sure they didn't disinfect the plane and I may have been on the same one at a different time, the US and foreign govt's because they didn't quarantine him. If we spent the money dedicated to these lawsuits to research and prevention we could probably stop the trasmission of 100's of diseases.
It's both. The CDC for not doing enough to give Andrew Speaker information about his diease. Andrew Speaker should have never gone on any plane. In this day and age you can get information for just about any diease out there.
I think both are at fault, but Mr. Speaker is moreso at fault. After all the government agency has only so much resources to get in to contact with Mr. Speaker where he clearly was not there to interact with the CDC.
How is that going to affect the lawsuits brought forth against Mr. Speaker, is the government agencies mentioned at all in the cases?
This blog post should have been titled, "Speaker's Hope for a Conscience."

Andrew Speaker has behaved like a typical snob (and lawyer)--never once apologizing. Imagine the reaction if he had actually been remorseful that he potentially put other's lives at risk? Instead, he blames the media, his doctors, and even the other folks on those planes. The public might have forgiven him, or at least tried to understand--if he'd only acted like a human being.

Oh, and if there's no danger of infection to others, why is everyone who shows up on TV with Speaker always wearing a mask? The passengers on those European flights should have been so lucky. And let's not forget about his father-in-law's connection to TB--too suspicious and scary for words.
Our public health system is not perfect. With certain diseases, the rights of the individual and the public health come into conflict. In this case, public health officials tried to balance the two by informing him of his risks to the public and himself, and trying not to violate his individual rights by detaining him, or holding him against his will. In a civilzed society we must rely on individuals to do the right thing for the greater good. In this case, such as decision would not have harmed Speaker but perhaps only inconvenienced him. Unfortunately Andrew Speaker and family decided their "need" for a nice vacation were more important than the health of others. He is shamelessly self centered, careless, and still refuses to take any responsibility for his actions.
You have to put yourself in Andrews situation. How is it possible that he needed to be quarantined as soon as he came back from Europe, but the only advise he was given before was that he should not fly.

Obviously if CDC felt that he should be quarantined once he returned, it should have been the same thing even before he left to Europe right.

CDC was just doing CYA act once he came back.

And why are people so paranoid. You have to look at human relations. Look at his fiancee who was with him even after fully knowing that he was dangerously contagious. She has to be commended.
I am old enough to remember houses being quarantined due to residents having Polio. I have worked in medical microbiology over 30 years. Determination of drug susceptibiliity and resistance is complex and can yield surprisingly differing results depending upon methodology and other factors. CDC was correct in its concern, Mr. Speaker was wrong in choosing to travel by public transport and is guilty of blatant disregard for the health of every passenger and crew member he exposed to a potentially lethal disease.

Quarantine should be used more broadly for tuberculosis. It is far more prevalent than most people are aware. Along with other education about public health matters, we need to revive the old anti-TB campaign to stop people spitting in the streets. We have allowed ourselves to forget that prevention of contamination is more effective in preventing TB than drugs are in curing it.

Dr, Gupta, you have a widespread public forum and would be doing the nation a service if you tackled this anti-spitting matter on television.
If the shoe were on the other foot, Andrew Speaker would most likely sue someone who knowingly exposed him to the tuberculosis while on an international flight.

He's a personal injury lawyer after all. I am guessing that he looked at this entire issue as a potential lawsuit from the beginning and estimated that his chances of losing the case would be low, particularly because the government did not specifically forbid him from flying.
Well, speaker did know that his TB could be serious or else he would not have been inquiring about his ability to travel. He remains responsible for endangering the many people on that flight.
It's hard to say who to believe. Speaker or the government? Did they say it was ok for him to leave the country or not? He said they did, they said they didn't. As a woman soon to be married (and a nurse), I know that my fiance, if he knew he had something so contagious as TB, even the REGULAR, non-drug resistant TB, he would wait until completely clear from the docs before being near me without the appropriate mask...irregardless of wedding expenses that may be lost due to rescheduling. My health is even more important to him than his own health. All I have to say is either Speaker doesn't value anyone other than himself (which means he doesn't value his wife's health) or he was truly told he was in the free and clear. If he was acting knowing he was still contagious, that lady should be heading to a divorce lawyer as I write this. Because if it was intentional, he very well may have put a metaphorical bullet in her head.
Andrew Speaker flew out of the country knowing he had some form of XTB, I'm sure he was fairly well informed on his condition by his doctor. According to Speaker, health authorities said he was not restricted to travel out of the country, but it was recommended he not. I believe there was some miscomprehension between the two parties, but at the same time, if you have honeymoon tickets booked from months prior, what is really going to stop you from going, regardless what your doctor says? However, the CDC issued a global state of emergency stating the TB patient was extremely infectious only to apologize after determining the TB form was not the highly infectious strain they had believed it to be. Who can we truly believe? I'm not sure, but Dr. Gupta, what is your take on this?
Does anyone really think that if Andrew Speaker thought he were contagious that he would travel the world with his new wife without protecting her from being infected?????
I agree that this whole thing has been a CYA from government agencies that don't want to take responsibilities for their screw-ups.
With hindsight being 20/20, we could probably point fingers at many people and make ourselves feel better knowing of course I'D never have behaved like that. An indulgent mental exercise to be sure.

For me, this case shed light on just how unprepared our country and the international community is for a health crisis such as this. It's funny because I've been involved in many seminars and planning activities for a pandemic flu and I always leave them feeling like we're going to do great when something actually happens. But you can never plan enough or predict enough for human error. All the procedures and systems and protocols in the world cannot make sure a lone border patrol agent doesn't ignore an alert message he's never seen before or make sure a TB researcher will tell his baby girl she can't fly to Greece for her dream wedding or make sure an American in a foreign country will feel comfortable enough staying in that country for treatment, etc. etc.
For all those who are saying we should have quarantined him, I ask you to think about this:

If the CDC had quarantined him thinking he had one type of TB and it turned out he had the less dangerous one, the ACLU and many other people would have been up in arms about our "police state." People would have equally blown out of proportion the quarantine and the CDC would have been in a similar situation as now.

The way I see it, the CDC took the lesser of two evils and just advised him not to fly.
Well, according to abcnews.go.com/GMA/OnCall/story?id=3231184
This interview describes the circumstances in which Speaker learned of his TB.
"Speaker, a 31-year-old lawyer from Atlanta, learned he had TB in January. In May, doctors realized his strain, known as XDR-TB, was extensively drug-resistant. He then boarded a commercial flight to Paris May 12, and returned from Europe 12 days later on a flight from Prague, Czech Republic, to Canada."
Now, that seems like they found out before he boarded the flight. I don't know if they told him before he left. That may have been a fault on the doctors' fault. However, once found out, I think he should have been quarantined or detained from leaving, simply because of the nature of the strain of the disease. Now, his step-father surely knows all the risks involved with TB, even normal strain. Yet he does not provide his step-son with any more advice than "fatherly advice"?
Seriously, if I had TB, I would not be traveling around. TB is still contagious, and I certainly do not want to be the one spreading it around. Regardless if it were normal or XDR-TB.
As a registered nurse who has worked for years with patients with many infectious diseases on a daily basis, I am amazed at the hoopla this one case is causing.

I have personally been exposed to over 3 dozen known cases of active TB in my 20+-year career, when neither the patient or myself had access to any masks. My skin test is still negative for TB.

Dr. Gupta would have you believe that by witnessing Mr. Speaker's surgery he was invovled in some rare and dangerous act, when in reality, hospital personnel are exposed to serious infectious diseases on a daily basis, both in the operating room and at the bedside.

Mr. Speaker had no cough - therefore, he wasn't contagious, and the CDC knew it. The CDC has handled this poorly.

Let's do the math:

In 2005, the CDC reported a total of 4,491 cases of drug-resistant streptococcus pneumoniae, far more deadly than drug-resistant TB, yet neither the media not Dr. Gupta has reported to us about it - evidently people dying of a drug-resistant strep infection is not nearly as exciting as TB on a plane.

Other serious diseases have also become drug resistant, such as gonorrhea. In 2005, the CDC reported a total of 339,593 gonorrhea cases, with no mention of how many were drug-resistant. For the same year, there were 14,097 reported cases of TB.

According to Dr. Gupta, there were 49 cases of extensively resistant TB from 1993 to 2006 - that's less than 4 cases a year!

Once again, the media has pushed the fear button about a disease that in reality will affect very few of us.

Except, of course, immigrants from Mexico, Africa and Asia - care to speculate on the real reason the CDC and the media are hyping TB?

Could it be that this is the real reason behind the CDC's fuss about TB, that in America, it is a disease that affects primarily immigrants, inmates and HIV+ people?

It makes you wonder, doesn't it?
Andrew Speaker continues to contradict himself. He says that he has a tape of the conversation with the CDC. If that is so, produce it. What is the secrecy? I believe he (his wife and family) knew how sick he was and they all continued to cover for him.
Hmmm...I wonder how he advises his clients.
Speaker does not deserve our sympathies. His actions were as negligent as an HIV patient having unprotected sex.

Dr. Gupta is disingenuine because he interviewed Speaker outside trying to show that speaker is safe.
Dr. Gupta, do you really expect us to take you seriously? Andrew Speaker? This fellow endangered the lives of others merely for his selfish desires. His father in-law studies TB for the CDC, so how could he not possibly understand the risk he posed? The father in-law traveled with him... give me a break. Besides Gupta you didn't wear a mask because you interviewed him outdoors... you as a physician know that this moved would prevent your contracting MDR from Speaker. Why not do your interview inside mask free next time?
Speaker cannot blame other doctors. His father in-law studies tb for the CDC for crying out loud. Are you for real?
Wasn't Seaker a loaded gun, knowingly aimed at potential victims? If he in fact missed, is it really relevant?
"Once again, the media has pushed the fear button about a disease that in reality will affect very few of us.

Except, of course, immigrants from Mexico, Africa and Asia - care to speculate on the real reason the CDC and the media are hyping TB?

Could it be that this is the real reason behind the CDC's fuss about TB, that in America, it is a disease that affects primarily immigrants, inmates and HIV+ people?

It makes you wonder, doesn't it?
Posted By C.MacLean,RN Raleigh,NC : 4:55 PM ET "

With all due respect, Ms. McLean, many of us in healthcare have been exposed to TB and other highly infectious and lethal diseases. We knowingly accept the risk and rely upon our professional skills and protective devices to prevent our acquiring such diseases.

You raise the spectre of "the diseased immigrant" as a reason for media involvement regarding TB. While it is certainly true that the incidence of TB is higher in Mexico and Asia, as in prisons, you fail to mention the steadily increasing population of U.S. citizens who are homeless. There was an increase in TB incidence among our homeless that coincided with the depopulationn of mental facilities under the Reagan administration.

The risk of infection is not tied to nations, but to behaviors. Watch the next group of day laborers waiting for employment, or the local homeless men pan-handlng. Observe anyone disposing of sputum or expectorate in tissues? Or do they simply spit on the ground?

There's are several reasons for the concern about TB in unskilled illegal immigrants. Culturally condoned behavior ranks high.

Please go back and review the campaigns mounted against TB in the middle 20th century. They were effective in reducing the incidence of TB.

It is really not valid to compare the rise of resistant bacterial strains such as MRSA to the increase in TB incidence. The former is due, largely, to misuse of antibiotics. The latter is largely due to behavior and to non-compliant patients
Dr. Gupta.

Thank you for your new feature on people loosing large amount of weight successfully.

What is missing in most of the stories is VERY OBVIOUS though -- HOW DID THEY DO IT.

Please make specifics about each story part of the story.

Thanks.

Brad
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