Tuberculosis Diagnosis Often Delayed by its Unfamiliarity in the US According to Pennsylvania Physician Lawrence Broxmeyer

Our present state of the diagnosis and treatment of tuberculosis, the greatest killer of all time, is in a sorry state of affairs. And there are many reasons for this, said doctor Lawrence Broxmeyer. A new generation of American doctors are at the helm, both unfamiliar with, and at the same time led to believe, that tuberculosis is a disease of the past. "Well, it isn't" confides Lawrence Broxmeyer. Broxmeyer likes to quote the great Harvard infectious disease specialist Louis Weinstein, who once reminded his peers that tuberculosis is far from gone among us, although fast becoming a greater masquerader than syphilis ever was, assuming over 25 forms as common as arthritis. "Therefore", says internist Lawrence Broxmeyer, "and as a direct result, the disease is being grossly underreported. And such underreporting skews statistics to the point where today's American doctors don't feel this disease has to be considered nearly as often as it should be. Unfortunately this just leads to further spread." Broxmeyer underscored that you don't need to be an impoverished immigrant or a patient with an immunosuppressive disease to get hit by tuberculosis. Many affluent white Americans are finding out daily.

The Times piece wasn't at a loss for examples. Take the 49-year-old Los Angeles businessman who endured 11 years of an agonizing mystery disease which gave him, at various times - asthma, diarrhea, fevers, blood-tinged sputum, vomiting and inflammation of the tissues around his heart before a doctor put him on the TB medications which led to his recovery in a few weeks time. But this was only after a grueling journey that lasted over a decade of going through top L.A. Hospitals, punctuated by a trip to Minnesota's Mayo Clinic for relief. "This patient was lucky", says clinician Lawrence Broxmeyer, "lucky to find a physician who would run a therapeutic trial of anti-TB drugs in the present American environment of malpractice litigation and the peer-pressure that the disease hardly exists. The vast majority of this physician's colleagues would not have stuck their necks out to give him that trial of medications………that is….. among the small percentage of doctor's who would have even considered the disease."

Lawrence Broxmeyer's TB research appeared in The Journal of Infectious Diseases. As a physician, he spent well over a decade in some of New York's finest teaching hospitals. During that tenure, such cases were not uncommon. Nor was the Times article's next pathetic case in which a female physician checked into an Atlanta hospital complaining of a relentless, splitting headache and a fever of unknown origin which wouldn't go away. She went to the hospital's ER a week before admission and was sent home with a remedy for stuffy sinuses, the ER physician erroneously thinking it sinus headache. This set up a succession of errors in which, days before she slipped into a coma, doctor's treated her for bacterial meningitis, ignoring her previously positive TB skin test. "What you don't look for, you don't find" reminded physician Lawrence Broxmeyer. Tuberculosis requires special medication." And so the physician-patient died of TB meningitis which, as a physician, this lady had treated enough of in her native Columbia and which from her deathbed she underlined in her medical textbook to show her husband, shortly before death. "This female physician died at 38, several weeks after giving birth to a daughter who also subsequently died, a tragedy beyond words."

"Her husband", relates Lawrence Broxmeyer, "a behavioral scientist for the CDC, felt that if they had treated her from the onset with TB medication she would not have died and there is a fair chance that he is right, depending upon the length of time before succumbing that she was treated. Advanced TB meningitis is not always the easiest thing to cure."

By the same token physician/researcher Lawrence Broxmeyer would remind us that TB is not the easiest disease to diagnose, even if the physician is aware of it. A negative TB skin test means nothing, because the patient might by then have such overwhelming disease that his immune system can't muster a positive skin reaction.

"Chest X-Rays are hit or miss at best, and TB cultures are often negative," said Lawrence Broxmeyer. Furthermore in such cases special stains and cultures to find tuberculosis must be ordered in the chart, something that is not in common practice, even among many infectious disease specialists.

The evasive and complacent philosophy of organized medicine was what led to the resurgence of TB between 1985 and 1992. Will it happen again, asks Lawrence Broxmeyer? "In 1990, a new Multi-Drug-Resistant (MDR) tuberculosis outbreak took place in a large Miami municipal hospital. Soon similar outbreaks broke out in three New York city hospitals, many sufferers dying within weeks. By 1992," Broxmeyer recalled. "Approximately two years later, drug-resistant tuberculosis had spread to seventeen US states, with mini-epidemics in Florida, Michigan, New York, California, Texas,
Massachusetts and Pennsylvania and was reported, by the international media, as out of control. MDR TB has been the focus of attention for some time and seems extremely important in a disease that killed one billion (yes, one billion) people between 1850 and 1950 alone, and continues to kill estimates as high as 2.8 million humans each year."

Additional information, and downloading of articles by physician Lawrence Broxmeyer and his ongoing research can be found at http://drbroxmeyer.netfirms.com/ copyright

Distribution: Lawrence Broxmeyer, TB under diagnoses, Dr.Lawrence Broxmeyer