Subject: Many Doctors Who Treat TB Fail To Follow Guidelines, Study Finds 
Date: Published: 5/20/93 (66 lines)
Source: Wall Street Journal. Copyright Dow Jones & Co. Inc.

    Technology:
    Many Doctors Who Treat TB Fail
    To Follow Guidelines, Study Finds
    ----
    By Helene Cooper
    Staff Reporter of The Wall Street Journal

    ATLANTA -- Many doctors are ignorant of recommended guidelines
 for treating tuberculosis, a new federal study found, a failing of
 critical concern as the number of TB cases continues to rise.
    A survey of more than 2,000 doctors working in areas with a high
 incidence of TB found that only 58% followed a federal regimen for
 TB treatment, according to the U. S. Centers for Disease Control and
 Prevention here.  The agency said 75% of the doctors incorrectly
 interpreted the results of a skin test for TB, and 27% used
 incorrect laboratory tests.
    What's more, 11% of the doctors surveyed "don't even realize that
 TB is supposed to be reported" to local health departments, said
 Esther Sumartojo, a behavioral scientist with the CDC's division for
 TB elimination.
    The physician survey comes at a time when concern is growing that
 TB -- once believed to have been all but eradicated -- is increasing
 at an alarming rate.
    In 1992, 26,673 active cases of TB were reported in the U. S., up
 1.5% from 1991, the CDC reported yesterday.  From 1985 to 1992, the
 total number of cases of TB increased more than 20%.  An estimated 10
 million to 15 million people in the U. S. are infected with TB
 bacteria, and about 10% will develop the disease.  Urban areas are
 the hardest hit, with Atlanta, Newark, N. J., and New York reporting
 the highest incidence of TB nationwide.
    The increase in TB cases reflects the increase in homelessness,
 AIDS and urban blight, said Mark R. Chassin, commissioner of health
 for New York state, one of the harder-hit areas.  "We've recreated
 the social conditions that allowed it to propagate before," Dr. 
 Chassin said.  "We've got overcrowded housing, drug use {and}
 inadequate health care."
    One of the most pressing problems is the presence of hundreds of
 drug-resistant TB strains, at least three of which are resistant to
 all TB drug therapies, Dr. Sumartojo said.  Such strains emerge when
 patients fail to finish treatment.  That allows those bacteria that
 survived the initial doses of drugs to proliferate and pass on the
 genes that enabled them to survive to their offspring.
    Physicians need to get patients to complete their therapy, Dr. 
 Chassin said.  "If you interrupt the treatment, that's a perfect
 recipe for more drug resistance."
    But getting patients to complete their treatment isn't as easy as
 it sounds.  Consider:  For some forms of multiple drug-resistant TB,
 patients must take as many as six or seven different drug
 treatments, all of which carry different regimens.  For instance, a
 patient might have to remember to take one treatment three times a
 day, four days a week; another treatment two times a day, three days
 a week; a shot three times a week; etc.
    Some doctors, Dr. Chassin said, don't realize they need to work
 out a therapy program with their patients that will better help the
 patients adhere to treatment.  Also needed, he said, are home therapy
 programs and visiting nurses, who can better help patients outside
 the confines of a doctor's office.

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