Wednesday, 3 June 2015

TB, Bladder cancer and Bacillus Calmette- Guerin.

           When I was a medical student, the era of massive devastation by tuberculosis in Ireland was just coming to an end. The countryside was studded with Sanatoria , then largely sparsely occupied or unoccupied because of the miracle of streptomycin.  Prior to that those who developed the disease were segregated to sanatoria where most of them wasted away and died.  To get some insight into what it was really like, compare it to the early days of AIDS, before there was any active treatment  The  great godsend, in addition to an effective antibiotic was the development of a vaccine, BCG, that neonates in Ireland got with their smallpox vaccination.  There was no consent sought in those days, it was a public health measure just as smallpox vaccination was,.  It was administered for the public good and no one was asked if they wanted or not.  For some reason this practice was not common in North America, although I believe it was practiced in Saskatchewan, particularly among the native population.  The vaccine was an attenuated version of  bovine tuberculosis,called BCG, so treated that in humans it stimulated resistance to the human form of M. Tuberculosis organisms without causing any serious side effects.
           Another surprising use for BCG emerged much later.  When inserted into the bladder of patients with bladder cancer it retarded or stopped the growth of the cancer, presumably by stimulating some sort of resistance on the bladder cells against the cancer.  many bladder cancer patients have avoided having their bladder excised because of this treatment.
             You can imagine then, the horror and fear of these patient to hear that shortage result in their dosage being reduced by two thirds, so there will be enough to go around!  Apparently there are only two firms in N.America that produce BCG, one in Canada and one in the United States.  Both companies say the problem is due to" manufacturing problems at the plants."    Makes one wonder the real reason for a shortage of a drug that can avoid such devastation.   Could it have anything to do with profit margins in drugs that have long since ceased to have a patent, if they ever had.   Here's a situation where there could be a real basis for the administridiots of the Health Care System to do something useful.  Not much danger of that happening!

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