Leprosy Mailing List – June 25, 2018
Ref.: (LML) Manifest against the implementation of MDT-U
From: P. Narasimha Rao, Hyderabad, India
Dear Pieter,
Ref: Mail from Claudio Salgado, Brazil, manifesto against the implementation of U-MDT. LML June 12, 2018.
Let me first congratulate President Dr. Claudio Salgado & executive of Brazilian leprosy society and all other medical societies for bringing forth lack of evidence and hazards in introduction of UMDT in that country. It is very unfortunate that authorities in Brazil are planning to going ahead with introduction of this unscientific UMDT based on specious logic. Any effort to stop this unwarranted shortening of existing MDT regimen by 6 months for MB patients is welcome and should be supported all concerned.
India and Brazil are two countries with large leprosy populations. Such short-sighted policy changes by authorities, without taking into consideration the ground realities, is very detrimental to the program, which is already reeling under in-attention, lack of expertise & funding.
The idea of U-MDT which was proposed in 2002 without any scientific basis by WHO, generated lot of criticism across the world. The authorities unrelenting as they were, went ahead to 'create evidence' in its support by initiating and funding a multicenter study with a conveniently poor design and distrustful end points. Any careful reader, why even a casual reader, of those final reports from china and India can easily understand how poor is the quality of evidence generated through them. And Dr Claudio has mentioned eloquently how the evidence was generated in Brazil to support U-MDT through various papers over last few years.
In 2017, there was a high level technical member committee meeting held in India, involving WHO, NLEP and other experts, one of the agenda being to push forward with U-MDT. Fortunately, the opinion was rallied against its implementation, due to the efforts of many leprosy workers and scientists of India, who saw the harm to program in introduction of UMDT in NLEP. There is a real danger that there will be efforts to push U-MDT forward once again, as it was introduced in Brazil already.
What is very surprising is, same members of international community who opposed U-MDT vehemently in beginning, for reasons unknown, prefer to be silent now, while U-MDT is being pushed in to the national / global leprosy programs. As evidence to such a thought, we can look at the WHO Global leprosy 2016-2020 document, wherein U-MDT implementation proposal is mentioned at least at three sperate areas of the document. We saw that happen once before, during 2003-2005 while 'final push' of leprosy was being implemented all over world, especially in India. We all know how the program managers brought down the numbers! World community of leprosy was a silent witness to it and did nothing then, only to write many-a-article wondering why it was done, how we all let it happen, years later! It is time we don't do the same and repeat the history.
As a person who diagnoses leprosy and manages them on daily basis, I am often amazed why WHO is in such a hurry to damage the program which is running so successfully world over! I am sure, if contacted, majority of 10,000 dermatologists and leprologists of India will vouch that they continue to see MB leprosy regularly, even in increased numbers every day, even today.
If U-MDT is introduced in India too, which is not unlikely in near future, there will not be a more unfortunate day for leprosy patients of India. This unwise move to introduce U-MDT in the national program does not benefit the end user, the leprosy patient at all! And none of the authorities involved in pushing this hazardous change seem to comprehend this truth!
Here in I am enclosing as attachment a letter written by IADVL to NLEP/ Govt of India in 2007 and a paper published in IDOJ regarding the potential harm in introducing U-MDT in India.
I wish and hope that wisdom will prevail and U-MDT would not replace the present WHO MDT. As a president-elect of IADVL, I will do my best through the office of IADVL, to resist such a move in India, which without doubt is detrimental to the leprosy program and more importantly to the individual patient.
with Best regards,
P. Narasimha Rao, MD, D.D, PhD
President- Elect, National IADVL 2018
Phone- 040-23514566
Mobile-09849044898
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
Contact: Dr Pieter Schreuder << editorlml@gmail.com
No comments:
Post a Comment