The Lancet report on what is now referred to as "NewDelhi metallo-beta-lactamase 1 (NDM-1)" certainly deserves our serious attention. The report has been prepared by 31 researchers of whom 12 are Indians. The rest are based in the UK and Pakistan. Of these 31 authors, only two have acknowledged possible conflict of interest. Karthikeyan K.Kumarasamy MPhil had received a travel grant from Wyeth, one of the sponsors of this study. David M.Livermore PhD had received conference support from numerous pharma companies and also holds shares in Astra Zeneca, Merck, Pfizer and GSK. All other authors have declared absence of conflict of interest.
Naming a bug after the possible place of its origin is not uncommon. Verona Integron encoded metallo-beta-lactamase 1 (VIM-1) was first reported in Verona, Italy in the year 1997. In the same year another bug called the Sao Paulo metallo-beta-lactamase 1 (SPM-1) was first isolated in the eponymous Brazilian city. However, it is uncommon and rather strange that an alarm is sought to be created about visiting India for surgical treatment.
Lancet's assertion that "Gram-negative Enterobacteriaceae with resistance to carbapenem conferred by NDM-1 are potentially a major global health problem" is certainly over the top. Carbapenem is the latest heavy-duty antibiotic but not the ultimate antibiotic. Superbugs are the mother of new antibiotics.
Lancet's argument that "Given the historical links between India and the UK, that the UK is the first western country to register the widespread presence of NDM-1 positive bacteria is unsurprising" is a little unscientific. Lancet's conclusion ("The potential {sic} for wider international spread of producers and for NDM-1 encoding plasmids to become endemic worldwide, are {sic} clear and frightening") is perhaps paranoia-genic in its impact and possibly suspect in its grammar.
The report draws inspiration from an an earlier editorial by Abdul Ghafur which highlighted the widespread non-prescription use of antibiotics in India. It is no consolation to realise that prescription abuse of antibiotics is more widespread and not less dangerous in India.
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