Friday, June 01, 2007

Drug resistant TB and one really bizarre "coincidence"

This whole drug resistant TB travel story just keeps getting more and more outrageous and bizarrely interesting. Certainly it is helping call attention to antibiotic resistance as an issue. I guess that is good. But it is also generating a level of panic that fits in well with the previous panics over bird flu and other scares.

But one thing really strikes me as too bizarre to be a coincidence, although some news stories are presenting it as such. Extreme drug resistant TB is pretty rare in the US. Studying drug resistant TB is also pretty rare among scientists. Yet the father in law of the man flying around the world with this TB is Robert C. Cooksey, a CDC researcher studying, among other things, drug resistant TB (e.g., here is a link to one of his review papers).

The CDC put out a press release implying that he could not have been the source of the infection. Interesting, the release seems to have been removed from the CDC site but can be found at the google cache. Here is the text of the release:


May 31, 2007

Contact: CDC Media Relations
(404) 639-3286

Statement by Robert C. Cooksey

Research Microbiologist, Division of Tuberculosis Elimination, CDC

First and foremost, I am concerned about the health and well being of my son-in-law and family, as well as the passengers on the affected flights.

I am the father-in-law of Andrew Speaker, who was recently publicly identified as a person infected with extensively drug resistant tuberculosis. I do work at the Centers for Disease Control and Prevention. I have worked at the CDC for 32 years. I´m a research microbiologist in CDC´s Division of Tuberculosis (TB) Elimination, and my work does involve working with a wide range of organisms, including TB. As a research microbiologist, my laboratory work involves identifying the characteristics and features of bacteria.

As part of my job, I am regularly tested for TB. I do not have TB, nor have I ever had TB. My son-in-law´s TB did not originate from myself or the CDC´s labs, which operate under the highest levels of biosecurity.

I wasn´t involved in any decisions my son-in-law made regarding his travel, nor did I ever act as a CDC official or in an official CDC capacity with respect to any of the events of the past weeks.

As a parent, frequent traveler, and biologist, I well appreciate the potential harm that can be caused by diseases like TB. I would never knowingly put my daughter, friends or anyone else at risk from such a disease.

I would ask the media to respect my privacy and that of my family, and I will be respectfully declining all media requests. My thoughts and focus over the next few months will be with my family, and we are hopeful that Andrew will have a fast and successful recovery.

Robert C. Cooksey

I understand his request for privacy, but come on, his son in law apparently flew around the world with a horribly nasty, possibly contagious form of TB. And even if the authorities did not tell him he could not travel, there is no doubt this is something I want reporters looking into. It is entirely possible that it really is a coincidence (son in law having this TB and him working in a lab that probably studies this type of TB) but it is worth investigating this further.


  1. I'm also eager to hear more about this: in terms of epidemiology, I wonder who in the CDC is scrutinizing Mr. Cooksey's adherence to protocol at the end of his workday. In terms of organizational behavior, I wonder if the CDC culture--the culture of those responsible for confronting the son-in-law and holding him in the U.S.--is one that would induce them to defer to their colleague and allow him to handle the discussion more or less informally.

  2. To my fellow scientists:
    Is it possible that Mr. Cooksey is a carrier of some TB strain, and that he infected his son-in-law prior to his travels? That would explain the coincidence.

  3. Well lots of people are carriers of TB. But I believe those people will still usually test positive in the various TB tests that are out there and that he claims to have taken and tested negative. But certainly it seems like a reasonable possibility to at least investigate.

    One question is, canthe CDC really objectively investigate this given that what they would be looking into is whether one of their own researchers spread the disease. I think they probably would do fine with such an investigation, but they should be up front about it.

    Other questions one might want to ask

    1. Did the infected person ever come by to visit the CDC TB lab?

    2. What other TB researchers did he have contact with?

    3. Does the genotype of the strain match any that ANYONE at that CDC lab was working on?

    4. Is ANYONE associated with that CDC lab a carrier of this type of TB

  4. Amongs the "doesn't add upss..."
    1. Panic is not a good thing. Are we creating unnec panic here? Why is the press using the words escape and flee -- Mr. Speaker may be stupid, negligenct, or a publicity hound, but he is NOT a criminal, or even under indictment. Those words are at best inappropriate-- inflammatory, and panic inducing. Why doesn't anyone object> we are still a country operating under the rule of law, at least for a little while longer.
    2. There are legal remedies available to the CDC -- why are the blaming Mr. Speaker for their own failures? Why didn't CDC get an immediate detention and quarantine order - and prohibit him from travelling to start, why send a letter, why not call, why not get an emergency injunction if he was such a threat? President and Julie G can order quarantine under the emergency quarantine act- provision number 9?
    3. Why didn't CDC notify WHO - as we are supposed to?
    4. How did CDC know he was in Italy, but not in Canada?
    5. Why did CDC contact a former CDC employee to contact Mr. Speaker- and not ask his father in law - who was apparently was at the wedding !!!! to talk to him

    Why did they tell him he would have to charter a plane


    WHY DID JULIE G state there was a need to determine whose p atient this was as a reason for her not acting sooner -- And if we can fly home a CDC Dr with SARS, which is far more contatious, why couldn't she bring Speaker home, and worry about the cost later?

    6. Why are we so concerned about the people exposed on the plane- doesn't anyone care about the fiance- her 8 year old daughter- whether the Mrs. Speaker -- if they ever did get married, and now there is some question about that--
    I gather her father doesn't think this is such a big deal? If he doesn't what makes CDC so concerned?
    And why doesn't anyone care about the other 3 score people in the US with XDR TB- after all no one is stopping them from travelling?Nor do we screen any of the other thousands of ppl with XDR from coming into the Us -- what is so special about this case?

    And --isn't anyone concerned with the persons exposed since he was dx in Mar, or infected in Jan?
    Has this atty been trying any cases in the lasts year- speaking to juries for 8 hours a day? taking depositions for days at a time in close proximity????
    Do we care about their exposures, or only the ones that happened since CDC decided to make an issue of this case?
    Why wasn't he taken immediately to Denver- does the bit about the media problem really wash?

    How come it took so long to determine the TB, which was dx in March was a drug resistent type- and how come it took so quickly to determine tha
    t the DNA fingerprint of the TB bacilli Dr Cooksey was working with was a different strain than the one infecting Mr. Speaker.

    And if addl regulations ensue from this, similar perhaps to the eggregiously draconian regulations proffered by CDC in Jan of 2004, (although apparently withdrawn under protest) which all but allows the CDC director to impound a plane for quarantine or isolation--on speculation that a passenger may have a novel infectious disease,and discard habeaus corpus regulations for up to six days , materialize after the hype associated with this situation, then perhaps we need to stop people with Measles from flying. After all, Measles is far more contagious, and people do die from it. At least once in a while. Then again, if the failed regulation gets resurrected, people WILL DIE from the consequences of mass involuntary quarantine.

    We must be very vigilant that we do not allow a minimally infectious diease to be the predicate for broad sweeping new quarantine regulations-- and the unanswered questions generated by the emerging Speaker-TB scenario presents just the fodder to get scientifically illiterate politicians on a very unwise bandwagon.