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TB Threat: A Survival Guide

Aired June 1, 2007 - 22:00   ET


DR. SANJAY GUPTA, CNN ANCHOR: Good evening from Denver.
I'm Dr. Sanjay Gupta. Anderson is off tonight, but he will be back Sunday night from New Hampshire, covering the Democratic presidential debate.

We're just outside the hospital where Andrew Speaker, who touched off an international health scare, is being treated for extensively- drug-resistant tuberculosis. He says he's sorry for endangering anyone, but he's also defiant.

Tonight: the battle over what health officials told him about traveling with a deadly disease; the homeland security breakdown; and the risk of more cases coming to the United States; as well the fight against tuberculosis around the world.

"TB Threat: A Survival Guide."

Let's start, though, with the patient.


GUPTA (voice-over): Andrew Speaker told ABC News, he's sorry. The Atlanta attorney with a deadly and rare form of TB was contrite when he apologized to the hundreds of airplane passengers he put at risk.


ANDREW SPEAKER, TUBERCULOSIS PATIENT: I don't expect those people to ever forgive me. I just hope they understand that I truly never meant to put them in harm. I never meant to hurt their families or them.

And I just hope they -- they can find a way to forgive me for putting them in harm, because I didn't mean to.


GUPTA: Speaker find out he carried a drug-resistant strain of tuberculosis, but, two days later, went ahead with his trip around Europe.

But, with his wife seated next to him, Speaker was defensive about his decision to travel, insisting health officials told him he never posed a danger to others.


SPEAKER: I said, what's changed? When I left, I was told I wasn't a threat to anyone. When I was -- left, I was told that I wasn't contagious. What's changed? Why are you abandoning me like this, and -- and expecting me to turn myself over for an indefinite time? What has changed?

And they didn't have an answer to that.


GUPTA: Speaker says he has that conversation on tape, but he has not made it public.

Fulton County health officials insist they told him not to fly. Speaker also says the Centers for Disease Control abandoned him, telling him he couldn't take a commercial flight back to the United States because it could jeopardize fellow passengers. The CDC says they were working to get him back to the U.S. safely, even considering a cargo ship.

But he flew back commercially anyway, saying a private jet would cost $100,000, and getting to Denver's top TB hospital was his only chance to save his life.

In a tearful interview, his wife also claims, they were never warned that her husband carried a potentially lethal threat.


SARAH COOKSEY, WIFE OF ANDREW SPEAKER: Up until six days ago, obviously, we -- no one ever told me that I was at any kind of risk.



SAWYER: A kiss was...

COOKSEY: Yes, I haven't -- I haven't, you know, kissed my husband. I mean, it's our honeymoon in a week. So, no, there's no -- I mean, I'm not -- I'm not in contact with him.

But, no, before that, you know, nobody ever said anything. Nobody ever said that we should be careful.


GUPTA: That was then. And being careful is now job one.

And they're very, very careful here. Jewish Hospital is arguably one of the best in the country for respiratory disease. See, for a long time in this country, if you had terrible lung disease, you were simply told to get fresh air and sunshine. Denver, high in the Rockies, was the perfect prescription. So, it became a mecca for tuberculosis. Now they offer much more, of course. And that's why Andrew Speaker is here for his tuberculosis treatment right behind me, as well. And, you know, an interesting thing is, he might be representing medical history. You see, they have never taken care of XDR-TB here. He will be the very first patient.

Dr. Martin Pomerantz is charged with taking care of Andrew and possibly saving his life. He laid out his plan for me.


GUPTA: So, this is the -- this is the operating room, where you perform these tuberculosis operations?


GUPTA: Now, let me ask you really quick, these masks, how effective are they?

POMERANTZ: They're quite good. They have a greater level of filtration than -- than the normal mask, and supposedly protect the surgeons and the nurses at the operating table.

However, if -- if you're doing the operations right, you shouldn't expose anyone to the organisms in the operating room, because, when you resect the part of the lung, you should be far away from the cavities and the diseased lung where the organisms reside. So, actually, it's fairly safe in the operating room.

GUPTA: I mean, you're actually operating on somebody, taking out a piece of their lung that has all the tuberculosis in it.


GUPTA: I mean, that's potentially dangerous, though, isn't it?

POMERANTZ: It's potentially dangerous, if you open into the cavities of the lung that contain the tuberculosis organisms. There are billions of organisms in a cavity. So, if you expose that cavity, or open into it, that -- that could get out into the air.

And that would be potentially dangerous. There are also special precautions we -- we take with the patient. The patient comes down to a special room, because he's an infected case. He comes into this room. And, from here, he goes -- he either goes back to that room or to a negative-airflow room in the intensive care unit.

So, all the rooms that this patient should be in will be negative-airflow.

GUPTA: When you do this operation, are you concerned about your own health or the health of your -- your staff?

POMERANTZ: We're concerned. But, in all the 180 operations we have done with all the staff and myself, none of us have ever come down with tuberculosis or converted our skin tests. My skin test is still negative.

GUPTA: After all those cases?

POMERANTZ: After all those.

GUPTA: You have never done a case of extensively-drug-resistant tuberculosis?

POMERANTZ: That's right.

GUPTA: He would be making medical history.

POMERANTZ: He would be the first one that we have done here. Now, I don't know if any have been operated on in other parts of the world, but they certainly aren't published, if they do.

GUPTA: Is that the plan, to operate on Mr. Speaker?

POMERANTZ: It depends.

I have not seen his films yet. And I have only talked to the people at National Jewish. If he has localized disease -- and I don't know if he does or doesn't -- if he has localized disease, the remaining part of his lung being normal, then logic would say, if you took out the localized disease, since you have very few good antibiotics to cover his infection, that the chance of curing him might be better.

GUPTA: So, he -- I mean, he would be cured; he would be done?

POMERANTZ: Well, I wouldn't say that, because you can't cut out all infection. You have to assume that there is some microscopic infection elsewhere. And it just depends upon the continued use of antibiotics for up to two years.

GUPTA: If you did nothing at all with him, what would happen?

POMERANTZ: Nothing at all, he would eventually die of the infection.

GUPTA: What would happen to his body?

POMERANTZ: Well, he would end up looking like a concentration camp victim. The old name for tuberculosis was consumption, because it consumes the body. And that's the way these patients looked untreated in the old days.


GUPTA: Of course, Dr. Pomerantz's job is to treat his patient, not to judge him.

Others, though, aren't holding back. They have turned Andrew Speaker into a watercooler topic, at best, and, at worst, some kind of modern Typhoid Mary.

CNN's Rusty Dornin on the friends who say he's no international TB villain.


RUSTY DORNIN, CNN CORRESPONDENT: (voice-over): Those who know him as Drew say Andrew Speaker is no villain.

RYAN PRESCOTT, FRIEND OF TUBERCULOSIS PATIENT: He's not a selfish person. He honestly believed that he was not putting others in danger.

DORNIN: Law school buddy Ryan Prescott says people have made rash judgments about his friend. He knew Speaker had TB way back in April.

PRESCOTT: He wasn't hiding it. He told his friends. People that knew him knew that he had TB. He was told that he was not contagious. He was told that he wasn't dangerous to us. And I was not afraid to be around him.

DORNIN: Neither was his fraternity brother, Greg Fansler. Fansler was Speaker's roommate more than two years, right up until last December.

(on camera): You lived with him for two years, perhaps during the time that he contracted tuberculosis.


DORNIN: Did the CDC contact you?

FANSLER: I contacted them when I actually went and visited with Drew on Wednesday, and called them Wednesday night, and then was on the phone with them yesterday, and just gave them names of people that he was close with.

DORNIN: Did they ask you to be tested?

FANSLER: They -- as a person who lived with him, I'm probably a little bit more wanting to be tested than the other folks, but no real urgency.

DORNIN: Brandon Smith also went to law school with Speaker. Smith, like the others, has spoken with Speaker since he was placed in isolation. They all believe he tried to do the right thing by coming straight back to the U.S.

BRANDON SMITH, FRIEND OF TUBERCULOSIS PATIENT: For him, it was matter of life and death. He knew that America -- the States have the best health care system there is, and he just -- he wanted to get back to that.

DORNIN: But what about endangering people on the flight back from Europe, after he had been told he had the extremely resistant form of TB?

PRESCOTT: He had a form that was going to jeopardize his life more, not a form that was jeopardizing others' lives more.

(on camera): Well, you could -- people might argue, if they had an immunosuppressive problem, it might endanger them more.

PRESCOTT: And I could argue that there's not a single reported case of tuberculosis being transmitted on an airplane.

DORNIN (voice-over): The three friends are unanimous in their belief that there's one person Drew Speaker would never place in harm's way, Sarah Cooksey.

FANSLER: He would not put the person that he cared the most about in danger. And that would be Sarah. If she's sitting next to him, I do not -- I cannot fathom him wanting to put her life in jeopardy, and especially the little one as well.

DORNIN: The little one is Sarah's 8-year-old daughter. His friends say Speaker is a family man, an outdoorsman. He and his fiancee did everything from running to rock-climbing, even after he was first diagnosed TB.

But, they wonder, where did their friend Drew get this disease? He traveled to Peru three years ago, and, last year, went on a charity trip to Vietnam and Cambodia. Maybe there, they say.

PRESCOTT: From what I understand, he visited an orphanage, visited a hospital. It could have been a place where he picked it up.

DORNIN: Speaker told his friends this week he's received some e- mails wishing him anything but well.

PRESCOTT: And there's a lot of people out there wishing him a horrible death. Drew would not wish harm on anybody. And, yet, these people are coming forward, telling him that they -- they want him executed.

DORNIN: So, they stand united behind a friend who they say stands wrongly accused.

Rusty Dornin, CNN, Atlanta.


GUPTA: Back to the medical detective angle -- it's some of the most fascinating stuff there is -- the CDC in Atlanta tells us tonight that some of the very early testing has not come back positive on people who may have been exposed to Speaker's infection, again, though, early testing on a handful of people. And that's where we are tonight.

Of course, with more on how we got here, CNN's Gary Tuchman.


GARY TUCHMAN, CNN NATIONAL CORRESPONDENT (voice-over): Air France has one flight a day from Atlanta to Paris. And, on May 12, the passengers who took the nearly nine-hour flight had no reason to think about the man in seat 30-H. No one had warned them about Andrew Speaker.

But what was said to the 31-year-old man with a dangerous string of tuberculosis before he got on that plane? Health officials in Fulton County, Georgia, say they ordered him not to travel.

DR. ERIC BENNING, FULTON COUNTY HEALTH DEPARTMENT: We are not a police authority. But we did tell him, in no uncertain terms, that he should not travel. And we told him the reasons why.

TUCHMAN: But, through an open records request, CNN has obtained a copy of a letter that the Health Department wrote to Andrew Speaker. And it specifically says, it is "strongly recommended that you postpone your travel."

As it turned out, Speaker never got the letter. It was mailed on May 11, health officials thinking he was planning on flying to Paris on May 14. But, instead, he left the day after the letter was mailed.

Officials say they learned that when they also attempted to hand- deliver the letter hours after he left.

Speaker was adamant when he told ABC News why he felt it was OK to fly.


SPEAKER: I had no symptoms. I was smear-negative. And I was told that, you are not contagious and you are not a threat.

That's why we went on.


TUCHMAN: Speaker has known since January that he's had TB. But the county health department says it learned that fact on April 23 from his private physician.

On May 10, Health Department officials determined it was a multi- drug-resistant strain. And, then, six days later, after his plane flight, they determined it was worse, the extremely-drug-resistant variety of TB.

BENNING: At that point, we certainly wanted to make sure that we notified the patient.

TUCHMAN: But it wasn't until well after Speaker was in Europe, specifically, in Rome, that the Centers for Disease Control was able to reach him by phone.

DR. MICHAEL LEONARD, EMORY UNIVERSITY SCHOOL OF MEDICINE: Public officials were in contact with him, and trying to come up with the safest way back to the U.S. And he chose an alternate route.

TUCHMAN: But Speaker says he wasn't offered any transportation, so he flew to Canada and then drove across the border into New York State.

Earlier that same day, the CDC says it recommended he be put on a no-fly list, but he got through anyway.

Now he is emotionally apologizing to the passengers that flew with him.


SPEAKER: I just hope they -- they can find a way to forgive me for putting them in harm.


TUCHMAN: Speaking from a Denver hospital, under federal order of isolation.

Gary Tuchman, CNN, Atlanta.


GUPTA: And, as Gary said, Andrew Speaker drove right into the country, crossing the border in Champlain, New York, even though his passport was on a hot list.

That meant, when the border agent scanned it, a message came up on his computer screen telling him to stop Speaker, isolate him, and put him on protective gear. Sources say the guard waved him and his wife through because they didn't look sick.

And get this. Canadian authorities didn't even know about Speaker's status until 12 hours after he left the country.

Amazing stuff.

Straight ahead: more on Andrew Speaker, tuberculosis, and the threat to people here and all around the world.


ANNOUNCER: It's global, and experts say this country is not immune.

THOMAS FRIEDEN, NEW YORK CITY HEALTH COMMISSIONER: In New York City, every week, on average, we do one investigation of someone with active tuberculosis who is working.

ANNOUNCER: TB and other global killers arriving daily in cities near you -- who's keeping you safe? 360 is on the front lines.

Also tonight: fighting TB at the source.

UNIDENTIFIED MALE: It comes down to, how do we -- how do we nip this at the grassroots level?

ANNOUNCER: See what it takes to knock out TB and how you can protect yourself by helping others -- when "TB Threat: A Survival Guide," continues.



GUPTA: Tuberculosis actually killed one person on that list, Eleanor Roosevelt. She died from complications of TB in 1962.

Forty-five years later, TB remains a deadly threat here in the United States. Like Andrew Speaker, an estimated 10 to 15 million Americans are infected with the bacteria. About 10 percent of them will actually develop active TB.

Here's CNN's Randi Kaye.


RANDI KAYE, CNN CORRESPONDENT (voice-over): Andrew Speaker's got company. The Centers for Disease Control says he and 13,767 others in the U.S. were diagnosed with tuberculosis last year, 1,000 people in New York City alone, says Health Commissioner Thomas Frieden.

FRIEDEN: Tuberculosis is not so rare. In New York City, every week, on average, we do one investigation of someone with active tuberculosis who is working, in a work site, in a financial institution, in a business, in a school.

KAYE: TB is here, coast to coast, and it has been here for a while. 1998, Norfolk, Virginia, 2,100 sailors aboard a Navy warship underwent TB tests after two crew members got sick.


UNIDENTIFIED FEMALE: We're anxiously waiting. And, hopefully, he doesn't have it.


KAYE: 2005, Broken Bow, Oklahoma, 220 people were tested after it was confirmed an employee at a Tyson chicken plant had the disease.

And, just this year, at New York City's Saint Barnabas Hospital, hundreds of patients, including more than 200 newborns, were screened after contact with an infected employee.

In America, the CDC has recorded 49 other cases of extremely- drug-resistant TB, like Speaker has, in the last 13 years.

(on camera): How many other Andrew Speakers might be out there?

FRIEDEN: It's really pretty rare. People with TB feel sick. They seek care. And, once they're in care, they're effectively treated.

KAYE: So, you don't expect that there are a lot of globe- trotting TB patients out there? FRIEDEN: It happens. We see this. And, when it happens, you have to take appropriate measures.

KAYE (voice-over): TB is often considered a poor man's disease because of its roots in poverty-stricken countries.

So, why is it that a country as advanced as the United States is battling a disease more commonly found in developing countries?

FRIEDEN: Tuberculosis is a global epidemic. Most of our cases in New York City and nationally are among people who are born overseas. We can't hermetically seal our borders, even if we wanted to.

KAYE: Globally, the CDC estimates, one-third of the world's population is infected with the bacteria that causes TB. Last year, the rate among foreign-born people was nearly 10 times greater than among American-born.

Ethnic minorities in the U.S. are at a disadvantage, too. Asians, for example, are 20 times more likely to have TB as Caucasians.

(on camera): With thousands of cases in the U.S. every year, how are you supposed to know if the person walking next to you is one of them? Frieden says, there really is no way to know, no obvious signs.

That's pretty alarming to some people, since we're all connected by the air we breathe.

FRIEDEN: It's in our best interest to help the countries of the world control tuberculosis better.

KAYE (voice-over): Another reason the United States is suffering, outdated tools.

FRIEDEN: The tests that we have is -- for the sputum test is 100 years old. The test -- the skin test that you may have had, that's about 90 years old. We haven't had a good new first-line drug for tuberculosis in nearly 50 years.

KAYE: Weak tools, no match for a terrible epidemic.


KAYE: Decades ago, the number of TB cases dropped. There were effective antibiotics back then. But, in the mid-'80s, TB was on the rise again -- a key reason, HIV and AIDS.

People with HIV are especially vulnerable to developing TB, Sanjay, as you know. They may have the infection, but the disease kicks in when the HIV compromises their immune system. So, in places like sub-Saharan Africa, where 30 percent of the people have HIV, they don't have the technology or the ability to control the TB that results from that -- Sanjay, back to you.

GUPTA: Amazing, Randi, a potentially treatable disease that can cause so many deaths.

Thanks for that report.

Tonight, still, there are so many unanswered questions about Andrew Speaker and his rare case of XDR-TB, one that strikes at the heart of this controversy now swirling around him: Was he contagious or not when he got on board those planes? In medical-speak, was the bacteria in his body latent, or did he have active tuberculosis?

Remarkably, as I talk to people, I'm still hearing varying answers to this question. If you're infected with TB, but not coughing, with a fever, and your sputum test is clear, you really aren't contagious.

By that standard, and according to reports from the hospital, Speaker may never really have been a threat in the first place. We're following that angle of the story very closely.

In the meantime, I want to take a moment to try to explain why tuberculosis can be so dangerous once it becomes active.

Let's start with the basics. Tuberculosis is a bacteria that lodges deep down in your lungs in the small air sacs known as the alveoli. Now, when your body realizes there is an invading organism, it tries to destroy the bacteria, but this particular bug has the ability to deactivate those first-line immune cells.

Once it shuts down those defense cells, the bacteria begins to grow and multiply in an uncontrolled way. Next comes the second-line defenders. In many cases, these immune cells are able to kill most of the bacteria. But, when they die, they form this thick cheese-like substance in your lung.

These deposits can migrate to other parts of your body and sprout even more infections. But they can also harden in your lungs, making it very difficult to breathe.

Often, the worst symptoms come from your body trying to fight off the infection, not from the bug itself. Left untreated, the bacteria can take over your whole body and wreak havoc on your immune system.

Of course, tuberculosis used to be called consumption for that very reason. Untreated, the bacteria will consume your entire living infrastructure. It's an awful way to die.

Treating this form of tuberculosis can be very expensive. Here's the "Raw Data."

For someone like Speaker, with XDR-TB, the cost can range an estimated $250,000 to $300,000 to treat the disease. Purportedly, his insurance company agreed to pay the $12,000 to hire a plane to take Speaker to Denver.

We will have much more on tuberculosis and why it remains a worldwide threat -- still ahead.

But, first, here's John Roberts with what is coming up Monday on "AMERICAN MORNING."


JOHN ROBERTS, CO-HOST, "AMERICAN MORNING": Monday on "AMERICAN MORNING," we're live from New Hampshire, the morning after the Democratic debate. We will be talking to the candidates on Monday.

Plus, the immigration debate fires up in Washington again. We will visit a small town right in the middle of a border battle. Walk in the front door of a town building, you're in the United States. Walk out the back right into Canada -- "AMERICAN MORNING," Monday, beginning at 6:00 Eastern.


GUPTA: And, just ahead, more on the tuberculosis threat -- it's a global pandemic. We are going to show you the hot spots.

Plus, the big question: With all the medicine available, why do more than a million people die of tuberculosis every year? We're "Keeping Them Honest" -- 360 next.


GUPTA: Of course, those two million deaths every year are from all types of tuberculosis.

Let's be frank. Every type of TB can kill. But the type that Andrew Speaker has, XDR-TB, is the worst of the bunch. The X in its name stands for extensively drug resistant. That means it has figured out a way to outsmart virtually all of the drugs we have to fight it. XDR-TB is rare, especially in the United States. But that could change.

CNN's Tom Foreman explains why.


TOM FOREMAN, CNN CORRESPONDENT: Sanjay, these are all of the countries in the world where cases of XDR-TB have been reported. And, as you can see, it's real scattershot picture of the planet.

But narrow into the countries with the most extensive number of cases, and, potentially, the hot spots for this disease, and the problem gets much more focused. The Russian Federation has about 35,000 cases of drug-resistant strains of TB, not just XDR-TB, but all forms that resist treatment.

China, which is one of the world's worst nations for TB in general, is also in very bad shape for drug-resistant strains in general, 140,000 cases there -- and India, another hot spot, in terms of just drug-resistant strains, 110,000 cases.

Still, these hot spots are on the other side of the globe. So, why should Americans worry? Well, because the world's people are more mobile than ever before, and an estimated 50,000 people from around the planet come over our borders into the United States every day -- Sanjay.


GUPTA: Tom, thank you.

We're in Denver, of course, just outside the hospital. Just behind me, Andrew Speaker is being treated for extensively drug resistant tuberculosis, XDR-TB. Everybody knows this term now. It's called that for short.

Denver may be halfway around the world from sine if those hot zones Tom was just talking about. But don't let the miles fool you. Someone who knows that better than anyone is Laurie Garrett. She's senior fellow for global health on foreign relations and a respected health and science writer. I spoke to her earlier.


GUPTA: Laurie, between 1993 and 2006, there have been almost 50 cases of XDR-TB in the United States. How are those patients usually treated? I mean, is the supervision adequate?

LAURIE GARRETT, SENIOR FELLOW FOR GLOBAL HEALTH ON FOREIGN RELATIONS, COUNCIL ON FOREIGN RELATIONS: First of all, that's cases that we know about. We don't have any idea how many people may be asymptomatically carrying XDR-TB in the United States or anywhere else right now.

We have no idea how many people get on airplanes carrying it or what have you. So we're jumping off a cliff here, reacting to an isolated case as if it were something quite, quite, quite extraordinary and exceptional.

In reality, it's just part of a larger piece of what's going on in the world right now and what's being experienced in countries all over the whole world.

GUPTA: I want to talk about that. But let me ask you something. Why is Andrew Speaker the first person to ever be federally quarantined with this particular problem, do you think? I mean, there have been other cases and maybe even cases that we don't know about. Why is this the first time?

GARRETT: Because Andrew chose to fly internationally. Ad if you go through the recommendations for how to handle tuberculosis that were meticulously worked out last year by the World Health Organization, and the CDC participated in that development of those guidelines, it says very clearly that, No. 1, a physician is supposed to instruct their patient, do not fly internationally if you carry tuberculosis.

And, No. 2, if it's drug resistant strain, there is supposed to be information passed up the food chain, including alerting the airline carrier, alerting federal and local authorities.

And in almost every single case, something went wrong in the transmission of information in the Andrew Speaker case.

GUPTA: How does this bode, do you think, for overall public health system? This is one case. What if there had been 10? What if there had been 100? We'd be having a much different conversation, wouldn't we?

GARRETT: Absolutely. And frankly, we've invested somewhere in the neighborhood of $6 billion in our public health system in the United States since the anthrax mailings in the fall of 2001. And this sort of rude awakening to how much we've let our infrastructure fall apart.

And that was supposed to provide us with the appropriate amount of protection and keep America strong and ready. But the truth of the matter is, it's a net full of holes.

GUPTA: You know, you're talking about invisible invaders in people's bodies. And they walk through airports probably all the time, Laurie. Is there any way to really make us safer from people who carry these dangerous bugs in their bodies?

GARRETT: Look, let's face it. We're in a globalized world. There was a time when the answer would have been, "Oh, you stay home, in your nice protected environment, and you won't get exposed to anything."

But right now, if you're in the business community, if you're in trade, in commerce and of course, just as a vacation traveler, you're going all over the world, and you're encountering people who've also been going all over the world.

It's very hard to say, "Oh, you're going to create a cocoon for yourself," or a nation can create a cocoon for the entire country.

GUPTA: All right. Laurie Garrett, from the Council on Foreign Relations. Thanks for your time.

GARRETT: Thank you.


GUPTA: A Pulitzer Prize winner, we might add, as well.

And up next, the personal dimension.


ANNOUNCER: Packed flights, close quarters.

UNIDENTIFIED FEMALE: I think the air is disgusting.

ANNOUNCER: But can it make you sick? The T.B. traveler touches off new questions. 360 investigates the air that you breathe on board.

Also, remember this line. BILL CLINTON, FORMER PRESIDENT OF THE UNITED STATES: Think of it this slogan: buy one, get one free.

ANNOUNCER: So how is the Bilary factor playing in New Hampshire? Is a big-name running mate an asset or a political distraction? Details ahead on 360.


GUPTA: These are eight young people, eight out of at least 28 Chicago public school kids killed so far this school year. As Anderson Cooper found out, while some are dying, many others are living in fear.


ANDERSON COOPER, CNN ANCHOR (voice-over): It's 10 p.m. Kids are hanging out on the streets here. In fact, you can find them at all hours. Listen to their stories. What's perhaps most disturbing is how they're so matter of fact, so hardened.

UNIDENTIFIED MALE: Last summer, caught a robbery case, aggravated battery case, got locked up in Cook County jail.

UNIDENTIFIED MALE: All you're thinking about is meeting women, riding on rails, jewelry, smoking weed, drinking liquor, getting money. That's all you're thinking about. You don't care about life.

COOPER: Death, witnessing it or fearing it, is a way of life here.

UNIDENTIFIED MALE: My best friend got shot. As soon as I walked in the store, some guy rode up on a bike and shot him two times in the head.


GUPTA: Wow. See more of Anderson's reporting. It's a very powerful edition of 360, "Deadly Lessons: 24 Hours in Chicago". That's coming up at the top of the hour.

Now, back to our T.B. special report. The fact that tuberculosis remains a global killer in the 21st century is more than sobering. It raises some tough questions.

The bacteria that causes T.B. was identified 125 years ago. The first cure and antibiotic arrived in the 1940s. You would think that by now, medicine would have won the fight against this ancient disease, which by the way, has been around since the pharoahs.

To understand why it hasn't, well, you need to follow the money.

CNN's Joe Johns is "Keeping Them Honest".

(BEGIN VIDEOTAPE) JOE JOHNS, CNN CORRESPONDENT (voice-over): The most recent figures are alarming. In 2005, T.B. killed 1.6 million people around the world.

But make no mistake: much is being done to fight the disease. The problem is that currently, the best medicine available to treat it is a combination of four drugs that dates back more than four decades. That treatment remains effective but -- and this is a big issue -- it's only reliable if patients follow it completely. And that's really hard.

Why? Because T.B. patients take the medication everyday for months, and they must be carefully monitored. It's called directly observed treatment.

That's why T.B. thrives in many developing countries where there's a stigma attached to the disease and where people living hand to mouth can't make the commitment of time and energy to go see a healthcare provider everyday.

MARIA FREIRE, TB ALLIANCE: So you can imagine, for example, a woman that leaves her family everyday to get the care she needs and then have to walk back to her home. And it becomes a very cumbersome thing for them to do. It's very difficult.

JOHNS: So why isn't there a vaccine or a more practical treatment that's easier and quicker for the patient and less hassle for the caregiver? Answer, money.

DR. NICOLE LURIE, RAND CORPORATION: Because T.B. is a disease of poor people and people in developing countries, there haven't been really good incentives in the private sector to develop a vaccine, to develop new drugs, et cetera, and that also needs attention and a real boost.

JOHNS: In case you didn't get it, incentives means profits for drug companies. Here's how the numbers work: the Global Alliance for T.B. Drug Development estimates global sales for first line T.B. drugs at $315 million a year.

By way of comparison, Fiagra sales around the world raked in $1.7 billion last year.

Plus, there are costs of developing better T.B. drugs. The Global Alliance says it would take ten years and nearly $5 billion just to get them to market. So those numbers don't work for the drug companies. In other words, no money, no incentive to make a cure.

FREIRE: This market is not large enough for a big pharmaceutical company to enter with the idea of making money. So we have to find a way of lowering the hurdles for companies to invest.

JOHNS: But better treatment may come any way, because with the currently available drugs and the ordeal of taking them daily and under supervision, people give up and don't follow through on the treatment. DR. MYLES DRUCKMAN, INTERNATIONAL SOS: And if it's not treated effectively, or inappropriately, you can get a lot of these diseases that are now drug resistant, which puts the whole, you know, globe at risk.

JOHNS: And that is what happened with Andrew Speaker. With air travel, a contagious disease can move around the world in a matter of hours.

Joe Johns, CNN, Washington.


GUPTA: We are truly living in a global world.

Just ahead, the threat in the skies. Can the air we breathe on an airplane make us sick?

More 360, live from Denver, coming up.


GUPTA: This summer, millions of us will be flying, often in packed planes with too little room to move and nowhere to go if someone sneezes or coughs. So what if the person next to you has something more than a cold?

CNN's Jason Carroll investigates.


JASON CARROLL, CNN CORRESPONDENT (voice-over): It's a top complaint among air travelers.

UNIDENTIFIED FEMALE: I think the air is disgusting.

CARROLL: Long lines, delayed flights and the feeling the air circulating on planes is unhealthy.

MIKE ACEVEDO, TRAVELER: I usually come out of here sniffing or coughing or stuff like that.

JULIE NEGRELLI, TRAVELER: It smells funny sometimes. It does make my eyes get all itchy.

CARROLL: Concerns go far beyond the fear of catching the common cold. Questions of air quality on board commercial flights made headlines four years ago during the SARS scare in Canada.

Now, more concern, since a man with a rare form of tuberculosis took flights in the United States, Canada and Europe.

And passengers are asking, just how clean is the air you breathe on board? None of the major airlines we contacted would comment.

But a Federal Aviation Administration spokesman told us U.S. airlines are required to provide a sufficient amount of uncontaminated air. Most newer planes do that with high efficiency particulate filters, HEPA filters for short. They're also used in hospitals, and federal officials say they remove 99 percent of airborne contaminants.

Dr. David Streitweiser helps airlines handle medical emergencies and says the reality is, there have been few cases of diseases transmitted on board. But the risk is there. It's small, but it's real.

DAVID STREITWEISER, MEDAIR: I think our access to easy travel will make an airborne contagious disease like avian influenza, if and whenever that comes, that will make it more of a threat. It will spread more rapidly, and we have to be prepared for that.

CARROLL: The FAA funded a study to develop a new censor, seen here in this animation, which should identify a passenger carrying an airborne virus. The red cloud shows how the sensor tracks the contaminated passenger. It's still years away from development.

For now, travelers like the Hendricks say they worry most about the common cold.

(on camera) Do you have a cold?


CARROLL: You sure do, don't you?


CARROLL: That your mom has a cold?

UNIDENTIFIED FEMALE: Yes. It's been annoying us the whole time. Stop coughing.

CARROLL: Airline officials say that the air inside the cabin actually recycles every three minutes and that air might actually be cleaner than the air you might find in most office buildings.

Jason Carroll, CNN, New York.


GUPTA: So do you think the air on planes is safe? Well, go to and let us know what you think. There you can also read my blog about the Andrew Speaker case.

We'll have much more on this topic tomorrow, as well, on "HOUSE CALL" at 8:30 a.m. Eastern.

Just ahead, though, a 360 special. School children killed in a major American city. So why is there so little outrage? Anderson investigates.

But first, the presidential candidates and the former president, how Bill Clinton is shaping up the 2008 race. Plus, the "Shot of the Day". Don't believe how much a single skull is worth.


GUPTA: CNN will be in New Hampshire this weekend for the next round of presidential debates. The Democrats face off on Sunday, the Republicans on Tuesday.

And after the debates, of course, join Anderson Cooper for some 360 "Raw Politics" with the best political team on television.

Hillary Clinton heads into the debate at the head of the pack, clearly the frontrunner for her party's nomination. The question is, though, can she hold the lead?

Well, it appears she will if the Granite State's friends of Hill, and especially of Bill, have anything to say about it.

Chief national correspondent John King is in Manchester tonight with the story.


JOHN KING, CNN CORRESPONDENT (voice-over): On the outside, it looks like any other New Hampshire middle class home.

ANITA FREEDMAN, FORMER DEMOCRATIC COMMITTEEWOMAN: He knows all of us, and he doesn't forget.

KING: But inside, it is a shrine to a president, who to many in these parts remains the stuff of legends.

FREEDMAN: He treated us, I guess I could say, like family.

KING: Anita Freedman is a friend of Bill from way back and didn't hesitate when the phone rang several months ago.

FREEDMAN: And the voice at the other end said, "Hi, Anita. This is Hillary Clinton."

KING: Then the former president joined in.

FREEDMAN: We must have talked about a half hour about campaigning, and how to help her, and what -- you know, what, if anything, they wanted me to do and stuff like that.

UNIDENTIFIED MALE: We want Bill, we want Bill.

UNIDENTIFIED MALE: We want Bill, we want Bill.

UNIDENTIFIED MALE: We want Bill, we want Bill.

Thank you. All right.

KING: It's safe bet you won't hear Hillary Clinton borrow this old line.

CLINTON: What do you think about this slogan? Buy one, get one free.

KING: But nowhere is the Bill factor more of an issue than in New Hampshire. Anita Freedman, one of the many Clinton 1992 veterans doing all they can for the other Clinton now.

Most insist their support wasn't automatic. Mrs. Clinton earned it through her work as first lady and now as senator.

(on camera) Just because she's his wife is not reason, right?

FREEDMAN: No. I mean, no, because there are plenty of dumb wives running around.

KING (voice-over): Terry Shumaker is another longtime friend of Bill turned friend of Hill, one of the people who deals with skepticism and doubts of younger New Hampshire Democrats who weren't involved back in 1992 or 1996.

TERRY SHUMAKER, FORMER CLINTON, NEW HAMPSHIRE CO-CHAIR: The questions asked most often, can she win? Is she polarizing? Is she this ambitious, brittle, shrill person that we heard about in the media? And of course, I say no, she isn't.

But now the genius of the New Hampshire primary is that people are getting to find that on their own.

KING: It is loyalty earned long ago and nurtured repeatedly for 15 years now. Invitations to White House parties, nights in the Lincoln bedroom. Personal touch.

FREEDMAN: These people were good to me when I needed it the most, when I lost my husband, when I lost my daughter.

KING: ... after personal touch.

FREEDMAN: I have his book. And in it, he said a little thing about it probably wouldn't have happened without you.

KING: Now, lines in old letters are seen as hints. "Hillary joins in sending her best wishes." The president, who insists they call him Bill, added to this note to Freedman, "Please say hello to everyone."

And lines in new speeches...

B. CLINTON: Madam President Newman, has a nice ring to it.

KING: ... like this University of New Hampshire commencement address, are viewed as warming up for a more public campaign role down the road.

B. CLINTON: I've about decided women should run everything.

KING: His old friends here are doing their part to help the cause.

John King, CNN, Portsmouth, New Hampshire.


GUPTA: All right, John. Thank you.

Randi Kaye now joins us with a 360 bulletin.

Hi, Randi.

RANDI KAYE, CNN ANCHOR: Hi again, Sanjay.

It is right on schedule, the first day of the Atlantic hurricane season. And the National Hurricane Center has already issued a tropical storm warning.

The storm, called Barry, is now heading for Florida's west coast. Heavy winds and rains are expected to hit the Sunshine State in the next 24 to 36 hours, but forecasters say Barry is not expected to reach hurricane strength.

New highs across the board on Wall Street today, the Dow closing the week at 13,668, a 0.03 percentage gain. Both the S&P and NASDAQ also followed the upward trend.

And earlier in the week, we wondered what reality TV producers were thinking, having a terminally ill woman pick which of three ailing contestants would get her kidneys.

What followed was international outrage, but the show aired anyway. And then at the end, an announcement. It turned out it was all a hoax. The donor, it turns out, is really an actress, and the potential recipients, they were real kidney patients in on the hoax. The whole thing was cooked up to draw attention to the shortage of organ donors.

I'm not sure if that really works, Sanjay, but we'll see.

GUPTA: Yes, reality show.

KAYE: Absolutely.

All right, Sanjay. Now it's time for tonight's "Shot". Absolutely. Tonight's "Show", and as you know, it is not brain surgery. We've never seen a head case like this, a $98 million skull, look at that, made of platinum, encrusted with over 8,000 diamonds, 8,000.

The piece is created by an English artist, using a real skull to make the cast. He says it is symbolic of victory over death.

I bet, Sanjay, doing any type of brain surgery there, you wouldn't want to cut into that skull, would you?

GUPTA: I've seen my share of craniums, Randi, but never something like that. That's absolutely amazing.

KAYE: Sure was.

GUPTA: Thank you so much.

We want you to send -- all of you had home to send your "Shot" ideas, as well. If you see some amazing video, tell us about it at We'll put your best clips on the air.

Up next, a 360 special with Anderson Cooper. These are eight young people, eight of at least 28 public school kids killed so far this school year.

Something's happening in Chicago and nationwide. Anderson went to Chicago to find out why children are dying and what's being done to stop it.

A special edition of 360, "Deadly Lessons: 24 Hours in Chicago" that's next.


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