an eventNDM-1, 2010

A study published online in August 2010 in The Lancet Infectious Diseases describing the spread of NDM-1 — New Delhi metallo-beta-lactamase-1, an enzyme that destroys carbapenems, the antibiotics kept for infections nothing else will treat — across India, Pakistan and the United Kingdom, and linking several British cases to hospital treatment taken while travelling. It is the moment antimicrobial resistance entered this subject, and the moment the subject acquired a naming dispute.

The counts are narrow and stated: "We identified 44 isolates with NDM-1 in Chennai, 26 in Haryana, 37 in the UK, and 73 in other sites in India and Pakistan." On the travel link: "At least 17 patients had a history of travelling to India or Pakistan within 1 year, and 14 of them had been admitted to a hospital in these countries." The admissions were for many things — "renal or bone marrow transplantation, dialysis, cerebral infarction, chronic obstructive pulmonary disease, pregnancy, burns, road traffic accidents, and cosmetic surgery" — and the authors noted that "several of the UK source patients had undergone elective, including cosmetic, surgery while visiting India or Pakistan".

The paper did not stop at description. "It is disturbing, in context, to read calls in the popular press for UK patients to opt for corrective surgery in India with the aim of saving the NHS money." That sentence, in a laboratory paper about a plasmid, is what made this an event in the history of medical travel rather than in the history of microbiology.

The objection came within days. India's health ministry said it would "strongly refute the naming of the enzyme … and also refute that hospitals in India are not safe for treatment including medical tourism", and that "to link this with the safety of surgery in hospitals in India and citing isolated examples to show that … India is not a safe place to visit, is wrong". V M Katoch, director general of the Indian Council of Medical Research, said: "When you link it to our antibiotics policy … say it is dangerous to get operated on in India and that you will get more infections, that is totally irrational." Members of parliament called the study a commercial attack on India's hospital export trade. The funding line — "Our work was funded by EU grant LSHM-CT-2005-018705 and Wellcome Trust grant 084627/Z/08", with pharmaceutical interests declared by two authors — was cited as evidence of motive.

In Delhi in January 2011 the editor of The Lancet, Richard Horton, said of the name: "It was an error of judgement. We didn't think of its implications for which I sincerely apologise", adding that it had unnecessarily stigmatised a single country and city. He did not withdraw the science. Indian authors later argued in print for a descriptive name instead, on the ground that organisms and genes should not be named after cities, countries or races.

Inference — the two claims never actually met. That a mobile carbapenemase was widespread in South Asia and reached Britain in patients who had been in hospital there is a laboratory finding, tested by other laboratories since. That naming it after a capital city was a choice with consequences for a country's hospitals is a claim about scientific practice. Both can hold. This record reports both and settles neither.