From:
Dr. George Paul
F-72, Brindavan Road
Fairlands
Salem – 636016
Tamil Nadu, India
To:
Dr. Manoj Murekhar
Dr. Balaji Veeraraghavan
Corresponding Authors,
Neuromelioidosis Outbreak in Tamil Nadu, India: An Investigation of
Transmission with Genomic Insight
Emails: mmurekhar@nieicmr.org.in, vbalaji@cmcvellore.ac.in
Subject: Request
for Clarifications on the Lancet Article on Neuromelioidosis
Dear Dr. Murekhar and
Dr. Veeraraghavan,
I hope this message
finds you well.
My name is Dr. George
Paul, an Oral and Maxillofacial Surgeon based in Salem, Tamil Nadu. While I do
not hold any governmental or statutory position, I am a qualified clinician and
legal professional, with additional credentials in bioethics. I have previously
served as the National President of the Association of Oral and Maxillofacial
Surgeons of India and as Member Secretary of an Institutional Ethics Committee
overseeing CRO-conducted pharmaceutical trials. I currently serve as Chairman
of the Institutional Review Board of Salem Polyclinic, Salem.
I write this letter
with due respect to the authors and institutions associated with the recent
article published in The Lancet (2025), titled Neuromelioidosis
Outbreak in Tamil Nadu, India: An Investigation of Transmission with Genomic
Insight. I would like to request clarification on a few important aspects
of the publication, particularly in light of the potential implications for
clinical practice and public trust.
- Seizure
of Evidence:
It is understood that a saline bottle, reportedly implicated in the findings, was obtained from a dental clinic in Vaniyambadi during a period when the clinic was under investigation and closed for approximately 45 days (April–May 2023). Could you clarify whether any receipt or documentation was issued to the clinic for the items seized for environmental sampling? - Source
and Documentation of Allegations:
The article references alleged use of the saline bottle for invasive dental procedures. Could you please specify the source of this information? Was this statement made by the dentist? If so, was it formally recorded in writing and signed by the dentist? - Author
Contributions and Conflict of Interest:
Several co-authors are affiliated with statutory bodies such as the ICMR, the National Institute of Epidemiology, and the Directorate of Public Health. Could you outline their specific roles in the study? Were they involved in the preparation and approval of the manuscript submitted to The Lancet? - Causality
and Epidemiological Reasoning:
The article suggests that a single clonal isolate was found in the "in-use" saline bottle. On this basis, can eight patient deaths be conclusively attributed to visits to the same dental clinic? Given the time gap—particularly the five-month interval between the dental visit and the death of the first patient in December 2022—is it accurate to infer causality, or should this be interpreted more cautiously as circumstantial? - Implications
of Findings:
If, as the article implies, there is verifiable evidence of contamination and direct harm attributable to dental treatment practices, was any formal action initiated by the relevant public health authorities? The article references eight deaths in connection with a dental clinic, which raises concerns about follow-up measures and legal or disciplinary proceedings.
I raise these
questions in good faith and in the interest of academic integrity and
responsible discourse. It is important that any commentary or public communication
on this matter reflects the facts accurately and avoids unintended
misrepresentation.
Thank you for your
time and consideration. I would appreciate your acknowledgement and an early
response.
Warm regards,
Dr. George Paul
