Likewise, the appearance of high rates of MDR-TB in New York city the early 1990s was associated with the dismantling of public health programmes by the Reagan administration.Paul Farmer points out that the more expensive a treatment, the harder it is for poor countries to get. Farmer sees this as verging on denial of basic human rights. Africa is low in quality of treatment partly  because many African cultures lack the concept of time essential to the schedule of administration.MDR-TB can develop in the course of the treatment of fully sensitive TB and this is always the result of patients missing doses or failing to complete a course of treatment. Thankfully, MDR-TB strains appear to be less fit and less transmissible. It has been known of many years that INH-resistant TB is less virulent in guinea pigs, and the epidemiological evidence is that MDR strains of TB do not dominate naturally. A study in Los Angeles found that only 6% of cases of MDR-TB were clustered. This should not be a cause for complacency: it must be remembered that MDR-TB has a mortality rate comparable to lung cancer. It must also be remembered that people who have weakened immune systems (because of diseases such as HIV or because of drugs) are more susceptible to catching TB. Children represent a susceptible population with increasing rates of MDR and XDR-TB. Since diagnosis in pediatric patients is difficult, large number of cases are not properly reported.
A parasitic twin, also known as an asymmetrical or unequal conjoined twin, is the result of the processes that also produce vanishing twins and conjoined twins, and may represent a continuum between the two. Parasitic twins occur when a twin embryo begins developing in utero, but the pair does not fully separate, and one embryo maintains dominant development at the expense of its twin. Unlike conjoined twins, one ceases development during gestation and is vestigial to a mostly fully formed, otherwise healthy individual twin. The undeveloped twin is defined as parasitic, rather than conjoined, because it is incompletely formed or wholly dependent on the body functions of the complete fetus. The independent twin is called the autosite. Variants
Conjoined parasitic twins joined at the head are described as craniopagus or cephalopagus, and occipitalis if joined in the occipital region or parietalis if joined in the parietal region. Craniopagus parasiticus is a general term for a parasitic head attached to the head of a more fully developed fetus or infant. Fetus in fetu sometimes is interpreted as a special case of parasitic twin, but may be a distinct entity. The twin reversed arterial perfusion, or T.R.A.P. sequence, results in an acardiac twin, a parasitic twin that fails to develop a head, arms and a heart. The parasitic twin, little more than a torso with or without legs, receives its blood supply from the host twin by means of an umbilical cord-like structure, much like a fetus in fetu, except the acardiac twin is outside the autosites body.