The Return of the White Plague: Global Poverty and the ‘New’ Tuberculosis
http://www.100md.com
《新英格兰医药杂志》
Since the World Health Organization declared tuberculosis a global emergency in 1993, its resurgence has become the source of several recent publications. Gandy and Zumla have assembled a prestigious and knowledgeable group of authors for an updated account that appropriately goes beyond the usual biomedical assessment of the current global situation. As suggested by the title and an introductory quotation provided by the editors, René and Jean Dubos had already drawn attention to the social and economic aspects of tuberculosis 51 years earlier in The White Plague: Tuberculosis, Man and Society (Camden, N.J.: Rutgers University Press, 1952).
There is special emphasis in the book on the social and economic factors that have influenced the persistence of tuberculosis in many parts of the world. Unfortunately, as the editors acknowledge, the limitations of the available data make it "difficult to disentangle fully the relationship" and interactions among socioeconomic status, racial differences, sex, wars, the pandemic of human immunodeficiency virus (HIV) infection, multidrug-resistant tuberculosis, and transmission of the disease in prisons. The reviews of these topics are fairly balanced and thorough, with appropriate citations and references.
The broad overview of the book challenges the prevailing notion that the global efforts to control tuberculosis and the attribution of credit to directly observed therapy have been the principal contributors to the reduction of tuberculosis in New York City and other places. In putting forth this challenge, the authors may provoke controversy. Ultimately, it becomes clear that both causal inference about and potential solutions to the problem of tuberculosis involve many factors. Some of the chapters outline the unmet humanitarian needs of persons with tuberculosis that involve race and ethnic background, "gender-sensitive" approaches to care, and immigration from countries where tuberculosis is prevalent. Instead of blindly siding with the good intentions that accompany much-needed reforms in the health sector, authors Harries, Hargreaves, and Zumla, who contribute a chapter on tuberculosis and HIV infection in sub-Saharan Africa, acknowledge the potentially drastic consequences of the "rapid dismantling of disease control programmes."
Other formidable challenges posed by HIV and multiple-drug resistance are adequately covered, as are potential solutions that emphasize the need to pay attention to neglected areas such as the primary prevention of tuberculosis. Authors also emphasize the importance of operational interdisciplinary research and the need for new drugs and safe and effective vaccines.
The call for the alleviation of poverty and the promotion of ethical and human rights is refreshing, and it is consistent with the control of tuberculosis in high-burden countries as integral to economic development. Both the editors and the chapter authors appropriately identify the need to go increasingly beyond humanitarian declarations into action and implementation. Doing so is a crucial component of a comprehensive and responsive approach to the global crisis of tuberculosis. The Return of the White Plague is a commendable treatise of much interest to socially minded health care practitioners.
Kenneth G. Castro, M.D.
Centers for Disease Control and Prevention
Atlanta, GA 30333
kgc1@cdc.gov(Matthew Gandy and Alimudd)
There is special emphasis in the book on the social and economic factors that have influenced the persistence of tuberculosis in many parts of the world. Unfortunately, as the editors acknowledge, the limitations of the available data make it "difficult to disentangle fully the relationship" and interactions among socioeconomic status, racial differences, sex, wars, the pandemic of human immunodeficiency virus (HIV) infection, multidrug-resistant tuberculosis, and transmission of the disease in prisons. The reviews of these topics are fairly balanced and thorough, with appropriate citations and references.
The broad overview of the book challenges the prevailing notion that the global efforts to control tuberculosis and the attribution of credit to directly observed therapy have been the principal contributors to the reduction of tuberculosis in New York City and other places. In putting forth this challenge, the authors may provoke controversy. Ultimately, it becomes clear that both causal inference about and potential solutions to the problem of tuberculosis involve many factors. Some of the chapters outline the unmet humanitarian needs of persons with tuberculosis that involve race and ethnic background, "gender-sensitive" approaches to care, and immigration from countries where tuberculosis is prevalent. Instead of blindly siding with the good intentions that accompany much-needed reforms in the health sector, authors Harries, Hargreaves, and Zumla, who contribute a chapter on tuberculosis and HIV infection in sub-Saharan Africa, acknowledge the potentially drastic consequences of the "rapid dismantling of disease control programmes."
Other formidable challenges posed by HIV and multiple-drug resistance are adequately covered, as are potential solutions that emphasize the need to pay attention to neglected areas such as the primary prevention of tuberculosis. Authors also emphasize the importance of operational interdisciplinary research and the need for new drugs and safe and effective vaccines.
The call for the alleviation of poverty and the promotion of ethical and human rights is refreshing, and it is consistent with the control of tuberculosis in high-burden countries as integral to economic development. Both the editors and the chapter authors appropriately identify the need to go increasingly beyond humanitarian declarations into action and implementation. Doing so is a crucial component of a comprehensive and responsive approach to the global crisis of tuberculosis. The Return of the White Plague is a commendable treatise of much interest to socially minded health care practitioners.
Kenneth G. Castro, M.D.
Centers for Disease Control and Prevention
Atlanta, GA 30333
kgc1@cdc.gov(Matthew Gandy and Alimudd)