American Journal of Epidemiology Vol. 152, No. 3 : 294-296
Copyright © 2000 by The Johns Hopkins University School of Hygiene and Public Health
BOOK REVIEWS |
Tuberculosis and Nontuberculous Mycobacterial Infections. Fourth Edition Edited by David Schlossberg
International Union Against Tuberculosis and Lung Disease 68, Boulevard Saint-Michel Paris 75006, France
Stefan Grzybowski frequently declared, "The world owes a deep debt of gratitude to India for teaching us how to manage tuberculosis. The only country not to benefit has been India" (1
). The authors of this book clearly do not seem to share Grzybowski's point of view.
In setting out to review a textbook on tuberculosis, it is useful to remind oneself that tuberculosis is a very serious global problem. Tuberculosis was declared by the World Health Organization (WHO) to constitute a "global emergency," the only time in the history of WHO that a single disease has been declared such. WHO has pointed out that tuberculosis is the most common cause of death from a single agent among persons between the ages of 15 and 49 years. Furthermore, the death toll from the disease is judged by WHO to be equivalent to the crash of a jumbo jet every hour (2). Moreover, 90 percent of cases and 95 percent of deaths from the disease occur in developing countries.
This book has an extensive list of eminent authors. They have contributed to a volume with 38 chapters covering a wide range of topics concerning tuberculosis and nontuberculous mycobacterial infections. The book is presented in three parts: general considerations (including epidemiology, pathogenesis, transmission, and treatment), clinical tuberculosis (outlining the clinical features of tuberculosis as it affects various anatomic sites and as it is affected by other conditions), and nontuberculous mycobacterial infection. Some chapters cover topics not frequently included in other books, such as upper respiratory tract tuberculosis; particularly, there is an extensive section on nontuberculous mycobacterial infection. Especially noteworthy in the section on tuberculosis are chapter 12, "Role of the Health Department–Legal and Public Health Considerations," and chapter 20, on musculoskeletal tuberculosis. In addition, there is a long bibliography at the end of each chapter which provides the reader with access to a great deal of published material concerning tuberculosis.
The target audience for the book seems to be primarily clinical practitioners, although this is not clearly stated in the preface. The extensive section on clinical tuberculosis (chapters 13–31, pp. 141–338), together with the sections on treatment (chapters 6–9, pp. 71–97), indicate that it is the clinician who would most benefit from the book. This holds true for the section on nontuberculous mycobacterial infection as well.
The public health practitioner is less well served by this book. Sections relevant to this audience include primarily chapter 5 (on tuberculin skin testing) and chapters 9–12 (entitled "Prophylaxis," "The Global Epidemic of Tuberculosis: a World Health Organization Perspective," "Tuberculosis in Enclosed Populations: Hospitals, Prisons, Shelters, and Nursing Homes," and "Role of the Health Department–Legal and Public Health Considerations," respectively).
The reader from outside the United States is even less well served by this book. The references to published material refer almost exclusively to authors from the United States. This is true in spite of the fact that much of the basis for an understanding of the epidemiology of the disease and of intervention strategies was developed outside the United States. Indeed, one could be forgiven if, after reading the book, one came away with no awareness at all of the work of groups such as the British Medical Research Council. This organization was responsible for the development of the clinical trials, which were the first international collaborative clinical trials ever mounted for any disease and the most extensive set of clinical trials for a single disease ever conducted in history.
The important negative impact of medical interventions is another issue which is not particularly highlighted. This was apparent from the earliest application of chemotherapy for the treatment of tuberculosis (3) and from its application to low income countries (4). The treatment of patients resulted in the saving of their lives while failing to cure them, increasing the prevalence of sources of infection in the community and enhancing transmission of infection (5). The effective application of multidrug chemotherapy successfully addressed this problem, provided that the application was efficient, a possibility realized on a mass scale in low income countries only recently (6). It is somewhat surprising that this point was not clearly made, when the failure of public health practice has been responsible for major unnecessary expenditures in the United States. It has also been the basis for the current crisis of multiple-drug-resistant tuberculosis and the resurgence of tuberculosis globally. The corollary of this observation–namely, the essential role of political commitment, an essential component of the comprehensive international strategy called DOTS–is consequently not developed. The failure of political commitment and its consequent cost, in terms of both human suffering and unnecessary financial outlay, is so well known in the United States that it is somewhat surprising that it was not highlighted in the textbook. Not surprisingly, the consequences for the rest of the world are not discussed.
The increasing contribution of foreign-born persons to the tuberculosis problem in the United States is noted in chapter 1. A substantial and rising minority of cases (currently one out of every three cases) arise from this sector. This is even more true of many other industrialized countries (Canada, the Nordic countries, The Netherlands, Switzerland, Australia, and New Zealand), giving us a picture of what is to come in the United States. The recommended response to this phenomenon is largely defensive (improved screening). Awareness of the tidal wave of tuberculosis, particularly of multiple-drug-resistant tuberculosis, awaiting offshore is remarkable by its absence. Consequently, the almost total lack of awareness of the appropriate response–international solidarity in the face of this common threat–is striking even in terms of self-preservation. This probably accounts for the signal failure of the US government to contribute in any substantial way to the global coalition and consensus for the fight against tuberculosis.
NOTES
ISBN 0-7216-7308-2, W. B. Saunders Company, Philadelphia, Pennsylvania (Telephone: 800-545-2522, Fax: 800-568-5136), 1999, 438 pp., $99.00
REFERENCES
- Grzybowski S. Drugs are not enough: failure of short-course chemotherapy in a district in India. Tuber Lung Dis 1993;74:145–6.[Medline]
- World Health Organization. TB advocacy: a practical guide. Geneva, Switzerland: World Health Organization, 1999. (Publication no. WHO/TB/98.239).
- Crofton J. The contribution of treatment to the prevention of tuberculosis. Bull Int Union Tuberc 1962;32:643–53.
- Frimodt-Moller J. Changes in tuberculosis prevalence in a south Indian rural community following a tuberculosis control programme over a seven years' period. Ind J Tuberc 1962;9:187–91.
- Grzybowski S, Enarson D. Results in pulmonary tuberculosis patients under various treatment program conditions. (In French). Bull Int Union Tuberc 1978;53:70–5.[Medline]
- Enarson DA. Principles of IUATLD collaborative tuberculosis programmes. Bull Int Union Tuberc Lung Dis 1991;66:195–200.[Medline]
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