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Science Friday > Archives > 1999 > March > March 19, 1999:

Hour One: Tuberculosis

One in three people worldwide is infected with the organism that causes tuberculosis. Many may never develop symptoms - an average carrier has a ten percent lifetime chance of developing the disease - but more and more, people ARE getting sick. About three million people worldwide die of tuberculosis every year - more than from any other single infectious disease The threat of an epidemic looms, boosted by the rise of tuberculosis bacteria resistant to the drugs that used to kill them and the fall of economies.

Countries in Southeast Asia, Central and South America, and the former Soviet Union have been especially hard hit. Russian prisons are saturated with patients, the product of crowding and lack of medical care. Economic recessions in other parts of the world are a cause as well, as standards of living decrease with economic belt-tightening. And with international travel so common in the global economy, even areas that are unaffected today may be at risk tomorrow.

More troublesome yet is the rising threat of threat of drug-resistant strains of tuberculosis - mainly caused by people that have stopped treatment before the disease has been cured. Incomplete treatment can kill off weaker bacteria, yet allow organisms that have developed mutations making them somewhat resistant to the drugs to live on - essentially "selecting" the strongest and the fittest of the bacteria for continued survival. About 40% of patients infected with multi-drug resistant TB go on to die of the disease.

Treating multi-drug resistant TB in a single patient can be a multi-year problem, with costs many times that of treating an ordinary TB infection. Some doctors are advocating a kind of treatment called DOT - Directly Observed Therapy - in which health care workers watch a patient take every dose of medication in an effort to prevent relapses. Other doctors say that DOT alone isn't enough - that medical programs must address some of the social factors that make it difficult to stick with treatment programs, from lack of food or clean water to addiction treatment programs.

On this hour of Science Friday, join guest host Joanne Silberner for a look at the problems posed by tuberculosis - both from a scientific and a public policy perspective.

Listen to this program in RealAudio!

Guests:

Ann Ginsberg
Program Officer for Tuberculosis, Leprosy and Other Mycobacterial Diseases
Division of Microbiology and Infectious Diseases
National Institute of Allergy and Infectious Diseases
National Institutes of Health
Bethesda, MD

Margaret Hamburg
Former Health Commissioner for New York City
Assistant Secretary for Planning and Evaluation
Department of Health and Human Services
Washington, DC

Paul Farmer
Associate Professor of Medical Anthropology, Harvard Medical School
Associate Physician, Internal Medicine and Infectious Disease, Brigham and Women's Hospital
Director, Institute for Health and Social Justice at Partners in Health
Boston, MA

Books/Articles Discussed:

Related Links:
CDC TB Program
WHO Global TB Programme
NIH's TB Research Unit at Case Western Reserve University
National TB Center in Newark, NJ
International Union Against TB and Lung Diseases

This segment produced by:
Charles Bergquist
Web producer:
Charles Bergquist