New England Journal of Medicine
September 6, 2012 Vol. 367 No. 10
200th Anniversary Article
Tuberculosis, Drug Resistance, and the History of Modern Medicine
Salmaan Keshavjee, M.D., Ph.D., and Paul E. Farmer, M.D., Ph.D.
N Engl J Med 2012; 367:931-936September 6, 2012
Tuberculosis is a treatable airborne infectious disease that kills almost 2 million people every year. Multidrug-resistant (MDR) tuberculosis — by convention, a disease caused by strains of Mycobacterium tuberculosis that are resistant to isoniazid and rifampin, the backbone of first-line antituberculosis treatment — afflicts an estimated 500,000 new patients annually. Resistance to antituberculosis agents has been studied since the 1940s; blueprints for containing MDR tuberculosis were laid out in the clinical literature and in practice, in several settings, more than 20 years ago.1,2 Yet today, barely 0.5% of persons with newly diagnosed MDR tuberculosis worldwide receive treatment that is considered the standard of care in the United States.3 Those who have not received appropriate treatment continue to fuel a global pandemic that now includes strains resistant to most — and by some accounts all — classes of drugs tested. 4,5 Despite the enormity of the threat, investments to contain the epidemic and to cure infected patients have been halting and meager when compared, for example, with those made to address the acquired immunodeficiency syndrome (AIDS) pandemic. In this essay we seek to elucidate the reasons for the anemic response to drug-resistant tuberculosis by examining the recent history of tuberculosis policy…