Everything Is Tuberculosis

1. Tuberculosis is a disease shaped by injustice and inequity.

TB is both a form and expression of injustice.

TB thrives on inequality. Tuberculosis disproportionately affects those living in poverty, with malnutrition, poor housing, and limited access to healthcare creating ideal conditions for its spread. It is not merely a biological phenomenon but a social one, deeply intertwined with systemic inequalities.

Poverty and TB:

• Crowded living conditions in slums and poorly ventilated factories facilitate airborne transmission.
• Malnutrition weakens immune systems, increasing susceptibility to active TB.
• Limited access to healthcare delays diagnosis and treatment, leading to further spread.

Breaking the cycle. Addressing TB requires tackling the root causes of poverty and inequality, including improving living conditions, ensuring access to nutritious food, and strengthening healthcare systems.

2. TB's history reveals the folly, brilliance, cruelty, and compassion of humanity.

For me at least, the history and present of tuberculosis reveal the folly and brilliance and cruelty and compassion of humans.

A complex narrative. The story of TB is not simply one of scientific discovery and medical progress. It is a tapestry woven with threads of human ingenuity, ethical failings, and profound empathy. From the search for cures to the stigmatization of sufferers, TB's history reflects the full spectrum of human behavior.

Examples of human complexity:

• James Watt's desperate attempts to find a chemical solution for phthisis, driven by personal loss.
• The romanticization of consumption, which, while misguided, reflected a desire to find meaning in suffering.
• The development of effective treatments, showcasing scientific brilliance and dedication.

Learning from the past. By understanding the multifaceted history of TB, we can gain insights into our own biases and blind spots, and work towards a more just and compassionate response to illness.

3. Colonialism and its legacy have profoundly shaped TB's prevalence in affected regions.

If you want to understand why Sierra Leone is poor, you must look at a map of our railroads.

Extraction over development. Colonial infrastructure was designed to extract resources, not to strengthen communities. This legacy of exploitation has left many formerly colonized nations with weak healthcare systems and persistent poverty, creating fertile ground for TB.

Impact of colonialism:

• Railroads connecting mineral-rich areas to ports, facilitating resource extraction.
• Limited investment in schools and clinics, hindering human development.
• Disruption of social structures and trade routes, exacerbating poverty and vulnerability.

Addressing the root causes. Overcoming TB in these regions requires addressing the ongoing effects of colonialism, including strengthening healthcare systems, promoting economic development, and empowering local communities.

4. Romanticizing TB obscured its true nature as a disease of poverty and marginalization.

Consumption, I am aware, is a flattering malady.

A dangerous illusion. The romanticization of TB as a disease of beauty, genius, and sensitivity served to mask its true nature as a disease of poverty and marginalization. This distorted perception hindered effective prevention and treatment efforts.

Consequences of romanticization:

• Focus on individual traits rather than social determinants of health.
• Neglect of the poor and marginalized, who were disproportionately affected.
• Delay in recognizing TB as an infectious disease, hindering public health interventions.

Shifting the narrative. Recognizing TB as a disease of injustice requires dismantling romanticized notions and focusing on the social and economic factors that drive its spread.

5. Germ theory revolutionized understanding, but stigma persisted.

What an infernal microbe it is!…How absurd that we who can kill the tiger should be defied by this venomous little atom.

A scientific breakthrough. Robert Koch's discovery of Mycobacterium tuberculosis in 1882 revolutionized our understanding of the disease, proving that it was caused by a specific bacterium. This led to new diagnostic tools and treatment strategies.

The persistence of stigma:

• Despite scientific advances, TB continued to be stigmatized, particularly among marginalized communities.
• Racialized medicine perpetuated the idea that certain groups were inherently more susceptible to TB.
• Stigma hindered access to care and fueled discrimination against those living with the disease.

Combating stigma. Overcoming TB requires not only scientific advancements but also a concerted effort to combat stigma and promote empathy and understanding.

6. Social forces and prejudice influence TB's spread and impact.

People who are treated as less than fully human by the social order are more susceptible to tuberculosis.

Dehumanization and disease. When individuals are marginalized and treated as less than fully human, they become more vulnerable to TB. This is not due to inherent weaknesses but to the social and economic conditions that result from prejudice and discrimination.

Examples of social forces:

• Racism leading to crowded housing, malnutrition, and limited access to healthcare.
• Stigma causing isolation, fear, and delayed treatment.
• Discrimination preventing access to education, employment, and other opportunities.

Creating a just society. Addressing TB requires dismantling systems of oppression and creating a society where all individuals are valued and have equal access to resources and opportunities.

7. DOTS, while beneficial, has limitations and can perpetuate distrust.

I know of no other field of medicine where therapy is based so completely on lack of trust toward patients.

A double-edged sword. Directly Observed Therapy (DOTS) has saved millions of lives by ensuring adherence to TB treatment. However, it can also perpetuate distrust and stigmatization, treating patients as non-compliant individuals rather than partners in their care.

Limitations of DOTS:

• Can be inconvenient and burdensome for patients, particularly those living in poverty.
• May not be as effective as other approaches when patients are adequately supported.
• Fails to address the underlying social and economic factors that contribute to TB.

Patient-centered care. Effective TB control requires a shift towards patient-centered care that empowers individuals, respects their autonomy, and addresses their unique needs and challenges.

8. Drug-resistant TB poses a significant threat, exacerbated by underinvestment.

The real problem is that in the forty-six years between 1966 and 2012, we developed no new drugs to treat tuberculosis.

A looming crisis. The emergence of drug-resistant TB strains poses a significant threat to global health security. This crisis has been exacerbated by decades of underinvestment in research and development of new TB drugs.

Consequences of underinvestment:

• Limited treatment options for drug-resistant TB.
• Increased morbidity and mortality among those infected.
• Higher costs associated with treating drug-resistant TB.

Prioritizing research and development. Addressing drug-resistant TB requires a renewed commitment to research and development, with a focus on creating new and effective treatments that are accessible to all.

9. Virtuous cycles of care, advocacy, and research are essential for progress.

In the long history of tuberculosis in man, despair follows hope, triumph and tragedies succeed each other.

A positive feedback loop. Progress in the fight against TB is driven by virtuous cycles of care, advocacy, and research. When effective treatments are available, more people survive and become advocates for further progress, which in turn leads to increased investment in research and development.

Examples of virtuous cycles:

• Partners In Health's success in treating MDR-TB in Peru, which led to increased global attention and resources.
• TB survivors advocating for access to affordable drugs, which has lowered prices and expanded treatment.
• Research leading to new diagnostic tools and treatment strategies, which has improved outcomes and reduced transmission.

Sustaining momentum. Maintaining progress requires a sustained commitment to these virtuous cycles, ensuring that care, advocacy, and research continue to reinforce each other.

10. Individual stories highlight the human cost of TB and the importance of compassion.

Mom you are special and beautiful / You stand closer / When everyone ran away / Especially my cousin ran away / But you stood firm.

Beyond statistics. The fight against TB is not just about numbers and statistics. It is about the lives of real people, each with their own unique story of suffering, resilience, and hope.

The power of empathy:

• Henry's story highlights the challenges of living with TB in a resource-limited setting.
• Isatu's unwavering love and support demonstrate the importance of family and community.
• Dr. Girum's dedication and compassion exemplify the role of healthcare providers in fighting TB.

A call to action. By listening to and sharing these stories, we can foster empathy, inspire action, and create a more just and compassionate world for those affected by TB.

Last updated: April 5, 2025