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The Return of the White Plague: Global Poverty and the New Tuberculosis

BMJ 2004; 328 doi: (Published 13 May 2004) Cite this as: BMJ 2004;328:1206
  1. David Mitchell, consultant respiratory physician (
  1. St Mary's Hospital, London

    Twenty five years ago the prevailing view was that infectious diseases were a problem of the past, thanks to vaccines and antibiotics, public health measures, and better socioeconomic conditions. HIV and AIDS changed everything—the devastating first example of many new infectious diseases, the latest being severe acute respiratory syndrome. At the same time old infectious diseases have returned, and tuberculosis leads the way, particularly in its new deadly partnership with HIV and its ability to develop multidrug resistance. Tuberculosis is now a leading cause of mortality in many parts of the world.

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    Eds Matthew Gandy, Alimuddin Zumla

    Verso, £25, pp 330 ISBN 1859846696

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    The central conundrum with tuberculosis is why it continues to kill about two million people a year when it can easily be cured with cheap, effective antibiotics. Also, why, especially with the advent of multidrug resistant disease, have no new drugs been introduced for 40 years? Why is there still no effective vaccine? Why do antituberculous agents have to be taken for a minimum of six months to be fully effective? And why is there still no robust diagnostic test? Sputum …

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