Poverty, unemployment and raw milk are associated with TB in RussiaBMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7533.0-c (Published 12 January 2006) Cite this as: BMJ 2006;332:0-c
All rapid responses
Is it exposure to raw cow's milk or unemployment that is the most
important factor in the prevalence of tuberculosis in Russia?
Mycobacterium bovis is defeated by modern pasteurisation, yet
infection in barns and from handling contaminated dairy products remains
a real source.
Poverty is, of course, unaffected by heat treatment and ever since
Robert Koch identified the Mycobacterium tuberculosis it has become
increasingly obvious that most cases of human TB are caused by inhalation,
that is droplet transmission.
This is unrelated to drinking unpasteurised milk.
I detect a whiff of the same hysteria that is so entrenched in health
workers the world over when it comes to pasteurisation. Today, with
cooling containers on farms where milk is immediately stored after milking
would normally make pasteurisation obsolete.
However, pasteurisation is here for the long haul as it does permit the
dairy farmer to be less than would be prudent in hygiene on his farm.
It is common practice to include sick cows, like those with pus-
discharging mastitis, in the milking line as it is considered
"impractical" to separate them.
I suggest that substandard nutrition, overcrowding and poor housing
and hygiene, as identified by Robert Koch in the late 1800's, are the
real culprit here.
It would not be difficult to identify the real cause(s) of the
problem and the author would have been able to present a more clear-cut
picture had he separated the two alleged causes.
Competing interests: No competing interests