La BohèmeBMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a2282 (Published 29 October 2008) Cite this as: BMJ 2008;337:a2282
All rapid responses
Professor Greenhalgh's acquaintance with Puccini appears to be
greater than her knowledge of the epidemiology of tuberculosis. She says
that, "the dramatic fall in the incidence of tuberculosis is associated
more closely with the rise in living standards and quality of general
public health measures than the discovery of any specific treatment."
No. Tuberculosis rates fell by by about 1.7% annualised from the mid 1800s
to the first World War, probably as a result of improved living
conditions. But when specific treatment was introduced in the 1950s
together with BCG, annualised rates fell by over 10%. The fall in TB is
therefore much more strongly associated with treatment than improved
Secondly though AIDS, because of the opportunist infections it brings, may
be the modern TB in developed countries the combination of AIDS and TB is
the modern TB across many parts of the impoverished developing world
because TB remains the single commonest cause of death in AIDS sufferers.
In the year that Mimi "died" she was probably one of half a million deaths
from TB in the world. Now there are three times as many.
The plight of
Mimi continues across much of Africa, Asia, South America and some
countries of Eastern Europe.
Though improved living conditions would be of help in reducing case rates,
if specific treatment could be given to all these modern day Mimis before
they infected others, tuberculosis could be virtually eradicated within a
Professor Peter Davies is in receipt of an unrestricted educational grant from Genus Pharma to finance the running of the national multidrug resistant tuberculosis service
Competing interests: No competing interests