Clin Chest Med 26 (2005) ix – x Preface Tuberculosis Neil W. Schluger, MD Guest Editor In 1952, Selman Waksman received the Nobel culosis rates in high-burden countries is not due to Prize for his discovery of streptomycin. In his Nobel lack of efficacy of drugs in those countries, but rather address, Waksman said: the confluence of medical and social factors that fuel the ongoing tuberculosis epidemic: the coepidemic In the treatment of tuberculosis, the more controlled of HIV; poverty; lack of a functioning public health dosage of streptomycin and the supplementary use of infrastructure; the economics of tuberculosis drug de- PAS tended to overcome some of the limitations of the antibiotic, notably its toxicity and the develop- velopment; bureaucratic and doctrinaire approaches ment of bacterial resistance. The recent introduction to tuberculosis control; lack of funding to support of isonicotinic acid hydrazide suggests the possibil- basic research aimed at development of new drugs, ity that its combined use with streptomycin will tend diagnostics, and vaccines; and apathy. further to control the disease and overcome undesir- The articles in this issue of the Clinics in Chest able complications. The conquest of the bGreat Medicine address many of these issues. They have White Plague,Q undreamt of less than 10 years ago, been written by leaders in the basic science, medical, is now virtually in sight.  and public health communities who have broad per- spective and expertise in their fields, and who are That same year, Rene and Jean Dubos, in their still engaged in efforts locally and globally to control the important and prescient book The White Plague, wrote: worldwide tuberculosis epidemic. However useful in specialized cases, vaccination, I would like to dedicate this issue to all patients antimicrobial drug therapy, or other therapeutic who have tuberculosis, in hopes that the information measures cannot possibly solve the social problem and knowledge offered within will improve their lives of tuberculosis. . .. It is only through gross errors in in a direct and immediate way. social organization, and mismanagement of individ- ual life, that tuberculosis could reach the catastrophic Neil W. Schluger, MD levels that prevailed in Europe and North America Division of Pulmonary, Allergy, and during the nineteenth century, and that still prevail in Asia and much of Latin America today.  Critical Care Medicine Columbia University College of Unfortunately, the Dubos’ assessment proved more Physicians and Surgeons accurate than Waksman’s. Despite great advances in PH-8, Room 101 immunology, microbiology, and drug development, 630 West 168th Street tuberculosis remains among the great public health New York, NY 10032, USA challenges of our time. The failure to reduce tuber- E-mail address: email@example.com 0272-5231/05/$ – see front matter D 2005 Elsevier Inc. All rights reserved. doi:10.1016/j.ccm.2005.03.001 chestmed.theclinics.com x preface References 12, 1952]. Available at: http://nobelprize.org/medicine/ laureates/1952/waksman-lecture.html.  Waksman SA. Streptomycin: background, isolation,  Dubos R, Dubos J. The white plague. New Brunswick properties, and utilization [Nobel lecture; December (NJ)7 Rutgers University Press; 1987. p. 224.