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					                                                 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. [1]                                  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. [2]                                                     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: ns311@columbia.edu

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.
[1] Waksman SA. Streptomycin: background, isolation,        [2] Dubos R, Dubos J. The white plague. New Brunswick
    properties, and utilization [Nobel lecture; December        (NJ)7 Rutgers University Press; 1987. p. 224.

				
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