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Christian W. McMillen, Professor of\u00a0History at the University of Virginia and author of\u00a0\u00a0Discovering Tuberculosis: A Global History, 1900 to the Present<\/a>,\u00a0New Haven and London, Yale University Press, 2015.<\/p><\/div>\n In\u00a0Discovering Tuberculosis: A Global History, 1900 to the Present<\/a>,\u00a0Christian McMillen\u00a0Professor of\u00a0History at the University of Virginia explores the global efforts to control\u00a0the disease. One of\u00a0the main questions is why there are still millions of people\u00a0dying from this curable disease in the twenty-first century.<\/p>\n In order to answer it, McMillen explores TB and race in Africa, Americas and India in the first half of the twentieth century,\u00a0explores the issue of drug resistance and discuss the resurgence of TB in the era of HIV\/AIDS.<\/p>\n In this interview to our blog he said that the greatest challenge is that TB is more a social problem than strictly a medical one and that thinking historically can help in controlling the disease.<\/p>\n<\/div>\n Why the history of tuberculosis has been a core part of global health during the 20th century?<\/strong><\/p>\n \u00a0<\/strong>TB has been at the core of global health for two reasons: first, curing TB was at the forefront of the antibiotic revolution of the mid-20th<\/sup>\u00a0century. Modern medicine\u2019s greatest triumph\u2014the ability to actually cure diseases\u2014was won by tackling tuberculosis.<\/p>\n But it\u2019s also been so central because TB kills so many people\u2014it\u2019s quite possible, in fact, that TB has killed more people than any other infectious disease. But as I argue in\u00a0Discovering Tuberculosis<\/em>, the antibiotic revolution was not only a great triumph.<\/p>\n It was also the source of modern medicine\u2019s hubris and over-confidence. When it was finally within medicine\u2019s power to cure TB, efforts to control the disease through other means were ignored and its control became a technical problem. And so TB is symbolic of the power and the perils of modern biomedicine.<\/p>\n From an historical perspective what are the main challenges of tb control in developing countries today?<\/strong><\/p>\n Following on the above, it seems to me that that greatest challenge\u2014and it really is profound\u2014is that TB is more a social problem than strictly a medical problem. While it will come as no surprise to anyone who has thought about the disease, I think it\u2019s safe to say that as long as the conditions that cause to TB to thrive still exist TB will in fact thrive.<\/p>\n The greatest challenge, then, is modifying those conditions. But, considering how challenging that is and how long it would take, it seems that in the meantime the challenges that have existed historically, with regard to TB as a medical problem, still exist today: inadequate infection control; the misguided search for \u201cmagic bullets\u201d; the lack of coordination between HIV and TB control; drug regimens that are toxic and time consuming. Of course, there are many people working to combat these challenges. I simply mean to suggest that from a historian\u2019s perspective the landscape does not look much different today than it did a generation ago.<\/p>\n In your book\u00a0Discovering Tuberculosis: A Global History, 1900 to the Present<\/a> you suggest that policy makers should think as historians, could you please say more about this idea regarding tuberculosis?<\/strong><\/p>\n As a historian I think everyone should! What I mean is not that policy makers should\u00a0be\u00a0<\/em>historians and do historical research, but that\u00a0thinking\u00a0<\/em>historically might be a good idea.<\/p>\n By doing so, it could allow them to identify inefficiencies or to look more carefully at policy proposals to learn, perhaps, if they\u2019ve been tried before and whether or not they\u2019ve worked.<\/p>\n It would be useful to know a country\u2019s history with TB control to better understand why something is or is not working or why a given place has more TB than another. At the most basic level, as I discuss in the book, the way TB is managed today is of course a product of a series of historical choices, each emerging out of a given historical context. Take DOTS (Directly Observed Therapy, Short Course).<\/p>\n When it became the dominant way of dealing with drug susceptible TB in the mid-1990s it was billed as novel, something not done before. But this was of course not the case: TB workers had been experimenting with watching people take TB drugs for years.<\/p>\n It emerged in the 1990s as a major breakthrough not so much because it was novel, but because it was considered cost-effective at a time when such solutions were very appealing. Why might this be important to know? It\u2019s important because to evaluate something like DOTS knowing the context from which it came would allow us to know how and why it was chosen as the single best way to treat TB and to question whether or not that was a wise decision.<\/p>\n DOTS was chosen not because it was determined to be, by some neutral, objective measure, demonstrably the best. It was chosen for a variety of reasons that have everything to do with the architects\u2019 motivations and points of view; the global economic context; the emerging dominance of the World Bank in global health matters; the neglect of drug resistant TB and TB\/HIV; and the persistent need for \u201cmagic bullet\u201d solutions in global health. This is not to say, as I make clear in the book, that DOTS has not worked in some places or cannot work. It\u2019s simply to suggest that understanding the origins of things can help us evaluate their efficacy, their appropriateness, or what have you.<\/p>\n Related articles and stories:<\/p>\n \u00c1lvarez, Adriana.\u00a0La experiencia de ser un \u2018ni\u00f1o d\u00e9bil y enfermo\u2019 lejos de su hogar: el caso del Asilo Mar\u00edtimo, Mar del Plata (1893-1920)<\/a>. Hist. cienc. saude-Manguinhos, Mar 2010, vol.17, no.1, p.13-31. ISSN 0104-5970<\/p>\n Vianna, Paula V. Carnevale, Zanetti, Val\u00e9ria and Papali, Maria Aparecida.\u00a0Geografia, sa\u00fade e desenvolvimento urbano no interior paulista na passagem para o s\u00e9culo XX: Domingos Jaguaribe e a constru\u00e7\u00e3o da Est\u00e2ncia Clim\u00e1tica de Campos do Jord\u00e3o<\/span><\/a>.\u00a0Hist. cienc. saude-Manguinhos<\/i>, Dez 2014, vol.21, no.4, p.1341-1360. ISSN 0104-5970<\/p>\n Herrero, Maria Belen and Carbonetti, Adrian.\u00a0La mortalidad por tuberculosis en Argentina a lo largo del siglo XX<\/a>.\u00a0Hist. cienc. saude-Manguinhos<\/i>, Jun 2013, vol.20, no.2, p.521-536. ISSN 0104-5970<\/p>\n Ortega Martos, Antonio Miguel.\u00a0\u00bfColonialismo biom\u00e9dico o autonom\u00eda de lo local? Sanadores tradicionales contra la tuberculosis<\/a>.\u00a0Hist. cienc. saude-Manguinhos<\/i>, Dic 2010, vol.17, no.4, p.909-924. ISSN 0104-5970<\/p>\n![\"\"](\"http:\/\/www.revistahcsm.coc.fiocruz.br\/english\/wp-content\/uploads\/2018\/03\/tuberculosis-a-global-history.jpg\")
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