Timebomb: The Global Epidemic of Multi-Drug Resistant Tuberculosis

Timebomb: The Global Epidemic of Multi-Drug Resistant Tuberculosis by Lee B Reichman with Janice Hopkins Tanne. McGraw-Hill, £18.99, pp 240. ISBN 0 07 135924 9. Rating: ★★★

Wars and famines come and go but tuberculosis is a consistent and important fixture for humanity. A third of all people are infected at some stage during their lives. For tuberculosis, the paradox is that although it is quite easy to diagnose and treat, it is an increasing global scourge and the leading cause of death from any chronic infectious disease. Why is this, when effective treatments are available?

The reasons relate to geopolitical, socioeconomic and health resource factors. HIV and AIDS further aggravate the situation. In the West people thought that TB was in terminal decline until the mid-1980s when numbers in the United States started to rise. Now TB is of major concern with rising rates globally as a result of the breakdown in healthcare systems, the advent of HIV, poverty, crowding, easy travel, and mass movements of populations following war. Current figures suggest that there are about eight million new cases a year and about two to three million people each year die from TB. There are huge problems with TB in Africa, Asia, and the former Soviet republics, yet with appropriate antibiotic therapy 98% of cases are curable. Few potentially fatal diseases can boast this sort of cure rate.

A main theme of this book, cowritten by a New Jersey TB expert and a medical journalist, is that if Russia does not modernise its antiquated sanatorium based TB service and control its TB epidemic, it will be bad news not only for Russia but also for the rest of the world. Russia has a huge prison population (1% of the Russian population is in jail), 10% of whom have TB. Many of these cases are resistant to the best standard drugs. The alarming increase in the spread of HIV throughout Russia compounds this problem.

The authors give a fascinating account of events over the past few years. The international community has attempted to find solutions but has faced considerable resistance. Various vested interests have prevented redeployment of resources towards community based solutions for tuberculosis control.

The message of this book is that tuberculosis control is possible, but only if the political will is present and an integrated, unified approach is adopted based on consensus of all parties involved. This would mean complete reorganisation of the current Russian system. The authors cite as a model of success the New York City epidemic of the early 1990s which, as with Russia, was related to the prison system, poverty, crime, and homelessness (the United States is the country with the second highest percentage of its population in jail). An appropriate but huge increase in resources controlled the New York epidemic. The authors end on the depressing note that things in Russia are certainly going to get worse before they get better.

The main strength of this book lies in the authors' hands-on experience in Russia, New York, and New Jersey. However, there is little mention of the equally devastating problems in Africa, India, and South East Asia.

Timebomb is aimed at the scientifically interested layman rather than the medical community. The second half of the book is far more interesting than the first half, which is rather slow. There is a lot of repetition, and the approach is didactic and very American—for example, fairly early on the book dismisses BCG, which is not used in the United States.

Tuberculosis is a huge global problem—there is no doubt of that—and this book is an interesting addition to the debate, providing insights into what is happening at the international level. But whether TB, which for many years already has been a massive and explosive health problem, has a further “timebomb” aspect, as the authors predict, remains to be seen. Let us hope not.