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Book review: History of an intractable disease [Tuberculosis]

Sunday, 1st of November 2015

Book review: History of an intractable disease [Tuberculosis]

Jennifer Thorley

Although, for many of us, thoughts of tuberculosis might conjure up images of sanatoriums and consumptives of the distant past, tuberculosis is one of the deadliest infectious diseases in the world today, killing almost 2 million people every year—startlingly (and despite declining incidence), now more than any other time in history. Therefore, Christian McMillens Discovering Tuberculosis, a vastly detailed account of developments, ideas, successes, and failures (of which there have been many) in the global history of tuberculosis provides a timely opportunity for reflection.

McMillen (who is an associate professor of history at the University of Virginia, VA, USA) provides a comprehensive chronology of tuberculosis, from the long believed fallacy that non-white races were more susceptible to infection, which hindered progress for much of the early 20th century, to the alarming resurgence of the disease in the era of HIV/AIDS.

In a story described as one of “faith and futility”, the reader journeys through the search for a vaccine, development of Bacille Calmette-Guerin (BCG), the wildly differing and much debated results of BCG clinical trials, and the widespread rollout of vaccination programmes in the founding days of the global health superstructures of WHO and UNICEF, in the face of a fervent anti-vaccine campaign—something we might consider a much more modern phenomenon. Strikingly, McMillen concludes that “no preventive agent has ever been given to so many people with so little effect” and that “BCG could easily be the worlds largest failed medical intervention”, which might come as a surprise for those of us still bearing the characteristic vaccination scar. Finally, we discover the mistakes of the naively optimistic early days of antibiotics, and the rampant resistance that rapidly ensued—perhaps a predictable outcome with the benefit of hindsight that a historical perspective affords. With this insight, we discover that, despite the lost promise of technology to bypass the decades needed for improvements in social infrastructure, antibiotics infiltrated many societies as a conduit to restore, or establish, faith in modern medicine.

But like so many interdisciplinary works, one wonders where Discovering Tuberculosis truly belongs and who its intended readers are. Indeed, McMillen himself ponders what a historians perspective can add to a story clearly not yet ready to be consigned to the history books. As he painstakingly portrays, factors more important than biology have long been at work and, as a disease of poverty, politics and public health have vital roles that have not been, and perhaps cannot be, trumped by modern medical advances alone. By shining a light on a catalogue of documented political and scientific failures, McMillen admirably aims to prevent history from repeating itself once again.

For a contextualisation few of us could expect to gain from perusal of the scientific literature, Discovering Tuberculosis is arguably essential reading for every researcher in the field, but the curious outsider could perhaps be better served by selecting a more engaging title. Remarkably, despite the promise of discovery and revelation of a new and surprising outlook on a disease perhaps many of us thought we knew, one does not find oneself turning the pages with appropriately eager enthusiasm. Although somewhat attributable to the discouraging history that has played out in repeated global attempts to eradicate such a scourge, some of the books denseness must be ascribed to the unfortunate repetitiveness of McMillens text.

At times, the historian is guilty of listing the impressive amount information he has gleaned (from what we can only assume were countless hours poring over papers and meeting reports), like an eager student trying to commit his expansive knowledge to the page, and the narrative pays the price in overenthusiastic jumps backwards and forwards, often with little rationale. Attempts to personalise the sometimes tedious text by generously lavishing it with lists of names and quotes from prominent figures throughout tuberculosiss torrid history is perhaps as futile as some of the eradication attempts he details. Too many names, often meaningless to the inexpert reader, vie for our attention, and at times, what we are presented with could more accurately be described as a history of tuberculosis in quotes.

The idea of a history of a disease very much of the present is problematic in itself; there is no happy ending here—no ending at all in fact. Tuberculosis is as insurmountable a global health problem today as it has ever been, and no broadly effective vaccine has been found. But what is most disappointing is that, in McMillens fervent efforts to capture the past, he has neglected to look to the future. What are the next steps for vaccine development? And what are the hopes for eradication of one of the most deadly infectious diseases? Unfortunately, we close the narrative none the wiser, and can only hope that the fight against tuberculosis is a story to be continued with the same faith, but with a little less futility than that of its past.