Timebomb: The Global Epidemic of Multi-Drug-Resistant Tuberculosis

Reviewed by: John S. Marr, MD, MPH

Disclosures

February 15, 2002

Introduction

By Lee B. Reichman with Janice Hopkins Tanne
McGraw-Hill
Copyright 2002
240 pages
ISBN: 0-07-135924-9
$24.95 hardcover

Fifty years ago when René Dubos published his classic essays on tuberculosis (TB) -- past and then-present -- they were a series of previous accomplishments and great expectations for the future.[1] He suggested that the bleak cultural baggage long associated with this disease might be cautiously discarded. By openly discussing TB and new microbiological remedies, Dubos offered hope for millions of people. Lee B. Reichman and Janice Hopkins Tanne's Timebomb: The Global Epidemic of Multi-Drug-Resistant Tuberculosis (MDR-TB) offers an equally important -- if somewhat different -- message.

Timebomb is but one of hundreds of books on TB written over the last half-century, but it belongs on a short shelf devoted to the best, in part because of its uniquely urgent warning. Previous books have had signature messages; many, like The Forgotten Plague, were well written, studiously read, and praised by the public, politicians, and policy makers, and then... forgotten.[2] Timebomb is an augury of things to come, and, hopefully, its message will not be set aside. As one of the top TB specialists in the US -- if not the world -- Lee Reichman, MD, MPH, a former president of the American Lung Association and a professor at New Jersey Medical School, has the credentials and authority to make these statements. Janice Hopkins Tanne's expert assistance as a science writer has seamlessly blended an otherwise complex translation of scientific concerns into a fascinating narrative.

Timebomb's introductory chapters generously allude to another excellent book on TB[3] -- a potential criticism until one realizes that the authors' purpose was to create an obligatory mise en scène before launching their primary narrative focus. Indeed, one of this book's leitmotifs is its generous praise of and attribution to the many individuals -- in and outside of governments -- who continue the good fight against TB. Minor incorrect word choices might be attributable to previous authors who claimed that Hermann Biggs was a New York City Health Commissioner (he was an advisor to the City and later a State Health Commissioner) (page 25); Typhoid Mary was not actually imprisoned (she was forcibly hospitalized on North Brother Island's Riverside Hospital (page 149).

Timebomb's 4 introductory chapters are a preamble to the book's major thrust -- recent Russian bureaucratic mistakes and an ongoing series of TB-related fiascoes that the authors ingeniously diagnose as the "Kursk Syndrome"(page 215). Chapters 5 ("Smoke and Mirrors in Moscow") and 10 ("Epidemic in New York") are tales of 2 cities responding differently to the emergence of TB and MDR-TB in the 1990s. Interspersed between these chapters are interesting, highly detailed diary accounts of Russian dysfunctional dogmas and irrational ideologies that may have lit the fuse. These are referred to as "medical jingoism" (page 207), or as "a lot of Soviet mentality in Russia. The rulers have changed; the mind-set has not" (page 203).

Before returning to a final update on the latest Russian political decisions for dealing with TB, DOTS (directly observed treatment, short course)/DOTS-Plus, scientific, pharmaceutical, and political considerations regarding compliance, new TB antibiotics, and illusions/realities surrounding a TB vaccine are discussed. Timebomb closes with high praise for professionals, politicians, and philanthropists who have wrestled with national and international infectious disease challenges over the last decade. It also suggests that the authors are in favor of creating a tort, as if there may be a future Nuremberg-like tribunal when the Russian are called to task for their failure to address MDR-TB resulting in a new, horrific pandemic. While diplomatically disagreeing, the authors have clearly documented a failed system's impotent TB program: its antiquated treatment regimens, Stygian prison conditions, and Kafka-esque passive-aggressiveness to internationally accepted TB policies. When the global epidemic does erupt, will many world leaders and politicians feign surprise at TB's resurgence? Timebomb should provide them an effective warning. Let's hope that those in a position to make a difference will become or remain committed to addressing what is certain to become a major new world problem.

A word should be said about Timebomb's enticing book jacket: it is a stylized chest radiograph rendered in electric green-blue/neon orange/yellow colors that draws immediate attention to the cover, as if it were a best-selling thriller on a high profile topic.* Also noteworthy is a Web site on the book (containing authors' biographies, chapter contents, and book reviews). For those who may not wish to judge a book by its cover, this Web site offers an immediate biopsy of Timebomb's contents, reflecting a well-organized inner structure about a most timely subject that -- even with a 4-drug regimen -- has an ominous prognosis.

* Timebomb has been Amazon's #1 TB listing since November 2001. In January 2002, Amazon listed 220 books on tuberculosis, second in the Infectious Disease category only to HIV (343) and followed by malaria (149). Smallpox, which has recently had elevated interest, holds 71 titles.

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