Timebomb: The Global Epidemic of Multi-drug-resistant Tuberculosis

click here for more details, find new or used items	Lee Reichman, Janice Hopkins Tanne New from £31.97 Used from £21.86 Pages: 320 (Paperback) ISBN: 0071422501 Pub: McGraw-Hill Professional Pub date: 2004-01-01 Amazon.co.uk Sales Rank: 561106

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Scary and revealing (4/4 people found this helpful)

For those of you unfamiliar with tuberculosis: TB is a life-threatening disease that is caused by bacteria. It is treatable, but the treatment is lengthy (at least 6-8 months) and relatively costly (around $900 in the US). If patients do not receive the correct combination of antibiotics, or if they stop treatment prematurely, they may develop (or transmit) multi-drug-resistant tuberculosis, a disease which is nearly impossible to treat, treatment requiring up to 2 years of taking very expensive (up to $250,000 for 1 case of multi-drug-resistant TB) antibiotics that have a lot of side effects.

In Timebomb Lee Reichman gives a very clear description of all the factors involved in Tb, its treatment, the ways in which such treatment may fail and the dire consequences of failure. He also gives personal account of his experiences with multi-drug-resistant tuberculosis, with an emphasis on the situations in the United States and Russia. In the beginning of the 1990s there was an outbreak of (multi-drug-resistant) tuberculosis is New York: a team of very dedicated public health officials, doctors and community health workers fought the outbreak by treating patients as much as possible at home and were capable of reversing the situation, be it at very high costs (1 billion dollars in excess spending on health care). These costs would have been unnecessary if policy makers had in the past realized the threat that TB poses to the society once you become complacent.

In Russia, on the other hand, doctors are far more influential and there are a lot of very perverse incentives that stigmatise patients to such an extent that they actually do not come forward with their TB: they are locked in hospitals for up to 2 years for treatment and 1 in every 5 TB patients is operated upon, even when these operations are absolutely not necessary. And in prisons everything goes wrong that can go wrong with regard to transmission and control of TB and the emergence of multi-drug-resistant TB: overcrowded prisons, interrupted treatment and amnesty for TB prisoners that have not finished their treatment, And all this combined with an unjustified national pride that prohibits the Russians to ask for help or to accept evidence-based interventions that are promoted by the World Health Organization.

I have worked in a few of the prisons in Russia myself to try and improve the diagnosis of TB and the descriptions are very recognizable for me. I wish I had read this book before I started that job, because it had given me a better understanding of the forces I had to fight against.

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