Tuberculosis (TB) is an infectious disease. It spreads through the air, attacks the lungs, and is present in about one third of the world’s population. About 10% of those cases progress from latent to active TB, which has a 50% chance of killing you if left untreated.
Why am interested in this topic? It’s hard to explain, but I can simply say that I’m horrified by it, and the amount of people it kills in developing countries. Mountains Beyond Mountains first introduced me to the impact of this disease (and other infectious diseases) in the poverty-stricken nation of Haiti. One of the big “problems” is that people in rich countries are not dying from TB, and therefore, the amount of money invested in TB research and aid is minimal relative to other diseases such as AIDS and cancer. The result is that most drugs available for treating TB are expensive, with few “market forces” or R&D progress driving down the prices.
Multi-Drug-Resistant Tuberculosis (MDR-TB) is particularly troubling in this regard. TB is remarkably good at evolving in your body to the point where it gains resistance to the first line of drugs: isoniazid and rifampicin. How do you treat it then? Well, you need:
- An MDR-TB specialist, with careful attention to your unique “species” of MDR-TB.
- A soup of very expensive “second-line” drugs that carry with them terrible side-effects.
- A realization that even if you have unlimited funds, you’re probably still going to die.
The troubling question for medicine is what to do about MDR-TB in Haiti where people cannot afford to eat, let alone pay anything for any kind of drugs to help them. Treating an MDR-TB patient is 10 to 100 times more expensive than a TB patient that responds positively to the first-line drugs. So what do you do? Do you just let them die? And because TB is highly contagious, do you force MDR-TB patients into isolation, while not providing any medical assistance with any real hope for treatment?
These are questions Mountains Beyond Mountains asks, and as I sit here typing these words, I am having trouble not losing myself in the hopelessness of such moral questions about death and dying.