[in-enaction] urban diseases: Tuberculosis in India and the United States

....
The contrast between the developed and developing worlds in the impact 
and management of tuberculosis shows how far therapies have advanced and 
how potent they can be if they are implemented successfully. A century 
ago, tuberculosis posed substantial challenges even to wealthy 
countries. Thomas Mann's opus The Magic Mountain, set in an affluent 
sanatorium in the Swiss Alps before World War I, vividly illustrates the 
passivity of tuberculosis treatment before the advent of effective 
pharmacologic agents. Mann describes not only the cutting-edge therapies 
of the day — enforced rest, fresh air, morning walks, and even 
artificial pneumothoraxes — but also the peculiar psychological 
ecosystem of a community of people placed in constant close contact by a 
chronic and unremitting disease. The deaths of the sanatorium's 
inhabitants, either from slow, progressive consumption or from rapid, 
massive hemoptysis, repeatedly remind the others of their own mortality. 
Mann takes a philosophical lesson from tuberculosis, musing that "[life 
is] the existence of what, in actuality, has no inherent ability to 
exist, but only balances with sweet, painful precariousness on one point 
of existence in the midst of this feverish, interwoven process of decay 
and repair."

Life with tuberculosis in India today seems similarly precarious. Nearly 
a century later — and 50 years after the development of effective 
treatments — India has lagged far behind developed countries in the 
containment and management of the disease. Despite the laudable progress 
that has been made in India in the 60 years since its independence, it 
remains challenged in fundamental ways. Social stigma often discourages 
people from seeking treatment for months, and when they do seek it, 
treatment is administered on an outpatient basis, since isolating 
otherwise functional people is rarely feasible. The treatment of latent 
tuberculosis with 9 months of single-drug therapy (the norm in the 
United States) is a concept found only in textbooks in India. If it were 
implemented, nearly a tenth of the population would require treatment.
.....

cont'd....
http://content.nejm.org/cgi/content/full/358/11/1092