MAKING TB TREATMENT FIT FOR EVERYONE
Carole Mitnick, ScD, Harvard Medical School
"Our research demonstrates that extensively drug resistant TB need not be considered a death sentence. With comprehensive, patient-focused, community-based care as part of an effective national TB program, this disease can be cured, even in poor areas. Significant research is required, however, to improve the likelihood of cure, which occurs in 60% of patients at most."
Carole Mitnick, ScD says she is a scientist working for equity and social justice. Through her research, drug resistant tuberculosis patients living in poor areas will receive better, more individualized treatment and care, and ultimately will get better chance to live. "The general global TB standard of care has had a ‘one size fits all approach,' and anybody who can't be cured by this approach is often considered too expensive to cure - yet another strike against ‘unlucky' people born into poverty. This standard epitomizes the inequities of health in the world." Although Mitnick's research primarily targets health in developing countries, the results have an enormous impact on and significance for our health in the United States.
While the major burden of TB is found in developing countries, the disease is not confined there. In 2007, there were more than 13,000 cases reported in the U.S. More than half of these occurred among non U.S.-born populations. And for Americans, TB, which has always been a disease of the poor, reflects persistent inequalities: 71.2% of the U.S.-born cases occurred among black Americans, who comprise only 12% of the U.S. population. Another concern is that the number of TB cases in the U.S. is declining very slowly. The Centers for Disease Control has emphasized a strong federal need for better and improved case management, treatments, understanding of TB transmission, and collaboration with other nations to reduce TB globally.
So although Mitnick has no self-interest in her research, she knows the U.S. does.
Mitnick's research looks at another serious threat of TB - the more complex and toxic drug resistant forms of the disease, where treatment is typically more difficult and expensive, and less effective. The ‘one size fits all approach' Mitnick describes has had little impact on drug resistant forms of TB, and without proper treatment, people remain sick and capable of transmitting resistant strains to their family and neighbors. Most developing countries lack the resources and infrastructure to properly handle such a complex health problem.
Mitnick is working to change this. Her research illustrates that, by working with public health systems, providing high-quality treatment and supportive services, as well as training and education, patients in poor areas can be successfully treated for all forms of TB. Mitnick has used the lessons learned in these areas to develop similar models of care in other developing countries, as well as international policy and guidelines for treating drug resistant TB. Her research also exemplifies cost-efficient ways to treat and manage chronic disease, important lessons for wealthy nations like the U.S. with expensive, exclusive health care systems.
"Current evidence reveals that the global burden of drug resistant TB is greater than anyone thought. Only a tiny fraction of people are treated with high-quality drugs and comprehensive care. If we continue at this pace, all our gains in TB control to date will be jeopardized, and we are looking at a terribly frightening future."