I had the opportunity to attend a valuable and important lecture on tuberculosis (TB), given by a real expert who has just joined our medical community, an expert who exhibited tremendous kindness and grace as they gave their presentation. Few Americans think much about TB anymore – most of us think about it as a disease of the past, a disease of old romantic poets and teeming slums, one that seems irrelevant to our daily life. But few people know that TB, which is said to have killed one person in seven among people who have ever lived, and still kills well over a million people a year around the world, is also the most common infectious lethal disease in the world. TB remains quite dangerous, particularly because it is adept at becoming resistant to antibiotics that can control it, as we develop those antibiotics, so most people who get TB require three or even four drugs to treat it effectively, and a few people develop very resistant TB that can’t be effectively treated.
The good news is that there is a robust community of researchers who are focused on developing and testing new treatments, which means that, although TB is usually a half step in front of our treatments, we are right on its tail, and our doctors and scientists have been able to keep it from running rampant over humanity. But TB remains a disease of poverty and overcrowding, and to a certain degree, of inadequate medical care, so it still kills way too many people in poor parts of the world where there aren’t enough doctors and nurses, and where there is inadequate access to clinics and hospitals. I was gratified to learn that there is a sophisticated and highly developed research community in the US, which has been funded to carefully train a deep bench of young researchers here, who actively participate in worldwide TB research efforts.
That’s the good news. The better news is that there are “only” five to six hundred TB deaths a year in the US, and half of those cases are in people who come here from other countries or were acquired abroad, which means TB isn’t a significant contributor to years of potential life lost to age 75 in the US. Years of potential life lost to age 75 is the most important and valuable measure of disease importance from a public health perspective, a measure we use to decide which diseases to target as we work to improve the public’s health, one that was invented in the 1940s to show the importance of battling TB, which then infected hundreds of thousands to millions of Americans, and killed many young people in their teens and twenties.
All that said, my heart broke for America just a little, hearing that lecture. It’s lovely that we have young doctors and great researchers battling this worldwide scourge. But it is also heart-breaking that we aren’t getting more of those young physicians and researchers focused on preventing the diseases and conditions that are killing Americans now – heart disease and stroke, cancer, chronic liver disease and suicide – the bulk of which is preventable, along with unintentional injuries (drug overdoses, poisonings, and motor vehicle accidents) and homicide, which are our major public health challenges now. And also heartbreaking that we aren’t devoting more resources to the care of pregnant women and their children, who are our future, a need and a potential heartbreak Newport knows only too well at the moment.
The major common pathway to preventing these diseases – and caring best for women of childbearing age — is to get all Americans involved in a robust primary care relationship, because primary care clinicians help their patients identify and control their high blood pressure and diabetes before those disorders become crippling, help them prevent death and disability from many cancers, and help identify and treat liver disease before it causes cirrhosis and liver cancer.
But few of our most able young American physicians are choosing primary care careers, and way too few of the 70,000 or so of our qualified premedical students can gain admission to our way too few American medical schools.
In the 1940s, when we developed treatments for TB and prevention for polio, which were the major causes of years of preventable life lost in those years, we rolled up our sleeves as a nation and got new treatments and vaccines that work to the millions of people who needed them — and we conquered both diseases.
Now we have treatments and prevention that works for the diseases that are disabling and killing Americans today, but we are leaving those treatments and that prevention on the table, because we aren’t focused as a nation and as a people on what we can do together.
That’s crazy.
PS It’s not too late to get a flu shot. Get immunized. Particularly if you are over 65 or have a chronic disease. Do it today.
Flu vaccine protects against hospitalization and death. And saves us all money by keeping people at work and school and out of the hospital, particularly when we all get immunized.
You can find Michael Fine’s commentaries and short stories on
https://michaelfinemd.substack.com/and on http://www.michaelfinemd.com.
Please join his Substack today at https://michaelfinemd.
