Tuber&
and Lang Dbrase
( I9921 73, 69-70
Editorial
Tuberculosis forgotten? The merger of the Bulletin of the International Union Against Tuberculosis and Lung Disease and Tubercle to form Tubercle and Lung Disease may be met with concern reflecting the sense that yet another special area reserved for tuberculosis has been usurped by those ‘other’ lung diseases. These concerns, of course, are highly consistent. They were the same concerns expressed when Tuberculosis Associations in many industrialized countries became first Tuberculosis and Respiratory Disease Associations, and then, simply, Lung Associations. I recall vividly, in the early 1970s when, as a postgraduate student, I indicated that I wished to focus on tuberculosis (and specifically, the epidemiology of tuberculosis), I was told by my contemporaries that I would be penniless if I did not also include the epidemiology of one of those ‘other’ lung diseases in my repertoire. In a similar manner, concern has been expressed within the International Union Against Tuberculosis and Lung Disease (IUATLD), since the name of the organization was changed from simply the International Union Against Tuberculosis, that tuberculosis was being forgotten. These concerns have been consistently expressed over many years and in a variety of circumstances. To what extent are these valid concerns? It is clear that tuberculosis remains a very great problem in the world today. It has been stated that there are more cases of tuberculosis today than when Dr Robert Koch discovered the bacillus which causes the disease, over 100 years ago. Indeed, in developing countries, tuberculosis is the most important cause of death in those in the economically productive age group (from 15 to 54). A significant proportion of the entire population of the world has been infected by (and carries the live bacilli of) tuberculosis. On the other hand, one must be aware that other lung diseases exact a very high toll in the world’s population. If one includes lung cancer, (which, after all, is a disease of the lungs), lung diseases are second only to cardiovascular diseases as causes of mortality in industrialized countries. The most common of these are, of course, those related to tobacco smoke exposure, lung cancer and chronic airflow obstruction. Indeed, while almost all other causes of death are declining (including cardiovascular diseases and other forms of cancer), lung diseases are remaining stable with the result that an
increasing proportion of all deaths in industrialized countries are due to lung diseases. The situation is no better in developing countries where the most common cause of death from lung diseases is acute respiratory infection, a condition which affects principally small children and causes almost twice as many deaths as tuberculosis. The total number of deaths from lung diseases per year in the world is approximately 10000000. Not more than one-quarter of these are tuberculosis. What is most important to note is that almost all of these deaths are avoidable. The conditions causing them are either preventable or treatable. In our concern for a continued emphasis on the importance of tuberculosis, we must not lose sight of the importance of all forms of lung disease and, in particular, that these afflictions can be overcome. Nevertheless, we must return to our concern for tuberculosis and ensure that the priority placed upon this disease is not diminished. One might ask, in what way has the interest in other lung diseases affected tuberculosis? For an answer to this question, it is instructive to look to the IUATLD. The broader emphasis on all forms of lung disease began in 1973. At this time, although tuberculosis was declining in virtually every industrialized country of the world, there was, as yet, no effective programme to reduce the problem in developing countries. In 1979, the IUATLD, in collaboration with national governments and donor partners, set about to develop a strategy for the control of tuberculosis which could be shown to be both effective and economical in developing countries. These programmes have now been developed and have been demonstrated to be among the most cost-effective of any health interventions in developing countries! They have become the basis for the new Global Programme Against Tuberculosis of the World Health Organization and, with donor-support, will very likely result in the containment of this disease in developing countries, even in the presence of the pandemic due to human immunodeficiency virus infection. Has Tubercle and Lung Disease abandoned tuberculosis? Certainly not! For a clear demonstration of this truth, one has only to look at the index of the present volume. The goal remains what it was in 1920, at the establishment of the IUATLD, when Professor Leon Bernard made the following statement: ‘It is necessary
69
70
Tubercle and Lung Disease
for all countries wishing to eradicate tuberculosis to decide among themselves on the methods, to agree on the most effective weapons, and to forge and implement them jointly against the common enemy...’ These words are just as true today as they were over 70 years ago.
Both the IUATLD and Tubercle and Lung Disease remain committed to this goal.
D. Enarson
and Lang Dbrase
( I9921 73, 69-70
Editorial
Tuberculosis forgotten? The merger of the Bulletin of the International Union Against Tuberculosis and Lung Disease and Tubercle to form Tubercle and Lung Disease may be met with concern reflecting the sense that yet another special area reserved for tuberculosis has been usurped by those ‘other’ lung diseases. These concerns, of course, are highly consistent. They were the same concerns expressed when Tuberculosis Associations in many industrialized countries became first Tuberculosis and Respiratory Disease Associations, and then, simply, Lung Associations. I recall vividly, in the early 1970s when, as a postgraduate student, I indicated that I wished to focus on tuberculosis (and specifically, the epidemiology of tuberculosis), I was told by my contemporaries that I would be penniless if I did not also include the epidemiology of one of those ‘other’ lung diseases in my repertoire. In a similar manner, concern has been expressed within the International Union Against Tuberculosis and Lung Disease (IUATLD), since the name of the organization was changed from simply the International Union Against Tuberculosis, that tuberculosis was being forgotten. These concerns have been consistently expressed over many years and in a variety of circumstances. To what extent are these valid concerns? It is clear that tuberculosis remains a very great problem in the world today. It has been stated that there are more cases of tuberculosis today than when Dr Robert Koch discovered the bacillus which causes the disease, over 100 years ago. Indeed, in developing countries, tuberculosis is the most important cause of death in those in the economically productive age group (from 15 to 54). A significant proportion of the entire population of the world has been infected by (and carries the live bacilli of) tuberculosis. On the other hand, one must be aware that other lung diseases exact a very high toll in the world’s population. If one includes lung cancer, (which, after all, is a disease of the lungs), lung diseases are second only to cardiovascular diseases as causes of mortality in industrialized countries. The most common of these are, of course, those related to tobacco smoke exposure, lung cancer and chronic airflow obstruction. Indeed, while almost all other causes of death are declining (including cardiovascular diseases and other forms of cancer), lung diseases are remaining stable with the result that an
increasing proportion of all deaths in industrialized countries are due to lung diseases. The situation is no better in developing countries where the most common cause of death from lung diseases is acute respiratory infection, a condition which affects principally small children and causes almost twice as many deaths as tuberculosis. The total number of deaths from lung diseases per year in the world is approximately 10000000. Not more than one-quarter of these are tuberculosis. What is most important to note is that almost all of these deaths are avoidable. The conditions causing them are either preventable or treatable. In our concern for a continued emphasis on the importance of tuberculosis, we must not lose sight of the importance of all forms of lung disease and, in particular, that these afflictions can be overcome. Nevertheless, we must return to our concern for tuberculosis and ensure that the priority placed upon this disease is not diminished. One might ask, in what way has the interest in other lung diseases affected tuberculosis? For an answer to this question, it is instructive to look to the IUATLD. The broader emphasis on all forms of lung disease began in 1973. At this time, although tuberculosis was declining in virtually every industrialized country of the world, there was, as yet, no effective programme to reduce the problem in developing countries. In 1979, the IUATLD, in collaboration with national governments and donor partners, set about to develop a strategy for the control of tuberculosis which could be shown to be both effective and economical in developing countries. These programmes have now been developed and have been demonstrated to be among the most cost-effective of any health interventions in developing countries! They have become the basis for the new Global Programme Against Tuberculosis of the World Health Organization and, with donor-support, will very likely result in the containment of this disease in developing countries, even in the presence of the pandemic due to human immunodeficiency virus infection. Has Tubercle and Lung Disease abandoned tuberculosis? Certainly not! For a clear demonstration of this truth, one has only to look at the index of the present volume. The goal remains what it was in 1920, at the establishment of the IUATLD, when Professor Leon Bernard made the following statement: ‘It is necessary
69
70
Tubercle and Lung Disease
for all countries wishing to eradicate tuberculosis to decide among themselves on the methods, to agree on the most effective weapons, and to forge and implement them jointly against the common enemy...’ These words are just as true today as they were over 70 years ago.
Both the IUATLD and Tubercle and Lung Disease remain committed to this goal.
D. Enarson
