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Timebomb:The Global Epidemic of Multi-Drug Resistant Tuberculosis Hardcover – September 26, 2001


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Product Details

  • Hardcover: 320 pages
  • Publisher: McGraw-Hill Companies (September 26, 2001)
  • Language: English
  • ISBN-10: 0071359249
  • ISBN-13: 978-0071359245
  • Product Dimensions: 9 x 6.1 x 1 inches
  • Shipping Weight: 1.2 pounds
  • Average Customer Review: 4.4 out of 5 stars  See all reviews (7 customer reviews)
  • Amazon Best Sellers Rank: #1,460,771 in Books (See Top 100 in Books)

Editorial Reviews

From Publishers Weekly

Tuberculosis, once a romantic 19th-century disease, has returned, reaching epidemic proportions worldwide. One only need remember New York City's 1991 epidemic. Over one-third of the world's population has latent tuberculosis; 15 million Americans are infected with this highly contagious, airborne respiratory disease. TB chooses hosts indiscriminately; average middle-class Americans are not immune, say the authors. Reichman (professor of medicine at the New Jersey Medical School and director of its National Tuberculosis Center), with medical writer Tanne, discusses a virulent strain, multi-drug resistant tuberculosis, or MDR-TB. This hard to treat, if not incurable, incarnation is believed to have entered the U.S. via immigrants often from the former Soviet Union, designated a TB epicenter by the World Health Organization. Reichman often undermines his warnings by lapsing into shrill xenophobia. "Just think how many legal and illegal immigrants from these countries are now in Western countries! And just think, in our global society, how many more are contemplating coming!" Stereotypes run the gamut: in an airport he observes "well-tailored, trim" French people "equipped with cell-phones and lap-tops," "culture crammed and shopped out" Americans, and a group of "shabby" Ukrainians. In the early 20th-century, the Irish, often living five to one room, worsened their condition with malnourishment and alcoholism. Despite these noxious problems, the book serves an important function, relaying statistics and TB hot spots, proposing funding and international standardized treatments. Government officials, researchers and nonprofit health organizations will likely cast this as the authoritative book on the subject. (Oct. 5)Forecast: Endorsements by the Global Health Council, several congressmen, the American Lung Association and former Secretary of Health Donna Shalala and MDR-TB's worldwide headlines will win the book ample media attention.

Copyright 2001 Cahners Business Information, Inc.

From The New England Journal of Medicine

If you wanted to cause an epidemic of multidrug-resistant tuberculosis in a country, what would you do? First, you would create a social and economic environment that promotes poverty and inequity. Second, you would temporarily subject those who have infectious tuberculosis to squalid and overcrowded conditions, let them mix with an uninfected population, and then release them back into the general population. Third, you would provide just enough treatment to prevent those who have the disease from dying but not enough to cure them, so that they would remain infectious longer. Fourth, you would provide inadequate treatment, guaranteed to create drug resistance. Fifth, you would add the possibility of infection with human immunodeficiency virus (HIV) to increase dramatically the risk of progression from infection to active tuberculosis disease.

Timebomb, written by Lee Reichman with Janice Hopkins Tanne, shows that this desperate situation has already occurred. Though clearly unintentionally, a combination of politics, economics, the emergence of a new infectious disease, and scientific belief has contributed to a major epidemic of tuberculosis in Russia. Multidrug resistance is a major component of this epidemic in prisons and parts of the civilian population. What makes the situation so worrisome is that the epidemic was well under way even without the added boost of HIV infection. Recent statistics from the World Health Organization and the Joint United Nations Programme on HIV/AIDS confirm that the pandemic of HIV infection is growing faster in Russia than anywhere else in the world. This appalling combination of HIV infection and multidrug-resistant tuberculosis is -- as the authors quite rightly assert -- a deadly time bomb, with consequences that reach far beyond the borders of any one country.

This is not a scientific analysis of the global dimensions of multidrug-resistant tuberculosis. In fact, the title is something of a misnomer, since in geographic scope the book mainly covers events in Russia and New York. Having set the scene with a description of a tuberculosis outbreak caused by a Ukrainian man traveling to the United States in 1998, the authors provide an excellent introduction to the science and history of tuberculosis, written primarily for the lay reader with little or no knowledge of tuberculosis. They then return to the main theme: recent attempts to help Russia adopt modern tuberculosis-control strategies.

Reichman, who is executive director of the New Jersey Medical School National Tuberculosis Center, has been involved in issues related to tuberculosis in Russia for the past few years, and his insights into what he calls a world of "smoke and mirrors" make compelling reading. Indeed, the authors are at their best in telling a story, with vivid and often detailed descriptions of people and events. The personalities are diverse and memorable: a Russian baby who is infected with tuberculosis and adopted in the United States, a Hungarian billionaire, a Russian dissident, a New York community health worker, and a Russian thoracic surgeon.

There are several minor mistakes in the book. For example, the countries listed at the end of the book are not the "hot spots" of multidrug-resistant tuberculosis that have been identified by the World Health Organization but rather are the 22 countries that together account for 80 percent of the global tuberculosis burden; the London conference on tuberculosis was held in 1998, not 1997; and most historians of tuberculosis control would assert that the principle of directly observed treatment for people with tuberculosis was promoted before 1973. An exploration of the reluctance of the Russian government to adopt a policy of international competitive bidding for tuberculosis drugs, as required in the proposed World Bank loan, would also have been interesting.

Timebomb is an important book with many lessons for those involved in public health. First, history repeats itself; as the poet Steve Turner says, "has to -- no one listens." The epidemics of tuberculosis currently raging in Russian prisons were common in British and American prisons in the late 19th century. In 1882, on announcing his discovery of the tubercle bacillus, Robert Koch described the disease as killing at least one third of people in the economically active age groups. The fact that the same bacterium continues to kill nearly 2 million people worldwide each year, despite the availability of a cheap and effective treatment, reminds us that complacency is one of the greatest threats to public health.

Second, the book demonstrates the multifaceted and complex nature of modern epidemics. Mix an intransigent medical profession with a judicial system based on imprisonment, and add a couple of virulent microorganisms to an environment of socioeconomic upheaval and inequity, and the results will be predictably appalling. Third, self-interest on the part of medical professionals can thwart attempts to improve the health status of the poor. Historians of health and development have documented many examples from the past. That they continue to do so in the present is a reminder that none of us are immune to this temptation.

The story is unfinished. The time bomb has yet to go off. There is still time to act, and proven strategies for tuberculosis control are available that can work -- as long as they are adopted quickly and widely. Whether this time bomb will be defused remains to be seen. The fact that it can be defused is indisputable. I look forward to reading the sequel.

Ian Michael Smith, M.B., Ch.B.
Copyright © 2002 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.


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Customer Reviews

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This is an important and worthwhile book, and one that I heartily recommend.
Barron Laycock
DOTS is always more effective than the methods used by Russian medics, but no stats or studies as to this issue are ever sited.
"greenelephant88"
This lively and well-written book is packed with fascinating nuggets of historical and medical information.
NB

Most Helpful Customer Reviews

9 of 9 people found the following review helpful By Alice Alexander on October 27, 2001
Format: Hardcover
I liked Lee Reichman's new book "Timebomb" on so many levels. As someone who writes about public health issues for a living, I already knew there was big trouble brewing in Russian prisons, where a virtually incurable form of TB has been brewing for years. The trouble is that TB treatment, though highly effective, is fraught with troubles, among them the extremely lengthy and often unpleasant course of treatment; and the acute lack of resources in the very places they're needed the most. What this book does is flesh out, in finely-wrought detail, why these problems have proven so intractable, and why Russia continues not to do the right thing. You can hold this book up as a mirror for any number of other gigantic, slow-moving demons now stalking the planet, from global warming to over-population to the AIDS epidemic ravaging sub-Saharan Africa, and see why we're in the state we're in. As "Timebomb" so tragically depicts, even the best solutions can get distorted in the lenses of culture, ego, and plain old human inertia. I'd heartily recommend "Timebomb" as a must-read to anyone in public health, as well as to anyone interested in how public health works. Recent terrorist attacks on the country make it all the more relevant, sometimes chillingly so. --Alice Alexander
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6 of 6 people found the following review helpful By Barron Laycock HALL OF FAME on April 23, 2002
Format: Hardcover
This shocking book focuses on the emerging public health threat associated with the rise of multiple drug resistant (MDR) strains of tuberculosis, especially in the former Soviet bloc of countries. In an age when worldwide travel can be accomplished in days if not hours, the connectivity between what is transpiring in the underdeveloped world and within our own borders is more striking than ever before. Therefore, we must recognize the threat posed by the emergence of such strains, and prepare to deal with the almost inevitable outbreaks of such strains of TB as they begin to occur in modern western societies.
This is not an easy read, but it is a quite fascinating and eye-opening one. The spread of MDR tuberculosis with the populations of Russia and the former satellite countries is shocking, and the total number of individuals latently infected now number some two billion people, or over one third of the total world population! Given the inability of modern medicine to counteract the course of the disease or to easily cure people infected with these new strains, the threat posed by them for people in all countries cannot be over-dramatized. Tuberculosis is indeed highly contagious, spreading freely through the air from infected individuals when they speak, cough, or sneeze. The authors refer to it as the "Ebola with wings", making a tacit reference to this most deadly form of hemorrhagic fever which is quite lethal when contracted, but which is thankfully more difficult to spread since (unlike tuberculosis) it is not airborne.
The predictions of its consequences are dire indeed; MDR tuberculosis is anticipated to kill 30,000,000 in the next decade alone.
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5 of 5 people found the following review helpful By Deborah F. Harkins on March 3, 2002
Format: Hardcover
Anthrax, shmanthrax. To come down with good, productive anxiety, read about "Ebola with wings"-drug-resistant TB. And no, tuberculosis is not a thing of the past: It's here, it's now, it kills 2 million people every year. Several chapters of this book read like a detective novel. Timebomb starts by showing us Nicolay, a Russian, as he flies into New York in 1998, coughing highly infectious, drug-resistant TB bacteria into the plane's air. Then Timebomb looks into risky-to-work-in TB labs; a Siberian prison (where much of the world's TB is generated); a lung operation; the Russian medical system that's failing to control the bug; and takes us along on the dangerous rounds of an unsung heroine, a public-health worker. The book is not only well written, it's about a threat that individual members of the public can actually do something about-if they know the problem exists.
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3 of 3 people found the following review helpful By NB on March 26, 2002
Format: Hardcover
This lively and well-written book is packed with fascinating nuggets of historical and medical information. From the "dark, Satanic mills" of the Industrial Revolution to the squalid prison cells of contemporary Russia, from Egyptian mummies to DNA fingerprinting, you will follow the trail of the TB bacillus and the heroic researchers and public health workers who remain committed to conquering it.
"Timebomb" is a winner!
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