Clin Chest Med 26 (2005) ix – x
Preface
Tuberculosis
Neil W. Schluger, MD
Guest Editor
In 1952, Selman Waksman received the Nobel
Prize for his discovery of streptomycin. In his Nobel
address, Waksman said:
In the treatment of tuberculosis, the more controlled
dosage of streptomycin and the supplementary use of
PAS tended to overcome some of the limitations of
the antibiotic, notably its toxicity and the develop-
ment of bacterial resistance. The recent introduction
of isonicotinic acid hydrazide suggests the possibil-
ity that its combined use with streptomycin will tend
further to control the disease and overcome undesir-
able complications. The conquest of the bGreat
White Plague,Q undreamt of less than 10 years ago,
is now virtually in sight. [1]
That same year, Rene and Jean Dubos, in their still
important and prescient book The White Plague, wrote:
However useful in specialized cases, vaccination,
antimicrobial drug therapy, or other therapeutic
measures cannot possibly solve the social problem
of tuberculosis. . .. It is only through gross errors in
social organization, and mismanagement of individ-
ual life, that tuberculosis could reach the catastrophic
levels that prevailed in Europe and North America
during the nineteenth century, and that still prevail in
Asia and much of Latin America today. [2]
Unfortunately, the Dubos’ assessment proved more
accurate than Waksman’s. Despite great advances in
immunology, microbiology, and drug development,
tuberculosis remains among the great public health
challenges of our time. The failure to reduce tuber-
0272-5231/05/$ – see front matter D 2005 Elsevier Inc. All rights reserved.
doi:10.1016/j.ccm.2005.03.001
culosis rates in high-burden countries is not due to
lack of efficacy of drugs in those countries, but rather
the confluence of medical and social factors that fuel
the ongoing tuberculosis epidemic: the coepidemic
of HIV; poverty; lack of a functioning public health
infrastructure; the economics of tuberculosis drug de-
velopment; bureaucratic and doctrinaire approaches
to tuberculosis control; lack of funding to support
basic research aimed at development of new drugs,
diagnostics, and vaccines; and apathy.
The articles in this issue of the Clinics in Chest
Medicine address many of these issues. They have
been written by leaders in the basic science, medical,
and public health communities who have broad per-
spective and expertise in their fields, and who are
engaged in efforts locally and globally to control the
worldwide tuberculosis epidemic.
I would like to dedicate this issue to all patients
who have tuberculosis, in hopes that the information
and knowledge offered within will improve their lives
in a direct and immediate way.
Neil W. Schluger, MD
Division of Pulmonary, Allergy, and
Critical Care Medicine
Columbia University College of
Physicians and Surgeons
PH-8, Room 101
630 West 168th Street
New York, NY 10032, USA
E-mail address: ns311@columbia.edu
chestmed.theclinics.com
x preface

References 12, 1952]. Available at: http://nobelprize.org/medicine/

laureates/1952/waksman-lecture.html.
[1] Waksman SA. Streptomycin: background, isolation, [2] Dubos R, Dubos J. The white plague. New Brunswick
properties, and utilization [Nobel lecture; December (NJ)7 Rutgers University Press; 1987. p. 224.