PHANTOM PLAGUE

A penetrating social history of a virulent disease.

Drawing on two decades of reporting on tuberculosis and HIV in India, Krishnan makes her book debut with a hard-hitting indictment of the greed, politics, and racism that have led to the prevalence of drug-resistant tuberculosis. The disease, medical historians speculate, likely began in ancient Egypt and traveled across the world along trade routes. It ravaged 19th-century slums, where overcrowding and filth incubated an illness that had no cure. Its victims, though, were hardly limited to the poor. Among TB’s sufferers were Orwell, Kafka, Eleanor Roosevelt, Chopin, and all of the Brontë sisters. Krishnan traces early efforts to stem contagion, including a campaign in the U.S. to ban spitting; although that effort failed, it led to the creation of public and hand-held spittoons. If men would not stop spitting tobacco, at least the mucus could be contained. The development of germ theory led to the creation of antibiotics, but while curing TB, overuse of antibiotics for all manner of maladies caused drug-resistant strains, especially rife in India. Ramshackle housing, inadequate medical care (doctors who fail to diagnose TB or prescribe correct treatment), and the rationing of drugs because of big pharma’s patent monopolies all contribute to the rise of drug resistance. “Tuberculosis,” writes the author, “demonstrates what happens to science when it leaves the lab setting and interacts with flawed human beings: patients, doctors, politicians, and rabble-rousers, all of whom have a unique effect on the course of the plague.” Krishnan writes that the World Health Organization estimates 25% of the world population has latent TB, fueled by an “architecture of unfairness,” inequality, and ignorance. Underscoring the vulnerability of the poor, Krishnan asserts that TB epitomizes “a new form of medical apartheid in which preventable and curable diseases, such as TB, are thriving while lifesaving medicines remain in a stranglehold.”

A timely, significant analysis of the dire consequences of public health failures.