Dr. Neil W. Schluger's main area of academic interest has been in tuberculosis, including clinical trials, molecular epidemiology, development and evaluation of diagnostics, and human host immune responses. He is the principal investigator at Columbia University for the Tuberculosis Trials Consortium, a CDC-funded collaboration in clinical trials in which patients are enrolled in trials of treatment of latent tuberculosis infection and active tuberculosis disease. In addition, Dr. Schluger has led studies examining the transmission dynamics of tuberculosis in New York City, using tools of molecular epidemiology. He has a long standing interest in the development and evaluation of new tools for the diagnosis of tuberculosis.
More recently, in addition to his studies in tuberculosis, he has led clinical trials for the use of retinoids in the treatment of emphysema and for the use of interferon gamma in the treatment of idiopathic pulmonary fibrosis.
Question: Why is tuberculosis still important?
Neil Schluger: So tuberculosis is not common in the US, it’s not common in most wealthier countries, but it’s very common in poor countries and it’s the 8th leading 'cause of death in the world and tuberculosis is a fascinating disease because it’s really a window into all sorts of larger problems in society. If you go back a hundred or so years when tuberculosis was very common, even in countries like the United States and Europe, everybody knew someone who had TB, it was part of the general consciousness. Writers wrote about it, composers composed about it, La Boehme is about someone with tuberculosis for example and it was really part of the general consciousness the way AIDS is now, because everybody knew about it and one of the fascinating things is that cases of tuberculosis in the United States declined very rapidly between let’s say 1900 and the end of World War II at a time when there was no treatment for tuberculosis at all. So the question is, you know, why did TB cases go away so much when there were no antibiotics to treat it and the answer of course is that general social conditions have so much to do with the spread of diseases in general and certainly tuberculosis. So people living in crowded housing conditions like we had and still have to a certain degree in tenements in the lower east side for example and there was lots of TB there. Malnutrition which is a close cousin of poverty is a real cause of tuberculosis and as those things improved in places like the United States and Western
Europe, TB cases went down quite a bit. The decline accelerated of course a lot after the introduction of antibiotics. But the fact that tuberculosis is such a epidemic around the world is a reminder of how little we’ve done to address just basic human conditions in so many parts of the world and now of course in certain parts of the world like southern Africa, TB is being fuelled by HIV and our inability to control that I think is also a reminder of how far we have to go in terms of social progress, not just progress in medical science. So I think it’s a very poignant disease and as I said really is a reminder of how far we’ve come in some places and how far we haven’t come in some other places. The failure to develop new diagnostic tools and new treatments for tuberculosis is also a reminder of the benefits and the costs of the system that we have for developing new tools like that. It’s a system that’s driven by markets, not always by human need and when you have a disease where 95% of the affected people live in developing countries there’s very little economic incentive for anybody to really do anything about it and so that’s the situation we have.
Recorded on: 04/25/2008