The contrast between the developed and developing worlds in the impact
and management of tuberculosis shows how far therapies have advanced and
how potent they can be if they are implemented successfully. A century
ago, tuberculosis posed substantial challenges even to wealthy
countries. Thomas Mann's opus The Magic Mountain, set in an affluent
sanatorium in the Swiss Alps before World War I, vividly illustrates the
passivity of tuberculosis treatment before the advent of effective
pharmacologic agents. Mann describes not only the cutting-edge therapies
of the day — enforced rest, fresh air, morning walks, and even
artificial pneumothoraxes — but also the peculiar psychological
ecosystem of a community of people placed in constant close contact by a
chronic and unremitting disease. The deaths of the sanatorium's
inhabitants, either from slow, progressive consumption or from rapid,
massive hemoptysis, repeatedly remind the others of their own mortality.
Mann takes a philosophical lesson from tuberculosis, musing that "[life
is] the existence of what, in actuality, has no inherent ability to
exist, but only balances with sweet, painful precariousness on one point
of existence in the midst of this feverish, interwoven process of decay
and repair."

Life with tuberculosis in India today seems similarly precarious. Nearly
a century later — and 50 years after the development of effective
treatments — India has lagged far behind developed countries in the
containment and management of the disease. Despite the laudable progress
that has been made in India in the 60 years since its independence, it
remains challenged in fundamental ways. Social stigma often discourages
people from seeking treatment for months, and when they do seek it,
treatment is administered on an outpatient basis, since isolating
otherwise functional people is rarely feasible. The treatment of latent
tuberculosis with 9 months of single-drug therapy (the norm in the
United States) is a concept found only in textbooks in India. If it were
implemented, nearly a tenth of the population would require treatment.