From the age of 12, I knew of (and adored) the novelist John Green not only for his works of fiction, but for the YouTube channel he shared with his brother, Hank. Vlogbrothers, their personal channel, has amassed 3.89 million subscribers over the past 18 years. In addition to this channel, Hank and John created CrashCourse, which you may be familiar with if you’ve ever scrambled to the Tube right before an anatomy exam or after a history lecture you definitely didn’t pay attention to. CrashCourse was designed to help students learn and review all sorts of material; from teaching students concepts in philosophy and history to biology and physics, the Green brothers have always been passionate about educating.
If you’re a Green brothers fan like me, you might have noticed John’s recent obsession with tuberculosis (TB), an infectious (although curable) disease, in the past couple of years. At first, I found myself a bit confused by his deep interest- as well as disinterested, even as a future healthcare provider- and it wasn’t until this month when I picked up his newest book, Everything is Tuberculosis, that I understood.
What I’ve already said sums up most of what you need to know about TB: most people don’t care enough to know about it, and that’s a huge problem.
What is Tuberculosis (TB)?
According to the World Health Organization (WHO), tuberculosis is “an infectious disease caused by bacteria [known as Mycobacterium tuberculosis] that most often affects the lungs.” This definition refers to respiratory TB, which is marked by prolonged cough with or without blood, chest pain, fatigue, weight loss, and night sweats. TB can potentially infiltrate any organ system (from the bones of the skeleton to the renal tubules of the kidneys), but only respiratory TB is contagious, meaning it can be spread from person to person.
Mycobacterium tuberculosis can potentially infect anyone, but that doesn’t mean we all have an equal chance of suffering from active TB. The bacteria, although highly contagious, tends to remain latent in healthy, able-bodied people. However, those suffering from malnutrition, high levels of stress, diabetes mellitus, weakened immune system (usually from HIV or worm infection), and/or substance abuse (smoking/drinking excessively), are much more likely to develop an active, deadly form of the disease. Further, those living/working in tight, poorly-taken-care-of spaces are more likely to develop active TB*
Thankfully, there is a cure. Crafted and (kind of) perfected over decades of scientific discovery, we can now say that TB is 100% treatable.
And still, an estimated 10.8 million people fell ill with TB worldwide in 2023, and 1.25 million of those people died of the disease.
But why?
The Cure problem
Treatment for TB is a little more complicated than how you’d treat the average bacterial infection. According to Mayo Clinic, active TB can take anywhere from four to nine months to treat and consists of taking a cocktail of drugs each day (a practice which is, for some patients, monitored by a healthcare provider daily). The most common of these are the RIPE drugs (Rifampin, Isoniazid, Pyrazinamide, and Ethambutol), a combination of antibiotics that have been used to treat TB since the 1970s. Not only is this regimen strict- as with any antibiotic, they must be finished and never skipped- but it can lead to some horrible side effects; vomiting, loss of appetite, jaundice, joint pain, depression, and unexplained tiredness are all common symptoms of TB treatment, on top of the already debilitating cough and fever caused by the disease.
That being said, active TB isn’t hard to treat, mostly just time consuming. The real issue we’re seeing is access to treatment. In third-world countries, including Sierra Leone, which Green explores thoroughly in his novel, access not only to these drugs but to diagnostic tools is extremely limited. So, not only are cases of TB going undiagnosed and untreated, they are being made worse.
Drug-Resistant TB
Drug-resistant TB occurs when a patient is unable to follow through with their treatment regimen, resulting in the bacteria inside of them becoming “immune” to the treatment, taking on an even deadlier form that requires newer, specialized drugs to combat. Drug-resistant TB comes in many forms, all of which are caused by a singular, catastrophic issue: the unfair distribution of antibiotics for TB in third-world countries has given these populations enough drugs to begin treatment but has not addressed the inaccessibility of treatment for those living in poverty.
Whether it be commuting to the clinic each day, paying for treatment, or dealing with the social stigma that accompanies a TB diagnosis, there are many socioeconomic factors that prevent someone from completing treatment, especially in countries that do not have well-funded, well-supported healthcare systems. Therefore, drug-resistant TB becomes an even greater risk for these communities. Looking back at the risk factors for TB, it is no surprise that those living in poverty, where air is shared and nutrition is scarce, are being overwhelmed with cases of drug-resistant TB.
We Americans have plenty of ways to screen for, diagnose, and treat drug-resistant TB. But as Green put it, “The cure is where the disease is not”.
These diagnostic tools and tailored drugs are not made accessible in countries like Sierra Leone, and when they are, they are seldom affordable (despite being fairly cheap to make). Because of this, we see an undeniably high number of deaths due to TB in third world populations. Preventable, unnecessary, deaths.
Why medicine?
“Why medicine?” is a question that crosses my mind nearly every day. I often find myself swamped with assignments to do, papers to write, and textbooks to read. I find myself doubting my own capabilities, wondering if all of the struggle to become a doctor is worth it. but Green’s novel is a reminder of exactly why I chose medicine, even if I hadn’t known it at the time I declared my major.
Our world is full of death and suffering that does not have to exist. Sickness that shouldn’t exist. I’ve spent the entirety of my life wanting to help others. I feel so deeply that this is my calling, and I have never been more excited about the future. And what a privilege it is to say that- to be excited about the future- to be in such good health that I can talk about such a thing without fearing the possibility of death.
I want to be a part of the generation who helped to create a healthier world, one where poor socioeconomic status is not equivalent to poor health. Where doctors do not see their patients for their disease, but for their humanity.
The fight against TB is not hopeless. As a country rich in resources, it is our responsibility not only to spread awareness of the toll tuberculosis is taking on third-world countries, but to actively participate in these countries’ treatment plans.
America’s involvement in global health is changing rapidly, and it is our duty to ensure that change is a humane one.
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I would highly recommend John Green’s Everything is Tuberculosis to everyone, whether you are planning a future in healthcare or merely passionate about humanity. On top of informing me about the “history and persistence” (as Green put it) of TB, this book has taught me so much about who I am and who I want to be.
*For further background information on the causes, signs/symptoms, prevention and treatment of TB, there are numerous sources online; however, I’ve found the CDC’s website to be most helpful, especially for those not well versed in healthcare lingo.