[0:00]They found the bones off the coast of Israel, in an ancient city long covered by the sea. The village was 9,000 years old, so old that the people who lived, died, and were buried there, didn't have basic technologies like pottery or the wheel. What they did have was tuberculosis. TB has followed us like a shadow for the entirety of human history. We found it in the lung tissue of Egyptian mummies, and references to it in the Bible, Vedic texts, and the work of Hippocrates. Infected seals appear to have carried it to South America long before the Columbian exchange. It is the closest thing humanity has to a biological nemesis. And in 1944, we found a cure.
[0:48]This series is brought to you by Child and Teen Checkups program. Every child needs a checkup at least once a year. If you live in Minnesota, they can help. Learn more at GetCTC.com. Though Robert Cock's tuberculin failed to become the cure doctors hoped for, by tuberculin's rollout in 1891, experts in other fields were already finding ways to combat tuberculosis. Cock's mistake was that he bought into the myth of the scientific genius. The idea that one man could destroy a malady with the strength of his intelligence. But in reality, that's not how science works in the modern world. In fact, it would take a team of scientists in different fields to cure the white plague, and an even larger group of non-scientists to implement that cure. Indeed, before Cock began working on tuberculosis, public health initiatives and medical technologies were already lowering the TB rate in Europe and North America. In cities where people lived close and had the highest rate of infection, health departments launched ad campaigns encouraging the public to cover their mouth when coughing or sneezing. They banned spatons and punished spitting on the street with a fine. Labor unions and reformers advocated for larger factory spaces so workers weren't crushed up against each other. Hospitals created separate TB wards to safeguard other patients. Doctors used new detection techniques like the stethoscope and the X-ray to identify cases early. And Cock's tuberculin, though a failure as a cure, flourished as a diagnostic test. And in 1908, a gathering of scientists determined that a type of tuberculosis called scrofula, which caused sores and lesions rather than lung infection, existed in cows. And could be passed to humans via milk. It turned out that briefly boiling the milk, in a process called pasteurization after Louis Pasteur, solved the problem. Unfortunately, public skepticism meant pasteurization wouldn't be widely accepted until World War II. But once implemented, scrofula rates plummeted. But this discovery of a link between bovine and human tuberculosis was exciting for another reason. It provided hope for a vaccine. After all, the first smallpox vaccine came from a similar situation where doctors inoculated patients with the less deadly cowpox in order to guard their systems against smallpox. The problem was that unlike cowpox, bovine tuberculosis was extremely deadly to humans. It took a French team 13 years to create a strain weak enough that it would build immunity in a subject without infecting them with full-blown TB. But the resulting vaccine, known as BCG, finally entered human trials in 1921. And it remains the most common tuberculosis vaccine to this day. But BCG was not a cure. It could guard an immune system for a decade, sure, but it couldn't help a patient after they got sick. To find that magical substance, science would have to delve into the most exotic and mysterious biological stew known to man. The dirt of New Jersey. Selman Waksman was a soil scientist at Rutgers, a professor who studied the biochemistry and microbiology of dirt. At first, he evaluated the microbes for possible agricultural purposes, but after the discovery of penicillin in 1928, he increasingly searched for antibiotics. A term he popularized that would prove effective against penicillin-resistant bacteria. He was essentially searching for microbes that would assassinate other microbes. Over four decades, Waksman and his team cultured 10,000 species of microbes from New Jersey dirt and other natural sources. Of those, only one was an effective antibiotic that could also be produced in sufficient quantity. Streptomycin. And tests in 1944 proved that streptomycin could kill tuberculosis. They kept it quiet at first. After all, everyone remembered what happened with Robert Cock and tuberculin. And he was one of the greatest medical minds in history. They kept the tests small and under tight controls, rolling it out slowly by trying it on troops returning from the war. But it was the British who proved its effectiveness with the world's first randomized clinical trial. A process that would become standard procedure for new drugs. Between 1946 and 1948, British doctors administered streptomycin to a group of random patients while comparing them to a control group with similar stages of tuberculosis. This plan came about not due to scientific rigor, but postwar belt tightening. The British government could only afford so much of the rare drug, and they wanted to make sure the data they got back from it was as clean as possible. But while the initial results looked good, once the treatment ran out, the patients taking streptomycin took a turn for the worse. They'd discovered a fact that would bedevil tuberculosis researchers for decades. Unless killed off completely, TB is extremely good at developing resistance to antibiotics. Luckily, the Swedish researchers, Jorgen Lehman and Carl Gustav Rosdal had synthesized an acid, PAS, that could inhibit the bacteria's metabolism. The British team tried using it on the resurgent microbes. It was the first combination drug therapy, and it worked. For the first time in human history, there was a cure for tuberculosis. And that discovery wasn't down to one brilliant scientist, it was a team effort. A fact highlighted in 1952, when Waksman received the Nobel Prize for Streptomycin, despite the fact that his student, Albert Schatz, had actually made the discovery. An ugly lawsuit ensued, eventually winning Schatz co-credit and royalties from the drug. Within a decade, a new battery of four anti-TB drugs had pushed streptomycin and PAS into the background. Things to be brought out when the frontline drugs failed. And it was important to have them in reserve, because despite having a cure in hand, tuberculosis revealed a certain stubbornness. It absolutely refused to die. Because to kill tuberculosis, and I mean really permanently kill it, a patient has to take a course of antibiotics that lasts weeks. In fact, they have to continue taking antibiotics even after they feel better, which is difficult, since the drugs themselves can have side effects ranging from nausea to hearing loss. Many patients quit, letting the microbe come roaring back, resistant to the antibiotics that treated it. Even when resistance isn't the problem, persistence can play a role. When antibiotics attack TB, the vast majority of microbes will die at a quick, steady rate, but a few will enter a kind of hibernation and persist, not immune, but waiting it out. Trixie, little buggers. Not to mention, the drugs themselves were expensive, meaning that while tuberculosis became rarer and rarer in the developed world, it still burned on in India, East Asia, Africa, and Latin America. And as patients received treatment, but didn't finish the course, more antibiotic resistant strains emerged. These strains required longer courses of treatment, some up to a year of doses totaling 20,000 pills and multiple approaches to make sure it died. These longer courses of antibiotics, along with hospitalization, might cost a million dollars per patient. But in the early 1980s, overseas charities and hospitals were making headway. For a brief moment, it seemed like the 10,000 year dream was possible. We could eradicate TB like we had smallpox. But two things changed the balance. Fast international travel, and AIDS. With a quick plane flight, drug resistant tuberculosis could spread to areas where it had been nearly wiped out, and where doctors had stopped screening for it. And with the rise of HIV-AIDS, it found a new immunocompromised subset of the population to infect. Particularly in places like South Africa where medical care was harder to obtain. The white plague once again threatened to become a fact of life. But there's no need to panic, and there's cause for hope. Currently, the World Health Organization, governments, and medical charities like the Bill and Melinda Gates Foundation are throwing resources into new low-cost diagnostic tests and improved vaccines. And there are new drugs in the testing phases that may help us combat these new antibiotic resistant strains. And local doctors are much more diligent about keeping TB on their radar when diagnosing patients. The battle between humanity and tuberculosis rages on. And beating it will be a team effort between governments, scientists, healthcare professionals, and you. In fact, the single biggest thing you can do to stop the spread of drug-resistant strains of, well, anything really, not just TB, is to make sure you finish a full course of antibiotics when you're sick. And look, we know that can suck. Actually, Rob wrote this while taking some pretty unfun antibiotics for bronchitis. But as much as he dislikes those pills, he's going to take all of them so the next person doesn't get infected with something worse. We've cured tuberculosis, but we still have to beat it. And that takes everyone, including you. So do your part and breathe easy, my friends. Once again, thanks so much to Child and Teen Checkups programs for sponsoring this series. Tuberculosis isn't as common as it once was, but it does still exist. Children should receive a health checkup every year, and doctors can ask questions to find out if your child is at risk. If you live in Minnesota, learn more at GetCTC.com. If you don't, click the link in the description below.
