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A researcher provides a firsthand look at a prolific killer

Catching Breath: The Making and Unmaking of Tuberculosis

Kathryn Lougheed
Bloomsbury Sigma,
2017
272 pp.
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In 2015, tuberculosis (TB) claimed about 1.8 million lives. An estimated 10.4 million new cases were diagnosed in that year, 1.2 million of which were in people coinfected with HIV. At least half a million cases showed varying levels of drug resistance, making treatment a greater ordeal for patients and vastly increasing the costs. If the ambitious goals of the World Health Organization’s 2015 “End TB Strategy”—to reduce deaths caused by TB by 95% and to reduce the incidence rate by 90%—are to be realized by their target date of 2035, all help offered will be gratefully received.

The fact that not everyone is aware of these daunting figures underwrites former TB scientist turned science writer Kathryn Lougheed’s first book, Catching Breath. Lougheed sets out the statistics calmly but returns to their enormity as she delivers on her aim to raise the profile of this prolific killer.

The most common form of tuberculosis is pulmonary TB, but it can affect all the major internal organs, skin, and bones. Not all who are infected will become ill, but for those who do succumb, the typical symptoms are fever with night sweats, weight loss, fatigue, and a persistent cough.

Mycobacterium tuberculosis has long been a fellow traveller with humanity. Ancient DNA reveals that people were dying of the disease at least 9000 years ago. As we have learned more about our intertwined evolutionary history, it has become clearer why it presents the challenges it does. Cheap and reliable diagnostic tests that can be employed in resource-poor settings, vaccinations to prevent adult pulmonary TB, and new, less toxic drug treatments remain to be found.

REUTERS/YUSUF AHMAD

A woman suspected to be infected with tuberculosis awaits treatment in Makassar, Indonesia.

Lougheed captures the past 20 years or so of TB research with an insider’s eye. She has sought out many at the forefront of the field, such as Koen Andries, who recently developed a new diarylquinoline-based drug. Licensed by the FDA in 2012 for the treatment of multidrug-resistant TB, bedaquiline is the only drug with a novel mechanism of action introduced since 1974. “When I tell the story about the development of bedaquiline, I call it a rocky road,” Andries tells her. “There were really big rocks on the road.” It’s stimulating to learn from these experts in the first person, but a little frustrating that the book has no bibliography.

Among the potential game-changing shifts in TB science in recent years is the move to look beyond uniform laboratory cultures of M. tuberculosis. In the real world, research has shown that infected lungs often come to house subtly disparate groups of bacilli in the characteristic lesions. These groups opportunistically develop after the original infection and may respond differently to drugs.

To her great credit, Lougheed reports negative as well as positive results, presenting current science in the round, and not as a neatly constructed fiction of linear progress. She frames the recent disappointment of a large vaccine trial in South Africa as an opportunity to think differently about the targets of other vaccines, for example.

Since WHO declared TB a global emergency in 1993, there has been a substantial investment in research that seeks to treat and prevent the disease around the world. But there are limits to buying more science. If the political will to close the health gap of the world’s disadvantaged TB sufferers is lacking, little progress will likely be achieved.

At one point, Lougheed makes the surprisingly candid admission that, as a young scientist in the laboratory, she was apt to forget that the aim of her work was not to achieve scientific goals but to extend “compassion for everyone living on our small, interconnected planet.” It can be easy to lose sight of the ultimate goal when one is focused on achieving the means to an end.

The book mainly steers clear of policy issues, which can easily sound preachy if a writer is not careful. Lougheed keeps her comments here brief, touching only lightly on “the complicated problem of global resources and cost-effectiveness of health interventions.”

She wields patient voices effectively, tempering what might otherwise come off as voyeurism with a commitment to show that there is hope. Similarly, she strives to lighten an inherently gloomy topic with personal anecdotes and jokes. I only wish these had been funnier.

Were I her editor, I would have requested that Lougheed swap some of the less-focused details about herself, her partner, and her daughter—charming as they are—for richer explanations of scientific terms and techniques. Why? Because, ultimately, it is the fascinating pathogen and its deadly interactions with its host that fuel Lougheed’s book. Through her passion, many others may find inspiration.

About the author

The reviewer is a freelance historian of medicine and science located in Suffolk, UK.