Editing Tuberculosis (section)

== Society and culture ==

=== Names ===

Tuberculosis has been known by many names from the technical to the familiar.<ref name="Lawlor" /> {{Lang|grc-latn|Phthisis}} ({{Lang|grc|φθίσις}}) in ancient Greek translates to ''decay'' or ''wasting disease'', presumed to refer to pulmonary tuberculosis;<ref>{{Citation |title=φθίσις |date=2025-02-26 |work=Wiktionary, the free dictionary |url=https://en.m.wiktionary.org/wiki/%CF%86%CE%B8%CE%AF%CF%83%CE%B9%CF%82 |access-date=2025-04-16 |language=en}}</ref> around 460 BCE, [[Hippocrates]] described phthisis as a disease of dry seasons.<ref>{{cite web |title=Hippocrates 3.16 Classics, MIT |url=https://classics.mit.edu/Hippocrates/aphorisms.mb.txt |access-date=15 December 2015 |archive-url=https://web.archive.org/web/20050211173218/http://classics.mit.edu/Hippocrates/aphorisms.mb.txt |archive-date=11 February 2005}}</ref> The abbreviation ''TB'' is short for ''tubercle [[Bacillus (shape)|bacillus]]''. ''Consumption'' was the most common nineteenth century English word for the disease, and was also in use well into the twentieth century.<ref name="Chambers_1998" /> The Latin root {{Lang|la|con}} meaning 'completely' is linked to {{Lang|la|sumere}} meaning 'to take up from under'.<ref>{{cite book| vauthors = Caldwell M |title=The Last Crusade|date=1988|publisher=Macmillan|location=New York|isbn=978-0-689-11810-4|page=[https://archive.org/details/isbn_9780689118104/page/21 21]|url-access=registration|url=https://archive.org/details/isbn_9780689118104/page/21}}</ref> In ''[[The Life and Death of Mr Badman]]'' by [[John Bunyan]], the author calls consumption "the captain of all these men of death."<ref>{{cite book| vauthors = Bunyan J |date=1808 |title=The Life and Death of Mr. Badman|url=https://archive.org/details/lifeanddeathmrb01bunygoog |quote=captain. |page=[https://archive.org/details/lifeanddeathmrb01bunygoog/page/n238 244] |location=London |publisher=W. Nicholson |via=Internet Archive |access-date=28 September 2016}}</ref> "Great white plague" has also been used.<ref name="Lawlor" />

=== Art and literature ===

[[File:Munch Det Syke Barn 1885-86.jpg|thumb|Painting ''[[The Sick Child (Munch)|The Sick Child]]'' by [[Edvard Munch]], 1885–1886, depicts the illness of his sister Sophie, who died of tuberculosis when Edvard was 14; his mother also died of the disease.]]
{{main|Cultural depictions of tuberculosis}}

Tuberculosis was for centuries associated with [[poet]]ic and [[art]]istic qualities among those infected, and was also known as "the romantic disease".<ref name="Lawlor">{{cite web| vauthors = Lawlor C |title=Katherine Byrne, Tuberculosis and the Victorian Literary Imagination|url=http://www.bsls.ac.uk/reviews/romantic-and-victorian/katherine-byrne-tuberculosis-and-the-victorian-literary-imagination/|publisher=British Society for Literature and Science|access-date=11 June 2017|archive-date=6 November 2020|archive-url=https://web.archive.org/web/20201106070752/http://www.bsls.ac.uk/reviews/romantic-and-victorian/katherine-byrne-tuberculosis-and-the-victorian-literary-imagination/|url-status=live}}</ref><ref>{{cite book | vauthors = Byrne K | title=Tuberculosis and the Victorian Literary Imagination |publisher=Cambridge University Press |year=2011 |isbn=978-1-107-67280-2}}</ref> Major artistic figures such as the poets [[John Keats]], [[Percy Bysshe Shelley]], and [[Edgar Allan Poe]], the composer [[Frédéric Chopin]],<ref>{{cite web|title=About Chopin's illness|url=http://www.iconsofeurope.com/chopin.tuberculosis.htm|publisher=Icons of Europe|access-date=11 June 2017|archive-date=28 September 2017|archive-url=https://web.archive.org/web/20170928150213/http://www.iconsofeurope.com/chopin.tuberculosis.htm|url-status=live}}</ref> the playwright [[Anton Chekhov]], the novelists [[Franz Kafka]], [[Katherine Mansfield]],<ref>{{cite journal | vauthors = Vilaplana C | title = A literary approach to tuberculosis: lessons learned from Anton Chekhov, Franz Kafka, and Katherine Mansfield | journal = International Journal of Infectious Diseases | volume = 56 | pages = 283–85 | date = March 2017 | pmid = 27993687 | doi = 10.1016/j.ijid.2016.12.012 | doi-access = free }}</ref> [[Charlotte Brontë]], [[Fyodor Dostoevsky]], [[Thomas Mann]], [[W. Somerset Maugham]],<ref>{{cite book |vauthors=Rogal SJ |title=A William Somerset Maugham Encyclopedia |url=https://books.google.com/books?id=H0MqigagKTkC&pg=PA245 |year=1997 |publisher=Greenwood Publishing |isbn=978-0-313-29916-2 |page=245 |access-date=4 October 2017 |archive-date=2 June 2021 |archive-url=https://web.archive.org/web/20210602212607/https://books.google.com/books?id=H0MqigagKTkC&pg=PA245 |url-status=live }}</ref> [[George Orwell]],<ref>{{cite web | vauthors = Eschner K |title=George Orwell Wrote '1984' While Dying of Tuberculosis |url=https://www.smithsonianmag.com/smart-news/george-orwell-wrote-1984-while-dying-tuberculosis-180962608/ |website=Smithsonian |access-date=25 March 2019 |archive-date=24 March 2019 |archive-url=https://web.archive.org/web/20190324161820/https://www.smithsonianmag.com/smart-news/george-orwell-wrote-1984-while-dying-tuberculosis-180962608/ |url-status=live }}</ref> and [[Robert Louis Stevenson]], and the artists [[Alice Neel]],<ref>{{cite journal |journal=Journal of the American Medical Association |url=http://jamanetwork.com/journals/jama/issue/293/22 |page=cover |date=8 June 2005 |volume=293 |issue=22 |title=Tuberculosis (whole issue) |access-date=4 October 2017 |archive-date=24 August 2020 |archive-url=https://web.archive.org/web/20200824105736/https://jamanetwork.com/journals/jama/issue/293/22 |url-status=live }}</ref> [[Jean-Antoine Watteau]], [[Elizabeth Siddal]], [[Marie Bashkirtseff]], [[Edvard Munch]], [[Aubrey Beardsley]] and [[Amedeo Modigliani]] either had the disease or were surrounded by people who did. A widespread belief was that tuberculosis assisted artistic talent. Physical mechanisms proposed for this effect included the slight fever and toxaemia that it caused, allegedly helping them to see life more clearly and to act decisively.<ref>{{cite journal |vauthors=Lemlein RF |s2cid=191371443 |title=Influence of Tuberculosis on the Work of Visual Artists: Several Prominent Examples |journal=Leonardo |date=1981 |volume=14 |issue=2 |pages=114–11 |jstor=1574402 |doi=10.2307/1574402 }}</ref><ref>{{cite thesis | vauthors = Wilsey AM | title = 'Half in Love with Easeful Death:' Tuberculosis in Literature | date = May 2012 | work = Humanities Capstone Projects | degree = PhD Thesis | publisher = Pacific University | ref = Paper 11 | url = http://commons.pacificu.edu/cgi/viewcontent.cgi?article=1010&context=cashu | access-date = 28 September 2017 | archive-url = https://web.archive.org/web/20171011220904/http://commons.pacificu.edu/cgi/viewcontent.cgi?article=1010&context=cashu | archive-date = 11 October 2017 }}</ref><ref name="Morens2002">{{cite journal | vauthors = Morens DM | title = At the deathbed of consumptive art | journal = Emerging Infectious Diseases | volume = 8 | issue = 11 | pages = 1353–8 | date = November 2002 | pmid = 12463180 | pmc = 2738548 | doi = 10.3201/eid0811.020549 }}</ref>

Tuberculosis formed an often-reused theme in [[literature]], as in [[Thomas Mann]]'s ''[[The Magic Mountain]]'', set in a [[sanatorium]];<ref>{{cite web |url=http://hsl.mcmaster.libguides.com/c.php?g=306775&p=2045587 |title=Pulmonary Tuberculosis/In Literature and Art| publisher=McMaster University History of Diseases |access-date=9 June 2017}}</ref> in [[music]], as in [[Van Morrison]]'s song "[[T.B. Sheets]]";<ref>{{cite news| vauthors = Thomson G |title=Van Morrison – 10 of the best|url=https://www.theguardian.com/music/musicblog/2016/jun/01/van-morrison-10-of-the-best|work=[[The Guardian]]|date=1 June 2016|access-date=28 September 2017|archive-date=14 August 2020|archive-url=https://web.archive.org/web/20200814152313/https://www.theguardian.com/music/musicblog/2016/jun/01/van-morrison-10-of-the-best|url-status=live}}</ref> in [[opera]], as in [[Giacomo Puccini|Puccini]]'s ''[[La bohème]]'' and [[Giuseppe Verdi|Verdi]]'s ''[[La Traviata]]'';<ref name="Morens2002" /> in [[art]], as in [[Edvard Munch|Munch]]'s painting of his ill sister;<ref>{{cite web|title=Tuberculosis Throughout History: The Arts|url=https://www.usaid.gov/sites/default/files/documents/1864/art_poster.pdf|publisher=[[United States Agency for International Development]] (USAID)|access-date=12 June 2017|archive-date=30 June 2017|archive-url=https://web.archive.org/web/20170630123411/https://www.usaid.gov/sites/default/files/documents/1864/art_poster.pdf}}</ref> and in [[film]], such as the 1945 ''[[The Bells of St. Mary's]]'' starring [[Ingrid Bergman]] as a nun with tuberculosis.<ref>{{Cite magazine | vauthors = Corliss R |title=Top 10 Worst Christmas Movies |magazine=Time |url=https://entertainment.time.com/2011/12/20/top-10-worst-christmas-movies/ |date=22 December 2008 |quote='If you don't cry when Bing Crosby tells Ingrid Bergman she has tuberculosis', Joseph McBride wrote in 1973, 'I never want to meet you, and that's that.' |access-date=28 September 2017 |archive-date=22 September 2020 |archive-url=https://web.archive.org/web/20200922042323/https://entertainment.time.com/2011/12/20/top-10-worst-christmas-movies/ |url-status=live }}</ref>

=== Folklore ===
In 19th century New England, tuberculosis deaths were associated with [[vampire]]s. When one member of a family died from the disease, the other infected members would lose their health slowly. People believed this was caused by the original person with TB draining the life from the other family members.<ref>{{cite journal |vauthors=Sledzik PS, Bellantoni N |date=June 1994 |title=Brief communication: bioarcheological and biocultural evidence for the New England vampire folk belief |url=http://www.yorku.ca/kdenning/+++2150%202007-8/sledzik%20vampire.pdf |url-status=live |journal=American Journal of Physical Anthropology |volume=94 |issue=2 |pages=269–74 |doi=10.1002/ajpa.1330940210 |pmid=8085617 |archive-url=https://web.archive.org/web/20170218082115/http://www.yorku.ca/kdenning/+++2150%202007-8/sledzik%20vampire.pdf |archive-date=18 February 2017}}</ref>

=== Law ===
Some countries{{Which|date=May 2025}} have legislation to involuntarily detain or examine those suspected to have tuberculosis, or [[Involuntary treatment|involuntarily treat]] them if infected.<ref>{{cite journal |vauthors=Coker R, Thomas M, Lock K, Martin R |date=2007 |title=Detention and the evolving threat of tuberculosis: evidence, ethics, and law |journal=The Journal of Law, Medicine & Ethics |volume=35 |issue=4 |pages=609–15, 512 |doi=10.1111/j.1748-720X.2007.00184.x |pmid=18076512 |s2cid=19924571}}</ref>

=== Public health efforts ===
In 2012, The World Health Organization (WHO), the [[Bill and Melinda Gates Foundation]], and the U.S. government subsided a fast-acting diagnostic tuberculosis test, [[GeneXpert MTB/RIF|Xpert MTB/RIF]], for use in low- and middle-income countries.<ref>{{cite web |date=6 August 2012 |title=Public–Private Partnership Announces Immediate 40 Percent Cost Reduction for Rapid TB Test |url=https://www.who.int/tb/features_archive/GeneXpert_press_release_final.pdf |url-status=live |archive-url=https://web.archive.org/web/20131029234310/http://www.who.int/tb/features_archive/GeneXpert_press_release_final.pdf |archive-date=29 October 2013 |publisher=World Health Organization (WHO)}}</ref><ref>{{cite journal | vauthors = Lawn SD, Nicol MP | title = Xpert® MTB/RIF assay: development, evaluation and implementation of a new rapid molecular diagnostic for tuberculosis and rifampicin resistance | journal = Future Microbiology | volume = 6 | issue = 9 | pages = 1067–82 | date = September 2011 | pmid = 21958145 | pmc = 3252681 | doi = 10.2217/fmb.11.84 }}</ref><ref>{{cite news |url=https://www.reuters.com/article/idUSTRE6B71RF20101208 |title=WHO says Cepheid rapid test will transform TB care |work=[[Reuters]] |date=8 December 2010 |url-status=live |archive-url=https://web.archive.org/web/20101211140847/http://www.reuters.com/article/idUSTRE6B71RF20101208 |archive-date=11 December 2010 }}</ref> This is a rapid molecular test used to diagnose TB and simultaneously detect rifampicin resistance. It provides results in about two hours, which is much faster than traditional TB culture methods. The test is designed for use with the [[Cepheid (company)|GeneXpert]] System.<ref name="CDC_Xpert_2024">{{Cite web |date=2024-04-29 |title=Xpert MTB/RIF Assay - A Tool to Diagnose Tuberculosis |url=https://www.cdc.gov/tb/php/laboratory-information/xpert-mtb-rif-assay.html |access-date=2025-04-15 |website=Centers for Disease Control and Prevention |language=en-us}}</ref>

A 2014 [[Economist Intelligence Unit|EIU]]-healthcare report finds there is a need to address apathy and urges for increased funding. The report cites among others Lucica Ditui "[TB] is like an orphan. It has been neglected even in countries with a high burden and often forgotten by donors and those investing in health interventions."<ref name="Kielstra-2014"/>

Slow progress has led to frustration, expressed by the executive director of the [[Global Fund to Fight AIDS, Tuberculosis and Malaria]] – Mark Dybul: "we have the tools to end TB as a pandemic and public health threat on the planet, but we are not doing it."<ref name="Kielstra-2014"/> Several international organizations are pushing for more transparency in treatment, and more countries are implementing mandatory reporting of cases to the government as of 2014, although adherence is often variable. Commercial treatment providers may at times overprescribe second-line drugs as well as supplementary treatment, promoting demands for further regulations.<ref name="Kielstra-2014"/>

The government of Brazil provides universal TB care, which reduces this problem.<ref name="Kielstra-2014"/> Conversely, falling rates of TB infection may not relate to the number of programs directed at reducing infection rates but may be tied to an increased level of education, income, and health of the population.<ref name="Kielstra-2014"/> Costs of the disease, as calculated by the [[World Bank]] in 2009 may exceed US$150&nbsp;billion per year in "high burden" countries.<ref name="Kielstra-2014"/> Lack of progress eradicating the disease may also be due to lack of patient follow-up – as among the 250 million [[migration in China|rural migrants in China]].<ref name="Kielstra-2014"/>

There is insufficient data to show that active contact tracing helps to improve case detection rates for tuberculosis.<ref>{{cite journal | vauthors = Fox GJ, Dobler CC, Marks GB | title = Active case finding in contacts of people with tuberculosis | journal = The Cochrane Database of Systematic Reviews | issue = 9 | pages = CD008477 | date = September 2011 | volume = 2011 | pmid = 21901723 | pmc = 6532613 | doi = 10.1002/14651858.CD008477.pub2 }}</ref> Interventions such as house-to-house visits, educational leaflets, mass media strategies, educational sessions may increase tuberculosis detection rates in short-term.<ref>{{cite journal | vauthors = Mhimbira FA, Cuevas LE, Dacombe R, Mkopi A, Sinclair D | title = Interventions to increase tuberculosis case detection at primary healthcare or community-level services | journal = The Cochrane Database of Systematic Reviews | volume = 2017 | pages = CD011432 | date = November 2017 | issue = 11 | pmid = 29182800 | pmc = 5721626 | doi = 10.1002/14651858.CD011432.pub2 | collaboration = Cochrane Infectious Diseases Group }}</ref> There is no study that compares new methods of contact tracing such as social network analysis with existing contact tracing methods.<ref>{{cite journal | vauthors = Braganza Menezes D, Menezes B, Dedicoat M | title = Contact tracing strategies in household and congregate environments to identify cases of tuberculosis in low- and moderate-incidence populations | journal = The Cochrane Database of Systematic Reviews | volume = 2019 | pages = CD013077 | date = August 2019 | issue = 8 | pmid = 31461540 | pmc = 6713498 | doi = 10.1002/14651858.CD013077.pub2 | collaboration = Cochrane Infectious Diseases Group }}</ref>

=== Stigma ===

Slow progress in preventing the disease may in part be due to [[social stigma|stigma]] associated with TB.<ref name="Kielstra-2014"/> Stigma may be due to the fear of transmission from affected individuals. This stigma may additionally arise due to links between TB and poverty, and in [[AIDS in Africa|Africa, AIDS]].<ref name="Kielstra-2014"/> Such stigmatization may be both real and perceived; for example, in Ghana, individuals with TB are banned from attending public gatherings.<ref name="Courtwright-2010">{{cite journal | vauthors = Courtwright A, Turner AN | title = Tuberculosis and stigmatization: pathways and interventions | journal = Public Health Reports | volume = 125 | issue = 4_suppl | pages = 34–42 | date = Jul–Aug 2010 | pmid = 20626191 | pmc = 2882973 | doi = 10.1177/00333549101250S407 }}</ref>

Stigma towards TB may result in delays in seeking treatment,<ref name="Kielstra-2014"/> lower treatment compliance, and family members keeping cause of death secret<ref name="Courtwright-2010"/> – allowing the disease to spread further.<ref name="Kielstra-2014"/> In contrast, in Russia stigma was associated with increased treatment compliance.<ref name="Courtwright-2010"/> TB stigma also affects socially marginalized individuals to a greater degree and varies between regions.<ref name="Courtwright-2010"/>

One way to decrease stigma may be through the promotion of "TB clubs", where those infected may share experiences and offer support, or through counseling.<ref name="Courtwright-2010"/> Some studies have shown TB education programs to be effective in decreasing stigma, and may thus be effective in increasing treatment adherence.<ref name="Courtwright-2010"/> Despite this, studies on the relationship between reduced stigma and mortality are lacking {{as of|2010|lc=yes}}, and similar efforts to decrease stigma surrounding AIDS have been minimally effective.<ref name="Courtwright-2010"/> Some have claimed the stigma to be worse than the disease, and healthcare providers may unintentionally reinforce stigma, as those with TB are often perceived as difficult or otherwise undesirable.<ref name="Kielstra-2014"/> A greater understanding of the social and cultural dimensions of tuberculosis may also help with stigma reduction.<ref>{{cite journal | vauthors = Mason PH, Roy A, Spillane J, Singh P | title = Social, Historical and Cultural Dimensions of Tuberculosis | journal = Journal of Biosocial Science | volume = 48 | issue = 2 | pages = 206–32 | date = March 2016 | pmid = 25997539 | doi = 10.1017/S0021932015000115 | doi-access = free }}</ref>