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Constellations of Pulmonary Citizenship

Presented at the Biopolitics of Science and Medicine Symposium, Friday 29th November 2013.

Paul Mason

on 29 September 2015

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Transcript of Constellations of Pulmonary Citizenship

Constellations of


From Consumption to Tuberculosis
The discovery of microorganisms that caused the white plague gave rise to the notion that these microorganisms must be eliminated wherever they might be and the body must be strengthened to fight against them.
Emergence of reforms to people's morality, sociability, sexuality and daily habits with a focus on hygienic participation in the world
Increasing medicalisation bolstered by fears of contagion.
Hygiene was not just an imperative,
it was a right.
From sanatoria to DOTS
From surveillance of Tuberculars in treatment centres to surveillance of individuals in daily lives.
Loss of community among people with Tuberculosis

is a complex disease that involves biological, genetic, physical, social, political and economic factors. The World Health Organisation estimates that 2 billion people have been exposed to Mycobacterium tuberculosis and carry a latent infection, while an estimated 10% of these people have an active Tuberculosis disease. While the active disease is curable, the treatment is lengthy and not without complications. Lack of adherence to treatment and co-infection with HIV/AIDS is thought to have contributed to multi-drug resistant and extremely drug resistant strains of the disease. In addition to 0.43 million HIV-associated Tuberculosis deaths in 2011, between 1.3 and 1.6 million deaths from Mycobacterium tuberculosis alone makes Tuberculosis second only to HIV/AIDS as the greatest killer worldwide due to a single infectious disease. Sadly, 95% of cases and deaths occur in the developing world. Of 22 high-burden countries for Tuberculosis, nine are in Sub-Saharan Africa, six are in Southeast Asia, and the remaining seven are in North Asia, South Asia and South America. From people with a latent Tuberculosis infection to people with active Tuberculosis disease and those with co-infection, this paper will examine the constellations of pulmonary citizenship forged by social stigma, medicalisation, and treatment surveillance.
Paul H. Mason, Woolcock Institute of Medical Research
Drug Susceptible TB
Current Therapy:
4 drugs >6 month therapy

Unmet Needs:
shorter simpler therapy
TB/HIV co-infection
Current Therapy
: drug-drug interactions with HIV medications
Unmet Needs
: ability to co-administer TB regimens with ARVs
Drug Resistant TB
Current Therapy:
few effective drugs,
injectable, toxicity, >5yrs
Unmet Needs
: oral, shorter, more efficacious, safer and lower cost therapy

Latent TB infection
Current Therapy:
6-9 months of treatment

Unmet Needs:
shorter, safer preventive therapy
Current Therapy:
makeshift use of
inappropriate formulations

Unmet Needs:
formulations with correct closing
For example:
1. Gender
2. Stigma
3. Resources: Educational & Material
According to the medical model....

BUT, these categories of Tubercular experience are bifurcated by dynamic social processes...
Vietnam is 1 of 22 countries with a high-burden of Tuberculosis
Together with local partners, Woolcock researchers commenced a 5-year study in 2010 to test the effectiveness of active case finding in contacts of patients with smear positive pulmonary tuberculosis, to estimate the cost-effectiveness of this strategy, and to examine the factors that influence the effectiveness.

Social Histories of Tuberculosis
Diego Armus (2011) The Ailing City: Health, Tuberculosis, and Culture in Buenos Aires, 1870-1950, Durham and London: Duke University Press.
Marc Arnold (2012) Disease, Class and Social Change: Tuberculosis in Folkestone and Sandgate, 1880-1930, Newcastle upon Tyne: Cambridge Scholars Publishing.
Barbara Bates (1992) Bargaining for Life: A Social History of Tuberculosis, 1876-1938, Philadelphia: University of Pennsylvania Press.
Helen Bynum (2012) Spitting Blood: The History of Tuberculosis, Oxford: Oxford University Press.
Mark Caldwell (1988) The Last Crusade: The War on Consumption, 1862-1954, New York: Atheneum.
Gillian Cronje (1984) Tuberculosis and Mortality Decline in England and Wales, 1851-1919, in Robert Woods and John Woodward, Eds., Urban Disease and Mortality in Nineteenth Century England, New York: St. Martin's Press.
Antonio Villanueva Edo (1984) Historia social de la tuberculosis en Bizkaia, Bilbao: Diputacion Foral de Bizkaia.
Claudio Bertolli Filho (2001) Historia social da tuebrculose e do tuberculoso: 1900-1950, Rio de Janeiro: Editora Fiocruz.
Debbie Futter-Puati, Linda Bryder, Julie Park, Judith Littleton, Phyllis Herda (2014) Partnerships for health: Decimating tuberculosis in the Cook Islands, 1920–1975 Original Research Article, 25, 10-18.
Isabelle Grellet and Caroline Krause (1983) Histoires de la tuberculose: Les fievres de l'ame: 1800-1940, Paris: Ramsay.
Antonio Pereira Loza (1999) La paciencia al sol: Histira social de la tuberculosis en Galicia, 1900-1950, A Coruna: do Castro.
Jorge Molero Mesa (1989) Historia de la tuberculosis en Espana, 1889-1936, Granada: University of Granada.
Francis Barrymore Smith (1988) The Retreat of Tuberculosis, 1850-1950, London: Croom Helm.
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