Introduction

Although unpalatable to consider, we are at a watershed in the history of the control of tuberculosis (Fauci, 2007). The progressive increase of resistance of tuberculosis (TB) to pharmacotherapy has raised the possibility of a response to tuberculosis without medications, in essence returning us to the situation as it was in the 19th century or, as some have posited, the dawn of the post-antibiotic age (Raviglione, 2006). The combination of high rates of TB infection with high seropositivity rates for HIV in sub-Saharan Africa has raised the ante of global tuberculosis control.

It is instructive to note that from almost any perspective, tuberculosis is one of the most well-understood diseases in all of medicine. Understanding tuberculosis has been important historically, in constituting the very notion of causality in biology and medicine. Robert Koch explained the concept of infectious diseases and stated his famous postulates largely on the basis of the study of tuberculosis. Our concept of clinical causality is rooted in randomised clinical trials, of which one of the first and most influential was the UK Medical Research Council's streptomycin trial for the treatment of tuberculosis (MRC, 1948), From Hippocrates to the present day, much of our understanding of clinical medicine, bedside lore, and the signs, symptoms and phenomenology of disease arise from our collective experience of tuberculosis.

Knowledge of the disease is extensive in a multitude of dimensions (Verma et al, 2004). We know its genetic fingerprints and its mechanism of resistance at the molecular level. The social determinants of the disease, rooted in poverty, adverse living conditions, and social disadvantage, are not contested (Benatar, 2001). The social consequences of stigma and how these vary from culture to culture are also well characterised (Croft and Croft, 1998; Rajeswari et al, 1999; Khan et al, 2000).