Econstudentlog

Tuberculosis

Khan Academy has, in collaboration with Stanford School of Medicine, made 15 videos about the disease (so far) with a total duration of two hours and 37 minutes – you can watch all of them here. There’s some overlap here and there, different videos covering similar stuff, and a lot of details are left out. But this is still good stuff and the videos were an enjoyable part of my day yesterday. I know I’ve covered this disease before, but given how many people have been exposed and how important it was in the past (roughly one hundred years ago one sixth of all French deaths were due to this disease), this is arguably a disease you should at least have some knowledge about. Some samples from the playlist below:

Note that the spelling is off in that video; it’s Ghon focus and Ghon’s complex, not Gohn -ll- …

A quote from the last video above: “DOT – Directly Observed Therapy – is very important.”

There are theoretical reasons why DOT may be useful/efficient, as mentioned in the video. And I’ve seen it argued elsewhere that “treating tuberculosis with the DOTS strategy is highly cost-effective” [DOTS means “directly observed therapy, short course” – which is a specific type of DOT therapy; “a comprehensive tuberculosis management programme that focuses on low-income countries.” (see the Cochrane link for more)]. But I’m also aware that there are reasons to be skeptical as well:

Authors’ conclusions

The results of randomized controlled trials conducted in low-, middle-, and high-income countries provide no assurance that DOT compared with self administration of treatment has any quantitatively important effect on cure or treatment completion in people receiving treatment for tuberculosis.

PLAIN LANGUAGE SUMMARY

Directly observing people taking their tuberculosis drugs did not improve the cure rate compared with people without direct monitoring of treatment

Tuberculosis is a very serious health problem with two million people dying each year, mostly in low-income countries. Effective drugs for tuberculosis have been available since the 1940s, but the problem still abounds. People with tuberculosis need to take the drugs for at least six months, but many do not complete their course of treatment. For this reason, services for people with tuberculosis often use different approaches to encourage people to complete their course of treatment. This review found no evidence that direct observation by health workers, family members, or community members of people taking their medication showed better cure rates that [sic] people having self administered treatment. The intervention is expensive to implement, and there appears to be no sound reason to advocate its routine use until we better understand the situations in which it may be beneficial.”

July 11, 2013 - Posted by | health, health care, Khan Academy, Lectures, medicine

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