Bharat Venkat (University of California Berkeley)
Paper short abstract:
In the 1950s, India’s first randomized controlled trial (RCT) established that the antibiotic cure for TB was equally effective at home and in the sanatorium. I argue that the new evidentiary power of the RCT undermined both sanatorium treatment and the relevance of poverty for TB treatment.
Paper long abstract:
In the history of tuberculosis, the mid-20th century witnessed a therapeutic shift. The development of new drugs and new forms of evidential procedure decisively undermined the sanatorium and its strictures. This quintessentially "social disease" no longer required social interventions, only biomedical ones. In this paper, I will talk about the 1950s' Madras Study, the first randomized controlled trial in India. This study produced decisive proof that the antibiotic cure was equally effective at home and in the sanatorium. Drawing upon the words of a surviving member of the research team, I will attempt to reconstruct the conditions of this study. India had long suffered from a dearth of public sanatorium beds, which government officials understood to be too expensive. The Madras Study was an effort to establish a more cost-effective alternative. Drugs promised to democratize tuberculosis treatment, bringing the cure to the masses. Study subjects drawn from Madras City were described as poor, underemployed, undernourished, and living in squalid circumstances. These negative conditions threatened to undermine patient adherence to the treatment regimen, but also bolstered the credibility of the study results. By proving that drug therapy worked even among the poor, poverty could be removed from the equation. I argue that the new evidentiary power of the randomized controlled trial not only showed the efficacy of the cure, but also established poverty as a non-factor in the treatment of tuberculosis. I suggest that sanatorium treatment and the relevance of poverty for tuberculosis both faded as part of the same process.
Infectious disease and wealth: exploring the links between tuberculosis and the political economy