TB Research Perspectives: Revised project description

This project will be carried out with the assistance and cooperation of the Division of Infectious Diseases and Immunology of the Department of Medicine at the NYU School of Medicine.

I met yesterday with Dr. Joel Ernst, director of the Division of Infectious Diseases and Immunology at the NYU School of Medicine. We met for over an hour during which I learned of various circumstances that alter somewhat the nature of this project. It turns out that my conception of the project was based in part on a misapprehension. Dr. Ernst is a respected authority in the field of TB research. He had made references to me on a couple of occasions of the existence of an "archive" of TB research in his possession. This seemed natural as Bellevue hospital has a long history of treating TB patients and has counted many illustrious scientists on its staff over its 200-year existence. A number of these scientists have made important contributions in their fields. None of these, however, were in the field of TB research. The "archive" to which Dr. Ernst was referring was a collection he has been compiling of scanned copies of some of the most important papers detailing research breakthroughs by specialists from around the world. These date back to an 1882 paper by Robert Koch and continue up to the 1970s. Dr. Ernst estimates he now has approximately 40-50 of these documents, and has in mind a total of about 100 documents that constitute the key contributions during three critical stages of tuberculosis research. He identifies five stages in the history of this research. They are:

1. Prehistory – this is the pre-scientific identification and treatment of tuberculosis, which has afflicted humanity since ancient times
2. Early history – from the discoveries of Robert Koch in 1882 until the late 1940s
3. Introduction of Chemotherapy – from the late 1940s until the mid 1970s
4. ‘Dark Ages’ (if a chronology were created identifying the stages in this history another name might be needed out of sensitivity to the few who made contributions during this period) – this is the period during which research was largely abandoned in the false belief that the disease had been conquered
5. ‘Reawakening’ – from the late 1980s to the present, when the realization was made that not only has TB not been ‘cured’ but may be re-emerging as a greater danger with its new strains resistant to multiple drug treatments

The idea then that we discussed February 9th was the possibility of developing a website on the history of TB research worldwide—focusing on the second and third stages identified above–without a privileged position being given to the work of any single institution or individual, although this would be clearly noted to be a project undertaken by the NYU School of Medicine. This then changes the profile of the main objectives I enumerated in my projected conception. In light of my new understanding of the situation I would have to revise my objectives to the following (these are the conclusions I came to in agreement with Dr. Ernst):

1. An historical recapitulation of the most important discoveries made over the last century would be an important contribution to continuing research. A "cure" per se has not been achieved. As new drug-resistant strains of the disease have emerged, science may be back in the words of Ernst "at square one." The following topics may serve as the basic categories into which the documents constituting our thematic archive may be constructed. These topics, therefore, may constitute very general selection criteria for documenting the historical research in tuberculosis:

• Pathology and microbiology
• Pathogenesis
• Chemotherapy treatment
• Vaccine trials

These and possibly other topics may be added on the basis of their value to present-day researchers, who we would consider our primary target audience.

2. This would be a work of collaboration with other institutions, whose labs are also deeply involved in TB research and may have historical documents to contribute.

3. This would continue to be a draw for researchers and others to the NYU Langone Medical Center's websites.

The intended audiences for such a website would be, in addition to specialized researchers, historians of medicine, science and others; policy analysts; and clinicians.

Providing a compendium in a single location of research otherwise not collected elsewhere would be of value.

In addition to the scientific articles, supporting and complementary materials may include facsimile reproductions of contemporary news articles, public health posters, etc. Also, Bellevue, due to its long history of clinical service in this field, has a fairly extensive photo archive.

Most of the authors of the articles we will initially wish to include are now deceased. Many of the journals in which the articles originally appeared have either ceased publication or have been taken over by other publications.

The first task for us is to identify the core articles that best represent the collection we hope to build. This will point us to the following tasks of copyright ownership research and requests for collaboration and permissions. Concurrently, we may begin to undertake a general search for graphic materials to accompany the research documents. To help facilitate these tasks I suggested that Dr. Ernst draft a brief paragraph describing the motivations behind this effort.

While this looks to be a formidable undertaking, Dr. Ernst has suggested the names of several postdoctoral fellows and research assistants we may be able to enlist. It appears likely that Dr. Ernst would assume the role of project director, providing the technical expertise and background knowledge necessary for going forward as well as enabling us to establish the bona fides of the project. Given the overwhelming set of responsibilities he carries, I would likely continue to function as the project manager carrying out the overall project coordination.

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