Walsh McDermott and Changing Conceptions of Tuberculosis Antibiotic Therapy: Latent Lessons for Health Care Reform

Although health care reform efforts are laudably directed at promoting quality and efficiency, added bureaucracy may have the unintended consequence of constraining physicians’ creativity. This has the potential to undermine clinicians’ freedom to reframe their thinking in response to unfolding biological knowledge, a defining feature of academic medicine. In this Perspective, the authors illustrate the confluence of creativity, context, and discovery through a historical example: the evolution of tuberculosis (TB) multidrug chemotherapy as espoused by Walsh McDermott and his colleagues during the 1940s and 1950s. Before the discovery of streptomycin in 1943, clinician–researchers aimed to identify a “magic bullet” that would rapidly eradicate tubercle bacilli from the body. In the years following the discovery of streptomycin, it became clear that the biology of TB did not conform to researchers’ expectations. The recognition that treatment would neither be simple nor quick prompted further attempts to devise an optimal streptomycin regimen, which would enable the host’s immune system to suppress infection and prevent the emergence of streptomycin-resistant strains. By the late 1950s, investigators clarified the limits of streptomycin’s effectiveness, which led to combined chemotherapy. In so doing, they gained a better understanding of drug–bacilli–host interactions and shifted attention from the host to the drug-resistant microbe. The authors argue that this tale of discovery offers a latent lesson for academic medicine: As the health care system undergoes systemic restructuring, it is essential to preserve the freedom to reframe thinking and creatively solve translational problems in research and practice.