George W. Comstock, nonagenarian leader against TB

Dr Comstock Isoniazid (INH) is one of the classic “magic bullets” which revolutionized public health in infectious diseases. Eastern Europe, at least until recently, was still using BCG routinely. Unfortunately, as the articles below describe, once immunized, only X-rays can be used to screen for TB. The YK region still has high rates of TB, although nothing like it was, I believe.

George W. Comstock, 92, Dies; Leader in Fight Against TB
By LAWRENCE K. ALTMAN, Published: July 18, 2007, NY Times

Dr. George W. Comstock, an epidemiologist who made major contributions to the treatment and prevention of tuberculosis and was regarded by many peers as the world’s foremost expert on the disease, died Sunday at his home in Smithsburg, Md. He was 92 and had worked until last week….

In 1957, the United States Public Health Service sought a doctor to study tuberculosis patterns in Alaska, where one of every 30 natives was in a tuberculosis hospital. Dr. Comstock volunteered, saying he saw an opportunity to study preventive treatment.

He conducted a controlled trial in 29 villages near Bethel, Alaska, where tuberculosis was rampant. Members of each household were given the drug INH or a placebo for a year, Dr. Chaisson said.

The study showed the effectiveness of INH in preventing tuberculosis: after a year, INH produced a 70 percent decline in cases of the disease; a follow-up study five years later showed the drug’s benefit had been sustained.

In the trial, Dr. Comstock and his family took INH themselves to convince the participants of his belief in the therapy’s safety, Dr. Chaisson said. After the trial, Dr. Comstock returned and gave INH to those who had received the placebo….

He was a lifelong advocate of public health efforts and expressed disappointment in later years that more doctors were not devoting their services to it. In an interview in 2003, Dr. Comstock said that members of medical school faculties had little contact with public health departments.

[read more]

George W. Comstock, 92; epidemiologist was influential in the treatment of tuberculosis
By Thomas H. Maugh II, LA Times Staff Writer, July 18, 2007

…Comstock was a young commissioned officer in the U.S. Public Health Service after World War II when federal officials were considering a mass vaccination campaign against tuberculosis using the relatively new Bacille Calmette-Guérin vaccine, which is made from an attenuated strain of mycobacterium that produces TB in cows.

He organized a trial of the BCG vaccine in Georgia and Alabama that stretched from 1947 to 1951 and concluded that the vaccine had an efficacy of only 14% in preventing the disease. He argued forcefully that the efficacy was too low to produce widespread benefit and that vaccination would render the Mantoux skin test for detecting TB infections useless by making vaccine recipients permanently positive.

In a country like the United States, with a relatively low incidence of TB, he argued, it was more important to be able to identify those exposed to the mycobacterium and treat them. Federal authorities agreed, and the vaccine was never widely used here….

Comstock frequently quoted Horace Mann’s 1859 commencement address at Antioch College: “Be ashamed to die before you have won some victory for humanity.” Comstock expanded on that theme, noting that “most of us aren’t going to win any big victories, but we can win little ones every day, and they mount up. [read more at…]

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