Burma and the challenge of humanitarian assistance.

www.thelancet.com Vol 370 October 27, 2007 1465 the community are homogeneous. The authors also assume that their single rural site in South Africa is typical. Although models must be intuitively plausible and qualitatively accurate, model validation does not necessarily follow from a good fi t to the available data, because many complex models can fi t limited data quite well. Many people in the developed world have forgotten the horror of tuberculosis in the age before antibiotics, a time in which only the wealthy could retreat to sanitoria, as in Thomas Mann’s The Magic Mountain, and the poor were threatened with stigma and fear, as portrayed in Victoria Spivey’s TB Blues: “TB’s all right to have, but your friends treat you so low down.” Now, as then, tuberculosis is associated with poverty. The same absence of resources that contributes to extensive drug resistance makes treatment of MDR and XDR tuberculosis impossible for many. Multidrug and extensive drug resistance are monsters of our own creation. They might be with us longer than we think and might need us to spend more than governments or institutions are willing or able to pay. Although scientifi c warnings are often ignored until too late, eff ective interventions for the control of XDR tuberculosis in Africa are national and international responsibilities, and the world community ignores this message at great peril.