Baby Needs A New Pair of Shoes

Abstract

Tn an article in this issue (see page 752), Yeager and Medinger make a forceful appeal to maintain long-term care beds for the management of patients with tuberculosis (TB), arguing that a recent ACCP Consensus Conference recommendation might have “thrown out the baby with the bath water.” As participants in the conference and coeditors of the proceedings, we would reply that the intent of the consensus statements was to empty another tub—stagnant and ill-used: the practice of hospitalizing all new patients with tuberculosis simply “because they have TB.” The data clearly indicate that the average patient does not constitute a public health menace once he or she has the diagnosis established and is begun and maintained on suitable chemotherapy. Implicit in our position about hospital care was a very compelling economic argument: in most states, hospital care for TB patients is provided through tax funds from state, county, or city sources. Rather than deplete these limited funds for routine (medically unnecessary) hospital services, we would strongly prefer to have them preserved for those special problematic cases to whom Yeager and Medinger refer in their essay.