By Erika Check-Hayden

People with active tuberculosis infections turn to the private market for treatment far more often than anyone had realized. And when they do, they encounter a chaotic array of treatment choices, many of which do not meet guidelines drawn up by the World Health Organization. These are the conclusions of a paper published on 4 May that counters the prevailing wisdom that the vast majority of people with tuberculosis are treated through publicly funded programs.

The study, conducted by the New York–based Global Alliance for TB Drug Development (TB Alliance), a nonprofit that supports the development of new tuberculosis drugs, examined data on private sources of medicines, such as pharmacies and the companies that stock them. The information was collected by IMS Health, a private consultancy that analyzes pharmaceutical sales data, in ten countries that together bear 60% of the world’s tuberculosis burden.

The analysis, funded in part by the Seattle-based Bill & Melinda Gates Foundation, revealed that vast quantities of tuberculosis treatments are sold through the private market—enough to treat two thirds of the people who develop an active tuberculosis infection each year (PLoS ONE 6, e18964, 2011). This puts the private market at about the same volume as the public market, the study found. And the discovery that the total in drug sales exceeds the number of cases points to overuse and improper use of the drugs.

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