It has been repeatedly demonstrated that DOTS alone is ineffective against MDRTB. This has recently been acknowledged by the WHO, which published a 6-country study of the use of SCC among patients with MDRTB. SCC failed in most patients, with cure rates varying between 20% and 60%.4 Even lower cure rates have been demonstrated in other settings. The CDC, working in Russia's Ivanovo Oblast, cured only 5% of primary MDRTB cases with SCC.5 These lower cure rates are closer to what would be expected given that many patients who have negative smears after treatment, and are thus declared "cured" by DOTS criteria, in fact only experience transient suppression and would actually have positive culture results throughout therapy. In the setting of underlying drug resistance, standardized DOTS retreatment regimens constitute ineffective therapy.