Noted: For now, this is just a hypothesis. But it’s “really interesting and thought-provoking”, says Caitlin Pepperell, from the University of Wisconsin, Madison, who studies the evolution of human disease. “It’s plausible because smoke inhalation is so damaging to the lung’s innate immune system—our first line of defense against tuberculosis. Perhaps the bacteria that breached this defense had an easier time of it from that point on. Smoke inhalation also increases coughing and could enhance TB transmission.”