TUBERCULOSIS: THE TICKING TIME BOMB
Lee Reichman, MD, MPH, New Jersey Medical School, University of Medicine and Dentistry of New Jersey
"We must raise awareness about the seriousness of TB. When we turned our backs before, it showed up, with a vengeance, again at our door. We cannot afford to do the same again - the risks are too high. We all have a serious stake in this matter, and we all need to get on board. To control TB anywhere, you have to control it everywhere."
The ticking time bomb. That's how Lee Reichman, MD, MPH, one of the world's preeminent tuberculosis experts, refers to the growing threat of TB. Once a leading cause of death in the United States, TB was practically eliminated with new drugs during the 1940s and 1950s. However, when the number of TB cases quickly spiked in the mid-1980s, the disease regained attention in the U.S., especially from Reichman. "I recognized that the increasing number of TB cases in the U.S. was completely caused by our complacency and neglect after assuming this threat was gone. Now, the opposite is very true - TB is a ticking time bomb waiting to go off."
Reichman's analogy is well-justified. First, the TB threat today is even more formidable than it was 60 years ago. Lack of treatment and/or the difficulty of sticking with a lengthy medication schedule have resulted in even more lethal and contagious forms of TB. Known as multidrug-resistant TB and extensively drug resistant TB, both can take anywhere from weeks to months just to diagnose, and are extraordinarily hard to treat. Current TB drugs are more than 40 years old, and getting a new drug onto the market has proven very difficult. Furthermore, HIV has heightened the risk for contracting TB, and TB remains the leading cause of death among people with AIDS. "TB and HIV are gasoline and a match," Reichman warns. Combine these with increased global travel, movement and trade, the increasing HIV rate in the U.S., and the lack of developing countries' political means or will to fight the disease where it is rampant, and you can very easily see Reichman's analogy.
Reichman's recent book "Timebomb: The Global Epidemic of Multi-Drug Resistant Tuberculosis," (2002 American Medical Writers Association's Best Trade Medical Book), draws attention to the exploding TB epidemic throughout Russia, a country on the WHO's list of "hotspots" for multidrug-resistant TB. The major concern is in Russian prisons, where underheated, under-resourced and overcrowded cells house infected and non-infected (and often HIV-infected) prisoners together, and thus are a perfect breeding ground for multidrug-resistant TB. Even worse, most prisoners are then released without follow-up and spread the disease.
In response to this recurring threat of TB, Reichman established the New Jersey Medical School National Tuberculosis Center in 1993. The Center was designated a national Model Tuberculosis Prevention and Control Center in 1994, and is internationally known for its state-of-the-art treatment, education, training and cutting-edge research. The Center's Directly Observed Therapy program, which sets TB patients up with field workers to oversee proper treatment administration, has a 99% compliance rate. The Center provides training and expertise to health officials worldwide, and in order to indicate its global commitment, the name was modified to the Global Tuberculosis Institute in 2006. Reichman and the Center have been focal points of major national television news programs and print media, Congressmen, foreign Presidents and international press.
"We must raise awareness about the seriousness of TB. When we turned our backs before, it showed up, with a vengeance, again at our door. We cannot afford to do the same again - the risks are too high. We all have a serious stake in this matter, and we all need to get on board. To control TB anywhere, you have to control it everywhere."