A Mix-Up in Priorities; By lavishing money on cures for bioterror attack, America ignores prosaic diseases that kill millions.

Byline: Mac Margolis

When Lee Reichman speaks in public, he likes to warm up the audience with a provocative graphic. He calls it a "disease scorecard." Listed on the left are some of the best-known illnesses of our time, and, on the right, a tally of the lives each of these ailments has recently claimed. Reichman, a professor at the New Jersey Medical School, knows the body count by heart. "SARS, 813 dead last year," he begins. "Ebola, 244. Anthrax, five since 9/11. Smallpox, zero. Mad cow, one dead--a cow." And so the list goes, until the final item. "Tuberculosis," Reichman deadpans, waiting half a beat for effect, "2 million a year." The punch line, he says, "usually gets a nervous laugh."

There is plenty to be nervous about. Last Wednesday marked the 122d year since the bacillus that causes tuberculosis was discovered. No one was celebrating. The newest drug to fight TB is 30 years old, and most patients are screened by the same hit-or-miss method used a century ago. International travel and migration have rekindled the disease in places where it had long disappeared, including New York and Moscow. AIDS patients, their bodies ravaged by HIV, are particularly vulnerable to TB. As the wily bacilli outsmart the best medicine, 300,000 new patients each year no longer respond to treatment. Yet, to Reichman's dismay, the buzz in public medicine is all about white powder in an envelope or spores in the ventilation system. "Here is this preventable illness that takes more lives today than it did a century ago," says Reichman, who wrote "Timebomb," a book about TB's comeback. "And all we hear about is bioterrorism and diseases that almost no one is dying from."

Reichman is part of a vocal but largely unsung group of researchers who think politics and hype have hijacked the U.S. health agenda. They want to get back to what he calls the "real killers": TB, malaria, AIDS and a slew of more prosaic diseases that take 14 million lives a year. It's not going to be easy. These are the scourges of the world's poor, hardly the choice demographic for pharmaceutical companies or taxpayer-funded research. Besides, ever since the first anthrax letters turned up in U.S. mail slots, some of the best minds in medicine have been drafted into the brigades of bioweapons defenders. Their mission: to stop microscopic enemies--germs, bacteria and viruses--that in the wrong hands might be fashioned into terrible weapons.

In theory, this is great news. Not since the cold war raised the specter of a nuclear winter has so much attention--and cash--been lavished on public health. Yet the war on bioterrorism has its dissenters. Why spend a fortune on illnesses that may one day become weapons, many physicians are wondering, when only a tenth of world health spending is being directed at the diseases known to cause 90 percent of human misery? "Before it was guns or butter," says Reichman. "Now it's guns or public health."

On the surface, there ought to be no contradiction. In times of instant epidemics like SARS and bird flu, any spending on the ailing global public-health infrastructure might seem a blessing. Some of the money for bioweapons defense is going to things like equipment, new labs and drug development that will help in fighting ordinary diseases as well. But the lion's share will be targeted at research specific to homeland defense. For instance, the U.S. Congress has earmarked $5.6 billion for the 10-year biodefense superfund known grandly as Project BioShield. Researchers investigating anthrax, smallpox and other priority pathogens have been flooded with nearly $1.8 ...