These pork barrels’ hold global MDR-TB projects

Post reporter, Sen. McCain should check facts

An editorial writer at the Washington Post purported to alert readers across the nation to a wasteful ripoff of taxpayer money intended to help TB victims abroad. It was described as a pork-barrel project intended to siphon big bucks from a foreign-aid spending bill and deposit the money into a little-known institute in Alabama.

The only trouble is that the "little-known institute" — the Gorgas Memorial Institute — has a world-class reputation for training clinicians in tropical medicine. As for the recipients of the USAID money, they’re not (as Post editorialist Sebastian Mallaby implied) close relatives to Rep. Sonny Callahan, the Alabama congressman who had a hand in drafting the foreign-aid bill.

Instead, the two men painted as villains turn out to be Richard Chaisson, MD, assistant professor of medicine at Johns Hopkins University Medical School and chief of the Baltimore TB clinic, and Michael Kimerling, MD, MPH, a consultant to Medecins Sans Frontieres and assistant professor of medicine and public health at the University of Alabama School of Medicine in Birmingham (UAB).

The editorial ruffled a few feathers and has also provided Kimerling and Chaisson’s colleagues, who are more than aware of the duo’s contributions, with a few chuckles. "To tell you the truth, I haven’t noticed any drastic changes — no fast cars or luxury cruises — in Michael’s behavior lately," laughs Nancy Dunlap, MD, PhD, medical director of the Alabama state TB program.

Kimerling says he spotted the editorial (which drew heavily from Sen. John McCain’s web site compendium of pork-barrel projects) on a recent flight home from Russia, where he was working on the epidemic of multidrug-resistant TB threatening to overtake Russia’s overcrowded prison system. He thought briefly about writing a letter to set Mallaby straight, he admits, but has been too busy with work to do so.

Chaisson, for his part, says he can’t even muster much indignation. "It’s too bad they wrote it, but I don’t think debating them in print will help any," he says, in a voice that sounds as if it’s usually reserved for students who fall asleep in anatomy class.

As for the Gorgas Memorial Institute, a busy political reporter might be forgiven for not having heard of it. Established at the turn of the century, it originally functioned as a prestigious school of tropical medicine situated in the Panama Canal. It was created by Congress with an eye to serving the needs of American military forces stationed in the tropics. After the Canal Zone was returned to Panama, Gorgas was downsized and relocated to the University of Alabama at Birmingham, where it still runs a modest but highly regarded program to train students in tropical medicine.

Once they had determined to collaborate on a number of international TB and HIV projects, Chaisson and Kimerling say they decided to use Gorgas as an intermediary in the partnership between the two medical schools.

In case you were wondering, here’s a sampling of what Kimerling and Chaisson are doing around the world with their share of the USAID-authorized TB funds:

The state of Veracruz in Mexico: Chaisson and Hopkins colleagues will provide technical support and collect data for a project that will establish a model program for identifying and treating MDR-TB in Mexico.

A slum in Lima, Peru: Working in a setting that has some of the highest rates of morbidity and mortality for HIV/MDR-TB on earth, the Hopkins group will use novel, costly techniques to make super-rapid TB diagnoses.

Brazil: In a rural inland area near Rio de Janeiro, the Hopkins group will collaborate with what they hope will serve as the nation’s model program for directly observed therapy, short-course (DOTS). The program, which has already moved treatment success rates from 60% to 84% in its first year of existence, is especially important, Chaisson explains, because Brazilian TB experts so far have resisted the introduction of DOTS programs. "It’s sort of like in Russia, where the attitude is, We’re not a third-world country, so stop trying to sell us on this third-world approach to TB control,’" Chaisson explains.

Russia: Kimerling is a regular commuter there, visiting grim prisons where he is trying to work the kinks out of one of the world’s first models of the World Health Organization’s new DOTS-Plus strategy. This is an attempt to develop sustainable therapeutic models for containing and controlling MDR-TB in parts of the world where MDR has already spun beyond the control of regular DOTS programs.

Cambodia: Kimerling and the UAB team will conduct HIV prevalence surveys and will work to integrate and provide cross-training to the country’s HIV and TB programs, partly by adding a TB component to a program that provides home care to about 700 symptomatic HIV patients in the Phnom Penh area and which is about to expand coverage substantially.

Indonesia: The UAB team will establish DOTS programs in hospitals, linking them to the national TB program, Kimerling says. "Again, our goal there is to strengthen the national TB program and try to get hospitals to follow the DOTS strategy," he adds.

He pauses for a beat. "And hey, if that’s pork-barrel . . . well, maybe we should be doing more of it."