Dr.Lee Reichman lectures on TB to Russian physicians visiting UMDNJ's Newark campus.

Reichman and Croft are alike in many ways: both are leaders in their fields, world travelers and highly articulate guys. And both have recently come back from work trips to Siberia. But it's immediately clear they're not collaborating on a travelogue about this remote region, which calls to mind vast stretches of snow, bone-chilling cold, and long dark days and nights that freeze the human spirit. Neither are they writing a novel a la Aleksandr Solzhenitsyn, with haunting scenes of harsh and barren vistas where only the very strong survive to return and tell their grim tales.

But what they have come together to present may be even more chilling, not only for the Russians, but perhaps for all of us. Multi-drug resistant tuberculosis (MDR TB) is stalking the Siberian jails and prisons, spreading through cells where ventilation is poor and prisoners are crowded 30 to a room, sleeping three to a bed in shifts, eating a daily diet of cabbage soup and dry bread.

Tuberculosis is spread through droplets that hang in the air when someone with the disease coughs or sneezes. And those with untreated or inadequately treated TB often cough continuously. "If you were a biological terrorist, and you wanted to spread this infection quickly and effectively, you would create these exact conditions," Reichman says.

Russian prisoners infected with multi-drug resistant tuberculosis

Couple the overcrowding, the lack of airflow and poor nutrition with inadequate drugs and physicians untutored in effective methods for combating the disease, and you have a situation that is potentially catastrophic. Last year, 20,000 prisoners were infected with strains of TB that resist treatment with at least two of the four primary medications, and when some of these prisoners were released, they went home and spread a drug-resistant form of the disease to 15,000 civilians.

“This is a ticking time bomb,“ says Reichman, who is a pulmonary specialist and executive director of the New Jersey Medical School National TB Center. His claim to fame is a 30-plus-year-career as adversary to this worldwide killer that sometimes seems to disappear from the headlines, then rears its ugly head to strike again and again. He tells Croft that tuberculosis kills 3 million people each year, then hammers home his point with statistics for the decade: 30 million deaths attributable to the tuberculosis bacterium and 90 million new cases of the disease.

Life in Siberia may seem to be light years away from that in the U.S., almost beyond our ability to imagine. But in truth, the region is just 600 miles from Anchorage, perhaps a bit too close for comfort. Take a plane, then a train or automobile, and you're talking a day's worth of travel from Siberia to a major American metropolis. Quicker transportation and cheaper airfares promote international business, studying abroad and far flung vacations, but these are also routes for the rapid spread of virulent infections, in this case resistant strains of TB.

The history of this disease in our country is a grim tale with a fairly happy ending for most. Before the early 1950s, the infection created havoc in countless households, sending many adults and children to sanatoriums, often to die a slow death. With the advent of antibiotic therapy in the 1950s, the disease became curable and hospitalization was no longer required. But, as Reichman often says, the medical system thought they had licked this killer, and they became lackadaisical.

Lee Reichman with "60 Minutes" interviewer Steve Croft.

Just when they thought it was a nonissue, along came HIV, which lowers immunity and places those infected at higher risk for other diseases. Poverty and large numbers of immigrants from places where TB is rampant also fueled the fire. So, in the late Ô80s and early '90s, TB came roaring back in many US cities. Then the drug-resistant variety of the disease was born. When a prison guard in New York state died of MDR TB, which he contracted on-the-job, The New York Times ran a five-part series in early 1992 about the growing problem of multi-drug resistance in New York City; and the public became aware that TB was still a vicious killer.

In order to understand why eight Russian physicians are in this country to learn how to deal with their public health emergency, you need an understanding of the emergence of drug resistant TB in the
U.S., and how what has been termed "soup kitchen medicine" brought it under control.