In 13,000 words on research priorities, the National Institutes of Health spanned the medical alphabet from arthritis to xeroderma pigmentosum. There was no mention of anthrax or bioterrorism.
That was in a booklet just four years ago. Today, the words are on everyone's lips, it seems. Federal agencies are pursuing research to counter bioterrorism with the same urgency -- even abandon -- that propelled the wars on cancer and AIDS.
In December, Congress for the first time pumped up annual funding for bioterrorism research to roughly $1 billion, according to an Associated Press estimate based on analysts' figures from the Office of Management and Budget and American Association for the Advancement of Science. That's more than double last year's budget of $430 million.
While championed by many prominent scientists, the explosive growth is also raising questions among some researchers, government officials and independent analysts.
"No one has really taken a systematic look and said, 'What do we really need in order to protect ourselves?"' says Kei Koizumi, an analyst at the American Association for the Advancement of Science.
Some worry that the research campaign is too focused on specific problems of the moment, shortchanging the basic science and local preparedness needed to combat the shifting threats of bioterrorism. Some say the effort is draining support from research on bigger health menaces like malaria, tuberculosis, pneumonia and flu.
Anthrax has killed five Americans. More than 15,000 die in a typical flu season.
And Dr. Robert Gould complains of neglected research on diseases like infectious diarrhea, which kills more than 2 million people worldwide each year.
It was only late in the last decade, with biotechnology bubbling and terrorism growing, that the government began a major research buildup to counter bioterrorism.
Then, the Sept. 11 terrorist attacks "refocused all of our attention," says Carole Heilman, who runs the Division of Microbiology and Infectious Diseases within the NIH. She adds that "it's still an unclear situation about where we're going."
Just the same, federal agencies are rushing to get there. The Department of Health and Human Services wants answers to urgent questions -- like how to dilute limited quantities of smallpox vaccine to spread it to more people and still keep it effective. It is offering grants for quick research projects that take no more than two years. It has reduced paperwork and promised to respond quickly to bioterrorism research applications.
Anthrax and smallpox have been the chief targets so far. The first has clearly proven itself dangerous in the wrong hands. As for smallpox, Americans have not been vaccinated against it since the 1970s, when the contagious disease was wiped out worldwide. Since immunity fades, even inoculated Americans are presumably vulnerable.
In the end, the focus may prove too narrow. The Centers for Disease Control and Prevention regulate 36 microbes with bioterrorism potential, from the Ebola virus, to the plague bacterium, to a fungus known as Coccidioides immitis. Would-be bioterrorists will probably strike, if they can, where the nation is least prepared -- maybe even with something not on the list.
"We need ... more basic science dollar spending that doesn't necessarily have a specific mission," says Dr. Peter Rosen of the University of California at San Diego, who has written about improving readiness for bioterrorism.
Basic research needed
Others appeal for more concrete measures apart from research, including better trained doctors and more emergency beds.
The government still relies largely on universities, drug and biotech companies, and other independent research centers to carry out work under contract or grant. However, in the past, most of those ignored bioterrorism.
But William Dietrich, a Harvard University geneticist studying anthrax toxin with an NIH grant, says the intensified federal effort "will increase the motivation" to take on bioterrorism projects.
A former president of the American Public Health Association puts it another way: "Within the health community, there's a big temptation to feed at the public trough in ... bioterrorism funding," says Dr. Victor Sidel of New York.