Inkwell: Authors and Artists

    
John Schwartz is a reporter at the New York Times who writes about
techhnology and society. Before coming to the Times, he worked at the
Washington Post as a science and technology writer, having come to the Post
from Newsweek magazine. He has written about the Internet, the Ebola virus,
food safety, the Food and Drug Administration, the dinosaurian origins of
birds, the tobacco wars, the Canadian band Moxy Fruvous and more. He worked
with former Minnesota state epidemiologist Michael T. Osterholm on "Living
Terrors," a book that braided many of the strands of his prior reporting in
public health, science, technology and law. He lives in New Jersey (the
Garden State!) with his wife of 16 years and three children. He is licensed
to practice law, but hopes that it will never come to that.

Living Terrors is a book about the horrible prospect of biological
terrorism. The authors argue that the technologies necessary to mount an
attack are now within the reach of people with a graduate student
education. At the same time, they show that despite highly-publicized and
expensive steps that the United States has taken to defend itself against
weapons of mass destruction such as nuclear, chemical and biological
weapons, America's leaders have left its citizens unprepared for biological
attack. Osterholm and Schwartz outline a handful of recommendations that
would enhance the nation's ability to cope with any public health
emergency, from an anthrax attack to a influenza pandemic.

John will be interviewed by Eric Mankin, who was fascinated by biology
before puberty, because of repeated readings of the All About Books: his
favorites wwere "All About Dinosaurs" and " All About Whales."
Subsequently he read Paul De Kruif's "Microbe Hunters," which fixed the
people who conquered disease in his firmament as among the primary
beneficiaries of mankind. Among the OTHER books that have guided his
thinking on the influence of disease on history are "Plagues and Peoples"
by William H. McNeill and "Guns, Germs, and Steel" by Jared Diamond.
Mankin has written about science for eight years for the University of
Southern California, including a year for writing about achievments of the
Keck School of Medicine AT USC. He currently works for the public
information office of USC's Information Sciences Institute.

Please join me in welcoming John and Eric to inkwell.vue!
  

    
John, can you begin by describing how you hooked up with your co-author,
epidemiologist Michael Osterholm -- was this an arranged marriage by
DeLacorte Press, or elective affinity?
  

    

  In classic singin' media business style, his agent called my agent. I had
interviewed Mike a number of times about such issues as food safety--a big
concern of his as Minnesota's chief epidemiologist, and a big issue for me
as a reporter covering the Food and Drug Administration. I liked his
straightforward style, and his willingness to make wake-up calls when he
thought they were necessary on issues as diverse as food safety, antibiotic
resistance and biological terrorism. He always seemed to speak from the
perspective of a concerned public health professional who saw things at the
juncture of disease and society.

   But I had no idea that he was hoping to write a book about bioterrorism.
And although I had hooked up with an agent, Rafe Sagalyn, about two years
before, and although we had discussed a number of book projects, nothing had
seemed right to us. But when Mike's agent got in touch with Rafe about
finding a science writer who could work with Mike, everything clicked. Here
was a guy I knew, though not very well, and a topic that I cared about. It
drew on my background as a reporter on science and technology issues, and
also my experience covering Washington and the regulatory scene; there was
even a component that would call on my training as an attorney. (I knew it
would come in handy some day!)

   Mike and I got together and discussed the issues, and it became clear
that we agreed about a few things. The current situation is a mess. Efforts
to improve things are not going to do enough to meet the challenges of
biological terrorism. People need to hear about this and to get the message
in an accessible way. So we shook on it, the agents drew up contracts, and
we wrote the proposal together. From start to finish, it has been a great
partnership.
  

    
Let's start with what was for me the single most astonishing fact in the
book: you note that in the century that just ended, one half billion
people died from smallpox, compared with 320 million people dead from wars
(including two world wars) and all other epidemics. Where did this number
come from? And what did you think when you first heard it>
  

    
Here's what I thought when I read it: I'm not immune. I grew up after
people stopped being vaccinated for smallpox. Because smallpox had been
eradicated. What the book made me think was that maybe it was time to,
just on the safe side, go to my clinic and ask for a scratch.
  

    
Moving right along: Defense Secretary Rumsfeld has today announced that he
is going to unilaterally suspend the ABM treaty (since he says it was with
the now no longer extant Soviet Union, not with the successor Russian
Federation) and proceed to build an ABM system at a cost that will spiral
well into the hundreds of billions. <jswatz>'s new book illustrates that
to a first approximation no effective defenses exist against an attack
that could be launched at a cost in the tens of thousands of dallars,
causing thousands to (with the right agent) millions of casualties and
virtual paralysis of states, regions or even the whole nation. How much
sense does this make?
  

    
None, unless you're in the business of selling overpriced weapons systems.
  

    
The book contains a lot of detail about the activities of the Japanese
terror group that carried out a nervce gas attack on the Tokyo subway,
material that isn't widely known, but that illustrates how biological
weapons -- bacteria, viruses, and the toxins they produce -- are within
a very modest budget and degree of technical expertise - John, can you
describe what Aum was able to do?
  

    
Well, Eric, you've given me a lot to respond to! Let's start with smallpox.
Like you, I was stunned when Mike, in our preliminary discussions, laid out
the astonishing figure of a half billion dead from smallpox. The estimate,
if my memory serves, came from the World Health Organization, which launched
the effort that finally eradicated smallpox, and was brought up separately
by D.A. Henderson, who led the W.H.O. effort. The number is even more
frightening when you consider the fact that smallpox, while eradicated in
the wild, is still out there in test tubes and could possibly be brought
back to be unleashed on a global community that has lost just about all of
its resistance to this terrible disease.
    Eric, you weren't vaccinated against smallpox, but I was. I thought it
was one of the advantages of being an old fart. But as I researched the
issue, I realized that most scientists who have studied the issue believe
that the resistance wears off after about 20 years. So I'm probably not any
better off than you are at this point.
    And if you want to go get that scratch, well, good luck. The smallpox
vaccine stockpile is tightly guarded and too small to handle an outbreak
that spreads to several cities; in fact, an outbreak in one city would spark
calls for vaccine in so many places and for so many people that the current
stockpile couldn't handle the demand. It will be years before more can be
produced.
    And now on to the question of guns versus bugs: Yes, the ABM news marks
a new era in expensive government programs. And the number of people who
could launch such an attack is so very small; meanwhile, the tools that
could be used to launch a bioterror or biological warfare attack are within
the abilities of graduate students. While such an attack hasn't happened
yet--terrorists tend to stick with simpler tools, such as explosives--both
Mike and I feel that it's really only a matter of time before a biological
terrorist mounts an attack.
     The ABM news shows that when America perceives a threat, it responds by
funding the tools of the military and law enforcement. That's been the
pattern of the nation's response to weapons of mass destruction as well...
enormous amounts of money go to preparedness for attacks using nukes or
chemical agents, where some horrible event will occur and an immediate
response to control the populace will be necessary. But a biological attack
is very, very different: it could come silently, with the initial attack
drawing no attention at all. The first sign would be sick people coming to
doctors' offices and hospitals. In other words, the police response is not
very useful when the attackers are too small to be seen. Mike and I make the
case in Living Terrors that the proper way to respond to biological terroris
m is to upgrade the nation's public health system to detect and respond to
disease outbreaks. Spend the money there, and it helps everyone. Spend the
money on an ABM system and... well, I don't think I need to finish the
sentence.
      Finally, Eric, you bring up the Aum Shinrikyo group, which carried out
an attack with sarin gas in the Tokyo subways. The group was able to develop
the chemical attack under the radar, so to speak--they were able to
synthesize deadly nerve gas without being caught. They didn't do a very good
job--the chemical process wasn't of the quality that a top-flight weapons
lab would come up with, and the delivery method (sealing the sarin in
plastic bags, dropping them in the subway and poking the bags open with
umbrella tips) was amateurish. But people died and thousands were sickened,
and a tremendous panic resulted. In other words, mission accomplished.
    Aum Shinrikyo was trying to develop biological agents as well, but the
efforts didn't come to fruition, luckily. There are people who say that
biological terrorism attacks are highly unlikely, and the point to the
failures of Aum Shinrikyo to come up with a biological attack as proof. The
group, after all, was well funded and had no small amount of scientific
expertise among its members. But Mike and I point out in the book that they
were continuing to work on biological projects and might well have come up
with a successful attack over time. The chemical attack itself was a rush
job because the leaders of the group feared that police might be about to
move in; the result might have been far more horrible if they had had the
time to develop a more efficient delivery system.
  

    

John, it seems to me that a good next step would be for Congress to
hold hearings about America's preparedness for a public-health crisis
of the sort you describe in your book. Has there been any interest
from any reps or senators?

And, if not, when are you and Mike going to publish your op-ed calling
for such hearings?
  

    

   Hearings are a good idea, Eric--especially hearings that would break out
the threat of biological terrorism and the best responses to it. Most
hearings so far that have touched in the subject have lumped biological
terrorism in with other terrorism using weapons of mass destruction--and, as
we point out in the book, that treatment does a real disservice to the
special horrors that biological terrorism would visit upon us.

   What's more, the hearings on weapons of mass destruction that have been
held involved Clinton administration officials. With a new president in
Washington and new heads of the Department of Health and Human Services and
Justice Department, we need to know what the new administration plans to do.

   On the other hand, you're giving Mike and me a little too much credit for
cunning--or even planning--to ask when our op-ed might appear. We haven't
written one, or even discussed it. Darned good idea, though.
  

    
One thing struck me about the possible preparations for a biological
agent attack. Unlike almost any other kind of military preparedness
action you can think of, they aren't otherwise totally useless. They
involve preposition of material and people that would be lifesaving in
all kinds of non-biological war situations. It basically means just a
drastic upgrade in the emergency health delivery infrastructure, plus
careful advance planning for epidemics. This is something a sane 
person would want, just as a matter of principle, even if you didn't
have to worry about a nut with a mason jar full of anthrax spores. It
would be comforting to have just in case, for example, a passenger
comes out of a jet from a duck market in South Asia where a new strain
of flu had just jumped species, or from Central Africa, where a patron
of a bushmeat market had just picked up something novel from his monkey
brain omelette. 

the comparison with (sorry to be repetitions about this) missile
defense leaps out. The cost is a minute fraction, and the usefulness
extends across a wide range of civilian applications. Is this a
no-brainer, or am I?
  

    

  I come down on the side of "no brainer," but of course I'm pushing the
book! In fact, when you look at it, raising the quality of the public health
infrastructure would improve the nation's health in every way. That's why
Mike and I didn't recommend, say, that everybody make space suits or dig
fallout shelters, or that the government vaccinate every American against
smallpox. We tried to focus on recommendations that would provide a benefit
whether or not an attack ever came. The ability to spot a foodborne outbreak
or disease epidemic early helps us all by putting the proper treatment in
place; suffering is alleviated and lives are saved.

   These aren't $500 toilet seats. These are valuable additions to the
public health system that will save lives no matter how they are used. And
we're up against a resource crunch that means most hospitals are overwhelmed
by simple flu epidemics.
  

    
What reaction if any has there been so far to the book?
  

    

  The response has amazed me; Mike has been interviewed on 60 Minutes and
Good Morning America, and the book has been discussed in articles in The
Washington Post, USA Today and elsewhere. People familiar with public health
issues have praised it highly--a good sampling of those opinions can be
found on the Amazon.com page devoted to the book. So the message is getting
out there.

  Here's one of the comments from the Amazon:

A Frustrated Public Health Professional
 November 25, 2000
Reviewer: A reader from Washington DC
 I'm part of the problem! I'm one of those individuals that Mike Osterholm
talks about in this very important book. Unfortunately he is right on
target. The federal response, of which I'm supposed to be a part of, remains
disorganized and lacking leadership... , if you really care about our future
and the potential of what bioterrorism can and will do to our country, you
should take to heart what Dr. Osterholm has said. I know my coworkers who
have read the book all wish our bosses and their bosses would read it and
take it to heart. I'm afraid that is not going to happen on this watch and
I'm not optmistic it will happen on the next one, regardless of who is
President. If we are to get our act together, it will have to come from the
people...who in turn get their local, state and federal elected officials to
REALLY understand the issues and respond accordingly. Dr Osterholm's book
should be the their Bible. It's the best we've got.
  

    

  And no, I didn't write that comment.
  

    
john, i dont recall where i read it sometime this year (mother jones?)
but some magazine article i read somewhere seem to debunk the notion
of bioterrorism...alas, i havent read yr book yet, and anything
that wants to upgrade public health is fine by me...but can
you address this? are you familiar with the article i vaguely remember?
  

    

  It was pretty discouraging to see the Mother Jones article, which made
exactly the same misjudgements as the policymakers.

   The article is the cover story of the October 2000 issue; the title is
"The Phantom Menace: Could terrorists attack the United States with weapons
of mass destruction? Highly unlikely, say defense experts. So why is the
Clinton administration spending billions to foil a most improbable threat?"

   Here's the URL:

   http://www.motherjones.com/mother_jones/SO00/phantom.html

   The main flaw in the article, as I hinted above, is that it lumps
biological terrorism in with other weapons of mass destruction such as
nukes and chemical weapons, and then treats the whole movement as an excuse
to boost defense and law enforcement budgets. Part of the argument is
valid--heck, in our book, WE criticize programs that seem to be the merest
excuses to boost those budgets while doing precious little to improve the
ability of the nation's health care system to respond to attacks.

   When the story DOES talk about biological terrorism, it falls back on
discussions of the relatively botched Aum Shinrikyo attack (try to explain
what a lousy attack it was to the people whose family members died or were
sickened in the attack) and quotes Milton Leitenberg of the University of
Maryland, who explains that turning bugs into weapons is very hard.

   Well, it is very hard. But it's not impossible. That's why we quote
people like William Patrick, who actually made bioweapons for a living
before the U.S. signed treaties prohibiting such weapons in the 1970s; he
said "O dpm

  "I don't think our domestic terrorists have the capability to make a
weapon yet..." but the emphasis was on the yet, and he has spent a good deal
of time and effort to show that a perfectly simple delivery system for
spreading biological weapons can be smuggled through weapons checkpoints and
airport scanners.

   One of the most frightening interviews I conducted for the book was with
David Pui, director of the particle technology laboratory at the University
of Minnesota's mechanical engineering department. He easily debunked the
notion that creating delivery systems for bad bugs is impossible for any but
the most sophisticated scientists. ""Actually, there are some bypes of
medical nebulizer that people can buy in a drugstore," he said. "For just a
few dollars, you can put this biological material in a supension form and
spray it--it's really quite effective." He said that any of his graduate
students could put together a handheld device to disperse dry spores or
biological agents in suspension.

   I've gotten pretty long-winded on this point, but it's crucial: yes,
there are experts who believe that the threat is overstated. Mike and I
don't agree with them, and wouldn't have written the book if we felt that
those arguments were correct. As a reporter, I have always sought to get the
TONE right, along with the facts: That means not sounding an alarm when none
is called for. It also means sounding an alarm when people are sleeping
through an emergency.
  

    

  "O dpm" was not part of the quote from William Patrick, of course. Please
pardon my pre-coffee typo lifestyle.
  

    
thanx. just wondered about that mojo piece...
  

    

I undertand that Clinton was obsessed with this, and was very inluenced by
the fiction works of Robert Preston. Did you go into that, and did that
have much to do with the Anti-terrorism bill of 1996?
  

    
I don't think Clinton could have been too obsessed with it, or he
would have pressed to spend more money. Another truly disquieting fact
-- I don't remember it in John's book -- was the comparison between the
budget for "Outbreak," the Dustin Hoffman helicopter chass turkey
about infectious disease; and the budget of the office in the Centers
for Disease Control which Hoffman worked for in the film.  The studio
spent much more on the film than the U.S. spends in a year on the
real-life agency.
  

    

   It doesn't qualify as an obsession, but Clinton was very concerned about
the prospect of a chemical or biological terrorism attack, and did read The
Cobra Event, Richard Preston's harrowing novel about bioterrorism. In
January 1999, in an interview with Judith Miller of the New York Times, he
said that such an attack is "highly likely" within the next few years.

   "I want to raise public awareness of this," he said, "without throwing
people into an unnecessary panic." The prospect of a biological attack, he
said, is the one that "keeps me awake at night."

   The interview kicked off an effort to pass a $2.8 billion anti-terrorism
budget. (Most of the money, of course, was slated for military and law
enforcement programs.) But Clinton was clearly not just reacting to a novel;
in the interview, he said that he really started to worry about the issue
after the 1993 World Trade Center bombing, and his concerns grew after the
blasts in Oklahoma City and at American facilities in the Middle East and
Africa, as well as the Aum Shinrikyo attack.

   (Oops--let me correct something here. Clinton's budget that year included
$10 billion to defend against terrorism, with $2.8 billion for existing and
a few new programs to counter biological, chemical and cyber attacks.)

   Ultimately, little of the money got through the budgetary process for new
programs. And as Mike and I point out in Living Terrors, much of the money
that is earmarked doesn't really do much to meet the threat.
  

    

John, this is all pretty depressing stuff, from the perspective of the
average citizen (me). What can *we* do to call attention to this problem? Is
there anything we can do to protect ourselves as individuals from the
possibility of this kind of attack?
  

    
And if there's one single thing that's the highest priority, what
would it be?
  

    
John, not to be completely doom and gloom, but isn't it relatively
useless to worry about bioterrorism?  I mean, after all, a
well-orchestrated bioterrorist strike can -- as the less successful
ones have shown -- wreak havoc and death on huge swaths of densely
populated cities and, as you point out, it is getting easier and easier
for people to generate the necessary stuff.  Other than being fully
prepared to execute a rapid response to the aftermath, is there really
anything that can be done to prepare for such an eventuality?

Not to say that our intelligence gathering organizations ought not to
be keeping a lookout for such threats, but we do have a thing called
civil liberties here that pretty much circumscribes the government's
ability to act as a complete risk reducer.