Inkwell: Authors and Artists

    
Cynthia, it CAN BE depressing, and can leave a person feeling a little
helpless--so much is beyond our control. And, in fact, there's no way to
prevent something like this from happening, just as there's no way to stop a
committed terrorist from setting off a highly destructive bomb. Timothy
McVeigh is no genius: he just knew that if you take four parts fretilizer to
one part heating oil and put it in a truck, you can blow up a federal
building. And John Hinckley just walked up to Ronald Regan and started
firing. So, at its most bleak, that's the story: you can't prevent bad
people from doing bad things, short of creating the kind of police state
that would be abhorrent to any thinking person.

   Does that mean it's hopeless? By no means. Preparedness can take a
bioterrorist attack that would otherwise breed chaos, panic and deaths by
the hundreds of thousands and very effectively limit the damage. Quick
response to an anthrax attack with the right antibiotics and vaccine can
reduce the number of deaths dramatically: the key is being able to detect an
outbreak quickly and get the proper treatments to the people who need them.
Even an infectious disease like smallpox can be kept from spreading by
setting up proper quarantine and treatment facilities. In Living Terrors,
Mike and I call these "mitigated disasters." One death is too many, but
without the right kind of response, an unmitigated disaster can easily
result.

   So the top priority is taking on the deficiencies in the nation's public
health system--demanding that our politicians and policymakers step up to
the challenge. NOT with restrictions on civil liberties or nutty plans to
put a biohazard-4-level suit in every home, but with real initiatives like
the ones we lay out at the end of the book.
  

    
John, could you give a brief bulleted summary of the actions ordinary
citizens can take? 

I'm really surprised there hasn't been more acts of terrorism, either
bombs or germs... I like to hope that there's something in everybody that
would make 'em stop short of mass destruction if they had the power, but
then somebody like McVeigh pops up.
  

    

  I think there are many reasons that terrorists haven't resorted to
biological weapons yet (for the most part; there was that incident of the e.
coli-in-the-salad-bar by the Rajneeshee cult in Oregon, for example); the
main reason is that it's so damned easy to make a bomb. Heck, you can get
the instructions out of readily available books, not to mention the
Internet. The day we get a McVeigh with graduate level training in
microbiology will be a very bad day.

   The steps that Mike and I outline to address the threat of bioterrorism
are pretty simple.
1) Stop talking about "Weapons of Mass Destruction." In other words, break
out the biological issues from those surrounding nukes and chemical weapons
so that we can begin to focus on the special issues of bio. If the folks at
Mother Jones had done that, their story might have been very different.

2) Build the stockpile. Our supplies of the right antibiotics and vaccines
to fight outbreaks are dangerously low; the nation needs a buffer. Yes, some
of these therapies have one use only: a smallpox vaccine won't help guard
against other diseases. But building a stockpile of the antibiotics that
have been proved effective in early treatment of Anthrax exposure would have
many uses and is worth doing for reasons besides bioterror preparedness.

3) Develop more "surge capacity." Unlike the first two recommendations,
which a citizen can address primarily through letters to the editor and to
politicians, this is an area where direct involvement can pay off. Hospitals
and pharmaceutical companies are running with little margin of error in case
of emergencies; there's too little play in the system when problems hit. In
the book, we compare the situation to fire departments at airports: for the
most part, the firefighters stand by without much to do. But we want them
there, and we are willing to pay to have them there, because the alternative
is too awful to imagine when trouble strikes. We pay for what we need when
we UNDERSTAND that we need it. Local activism can help to push hospitals in
the right direction on this, along with the same letters to policymakers.

  Those are the big policy issues to press for. We don't recommend getting
vaccinated against anthrax or buying a suit, because the likelihood that any
ONE individual will be exposed is low, and the vaccination program would ber
horrendously expensive. We'll need our stockpile for the emergency workers,
if the worst happens.

  What we can do is continue to inform ourselves, and be ready to argue with
the scaremongers who are out for their own benefit on the one hand and the
professional naysayers who tell us that everything is fine. We need to be
part of the debate, drawing it toward a reasonable middle course that sounds
the alert without hysteria and demands action instead of public relations
moves.
  

    
Are there particular legislators who are more in tune with these issues?
  

    

BTW, although posting 9 was written in the style of Eric Mankin, it's
by Mike Godwin.
  

    
Posting again in the style of Eric Mankin, John, did anything you learned
researching the book make any difference in your personal life -- anything
having to do with your health or that of your family that you changed,
or thought about changing?
  

    

 Jon, there are members of Congress who have a good grasp of the basic
issues -- Sen. Bill Frist comes to mind -- but there's nobody out there
leading the charge.

   Eric, you ask if there is something that I learned in my personal life
that I have changed because of my research. Well, I have NOT bought a
biohazard-level-4 suit, though I think it would be a really cool thing to
own. I have not entered the Army Reserves in order to get vaccinated against
anthrax. I think that the research, more than anything, helped me to gain
perspective about what I could and should do, and should not do. Rather than
get a terminal case of shvilkes that would lead me to take drastic and silly
action, it set within me a firm belief that the most important thing to do
is to send a message to policymakers and the public, that the government
needs to take the right kind of action. That's why it's been so gratifying
to hear from Mike Osterholm that federal health officials approach him at
conferences to tell him that we got the book right -- that it sounds an
alarm without being overly alarmist. I hope that it also leads people to
write letters to their members of Congress to call for the public health
measures we recommend.
  

    
> it's been so gratifying
>  to hear from Mike Osterholm that federal health officials approach him at
>  conferences to tell him that we got the book right

Wow! That's got to feel great. Good for you!

As a writer for the New York Times, have you had the chance to present this
information (the threat of bioterrorism, I mean, not the bit about a well-
deserved stroke from federal health officials) to the newspaper's readers?
Do you try to find opportunities to sneak a little info into pieces you're
writing?
  

    

   I have not tried to write about this topic for the Times; when I got here
last September, the book was just coming out, and I was wary of appearing to
promote the book from my new position. Also, bioterrorism doesn't fall
within my technology beat, and it has seemed a little early to stray too far
from the job I was hired to do here. But most important, the Times already
has Judith Miller reporting and writing in the area, and her work has been
outstanding. With William J. Broad, she got the interview with Clinton in
which he discussed his fears of a bioterrorist attack, and their special
report, The Germ Warriors (12/98) laid out attempts by Iran to lure
scientists from the former Soviet biological warfare system away to work for
as much as $5,000 a month in Tehran.
  

    

I am astounded to note that it has been two weeks already!  Thanks to Eric
and to John for being here with us -  it feels like we've barely
scratched the surface of this topic.

You are more than welcome to continue for as long as you like.  It was
great having you.
  

    
Thanks! This has been a great, and chilling, discussion.
  

    

   Well, it's been a pleasure to chill you!
  

    
The pleasure was all mine! (Brrr)
  

    
 I don't know if anyone is still around reading this topic, but I had a 
question. 

 What does the current outbreak of foot and mouth disease tell us about 
fast spreading contagions in present times?  Are we learning anything
about our preparedness for such outbreaks from the current crisis?  

 John, has anything surprised you about the outbreak or the response to
it?
  

    

Great question!!
  

    
Using America's agribiz/fast food system as a vector? Death by
McDonald's! Scary thought.
  

    

  <Rafeco>, it IS a great question. It's not a world of villages but a world
of free travel, with diseases moving around at jetspeed. It's interesting to
compare the huge reaction to foot in mouth now with the, pardon the
expression, foot dragging that accompanied the emergence of Mad Cow.
Remember: Mad Cow, transmitted as nv Kreutzfeld Jakob disease, actually
kills people. Foot in Mouth sickens animals and has to be contained, but
presents little risk for people. But the reaction has been a near-panic.

   What does this tell us? That things move fast. That outbreaks, now more
than ever, cause panic. And that there are more vectors than ever for
transmitting disease.

   One of the chapters in our book raises the notion of bioterrorist using
the food supply as a vector; in the scenario that begins the chapter, we lay
out an e. coli outbreak via a central kitchen for a city's private schools.

  That one creeped me out more than just about anything because it seemed so
very easy.
  

    
It also tells us that the incubation period is much shorter
for hoof & mouth disease. Our attention span is ,um, rather
limited. 
  

    
You don't have to make people sick to have a highly useful weapon. In
terms of economic impact, this is going to be unbelievably costly in
Britain. And it's almost untraceable.
  

    

Am I simply being too pessimistic if I think it's inevitable that both
foot and mouth and mad cow will reach our shores AND have a similar
economic impact?
  

    
Foot and Mouth will almost inevitably reach the US, where we call it Hoof
and Mouth (cf. op cit Bill Cosby). It's very, very hard to contain.

  I think that Mad Cow will show up here, too, and will cause a horrendous
panic when it does. I don't think that we'll see many cases, despite the
blending of meat in our food supply chain, but we'll eventually see isolated
cases if for no other reason than CJD sometimes emerges spontaneously in
nature, and not-so-good slaughterhouses use methods that allow
centralnervous tissue to come into contact with the meat.

  I think of these as very small amounts of absolute risk of a very horrible
outcome--you know, like flying in an airplane. So I continue to eat beef.