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Bioterrorism Prevention Means Changing our Minds

Discussions with my medical school colleagues who are experts in infectious disease lend special urgency to the concerns expressed in the media about bioterrorism via smallpox or anthrax. Some steps have already been taken in various localities to address initial concerns. In the New York City area police have been issued gas masks and charcoal body suits. When it comes to bioterrorism however, the old adage, "an ounce of prevention is worth a pound of cure" holds true. For prevention to work however, we must think and act locally and globally.

Some potentially helpful local measures include:

  1. The recognition of the biological attack in the early stages so containment can be attempted.

    This includes both hardware and people. Suspect bioorganism detectors in public places can be of some help. But, early recognition must start with training hospital personnel, clinics and pharmacists in the recognition of early symptoms of potential biological warfare attacks. Training in such symptom pattern recognition must immediately become part of the curriculum in the medical schools, nursing schools and pharmacy schools. Risk management credits for continuing health professional education can be expanded to include recognition and responses to bioterrorism symptom patterns.

  2. The devising of a contingency plan to deal with the various types of biological agents, either through stockpiling of drugs or establishing emergency procedures to produce antidotes in a short period of time (There is a precedent in the mobilization of pharmaceutical firms to produce penicillin for WWII).
  3. Utilization of a centralize agency to track potential outbreaks via databases.
  4. Including responses to bioterrorism as part of public and private school curricula for health education.
  5. Training of public and private school nurses and EMT's for first line and secondary responses to a bioterrorist attack.
  6. Parent and workplace education courses on initial responses to bioterrorism.
  7. Use the existing Veteran's Administration health care system and mobilize medical schools as focal points for bioterrorist emergency response preparedness.

When all is said and done however the variety of proposed measures such as gas masks that can help in damage control for chemical weapons attack are relatively useless versus biological weapons. Availability of vaccines, while helpful, is not likely to be an impregnable Maginot line for preventing casualties in the millions. Unfortunately, for bioterrorism, the old military adage of "the best defense is a good offense" holds true. This means destroying state sponsored manufacture of such bioterrorism weapons of mass destruction at their source. Today, at the very least this means destroying the Sadam Hussein's capability for biological weapons manufacture as well as the Israeli's destroyed his capability for nuclear weapons manufacture in the 1980's. More likely, since under state sponsorship, biological weapons manufacture is far easier to widely disperse than nuclear weapons manufacture, it means completing the unfinished work of the 1991 Gulf War: the liberation of the Iraqi people from their oppressive regime.

To proceed effectively however, we need to change our minds. In the face of terror and the understandable need to maintain continuity post-catastrophe, changing our minds is particularly challenging. To change our minds we need to be aware of and avoid the variety of decision-making heuristics and psychological defenses which are pitfalls to effective bioterrorism prevention. I was struck by the prevalence of these pitfalls even among the flower of our own intelligentsia. Among some of my most world-renowned colleagues there still is understandable denial. This denial is one well-meaning response in the face of terror, the desire to continue with our lives as if there is nothing to worry about.

One misguided attempt at being helpful to those who feel terrified is summed up by statements such as "We need to go on just the way we did before September 11th except a little kinder to each other". While these are different times, I remember my parents, members of the Jewish resistance in Poland during the Shoah of World War II, recounting their frustration when they tried to warn and organize other Jews in the Lodz ghetto. "Let's be kind to each other and just go on with our lives" was a tragically common dismissive response.

There is now, as there was than, an all too prevalent a sense that talking about "it" will lead to panic or paralysis. Other mechanisms contributing to paralysis include a misguided holier than thou perfectionism such as that embodied in a recent petition for academics originating in the University of Toronto urging the U.S. President not to take any action that might involve the loss of any innocent lives. Of course, this impossible to achieve when the mass murderers use human shields reminiscent of the way the Nazi's would execute innocent hostages for any acts of self-defense by the Jewish resistance. Other mechanisms include blaming the victim in a variety of ways ranging from reductionistic causal heuristics to misleading moral equivalencies. These are heard as statements ranging from "their murders are caused by the West's US, Israel's actions" to "we are as bad as they are for embargoing the Iraqi's use of chlorine (a poison gas ingredient) to purify their water". Other counterproductive responses to terror and mass murder heard in the academic world include "que sera sera" fatalism. "The mass murderers represent an emerging world order, the decline of the West has to come sooner or later", or as in 1991, "if we overthrow Hussein, someone worse will come along" or "nothing can be done until we address root causes such as the economic inequalities which exist between us and them."

One also needs to also avoid extreme conservatism in probability assessment based on anchoring on our pre-September 11th model of the world and failing to adjust our probability estimates as to the likelihood of another attempt at mass murder. Such a failure represents a common human rigidity as to updating probabilities based on new information. This is a pitfall all the more tempting as a way to maintain continuity post catastrophe. A common refrain is that "there is as little or even less likelihood today of another mass murder as there was on September 10th. Unfortunately, while we are now better able to defend ourselves against such threats as use hijacked airplanes or explosives, the sheer magnitude of the murder committed is likely to encourage other megalomaniacs to attempt to copycat using different, less readily defended against, means. In that respect, bioterrorism all to readily fits the bill as the next terrorist weapon of choice.

It is true that we should not be too hasty to act. But the old chess and military dictum of "getting there the fastest with the mostest" still matters. While many have focused on "haste makes waste" as a dictum, we need not succumb to either panic and paranoia or perfectionism and paralysis in considering when to act. Deliberate yes, but speed is key. We cannot safely give Sadam Hussein and his associates much more time by being deliberate beyond prudence. The longer we wait to act to topple his regime the more we unwittingly increase the risk of biological weapons of mass destruction being effectively used in the foreseeable future. The West cannot continue to put its blinkers on by focusing exclusively on bin Ladin and his particular cult-like network, nor to continue to wait distracted. Until we act to stop the threat at its source of manufacture, Sadam Hussein's regime will continue to manufacture these bioterrorism weapons. We cannot wait forever to overthrow those governments who right now manufacture the next weapons of choice for those cult murderers who misuse Islam to rationalize tyrannical domination and rule via mass murder.