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:
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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.
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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).
-
Utilization of a centralize agency to track potential outbreaks via
databases.
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Including responses to bioterrorism as part of public and private
school curricula for health education.
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Training of public and private school nurses and EMT's for first
line and secondary responses to a bioterrorist attack.
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Parent and workplace education courses on initial responses to bioterrorism.
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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.