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Memo from the Editor's Guest: We must prepare!


We must prepare


Memo From The Editor's Guest

We must prepare!

Donald Fox, MD

I know firsthand why we should be afraid of a terrorist attack with biological weapons. I know why we should fear anthrax. Unlike 99.44 percent of physicians, I've actually treated a case.

Way back in 1955, fresh out of my internship, our government made me Post Surgeon of the Army Biologic Warfare Center at Fort Detrick, a small camp outside rural Frederick, MD. A civilian bacteriologist presented in our dispensary with an acute onset of fever, cough, and shortness of breath. We knew immediately what he had. He knew what he had. Laboratory-acquired anthrax.

Despite the efforts of five physicians and massive doses of IV penicillin, the patient's lungs were quickly inundated with pus and blood. He died in less than 24 hours. His obituary said he died of flu.

Since Sept. 11, I think about Fort Detrick often. To those who passed by, it seemed to be an ordinary military facility, but those innocuous wood structures next to the drill fields existed for one purpose only: to produce deadly biologic agents. Killer germs.

What made this activity so important to our military? Germs are cheap. Germs are easy to grow. Germs destroy. And 50 years ago at Detrick, when the search was on for the most destructive biologic agent of all, the clear winner was pulmonary anthrax.

But this was top secret stuff, so no one at Detrick ever uttered the word "anthrax." The Army used an alphabet code for all of the biologic diseases. Anthrax was "N," and it was synonymous with certain death.

It was easy to grow tons of N. But how did you disseminate it to the enemy? An aerosol delivery system. Hundreds of N-loaded canister bombs that would explode close to the ground were produced.

But how effective would they be? There was no way that N itself could be tested on a civilian population. Instead, a supposedly harmless bacterium, Serratia marcescens, was substituted.

In the pre-dawn hours of the appointed day, planes loaded with Serratia-filled canisters dropped their payload over a sleeping Washington, DC. The next day, swarms of Detrick bacteriologists went about culturing every nook and cranny of the capital. Wherever they explored—the water supply, subways, parks—the results were the same. Serratia was everywhere. What a fantastic success. Without endangering the local populace, they had proven the delivery system worked. N was ready to go.

Then, about six months later, there began to appear in Washington a variety of unusual respiratory infections—caused by the agent thought to be harmless, Serratia! Several deaths occurred. It came to light that a similar test had been done in San Francisco, and when the father of a congressman died there, a class action suit by the victims was initiated.

The case was settled quietly. The canisters of N were stored away and, in 1968, were supposedly destroyed when President Nixon ordered the destruction of all bacterial weapons.

Today there are obvious reasons why the use of biologic agents is attractive to terrorists. Biologic weapons can be created for a fraction of the cost of conventional ones and with no danger of detection. Depending on the agent, the effects can range from mild illness to fulminant death. And the attackers can protect themselves through immunization.

Are we vulnerable to a biologic attack? You betcha! It's infinitely easier to introduce anthrax into our environment than it is to commandeer four jets and fly three of them into national icons.

What can we as physicians do to protect our people?

First, we should press for immunization. At the moment 2.5 million doses of vaccine are being made to immunize the military. Let's mount a drive to put vaccine production into overdrive so we can safeguard our entire population.

We should also use our influence to help the nation be ready for the worst. The government should suspend all patent rights on all antibiotics effective in treating anthrax, and contract with generic drug manufacturers to produce enough of the drugs to be available in case of a mass biologic attack.

Finally, on an individual level, a coalition of physicians should be created in every geographic area to plan treatment strategies in the event of an attack.

We must be prepared. If not, the destruction and loss of life at the Pentagon and the World Trade Center will seem minuscule in comparison.

The author is an internist in Philadelphia.


Donald Fox. Memo from the Editor's Guest: We must prepare!. Medical Economics 2001;20:6.

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