February 07, 2012
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Bioterrorism - Scare Stories Can Be Dangerous to Our HealthDr. Cohen is Assistant Professor, Department of Epidemiology and Social Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, New York, Dr. Sidel is Distinguished University Professor, Department of Epidemiology and Social Medicine, Albert Einstein College of Medicine and Montefiore Medical Center and Dr. Gould is President, SF-Bay Area Chapter, Physicians for Social Responsibility, San Francisco.
Drs. Cohen, Sidel and Gould have written this article in response to a previous TheDoctorWillSeeYouNow.com article on bioterrorism. —The Editors Bioterrorism. The word itself sounds scary. Novels and movies have portrayed shadowy figures spreading deadly disease among an unsuspecting public. Government officials and public health figures repeatedly issue warnings about the terrible threat. While the potential threat has been widely publicized, there has been little discussion of the risks of the suggested responses. From the statements of public officials and media coverage, one might think that bioterrorism incidents have done tremendous damage and have increased dramatically in recent years.(1) Actually, examples of bioterrorism have been very rare. The only documented terrorist use of a biological agent was in Oregon, where in 1984 a religious cult allegedly contaminated several salad bars with salmonella, with hundreds of illnesses but no deaths.(2) The only documented terrorist uses of chemical agents were in Japan where a religious cult used Sarin, a nerve gas, killing seven people in the suburb Matsumoto in 1994, and used it again in 1995 in a Tokyo subway killing 12 people and injuring many more.(3) Is It Hype?
These same cases are cited over and over, in virtually every article and speech on bioterrorism. In another article on TheDoctor, the author cites these incidents but adds a few more. His list of what he calls "bioterrorist attacks around the world" begins with the 1979 "accidental release of anthrax spores from a Russian military base" and ends with a series of scares, threats and hoaxes, mostly concerning anthrax.(4)
The Russian accident illustrates the dangers of manufacturing and storing biological and chemical weapons, as does the release of VX nerve gas at a U.S. military base in Utah in 1968 that killed thousands of sheep, although no people were in the area.(5) These were tragic accidents but not "bioterrorist attacks." Listing anthrax hoaxes as if they were attacks is also misleading. Anthrax samples are not easy to obtain and samples that are available are not particularly dangerous. The dangerous, weaponized version that uses anthrax spores are only possessed by a handful of governments with large military establishments. All the scare stories about bioterrorism may have helped make anthrax hoaxes more common. As long as the public is led to believe the unsupported notion that an anthrax attack is likely, then many more such hoaxes should be expected.(6) Removing hoaxes and military accidents from the list of bioterrorist attacks leaves a worldwide incidence, over 16 years, of 751 illnesses and no deaths from a food-borne contaminant and 19 deaths and scores of hospitalizations from the nerve gas events in Japan. How does the public health burden of these dramatic and deplorable incidents compare with that of 'ordinary' diseases and accidents? In the United States alone, there are an estimated 76 million illnesses from food-borne disease each year, with 325,000 hospitalizations and 5,000 deaths.(7) Also each year in the U.S. there are approximately 60,000 chemical spills, leaks and explosions, of which about 8,000 are considered 'serious', with about 300-400 deaths.(8) In the context of everyday public health problems, the actual morbidity and mortality from bioterrorism have been minuscule. How then has bioterrorism been presented as a major threat to public health? Presentations on the topic generally open with 'scenarios' — fictional accounts of what 'could' happen. The Centers of Disease Control and Prevention produced a video that shows a shadowy, fictional terrorist with a parcel of deadly biological agents that could kill thousands or even millions.(9) In 1998, U.S. Secretary of Defense William Cohen held up a five-pound bag of sugar on a national television broadcast and declared that if the sugar were anthrax, the organisms could kill half the population of Washington D.C. Presentations like these do get the attention of the listeners. But are they based on any reasonable assessment of risk? The Real Risk?
In order to make a reasonable estimate, it is useful to distinguish between very different types of potential incidents. The most frightening is the use of chemical, biological or nuclear agents in a manner that would cause huge devastation and tens of thousands or even millions of casualties. Dr. Carey writes, "ironically, the threat of a massive chemical or biological attack, especially with certain infectious agents such as smallpox and anthrax, exists because of the achievements of modern medicine that have eradicated these scourges."(4)
On the contrary, it is not modern medicine that has created the risk of such catastrophes but the practices of modern warfare. Ever since the devastation of Hiroshima and Nagasaki, the world has been well aware of this danger. The various international treaties and conventions against nuclear, chemical and biological weapons proliferation reflect the recognition by even those states in possession of such weapons that their use could bring about self-destruction, as well as the destruction of the intended targets.(10)(11)(12) Biological and chemical weapons of the kind and amounts that could cause catastrophic casualties are extremely difficult to obtain and still harder to deploy. Only countries with nuclear weapons capability and a relatively few others with large military establishments have had that capacity.
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