Robin Cook - Vector

Yet the medical profession’s responsibility with regard to bioterrorism goes beyond detecting an episode and treating its victims. The medical profession has an ethical duty to continue to institutionalize the opprobrium currently associated with the use of bioweapons. Members of the medical profession of all countries must insist on investigating any suspicious disease incidents within their borders and report such circumstances to the world forum. If that had happened in Sverdlovsk in 1979 following the anthrax leak from a Biopreparat bioweapon facility, the Soviet medical profession would have done the world a service. It would have exposed the illegal Soviet offensive bioweapon program. Instead, the world was treated to elaborate KGB disinformation, and Biopreparat continued its illegal and ethically repulsive secret work for another ten years.

Another reason the medical profession has an ethical role to play in relation to bioweapons is that this technology represents the ultimate perversion of biomedical research. Indeed, with the help of the burgeoning field of bioengineering, the possibility exists of constructing new doomsday organisms. Experts shudder at the thought of combining the contagiousness of the common cold or even smallpox with the pathogenicity of Ebola.

As is the case with the nuclear threat, the public feels it can do little to thwart the development or deployment of bioweapons. But that is not entirely true. The public can play a role in this worsening biological nightmare by being cognizant of the threat bioweapons pose. Counterintelligence is the only way to actually prevent occurrences, and the public should be suspicious and vigilant. Since it is true that small labs and production facilities can be made in private locations like basements or spare rooms, it is important to be on the alert for tip-offs, like fermenting odors or the sound of constant, circulating fans. These should be reported to the authorities. Any unexpected traffic or theft involving microorganisms, microbiological equipment, microbrewery fermenters, biocontainment gear, or pest control spraying devices should also be brought to the attention of law enforcement.

With everything else there is to worry about these days between AIDS, famine, economic woes, civil war, ethnic cleansing, and global warming, it seems there is hardly room for the specter of bioterrorism. Yet few threats have the capability of killing so many so fast. For years we lived under the fear of nuclear winter annihilating the human race. Now there is a similar threat from biology.

Finally, on a more positive note, governments and local authorities, particularly in the United States, have started to consider seriously the menace of bioterrorism and have begun to act. Money has been appropriated. The Department of Defense and the FBI have formed specialized response units. Major cities like New York have tasked their emergency management organizations with the problem. There have been efforts at training on the local level and exercises to mimic real events. Still, the results to date are equivocal. It may take an actual bioterrorist strike to harden government initiative, but by then, for many, it will be too late. Much needs to be done, and we all have to contribute. Let’s not wait for an incident like the planned one in Vector to solidify our resolve.

Robin Cook, M.D.

Naples, Florida

December 1998

1. Davis, Lorraine, et al., editors, Medical Aspects of Chemical and Biological Warfare, Washington, D.C., office of the Surgeon General, 1997.

This is a thoroughgoing, textbook treatise.

2. Falkenrath, Newman, and Thayer, America’s Achilles Heel: Nuclear, Biological, and Chemical Terrorism and Covert attack. Cambridge, MA, M.I.T. Press, 1998.

This is the best general book on the subject that I found. It focuses directly on policy implications.

3. Hamm, Mark, American Skinheads: The Criminology and Control of Hate Crime. Westport, Conn. Praeger, 1993.

I didn’t know the difference between skinheads, punks, and rockers until I read this book. I found it fascinating, particularly in relating these movements to rock music.

4. Laqueur, Walter, Fascism: Past, Present, Future. New York, Oxford University Press, 1996.

This is an extraordinarily readable book about a movement that most of us thought had been defeated in World War II. I found it inordinately stimulating, particularly in relation to the current economic and social turmoil in Russia.

5. Lundberg, George, Journal of the American Medical Association (JAMA). Chicago, Vol. 278, No. 5, August 6, 1997.

This entire issue of JAMA was devoted to the issues of bioweapons, biowarfare, and bioterrorism. It is written from the point of view of the health-care provider.

6. Preston, Richard, “Annals of Warfare: The Bioweaponeers.” The New Yorker, Vol. 74, No. 3 (March 9, 1998).

This is a wonderfully written article that is bound to disturb any reader.

7. Remnick, David, Resurrection: The Struggle for a New Russia. New York, Random House, 1997.

This is another enormously readable, enlightening, and ultimately disturbing book. It is a must for anyone interested in the current chaotic situation in Russia.

ANTHRAX: An infectious and usually fatal disease of warm-blooded animals, particularly sheep, goats, and other ruminants, that can, on occasion, be transmitted to humans. Human-to-human spread generally does not occur. By common usage, anthrax also refers to the causative agent, Bacillus anthracis. This bacteria is present in soil worldwide. Anthrax is well suited as a bioweapon because it is capable of forming hardy spores that can remain stable for decades. The deadliest form of this disease occurs when the spores are inhaled and germinate in the lungs. Death can be rapid.

BIOTERRORISM: The threat or actual use of a bioweapon to cause widespread terror and/or mayhem, often deployed to exact revenge or promote an ideological agenda.

BIOWEAPON: A biological weapon of mass destruction composed of living organisms (e.g., bacteria, viruses, fungi) or the products of such organisms.

BOTULINUM TOXIN: A toxin produced by the bacteria Clostridium botulinum. Botulinum toxin is a neurotoxin, exerting its effect by interrupting nerve cell function. Clostridial neurotoxins have the dubious distinction of being the most poisonous substances known to science. These toxins can be ingested, inhaled, or injected to exert their deadly effect. It is estimated that less than a pound (or less than a half kilogram) would be enough to kill every man, woman, and child on earth.

TOXIN: A poisonous substance produced by a living organism.

WEAPON OF MASS DESTRUCTION (WMD): A nuclear, chemical, or biological weapon capable of killing or incapacitating tens of thousands or even millions of people and/or destroying vast areas.