Saturday, May 27, 2006

BIOTERRORISM- Don't Trust A Wealthy Heart Surgeon

I began by writing a book review of Senator-Doctor Bill Frist’s 2002 book
"When Every Moment Counts- What You Need to Know about BIOTERRORISM from the Senate's Only Doctor"- Published by Rowman & Littlefield Publishers-Lanham, MD -$14.95. But I found myself drifting from the traditional book review format to comment on the credibility of the author himself. Since I am trained and hold board certification in the medical specialty of Preventive Medicine I felt some latitude in doing so.

First- A few pre-review comments. Personally I do not believe it is ethical or wise for a sitting Senator to write a for profit book about a topic over which he/she has legislative involvement and oversight. Secondly Dr. Frist is a well-trained cardio-thoracic surgeon who to my knowledge has no formal training in Public Health or Preventive Medicine. Thirdly gratis copies of the book are presumably being distributed by Sanofi -Pasteur, a multinational vaccine production company, who stands to directly benefit financially from this book's recommendations and implications.

Written in 2002 I apologize for this late review but I received the book @ 1 month ago. The book is endorsed by former US Surgeon General C. Everett Koop, Senator Edward Kennedy and former Senator Sam Nunn. The book must be reviewed in the context of the horrific post “9/11” 2001 terrorist events and the shortly thereafter (only three weeks later) anthrax mailings in US in October 2001 as well as wide press coverage of pronouncements made about pre- Iraqi war intelligence regarding the "obvious imminent threat" of bio-weapons of mass destruction.

The book begins with the "Anthrax in the Capital" (Chapter 1) the dramatic day-by-day account of the unfolding story beginning in our nation's capital on October 15, 2001- the very day an anthrax laced letter was opened in the offices of US Senator Tom Daschle. And my guess is that this book was hastily written by Sen. Frist as a result of that very real tragic incident and the role that Dr. First, personally played in “managing” that event as the then Senate’s only “trust me I am a (albeit heart surgeon) doctor.”(There is now a second doctor-senator) Fortunately deaths were limited and we presumably learned a lot. Of course the perpetrator of that dastardly deed which ultimately infected 22 people and killed 5 fellow Americans in other locations is still at large today. (I might add that 33,000 were given preventive antibiotics- really necessary in retrospect?)

The only other know "bio-terrorism attack" in recent US history was the purposeful contamination of food using Salmonella bacteria at a salad bar in Oregon by the followers of guru Bhagwan Shree Rajneesh in September of 1984 who were trying to sicken enough people to swing a local election ballot initiative their way. A total of 751 people became ill with zero deaths.

So the remainder of the book represents hypothetical risks of bio-terrorism with also one chapter on Chemical Weapons another chapter on The Threat to Our Food and Water Supply. Finally a final chapter on how we can prepare as a nation individually at the state and Federal level and through legislation. The book, to its credit, is written mostly in a Q&A format and at a language level that makes for easy reading by the general public. Chapter 2 is dedicated to "Safe at Home- A Family Survival Guide" which had some good tips in it which including psychological prep of children and how to stay generally healthy. I liked this chapter.

Following are specific chapters on specific threats;

-Ebola and Other Viral Hemorrhagic fevers
-Chemical Weapons
-The Threat to Our Food and Water Supply.

These chapters seemed generally scientifically accurate given the mega-proviso that terrorists can and will likely successfully utilize these organisms and methodologies?

The book closes with a Chapter 11 - "A Nation Prepared - Safeguarding Our Future". It references Senator Frist's political work that led to the passage of The Public Health Threats and Emergencies Act of 2000 co-sponsored by Sen. Ted Kennedy. It also references The Bioterrorism Preparedness Act of 2001 proposed post anthrax incident and according to Dr Frist "also addresses the areas of food safety and agroterror that have been sorely neglected in the past." The chapter calls improved intelligence gathering, improved collaboration with the US Department of Defense (DOD), more oversight by the FDA to protect our nation’s food supply and there is a special emphasis on the need for coordinated communications.(hah!)

Of course Republican Frist calls more public-private partnerships regarding drug and vaccine development and antitrust relief to drug companies and vaccine makers as well as increased liability protections. Dr. Frist had the honesty and accuracy to state then in 2002 in this book that the nation was not yet prepared “Clearly America is not yet ready to meet this deadly threat" says the good Doctor Frist.

But here we are four years later in May of 2006 and we have the following:

1) Not a single bioterrorist event occurred in the US since the Oct 2001 Anthrax letters.

2) Re: Intelligence- the perpetrator of the sent Anthrax laced letters remains at large.

3) No Weapons of Mass Destruction including Bio-Weapons were found in Iraq before or during the war as of the writing of this essay.

4) "Coordinated Communications" during the very real (non-bio event) Hurricane Katrina (summer 2005) proved to be absolutely abysmal.

5) The US experienced a very real and dangerous extreme shortage of "regular flu" vaccine in winter flu season 04/05 because of our financial ties to a single flu vaccine plant in Great Britain that had quality control problems.

6) The US attempt at Smallpox vaccination program initially geared toward first responders and health care providers (2003-present) was/is a medico-legal fiasco especially in the private sector.

7) The US attempt at Anthrax vaccination in the military was moderately successful but also experienced very difficult medico-legal problems as well.

8) We are currently spending perhaps billions on a potential pandemic flu plan (admittedly not bioterrorist) which some experts are stating was at least initially ill conceived because of its focus on a single organism (bird-flu variety H5N1) and a failure to allocate pandemic flu dollars where they could be most effectively utilized. See

Senator-Doctor Bill Frist presided over the US Senate in the powerful position of majority leader since Dec 23, 2002 during which most of the problems I note above (1-through 8) occurred.

Perhaps I'm being unfair in what started as a book review also when I state that Senator Doctor Bill Frist's family wealth was derived from the largest for profit Hospital Chains in the US called Hospital Corporation of America (HCA) subject of a decade long federal investigation on Medicare, Medicaid, and Tricare fraud charges resulting in a payment of $1.7 billion dollars in fines -the largest health fraud settlement in US history. And Dr. Frist's mishandling of the Terri Schiavo landmark death and dying case where the good doctor-senator Frist engaged in "long distance video neuro-diagnosing" under pressure from the fundamentalist Christian right to unsuccessfully prevent Terri Schiavo from being removed from her "life" supporting technology despite her neuro-vegetative state. But I add this here since the very credibility of the author of this book both as a doctor and a political leader are strained by these events.

In summary, the Frist book on bioterrorism itself is not a bad handbook for those who believe a bioterrorist event is indeed likely or even imminent. Actually this writer honestly does not know what the true risk really is? Some of the data is necessarily top secret. Just this month UN Secretary-General Kofi Annan urged the 191 UN member states to agree on a global strategy to combat terrorism with “a top priority to come up with new ideas to prevent terrorists from using biological weapons” See

What I do believe is, that if the risk is indeed real, I would not place my personal confidence in, nor urge my fellow American Citizens to place their confidence in, a very wealthy heart surgeon turned politician whose leadership and self- professed expertise in this important arena of bioterrorism and related health issues has proven to be at least so far an embarrassing and dangerous failure- perhaps placing our nation at even greater risk than before his book was ever written.

Rick Lippin MD, (“Blake”)

Sunday, May 14, 2006

The US Workplace-"The Forgotten Environment"

The 91st Annual American Occupational Health Conference, my own medical specialty’s most well attended annual conference held last week, brought me back to Los Angeles,California which I hadn’t visited in over a decade. Well, the City of Angels still impresses me as a unique but quirky American City. Their addiction to automobiles with soaring gasoline prices has got to scare them soon I hope into much more mass transit and their glitz, glamour, and botox party Hollywood/Beverly Hills “scenes” seems hopelessly out of sorts with the gravity of our nation’s current numerous crises. One irritant (actually quite dangerous especially for the elderly) demonstrating how pedestrian unfriendly this city is was the amount of time the walk sign provides you, the lowly pedestrian, after you press a button to allegedly halt the constant stream of high speed traffic to “allow” you to walk across a 4-6 lane high speed highway. I promise you, Mayor Villaraigosa and Governor Schwarzenegger the time provided requires literally running for any age group. Maybe this is the good Mayor’s or Governor’s civic wellness program for Los Angelinos?

Well more importantly is the state of the specialty of Occupational Medicine, as I perceived it through the conference and in the hallways or over coffee with my colleagues. The biggest shift in the field is a sea change in the American College of Occupational and Environmental Medicine (ACOEM) membership demographics from company and government employed occupational doctors in the 1970s (over 80 % of the membership) who actually collaborated with Safety, Industrial Hygiene, Toxicologists and Epidemiologists to seek to understand and mitigate workplace safety and health hazard to most Occupational Docs now working in for profit clinics (over 80%) mostly attempting to “manage” (i.e. reduce) workers compensation costs for mostly musculoskeletal "injury" cases. Hence, Dr. Joseph LaDou, an academic leader in Occupational Medicine from California himself, has written about “The Rise and Fall of Occupational Medicine in the United States ” and calls for radical reform including a public health model of Occupational Medicine and the dismantling of the US workers compensation system as two means to save the profession

Beginning with Clinton admin and accelerated by the Bush admin the enabling law and regulatory agency for Occupational Medicine –OSHA- has almost been completely gutted giving corporate America little incentive to retain or hire occupational health professionals. Instead companies are “encouraged” to engage in voluntary partnerships with OSHA -reminding me of faith based volunteerism that Mr. Bush believes should replace other government funded or regulated social safety net programs in other fields.

Alas published data reveals that recent trends in workplace related injuries and illnesses are not good (see
And I for one believe that work stress and depression remain at epidemic proportions due to either layoffs-“you cant have occupational heath without an occupation” and the fear of layoffs re downsizing and outsourcing trends. Although I must admit things seem a bit brighter in recent months regarding these trends. I wrote a piece in 2004 on US worker use of antidepressants in which I still believe remains excessive.

In 2004 I also wrote a review of sociologist Elaine Draper’s book called The Company Doctor: Risk, Responsibility, And Corporate Professionalism wherein I basically agreed with Draper that the US must adopt an independent tripartite model of Occupational Medicine funded by Industry, Government and labor which is the working model in many European nations. This model might save US Occupational Medicine?

A few bright spots of the conference were the opening key-note address by Dr. Paul Brandt-Rauf from Columbia University and Editor of ACOEM’s journal JOEM who urged occupational doctors to sign up now for work in environmental medicine in third world nations like Bangladesh where Brandt-Rauf and his colleagues from Columbia are doing quite remarkable work on lowering arsenic in drinking water which is a huge environmental health problem in many countries including parts of the US. My professional association to its credit had the vision to add Environmental Medicine to its worker health field in 1992 recognizing the magnitude and the importance of the global environmental moment yet not long after prompting organized labor to correctly call the workplace “the forgotten environment” hence the title of this blog piece.

Also a seed of social conscience has become manifest in ACOEM called the Section on Underserved Populations was founded just two years ago. This small section is correctly focusing on preparing migrant clinic based primary care docs in occupational medicine basics who will absorb the estimated 11-12 million soon to be legalized workers who are now working “undercover” on farms, in landscaping, hotels, garment factories, construction etc. These workers don’t currently dare call any attention to themselves by reporting an occupational injury or illness less they be arrested and deported for illegal immigrant status. Go to

Finally, if progressive dems or independents win US congressional elections in November of this year and capture the White House in 08 look for a long overdue stronger OSHA and increased activities in Occupational Health no matter what delivery model prevails.

I have practiced Occupational Medicine for over 30 years and it always occurred to me that the term “worker health” was inherently a liberal concept where workers might be viewed as assets and not expendable costs on the balance sheet despite the inherent power dominion that empoyers have over employees and the classical business definition of efficiency.

But I have always been a dreamer- I know of no other way to live?

My view of Occupational Medicine romantically goes beyond the avoidance of work related pathology which I would die very happy to see come to pass. My view is that work, being so central to human existence, is actually a prerequisite to good heath. I hold the view that job satisfaction is grossly understudied and under appreciated as a determinant of human health. One of my mentors Dr. Lennart Levi from the Karolinska Institute in Stockholm, Sweden said it well many years ago when he said-

“Work should be designed by man for man. Work should serve human needs- not vice versa. Good and healthy work should give meaning to life. This is not what work looks like to millions of workers all over the globe. Work should become man’s servant-not his master”

Dr. Rick Lippin ("Blake")

Wednesday, May 10, 2006

Ignore This Post

You probably don't know that Board-Certified Homevideoneurodiagnostician Bill Frist has declared this to be "Health Week" in the Congress, because the corporate media, to their credit, have largely ignored it. The basic idea seems to be for the Republicans to move outrageous proposals that they know won't pass, in order to score points with some of their base constituencies. I was committed to joining in the mass movement to completely ignore this, but then I decided it might be instructive with respect to some recent topics to take a quick look.

The first thing they tried was to cap jury awards in malpractice suits. That didn't get the 60 votes it needed to break a Democratic filibuster. (And let's acknowledge the resurrection of the minority from the dead.) The malpractice system definitely has flaws, but excessive compensation to horribly injured people is not one of them. (Okay then, malpractice is now on the to-do list here.)

Now they have an even more nefarious proposal. Under cover of a bill to allow small businesses to form purchasing cooperatives across state lines, they want to override state regulations requiring that health insurance be comprehensive. The plans could be lower in cost because they wouldn't have to cover things like mammograms, well-child care, or even chronic disease care.

If you've been reading Stayin' Alive, you already know that one of the most pernicious consequences of our fragmented health insurance system is that insurers don't have an incentive to keep you healthy, because by the time you get sick, you probably won't be their problem any more. Therefore, while it saves society money to provide services like cancer screenings and immunizations, preventive care represents a cost to insurers that they might not recoup. That is why state regulations require that plans offer certain basic services. But now "Dr." Bill Frist wants to kill you, so that businesses can save money, and give some of it to Republican candidates.

You can read all about Sickness Week in Forbes. Or you can ignore it, which is what I recommend.

(Cross-posted on Stayin' Alive)