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;

-Anthrax
-Smallpox
-Plague
-Botulism
-Tularemia
-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 http://www.thenation.com/doc/20060605/siegel

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 http://www.wtop.com/?nid=251&sid=779748

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”)