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Anthrax scare: Time for informed leadership

The AMA was prepared long before Sept. 11 to show leadership in the event of a bioterrorism attack.

Editorial. Nov. 12, 2001.

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The anthrax scare has created a need for well-grounded leadership in medicine and public health not seen since the AIDS crisis in the 1980s.

As it was with AIDS, the response to the anthrax postal attacks so far has produced both praiseworthy efforts and missteps. The testing of congressional staffers, at the first sign of trouble, demonstrated a quick response. However, testing was ordered too late for postal service employees. Two postal workers died, and others got sick, from inhaled anthrax spores that apparently escaped the envelopes en route to Capitol Hill -- a risk not taken into account early enough in the investigation.

On the individual physician level, it is noteworthy that the first diagnosed cases of anthrax in Florida and New York were discovered by physicians who did an admirable job of putting all the facts together, clinical and circumstantial. Meanwhile, it is unfortunate to report that some physicians have proven too pliable in light of patient demands for antibiotics. The result is an alarming number of unnecessary prescriptions for Cipro, the drug of choice for initial treatment of anthrax.

That the privileged, or at least the persistent, can obtain such prescription drugs without being realistically at risk of exposure is disturbing. "It's not what you know, it's who you know" may be useful advice on how to succeed in the business world, but it should not apply to patients who are trying to obtain prescription drugs.

Unnecessary personal stashes of Cipro and other antibiotics clearly present a potential public health problem in terms of antibiotic resistance. There's also a significant risk of adverse side effects. But science aside, the socially corrosive mix of hoarding, shortages and haves versus have-nots only plays into the hands of whoever sent the anthrax-laced letters.

Antibiotics are also being ordered via the Internet. It is just one more example of the potential danger that online prescription sites pose. However, their owners may rue their antibiotic windfall.

Regulators were largely indifferent when the risk for harm was limited to the fool inclined to self-prescribe Viagra. Perhaps the wholesale distribution of antibiotics will bring even greater government attention to the sites. It's about time.

In light of recent events, the AMA has taken a prominent role in warning the nation's physicians to avoid unnecessary antibiotic prescriptions. It was only one of the many important messages that the AMA is well-qualified to send in this crisis.

Well before Sept. 11, the AMA was studying bioterrorism and disaster preparedness. Since 1999, its Council on Scientific Affairs has produced two major reports on the subjects, containing findings and recommendations about the medical and public health response. The AMA also has co-sponsored meetings and educational sessions on how to respond to bioterrorism. The Journal of the American Medical Association has published major articles on anthrax, botulinum toxin, plague, smallpox and tularemia. The AMA has collected the CSA reports, JAMA articles and other information at a special Web site (http://www.ama-assn.org/go/disasterpreparedness). Also included is access to a transcript of the recent Webcast "Anthrax: What Every Clinician Should Know," sponsored by the CDC, AMA and other health organizations.

Beyond the information, analysis and recommendations that the AMA has to offer on the specific issue of bioterrorism, are broader assets that come from being the nation's overarching organization representing physicians. The AMA has unparalleled experience in how to communicate with physicians and inform them on clinical and public health matters. Its long-time leadership and convenor role in the Federation -- state, local and specialty societies -- gives the AMA even further reach.

The AMA's longtime mission has been to promote the art and science of medicine and the betterment of the public health. The anthrax scare and other bioterrorism threats present an unprecedented challenge, but one in which the AMA has already demonstrated its own preparedness to serve American physicians and their patients.

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