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Virus alert: Physicians go online to share data about bioterrorism

Web sites are cropping up all over that can tell doctors what they need to know about biological and chemical threats.

By Tyler Chin, amednews staff. Jan. 28, 2002.

After the events of Sept. 11, 2001, Ronald K. Reynolds, MD, an emergency physician in Myrtle Beach, S.C., and his colleagues obtained most of their information about biological agents from CNN and its Web site.

"Although CNN was a very good and reliable information source, we realized as physicians that it should not be our primary source of information on those agents," Dr. Reynolds said. "We should be hearing from physicians and specialists within the field."

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So Dr. Reynolds, co-founder and CEO of AnywhereWC LLC, a Web conferencing business in Myrtle Beach, contacted the University of Tennessee in Knoxville, where he had received advanced training in technology, about creating an Internet-based educational program on bioterrorism. In December, they began broadcasting lectures by physicians who are bioterrorism experts.

The webcasts are among a growing phalanx of online resources designed to inform physicians practicing under the shadow of bioterrorism how to diagnose, treat and prepare for biological threats.

The sponsors of these offerings -- physicians, medical societies, government agencies, academic institutions and commercial entities -- are using the Internet to rapidly disseminate information that physicians can use and refer patients to. Most of the offerings are free.

The American Medical Association, for example, has set up Web pages to keep physicians up to date with developments involving bioterrorism and help them answer patients' questions. It also has co-sponsored a satellite presentation from the Centers for Disease Control and Prevention that has been broadcast on the Internet. Physicians who missed that and other CDC presentations can access them free at the Web site of the University of North Carolina School of Public Health, Chapel Hill.

Some online bioterrorism courses are available for CME credit.

The online bioterrorism program Dr. Reynolds helped create consists of three one-hour interactive presentations given by emergency and other physicians with backgrounds in bioterrorism or infectious diseases, he said. Speakers were recruited by the American Academy of Emergency Medicine, the American College of Emergency Physicians and Michael Stahl, PhD, program director of the University of Tennessee's Physician Executive MBA program.

The lectures are limited to emergency physicians, who would be among the first line of defenders in the event of a biological attack. They may be offered later to primary care physicians and other health professionals, Dr. Reynolds said.

More than 400 physicians had registered for the online lecture series as of early December. Physicians cannot use the lectures for credits in continuing medical education, but at press time Dr. Reynolds said he was working toward that goal.

Meanwhile, the Florida Medical Assn. is offering an online course on bioterrorism that physicians can take for one hour of CME. The course, created by Bernd Wollschlaeger, MD, is available for $25 to $35, depending on whether the doctor is an FMA member, he said.

Training for chemical warfare

Unlike most physicians, Dr. Wollschlaeger, a family physician in North Miami Beach, Fla., has been trained to deal with biological and chemical warfare. He received such training with the Israeli Defense Forces.

"We anticipated all the time that we would be attacked by [hostile states] that had biological and chemical weapons," Dr. Wollschlaeger said. He and other physicians also had prepared for a potential chemical attack after Iraq's invasion of Kuwait in 1990.

The attack never came. But his experience in Israel left an indelible impression on him.

In 1991, Dr. Wollschlaeger left Israel for the United States but continued to follow chemical warfare issues and Middle East developments. After the United Nations weapons inspection program involving Iraq was shut down in 1998, Dr. Wollschlaeger began developing a bioterrorism course because he believed physicians needed to learn more about biological and chemical attacks.

He had come to realize that it was no longer a question of whether an attack would take place; it was a matter of when.

At its annual meeting, held after the Sept. 11 attacks, the FMA approved his course for one hour of CME credit. Since then, more than 160 physicians have taken the online course, said Dr. Wollschlaeger, who already is making revisions to reflect new information and guidelines.

To develop the course, Dr. Wollschlaeger drew on his personal experience and material from his military training, the U.S. Dept. of Defense and peer-reviewed publications. "Online Now: Biological and Chemical Terrorism: A Guide for Healthcare Professionals" is the first of a series of online courses related to bioterrorism, he said.

Dr. Wollschlaeger regularly attends lectures, reads peer-reviewed publications and accesses the Web sites of medical societies and government agencies.

That's what other physicians must do, he said. "One course will not do it. You have to learn continuously about the topic."

A critical eye

Dr. Wollschlaeger does quite a bit of his learning on the Internet because he said it provides a convenient and quick way to get the information he needs.

His patients also are going online. Some have brought information into the office or called him about something they read on the Internet.

"Some of the material was questionable," Dr. Wollschlaeger said. "It came from Web sites saying that we're in a national emergency and everybody has to be on Cipro" for treatment of anthrax. Several patients also have asked him about buying herbal remedies and disinfectant soap to fight anthrax.

He advised them to stay away from those products because there are no peer-reviewed articles or clinical studies showing that they work.

He also recommended that they go to sites he visits regularly -- Johns Hopkins University, the Florida Medical Assn., the American Medical Association and the CDC -- for reliable and up-to-date information about bioterrorism. He does not recommend commercial sites to patients.

"My attitude is, why should I go to a commercial site if I can get much better information from another site?" he said. "I wouldn't say that WebMD is not a good site ... but if I have a choice about where to get information about biological and chemical agents, I'd prefer the CDC or Johns Hopkins or the Dept. of Defense to WebMD."

Other physicians agreed.

Jim Martin, MD, a San Antonio family physician who checks his specialty society's bioterrorism Web page weekly, recommends the sites of the CDC and the American Academy of Family Physicians, of which he is president-elect.

"Maybe all those [commercial] sites offer clear and unbiased information, but I certainly feel that the CDC and our specialty society would be very careful in making sure that what information they had was accurate as possible and not flavored in any way," he said.

Emergency physician Dr. Reynolds said he would recommend the Web sites of academic institutions because they have "enhanced credibility." But he also would steer patients to CNN's site, even though it did not meet his information needs as a physician.

"I think that to the lay person CNN is a wonderful site," Dr. Reynolds said. "I can't say it is not a credible resource. It is. It has gone out of its way to provide some very good information, and I have been very impressed with it."

Some commercial sites offer authoritative and credible information for physicians and patients.

EMedicine.com, a St. Petersburg, Fla.-based online publisher of peer-reviewed medical textbooks, for example, offers a free online version and handheld version of a bioterrorism book to health care professionals and the public. The online textbook was completed last July by about 100 physicians who are experts in bioterrorism and infectious diseases, said Scott Plantz, MD, an emergency physician and eMedicine.com's CEO.

"The nice thing about it is that we can update it as new information becomes available," Dr. Plantz said. "For example, when the CDC issued new recommendations on how to treat anthrax, we added them within 24 to 48 hours.

"Physicians can get updates themselves at any time of day or night, 24 hours a day on anything that comes in the door."

ADDITIONAL INFORMATION:

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Consider these factors when evaluating the quality and reliability of online information on bioterrorism:

Who wrote the articles? Who are the authors? What are their credentials and backgrounds? Do the authors have expertise in bioterrorism or infectious diseases?
Who runs the site? Internet content from government agencies, organized medicine and academic institutions usually carries more clout with doctors.
Is the material peer-reviewed?
Is content updated regularly?

Sources: Bernd Wollschlaeger, MD; Jim Martin, MD; Ronald K. Reynolds, MD; Scott Plantz, MD

Weblink

Resource compilations, including fact sheets, diagnostic tools and announcements, from medical and governmental organizations:

AAFP Bioterrorism and Preparedness page (http://www.aafp.org/btresponse/)

ACP-ASIM Bioterrorism Resources resources (http://www.acponline.org/bioterro/)

AMA Disaster Preparedness and Medical Response page (http://www.ama-assn.org/go/disasterpreparedness)

California Medical Assn. Bioterrorism Resource Center (http://www.cmanet.org/publicdoc.cfm/534/207/gener/677)

CDC public health emergency preparedness and response site (http://www.bt.cdc.gov/)

FDA Bioterrorism page (http://www.fda.gov/oc/opacom/hottopics/bioterrorism.html)

Johns Hopkins University's Center for Civilian Biodefense Strategies (http://www.hopkins-biodefense.org/)

Medical Library Assn. Bioterrorism Bibliographies (http://mlanet.org/resources/caring/resources.html)

Michigan State Medical Society Biodefense Resource Center (http://www.msms.org/biodefense/)

Texas Medical Assn. Bioterrorism Resource Center (http://www.texmed.org/has/bioterrorism.asp)

University of Minnesota Center for Infectious Disease Research & Policy bioterrorism preparedness page (http://www1.umn.edu/cidrap/content/bioprep/)

World Medical Leaders Bioterror Resource Center (http://www.wml.com/video_lib/bioterror.jsp)

Educational offerings, including courses, textbooks and webcasts:

AMA bioterrorism webcast, good for five free hours of CME credit (no longer available)

U.S. Army courses on medical management of biological agent casualties, from the Medical Research Institute of Infectious Diseases (http://www.usamriid.army.mil/education/)

University of Tennessee BT 101, a bioterrorism intervention-based training forum for emergency physicians (http://www.anywhere.tennessee.edu/bioterrorism/)

eMedicine.com Disaster and Trauma eBook (http://www.emedicine.com/specials/)

UNC bioterrorism page, with webcasts from the University of North Carolina School of Public Health (http://www.sph.unc.edu/bioterrorism/)