Wednesday, March 09, 2005

Risk Assessment 

We are grateful to our esteemed colleague Majikthise for introducing us to the excellent blog Effect Measure, where a number of public-health professionals write under the group pseudonym "Revere"-- after Paul, who was a member of "the first local board of health in the United States (Boston, 1799)." In a long post entitled "Biodefense: A (Very) Bad Idea Whose Time Has Come?" we learn that 750 microbiologists recently sent an open letter to Elias Zerhouni, director of the National Institutes of Health, warning him that a governmental overemphasis on biodefense was sucking vital research funds away from areas of more pressing concern (see, for example, avian flu). But the problem, according to "Revere," is far larger than the letter indicates. These are only two of the issues he raises:
The wholesale distortion of priorities entailed by the biodefense agenda is not limited to infectious disease research. Virtually all of public health is affected. It is no secret that fiscal pressures on federal, state and local health authorities have produced cutbacks in routine public health services like substance abuse, maternal and child health, immunization programs, vital records and surveillance, sexually transmitted disease clinics and programs, and many others. Simultaneously, earmarked funds for biodefense have been flowing uncontrolled into the system. The result is that personnel are taken off routine public health activities that deal with problems that happen daily and put onto worthless biodefense "leaf-raking" exercises (like repeated needs assessments and contingency planning for events that will likely never happen). This produces major personnel reassignments and massive reordering of priorities . . . .

The "biodefense" agenda is likely to make us less safe, not more safe, even from bioterror weapons. Terrorists aren't sitting around reading molecular biology journals and planning intricate experiments that are not likely to succeed, even after months or years of effort. These kinds of experiments require years of training and equipment not found in apartments in Hamburg or ranches in Montana. If they are so inclined they fill up a truck or a car with explosives or buy a dozen assault rifles and hit a "soft" target. The weapons are ready to hand. Novel pathogens are not . . . They aren't, that is, unless someone is obliging enough to make them for you, which is exactly what is happening under the guise of the biodefense research and development agenda. If you want to make a detector, a diagnostic reagent kit, a therapeutic drug, a vaccine--the first step is to make the organism. Now, something that never existed before is ready to hand. Forget about the high containment and high security laboratories are springing up to house this work. No matter what the containment, the weak link is always the human element. Even without considering the inevitable lab accidents (and they happen and even cause death to workers in the highest containment laboratories in the world), we shouldn't forget that the weaponized anthrax that brought American public health to its knees responding to "white powder events" in 2001 almost certainly came from one of these laboratories.
When you finish the biodefense post, check out "CDC on the Skids":
The open secret that CDC [Centers for Disease Control] was in disarray poked its head above water Saturday in a story in the Washington Post, "Internal Dissension Grows as CDC Faces Big Threats to Public Health." For months there has been a rush to the exits by some of the agency's most senior scientists, as Director Dr. Julie Gerberding "restructures" CDC out of existence and opens the door wider to political interference.

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