Anthraxiety

My first anthrax inquiry came on Monday. A patient – who had been on holiday in New York on 11 September and witnessed the attacks on the World Trade Center – reported that this experience had at first banished his long-standing symptoms of chronic fatigue syndrome. However, now he had returned to England, he had developed generalised muscle aches and pains and a vague malaise.

The patient was suspicious that he might have been exposed to some chemical or biological agent released in the course of the attack. He agreed that it was surprising that the several million residents of New York, who might have been expected to suffer a similar exposure to toxins, did not appear to have been similarly afflicted.

Although, according to the newspapers, British GPs have been placed on full alert for biological warfare, at our surgery we have not yet received our official battle briefing. So I hastened to the Public Health Laboratory Service (PHLS) website to refresh my very vague recollections of the clinical features of anthrax (1). As well-informed readers will now be aware, there are three forms, affecting the skin, gut and lungs.

The skin disease is the most common; the lesions are distinctive and fairly easily treatable with antibiotics. By contrast, the gut form is ‘very difficult to recognise and consequently often fatal’. It is, mercifully, rare. The lung form is also rare, presenting at first with ‘mild and non-specific’ symptoms of fever, tiredness, mild cough and chest pain. It is, in other words, very similar to the flu-like viral illnesses that bring patients in their thousands every week to GPs’ surgeries. It proceeds rapidly to a second phase of acute respiratory distress, with shortness of breath, high fever and typical chest x-ray appearances: ‘at this stage the disease often has a fatal outcome.’

I tried to reassure my patient that his symptoms did not appear to correspond to any of the three forms of anthrax, but he was unconvinced. How long was the incubation period? According to the PHLS, usually between one and seven days – but it could be up to 60. Could he have a vaccine? No, these were not recommended to the general public, but only to those at high risk of occupational exposure. Was there any diagnostic test? Yes, it was possible to send blood specimens, swabs of skin lesions or sputum for culture, but this was only recommended for those who had been in direct contact with the outbreak in Florida. Was there any treatment? Yes, the antibiotic Ciprofloxacillin was said to be effective, if taken early in the course of the disease. Could he have some, ‘just in case’? No, this was not recommended in the guidelines.

One thing that emerges from the numerous articles about anthrax that have appeared since the first case was confirmed in Florida a couple of weeks ago is that, though it is a nasty disease, it is difficult to disseminate the spores in a form suitable for biological warfare. The fact that it is rarely transmitted from one human being to another means that it has never assumed epidemic proportions in human society, though it may do so in cattle and other animals. As one microbiologist commented, ‘why would anybody go to the trouble of trying to give their enemies anthrax? It would be much easier to shoot them’.

While President George W Bush asserted his conviction that the handful of cases confirmed in the USA may be the work of the al-Qaeda network, Professor Martin Hugh-Jones, a British authority on anthrax working in the USA, thinks that ‘an opportunist individual’ with rudimentary microbiological skills is a more likely culprit.

Anthrax may not be a very useful weapon of mass destruction, but the impact of the anthrax scare, not only in the USA but worldwide, confirms its potency as a metaphor for the menace to the Western order revealed by the events of 11 September. As Kenan Malik argued in the New Statesman on 8 October: ‘Of all the imagined weapons in the terrorist arsenal, biological warfare appears the most terrifying: a silent, invisible killer, gnawing away at the population from the inside’. (2)

As Malik observes, there has been a shift in the focus of popular anxieties from nuclear weapons to biological agents. This is linked to wider fears about biotechnology – genetically modified organisms, cloning, and so on. It also expresses a sense of vulnerability to an enemy within. Just as the hijackers operated within the structures of Western society and turned its own artefacts – planes, tower blocks – into weapons of destruction, so the germs of anthrax are (apparently) disseminated by post and spread their corruption within the spheres of the media and politics. The spectre of the bio-terrorist expresses and reinforces a range of contemporary anxieties, ‘from the dangers of messing with nature to the sense of the fragility of western values’.

The anthrax panic reveals the grip of the culture of fear in Western society. This culture predates 11 September, but was powerfully reinforced by the apocalyptic events of that day. In a grim dialectic, insecure governments issue public alerts about biological warfare and calls for vigilance to a populace in a heightened state of anxiety over earlier scares about environmental dangers to health. Doctors have been advised to ‘be particularly suspicious of illness in previously healthy people’ and warned to ‘raise the alarm immediately’ (3). The fact that most illness occurs in previously healthy people should guarantee a high level of public alarm.

According to Professor Liam Donaldson, the government’s chief medical officer, ‘we now have to be prepared to think the unthinkable – it is only by doing that that we will get the best plans in place’ (4). But, while it is true that it is the responsibility of governments to plan for all sorts of contingencies, the public discussion of doomsday scenarios has the inevitable effect of promoting fear. Far from protecting the health of the population, the result is a wave of panic and a pervasive climate of anxiety and despondency.

Judith Miller, a journalist on the New York Times, received a letter last week containing a suspicious powder (subsequently confirmed not to contain anthrax spores). By a strange coincidence, Ms Miller is the author of Germs: Biological Weapons and America’s Secret War. She subsequently declared that ‘we remain woefully unprepared for a calamity that would be unlike any this country has experienced’. The notion that society should be organised so that it is prepared for all forms of unthinkable calamities, unlike any previously experienced, draws out the absurdity of the precautionary approach to modern life. It amounts to a call to retreat to a bunker with full provisions, and gas masks, to await whatever grisly fate might befall us.

By elevating the anxieties generated by 11 September to a new pitch of irrationality, the anthrax panic also points the way forward. Just as medical science can contain anthrax, so a more rational human response can deal with the forces of destruction that have recently been unleashed with such savagery within Western society.

Dr Michael Fitzpatrick is the author of MMR and Autism, Routledge, 2004 (buy this book from Amazon (UK) or Amazon (USA)); and The Tyranny of Health: Doctors and the Regulation of Lifestyle, Routledge, 2000 (buy this book from Amazon UK or Amazon USA). He is also a contributor to Alternative Medicine: Should We Swallow It? Hodder Murray, 2002 (buy this book from Amazon (UK) or Amazon (USA)).

Read on:

The fear within, by Dr Michael Fitzpatrick

Fear and defeatism infect the West, by Mick Hume

A pox on scientific debate, by Sandy Starr

Over-anxious over anthrax, by Howard Fienberg

spiked-issues: After 11 September

(1) See information on anthrax on the PHLS website

(2) Don’t panic: It’s safer than you think, Kenan Malik, New Statesman, 8 October 2001

(3) Guardian, 16 October 2001

(4) Guardian, 15 October 2001