Doctors Must Play New Role in Bioterrorism Era
ST. LOUIS -- The emergence of bioterrorism as a threat is creating new responsibilities for the medical community and, for the first time in history, is putting physicians at the forefront of managing disaster, according to an article by Saint Louis University researchers in The Lancet.
"Unlike other forms of terrorism, in which an acute exposure or traumatic
injury is rapidly inflicted and quickly recognized, such as the 9/11 attacks,
bioterrorism may involve an incubation period of days or even weeks," says
Bruce W. Clements, MPH, associate director of the Institute for Bio-Security
at Saint Louis University School of Public Health, and the lead author of the
article.
"During these events, patients will turn to their most trusted adviser on
health issues -- their doctors -- who will be expected to recognize sometimes
rare conditions and take appropriate action. This means doctors will be the
tip of the sword -- not the military, not the police, not the firefighters."
Clements presents his argument in an article published in the Dec. 18 issue
of the medical journal, The Lancet. Clements, and his co-author R. Gregory
Evans, PhD, MPH, director of the Institute for Bio-Security at Saint Louis
University, argue that this transfer of first-responder status puts greater
responsibility on doctors, a responsibility that they currently are not
prepared to shoulder.
"They will be in the driver's seat deciding how an outbreak will be
managed so they must be trained for it," Clements says. "The challenge lies in
finding the balance between suspicion and hysteria."
Clements says it is a delicate balance because most potential bioterrorism
agents listed by the Centers for Disease Control and Prevention (CDC) -- such
as those that cause smallpox, anthrax, botulism, plague, tularemia --
initially present in patients as flu-like symptoms.
"You don't want to walk into your doctor's office with flu-like symptoms
and be told you might have Ebola," says Clements. "On the other hand, if you
were exposed to something exotic, such as a biological agent, you would hope
your physician has a high enough index of suspicion that he or she may take
the extra moment to consider something unusual or atypical."
Clements and Evans urged medical schools to incorporate more information
about bioterrorism into their curriculums to prepare doctors to meet the
diagnostic challenge.
In addition, continuing medical education programs and community drills
(such as a simulated smallpox scenario Evans and Clements developed for the
CDC for use by state and local health departments) are critical in preparing
doctors, they said. The exercises are designed to help physicians see how
things may unfold in an atypical outbreak of smallpox and how different their
work environment might be.
"In a bioterrorism incident, physicians will have to interface with the
FBI and other government agencies that they've never had to speak with
before," Clements says. "This type of communication doesn't come naturally.
It's learned."
While physicians stand at the forefront of preparing for bioterrorism
threats, Clements and Evans point out in their article that physicians have
contributed to the creation and proliferation of these weapons -- both
wittingly and unwittingly.
"Ethics must be integrated into all medical school courses, not just a few
lectures in the first or second year of training," says Evans, a professor of
environmental health.
The Institute for Bio-Security at Saint Louis University School of Public
Health was established in 2000 with funding from the CDC. The Institute's
original mission was preparing for bioterrorism or an emerging infectious
disease. The mission was expanded in 2002, however, to include preparedness
for all aspects of bio-security. Saint Louis University School of Public
Health is one of only 36 fully accredited schools of public health in the
United States and the nation's only School of Public Health sponsored by a
Jesuit university.
Source: Saint Louis University Health Sciences Center
