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



"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