The Anthrax Letters: A Medical Detective Story [Hardcover]

Leonard A. Cole (Author)

Book Description

ISBN-10: 030908881X | ISBN-13: 978-0309088817 | Publication Date: October 1, 2003 | Edition: 1st

At 2:00am on October 2, 2001, Robert Stevens entered a hospital emergency room. Feverish, nauseated, and barely conscious, no one knew what was making him sick. It was the doctors and public health officials who solved this medical mystery. Stevens was the first fatal victim of bioterrorism in America. The events of September 11th and the anthrax attacks that followed only three weeks later were horrifying. Many of us felt we were living in a world gone mad. Already shaken by the images of jetliners deliberately flown into the Twin Towers at the World Trade Center, we were soon scared to open our mail. No longer could we look forward to birthday wishes or holiday postcards. We couldn't even safely face the delivery of our monthly bills. We had now become literally afraid of the microbial menace that could be lurking in our mailboxes. This time terror had struck close to home - to everyone's home. But, behind the panic and the politics was a key line of defense. While the police and FBI frantically investigated a crime, there were other professionals at work, conducting their own painstaking inquiry - medical and scientific detectives hot on the trail of deadly organisms deliberately set loose in the postal system. Modern heroes in a quickly changing world, the public health officials, physicians, researchers, and scientists who staff our hospitals, clinics, and laboratories will be the first responders on the scene of any future biowarfare event. Conducting his own detective work, bioterrorism expert, Leonard Cole has composed a series of fascinating stories that get to the heart of all the noisy sound bytes and hysterical headlines. Cole is the only person outside law enforcement to have interviewed every one of the surviving inhalation-anthrax victims, along with the relatives, friends, and associates of those who died, as well as the public health officials, scientists, researchers, hospital workers, and treating physicians - indeed, anyone who has something of value to add to the story. Speaking through their voices, the narrative reflects the tension and emotions stirred by the events from the fall of 2001. Fast paced and riveting, this minute-by-minute chronicle of the anthrax attacks recounts more than a history of recent current events, it uncovers the untold and perhaps even more important story of how scientists, doctors, and researchers perform life-saving work under intense pressure and public scrutiny. The "Anthrax Letters" amply demonstrates how vulnerable America and the world really were in 2001. It also shows quite clearly how scientific research promises to strengthen our ability to address the challenges we must meet in the future.

Editorial Reviews

From Publishers Weekly

On October 5, 2001, Bob Stevens, a 63-year-old photo editor for the tabloid newspaper the Sun, became the first confirmed bioterrorism fatality in the U.S. Over the next several weeks, nearly two dozen people were diagnosed with anthrax, five of whom died. Disentangling a coherent story from the snarl of conflicting reports, multi-agency responses, blaring headlines, empty leads and the shaky scientific data surrounding the anthrax attacks is no simple task, which makes Cole's accomplished book all the more impressive. As an expert on the intersection of politics and terrorism, Cole (The Eleventh Plague) takes the reader on a captivating, no-nonsense tour of America's public health system, where physicians, scientists and administrators work tirelessly to establish protocols and policies, task forces and education programs, emergency response strategies and stockpiles of vital medicines to safeguard the country from a potentially catastrophic bioterror event. The book also supplies the chilling details that the short-lived media flareup failed to convey-such as the durability of anthrax spores, which can lie dormant but remain lethal for hundreds of years; the contamination of massive postal facilities that remain unsafe even after multimillion-dollar clean-up efforts; the difficulties involved in diagnosing many anthrax cases, which can display ambiguous symptoms; and the persistent, residual effects of the disease. Without even a hint of sensationalism, this disquieting but hopeful book skillfully zeros in on the most crucial issues and scientific advances as well as the heroic individuals who averted disaster while under the intense glare of public scrutiny.
Copyright 2003 Reed Business Information, Inc.

Review

"... [a] thoroughly researched, detailed, and fascinating book... a well-written forensic mystery..." -- Journal of the American Medical Association, July 21, 2004

"...absolutely riveting. ... [Cole is] a superb writer and his book reads like a fine-tuned suspense novel." -- DingBat Magazine, December 2003

"...deliver[s] all the drama of a modern-day thriller... offers the most complete look available at the still-unsolved mystery..." -- Roll Call, October 14, 2003

"...excellent insights ... fascinating discussion of the attacks and how they will influence our level of preparedness for the future." -- Library Journal, November 1, 2003

"...interesting and genuinely informative reading..." -- Bulletin of the World Health Organization, January 2004

"...offers us a wealth of detail on the case -- even as it reminds us how little we know." -- James P. Pinkerton in Newsday, October 7, 2003

"...one of the most authoritative of the recent crop of books on the anthrax letters... undeniably intriguing." -- The Washington Times, November 16, 2003

"...vivid portraits of the bacteria, those who were infected, and those whose job it was to counter the threat." -- Kirkus Reviews, August 2003

"An excellent job... Probably the most detailed book on the subject. ... This book is a must." -- Counterterrorism Homeland Security Reports, 2004

"[Cole’s] storytelling abilities rank with those of Richard Preston, without ever losing sight of the science." -- Lancet Journal of Infectious Diseases, January 1, 2004

See all Editorial Reviews

Product Details

• Hardcover: 280 pages
• Publisher: Joseph Henry Press; 1st edition (October 1, 2003)
• Language: English
• ISBN-10: 030908881X
• ISBN-13: 978-0309088817
• Product Dimensions: 9.1 x 6.2 x 1 inches
• Shipping Weight: 1.1 pounds (View shipping rates and policies)
• Average Customer Review: 4.5 out of 5 stars  See all reviews (19 customer reviews)
• Amazon Best Sellers Rank: #1,081,182 in Books (See Top 100 in Books)

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13 of 14 people found the following review helpful:

4.0 out of 5 stars In-depth report that questions the FBI profile, January 15, 2004

By 

Dennis Littrell (SoCal) - See all my reviews
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This review is from: The Anthrax Letters: A Medical Detective Story (Hardcover)

This is the second book I've read on the anthrax attack. The first, The Killer Strain: Anthrax and a Government Exposed (2003) by Washington Post journalist Marilyn W. Thompson is a good book (with a different emphasis), but this is a better one. Written by Rutgers University Professor Leonard A. Cole, who is an expert on bioterrorism, The Anthrax Letters is both more extensive and goes into greater depth than Thompson's book.

Perhaps the most important thing (from my point of view) that Professor Cole does is argue convincingly against the FBI's disaffected loner theory of who did it. Instead Cole presents a lot of evidence that strongly suggests that Al Qaeda may indeed have been responsible.

First of all, the leading suspect, Attorney General John Ashcroft's "person of interest," Steven Hatfill, actually had an alibi. He was working in another state at the time some of the letters were mailed in Trenton, New Jersey. More importantly though, Cole sees a link between Iraq's known bioweapons program and Al Qaeda; he believes that the Ames anthrax strain in the Daschle letter was possibly purified and concentrated by "the Iraqi BW team." (p. 201)

Furthermore the fact that there were at least two types of "weapons" sent by mail suggests more than a lone perpetrator. Additionally, the mystery of why the tabloid people in Florida were targeted (and indeed how they became targets) is explained when one learns that two of the suspected 9/11 hijackers rented an apartment from Gloria Irish, the wife of Mike Irish, editor of the Sun tabloid, an American Media Inc. publication. One of the men, Marwan Akl-Shehhi, told her that he was a pilot and was taking flying lessons. (p. 42) And it is not to be forgotten that the Al Qaeda suspects were interested in learning to fly crop dusters. That alone makes it clear that they expected to have access to and intended to use either chemical or biological weapons. Finally, there is the unsettling fact that one of the hijackers was actually treated for a black lesion on his leg that could very well have been cutaneous anthrax.

Cole also suggests that it was no coincidence that the anthrax attacks began less than a month after September 11, 2001.

To all of this I would add the fact that the Bush administration has become entirely mute on this question, which may suggest that they know who did it but for reasons unknown to us are not telling. What could those reasons be? Originally I thought it was because the FBI had bungled the evidence and didn't have enough left to stand up in court, or that something about the perp or information he or she had would be embarrassing to the government. Now I think it is possible that Al Qaeda was indeed responsible but the Bush administration won't acknowledge that because it would have to reveal secret information about our counter-terrorism program, and also possibly because such information may work into the hands of Al Qaeda's desire to psychologically terrorize the US population.

Another interesting point that Cole brings up is the question of exactly how many cases of anthrax illness were caused by the mailed spores. He reports that there were eleven confirmed cases with five deaths. However, as noted in the final chapter, there is a twelfth case that the CDC would not confirm, that of postal inspector William Paliscak who had inhaled dust in which there were spores, and who had anthrax spores on his clothing and in his car. The problem is that the CDC was not able to culture anthrax from blood samples taken from Paliscak. Cole speculates that Paliscak and possibly others at the Brentwood postal facility did indeed contract anthrax, asking, "Could bacilli have been embedded in the brains of Bill Paliscak and others who were exposed to spores...?" He adds that there were eight deaths at Brentwood in the year following the anthrax attack when usually there are only two a year. Four of the people who died had inexplicably enlarged hearts. (p. 237)

Also significant is Cole's point that what we learned from the attacks is that we are not nearly as well prepared as we thought, and that the use of the postal service as a means of disseminating a bioterrorist weapon was greatly underrated. What was not realized prior to these attacks was that anthrax spores in the size of about three microns would easily slip through the 20-micron pores in a typical envelope resulting in cross-contamination of the mail. The two women, Kathy Nguyen and Ottilie Lundgren, who died of inhalation anthrax even though spores were never found in their homes or in their mailboxes, were probably the victims of cross-contamination. Cole posits that by the time the mailboxes were swabbed the spores had dissipated. In support of this idea Cole quotes Harvard microbiologist Matthew Meselson as saying, "a single organism [of anthrax] has a chance of initiating infection." (p.110)

This raises the question of how many other people died because of their exposure to the bacterium, cases that were either not reported or unrecognized as anthrax killings.

This leaves me with an idea. Cole reports that how the perps got the very, very fine and slippery weapons-grade anthrax spores into the envelops without getting some into the air and eventually into their lungs is not known. With Al Qaeda's complete disregard for human life, they may not have warned their operatives of the dangers. Perhaps the FBI ought to look for some dead Al Qaeda operatives in the US and double-check the cause of death.

6 of 6 people found the following review helpful:

5.0 out of 5 stars Gripping, Moving, Important....A Very Significant Book, October 22, 2003

By 

W. C HALL (Newport, OR USA) - See all my reviews
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This review is from: The Anthrax Letters: A Medical Detective Story (Hardcover)

One great terrorism event of 2001, the attacks of September 11th, remains seared into America's national memory...as well it should. But another deadly deed, which unfolded just a few days later, seems to be rapidly receding from the foreground: the anthrax letters. In this powerful new book, Dr. Leonard Cole persuasively lays out a case why this act of bioterrorism should not be forgotten.

Dr. Cole's book is, as the subtitle suggests, a true medical detective story. It took great insight and certain leaps of faith for the first health professionals who confronted this situation to recognize it for what it was. Anthrax in humans was, and fortunately, is, quite rare. And although there had been hoax letters previously claiming to contain anthrax, it had never actually been transmitted by the U.S. Mail before this incident.

Thanks to exhaustive interviews with the professionals, survivors and families of the victims, Cole is able to present an almost minute-by-minute account of the appearance of the disease, the search for answers, and the aftermath. Although the public health community was the target of much criticism in the hysteria following in the immediate wake of the event, Cole suggests, and rightly so, I believe, that most of the people are truly unsung heroes.

Beyond being a record of a deadly crisis, Cole poses some important questions. Are we better prepared for the next bioterrorist event? The answer is a qualified yes. The scientific and health communities seem to be better informed, and have established important networks of communication and cooperation. But what of the public at large? Here, the signs are not so hopeful.

I must praise this book for another reason: its readability. Cole lays out the science in terms that are crystalline clear. He provides just enough details about people and places to make them living, flesh and blood individuals, not lifeless characters on a page. And I'm sure he practiced admirable restraint in distilling what must have been a massive amount of research into a concise package. Too many writers these days seem to be falling victim to the "file dump" phenomenon--wanting to make sure all their hard work finds its way between covers.

A worthwhile and important book.--William C. Hall

4 of 4 people found the following review helpful:

5.0 out of 5 stars Anthrax - We are so vulnerable!, October 21, 2003

By 

Paul Talalay (Baltimore, MD USA) - See all my reviews

This review is from: The Anthrax Letters: A Medical Detective Story (Hardcover)

Dr. Leonard Cole's "The Anthrax Letters"is a very engaging, in fact gripping, account of the first and uncertain steps that went into the identification of systemic anthrax as the disease responsible for the mysterious illnesses that affected 11 individuals and killed five. The illness appeared out of nowhere and was traced to letters sent from a Newark, New Jersey address. Cole traces the connections through interviews with true-to-life personalities, including disease survivors. It is a medical detective story that captures the high drama of the events and the associated widespread anxieties. This book transcends sophisticated investigative reporting. It gives simple but accurate explanations of the scientific problems involved in producing "weapon grade" anthrax spores, and the techniques required to identify a disease that almost none of the first responders had ever seen before. It also points out our weaknesses in dealing with potential bioterrorism. The book is beautifully written. I think that it will be widely read by concerned members of the public, as well as audiences drawn from law enforcement, government, and science.

Paul Talalay MD, Professor of Pharmacology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205. email: [e-mail]