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The Anthrax Letters: A Medical Detective Story

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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.

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

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: ptalalay@jhmi.edu

I was drawn into this book from page 1. An intriguing and scary look into just how deadly biological weapons are, and how easy it would be to release a deadly pathogen into a population. One cannot help but sympathize with the residents of this Ural town who were unfortunate enough to breathe in the deadly spores. It is also heartbreaking to read the effects felt by family and friends of the deceased as they mourned the untimely, sudden and unexplainable deaths of their loved ones.

But the most disturbing part of all is how the victims contracted the disease (though this is still up for debate) by just being in the wrong place at the wrong time, as the deadly pathogens were borne here and there by the wind. One victim happened to be out gardening while the invisible, deadly breeze swept by, while her neighbors who remained in their homes at that moment were unaffected. One comes away from reading this book with the realization of how fragile and precious life is, and how it can be ended by the vagaries of Fate.

Comparing this book with others written about Anthrax is inevitable, but this publication is written from the viewpoint of the author's occupation. As an added feature, one learns about the paranoia that still continues to exist in that part of the world, and the roundabout methods the writer sometimes had to employ to fully investigate this terrible event.

I give the book 4 stars because of its sometimes very academic approach, which may discourage some readers. But in this era when any country can obtain such dangerous and deadly microbes, each book on this subject is a must read in order to understand the seriousness of biological weapons and how easily this type of warfare can decimate a population.

I'm grateful to Mr. Cole for researching and writing this book. I work for the U.S. Postal Service and happened to find myself in the thick of this whole business in October 2001 in Boca Raton. Mr. Cole assembles the facts in a clear and logical way, provides useful digressions and details, and sheds light on many things that I did not understand before. This is very good work and, though some will undoubtedly question this detail or that, I think his book contains many valuable "lessons learned" which will assist those who have to deal with similar emergencies in the future.

"The Anthrax Letters" recounts the story fairly well but is somewhat dated and some of the authors assumptions and bias stand out. The first mailings arrived at the American Media Inc. (AMI) building in Boca Raton Florida and the previous address at the National Enquirer building. This raises the question as to where the perpetrators obtained the addresses and whether they were local. It's common knowledge that many of the 911 hijackers lived in Florida. Marwan Al Shehhi and Hamza Alghamdi lived in Del Ray about 15 minutes from AMI. A librarian, Martha Moffett is quoted because she believed Bin Laden read "The Sun", a tabloid periodical and that he would be angry with the stories that had been written about him. Never mind that photo journalist Robert Stevens, the first victim of the anthrax letters had published pictures of the drunken Bush twins and possibly angered the leader of the so called free world.
In any case the letters were mailed from Trenton, New Jersey and not Florida.
Steven Hatfill, microbiologist at Fort Dietrich, MD became the first subject of the FBI's suspicion. Recently Hatfill was awarded 5.6 million dollars for the false accusations that ruined his life.
The point is that while warmongers like John McCain were on TV making noise about the anthrax being produced in Iraq, the truth was that it was made in the good ol' USA.
The AMES strain of anthrax was collected in Iowa and cultivated and weaponized by Battelle Labs of West Jefferson, Ohio. The silica-powdered anthrax was ionized to be easily distributed in the air. The process of coating and ionizing the anthrax is extremely difficult and dangerous and can only be done in a proper lab with proper training.
Letters were sent to Senators Tom Daschle and Patrick Leahy as well as media personality Tom Brokaw. Leahy and Daschle, who were holdouts on signing the Patriot Act, signed immediately after receiving the letters.
Seven years went by and now the FBI have supposedly solved the case and laid the blame of the attacks on Dr. Bruce Ivins, a microbiologist, who like Hatfill worked at Ft. Dietrich. Ivins was a specialist in research and development of bio-toxin vaccines.
Days prior to his scheduled arrest Ivins overdosed on Tylenol and died.
Case closed.
Dr. Cole's 2004 "The Anthrax Letters" could stand a revision.

"The Anthrax Letters" provides a good deal of background information on the Anthrax attacks of 2001, and perhaps until the culprit(s) are identified, this book may remain as the credible only work available. The book provides a great deal of information on both the victims and the professionals that treated them (maybe even too much?). I would have preferred a bit more on the science of the forensics used to try to track down the perpetrators (but in the author's defense, that may still be kept closely under wraps by the FBI). Would also have liked more information on the method, costs and procedures used to clean up the effected buildings. But the book is easy to read. Author does not subscribe to the lone disgruntled scientist theory and sees a possible link to Al-Queda.

This book was based on the mysterious medical cases of anthrax that occurred through the mail during the year of 2001. Author Leonard A. Cole takes the reader personally through the many accounts of the anthrax sicknesses that have been reported following the September 11, 2001 attacks on America.

After the first case of anthrax was discovered it would soon become obvious that these acts were of biowarfare towards our country. Cole educates you on the history and mannerisms of the anthrax bacteria. He describes how it forms, grows and infects the people who come in contact with it. He takes you inside the hospitals to the doctors that treated the suffering patients and into the homes of those who were left behind wondering what was wrong. The medications used to treat the victims and procedures they underwent are drawn out for the reader to see as well. Not only were the families of these victims left in the dark, but our nation as a whole was left shocked and fearful of what was happening during this time. Cole went inside the police cases and FBI findings in their attempts to try and catch the culprits of these offenses. They take you through the procedures they undertook in their endeavors to track down the source of the attacks. Desperately trying to discover the cause of these biohazard assaults and being able to diagnose them quickly enough to save lives, is the aspect of this novel that will keep you on the edge of your seat.

If you thought you knew all that had happened with the anthrax you will become surprisingly more aware of what really transpired after reading this book. As the author leads you from case to case of the reported diagnoses, the reader becomes more frightfully conscious of the bio-terrorism threats that our nation faced. It's fast moving pace and hard hitting facts keeps the reader's interest throughout the entirety of the book. Though at some points it can be slightly difficult to follow due to the medical terms and research discussed about anthrax, it is still a highly enjoyable read.

The Anthrax Letters is an elaborate chronicle of incidents our nation was exposed to when the horrifying bio-terrorism attacks were conducted by mail in the year 2001. It was only three weeks after September 11th occurred that a Florida man by the name of Bob Stevens died due to inhalation of anthrax. His death became the first to be caused by bio-terrorism in the United States. This book describes in-depth, the many lives anthrax affected and how it affected our nation as a whole. The measures that many doctors, scientists, policemen, etc... took to try and put a stop to such a terror are thoroughly acknowledged throughout this book.
The Anthrax Letters greatly portrayed the concerns about bio-terrorism as being seen from theory to a reality. This was a very scientific book and provides the viewer with a better understanding of the substance anthrax itself and the horrifying effects that it can have. This book was very informative and definitely keeps ones interest. Though at times it is scientifically hard to follow, and understand, it is still very enjoyable and well written. This book is highly recommended to anyone with an interest in the anthrax bio-terrorism attacks that so dolefully struck our nation during the year of 2001.

The Anthrax Letters by Leonard Cole is a detailed account of the events that took place when the nation was terrorized by the sudden cases and deaths caused by the highly destructive anthrax bacilli. On October 5, 2001, Bob Stevens, became the first confirmed bioterrorism fatality in the U.S. After him, four more people died because of this terror attack. This book was very informative and never left out any details. If you ever wanted to know anything about what happened in those weeks of terror, then this would be the book to pick.
When these attacks were happening, I was eighth grade, so I knew they had happened, but not really knowing what was going on. I didn't even know that five people had died from these attacks. This book was packed with information with what really happened and it gave me a new understanding to it. It was never uninteresting at any point and was always wanting to keep reading to know what was the next events that took place in those weeks.
One thing that I didn't like too much was the way the books order of events went. It kept skipping around a lot and for younger readers, it may have been hard to understand. Also, I found that there was a large amount of unneeded information that the book really could have done without and it would have been fine, like a background story to every person introduced in the novel. Overall, I enjoyed reading this book and it was a well written, information packed book. I recommend this book to anyone wanting to know the events that took place during the weeks of anthrax terror and this book will tell you who did what to try to control it and save the people infected with it. The book brings the terror from those weeks to real life and make you really feel like you know went on, which I think makes it a very well researched and written book.