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The Killer Strain: Anthrax and a Government Exposed

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The Killer Strain: Anthrax and the Exposed Medicine

I am peruvian medical , and for some years , have been investigating anthrax in Peru, reason why caused to much interest for me the appearance of the book: The Killer Strain.
The book that narrates the events related to the first outbreak of bioterrorismo in the U.S.A., submerges to us in the interior of the scientific work during the epidemic , show some more than appears in the scientific journals . Although the author certainly has obtained much related information to this epidemic, probably, the lack of a biomedica formation, has taken it to an incomplete vision of the epidemic of anthrax. The book shows some mistakes that reflect the nonmedica formation of the author, as a sample : in the figures of the book, call as symptoms to the injuries of the skin,instead of use signs. Would had been ideal that some medical professional help in revising or writing the book.
Maybe , the great problem in analyzing this epidemic is that in the world exist few experts in anthrax As the same author recognizes in her book, many doctors what participated in the epidemic , never has been sight a case of anthrax. (1) For that reason many mistakes that exist during the epidemic maybe has been unnoticed. Some of these faults in the epidemic, can be justified by the low degree of scientific knowledge with respect to this pathology, maybe for example : not to diagnose inhalational anthrax.
Inhalation anthrax is the main clinical form in the bioterrorism scope given its high mortality, however early diagnosis (a time when treatment can be effective),(2) is rather difficult to achieve In their initial stage symptoms of inhalation anthrax are very similar to influenza .
Although the cutaneous form has low mortality rates and is thus, considered as less important in a bioterrorist attack, its diagnosis may serve as an epidemiological alerta and lead, indirectly, to the early search for possible inhalation anthrax cases. These difficulties in early recognition were observed in the recent bioterrorism event with anthrax in the United States. In the bioterrorism- related outbreak of anthrax , in october 2001, the first cases were not for inhalation, but cutaneos , the detection of these cases would likely iniate the epidemiological investigation more precociously and maybe diminished even more the mortality in this outbreak. Because of this, it is necessary for physicians to learn to recognize cutaneous anthrax at its early stage.
Contrary to what occurs with the inhalation form, cutaneous anthrax there are well defined clinical characteristics and is relatively easy to diagnose clinically, to however, the early stage of cutaneous anthrax often remains undiagnosed, probably due to many reasons: a) It is to rare pathology; b) The this physician associates pathology mainly with to annoys stage necrotic to ulcer and; c) Absence of pain in the cutaneous injury makes the patient recognize the cutaneous injury annoys and delay seeking medical attention clinical Emphasis on early recognition of cutaneous anthrax is highly used in anthrax endemic area in peruvians andens, as part of the traditional medicine knowledge developed by these communities due to the absence of physicians and it could be useful to the field of bioterrorism. In Peru, farmers emphasize the clinical recognition of cutaneous anthrax in an early stage and call it "waytacha" (A quechua term that means bad flower) (3).
In this outbreak , although is certain were errors of the government and of institutions, there were also medical mistakes, that are necessary to recognize them so that they do not repeat in the future. The most critical component for bioterrorism outbreak detection is the doctor ( 4 ), and the great medical mistake of this epidemic was not undiagnose anthrax by inhalation but not to diagnose the cases of cutaneous anthrax, the detection of these cases would also , of to be certain the relation between hijjackers and anthrax ( 5 ), also initiate the investigation related to hijjackers and maybe, help to prevent the tragedy of September 11.
This epidemic more than show a exposed government , show to an exposed medicine, exposed to anthrax , a disease that does not even manage to know nor to control.

David Salinas Flores

REFERENCES

1. Thompson. The Killer strain. Anthrax and a Government exposed. Harper Collins Publishers.2003. pg. 72-73

2. Mc Carthy M. Early and aggressive treatment saves US antrax victims. Lancet. 2001 ; 358 : 1703

3. Salinas D. Diagnóstico y Tratamiento del Antrax: Medicina Tradicional vs Medicina Científica. Revista Peruana de Enfermedades Infecciosas y Tropicales. 2001;1:157-164

4. Ashford D, Kaiser R, bales, M. et al Planning against biological terrorism.: Lessons from Outbreak investigations. Emerg Infect Dis . 2003 .9 :515

5. Report linking anthrax and hijackers is investigated. New York Times. 23 marzo 2002

This is a very carefully written account of the anthrax mailings with an emphasis on the victims and the governmental response. It sheds little new light on the investigation which to this day has still not turned up a suspect.

Marilyn W. Thompson, who is an editor at the Washington Post, and her research assistants, Davene Grosfeld and Maryanne Warrick, interviewed scores of people from Leroy Richmond, a postal employee who almost died from inhalation anthrax, to Dr. Jeffrey P. Koplan, then director of the Centers for Disease Control, in putting together the story. But apparently they were not able to interview anybody in the FBI, nor did they talk to Steven J. Hatfill, who was dubbed by Attorney General John Ashcroft as "a person of interest" in the investigation and was prominently in the public eye as a possible suspect. Much of the material was culled from news sources and public records. Consequently, what we have here is a presentation of what is publically known about the case and a record of events.

One of the aspects that Thompson concentrates on is the differential between the public health response to the anthrax found on Capitol Hill and the response to that found at the Brentwood Mail Processing and Distribution Center in Washington, D.C. with the suggestion that there was a dual standard at work, one for the white and powerful and another for the black and blue collar. This may be so, but the most damaging criticism she presents--against the CDC at least--is their failure to realize that anthrax could escape a sealed envelope. However it could, and did, especially in the Brentwood Center.

Thompson does get into "who done it," hinting that Al-Qaeda may be responsible as she recalls the pre-9/11 activities of Mohammed Atta, alleged ringleader of the hijackings, who is reported to have met with Iraqi intelligence in Prague where he accepted "a glass container" that may have contained an anthrax sample. (pp. 53-54) She also recalls Atta's interest in crop dusters and his visits to a south Florida rural airstrip to check out an Air Tractor AT-502 crop duster. (p. 54)

Even more sensational (to me at least) is the write up of "a textbook description of cutaneous anthrax" by Dr. Christos Tsonas of Fort Lauderdale, Florida after treating Ahmed Ibrahim al-Haznawi, one of the hijackers who went down with United Airlines Flight 93 in Somerset County Pennsylvania, for a "dry, blackish scab covered wound" on his leg. As Thompson remarks, "skin anthrax could be acquired in only one way: through direct contact with anthrax spores." (pp. 51-52)

A lot of ink is also spent on Hatfill, although Thompson is careful not to propose that he is the culprit. What she does is give a report on his background including his partially falsified resume, including a false claim that he has a Ph.D in microbiology (p. 191) and a report on his soldier of fortune persona. She also quotes scientist Barbara Hatch Rosenberg's "likely portrait of the perpetrator," a portrait that fits Hatfill very well. (See pages 202-205.) However, Rosenberg also refused to name Hatfill. The way Thompson organizes this information in Chapter 15, "A Person of Interest," with the juxtaposition of the characterizations and the profiling and Hatfill's grand-standing insistence that he is innocence, suggests that he is, if nothing else, a prime suspect. Of course, this is nothing new. Since his name first surfaced he has been "a person of interest" in the media and in the minds of many people. But the FBI, despite investigating every aspect of his life, has failed to arrest him.

The big question here is why the FBI has not solved this case. As reported here and elsewhere the number of people who could have the expertise, the opportunity, and some kind of motive for this crime (involving "weaponized" anthrax, remember) probably can be counted without taking off our shoes. I have speculated that either the FBI has somehow compromised the evidence and is stuck without enough for an indictment, or the identity of the culprit (or the details of the investigation) would somehow embarrass the administration--or (that old standby) compromise the investigation of other, perhaps larger crimes or even crimes being planned. Thompson allows Rosenberg to add a third possibility, namely that the perpetrator "participated in the past in secret activities that the government would not like to see disclosed." (p. 204)

I have one small question. On page 174 and page 185 it is suggested that "over irradiation" of the mail (to kill possible anthrax spores) could cause those opening such letters to feel sick to their stomachs or feel some other illness. From what I know about the use of radiation to kill germs, whatever is radiated contains no residue of radiation (how could it?) and poses no health hazard whatsoever. Thompson's suggestion of the "post-traumatic stress of returning" to the once contaminated mail facility is the more likely reason for illness.

Bottom line: this is a thoroughly professional tiptoe through the tulips that allows Thompson to maintain a journalistic objectivity while pointing an accusatory finger at governmental incompetence in the face of the first bioweapons attack ever in the United States.

I cannot believe that a Washington Post investigative writer would include allusions to "connections to al Qaeda" in a book on the anthrax attacks. Why do we find this in the offical book description? Why would an author or publisher want that as part of the official description, unless they're pandering to the neocons and collaborating with damage-control propaganda?

These connections were "hinted," of course, by the bogus letters talking about Allah, which were sent along with the anthrax. And the Bush administration and its fans are working very hard to get the public (and the FBI) to stop thinking, and claiming, that the profile of the perpetrator points to a domestic, right-wing, inside job.

Surveys have shown that a high percent of US citizens, never much lower than 50%, have believed for years that Iraq and al Qaeda were in league with each other for the 9-11 attacks. This has been disproved, and Bush has even admitted as much--but then Cheney keeps talking as if the connection is there.

Give it up. It was the Easter Bunny. It was Santa Claus. It was the Great Pumpkin who sent the Anthrax letters, cooking up and weaponizing the anthrax in the pumpkin patch, weaponizing it by a process known only to a relatively small group inside the US military-intelligence community. That makes as much sense as any speculation about al Qaeda, which only serves to deflect attention from the FBI's findings, that it was an inside job.

Read the news stories since the events first unfolded, and you will notice the damage control, the effort to blame al Qaeda or Iraq, and to turn public opinion away from the FBI's original findings.

A government exposed? Not quite, not enough, not in their propaganda-producing role, and not in their ability to compromise the journalistic integrity of some investigative reporters by suspending their disbelief in the Bush myth that dark-skinned, middle-eastern extremists were behind the anthrax attacks.

Despite the attention-grabbing subtitle, "The killer strain: anthrax and a government exposed," this book is no more than a compilation of newspaper-type stories with the same sorts of howlers that one expects in The Daily Bugle. There is certainly nothing new here. But how could there be anything new on a such a thoroughly reported topic? There is, however, fairly good organization, reasonable thoroughness, and at least an attempt at objectivity. I appreciated the book because it answered, for me, two questions that have nagged me: (1) Did CDC officials really fail to do their job properly or were they, like Ms Lundgren and Ms Nguyen, just exceptionally unlucky, and (2) Is Hatfill justifiably a "person of interest" or is he just a scapegoat for investigators who have failed to find the real culprit?

As for CDC culpability, Marilyn Thompson's leisurely account seems to confirm what I had suspected from less complete accounts in the newspapers: the CDC wasn't just unlucky, the CDC failed to do what the CDC does best, to thoroughly investigate the factors that have led to sickness or death and, by impartially analyzing those factors, to provide the public with recommendations that can be used to reduce future sickness and death from the same cause. What the CDC investigators apparently failed to do in this case was to thoroughly examine the operations of the mail handling facilities early on in the investigation. Had they seen the sorting machines in action they would have realized that these things can aerosolize bowling balls. Instead, they evidently remained convinced that anthrax in a sealed letter would remain in the letter through the sorting process. And if they had seen how the sorting machines were cleaned with compressed air, they would have seen that their concept of "no re-aerosolization of anthrax spores" was inapplicable in the automated mail handling environment.

The other issue of interest to me was the evidence against Hatfill. I couldn't tell from what I have read in the papers how strong it is. Now, from Thompson's book, I can see that it is only circumstantial, yet compelling. (It is certainly clear that Thompson believes Hatfill was the perpetrator.) I can understand why the FBI has had Hatfill under surveillance for two years. (On the other hand, the FBI seemed equally justified in their suspicion that Richard Jewell was the Olympic Park bomber and look how that case turned out.)

What's wrong with "The Killer Strain"? It's too long for one thing. Thompson goes on at length about a few characters, describing in more detail than I care for aspects of their home decor and personal grooming. More important are the factual errors which are so egregious as to make the entire text suspect. One Amazon customer reviewer already pointed out that Thompson has Trent Lott as a representative from Louisiana. My favorite is on p. 184 where she refers to the "notorious Tuskegee syphilis study...performed...in Macon County, Georgia. The Tuskegee study was performed in Tuskegee, for heaven's sake! Tuskegee is in Alabama. Would we tolerate a historian who wrote that Lincoln was buried in Grant's tomb?

In summary, Thompson has produced a "newspaper quality" account of the anthrax attacks that will probably be of interest to people who slept through the winter of 2001-2002. For this she deserves three stars. But there's nothing new in the account and the factual errors numerous and substantive enough that three stars is all she deserves.

enthralling,
I wrote this review which you now have posted under the author's name.

This book is totally engrossing from the first page to the last. It manages to take a story about a real-life incident (the anthrax letters of 2001) and spin it into a fascinating yarn that has shades of fiction. The characters are richly drawn -- Leroy Richmond, the devoted postal worker who contracts anthrax when his boss asks him to leave his work station and clean up some rubbish behind the anthrax-contaminated Machine 17; John Ezzell, the scientist who frets during sleepless nights about how to protect the public from this menace; Jeff Koplan, the dedicated bureaucrat who ends up being the Bush administration's fall guy. Despite its title, which is a play on words about anthrax exposure, Thompson tries to engage the reader and succeeds in spinning a story that informs, enrages and leaves lingering questions about our government's ability to deal with acts of orchestrated terror. Can't put it down reading.

This is a well writen book. I could not put it down until I had read it through. Ms.Thompson took the truth and made it seem like fiction. It was hard to believe that someone could do this to innocent people. I hope all of your readers will buy this great book

This book is a little dense and sometimes repetitive. For those looking for a medical mystery this book will probably not be very satisfying. The point of this book, which is made several times and then some, is that the response from federal agencies to the 2001 anthrax attacks was not perfect. And those mistakes cost lives.

The history of US anthrax production was interesting and offered perspective, and the chapter on the US Justice Departments attack and smear of a scientist was good and should have been developed more.

I read this book after hearing the author interviewed on NPR. While the author evidently knows the subject matter well, the book reads as if it were written to be read aloud rather than just read. Confusingly, it's not really written chronologically, either.

But it's pretty good anyway, and offers an excellent, though brief, summary of the events of fall 2001 without dwelling overly long on subjects (like September 11) that we're all quite familiar with. The author also spends some time reviewing the "person of interest", Stephen J. Hatfield, and his background. It's a short read (I read it cover to cover in about a day), but it's worth it.

Marilyn Thompson is a crackerjack investigative reporter for the Washington Post. So it's no surprise that she's turned out an excellent book on the anthrax attack that followed on the heels of 9/11. Her book is based on dozens of interviews and reams of documentation. It's very detailed, remarkably clear, and extremely informative. Reading it, you would think that the author had been there with a videocamera to record each event as it unfolded.

A few eye-openers from the book:

Prior to 1972, the U.S. government made (and eventually destroyed) 220 lbs. of weapons-grade anthrax. If dispersed throughout a big city, that's enough to cause 250,000 infections and perhaps 200,000 deaths. The Soviets made (and hopefully destroyed) much more.

The contrast between how authorities at all levels dealt with the contamination of the Senate Office Building and the threat to Senators and their staffers, compared to postal facilities and postal workers could not be more striking. This was not simply the case of one oversight or mistake, but of a system-wide reluctance to conceive of a significant risk to postal workers (two of whom died) or to contemplate closing down potentially contaminated processing facilities.

As has been shown in similar situations, such as the first appearance of West Nile Virus, so many government agencies get involved that any kind of coherent response seems to take far too long, if it comes together at all.

Despite years of warnings, laboratories, hospitals, doctors, police plus other agencies and facilities were "uniformly unprepared."

Early on, the government blocked the Centers for Disease Control from releasing information, leading to a major credibility gap.

The CDC's performance was far from ideal. Despite or perhaps because of their expertise, they remained convinced that there could be no risk to postal workers, and clung to the standard (and usually sensible) medical reluctance not to prescribe antibiotics far too long, especially in the case of potentially exposed postal workers.

As Thompson points out, we now are painfully aware that bioterrorism is a reality. Anyone who is interested in the details of how the anthrax attacks unfolded, or who wants to be better prepared the next time bioterrorists strike, should read _The Killer Strain_.

Robert Adler, author of _Science Firsts: From the Creation of Science to the Science of Creation_ (John Wiley & Sons, September 2002).

I found this book so disappointing that I feel compelled to write a brief review. While Ms. Thompson clearly did her homework, she tells us nothing new in this book. It is simply a cogent narrative of the events surrounding the anthrax letters. There is no investigative journalism in the sense that nothing previously unknown is revealed, nothing is uncovered, no "government [is] exposed." There is the usual journalistic play on the ordeal of one survivor and the invasive note of titillation over the dead. I was uncomfortable with the tone. After all, several people died --were maliciously murdered -- and it was a tragedy; it doesn't need inflaming. But heat is not light, and mistakes and errors in judgment are not the big story. The big story is: what in the world happened here? Where specifically did the anthrax come from? Do we know? If not, why not? Who could have perpetrated these crimes? Who in the government knows what? Are the investigators incompetent or are there darker forces at play? The Ames strain came from our programs; how did it get into deadly hands? With all the experts--scientists and criminologists-- involved, do we truly know nothing much to date? These people have devoted their lives to tracking things down, to pinning down facts. You get my point.
This is portrayed as one kind of book, and it is really something else and something much less interesting. Sorry. The books that will take us deeper into this story are yet to be written. We ought to be clamoring for them. The anthrax murders were an urgent and ominous series of events. And the silence is, well, the silence is suspect. Who's in charge here? Where are Bush's vaunted leadership skills? Where do things stand now? Are we safe?