[Congressional Record (Bound Edition), Volume 147 (2001), Part 16]
[Extensions of Remarks]
[Page 23302]
[From the U.S. Government Publishing Office, www.gpo.gov]



                        ANTHRAX ISN'T THAT RISKY

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                          HON. JOHN J. LaFALCE

                              of new york

                    in the house of representatives

                      Wednesday, November 28, 2001

  Mr. LaFALCE. Mr. Speaker, I would like to share with my colleagues 
the following article, which appeared in the Wall Street Journal on 
October 22, 2001. The article underscores the importance of putting 
into perspective the relatively small risk to average Americans posed 
by the threat of anthrax and bioterrorism, and the need for Americans 
to continue to go about their daily lives as before.

             [From the Wall Street Journal, Oct. 22, 2001]

                  Chill Out: Anthrax Isn't That Risky

                        (By Ezekiel J. Emanuel)

       My brother's business partner, a well-educated Hollywood 
     agent, called to say that he just purchased $1,900 worth of 
     Cipro to protect his wife and two kids. Knowing there was a 
     threat of anthrax out there, he couldn't sleep comfortably 
     without Cipro at home.
       The fear of anthrax, and the public response to it, has so 
     far reflected bad math, bad medicine and bad public health. 
     We cannot continue to let confusion determine how we act. It 
     may hurt us badly.
       First, the bad math. Anthrax is out there. Letters 
     containing spores are a real threat. But the question is: How 
     big a threat? So far one person has died of inhaled anthrax, 
     and several others have cutaneous anthrax--from which they 
     will probably recover uneventfully with treatment. Several 
     hundred more people have been exposed, but far fewer than 100 
     have tested positive for having anthrax without being 
     infected. For the family of Robert Stevens, who died in 
     Florida, it is a terrible tragedy. But for the rest of us, 
     anthrax is not a public-health menace that should drive us to 
     do crazy things.
       The risk of dying of anthrax needs to be put into 
     perspective. One death among 280 million Americans is a 
     miniscule risk. It is less than the risk of dying from 
     driving just one mile. To put it another way, 280 people 
     would have to die of anthrax to equal the risk of driving 50 
     miles in a car (about one in a million). How many Americans 
     refuse to drive because of the risk of dying in a car 
     accident?
       More important, the risk is hardly random. There may be 
     call for people working on Capitol Hill or at the White House 
     or federal agencies or major news organizations to be 
     concerned. But for average Americans the chance of an 
     anthrax-filled letter is less than one in a billion, 
     substantially less than the risk of being struck by 
     lightening (about one in 600,000 in a year).
       There are many reasons we react more strongly to the risks 
     of anthrax than to the risks of driving. We are used to 
     driving; we are habituated to the risks. We take 
     precautions--we buckle up, we don't drink and drive. But 
     anthrax is new, unexpected, outside our routine, and 
     therefore scary.
       Also, it is not the single death from anthrax that really 
     worries us but the unknown possibility of a full-scale 
     bioterror attack. But here we need to rationally consider the 
     risk of a large attack and the likely harm it will cause. It 
     takes a great deal of sophistication to generate the right-
     sized spores and, even more challenging, the right way of 
     aerosolizing them over a large area. Spiked letters are not 
     terribly effective at spreading anthrax to thousands, let 
     alone millions, of people. During the Cold War, it took the 
     U.S. and the Soviet Union decades to work out the details of 
     biological warfare with anthrax. Is it likely a terrorist 
     group could do the same in a few weeks or even years?
       Also, anthrax does not kill instantly. It takes several 
     days. With the nation on high alert to the threat, any large-
     scale dissemination would be detected and people in the 
     exposed area would be monitored and treated. The risks of 
     dying of anthrax are simply not very high.
       Stocking up on Cipro is bad medicine. First, children 
     should not take Cipro; it can damage the development of their 
     joints. Second, while relatively safe, Cipro, like all drugs, 
     has side effects, some of which can be serious. Besides minor 
     annoyances of nausea, diarrhea and rashes, Cipro can cause 
     the inflammation and rupture of tendons. Prolonged use--like 
     the 60 days of treatment necessary for prophylaxis against 
     anthrax--can cause superinfections with very serious and even 
     life-threatening bacteria. It also can have serious, 
     potentially fatal, interactions with other drugs, such as the 
     asthma drug theophylline.
       And spending $1,900 on Cipro for anthrax is foolish. There 
     are many other drugs that are just as effective against 
     anthrax, safer for children and considerably cheaper, 
     including penicillin, erthyromycin and doxycycline.
       Cipro is a prescription drug. It should be used when there 
     is a medical indication for its use, making the benefits of 
     specific treatment favorable compared to the risks of the 
     drug. Physicians should not dispense it as a way of calming 
     worry. Real facts, not the prescription pad, are the right 
     treatment for the insomnia of my brother's partner and his 
     wife.
       Bad medicine produces bad public health. The dispensing of 
     antibiotics for colds, sore throats, the flu and other minor 
     viral infections has created a serious problem; many bacteria 
     are becoming resistant. We have been able to stay ahead by 
     developing new antibiotics, but we are losing the race. The 
     bacteria are able to mutate to outsmart our drugs faster than 
     our pharmaceutical companies can develop, test and market and 
     market new antibiotics. The result is a danger to us all. The 
     next infection we get may be harder--or, God forbid, 
     impossible--to treat because the bacteria no longer respond.
       Millions of Americans self-medicating with Cipro is a real 
     threat to public health. In the years since it has been on 
     the market, bacteria have become resistant to Cipro. 
     Widespread use serves no medical purpose, but only increases 
     the chances of other bacteria--more threatening than 
     anthrax--becoming resistant. We would end up protecting 
     ourselves against the miniscule risk of anthrax, only to make 
     ourselves more vulnerable to more common everyday bacteria. 
     Not a good bargain.
       My advice to my brother's partner: Take the Cipro to the 
     pharmacy and get your money back. Keep driving your car and 
     be sure you buckle up every time. Stop asking for antibiotics 
     for every cold. And keep alert, contacting your local health 
     department, hospital or physician if there is a credible 
     threat.





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