March 20, 2003 -- Dr. Bill Frist says War Is the Best Medicine

This letter was written by an American Public Health Association
member in response to an op-ed piece by Senate Majority Leader Bill
Frist M.D., asserting that the invasion and occupation of Iraq is the
best preventative medicine against Iraqi bio-attack against the US. My
apologies for the delay.



March 16, 2003

To the Editor:

Senator Bill Frist's assertion that war against Iraq is "the best
medicine" is a sinister perversion of medical ethics and a spurious
medicalization of what is always a political and moral choice: the
decision to launch a war. A cardinal principle of medicine is Primum
non nocere" "First, do no harm" and yet the physician-senator seems
perfectly willing to risk the inevitable deaths of thousands of Iraqi
civilians to "protect" Americans from what are at best undocumented
and hypothetical scenarios of biological and chemical assault from
Iraq. Modern warfare always involves the slaughter of innocents. To
call that "prevention" borders on the obscene.

Superficial and horrific medical accounts of the effects of biologic
weapons do not change the moral calculus, which knows no national
boundaries. We should remember that the weaponized anthrax that
terrorized Washington apparently came from American sources, and that
we are one of many nations, some of them our allies, that have worked
to possess biological, chemical and nuclear weapons of mass
destruction.

Dr. Frist rightly asserts that "physicians have an imperative duty to
help keep people healthy and alive." They have no moral justification
for doing so, however, by killing others, the more so when other
preventive (not "pre-emptive") choices are available. In calling for
war, Dr. Frist speaks only for himself, and does not represent
medicine in this nation or around the world.


H. Jack Geiger, M.D.

The writer is the Arthur C. Logan Professor Emeritus of Community
Medicine, City University of New York Medical School, and is a
founding member and past president of Physicians for Human Rights,
USA.


(Incidentally, the New York Times carried another article showing that
the US and France supplied Iraq with its source stocks of bioweapons
during the 1980, when arming Iraq was seen as a way to reduce the
threat of Iran.)


Washington Post, Sunday, March 16, 2003; Page B07


When War Is the Best Medicine

By Bill Frist

Physicians and policymakers have an imperative duty to help keep
people healthy and alive. In doing so, preventive care is always
preferable to the treatment of avoidable disease. Understanding the
causes of disease and death enables prevention. Physicians and
policymakers must gather and evaluate critical information to meet our
obligation to protect humanity by preventing illness and death.

Today is the 15th anniversary of Saddam Hussein's horrific chemical
attack on his own people in Halabja, Iraq. It is estimated that 5,000
Iraqis died terrible deaths and at least 10,000 were injured. Today
the people of Halabja suffer from high rates of birth defects, cancer
and blindness, and many have respiratory illnesses.

So we know that chemical weapons cause illness, disease and death. We
also know that biological weapons using anthrax and botulinum toxin,
plague and Ebola cause severe illness and death.

And we know that Hussein has admitted to having quantities of
weaponized anthrax, botulinum toxin, aflatoxin and ricin. He has also
tested plague, typhus, cholera, camel pox and hemorrhagic fever. And
we know he has mustard gas and the VX nerve agent.

We know he has no compunction when it comes to killing people.

We know that there are no vaccines -- and sometimes no treatments --
for the disease and illness that would result from his use of many of
these weapons.

Scientists in the best research facilities in the world are constantly
seeking vaccines and cures. But as we know from the search for a
vaccine and a cure for HIV/AIDS, it is a very slow process.

Should we gamble the health of our families and our nation on the
likelihood that pharmaceutical vaccines and cures will be found before
Hussein decides he would like to try an attack against Americans and
our allies? Or should we look to nontraditional means of preventive
care? Both physicians and policymakers must make that choice only when
there is enough information to weigh the relative benefits of
traditional vs. nontraditional.

We have the information that Hussein will use chemical and biological
weapons. The question is whether he will use them against Americans,
directly or indirectly.

During the Cold War, the controlled insanity of mutually assured
destruction meant that we and the Soviet Union had a built-in
deterrent to attacking each other. This worked because there was
relative stability, even in the unfortunate spread of biological,
chemical and nuclear weapons throughout the world. If attacked, each
nation knew for certain the identity of the attacker -- and would
retaliate.

The deterrence of Cold War discipline evaporated with the demise of
the Soviet Union. The proliferation of non-state actors --
proliferators and terrorists -- eager to obtain and use weapons of
mass destruction, combined with a global environment devoid of real
penalties for the stockpiling of such weapons by rogue nations, means
we inhabit a new world of uncontrolled insanity. Sept. 11, 2001,
provided clear evidence that our enemies want to kill us. I have no
doubt that Hussein would gladly provide weapons of mass destruction to
nationally unaffiliated groups to use against us -- if he has not
already -- and no doubt he would be just as glad to sit back and take
no credit. This empowers him in the underworld of terror and
accomplishes his desire to see us suffer.

To determine, then, the best preventive medicine in this case, we must
combine our understanding of Hussein with an understanding of the
impact his weapons would have on Americans.

In theory, just a single gram of botulinum toxin -- the deadliest
toxin known to science -- could kill 1 million people if released into
the air. Once the toxin enters the body it binds to nerve endings
where they join with muscles. Victims would experience double or
blurred vision, slurred speech, difficulty swallowing, nausea,
vomiting and muscle weakness. If untreated, the disease will paralyze
the arms, legs, trunk and respiratory muscles, perhaps resulting in
suffocation. There is no reliable vaccine. Although an antitoxin is
available, its supply is limited.

What about hemorrhagic fevers? The name itself tells us a lot about
these infections. They cause high fever and widespread,
uncontrollable bleeding. Ebola is a hemorrhagic fever, and we know
that Hussein has experimented with it. In its most severe form, Ebola
causes bleeding under the skin, in internal organs, and from the
mouth, nose, ears and eyes and other openings in the body. There is
no vaccine and no standard treatment. All we can do is provide
supportive therapy.

What about the VX nerve agent? It can enter the human body through
inhalation or through the skin. It can quickly cause convulsions, a
loss of consciousness and death from suffocation because the muscles
can no longer sustain breathing functions. In milder cases, victims
will experience vomiting, headaches, difficulty in thinking, muscle
twitches, weakness, diarrhea and involuntary urination. Antidotes are
available, but they must be administered immediately. Because it is a
chemical weapon, there is no possibility for a vaccine.

These are but three of the nightmares Hussein can inflict upon us.

I firmly believe that to wait for the long-term development of
vaccines and cures is a losing-odds bet on the goodness of Hussein.
Attacks on human beings designed for the maximum of unspeakable
suffering call for nontraditional preventive care on our part.

Getting rid of Saddam Hussein's regime is our best inoculation.
Destroying once and for all his weapons of disease and death is a
vaccination for the world.

Bill Frist (R-Tenn.), a physician, is the Senate majority leader.