EDITORIAL

Volume 6,Number 4
October-December 2001

Vol. 6, Num. 4: Contents | Editorial | Up Front | Abstracts

Real Risks: The Need for Health Leadership and Security

SCOTT C. RATZAN

The events since September 11, 2001 generated a level of leadership in America’s First war of the 21st Century. Thus far, the commander in chief has fulfilled his role along with diplomatic and military support of greatest regard. Yet, since this is the first threat on American soil most can remember, the health response fuels fear on a nervous and anxious public from Washington DC to Washington State.

What has been the health response to the new bizarre threats of anthrax, chemical weapons, and reemergence of small pox? Initially, the government response was led by the U.S. Secretary of Health and Human Services, Tommy Thompson, who suggested the first anthrax victim was an outdoorsman who might have contracted the disease drinking water from a stream, an improbable explanation for those who know how anthrax is transmitted. Later, while updating the evidence on anthrax, he reassured Americans there would be enough antibiotics to treat 2 million Americans, if there were a real threat. Note, using the Secretary’s logic, this would be less than 1% of the American population.

The ultimate media response was best captured with, ``In Cipro we trust,’ ’ a phrase Tom Brokaw used to close his Nightly News in early October. Repetitive discussion on network television highlighted the potential and speculative nature of the attack and the actual risk, while a confused offcial health response was spread out amongst different agencies.

How long did it take until it was clear that anthrax is not contagious, and is inactivated by ultraviolet light or direct moisture, and that treatment was available? And why did Cipro become emphasized, even though generic preparations of doxycycline or amoxicillin also are effective?

While it may be too early for the Office of Homeland Security to respond, why was the offcial response limited with the Secretary of Health and Human Services as the principal (and only) spokesperson on such threatening health issues during the crucial
initial phase of the crisis? Is it in the best interest of the public? Is it the hallmark of an evidence-based approach to dealing with risk-issues?

Ever since the ancient Greeks set the foundation for what has become the field of modern-day communication, trustworthiness, forthrightness, and integrity are hallmarks of effective communication. Today, scientific studies reiterate how the public perceives
health information: governmental and political appointed offcials are of lesser trust-worthiness than physicians and scientists on complex health issues.

For example, a recent study in the UK showed that fewer than 1 in 5 government offcials or politicians were believed by the public to tell the truth. Yet, nearly 9 out of 10 citizens believed doctors would tell the truth. This translates into a horrible trust factor of
government on health issues. In the UK, this helped presage the mad cow crisis and other health scares.

The absence of centralized quality expertise and ongoing, open channels of communication fuels media sensationalization and public speculation. While scientists argue over how the public responds ± whether rationally or emotionally ± emotions always win
in an era of uncertain ``new’ ’ threats. The newer the risk, the more unfamiliar and dreadful it is ± the greater the fear. Each year in America, over 40,000 Americans die in motor vehicle accidents and over 10,000 from side effects to the common use of such
drugs of aspirin and ibuprofen. Regardless, statistic s do not motivate our responsiveness to directives on actual risk.
It is not meant to be un-American or unsupporting to criticize an effort that is undoubtedly an administration’s best effort in the best interest of the American public. Instead, just as we marshal the best in military and diplomatic strategy abroad, we ought to muster the same campaign amongst health security here at home. Our nation has a united front against terrorism, but remains terrorized in coordinating a united public health response.

Consider this, how visible has the U.S. Surgeon General been? Since the 18th century the Office of the Surgeon General has been a leader in health issues. And, in the late 1980s, the Surgeon General began managing the 6,100 Commissioned Corps personnel
system of the Public Health Service, those responsible for public health delivery. Should the current Surgeon General, David Satcher, MD, who also has served as Director of the Centers for Disease Control, be a principal reliable source?

To protect health security we need to enlist the best of America - the commissioned medical corps, our physicians and health care personnel, and our extended health community of the pharmaceutical industry, health insurers, health facilities and laboratories -
to provide clear advice to the American public. This may need to be spearheaded by an active role of the federal government to open communication channels, provide clear and reliable advice to media outlets and directly to the public, and help develop a health
literacy so that people understand the actual risk and necessary response of any future event that may be related to bioterrorism.

``In Cipro we trust’ ’ suggests a higher-than-thou belief in medicine, even when it should not have been taken given Mr. Brokaw’s improbable exposure. While many Americans panic as they do not have the same access to high level antibiotics, many
others will respond and get real side effects of debilitati ng disease due to the misuse of antibiotics. The loss of faith in the media and government are even greater maladies if we do not have a platform that is strong enough and scientifcally sound to protect the nation from panic and threats that may seem unimaginable today.

If the government or the media do not rise to the task, it is incumbent upon the private sector or academia to take the lead. This new battle requires a 21st century evidence-based communication approach that rises above fear itself and addresses the fear scientifically, offering the appropriate response through effective communication and leadership.