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September 1999
Volume 63 |
Number 9
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VENTILATIONS
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| The CEO and the
Virus |
Roger W. Litwiller,
M.D., Chair
In the War of the Worlds, H.G. Wells portrayed the human
race as a species on the verge of complete defeat at the hands
of foreign, invading and uncaring Martians. Despite humankind's
collective firepower and ingenuity, civilization was destroyed
and reduced to small collectives that foraged and hid from the
aliens. In "deus ex machina" fashion, all of the Martians suddenly
died due to a lack of immunity to bacteria (viruses were not yet
invented). Wells was trying to point out the irony of the smallest
creature's ability to overcome what seemingly more complex organisms
were incapable of accomplishing. It also served to point out that
one never has all the bases covered!
Last week, I read an article in The New Yorker
by Richard Preston1 that thoroughly
frightened me. Preston, author of The Hot Zone and The
Cobra Event, has a way of elucidating the perils of viral
outbreak so that it appears imminent. He interviewed Donald Henderson,
M.D., once director of the World Health Organization's Smallpox
Eradication Unit. What Preston disclosed should have every person
on "Spaceship Earth" in a panic. Smallpox has been secretly modified
and tested for use as a bioweapons agent by the Soviet Union during
the cold war. Smallpox is communicable, airborne, lethal and now
exotic so that one infected person could spread the virus worldwide
during its 14-day incubation. Only one viral particle is sufficient
to infect and probably kill a person. Moreover, if a single person
contacted smallpox in Baltimore, Maryland, more than 100 million
people would need immediate vaccination to stop the wave of infection.
Today, without booster vaccinations, virtually no one
is immunized ... and there are less than 8 million effective
vaccination doses stored at Wyeth-Ayerst Laboratories in Pennsylvania.
The Russians have now admitted that they did not keep track of
all warehoused smallpox vials and expect that China, India, Pakistan,
Israel, North Korea, Iraq, Iran, Cuba, Serbia, the AUM Shinrikyo
group and the Osama Bin Laden group may have clandestine stocks
for bioweapons development.
Chief executive officers (CEOs) of health maintenance organizations
(HMOs) are effectively forcing doctors, hospitals, academic medical
centers and pharmaceutical companies to trim the "fat" within
their operations. With the reduction of research time for physicians
and the shift to marketing newer $100 million drugs by pharmaceutical
companies, the smallpox issue occupies low priority. Moreover,
hospitals are reducing the number of beds and medical education
has reshaped the physician workforce to more general practice
physicians.
Having just heightened your insecurity by a factor of
tenfold, you might be wondering how H.G. Wells, smallpox and HMO
executives are related. Just like the Martians invading Earth,
the CEOs have taken over health care in the United States, skeletonizing
programs by reducing reimbursements. They, too, are foreign to
the intricacies of this medical culture and are also uncaring
about the long-term effects (satisfying shareholders from quarter
to quarter is their time frame). By analogy, the present health
care situation is akin to a yuppie family with high fixed monthly
expenses, living from paycheck to paycheck without a savings account.
One unanticipated disaster will bring about collapse.
So, it may be my paranoia, but events are aligning in
such a way that the concept of a "doomsday bug" may not be so
fictitious. More than two million people died in 1966 from smallpox
when humanity was largely immune to the disease. Today, it is
not inconceivable that 1 billion people could contract this disease
if used in a terrorist act. Meanwhile, the country is preoccupied
with the business of medicine (invasion), controlled by the CEOs
(Martians) believing that organized medicine can handle any disaster.
Unfortunately, a smallpox outbreak, unlike H.G. Wells' human-saving
bacteria, will eradicate both CEO and citizen alike.
-- M.J.L.
Reference:
1. Preston R. A reporter at large: The
demon in the freezer. The New Yorker. 1999; July 12:44-61.
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