Government needs point man on health issues, lawmakers say

The government should appoint a spokesman with a medical background to provide credible health information on bioterrorism to avoid the confusion created during the anthrax outbreak, a panel of doctors said Thursday. The federal government failed to effectively inform the public and local health officials during the anthrax outbreak, leading members of the medical community, including former U.S. Surgeon General C. Everett Koop, testified at a hearing before a House Government Reform subcommittee Thursday. "On communicating information to the public on bioterrorism, I would not give the government high marks," Koop said. "The spokesperson in such situations is usually the Surgeon General; I have heard little from him, and those who were his surrogates-with the exception of Drs. Anthony Fauci and Jeffrey Koplan-have not been accurate." Fauci is the director of the National Institute of Allergy and Infectious Diseases in the Health and Human Services Department. Koplan is head of the Centers for Disease Control and Prevention. The lack of accurate information during the anthrax crisis provided fertile ground for panic, according to Dr. Joseph F. Waeckerle, editor-in-chief of the Annals of Emergency Medicine. "Reports of stores running out of gas masks and other protective gear appeared in the media," he said. "Many believed a visit to the nearest emergency department for a nasal swab was the most prudent step to take." Waeckerle said the public was not told that nasal swabs are used to determine exposure, but are not sensitive enough to be used in a diagnosis. Koop and the other panelists encouraged the administration to delegate one person within HHS, preferably the Surgeon General or the head of the Centers for Disease Control and Prevention, to be responsible for disseminating credible information on health topics relating to bioterrorism, including anthrax and smallpox. Dr. Kenneth I. Shine, president of the Institute of Medicine at the National Academy of Science, called for an associate director of health within the Office of Homeland Security, who would cooperate with the principal HHS spokesman. "We know far too little about the availability of hospital beds, burn units, decontamination capability and a variety of other parameters required by the health system to deal with terrorism," Shine said. Current Surgeon General David Satcher acknowledged the communication problems that occurred during the anthrax outbreak, but also defended his office's efforts to inform the public and the rapid response of the medical community to provide antibiotics to people exposed to anthrax bacteria. "Clearly there were problems, but if we don't point out the positives, we do a disservice to those at the state and local levels who did a good job," said Satcher. "Some things went right here, and we have to build on that." Five people, including two postal workers, died from inhalation anthrax. "While five people too many have lost their lives," countless lives were saved by the health community's response to the outbreak, Satcher said. He praised the CDC, FBI and the state and local public health departments in Florida for quickly providing medicine and testing for employees at the America Media Inc. building in Boca Raton, Fla. One of the five victims contracted inhalation anthrax from mail sent to America Media's office. Satcher, who is leaving his post soon, said he supported strengthening the Office of the Surgeon General and using the position to keep the public informed on health issues related to bioterrorism. But he also pointed out the difficulty of providing accurate medical information and definitive answers in the constantly changing environment created by bioterrorism. "The Surgeon General is responsible for communicating directly with the American people based on the best available science," Satcher said. "To date, most communications with the Surgeon General have been based on topics for which there has been extensive research and investigation." But Sept. 11 and the anthrax outbreak have made the need for information and effective communication with the public and among government agencies more urgent, Satcher said. "We have not been here before; we no longer have the time to assemble all the science before we talk to the public."