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The Cipro Bailout

In the past week the government has toiled ceaselessly to assure a restive public that the bioterror threat is under control, even as our elected representatives were lighting out for the territories at the first sign of anthrax spores on Capitol Hill. But never fear. Americans at large face minimal risk, the feds are hot on the trail of the terrorists and there will be antibiotics enough for all. It’s true the public health risk-so far-is low unless you happen to be a Congressional aide, or secretary to a network news luminary. Or, of course, a postal worker like those unfortunate souls in Trenton and D.C. who were still being told they didn’t need testing while the House and Senate sounded retreat. Two of them are dead now, and at least two more are likely to follow; some wire accounts refer obliquely to an additional eight or nine post office staffers whose illnesses are deemed “suspicious.” Again, though, have no fear. The New York Times reports the White House has made discreet inquiries about purchasing equipment to irradiate the mail and kill any spores inside-inside the mail bound for federal government offices, that is.

Meantime investigators are phoning around to see if, and where, any anthrax has gone missing from labs lately. This portion of the official PR campaign is ludicrous. It seeks to comfort the public by implying that there’s something exceptional, and therefore likely to be traceable, about the process of getting one’s hands on a sample of anthrax. Until very recently, at least, the opposite has been closer to the truth. Anthrax cultures are kept in countless labs in the U.S. and elsewhere. According to Michael Osterholm’s book, Living Terrors: What America Needs to Know to Survive the Coming Bioterrorist Catastrophe, they could be ordered from any of 50-plus commercial vendors around the world as recently as 1998. But to say as much would only promulgate more panic; this is not an option.

Consequently there’s a great deal of serious-sounding hoohah about “weapons-grade” and “non-weapons-grade” spores, much of it from officials still struggling to get straight whether anthrax is a virus or a bacterium. To pretend there is any means of tracing a particular strain to a single lab, or a country where it was acquired, is only blowing smoke. There has been conjecture that the strain now circulating may have come from an Ames, Iowa, veterinary lab originally, but suppose that’s so-there’s no telling when it was lifted or whether it then fell into the hands of terrorists from Kabul, Kuala Lumpur, or Des Moines. Unless police agencies get lucky in locating the perpetrator or perpetrators by other means (an acquaintance, perhaps, a nosy neighbor) they’ll probably never know the pedigree of the spores. Which doesn’t mean they won’t concoct one. Remember always that Iraq a) is known to possess anthrax and b) was on the Pentagon’s short list of preferred targets even before the first powdered letter arrived.

But these sleights of hand concerning the investigation are a small thing compared to the whoppers being passed off about public health. To date we’ve seen no sign of any wide-scale public release of spores through open air or the ventilation systems of large buildings, but it remains entirely in the realm of possibility. It’s no trick growing the bacteria in quantity; the tougher part is milling it to a size that can cause infection in the lungs, and whoever is behind the attacks has already proven they can do that.

If one or more such mass releases were to occur, the public health system is in no way prepared to respond. Osterholm’s book paints a revolting picture. The government has no plan for meeting bioterror, he writes, just a Babel of conflicting jurisdictions and priorities; and the health care system itself is strained to the breaking point by the unbridled gouging of managed care consortiums and their suppliers of equipment and medicine. For years health care syndicates been taking sumptuous profits and reinvesting token sums in the capacity of the system. Relatively minor flu outbreaks already cause crises in major urban hospitals, and the numbers of people involved are minuscule compared to what we might see in a concerted bio-war attack.

The deeper fissures in the public health system are not yet widely evident to those Americans who enjoy private health insurance; right now everyone’s looking at drug supplies. And in the aftermath of September 11 there has been no spectacle here at home quite as galling as watching the pharmaceutical companies cast both eyes to the bottom line and dig in their heels, and seeing governments capitulate. When the Canadian health service ordered large quantities of a generic Cipro clone as a precautionary measure, the German patent-holder, Bayer AG, howled to the heavens and threatened litigation. Canada backed down. (Cipro, by the way, is not the only drug likely to be viable for treating anthrax exposure, nor Bayer the only recalcitrant patent owner; it belongs to a family of relatively new antibiotics known as fluoroquinolones.) South of the border the reaction has been even more timorous. Pursuant to 28 USC 1498, the American government has the legal authority to declare patents on essential goods null and void in a national crisis, despite Health and Human Services Secretary Tommy Thompson’s plaintive cries to the contrary last week. On Monday, finally, George W. Bush issued an executive order asserting that prerogative-with a twist.

After last month’s airline aid package, Bush feinted at drawing a line in the sand: Read my lips; no new bailouts. But his executive order struck a very different chord. In the event that the U.S. might maybe someday need to, you know, violate drug patents, then Thompson’s HHS would be empowered to pick up the tab for any legal and financial risks that fell to the manufacturers of patented drugs or their generic substitutes. National emergency or no, in other words, the United States will subsidize pharmaceutical companies who see their almighty patents trod upon. On the bright side, however, Bayer AG has agreed to stop the profiteering it has practiced since the anthrax scare first surfaced. In reaching its settlement with Canada, the company announced it would scale back its soaring wholesale prices for Cipro to pre-September 11 levels. CP

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