The United States should recognize that it is vulnerable on many fronts and adapt its terrorism prevention policy to recognize that, former Surgeon General C. Everett Koop '37 said yesterday.
Koop, addressing the fallout of the recent terror attacks on the medical community, said the basic problem that arose after Sept. 11 is the deepening of the economic crisis.
The layoffs that accompany such crises are very harmful to the medical community because most people rely on their employers for health insurance, Koop said.
"A recession, depression or time of unemployment affects health care tremendously because if you lose your job, you lose your health care," he said.
This has the potential to worsen the economy, he added, because the insurance costs owed to laid-off workers could total as much as $5 billion -- far more than the $3 billion allocated by Congress to help states pay these added costs.
Rather than spelling doom for proposed health care reform bills, Koop believes that "for political reasons" the attacks will spur the passage through Congress of a patient's bill of rights, Medicare reform and health care assistance for the elderly.
Among other reasons, he said such reform measures are necessary because "drug costs are still a very significant issue."
Some of the proposed changes are not comprehensive enough, and would leave many millions of people with no real change in their health care, he said.
"The patients' bill of rights is not rights for patients, but for insured patients," he said.
"It's a bad economic picture for anyone in this country," he said.
A major implication of the terrorist attacks would be the added stress incurred by people living in New York, Washington or other areas of the nation, Koop said.
In particular, he noted the region of Queens, New York, that lost over 100 residents in the World Trade Center collapse and suffered a plane crash on Monday.
He estimates, based on his experience as Surgeon General, that "an amazing number of people in any large organization are disabled in some way," a trend likely more pronounced today.
Koop also discussed the potential medical threats posed by the recent rash of terror attacks, including the potential for biological, chemical, computer or even nuclear attack.
"I think cyber-terrorism could bring this country to its knees," Koop said, because the nation is so dependent on computers.
One of Koop's primary fears was that individuals, rather than organized groups, could propagate terror by infecting themselves to spread disease, placing harmful substances in food or water supplies or by placing small amounts of nuclear material in strategic areas.
"Our enemy, and the individuals who make up the enemy, are anonymous," he said, adding that "it's pretty hard to fight an enemy who doesn't mind dying."
A further problem lies in the vaccinations proposed by the federal government to protect against smallpox.
Since vaccinations can cause the disease they are intended to prevent, producers are often unwilling to produce vaccines in large quantities in order to avoid costly lawsuits.
In addition, the vaccines themselves are costly and hard to produce, though Koop "heard we have 133 million doses of vaccine stored in Atlanta."
Lamenting the poor response to the recent anthrax attacks and subsequent scares, Koop suggested that U.S. Surgeon General David Satcher make reassuring statements to the nation to alleviate fears and eliminate the potential for harmful rumors.
"The guy who knows the most about bio-terror is the guy who was the head of the Center for Disease Control," Koop said, recommending that Satcher appear publicly more often.
Koop also questioned the government's belief that with further intelligence it could have stopped the attacks.
"How could you have prevented the Trade Center fiasco and prevent someone from mailing anthrax?" he asked.
"You get the impression, I hope, that we are extremely vulnerable," Koop said.
"Although I'm an optimist under most circumstances, I think the future has a lot of deep valleys in it," he said.
