I am almost (but not quite) of the generation that you can ask the question of: “Where were you when JFK died?” For those of you who do not know who JFK was … well, that’s just sad. Anyway, I do remember where I was when JFK died.

The modern version of this question may be “Where were you when 9/11 happened?” I was in my lab, doing my usual work, and got to listen on the radio to much of the horror with my students. It was so surreal, as it must have been for many of you.

And then there were the “Amerithrax” attacks, on the tail of the general horror. I was cleaning up piles here at home, and I chanced across something the University put out around that time “Commonly Asked Questions About Bioterrorism.” It is instructive. “Individuals should not store antibiotics at home.” Well, that’s pretty much true. But pointless. If you think you’re going to die, you are not going to trust the government to save your life. Heck, we don’t even trust the government to provide us with health care. “Can we obtain anthrax and smallpox vaccines?” This was interesting because … smallpox? What? I don’t recall there being a big smallpox scare at the time. I guess the University Health Services just picked a disease out of the hat, to show that we were on top of things? “What should I do with suspicious mail?” Oh my, the suspicious mail. I had folks cold-calling me to ask me to test their mail for anthrax. I did what I usually do in such situations: set a price point so high that they are discouraged, unless they’re super-rich. Knowing super-rich, super-stitious folks is not necessarily a bad thing. Anyway, one of the best recommendations the UHS gave us was: “As soon as practical, shower with soap and water.” I love this because at first glance it seems stupid, but it’s perhaps the best public health advice of all time. Seriously, I think we’ve avoided so many plagues just because we’re cleaner now.

OK, I know I’m babbling a bit here, which is what most reminescences are. “People wore onions on their belts, which was the style in those days,” as I believe Abe Simpson likes to say.

But I do have a point in here somewhere. And that point is this: we were taken down as much by fear as by anything else. Several folks died, which is tragic and horrible. But many more folks die in car crashes on most days, and we don’t run screaming from our vehicles. Yet we did begin to microwave our mail, refuse to go outside, and various other odd behaviors. They went away, it’s true. But we were taken down by fear.

Now, suppose we ever had a real catastrophe, one that actually resulted in many thousands of deaths or illnesses. We would be beyond paralyzed. The psychic aftershock would put us down for the count.

And it’s because we’re primed to be afraid. We are conditioned to not understand and to therefore run around like chickens with our heads cut off. To my great shame, I canceled a trip post 9/11. But with respect to bioterrorism, it’s even worse. Most people don’t know what smallpox is anymore, much less why we should or shouldn’t worry about it. Heck, many people don’t even believe in the utility of vaccines anymore.

And this is where my beef with the government really starts. It’s not that we don’t have a good vaccine program, or that we don’t have good public health programs or emergency response capabilities or even some sort of plans on how to quarantine. I actually think that in terms of command and control we’re doing a pretty good job.

But the one incredibly cost-effective thing we could do, educate the public, is nowhere. In various forums I have advocated just having the Surgeon General come on the TV once a month for 15 minutes (or do a YouTube video, whatever) and explain disease. Explain how we responded to the last incursion of smallpox in the US, in the 1950s. Virtually all of NYC was vaccinated within a short period of time. Or how our ancestors more or less knew how to deal with yellow fever. It made many sick, and some died, but we got through it. We need to demystify disease and how disease is spread and how disease is handled. We need to make responding to bioterrorism as commonplace as getting screened in the airport.

Until that time we’re primed to be taken down as much by fear as by anything else. It often amazes me that our adversaries don’t see how much cost-effective damage can be done by a well-placed letter to the New York Times.

- originally posted on Saturday, August 21st, 2010