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HBO
Do you have a follow-up on any developments down at the World Trade Center?

DR. MICHAEL BADEN
The New York Medical Examiners Office has begun to identify bodies solely by DNA. The first 400 or so bodies that were identified were identified by traditional means, i.e., fingerprints, direct visualization, dental identification, X-rays, tattoos, etc. But techniques for matching DNA from bodies to their relatives is now beginning to provide results and there will be more DNA matches forthcoming.

Another development is that there have been reports of possibly toxic odors coming from the Ground Zero site. As bodies deteriorate, and chemicals in the basement of the World Trade Center shift around, some noxious odors may result. But there's no disease that can be transmitted from a dead body; even though the decomposition process causes noxious odors, it cannot transmit disease. Finally, the weather is getting colder; it's sad that they'll still be searching for bodies well past Christmas.

HBO
Any thoughts on anthrax?

DR. MICHAEL BADEN
The concern about anthrax is an evolving one; our knowledge about anthrax increases every day. The reason I say that is because apart from one discharge of anthrax in Russia in 1979, we don't have any experience with pulmonary or gastrointestinal anthrax. We've never had a case of gastrointestinal anthrax - which comes from eating rotten meat that has anthrax in it - in this country. In our experience, anthrax is typically found in cows and sheep in the Midwest and in Canada. It's traditionally been more a veterinary problem in this country than a human one, because it is very unusual for anthrax in cows and sheep to infect humans and cause disease. Even when anthrax is deposited on human beings, it doesn't usually infect them. It's important to keep in mind that our skin isn't naturally sterile - we typically have streptococci and staphylococci on our hands, arms and the rest of our body. But washing our hands and taking showers enables us to avoid disease and survive very nicely, even with lots of bacteria on us. Part of the current problem with anthrax is that studies were never done on how much background anthrax there is in the city - on horses, for example. The only studies on lung anthrax, really, come from Sverdlosk, in Russia.

In Sverdlosk, in 1979, there was an accidental discharge from a biological warfare plant there. At that time the Russians were making anthrax for possible use as a biological weapon. A cloud of anthrax was inadvertently released into a population of thousands of people. But only 66 died from the disease. Nobody under 24 years of age died --young people, children, babies - none of them died from this massive exposure to anthrax. Some people died from eating infected meat and getting the gastrointestinal form of the disease, some developed skin anthrax and some died from inhaling the anthrax spores. The concern I have regarding what's going on now, in this country, is that we don't know how to interpret a finding of anthrax on a carpet, or in the nose, etc. Just because someone has anthrax on a nasal swab does not mean that that person is going to get sick from it. But on the other hand, people who don't have anthrax in the nose can get sick if they inhale the spores into the lungs.

The number of people who get pulmonary - lung - anthrax is really very small, but of course it's important to protect people from getting it. It's the same bug, whether it's on the skin or in the lungs; the same bacterium, with the same spores. Like I said, we'll be learning more about it as time progresses, but I think the worst thing that's happened is that the fear of anthrax has greatly outstripped the actual danger from it. Anthrax is not as dangerous as has been portrayed in the media; more people have died from being hit by lightning than from anthrax.

The other point I'd like to make regards antibiotics, particularly Cipro. Penicillin, tetracycline and doxycycline are all equally as good against anthrax as Cipro. This idea that it's necessary to get Cipro is distorted. The reason Cipro was initially recommended for stockpiling was in case the bad guys modified anthrax so that it was resistant to penicillin: if the anthrax is resistant to penicillin, then Cipro could be used. But, suppose the bad guys modify anthrax to make it resistant to Cipro? Then penicillin would be good. It's sad that a drug as good as penicillin is has no champions in this country; very few large drug companies make penicillin anymore; it's so cheap to make that there's not a profit motive to make it in the United States. The penicillin we have in this country is largely imported from Asia and England. As a result, Cipro becomes the drug of choice, even when it's unnecessary - because every strain of anthrax that's been identified in this country, so far, has been sensitive to penicillin. We have not found any penicillin-resistant anthrax yet. And that's the only reason one would want to use Cipro, which is much more expensive and in lesser supply.

Another concern with Cipro is that it's being overused. We could get a lot of Cipro-resistant bacteria developing in the months ahead, so that diseases that used to be treated with Cipro won't respond to it anymore. Penicillin, tetracycline and doxycycline are equally good for treating anthrax, and they're much cheaper and more widely available than Cipro. Every case of anthrax in this country so far - cutaneous or lung anthrax - has been sensitive to penicillin. That means that penicillin is the best drug for it; we've gone off target with our mania for Cipro.

HBO
Smallpox?

DR. MICHAEL BADEN
Smallpox is, in a many ways, a much greater potential hazard than anthrax. This is because a person can come into a community showing no symptoms of smallpox - there's about a seven to ten day incubation period - and infect lots of people with the virus. They won't even know they're infected until a week or so later. There used to be huge numbers of people dying from smallpox. But it's not clear how many died from the viral infection itself and how many from the bacteria that got into the blisters; smallpox causes blisters all over the skin and when bacteria get into the blisters, they cause infection. Most smallpox deaths were before we had antibiotics to treat bacterial infections.

To give you some history, in 1947, a Mexican businessman came through New York City and died of smallpox. The whole city was then immunized - 7 million people immunized against smallpox. Twelve people in New York City got smallpox and one died; another died in Westchester County. So, out of 12 people infected, two died and ten didn't. (This was in 1947, when the only antibiotic we had was penicillin.) In addition, there were about 6 deaths from the immunization; meaning six times as many people died from the vaccination as from the disease. So we have to be careful when we do mass vaccinations because there's going to be a certain number of people who are going to have bad reactions - some of whom are going to die.

For example, in the 1970s, we were afraid of a potential swine flu epidemic because a solider at Fort Dix died of a virus that was thought to be the same one that caused that illness in 1920, when there was a swine flu pandemic that killed 20 million people. As a result, the whole country began to receive the swine flu vaccine - until hundreds of people got sick from it. They developed neurological diseases and dozens of people died as a result of that immunization program. So it was stopped. And there's no evidence at that anybody ever had swine flu. So again, one has to be careful. Even public health doctors can sometimes make mistakes.

But I think that smallpox is a real threat, maybe more so than anthrax. But at the same time, in 1947 in New York City - a big city like New York - of a dozen people who were infected with and developed smallpox, only two died. So, smallpox doesn't kill 50 percent of infected people as it may have 200 years ago when Dr. Jenner first developed an immunization program. Many of those deaths were due to the severity of the bacterial infections that occurred after the viruses caused blistering of the skin. Now those infections can be treated very nicely with antibiotics. The worst thing about smallpox is that it can be spread very widely, very quickly, from person to person. Anthrax can't be spread to person to person. But the good news is that smallpox is much more treatable today than it was in medieval and colonial days, when there were smallpox plagues.

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