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lrogers{at}ajroffice.org
We now find ourselves at war. But not a war, as previous wars, waged by uniformed, readily identifiable armies arrayed against each other in an identifiable geographic quarter of the world. Rather, we find ourselves at war with furtive, clandestine figures aligned with shadowy, diasporic organizations throughout the world. The enemy are individuals who dress like us and who have melted into the interstices of our own countries. Here in America these people are able to move about freely and take advantage of our liberties and freedoms, the very same liberties and freedoms that they supposedly so deplore and reject.
These people are not, indeed cannot be, armed with the products of their own countries, for their countries are neither able to make nor do they seem interested in the manufacture of modern machinery and instruments, be they weapons of war or tools for civil purpose. These terrorists are therefore forced to arm themselves with goods produced by the very society they so wish to destroy.
The terrorists have adopted products devised for peaceful purposes and turned them into the implements of war. Civil aircraft laden with jet fuel, and automobiles, trucks, and vans loaded with explosives have been converted to horrendously effective bombs when directed by messianic, suicidal zealots. Even a simple tool, the box cutter, has morphed in their hands into the unthinkable—an instrument of intimidation and murder.
We have taken steps to defend ourselves from this menace. And our government's assessment of the threat has found that the defensive measures required are not exactly the same as those in which our country has long invested. Terrorism poses new and different challenges unlike those we have confronted in the past.
In seeking to protect ourselves and to defeat the forces that threaten us, we have been obliged to ask, "What other methods, what other products of modern society are potentially available to these culprits? What else could be used to disrupt and intimidate the civilized world?"
Bioterrorism, the use of biologic agents, is certainly one of those methods. Shortly after 9/11, anthrax was sent through the mails to several offices of the federal government. Although the attack was limited in scope, its effects were widespread. Seventeen people were infected and five died [1]. Prolonged decontamination procedures required the closing of the affected postal facilities and government offices.
The person or persons responsible for these attacks have yet to be identified. Was it the same terrorist organization that was responsible for the attacks on the World Trade Center and the Pentagon? Or was it a disgruntled employee or former employee of the federal government? Or was it no more than the act of a lone "mad" scientist? Nobody knows. The search continues.
Physicians, radiologists included, were ill prepared for their encounters with anthrax infection, a rare disease with which we have had little recent experience. After some scurrying about, we came up with the information required to diagnose and treat the infection properly. We now know that anthrax has a relatively characteristic appearance on chest radiographs [2, 3]. It would be better to have such information ahead of time.
In this issue, Ketai et al. [2] offer a timely review of what are commonly considered to be potential agents of biologic terrorism and describe their radiologic manifestations. The article is a primer on bioterrorism for radiologists (or, for that matter, all physicians). Most biologic agents—such as anthrax, plague, tularemia, and Q fever—are likely to be delivered as aerosols and therefore would manifest as pneumonia.
That said, the problems encountered by radiologists and other physicians in recognizing the exact nature of these bioterrorism-linked infectious diseases pale in comparison with the far weightier implications of the societal and political changes that may be proposed and subsequently required to secure us from the threat of terrorism.
Certainly, those of us who travel by air have been inconvenienced by the added security measures, which seem no more than necessary. What does the future hold? Should additional attacks occur, would further restrictions be implemented? Must we give up the very freedoms that we are defending in order to assure our safety? If so, some very serious, basic concerns could and should arise. It is chilling to contemplate.
But for now, read up on the radiologic manifestations of bioterrorism by Ketai et al. [2] and file the article. Then, should you need it, you will have it. At the same time, let's hope for the best. Let's hope that the antiterrorism campaign goes so well that we won't find the need to refer to their informative paper.
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