October 20, 2001
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I bought Cipro even before the first anthrax case. Yes, I admit it. I wasn't eager to mention it here but I couldn't honestly write an article about anthrax without telling you that. I'll come back to this and link it up at the end.
Within a day or two after Robert Stevens, the American Media photo editor, came down with inhalation anthrax, there was the usual knee-jerk disclaimer, made by Tommy Thompson, the secretary of health and human services: the victim was an outdoorsman; he probably contracted the disease by drinking from a stream. This has to qualify as one of the most inane statements ever made by a public official, right up there with the famous "loose shoes" remark made by Earl Butz in the Nixon administration. A case of anthrax occuring just as the country was starting to worry intensely about biological warfare, was deserving of much more than the usual attention. Mr. Thompson, before opening his mouth, could very well have stopped to ask himself whether the potential existed that his assertion of fact could be proved false in an instant. If the answer was yes--which it was-- then why make it at all?
I think I know what was motivating him. There were two related concerns, fear for his own gravitas, and fear of a public panic.
Authority must always appear to be in charge, to understand what is happening and to know what to do. George Orwell wrote an essay on this topic, Shooting an Elephant, which I greatly admire. (I would like to be George Orwell when I grow up.) The piece is short, and you may want to go read it, then come back here. If the link no longer works, do a search; there seem to be numerous copies on the web.
Orwell served as a British police officer in Burma when it was part of the Empire, and one day he got word that a domesticated elephant had gotten loose and was tearing up a bazaar. The elephant was in a state of "must", meaning presumably that it was in heat, a condition likely to wear off soon. When he got to the scene, the elephant had already killed one man, a "Dravidian coolie" who got too close to it.
Orwell relates that at first he had no intention of shooting the animal. "It is a serious matter to shoot a working elephant..." If the attack of "must" was wearing off, the elephant would calm down and shortly its handler would arrive and place it back under control. But shortly after, he realized he would have to kill it despite the fact his judgment told him otherwise: he had two thousand people watching him eagerly and he was going to have to act to satisfy them, rather than to do what he knew to be right. "The people expected it of me and I had got to do it; I could feel their two thousand wills pressing me forward, irresistibly." He felt he was an "absurd puppet", a "hollow, posing dummy". "A sahib has got to act like a sahib; he has got to appear resolute, to know his own mind and do definite things." And so he fired ten shots or more into the elephant, which took an agonizing half hour to die. (By the way, not relevant to this essay, Orwell's account of the finale is beautifully written: "He neither stirred nor fell, but every line of his body had altered. He looked suddenly stricken, shrunken, immensely old...")
It is safe to assume that Mr. Thompson felt this same pressure upon him, which all public officials do. But then he had a second motivation: the goal of keeping the public calm. I suppose in the back of everyone's mind, at least since the nuclear 1950's and probably since the beginning of time, is a vision of terrified multitudes trampling one another in their haste to get to an exit: a terror, incidentally, which was not in evidence at the World Trade Center on September 11.
Of course, knowing that the Florida man had anthrax wasn't going to send us all running for the exits. Panic about anthrax would manifest itself in other ways: people hoarding Cipro and other antibiotics, and possibly taking them without any kind of medical diagnosis. Perhaps there was fear of a slippery slope; once people start hoarding Cipro who knows what would follow, possibly the hoarding of food, acquisition of weapons, survivalist behavior, people living off the grid, and then the general downfall of western civilization.
The same denial was evident when a second American Media employee was hospitalized: Ernesto Blanco, who worked in the mailroom. About him we were told that he had pneumonia, and that there was no reason to link his illness to anthrax. It took a long time, a week or so, before we heard that he too had the inhalation form of the disease, but was recovering.
The result of these denials, however, was to foster a belief that the authorities were grudging with the facts. One thing we needed to know, but which was not forthcoming, was that the tests for anthrax were not reliable. In the confusing days that followed, there were reports of anthrax letters sent to a Microsoft office in Nevada, a private individual in Kenya and a New York Times bureau in Argentina that were then retracted, and an account of anthrax spores found in Governor Pataki's office that also turned out to be wrong. The tests seemed to give false positives and negatives with equal abandon.
The official, Orwell said, "wears a mask, and his face grows to fit it." Governor Pataki's mask cracked when he announced, with seeming calm, that he was declining an anthrax test but taking Cipro. This was the exact opposite of what everyone else in authority was telling us that day, advice which sounded very logical but, as it proved, wrong.
Today, just a week later, thousands of postal workers are being treated with Cipro in the absence of any medical diagnosis, after two of them died quietly in Washington while medical authorities were scrambling to treat Congressmen and interns. The sequel suggests that Governor Pataki may have understood the unreliability of tests and the consequent advantages of taking strong antibiotics as a prophylactic, even though we the public had not been told.
One of the major problems I have with obedience to authority is that each of us is an individual to ourselves but merely part of a somewhat faceless mass to them. We are each concerned with the possibly dire consequences of our own actions, but the authorities are concerned only with the effects of the entire mass moving together like an ocean wave.
For this reason, we are speaking two different languages. If, the day before he started taking it, you asked Governor Pataki, "Should I take Cipro prophylactically?" he most likely would have answered "No, there's no need." But a complete and honest translation of that answer would have been, "No, that wouldn't be convenient. Though there is some chance you would save your own life, we are concerned about various consequences of mass use of prophylactic antibiotics, including the stirring up of panic, supply problems caused by private purchasing and hoarding, and the possibility that antibiotic resistant strains of disease will be encouraged."
Politicians deal in making life or death decisions about us; that is their job. Every time a government standard is created--for seatbelts, highway speed, or automobile emissions, for example--a balance is being struck between a certain number of human deaths, and other benefits. When the speed limit is raised, it is because we have decided to trade the death of more people in auto accidents for the convenience of being able to get where we want faster. This balance is struck even in decisions where it is not immediately obvious, for example, immigration. For years we have leaned in favor of a liberal immigration policy, despite the occasional murder of an American by an immigrant. When hijackers visiting on tourist, business and student visas kill five thousand of us, suddenly the calculus seems very different and we are thinking of closing our borders.
Another very prominent feature of the anthrax crisis was a multitude of contradictory governmental voices talking about it. Tom Ridge, the recent governor of Pennsylvania and newly appointed czar of Homeland Security (that word "homeland" makes me very nervous), was nowhere to be seen at first. When he stepped in the other voices--Mr. Thompson, David Satcher the Surgeon General, and various other federal, state and local officials-- continued chattering about anthrax. No-one seemed to be clearly in charge of managing the project of defending us against it. One very disturbing development: two different laboratories tested the New York and Washington letters, and they both reported results only to the FBI, instead of talking to one another. This delayed public announcement of several key facts, including whether the bacteria in both places came from the same source, and whether the DC anthrax was "weaponized", as was first reported, then denied, and then confirmed.
The perception of no-one clearly in charge mirrors something I learned at Ground Zero last week. I spent a day working on the loading dock at the Red Cross Respite Center Number 1. For long stretches of time, in between unloading bags of ice or coolers of food cooked for the rescue workers by Bouley's restaurant, we sat watching throngs of men and women pass us, with jackets or uniforms indicating they were NYPD, fire department, Mount Vernon or Boston police, Secret Service, FBI, EPA, OSHA, and from numerous other agencies. "There are more than 200 agencies represented here," said one of the men on the loading dock, who had been in Ground Zero for three weeks, "and there is no unified command and control system. They tried to put one in place, run by the mayor's office, but it didn't take. There have been incidents where a New York policeman tries to give instructions to one of the guys from out of town, who says, 'I don't take orders from you.' And of course no-one can tell the Secret Service or the FBI what to do."
The idea behind Tom Ridge's appointment was to pull all the civil defense strands together, but he doesn't appear to have been granted the authority to do his job. As I once wrote in a piece on leadership, "The worst nightmare in any human enterprise is to be responsible for something but to lack the authority to make it come out right."
The opposite state, that of authority without responsibility, also is a serious problem. When the members of the House of Representatives vanished for days after anthrax was found in the letter in Senator Daschle's office, it highlighted a major flaw in the current state of our government: the fact that our representatives are used to being completely unaccountable for their actions and therefore do not feel the need to establish any model of leadership or of courage for the people they help to govern. I believe that the same mentality that enables legislators to intervene ridiculously in matters of international relations, leak classified information, and use national crises to advance personal agendas, caused large numbers of them to run away, on September 11 and after the discovery of the Daschle letter.
This leads us back to the Cipro I bought. Even before the first anthrax case was diagnosed, the word on the street was that biological warfare was on the way. I had the opportunity to obtain a ten day supply of the drug for myself, my wife and my stepson and daughter-in-law, and I did so. None of us have taken any of it, but I feel more secure having it.
What am I anticipating, that I would want my own stockpile? The first thought I had was that such severe disruption would be possible that treatment might not be available, either because we couldn't get to it, or because the facilities were overwhelmed. On September 11, there was a harbinger of that: the U.S. government simply seemed to vanish from public sight for most of the day. The president was being rushed from place to place, and while numerous ex-governmental warhorses like Wesley Clark and Henry Kissinger appeared on CNN all day, no-one any higher up than an assistant White House counsel came on until much later that night. While the New York hospitals were working (they had few patients to treat, due to the extremely lethal nature of the attacks) we got a glimpse of the way in which our system could be overwhelmed, at least for a day or two.
And we now have proof that it can, though not in the way I anticipated. The deaths of two Washington postal workers, at a time when everyone was concentrating on anthrax and the symptoms were widely known, illustrates how easy it was for two water molecules in the wave to be disregarded. They simply did not fit into the paradigm that was being advanced publicly, and at least one of them was sent home from an emergency room with flu medication before he worsened, checked back in and died. If either man had self-medicated with Cipro, damn what the doctors say, he would be alive today. In a sense, they died not just of anthrax but of obedience to authority.
What we tend to forget, in normal times and especially in times like these, is that we are independent moral actors and that government is not a magical, all-powerful parent. It is, instead, the way responsible people organize themselves to get certain kinds of work done. The people we tap to do it for us--including Tom Ridge, Tommy Thompson, David Satcher, George Pataki and the rest--are generally as nervous and confused as the rest of us. They then have the additional burden of worrying about their own gravitas and the human wave. Someone thinking about his dignity and then about the mass predilections and movements of people is not particularly thinking about me. But it is my job to do that.
Twisted the wrong way, this sounds like a plea for selfishness. (Some of my libertarian friends would have no problem if it were.) I see it more as a call for realism and for an ethical framework based on personal responsibility. I can support the nation and our government while supporting myself. Taking the pronouncements of those in authority uncritically makes us all infants. They are the same people they were before September 11, and if we were skeptical then we have more reason to be so now, when they are facing much greater challenges. The collision of the two 767's with the two towers on September 11 was not a call to suspend judgment but to exercise more of it than ever.