You Can’t Cure Fear of Terrorism With Antibiotics

In just weeks, the anthrax scare has caused many physicians to reexamine the basic principles of how we practice medicine. In the past, I have tried to be a provider of information, a translator of the medical language of illness into English. I have tried to guide my patients but not decide for them. I have never pressured someone to take a pill of my choosing. Neither have I ever written a prescription because I was pressured to do so.

Recently, however, I have been compelled to adjust my methods. Like many physicians, I have experienced an onslaught of phone calls and unscheduled visits to my office by patients fearful that they may have been exposed to anthrax. There is a heightened awareness of every cough and skin sore. Many don’t want my opinion; they just want antibiotics.

I try to reassure them. Unless they work for the media, the government or the Postal Service, their risk of exposure is infinitesimally low.

I also tell them that they are reacting normally to the sudden feeling of being vulnerable. Anthrax is scary because it can kill. Patients can take on the symptoms of an illness they do not have because they experience a fear of death when they think about it. At the same time, their mail and the air they breathe remain safe.

The antibiotic that people want to stockpile has side effects. It can cause diarrhea, rash and insomnia. It is not safe for children. If I allow people to have it, they are more likely to take it unnecessarily when there is no indication for it. If I prescribe it, I am giving patients permission to decide when it is right to take it. If there are side effects, I will be responsible.

High-profile anthrax incidents have caused waves of hysteria. The antidote for fear is knowledge, but this takes time to work. Meanwhile, people may sublimate their fears by checking their mail carefully, washing themselves well and calling their physician with their concerns.

Patients must remember, however, that a physician is a guide, not a pill dispenser.

I have spent years studying illness, predicting its outcomes and living with its risks. As a practicing physician, I try to impart what I’ve learned to my patients.

As a country, we can no longer feel invulnerable. Our wounds are raw. This makes us more susceptible to every pathogen used as an instrument to terrorize us.

The main risk is still psychological. To calm the panic, sometimes it is necessary to administer tests to prove to a patient that he doesn’t have the disease. I am against unnecessary antibiotics, but I am for increased surveillance. Our laboratories must gear up to handle more nasal swabs and antibody tests for anthrax. For years I have been checking HIV antibodies on patients with almost no risk just so their dating lives could be more comfortable.

Right now the mere presence of a new--actually it is quite old--deadly disease is enough to cause multitudes to need reassurance that they are free of exposure.

For the handful of patients I cannot reassure, who continue to believe that they have anthrax or insist on medication for anthrax, there is only one thing I can do. I am compelled to admit that there is one condition that can mushroom beyond any physician’s ability to intervene--a condition fueled by speculation, resistant to all treatment including antibiotics.

This condition, this tool of terrorists, is fear itself.