Might sound alarmist, until you realize that the author is Stewart Baker, a former General Counsel of the National Security Agency, the Assistant Secretary for Policy at the United States Department of Homeland Security from 2005 to 2009 (where thinking about possible attacks, including biological attacks, was a big part of his job), and on security policy more of a big-government conservative than a let-everyone-do-his-own-thing libertarian.
Baker definitely knows facts on this topic that we don’t, so I’d take his advice quite seriously — the details of his argument and his suggestion are at his blog, here, and there’s a follow-up on the bigger picture here. (The news hook prompting his post was this Executive Order issued a few days ago.)
Kevin says:
Isn’t it illegal to get antibiotics without a prescription?
Do you just tell your physician you are stockpiling in case of an anthrax attack and ask him to write you a prescription or three?
Or does Heller mean that the FDA can’t interfere with your right to antibiotics for self defense?
Quote
January 3, 2010, 5:41 pmMark N. says:
Although this is good advice for smart, responsible people, I can’t help but think that a paternalistic attitude is sadly probably not without foundation, either. If we let everyone in the U.S. get some antibiotics to home-stockpile in case of Anthrax attack, would they really leave them there, using them only in case of actual Anthrax attacks? Or would a significant percentage of people pop their Cipro next time they had some minor ailment and felt they needed antibiotics? Worse, they would probably not want to use up their whole stockpile, so would only pop a single pill or two, the absolute worst type of dosage for building antibiotic resistance.
If a stockpile plan like that led to even 1% of households in the U.S. taking unnecessary antibiotics for minor ailments, it would quickly decrease antibiotic effectiveness, itself directly contributing to future deaths.
Quote
January 3, 2010, 5:41 pmfrankcross says:
Intuitively, this seems pretty irrational. Using historic evidence, the historic risk is essentially zero, no? No evidence has been presented that future risk should be materially different from historic risk. So it seems like a waste of money, which could be spent on other things with greater lifesaving capability. Plus the inevitable risk of some harm coming from the antibiotics themselves. In addition to resistance issues, there’s some evidence linking antibiotics to direct harm.
Quote
January 3, 2010, 6:22 pmDavid Newton says:
This advice is wrong. The qualifications of the person in question are impressive but he is not taking notice of human nature. The general population should not be able to stockpile something like antibiotics because, as others have said, there are many, many people who will misuse them and produce epidemics of deadly antibiotic-resistance bacteria. The risk of that happening is far, far, far greater than an anthrax attack. It would also likely get far, far, far more people killed since the antibiotic-resistance bacteria would then be endemic to the environment.
It is already the case that tens of thousands of people worldwide are killed each year by MRSA and similar bugs. It is not the case that tens of thousands of people worldwide are killed each year by anthrax sent through the post. This policy would certainly see the tens of thousands of people escalating into hundreds of thousands and possibly millions. An anthrax attack has already happened, albeit in a relatively minor way: it hardly killed tens of thousands of people despite some large mail distribution centres being hit with the spores.
Quote
January 3, 2010, 6:43 pmMonty says:
While the risk may be low, the potential harm is enourmous. An attack at a major sporting event could expose 75,000 people. A coordinated attack on a major city? Hundreds of thousands on the low end. If untreated, your looking at a 92% potential mortality rate. Terrorists have shown an interest in weaponized antrax. I couldn’t tell you what the risk of attack is, how hard it would be to carry out, or the odds of sucsess, but I can see that there is reason to be prepared even though there has never been a major attack in the past.
What if some acountability measure was implemented to ensure that no one misused the drugs? Offer sealed packages of the anti-biotic, and require that the receiver agrees to return the package unopened at the end of drugs shelf life. Then have them acknowledge that if they open the package, absent an anthrax attack, they will be fined some amount of money, enough they they really wont open it. Make it strict liability, your responsible for the package, regardless.
Quote
January 3, 2010, 6:55 pmKen Arromdee says:
This raises slippery slope issues. It may be possible to go from antibiotics with accountability to antibiotics without accountability, even though directly allowing antibiotics without accountability would never pass.
I can just imagine the news headlines about how some poor person opened their antibiotics and couldn’t afford to pay the fine, and besides they didn’t hurt anyone, so why not waive the fine instead of make their children go hungry.
Quote
January 3, 2010, 7:28 pmSW says:
What’s the shelf life? The cost? Isn’t the only way to get it, illegal? Black market? (“Cipro?” whispered by shady guys outside the Port Authority terminal to rush hour passengers)
Quote
January 3, 2010, 7:41 pmGreg Conen says:
Cipro is probably “safer” to stockpile than most antibiotics, due to nasty side-effects making self-medication less desirable. Of course, it has a higher risk of a dumb-ass killing or permanently injuring himself (and maybe even his family) by taking it.
Still, I’m skeptical this is a serious risk, at least as described. Inhalation Anthrax, though scary, is something of pain to deliver, since the spores have to be inhaled, and it doesn’t spread person-to-person. If terrorists have a mechanism for aerosolizing and distributing spores to hit thousands of people, there’s a fair chance they could simply use a toxin like Sarin (remember Aum Shinrikyo?) instead.
And what if it’s a different contagion. Drug resistant TB spreads person-to-person. Heck, an TB outbreak could happen accidentally. Should you stock every antibiotic that you might need?
Quote
January 3, 2010, 8:42 pmptt says:
Uh... if this man’s “credentials” are that he was, for several years, within an administration that had six years to guide America’s response to the anthrax threat and he has just now decided to go the individual stockpile route, prompted, it appears, by an executive order about the role of the Postal Service in a national crisis, it’s not clear to me that his advice is particularly relevant.
That doesn’t necessarily mean it’s a bad idea, just oddly timed if it is good advice.
Quote
January 3, 2010, 9:02 pmmack says:
The ironic thing about the worry about resistant infections and uncontrolled use of antibiotics is that the last I knew from personal experience and from family experience is that such antibiotics are available over the counter in many other countries around the world — including mexico and brazil — also I guess if you are hard up in this country one could get many of the common antibiotics over the counter in pet and fish stores — albeit not meant for human consumption — though I have met individuals who have used them — wouldn’t personally recommend it. Do have a doctor aquaintance, who unsolicited five or six years ago, offered to write scrips for antibiotics for myself and my family for an emergency supply. He thought it was prudent — didn’t avail myself of the opportunity at the time as didn’t want to lay out the money and then have to replace them down the road anyway. Hey, if things get that bad — just knock over a pharmacy — like bonnie and clyde. ;)
Quote
January 3, 2010, 10:07 pmfishbane says:
PTT has it right. Baker has a bad combination of Beltway Blinders, a “if you knew what I know, you’d be scared” paternalist-authoritarian streak, and a visceral disdain for civil rights that leads him to be disturbingly dismissive of any concern regarding limits on government power in the name of security.
Now he seems to be allowing a partisan dislike to lead him to making irresponsible suggestions for irrational reasons.
Don’t take my word for it — he’s been very vocal on the net for a long time.
Quote
January 3, 2010, 11:03 pmDavid Nieporent says:
Yes; that’s one way to fan the flames of hysteria: make worst-case scenario estimates as though they were realistic. Why on earth would it be “untreated”?
Also, anthrax does not have a mortality rate nearly that high, and given that it’s not directly communicable, how on earth are you getting “hundreds of thousands” of people infected?
Quote
January 4, 2010, 1:52 amNinjaMedic says:
This is absolutely wrong info, there is more than enough antibiotics available at the state and national level including through the Strategic National Stockpile. Anthrax is not communicable on any large scale and disseminating it beyond one structure or event would be difficult. Very poor advice.
Quote
January 4, 2010, 2:02 amDavid Schwartz says:
Unless he has some information that suggests that terrorists are going to get orders of magnitude more sophisticated and for some odd reason are going to use Anthrax for the first of their new-style attacks (a very poor choice), it’s very bad advice. There has *never* in history been a terrorist attack requiring real technological sophistication. The average terrorist blows *himself* up just to kill a dozen people if he’s lucky.
Quote
January 4, 2010, 3:05 amAdvice: Citizens Should Stockpile Their Own Antibiotics in Case of Anthrax Attack | Drugs Reviews | Dugs News says:
[...] policy more of a big-government conservative than a let-everyone-do-his-own-thing libertarian. Read more about Advice: Citizens Should Stockpile Their Own Antibiotics in Case of Anthrax [...]
Prof. S. says:
I’ll get on this right after stockpiling tamiflu for the Swine and Avian flus, getting some antibiotics for SARS, throw away all of my beef in fear of mad cow disease, making sure my computer is Y2k compliant, and selling all my possessions before the 2012 end of the Mayan calendar.
Quote
January 4, 2010, 9:57 amDavid Newton says:
That doctor acquaintance should be disciplined for unprofessional behaviour. It is precisely that sort of attitude which leads to antibiotic resistance and big problems. It is also precisely overuse of antibiotics in agriculture and in other countries where they are available over the counter and in the United States where family doctors succumb to whinging, whiny patients by writing out unnecessary prescriptions which is the major source of problems with resistance. Resistance is bound to happen since bacteria do evolve. However antibiotic overuse has lead to resistance occurring much faster than it otherwise would have done.
This is a public health matter and as is so often the case with public health, the needs of the many outweigh the needs of the few, or the one. The needs of the many dictate that antibiotics should not be stockpiled in this way as it will lead to resistant bacteria proliferation. The needs of the one dictate that antibiotics should be stockpiled in this way because it would likely allow survival of an anthrax attack. The resistant bacteria problem will occur and indeed has occurred: this would make it even worse. The anthrax attack is extremely unlikely to occur, and even if it did occur the likely deaths would be in the hundreds at most due to the difficulty of using weaponised anthrax and its lack of human-to-human transmissability.
One scenario would certainly occur and would certainly lead to tens of thousands of deaths. One scenario might occur and would possibly lead to hundreds of deaths. The former is from stockpiling antibiotics in the fashion suggested and the latter from an anthrax attack. Which course of action is it more prudent to take? Definitely the latter.
Quote
January 4, 2010, 11:17 amPintler says:
Our GP gave us a prescription for some super antibiotic and strong painkillers, because we explained we hike in remote areas where medical help may be some days away. I’m not sure there is as much potential for abuse as people think: if you have talked your doctor into such a deal, and you use them for the sniffles, you no longer have them for an emergency.
I concur that casual use of antibiotics is a very bad thing.
This article suggests that more restrained use of them could save upwards of 19000 deaths a year.
I also concur that being the victim of an anthrax attack is a negligible risk.
:-)
Quote
January 4, 2010, 12:14 pmlgm says:
More excellent advice from one of those heckovajobbers.
Quote
January 4, 2010, 12:18 pmzuch says:
We laid in a stock of Cipro while in the Dominican Republic (where you just go to the pharmacy and ask for it; and where you also just go to the clinics and they treat you for free ... although we felt compelled to make a donation). But this was because Cipro is a reasonably good antibiotic for the bugs you might encounter in tropical waters.... It doesn’t hurt to have some prophylactics on hand if you’re not sure of easily available medical facilities ... but you should know what you’re doing and not overuse it.
Cheers,
Quote
January 4, 2010, 12:38 pmNickM says:
IMO people are markedly underestimating the death potential from a single anthrax attack. If you want to kill large numbers of people, you don’t mail it to an office, you try to get it into the ventilation system at a very crowded public event (major concert or sporting event, Black Friday at the Mall of America, national political convention, etc.). This also has the added advantage from the terrorists’ perspective, even if you kill only circa 1% of the attendees, of essentially shutting down many large public gatherings due to people’s fear of being at the site of the next such attack.
Nick
Quote
January 4, 2010, 1:16 pmBrooks Lyman says:
Prof. S,
I read somewhere that Tamiflu doesn’t work very well. Back to the drawing board.
Quote
January 4, 2010, 9:21 pmceteris paribus says:
Well, so did Dick Cheney. There’s a question of judgment and intent that’s also extremely relevant in evaluating such remarks. Now I don’t follow Baker’s blog, and this comment is not an insinuation against Mr. Baker, just a remark about your suggestion.
Quote
January 5, 2010, 11:36 pm