David Relman on Bioterrorism
The threat of bioterrorism has prompted the government to invest billions of dollars to defend against such an attack as well as impose new restrictions on how research should be conducted. In the Jan. 12 issue of the New England Journal of Medicine, David Relman, MD, associate professor of microbiology and immunology, has an opinion piece evaluating the threat and the nation's response. The interview below is adapted from that article. Relman is a member of the U.S. Health and Human Services Department's National Science Advisory Board for Biosecurity.
Question: How have advances in bioscience changed the risk of biological threats?
Relman: So far, nature has been the most effective bioterrorist. In the future, however, the ability of experimenters to create genetic or molecular diversity not found in the natural world and to select for virulence-associated traits may result in new biologic agents with previously unknown potency.
Q. But don't policy-makers have decades of experience in preparing for germ warfare?
Relman: Policy-makers weighing the likelihood and dangers of bioterrorism tend to seek guidance from a past era of large, state-sponsored bioweapons programs, but we cannot assume that the logic behind biowarfare programs of the past will either guide or predict future misuses of the life sciences. Indeed, the lessons of this history can be dangerously misleading. Large-scale industrial processes are not necessary for the development of potent biologic weapons.
Q. So in a nutshell, what is different about bioterrorism when compared with the past?
Relman: Today, anyone with a high-school education can use widely available protocols and prepackaged kits to modify the sequence of a gene or replace genes within a micro-organism. One can also purchase small, disposable, self-contained bioreactors for propagating viruses and micro-organisms. Such advances continue to lower the barriers to biologic-weapons development.
Q. Is there an upside to all of these advances?
Relman: Tomorrow's science and technology will present a new landscape with features that are both worrisome and reassuring: the methods and reagents used for reverse-engineering a virus with novel, potentially harmful properties, for instance, can also be used to engineer a vaccine against it. It is reasonable to expect that the "forces of good" can keep up with the relatively few that intend harm.
Q. What specifically do we need to do to prepare for bioterrorism?
Relman: First of all, the idea that we might restrict the flow of information in the life sciences must be rejected as counterproductive, not to mention impractical.
We must sensitize the science and technology communities to the "dual-use" potential of the life sciences. Thoughtful discussions about codes of conduct in the life sciences must take place at multiple levels. The general public and some policy-makers are clearly concerned about the cavalier attitude of some in the science and technology sector who dismiss this problem outright; such attitudes will come back to bite us.
In devising a robust biodefense strategy, a key challenge will be to define the optimal balance between fixed and flexible defenses. The creation of fixed, or static, defenses against specific agents can be justified for clear, imminent and potentially catastrophic biologic threats-including avian influenza and prominent drug-resistant bacteria, such as Staphylococcus aureus, as well as anthrax and smallpox.
For the vast array of other potential threats, however, we should invest even more in flexible, dynamic defenses, which will rely on integrative science, new insights into biologic systems and advancing technology. We need methods and technologies that can generate effective diagnostics, therapeutics and prophylactics against any new or variant infectious agent within days or weeks after its characterization.
Given the pace of change in the life sciences, we cannot afford to be constrained by the past, nor can we afford to make incremental, short-term fixes. Recent investments in biodefense offer immense potential benefit, if guided by a creative, future-oriented perspective.
Stanford Medicine integrates research, medical education and health care at its three institutions - Stanford University School of Medicine, Stanford Health Care (formerly Stanford Hospital & Clinics), and Lucile Packard Children's Hospital Stanford. For more information, please visit the Office of Communication & Public Affairs site at http://mednews.stanford.edu.