Health and Medicine

FSI’s researchers assess health and medicine through the lenses of economics, nutrition and politics. They’re studying and influencing public health policies of local and national governments and the roles that corporations and nongovernmental organizations play in providing health care around the world. Scholars look at how governance affects citizens’ health, how children’s health care access affects the aging process and how to improve children’s health in Guatemala and rural China. They want to know what it will take for people to cook more safely and breathe more easily in developing countries.

FSI professors investigate how lifestyles affect health. What good does gardening do for older Americans? What are the benefits of eating organic food or growing genetically modified rice in China? They study cost-effectiveness by examining programs like those aimed at preventing the spread of tuberculosis in Russian prisons. Policies that impact obesity and undernutrition are examined; as are the public health implications of limiting salt in processed foods and the role of smoking among men who work in Chinese factories. FSI health research looks at sweeping domestic policies like the Affordable Care Act and the role of foreign aid in affecting the price of HIV drugs in Africa.

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A new united nations report recommending the most sweeping reform in the institution's history offers a global vision of collective security for the 21st century that is as committed to development in poor nations as it is to prevention of nuclear terrorism in rich ones.

A new united nations report recommending the most sweeping reform in the institution's history offers a global vision of collective security for the 21st century that is as committed to development in poor nations as it is to prevention of nuclear terrorism in rich ones.

The point is, according to the report's research director, Stephen Stedman, a threat to one is a threat to all in today's world. "Globalization means that a major terrorist attack anywhere in the industrial world would have devastating consequences for the well-being of millions around the developing world," the document states. The report's value lies in putting forward a comparative framework of collective security that addresses all the compelling threats of the day, Stedman explained. "The recommendations really are the most important possible makeover of the institution in 60 years," he said. "I think something is going to come out of it." Stedman, a senior fellow at the Center for International Security and Cooperation (CISAC) at the Stanford Institute for International Studies (SIIS), was recruited a year ago by U.N. Secretary General Kofi Annan to direct research for the High-Level Panel on Threats, Challenges, and Change. Stedman is an expert on civil wars, mediation, conflict prevention, and peacekeeping.

Annan created the 16-member blue-ribbon panel, made up mostly of former government leaders and ministers, in the wake of widespread heated criticism of the United Nations following the U.S.-led war in Iraq. In Annan's annual report to the General Assembly in 2003, he said, "Rarely have such dire forecasts been made about the U.N. ... We have reached a fork in the road ... a moment no less decisive than 1945 itself, when the U.N. was founded." The panel was charged with analyzing global security threats and proposing far-reaching reforms to the international system.

On December 2 the panel, chaired by former Thai prime minister Anand Panyarachun, issued its 95-page report: "A More Secure World: Our Shared Responsibility." The document identifies six major threats to global security:

-War between states;

-Violence within states, including civil wars, large-scale human rights abuses, and genocide;

-Poverty, infectious disease, and environmental degradation;

-Nuclear, radiological, chemical, and biological weapons;

-Terrorism; and

-Transnational organized crime.

Although states do not face these threats equally, a collective security system must take all member states' threats seriously and deal with them equitably, the report noted. It specifically mentioned the world's appallingly slow response to AIDS.

The report makes 101 recommendations for collective prevention and response to the threats, including ways to reform the United Nations. Annan described these in a December 3 editorial in the International Herald Tribune as "the most comprehensive and coherent set of proposals for forging a common response to common threats that I have seen."

The document also reaffirms the right of states to defend themselves-even preemptively-when an attack is imminent, and it offers guidelines to help the Security Council decide when to authorize the use of force. Stedman said other significant proposals involve improving biosecurity, strengthening nuclear nonproliferation, and defining terrorism. Panel members agreed that any politically motivated violence against civilians should be regarded as terrorism and condemned.

The panel was very critical of the Human Rights Commission, a body that has often harmed the United Nations' reputation by permitting the membership of some of the worst human-rights violators, including Cuba, Libya, and Sudan. The report also discussed the need for new institutions, such as a peace-building commission, that would support countries emerging from conflict.

Scott Sagan, co-director of CISAC, described the report as hard-hitting, although he said he would have tried to extend the withdrawal clause of the nonproliferation treaty from three months to a year. "I think it's the beginning of some major changes that will be helpful," he said. "We need to get states to work together to reform the U.N. rather than sniping at it."

CISAC was closely involved in the panel's work and was named in a cover letter accompanying the report from Panyarachun to Annan. Co-director Chris Chyba served on the panel's 30-member resource group, providing expertise on nuclear nonproliferation and bioterrorism. Bruce Jones, a former CISAC Hamburg Fellow, acted as Stedman's deputy, and Tarun Chhabra, a graduate of CISAC's undergraduate honors program and recent Marshall Scholarship recipient, worked as a research officer. Political science Professors David Laitin and James Fearon, and SIIS Senior Fellow David Victor, provided, respectively, expertise on terrorism, civil wars, and the environment, Stedman said. "There is an immense amount of Stanford influence in the report," he added.

CISAC also hosted a nuclear nonproliferation workshop for the panel on campus last March and helped organize a meeting during the summer in Bangkok. SIIS co-hosted a conference on governance and sovereignty on campus in April and a meeting at Oxford University in June. CISAC provided workspace to give the research team a quiet place to focus on writing the report's first draft in August.

The report has attracted intense international media interest in part because it calls for expanding the U.N. Security Council, its top decision-making group, from 15 to 24 members. The panel was unable to agree on one proposal and offers two options that would make the council more representative and democratic. "I believe either formula would strengthen the legitimacy in the eyes of the world, by bringing its membership closer to the realities of the 21st century-as opposed to those of 1945, when the U.N. Charter was drafted," Annan wrote in the International Herald Tribune.

According to Stedman, the media has highlighted the Security Council's proposed expansion because so many nations have a stake in it. "But in the absence of a new consensus on international peace and security, expansion of the council will not be effective," he explained.

In March, Annan will use the report to inform a series of proposals he will present to the 191 U.N. member states. These, in turn, will be submitted to a summit of world leaders before the General Assembly convenes next September in New York. Stedman said he has been asked to stay on for another year as a special advisor to the secretary general to keep the United Nations "on message" during negotiations.

Engagement by the United States, which has openly questioned the institution's relevance, will be critical to implementing the report's recommendations, said Stedman, who added that the superpower can benefit from a revamped United Nations. "Putting threats to the United States into a global framework makes it more secure," he said.

Stedman noted that one of the most disturbing aspects of the panel's consultations was listening to government representatives from civil-society organizations dismiss the seriousness of bio- and nuclear terror threats against the United States. "They were essentially denying this as a real threat to American security," he said. "I said it's as real a threat to the U.S. as other threats are to you."

When Stedman accepted the job, he thought he would spend 80 percent of his time on research and writing and 20 percent on consultations and negotiating. In fact, he said, it was the other way around. "It's unlike anything I've ever done," he said. "It's been a blast." In contrast to academia, where a researcher presents his or her best findings and defends them, Stedman was faced with 16 people who would push back, reject, or accept his work. "I had to work to change language to include their concerns," he said. "My biggest concern at the beginning was that the report would be based on the lowest common denominator. It's not."

Stedman said the panel members remained open-minded throughout the year. "They showed flexibility, listened to arguments, and changed their minds," he said. "Our job was to be as persuasive, rigorous, and comprehensive in our analysis as we were able to achieve."

In the end, Stedman said, the report belongs to the panel. "Parts of what the exercise shows is that access to those making policy is really important," he said. "If you do really good work and you have access, you have a chance of being heard. Kofi Annan gave me that opportunity."

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We developed a mathematical model of a cows-to-consumers supply chain associated with a single milk-processing facility that is the victim of a deliberate release of botulinum toxin. Because centralized storage and processing lead to substantial dilution of the toxin, a minimum amount of toxin is required for the release to do damage. Irreducible uncertainties regarding the dose-response curve prevent us from quantifying the minimum effective release. However, if terrorists can obtain enough toxin, and this may well be possible, then rapid distribution and consumption result in several hundred thousand poisoned individuals if detection from early symptomatics is not timely. Timely and specific in-process testing has the potential to eliminate the threat of this scenario at a cost of less than 1 cent per gallon and should be pursued aggressively. Investigation of improving the toxin inactivation rate of heat pasteurization without sacrificing taste or nutrition is warranted.

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Proceedings of the National Academy of Sciences
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Lawrence M. Wein
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In 1920, the Irish Republican Army reportedly considered a terrifying new weapon: typhoid-contaminated milk. Reading from an IRA memo he claimed had been captured in a recent raid, Sir Hamar Greenwood described to Parliament the ease with which "fresh and virulent cultures" could be obtained and introduced into milk served to British soldiers. Although the plot would only target the military, the memo expressed concern that the disease might spread to the general population.

Although the IRA never used this weapon, the incident illustrates that poisoning a nation's milk supply with biological agents hardly ranks as a new concept. Yet just two weeks ago, the National Academy of Sciences' journal suspended publication of an article analyzing the vulnerability of the U.S. milk supply to botulinum toxin, because the Department of Health and Human Services warned that information in the article provided a "road map for terrorists."

That approach may sound reasonable, but the effort to suppress scientific information reflects a dangerously outdated attitude. Today, information relating to microbiology is widely and instantly available, from the Internet to high school textbooks to doctoral theses. Our best defense against those who would use it as a weapon is to ensure that our own scientists have better information. That means encouraging publication.

The article in question, written by Stanford University professor Lawrence Wein and graduate student Yifan Liu, describes a theoretical terrorist who obtains a few grams of botulinum toxin on the black market and pours it into an unlocked milk tank. Transferred to giant dairy silos, the toxin contaminates a much larger supply. Because even a millionth of a gram may be enough to kill an adult, hundreds of thousands of people die. (Wein summarized the article in an op-ed he wrote for the New York Times.) The scenario is frightening, and it is meant to be -- the authors want the dairy industry and its federal regulators to take defensive action.

The national academy's suspension of the article reflects an increasing concern that publication of sensitive data can provide terrorists with a how-to manual, but it also brings to the fore an increasing anxiety in the scientific community that curbing the dissemination of research may impair our ability to counter biological threats. This dilemma reached national prominence in fall 2001, when 9/11 and the anthrax mailings drew attention to another controversial article. This one came from a team of Australian scientists.

Approximately every four years, Australia suffers a mouse infestation. In 1998, scientists in Canberra began examining the feasibility of using a highly contagious disease, mousepox, to alter the rodents' ability to reproduce. Their experiments yielded surprising results. Researchers working with mice naturally resistant to the disease found that combining a gene from the rodent's immune system (interleukin-4) with the pox virus and inserting the pathogen into the animals killed them -- all of them. Plus 60 percent of the mice not naturally resistant who had been vaccinated against mousepox.

In February 2001 the American SocietyforMicrobiologists' (ASM) Journal of Virology reported the findings. Alarm ensued. The mousepox virus is closely related to smallpox -- one of the most dangerous pathogens known to humans. And the rudimentary nature of the experiment demonstrated how even basic, inexpensive microbiology can yield devastating results.

When the anthrax attacks burst into the news seven months later, the mousepox case became a lightning rod for deep-seated fears about biological weapons. The Economist reported rumors about the White House pressuring American microbiology journals to restrict publication of similar pieces. Samuel Kaplan, chair of the ASM publications board, convened a meeting of the editors in chief of the ASM's nine primary journals and two review journals. Hoping to head off government censorship, the organization -- while affirming its earlier decision -- ordered its peer reviewers to take national security and the society's code of ethics into account.

Not only publications came under pressure, but research itself. In spring 2002 the newly formed Department of Homeland Security developed an information-security policy to prevent certain foreign nationals from gaining access to a range of experimental data. New federal regulations required that particular universities and laboratories submit to unannounced inspections, register their supplies and obtain security clearances. Legislation required that all genetic engineering experiments be cleared by the government.

On the mousepox front, however, important developments were transpiring. Because the Australian research had entered the public domain, scientists around the world began working on the problem. In November 2003, St. Louis University announced an effective medical defense against a pathogen similar to -- but even more deadly than -- the one created in Australia. This result would undoubtedly not have been achieved, or at least not as quickly, without the attention drawn by the ASM article.

The dissemination of nuclear technology presents an obvious comparison. The 1946 Atomic Energy Act classifies nuclear information "from birth." Strong arguments can be made in favor of such restrictions: The science involved in the construction of the bomb was complex and its application primarily limited to weapons. A short-term monopoly was possible. Secrecy bought the United States time to establish an international nonproliferation regime. And little public good would have been achieved by making the information widely available.

Biological information and the issues surrounding it are different. It is not possible to establish even a limited monopoly over microbiology. The field is too fundamental to the improvement of global public health, and too central to the development of important industries such as pharmaceuticals and plastics, to be isolated. Moreover, the list of diseases that pose a threat ranges from high-end bugs, like smallpox, to common viruses, such as influenza. Where does one draw the line for national security?

Experience suggests that the government errs on the side of caution. In 1951, the Invention Secrecy Act gave the government the authority to suppress any design it deemed detrimental to national defense. Certain areas of research-- atomic energy and cryptography -- consistently fell within its purview. But the state also placed secrecy orders on aspects of cold fusion, space technology, radar missile systems, citizens band radio voice scramblers, optical engineering and vacuum technology. Such caution, in the microbiology realm, may yield devastating results. It is not in the national interest to stunt research into biological threats.

In fact, the more likely menace comes from naturally occurring diseases. In 1918 a natural outbreak of the flu infected one-fifth of the world's population and 25 percent of the United States'. Within two years it killed more than 650,000 Americans, resulting in a 10-year drop in average lifespan. Despite constant research into emerging strains, the American Lung Association estimates that the flu and related complications kill 36,000 Americans each year. Another 5,000 die annually from food-borne pathogens -- an extraordinarily large number of which have no known cure. The science involved in responding to these diseases is incremental, meaning that small steps taken by individual laboratories around the world need to be shared for larger progress to be made.

The idea that scientific freedom strengthens national security is not new. In the early 1980s, a joint Panel on Scientific Communication and National Security concluded security by secrecywasuntenable. Its report called instead for security by accomplishment -- ensuring strength through advancing research. Ironically, one of the three major institutions participating was the National Academy of Sciences -- the body that suspended publication of the milk article earlier this month.

The government has a vested interest in creating a public conversation about ways in which our society is vulnerable to attack. Citizens are entitled to know when their milk, their water, their bridges, their hospitals lack security precautions. If discussion of these issues is censored, the state and private industry come under less pressure to alter behavior; indeed, powerful private interests may actively lobby against having to install expensive protections. And failure to act may be deadly.

Terrorists will obtain knowledge. Our best option is to blunt their efforts to exploit it. That means developing, producing and stockpiling effective vaccines. It means funding research into biosensors -- devices that detect the presence of toxic substances in the environment -- and creating more effective reporting requirements for early identification of disease outbreaks. And it means strengthening our public health system.

For better or worse, the cat is out of the bag -- something brought home to me last weekend when I visited the Tech Museum of Innovation in San Jose. One hands-on exhibit allowed children to transfer genetic material from one species to another. I watched a 4-year-old girl take a red test tube whose contents included a gene that makes certain jellyfish glow green. Using a pipette, she transferred the material to a blue test tube containing bacteria. She cooled the solution, then heated it, allowing the gene to enter the bacteria. Following instructions on a touch-screen computer, she transferred the contents to a petri dish, wrote her name on the bottom, and placed the dish in an incubator. The next day, she could log on to a Web site to view her experiment, and see her bacteria glowing a genetically modified green.

In other words, the pre-kindergartener (with a great deal of help from the museum) had conducted an experiment that echoed the Australian mousepox study. Obviously, this is not something the child could do in her basement. But just as obviously, the state of public knowledge is long past anyone's ability to censor it.

Allowing potentially harmful information to enter the public domain flies in the face of our traditional way of thinking about national security threats. But we have entered a new world. Keeping scientists from sharing information damages our ability to respond to terrorism and to natural disease, which is more likely and just as devastating. Our best hope to head off both threats may well be to stay one step ahead.

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In 1920, the Irish Republican Army reportedly considered a terrifying new weapon: typhoid-contaminated milk. Reading from an IRA memo he claimed had been captured in a recent raid, Sir Hamar Greenwood described to Parliament the ease with which "fresh and virulent cultures" could be obtained and introduced into milk served to British soldiers. Although the plot would only target the military, the memo expressed concern that the disease might spread to the general population.

Although the IRA never used this weapon, the incident illustrates that poisoning a nation's milk supply with biological agents hardly ranks as a new concept. Yet just two weeks ago, the National Academy of Sciences' journal suspended publication of an article analyzing the vulnerability of the U.S. milk supply to botulinum toxin, because the Department of Health and Human Services warned that information in the article provided a "road map for terrorists."

That approach may sound reasonable, but the effort to suppress scientific information reflects a dangerously outdated attitude. Today, information relating to microbiology is widely and instantly available, from the Internet to high school textbooks to doctoral theses. Our best defense against those who would use it as a weapon is to ensure that our own scientists have better information. That means encouraging publication.

The article in question, written by Stanford University professor Lawrence Wein and graduate student Yifan Liu, describes a theoretical terrorist who obtains a few grams of botulinum toxin on the black market and pours it into an unlocked milk tank. Transferred to giant dairy silos, the toxin contaminates a much larger supply. Because even a millionth of a gram may be enough to kill an adult, hundreds of thousands of people die. (Wein summarized the article in an op-ed he wrote for the New York Times.) The scenario is frightening, and it is meant to be -- the authors want the dairy industry and its federal regulators to take defensive action.

The national academy's suspension of the article reflects an increasing concern that publication of sensitive data can provide terrorists with a how-to manual, but it also brings to the fore an increasing anxiety in the scientific community that curbing the dissemination of research may impair our ability to counter biological threats. This dilemma reached national prominence in fall 2001, when 9/11 and the anthrax mailings drew attention to another controversial article. This one came from a team of Australian scientists.

Approximately every four years, Australia suffers a mouse infestation. In 1998, scientists in Canberra began examining the feasibility of using a highly contagious disease, mousepox, to alter the rodents' ability to reproduce. Their experiments yielded surprising results. Researchers working with mice naturally resistant to the disease found that combining a gene from the rodent's immune system (interleukin-4) with the pox virus and inserting the pathogen into the animals killed them -- all of them. Plus 60 percent of the mice not naturally resistant who had been vaccinated against mousepox.

In February 2001 the American SocietyforMicrobiologists' (ASM) Journal of Virology reported the findings. Alarm ensued. The mousepox virus is closely related to smallpox -- one of the most dangerous pathogens known to humans. And the rudimentary nature of the experiment demonstrated how even basic, inexpensive microbiology can yield devastating results.

When the anthrax attacks burst into the news seven months later, the mousepox case became a lightning rod for deep-seated fears about biological weapons. The Economist reported rumors about the White House pressuring American microbiology journals to restrict publication of similar pieces. Samuel Kaplan, chair of the ASM publications board, convened a meeting of the editors in chief of the ASM's nine primary journals and two review journals. Hoping to head off government censorship, the organization -- while affirming its earlier decision -- ordered its peer reviewers to take national security and the society's code of ethics into account.

Not only publications came under pressure, but research itself. In spring 2002 the newly formed Department of Homeland Security developed an information-security policy to prevent certain foreign nationals from gaining access to a range of experimental data. New federal regulations required that particular universities and laboratories submit to unannounced inspections, register their supplies and obtain security clearances. Legislation required that all genetic engineering experiments be cleared by the government.

On the mousepox front, however, important developments were transpiring. Because the Australian research had entered the public domain, scientists around the world began working on the problem. In November 2003, St. Louis University announced an effective medical defense against a pathogen similar to -- but even more deadly than -- the one created in Australia. This result would undoubtedly not have been achieved, or at least not as quickly, without the attention drawn by the ASM article.

The dissemination of nuclear technology presents an obvious comparison. The 1946 Atomic Energy Act classifies nuclear information "from birth." Strong arguments can be made in favor of such restrictions: The science involved in the construction of the bomb was complex and its application primarily limited to weapons. A short-term monopoly was possible. Secrecy bought the United States time to establish an international nonproliferation regime. And little public good would have been achieved by making the information widely available.

Biological information and the issues surrounding it are different. It is not possible to establish even a limited monopoly over microbiology. The field is too fundamental to the improvement of global public health, and too central to the development of important industries such as pharmaceuticals and plastics, to be isolated. Moreover, the list of diseases that pose a threat ranges from high-end bugs, like smallpox, to common viruses, such as influenza. Where does one draw the line for national security?

Experience suggests that the government errs on the side of caution. In 1951, the Invention Secrecy Act gave the government the authority to suppress any design it deemed detrimental to national defense. Certain areas of research-- atomic energy and cryptography -- consistently fell within its purview. But the state also placed secrecy orders on aspects of cold fusion, space technology, radar missile systems, citizens band radio voice scramblers, optical engineering and vacuum technology. Such caution, in the microbiology realm, may yield devastating results. It is not in the national interest to stunt research into biological threats.

In fact, the more likely menace comes from naturally occurring diseases. In 1918 a natural outbreak of the flu infected one-fifth of the world's population and 25 percent of the United States'. Within two years it killed more than 650,000 Americans, resulting in a 10-year drop in average lifespan. Despite constant research into emerging strains, the American Lung Association estimates that the flu and related complications kill 36,000 Americans each year. Another 5,000 die annually from food-borne pathogens -- an extraordinarily large number of which have no known cure. The science involved in responding to these diseases is incremental, meaning that small steps taken by individual laboratories around the world need to be shared for larger progress to be made.

The idea that scientific freedom strengthens national security is not new. In the early 1980s, a joint Panel on Scientific Communication and National Security concluded security by secrecywasuntenable. Its report called instead for security by accomplishment -- ensuring strength through advancing research. Ironically, one of the three major institutions participating was the National Academy of Sciences -- the body that suspended publication of the milk article earlier this month.

The government has a vested interest in creating a public conversation about ways in which our society is vulnerable to attack. Citizens are entitled to know when their milk, their water, their bridges, their hospitals lack security precautions. If discussion of these issues is censored, the state and private industry come under less pressure to alter behavior; indeed, powerful private interests may actively lobby against having to install expensive protections. And failure to act may be deadly.

Terrorists will obtain knowledge. Our best option is to blunt their efforts to exploit it. That means developing, producing and stockpiling effective vaccines. It means funding research into biosensors -- devices that detect the presence of toxic substances in the environment -- and creating more effective reporting requirements for early identification of disease outbreaks. And it means strengthening our public health system.

For better or worse, the cat is out of the bag -- something brought home to me last weekend when I visited the Tech Museum of Innovation in San Jose. One hands-on exhibit allowed children to transfer genetic material from one species to another. I watched a 4-year-old girl take a red test tube whose contents included a gene that makes certain jellyfish glow green. Using a pipette, she transferred the material to a blue test tube containing bacteria. She cooled the solution, then heated it, allowing the gene to enter the bacteria. Following instructions on a touch-screen computer, she transferred the contents to a petri dish, wrote her name on the bottom, and placed the dish in an incubator. The next day, she could log on to a Web site to view her experiment, and see her bacteria glowing a genetically modified green.

In other words, the pre-kindergartener (with a great deal of help from the museum) had conducted an experiment that echoed the Australian mousepox study. Obviously, this is not something the child could do in her basement. But just as obviously, the state of public knowledge is long past anyone's ability to censor it.

Allowing potentially harmful information to enter the public domain flies in the face of our traditional way of thinking about national security threats. But we have entered a new world. Keeping scientists from sharing information damages our ability to respond to terrorism and to natural disease, which is more likely and just as devastating. Our best hope to head off both threats may well be to stay one step ahead.

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Washington Post
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Authors
Lawrence M. Wein
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Milk processing is just as susceptible to terrorism as chemical production, yet the nation's milk supplies are far more vulnerable because many security measures are voluntary, CISAC faculty member Lawrence M. Wein points out in this New York Times op-ed. Using research he conducted with Yifan Liu, an incoming CISAC fellow next year, Wein makes the case for stricter controls of the milk supply "from cow to consumer."

While the anthrax scare at Washington Post offices this year proved to be a false alarm, it was a reminder of how vulnerable Americans are to biological terrorism. In general, two threats are viewed as the most dangerous: anthrax, which is as durable as it is deadly, and smallpox, which is transmitted very easily and kills 30 percent of its victims.

But there is a third possibility that, while it seems far more mundane, could be just as deadly: terrorists spreading a toxin that causes botulism throughout the nation's milk supply.

Why milk? In addition to its symbolic value as a target--a glass of milk is an icon of purity and healthfulness--Americans drink more than 6 billion gallons of it a year. And because it is stored in large quantities at centralized processing plants and then shipped across country for rapid consumption, it is a uniquely valuable medium for a bioterrorist.

For the last year, a graduate student, Yifan Liu, and I have been studying how such an attack might play out, and here is the situation we consider most likely: a terrorist, using a 28-page manual called "Preparation of Botulism Toxin" that has been published on several jihadist Web sites and buying toxin from an overseas black-market laboratory, fills a one-gallon jug with a sludgy substance containing a few grams of botulin. He then sneaks onto a dairy farm and pours its contents into an unlocked milk tank, or he dumps it into the tank on a milk truck while the driver is eating breakfast at a truck stop.

This tainted milk is eventually piped into a raw-milk silo at a dairy-processing factory, where it is thoroughly mixed with other milk. Because milk continually flows in and out of silos, approximately 100,000 gallons of contaminated milk go through the silo before it is emptied and cleaned (the factories are required to do this only every 72 hours). While the majority of the toxin is rendered harmless by heat pasteurization, some will survive. These 100,000 gallons of milk are put in cartons and trucked to distributors and retailers, and they eventually wind up in refrigerators across the country, where they are consumed by hundreds of thousands of unsuspecting people.

It might seem hard to believe that just a few grams of toxin, much of it inactivated by pasteurization, could harm so many people. But that, in the eye of the terrorists, is the beauty of botulism: just one one-millionth of a gram may be enough to poison and eventually kill an adult. It is likely that more than half the people who drink the contaminated milk would succumb.

The other worrisome factor is that it takes a while for botulism to take effect: usually there are no symptoms for 48 hours. So, based on studies of consumption, even if such an attack were promptly detected and the government warned us to stop drinking milk within 24 hours of the first reports of poisonings, it is likely that a third of the tainted milk would have been consumed. Worse, children would be hit hardest: they drink significantly more milk on average than adults, less of the toxin would be needed to poison them and they drink milk sooner after its release from dairy processors because it is shipped directly to schools.

And what will happen to the victims? First they will experience gastrointestinal pain, which is followed by neurological symptoms. They will have difficulty seeing, speaking and walking as paralysis sets in. Most of those who reach a hospital and get antitoxins and ventilators to aid breathing would recover, albeit after months of intensive and expensive treatment. But our hospitals simply don't have enough antitoxins and ventilators to deal with such a widespread attack, and it seems likely that up to half of those poisoned would die.

As scary as this possibility is, we have actually been conservative in some of our assumptions. The concentration of toxin in the terrorists' initial gallon is based on 1980's technology and it's possible they could mix up a more potent brew; there are silos up to four times as large as the one we based our model on, and some feed into several different processing lines that would contaminate more milk; and the assumption that the nationwide alarm could go out within 24 hours of the first reported symptoms is very optimistic (two major salmonella outbreaks in the dairy industry, in 1985 and 1994, went undetected for weeks and sickened 200,000 people).

What can we do to avoid such a horror? First, we must invest in prevention. The Food and Drug Administration has some guidelines - tanks and trucks holding milk are supposed to have locks, two people are supposed to be present when milk is transferred - but they are voluntary. Let's face it: in the hands of a terrorist, a dairy is just as dangerous as a chemical factory or nuclear plant, and voluntary guidelines are not commensurate with the severity of the threat. We need strict laws - or at least more stringent rules similar to those set by the International Organization for Standardization in Geneva and used in many countries - to ensure that our milk supply is vigilantly guarded, from cow to consumer.

Second, the dairy industry should improve pasteurization so that it is far more potent at eliminating toxins. Finally, and most important, tanks should be tested for toxins as milk trucks line up to unload into the silo. The trucks have to stop to be tested for antibiotic residue at this point anyway, and there is a test that can detect all four types of toxin associated with human botulism that takes less than 15 minutes. Yes, to perform the test four times, once for each toxin, on each truck would cost several cents per gallon. But in the end it comes down to a simple question: isn't the elimination of this terrifying threat worth a 1 percent increase in the cost of a carton of milk?

One other concern: although milk may be the obvious target, it is by no means the only food product capable of generating tens of thousands of deaths. The government needs to persuade other food-processing industries - soft drinks, fruit juices, vegetable juices, processed-tomato products - to study the potential impact of a deliberate botulin release in their supply chains and take steps to prevent and mitigate such an event.

Americans are blessed with perhaps the most efficient food distribution network in history, but we must ensure that the system that makes it so easy to cook a good dinner doesn't also make it easy for terrorists to kill us in our homes.

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Cellular prion protein (PrPC) is present in the healthy adult brain. It is a presumably essential membrane protein but its cellular function is unclear. Like Ice-9 - the fictitious water allotrope in Kurt Vonnegut's Cat's Cradle, which "taught the atoms a novel way in which to stack, lock and crystallize until the oceans turned to ice" - cellular prion protein can, in a rare event, adopt a pathogenic and 'contagious' shape, PrPSc, which causes mad cow disease or Bovine Spongiform Encephalopathy (BSE). New variant Creutzfeldt Jakob Disease (vCJD) is the human malady attributed to eating beef tainted with BSE. In comparison to the UK epidemic (at the peak of which 37,280 cases of BSE were reported in the single year 1992), the emergence of four North American mad cows since May 2003 is minor yet still alarming. This work examines the USDA's response to indigenous BSE as manifested in "The Final Rule" (9 CFR 93-96, Jan 4, 2005) and questions whether current regulations are stringent enough to keep PrPSc out of cattle feed and human food.

Sheila Healy is a CISAC Science Fellow. She is currently analyzing USDA policy addressing Bovine Spongiform Encephalopathy (BSE) or mad cow disease. She recently finished a postdoctoral appointment in Stanley Prusiner's laboratory in the Department of Neurology at the University of California, San Francisco. There she studied the molecular and structural requirements for the conversion of cellular prion protein to its pathogenic form, the agent that causes BSE. She holds a doctoral degree in biochemistry and molecular and cellular biology from the University of Arizona.

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This article originally appeared in Stanford Report.

By Dawn Levy

Responding to a terrorist attack employing biological or chemical agents requires knowledge spanning many disciplines. Three Stanford researchers were among nearly 135 leading scientists and technical experts from industry, academia and government invited to participate in the Gordon Research Conference on Chemical and Biological Terrorism Jan. 30-Feb. 4 in Buellton, Calif. The conference brought together public and private sectors to discuss what has worked, where problems are now and may appear in the future, and what needs more attention in responding to and preventing terrorism. The goal was to move toward a better "systems approach" to defense.

The Stanford participants were Margaret E. Kosal, a science fellow at the Center for International Security and Cooperation (CISAC) with a doctorate in chemistry; Steven M. Block, a professor of applied physics and of biological sciences and senior fellow, by courtesy, at the Stanford Institute for International Studies; and Mark A. Musen, a professor of medicine (medical informatics) and, by courtesy, of computer science.

The conference included discussions of public health surveillance and response, food supply vulnerabilities and agricultural security, forensics of biological and chemical evidence, and the changing nature of the threat environment.

Both biological and chemical terrorist attacks have the potential to cause a large number of causalities and overwhelm medical capabilities, or "surge capacity." The nation's terrorism defense plans focus on mass-effect bioterrorism--events with the potential to infect tens of thousands and kill more than a thousand. But those plans may not effectively counter small-scale biological or chemical attacks, much less nuclear or radiological attacks, Kosal asserted.

Musen spoke about the computational problems of automating surveillance for possible bioterrorism using "prediagnostic" indicators that become available even before health-care workers can identify a specific epidemic.

"There is enormous enthusiasm--and enormous spending--for combining databases of over-the-counter drug sales, absenteeism records, 911 calls and admitting diagnoses to emergency rooms and clinics," he said. "There has been virtually no empirical evaluation of any of these efforts, despite all the excitement."

Musen discussed difficulties computers have making sense of high-volume, low-signal data streams, including basic problems with the way that the data typically are represented, difficulties of integrating disparate data sources and uncertainty in how to present the results of computational analyses to public-health officials in an optimal way.

"Although there is enormous political pressure to be 'doing something' to monitor for bioterrorism, it's also important to take a step back and to engage in the research needed to determine what we really should be doing," Musen said.

Chemical threats are underestimated

The focus on bioterror threats may miss a more frequent occurrence--chemical attacks. In a presentation titled "The Shifting Face of Chemical Terrorism: Assessing an Emerging Threat," Kosal examined the growing trend of non-state actors to use improvised chemical devices (ICDs) that may include choking and blistering agents.

"The path from the 'street chemistry' of improvised explosive devices [IEDs] to ICDs incorporating commercial chemicals is very short, whereas the path from IEDs to transgenic biological agents effectively weaponized is a substantial leap for states and even more so for terrorists," Kosal said. "While U.S. policy is focused on defending against a mass-effect bioterrorism attack, we may be missing a lower-tech threat of much higher probability."

Half of the U.S. fatalities in Iraq have been due to IEDs, typically roadside bombs, Kosal said. "This strongly suggests there is a substantial tacit knowledge base and readily available materials for constructing these types of weapons--one guy has not been making them all in a Mosul garage." While incorporating chemicals into roadside bombs would not dramatically increase military casualties, incorporating them in devices employed in enclosed spaces could, Kosal said.

An analysis of terrorism between 1910 and 2003 from open-source information shows the lion's share of 265 terrorist attacks--76 percent--were chemical. Only 17 percent were biological, 0 percent nuclear (involving fissile material, such as that powering an atomic bomb) and 7 percent radiological (involving radioactive elements that cannot be used for fission or that contain less than a critical mass of fissionable material, such as those employed in "dirty bombs").

It used to be that the major threat of chemical weapons came from state-based programs. Chlorine and mustard gases were used extensively in World War I, for example. The United States and the former Soviet Union amassed stockpiles exceeding 40,000 tons, which are still being destroyed. International efforts to control the exchange of certain chemicals, such as precursors for nerve and blister agents, have been effective. Kosal cited the refusal in the 1980s during the Iran-Iraq war of the world community to sell Iraq the key precursor to mustard gas.

Nowadays, terrorists both foreign and domestic may disperse traditional chemical warfare agents using improvised methods. In 1995, for example, the Aum Shinrikyo group crudely dispersed a nerve agent in a Tokyo subway--killing 12 and panicking thousands--using umbrellas to puncture 11 garbage bags, each filled with a common solvent and about a pound of sarin. Today's chemical weapons may just as likely come from common commercial sources, such as agrochemicals. Radical Islamists have even attempted to weaponize a research chemical, osmium tetroxide, used to prepare biological specimens for electron microscopy.

In contrast with nuclear or mass-effect biological weapons, chemical weapons may not require sophisticated knowledge to produce. In 2003 at a rented storage space in Tyler, Texas, government agents seized half a million rounds of ammunition, more than 60 pipe bombs, remote-controlled bombs disguised as briefcases, pamphlets on how to make chemical weapons and improvised hydrogen cyanide dispersal devices hypothetically capable of killing thousands in a minute. The stockpiler, William J. Krar, described as a white supremacist and anti-government extremist, was sentenced to 11 years in federal prison. His specific objectives remain unknown to authorities.

Kosal said terrorists do not appear to be concocting new chemicals; they're co-opting existing ones. "Chemical terrorism is likely to be a crime of opportunity and familiarity with chemicals and chemistry," Kosal said. "Perhaps the basic knowledge and materials--commercial dual-use chemicals in this instance--are too globally widespread to justify efforts to control the capability of terrorists to co-opt them for malfeasant uses. . . . The best threat-reduction policy may be to reduce the motivation.

"Much of the academic and policy dialogue segregates the folks discussing motivation from the folks discussing capacity and vulnerability. The former tend to be historians and social scientists and the latter, biologists, chemists and physicists. It may prove that decreasing terrorist motivation is unfeasible in the near term, but here is an example where those with the technical knowledge and those with the social science knowledge need to be working cooperatively, the type of interaction that the CISAC Science Fellows program fosters," Kosal said.

Ten thousand fingers on the bioterror "button"

Block's talk focused on the growing threat of bioterror. While chemicals have killed more people to date than have biological weapons, future biological attacks using infectious, untreatable pathogens have the potential to kill more people than chemicals. Block wryly called such biological attacks "the gift that keeps on giving."

Block said post-9/11 restrictions aimed at keeping pathogens out of the wrong hands have backfired. One is the Department of Health and Human Services' "Select Agent Rule," which establishes requirements regarding possession and use in the United States, receipt from outside the United States and transfer within the United States of a particular list of agents and toxins.

"We're shooting ourselves in the foot," Block said. "We've made it so hard to work on these pathogens that even our so-called 'A-Team' can't do research with them." World-renowned plague researcher Stanley Falkow of Stanford and famed anthrax expert John Collier of Harvard have stopped working on live pathogens because of restrictive effects of recent legislation, according to Block. They now confine their research to a handful of cloned genes. "It's almost impossible to hire grad students or postdocs to work on Select Agents. Such research has been driven underground or into our national labs, which historically have not had the biological expertise found in the top academic labs and biotech companies."

Much of our response to bioterror threats is based on how we've historically responded to nuclear terror threats, Block said. "With nuclear weapons, only two things can be made to go 'boom'--plutonium and highly enriched uranium," he said. That made it comparatively easy to track and control materials, and to get a handle on the problem. "We tried to keep nuclear secrets secret. Not everyone knows how to make an atomic bomb."

In contrast, the genie has long been out of the bottle when it comes to biological agents. Virtually all research is reported in the open literature. "Even if we were to stop publishing everything now, there'd be enough public information to keep bioterrorists busy for at least another 50 years," he said.

"Back in the nuclear age, only a few countries were nuclear powers, and only a few people were authorized to have their 'fingers on the button,'" Block said. "Like them or not, they were responsible people. Contrast that with a world where genetically engineered weapons can be produced by, say, 10,000 people. Someone is guaranteed to press that button. We can't stop [bioterror acts] at the source any more than we can stop a computer virus at the source."

Rather than futilely attempting to thwart biological threats at their sources, which are ubiquitous, Block advocated shoring up the public health system so it can respond nimbly once threat turns to reality. A new generation of antitoxin, antiviral and antibacterial agents may mitigate ill effects, and improved vaccines may prevent damage altogether. "We need to work the problem from the other direction," he said. "To confine our attention to Select Agents alone is essentially putting on blinders. The future threats we may face may bear little relation to the organisms on the current list."

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United Nations Secretary-General Kofi Annan created the High-Level Panel on Threats, Challenges, and Change in September 2003 with SIIS and CISAC senior fellow Stephen J. Stedman as its research director to identify the major global threats and generate new ideas about policies and institutions to enable the U.N. to be effective in the 21st century.

The panel issued a four-part report, A More Secure World: Our Shared Responsibility, in December 2004.

PART ONE: The panel identifies six types of threats of greatest global concern: war between states; violence within states; poverty, infectious disease, and environmental degradation; nuclear, chemical, biological, and radiological weapons; terrorism; and transnational crime. A collective security system must take all member states' threats seriously and deal with them equitably.

PART TWO: In prescribing policies to prevent threats from spreading or worsening, the report emphasizes development as the first line of defense. Combating poverty and infectious disease, the panel argues, will save millions of lives and strengthen states' capacity to deter terrorism, crime, and proliferation of nuclear and biological weapons. The report also urges the U.N. to improve its capacity for preventive diplomacy and mediation and to forge a counterterrorism strategy.

PART THREE: The report reiterates the U.N.'s recognition of states' right to self-defense, but also suggests that the Security Council should consider stepping in more often to exercise its preventive authority. Peacekeeping, peace enforcement, and peace building are vital to global security, and developed nations should do more to transform their armies into units suitable for peace operations. Post-conflict peace building should be a core function of the U.N.

PART FOUR: The report prescribes revitalization of the Security Council and the General Assembly, and creation of a new Peacebuilding Commission. On the Security Council, the report provides two options for achieving reforms: one would appoint new permanent members, and the other would establish new long-term, renewable seats. Neither option creates any new vetoes.

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The web of measures that comprise the nuclear non-proliferation regime continues to hold at bay the "nuclear-armed crowd" that was part of President John F. Kennedy's alarming vision in 1963. The number of nuclear weapons states in 2004 stands at only eight or nine, and assertive steps may yet keep this number from growing. The proliferation of biological weapons, however, is quite another matter. Biotechnological capacity is increasing and spreading rapidly. This trend seems unstoppable, since the economic, medical, and food-security benefits of genetic manipulation appear so great. As a consequence, thresholds for the artificial enhancement or creation of dangerous pathogens--disease-causing organisms--will steadily drop. Neither Cold War bilateral arms control nor multilateral non-proliferation provide good models for how we are to manage this new challenge. Much more than in the nuclear case, civilization will have to cope with, rather than shape, its biological future.

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As the war on terrorism continues, statistics on terrorist attacks are becoming as important as the unemployment rate or the GDP. Yet the terrorism reports produced by the U.S. government do not have nearly as much credibility as its economic statistics, because there are no safeguards to ensure that the data are as accurate as possible and free from political manipulation. Alan B. Kreuger and David Laitin outline a solution.

From the September/October 2004 issue of Foreign Affairs.

As the war on terrorism continues, statistics on terrorist attacks are becoming as important as the unemployment rate or the GDP. Yet the terrorism reports produced by the U.S. government do not have nearly as much credibility as its economic statistics, because there are no safeguards to ensure that the data are as accurate as possible and free from political manipulation. The flap over the error-ridden 2003 Patterns of Global Terrorism report, which Secretary of State Colin Powell called "a big mistake" and which had to be corrected and re-released, recently brought these issues to the fore. But they still have not been adequately addressed.

Now-common practices used to collect and disseminate vital economic statistics could offer the State Department valuable guidance. Not long ago, economic statistics were also subject to manipulation. In 1971, President Richard Nixon attempted to spin unemployment data released by the Bureau of Labor Statistics (BLS) and transferred officials who defied him. This meddling prompted the establishment of a series of safeguards for collecting and disseminating economic statistics. Since 1971, the Joint Economic Committee of Congress has held regular hearings at which the commissioner of the BLS discusses the unemployment report. More important, in the 1980s, the Office of Management and Budget issued a directive that permits a statistical agency's staff to "provide technical explanations of the data" in the first hour after principal economic indicators are released and forbids "employees of the Executive Branch" from commenting publicly on the data during that time.

The State Department should adopt similar protections in the preparation and dissemination of its reports. In addition to the global terrorism report, the State Department is required by Congress to report annually on international bribery, human rights practices, narcotics control, and religious freedom. Gathering and reporting data for congressional oversight is presently a low-level function at the State Department. The department rarely relies on high-quality, objective data or on modern diagnostic tests to distinguish meaningful trends from chance associations. Adopting safeguards against bias, both statistical and political, would enable Congress to better perform its constitutional role as the White House's overseer and allow the American public to assess the government's foreign policy achievements.

A PATTERN OF ERRORS

Congress requires that the State Department provide each year "a full and complete report" that includes "detailed assessments with respect to each foreign country ... in which acts of international terrorism occurred which were, in the opinion of the Secretary, of major significance." The global terrorism reports are intended to satisfy this requirement, but, over time, they have become glossy advertisements of Washington's achievements in combating terrorism, aimed as much at the public and the press as at congressional overseers.

The 2003 global terrorism report was launched at a celebratory news conference in April. Deputy Secretary of State Richard Armitage and Ambassador J. Cofer Black, the State Department coordinator for counterterrorism, outlined some remaining challenges, but principally they announced the Bush administration's success in turning the terrorist tide. Black called the report "good news," and Armitage introduced it by saying, "You will find in these pages clear evidence that we are prevailing in the fight." The document's first paragraph claimed that worldwide terrorism dropped by 45 percent between 2001 and 2003 and that the number of acts committed last year "represents the lowest annual total of international terrorist attacks since 1969." The report was transmitted to Congress with a cover letter that interpreted the data as "an indication of the great progress that has been made in fighting terrorism" after the horrific events of September 11.

But we immediately spotted errors in the report and evidence contradicting the administration's claims. For example, the chronology in Appendix A, which lists each significant terrorist incident occurring in the year, stopped on November 11-an unusual end to the calendar year. Clearly, this was a mistake, as four terrorist attacks occurred in Turkey between November 12 and the end of 2003. Yet it was impossible to tell whether the post- November 11 incidents were inadvertently dropped off the chronology and included in figures in the body of the report or completely overlooked.

More important, even with the incomplete data, the number of significant incidents listed in the chronology was very high. It tallied a total of 169 significant events for 2003 alone, the highest annual count in 20 years; the annual average over the previous five years was 131. How could the number of significant attacks be at a record high, when the State Department was claiming the lowest total number of attacks since 1969? The answer is that the implied number of "nonsignificant" attacks has declined sharply in recent years. But because nonsignificant events were not listed in the chronology, the drop could not be verified. And if, by definition, they were not significant, it is unclear why their decrease should merit attention.

On June 10, after a critical op-ed we wrote in The Washington Post, a follow-up letter to Powell from Representative Henry Waxman (D-Calif.), and a call for review from the Congressional Research Service, the State Department acknowledged errors in the report. "We did not check and verify the data sufficiently," spokesman Richard Boucher said. "... [T]he figures for the number of attacks and casualties will be up sharply from what was published."

At first, Waxman accused the administration of manipulating the data to "serve the Administration's political interests." Powell denied the allegation, insisting that "there's nothing political about it. It was a data collection and reporting error." Although there is no reason to doubt Powell's explanation, if the errors had gone in the opposite direction-making the rise in terrorism on President George W. Bush's watch look even greater than it has been-it is a safe bet that the administration would have caught them before releasing the report. And such asymmetric vetting is a form of political manipulation.

Critical deficiencies in the way the report was prepared and presented compromised its accuracy and credibility. Chief among these were the opaque procedures used to assemble the report, the inconsistent application of definitions, insufficient review, and the partisan release of the report. These deficiencies resulted in a misleading and unverifiable report that appeared to be tainted by political manipulation.

It is unclear exactly how the report was assembled. The report notes that the U.S. government's Incident Review Panel (IRP) is responsible for determining which terrorist events are significant. It says little, however, about the panel's members: how many there are, whether they are career employees or political appointees, or what affiliations they have. Nor does it describe how they decide whether an event is significant. Do they work by consensus or majority rule? What universe of events do they consider?

The State Department announced a decline in total terrorist attacks, which resulted from a decline in nonsignificant events. But without information about the nonsignificant events, readers were essentially asked to blindly trust the nameless experts who prepared it.

The report's broad definitions, moreover, are sometimes too blunt to help classification. Terrorism is defined as "premeditated, politically motivated violence perpetrated against noncombatant targets by subnational groups or clandestine agents, usually intended to influence an audience." The report specifies that an international terrorist attack is an act committed by substate actors from one nation against citizens or property of another. An incident "is judged significant if it results in loss of life or serious injury to persons, major property damage, and/or is an act or attempted act that could reasonably be expected to create the conditions noted."

But hardly any explanation was provided about how the IRP distinguishes significant from nonsignificant events. When is property damage too minor for an event to be significant? How are nonsignificant events identified? Is the IRP responsible for making these determinations too? Has the source and scope of their information changed over time? The corrected 2003 report, the first to list individual nonsignificant acts, defines as "major" property damage that exceeds $10,000. It does not indicate, however, whether that criterion applied to previous reports.

Admittedly, measuring international terrorism is no easy task. Even scholarly reckonings are not free from subjective judgment, and there are inevitably close calls to be made. The most one can hope for in many cases is consistent application of ambiguous definitions.

Unfortunately, in the global terrorism reports the rules have been applied inconsistently. Many cross-border attacks on civilians in Africa have not been included in the reports, for example, even though similar attacks in other regions have been. The report for 2002, moreover, counts as significant a suicide attack by Chechen shaheeds (Islamist martyrs) against a government building in Moscow that killed 72 people. Yet none of the numerous suicide attacks by the Chechen "black widows" that terrorized Russia and killed scores in 2003 was tallied as an international terrorist attack in the latest report. After one such attack, Russian President Vladimir Putin said, "Today, after a series of recent terrorist attacks, we can say that the bandits active in Chechnya are not just linked with international terrorism, they are an integral part of it." If the State Department considers such attacks domestic, rather than international, it should do so consistently from one year to the next.

Another problem is that the staff that prepared the 2003 global terrorism report did not participate in releasing it; in fact, they have yet to be identified. High-level Bush administration officials presented the report to the media, using it to support White House policies and take credit for the alleged decline in terrorism. Even after the report's flaws were recognized, they continued to spin the figures. When the corrected version was released, Black repeated that "we have made significant progress," despite being pressed to acknowledge that last year the number of significant attacks reached a 20-year high. Given the war on terrorism's central role in the upcoming presidential election, such presentation gives the appearance that the report is being manipulated for political gain.

The State Department has tried to explain the report's flaws using language eerily reminiscent of the Bush administration's justification of the failure to find weapons of mass destruction in Iraq. Spokesman Boucher told reporters that previous claims that the war on terrorism was succeeding had been based "on the facts as we had them at the time [and] the facts that we had were wrong." Even Powell partook in the spinning. On the one hand, he announced that "the [original] narrative is sound and we're not changing any of the narrative." On the other hand, he acknowledged, "We will change the narrative wherever the narrative relates to the data."

To his credit, Powell instructed those responsible for preparing the report to brief Waxman's staff on the procedures they had used and the origins of their mistakes. Based on a summary of the briefing by Waxman's staff, much has come to light. Authority for compiling the list of attacks was shifted from the CIA to the Terrorist Threat Integration Center (TTIC), an organization created in May 2003 to "merge and analyze all threat information in a single location." The TTIC provided information to the IRP, which, it was disclosed, consists of representatives from the CIA, the Defense Intelligence Agency, the National Security Agency, and the State Department's Bureau of Intelligence and Research. A TTIC representative chaired the meetings and could cast a vote to break ties on the classification of an event as significant or nonsignificant.

At least this year, chaos prevailed. The IRP's members changed from meeting to meeting-when they attended the meetings at all. The CIA employee responsible for the database left but was never replaced; in mid-process, an outside contractor who entered data was replaced by another contractor. Because of technical incompetence, the report relied on the wrong cutoff date.

Arithmetic errors were rampant. Larry Johnson, a retired CIA and State Department professional, discovered that the total number of fatalities in the chronology exceeded the number listed in the statistical review in Appendix G. According to Black, the errors resulted from "a combination of things: inattention, personnel shortages and database that is awkward and is antiquated and needs to have very proficient input be made in order for to be sure that the numbers will spill then to the different categories that are being captured [sic]." The debacle is more like an episode of the Keystone Kops than a chapter from Machiavelli, but even that analogy is not very comforting.

SETTING THE RECORD STRAIGHT

Despite the data's limitations, the chronology of significant events in the 2003 global terrorism report yields important information about terrorism's trends, its geographical characteristics, and its magnitude.

Time-series analysis, which seeks to discern trends in given phenomena over time, requires a consistent approach to collecting data. The State Department's terrorism report presents time-series analysis, but by focusing on the total number of attacks it misleadingly combines verifiable data on significant events with nonverifiable data on insignificant ones. And because, as TTIC director John Brennan admitted, "many nonsignificant events occur throughout the world that are not counted in the report," one must also be concerned about consistency in the measurement of the total number of terrorist events. Even if the nonsignificant events were listed (and thus could be verified), trends in significant events are more relevant because they track events that, by definition, are more important. Accurately measuring these trends is a prerequisite for understanding the factors that underlie them and the policies that shape them. In fact, an analysis of the revised report reveals that the number of significant attacks increased from 124 to 175, or by 41 percent, from 2001 to 2003-a significant fact indeed.

The detailed chronology also allows analysts to cumulate terrorist events for each country and cross-classify them according to the country where they occurred and the perpetrators' country of origin. These figures can then be related to the countries' characteristics, yielding information that can help policymakers devise strategies to address terrorism's root causes. Using the global terrorism reports for the years 1997-2002, the authors of this article have previously found that terrorists tend to come from nondemocratic countries, both rich and poor, and generally target nationals from rich, democratic countries.

The State Department has rightly emphasized that the threat of terrorism remains serious, but a close examination of its data helps put the magnitude of the threat in perspective. In 2003, a total of 625 people--including 35 Americans--were killed in international terrorist incidents worldwide. Meanwhile, 43,220 died in automobile accidents in the United States alone, and three million died from AIDS around the world. Comparative figures, particularly when combined with forecasts of future terrorism trends, can help focus debate on the real costs people are willing to bear--in foregone civil liberties and treasure--to reduce the risk posed by terrorism.

CHANGING TRACKS

The State Department currently uses, and Congress accepts, nineteenth-century methods to analyze a twenty-first-century problem. To prevent errors of the type that riddled the 2003 global terrorism report, Congress has two alternatives. It could reassign the State Department's reporting responsibilities to a neutral research agency, such as the GAO (the General Accounting Office, recently renamed the Government Accountability Office) which routinely uses appropriate statistical practices. The problem is that the GAO has little foreign policy expertise and does not necessarily have access to the (sometimes classified) information that goes into the reports. Alternatively, Congress could keep the reports within the State Department's purview but demand that its practices for data collection and analysis be improved and that the reports be insulated from partisan manipulation.

If responsibility remains within the State Department, Congress should establish a statistical bureau in the department to ensure that scientific standards are respected in all reports, thereby elevating the status of data-gathering and statistics there. The bureau would promote consistency, statistical rigor, and transparency. When appropriate, it could seek input from the scientific community. And, while respecting classified sources, it could also insist that sufficient information be released to independent analysts for verification.

To overcome conflicts of interest facing political appointees who issue government reports, the State Department should adopt rules similar to those that govern the production and dissemination of key economic indicators. Career staff who prepare the reports should be given an hour to brief the media on technical aspects of the data, during which time political appointees would be precluded from making public comments. (After the hour elapses, it is expected that political appointees would offer their interpretations.) Career staff should be protected so they can prepare mandated reports without interference from political appointees and then present them for review by the statistics bureau. Once the reports are finalized, but before they are publicly released, they should be circulated to designated political appointees who need to prepare for their release. Disclosure dates should be announced long in advance to prevent opportunistic timing by political appointees.

Last October, in a candid memorandum to top aides that was leaked to the press, Secretary of Defense Donald Rumsfeld admitted, "Today, we lack metrics to know if we are winning or losing the global war on terror. Are we capturing, killing, or deterring and dissuading more terrorists every day than the madrassas [Islamic schools] and the radical clerics are recruiting, training, and deploying against us?" The statement was a stinging acknowledgment that the government lacks both classified and unclassified data to make critical policy decisions. It is also a reminder that only accurate information, presented without political spin, can help the public and decision-makers know where the United States stands in the war on terrorism and how best to fight it.

Alan B. Krueger is Bendheim Professor of Economics and Public Policy at Princeton University. David D. Laitin is Watkins Professor of Political Science at Stanford University.
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