A biological terrorist attack probably would first be detected by doctors or other health-care workers. The speed of a response would then depend on their rapid recognition and communication that certain illnesses appeared out of the ordinary. For this reason, preparing for biological terrorism has more in common with confronting the threat of emerging infectious diseases than with preparing for chemical or nuclear attacks. Defense against bioterrorism, like protection against emerging diseases, must therefore rely on improved national and international public-health surveillance. Too often, thinking about bioterrorism has mimicked thinking about chemical terrorism, a confusion that leads to an emphasis on the wrong approaches in preparing to meet the threat.

The Twenty-fifth Amendment to the Constitution evolved as a response to the need to relieve a sick and disabled president fromthe responsibilities of office, in the best interests of both the sick president and the nation. The congressional hearings that preceded and accompanied its enactment made clear that some members of Congress understood the need for objective medical information to be available to the vice president andCabinet before they couldmake the political determination of disability.Nevertheless, not a single physician was called to testify or advise in the Senate or the House despite the fact that they represent the only societal repository of expertise on physical and mental impairment. Nor was any mechanism defined whereby a dispassionate medical appraisal of the cognitive competence of the president could be obtained if it were in question. Instead, there was an implicit reliance on the physician to the president, whose conflict of interest is so strong that he or she has been used in the past more to conceal than to reveal the true state of the president’s health. The Twenty-fifth Amendment remains a vital mechanism for ensuring the stability of the presidency. But its disability provisions (sections 3 and 4) have not been implemented as the framers intended. Sooner or later, the nation will be confronted with a president who has Alzheimer’s disease, brain trauma, or illness such that his cognitive faculties are not up to the demands of office. A powerful antidote to the White House cover-ups of the past would be a medical advisory committee on the health of the president, created by congressional action. The committee would review the president’s health annually and report to the nation on its significant findings; it also would be convened urgently to assess his health status whenever it was in serious question. It would then advise the vice president and Cabinet of the degree of presidential impairment to provide a scientific medical foundation for the political decision as to the presence or absence of disability. The independence, breadth of expertise, lack of conflict of interest, availability, and credibility of the committee would assure the public of an objective appraisal and would preclude inaction by the executive branch in the face of disability. The arguments against such an advisory committee—that physicians would decide rather than advise; that they might disagree; that they might harass the president or violate confidentiality; and that the committee is unnecessary,would function poorly,
could not assemble quickly, and would infringe on the separation of powers doctrine —have been carefully analyzed and been found wanting. Because the advantages of establishing a medical advisory committee are compelling, it should be the subject of congressional action before, rather than after, the next medical cover-up in the White
House and the accompanying public crisis of confidence.

Background: In the 1980s, many medical organizations identified the prevention of nuclear war as one of the medical profession's most important goals. An assessment of the current danger is warranted given the radically changed context of the post–Cold War era.

Methods: We reviewed the recent literature on the status of nuclear arsenals and the risk of nuclear war. We then estimated the likely medical effects of a scenario identified by leading experts as posing a serious danger: an accidental launch of nuclear weapons. We assessed possible measures to reduce the risk of such an event.

Results: U.S. and Russian nuclear-weapons systems remain on high alert. This fact, combined with the aging of Russian technical systems, has recently increased the risk of an accidental nuclear attack. As a conservative estimate, an accidental intermediate-sized launch of weapons from a single Russian submarine would result in the deaths of 6,838,000 persons from firestorms in eight U.S. cities. Millions of other people would probably be exposed to potentially lethal radiation from fallout. An agreement to remove all nuclear missiles from high-level alert status and eliminate the capability of a rapid launch would put an end to this threat.

Conclusions: The risk of an accidental nuclear attack has increased in recent years, threatening a public health disaster of unprecedented scale. Physicians and medical organizations should work actively to help build support for the policy changes that would prevent such a disaster.

By the end of 1995, China had built the world's ten largest telecommunications networks and the industry was growing at a faster rate than any other sector of the booming Chinese economy. For example, the country's 40 million telephone subscribers with 50 million telephone numbers represented an average annual growth rate of nearly 100 percent over a ten-year period. Internet users served by ChinaNet jumped from 6,000 in 1995 to 53,739 in March 1997. Progress was qualitative as well, as China procured state-of-the-art fiber-optic and satellite technologies and narrowed the gap between itself and the United States and between its own urban and rural areas. The achievement can be attributed to the government's commitment to telecommunications as the key to further development--a commitment backed by preferential policies; to foreign financial and technical support; and to changing attitudes of the Chinese people themselves.

However, China faces some major problems. The gap in living standards between coastal and interior provinces is widening, as people migrate from poor villages to increasingly affluent cities. The government must focus more on developing isolated regions. Rapid development of telecommunications cannot be sustained under a government monopoly, which aids the government's economic and security interests but discourages foreign companies from investing and transferring technology. At the same time, there has been little headway in developing domestic telecommunications products. Management of the industry is chaotic in the absence of clear regulations, and a multilayered bureaucracy encourages wasted resources, duplication, red tape, and corruption. Political problems are likely to emerge as telecommunications continues to help open Chinese society and young Chinese come to embrace Western industrial culture.

Nevertheless, China is destined to become and remain the world's "super market" as long as it remains politically stable in its transition from a plannned to a market economy. Telecommunications will continue to play a key role during this transition.

Disabling illness has been widely observed among national leaders. This is hardly unexpected because many of them govern at an age when there is a high incidence of debilitating disease. Age became an important issue during the presidential campaign of 1996 because Senator Dole was the oldest candidate ever nominated for a first term. Polls demonstrated a substantial level of concern in the electorate, particularly among older Americans.

The heightened risk of disability or death from heart disease, stroke, and cancer at age 70 and over was one important consideration. It raised doubts as to whether a 73-year-old president would be able to fulfill his implicit contract to serve 208 weeks in office. A second related element was the profound change in cognitive capacities known to be associated with those diseases, even when the symptoms and physical impairment are stable or have improved. Finally, quite separate from the cognitive impairment of illness, age itself carries with it on average a decline in mental acuity, efficient information processing, memory, problem solving, and other requisites of effective decision making. Many older voters reacted to Dole as they did because of their awareness that their own memory, concentration, and energy levels had diminished over the years, sometimes drastically.

In spite of the national concern about job discrimination of any kind, including that based on age, it seems clear that mandatory retirement for chief executive officers at the age of 65 will continue to be an important tenet of our great corporations. Similarly, the most demanding job in the world--the U.S. presidency--need not be imposed on senior citizens. Congress should craft a resolution expressing its conviction that 65 should be the upper age limit for candidates running for a first term as president of the United States.

The renewed American debate over ballistic missile defenses (BMD) echoes loudly in NATO, in Europe, and in France. This issue will be decisive for the future of European political organization and its security and defense. The issue will also be important for the future of relations between Europe, the United States, and Russia.

Faced with the potential threat of ballistic missiles equipped with nuclear warheads (or biological and chemical payloads) that could strike French and European territories, deterrence is sufficient and offers the greatest cost-effectiveness. In this analysis, the question of the broadening of the French and British deterrent and the political organization of a possible European anti-missile defense system will be discussed. Then, a new transatlantic strategic partnership, the robustness of which lies in counterbalancing the vulnerabilities of its members, will be described.