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Anthrax Attacks Left a Lingering Mistrust

Victims say health officials acted poorly in 2001 crisis

THURSDAY, Feb. 24, 2005 (HealthDay News) -- The anthrax attacks of 2001, which terrified millions of Americans, left many of those most directly affected with a shattered faith in public health officials, new research contends.

In just-published focus-group interviews, U.S. Senate staff members and postal workers who were exposed to the lethal white powder contended that the government failed to make them feel secure.

"There is a lot of mistrust of public health agencies in these groups. That was a consistent message," said Dr. Janice Blanchard, an assistant professor of emergency medicine at George Washington University who conducted the interviews a year after the attacks.

But perceptions varied, according to Blanchard's findings, published in the March issue of the American Journal of Public Health.

Postal employees at risk, almost all black, felt they were neglected because of their race and income, with some harkening back to the notorious Tuskegee medical study of decades past.

A handful of U.S. Senate workers, mostly white, were unimpressed by what they termed inconsistent and confusing messages from the government.

The attacks, in the fall of 2001, involved the infectious agent Bacillus anthracis concealed in envelopes that were mailed to various political figures and media outlets around the country.

Twenty-two people were stricken with the disease. Eleven contracted inhalation anthrax, the most lethal form; five of them died. The rest developed cutaneous anthrax, the form of the disease that mainly affects the skin.

When the attacks occurred, Senate workers were initially considered at high risk since anthrax-infected letters were sent to Capitol Hill. Postal workers at the Brentwood mail processing plant, which sorted the letters, were not considered to be in danger, at least initially, and weren't treated until nearly a week after Senate workers.

But four employees at Brentwood became ill with inhalation anthrax; two of them died.

To determine lingering impressions of the response to the attacks, researchers held two-hour focus group sessions with 36 postal employees from the Brentwood station and seven employees from the U.S. Senate in late 2002 and early 2003. Almost all of the postal employees were black; five of the Senate employees were white.

"We asked a series of open-ended questions," said Blanchard, who helped treat anthrax patients during the attacks. "We wanted to know where they got information, what they thought of that information. We also asked them about suggestions for future improvement."

Of all the comments made by the postal workers about people who delivered information about the attacks, 34 percent touched on issues of mistrust, and 16 percent dealt with perceived bias against their race and income level, the researchers report.

"They thought they'd been treated differently due to race," Blanchard said. "Many thought they were being experimented on and (mentioned) the Tuskegee study." The infamous Alabama study involved federal researchers who tracked the long-term effects of syphilis by withholding treatment from infected black men, many of whom died.

The Senate workers, by contrast, were mainly concerned about lack of organization by health officials.

Dr. Ivan Walks, who was the Washington D.C. chief health officer during the attacks, said he was not surprised by the findings, although he contend that health officials made the best decisions at the time with the information they had.

"This research really illustrates how important perception is," said Walks, who now works as a consultant.

In any emergency, he added, perception is "all that really matters when it's time for (citizens) to engage in behavior that will make them safe."

According to Walks, federal health officials are working to make messages more consistent during emergencies. As for the study's recommendations, he agreed with the suggestion that "natural leaders" be appointed in various workplaces to act as liaisons with health officials. He also seconded the study's advice that officials be open about their uncertainties during crises.

On that front, Walks said he follows some advice from his mother: "When you tell people honestly what you don't know, they'll believe you when you come back and tell them what you do know. Those are words to live by."

More information

To learn more about anthrax, try the U.S. Centers for Disease Control and Prevention.

SOURCES: Janice Blanchard, M.D., M.P.H., assistant professor, emergency medicine, George Washington University, Washington, D.C.; and Ivan Walks, M.D., chief executive officer, Ivan Walks & Associates, and former chief health officer, Washington D.C.; March 2005 American Journal of Public Health
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