by Kelly Patricia O'Meara
INSIGHT magazine
November 2, 2001
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Weeks into the drama of anthrax attacks against the American homeland, the Bush administration trumpeted a victory when it announced a "deal" on the purchase of Cipro (ciprofloxacin), the government's drug of choice against the anthrax bioweapon. This extraordinary wheeling and dealing was done in the name of public health and safety and caused Health and Human Services (HHS) Secretary Tommy Thompson to pat himself on the back, explaining: "Everyone said I wouldn't be able to reduce the price of Cipro. I'm a tough negotiator." But no sooner had the "deal" been announced than several pharmaceutical companies offered alternative antibiotics at no cost, making the Bayer victory even more suspect.
One need only speak with physicians, microbiologists and pharmacists to understand that one of the parties to the "deal" got snookered. Not only are bioterrorism experts questioning the price — 95 cents per pill, marked down from $1.77, a reduction from Bayer's retail price of $4.67 per tablet, but still guaranteeing an estimated 65 cents profit. They also have raised the much bigger issue of choice of treatment.
While Cipro has been called the most popular "antianthrax" drug, the truth is that this patent medicine is by no means the only drug suitable for treatment of anthrax exposure, nor is it the safest or most affordable. When all is said and done, Cipro is the pill being pushed because its manufacturer obtained approval from the Food and Drug Administration (FDA) for its use on postexposure anthrax, a highly unlikely infection under normal circumstances. This does not mean that other antibiotics, known to be safe after years of widespread use, are not as effective against anthrax exposure, say experts; it only means that the patents of those manufacturers had expired, taking the big profit out of it.
Leonard Horowitz, a physician and author of numerous books including Death in the Air: Globalism, Terrorism and Toxic Warfare and Emerging Viruses: Aids & Ebola: Nature, Accident or Intentional?, tells Insight, "Every expert for the last century has said that anthrax is very effectively treated by virtually every antibiotic we have, including penicillin G, penicillin VK, doxycycline, cyclosporines and tetracyclines."
According to Horowitz: "Making Cipro the drug of choice was largely speculative, if not irrational. The government has said, 'It's not that this drug is any more effective than any other drug or even more readily available.' The decision was made merely on speculation that in case a strain of anthrax were to be taken by bioterrorists and mutated to become unsusceptible to all other antibiotics, they would still have Cipro. That's not science and it isn't what is best for the health and safety of Americans."
The microbiologist explains that there are "1,500 to 1,800 strains of known anthrax and virtually all of those have not yet been made completely unsusceptible to any of the antibiotics. So, metaphorically speaking, what the government is saying is, 'How about if we plan for the moon to collide with the Earth and we'll charge all Americans $700 for a two-month space suit?'"
It gets worse. Says Horowitz, "At least the other antibiotics have been approved for adolescent use and long have been used by people under the age of 18 and have less-severe side effects. You can simply take penicillin for exposure to anthrax, and honestly that's what every single bioterrorism expert has said, including those experts that have been trained by the Department of Defense."
Meanwhile, one doesn't even have to wait for a doctor's prescription to get such an antibiotic. "I went down to the local farm-feed store," Horowitz tells Insight, "opened the refrigerator, pulled out a bottle of penicillin G, paid $19 for it and have enough penicillin to treat mine and three other families for two months if necessary." Laughing, the microbiologist explains, "Look, I'm not kidding. Penicillin is the same for animals as it is for humans, which is why these drugs are tested on animals. This government 'deal' on Cipro is a scam. The fact is we're not getting all the information we need to be protected and are being left to rely on big government to handle everything. This is insane."
Lawrence Joyce, a pharmacist, attorney and author of Lessons From Dugway: What I Learned About Surviving Germ Warfare at the U.S. Army Proving Grounds, agrees with Horowitz's assessment of Cipro. He tells Insight, "Cipro is very expensive compared to doxycycline, but people are thinking in a box. The other antibiotics work just as well. It's just that they haven't been approved by the FDA for treatment of anthrax." And here's why, according to Joyce: "Out of all the antibiotics, Cipro is the only one still on patent, so the manufacturers of the other drugs had no incentive to ask the FDA for approval for an indication for using them for anthrax exposure — people would buy the less expensive generic brand. Bayer had the incentive to get the FDA approval and, knowing that germ warfare could come at any time, the company was anxious to get whatever life out of [Cipro] it could."
Joyce continues: "I definitely think the government should not be pushing Cipro, and in fact I'd recommend doxycycline because it is a broad-spectrum antibiotic, is highly effective, has less harmful side effects and is much less costly." Like Horowitz, Joyce sees no danger to people under emergency circumstances from purchasing and using indicated veterinary medicines. "Penicillin G is exactly what humans use," explains Joyce, "and when we're talking about anthrax I can't imagine anyone having a problem using animal-medicine products. I've been recommending for years, in the event of a national medical crisis, people use veterinary medicine. This shouldn't be construed as a substitute and it isn't my first line of recommendation, but it is an alternative and an option if there is a crisis."
To confirm that antibiotics suitable for resisting anthrax can be bought from a local vet or farm-feed store, Insight traveled an hour outside of Washington to a small agricultural community where the local vet not only was happy to provide a bottle of penicillin G, the equivalent of two-months' supply, but neither required a prescription nor asked a single question about why it was needed or whether it was intended for animal use. The only warning came on the bottle label, which read: "For Animal Use Only." Horowitz chuckles, "Well, sure that's what it says. You don't think the pharmaceutical companies want people to get that kind of deal on antibiotics, do you?"
There is widespread suspicion that the pharmaceutical industry is in league with organized medicine to keep antibiotics from being as readily available, and almost as inexpensive, as aspirin. But doctors warn that frequent or continuous use of antibiotics risks creating antibiotic-resistant strains of infection, necessitating careful prescription. According to James Zuckerman, a distinguished Boston physician, there are downsides to indiscriminate use of antibiotics. "It is the consensus among physicians and public-health workers that indiscriminate use of any antibiotic without a specific indication is fraught with hazards," explains Zuckerman. "There are contraindications and severe side effects to many of these antibiotics, and for the community, large indiscriminate use of antibiotics can create a reservoir of drug-resistant microorganisms."
But suspicion of the medical establishment abounds, and suspicion was raised further when HHS had a sudden change of heart about its drug of choice for treating anthrax just days after Secretary Thompson negotiated his $100 million "deal" on Cipro, announcing doxycycline and penicillin are just as effective for treating anthrax.
Bioterrorism experts say they are wondering why the government didn't recommend doxycycline or penicillin as an alternative until after the "deal" with Bayer was done. But Campbell Gardett, a spokesman for HHS, tells Insight that the $100 million Cipro purchase is to provide "just 10 percent of the stockpile — to be ready if needed. It's for readiness to expand the numbers of people that could be treated all at once." You see, says Gardett, "this Cipro buy doesn't have to do just with, or mainly with, this incident. It has to do with preparing for multiple potentials in the future."
While it seems clear that HHS is ill-prepared for handling the anthrax attacks, and who knows what other biowarfare agent, Joyce's concern is focused on a much more deadly possibility. What is the government's plan in the event of a smallpox attack, he asks, which unlike anthrax is virulently contagious and for which no prophylactic may be provided after exposure.
According to HHS Secretary Thompson the United States only has about 15 million doses of smallpox vaccine for a nation of 280 million people. Joyce asks, "Wouldn't it make sense to vaccinate the nation to remove the incentive for an enemy to use smallpox as a weapon? But you can't even get a smallpox shot from your family doctor — they don't have it. And never mind that some of us have been beating the health establishment over the head for years without getting anyone to listen. Now they're listening but the government isn't leading."
Kelly Patricia O'Meara is an investigative reporter for Insight magazine.