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October 18, 2001

Rudolph Giuliani, Mayor, City of New York

Dear Mr. Mayor:

I am a physician and specialist in infectious and tropical diseases with 35 years of clinical, academic, research, and laboratory experience in infectious and immunological diseases. Currently I work as a laboratory technologist at the Laboratory of Molecular Diagnosis at The New York Presbyterian Hospital Weill Cornell Medical Center.

I understand that your office is doing its utmost to deal effectively with the occurrences of anthrax. You have been urging people not to overreact and have explained how “there are situations people faces every day in their lives that are significantly more dangerous than this.” However, I would like to comment on two matters:

1. Unnecessary anxiety.

It seems to me that the major emphasis that is being placed on the anthrax bacillus itself is creating an unnecessary and dangerous situation with potential for serious economic and social consequences for the future of our city and of our country.

I entirely support you in the goal that we all must assist in bringing our city back to normal as soon as possible. Certainly, we should encourage people to come and visit New York. However, the way the media has been educating the public concerning anthrax constitutes a major obstacle to this objective. People not only do not want to come to New York or to USA, many residents are already leaving the city.

According to the news reports, criminals are mailing spores of B. anthracis to different places in our nation. If we really want to do our best to protect our populace we must remember that for any infectious disease to occur three conditions must be fulfilled:

Of the three the last one is the one that should be emphasized. I believe this is precisely the one that many public health officials and the media are not addressing in a proper way. Professionals from the Centers for Disease Control and Prevention (CDC), Department of Health and Human Services (DHHS), and the New York City Department of Health (NYCDOH) are concentrating the information on the bacillus, its spores, ways in which they can be contracted, and how the bacillus can easily be treated with antibiotics. Often we hear phrases like “the deadly anthrax” or “the killing bacteria” However, very little or nothing is being said about the susceptibility of the host.

All the information that we are listening on the radio or watching on TV concerns testing positively or negatively for anthrax. Also, frequently the media speak erroneously about “a case of anthrax” when someone tests positively on a culture for B. anthracis. Exposed individuals are put on antibiotics, and people are auto-medicating themselves with a variety of antibiotics, in the belief that this will prevent from contracting anthrax. The public is doing everything possible to obtain Cipro. However, we may remember that antibiotics can destroy the immune system and make people vulnerable to infections including anthrax. This is why antibiotics are medication to be used only in restricted instances.

Very often, public health officials and the media use terms such as “exposed”, “infected”, and “sick” as if they had the same meaning. However, exposure to an infectious agent means that the person has been in contact with it and nothing more. Infection means that in an exposed person the microbes are growing and that very probably the immune responses are neutralizing them. Infectious disease is the clinical manifestation with symptoms and signs of colonization by microbes, and only happens if the immune system is weakened and is not able to control the infection. Usually in infectious diseases, including anthrax, many individuals can be exposed while only some of them will be infected and very few of those infected will get sick.

Since the era of Pasteur and Koch, people have been overly concerned about germs and infectious diseases. This is why the way that people are being informed, instead of protecting them from anthrax or any other infectious disease, is creating anxiety, depression, and panic. This is making residents of New York City and the Nation vulnerable to anthrax and to other infectious diseases. Many will come down with all types of mild and severe infections due to the behavior of public health officials and the media. Anxiety, depression, and panic are all scientifically known causes of immunosuppression. Once we are immunosuppressed, any germ, even the ones from our normal flora can attack us.

In this regard, I would very much suggest that public health officials review the issue of psychoneuroimmunology. There are numerous scientific publications and books on the matter. At the end of this letter I list a few references on how anxiety, depression, and panic weaken the immune system and make individuals susceptible or vulnerable to infections. Besides, due to the current stressful times, it is very probable that many diseases related with immunodeficiency like AIDS will rise.

Additionally, I am concerned that the manner in which the problem of anthrax is being dealt with is creating a perfect ambience for a mass psychogenic illness, also known in the scientific world as epidemic hysteria or mass hysteria. At the end of this letter I also list some references on this crucial matter. Undoubtedly, the way information is being provided is creating an epidemic hysteria. There are already many stories of airplanes, trains and buses that had to stop in the middle of their journeys. Offices, public buildings including the Congress, are closing their doors. Very probably, this chaotic situation will get worse and worse.

We may remember that the main goal of terrorists is to create terror, and the way the issue of anthrax is being dealt with is creating terror. In this way, I am concerned that even with the best intentions public health officials and the media individuals are helping terrorists to achieve their goals.

The terrifying chaos needs to be stopped!

2. Making our immune systems stronger.

An individual or potential host that is in good health (not susceptible), cannot be attacked by any germ including the bacillus of anthrax. This is a law in infectious diseases! In this regard public health officials and the media, instead of creating panic and terror and spreading immunosuppression by concentrating on the germs, should explain in detail the ways to make our immune systems stronger.

At these stressful times it is necessary to explain in detail the spiritual, mental, biological, and physical measures that are available to cope with stress and make our immune systems stronger, so that we do not need to be overly concerned about bio-terrorism with the anthrax spores or with any other germ. This is an effective way to overcome bio-terrorists.

For example, anti stress diets could be explained, as well as diets and dietary supplements that can stimulate the immune system. Meditation, physical exercise, entertainment, and cultural activities, are other tools to cope with stress. These too need implementation.

In this vein, I strongly recommend conducting workshops on the issues described in this letter with media professionals and with the population at large, using radio and TV. I would be honored to volunteer my professional skills in helping to organize and conduct some of these workshops. Logically, these actions need the support from the Mayor.

Very cordially and with best wishes,

Roberto Giraldo

Some Refeences on Psychoneuroimmunology:

Some References on Coping with Stress:

Some References on Epidemic Hysteria:

Roberto A. Giraldo

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