Correspondence
The Acts of Terrorism
N Engl J Med 2002; 346:539February 14, 2002
- Article
To the Editor:
People all over the world were shocked by the disaster of September 11, 2001. I want to emphasize what the editors wrote about medical insurance in the Journal's editorial on the subject (Oct. 11 issue)1: “Victims and their families must receive medical and mental health attention regardless of their ability to pay and whether or not they have medical insurance.”
I believe that the international community of physicians should fight for justice in medical treatment. It is noteworthy that 40 million Americans have no medical insurance and billions of people in the Third World do not receive basic medical treatment. Physicians may not be able to save the world, but our united voice must be heard loud and clear. Everybody on this planet deserves medical and mental health care, regardless of his or her ability to pay. Justice in medical care might help to prevent hatred and frustration. Justice in medical care will not solve the problem of terrorism, but it might play a part in preventing it.
1 ReferencesAriel Rokach, M.D.
Hadassah University Hospital, Jerusalem 91240, Israel
arielr@hadassah.org. il 1
September 11, 2001. N Engl J Med 2001;345:1126-1126
Full Text | Web of Science | Medline
To the Editor:
The editorials on bioterrorism (July 26 issue1 and Oct. 11 issue) called for an improved national program of preparedness, including a strengthened public-service infrastructure, improvements in diagnosis, better integration of information, and timely reporting of laboratory results. An important omission in these proposals is the role of the nation's 17,000 nursing homes as a necessary addition to the evolving system of response. There are 1,600,000 nursing home beds, of which approximately 200,000 are unoccupied on any given day.2 The nursing homes have about twice the total number of beds that hospitals have, are located in every community in the United States, employ skilled nursing staffs and medical directors, and are linked with other medical staffs in the community. They also have established mechanisms for rehabilitation, laboratory testing, radiology, and the transportation of patients. Moreover, family and social-service support are part of the work of nursing homes.
With a small amount of additional effort and planning, the nursing homes can enhance the developing response to natural or man-made emergencies. A beneficial byproduct will be a strengthening of the nursing homes in each community and improvement in their performance of their traditional role. Fear of terrorism is understandable, but fear of the nursing home is not an acceptable reason to overlook this opportunity to enhance our response to these threats to the public.
2 ReferencesLeslie S. Libow, M.D.
Jewish Home and Hospital, New York, NY 10025
llibow@jhha.org 1
Khan AS ,Ashford DA . Ready or not -- preparedness for bioterrorism. N Engl J Med 2001;345:287-289
Full Text | Web of Science | Medline2
Gabrel CS. An overview of nursing home facilities: data from the 1997 National Nursing Home Survey. Advance data from vital and health statistics. No. 311. Hyattsville, Md.: Public Health Service, 2000:1-12.
To the Editor:
The same species that eradicated smallpox and has very nearly eradicated poliomyelitis has also committed innumerable acts of violence against itself. Will we ever learn that every war is a civil war?
John R. Dykers, Jr., M.D.
P.O. Box 565, Siler City, NC 27344Author/Editor Response
The editors reply:
The new threats of massive terrorism have developed amid the anger and resentment that have been building in oppressive, failing countries that do not provide for the basic needs of their people. Dr. Rokach's statement is a reminder that any plan to counter the underlying causes of terrorism should include plans to improve the health of those trapped in severe poverty. The health care resources of the economically developed countries are enormous. Some small fraction of those resources could produce substantial improvements for those living in the poorest countries.
In the aftermath of September 11 and the subsequent acts of biologic terrorism, we know that preparedness is now required for responses to acts that once seemed unimaginable. Those responses should draw on all our health care resources, including nursing homes and their personnel, as Dr. Libow points out. As Dr. Libow also suggests, being forced to create such contingency plans could result in the development of a better perspective on some of the problems in the fragmented health care system of the United States.
Edward W. Campion, M.D.
Jeffrey M. Drazen, M.D.- Citing Articles (7)
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