The good news is that Americans are finally getting universal healthcare. The bad news is that you qualify only after you've been exposed to a weapon of mass destruction. It is an irony of almost cosmic proportions that the most profound danger to the future of American medicine is the headlong, chaotic rush to militarize biotechnology.
The federal government has sold us a hundred-billion-dollar insurance policy that promises ultra-high-tech "bioterror countermeasures" in the event of a contagious Armageddon so improbable that the sales pitch achieves an hallucinatory level of paranoia. To underwrite this policy, our medical research infrastructure has been tasked with developing monumentally expensive containment systems for epidemics that, in all probability, will never happen. Bye-bye, Prozac nation. Anxiety is back in vogue, requiring us to put the greatest medical-research system in history under the control of politicians and their scientifically subliterate security czars.
The shocking reality is that, as a result of 9/11, we are in the process of turning over control of our national medical-research infrastructure to the Department of Defense (DOD) and its new domestic incarnation, the Department of Homeland Security (DHS). Just as we stand poised to reap the benefits of 50 years of revolutionary progress in molecular medicine, we are told, in effect, that cures for cancer, atherosclerosis, and Alzheimer's will have to wait. America's national security dictates that biodefense is job one.
This may spell the end of America's dominance of the cutting edge of molecular medicine. Like the tropical rain forest or the Great Barrier Reef, our leadership in biomedical technology has grown as a result of a unique ecosystem where government, the marketplace and academic forces are held in a dynamic and complex equilibrium. Our biotechnology "industry" is a marvelous experiment in controlled chaos, linking universities and multinational corporations, geriatric investment bankers, and gonzo graduate students. Propagating this exotic and delicate creature makes breeding pandas in captivity look like a milk run. The rush to divert research dollars to bioterror defense will screw up everything.
A recent New York Times editorial quotes our president saying, "It would take only one vial, one canister, one crate slipped into this country to bring a day of horror like none we have ever known." The DHS and DOD intend to use this endgame declaration as a mandate to convert the diverse ecosystem of basic medical research into a working ranch. They say we are at war and have no choice. But what about the horrors faced daily by the millions of Americans who are victims of the bioterror caused by cancer, stroke, and diabetes?
We have a right, in fact a duty, to question the wisdom of hijacking our biomedical research infrastructure for a theoretical battle against bioterrorism when there are shooting wars all over the medical landscape now. We need to know who has sanctioned this new imperative, and who will supervise its implementation, because the resources for biodefense research reside mostly in nonmilitary venues: namely, those that serve human healthcare. Our federal biomedical research infrastructure is simultaneously powerful and fragile, infinitely resourceful yet painfully finite in its resources. This is especially true for the "research community" that inhabits the unique environment that forms around a specific disease. Laboratories working on HIV or liver cancer form a delicate, extremely complex intellectual ecosystem.
To function effectively, researchers must navigate a densely tangled web of shared information and resources. New ideas entering a research ecosystem are continuously filtered by a self-critical apparatus whose very nature is anathema to big military projects. The name of this filter is peer review. On the cutting edge of human knowledge, basic research organizations like the National Institutes of Health (NIH) and the National Science Foundation (NSF) must constantly scan the horizon of new ideas. What is probable? What is absurd? To do this, science has evolved a rigorous system of analysis whereby the distribution of research funds in any given area is controlled by experts in that area. This is the essence of peer review.
But now, billions of dollars are being diverted into biodefense on a scale that will warp existing research priorities completely out of whack. If the current trend continues, defense and security applications may quickly become the premier source of all federal biotechnology funding. The enormous allocation of new funds for biodefense threatens to destroy the peer review system and uncouple this crucial symbiotic relationship between basic life sciences researchers and the federal agencies that fund them -- a symbiosis that, arguably, has been the best investment ever made by the U.S. taxpayer.
Before the federal government spent a dime, the Manhattan project had been rigorously vetted by some of the greatest minds of the 20th century. Today, with a minimum of consideration for scientific feasibility, the executive branch is moving inexorably toward the establishment of a multibillion-dollar program whose goal is to use America's leadership in biotechnology to make us invulnerable to bioweapons. Budgets are announced and billions of dollars become available with little discussion of how a gold rush in biodefense spending might rock the world of peer-reviewed scientific research.
The agents of death derived from life, bioweapons, are the most terrifying exactly because they operate far beyond the twilight zone of our collective imagination. Even the experts don't know what can be created, what the symptoms will be, how deadly, how painful. Even the experts don't know how it will spread or who is at risk. Theoretical next-generation bioweapons invoke a surreal level of terror because, in truth, we have no idea where this technology can go.
We are talking about the potential for a deadly marketplace of metabolism where "genetic or protein engineering" and "directed evolution" are standard tools of the trade. And it is precisely because no one can tell us what could happen that American biotechnology, the undisputed world heavyweight champion, appears ready to go down and take that induction physical. The plan is to multitask this crown jewel of our economic future to drive America's other great technology business: weapons. But how far should the cutting edge of biotechnology research be deflected toward national defense? How much of the federal budget for life sciences R&D should go toward defense and security applications -- and who decides?
This question is crucial because the federal government supports almost all the basic research from which next-generation biotechnology products evolve. This in no way minimizes the creativity of America's biotechnology industry, which invests an enormous amount of money and intellectual capital to bring these basic discoveries to the marketplace. But the current pipeline is almost entirely filled with blockbuster products that originated in long-term fundamental research sponsored by NIH and NSF. What happens when the basic research mission of these agencies is short-circuited by the delusional lurches of homeland security?
Fueled by the enormous budgetary clout of the new Department of Homeland Security (DHS), biodefense mission creep is already reaching inward to federal labs and outward to the universities and private industry. The American Association for the Advancement of Science reported that for the fiscal year 2004 there would be an increase in federal R&D of $7.9 billion, nearly all of which would go to just three agencies: DHS, DOD and NIH. Nowhere is the golden rule more relevant than in the brutally expensive world of technology research. Whoever has the gold rules, which now makes DHS a major player in American science policy.
The newly hatched DHS has a baby of its own: "Project BioShield." While still in its infancy, this government venture in biodefense has been budgeted for $6 billion, twice the amount spent on the entire Human Genome Project. Originally announced in the president's State of the Union address, Project BioShield is billed as a comprehensive effort to develop and make available modern, effective drugs and vaccines to protect against attack by biological and chemical weapons or other dangerous pathogens. Project BioShield is a putative collaboration between DHS and NIH, but many in the research community doubt that this shotgun wedding can work.
Because Project BioShield is designed to protect a civilian population, $1.75 billion will be subcontracted by DHS to NIH's National Institute of Allergy and Infectious Diseases (NIAID). We are supposed to be reassured that biomedical research will be handled by the professionals. But DHS still writes the checks for a project that is supposed to reach warp speed in a single year. Informed sources estimate that a staggering 10 percent of NIH's funding is now directly or indirectly related to biodefense R&D. In coming years, the "expedited" authority provided by Project BioShield will route additional hundreds of millions into biotech research that does not follow the normal protocols of peer review.
This is a very risky proposition. NASA brought us Tang and DARPA may have created the Internet, but for every executive branch R&D success there have been spectacular failures. Billions of dollars disappeared into the ill-fated Strategic Defense Initiative (popularly known as "Star Wars") venture. Billions more are still required to decontaminate the residue of a nuclear arms race that represents the last time the federal government took one of our great scientific assets to war. In the final analysis, our national defense infrastructure is simply not designed to foster the environment essential for pushing back the frontiers of basic science.
The Department of Defense is also requesting an enormous slice of the biodefense pie, but bottom-line numbers are impossible to assess. Unlike DHS or NIH, DOD can hide biodefense funding within a maze of classified projects that makes Chris Carter's vast X-Files conspiracy look like a game of kick-the-can.
Even a cursory analysis of the DOD budget shows an enormous amount of biotech funding buried under a bewildering array of acronyms like COWATAA and DTRA or embedded in mega-technology initiatives like DARPA's Bio/Micro/Info Sciences Program -- which could just as well be called the DARPA's EVERYTHING Program.
Under the heading "Combating Terrorism" the president's budget request allocates $7.3 billion for DOD efforts to combat terrorism, including biowarfare. Highlights include $578 million in R&D funding for advanced individual-protection programs, and for equipment to detect and decontaminate chemical-biological agents. Additional biowarfare countermeasures are buried in the $378 million Cost of War Against Terrorism Authorization Act (COWATAA), as well as $452 million for something called the "Defense Threat Reduction Agency (DTRA)." In just those few appropriations we find almost $1.5 billion dollars.
Don't feel safe quite yet? There's the "Homeland Security Biological Defense Test Bed." Sorry, no acronym and no explicit price tag -- but if you have to ask, you can't afford it. In this modest little program, DOD will create an "integrated capability for protection of urban areas, high value assets, and special events, and detect and respond to biological incidents." In FY 2003 we start on the "establishment of fully equipped test beds on selected military installations, an enhanced biological monitoring system in the National Capital Region, and an initial biological monitoring capability in two additional urban areas." Welcome to Tomorrowland in the paranoid magic kingdom of bioterror.
One can only guess at what an "integrated capability to protect, detect, and respond to biological incidents" in urban areas might include, but this project has the potential to make Star Wars be the last nickel bargain on the planet. One is assaulted by visions of ubiquitous bioweapons sensors hanging like smoke detectors and air fresheners. Mood rings replaced by miniature DNA sequencers that constantly sample the genomes of microorganisms as they fall on our skin. Office buildings equipped with windowpanes that change color when a chemical or biological agent settles on its surface.
Finally we come to DARPA's Biowarfare Defense Technology (BDT) program. For FY 2003, DARPA proposed to dedicate 50 percent of its entire $150 million budget to a project called "Bio/Info/Micro Sciences." This project will "explore and develop potential technological breakthroughs that exist at the intersection of biology, information technology and micro/physical systems." That's the same as saying that this project will explore and develop the fusion of biotechnology, computer technology and nanotechnology -- essentially the entire future of high technology! This 50 percent allocation becomes even more amazing when compared to the historical DARPA funding requests, which show that Bio/Info/Micro Sciences was budgeted for zero dollars in FY 2001.
It is essential to recognize that very little of DOD's research will occur in-house, which means that just like the DHS, DOD will be a major player in science policy through its vast capability to fund university and industry laboratories. As our military and security commanders draft more of America's biotechnology infrastructure to support a war on terror that has already cost hundreds of billions of dollars, it is crucial to remember that NIH, the premier federal source of all basic healthcare research, will receive only about $28 billion in FY 2004. This budget includes everything from public health initiatives to basic genome research. If the current trend continues, federal biotechnology funding for defense and security will easily rival funding for basic biomedical research within a generation.
But will this current trend continue? Industrial biology is coming of age in a government-proclaimed age of terrorism, and that will be hazardous to your health... though the reason may not be obvious. Before we spend these uncounted and uncountable billions for biodefense, we must ask whether we have the real enemy in our sights.
What if the true danger is not some fanatic attempting to slip across an international border? Do we dare consider that, fueled by a xenophobia that is out of all proportion to reality, we are in pursuit of a specious alien "other"? Is the greatest threat to our security really the possibility that a group of fanatics enabled by satellite phones and e-mail will get their hands on a doomsday vial? These questions take on monumental significance when we recognize the true cost of the war on terror, when we understand too late that these valuable resources could have been used to target and destroy a much more dangerous enemy that is already here. It's in our true heartland, it's in someone we love: a mother, a husband, a child.
This enemy doesn't have to cross an ocean in disguise or procure forged documents. This alien has already gained entry into our homes. We must seriously reconsider a policy that deflects attention from an enemy that is here, known and extremely deadly. No WMDs have been found in Iraq, but it is an irrefutable fact that there are WMDs in our living rooms. No conceivable enemy of the American people has the might and capability to destroy, ravage and inflict damage the way real cellular terrorists do. Maybe we should be outraged that, even as we stand on the threshold of annihilating the enemy within, our resources are being summarily redirected by acts of subterfuge and deceit camouflaged to make us think, with the old American sense of isolationism, that we are safe only when the enemy is kept far across the ocean.
We will all die eventually, of course. But it is a terrifying fact of life that, in the year 2000, cancer and heart disease alone prematurely took the lives of more than 1.2 million Americans and, since Sept. 11, 2001, these diseases have killed more than 2,500,000 of us while the total number of lives lost to terrorism must stand well below 4,000.
This staggering reality does not even begin to count the terror suffered by survivors of these and other major diseases or, of course, their families. To date, the war on terrorism has cost hundreds of billion of dollars, enough to accelerate discoveries in the basic life sciences by a decade or more. It is beyond irony that just as we stand on the brink of turning an abstract struggle against our own metabolism into a plausible stand-up fight with recognizable victories, we should be ambushed and paralyzed by the fear of vague, implausible scenarios. By remaining at this level of fear, we sentence millions of Americans to a premature death.
The war on terror is very real, and America needs to fight its suicidal, homicidal enemies with all appropriate vigor. But if we let these people distort the greatest scientific enterprise our democracy has ever created, they will have achieved a victory out of all proportion to their true capabilities. For all its horror, the World Trade Center disaster was a preventable anomaly. But cancer, heart disease and their allies are the true inevitability that must be fought with every weapon in our arsenal.
The post-9/11 militarization of our federal biotechnology research infrastructure represents the most dangerously misguided government science initiative in history. Al-Qaida and the new Department of Homeland Security have coauthored a national performance-art piece wherein the American people join a cargo cult dedicated to the construction of multibillion-dollar totems with the magical power to make our borders impermeable to all vials, ampuls, and other canisters of contagion ... including the ones that don't exist. As executive producer of our new national reality show, "Survival of the In-vial-ate," Osama bin Laden will kill millions of Americans without losing a single minion. We will die. Not from terrorist cells, but from the cellular terrorists whose molecular weapons of mass destruction -- cancerous mutations, arterial plaques and cryptic retroviruses -- are already embedded in our bodies.