Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!

We welcome Ketan Desai, a physician executive, as we’ll delve into the fascinating and concerning realm of biological warfare and bioterrorism. Join us as we explore historical instances of biological weapons, the implications of genetic technology advancements, and the ethical considerations surrounding biotechnological research.

With Ketan’s expertise, we’ll discuss the motivations behind biological attacks, the potential dangers of genetic manipulation in bioterrorism, and the urgent need for global biosecurity measures.

Ketan Desai is a physician executive.

He discusses the KevinMD article, “Biological weapons: a history and emerging risks.”

Our presenting sponsor is Nuance, a Microsoft company.

Do you spend more time on administrative tasks like clinical documentation than you do with patients? You’re not alone. Clinicians report spending up to two hours on administrative tasks for each hour of care provided. Nuance, a Microsoft company, is committed to helping clinicians restore the balance with Dragon Ambient eXperience – or DAX for short. DAX is an AI-powered, voice-enabled solution that helps physicians cut documentation time in half. DAX Copilot combines proven conversational and ambient AI with the most advanced generative AI in a mobile application that integrates directly with your existing workflows. DAX Copilot can be easily enabled within the workflow of the Dragon Medical application to bring the power of ambient technology to more clinicians faster while leveraging the proven and powerful capabilities used by over 550,000 physicians.

Explore DAX Copilot today. Visit https://nuance.com/daxinaction to see a 12-minute DAX Copilot demo. Discover clinical documentation that writes itself and reclaim your work-life balance.

VISIT SPONSOR → https://nuance.com/daxinaction

SUBSCRIBE TO THE PODCAST → https://kevinmd.com/podcast

RECOMMENDED BY KEVINMD → https://kevinmd.com/recommended

GET CME FOR THIS EPISODE → https://earnc.me/4nM4Ax

Powered by CMEfy.

Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast, and get CME for this episode by clicking on the CME link in the show notes. Today we welcome back Ketan Desai. He’s an author and physician executive. Today’s KevinMD article is “Biological weapons: a history and emerging risks.” Ketan, welcome back to the show.

Ketan Desai: Thank you for having me.

Kevin Pho: So go to KevinMD.com/podcast to search for Ketan’s name, story, and prior episodes. Today we’ll jump right into the most recent KevinMD article about biological weapons. For those who didn’t get a chance to read this article, tell us what it’s about.

Ketan Desai: The article essentially delves into the history and the future of biological weapons, and how they pose a threat, and who poses the threat, and how they can be made and how they can be deployed.

Kevin Pho: All right, so give us some historical context of biological weapons.

Ketan Desai: Biological weapons have been around for a long time. In fact, the plague was started as an unintended biological weapon, when the Eastern forces had surrounded the city of Caffa. It was the Golden Horde, the army of the Golden Horde, in 1347, and they had surrounded the port of Caffa in Crimea. And the people inside the port were not able to do anything with their dead, so they started catapulting them at the people outside. Well, the Golden Horde returned the favor and started catapulting their dead inside the city, and those people had the plague. And so the plague started in Crimea and then spread from there to the rest of Europe, and by the time it was done, about 30 percent of the European population had perished. So that’s the first recorded history.

Then, unfortunately, more recently, the conquistadors had used smallpox against the natives, both in the south of America as well as parts of the U.S., against the native population, and wiped out a lot of people there too.

Kevin Pho: All right, in your article you make the distinction between bioterrorism and biological warfare. Tell us the difference between those two terms.

Ketan Desai: So in bioterrorism the intent is to cause a lot of panic but not cause a lot of deaths. So for example the anthrax attacks in 2001 caused a lot of panic but not a lot of people died, actually. Whereas in biological warfare the intent is to kill as many people as possible.

Kevin Pho: And today, tell us about the current state of biological warfare. What new innovations are we seeing incorporated in these weapons?

Ketan Desai: So a lot of this is very hush hush, for obvious reasons. When I consulted for DTRA, which is the Defense Threat Reduction Agency in the United States, as well as a couple of other agencies in the US, they were focusing more on the conventional side of biological warfare, such as the use of smallpox or the use of anthrax or the use of various other lentiviruses.

Whereas other countries and other groups have kind of moved on. They have started using gene manipulation to increase both the effectiveness as well as the ability of these agents to resist antibiotics. And they also mix and match, so they take parts of one virus and add it to another, so at the end it becomes hard to know what you have on hand, as well as to treat it, because it’s a mix of different viruses or bacteria, as the case may be.

Kevin Pho: Talk more about that genetic manipulation when it comes to viruses. Has that been used already today? What would be an example of that?

Ketan Desai: So a couple of examples of where this has taken place, both intentionally and accidentally. There were Australian scientists, Ron Jackson and Ian Ramshaw, who unwittingly created a vicious strain of mousepox, which is a cousin of smallpox, and they were kind of doing the same thing, they were mixing and matching, and they came up with this thing which they realized that it would be impossible to stop, and so they basically destroyed that completely.

There was also another company called Maxygen in California. It also had done something like this, and their creator was Willem Stemmer, who was chief scientist, and he used what’s called gene shuffling, DNA shuffling technology, that involves moving the DNA around, which actually creates increased resistance in the bacteria.

And so these are just two of the examples. There are lots of other countries and organizations that have done much more dangerous stuff, example being North Korea and China and Russia. And then I won’t say we are entirely pure either, who knows what’s going on behind closed doors here too. So there’s a lot of this going on, both for the purposes of identifying what could be a threat and coming up with cures for that, as well as being on the offense sometimes.

Kevin Pho: And in general, when coming up with new biological weapons, are they entirely government sanctioned, or are there private companies doing this research as well?

Ketan Desai: If they are private, at least in the US, they are reasonably well controlled and well regulated. But who knows what’s going on in North Korea and Russia and China, for that matter.

Kevin Pho: So tell us, what kind of safeguards do we have about this type of research potentially escaping into civilization? How safe are we from this type of research?

Ketan Desai: Yeah, so this is actually a somewhat maybe controversial issue. For example, the whole issue of where COVID-19 came from, as some people speculate it actually escaped from a lab, for gain of function research that was being supported by the NIH. We don’t know if that’s the case or not, there are theories on both sides of the issue, but that’s an example of something that could happen and may have happened. Who knows really what took place.

But that is one of the things, and one of the heroes of this whole episode was the Chinese physician Dr. Li, who was actually an ophthalmologist, who identified initially in Wuhan what was going on and alerted the world to it. So we need that kind of surveillance on an individual physician basis and individual hospital basis, to see trends of unusual infections, unusual illnesses taking place, and which we can then respond to proactively.

Kevin Pho: So in terms of historical examples of biological weapons being used, you went back way in the past and talked about things like the plague and the conquistadors using smallpox. Give us some examples recently of biological weapons being used today.

Ketan Desai: There are not so many examples of biological weapons. I think the most recent one was the anthrax attacks in 2001. There have been certain claims, and again it’s probably controversial, about what’s going on in Ukraine. It’s totally unverified so I won’t go into that in detail, but probably the most recent one has been the anthrax attacks of 2001.

Kevin Pho: Are there any dangers of these terrorist groups obtaining some of these weapons?

Ketan Desai: Yeah, so for example, if someone like ISIS, which has a doomsday mentality anyway, if they obtain something like this they could easily deploy it.

But I had an interesting conversation with someone from the government agency, and their mindset is that terrorist groups like that like to see things go boom. They like to see explosions, because it has a bigger impact, whereas bioterrorism to them is not that impactful. They don’t see that big ball of fire and people being thrown apart. So they don’t think that terrorist groups like that would use biological weapons. I disagree, but that is the mindset of the government agency right there.

Kevin Pho: And in terms of the government agencies, are there treaties that are in existence that perhaps would limit the research, like we see with other weaponry?

Ketan Desai: Yeah, there are treaties in place. How much people adhere to that is a different issue.

Kevin Pho: So we talked about genetic manipulation of viruses. What are other major areas of biological warfare technology?

Ketan Desai: Well, other than genetic manipulation, it could also be that they just find bacteria or a strain that is resistant to antibiotics. For example, E. coli, just a good old E. coli which is resistant to antibiotics, or Staph aureus, and they just help propagate that. And there are some very nasty strains of Staph aureus running around right now, and E. coli too. So without even genetic manipulation, nature has already done that, in some cases, and they could just propagate that.

Kevin Pho: All right, so obviously we’ve talked about the negative ramifications of biological warfare. Has any of the research that goes into biological weapons and biological warfare, has that translated into beneficial advances when it comes to medicine?

Ketan Desai: It’s not A to B to C, it’s more like A to C, D, E at the same time. So the whole science of genetic engineering can be applied, and has been applied, to a whole bunch of diseases and models. I mean, in some ways even ordinary drugs, not ordinary drugs, but a lot of the biological medicines we use right now, including antibodies, et cetera, have all come out of the whole idea of genetic engineering. You can move genes around to make antibodies which are more powerful, more specific, et cetera.

Kevin Pho: All right, so tell us, what do we have to look forward to when it comes to this technology in this area?

Ketan Desai: The most important thing is surveillance and awareness. Look for unusual trends, unusual diseases, especially by physicians in the hospital or just around you. Unusual cases suddenly coming up, a whole bunch of measles for example suddenly arriving from nowhere. Those are the kind of tipping points.

And then, again, this is somewhat controversial, some people say masking works, some people say it doesn’t work. That’s up to the individual. But when you see something, take precautions, whatever the appropriate precautions the person thinks is appropriate for that, whether it’s hand washing or masking or whatever. That’s up to the person.

Kevin Pho: Now obviously we are coming out of the recent COVID pandemic. Are there any lessons from the pandemic that we can take to protect ourselves against biological weaponry, or any lessons that we can learn from the pandemic as it relates to this area going forward?

Ketan Desai: Yeah, one of the biggest lessons was how controversial some of the science became, and how political and politicized the whole thing became. So WHO’s guidelines, for example, they had to go back and forth for a while about whether masking works or not, how far to stay away from somebody, the social distancing and all that. Maybe in the future we could be less political about it and more open, so that we could have science and not politics involved in health care.

Kevin Pho: We’re talking to Ketan Desai. He’s a physician executive and author. Today’s KevinMD article is “Biological weapons: a history and emerging risks.” Ketan, as always, we’ll end with some of your take-home messages that you want to share with the KevinMD audience.

Ketan Desai: Well, stay aware, and take actions accordingly as you see fit.

Kevin Pho: All right, Ketan, thank you so much for joining me again and sharing your perspective and insight.

Ketan Desai: Thank you.