Chemical Warfare Agents: Toxicity at Low Levels

Abstract

Weapons of Mass Destruction (WMD) have become the buzzwords for disaster planning in the United States over the past 5 years. Since the activities of the September 11 terrorist hijackings and bioterrorist anthrax attacks, the interest has widened to include all health care providers in the United States and throughout the world, not just those interested in disaster preparedness. There have been a number of excellent works published in the past 5 years discussing the effects of WMD, including chemical, biological, and nuclear weapons. All of these have discussed the acute exposure but not the long-term or residual effects of small amounts of toxins. One of the editors of this work, Somani, edited Chemical Warfare Agents, published in 1992. This text has 37 contributors, 34 who are PhD-scientist types and 3 who are MD-clinicians. They represent the military and civilian expertise in chemical agents from the United States, Israel, and the Netherlands. The text is divided into 14 chapters with no particular organization except for perhaps a preference for nerve agents. Information on the effects of low-level chemical warfare agents on humans is derived not from exposure to chemical warfare agents but to insecticides that are similar in chemical composition and pharmacology. Much of the discussion of blood-brain barrier modulation toxicokinetics and xenobiotics will be of great interest to researchers in these areas but of little interest to the clinician. Despite what the title of this work implies, there is an abundance of information on the toxicology of chemical agents, new approaches to medical protection, bioscavengers, and acute botulinum toxin countermeasures. The real value of the work for clinicians is 4 chapters that would be missed by the casual observer of the title of this book. Chapter 9, “Gulf War Syndrome: Questions, Some Answers, and the Future of Deployment Surveillance,” is 40 pages of the best nonpolitical or “non-ax-to-grind” summary of the problem that I have seen. Chapter 11, “Riot Control Agents,” is a good review of these agents, which clinicians are more likely to see than VX or mustard gas. Chapter 13, “Psychological Factors in Chemical Warfare and Terrorism,” is an extremely important topic and, although discussed well by the authors, should be expanded to include the experience of the military and civilian victims during the Iran-Iraq War and the studies of World War I veterans. The final chapter of the book, Chapter 14, “Emergency Response to a Chemical Warfare Agent Incident: Domestic Preparedness, First Response, and Public Health Considerations,” is an excellent overview of what every physician needs to know when planning for a WMD response, what to tell your patients, and some background on the national plan. In summary, there is something here for everyone with an interest in chemical warfare agents. I recommend it for those interested in research or for those who are formulating plans for response to terrorism that has become not a “what if” but a “when and where” public health problem in the United States.