A Bitter Pill to Swallow: Nonadherence With Prophylactic Antibiotics During the Anthrax Attacks and the Role of Private Physicians

Bradley D. Stein; Terri L. Tanielian; Gery W. Ryan; Hilary J. Rhodes; Shalanda D. Young; Janice C. Blanchard


Biosecur Bioterror. 2004;2(3) 

In This Article


As public health agencies continue to prepare for a future bioterrorism event, the interviews with victims of the anthrax attacks highlight several important limitations to public health actions. The credibility of information provided by public health officials will be enhanced if the information communicated during the initial crisis response is clear, consistent, and appropriate. Yet, officials must anticipate that even with optimal communication efforts, a substantial number of people may remain uncertain about the best course of action, or may misunderstand or misinterpret the reasons for public health actions (e.g., nasal swab testing) or recommendations (e.g., continuing prophylactic medications in the absence of symptoms). In any event with an uncertain and persistent threat, effective communication with the public must become an ongoing effort, because people will revisit decisions about their behavior many times as the crisis evolves.

Our interviews confirmed the critical role played by trusted individuals, such as family, friends, and coworkers, as people make important decisions. Our study identified advice provided by private physicians as one of the most critical factors influencing long-term adherence. That advice often contradicted the larger public health message, undermining its potential effectiveness. Increased effort and attention are urgently needed to ensure that private physicians are equipped for their key role in aiding personal decision-making during a public health crisis. Unless private physicians are actively involved in shaping and communicating the public health response, our nation's ability to thwart an emerging infection may be seriously hampered.


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