Biological weapons control. Prospects and implications for the future.

The Biological and Toxin Weapons Convention (BWC), which prohibits the acquisition of biological materials for hostile purposes and armed conflict, entered into force in 1975 and now has the participation of 140 nations (158 nations have signed the BWC, but only 140 of these have also ratified it). However, there is no monitoring mechanism associated with the BWC. Diplomatic efforts are now under way to create a supplemental, legally binding protocol to strengthen the convention. Measures to strengthen the BWC are analogous to the diagnostic processes familiar to physicians; the problem facing negotiators is to identify procedures with high positive and negative predictive value. Few proposed measures meet these criteria. However, the investigation of unusual disease outbreaks and allegations of use are highly diagnostic of illicit activities while avoiding false-positive accusations. At the same time, such information generated by the BWC can contribute to worldwide efforts to improve public health, control emergent disease, and establish an international norm against biological weapons proliferation.

Preventing disease and non-battle injury in deployed units.

Most military physicians know that disease and non-battle injuries (DNBIs) have historically caused more death during war than battle injury. Most DNBIs are preventable, but many unit surgeons and physician assistants, especially at battalion/squadron and brigade/wing level, may not have had the benefit of preventive medicine training or experience. The authors present a logical and thorough framework that all unit surgeons can use to organize their preventive efforts.