VITAL SIGNS

If a strange new epidemic is on the way, how will we know?

ANTHRAX and heroin. Could there be a more sensational mix of modern-day
nightmares? Yet there really are anthrax spores in some heroin in Norway.
They have killed at least one man and could be to blame for the worst year
the country's seen for deaths among addicts. Anthrax may also be killing
Scottish drug users (p 4). And, since virtually all Europe's supplies come
from Asian countries where anthrax is endemic, spore-laced heroin might be
scattered right along the drug's trade routes.

And yet some will say, so what? Junkies die young anyway. Anthrax is not
communicable, so the addicts are only harming themselves.

Try telling that to the six-year-old orphaned by the latest death in
Scotland. All these deaths are personal tragedies. But there is another
reason to care about them: they tell us whether we are alert to new
diseases, and yes, even biological weapons. So the news is not all bad. We
caught this outbreak.

South-West Asia has been supplying Europe with heroin for more than a
decade. Why should anthrax only appear now? Most heroin comes from
Afghanistan, home to some of the Western world's arch-enemies. Maybe they
have suddenly started infecting their prime export, even if killing addicts
does seem a bizarre form of terrorism.

More likely, pure heroin was cut with a powder that included some material
from infected animals, which means this could have been happening for
years. But who bothers to autopsy dead addicts? Every few months there is a
surge in deaths which is blamed on overdosing with unusually pure heroin,
and no one looks further.

Except that this time someone did. Norwegian doctors decided to autopsy a
heroin addict who had died of a strange septicaemia, and were surprised at
what they found. Next came a series of events outside official channels. In
an informal Internet newsletter one doctor asked if anyone else had found
anthrax in heroin. At the same time, Glasgow hospitals noticed more dead
addicts than usual-with similarly strange symptoms. The penny dropped.
Otherwise, no one would have suspected anthrax.

So let us have more openness between people with information about
infectious diseases. True, it's not always easy to share details when the
police call for silence while they track down suppliers and traffickers.
But as events over the past few weeks show, the more people talk, the
easier it is to spot patterns of disease.

Other European countries should check for infection. And let us continue to
investigate. Samples should be sent to American labs with the wherewithal
to tell us precisely where the anthrax strain came from. Maybe it was an
escapee from a weapons lab.

Paying more attention to what addicts die of will help to show which
pathogens are moving around the world, and how. Next time it might be
something even more malevolent.