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To the Editor.—In addition to the well-organized and instructive perspectives presented in the article by Dr Kadlec and colleagues,¹ I would like to add 1 more point regarding primary prevention measures against biological weapons. This approach is exactly what physicians and biomedical scientists would have to engage. In 1995, a terrorist group in Japan, the Aum Shinrikyo cult, secretly produced biological weapons such as anthrax spore and botulinum toxin.² During World War II, Unit 731 in the Japanese Army was the classic and notorious example of production of biological warfare agents and their wartime use.³ Both Aum Shinrikyo and Unit 731 included physicians and microbiology experts. Considering that these individuals seemed to have had an important role in the production of biological weapons, they had violated the most basic bioethical principle, primum non nocere.

The families and descendants of the victims in a Chinese village recently brought a lawsuit in Tokyo local district court against the Japanese government for the use of flea aerosol of Yersinia pestis by Unit 731 during World War II.⁴

Inadequacy of ethical education in the Japanese biomedical community⁵ is responsible in part for this tragedy. Ethics education for the current and future generations of physicians and scientists could be one of the most important tools for primary prevention of biological weapons.⁶

Yasuharu Tokuda, MD
Okinawa Chubu Hospital
Okinawa, Japan

1. Kadlec RP, Zelikoff AP, Vrtis AM. Biological weapons control: prospects and implications for the future. JAMA. 1997;278;351-356. 2. Aum Shinrikyo Cult and biological weapon [in Japanese]. Yomiuri Shimbum. May 15-26, 1995:1, 31. 3. Gold H. Unit 731 Testimony. Tokyo, Japan: Yenbooks; 1996. 4. Lawsuit for Unit 731 biological warfare [in Japanese]. Asahi Shinbun Evening. August 12, 1997:14. 5. Hoshino K. Present Conditions of Bioethics Education in Japan [in Japanese]. Tokyo, Japan: Tokyo Medical Inc; 1988:51. 6. Tokuda Y. Teaching ethics in Japan. Lancet. 1995;345:1574. PUBMED

In Reply.—Dr Tokuda has touched on the importance of physicians' ethical responsibilities. This point was not fully emphasized in our article, but it lies at the heart of both the proliferation and deterrence of biological warfare.

Scientists and physicians have played a central role in the development of offensive biological weapons. In addition to Tokuda's examples of the Aum Shinrikyo cult and Unit 731, we would add that the former US offensive program enlisted some of the brightest minds in microbiology during World War II. It was a wartime effort that "vied only with the Manhattan Project . . . in securing certain types of scientists."¹ The entire US effort was focused on research and development of biological weapons for retaliation in the event the Axis countries resorted to their use.¹ However, based on ethical considerations, the US Army Surgeon General recused the use of the military's medical staff for any offensive research and development.¹

Since that time, the United States unilaterally renounced biological weapons in 1969, a move that undoubtedly accelerated international arms control efforts and lead to the signing of the Biological and Toxin Weapons Convention in 1972. Other efforts in the medical community have been made to heighten the awareness of the potential for misuse of microbiological techniques. Ethical guidelines for work in defense against the use of biological weapons have been published,² and such work is not prohibited by the convention.

Regrettably, even with such pronouncements, history shows that scientists and physicians have been willing participants in offensive biological weapons research and development (unpublished data). They have done so for a variety of personal and political reasons that run the gamut from frank criminal activity to actions rationalized as patriotic. In the final assessment, Tokuda's comment about the most basic ethical principle, primum non nocere, represents both the first and last line of defense against proliferation and use of biological weapons. It is with both despair and hope that we note these words that define our profession do not always govern the hearts and minds of those in it.

Robert F. Kadlec, MD
US Department of Defense
Washington, DC

Alan P. Zelicoff, MD
Sandia National Laboratories
Albuquerque, NM

1. Brothy L, Miles WD, Cochrane RC. United States Army in World War II: The Technical Service—The Chemical Warfare Service: From Laboratory to Field. Washington, DC: Dept of US Army; 1959:105-111. 2. Orient J. Chemical and biological warfare: should defenses be researched and deployed? JAMA. 1989;262:644-648. ABSTRACT

Edited by Margaret A. Winker, MD, Senior Editor, and Phil B. Fontanarosa, MD, Senior Editor.

JAMA. 1998;279:273-274.