Early Warning

Stung by anthrax mailings after suicide skyjackings, the United States is hurrying to erect an electronic line of defense against further bioterrorism. At least five sophisticated biosurveillance systems are under development with federal funding to nonprofit and to proprietary ventures; two other groups already have products on the market. The goal is to install a national sentinel network that can detect suspicious trends in medical data and in illness behavior before diagnosis, to help contai

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The data processed by these systems range from traditional patient charts to such nontraditional sources as Internet health site hits, over-the-counter drug sales, or absences from work and school. A major challenge is accurate analysis of the data, which can involve complex statistical methods, decision-making tools, and even artificial intelligence. But many questions remain to be fully answered, including: How much time between infection and medical treatment can be saved by these methods; what kinds of data are the best indicators of serious disease outbreak; and how well will the systems cope with the problem of raising false alarms?

"This was solidly a research field on Sept. 10 and was considered to be a standard technology on Sept. 12," says Kenneth D. Mandl, an assistant professor of pediatrics at Harvard Medical School and research director in the emergency medicine division at Children's Hospital, Boston. Mandl is coprincipal investigator of an ...

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