Tag Archives: politics


Challenges in Developing  Standards

The U.S. health care industry is contemplating the implementation of pay-for-performance reimbursement schemes in order to increase quality and safety in the delivery of health care. Pay-for-performance is a business model that combines reduced compensation for those who fail to meet standards and bonus payments for those that meet or exceed the stated expectations, but the results of such programs, thus far, is mixed (Baker, 2003; Campbell, Reeves, Kontopantelis, Sibbald, & Roland, 2009; Lee & Ferris, 2009; Young et al., 2005). The introduction of pay-for-performance models is primarily to provide relief from other, more extreme, reimbursement models, such as fee-for-service (which rewards overuse) and capitation (which rewards underuse), and with rising health care costs, a diminishing economy, and the increasing number of Americans lacking adequate health insurance, its introduction to the U.S. health care system could not be more timelier (Lee & Ferris, 2009).

The impetus of contemporary pay-for-performance schemes is derived from a report from the Institute of Medicine (2001). This report argued that current reimbursement schemes fail to reward quality in health care and may possibly create a barrier to innovation (Baker, 2003; Young et al., 2005). There are many international supporters of health care pay-for-performance, especially in England where the National Health Service employs pay-for-performance to keep costs under control while attempting to provide for quality and safety in the delivery of primary health care (Baker, 2003; Campbell et al., 2009; Young et al., 2005). However, the adoption of pay-for-performance seems to face many challenges.

One challenge to pay-for-performance implementation concerns the effectiveness in the overall continuity of care. Campbell et al. (2009) conducted an analysis of the effect of pay-for-performance in England and found that, although implementation of pay-for-performance in 2004 resulted in short-term gains in the quality of care, the improvements receded to pre-2004 levels. Beyond the pay-for-performance standards, though, the quality of care in areas not associated with incentives declined. Cameron (2011) reports on a recent study of the effectiveness of pay-for-performance on hypertension – the study shows no improvement in any measure including the incidence of stroke, heart attack, renal failure, heart failure, or combined mortality among the group (Lee & Ferris, 2009). McDonald and Roland (2009) describe these effects on other aspects of care as unintended consequences detrimental to health care quality and safety as a whole.

Another significant challenge to pay-for-performance implementation is ensuring that certain patient populations continue to be able to access appropriate care (McDonald & Roland, 2009). Under some pay-for-performance schemes, practices with a sicker patient demographic (i.e. geriatrics, oncology, neonatology, etc.) will suffer economically despite providing a higher level of care than their counterparts in family medicine or other more generalized practices. Specific concerns address a physicians ability to choose not to treat patients due to their non-compliance with medical orders (McDonald & Roland, 2009). Equity and access cannot suffer under a just reimbursement model, just as physicians with a sicker demographic should not suffer.

Identifying a reliable standard of measure in health care quality proves difficult. Earlier methods, such as those developed by Campbell, Braspenning, Hutchinson, and Marshall (2002), initially appeared sound, but ineffective methods and unintended consequences were soon identified (Cameron, 2011; Lee & Ferris, 2009; McDonald & Roland, 2009). More recent work by Steyerberg et al. (2010) shows that new approaches are on the horizon and that pay-for-performance may still remain a viable scheme, providing the measures and standards are, in fact, legitimate and accurately identify improved quality without detracting from other aspects of heath care. Steyerberg et al. identifies novel approaches to prediction models that may help to standardize measures in pay-for-performance schemes to be more realistic and reliable without causing many of the unintended consequences of earlier plans.

As we become more technologically advanced and find ways, albeit expensive, to cure and treat diseases that until now were intractable, we must address the ethics surrounding the provision of this care as a system of management. By combining the whole of health care into the ethics discussion, we opt to leave no one wanting for care, but we now have to address the problem of paying for the expensive care that we have all but demanded. Pay-for-performance, though not perfect, shows much promise in keeping health care costs manageable. However, we must strive to identify those patients and practitioners that lose out under this system of reimbursement and strive to identify just and ethical means of repairing the scheme. Though, we should first answer the question: is health care a right or a privilege?


Baker, G. (2003). Pay for performance incentive programs in healthcare: market dynamics and business process. Retrieved from http://www.leapfroggroup.org/media/file/Leapfrog-Pay_for_Performance_Briefing.pdf

Cameron, D. (2011, January 27). Pay-for-Performance does not improve patient health. Harvard Medical School News. Retrieved from http://hms.harvard.edu/public/news/2011/ 012611_serumaga_soumerai/index.html

Campbell, S. M., Braspenning, J., Hutchinson, A., & Marshall, M. (2002). Research methods used in developing and applying quality indicators in primary care. Quality and Safety in Health Care, 11(4), 358–364. doi:10.1136/qhc.11.4.358

Campbell, S. M., Reeves, D., Kontopantelis, E., Sibbald, B., & Roland, M. (2009). Effects of pay for performance on the quality of primary care in England. New England Journal of Medicine, 361(4), 368-378. doi:10.1056/NEJMsa0807651

Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Retrieved from http://www.iom.edu/reports/2001/Crossing-the-Quality-Chasm-A-New-Health-System-for-the-21st-Century.aspx

Lee, T. H. & Ferris, T. G. (2009). Pay for performance: a work in progress. Circulation, 119(23), 2965-2966. doi:10.1161/CIRCULATIONAHA.109.869958

McDonald, R. & Roland, M. (2009). Pay for performance in primary care in England and California: comparison of unintended consequences. Annals of Family Medicine, 7(2), 121–127. doi:10.1370/afm.946

Steyerberg, E. W., Vickers, A. J., Cook, N. R., Gerds, T., Gonen, M., Obuchowski, N., … Kattane, M. W. (2010). Assessing the performance of prediction models: A framework for traditional and novel measures. Epidemiology, 21(1), 128–138. doi:10.1097/EDE.0b013e3181c30fb2

Young, G. J., White, B., Burgess, J. F., Berlowitz, D., Meterko, M., Guldin, M. R., & Bokhour, B. G. (2005). Conceptual issues in the design and implementation of pay-for-quality programs. American Journal of Medical Quality, 20(3), 144-50. doi:10.1177/1062860605275222

WMD Coordinator

According to the Federal Bureau of Investigation (FBI; 2007) and the U.S. Department of Justice (2009), the WMD Coordinator, a designated Special Agent within each field office, is responsible for initiating the federal response to any possible WMD event. “The Attorney General has lead authority to investigate federal crimes, which includes the use or attempted use of a WMD. 28 U.S.C. § 533 (2008) and 18 U.S.C. § 2332(a) (2008). The Attorney General has delegated much of this investigative authority to the FBI” (U.S. Department of Justice, 2009, p. 1). The WMD Coordinator helps to fulfill this mandate by being the point of contact for local and state officials when an event involving an WMD is suspected to have occurred.

In the Mattapan scenario, the initial response by the Boston Police Department and the Massachusetts Bay Transit Authority Police Department unveil a possible attempt to utilize an explosive to disseminate a chemical or biologic material in a public place. As soon as this plot is uncovered, an emergency response plan should be initiated, which involves notifying the Boston FBI field office of the suspected WMD event. The WMD Coordinator of the Boston field office would be the person receiving this notification. The Massachusetts State Police would also be notified to respond as they are able to provide their own subject matter experts and resources.

As a WMD subject matter expert, once notified of the circumstances, according to the FBI (2007), the WMD Coordinator responds to the scene and assists local and state law enforcement in determining the threat. Once it is established that an WMD is involved, whether by direct investigation at the scene or based on reports from law enforcement, the WMD Coordinator would immediately notify the WMD Directorate at FBI Headquarters. This notification would activate a team of WMD experts who would participate in a conference call with the WMD Coordinator to further identify the threat and, also, identify the additional federal resources needed to respond to the event. The additional resources could be individual experts, federal response teams from other departments or bureaus (e.g. the Joint Terrorism Task Force, the Bureau of Alcohol, Tobacco, Firearms, and Explosives), or the special teams of the FBI, including the Chemical and Biological Sciences unit (to identify the particular payload material), photo operations personnel, an explosives team (based on the dispersal mechanism being explosives), the disaster squad (to identify any potential victims), and the national level Hazardous Material Response Unit and the local Hazardous Material Response Team to collect evidence from the scene. The WMD Coordinator would, then, be responsible for leading the investigation.

The WMD Coordinator would most likely fulfill his role within the unified incident command structure as Law Enforcement Command. This position would allow him or her to delegate the responsibilities of the response, including the need to provide information to the public. Public Information Officers provide a critical role in major response efforts. They provide enough information to the public to allay any unfounded fears, provide direction and instructions when needed, and filter sensitive information so that it does not become public knowledge. It is important for the public to be apprised of the situation in a calm and authoritative manner to assure them that everything necessary is being done. It is also important for the public to understand the risks of the situation in a realistic manner to prevent a mass overreaction.

The WMD Coordinator position is a valuable tool of the FBI and the federal government. Though the value of this position has been criticized for the lack of readiness and training, preparations are being undertaken to ensure a quality approach to responding to WMD events in the future (McDonald, 2009; U.S. Department of Justice, 2009).


Federal Bureau of Investigation. (2007, March 5). WMD threats: How we respond. Retrieved from http://www2.fbi.gov/page2/march07/wmd030507.htm

McDonald, J. (2009, October 8). FBI WMD Coordinator program needs improvement [Web log]. The OC Sheriff Blog. Retrieved from http://blog.ocsd.org/post/2009/10/08/Audit-of-FBI-Weapons-of-Mass-Destruction-Coordinator-Program-Recommends-Improvements.aspx

U.S. Department of Justice. (2009, September). The Federal Bureau of Investigation’s Weapons Of Mass Destruction Coordinator program (Audit Report #09-36). Retrieved from http://www.justice.gov/oig/reports/FBI/a0936.pdf

Electronic medical records:

The Push and the Pull

Increasing safety and efficiency in medicine can only lead to an increase in health care quality, right? Some might not agree, especially when it comes to the implementation of electronic medical records (EMRs). There is a federal effort to ensure all medical records are in digital format by 2014, and supporters of EMR technology laud their effectiveness at minimizing medical errors, keeping records safe, facilitating information portability, and increasing cost-efficiency overall (The HWN Team, 2009; Preidt, 2009). Unfortunately, many are skeptical of the cost, security, and utility of such systems (Brown, 2008; The HWN Team, 2009; Preidt, 2009; Terry, 2009). These concerns (and others) are dramatically slowing the pace of EMR adoption, especially in smaller private practices where cost is a significant issue (Ford, Menachemi, Peterson, & Huerta, 2009).

Does EMR adoption actually increase safety? As Edmund, Ramaiah, and Gulla (2009) point out, a working computer terminal is required in order to read the EMR. If the computer system fails, there is no longer access to the medical record. This could be detrimental in a number of cases, especially when considering emergency medicine. Edmund, Ramaiah, and Gulla also describe how difficult it can be to maintain such a system. With this in mind, it is plain that as the system ages there will be more frequent outages and, therefore, more opportunity for untoward effects. Further, recent research shows how EMRs enforce pay-for-performance schemes that many U.S. physicians resent. McDonald and Roland (2009) demonstrate that physicians in California would rather disenroll patients who are noncompliant when reimbursed under pay-for-performance models enforced by the EMR software. Declining to treat patients who express their personal responsibility and choice in their own medical treatment cannot improve the effectiveness of safety in the care that they receive.

There needs to be a middle ground. Baldwin (2009) offers some great real world examples of how some hospitals and practices use hybrid systems to ensure effectiveness and quality while enjoying the benefits of digital records. According to Baldwin, there are many concerns to account for when considering a move from an all paper charting system to an all digital system. Many times, these concerns cannot be allayed and concessions between the two systems must be made. Brown (2008) suggests providing a solid education to the front-line staff regarding EMR implementation, and hence, obtaining their ‘buy in’ to the process to create a smoother transition to implementation. However, this does not address the safety concerns. Baldwin’s advice to analyze which processes should be computerized allows a solid business approach to EMR implementation, allowing some processes to remain paper-based if it makes sense to do so.


Baldwin, G. (2009). Straddling two worlds. Health Data Management, 17(8), 17-22.

Brown, H. (2008, April). View from the frontline: Does IT make patient care worse? He@lth Information on the Internet, 62(1), 9.

Edmund, L. C. S., Ramaiah, C. K., & Gulla, S. P. (2009, November). Electronic medical records management systems: an overview. Journal of Library & Information Technology, 29(6), 3-12.

Ford, E. W., Menachemi, N., Peterson, L. T., & Huerta, T. R. (2009). Resistance is futile: But it is slowing the pace of EHR adoption nonetheless. Journal of the American Medical Informatics Association, 16, 274-281. doi:10.1197/jamia.M3042

The HWN Team. (2009, March). Electronic medical records: the pros and cons. Health Worldnet. Retrieved from http://healthworldnet.com/HeadsOrTails/electronic-medical-records-the-pros-and-cons/?C=6238

McDonald, R. & Roland, M. (2009, March). Pay for performance in primary care in England and California: Comparison of unintended consequences. Annals of Family Medicine, 7(2), 121-127. doi:10.1370/afm.946

Preidt, R. (2009, December 16). Pros and cons of electronic medical records weighed. Business Week. Retrieved from http://www.businessweek.com/lifestyle/content/healthday/634091.html

Terry, N. P. (2009). Personal health records: Directing more costs and risks to consumers? Drexel Law Review, 1(2), 216-260.

The Need for Multi-Agency Coordination

Terrorists, whether foreign or domestic, typically choose targets that have value in societies or philosophies that they oppose (LaFree, Yang, & Crenshaw, 2009). For instance, according to the Federal Bureau of Investigation (n.d.), al Qaeda, under the leadership of Usama bin Laden, had their sights on the World Trade Center, a symbol of global capitalism, for many years. Another example, involving domestic terrorism, is the bombing of the Alfred P. Murrah Federal Building in Oklahoma City by Timothy McVeigh, Terry Nichols, and Michael Fortier. This target was chosen as a representation of the federal government, which McVeigh and Nichols despised, citing the incident involving federal agents in Waco, Texas, two years earlier.

Considering local community events that might be of significant interest to terrorists as potential targets, the Bristol Fourth of July Parade comes to mind. The parade is a major component of the oldest celebration of our nation’s independence and is attended by over 200,000 people each year (Fox Providence, 2011). The parade is symbolic and casualties could number in the thousands, depending on the tactics and strategies used.

There is limited egress from the Town of Bristol (see figure 1). Hope Street and Metacom Avenue are the only two roads that provide a route in and out of the town. Both lead to the Town of Warren to the north, and Hope Street converges with Metacom Avenue just before exiting the town by way of the two-lane Mount Hope Bridge to the south. Both roads are heavily trafficked during the parade inhibiting both evacuation and emergency response.

In the event that a significant terrorist act was to occur at this parade, the initial law enforcement response would be limited to those officers already on site. These officers, operating under the auspices of the Bristol Police Department would be primarily Bristol police officers with a small contingent of off-duty officers from neighboring jurisdictions. There is usually a small contingent of Rhode Island State Police troopers present. These officers would be on their own for a length of time, some of them probably affected by the attack.

Secondary responders would include both Rhode Island and Massachusetts State Police, along with mutual aid officers from approximately 10 to 15 neighboring communities; however, as people flee the initial attack, a secondary attack could create further confusion and increase the likelihood of severe traffic jams at all three evacuation points further inhibiting a timely response. Once the degree and scope of the incident is ascertained and the access difficulties are identified, it would make sense for a contingent of law enforcement to board helicopters and boats out of Providence and cross Narragansett Bay. Once on land, these officers (most likely consisting of U.S. Coast Guard, Providence Police, U.S. Border Patrol, and other federal law enforcement entities housed in Providence, RI) would rely on alternative means (walking, bicycles, ATVs, et al.) to reach the scene.

Colt State Park, to the southwest, would make a viable forward area command, allowing access for all types of vehicles, including single-engine fixed-wing aircraft. There is also an added benefit of a strong sea breeze to help direct any plume away from this forward area command post.

I have to consider that the law enforcement entities, along with the local emergency management authorities, have a working disaster plan in place for the Bristol Fourth of July parade; however, the plan must detail the fact that all resources would be overcome due to the scope and severity of such an incident; therefore, contingencies, such as stand-by assets, must be established and ready to respond by alternative means in the event that a catastrophic event were to occur, whether criminal or accidental in nature.


Federal Bureau of Investigation. (n.d.). Famous cases & criminals. Retrieved from http://www.fbi.gov/about-us/history/famous-cases/

Fox Providence. (2011, July 5). Inbox: Fourth of July festivities. Retrieved from http://www.foxprovidence.com/dpp/rhode_show/inbox-fourth-of-july-festivities

LaFree, G., Yang, S., & Crenshaw, M. (2009). Trajectories of terrorism: Attack patterns of foreign groups that have targeted the United States, 1970-2004. Criminology & Public Policy, 8(3), 445-473. doi:10.1111/j.1745-9133.2009.00570.x

Rhode Island Emergency Management Agency. (2008). State of Rhode Island hurricane evacuation routes: Town of Bristol [Map]. Retrieved from http://www.riema.ri.gov/preparedness/evacuation/Hevac_Bristol.pdf

Figure 1.

Bristol RI Evacuation Route
“State of Rhode Island hurricane evacuation routes: Town of Bristol” (Rhode Island Emergency Management Agency, 2008).

Expansion of Law Enforcement Post-9/11

Prior to 1993, federal law enforcement agencies, specifically the Federal Bureau of Investigation (FBI), felt more than adequate in investigating and preventing terrorism on U.S. soil (Smith & Hung, 2010). On September 11, 2001, as has been done on numerous emergent occassions, the U.S. government all but suspended Article III, Sec. 2 and Amendments II, IV, V, VI, IX, X, XIII, XIV of the U.S. Constitution in the name of protecting liberty; a premise I find sadly ironic.

According to an article by Abramson and Godoy (2006), the passage of the USA PATRIOT Act (2001) promotes intelligence sharing among the intelligence community, utilization of technological tools to combat tech-savvy terrorists, allows easier access to the business records of suspected terror supporters, allows search warrants to be affected without undermining other concomitant investigations, and allows wiretaps to be dynamic in order to follow the target suspect more easily. Detractors of the USA PATRIOT Act, however, argue that these measures undermine certain liberties that Americans are right to enjoy. These detractors warn of information cataloging that could lead to massive data stores of private information of regular citizens, unwarranted investigations, searches, and seizures of casual contacts of someone under investigation, and general use of “sneak and peek” warrants for the investigation of petty crimes.

One particular part of the USA PATRIOT Act, the usage of letters of national security that demand secrecy of government involvement from the recipient, was struck down by a federal judge based on Constitutional freedom of speech issues (Liptak, 2007). This is no surprise. Passing 357 to 66 in the House of Representatives and 98 to 1 in the Senate just six weeks after 9/11 and with little debate, this knee-jerk legislation was destined for failure, at least where public relations is concerned (Weigel, 2005).

The USA PATRIOT Act (2001) grants immeasurable power to law enforcement to investigate and prevent terrorism, this is a good thing; however, most of the provisions seem to fail whenever exercised against a U.S. citizen or lawful resident (Weigel, 2005). We need to rethink our approach to terrorism and ask the question of ourselves: is our safety worth every ounce of our liberty?


Abramson, L. & Godoy, M. (2006, February). The Patriot Act: Key controversies. Retrieved from http://www.npr.org/news/specials/patriotact/patriotactprovisions.html

Liptak, A. (2007, September 7). Judge voids F.B.I. tool granted by Patriot Act. The New York Times, pp. A18. Retrieved from http://www.nytimes.com

Smith, C. S. & Hung, L. (2010). The Patriot Act: issues and controversies. Springfield, IL: Thomas Books.

USA PATRIOT Act. P. L. 107-56 Stat. 115 Stat. 272. (2001).

Weigel, D. (2005, November). When patriots dissent. Reason, 37(6). Retrieved from http://www.reason.com/news/show/33167.html

Using the U.S. Patriot Act to Fight Terrorism

Many of the fundamental tenets of a free American society are founded on the basis of liberty. Americans enjoy liberty, but I surmise that many are unfamiliar with term. We as Americans can enjoy certain freedoms because of liberty. Liberty describes the condition of man to be able to govern him- or herself with regard only to the consequences of actions and decisions, the responsibility of liberty. Merriam-Webster (2011) defines liberty as “freedom from arbitrary or despotic control, the positive enjoyment of various social, political, or economic rights and privileges, and the power of choice” (para. 1). Using liberty as a foundational political philosophy, our forefathers prescribed our abilities as citizens in our freedom.

Faced with horrible, vicious, and unfamiliar terror, our society became frightened and called on our lawmakers to ease this fear. Without a full understanding of that which we were facing, the knee-jerk reaction that is the USA PATRIOT Act (2001) was signed into law. The unfortunate reality is that this law violates almost every libertarian prescription codified in the U.S. Constitution and those of the many states. No longer are we, as citizens, free to travel interstate by a common means of the day (air travel) without undue and warrantless searches and seizures. No longer can an American citizen be knowingly free to have private phone conversations without the fear of wiretaps, save for those that are reviewed by a judge to be warranted.

It would indeed be ironic if, in the name of national defense, we would sanction the subversion of . . . those liberties . . . which make[s] the defense of the Nation worthwhile” (U.S. v. Robel, 1967, pp. 258, 264). (as cited in Strossen, 2004, p. 368)

America is resilient because of the liberties enjoyed by every citizen. Legislation, such as the USA PATRIOT ACT (2001), undermines these liberties and creates a weaker nation as the focus turns towards government for the protection of the individual instead of the individual protecting the government as it has been since America’s inception. Focusing more on our freedoms and liberties while restating the need for each citizen to take an active role in their personal security and that of their community would go much farther than any knee-jerk legislation could ever hope to. I agree with Strossen (2004) that the USA PATRIOT Act is unnecessary, overreaching, and counterproductive the security of our free State.


Liberty. (2011). The Free Merriam-Webster Dictionary. Retrieved from http://www.merriam-webster.com/dictionary/liberty

Strossen, N. (2004). Terrorism’s toll on civil liberties. Journal of Aggression, Maltreatment & Trauma, 9(3), 365–377. doi:10.1300/J146v09n03_07

USA PATRIOT Act of 2001, Pub. L. No. 107-56, 115 Stat. 272 (2001).

Hacking Cyberterrorism

Although not particular to cyberterrorism, for this discussion I have chosen hacking as a type, or means, of cyberterrorism. Hacking covers virus loading and denial of service attacks, also. In order to carry out a cyberterrorism attack, it must be based on some sort of hacking. First, however, we must agree on the definitions of hacking and cyberterrorism. US Legal, a website dedicated to providing legal reference, broadly defines hacking as “intentionally accesses a computer without authorization or exceeds authorized access” (Computer hacking law & legal definition, n.d., para 1). Cyberterrorism is, according to Denning (2006):

…[H]ighly damaging computer-based attacks or threats of attack by non-state actors against information systems when conducted to intimidate or coerce governments or societies in pursuit of goals that are political or social. It is the convergence of terrorism with cyberspace, where cyberspace becomes the means of conducting the terrorist act. Rather than committing acts of violence against persons or physical property, the cyberterrorist commits acts of destruction or disruption against digital property. (p. 124)

Arguably, in order to use a computer system to do any of the above, it involves hacking, but without hacking, there can be no cyber- component to cyberterrorism, which leaves mere terrorism. Fortunately, using these definitions, there has never been a cyberterrorism attack ever in history (Brunst, 2008; Conway, 2011). Brunst (2008) goes further using the term terrorism to include the planning (and, even pre-planning) phases of an event. I disagree with this tact in scholarship. Brunst fails to provide the distinction between cybercrime and cyberterrorism. Thinking simply, having a Facebook account in order for ease of communication does not amount to meeting for coffee. Messaging a friend on Facebook and organizing a meeting does not constitute meeting for coffee. The act of two or more persons meeting for coffee is a conventional one, however it was planned. This is the same with terrorism. I argue that, although much planning and radicalization can occur using computer networking (e.g. Facebook, MySpace, general information websites, et al.), any terroristic act that stems from such organization would still be considered conventional terrorism unless the act, itself, is described as being technological in nature (Conway, 2011).

There is potential for a cyber-attack to generate fear, economic impact, and the loss of life. This is why we concentrate on security measures to ensure difficulty in accessing systems without proper credentialing, rapid identification and response to active intrusions and threats, and recovery techniques to identify and repair data, networks, and nodes that were involved. For this reason, networks are designed with human redundancy. Human redundancy, as Clarke (2005) explains, integrates human decision points within a technological operational structure in order to detect, indicate, explain, and correct an error. Additionally, infrastructure, a commonly regarded target by the experts, tends to be resilient by its own nature making cyber-attacks inefficient and ineffectual (Conway, 2011; Lewis, 2002; Wilson, 2005)


Brunst, P. W. (2008). Use of the internet by terrorists: A threat analysis. Responses to Cyber Terrorism, 34(1), 34–60.

Clarke, D. M. (2005). Human redundancy in complex, hazardous systems: A theoretical framework. Safety Science, 43(9), 655-677. doi:10.1016/j.ssci.2005.05.003

Computer hacking law & legal definition. (n.d.). US Legal. Retrieved from http://definitions.uslegal.com/c/computer-hacking/

Conway, M. (2011). Against cyberterrorism: Why cyber-based terrorist attacks are unlikely to occur. Communications of the ACM, 54(2), 26-28. doi:10.1145/1897816.1897829

Denning, D. (2006). A view of cyberterrorism five years later. In K. E. Himma (Ed.), Internet security: hacking, counterhacking, and society (pp. 123-139). Sudbury, MA: Jones and Bartlett.

Lewis, J. A. (2002, December). Assessing the risks of cyber terrorism, cyber war and other cyber threats. Washington, DC: Center for Strategic and International Studies. Retrieved from http://www.steptoe.com/publications/231a.pdf

Wilson, C. (2005, April 1). Computer attack and cyberterrorism: Vulnerabilities and policy issues for Congress (CRS Congressional report No. RL32114). Retrieved from http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA444799&Location=U2&doc=GetTRDoc.pdf

Cyberterrorism vs. WMD

Perhaps in an Orwellian society where computers are independant and there is very little human-to-computer interaction could a cyberterrorist cause such an impact as to be equal with a weapon of mass destruction. This is not true, however, regarding the technology of today. According to James Lewis (2002) from the Center for Strategic and International Studies, “cyber attacks are less effective and less disruptive than physical attacks. Their only advantage is that they are cheaper and easier to carry out than a physical attack” (p. 2). Studies of the implementation of efforts to reduce the effectiveness of infrastructure during war show a resiliency that is poorly respected. Redundant systems in conjunction with a focused human response provides mitigation to reduce the impact of disruptive efforts on infrastructure (Wilson, 2005). It seems the more important the system, the larger and focalized the response.

The northeast blackout of 2003 provides a decent case study, although the cause was a systems failure and not related to terrorism. According to the article by Minkle (2008), within an hour and a half, 50-million subscribers lost power in eight states and parts of Canada for a few days, yet it only contributed to about 11 deaths within the affected area. While the impact was significant, geographically, it was more or less a nuisance for most people.


Lewis, J. A. (2002, December). Assessing the risks of cyber terrorism, cyber war and other cyber threats. Washington, DC: Center for Strategic and International Studies. Retrieved from http://www.steptoe.com/publications/231a.pdf

Minkle, J. R. (2008, August 13). The 2003 northeast blackout — five years later. Scientific American. Retrieved from http://www.scientificamerican.com/

Wilson, C. (2005, April 1). Computer attack and cyberterrorism: Vulnerabilities and policy issues for Congress (CRS Congressional report No. RL32114). Retrieved from http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA444799&Location=U2&doc=GetTRDoc.pdf

Bioweapons of Mass Destruction: Actual Use or Hoax

Weapons of mass destruction (WMDs) provide an alternative impact when compared to conventional weapons (e.g. artillery, firearms, blades and knives, batons, et al.). WMDs can be chemical, biological, radiological, nuclear, or explosive (CBRNE) in nature attacking the human body in manners not typical of conventional weapons (Cameron, Pate, McCauley, & DeFazio, 2000). WMDs can, therefore, have devastating effects on the preparedness of the health care system (Macintyre et al., 2000; Subbarao, Bond, Johnson, Hsu, & Wasser, 2006).

Considering an attack such as a mass contamination of the money supply, there are two possibilities: actual contamination and hoax contamination. In actual contamination, the epidemiology of illness will correspond with the travel of contaminated bills, reaching long distances in short periods of time (as evidenced by the website http://www.wheresgeorge.com). As the contaminated money travels from one consumer to the next (possibly also infecting adjacent bills, wallets, counter-tops, and register drawers), it will do so undetected until the incubation period lapses and the first wave of infected people begin presenting to health care facilities for treatment (presumably, with a difficult diagnosis – an uncommon pathogen). These people should be geographically dispersed so that identification of the terrorist act is yet to be made. Not until epidemiologists track the vector to the money supply will the threat be discovered. Once this occurs, the populace will be suspicious of money, causing an entirely different catastrophe, but the fear will be real.

On the other hand, if the attack is a hoax, there will be no incubation period or actual illness, yet psychogenic effects will be almost immediate, causing many people to seek medical care at once overburdening the health care system (MacIntyre et al., 2000). Arguably, this type of attack will be short-lived; however, the effects can be disastrous.

Regardless of the type of attack, whether actual or hoax, there will be a large, resource-intensive response from national, state, and local levels of government and the private sector (Walsh et al., 2012). This would place a strain on response resources and other infrastructure, such as health care as previously mentioned. In both instances, though, lives could be lost, also. With the real attack, many people could die from the disease, but if resources are taken away from other sick patients, they are at risk of dying also. This holds true for hoax attacks. As many healthy people flood emergency rooms with mysteriously fleeting symptoms, truly sick patients are not being managed efficiently and are put at serious risk.

Though the example attack might not be feasible for one reason or another, it is interesting to think of the many ways in which we as a nation are vulnerable. This leads to the question of how much we value our freedom vs. how many freedoms are we willing to give up in order to feel safe. I have decided that I value my freedom, the freedom that most foreign terrorists despise, so much that I am not willing to part with it to any extent. So long as we live free and without fear, the terrorists cannot win.


Cameron, G., Pate, J., McCauley, D., & DeFazio, L. (2000). 1999 WMD terrorism chronology: Incidents involving sub-national actors and chemical, biological, radiological, and nuclear materials. The Nonproliferation Review, 157-174. Retrieved from https://www.piersystem.com/clients/PIERdemo/ACF1D7.pdf

MacIntyre, A. G., Christopher, G. W., Eitzen, E., Gum, R., Weir, S., DeAtley, C., … Barbera, J. A. (2000). Weapons of mass destruction events with contaminated casualties: Effective planning for health care facilities. Journal of the American Medical Association, 283(2), 242-249. doi:10.1001/jama.283.2.242

Subbarao, I., Bond, W. F., Johnson, C., Hsu, E. B., & Wasser, T. E. (2006). Using innovative simulation modalities for civilian-based, chemical, biological, radiological, nuclear, and explosive training in the acute management of terrorist victims: a pilot study. Prehospital and Disaster Medicine, 21(4), 272-275. Retrieved from http://www.hopkins-cepar.org/downloads/publications/using_sim_modalities.pdf

Walsh, D. W., Christen, H. T., Callsen, C. E., Miller, G. T., Maniscalco, P. M., Lord, G. C., & Dolan, N. J. (2012). National Incident Management System: principles and practice (2nd ed.). Sudbury, MA: Jones & Bartlett.

Planning a Terrorist Attack

Planning a clandestine attack using a weapon of mass destruction (WMD) is not simple. First, in order to promote an attack, the target needs to be viewed to have violated some ideology, policy, or other deeply held belief (“Terrorism, definition and history of,” 2002). Usually, a symbol of the offense will be chosen as either a specific target, such as the case of the World Trade Center, or as a vehicle or vector for the attack, as in the case of the U.S. Postal Service anthrax attacks (“Biological terrorism,” 2002; Marshall, 2002; “Weapons of mass destruction,” 2002). The dollar is an international symbol of capitalism and the might of the United States. In the current climate, especially with the declining U.S. economy, I would expect the money supply, itself, to be a viable vector for disseminating some sort of substance capable of causing terror. A dollar bill has a circulating life of 42 months and changes hands, on average, twice a day, and by impregnating paper money with a chosen substance, a single dollar bill could potentially harm more than 2,500 people during its circulation (U.S. Department of the Treasury, Bureau of Engraving, n.d.).

Almost as important as the vehicle is the impregnating substance. Chemical and radiological substances would be too easy to eventually detect, and the amount dispersed on each dollar bill might not be enough to cause harm. A live biological agent suspended in an aqueous nutrient solution could easily coat a dollar bill without detection and easily transfer to hands, surfaces, and other bills. According to Winfield and Groisman (2003), Salmonella enterica might prove to be a hardy pathogen capable of existing in such a solution for months. S. enterica is responsible for typhoid fever in humans. Escherichia coli, though a highly pathenogenic mycobacterium, does not have the same persistance outside of a living host. Both S. enterica and E. coli have detrimental health effects, especially for those with deficient immune systems.

Delivery and dispersion of the weapon would be the next consideration. This would have to be accomplished using a number of distribution points, geographically distant, that transfer small denomination bills easily both in and out, such as gasoline stations, convenience stores, fast food restaurants, and liquor stores. Using a website designed to track dollar bills (http://www.wheresgeorge.com), a single bill has been tracked in about two and a half years, as follows: Florida, Georgia, Florida, Indiana, Arizona, Oregon, New York, Tennessee, and South Carolina. Another has been documented as travelling from Ohio to Michigan via Kentucky, Tennessee, Florida, Texas, Louisiana, Texas, and Utah in a mere 212 days. This is evidence that general dispersion techniques will work well if initially geographically distributed.

Additionally, as the Salmonella bills are being dispersed, I would encourage a technological attack on various credit card networks. If the hacking results in increased network downtime, the American citizenry would be encouraged to use paper money more often, potentiating the transfer of the Salmonella bills. As a final coup de grace, when the American populace finally begin to realize that the money supply, itself, is tainted, I would encourage conventional attacks on banking institutions to include random bombings, shootings, and threats of the same. This would further drive the message against the U.S. money supply and could crash the economy.

This plan was developed in about twenty minutes. The terrorists of the day have had decades to consider such plans, and I for one am glad that they tend to be grandiose. When the terrorists realize the simplicity required of causing terror in the U.S., we need to be very wary.


Biological terrorism. (2002). Encyclopedia of terrorism. Retrieved from http://sage-ereference.com.ezp.waldenulibrary.org/view/terrorism/n76.xml

Marshall, P. (2002, February 22). Policing the borders. CQ Researcher, 12, 145-168. Retrieved from http://library.cqpress.com.ezp.waldenulibrary.org/cqresearcher/

Terrorism, definition and history of. (2002). Encyclopedia of terrorism. Retrieved from http://sage-ereference.com.ezp.waldenulibrary.org/view/terrorism/n415.xml

U.S. Department of the Treasury, Bureau of Engraving. (n.d.). FAQ library. Retrieved from http://www.moneyfactory.gov/faqlibrary.html

Weapons of mass destruction. (2002). Encyclopedia of terrorism. Retrieved from http://sage-ereference.com.ezp.waldenulibrary.org/view/terrorism/n453.xml

Winfield, M. D. & Groisman, E. A. (2003). Role of Nonhost Environments in the Lifestyles of Salmonella and Escherichia coli. Applied Environmental Microbiology, 69(7), 3687-3694. doi:10.1128/AEM.69.7.3687-3694.2003