Indeed, that sort of surveillance -- environmental detection and observing the response of target populations -- is getting better, according to Relman, "but we're still learning to sort the noise from the true signal."
And the next attack, if there is one, will probably still be first detected by someone on medicine's front lines, rather than watching numbers on a chart, he said.
Another major unsettled issue, Bush said, is who should be in charge. On one hand, a bioterror attack is by definition a medical emergency. On the other, it's a criminal act.
"I can tell you," Bush said, "that in Florida the medical folks were pushed aside by the FBI."
Eventually -- long after the medical response was over -- the criminal investigation led the FBI to the conclusion that a single person was behind the attacks: Bruce Ivins, PhD, a microbiologist at the United States Army Medical Research Institute of Infectious Diseases in Fort Detrick, Md.
Ivins died in 2008, apparently a suicide, after learning that the FBI planned to charge him. No charges were ever brought and there remains significant controversy over whether the FBI got it right.
"The government has decided it was one crazed person and it doesn't go beyond that," Bush said. "I don't know if that's true or not, but if it isn't true haven't we sort of missed the boat?"