Beyond irony. Way-y-y beyond.

From Political Site of the Day (PSoTD):

Beyond. any. sense. of. irony.

President Discusses Schiavo

"In cases where there are serious doubts and questions, the presumption should be in the favor of life."

Among Bush's accomplishments

• Most Americans killed in war since the Presidency of Richard M. Nixon.
• Most noncombatants killed by American forces since at least Bush's Dad, if not before.
• Most death row inmates put to death under any Governor in the history of the United States.
• First war started by America under proven wrong reasons in which there were considerable doubts since the Spanish-American War.

Update, Suicide-by-Governor:

Governor Jeb Bush:

"I still firmly believe that human life is a gift and a mystery, and that its mystery is most evident at its beginning and ending. May all of us whose hearts were moved during the life of Terri Schiavo grow in wisdom at its ending," said Governor Bush in a statement sent to the Governor's e-mail list shortly after Schiavo passed away.

Floridians for Alternatives to the Death Penalty:

"I certainly hope Governor Bush has gained some wisdom about the value of life -- all life," said Abe Bonowitz, director of Floridians for Alternatives to the Death Penalty (FADP). "We hope and pray that he will now adopt a consistently pro-life policy."

[snip]

"Suicide-by-Governor is getting very popular in Florida," said FADP Director Abe Bonowitz, noting that five of the last eight Florida executions were of prisoners who waived their appeals and asked to be killed. So far Governor Bush has overseen the execution of 16 prisoners, seven of whom have been volunteers.

(via Common Dreams)

You bet your life

The epidemic of bird flu among poultry in North Korea is taking on a decidedly desperate cast. UN Food and Agriculture experts are flying there from Bangkok, China and Australia (Reuters).

The context is grim. A great deal of money, effort and hope was invested in poultry production by the North Korean government. Struggling to feed its undernourished population of 23 million, a special state agency was established for breeding chickens and ducks in December of 2001 (UPI via World Peace Herald). While poultry was one of the few growing sectors of the economy, the country produced only about 25 million birds in 2004, just over one per person/year, far short of Kim Jong Il's promised one kilogram of chicken meat and 60 eggs a month for every household in Pyongyang. The number of chickens estimated in North Korea is about 19 million. Now mass culling is reducing this already inadequate source of protein.

Pyongyang's public admission of the previously denied bird flu outbreak is seen by many as a sure sign the problem has spiraled out of control and foreign help is needed. The epidemic has probably already hit the poor rural area and is spreading. North Korea has mobilized its military to cull and disinfect poultry farms around Pyongyang, according to the South Korean Unification Ministry:

"Thousands of soldiers from the Pyongyang Defense Command and 3d Army Corps are involved in the slaughter and burial of diseased fowl," a Unification Ministry official told the Joong Ang Ilbo.

[ . . . ]

According to the Unification Ministry, the North's mobilization of the military is evidence of the seriousness of the situation. North Korean troops, after finishing winter drills this month, were scheduled to assist farmers during spring planting, the ministry said. The North shifted the assignment of the soldiers to cope with the spread of bird flu, officials said.

So while the Bush Administration and our European allies were dithering over North Korea's nuclear shenanigans, another kind of bomb was ticking in the Korean peninsula, where the current Asian bird flu outbreak began in 2003 in the South and spread to Cambodia, Thailand, Vietnam, China and Indonesia.

Reuters reports that the FAO experts are hoping to contain the virus before it mutates to a form easily transmissible between humans. This view is incomprehensible. The virus is already solidly entrenched in poultry in Asia, animals in close proximity to human beings. By common consent the virus cannot be eradicated at this point. If there is no intrinsic biological barrier to its making the feared genetic change, it will happen and containing the poultry epidemic (a worthwhile enterprise on its own) will not prevent it.

It is time to stop talking this way and plan seriously for a pandemic in the near future. With good luck it won't happen, although no one at the moment can give a convincing argument why it shouldn't and there are plenty of plausible arguments why it should. If I were a betting person, I wouldn't bet my money against a pandemic. Why should I bet my life on it?

CDC fallout cover-up

If you were a resident of southern Utah or nearby Nevada years ago in the nuclear testing era you are now safe. Safe, that is, from finding out if you aren't safe. After spending 8 million dollars to investigate any connections between thyroid disease and fallout, CDC is pulling the plug on an ongoing study that was designed to provide the answer (Joe Bauman, Deseret News [Utah]).

Reason given: CDC can't afford it (I guess the government needs the money for the $38 million additional they gave to the worthless "sexual abstinence program"; maybe if they practiced what they preached and stopped screwing people . . . )

It is highly unusual to stop funding in the middle of a study. Earlier work, done by principal investigator epidemiologist Joe Lyon of the University of Utah, showed an increased cancer risk in those downwind of the above ground nuclear tests at the Nevada Test Site. Additional work by Lyon in 1993 suggested a link to thyroid disease (nodules and some malignancies). He was in the midst of studying 4000 people identified in the St. George-eastern Nevada area who were 6th to 12th graders in 1965. Lyon has already examined 1300 and located most of the rest.

Lyon said he is loath to use the word cover-up, but it seems the federal government does not want to know about health effects of fallout on American citizens. Still, "That's the only interpretation I can place on it," he said.

I know Joe Lyon. Besides being a good epidemiologist he is a nice guy. So I'll say what he is too nice to say:

Cover-up.

Reading Secretary Leavitt's mail

A reader sent along the following letter that The Sexuality Information and Education Council of the United States (SIECUS) sent DHHS Secretary Leavitt regarding the Department's www.4parents.gov website. The letter is long, so if you don't have the patience (or the stomach) to read it, here is the short version: inaccurate, misleading, incomplete, unhelpful and with subtle anti-gay and anti-choice framing aimed at parents to use in educating their children. Paid for by the US taxpayer.

March 31, 2005

Secretary Michael O. Leavitt
The U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201

Dear Secretary Leavitt,

We the undersigned are writing to express our deep concern with the Department of Health and Human Services‚ recently launched website: www.4parents.gov. While all of us agree that parents should ideally be the primary sexuality educators of their children, it is incumbent upon all of us to make sure that parents receive the most accurate information and resources they need to achieve this difficult task. Unfortunately, 4parents.gov fails to meet these goals and instead, relies on fear to motivate and contains many errors and biases that undermine its intent of encouraging parent-child communication around sex and sexuality. 4parents.gov presents biased and inaccurate information as fact and does not address the needs of many youth, including sexually active youth, youth who have been or are being sexually abused, and lesbian, gay, bisexual, transgender and questioning (LGBTQ) youth.

Specifically, the website dictates values to parents rather then helping them to incorporate their own values into discussions regarding sex and sexuality. For example, while discussing what parents can do if their child has become sexually active, parents are told how to convince their teens to stop having sex by telling their children that they are "worth it." No resources or suggestions are given if a parent does not convince their teen to stop being sexually active, implying that these youth are not "worth it."

Additionally, the website contains inaccurate information regarding the effectiveness of condoms and the ability of youth to properly use condoms and other forms of contraception. While www.4parents.gov states that it is easier to prevent a teen's first sexual experience rather then to increase contraceptive use, research has shown that programs that include both messages actually effectively do both. According to the Youth Risk Behavior Surveillance System, condom usage among sexually active teens has gone up almost twenty percent in the past two decades (from 46 percent to 63 percent). Messages to teens should encourage them to delay sexual activity and, when sexually active, to use condoms and other forms of contraception.

4parents.gov also contains a distressing lack of information for parents of sexually abused and assaulted youth. While it is commendable that the website includes some of the signs of sexual abuse in youth, it lists only one resource for parents and this resource does not focus specifically on sexual abuse, but rather on all forms of child abuse.

The website also fails to address the unique needs of parents with LGBTQ children. Whenever 4parents.gov discusses LGBTQ youth, it uses outdated and alienating language and ideas. For example, in the section of the website where sexual orientation is mentioned, it repeatedly uses the terms "alternative lifestyle" and "homosexuality." This language assumes that being lesbian, gay, or bisexual (LGB) is a choice and also reduces LGB people to the mere equivalent of their sexual activity. The website also fails to include any information about transgender youth. Additionally, referrals for further information for LGBTQ youth and their parents is conspicuously absent.

The website also contains language that is clearly anti-choice in nature. For example, 4parents.gov states that "abortion complications" are one of the major reasons for infertility. In reality, less than 1 percent of woman receiving an abortion have a major complication and there is no evidence of infertility issues resulting from abortion among woman who have had the overwhelming majority of abortions. Further, the website omits the more likely causes of infertility, such as blocked fallopian tubes. In other examples:

• In its definition of menstruation, the website states that "If the egg is fertilized, this lining will nourish and protect the unborn child." "Unborn child" is not medically correct language; embryo or fetus would be accurate.
• The website defines abortion as "ending a pregnancy before a live birth occurs by removing the fetus or unborn baby from the uterus." Again, there is an agenda inherent in the language used.
• In its definition of uterus, the glossary section states "It is also called a womb. Womb has a religious, not medical, context.

Also troubling is that only one non-governmental organization is credited as having worked with HHS to create 4parents.gov: the National Physicians Center for Family Resources (NPC). The NPC represents views that are far outside the values of mainstream Americans and the public health community. NPC has ties to right wing religious organizations, like the California Family Council, Alabama Family Alliance, and Focus on the Family and boasts of alliances with fringe medical associations and doctors such as the Alabama Physician Resource Council, the Physicians Consortium and Dr. Laura Schlesinger. Additionally, the NPC has repeatedly asserted a specious connection between abortion and increased breast cancer and has advocated for non science based interventions like "abstinence only until marriage" programs. By creating the website with only one organization--and one organization that has questionable credentials in this area--HHS has dangerously narrowed the information included on 4parents.gov and in turn, shortchanged the very parents the site is meant to serve.

We respectfully request that the 4parents.gov website be immediately taken down and subject to a formal review of its content and techniques for communication and behavioral learning. This review should be done by a broadly accepted panel of experts in parent/child communication with well established credentials in this area.

We look forward to a response and to working with you further on creating a website that truly meets the needs of all parents and is based on the best available research.

Sincerely,

The Sexuality Information and Education Council of the United States (SIECUS)

Haiphong and North Korea

We have made a conscious decision not to chase every case report or bird flu event on this site but instead to summarize every few days, with any appropriate observations (other than "Holy Shit!"). We do this now with the Haiphong cases and the North Korean poultry outbreak.

Haiphong

Simultaneous infection with H5N1 influenza of five members of one family in northern Haiphong has now been confirmed by health officials there:

Initial tests showed the H5N1 virus was present in samples taken from a 35-year-old man, his 32-year-old wife and their three daughters, aged 10 years, 4 years, and 4 months, said Nguyen Van Vy, director of Haiphong Health Department.

The five family members were admitted to the hospital on March 22 (one week ago) with fever and shortness of breath. The family raised about 400 chickens. A month ago the birds began to die and the family ate some of them. Today XinhuaNet reported a 41 year old woman who lives "near" the family was admitted to the hospital with suspicion of H5N1 infection. Niman at Recombinomics reports two other "neighbors," a 41 year old male and a child (or perhaps a 35 year old woman, a 41 year old male and a child). There is no information if there was any actual contact in any of these instances.

Exactly how many people are involved in addition to the family, whether they all have H5N1, and their condition is unclear at this point, as is what all this means. Niman's interpreation is that it is evidence of suddenly increased transmission efficiency (from birds to humans). He may very well be right and this is an obvious interpretation. Others might be some unusual host factor among the family, an unusually heavy exposure of some sort, or (less likely) a common exposure other than the family's chickens. The significance of the "neighbors" is also unclear at this time.

What is clear is that H5N1 infection is entrenched in local poultry, has not been eliminated and continues to be transmitted to humans. Whether this witch's brew is simmering or starting to boil over is not obvious. One could defensibly see it either way. But it is indefensible to act as if it is not boiling over. The costs of an error are too great. But that is what we continue to do.

North Korea

As long as two weeks ago there were rumors that North Korea had an avian influenza outbreak (emphatically denied at the time), but not until Sunday did North Korea admit it had avian influenza virus at "two or three poultry farms" in Pyongyang and had destroyed hundreds of thousands of chickens. The nature and scope are still unclear, however. In particular, WHO's Delhi office still is unsure if this is an H5, H7 or H9 (or some other?) strain and how widespread the outbreak is. Scattered reports say the infection has spread to rural areas and poultry was not being sold in the markets, a blow to North Korea's poorly fed population. (AFP via Turkish Press and New Zealand TV)

We now learn that WHO was in touch with Pyongyang well before the rumors surfaced to offer assistance in preparing for human cases of avian flu. At this point, however, the lead UN agency is FAO. No human cases have been reported but no one trusts the North Koreans. An Editorial in South Korea's Joong Ang Daily believes the public admission is evidence that the damage "must be colossal." North Korea's lack of credibility and the perilous nutritional state of the population is spawning rumors that "North Korean citizens are digging up dead poultry and selling it on the market." These rumors have not been verified. However it has been known that the country has been trying to expand its poultry industry since 2001 in an effort to increase sources of protein to the population and this has resulted in "scores" of "poultry factories" in the country.

Now South Korean intelligence sources are being cited as believing that the cancellation of the regular session of the Supreme People's Assembly, that had been scheduled for March 9, was postponed because of fears of an avian flu epidemic (Joong Ang Daily):

"With more than 600 delegates from all over the country supposed to gather in Pyongyang for the legislative meeting, there was concern the disease would spread uncontrollably," the [South Korean] Unification Ministry source said. In connection with the Supreme People's Assembly session, North Korean officials usually tour poultry farms, other cooperatives and power plants in and around Pyongyang.

Even more interesting was the report in the same paper that South Korea was aware of the outbreak sometime before rumors surfaced and had imposed secret quarantine measures.

Following the indications that North Korea was facing a bird flu outbreak, Seoul quietly began quarantine measures. The 400,000 tons of chicken meat, scheduled to be imported from the North on March 11, was stopped, and incoming travelers from the Kaesong industrial complex and the Mount Kumgang resort were given thorough health checks at the border.

"Because the North would possibly get upset, we had to carry out the measures secretly," Rhee Bong-jo, vice minister of unification, said.

This is just one more example of the complex interaction between politics, social conditions and the natural environment. Fortunately most of the time the stars don't line up just right. But sometimes they do.

If a tree doesn't fall in the forest . . .

A new national opinion poll conducted in Canada estimates that 36% of Canadians feel authorities are exaggerating the risk from bird flu in order to encourage people to take precautions. Yes, really. Sixty percent are not very worried or aren't worried at all. But two thirds are aware of the issue.

"These numbers say that they're not sure yet what they should do or how worried they should be," [poller Bruce] Anderson said in an interview.

American risk communication expert Peter Sandman was surprised by the results.

"There are ways to prepare -- but so far I don't think the government has asked people to do anything at all," says Sandman, who consults with the WHO and other agencies.

"Far from exaggerating, I think the government is actually understating the risk--the worst cases the experts are considering are far worse than the public announcements tend to imply."

I don't find the results at all surprising, however. People have enough to do just getting by, in what has become a difficult world. There is only so much you can worry about, especially when worrying doesn't get you anywhere. The only reason why people should worry is if worrying is a spur to productive action. And that can't happen without leadership. And apparently, that can't happen at all.

In one respect Canadians are way ahead of Americans. Sandman nails the reason:

"At least most Canadians know that the Canadian authorities are worried about the pandemic possibility. Most of the U.S. public still thinks bird flu is a Southeast Asian problem. They haven't quite reached the stage of doubting their government's warnings; they're not yet hearing the warnings."

Here's a riddle: If a tree doesn't all in the forest but everyone is there to hear it, does it still make a sound?

"Terri's" budget cuts

The Bush budget proposal of last month continues to amaze. Little noticed in the pre-Schiavo circus days was the complete zeroeing out of the Health Resources and Services Administration (HRSA) Federal Traumatic Brain Injury (TBI) Program. It wasn't a lot of money ($9 million), not even a fourth of the $38 million additional (to $206 million) for the federal sexual abstinence program that demonstrably doesn't work (or even works in reverse). The HRSA TBI Program was chump change. But highly symbolic of priorities.

Doubly damning in that an unusually high proportion of injured Iraq war veterans have some kind of traumatic brain injury.

A growing number of U.S. troops whose body armor helped them survive bomb and rocket attacks are suffering brain damage as a result of the blasts. It's a type of injury some military doctors say has become the signature wound of the Iraq war.

Known as traumatic brain injury, or TBI, the wound is of the sort that many soldiers in previous wars never lived long enough to suffer. The explosions often cause brain damage similar to "shaken-baby syndrome," says Warren Lux, a neurologist at Walter Reed Army Medical Center in Washington.

"You've got great body armor on, and you don't die," says Louis French, a neuropsychologist at Walter Reed. "But there's a whole other set of possible consequences. It's sort of like when they started putting airbags in cars and started seeing all these orthopedic injuries."

The injury is often hard to recognize — for doctors, for families and for the troops themselves. Months after being hurt, many soldiers may look fully recovered, but their brain functions remain labored. "They struggle much more than you think just from talking to them, so there is that sort of hidden quality to it," Lux says. (H. Darr Beiser, USA TODAY)

Physicians at Walter Reed Army Medical Center have surveyed all returning soldiers injured in explosions, vehicle accidents, falls and gunshot wound to the face, neck or head. They found evidence of TBI in 60%. In 2003 there were 437 cases of TBI, with slightly more than half showing permanent brain damage. Results at other military medical centers are similar. The HRSA money is directed to help cash-strapped states prevent traumatic brain injury, improve rehabilitation outcomes through research, strengthen and improve State systems to better serve individuals with traumatic brain injury and their families, and advocate for and protect the rights of individuals with traumatic brain injury and their families. In other words, the kind of programs that help discharged veterans with TBI. Like this person:

In severe cases, victims must relearn how to walk and talk. "It's like being born again, literally," says Sgt. Edward "Ted" Wade, 27, a soldier with the 82nd Airborne Division who lost his right arm and suffered TBI in an explosion last year near Fallujah. Today, he sometimes struggles to formulate a thought, and his eyes blink repeatedly as he concentrates.

They can't spend $9 million for this but they can spend $209 million for abstinence education that doesn't work.

That says it all. What a bunch of miserable hypocrites.

US News on bird flu

We have complained here about the relative lack of attention to the bird flu problem in the American MSM, but there have been some very good articles here and there. The problem is they get lost in the din created by media circuses like the Scott Peterson trial, the Schiavo affair and the Social Security non-crisis. There has been some good reporting but it is lost in the noise. And it will probably stay that way until the Four Horsemen are galloping across the Great Plains.

Anyway.

This week brings some good reporting by US News Senior Correspondent Nancy Shute. It covers the usual material (at least for readers of this site) and also brings to the front issues that need to be grappled with at the local level if a threatened pandemic were to materialize. Things like where will be find the hospital beds? what kinds of things will be closed (what businesse? what schools by whom)? who will deliver food to the supermarket, pump gas, bury the dead (where and in what)?

The doctors are alarmed not because of the number of people that "bird flu" has killed but because the H5N1 virus displays an ominous adaptability and persistence. About 70 percent of those infected so far have died. Since 1997, when the new virus first showed up in chickens and killed six people in Hong Kong, it has spread to birds in eight countries in the region despite repeated efforts to halt it by slaughtering millions of chickens. "The virus has gotten even more widespread," says Klaus Stohr, head of influenza for WHO.

Shute acknowledges that this is not 1918, a time when the cause of the disease that eventually killed an estimated 40 million people worldwide was not even known (it was only identified as a virus in the 1930s). But she correctly points out that despite our ability to make vaccines and antiviral agents, if a pandemic were to strike in the immediate future we would be unprepared. This is not news to readers of this site, but it is good to see an explicit and in-context statement in the MSM:

All this casts harsh light on long-standing weaknesses in the nation's medical defense system, which include an unreliable vaccine supply and insufficient hospital surge capacity. Many hospital emergency rooms are already hard pressed to treat the influx of patients from a normal flu season, let alone a contagion that could send as many as 10 million people to the hospital. And the country's vaccine production capability is woefully inadequate, with only two manufacturers in the market and little financial incentive for other companies to enter. When contamination shut down one company's plant last year, obliterating half the nation's flu vaccine supply, the United States' entire influenza immunization program was thrown into chaos.

This is exactly correct. It puts the lie to the public health establishment's delusion that the influx of biodefense money would somehow "save" public health and rejuvenate its infrastructure. Indeed, as Shute notes, the Bush administration has made things much worse:

Yet the call to arms comes at a time when perpetually lean local health departments have exhausted a few years' worth of federal bioterrorism funding that came their way after 9/11. State budgets are hurting, and the Bush administration proposes cutting funding for the CDC, which is leading much of the nation's antipandemic efforts, by $500 million.

Nor has the endless cycle of needs assessments, draft draft plans, draft plans and no implentation or leadership produced any outcome of use:

The Department of Health and Human Services unveiled a draft national pandemic plan last August; many reviewers said the feds need to be far more explicit, providing state and local governments with priority lists for vaccine distribution and other guidance. HHS is convening panels to revise the plan, with the aim of finishing sometime this summer. "This is one of those rare times when states are saying we really do need some direction and guidance from the feds," says George Hardy, executive director of the Association of State and Territorial Health Officials.

There is much else of interest in Shute's US News report (newstand issue of April 4, 2005). Here is one last sinippet:

Although the 2003 SARS outbreak is estimated to have cost the global economy at least $30 billion, most businesses have yet to consider the cost of a flu pandemic, both in terms of employee absenteeism and disruptions of the global economy. The CDC estimates the economic impact of a pandemic in the United States at between $71 billion and $167 billion, but those numbers don't include disruptions to commerce and society.

Given this scenario, it is amazing that knowledgeable people still don't get the big picture. In a short companion piece antivirals are briefly discussed:

So far, 17 countries are stockpiling Tamiflu, but lagging countries could end up with too little, too late. Hong Kong has only enough to cover 5 percent of its population. The United States has 293 million people--and 2.3 million treatment courses.

Why delay? "Choosing an arbitrary number is probably not the most efficient way to spend public-health dollars," says physician Ben Schwartz, a science adviser in the National Vaccine Program. Among his concerns is Tamiflu's five-year shelf life: "If we stockpile enormous amounts and the pandemic doesn't occur within that time the drug would be worthless."

If a pandemic were to arrive this year or next, relying on antivirals would be futile as the sole manufacturer does not have the capacity to supply the US, much less the global population. But let's examine the thinking here. The Infectious Disease Society of America called for antivirals to supply half the US population, roughly 150 million people, or sixty times the current stockpile for ten days or 240 times the current stockpile for 6 weeks, the recommended time for prophylaxis in the case of an outbreak. At approximately $300/six week course that's quite a lot of money: about $45 billion dollars to keep in reserve for five years. That's an insurance policy of $9 billion/year, or about 2 months costs of the Iraq debacle per year. And the costs of not having it?

"We've never suffered an event of such magnitude that it shuts down the global economy," says infectious-disease specialist [Michael] Osterholm [of CIDRAP]. "In 1918 we were much more self-sufficient."

We'll have to become self-sufficient again because there is no leadership at the national level. Time to roll up our sleeves at the local level, which is where the action will be anyway.

[NB: I have corrected an earlier arithmetic error that was posted briefly earlier this morning]

I want a Frist opinion

If you can't afford health insurance--or even it you can--there is now a new resource open to you. The Dr. Bill TeleDiagnosis Service, courtesy the US Senate. Senate Majority Leader Bill Frist launched the service this week, speaking from the Senate floor. Its first patient was Terri Schiavo, who, Dr. Bill opined ("more as a physician than as a US senator") had not been definitely diagnosed because there was "insufficient information to conclude that Terri Schiavo is in a persistent vegetative state." Dr. Bill used digital imaging--in this case a years old video of the patient--to reach his professional opinion.

Announcement of the new service came from Michael Bassik who is brokering the system at the technology oriented Personal Democracy Forum. Here are the details, as Bassik revealed them:

Take a digital picture or video of your medical problem – tennis elbow, acne, runny nose, hemorrhoids, or whatever ails you - and send it to the doctor in charge of the US Senate and your health care.

Everyone, take two minutes and upload your photos to Flickr.com [register first if you aren't a member; it's free]. "Tag" the photo "Frist." If we get critical mass, we'll send everyone's photos to Dean Rosen, the good doctor's Health Care policy director!

My hat's off to Dr. Bill. I've been a doctor for almost four decades but I can't make a diagnosis from a fuzzy video image. I guess I learned before we had that kind of fancy technology.

Quang Binh status still unclear

A story from Bloomberg News Service (reported by Jason Folkmanis in Ho Chi Minh City) provides the most detailed information to date on the situation in Quang Binh. The story broke Monday (March 21, although Bloomberg records it as March 23) when a local newspaper, Nguoi Lao Dong, reported 195 people in the province suffering flu-like symptoms. The story was picked up by Thanh Nien News and posted on the net (see our posts here and here). There had already been several cases of H5N1 in the province, so this report sounded alarm bells.

According to Bloomberg, the figure was based on a household survey asking for the number of people feeling ill, rather than on a medical assessment of each person. A follow-up investigation by "local health officials" brought the 195 number down to 24 with flu-like symptoms. The drop from 195 to 24 is substantial, but even if accurate, is rather a large number of simultaneous cases. The report now says the figure of 24 has been reduced to 7 people with temperatures above 38 degrees Celsius (100.4 degrees F.). This criterion neither rules in nor rules out influenza infection, but selects the more seriously ill for further investigation.

Characteristically, WHO is playing down the seriousness of the situation:

"The whole thing seems to be shrinking,'' said Hans Troedsson, WHO's chief representative in Vietnam, in a telephone interview yesterday. "But we still need to get this verified and confirmed officially. We are still waiting for the conclusions in the reports from the investigating teams.''

[snip]

"We don't have enough information to make any certain statements about whether there's anything significant happening in Quang Binh or not,'' said Peter Horby, an epidemiologist with WHO in Hanoi. "Our information is that the numbers reported in the local press are very exaggerated, but we don't know the number of people with significant symptoms.''

So they have no idea, but they are relying on reports from local health officials that it's not likely anything significant to reassure us. Unfortunately accurate information, one way or another, seems difficult to obtain from "local officials":

Meanwhile, a local health official said that there are about 200 people in the commune suffering from flu, 120 of them in the village.

Nguyen Tang Ba, an official of the Centre for Hygiene and Epidemic Prevention, said it’s difficult to contact the communal health centre because they lack money for telephone service. The centre sent seven workers to the commune, but they lack resources to stem an outbreak.

Ba said no one here wants to be moved to the district or provincial hospital because they will lose their livelihoods. However, Local residents are already having difficulty selling their agricultural products because buyers worry about catching the bird flu. (Vietnam News Agency)

Agence France Presse (via Vietnam Tribune) reported on Thursday that all test samples submitted so far are "negative," although other tests were being done, exact number and nature unclear. All this tells us is that whatever tests have been done on whatever kind of samples and of whatever number have so far not come up with anything.

There are clearly significant obstacles to getting information and incentives and disincentives to report. It doesn't sound as if we should place much confidence, one way or another, on the basis of what we know from this. Why WHO feels the constant need to minimize public concern when it has insufficient basis to do so is beyond me. Apparently they don't understand they are wasting one of their most precious resources: credibility.

Something they're going to need it when it counts.

Menu tip: meatpacking is dangerous work

This is the story of a diner in Santa Clara, California, who took a spoonful of chile at a Wendy's restaurant and found she was eating the tip of a human finger. She immediately spit it out, warned the other diners, and threw up. Santa Clara County Health officer Dr. Martin Fenstersheib sought to reassure her:

[Fenstersheib] said the finger had been cooked at a high enough temperature to kill any viruses, including hepatitis or HIV, and it was unlikely that she will suffer any health effects from her experience, aside from psychological trauma.

The finger was described by Santa Clara County Medical Examiner Dr. Joseph P. O'Hara as cooked but not decomposed. The finger was found in two pieces, a one and three-eighths inch long fingertip complete with the skin whorls used in fingerprinting, and a half-inch long piece of fingernail. The joint appeared to have been torn off, possibly by manufacturing machinery, rather than cleanly cut. Because of its slightly longer than average length and neat grooming, it may have belonged to a woman, O'Hara said. (SFGate)

Since all restaurant employees had a complete set of intact digits, the assumption was that the finger tip had entered the food chain during "the manufacturing process." Which is the point of this post.

If you read Upton Sinclair's The Jungle in highschool you have a pretty fair idea of the extremely dangerous workplaces slaughterhouse and meatpacking workers endured a hundred years ago. If you read Eric Schlosser's Fast Food Nation you also know things have changed little in today's industrial killing machine we call the meatpacking industry. Packing houses are still incredibly dangerous places to work.

And now you also know that somewhere there is a worker in one of these meatpacking houses missing the end of one of her fingers.

Bird flu recap

On Sunday Thanh Nien News reported 195 people had flu symptoms in the same commune in Quang Binh province where the care-giver aunt and 5 year old brother of a 13 year old girl who reportedly died of bird flu on March 9 were also reported ill. The brother had already been shown to have H5N1 infection. The aunt developed a fever after caring for the girl but now appears to be better. In addition, a 41 year old male was admitted to the Hue hospital on March 21 after suffering high fever during the previous week. However there are also reports that a 41 year old male from the same commune (Chau Hoa) walked out of the hospital and was being sought by authorities (Reuters). It is not clear if this is the same individual. Today Thanh Nien News reported a 16 month old from Quang Binh was admitted to Hue Central Hospital Tuesday. But the deputy director of the hospital is quoted as saying the toddler no longer has a fever and no symptoms of flu were evident (AFP). Finally, a woman from another commune was reported to have a light fever and breathing difficulty and was being monitored at home.

WHO and Vietnamese authorities despatched a team to Quang Binh to investigate. As yet we don't know the results. AFP reported today from Hanoi that

The first bird flu tests carried out on several inhabitants of a village where residents reported an epidemic were all negative, a doctor in central Vietnam said.

Chau Hoa commune in central Quang Binh province, 400 kilometres (248 miles) south of Hanoi, is under scrutiny after local people reported a flu epidemic. A five-year-old boy there tested positive for bird flu last week.

"All tests on samples sent from Quang Binh province are negative," said Bui Trong Chien, deputy director of Pasteur Institute in the coastal city of Nha Trang, 500 kilometres north of Ho Chi Minh City.

"We are still making other tests," he said Thursday. The exact number of tests was unclear but he said both sick patients and residents without symptoms were examined.

[snip]

[O]n Thursday Peter Horby, a WHO epidemiologist in the capital, Hanoi, said there was "no serious information so far to substantiate media reports."

On the other hand, The Sun (UK) reports that nine people in Quang Binh have reported symptoms and a total of 30 samples were taken from villagers in the province. Yet Reuters reports that

In hardest-hit Vietnam, where 34 Vietnamese have died, health inspectors found 37 people with fever in Chau Hoa commune in the central province of Quang Binh, where the 5-year-old boy tested positive for bird flu nearly 2 weeks ago.

"We don't see anyone in serious condition and nobody shows clinical symptoms that need medical intervention," said senior provincial health official Truong Dinh Dinh, disputing state media reports that up to 200 people had flu-like symptoms.

He said samples taken from residents, chickens, flies and the water supply would be tested for bird flu.

Finally, today Thanh Nien reports:

Currently, over 190 residents of the commune have a common flu. Bird flu outbreaks were spotted in the area in early February.

To deal with the situation, Vietnam has sent more health and veterinary officials to probe into suspected cases and work out concrete preventive measures. Over 1,000 fowls in the commune have been culled.

Thus the reporting is confusing, if not contradictory. It is becoming even more difficult to keep all the cases (confirmed and unconfirmed) straight.

Meanwhile, the death of a 28 year old Cambodian man is being widely reported (see, for example, AFP via ABC [Australia]). He came from the same area, bordering Vietnam, as Cambodia's first victim, a woman who crossed the border and died in a Vietnamese hospital last month. The victim was a business man who traveled frequently to Vietnam. Recently 400 to 500 chickens and ducks had died in his village, although it was unknown if he had any contact with poultry in Cambodia or Vietnam. Eight contacts of the victim had been "tested" for bird flu and "cleared."

Thus, Quang Binh is still under investigation and there are contradictory reports as to the number of people affected there. Additional cases in Quang Binh are suspected. A Cambodian man has become the second reported death from that country.

Again, the bottom line is there is nothing particularly reassuring in the news. On the contrary, to use one of Henry Niman's stock phrases over at Recombinomics, there is still "cause for concern."

The shoe is still on the other foot

Hong Kong certainly seems to be taking the situation in Vietnam seriously, and in particular the possibility of a flu outbreak in Quang Binh. Hong Kong authorities have set up a telephone hotline for travelers to Vietnam who feel unwell after visiting, have established a special liaison with WHO and the Vietnamese Consulate in Hong Kong to get the latest information and are setting up temperature screening at the airport with informational leaflets on all in-bound flights from Vietnam.

The Quang Binh story appears to have precipitated tougher measures (via The Standard [HK]):

"Up to [Wednesday] morning, the WHO tells us they are still investigating the reported outbreak,'' [Dr. Thomas] Tsang said. ``The situation in Vietnam is changing fast but if the WHO confirms that bird flu is being transmitted from humans to humans, we do not rule out endorsing further measures, including issuing a travel warning.''

Asked if people from Vietnam will be banned from entering Hong Kong, or have to go through compulsory health checks before being allowed to enter should there be a confirmed bird flu pandemic in the country, Tsang said the government "does not rule out taking further measures.''

Tsang is a consultant to the Centre for Health Protection. He noted Hong Kong is just entering peak flu season, and unlike last year when most strains were H3N2, this year they are seeing a mixture of H3N2, H1N1 and influenza B virus. Reports from public clinics of influenza-like illness were up 78% from the previous week. Tsang said Taiwan and Japan were also seeing a high number of flu cases.

Meanwhile, reports from Cambodia and Vietnam indicate that the H5N1 strain may be changing once again. We will follow up with a summary shortly. So while we wait for the other shoe to drop with bird flu, the "garden variety" viruses are still with us, causing serious illness and death in Asia, and co-circulating with H5N1, with the obvious increase in chances for reassortment and recombination.

Preparing for a pandemic: GMAFB

In a companion post (here) we drew up a quick "To Do" list for preparing for a pandemic on a local level (the only level that counts for preparation). It is interesting to compare this to the "immediate action" items proposed by the Infectious Diseases Society of America (IDSA) this week, as reported in Medical News Today:

Immediate action is needed to prepare the United States for a deadly pandemic of influenza, the Infectious Diseases Society of America (IDSA) is telling policymakers.

In meetings with congressional and administration leaders, IDSA has explained that the H5N1 “bird flu” spreading in Asia has the potential to develop into a pandemic like the one that claimed more than half a million American lives in 1918. Even if this strain does not emerge as a pandemic, infectious disease experts agree that another flu pandemic is just around the corner. The U.S. Centers for Disease Control and Prevention (CDC) predicts even a “mild” pandemic could kill at least 100,000 people if the nation is not prepared.

“This year's serious problems with flu vaccine supply showed us just how unprepared we are,” says Andrew T. Pavia, chair of IDSA's Pandemic Influenza Task Force. “If this had been a pandemic year, we would have been in serious trouble. Now is the time to fix these problems and develop the ability to respond, before the pandemic strikes.”

Good start. Let's look at IDSA's "seven steps to prepare for a flu pandemic" (my comments indented and small text):

1. Secure vaccine and antiviral supplies. Enough vaccine and antivirals need to be in place before a pandemic strikes, as well as a plan to distribute them. IDSA is calling for a stockpile of antiviral drugs that is adequate to treat at least 50 percent of the U.S. population.

This seems infeasible if you don't have a vaccine and won't have one until you know the nature of the pandemic strain. Nor is there the vaccine capacity in the US for this. The same goes for antivirals. This recommendation calls for 150 million courses. It is estimated that there are only 6 million courses in the US currently and we are competing with the rest of the world for the very limited production capacity of a single company (Roche in Switzerland). Unless there is an immediate move to make production license free and allow any company in the world to produce it, the cost is prohibitive at Roche's prices (~$75/10 day course of treatment or $300 for 6 week prophylaxis). Worse, if the US were to buy up the supply at that price there would be nothing left for the rest of the world. There is also no infrastructure for delivering them in the "pay for play" US health care system.

2. Strengthen liability protections during emergency outbreak response. In case of a declared influenza emergency, it will be vital to immunize and treat large numbers of people. Even rare adverse reactions associated with a therapy would become more common when millions are treated. Health care workers and medical facilities administering emergency therapeutics, as well as the companies that make them, should be protected from lawsuits stemming from these adverse events so long as they follow standard medical and manufacturing procedures. A fund should be established to cover the medical costs and lost earnings of anyone who develops complications due to vaccination or treatment.

Why do we always socialize the losses and keep the profits private? Let's socialize both the losses and the profits. I'm sick of hearing about "liability" barriers. How about "affordability barriers" for a change?

3. Require health care workers to be vaccinated. Unfortunately, health care workers caring for sick people often spread patients' infections. To prevent unnecessary deaths and disease, an annual flu vaccination should be mandatory for all health care workers who have contact with patients.

Vaccinated with what? There is no H5N1 vaccine at the moment. The question of priority for antivirals is important and is raised in my post.

4. Strengthen education. Health care workers and the public need to better understand the seriousness and potential impact of an influenza pandemic, as well as how to prevent and treat it.

You might start by educating our public health non-leaders. Education is always good. Yawn.

5. Create financial incentives. Most pharmaceutical companies have left the vaccine business because demand is extremely unpredictable. Even this season, after starting out with a shortage, millions of doses of flu vaccine will likely be thrown away. To secure vaccine supplies for the future, the government needs to guarantee it will buy a set amount of vaccine each season, and buy back a percentage of unsold vaccine at the end of the season.

Also, the United States does not have the manufacturing capacity to produce enough vaccine and antivirals to meet its needs in a pandemic. Tax credits should be offered to encourage companies to build new manufacturing facilities in this country so that the United States is not dependent on foreign suppliers. Tax incentives and patent extensions should be available for companies that research and develop new anti-flu therapies.

See number 2, above. If the pharmaceutical companies don't find this profitable, that's their choice. Let's produce this with public monies and public production facilities.

6. Strengthen federal agencies' responses. The Food and Drug Administration should “fast-track” vaccine and antiviral review, and streamline regulation of the manufacturing process. Congress should increase CDC's budget for global surveillance to detect influenza strains with pandemic potential. The U.S. Department of Agriculture should develop a plan for culling poultry or other livestock and compensating farmers in the event of a pandemic, if necessary.

How about strengthening the backbone of our public agencies?

7. Improve coordination, communication, and planning. The Department of Health and Human Services should develop a detailed plan to coordinate pandemic response at all levels, from local to national to international, including links between federal authorities and clinicians throughout the country.

Yawn. There have been many draft plans, needs assessments, efforts to improve communication, etc., etc. The sound of spinning wheels is deafening.

"IDSA is working with congressional leaders to integrate these recommendations into bio-preparedness legislation now being considered on Capitol Hill. The Society is working to achieve bipartisan support for this effort."

My (unprofessionally phrased) response? Give me a Fucking Break! (GMAFB)

Pandemic "To Do" list: some initial thoughts

If there isn't a pandemic this year, there will be one at some point. So I started to make a To Do list of things we need to think about in preparation. I don't mean a "Pandemic Influenza Plan." I mean a To Do list. Consider this "shark bait" to be torn to pieces by wiser minds.

I'll start it off. Feel free to add/correct/delete things that will need to be done. Then we can set about trying to get someone to start doing them in our local communties. For if there is a pandemic, it will be everywhere and have to be fought at the local level--everywhere. This is not a situation where "federal stockpiles" can be rushed to the scene of a disaster. "The scene of the disaster" will be everywhere.

1. The rationing problem

Whenever it happens, I will be very surprised if we have enough of most of the things we'll need. So we have to think of an ethical, humane and pragmatic plan to ration antivirals, vaccines (if they exist), etc.

Some questions: Who gets what first? Who gets what at all? Some possibilities:

• Essential services such as health care workers (which ones?), public safety, transportation, communications, ?
• Highest risk or those where intervention might stop the epidemic fastest (e.g., the elderly or healthy young adults/children).
• Lottery?
• Market forces (highest bidder)? (I should hope not, but you know this question will arise)
• Citizenship status? (I should hope not, but you know this question will arise)

And some way to assure the security of scarce supplies to prevent them from being looted or diverted into a black market.

Obviously we all have views about how to do some of this, but we need some kind of mechanism to think this through together and debate it in our local communities, assuming we have the luxury of a little time (of course, if the immediate threat recedes, we'll probably waste the time handed to us).

2. The care-giving problem

There aren't enough hospital beds for even a moderately bad epidemic. In many big cities emergency rooms are frequently on "diversion" (they send cases to other hospitals) already. In an epidemic we will have to make use of alternatives.

Some possibilities: hotel and motel beds (every room has a bathroom); increased use of Visiting Nurse assistance to keep very ill people at home.

The nursing problem will be particularly important. Hospitals beds that aren't staffed are essentially worthless. But if 25% of the workforce is sick there will be an acute shortage of nursing care. Some alternatives: organizing retired nurses, trained volunteers (requires a training program, of course), etc. This would require rosters, a way to contact people and some means to assure minimal skill level, perhaps on a tiered basis.

Mortuary space, enough caskets, burial arrangements, grief counseling. We need to organize the funeral homes.

3. Equipment

There are probably not enough respirators to handle the huge increase in adult cases that would need them, and certainly not enough pediatric respirators to handle a disease with a proclivity for the young. Do we even have an idea of how big the shortfall is? Do we have any inventories that would allow a local area to re-distribute them according to need?

What other critical equipment problems do people foresee?

This is just a start and meant only to get people thinking about what needs to be done and how it might be accomplished. All of these things can be done without huge resources and done locally. I'd love to hear about folks getting some of them started.

Obviously a strong and vigorous public health infrastructure would be the best solution, although a pandemic would stress even the strongest system. But we don't have a strong and vigorous infrastructure and neither this Administration nor our public health non-leadership is securing us one. Indeed, our public health infrastructure is going right down the toilet. Maybe addressing this important task can help jump start a re-invigoration of public health from the ground up. At the moment, that seems to be the only place it can come from.

Tangled Bank #24 is up

Tangled Bank #24 is up, hosted by Syafolee. For those not familiar with Tangled Bank, it is a weblog "Carnival" or compendium that selects submitted links from around the net, in the case of TB, the best articles in science and medicine, very broadly defined. Effect Measure is represented via its "How oseltamivir works" post, but there is much else of interest there, including a good primer on influenza virus and how vaccines are produced in eggs over at Living the Scientific Life. There are a couple of more flu posts on that site. There is also much else of interest up at TB for the scientific omnivore, so check it out.

Quang Binh: earning trust

According to Agence France Presse, WHO's Hans Troedsson has said "[t]he (200 people) figure [for people with symptoms of bird flu in Quang Binh] seems to be very exaggerated. We have discovered very few sick people so far after examining seven families."

This should remind us that responding to news of disease outbreaks or clusters is rarely straightforward. In my experience as an epidemiologist who has looked into many cancer clusters over decades, the first step when responding to a report of a cluster is the most important: first, verify the diagnosis. That works fine for chronic diseases like cancer. It is still important but tougher to implement for an infectious disease like influenza that evolves and may spread even as verification is taking place.

AFP reports that verification is underway:

World Health Organization representative Hans Troedsson said the cases "needed to be rapidly and thoroughly investigated."

"We have asked for an urgent meeting with the Ministry of Health," he said. "We could send a team from abroad at very short notice."

Pham Sinh Quyet, an official from the provincial health department, said a local team was sent to the commune on Saturday.

How soon can we expect some information? Past experience is not encouraging. WHO's record of keeping the world informed is spotty. The result is that unverified information rushes in to fill the information vacuum reticence produces.

One of the things we hear most often from public health authorities concerning bird flu is "there is no reason to panic." This reveals a mistaken attitude toward the general public. Yes, it is true many people keeping track of this situation are extremely anxious about it. But the source of their anxiety is not hard to find: good reasons to be anxious. But the readers of this site and the other sites aren't panicked any more than public health authorities, who are also anxious about bird flu, are panicked. Those who are paying attention want and need accurate and timely information. Panic comes from uncertainty. Uncertainty is fed when trust is lost in what public health authorities are saying.

I hope we will see the results of the Quang Binh investigation made public soon. Very soon.

Correction (3/22/05, 7 pm EST): Henry Niman (via Comments) points out an error in this post. The statement that the number of symptomatic individuals was "exaggerated" was not made by WHO's Hans Troedsson but by Pham Sinh Quyet, an official from the provincial health department. We apologize for the error and thank Dr. Niman for pointing it out.

Pulling the plug on Agent Orange

When Federal judge Jack B. Weinstein dismissed the lawsuit against the 37 chemical companies that supplied the US military with the dioxin contaminated herbicide Agent Orange, the news was little noticed in the US. In a day it was submerged under the outrage du jour. But in Vietnam it didn't just fade away. The Vietnam News agency describes how the news was received there:

A farmer whose village was fiercely destroyed by US troops dropped his fork over dinner and gaped at the television as the US court dismissed the lawsuit filed by Vietnamese victims of Agent Orange (AO/Dioxin).

Huynh Ky is a victim of AO/Dioxin and has fathered four disabled children in An Xuan Village of Tam Ky Commune in Quang Nam Province. Three of his four children were born with mental disabilities.

"The criminals have turned their back on my children," the farmer angrily argued, saying he often watched the lawsuit process on television and wanted the US chemical companies (administration) to take responsibility for his condition and that of his children and all of the Vietnamese suffering from the effects of AO/Dioxin.

[snip]

"It is an unjust verdict," said Vo Sy Kieu of HCM City. Kieu, 60, is a father of an 18-year-old boy who is paralysed and mentally disabled. Kieu was in the army and fought in the Quang Tri Battle of 1968, which was hit hard with AO/Dioxin.

"They reject their crimes and fail to claim responsibility in fear of scrutiny and condemnation of Americans and the international community," he said.

Weinstein ruled there was insufficient evidence that dioxin exposure was linked to the damages claimed by the Vietnamese, although he also cited broad legal grounds as a basis for his decision. The US government has never accepted the link, although they compensate US veterans for many of the same injuries.

Not surprisingly, the government seems uninterested in resolving the scientific issue. Last week they cancelled a major study of the health effects of Agent Orange in Vietnam (New Scientist):

Under a 2003 US-Vietnam agreement, the study would have looked at the health effects of the dioxin TCDD, with which Agent Orange was contaminated. But the US National Institute of Environmental Health Sciences cancelled the project on 25 February 2005 after "failing to receive the necessary cooperation from the Vietnamese government".

Project head David Carpenter, director of the Institute for Health and the Environment at the University of Albany in New York, US, adds that the research "could have been definitive" in a class action brought by Vietnamese plaintiffs against US manufacturers of Agent Orange, including Monsanto and Dow Chemicals. Carpenter says the ongoing legal action would have "increased the reluctance of the US government to fund this project".

The cynicism of this takes one's breath away.

More on Quang Binh

Thanh Nien News now says authorities in the central Vietnamese province of Quang Binh were unaware of an outbreak, possibly involving hundreds of residents in Chau Hoa commune, until the newspaper reported it. The nature of the outbreak is still unclear except to be characterized as "symptoms of bird flu." Two children from the commune were reported to have tested positive for H5N1, one of whom, a 13 year old girl has died at Dong Hoi Hospital on March 9. The newspaper says the hospital never reported the case to provincial leaders. Commune residents were also said to have continued "to eat dead chickens" (sic) throughout the Tet holidays in mid February while mass culling was going on in other parts of the country. It sounds like the finger pointing has started in earnest.

Vietnamese authorities have apparently recognized the potential seriousness of this situation:

An interagency task force has now arrived at the commune to take immediate necessary actions to stabilize the situation and fend off the spread of the epidemic, a Thanh Nien source said.

Tests are being carried out with all 195 suspected patients to determine whether they are infected with bird flu.

Meanwhile, patients with unusual symptoms have been transferred to a special hospital in the central city of Hue for quarantine treatment.

It seems strange that a small quasi-official newspaper should be the main source of information about this worrying situation.

Homeland Security: a political autoimmune disease

Wow, talk about nailing it. This from Sandia National Laboratories (via Science Bl0g):

Anticipating attacks from terrorists, and hardening potential targets against them, is a wearying and expensive business that could be made simpler through a broader view of the opponents' origins, fears, and ultimate objectives, according to studies by the Advanced Concepts Group (ACG) of Sandia National Laboratories. "Right now, there are way too many targets considered and way too many ways to attack them," says ACG's Curtis Johnson. "Any thinking person can spin up enemies, threats, and locations it takes billions [of dollars] to fix."

That U.S. response is actually part of the war plan of our opponents, points out ACG vice president and Sandia Principal Scientist Gerry Yonas. Yonas reports that an al Quaeda strategy document signed by Shiekh Naji, dated September 2004, reads: "Force the enemy to guard every building, train station, and street in order to plant fear in their hearts and convince Muslims to join and die as martyrs instead of dying as infidels."

Osama bin Laden put it in this way, according to Yonas: "We are continuing . . . to make America bleed profusely to the point of bankruptcy . . ."

There is also a lot of dangerous horse crap from the Sandia guys (" 'Suppose every PDA had a sensor on it,' suggests ACG researcher Laura McNamara. 'We would achieve decentralized surveillance.' These sensors could report by radio frequency to a central computer any signal from contraband biological, chemical, or nuclear material." Lovely.) But what do you expect from scientists called the Advanced Concepts Group ("a technical think tank that influences the direction of long-term research at Sandia, a National Nuclear Security Administration laboratory")? Let's stay with the obvious.

You can't harden every target or even any but a miniscule number of targets. Anybody with more than a neuron or two firing can think of ways to attack the soft targets all around us with easily obtainable materials or products (like assault rifles). Yet except for 9-11 the only such attacks so far are from "homegrown" terrorists like Timothy McVeigh, the Unabomber, anti-abortion assassins like Eric Rudolph or the as yet unknown anthrax attacker who almost certainly came from within the bioweapons establishment itself.

What that says is there aren't many, if there are any, al-Qaeda type terrorists in this country. And as the Sandia analysts point out, why should there be? They are getting everything they want without lifting a finger. And they aren't stupid enough to think they can actually attain the objective of bringing the society down from terror attacks.

Autoimmune disease occurs when the body's defense mechanisms turn against its own tissues, as in rheumatoid arthritis or lupus. Homeland Security is a political autoimmune disease.

Teflon and ACSH: truth-proof

Headline of a Medical World News story: "Teflon-Production Chemical Does Not Pose Health Risk to General Population, Science Panel Finds." Unfortunately the "science" panel involved are the hacks from the American Council on Science and Health and they bear as much relation to a real science panel as particle board does to wood. Cheap sawdust for principles held together with a noxious cement (money).

EPA's Science Advisory Board, a real science panel, recently reviewed the same subject. Their report has not been issued yet, but judging from comments made at the public hearing by panel members, it is unlikely to ratify the ACSH's judgment that the chemical at issue, perfluorooctanoic acid (PFOA), is absolutely harmless.

ACSH, a notorious industry whorehouse, regularly puts out "don't worry, be happy" stories for their corporate johns. They are the subject of an earlier post here that the real health hazard in New York City is bicyclists. Enough said.

For more (and more reliable) info on PFOA, visit the Environmental Working Group site.

Very worrying bird flu report

Henry Niman at Recombinomics saw it first and posted it this morning. I saw it shortly afterward on the Thanhnien news site. As far as I can make out, it was posted there about 8:30 am EST. So far there are no other reports or confirmation. Thanhnien News is a publication of the Vietnam National Youth Federation and has tended to minimize bird flu news (this is the source that earlier reported the second nurse from the Thai Binh cluster had "tested negative").

Thus the Thanhnien story this morning that a top provincial official has reported a commune in central Vietnam with 195 patients with symptoms and two confirmed H5N1 infections is extremely unsettling. As the story states, it is not clear if the symptoms are from bird flu, the "usual" human strains (H3N2, H1N1 or influenza B) or some other respiratory malady.

Here is the full report from Thanhnien:

Bird flu hits central province, 195 locals show symptoms

A commune in central Vietnam has been severely hit by the bird flu, with 195 patients showing symptoms and two children testing positive with the virus, reported a top provincial official.

Two siblings from the province’s Chau Hoa commune of Quang Binh province had tested positive for the H5N1 strain of bird flu, said Mai Xuan Thu, vice chairman of the provincial People’s Committee on March 20.

The older sister, Hoang Lan Huong, 13, died from the bird flu on March 9, while the brother, Hoang Trong Duong, 5, is in serious condition at the Hue Central Hospital.

Meanwhile, there are 195 other local residents who have shown symptoms of the flu, said Ms. Thu.

It is not yet clear whether these people, some of who had reportedly eaten sick chickens, have the symptoms of the deadly bird flu or the normal flu.

Of the 195 patients showing symptoms, 108 are from Kinh Chau village while the rest live in other villages in Chau Hoa commune.

The outbreak hit the province’s Kinh Chau village in Chau Hoa commune just ahead of the Lunar New Year holidays which started Feb. 9.

The province is currently trying to stop the spread of the influenza by culling all poultry in the commune.

More details as they become available. With any luck we will report this is a false alarm. However, this is one way we would expect the story to unfold if it were the real thing.

Abstinence education: tough love

While Bush's budget claims to cut "programs that don't work," it rewards at least one program that really doesn't work. Which one is that?

The one that peddles sexual abstinence to teenagers. The one that lies to them that condoms don't prevent sexually transmitted diseases or prevent pregnancy. The one that purveys false information on the risks of abortion and portrays blatant sexist stereotypes. The one that numerous studies has shown is ineffective and a waste of money (Reuters Health):

In one of the latest, conducted by researchers in Bush's home state of Texas and released last month, teenagers in 29 high schools became increasingly sexually active after taking such courses, mirroring overall state trends.

The one that eliminates accurate sex education about contraception and reproductive options:

[Michael McGee of Planned Parenthood] said the abstinence-only movement had had a chilling effect on U.S. classrooms, forcing teachers to stop mentioning contraception in health classes even when the curriculum requires them to do so.

The one that drops all pretense to provide a balance:

"Our program started 11 years ago out of grassroots concern that students were only hearing safe sex messages and didn't even realize that abstinence was an option," [Jimmy Hester, coordinator of True Love Waits, sponsored by Lifeway Christian Resources, a Nashville-based publishing group] said.

Including information about contraception and safe sex just "waters down the message," [Hester] said.

The one that gets an increase in funding from $39 million to $206 million in Bush's budget.

That one.

Rachel Corrie, 1979 - 2003: in memoriam

Rachel Corrie, 1979 - 2003
Originally uploaded by Revere.

From The Dominion blog of March 17:

Two years ago today, Rachel Corrie, a 23-year old American volunteer with the International Solidarity Movement, was crushed to death by an Israeli Defence Force bulldozer as she sought to prevent it from demolishing the home of a Palestinian doctor. Her family's efforts to find justice have so far been unsucessful, and her story now all but forgotten by the mainstream media.

To honour her memory, please take a moment to read the writings of, and about, this woman who died for her conviction that we all have a responsibility to stop preventable injustices, and who thought her body and her passport would be enough to stop a man in a bulldozer from going forward.

Rachel Corrie Memorial

Rachel's letters home (which were published in both the Guardian and the Globe and Mail):

The International Solidarity Movement

Background on Palestine, Israel and the Arab-Israeli Conflict

And from a letter to the International Herald Tribune on the first anniversary of Rachel Corrie's death from her cousin, Elizabeth Corrie:

Rachel was run over by a Caterpillar bulldozer, manufactured in the United States and sent to Israel as part of the regular U.S. aid package to Israel, which amounts to $3 billion to $4 billion annually, all of it from U.S. taxpayers. The use of Caterpillar bulldozers to destroy civilian homes, not to mention to run over unarmed human rights activists, violates U.S. law, including the U.S. Arms Export Control Act, which prohibits the use of military aid against civilians.

. . . residents and citizens of the United States should ask themselves how it is that an unarmed U.S. citizen can be killed with impunity by a soldier from an allied nation receiving massive U.S. aid, using a product manufactured in the United States by a U.S. corporation and paid for with U.S. tax dollars. When three Americans were killed, presumably by Palestinians, in an explosion on Oct. 15, 2003, as they traveled through Gaza, the FBI came within 24 hours to investigate the deaths. After one year, neither the FBI nor any other U.S.-led team has done anything to investigate the death of an American killed by an Israeli.

Congress responds to gun violence

Congress is responding to the news of the shooting of a judge, a court reporter and two others in Atlanta; the shooting of a judge's family in Chicago; and the shooting of seven people at a church gathering in Wisconsin. They are going to immunize gun makers from lawsuits. (Newsday)

The mastermind behind this is Sen. Larry Craig (R, Idaho):

Craig had the 60 votes last year to ensure the bill's passage, but Democrats succeeded in persuading a few Republicans to help them attach a renewal of the assault weapons ban onto the legislation. Republicans -- at the NRA's urging -- then killed the legislation.

The NRA's political action committee spent hundreds of thousands of dollars on ads, postcards and other publicity calling for the election of the new GOP senators or the defeat of their Democratic opponents.

For example, the NRA Political Victory Fund spent at least $526,911 in support of Florida's Mel Martinez. Other freshmen benefiting from the gun-rights group's independent spending were North Carolina Sen. Richard Burr, at least $468,376; South Dakota's John Thune, at least $349,120; Jim DeMint of South Carolina, at least $176,833; and Georgia's Johnny Isakson, at least $68,109.

According to Newsday, Craig will bring the legislation to the floor for approval right after Easter recess. Opponents will again try to tie to an assault weapons ban. The bill protects not only gun makers, but ammunition manufacturers, distributors, dealers and importers and bars local authorities or private individuals or groups from bringing cases.

Makes you glad to know congress can respond when the stakes are important. All it took to immunize the gun industry was money.

Maybe next they'll look into to immunizing the public against flu. All they want is a bribe.

Bird flu and labor organizing

A reader sent us this from the International Labor Commuications Association:

One of the largest concentrated groups of unorganized workers in the US is largely ignored by organized labor. This proposal is for a coordinated effort to organize in this key industry.

Organizing the poultry industry would have a significant and immediate impact on the future of the labor movement and would carry national resonance on debates over the rights of workers both to organize and have real enforcement protections from state and federal agencies. Labor can simultaneously increase our membership numbers, strengthen labor's image as the advocate for working people, and increase our relevancy within minority communities.

It should be an embarrassment for Labor that a human rights organization (Human Rights Watch 'Blood, Sweat, and Fear: Workers' Rights in U.S. Meat and Poultry Plants, January 25, 2005) and the GAO (Safety in the Meat and Poultry Industry, While Improving, Could Be Further Strengthened, January 27, 2005) are the only ones speaking out against the systemic abuses in poultry. Those abuses are legion and must be addressed by Labor.

The bird flu situation should remind us that there is an important occupational health and safety issue here for poultry workers. A major population of the poultry workers is in the south. Health and safety, especially if it potentially involves the families and children of workers, is a potent organizing issue, more so than wages. The ergonomic and injury issues of great concern to poultry workers can be strengthened by adding an infectious disease that can be brought home to the list of issues. Organized labor should be alerted to this problem and begin to organize poultry workers around it. (Hat tip: Debbie)

Skeptic's Circle #4

Fourth edition now up. Our Biodefense post is up along with lots of other great stuff from other blogs. Visit early and visit often at Two Percent Company.

Georgia on my mind

Most of you have likely never heard of the Daubert Decision, the 1993 Supreme Court case that instructed federal trial judges to examine scientific evidence for relevance and reliability before allowing it in court. Sounds pretty good, especially as it replaced what was clearly an unscientific criterion, the Frye Rule, requiring evidence to be "generally accepted by the scientific community." Science is not a "majority rules game" and the Frye Rule was out of step with scientific practice. Unfortunately, the way Daubert has been applied has worked out very badly for those who wish to get their Day in Court against powerful and moneyed interests. It has decimated the toxic tort landscape and is now threatening to worm its way into the regulatory arena as well. We have previously discussed this so I won't go into it further.

Instead I want to call attention to a recent Georgia law, billed as "tort reform," that makes Daubert the governing principle in the state's civil cases as well (hat tip to Daubert on the Web, an invaluable source of information on a matter that should be of concern to all scientists).

Among other measures, the legislation now places Georgia squarely in the ranks of the Daubert states, for civil cases. In civil cases, the bill emphasizes Georgia's insistence that its courts "not be viewed as open to expert evidence that would not be admissible in other states."

Criminal cases, however, are another matter. The bill provides: "In criminal cases, the opinions of experts on any question of science, skill, trade, or like questions shall always be admissible; and such opinions may be given on the facts as proved by other witnesses." (The emphasis is ours.)

There has long been a de facto dichotomy in federal court between Daubert's application in criminal cases (fairly licentious) and civil ones (more strict). Perhaps Georgia is to be applauded for its candor in making the difference in standards explicit and official, though some might feel that the distinction should operate in the opposite direction.

What is really unbelievable about this is it that it raises the bar for getting scientific evidence into court to force a defendant to pay money to a victim while at the same time preventing those stricter standards of scientific evidence from being used on behalf of a criminal defendant whose life and liberty are at stake. One would imagine that the burdens would be just the reverse, but not in Georgia. In Georgia a "scientist" can opine on how psychology shows that a person will commit a future violent act and should therefore face the death penalty, or how "fiber analysis" or "footprint" analysis "proves" that someone is guilty (despoite the fact that neither practice has been subjected to scientific scrutiny or test), but not be able to use epidemiology in a courtroom when a well-heeled civil defendant like a chemical company hires some hack to say it isn't good science.

In a related story, the Justice Department has finally decided to find some answers to the Big Cahuna of forensic science, fingerprinting (which of course could not be subject to challenge under Daubert in Georgia, no matter what DOJ research finds about its validity).

The research solicitation [by the National Institute of Justice, DOJ's research arm] seeks to "provide juries with increased information about the significance and weight of fingerprint evidence" and also to create tools "to improve the fingerprint examination process," said Catherine Sanders, spokeswoman for the Office of Justice Programs, which includes the institute.

The agency's decision is the latest example of an unmistakable shift in the previously defiant world of fingerprint experts. Until recently, they had pointed to nearly a century of convictions in U.S. courts to dismiss calls for a closer examination of their discipline.

[snip]

The broader reassessment of fingerprint comparison is largely being driven by a series of high-profile errors committed by examiners, including their role in the wrongful conviction of Stephan Cowans, a Boston man imprisoned for six years after a false match linked him to the shooting of a police sergeant.

A few months after Cowans' release last year, an even more embarrassing mistake occurred when the fingerprint world's elite--examiners at the FBI lab--falsely connected Brandon Mayfield, an Oregon lawyer, to the 2004 train bombings in Madrid through a print found near the scene. (superb reporting by Flynn McRoberts and Steve Mills in The Chicago Tribune)

The use of Daubert in a criminal proceeding in federal court burst on the scene several years ago when it was used to challenge fingerprint testimony in a Philadelphia court. The judge initially granted the Daubert motion. The FBI countered by sending the controverted prints to examiners across the country.

While most examiners agreed with the FBI's conclusion that the defendant's prints matched those found on the getaway car, 17 examiners in nine states were unable to make an identification, underscoring that the discipline is much more subjective than many fingerprint experts have acknowledged.

After receiving the conflicting responses, one of the FBI's top fingerprint experts asked the dissenting examiners to take another look, with the help of some FBI enlargements of the prints in question.

`Test your prior conclusions'

"These enlargements are contained within a clear plastic sleeve that is marked with red dots depicting specific fingerprint characteristics," wrote Stephen Meagher, chief of the FBI lab's latent print unit, in a June 1999 letter. "Please test your prior conclusions against these enlarged photographs with the marked characteristics."

Three months after Meagher's letter, the National Institute of Justice approved a call for research into fingerprinting, only to eventually let it die amid uproar from police and prosecutors.

Meanwhile, in Boston the police are rebuilding their fingerprint unit.

Six years after authorities used a fingerprint match to implicate him in the shooting of a Boston police sergeant, DNA tests excluding Cowans forced them to recheck the print. The re-examination last year revealed that his print wasn't even close to a match of the one found at the crime scene.

Six years into a 35- to 50-year prison sentence, Cowans was released from prison last winter.

Don't worry. This couldn't happen in Georgia.

Bird flu miscellany

This is a miscellany of bird flu items from the last day or two. Most people who read this site are aware of these things as they read other sites. Here is my take.

The Journal of Virology has just published a paper by Nguyen et al. ("Isolation and Characterization of Avian Influenza Viruses, Including Highly Pathogenic H5N1, from Poultry in Live Bird Markets in Hanoi, Vietnam, in 2001," J Virol. 2005 Apr ; 79(7): 4201-12) that examines the genomes of the highly pathogenic poultry viruses circulating in Vietnam in October, 2001. Strains included H5N1, H9N2, H4N6, H5N2 and H9N3, collected from 189 birds and 18 environmental samples in live bird markets in Hanoi. I have only been able to see the abstract so far. Examination of the HA protein on the H5N1 viruses showed them to be similar to H5N1s isolated elsewhere in Asia during this period, suggesting that the viruses came from a common original source. But they were also genetically distinct from H5N1 viruses isolated in early 2004 during the most recent outbreak. Thus either the more recent virus comes from a different source or represents a mutated 2001 virus. The abstract does not indicate the nature of the genetic differences or the authors' interpretation, if any, of this. Meanwhile there is continued fretting over the lack of timely information provided to WHO and the international community by the Vietnamese authorities. New reporting procedures are allegedly in place that will remedy this. We'll see.

The case of the female nurse from the Red River Delta province of Thai Binh, initially thought to have bird flu but then reported as "testing negative," has not been further clarified with any official reports. There is some skepticism about the negative test, as false negatives have been common in Vietnamese testing. This is a matter of considerable importance as it bears on whether the case clusters are increasing in size (the Thai Binh cluster is already four and with this nurse would be five, the largest cluster yet reported).

Thanh Tien News (Vietnam) is now reporting a 5 year old boy from the northern province of Quang Binh hospitalized with fever and pneumonia. His 13 year old sister died 10 days after eating "a dead chicken" (sic) 3 weeks ago. His illness, if of recent onset, is 10 days after that, so human transmission is a distinct possibility. And SABC News (South Africa) reports that a death over the weekend of a male, age not given, is being investigated by Vietnamese authorities as due to bird flu. The patient was from the southern province of Kien Giang, the first death in the south in many weeks. Tissue testing was not complete, so we await further details on this case.

The Vietnamese are also considering poultry vaccinations, something now only done officially by China and Indonesia, although the Thais are planning to do it. There is some controversy about this as vaccination prevents birds from getting sick and probably decreases viral shedding, but also allows infection without visible symptoms, increasing the likelihood that the birds can infect other birds, or possibly people, although the latter has not been shown. to date there is little experience with H5N1 vaccination. There are unconfirmed reports of fresh outbreaks of avian influenza in poultry in North Korea (News24, South Africa) and Indonesia (Irish Examiner). Now South Korea is postponing a planned import of chicken for later this month.

A ministry [of Agriculture and Forestry] official said Tuesday it was waiting for confirmation of rumors that a high-ranking North Korean official who defected to the South spoke of an outbreak of avian influenza in the reclusive country. It asked the Unification Ministry to confirm the validity of the rumours through communication with the North, and failing this, will take preventative measures against the deadly virus, he said.

Thus the disease is firmly entrenched in Asia, providing the ingredients for the kind of genetic shift that emerges periodically as pandemic influenza. The H5N1 strain has already mutated considerably, increased its host range to infect mammals including humans, and is remarkably virulent.

Bottom line: no good news to report.