Wednesday, November 30, 2005

. . . he said to push on

It is disappointing President Bush wasn't persuaded by our advice to announce an immediate, timely withdrawal from Iraq. I tried to post it before his speech, although of course I didn't give him much time, so maybe he didn't get a chance to read us today. But I would have thought Rummy or the Vice would have read it and ordered him to do it.

Since I know how sensitive The Preznit is to musical ideas (I remember the contents of his iPod), I thought I'd remind him of an educational song by Pete Seeger, written in 1963. Pete planned to sing it for the Smothers Brothers Comedy Hour in 1967 but CBS blacklisted him for implying the resident of the White House at the time was a "big fool." Pete finally got to sing it on the show in 1968. Here it is, Mr. Preznit:
Waist Deep In The Big Muddy (.mp3 here)

It was back in nineteen forty-two,
I was a member of a good platoon.
We were on maneuvers in-a Loozianna,
One night by the light of the moon.
The captain told us to ford a river,
That's how it all begun.
We were -- knee deep in the Big Muddy,
But the big fool said to push on.

The Sergeant said, "Sir, are you sure,
This is the best way back to the base?"
"Sergeant, go on! I forded this river
'Bout a mile above this place.
It'll be a little soggy but just keep slogging.
We'll soon be on dry ground."
We were -- waist deep in the Big Muddy
And the big fool said to push on.

The Sergeant said, "Sir, with all this equipment
No man will be able to swim."
"Sergeant, don't be a Nervous Nellie,"
The Captain said to him.
"All we need is a little determination;
Men, follow me, I'll lead on."
We were -- neck deep in the Big Muddy
And the big fool said to push on.

All at once, the moon clouded over,
We heard a gurgling cry.
A few seconds later, the captain's helmet
Was all that floated by.
The Sergeant said, "Turn around men!
I'm in charge from now on."
And we just made it out of the Big Muddy
With the captain dead and gone.

We stripped and dived and found his body
Stuck in the old quicksand.
I guess he didn't know that the water was deeper
Than the place he'd once before been.
Another stream had joined the Big Muddy
'Bout a half mile from where we'd gone.
We were lucky to escape from the Big Muddy
When the big fool said to push on.

Well, I'm not going to point any moral;
I'll leave that for yourself
Maybe you're still walking, you're still talking
You'd like to keep your health.
But every time I read the papers
That old feeling comes on;
We're -- waist deep in the Big Muddy
And the big fool says to push on.
Waist deep in the Big Muddy
And the big fool says to push on.

Waist deep in the Big Muddy
And the big fool says to push on.
Waist deep! Neck deep! Soon even a
Tall man'll be over his head, we're
Waist deep in the Big Muddy!
And the big fool says to push on!

Words and music by Pete Seeger (1967)
TRO (c) 1967 Melody Trails, Inc. New York, NY

Iraq withdrawal

We believe it is time to declare ourselves on the question of the day. Here is Effect Measure's position on the public health catastrophe that is the Iraq mistake:

The governments of the US and the UK should immediately announce an imminent date (we suggest December 16, the day after this month's vote in Iraq), at which time they will begin the withdrawal of all military forces and their paid contractors to bases outside the region or to the continental US. Full withdrawal could be finished by the first half of 2006.

FAQ about this position

Won't Iraq descend into chaos if we create a power vacuum?

You mean descend further into chaos? Maybe. It is already heading in that direction, so we are talking about the speed of descent. There is already a power vacuum, as we don't exert effective power over much of the country. Personnel can't even move freely within the highly protected Green Zone any longer. The Kurdish regions are already semi-autonomous and will likely improve once foreign military are gone. The same may be true of the Shiite south, around Basra.

Won't this precipitate a civil war, with Shiites fighting Sunnis fighting Kurds fighting Baathists, etc.?

No. You can't precipitate something that has already started. In case you haven't noticed, there is already a civil war going on, made worse by "outside forces," of which the primary ones are the US and the UK. Besides the deaths of combatants, independent estimates are that the post invasion risk of violent death is more than 50 times higher in the civilian population compared to a year prior to it. The Lancet study conservatively estimates 100,000 Iraqi deaths as a result of the invasion. Aerial bombardment and modern high power weaponry has been a major factor in this death toll. There is reason to believe that if fighting continues it will be with means less liable to cause mass casualties. In any event, it isn't likely we will see increased suicide bombing in the kind of civil war that would be conducted in the absence of US and UK troops.

Substitution of aerial bombardment for ground troops to "support" the Iraqi military is not a solution but would multiply civilian deaths. It is universally known to be ineffective against an insurgency.

Won't this allow Iraq to become a haven for terrorists?

Look again. It already is a haven for terrorists and we are making more by the day with our noxious presence there.

Won't the US "lose face" by cutting and running?

You mean lose more face than by its incompetent and immoral current position? Maybe. But Iraqis shouldn't be punished for our shameful errors.

Don't we owe the Iraqis something after having despoiled their country?

Absolutely. When the situation stabilizes we should compensate them with massive amounts of aid, which might be funneled through a new framework of non-aligned countries to coordinate a crisis response during a post-war transition period. Everyone knows we wouldn't do this, of course, since the welfare of the Iraqi people is not our main objective.

Won't immediate withdrawal mean that all the US, UK and Iraqi lives lost have been in vain?

Yes. More wasted lives won't change this.

So that's where we stand. Here is where the current democratic wannabes stand (Roll Call via DailyKos):
Bayh: find realistic way to define success, then set benchmarks

Edwards: was "wrong". Wants "significant" reduction of troops after elections early next year. He'd tie the proportion of troops withdrawn to benchmarks set for Iraqi soldier performance.

Biden: no withdrawals until political situation improves, but sees 100K troops back home by '07. Does not rule out more troops if necessary. Wants admin to come clean about targets for Iraqi troop training. More civillian staff in Iraq.

Clark: add civillian component; consider adding troops; adjust the mix on the ground; establish clear benchmarks for training

Clinton: No immed. withdrawal, no troop increase, set specific benchmarks for training Iraqi forces and make it clear to Iraq that the US's military committment is limited.

Feingold: 12/31/06 is a "target date" for troops to come home. But he's flexible.

Kerry: begin drawn down of 20K troops after elections in Dec and continue if successful.

Richardson: "It is now time for the military commanders to design a phased, definitive withdrawal plan."

Warner: No immed. withdrawal, no troop increase, set specific benchmarks for Iraqi forces. Eschews "debating the past."
With regard to democratic candidates, we also adopt the position of The Nation:
The Nation ... takes the following stand: We will not support any candidate for national office who does not make a speedy end to the war in Iraq a major issue of his or her campaign. We urge all voters to join us in adopting this position.
A few of the many previous Effect Measure posts on Iraq can be found here, here, here, here, here, here, here, here, here, here and here.

Tuesday, November 29, 2005

The Royal Society of Microsoft

Two unrelated but related stories.

UK's Royal Society (their equivalent of the US National Academy of Sciences) is issuing dire warnings about making scientific papers freely available on the internet, what is called Open Access publishing (see previous EM posts here, here and here).
The Royal Society fears it could lead to the demise of journals published by not-for-profit societies, which put out about a third of all journals. "Funders should remember that the primary aims should be to improve the exchange of knowledge between researchers and wider society," The Royal Society said.

Its position is a thinly veiled attack on proposals by Research Councils UK - the umbrella body for Britain's eight public backers of research. The body has said researchers should be obliged to place a copy of their work in an online archive, usually connected with a university, preferably at the same time as the work appears in a subscription-based journal. (The Guardian)
The Royal Society is protecting its turf (don't blame them), but not protecting science. Many of us depend on OA journals, of which there are now hundreds (Disclaimer; one of the Reveres is Editor in Chief of an OA peer reviewed scientific journal). The developing world benefits. Scientists benefit because many more people are able to read their papers without having to subscribe to a journal. So if the Royal Society's journals go under because they are the buggy whip of the automobile age, that's too bad for them, but on balance science is better off. Meanwhile rapacious for-profit publishers (chief among them the Dutch company Elsevier) are pricing libraries out of the serials business and making a handsome profit at it.

Physicists and mathematicians have been making their papers available for free and on a timely basis for years via preprint archives. It has taken the medical world much longer because of the distorting influence of advertisers and the profitable business of reprints and copyright. But we are catching up. Some sources for this fast growing field are the website Free Medical Journals, the Biomed Central family of journals and the Public Library of Science (PLoS). More on Open Access at Peter Suber's site. Check them out.

Now the other story. I learned via Slashdot that all references to free software were removed from a UN World Summit on the Information Soceity (WSIS) conference proceedings.
Microsoft asked for references to free software to be removed from a document presented at last week's UN World Summit on the Information Society (WSIS) conference, the software giant admitted on Friday.

The Free Software Foundation Europe (FSFE) is unhappy that the document was changed and claims that even though it was on the panel discussing the document, it was not made aware of Microsoft's changes.

The document, known as the Vienna Conclusions, discusses issues around IT and creativity. The original draft of the document discussed how the free software model is changing the way people do business.

"Increasingly, revenue is generated not by selling content and digital works, as they can be freely distributed at almost no cost, but by offering services on top of them. The success of the free software model is one example," stated the original document, according to the FSFE.

But the final version of the document contains no reference to free software. "Increasingly, revenue is generated by offering services on top of contents," states the final version of the document. (ZDnet)
Apparently Microsoft also had a reference to Linux removed.

Open Access publishing is not the same as Open Source computing, but they are philosophical cousins. Microsoft and The Royal Society also share the same instincts. Nothing I'd be proud of if I were the Royal Society.

Still loose in Pennsylvania but not to worry

Pennsylvania now declares itself able to protect its citizens from bird flu. Of course they have yet to tell them how. This is the state, remember, that also declared its flu plan a state secret:
. . . Pennsylvania officials say their pandemic plan includes sensitive details - such as phone numbers and vaccination storage sites - that could devastate response efforts if the information got into the wrong hands.

"We are walking on a knife's edge," said Adrian R. King Jr., director of the Pennsylvania Emergency Management Agency. "We want to act in good faith to give information. At the same time, we have an obligation for operational security." (from a story quoted in our post
"Warning, Idiots loose in Pennsylvania," May 20.)
Don't worry. It's a heckuva plan, Brownie.
According to State Health Secretary, Dr. Calvin B. Johnson and state Agriculture Secretary, Dennis Wolff, measures that have been put in place include surveillance and detection systems, both animal and human. The Pennsylvania Department of Agriculture states that it has what is regarded as one of the most comprehensive avian flu plans in the Country. Additionally, Pennsylvania has one of the best human disease surveillance systems in the nation, including being able to receive real time reports from hospitals, public health departments, physicians and pharmacies on possible disease outbreaks.

The Pennsylvania Department of Health has worked out a plan for dealing with an outbreak if one would occur, with hospitals, EMS providers and other health care organizations on the county, regional and state level. (TriState News)
The plan is so good that if a pandemic happens, Pennsylvania will be in the same boat as everyone else:
Dr. Johnson emphasized that if the H5N1 avian flu were to spread, it would be a global concern and Pennsylvania would be working with public health partners from around the world to deal with the outbreak. At this time, there is no vaccine against this virus.
Very comforting. Maybe you'll tell us what the plan is? No hurry. Wouldn't want a terrorist to find out where to get vaccinated.

Monday, November 28, 2005


I was going to let the day pass unmarked, but then I changed my mind. It was a year ago that Effect Measure saw its first post. In the 366 days since last Thanksgiving (November 27, 2004), EM has seen 766 posts, slightly more than two a day and no day has passed without at least one post. Last December we had less than 1,000 unique visits. Now we get 1,000 - 2,000 each day. The audience is small, by some standards, but influential. The referrer logs consistently show readers from NIH, CDC, USGS and USDA, all over academia in the US and abroad and many, many sharp witted and knowledgeable readers lending their raw brain power, astuteness and sometimes nuttiness. The Reveres get interesting email from names most public health people would recognize.

I know about the visits because I compulsively check the various site counters. Melanie of Just a Bump in the Beltway warned me early on there is no 12 step program for bloggers to stop checking their site counters, and she was right. But we have also made it a firm practice not to "chase traffic," that is, to change our posts just to attract people to the site. As our masthead proclaims, we still are a " forum for progressive public health discussion and argument as well as a source of public health information from around the web that interests the Editor(s)." We almost never ban anyone from the Comments and never cut off true argument, although on occasion we have declared a thread closed when it was becoming tiresome even to the highly tolerant and patient editors. Even when we have done so, all readers have accepted the closure without our actively enforcing it. In the course of the year we have managed to accrue a nice community. All welcome. Some of you are certifiably crazy, but you are well behaved, for which we thank you.

Who is Revere in "real life"? Wouldn't you like to know. We have heard some interesting speculation. As to how many Reveres there are, we will divulge this much: the number is greater or equal to one (which you know, because you are reading this) and strictly less than five. It is not a prime number. No more clues.

As we embark on Year II, we expect to be doing much the same as in Year I: Talking about the leadership void in public health (for which the bird flu problem is both a metaphor and an embodiment); criticizing the public health establishment when it deserves criticism (which is pretty much all the time; what a bunch of wusses!); discussing public health topics that interest one or the other of us (just because we want to and it's our blog); talking about war and peace and the baneful effects of religion on the way we treat each other (because we feel compelled to do so).

We're not sure how long one Blog Year is in human time, but we feel confident it's more than a dog equivalent. We know there are blogs out there up for five or more years, the blog equivalent of Methusaleh. All we can say is we'll keep doing it until we don't do it anymore.

Thank you (11:30 pm EST, 11/28/05): To all who congratulated us, wished us well, said kind things, encouraged us, a big Thank You. This kind of feedback is the only recompense for an anonymous blog, but it is the best kind. It is obviously gratifying to have the nods from fellow bloggers but also from the non-bloggers, many of whom comment often and visit faithfully. For those who have just discovered EM, welcome to you. And now I will do something I definitely should NOT do, single out one person from others, although all of you have a solid claim to my respect and affection. But I would be remiss if I didn't recognize Jordan Barab and his superb blog, Confined Space, which led the way among public health blogs and has been the model for committed public health blogging for me and so many others, bloggers and non-bloggers. Confined Space is not just a blog. It is the way people in Occupational Health and Safety find out about what is going on. Jordan's blog predates ours by more than a year (he is the true trailblazer) and while EM's traffic has caught up, our quality, commitment and dedication can only aspire to the standard he has set. Hats off to you, brother Jordan.

Now, back to work. Much to do and no one knows how much time to do it.

About time

It's about time. The International Herald Tribune has a story that WHO is doing a seroprevalence survey (looking for blood evidence of past infection) of a "healthy village" in Indonesia. We have long called for this and the failure to do it prior to this is inexplicable.
The researchers are part of a team of about 20 who have been studying 42 villages in Bali over the past three weeks, taking blood samples from 800 humans and 1,800 animals. So far, it is one of the largest and most comprehensive studies on bird flu in Southeast Asia.

The team, working with the World Health Organization, is conducting extensive interviews to find out just how humans and animals interact here. The experts hope they will then begin to understand a relationship between the interaction and the distribution of the disease.

Apart from the potential scientific benefits, officials would like the study to help educate ordinary Indonesians, many of whom live in isolated villages and remain, like Kenori, ignorant of the disease.

Officials of the World Health Organization also said the study should help local health officials develop an efficient procedure for response to bird flu outbreaks, one that could be imitated in other rural areas in Indonesia, including the tsunami-devastated province of Aceh, which reported its first bird flu outbreak last week. (IHT)
The article also comments on Indonesia's unwillingness to undertake mass bird culls. But the question is more complicated in Indonesia than the problem of government "unwillingness," as we noted in a post last September. Here's the relevant part of an excellent BBC article we were linking to at that time:
As human deaths from bird flu begin to mount in Indonesia, the dilemma for the Indonesian authorities is as much how to save the birds as how to save the people.

To say that Indonesians love their caged birds is a serious understatement. Almost every house has at least one cage, and often a row of them, hanging from the eaves.

Every major town has a crowded bird market lined with hundreds of cages, where a top-quality singing dove can sell for the same price as a house.

As in several other Muslims countries, doves occupy a special place of honour in the culture, with streets, companies and even a domestic airline - Merpati - named after them.

The doves are not merely kept for decoration - they are taken out and handled, treated as much-loved pets and taken to vets when they fall ill.

Tapes of champion singing doves are available in cassette shops, and are played at home to birds in the hope that they will learn to emulate the champions, and become champions themselves.

In Javanese folklore, a man is only considered to be fully a man if he has a house, a wife, a horse, a keris (traditional dagger) and a singing dove in a cage.
Given this background, it seems the most important part of doing a study like the one described here is to find out more about the true prevalence of H5N1 infection in the population, not as an adjunct to "risk communication." Seroprevalence studies should be done all over southeast asia and China as well.

Why they haven't been done remains a mystery to us.

Sunday, November 27, 2005

Freethinker Sunday Sermonette: Thanksgiving

Sunday, the end of the Thanksgiving Day holiday in the US. We don't do prayers here. Beat poet William Burroughs's offering is as close as we will get. Hat tip, Boingboing:
Thanksgiving Prayer

Thanks for the wild turkey and the Passenger Pigeons, destined to be shit out through wholesome American guts

thanks for a Continent to despoil and poison—

thanks for Indians to provide a modicum of challenge and danger—

thanks for vast herds of bison to kill and skin, leaving the carcass to rot—

thanks for bounties on wolves and coyotes—

thanks for the AMERICAN DREAM to vulgarize and falsify until the bare lies shine through—

thanks for the KKK, for nigger-killing lawmen feeling their notches, for decent church-going women with their mean, pinched, bitter, evil faces—

thanks for "Kill a Queer for Christ" stickers—

thanks for laboratory AIDS—

thanks for Prohibition and the War Against Drugs—

thanks for a country where nobody is allowed to mind his own business—

thanks for a nation of finks — yes, thanks for all the memories... all right, let's see your arms... you always were a headache and you always were a bore—

thanks for the last and greatest betrayal of the last and greatest of human dreams.

William S. Burroughs
For John Dillinger
In hope he is still alive
Thanksgiving Day, November 28, 1986 (video here)

Harbin, China

Some years ago Mrs. R. and I were invited by a Chinese colleague to visit Harbin, in China's north. Free trip. Except . . . it was in January. Harbin makes a virtue out of necessity by having a huge Ice Festival every January. Because it's cold there. Really, really cold. Average winter temperature is about -16 C. (4 degrees F.), and it can go down as low as -38 C. (-36 F.) I don't like the cold. Mrs. R. hates the cold. We didn't go.

Now Harbin (population 9.5 million) is known for something other than being the snow and ice culture capital of the world. On November 13 a state-owned chemical plant exploded 200 kilometers up the Songhua River, in Jilin, releasing a huge slick of benzene into the river, the source of Harbin's drinking water supply. Benzene is a known human carcinogen, causing a variety of cancers of the blood forming organs (leukemia, lymphoma, multiple myeloma) and can also cause a complete shutdown of the bone marrow (aplastic anemia). Local officials expect the slick to pass through this weekend, having passed the inlet of the drinking water system two days ago. Residents have been warned to stay away from the river. The city water supply is being shut down for four days.
A mood of distrust and paranoia spread through Harbin, sharpened by the local government’s decision to turn off water supplies for fear of an environmental catastrophe.

Trains leaving the city have already sold out until the weekend. All 42 flights from the city’s airport were also full yesterday.

Officials at the railway station and airport said the scenes resembled the crush during the Chinese New Year holiday, when travellers overload the public transport system in order to return home to their families.

The growing unease was fuelled by the clumsy handling of the crisis by the city’s authorities, which at first said the water supply was being closed only for maintenance purposes. The lack of clear information spawned rumours of an imminent earthquake, which triggered panic buying of food and bottled water.

“I am fleeing,” said Pang Shijun, a 50-year-old man among the crowds at the central railway station. He said his wife had already left the night before to go to the nearby city of Jixi. “I just do not trust the government to provide true information on this.”


After a series of contradictory statements by the city and PetroChina, the overseas-listed energy giant which runs the plant where the accident occurred, Beijing’s environmental watchdog confirmed the Songhua river had been contaminated.

The State Environment Protection Agency said an 80km stretch of the river had been polluted by benzene, a carcinogen used in the manufacture of plastics, detergents, pesticides and other chemicals. Some sections of the river contained benzene levels more than a 100 times higher than national safety levels.

The accident occurred at a plant adjacent to the river near the city of Jilin. The polluted portion of the river is expected to arrive in Harbin this morning and take about 40 hours to pass by. A city spokesman, quoted by the official Xinhua news agency, said 15 hospitals had been put on standby to deal with cases of poisoning. Schools have been closed until further notice. (Financial Times)
While the rest of the world waits with bated breath for bird flu to fly out of China's infested 5 billion poultry, the Russians wait for the toxic benzene slick to make its way to its eastern city of Khabarovsk, the second largest city in the region. It takes its drinking water from the Amur River, of which the Songhua is a tributary.

So once again China stands out as a world class environmental polluter, a leader in horrific and preventable industrial accidents and coal mine disasters, and a nest of clumsy cover-up artists. Tom Friedman and others believe China is the economic power of the future. Maybe. But any country that operates like this has built-in weaknesses that catch up with it sooner or later. Whether it will be sooner or later is hard to say.

Superpowers: and then there were none

Jane Smiley at Huffington Post had a telling elegy for American superpowerhood the other day. Here is some of Smiley's post:
We are a country that can no longer pay our bills, no longer wage an effective military action, and no longer protect our citizens from disaster. And it doesn't matter what fiscal responsibility individuals show, what bravery individual soldiers show, or what generosity individual Americans show. As a nation-as a geopolitical entity-we have been stripped of all of our superpowers and many of our powers, and it has been done quickly and efficiently, in the name of blind patriotism, by Bush, Cheney, Rumsfeld, Rice, and their neocon advisors. The very powers that these people thought they were going to enjoy exercising have slipped out of their grasp. It's laughable now to remember the name of the campaign against Baghdad, "Shock and Awe". No one in Iraq feels any "shock and awe" toward the US presence there any longer. "Fear and Loathing" is more like it.
Oh, and one more thing to add to Smiley's list. We are no longer a country able to protect our citizens from the threat of epidemic infectious disease.

[Cross-posted at Stayin' Alive]

Saturday, November 26, 2005

Poisoning pigeons in the park (tra la)

Vietnam's Ho Chi Minh City (neé Saigon) has a population of 10 million people and has banned poultry within its limits to prevent the spread of bird flu. Most of the human cases are now in the cooler north. The last case in the south's HCM City was in December of last year, but new poultry outbreaks in nearby Long An province are being reported. So the Vietnamese have begun poisoning pigeons in HCM City.
"We will make sure that no birds are left in the city to minimize the risk of bird flu," Huynh Huu Loi, Director of Ho Chi Minh City's Animal Health Department, told Reuters. Loi said beside the poisoning campaign, city authorities would also move pet birds outside the city until Vietnam is free of bird flu. (Reuters)
This recalls the beloved Tom Lehrer song, Poisoning Pigeons in the Park. For those who missed it first time around (1959), here are some lyrics:
When they see us coming, the birdies all try and hide
But they still go for peanuts when coated with cyanide
The sun's shining bright
Everything seems all right
When we're poisoning pigeons in the park
La la, dum de da da da doo deedeedee

We've gained notoriety and caused much anxiety
In the Audubon Society with our games
They call it impiety and lack of propriety
And quite a variety of unpleasant names
But it's not against any religion
To want to dispose of a pigeon

So if Sunday you're free
Why don't you come with me
And we'll poison the pigeons in the park
And maybe we'll do
In a squirrel or two
While we're poisoning pigeons in the park

We'll murder them all amid laughter and merriment
Except for the few we take home to experiment
My pulse will be quickenin' with each drop of strych-a-nin'
We feed to a pigeon
It just takes a smidgen
To poison a pigeon in the park

Friday, November 25, 2005

No-brainer for the brainless

Scott Shields at MyDD is right on target regarding an issue, universal health care, that should be both a no-brainer for GM and a no-brainer for Democrats. And that's a good trick.

More than $1500 of every GM car goes to pay for employer-based health benefits--benefits that are being reduced in ways that cut into worker productivity and security, even as they continue to put GM and other US automakers at a severe competitive disadvantage to Asian and European automakers.

It has puzzled many that US automakers and other corporate interests with the same problem do not jump on the universal healthcare bandwagon. Shields points to one explanation from Dave Lindorff at In These Times:
How can the same corporations that in Canada recognize the bottom-line logic of a national health system be so opposed to the idea here?

One answer is ideology. The notion of having the government take over an industry that represents about 15 percent of the U.S. economy gives U.S. executives the willies. But in backing insurance company interests, GM runs counter to both its own business interests and the sentiments of many customers. (ITT)
It's as good or better explanation as any and it rings true to these ears. Shields concludes:
As the General Motors layoffs are showing us, even though it may make some uncomfortable, a clear case is to be made for universal healthcare in the United States. Simply put, it's an issue of competitiveness. There's a reason GM is cutting thousands of jobs mostly in American factories. The executives will never admit it for political reasons, but the crushing burden of healthcare costs is taking away American jobs. While universal healthcare has long been an interest of the party, it's often pushed to the back, being seen as too controversial. But now that Democrats have seemed to find their footing and the will to fight back, it certainly seems the time has come for bold healthcare proposals supported by obvious economics. This issue should be a no-brainer for Democrats in 2006 and 2008.
But no-brainers are only no-brainers for people with brains. Another paradox.

Thursday, November 24, 2005

Dr. Toshiro clarifies (or does he?)

Responding to the report in ProMed that Dr. Masato Tashiro has said a German medical meeting that more than 300 deaths from bird flu have been systematically covered up by Chinese authorities (see post), Dr. Toshiro has issued this statement:
Statement to ProMed by Dr. Masato Toshiro

I am surprised to read the report in ProMED-mail, Avian influenza,human - East Asia (180): China, RFI [part 1] (archive number 20051123.3399).

First of all, it is not correct. Therefore, I would ask you to correct it.

[NB: The first two sentences were inadvertantly left off this post and have been restored.]

In my presentation at the meeting in Marburg, I stated that WHO's official numbers of H5N1 human cases are only based on laboratory confirmed cases. It should be therefore an iceberg phenomenon. Due to poorly organized surveillance and information sharing systems in many affected countries including China, it is reasonable to consider that more cases have occurred actually. We have heard many 'rumors' or unauthorized information which we cannot confirm. In this context, I talked about a few examples of non-authorized information and rumors about Asian countries which I received through private channels. I clarified that I do not know the original sources and I cannot confirm whether they are true, how these numbers were derived and what laboratory tests and epidemiological investigation were done.

Therefore, the article cited in ProMed-mail is incorrect and misleading. I did not receive any interview during my stay in Germany. I did not say anything that I believe the figures of the unauthorized information.

My message at the meeting was that international societies should help China to establish and perform nationwide surveillance and information sharing systems. I do not think that the Chinese Authority will conceal the facts from the world. Since the SARS event, they are collaborative to WHO. But they may have still limited capacity to monitor all human cases particularly in rural areas.
Dr. Tashiro is not issuing a denial, as I read it. It sounds more like he is doing damage control in a delicate diplomatic situation. He is saying he cannot source or verify the information, and that cases beyond the officially reported ones should be expected. He further says he did not give a newspaper interview. But the newspaper article only said he presented this information to "astonished colleagues," not that they were part of an interview. He acknowledges that there are many rumors about additional cases (presumably including the 300 deaths) within China. This is of some interest as the Boxun News source is an expatriate organization. This appears to corroborate the fact they are reporting information from within China, whether correct or not.

We and others have assumed there were many other cases in China besides the officially reported ones. Given the extent of the poultry infection and the degree of population contact, this is to be expected. The Toshiro report was alarming in that it appeared to be reporting a large cluster of deaths which might indicate a new transmission pattern. With Dr. Tashiro's "clarification" we are left wondering again.

Update, 11/25/05: Monotreme (in Comments) points out correctly that the 300 cases are not a cluster but are scattered throughout China. Some may be in clusters in particular localities, but not all in one large cluster. EastWestNorthSouth cast a skeptical eye on the Boxun reports last week. According to their reckoning, we clearly fall in option 3. (Hat tip crofsblog)

Update, 11/25/05, 8:18 pm EST: In an email to ProMed, Dr. Toshiro confirms Chinese statements that he was not in Hunan, as widely reported. He reiterates that he was merely passing on unsourced and unverified information from a private source. Thus we are back to Square One on the Boxun reports, which were given additional credence by being passed through a mainstream media outlet (Frankfurter Allgemeine Zeitung) and New Scientist via Dr. Tashiro. It was these additional reports that overcame our original hesitation about repeating this information. A cautionary tale, once again.

Public health Maginot Line

A lot of people traveling by air this Thanksgiving weekend. We keep hearing the airlines are the front lines of defense against bird flu. This is nonsense.

Two things are true. (1) The airline industry will be severely affected. (2) Bird flu will plausibly arrive via airplanes, probably many of them. There isn't a lot we can do about either except plan for the consequences.

Everyone knows world tourism would be seriously affected if there were an influenza pandemic. SARS was a powderpuff in comparison and it took a real bite out of air travel. Airlines already operate on razor thin profit margins, with half of US airlines in bankruptcy proceedings already. A pandemic could be the coup de grace for some of them. But I'm not an expert on airline economics, so I'll leave it at that.

Public health is another matter. Almost every public health scientist who has thought about it believes quarantine won't work for influenza because it becomes infectious at a stage when people show little or no symptoms. Thus you can't stop it and it is futile to put a lot of resources into trying. Again, the task is to manage the consequences. However sharpening disease surveillance in general, including at airports, may be useful for other diseases. The inability to trace passengers after they leave the plane has been identified as a serious gap in the US disease surveillance and early warning system. CDC is about to propose new rules to require airlines to keep passenger manifests for 60 days and to provide contact information (full proposal and instructions for public comment here). Allegedly there will be strict privacy controls, although we know the government feels no compunction about violating the law when it feels like it. Thus from the public welfare side, these new rules are a balancing act and the balance depends upon how trustworthy the government is. The current one isn't at all trustworthy. One can hope the next one will be an improvement, or at least enough of an improvement to make the balance a net positive. In any event, these new rules will almost certainly be instituted.

In addition the Public Health Service is setting up new "quarantine stations" in international airports. A quarantine station can be as little as a public health service officer in residence or a more elaborate evaluation facility with beds and some equipment. Many "stations" are just desks or offices at the moment. The number has increased from 8 two years ago to 18 today, with a planned expansion to 25 in the near future.

The Northwest Airlines Professional Flight Attendants Association also wants laws requiring continuous ventilation on airplanes. Most airliners have High Efficiency Particulate Air (HEPA) filters that clean recirculated air in the cabin (which mainly moves side to side rather than along the length of the airplane), but not all older regional jets have them. It is estimated that about 15% of planes don't have HEPA filters, which are not required by the FAA. Moreover the systems need to be on all the time, including while sitting on the tarmac in a hold. There is at least one paper in the literature of an influenza outbreak when the airplane ventilation system was inoperative during a ground hold of three hours (Am J Epidemiol. 1979 Jul;110(1):1-6.). Thus increased attention to cabin air quality is a reasonable request.

But neither HEPA filters nor quarantine stations are going to keep out bird flu if the virus becomes as transmissible as the usual human-adapted influenza virus. Airport quarantine measures are a public health Maginot Line.

Wednesday, November 23, 2005

China syndrome

China has announced a third death from bird flu even as unconfirmed reports are circulating of hundreds of unannounced cases. Unofficial and unsourced reports from the expatriate Boxun News have been around for some months. What makes this instance different is that it is being corroborated by a visiting Japanese virologist, Dr. Masato Tashiro. Tashiro is described by the German newspaper Frankfurter Allgemeine (via ProMed but also discussed extensively on CurEvents) as a WHO consultant. As we noted in Comments a day or so ago, there is a scientist of that name at the Division of Respiratory Viral Diseases and SARS, Department of Virology, Special Pathogens Laboratory, National Institute of Infectious Diseases, in Tokyo.

Tashiro reported at a colleague's retirement party that "a reliable source" had told him in a recent visit to Hunan on behalf of WHO to look into bird flu there that more than 300 deaths had occurred but were systematically covered up by Chinese authorities.
Dr. Masato gave his lecture in the University of Marburg Clinic before some the most outstanding virologists in the world and shocked the meeting with his unauthorized data [report] from inside China.

The Japanese virologist [said he] firmly believes in the reliability of the source and its data. The secrecy of the Peking government is still causing concern as it was at the beginning of the SARS epidemic disease, complained Tashiro. At least 5 medical co-workers who should be reporting on the situation in the provinces were arrested, and [other] publication-willing researchers were threatened with punishments [he said]. (Frankfurter Allgemeine via Promed).
Needless to say this is both a serious charge and a serious situation, if true. We have held off on reporting this hoping some clarification would materialize, but none has. Even if this turns out to be untrue, the plausibility of the idea is a problem of China's own making. Despite repeated claims of transparency, words and actions do not always match up. It will be hard to convince many observers there arren't some grounds for this.

Unfortunately, it is not just a matter of China's reputation. The substance of the matter is of some importance. WHO should immediately request another visit by an international team. While this is no guarantee, it will put pressure on Chinese authorities and is one of the few things the world community can do.

PFOA still sticking around

Chemical body burdens are not everyone's cup of tea. You may not be "into the subject," as the idiom goes. Unfortunately, the subject is into you, or at least 95% of you. There are now many chemicals comfortably residing in almost everyone's bodies that don't belong there. More surprising, for many we don't know exactly how they got there, although we know where they came from: consumer products and improperly managed chemical wastes.

One of the most prominent body burden chemicals these days are the perfluorooctanoic acids, or PFOAs, used in non-stick products like teflon coated cookware and stain resistant fabrics. Now, it turns out, PFOAs are produced when chemicals are ingested after grease resistant paper coatings used in microwave popcorn bags, fast food and candy wrappers and pizza box liners heated. Didn't know that? Well the DuPont company knew it and concealed it 20 years ago, according to chemical engineer Glenn Evers who worked for the company at the time. (USA Today)
At a briefing arranged by the watchdog Environmental Working Group, Evers said that in 1987, DuPont scientists were testing two potential products to see how much perfluorinated chemical leaches out when they are exposed to water and heat, as they are when used to wrap hot foods.

The scientists used the company's widely used Zonyl RP grease-resistant coating as a benchmark because it was supposed to leach out the chemicals at a rate of 0.2 parts per million or less. But when the tests results came back, Evers said, they showed that the popular product leached out at 0.62 parts per million, three times the amount allowed by the Food and Drug Administration.

The two products tested were never put on the market for unrelated reasons, but Zonyl RP is still in use.
Documents to corroborate Evers's story were made available by the Environmental Working Group on their website. DuPont is already being sued by Bush's EPA for withholding other health information, so you can imagine how flagrant the infractions are. Not that the Bushies have shown much appetite for sticking it to DuPont on their non-stick products:
Bush EPA political appointees could seek the maximum possible fine of $314 million, but they have shown little appetite for pursuing such a penalty. The next court date for the civil suit was negotiated to fall on Wednesday, November 23, the day before the Thanksgiving holiday and the busiest travel day of the year. (EWG)
Typical. Will Bush pardon these turkeys today?

Sweet Adelaide

Donald (Rummy) Rumsfeld, the US Hauptfuhrer, is naturally one of the most well protected people in the world. Not hard to imagine why. In his recent visit to Adelaide, Australia (a lovely place, by the way; no sarcasm here. We loved it and the food is wonderful), the security was described as "unprecedented." Except for . . .
Yellow business envelopes containing a six-page itinerary for Rumsfeld's high-security visit were placed under guests' hotel doors early Thursday, the Daily Telegraph reported.

Three floors of the Hyatt hotel have been given over to Rumsfeld and his entourage and guests staying on these levels received the envelopes marked "United States of America, Official Business".

One guest said he was "astonished" to receive the document, which included the names and room numbers for the Defense Secretary and his staff as well as the mobile phone numbers, names and titles of a large number of operational staff.

"When it was poked under the door I thought it was for me," the guest, who refused to be named, told the newspaper.

Guests were later told that the envelopes had been issued by mistake [not by the hotel] and would be collected if they pushed them back under the doors. (Agence France Presse)
Oh, oh. Nevermind.

I wonder why the war in Iraq isn't going smoothly. Hmmm.

Tuesday, November 22, 2005

Chinese news stories

A lot of bird flu news these days. We decided not to do a play by play, but we'll clear up the China news as a public service. We'll start with reports from UPI (via Only Punjab):
China's minister of health Sunday said the country has brought avian influenza under control.

At the Shanghai Healthy City Forum, Gao Qiang said no new cases have been reported in 10 days in the area hardest hit by bird flu, Heishan County in Liaonang in northeast China, Xinhua, the official government news agency, reported.

"The spread of bird flu virus is caused mainly by migratory birds, and their migration has almost completed," Gao said.

At the Shanghai Healthy City Forum, Gao Qiang said no new cases have been reported in 10 days in the area hardest hit by bird flu, Heishan County in Liaonang in northeast China, Xinhua, the official government news agency, reported.

"The spread of bird flu virus is caused mainly by migratory birds, and their migration has almost completed," Gao said.
Good, I understand that. Things are under control. The same newspaper, the next day:
China reported today two new outbreaks of bird flu in which almost 3,700 poultry died and more than 7,000 were culled as provinces hit by the deadly virus tightened preventive measures.

About 3,500 geese died at a family farm in a development zone in Shishou city in the central province of Hubei, the official Xinhua news agency said, adding that 3,800 poultry were slaughtered within a radius of 3 km (2 miles).

In the northern region of Inner Mongolia, 176 domestic poultry died and 3,202 poultry were culled, Xinhua said. It gave no further details.

The agency quoted Health Minister Gao Qiang as saying China has basically brought bird flu under control.
Still under control. I think.
China ordered already strict anti-bird flu measures tightened on Monday following two new outbreaks in poultry, while Romania said it would destroy 2,000 farm birds after finding the virus in hens and North Korea tightened border controls.

"There is a growing threat to human health," Yin Chengjie, a deputy Chinese agriculture minister, said at a news conference.


China's latest outbreaks were its 16th and 17th in poultry in recent weeks and came despite a nationwide effort to vaccinate billions of poultry against the virulent H5N1 strain of the virus.

Yin, the Chinese official, warned that the disease's virulence, or its ability to cause illness, appeared to be increasing. He pointed to rising numbers of cases in ducks and geese, while earlier outbreaks were limited to chickens.

"It shows the increasing virulence of avian influenza," he said.

Yin and other officials announced new rules requiring local Chinese officials to set up disease-warning networks and to stockpile disinfectant and other emergency supplies. Officials who fail to pinpoint and report outbreaks quickly face firing or jail.

The latest Chinese outbreaks in the northern region of Inner Mongolia and the central province of Hubei killed a total of 3,676 chickens, ducks and geese, the official Xinhua News Agency said. It said authorities destroyed a total of 7,002 birds to contain the outbreaks. (AP)
Uh, oh.
The bird flu crisis in China is "severe" and set to get worse as winter deepens, the government said on Monday as it revealed there had been 21 outbreaks in the world's most populous country this year.

Officials made the grim assessment as they announced that China's cabinet, the State Council, had adopted tough emergency laws requiring local governments and people to respond quickly to bird flu and other animal diseases.

The 21 outbreaks occurred in nine provinces in China, affecting 45 villages and causing the deaths of 144,624 birds, while a further 21.1 mn have been culled, Vice Agriculture Minister Yin Chengjie said.
"Although some cases in affected areas have been controlled effectively, the whole situation of avian flu control is still severe," Yin told reporters at a briefing.

"The task ahead of us is still arduous."

China had previously announced 19 outbreaks of the deadly H5N1 virus this year, including 17 since October 19, 2005.

With the world's biggest poultry industry —14 billion fowls produced each year — China faces a crisis that is far from over, Yin warned.

He said the danger was expected to grow as temperatures dropped across the nation throughout winter, making it easier for viruses to stay alive.

"The colder the weather is, the higher the risk of epidemics breaking out," Yin said.

Controlling the outbreaks is also getting more difficult as the bird flu gets more virulent, he said.

"The virulence of bird flu can not only lead to the deaths of chickens but can also affect water fowl such as ducks and geese," he said.

"This situation was hard to find in the past."

Yin also admitted that "backward" farming methods in China, with poultry being raised alongside livestock in family farms, also made controlling the spread of H5N1 "difficult."

Grassroots-level prevention was also "lagging," he said.

The new emergency regulations, adopted on November 16, 2005 outline the obligations of every level of government, as well as people and companies, when faced with a potential bird flu outbreak.

Yin said the new laws require the reporting of outbreaks in a timely manner, dealing with them "promptly and resolutely," and being fully prepared with adequate financial resources, medical supplies and personnel.

"For any cases of false reporting or late reporting, severe punishment will be applied," Yin said. (Sify)
Did someone say punishment?
China unveiled new rules to combat bird flu on Monday, threatening fines and police action against people who do not cooperate.


Bird flu outbreaks have to be reported to the State Council, or cabinet, within four hours of being discovered by regional governments, and fines of up to 5,000 yuan ($620) can be levied for obstructing prevention work or refusing to comply.

"Any practices which affect the reporting of epidemic diseases, including deception, false or late reporting, are forbidded," Yin said.

If needed, the police and even the army may be called in. Officials could be demoted or fired for not reporting outbreaks.

Quarantine measures have also been stepped up in China, and even North Korea said on Monday it was was tightening border controls to stop bird flu.

"China is a large country, and there have been some places where there has been a lack of compliance," said Cao Kangtai, head of the State Council's laws and regulations office.

"Only by taking such severe measures can we guarantee the prevention work," Cao later told Reuters. (Reuters)
OK. Everything's obviously under control.

Nursing advice

I Pass on these Progress notes from the imPacted nurse without comment:
The 29 P's of surviving bird-flu

Proper Prior Planning and Preparation Promotes Pandemic Preparedness, Preventing Piss Poor Performance, Pernicious Pestilence, Pervasive Public Panic, Probable Personal Petulance, Pulmonary Pathogens, Poor Patient Prognosis, Preventable Pain and Poo-ing your Pants when it all goes Pear-shaped.

Monday, November 21, 2005

The short and the long of the US - China announcement

In an announcement on Sunday, China and the US have agreed to cooperate on the prevention and control of bird flu.

Here's the short version:
According to the document, China and the United States are dedicated to the prevention of the spread of blah, blah, blah ....
If you must, here's the whole thing (People's Daily):
Chinese and US presidents reached consensus in Beijing Sunday on enhancing bilateral cooperation in the prevention and control against bird flu and issued a common document.

According to the document, China and the United States are dedicated to the prevention of the spread of the newly-reported epidemic including the highly pathogenic bird flu.

The two sides will seek to expand efforts in fighting against the potential human flu pandemic and agreed to conduct common action on bilateral, regional and global cooperation on this issue, the document said.

China and the United States promised to beef up cooperation between the ministries of public health and agriculture in the areas of research, development and testing of flu vaccines and medicines and quick actions towards the flu pandemic in a bid to improve the ability of discovery and control of the outbreak of bird flu.

The document said the two sides will make active support to and participation in the global cooperation of bird flu. The two sides will back up the due role of the organizations within the United Nations, especially the World Health Organization, the UN Food and Agricultural Organization and other international organizations.

China will continue to support a US-initiated international partner plan on bird flu control and the United States agreed to support a China-sponsored conference on fund-raising of international and regional bird flu control in next January, said the document.

The two countries will keep close coordination and cooperation so as to ensure the success of the two global proposals. The document said China and the United States are ready to contribute common efforts to and actively participate in the bird flu control in the Asia-Pacific region. The two sides promised to jointly implement a proposal of the Asia-Pacific Economic Cooperation (APEC) on bird flu control and hold a successful APEC Symposium on Emerging Infectious Disease in Beijing next April.

Iraq and Terri Schiavo

Two subjects some readers of EM find hard to digest are Freethinker posts (my weekly Sunday Sermonettes) and posts about the Iraq mistake. They wonder what they have to do with public health. I addressed both in a series of posts in August (here, here, here, here and here). With the Iraq issue heating up in Congress as a result of congressman Murtha's epiphany (better late than never), we'll weigh in again.

If hundreds of billions of dollars badly needed by public health and social services were put into a big bonfire that also burned people to death, we don't think we would have to justify it as a public health topic. So we won't bother. Instead we'll pop in this post from John Aravosis at Americablog:
Iraq is Terri Schiavo
by John in DC - 11/19/2005 04:51:00 PM

The Republicans' main argument for the US staying in Iraq is that if we leave Iraq it will become an even bigger disaster. To wit, the following remarks from the conservative Weekly Standard about Murtha:

REP. JACK MURTHA has had a distinguished congressional career. But his outburst last Thursday was breathtakingly irresponsible. Nowhere in his angry and emotional call for the immediate withdrawal of U.S. troops from Iraq did the Pennsylvania Democrat bother to ask, much less answer, the most serious questions his proposal raises. What would be the likely outcome in Iraq if the United States pulled out? Does Murtha actually believe the Iraqi people could fight the al Qaeda terrorists and Saddam Hussein loyalists by themselves once American forces left? He does not say. In fact, he knows perfectly well that the Iraqi people are not yet capable of defending themselves against the monsters in their midst and that, therefore, a U.S. withdrawal would likely lead to carnage on a scale that would dwarf what is now occurring in Iraq.

And the Weekly Standard is right. If we leave Iraq, all hell will break loose. But we still should leave, and here's why.

1. Iraq is a mess.

2. If the US leaves, all hell (more hell) WILL break loose, as described by the Weekly Standard, above.

3. But if the US stays, all hell will still break loose. We're not winning the war, 80% of the Iraqi public wants us out, 45% of the Iraqi public wants us dead (these are true poll numbers), US military deaths are increasing rather than decreasing, and our continued presence has been a boon for Al Qaeda recruitment and training.

4. The US military occupation of Iraq is simply prolonging the inevitable. Iraq is going to fall apart at the seams, with us or without us - it's only a question of when.

5. Thus, the debate isn't whether we should or shouldn't let Iraq fall apart. The only question we need to settle is whether it's worth the price - in terms of both US military deaths and the benefit our presence bestows on Al Qaeda - for the US to help prolong Iraq's certain death.

Iraq is Terri Schiavo.

Already dead, living on borrowed time, but the Republicans refuse to accept the inevitable. Yes, you can prolong the patient's life for decades. But at what cost, and for what real benefit?

The day a Republican responds to THIS argument, rather than simply saying "but Iraq will fall apart if we leave," that's the day we start having a REAL debate about Iraq in this country. In the meantime, the Republicans will keep scouring the videos for signs of life in a patient who's long-since checked out.
And when the US exacerbated fury subsides, we should figure out a way to pay reparations.

Update, 11/22/05: They want us out and they want a timetable. And US soldiers are fair game.

Sunday, November 20, 2005

Our own wedge issue

There is a significant new movement developing for a Constitutional Amendment and it bears watching--and support. I first saw it mentioned on Echidne of the Snakes, attributed to Seattle columnist Dan Savage in a New York Times Op Ed piece. It is now also appearing on A-list blogs like DailyKos and MyDD. Whoever came up with the idea, I think it is important, both tactically and as a matter of principle.

We're talking about a Constitutional Amendment for the Right to Privacy. This, from Savage's Op Ed:
Will Estelle Griswold ever be able to rest in peace? Although she died in 1981, the poor woman gets kicked up and down the block whenever someone is nominated to a seat on the United States Supreme Court. But few people remember who Griswold was or what she did.

In 1961, Griswold, the executive director of the Planned Parenthood League of Connecticut, opened a birth-control clinic in New Haven. She was promptly arrested for dispensing contraceptives to a married couple and was eventually convicted and fined $100. She appealed, and when her case reached the Supreme Court in 1965, seven of nine justices voted to overturn the conviction, striking down Connecticut's law against selling birth control (effectively overturning similar laws in other states). Americans, the court ruled, had a fundamental right to privacy.

Much of American jurisprudence since then flows from Griswold - including Roe v. Wade, which found that women had a right to abortion, and Lawrence v. Texas of 2003, which found that the right to privacy prevents the government from banning sodomy, gay and straight.

Problematically, however, a right to privacy is not explicitly mentioned in the Constitution. The majority in Griswold held that it was among the unenumerated rights implied by the Constitution's "penumbras" (which sound like something a sodomy law might keep you away from). The Griswold case didn't settle the matter, and the right to privacy quickly became the Tinkerbell of constitutional rights . . . . (New York Times)
Since both Griswold (the right to buy and sell contraceptives) and Roe v. Wade were based on the right to privacy, this would be an important constitutional backstop for reproductive rights. But it would have other effects as well, perhaps putting a stake through the heart of such pernicious legislation as The Patriot Act and other gross violations of privacy now practiced routinely by the Bush Administration and large corporations.
. . . if the right to privacy is so difficult for some people to locate in the Constitution, why don't we just stick it in there? Wouldn't that make it easier to find?

If the Republicans can propose a constitutional amendment banning gay marriage, why can't the Democrats propose a right to privacy amendment? Making this implicit right explicit would forever end the debate about whether there is a right to privacy. And the debate over the bill would force Republicans who opposed it to explain why they don't think Americans deserve a right to privacy - which would alienate not only moderates, but also those libertarian, small-government conservatives who survive only in isolated pockets on the Eastern Seaboard and the American West.
That's what I call a wedge issue!

Freethinker Sunday Sermonette: Greek salad

Sunday dinner will be of the diet variety: salad. Greek salad, courtesy our caterer, Famous Dead Nontheists:
Anaxagoras, Greek philosopher (500?-428? BCE). ". . . probably the first freethinker we know of to be condemned for his beliefs." "He regarded the conventional gods as mythic abstractions endowed with anthropomorphic attributes. His writings led him to a dungeon, charged with impiety, probably about the year 450 B.C.E." Only the intervention of the great statesman and orator Pericles saved Anaxagoras from a death sentence. He had to pay a fine and, according to some accounts, was banished. He lived his final years in exile.

Diagoras "the Atheist" of Melos, Greek poet, (5th cent. BCE). Threw a wooden image of a god into a fire, remarking that the deity should perform another miracle and save itself. The uproar this caused in Athens prompted Diagoras to flee for his life. "Athens outlawed him and offered a reward for his capture dead or alive. He lived out his life in Spartan territory."

Protagoras, Greek philosopher (481?-411 BCE). "As to the gods, I am unable to say whether they exist or do not exist."

Democritus, Greek philosopher (460?-357 BCE). The father of Materialism. Argued that mechanical relationships or arrangements of the atoms account for various characteristics of nature, the intimation here being that the natural order of the world resulted from chance. Even morality, the soul, and all mental life are reducible to mechanistic terms with physical imperceptible atoms as their basic structure. Spiritual reality does not exist; what appears to be spiritual is attributed simply to subperceptible atomic structure or else to mere superstition. Hence, the Democritan philosophy of mechanistic Materialism is complete, self-sufficient, and self-contained.

Epicurus, Greek philosopher (341-270 BCE). As a Materialist, Epicurus accepted the idea that the soul consists of atomic material which disintegrates at death, at which time all sensation ceases. Consequently, he said, death need not be a matter of anxious concern, inasmuch as it is merely the state in which all sensation ceases.
Just so no one gets the idea Freethought is new, the result of children brought up on Dr. Spock or just about right wing Christian Fundamentalists (or Christianity at all).

Saturday, November 19, 2005

Chinese viruses not available to other scientists

Helen Branswell of Canadian Press reports scientists are worried things could be happening with the H5N1 viruses in China, but the Chinese haven't shared any since the spring of 2004, 18 months. A lot can happen to a flu virus in 18 months.
Chinese authorities have not shared samples of H5N1 avian flu viruses with scientists outside the country since the spring of 2004, leaving influenza experts worried that the world has an incomplete picture of how the worrisome viruses are evolving.

With confirmation of human cases of H5N1 infection in China, the need to look at a range of viral samples or isolates from that country has taken on a heightened sense of urgency, officials say.
"The new outbreaks are coming hot and heavy now and we just don't know what's out there. We don't know if it's the same virus or different viruses. And we need to get that information," says Michael Perdue, a scientist with the World Health Organization's global influenza program.

"Thus far, we're in the dark."

The international agencies involved in trying to contain the spread of H5N1 have made a number of entreaties to China for virus samples and have received assurances from authorities there that viruses will be shared.

But the wait continues. (Helen Branswell, Canadian Press via 900chml)
The Chinese are sharing genetic sequences, apparently, but not the viral cultures themselves. The cultures are needed to study the biology of the virus, not just its genes, from which some biology can be inferred but not some important questions, like changes in virulence.

Branswell's story discusses some of the possible motives behind this, and they are interesting and by no means idiosyncratic to China. One is a scientist's desire to get as much scientific credit as possible from a "resource" that you have (the virus). Scientists everywhere are hesitant to share reagents if it means others will be able to scoop them, especially when those others have high power laboratories, many scientists and sophisticated equipment. As a practicing researcher, this has the ring of truth to it, as much as I hate to admit it. Scientsts are human beings and act like human beings.

But a second possible reason is especially revealing and should give everyone pause.
Another concern has been voiced by several countries affected by H5N1 outbreaks. They know part of the reason the developed countries want access to virus samples is to ensure that the seed strain for H5N1 vaccine is up-to-date enough that the vaccine would be protective.

That rankles because these countries further understand that should H5N1 spark a human pandemic, their people stand little chance of getting access to limited global supplies of vaccine.

"Some of the developing countries anticipate that they're going to be short-changed with that step," Lubroth admits.

"So to convince . . . the countries that we're honest brokers is not an easy process. And to get them to agree on a material transfer agreement (for viruses) doesn't happen overnight."
As I said, interesting.

Proof and disproof

The human bird flu cases in Indonesia continue to be worrisome. The virus there seems to move more easily now from birds to humans, since recent cases (and the zoo associated cases) haven't had heavy contact with infected birds, although in most of the cases some history of dead or dying birds in the vicinity has been reported.

The two most recent women who died, however, fall into the category of those with no known contact with flu-infected birds, reminiscent of the first cases of the government civil servant (an auditor) and his child who started the Indonesian outbreak in July.
"It remains unclear how the two people contracted the disease,'' said Ilham Patu, 47, a medical officer with Sulianti Saroso, one of two hospitals in Jakarta designated to treat bird-flu cases.

A government investigation found no fowl or other birds were infected with the bird-flu virus near their homes, Patu said in an interview today.


In about 80 percent of human cases, the infection was probably caused by direct contact with sick or dying birds, Georg Petersen, WHO's representative in Jakarta, said in a Nov. 14 interview.

"Then we are left with a group of people where we don't know exactly how they got infected,'' Petersen said. In cases where more than one person in a family became infected, authorities may ``know the source of one person, but not the others,'' he said.

Human-to-human transmission of the H5N1 avian flu virus is "not proven and not disproved,'' Petersen said. "There is only one case published from Thailand'' where human-to-human transmission is implicated, he said.

In Indonesia, two teenagers who had developed symptoms are undergoing tests for the virus. Neither had been exposed to H5N1-infected chickens at their homes, Patu said. (Bloomberg)
So there you have it. Human-to-human is neither proven nor disproved. On the other hand, if there are dead birds in the vicinity, this seems to demonstrate it isn't human-to-human. Which makes me wonder, what will proof consist of? A large cluster?

Just asking.

Friday, November 18, 2005

All the time in the world

Human cases of bird flu in China. Human cases of bird flu in Indonesia. Human cases of bird flu in Vietnam. Bird flu spreading in poultry. All this in the last month.

And this week:
After days of intensive talks between the House and Senate, negotiators dropped a plan for $8 billion in funds that Democrats pushed through the Senate last month.

Conservative Republicans in the House insisted that an emergency U.S. effort to stockpile vaccines and anti-viral drugs that could be effective against the deadly flu would have to be paid for by cutting other government programs.

Republican leaders in the House said that instead of attaching the bird flu money to a health and labor spending bill moving through Congress, they would try separate legislation later this year or early next year. (Reuters)

Stake through the heart of OSHAct

Short of breath? No? You will be in a minute when you hear about these breathtakingly noxious pieces of shit about to be squeezed out of some congressional assholes. We learn from the always on target Jordan Barab at Confined Space about Wyoming Senator Mike Enzi's (guess his party affiliation) twin turdoramas, about to be introduced as bills in the Senate:
Occupational Safety Partnership Act: Enzi will . . . repropose his pet project -- privatizing OSHA enforcement by allowing employers to hire private sector consultants to inspect their workplaces and issue a "certificate of compliance," exempting them from an OSHA citation for two years. The Partnership act will also increase the use of voluntary protection programs and technical assistance programs. These are the same programs that the Government Accountability Office studied in 2004 and found to have no proven value.

Occupational Safety Fairness Act: This bill includes Charlie Norwood's (R-GA) four OSHA-weakening bills that already passed the House of Representatives last July. In addition, there's are some even worse provisions, including one that would allow employers to vacate citations "if an employer can demonstrate that the employees of such employer were protected by alternative methods equivalent or more protective of the workers’ safety and health." In other words, instead of citing according to OSHA standards, the agency would be forced to use its shrinking resources to prove that the employer's "alternative" methods weren't equally as protective as the OSHA standard.
Here's the good part:
But the worst part of this bill is that for the first time in OSHA's history, the agency would be empowered to cite workers if they aren't wearing their personal protective equipment. Yes, this is the same agency that after five years, still refuses to issue a completed regulation requiring employers to pay for personal protective equipment mandated by OSHA standards.
I don't want to leave the impression this bill has everything Enzi wanted. According to Jordan's information the bill originally made it easier for OSHA to seek criminal indictments for willful violations and would have raised maximum prison sentences from -- hold onto your hats --six months to eighteen months. But the Republican's industry patrons apparently struck those onerous provisions.

What can you say?

Chinese transparency compromised?

At the same time China is being praised for its vigorous moves against bird flu, it has taken steps that compromise the appearance of transparency and oppenness. Yesterday the English language version of The People's Daily Online reported all Chinese scientists are now required to get authorization to conduct research on bird flu:
All institutions are, if unauthorized, forbidden to conduct scientific research on bird flu, according to a notice issued by the the Ministry of Science and Technology.

According to the notice, all unauthorized institutions are not allowed to carry out scientific study on the highly pathogenic virus or collect, transport and harbor virus strains.

Institutions and individuals are also banned from introducing foreign virus strains to China or transporting Chinese samples abroad. International cooperation requires government approval.
Whatever the motives, here, the appearance is one of tight government control over information generation and information sharing, reminiscent of an earlier edict that threatened to shut down one of the leading flu research laboratories in China because it produced information deemed inconvenient by the government.

As we said then, How stupid can you get?

Thursday, November 17, 2005

Crystal ball becomes cloudier still

The H5N1 virus, like all influenza viruses, has a natural tendency to mutate. There are a variety of mechanisms whereby this can happen. In the not so distant past one of the worrisome scenarios was that human and bird viruses would co-infect pigs and mix and match their genes to produce some hybrid of the worst of human and bird influenza viruses, the so-called reassortment mechanism. Then it become plausible that the virus didn't need to mix and match whole segments but might swap pieces of genes, either between its own gene segments (non-homologous recombination) or among the same genes from another viral strain or subtype co-infecting the cell (homologous recombination). This recombination mechanism has been championed by Henry Niman at Recombinomics. Long disparaged by flu researchers as a minor mechanism, it may turn out to be one of the principal drivers of genetic variation. Or maybe not. Then there is random mutation, the so-called genetic drift that viruses do on a daily or hourly basis when they replicate unfaithfully. We now believe that the kinds of genetic alternations needed to cause major changes in host range or virulence may be rather small and not require the kinds of wholesale substitutions the reassortment and recombination mechanisms use for the emergence of a pandemic strain.

And now the specter of reassortment is back with us with the announcement by Vietnamese scientists that other influenza subtypes, specifically H3 and H4 are circulating in poultry along with H5.
"The presence of more subtypes of the flu virus in poultry make the virus all the more dangerous," [Regional Animal Health Centre director Dong Manh] Ha said, adding that samples had been sent to a World Organisation for Animal Health (OIE) laboratory in Australia for further investigation.

State media reports said the new virus strains are H3N4 and H4N5. (Reuters)
Fourteen of Vietnam's 64 provinces now have designated bird flu outbreaks. In the last century, human influenza infections have been almost entirely subtypes H1N1, H2N2 and H3N2 but sporadic human cases with avian flu subtypes H5, H7 and H9 have occurred, the most virulent being the H5N1 that is currently the focus of concern. Now that H3 and H4 viruses are co-infecting birds that also have H5N1, we see entirely new opportunities for genetic combinations in animals in close proximity to humans. What the result of this will be no one knows. Maybe it has been going on for a long time and nobody bothered to look for the other subtypes, which cause generally milder disease in birds. Maybe not.

The situation can best be described as unpredictable. But you knew that.


The news from China is that it is news in China. Everyone who comes here almost certainly already knows China is reporting its "first" human cases of bird flu. Two are a brother and sister in Hunan, the brother recovered and with laboratory confirmed diagnosis (reportedly a rise in antibody titer), the sister deceased with no lab confirmation but a presumptive diagnosis. A farmer in Anhui province is also reported to have died after chickens on ducks on her farm died (Bloomberg) (note that another report from Reuters says that no outbreak of among birds was reported in her village). Another suspected case in Liaoning province in the far north is under investigation and WHO is "seeking further information." Rather than downplaying the cases, as they have in the past, the Chinese press is printing pictures of distraught relatives and giving it blanket coverage (Reuters).

All live poultry markets were shut down in Beijing earlier this month (ChannelNewsAsia) and the government is instituting strict measures in poultry farms. But it is estimated there are 14 billion poultry in China, 70% in backyard settings. The potential degree of human contact with a panzootic (pandemic among animals) is perhaps unprecedented.

Almost certainly these aren't really the first cases in China. They are only the first officially recorded cases. The current outbreak in humans was heralded in February of 2003 when tow members of a family returning to Hong Kong from Fujian province were found to have H5N1 infection. The father died, the young boy survived. His sister was reported to have died in China before their return home. Human cases have probably been occurring years before 2003 and also since, either not reported and/or not detected. Thus the reported cases in China may not signal a new phase of the disease but only a situation whereby international attention has forced existing cases to stick their head above water and be seen.

But maybe not.

Wednesday, November 16, 2005

Faith-based vaccines

Given the completely incompetent handling of the yearly flu vaccine supply by the FDA and CDC, the idea of a single federal agency responsible for developing potential vaccines (oh, yes, and also countermeasures for use in case of a bioterrorist attack; sigh) sounds like a good idea. Pushed by Republican Senator Richard Burr of North Carolina in a bill for a Biomedical Advanced Research and Development Agency (BARDA), the proposed new agency is problematic. We think. If it happens, we doubt we'll know. Because its operations will be under wraps:
"I am not aware of any agency that has the full FOIA (Freedom of Information Act) exemption, even the CIA," said Mark Tapscott, the director of the Center for Media and Public Policy at the Heritage Foundation.

"What do they think they will be doing that will not be covered by the exemptions that the CIA has in place?" he said. "There needs to be a detailed explanation for why."

The agency would report directly to the Secretary of Health and Human Services, would receive a full exemption from the Freedom of Information Act, and would offer limited liability to companies that manufacture drugs that could be used in the event of an attack. (Winston-Salem Journal)
Why? National security? Nope.
Drug companies say they need to be free of public scrutiny to protect their research.

"The confidentiality is not meant to hide untoward results," said George Painter, the president and CEO of Chimerix Inc., a biotechnology company, based in Research Triangle Park, that is working on a smallpox vaccine, among others.

"To immediately have that information available would be harmful to a company because their competition could immediately get ahold of the work that's been done," he said.

Painter added that investors would be reluctant to pay for the work if they were not assured it would be protected from other companies usurping the results for free.
So if there is an emergency, we'll just have to "take our medicine," informed or not. Not to worry:
Doug Heye, a spokesman for Burr, said that the FOIA exemption was not automatic. It would only be used in limited circumstances, and the people making the decision would all be public officials.

"The exemption is for limited situations for proprietary use or national-security concerns that would make it necessary," Heye said.
Oh, they'll all be public officials. Why didn't you say so? Until they go to work for the pharmaceutical industry, anyway.

And there will also be immunity from liability if the drugs are made following FDA guidelines and in "good faith." Bad actors need not apply. But without oversight, how will be know if guidelines are being followed and good faith pursued? We'll just have to trust everyone concerned: the drug companies, the public officials, the drug company execs who are former public officials, the public officials who are used to be drug company execs.

That sounds fair.

As sure as Death and Taxes: sticking it to the poor

You can't run up a bill of $177 million per day in an Unholy War without running up a debt. You can't cut your revenues dramatically by giving your rich friends a free pass without running up even more of a debt. And you shouldn't be able to liquidate your debt by welshing on your obligations to your most vulnerable citizens.

But that's what H.R. 4241, the Deficit Reduction Act of 2005 proposes to do by cutting $11.9 billion from the Medicaid program over five years. The result will be higher cost sharing (co-pays), higher premiums and fewer benefits for the poor. As if that isn't enough, it will change food stamp eligibility in ways expected to deny this important nutritional benefit to 300,000 of our poorest neighbors and will toss 40,000 children out of the school lunch program. For many children, school is about the only place they get something to eat. On the weekends they go hungry.

Write your CongressThing today. The American Public Health Association is trying to make it easy by providing you with this link (when I tried it was unavailable because of high traffic; if that happens, try again a little later).

$11.9 billion over five years of concrete, material harm to our fellow citizens, men, women and children. Equal to sixty-seven days of the Iraq Mistake. Concrete and material harm to American soldiers and their families and Iraqi men, women and children.

For what?